Exam 2 - Cancer

Front 1

3 phases of cancer

Back 1

initiation
promotion
progression

Front 2

Describe initiation phase of cancer development

Back 2

mutation of cell's genetic structure resulting from an inherited mutation or following exposure to chemical, radiation or viral agent. also linked to diet, hormones.

Front 3

Describe promotion phase of cancer development

Back 3

characterized by reversible proliferation of altered cells. has laten period that can last 1-40 years

Front 4

Describe progression phase of cancer development

Back 4

increased growth rate of tumor
invasiveness & metastasis

Front 5

Describe the role of the immune system to cancer.

Back 5

Provides defense, homeostasis & SURVEILLANCE
•Cancer cells look very much like normal cells but usually have antigens on them

Front 6

Describe risk factors for lung cancer.

Back 6

20yr pack history, asbestos, uranium, COPD

Front 7

Describe risk factors for breast cancer.

Back 7

Caucasian, early menarche or late menopause, fibrocystic disease, infertility, 1st pregnancy after age 30, maternal hx of breast ca, obesity

Front 8

Describe risk factors for prostate cancer.

Back 8

African American, elderly

Front 9

Describe risk factors for colorectal cancer.

Back 9

ulcerative colitis, family hx of polyps, high-fat, low fiber diet

Front 10

Describe risk factors for cervical cancer.

Back 10

early intercourse, multiple partners, STI’s or cervical dysplasia (abnormal pap)

Front 11

7 warning signs of cancer:

Back 11

C – change in bowel, bladder – stringy stool, passing around tumor
A – a lesion or sore not healing
U – unusual bleeding or discharge
T – thickening or lump in breast or elsewhere
I – indigestion or difficulty swallowing
O – obvious changes in wart or mole
N – nagging cough or persistent hoarseness

Front 12

What is the purpose of the CEA tumor marker?

Back 12

detects breast, liver, lung, GI cancers

Front 13

What is the purpose of the AFP tumor marker?

Back 13

incr in liver, renal, Hodgkin’s lymphoma ca

Front 14

What is the purpose of the CA-125 tumor marker?

Back 14

ovarian ca

Front 15

What is the purpose of the CA 19-9 tumor marker?

Back 15

cystic fibrosis, lung, billiary, pancreatic cancer

Front 16

What is the purpose of the CA 15-3 tumor marker?

Back 16

metastatic breast cancer

Front 17

What is the purpose of the PSA tumor marker?

Back 17

prostate specific antigen, night frequency w/urination, trouble starting or stopping, blood in urine, back pain while urinating. Typical normal result is 0-4, but w/hx of BPH 4-8 before ca suspected.

Front 18

What are normal values for RBCs

Back 18

female 4.2 – 5.4, male 4.7 – 6.1

Front 19

What are normal values for WBCs

Back 19

4,000 – 10,000

Front 20

What are normal values for Hemoglobin

Back 20

female 12-16, male 14-17.4

Front 21

What are the normal values for hematocrit?

Back 21

38-48%, male 42-52%

Front 22

Describe how various types of cancers are staged

Back 22

• Stage 0 – in situ; tumor is in place of origin, hasn’t moved anywhere
Stage 1 – tumor is in tissue of origin
Stage 2 – local spread has occurred
Stage 3 – local & regional spread
Stage 4 – metastasis

Front 23

Describe how various types of cancers are classified according to TNM

Back 23

i.Primary Tumor (T)
1.T0 – no evidence of primary tumor
2.Tis – carcinoma in situ (place of origin)
3.T1-4 – ascending degrees of incr in tumor size & involvement
4.Tx – tumor cannot be measured or found
ii.Regional Lymph Nodes (N)
1.N0 – no evidence of disease in lymph nodes
2.N1-4 – ascending degrees of nodal development
3.Nx – regional lymph nodes unable to be assessed clinically
iii.Distance Metastases (M)
1.M0 – no evidence of distant metastases
2.M1-4 ascending degree of metastatic involvement of the host, including distant nodes
3.Mx – cannot be determined

Front 24

i.Most common radiation treatment
ii.Prep skin first, marks for as long as tx occurs – do not wash off or rub off, immobilized
iii.Other areas shielded
iv. No radiation safety risk for others

Back 24

External radiation – aka teletherapy

Front 25

i.Implantation or insertion of radioactive materials into or close to tumor – seed, wire, tube – can be temporary or permanent
ii.Minimal exposure to healthy tissue
iii.Used in combination w/teletherapy
iv.Patient should understand need for time & distance restrictions on healthcare workers
v.Permanent – body acts as shield
vi.Temporary – uterine – pt in lead private room, usually on bed rest because it can dislodge
vii.Can’t have people sitting on lap, can’t sleep with partner

Back 25

Internal radiation – aka brachytherapy

Front 26

Identify the side effects of radiation therapy

Back 26

Fatigue, skin reactions, alopecia, anemia, neutropenia, thrombocytopenia, anorexia, N/V, consitpation, diarrhea, stomatitis

Front 27

nsg mgmt for fatigue

Back 27

encourage periods of rest, pace activities according to energy level

Front 28

nsg mgmt for skin reactions & alopecia

Back 28

i.Dry skin should be lubricated w/nonirritating lotion or solution that contains no metal, alcohol, perfume or additives
ii.Wet reaction must be kept clean & protected from further damage
iii.Prevent infection
iv.Facilitate wound healing
v.Protect irritated skin temperature extremes
vi.Avoid constricting garments, harsh chemicals, & deodorants, no wool, corduroy
vii.Help patient to deal w/hair loss

Front 29

nsg mgmt for anemia

Back 29

monitor H&H, administer iron supplements and erythropoietin as ordered, encourage foods that promote RBC production (liver, eggs, dried fruits, legumes, dark green leafy veggies, whole-grain and enriched bread & cereals), , observe for signs of bleeding

Front 30

nsg mgmt for neutropenia

Back 30

i.Assess for signs of infection
ii.Interventions: good personal hygiene
iii.Avoid crowds
iv.Avoid dental work when counts low
v.No immunizations unless MD approves
vi.Neutropenic precautions if WBCs less than 2000 – reverse isolation, no fruits/veg
vii.Assess Nadirs – lowest WBC they have 7-15 days after chemo typically, expected, no resistance to anything, avoid visitors, crowds

Front 31

nsg mgmt for thrombocytopenia

Back 31

i.Assess for overt or covert bleeding
ii.Avoid IM/SC injections - bleeding
iii.Check BP infrequently
iv.Safe environment
v.Soft toothettes, no flossing, no toothpicks
vi.Avoid straining – stool softeners, don’t do high fiber diet – too much bulk
vii.Gentle lubricated sexual intercourse
viii.Use electric razors
ix.Avoid tight clothing, ASA, NSAIDs, anticoagulants
x.May require Neumega, Procrit

Front 32

nsg mgmt for anorexia

Back 32

monitor weight, small, frequent meals of high protein high calorie foods, serve foods they like in pleasant environment

Front 33

nsg mgmt for n/v

Back 33

– teach to eat/drink when not nauseated, administer antiemetics PRN

Front 34

nsg mgmt for diarrhea

Back 34

administer antidiarrheals as needed, encourage low-fiber low-residue diet, encourage fluid intake

Front 35

nsg mgmt for constipation

Back 35

take stool softeners as needed, eat high-fiber foods, incr fluid intake

Front 36

nsg mgmt for stomatitis

Back 36

i.Assess oral mucosa daily for ulcers, candida, herpes, xerostomia (dry mouth)
ii.Teach pts to examine oral cavity daily & maintain oral care routine
iii.Use toothettes
iv.Oncology mouthwash
v.Dental work should be performed before initiation
vi.Pain relief
vii.Salivart – oral moisturizer, suck on hard candy
viii.Discourage tobacco & alcohol use

Front 37

nsg mgmt for pulmonary effects (pneumonia) r/t cancer tx

Back 37

Treatment symptoms
1.Bronchodilators
2.Expectorants/cough suppressants
3.Bed rest
4.Oxygen

Front 38

nsg mgmt for reproductive effects r/t cancer tx

Back 38

i.Inform pt on expected sexual side effects
ii.Use appropriate shielding
iii.Encourage discussions of issues related to sexuality
iv.Refer pt to counseling if needed

Front 39

nsg mgmt for ineffective coping r/t cancer tx

Back 39

i.Assist in planning
ii.Teach symptom mgmt to maintain quality of life
iii.Tell pt what to expect to decrease anxiety
iv.Encourage discussion of fears
v.Inform pt of provided supportive care

Front 40

External radiation precautions to protect individuals & others

Back 40

shield areas not receiving external radiation
no radiation safety risk for other from external radiation

Front 41

Internal radiation precautions to protect individuals & others

Back 41

i.Organize care to limit amount of time spent in direct contact w/patient
ii.Make sure patient understands time & distance precautions
iii.Pt body acts as a shield w/permanent internal radiation
iv.Pt will need to be in a lead lined room for temporary internal radiation
v.Can’t have people sitting on lap,, no exposure to children, may not be able to sleep with partner
vi.Double-triple flushing commode, double bag trash
vii.Nurse must wear film badge and lead apron while in room

Front 42

Safety precautions for handling chemotherapeutic agents

Back 42

•Chemo bags are in yellow bags, all trash thrown into yellow bio-hazard bags.
•Special handling w/gloves.
•Nurses pregnant/trying to get pregnant should not handle chemo drugs.
•Extravasation goes out of vein, tissue damage. Leave IV in and give antidote. Stop admin immediately. Then notify MD and administer antidote. Cold packs can provide relief or hot packs depending on pain.

Front 43

Describe the effects biological response modifiers (BRM) have on cancer.

Back 43

Consists of agents that modify the relationship between the host and the tumor by altering the biologic response of the host to the tumor cells in one of 3 ways:
i.They have direct antitumor effects
ii.They restore, augment, or modulate host immune system mechanisms
iii.They have other biologic effects, such as interfering w/the cancer cells’ ability to metastasize or differentiate.

Front 44

Describe the effects targeet therapy have on cancer.

Back 44

•Targeted therapy interferes w/cancer growth by targeting specific cellular receptors & pathways that are important in tumor growth.
•They attack tumor cells but spare normal cells

Front 45

Describe the effects interferons have on cancer.

Back 45

Interferons interfere w/tumor cell production and inhibit DNA protein synthesis in the tumor cell & cause tumor antigen expression on tumors

Front 46

Describe the effects interleukins have on cancer.

Back 46

Interleukins stimulate immune system and rebuild natural killer cells

Front 47

Describe the effects monoclonal antibodies have on cancer.

Back 47

•Monoclonal antibodies are capable of binding to specific target cells to ultimately destroy them – in last 15 yrs chemo agents have been mixed w/monoclonal antibodies to get them directly to cancer cell

Front 48

Identify the toxic effects & common SE of immunotherapy

Back 48

SE are dose dependent and include:
i.Flu-like symptoms
ii.Anorexia/weight loss
iii.Fatigue
iv.Nausea/vomiting – if they get motion sickness more likely to get nauseous
v.Changes in cognitive function
vi.Also cardiotoxicity – arrhythmias, heart failure, renal failure, liver failure, “take patients w/in an inch of their lives”
vii.Monoclonal Antibodies may cause infusion related symptoms such as fever, chills, urticaria, and rarely anaphylaxis

Front 49

Nsg mgmt for immunotherapy

Back 49

i.Treat symptoms, don’t stop chemo
ii.Administration of acetaminophen before treatment and every 4 hrs after treatment
iii.IV meperidine to control severe chills
iv.Monitor vital signs & temp
v.Plan rest periods for the patient
vi.Assist w ADLs
vii.Monitor for adequate oral intake
viii.Diphenhyramine
ix.Increase in fluids

Front 50

3 categories of hematopoietic stem cell transplants (HSCT)

Back 50

i.Allogeneic - donor
ii.Syngeneic – twin donor
iii.Autologous – pt own bone marrow

Front 51

3 sources of cells for transplant include:

Back 51

i.Bone marrow
ii.Peripheral blood
iii.Umbilical cord blood

Front 52

Describe the procedure for bone marrow transplant

Back 52

•Harvesting of bone marrow is done under general anesthesia, marrow is aspirated from sternum and iliac crest, donor may have pain at site, marrow is replaced after a few weeks naturally, marrow is purged & frozen – person donating bone marrow has more problems than pt
•Takes 2-4 weeks for marrow to begin working looks like they are getting blood – hangs in bag)

Front 53

Nsg mgmt for pain in cancer

Back 53

i.Rate pain using a patient reporting scale including location, intensity, quality, aggravating/alleviating factors, relief measures
ii.Use the pain ladder, stepping up when pain is not controlled
iii.Administer pain meds around the clock especially the “contin” meds to maintain a pain free state. Also treat breakthrough pain w/short acting narcotic or NSAID.
iv.Do not equate opioid tolerance & physical dependence w/addiction. Cancer patients will develop tolerance & physical dependence but not psychological dependence (addiction).
v.all cancer patients deserve pain control regardless of their past history w/addiction.
vi.dose the patient using the amount of opiod that controls pain with the fewest side effects. Morphine is drug of choice.
vii.If patient builds up a tolerance to opioids he may require high doses of medication w/o suffering untoward effects seen w/acute pain management (overdose & respiratory depression).
viii.never use Meperidine for chronic pain management. It produces a toxic metabolite causing muscle twitching & renal damage.
ix.Avoid opiate agonist/antagonist medications on patient receiving long-term opioid therapy. They may cause withdrawal symptoms due to the opiod antagonist action. (Stadol, talwin, nubain)
x.Use simplest doses & least invasive pain modalities first. Oral, rectal, if vomiting, transdermal, IV, IM, SQ, intraspinal.
xi.Placebos should never be used in management of cancer pain.
xii.use other pharmacological alternatives for pain mgmt also. Relaxation, guided imagery, biofeedback, TENS, heat/cold therapy, massage, exercise, etc.
xiii. “The person dying of cancer should not be allowed to live out life with unrelieved pain because of the fear of side effects, rather appropriate aggressive palliative support should be given.”

Front 54

Describe importance of early detection & prevention of cancer.

Back 54

•Elimination of predisposing risk factors reduces the incidence of cancer and increases the survival of patients who have cancer
•Seven warning signs of cancer (see above)
•Lifestyle habits –
i.avoid exposure to known carcinogens – smoking, sun, tanning beds, charcoal grilled food, hot dogs, limit nitrites & asbestos
•Eat a balanced diet including low fat high fiber, soy & legumes (rich in vit B,A,C), cruciferous stop cancer growth (broccoli, cabbage, brussel sprouts, bok choy, kale)
i.Impede cancer growth – dark beer, green tea, calcium, constipation
•Exercise regularly
•Obtain adequate rest
•Regular health exams
•Change perceptions of stressors
•Learn to cope w/stress
•Enjoy consistent periods of relaxation & leisure
•Practice self-examination
•Seek medical care if cancer is suspected

Front 55

35. Describe health promotion & disease prevention activities – teaching protocol related to rehabilitative goals.

Back 55

• Early detection – ACS guidelines
i.CEA - carcinoembryonic antigen found in GI ca & others – test for this
ii.High risk (20yr pack history, asbestos, uranium, COPD – lung cancer but no screening available
iii.High risk breast ca – Caucasian, early menarche or late menopause fibrocystic disease infertility 1st pregnancy after age 30, maternal hx of breast ca, obesity – mammogram age 40 1xyr or 2, SBE, 1 professional exam Q3 yr
iv.Ca risk incr w/age – inability to fight as body gets old
v.Prostate ca – African American, elderly. Rectal exam age 50 & PSA (prostate specific antigen) blood test
vi.Colorectal ca – ulcerative colitis, fam hx polyps, high fat, low fiber diet. Colonoscopy age 50 repeat every 5 or 10 yrs depending on results & fam hx
vii.Cervical ca – pap smears once sexually active, high risk if intercourse early, multiple partners, STI’s or cervical dysplasia (abnormal pap)
•Teaching plan
i.Diet see above
ii.Medication
1.Hormone therapy
2.Previous anticancer therapies

Front 56

Describe S/S of common oncological crises - superior vena cava syndrome

Back 56

tumor obstructs superior vena cava
•May manifest as facial edema, cough, distension of neck & chest veins, periorbital edema
•Treatment is palliative radiation, chemo

Front 57

Describe S/S of common oncological crises - paraneoplastic disease (aka metabolic syndrome)

Back 57

•Hypercalcemia – because tumor is secreting hormone to cause or due to bone CA, tx w/ tumor removal or calcitonin (acts like diuretic on blood)
•SIADH – ADH tells us to stop peeing, this signals to stop peeing but body isn’t overloaded, fluid management
•Insulin – cancer cells more sensitive to insulin – hypoglycemia may develop
•ACTH – secreted by pituitary, tells adrenal cortex to secrete glucocorticoids to relieve stress, androgens to release testostone. Tumors can release ACTH to control adrenals. Tx tumor or remove it to handle the problem.
Treatment includes mgmt of symptoms & treatment of tumor

Front 58

Describe S/S of common oncological crises - disseminated intravascular coagulation (DIC)

Back 58

•May manifest as bleeding from 3 separate sites w/bleeding & clotting at the same time, elevated PTT & PT, decreased platelets (urine, mouth, nose, any area)
•Treatment includes heparin to control clotting & fresh frozen plasma (FFP)

Front 59

Describe S/S of common oncological crises - spinal cord compression

Back 59

•May manifest as intense back pain, motor weakness, dysfunction, paresthesia
•Treatment includes palliative radiation, corticosteroids

Front 60

2 types of chemo drugs

Back 60

cell cycle phase
nonspecific &
specific

Front 61

what do nonspecific cell cycle phase drugs do?

Back 61

attack at any stage of replication or at rest

Front 62

examples of nonspecific cell cycle phase drugs

Back 62

oAlkylating agents (cisplatin, cytoxan, nitrogen mustard)
oNitrosoureas
oPlatinum drugs
oAntitumor antibiotics (adriamycin, bleomycin)
oCorticosteroids
oHormone therapy (progestins, tamoxifen) – control estrogen release Megace will increase appetite and tumor regression (adjuvant therapy) – doesn’t kill cells just slows them down.

Front 63

examples of specific cell cycle phase chemo drugs

Back 63

oAntimetabolites (fludara, methotrexate, 5Fu, Taxol)
oMitotic inhibitors
oTopoisomerase inhibitors

Front 64

examples of biologic therapy drugs

Back 64

•Tyrosine kinase inhibitors (gleevec)
•Monocolonal antibodies (rituxan, herceptin)

Front 65

example of adjuvant therapy for cancer

Back 65

•Erythropoietin (Epogen, Procrit)
oCSF responsible for stimulating erythroid precursor cells to produce mature RBCs produced in the kidneys
•Interleukin-11 (Neumega)
oPlatelet growth factor
oIndicated for prevention of severe thrombocytopenia and reduction of need for platelet transfusions
oAdverse effects include edema, dyspnea, tachycardia, nausea & mouth sores
oNeupagen stimulate granulocytes & macrophages

Front 66

fast-acting narcotics for pain mgmt

Back 66

oMSO4, MSIR (roxanol)
oCodeine
oOxycodone (Roxicodone, Percolone)
oOxycodone+acetaminophen added (Percocet, Roxicet, Tylox)
oOxycodone+aspirin added (Percodan)
oHydrocodone biturate + acetaminophen (Vicodin)
oHydromorphone (Dilaudid)

Front 67

examples of long-acting narcotics for pain mgmt

Back 67

oMScontin, Oxycontin
oTransdermal fentanyl (Duragesic)-100x more potent than Morphine (patch must be wasted by 2 RNs)

Front 68

common s/e of narcotics

Back 68

sedation, constipation, urinary retention, respiratory depression, pruritis, orthostatic hypertension

Front 69

Other meds for cancer pain

Back 69

•Nonopioids work in peripheral tissues (NSAIDs)
•Adjuvants are not conventional pain meds but augment the actions of opioids
•Tricyclic antidepressants (Elavil, Pamelor, Tofranil) – nerve pain
•Anticonvulsants (Tegretol, Dilantin, Neurotin) – nerve pain
•Steroids – pain
•CNS stimulants – Ritalin
•Antihistamines – Vistaril
•Biphosphonates – Aredia (cancer bone pain)

Front 70

antiemetic drugs

Back 70

•Ondansetron (Zofran) – blocks vomiting
•Trimethobenzamide (tigan) – suppresses medulla vomiting response – IM injection is painful
•Metoclopramide (reglan) – shortens gastric emptying & transit time
•Lorazepam (ativan) – has antiemetic properties
•Dexamethason (Decadron) – antiemetic, especially for cisplatin