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196 Cards in this Set
- Front
- Back
where is the prostate
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at the base of the penis below the urinary bladder and in front of the rectum.
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what does the prostate do
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Secretes milky alkaline fluid
adds bulk to semen enhances sperm motility neutralizes female vaginal secretions |
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how prevalent is prostate cancer
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most prevalent cancer in men
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what is the growing pace of a prostate tumor
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slow
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where does the tumor begin in prostate cancer
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Begins in posterior or lateral portions of prostate
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how does a prostate tumor spread
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direct extension
lymphatics bloodstream |
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what are the common locations of metastasis of prostate tumors
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Lymph nodes
Pelvis Bone marrow Bones of pelvis, sacrum, lumbar spine |
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whawhat type of cancer cell is prostate cancer, what kind of mutation and what hormones are important
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Androgen-dependent
95% adenocarcinoma BRCA2 mutation |
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what are risk factors for prostate cancer
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African American
Age Familial predisposition Diet: red meats, dairy, obesity Smoking |
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when should a screen for prostate cancer be done
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annually at 50
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what ages are at high risk for prostate cancer
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40-50
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what screening tools can be used for prostate cancer
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digital prostate exam, transrectal ultrasound, prostate specific antigen test, CT scan and bone scan, biopsy
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what are the types of biopsies for prostate cancer
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TUR-transurethal resection
Open prostatectomy Transrectal needle biopsy |
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when is a PSA taken
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PSA, annually along with DRE, but prior to DRE!!!!!!
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what is the PSA
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Serum protease (protein) produced by normal and epithelial tissue
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what does the PSA measure
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Measures the antibody in the serum( biological marker)
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what do PSA levels mean
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-presence of prostate tissue
-These levels are proportional to the total prostate mass and does not necessarily indicate malignancy. |
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what is an abnormal PSA
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PSA > 4.0 ng/mL is abnormal
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what else besides cancer can increase the PSA
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BPH, prostatitis, cancer, & foleys
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what are the manifestations of prostate cancer
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Hesitancy
Intermittency Decreased force and stream Sensation of incomplete emptying of bladder Post void dribbling ? Bladder infections ? Gross, painless hematuria Bone pain/back hip Stiffness Painful ejaculation Dysuria Frequency Urgency Nocturia Oliguria Retention Weight loss Weakness |
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what is done for the diagnosis prostate cancer
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Annual visit
Abnormal PSA And/or Abnormal DRE Biopsy Possible MRI Possible CXR Possible Bone Scan |
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what is the gleason score
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Two largest tissue samples are scored based on appearance 1-5
Two scores are added yielding the Gleason Score The higher the score, the more poorly differentiated and dominant the cells are |
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what are the treatment options for prostate cancer
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Watchful waiting
Radiation Hormonal Therapy Surgical |
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what are the kinds of radiation therapy for prostate cancer
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IMRT
Brachytherapy |
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what is hormone therapy for prostate cancer
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Androgen-dependent
Anti-androgen Therapy: suppresses androgenic stimuli to the prostrate by decreasing the level of circulating plasma testosterone |
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what does anti-androgen therapy use
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LHRH agonists (luteinizing hormone)
Non-steroidal androgen receptor blockers Orchiectomy Estrogen (diethylstilbestro |
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what does LHRH agonist do
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Suppresses testicular androgen
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what are the side effects for anti-androgen therapy
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Impotence
Hot flashes Nausea Vomiting Chemical Hepatitis Diarrhea |
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what are the types of surgeries that can be done for prostate cancer
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RADICAL PROSTATECTOMY
SUPRAPUBIC PERINEAL TRANSURETHRAL resectomy of prostate |
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what are the side effects of a TURP
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Urethral strictures
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why is a turp good
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low rate of complications
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what does a TURP rarely cause
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erectile dysfunction
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what can a TURP cause
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May retrograde ejaculation
Seminal fluid to flow backward into the bladder than forward through the urethra during ejaculation |
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how is a TURP performed
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through endoscope
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what does a TURP do
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Gland is removed in small chips with electrical cutting loop.
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what is perineal surgery
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Remove gland through incision in perineum
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what is a post-op complication of perineal surgery
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infection due to contamination
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what are the side effects of perineal surgery
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incontinence, impotence, rectal injury
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what causes the side effects of perineal surgery
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Nerves control urinary continence and penile erection may be damaged
Nerves around rectum can also be damaged. |
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what is used in a perineal surgery
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penrose drain
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what is suprapubic surgery used for
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Performed for large tumor/gland mass
Rarely used today |
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where is the incision for suprapubic surgery
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low midline
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what is used post op for suprapubic surgery
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suprapublic catheter and continuous bladder irrigation, and urethral catheter with 30cc balloon
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what does a suprapubic surgery increase the risk of
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UTI, incontinence, bladder spasms, hemorrhage
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what is a radical prostatectomy
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GOLD STANDARD THERAPY
Removal of prostate, seminal vesicles capsule, tip of vas deferens and surrounding fat, nerves and blood vessels Bladder neck sutured to urethra Sterile not impotent |
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what is a nerve sparing radical prostatectomy
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Campbell-Walsh
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what can be used to do a radical prostatectomy
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Robotic vs. Laparoscopic vs. Open
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what are post-op complications for prostate surgery
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Hemorrhage
Blood clot formation Catheter obstruction Infection DVT SEXUAL DYSFUNCTION/IMPOTENCE |
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what is post operative nursing management for prostate surgery
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Urethral or abdominal catheter
TCDB Pain control Ambulation TED’s/ SCD’s Fluid intake Incision specific |
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what discharge information is provided to prostate surgery patients
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Foley catheter care
Dressing care Drainage tube care Activity orders Complications: management? incontinence impotence Maintaining oral fluids: 2-3L/day Observing for S&S of infection Preventing constipation Avoiding heavy lifting Refrain from intercourse for 6 weeks Follow up compliance!!! |
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what is the most common cancer in young men
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testicular
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what is the cell origin for testicular cancer
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Malignant neoplasm usually of germ
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what is the peak age for testicular cancer
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20-40
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what are the types of testicular cancer
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Many types, generally divided into seminomas and non-seminomas for treatment purposes
5-10% Leydig or Sertoli cell |
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what are the symptoms of testicular cancer
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usually a painless mass
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what is the exam for testicular cancer
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usually firm irregular mass arising from the testicle
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how do you stage testicular cancer
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testicle size
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what are the treatment options for testicular cancer
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Surgery
Radiation Chemotherapy |
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What is the incidence of lung cancer
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Leading cause of death in men and women who have malignant disease
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what is the survival time for lung cancer
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long term survival rate is low
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what are the two main causes of lung cancer
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SMOKING (90%)
Inhaled carcinogens Radon Occupational and environmental agents Genetics |
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what is the pathophysiology of lung cancer
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Primarily bronchogenic
Single transformed cell in epithelium transforms DNA Grows slowly into large masses |
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what does a lung tumor obstruct
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bronchi
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where does lung cancer metastasize to
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Metastasizes to liver, brain, bone, lymph nodes and adrenal glands
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how long to it take for a lung tumor to reach 1 cm size detectable on CXR
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10 years
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how is lung cancer classified
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by histologic types
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where does the tumor for lung cancer occur
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hilus of lung
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what are the types of lung cancer
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Small Cell Lung Cancer (SCLC) 15-20 %
Non-Small Cell Lung Cancer (NSCLC) 80% |
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what type of carcinomas are in Small Cell Lung Cancer (SCLC)
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small cell anaplastic / Oat cell
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what type of carcinomas are in Non-Small Cell Lung Cancer
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Squamous ( 20-30 %)
Adenocarcinoma (40%) Large cell CA (15%) |
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what is the most prevalent carcinoma of the lungs in men and women
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Adenocarcinoma
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what are the fastest growing carcinomas
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large cells
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what is the primary problem when lung cancer is diagnosed
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70% already metastasized
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what is the most common carcinoma of SCLC
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oat cell
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what are the primary causes of SCLC
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Associated with smoking and carcinogens
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what is the lung area for SCLC
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lung hilus
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what is the problem with SCLC
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Most malignant and virulent with early mets. Very poor prognosis
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what is SCLC treated
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Treated with chemo, adjunct radiation, and palliation – rarely surgical intervention
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what is the median survival for SCLC
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less than 1 year (35 weeks)
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what is NSCLC Squamous Cell associated with
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smoking
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what does NSCLC Squamous Cell produce
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earlier symptoms of obstruction
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how does NSCLC Squamous Cell spread
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Does not have tendency to metastasize, but does spread by local invasion
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how is NSCLC Squamous Cell treated
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Usually surgically treated
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what is the survival rate of Squamous Cell NSCLC
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5 yr. survival rate – over 50% without evidence of mets.
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where is NSCLC - Adenocarcinoma located
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outer edges of lung
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who is NSCLC - Adenocarcinoma most common in
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men and women
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what are the manifestations of NSCLC - Adenocarcinoma
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Usually no manifestations until widespread metastases
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what is the treatment for NSCLC - Adenocarcinoma
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Usually surgically treated
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what is the 5 year survival rate for NSCLC-adenocarcinoma
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less than 10%
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what is NSCLC - Large Cell Undifferentiated associated with
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Associated with smoking and carcinogens
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what is the problem with NSCLC - Large Cell Undifferentiated
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Very fast progression with mets.
High incidence of mets Poor prognosis: adjuvant and palliative treatment; |
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what is the 5 year survival rate of NSCLC - Large Cell Undifferentiated
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less than 10%
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what are the risk factors for lung cancer
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Tobacco smoke
Second hand smoke Environmental and occupational exposures Gender Genetics Dietary deficits-low in fruits and veggies Resp. Diseases i.e. TB and COPD |
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what do manifestation of lung cancer depend on
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depend on the location and size of the tumor the degree of obstruction and the existence of metastases to regional or distant sites
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what are the manifestations of lung cancer
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Cough that changes in character
Persistent Cough Dyspnea Chest pain Hemoptysis Anorexia Fatigue Weight loss Hoarseness Dysphagia Shoulder pain Symptoms of Pleural effusions |
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what are the diagnostic studies for lung cancer
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CXR
Fiberoptic bronchoscopy Percutaneous transthoracic needle bx Endoscopic Ultrasound Fine needle aspiration Surgery CT scan/PET scan/MRI/Organ/Bone Scan Sputum for cytology |
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what is Paraneoplastic Syndrome
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Neurologic effects of cancer
Nervous system dysfunction |
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where is Paraneoplastic Syndrome mostly seen
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<1% of cancer patients
Seen mostly with SCLC |
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what is the tumor staging for SCLC
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Limited
Extensive |
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what is the tumor staging for NSCLC
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Stages 0 to 4
Tumor size/spread Tx to T4 Nodal involvement N1 to N3 Distant Metastases M0 to M1 |
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what is the therapeutic management for lung cancer
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Radiation
*Chemotherapy *Surgery Biologic therapies Phototherapy or Photodynamic Therapy |
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how is radiation therapy used palliatively
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Prophylactically usage relieve cough, pain, chest pain, hemoptysis , bone and liver pain
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how is radiation therapy used palliatively
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Palliative to reduce symptoms in non resectable tumors
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what are complications of radiation therapy
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burns, pneumonitis, pericarditis, esophagitis, radiation lung fibrosis
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when can radiation therapy be used
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preoperatively or postoperatively
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what is chemotherapy used for
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Used for non-resectable tumors or as adjunct to surgery
Used to alter the growth of tumor cells |
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what is chemotherapy a protocol of
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multi-drug regimens
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what does chemotherapy have the best outcome for
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Best outcome with small cell cancers
Not good outcome with non-small cell cancers |
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what are complications to chemotherapy
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Bone Marrow Suppression
Leukopenia sepsis Anemia Thrombocytopenia Peripheral Neuropathy N/V Alopecia Nutrition and weight loss concern |
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what does biological therapy use
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Biologic response modifiers
Interferon Interleukins Monoclonal Antibodies Growth factors |
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what does biological therapy do
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Alters the biologic response of the host toward the tumor cells
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how is biological therapy used
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used as an adjuvant
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what does phototherapy do
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YAG - Shrinks the tumor as a result of thermal necrosis
Not a curative measure |
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what is phototherapy
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Porfimer injected IV concentrates in tumor cells, is activated by laser light, destroys tumor cells by producing a toxic form of oxygen
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what are the types of surgical management of lung cancer
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Lobectomy ( single)
Bilobectomy ( two lobes) Sleeve resection lobe removed & bronchus resected Pneumonectomy ( entire lung) Segmentectomy ( segment removed) Wedge resection (small pie shaped) Chest wall resection |
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what is pre-operative teaching to lung cancer patients
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Chest tubes
Incentive spirometer Activity PAIN CONTROL Oxygen therapy Monitor SaO2 values Repeat CXR Arm exercises Clinical trials |
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what is post-operative management of a lung cancer patient
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positioning in bed
respiratory pain subcutaneous emphysema chest tubes |
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what are post-operative complications to lung cancer surgery
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Empyema
Bronchopleural fistula |
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when is a chest tube used
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Air or fluid in pleural space restrict lung expansion and decrease gas exchange
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what does a chest tube do
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restores negative intrathoracic pressure so lung can reexpand.
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how do chest tubes improve gas exchange
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returning negative pressure to the intra pleural space
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what are chest tubes used to do
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Used to re-expand the involved lung to remove excess air, fluid or blood
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what cause air to move into the lungs during inspiration
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Normal breathing mechanism negative pressure , lower than atmosphere
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what happens if the chest is open
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loss of negative pressure compromise
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with a chest tube, when should use phone the doctor
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Greater than 50cc/hr
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how much suction out of the chest tube
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20-40 cm/h2o
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what are the types of chest tubes
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Traditional water seal: most common
Dry suction water seal Dry suction Wet suction water seal |
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what is most important in end of life care
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pain control
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where can care be done in end of life care
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hospital or hospice
|
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what are the benefits of quitting smoking
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At 8 hours
carbon monoxide level in blood drops to normal oxygen level in blood increases to normal At 24 hours chance of a heart attack decreasesAt 48 hours nerve endings start re growing ability to smell and taste is enhanced At 2 weeks to 3 months circulation improves walking becomes easier lung function increase At 1 to 9 months coughing, sinus congestion, fatigue, shortness of breath decreasesAt 1 year excess risk of coronary heart disease is decreased to half that of a smoker At 5 years from 5 to 15 years after quitting, stroke risk is reduced to that of people who have never smoked. At 10 years:risk of lung cancer drops to as little as one-half that of continuing smokersrisk of cancer of the mouth, throat, esophagus, bladder, kidney, & pancreas decreasesrisk of ulcers decrease At 15 years risk of coronary heart disease is now similar to that of people who have never smoked risk of death returns to nearly the level of people who have never smoked |
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what health cares are used in oral cancer
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Combine, oncology, critical care and psychiatric-mental health skills
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what is emphasized in oral cancer
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self care
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what are the head and neck cancers
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40% Oral Cavity
25% Larynx 15% Oropharynx / Hypopharynx 7% Salivary Glands 13% Remaining sites – nasal cavity, nasopharynx, paranasal sinuses |
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what is the carcinoma of head and neck cancers
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90% squamous cell carcinoma
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what are the types of lesions in oral cancer
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Leukoplakia and Erythroplakia
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what is Leukoplakia
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white lesions
“Smokers patch” |
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what is Erythroplakia
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bright red and velvety (Associated with significantly higher risk of cancer)
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what are risk factors for oral cancer
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Tobacco
Smoking Chewing Alcohol Chronic Irritation Acid Reflux Environment Chemicals Wood dust Radiation |
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who is common in oral cancer
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2xs more frequent in males
age > 50 |
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what are symptoms of oral cancer
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painless ulceration/lesion
difficulty speaking, swallowing swollen lymph nodes blood-tinged sputum ANY ORAL LESION THAT DOES NOT HEAL IN 3-4 WEEKS SHOULD BE EXAMINED |
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how do you diagnose oral cancer
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Physical exam, oral cavity, cervical lymph nodes
Exfoliative cytology Lesion biopsy Staging further tests-CT, MRI |
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what are the treatments for oral cancer
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chemotherapy, Radiation and surgery
|
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what does chemotherapy depend on
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depends on stage
|
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what does radiation do
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shrink the tumor
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what is used in radiation of oral cancer
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Brachycathers
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what are the side effects of radiation in oral cancer
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Xerostomia
Stomatitis dysgeusia |
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what does surgery for oral cancer do
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resect/maintain airway
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what are the manifestations for tongue cancer
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Ulcer or area of thickening
Soreness/pain Increased salivation Slurred speech Dysphasia Toothache Earache (late) |
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what are the treatments for tounge cancer
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surgery (hemiglossectomy) or radiation
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what is the problem with tongue cancer
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Early Metastasis
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what are the nursing management for tounge cancers
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Maintain airway
tracheostomy Malnutrition increased calories/liquids enteral/parenteral feeding Pain Control |
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what is the prevention for head and neck cancer
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education of risk factors
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what are the health promotions for head and neck cancers
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Regular Dental Exams
Encourage use of sunscreen Reduce Risk Factors: Stop smoking and using smokeless tobacco Early Detection |
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what is seen for early detection
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Unexplained pain/soreness in mouth
Unusual bleeding from oral cavity Dysphagia Swelling of lump in neck |
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what is the surgical treatment for head and neck cancers
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neck dissections
|
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what are the types of neck cancers
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Selective
Modified Radical |
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what is a radical neck dissection
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tissue removed from the mandible to clavicle, cervical lymph nodes, sternocledomastoid muscle, internal jugular, cranial nerve XI can be removed
skin grafts, head weakness, shoulder weakness (CN XI removed) |
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what are Reconstructive Techniques Post Radical Neck
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Free Flap
Myocutaneous flap |
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what is a free flap
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flap of skin moved to new site. Blood vessels attached micosurgically
|
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where is the blood supply for a myocutaneous flap
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blood supply to muscle and overlying skin
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what is Nursing Care Post Radical Neck
|
Airway
Pain Relief Wound Care JP’s Nutrition Mobility Skin grafts/ donor sites |
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what are complications of a radical neck
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Bleeding
Chyle Fistula Nerve Injury |
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what are benign vocal cord polyps from
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develop in patients who abuse their voice
cigarette smoking industrial pollutants hoarseness/breathy quality to voice rest/steroid sprays/excision |
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who most commonly gets laryngeal cancer
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5x more common in males
Usually >50 years (originally 60’s) |
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what is the carcinoma in vocal fold cancer
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90% Squamous Cell Carcinoma
|
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what can laryngeal cancer involve
|
Supraglottis
Glottis Subglottis |
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what are the risk factors for laryngeal cancer?
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Tobacco
Alcohol Asbestos Secondhand smoke GERD Genetics Exposure to chemicals/toxins Exposure to radiation Straining voice Chronic laryngitis Race (African Americans) Gender HPV virus Bulimics |
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what are the early signs of laryngeal cancer
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Hoarseness
Voices changes Persistent cough Sore throat and burning |
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what are the late signs of laryngeal cancer
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Dysphasia
Dyspnea Persistent hoarseness Persistent ulceration Foul breath Cervical lymph adenopathy Weight loss Pain |
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what are the labs and diagnostic studies for laryngeal cancer
|
laryngoscopy
lesions biopsied x-rays, CT scans, MRIs needle bx of lymph nodes |
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what is the treatment for laryngeal cancer
|
Radiation
Surgery Chemotherapy |
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what are the types of radiation for laryngeal cancer
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External radiation
therapy Brachytherapy |
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what is the cure rate for radiation therapy in laryngeal cancer
|
96%
|
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what care should be done for radiation therapy in laryngeal cancer
|
skin care
|
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what is the surgery for laryngeal cancer
|
laryngectomy
|
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what are the types of laryngectomies
|
Partial
Supraglottic Hemi Total Subglottic |
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what is a supraglottic laryngectomy
|
false cords, epiglottis, base of tongue can be removed
voice preserved but at risk for aspiration |
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where is the supraglottic laryngectomy
|
above vocal cords
|
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what must a patient learn with a supraglottic laryngectomy
|
Supraglottic swallow
|
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what is the patient at risk for with a supraglottic laryngectomy
|
aspiration
|
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how do you prevent aspiration in a supraglottic laryngectomy
|
Keep HOB elevated during and after tube feedings.
Check gastric residual when administering tube feedings. When the patient begins oral feeding, maintain upright bed position during and after feedings. Swallowing maneuvers to prevent aspiration Use of thickened liquids |
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what is subglottic cancer
|
Located below true vocal cords-first tracheal ring
|
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what is the big problem with subglottic cancer
|
No early manifestations: worse prognosis
|
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what is subglottic cancer manifested as
|
Manifest as airway obstruction/stridor -->spread to lymphatics
|
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what is a Total Laryngectomy
|
Entire larynx removed
Esophagus/trachea separated Epiglottis, tracheal rings, hyoid bone removed Permanent tracheostomy created-”stoma |
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what are the Changes in Airflow with Total Laryngectomy
|
minimal air entering nose and mouth
Air flowing to lungs in and out of opening in neck |
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what is done for pre-op for laryngeal cancer
|
“C” Word
Prepare patient as best as possible/focus on probable cure of cancer Establish a way to communicate after surgery Will affect sense of taste and smell Speech Therapy prior to surgery Support groups: Lost Cord Clubs |
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what is post op cancer for laryngeal cancer
|
Airway assessment-tracheal suctioning
Humidification of inspired air/oxygen Check Doppler's q 1 hour Graft site for (Color, Blanching, Warmth) Manage Withdrawal (WAS) Support head/neck w/Fowler’s Pain Relief Wound management clean and apply bacitracin JPs care Support Head/ Neck Anxiety/call bell Nutrition Communication Inability to Valsalva |
|
what is a big issue after surgery for laryngeal cancer
|
communication
|
|
what are the types of speech therapy for laryngeal surgery
|
Esophageal Speech
Electric Larynx Tracheoesophageal Puncture |
|
what is a Tracheoesophageal Puncture
|
fistula between post tracheal wall and ant. esophagus/close off trach stoma during exhalation to allow air into esophagus thru a one-way valve (tracheoesophageal prosthesis)
|
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what is a major change in patient with a laryngecotmy
|
body image change
|
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what is the discharge planning for a laryngectomy
|
Self stoma care
Tube feeding boluses Humidification( warm air) Med alert bracelet Wound management Communication Support groups Sexual Concerns Supplies: stoma covers |
|
what is a Tracheoesophageal Puncture
|
fistula between post tracheal wall and ant. esophagus/close off trach stoma during exhalation to allow air into esophagus thru a one-way valve (tracheoesophageal prosthesis)
|
|
what is a major change in patient with a laryngecotmy
|
body image change
|
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what is the discharge planning for a laryngectomy
|
Self stoma care
Tube feeding boluses Humidification( warm air) Med alert bracelet Wound management Communication Support groups Sexual Concerns Supplies: stoma covers |