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196 Cards in this Set

  • Front
  • Back
where is the prostate
at the base of the penis below the urinary bladder and in front of the rectum.
what does the prostate do
Secretes milky alkaline fluid
adds bulk to semen
enhances sperm motility
neutralizes female vaginal secretions
how prevalent is prostate cancer
most prevalent cancer in men
what is the growing pace of a prostate tumor
slow
where does the tumor begin in prostate cancer
Begins in posterior or lateral portions of prostate
how does a prostate tumor spread
direct extension
lymphatics
bloodstream
what are the common locations of metastasis of prostate tumors
Lymph nodes
Pelvis
Bone marrow
Bones of pelvis, sacrum, lumbar spine
whawhat type of cancer cell is prostate cancer, what kind of mutation and what hormones are important
Androgen-dependent
95% adenocarcinoma
BRCA2 mutation
what are risk factors for prostate cancer
African American
Age
Familial predisposition
Diet: red meats, dairy, obesity
Smoking
when should a screen for prostate cancer be done
annually at 50
what ages are at high risk for prostate cancer
40-50
what screening tools can be used for prostate cancer
digital prostate exam, transrectal ultrasound, prostate specific antigen test, CT scan and bone scan, biopsy
what are the types of biopsies for prostate cancer
TUR-transurethal resection
Open prostatectomy
Transrectal needle biopsy
when is a PSA taken
PSA, annually along with DRE, but prior to DRE!!!!!!
what is the PSA
Serum protease (protein) produced by normal and epithelial tissue
what does the PSA measure
Measures the antibody in the serum( biological marker)
what do PSA levels mean
-presence of prostate tissue
-These levels are proportional to the total prostate mass and does not necessarily indicate malignancy.
what is an abnormal PSA
PSA > 4.0 ng/mL is abnormal
what else besides cancer can increase the PSA
BPH, prostatitis, cancer, & foleys
what are the manifestations of prostate cancer
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
what is done for the diagnosis prostate cancer
Annual visit
Abnormal PSA
And/or Abnormal DRE
Biopsy
Possible MRI
Possible CXR
Possible Bone Scan
what is the gleason score
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
what are the treatment options for prostate cancer
Watchful waiting
Radiation
Hormonal Therapy
Surgical
what are the kinds of radiation therapy for prostate cancer
IMRT
Brachytherapy
what is hormone therapy for prostate cancer
Androgen-dependent
Anti-androgen Therapy: suppresses androgenic stimuli to the prostrate by decreasing the level of circulating plasma testosterone
what does anti-androgen therapy use
LHRH agonists (luteinizing hormone)

Non-steroidal androgen receptor blockers
Orchiectomy
Estrogen (diethylstilbestro
what does LHRH agonist do
Suppresses testicular androgen
what are the side effects for anti-androgen therapy
Impotence
Hot flashes
Nausea
Vomiting
Chemical Hepatitis
Diarrhea
what are the types of surgeries that can be done for prostate cancer
RADICAL PROSTATECTOMY
SUPRAPUBIC
PERINEAL
TRANSURETHRAL resectomy of prostate
what are the side effects of a TURP
Urethral strictures
why is a turp good
low rate of complications
what does a TURP rarely cause
erectile dysfunction
what can a TURP cause
May retrograde ejaculation
Seminal fluid to flow backward into the bladder than forward through the urethra during ejaculation
how is a TURP performed
through endoscope
what does a TURP do
Gland is removed in small chips with electrical cutting loop.
what is perineal surgery
Remove gland through incision in perineum
what is a post-op complication of perineal surgery
infection due to contamination
what are the side effects of perineal surgery
incontinence, impotence, rectal injury
what causes the side effects of perineal surgery
Nerves control urinary continence and penile erection may be damaged
Nerves around rectum can also be damaged.
what is used in a perineal surgery
penrose drain
what is suprapubic surgery used for
Performed for large tumor/gland mass
Rarely used today
where is the incision for suprapubic surgery
low midline
what is used post op for suprapubic surgery
suprapublic catheter and continuous bladder irrigation, and urethral catheter with 30cc balloon
what does a suprapubic surgery increase the risk of
UTI, incontinence, bladder spasms, hemorrhage
what is a radical prostatectomy
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
what is a nerve sparing radical prostatectomy
Campbell-Walsh
what can be used to do a radical prostatectomy
Robotic vs. Laparoscopic vs. Open
what are post-op complications for prostate surgery
Hemorrhage
Blood clot formation
Catheter obstruction
Infection
DVT
SEXUAL DYSFUNCTION/IMPOTENCE
what is post operative nursing management for prostate surgery
Urethral or abdominal catheter
TCDB
Pain control
Ambulation
TED’s/ SCD’s
Fluid intake
Incision specific
what discharge information is provided to prostate surgery patients
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!!!
what is the most common cancer in young men
testicular
what is the cell origin for testicular cancer
Malignant neoplasm usually of germ
what is the peak age for testicular cancer
20-40
what are the types of testicular cancer
Many types, generally divided into seminomas and non-seminomas for treatment purposes
5-10% Leydig or Sertoli cell
what are the symptoms of testicular cancer
usually a painless mass
what is the exam for testicular cancer
usually firm irregular mass arising from the testicle
how do you stage testicular cancer
testicle size
what are the treatment options for testicular cancer
Surgery
Radiation
Chemotherapy
What is the incidence of lung cancer
Leading cause of death in men and women who have malignant disease
what is the survival time for lung cancer
long term survival rate is low
what are the two main causes of lung cancer
SMOKING (90%)
Inhaled carcinogens
Radon
Occupational and environmental agents
Genetics
what is the pathophysiology of lung cancer
Primarily bronchogenic
Single transformed cell in epithelium transforms DNA
Grows slowly into large masses
what does a lung tumor obstruct
bronchi
where does lung cancer metastasize to
Metastasizes to liver, brain, bone, lymph nodes and adrenal glands
how long to it take for a lung tumor to reach 1 cm size detectable on CXR
10 years
how is lung cancer classified
by histologic types
where does the tumor for lung cancer occur
hilus of lung
what are the types of lung cancer
Small Cell Lung Cancer (SCLC) 15-20 %

Non-Small Cell Lung Cancer (NSCLC) 80%
what type of carcinomas are in Small Cell Lung Cancer (SCLC)
small cell anaplastic / Oat cell
what type of carcinomas are in Non-Small Cell Lung Cancer
Squamous ( 20-30 %)
Adenocarcinoma (40%)
Large cell CA (15%)
what is the most prevalent carcinoma of the lungs in men and women
Adenocarcinoma
what are the fastest growing carcinomas
large cells
what is the primary problem when lung cancer is diagnosed
70% already metastasized
what is the most common carcinoma of SCLC
oat cell
what are the primary causes of SCLC
Associated with smoking and carcinogens
what is the lung area for SCLC
lung hilus
what is the problem with SCLC
Most malignant and virulent with early mets. Very poor prognosis
what is SCLC treated
Treated with chemo, adjunct radiation, and palliation – rarely surgical intervention
what is the median survival for SCLC
less than 1 year (35 weeks)
what is NSCLC Squamous Cell associated with
smoking
what does NSCLC Squamous Cell produce
earlier symptoms of obstruction
how does NSCLC Squamous Cell spread
Does not have tendency to metastasize, but does spread by local invasion
how is NSCLC Squamous Cell treated
Usually surgically treated
what is the survival rate of Squamous Cell NSCLC
5 yr. survival rate – over 50% without evidence of mets.
where is NSCLC - Adenocarcinoma located
outer edges of lung
who is NSCLC - Adenocarcinoma most common in
men and women
what are the manifestations of NSCLC - Adenocarcinoma
Usually no manifestations until widespread metastases
what is the treatment for NSCLC - Adenocarcinoma
Usually surgically treated
what is the 5 year survival rate for NSCLC-adenocarcinoma
less than 10%
what is NSCLC - Large Cell Undifferentiated associated with
Associated with smoking and carcinogens
what is the problem with NSCLC - Large Cell Undifferentiated
Very fast progression with mets.
High incidence of mets
Poor prognosis: adjuvant and palliative treatment;
what is the 5 year survival rate of NSCLC - Large Cell Undifferentiated
less than 10%
what are the risk factors for lung cancer
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
what do manifestation of lung cancer depend on
depend on the location and size of the tumor the degree of obstruction and the existence of metastases to regional or distant sites
what are the manifestations of lung cancer
Cough that changes in character
Persistent Cough
Dyspnea
Chest pain
Hemoptysis
Anorexia
Fatigue

Weight loss
Hoarseness
Dysphagia
Shoulder pain
Symptoms of Pleural effusions
what are the diagnostic studies for lung cancer
CXR
Fiberoptic bronchoscopy
Percutaneous transthoracic needle bx
Endoscopic Ultrasound Fine needle aspiration
Surgery
CT scan/PET scan/MRI/Organ/Bone Scan
Sputum for cytology
what is Paraneoplastic Syndrome
Neurologic effects of cancer
Nervous system dysfunction
where is Paraneoplastic Syndrome mostly seen
<1% of cancer patients
Seen mostly with SCLC
what is the tumor staging for SCLC
Limited
Extensive
what is the tumor staging for NSCLC
Stages 0 to 4
Tumor size/spread
Tx to T4
Nodal involvement
N1 to N3
Distant Metastases
M0 to M1
what is the therapeutic management for lung cancer
Radiation
*Chemotherapy
*Surgery
Biologic therapies
Phototherapy or Photodynamic Therapy
how is radiation therapy used palliatively
Prophylactically usage relieve cough, pain, chest pain, hemoptysis , bone and liver pain
how is radiation therapy used palliatively
Palliative to reduce symptoms in non resectable tumors
what are complications of radiation therapy
burns, pneumonitis, pericarditis, esophagitis, radiation lung fibrosis
when can radiation therapy be used
preoperatively or postoperatively
what is chemotherapy used for
Used for non-resectable tumors or as adjunct to surgery
Used to alter the growth of tumor cells
what is chemotherapy a protocol of
multi-drug regimens
what does chemotherapy have the best outcome for
Best outcome with small cell cancers
Not good outcome with non-small cell cancers
what are complications to chemotherapy
Bone Marrow Suppression
Leukopenia sepsis
Anemia
Thrombocytopenia
Peripheral Neuropathy
N/V
Alopecia
Nutrition and weight loss concern
what does biological therapy use
Biologic response modifiers

Interferon
Interleukins
Monoclonal Antibodies
Growth factors
what does biological therapy do
Alters the biologic response of the host toward the tumor cells
how is biological therapy used
used as an adjuvant
what does phototherapy do
YAG - Shrinks the tumor as a result of thermal necrosis
Not a curative measure
what is phototherapy
Porfimer injected IV concentrates in tumor cells, is activated by laser light, destroys tumor cells by producing a toxic form of oxygen
what are the types of surgical management of lung cancer
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
what is pre-operative teaching to lung cancer patients
Chest tubes
Incentive spirometer
Activity
PAIN CONTROL
Oxygen therapy
Monitor SaO2 values
Repeat CXR
Arm exercises
Clinical trials
what is post-operative management of a lung cancer patient
positioning in bed
respiratory
pain
subcutaneous emphysema
chest tubes
what are post-operative complications to lung cancer surgery
Empyema
Bronchopleural fistula
when is a chest tube used
Air or fluid in pleural space restrict lung expansion and decrease gas exchange
what does a chest tube do
restores negative intrathoracic pressure so lung can reexpand.
how do chest tubes improve gas exchange
returning negative pressure to the intra pleural space
what are chest tubes used to do
Used to re-expand the involved lung to remove excess air, fluid or blood
what cause air to move into the lungs during inspiration
Normal breathing mechanism negative pressure , lower than atmosphere
what happens if the chest is open
loss of negative pressure compromise
with a chest tube, when should use phone the doctor
Greater than 50cc/hr
how much suction out of the chest tube
20-40 cm/h2o
what are the types of chest tubes
Traditional water seal: most common
Dry suction water seal
Dry suction
Wet suction water seal
what is most important in end of life care
pain control
where can care be done in end of life care
hospital or hospice
what are the benefits of quitting smoking
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 decreases At 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 decreases At 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 smokers risk of cancer of the mouth, throat, esophagus, bladder, kidney, & pancreas decreases risk 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
what health cares are used in oral cancer
Combine, oncology, critical care and psychiatric-mental health skills
what is emphasized in oral cancer
self care
what are the head and neck cancers
40% Oral Cavity
25% Larynx
15% Oropharynx / Hypopharynx
7% Salivary Glands
13% Remaining sites – nasal cavity,
nasopharynx, paranasal sinuses
what is the carcinoma of head and neck cancers
90% squamous cell carcinoma
what are the types of lesions in oral cancer
Leukoplakia and Erythroplakia
what is Leukoplakia
white lesions
“Smokers patch”
what is Erythroplakia
bright red and velvety (Associated with significantly higher risk of cancer)
what are risk factors for oral cancer
Tobacco
Smoking
Chewing
Alcohol
Chronic Irritation
Acid Reflux
Environment
Chemicals
Wood dust
Radiation
who is common in oral cancer
2xs more frequent in males
age > 50
what are symptoms of oral cancer
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
how do you diagnose oral cancer
Physical exam, oral cavity, cervical lymph nodes
Exfoliative cytology
Lesion biopsy
Staging further tests-CT, MRI
what are the treatments for oral cancer
chemotherapy, Radiation and surgery
what does chemotherapy depend on
depends on stage
what does radiation do
shrink the tumor
what is used in radiation of oral cancer
Brachycathers
what are the side effects of radiation in oral cancer
Xerostomia
Stomatitis
dysgeusia
what does surgery for oral cancer do
resect/maintain airway
what are the manifestations for tongue cancer
Ulcer or area of thickening
Soreness/pain
Increased salivation
Slurred speech
Dysphasia
Toothache
Earache (late)
what are the treatments for tounge cancer
surgery (hemiglossectomy) or radiation
what is the problem with tongue cancer
Early Metastasis
what are the nursing management for tounge cancers
Maintain airway
tracheostomy
Malnutrition
increased calories/liquids
enteral/parenteral feeding
Pain Control
what is the prevention for head and neck cancer
education of risk factors
what are the health promotions for head and neck cancers
Regular Dental Exams
Encourage use of sunscreen
Reduce Risk Factors: Stop smoking and using smokeless tobacco
Early Detection
what is seen for early detection
Unexplained pain/soreness in mouth
Unusual bleeding from oral cavity
Dysphagia
Swelling of lump in neck
what is the surgical treatment for head and neck cancers
neck dissections
what are the types of neck cancers
Selective
Modified
Radical
what is a radical neck dissection
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)
what are Reconstructive Techniques Post Radical Neck
Free Flap
Myocutaneous flap
what is a free flap
flap of skin moved to new site. Blood vessels attached micosurgically
where is the blood supply for a myocutaneous flap
blood supply to muscle and overlying skin
what is Nursing Care Post Radical Neck
Airway
Pain Relief
Wound Care
JP’s
Nutrition
Mobility
Skin grafts/ donor sites
what are complications of a radical neck
Bleeding
Chyle Fistula
Nerve Injury
what are benign vocal cord polyps from
develop in patients who abuse their voice
cigarette smoking
industrial pollutants
hoarseness/breathy quality to voice
rest/steroid sprays/excision
who most commonly gets laryngeal cancer
5x more common in males
Usually >50 years (originally 60’s)
what is the carcinoma in vocal fold cancer
90% Squamous Cell Carcinoma
what can laryngeal cancer involve
Supraglottis
Glottis
Subglottis
what are the risk factors for laryngeal cancer?
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
what are the early signs of laryngeal cancer
Hoarseness
Voices changes
Persistent cough
Sore throat and burning
what are the late signs of laryngeal cancer
Dysphasia
Dyspnea
Persistent hoarseness
Persistent ulceration
Foul breath
Cervical lymph adenopathy
Weight loss
Pain
what are the labs and diagnostic studies for laryngeal cancer
laryngoscopy
lesions biopsied
x-rays, CT scans, MRIs
needle bx of lymph nodes
what is the treatment for laryngeal cancer
Radiation
Surgery
Chemotherapy
what are the types of radiation for laryngeal cancer
External radiation
therapy
Brachytherapy
what is the cure rate for radiation therapy in laryngeal cancer
96%
what care should be done for radiation therapy in laryngeal cancer
skin care
what is the surgery for laryngeal cancer
laryngectomy
what are the types of laryngectomies
Partial
Supraglottic
Hemi
Total
Subglottic
what is a supraglottic laryngectomy
false cords, epiglottis, base of tongue can be removed
voice preserved but at risk for aspiration
where is the supraglottic laryngectomy
above vocal cords
what must a patient learn with a supraglottic laryngectomy
Supraglottic swallow
what is the patient at risk for with a supraglottic laryngectomy
aspiration
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
what is subglottic cancer
Located below true vocal cords-first tracheal ring
what is the big problem with subglottic cancer
No early manifestations: worse prognosis
what is subglottic cancer manifested as
Manifest as airway obstruction/stridor -->spread to lymphatics
what is a Total Laryngectomy
Entire larynx removed
Esophagus/trachea separated
Epiglottis, tracheal rings, hyoid bone removed
Permanent tracheostomy created-”stoma
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
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
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)
what is a major change in patient with a laryngecotmy
body image change
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
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