Med Surge - Final Exam - Cancer

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define cancer

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an “umbrella” term for a group of disorders characterized by uncontrolled cellular growth with local tissue invasion and/or systemic spread

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KEY TERMS
-Carcinogenesis:

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simply, the “production” of Cancer;

a carcinogen causes cancer!

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KEY TERMS
-Neoplasm:

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literally a “new growth,” usually of abnormal tissue (can be normal or abnormal) when a tumor is first found, it’s going to be called a neoplasm. When we go in and do a surgical procedure, the term changes. One of the famous places to see these are in the ovaries.

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KEY TERMS
-Tumor:

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– derived from the Latin, “tumere,” meaning “to swell,” usually to overgrowth of pathologic tissue

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KEY TERMS
-Oncology:

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simply, the study & knowledge of tumors

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KEY TERMS
-Cachexia

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– a state of malnutrition (think, flesh is hanging on bones) very undernourished.

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KEY TERMS
-Emaciation –

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simply, “to grow thin”

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KEY TERMS
-Differentiated

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– a maturation/diversification of cells; a NORMAL process; example: cells “differentiate” into pancreatic cells (we want cancerous tumors to be differentiated so you can see the good cells and bad cells. It will be capsulated where you can move.

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KEY TERMS
-Undifferentiated –

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a lack of normal differentiation; cells resemble a primitive structure; an ABNORMAL process! (think brain cancer. Blending of normal and abnormal cells)

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cancer cells

-loss of regulation of ____

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miotic rate

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cancer cells

-ability to move from a primary site to a secodnary site, is known as:

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metastasize

-they have the capacity to invade and destroy normal tissue in which the cancer grows

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benign or malignant tumors

normal cells growing in the wrong place at the wrong time or at the wrong rate

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benign

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benign or malignant tumors

usually not recurrent or tendign to progress

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benign

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benign or malignant tumors

examples are moles, uterine fibroids, skin tags

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benign

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benign or malignant tumors

the cells appear normal

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benign

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benign or malignant tumors

abnormal cancer cells which serve no useful function

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malignant

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benign or malignant tumors

tend to become progressively worse and possess the capcility to invade and destroy

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malignant

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benign or malignant tumors

examples are breast cancer, lung cancer

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malignant

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benign or malignant tumors

cells look very different from the origin or primary cell

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malignant

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benign or malignant tumors

Usually “typical” of tissue of origin, as cells, as tissues

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benign

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benign or malignant tumors

Rate of growth is usually slow & in an orderly fashion

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benign

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benign or malignant tumors

Mode of growth is “expansile” and are often encapsulated (you can take it out in it’s totality)

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benign

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benign or malignant tumors

Metastasis is absent or rare

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benign

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benign or malignant tumors

Slight vascularity, but necrosis and ulceration is rare or unusual

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benign

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benign or malignant tumors

Adhere tightly together

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benign

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benign or malignant tumors

Usually “atypical” as cells, as tissues

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malignant

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benign or malignant tumors

Rate of growth is usually rapid or very rapid & fatal if untreated

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malignant

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benign or malignant tumors

Mode of growth is infiltrative, as well as expansile; poorly
encapsulated

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malignant

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benign or malignant tumors

Metastasis is frequently present, recurrence is common (ex: ovarian cancer)

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malignant

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benign or malignant tumors

Adhere loosely together

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malignant


b/c they do not make fibronectin. As a result, cancer cells easily break off from the main tumor

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benign or malignant tumors

Loss of “contact inhibition”

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malignant


Contact inhibition is the
stopping of further rounds of cell division when the dividing cell is completely surrounded and touched by other cells. Cells divide only when some of its surface is not in direct contact with another cell.

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benign or malignant tumors

Moderate or marked vascularity & ulceration is common

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malignant

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cancer cellss
-are they symmetrical or asymmetrical

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asymetrical

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What are Three (3) Factors that Assist a physician in Classifying Tumors

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1. Histogenesis – Body tissue of origin

2. Biologic Behavior – Benign or Malignant

3. Anatomic Site – Origin or region

-all of these come together to determine primary or secondary cancer

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Cancers are classified by what 2 things?

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the type of tissue from which they arise


-Epithelial
-Connective
-Nervous system = brain
-Hematopoietic = bone
Tumors of more than one tissue, “teratoma” = rare, usually present at birth and then grow over time

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CARCINOMAS

malignancy of what kind of tissue?

5 examples

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Malignancy of epithelial tissue:


breast
uterus
G.I. tract
skin
tongue

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SARCOMAS

malignancy of what kind of tissue?

5 examples

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Malignancy of connective tissue;


bone,
cartilage,
muscle,
blood vessels,
lymph tissue

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METASTASIS

Metastasis occurs when cancer cells move from:

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the primary location by breaking off the original group and establish colonies.

These additional tumors are called metastatic or secondary tumors.

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METASTASIS

These additional tumors are called “metastatic” or __________ tumors

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“secondary”

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Characteristics of Malignant Cells that Facilitate Metastasis


(less or more) cohesive than other cells

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Less cohesive than other cells (look very much abnormal and stuck together) they move around. Normal tissue doesn’t move around. You wont find ovarian tissue in your lung unless it metastasized)

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Characteristics of Malignant Cells that Facilitate Metastasis

Bonding is affected

true or false

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Loss of “contact inhibition” – therefore persistent cell division is why its hard to control

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Characteristics of Malignant Cells that Facilitate Metastasis

Migration occurs because cancer cells do not bind tightly together and have many enzymes on their cell surfaces. These features allow the cells to do what?

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slip through blood vessels and tissues, spreading from the main tumor site to many other body sites.

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extravasation means what?

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Extension into surrounding tissue (extravasation)
anything that gets into surrounding tissue..another ex
is an IV the infiltrates

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intravasation means what?

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Penetration into Blood Vessels (intravasation) by
attaching the walls and as it grows it erodes the
tissues so what you get is a blood vessel dissection.
this is a way pancreatic cancer kills. They die by the
secondary effects (very fast and painless)

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Invasion at the site of arrest – when conditions in the remote site are favorable, the cells do what?

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stop circulating (arrest), and invade the surrounding tissues, creating secondary tumors

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What’s an “Oncogene?”

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A potentially cancer-inducing gene. Under normal conditions, proto-oncogenes play an important role in the growth & proliferation of cells, then are suppressed, but when exposed to any carcinogen (initiator) the normal cell’s DNA can be damaged or mutated

This mutation can cause the “proto-oncogenes” (which should be suppressed) to be turned on or activated again & transform other cells into cancer cells!

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proto-oncogenes are regulators of normal cell processess and mutations activate them to fucntion as oncogenes (tumor producing genes)

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Grading of Tumors Cellular Characteristics

Grading classifies what?

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cellular aspects of the cancer cell (we're looking at cellular characteristics)

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Grading of Tumors Cellular Characteristics

GX –

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Grade cannot be assessed

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Grading of Tumors Cellular Characteristics

G1-

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G1 – 75% of cells are well-differentiated; 25% abnormal -

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Grading of Tumors Cellular Characteristics


tumor cells are well differentiated and closely resemble the normal cells from which they arose.

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G1

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Grading of Tumors Cellular Characteristics

G2 –

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50-75% of cells are well-differentiated;

25-50% are abnormal

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Grading of Tumors Cellular Characteristics

The retain some of the characteristics of normal cells but have more
malignant characteristics than G1 tumor cells

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G2

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Grading of Tumors Cellular Characteristics

G3 –

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25-50% of cells are well-differentiated;

50-75% are abnormal

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Grading of Tumors Cellular Characteristics

Tumor cells are poorly differentiated but the tissue of origin can
usually be established

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G3

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Grading of Tumors Cellular Characteristics

G4 –

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0-25% of cells are well-differentiated;



75-100% are abnormal

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Grading of Tumors Cellular Characteristics

Tumor cells are poorly differentiated and retain no normal cell characteristics. Determination of the tissue of origin is difficult and perhaps impossible.

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G4

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Once you grade the CA, you then stage it:
--What is the purpose of staging?

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staging determines the cancer’s exact location & degree of metastasis at time of diagnosis

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Staging Using the “TNM” System
-what does it mean?


-the americna joint committee on cancer created this and it's used to describe what?

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The “TNM” (Tumor, Node, Metastasis)




describes the anatomic extent of cancers. (how far have they gone?)

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Staging Using the “TNM” System

-it's based on the concept that:

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similar cancers share similar patterns of growth and extension, & are specific to each SOLID tumor site.

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Staging Using the “TNM” System

-this is NOT useful for cancers that arise in (2)

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in the bone marrow or lymphoid tissue. (lymphomas)

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Staging Using the “TNM” System

Tx =

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Primary tumor cannot be assessed

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Staging of cancer

-of the 3 ways to stage cancer, what is the most definitive?

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pathologic staging.. exam of tissues obtained during surgery

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Staging Using the “TNM” System

T0 =

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No evidence of primary tumor

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Staging Using the “TNM” System

Tis =

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Carcinoma in situ (cancer is present and has invaded tissue)

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Staging Using the “TNM” System

T1, T2, T3, T4 =

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Increasing size/extent of tumor (expanding – how big is the tumor )

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Differentiated cells =


So what type of cancer (malignant or benign) has poorly differentiated cells?

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similar cells

malignant (cell dont look like the original tissue)

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Staging Using the “TNM” System

Nx =

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Cannot assess regional lymph nodes

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Staging Using the “TNM” System

N0 =

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no evidence of disease of lymph

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Staging Using the “TNM” System

N1, N2, N3 =

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Increasing involvement of regional lymph nodes

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Staging Using the “TNM” System

Mx =

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Distant metastasese cannot be assessed

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Staging Using the “TNM” System

M0 =

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no evidence of distant metastsases

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M1 =

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Distant metastasis

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Staging Using the “TNM” System

Patient is “staged” as either:

Stage I
Stage II
Stage III
Stage IV

The (higher lower) the stage, the poorer the prognosis!

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higer

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Staging Using the “TNM” System

M+ means what

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you have metastasis

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Seven (7) Warning Signals of Cancer

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C = change in bowel or bladder habits
A = a sore that does not heal
U = unusual bleeding or discharge
T = thickening or lump in the breast or elsewhere
I = indigestion of difficulty in swallowing
O = obvious change in a wart or mole
N = nagging cough or hoarseness


-unexplained of weight loss, night sweats
* Acronym spells “CAUTION!”

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Tumor Markers

-what are they

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Tumor markers are substances produced and secreted by tumor cells that are found in the serum of individuals with cancer!


-they are a screen tool, they do not confirm diagnosis

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Cancer Treatment
-treatment of choice?

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If surgery is confined to the removed tissue, surgery alone can result in a cure for that cancer
Removal of diseased tissue

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Radiation Therapy
-what is the purpose of radiation?

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The purpose of “RT” is to destroy cancer cells with minimal exposure of normal cells to the effects of damaging action of radiation

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Radiation Therapy
-is it localized or systemic?

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localized, NOT systemic! For ex: radiation to the chest for breast CA or lung CA causes skin changes and hair loss only on the area of the chest actually being irradiated. The person does NOT close hair on their scalp.

Cells damaged by radiation either die or become unable to divide

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Radiation Therapy
-what cancer wont this work on

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It doesn’t work on CA that metastasized

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Radiation Therapy
- Delivered as so many “RAD” per day, which means, “radiation absorbed dose”

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(the amount of radiation absorbed by the tissue)

the dose is always less than the exposure (the amount of radiation delivered to a tissue)

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Radiation Therapy
-based on what 2 things?

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Based on pts weight and type of tissue

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Chemotherapy
-what is it all about?

-what's the goal

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About killing cells. Both cancer and normal.


Goal is to kill more malignant cells / The goal is malignant cell death and/or cell shrinkage!

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Chemotherapy
--The killing effect on cancer cells is related to the ability of chemotherapy to damage DNA and interfere with cell division.


-local or systemic approach?

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Chemotherapy provides a systemic approach to cancer treatment. b/c of the opportunity to kill metastatic cancer cells that may have escaped local treatment



Because cancer cells divide more quickly than other cells, chemotherapy has a greater effect on malignant cells!

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Cancer

The type of drugs you give depends upon what

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the cell cycle

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Surgery is most effective for cancer therapy when tumors are ________ & _________

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small & well-localized

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What cancer treatment is being described:

is LOCAL & side-effects are confined to tissue within the radiation path

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radiation therapy

Common SE of radiation are: skin irritation (aka: radiation dermatitis), fatigue & altered taste sensation

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What cancer treatment is being described:

is SYSTEMIC & affects ALL body tissues;

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Chemotherapy

Common SE of Chemotherapy are: alopecia, nausea & vomiting, mucositis (open sores on mucous membranes), anemia, thrombocytopenia, neutropenia, skin changes and BONE MARROW SUPPRESSION (the most LIFE-THREATENING!)

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Cancer - Neutropenia


-The patients Neutrophils are (more or less) than normal & they’re prone to secondary infection!

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far less

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Neutrophils tell us what

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if the pt will be able to fight off infection

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Neutropenia is defined as what

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ANC of less than 1000 mm3 blood

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when would your patient require "reverse isolation" AKA protective isolation?

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when they are neutropenia, which is an ANC of less than 1000 mm3 blood

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when is chemotherapy held? 2

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if the pts ANC is less than 1500mm3 blood


OR



if the platelet count is less than 100,000 mm3 blood

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how do you calculate ANC?

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add segs and bands, then chance them to a decimal. multiply this number by your total WBC count

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Check the “Risk of Infection” Chart

1500-2000/mm3

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no significant risk

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Check the “Risk of Infection” Chart

1000-1500/mm3

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minimum risk

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Check the “Risk of Infection” Chart


500-1000/mm3

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moderate risk

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Check the “Risk of Infection” Chart


less than 500/mm3

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sever risk

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Thrombocytopenia
-is what?

-what are the #s?

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A decrease in the amount of circulating platelets, resulting in risk for bleeding

The “general” normal platelet count is: 150,000 – 450,000/mm3 blood

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Nursing Care of the Thrombocytopenic Patient


-Increased risk for bleeding if count is below _________mm3 (The patient is usually placed on “Bleeding Precautions”)

vital signs:
-pulse?
-BP?

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50,000


increased pulse

decreased BP

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cancer is the most common cause of SIADH.
-what results?

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Water is reabsorbed to excess by the kidney and put into systemic circulation. This increased water causes hyponatremia and fluid retention.

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Cancer
-hypocalcemia or hypercalcemia?

why?

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Hypercalcemia -


from chemotherapeutics
Cancer in bone causes the bone to release Ca+ into the bloodstream.

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Tumor Lysis Syndrome

– Most often seen in pts receiving radiation of chemotherapy.


what is it??

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lg # of tumor cells are destroyed rapidly. Their intracellular contents (K+) is released into the blood stream faster than the body can eliminate them.

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Superior Vena Cava Syndrome

-what is it?



-what do the S/S result from?

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An encroachment of tumor on the superior vena cava, preventing blood return to the heart.

Occurs when the SVC is compressed or obstructed by tumor growth or by the formation of clots in the vessel.

S/S result from the blockage of blood flow in the venous system of the head, neck and upper trunk.

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Tumor Lysis Syndrome (“TLS”)
--A metabolic imbalance that occurs as a result of tumor cell kill, resulting in the rapid release of

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intracellular potassium, phosphorus, and nucleic acid into the blood stream (seen 1-5 days after initiation of treatment, & ends 5-7 days after the end of therapy).

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Tumor Lysis Syndrome (“TLS”)

The syndrome results in:
(hypokalemia or hyperkalemia)
(hypophosphatemia or hyperphosphatemia)

hypocalcemia or hypercalcemia)


(hypouricemia or hyperuricemia)

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hyperkalemia

hyperphosphatemia (binds to calcium and we have a decreased circulating calcium and we become hypocalcemic),
-----hypocalcemia results from the binding of increased phosphorus with calcium to form calcium salts.



hyperuricemia (conversion of nucleic acid to uric acid);

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Treatment for TLS

-best management is what?

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hydration (3000 to 5000 ml the day before treatment, the day of, and for 3 days after treatment) is the BEST management for TLS b/c it can dilute the serum K level and increase the kidney filtration rate