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49 Cards in this Set
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What are the 5 general characteristics of normally dividing cells?
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~Repair genes "proof read" the nucleotides and replace them when they are bad (muscle and nerve cells rarely divide, they repair)
~Tumor suppressor genes are present and functional (Ex. p53 gene) - cause apoptosis when a cell is abnormal ~Growth hormones are used from adjacent cells or tissues in the body ~Cell contact inhibition causes cells to stop dividing when they run out of room ~The cells adhere to one another through junctions |
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What are the 6 general characteristics of cancer cells?
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~There is a mutation in the repair gene
~No tumor suppressor gene is inherited (Ex. BRCA1 or 2; 50% of CA cells lack the p53 gene) ~There is an increase in growth factors and mitosis is enhanced (estrogen can cause this) ~There is no cell contact inhibition ~There is no adherence to other cells - no cell junctions ~Angiogenic factors are present and create vessels to supply the tumor |
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What are the three factors used for invasion and metastasis?
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1. Direct Extension - They secrete destructive enzymes to cut through normal cell adhesion to spread
2. Spreading through the blood system* 3. Spreading through the lymph system* *The CA cells migrate between normal cells and enter a low pressure system like the lymphatic system or blood stream. They end up at a site of loose epi and migrate into that tissue (usually end up in the lungs). Most CA cells don't survive the trip. GI cancer goes down stream and ends up in the liver. |
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What is angiogenesis as related to cancer?
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This is a secretion of growth factors to bring in a blood supply to clear away waste and supply nutrients. This typically only happens when there is an injury due to suppression factors that inhibit it.
This is needed by a tumor that ~2mm in size. |
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What are the reasons that everyone doesn't get cancer?
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~Most mutated cells die
~We normally have feedback controls that regulate growth ~Our immune system usually detects the rogue cells due to abnormal proteins on the cell surface - Our body forms antibodies/antigens that take care of the problem ~There are several oncogenes required to cause cancer. The host tissue has to be receptive to cancer growth and typically our tissue will prohibit the growth factors needed for tumor formation |
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What are 5 reasons abnormal cells may be allowed to progress into a tumor?
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1. If the immune system can't get to the tumor, such as in the CNS, it can't kill the cancer cells
2. Cancer cells that are similar to the host tissue aren't recognized as a threat 3. We can have an overactive immune system that actually suppresses immune function 4. Sometimes, the immune system can't respond genetically 5. If platelets coat the cancerous cell, the immune system can't recognize it |
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What are 6 things that can cause cancer from genetic mutations?
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*A lot of mutations are required for cancer to develop
1. Ionizing radiation ruptures DNA 2. Chemicals, like smoking, can alter genetic programming. Other examples are PVC, asbestos, wood dust, benzine dyes 3. Physical irritants - The constant removal of cells increases mitosis, which increases the chance of CA 4. Heredity - Suppressor gene is not there, so less mutated genes are required to cause CA 5. Viruses - Have enzymes that cause RNA to translate DNA that is inserted into normal cells (Ex. leukemia, Hep. B & C can lead to CA) 6. Diet - Charred meat and a low diet of fruits and veggies for the flavinoids can cause CA |
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What are the three main types of cancer and their sub-classifications?
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1. Carcinoma - In epithelial and nerve tissue
-Adenocarcinoma - Glandular tissue -Squamous - Squamous epi (skin) 2. Sarcoma - Connective tissue 3. Blastoma - Embryonic tissue |
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What is grading regarding CA, how is it done, and what are the stages?
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Grading is looking at he cellular maturity (differentiation) through a microscope by a pathologist.
G I - Well differentiated (nucleus looks more normal and cell is similar to it's host tissue) G II - Have more malignant changes than GI, but still similar to host tissue G III - Tumor cells are poorly differentiated, but tissue of origin can usually be identified G IV - Tumor cells are poorly differentiated and have no characteristics of normal cells |
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What is staging of CA and who performs that?
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Staging is done by an oncologist - It refers to the extent of tumor spread through the body.
Stage 1 - Local invasion Stage 2 - Invasion into adjacent structures Stage 3 - Spread into lymph nodes Stage 4 - Distant metastasis |
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What are the general signs of cancer?
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~Unexplained weight loss due to increased metabolism
~Fever from the immune system trying to stop the cancer ~Fatigue from increased metabolism ~Pain is a late symptom and not usually a good sign |
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What are specific signs and symptoms of lung CA, colon CA, GI CA, and breast CA?
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~Lung CA - Frequent pneumonia, hemoptisis
~Colon CA - Change in bowel habits, pencil-like stool from squeezing past the tumor, constipation and diarrhea, blood in the stool ~GI CA - Slow blood loss is a sign something is going on in the GI system ~Breast CA - Painless lump or discharge (can be a tumor or a cyst) |
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What are specific signs and symptoms of testicular CA, prostate CA, urinary tract CA, throat CA, skin CA, and female reproductive system CA?
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~Testicular CA - Painless lump
~Prostate CA - Changes in urination (can also be BPH) ~Renal cell CA or transitional cell CA in the bladder - hematuria ~Throat CA - Hoarseness can be vocal cord CA or airway CA (can also be allergies) ~Skin CA - Changes in a wart or mole; change to a bluish color or development of nodules ~Female repro CA - Unexplained vaginal bleeding can be endometrial or cervical CA and is a strong sign in menopausal women (can also be hormonal changes) |
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How is a CA diagnosis made using tumor markers and through cytology?
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Tumor Markers (antigens)
~PSA - Produced by CA cells ~CA 125 - For ovarian CA ~CEA - Cardinogenic Embryonic Antigen - Non-specific, can be used to monitor the effectiveness of tx - Can indicate ovarian, lung, breast, pancreatic, or GI CA - can be from infection, also Cytology - Looking at actual cells, not definitive, either ~Pap Smear - Scraping of cells from the cervix ~Pleural Fluid - Aspirated from pleural cavity ~GI Washings - Flushes cells out of the GI system for esophageal and stomach cells ~Bronchial Washings - Flush cells out of the bronchi |
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How is a CA diagnosis made using imaging studies, biopsy, or endoscopy/bronchoscopy?
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Imaging Studies
~CXR - Abnormal densities or structure arrangements in the chest ~Mammogram - Calcifications in breast tissue ~CT, MRI, PET - Look for abnormal patterns in tissues ~IVP - Looks for abnormalities in the shape/structure of the urinary system ~Barium Enema - Looks for abnormal structures on the lining of the colon Biopsy - The only definitive method of diagnosis Endoscopy/Bronchoscopy - Allows visualization of the area and attainment of a biopsy |
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What are the 4 general types of treatment in CA management?
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1. Surgery - 1st and most effective tx; can be a biopsy, primary removal, or palliative
2. Chemotherapy - Interferes with cellular function and produces cellular death; has a systemic effect 3. Radiation - Used internally or externally; causes destruction of the cellular DNA; can cause GI problems, taste and salivation problems, and bone marrow suppression 4. Other Therapies ~Angiogenesis inhibitors - Stop the process of creating a blood supply for the tumor ~Biological - Designed to stop CA growth, may make CA easier to detect by the immune system |
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What are the effects chemotherapy can have on the GI system, bone marrow, renal system, heart and lungs, reproductive system, and nervous system?
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~GI - Toxicity, lose most sensations
~Bone Marrow - Suppression, toxicity, bleeding, anemia ~Renal - Toxicity from lysed CA cells getting in to the blood - Watch creatinine levels! ~Heart & Lungs - Can cause a reduced ejection fraction ~Reproductive - DNA can be disrupted and sterility/birth defects can result ~Nervous - Neuropathy - Goes away after tx |
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What are 6 nursing interventions (NIs) for the dx of "Impaired skin integrity r/t radiation"?
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1. Avoid soap, cosmetics, perfume, etc over the radiation area
2. Shower with warm water, not hot 3. Pat skin dry 4. Don't rub off the markings on the skin 5. Don't use heating pads, ice, or bandages over the site of tx due to increased sensitivity to temperature 6. Keep skin covered from sun exposure - can cause erythemia and disqueminate to cause fibrosis later |
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What are 6 things to assess for related to the dx of "Inflamed adjacent tissues r/t radiation"?
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Assess for:
1. Difficulty swallowing 2. Infection - Listen to lung sounds 3. Fever - Inflammation and fever can destroy healthy cells 4. Anorexia - GI system is disrupted 5. Diarrhea - Dehydration 6. Fatigue |
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What are 4 things to assess for related to the dx of "Infection r/t bone marrow suppression 2° to chemo or radiation therapy, or metastasis to bone?
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Assess for:
1. Neutropenia (neutrophils <1,000!!) ~ The usual s/s of infection will not be present (erythemia, swelling, or pus due to too few WBCs!) ~This is the most common reason tx has to stop! ~Do blood cultures, sputum cultures, urine cultures, and wound cultures 2. Fever 3. Impaired skin and mucus membrane integrity 4. Sepsis if hypotensive |
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What are specific guidelines to follow regarding a neutropenic patient?
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1. Administer antibiotics as ordered
2. Hand washing!! 3. Avoid taking rectal temperatures, performing vaginal procedures, or urinary catheters 4. Avoid constipation to prevent trauma to rectal tissue 5. Avoid meds that will mask a fever, such as NSAIDs and ASA 6. Perform good personal hygiene for the pt 7. Avoid fresh fruits and veggies because bacteria can't be removed - Use canned products 8. No plants in the room! The soil harbors microorganisms 9. No dust! - Use a HEPA filter to keep asperillis spore counts down 10. Administer Neupogen (granulocyte colony-stimulating factor) as ordered to increase WBC growth |
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What do we assess and perform interventions for concerning the dx of "Bleeding r/t bone marrow suppression"?
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1. Assess platelet count
2. Assess bleeding, mucus membranes, urine content; watch for petechiae, ecchymosis, decreased Hct, and prolonged bleeding from minor cuts and scratches 3. Use a soft toothbrush to minimize bleeding from the gums 4. Use an electric shaver 5. Eat a soft diet to avoid trauma to GI tissues 6. Avoid IM injections 7. Apply pressure to venipuncture/IM injection sites for at least 5 minutes! 8. Use stool softeners 9. Transfuse platelets when count is <20,000 10. Transfuse packed RBCs when Hct is <27% |
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What are the NIs for "Imbalanced nutrition, less than body requirements, r/t N/V, diarrhea, anorexia, stomatitis, and malabsorption 2° to destruction of rapidly dividing cells of GI tract from the effects of radiation or chemo?
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1. Administer antiemetics for N/V
2. Use TPN or tube feedings if necessary 3. Eat small, frequent meals and a soft diet 4. For stomatitis, use good oral hygiene, rinsing, avoid alcohol-based mouth wash, and lubricate lips |
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What are the NIs for "Fluid volume deficit r/t N/V, stomatitis, and diarrhea"?
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1. Administer IV fluids as ordered
2. Monitor I&O closely |
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What are the NIs for "Fatigue r/t anemia 2° to bone marrow suppression"?
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1. Rest and sleep
2. Conserve energy 3. Planned exercise - Plenty of rest before had 4. Administer pain medications 5. Administer Epogen (CSF) as ordered - It gives energy like ereythropoietin |
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What are the NIs for "Alopecia r/t destruction of rapidly dividing hair cells"?
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1. Avoid electric curlers, curling irons, dryers, clips, barrettes, hair spray, hair dye, and permanent waves to minimize hair loss and possible injury
2. Purchase a wig or hair piece to improve self image and wear it prior to hair loss 3. Reassure that hair loss is usually temporary, but hair may be a different color/texture |
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What are the NIs for "Pain r/t pressure of tumor or diagnostic procedures"?
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1. Administer narcotics - CNS receptor inhibitors
2. Administer antidepressants - Some help block the transmission of pain (like Lyrica) 3. Administer neuroleptics - Some help block the transmission of pain 4.Administer NSAIDs to decrease inflammation |
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What are the reasons for, manifestations of, and NIs for Hypercalcemia?
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This is an Oncologic Emergency!
Hypercalcemia - >11 mg/dL Due to: ~Tumor destruction of bone ~Bone being unable to reabsorb calcium ~Kidneys being unable to excrete calcium Manifestations: ~Weakness ~Decreased responsiveness ~N/V and dehydration ~Dysrhythmias Care: ~Comfort measures ~IV hydration with NS at 500-1,000 mL/hr for 1 hour to increase UO ~No loop diuretics!!! They tend to increase hypercalcemia ~Later stages of CA may show hypercalcemia, but we may not treat it due to comfort measures |
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That is Tumor Lysis Syndrome, what does it cause, and what are the manifestations of it?
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This is a Metabolic Emergency!
It is the massive release of intracellular contents after tumor cell death - It causes electrolyte imbalances such as: ~Uric Acid - Crystals block the renal tubules which creates decreased UO and renal failure - Creatinine >1.5-3.0! ~Hyperkalemia - >3.5-5.5 mEq/L ~Hyperphosphatemia - >3.0-4.5 mg/dL ~Hypocalcemia - <9.0-10.5 mg/dL Manifestations: ~N/V ~Weakness ~Numbness and tingling ~Seizures ~Decreased UO |
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What is the care given for a pt with TLS regarding hypovolemia, hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia?
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Hypovolemia:
~IV fluids to counter, be cautious with CHF, listen for changes in breath sounds ~Start fluids 48 hours before and after cytotoxic therapy Hyperuricemia: ~Give Allopurinol 2-3 days in advance to keep uric acid levels down Hyperkalemia: ~Give insulin to decrease K+ and it's shift into cells (give with 50% glucose!!) ~Calcium Gluconate to decrease the effects of high K+ ~Kayexalate to bind with K+ in the gut ~Albuterol to decrease K+ Hyperphosphatemia: ~Give oral phosphate binders Hypocalcemia: ~Give calcuim gluconate IV |
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Where do the problems occur, what are the clinical manifestations, and what are the NIs for "Spinal cord compression or decreased blood flow r/t metastasis to vertebral body from breast, lung, or prostate CA"?
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**Most of the time this occurs at the thoracic level
Manifestations: ~Back pain r/t ischemia, inflammation, and edema ~Decreased neuro function along dermatome Care: ~Radiation is given to decrease the size of the tumor ~Corticosteroids to decrease the inflammation/swelling (dexamethasone is the most lipid-soluble to get into nerve tissue!) ~Pain medications and non-pharmacological measurements |
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What are the manifestations and NIs for "Neutropenia & risk for infection r/t chemotherapy/radiation"?
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Manifestations:
~Neutrophil count<1,000 ~Neutrophil count <500 requires isolation! ~Fever of 100.4 for 1 hour - call the doctor! ~Sepsis manifested by hypotension Care: ~Blood culture from peripheral vein and central line ~Urine culture ~Sputum culture if productive cough is present ~Broad spectrum antibiotics ~Strict asepsis with IV lines ~No exposure to others with an active infection ~Protective environment ~Low bacteria diet - no fresh fruits or veggies ~Scrupulous hand hygiene ~Cough & Deep Breath (C&DB) |
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What is the pathology behind and the manifestations of Disseminated Intravascular Coagulation (DIC)?
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Pathology:
~Massive clotting consumes all clotting factors ~Platelets are used faster than they can be made ~Clots are deposited in microvasculature resulting in ischmeia ~Fibrinolysis breaks down clots and increases anticoagulants to produce spontaneous bleeding ~Massive clot formation and breakdown at the same time - Feeds itself Manifestations: ~Prolonged PT, PTT, thrombin time, and D-Dimer is increased (product of fibrinolysis that is not normally present) ~Decreased platelets and clotting factors ~Decreased Hgb and Hct |
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What is the care given for DIC?
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~Heparin is give to stop the formation cycle!!
~Monitor lab tests ~Assess for bleeding - Observe obvious bleeding and monitor BP, HR, and UO ~Apply pressure to venipuncture sites and injuries ~Avoid tape on the skin! ~Gentle oral hygiene ~Transfuse platelets ~Transfuse clotting factors - Cryoprecipitate, FFP ~Transfuse packed RBCs for bleeding leading to anemia |
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What are the top four caners among women & men?
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Prostate, lung, breast, & colorectal
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What are the common concepts of oncology?
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~Patient Presentation
~CA types/Markers ~Oncology "work-up" ~Grading/Staging ~Treatment options ~Side effects of treatment ~Emergencies |
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What are Caners Seven Warning Signs?
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1. Change in bowel or bladder habits
2. Sore throat that does not heal 3. Unusual bleeding or discharge 4. Thickening or lump in breast or elsewhere 5.Indigestion or difficulty swallowing 6. Obvious changes in a wart or mole 7. Nagging cough or hoarseness |
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What is PSA?
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Tumor marker, Prostate-specific antigen; Adenocarcinoma of prostate.
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What is the tumor marker for Epithelial ovarian neoplasms?
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CA-125
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CEA or Carcinoembryonic antigen is a tumor marker for what types of cancer?
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Colorectal, breast, pancreatic, gastric, & sarcomas
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What tumor marker would be present in hepatoma, germ cell, teratoma, lymphoma, and renal?
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Alpha-Fetoprotein (alpha-FP)
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What tumor marker does Germ cell tumors, uterine, testicular cancer have in common?
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HCG (Human chorionic gonodotropin)
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What is the tumor marker for adenocarcinoma pancreas/colon?
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CA 19-9
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CA-27-19 is a tumor marker for what?
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Breast caner recurrence
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What disease process has Reed-Stemberg Cells?
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Hodgkins Lymphoma
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What disease process can have Bence Jones protein in the urine?
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Multiple Myeloma
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What is Lactate dehydrogenase (LDH)?
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LDH is found in the cells of many body tissues, especially the heart, liver, red blood cells, kidneys, skeletal muscles, brain, and lungs. Because LDH is widely distributed throughout the body, the total LDH level is not a specific indicator of any one disease affecting any one organ. When disease or injury affects the cells that contain LDH, the cells lyse and LDH is spilled into the bloodstream, where it is identified in higher than normal levels. The LDH test is a measure of total LDH. There are actually five separate fractions (isoenzymes) that make up the total LDH. Each tissue contains a predominance of one or more LDH enzymes.
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What is LDH used for?
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Monitoring response
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What does an oncology "work-up" include?
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Blood work, X-Rays, CT scan, Cytology, Bone marrow core needle biopsy/fine needle aspirate, Mammogram or SNLB
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