Oncology

Front 1

Cancer

Back 1

when normal cells mutate into abnormal cells that reproduce uncontrollably in the body

Front 2

Carcinogenesis

Back 2

carcinogens that cause mutations in DNA
3 stages
- initiation: permanent damage in cellular DNA R/T exposure to a carcinogen
- promotion: may last for years and included conditions that act repeatedly on the already affected cells
- progression: further inherited changes acquired during the cell replication develop into a cancer

Front 3

Viral theory

Back 3

may play a role in cell mutation, damage cells and cause overactive growth, weakens immune defense against neoplasms, many types linked to specific cancers

Front 4

Herpes simplex virus

Back 4

cervical, lip, and Kaposi's sarcoma

Front 5

Human CMV

Back 5

prostate, Kaposi's sarcoma

Front 6

Epstein-Barr virus

Back 6

Burkitt's lymphoma, nasopharyngeal cancer, some type of Hodgkin's lymphoma and Hodgkin disease

Front 7

Hep B & C

Back 7

liver cancer

Front 8

Papillomavirus

Back 8

melanoma, cervical, penile, laryngeal

Front 9

Human T lymphotropics

Back 9

adult T cell leukemia, Kaposi's sarcoma

Front 10

H. Pylori

Back 10

increased incidence in GI malignancy

Front 11

Physical agents that can cause Ca

Back 11

excessive exposure to ultraviolet rays of the sun, especially in fair skinned, blue or green eyed ppl, increases the risk
Assoc factors: clothing (shorts, sleeveless shirts), use of sunscreens, occupation, recreational habits, and environmental variables (humidity, altitude, and latitude), having a severe sunburn as a child
Exposure to ionizing radiation can occur with repeated diagnostic x-ray procedures or with radiation therapy used to treat disease. Exposure to radioactive materials at nuclear weapon manufacturing sites or nuclear power plants are assoc with a higher incidence of leukemias, multiple myeloma, and cancer of the lung, bone, breast, and thyroid.

Front 12

Chemical agents that can cause Ca

Back 12

Tobacco smoke is thought to be the single most lethal carcinogen, accounts for 30% of cancer deaths. It is strongly assoc with cancers of the lung, head and neck, esophagus, pancreas, cervix and bladder. Chewing tobacco is assoc with cancers of the oral cavity, which occurs in men younger than 40 y/o. Other chemicals such as pesticides, formaldehyde, soot and tar, abestos, cadmium, wood dust are linked with liver, lung, and kidney cancers, presumably because of their roles in detoxifying chemicals

Front 13

Genetics and familial factors

Back 13

Approx 5% of cancers of adults display a familial predisposition. Cancers assoc with familial inheritance include breast, ovarian, colorectal, stomach, prostate and lung.

Front 14

Dietary factors

Back 14

Dietary substance that appear to increase the risk cancer include fats, alcohol, salt-cured or smoked meats, and nitrate and nitrite containing foods. High caloric diet is also assoc with increased cancer risk. High-fiber foods (fruits, veggies, whole-grain) and cruciferous veggies ( cabbage, broccoli, cauliflower, brussel sprouts) appear to decrease the risk of cancer. Obesity is assoc with endometrial and postmenopausal breast cancers.

Front 15

Hormonal agents

Back 15

DES has been assoc with vaginal carcinomas. Oral contraceptives and prolonged estrogen replacement therapy are assoc with increased hepatocelluar, endometrial, and breast cancers, but they decrease the risk of ovarian cancers

Front 16

Immune system role

Back 16

some evidence indicates that the immune system can detect the development of malignant cells and destroy them before the cells growth become uncontrolled. When the immune system fails to identify and stop the growth of malignant cells, clinical cancer develops. Patients who are immune-suppressed have been shown to have an increased incidence of cancer. Patient's with immunodeficiency diseases (AIDS), have an increased incidence of Kaposi's sarcoma, lymphoma, rectal, head and neck cancers.

Front 17

Primary care

Back 17

preventative care: eat well, exercise, vaccinations

Front 18

Secondary care

Back 18

screening and early detection

Front 19

Tertiary care

Back 19

treatment after diagnosed with the disease, care for the disease

Front 20

Early breast cancer detection

Back 20

20-39 y/o: clinical breast exam q 3 yrs, self breast exam q monthly
> 40 y/o: CBE q yearly, SBE q monthly, mammogram q annually,

Front 21

Immune system role

Back 21

some evidence indicates that the immune system can detect the development of malignant cells and destroy them before the cells growth become uncontrolled. When the immune system fails to identify and stop the growth of malignant cells, clinical cancer develops. Patients who are immune-suppressed have been shown to have an increased incidence of cancer. Patient's with immunodeficiency diseases (AIDS), have an increased incidence of Kaposi's sarcoma, lymphoma, rectal, head and neck cancers.

Front 22

Primary care

Back 22

preventative care: eat well, exercise, vaccinations

Front 23

Secondary care

Back 23

screening and early detection

Front 24

Tertiary care

Back 24

treatment after diagnosed with the disease, care for the disease

Front 25

Early breast cancer detection

Back 25

20-39 y/o: clinical breast exam q 3 yrs, self breast exam q monthly
> 40 y/o: CBE q yearly, SBE q monthly, mammogram q annually,

Front 26

Early detection for colon/rectal cancer

Back 26

F/M, 50 y/o and older, hemoccult annually, flex sigmoidoscopy q 5 yrs, colonoscopy q 10yrs or q 5 yrs if family hx, double contrast barium enema q 5 yrs

Front 27

Early detection for prostate cancer

Back 27

M, 50 y/o and older, 40-45 y/o if high risk, PSA and DRE annually

Front 28

Early detection for cervical cancer

Back 28

F, 21 y/o and older or within 3 yrs after starting to have intercourse, Pap smear, annually if regular Pap or q 2 yrs if liquid Pap

Front 29

Cancer-related checkups

Back 29

M/F, 20-39, Pelvic exam annually, exams for thyroid, testicles, ovaries, lymph nodes, oral cavity, and skin q 3 yrs, ages 40+ annually

Front 30

Staging

Back 30

determines the size of the tumor and existence of metastasis, TNM system frequently used
T: refers to the extent of the primary tumor
N: refers to the lymph node involvement
M: refers to the extent of the metastasis
CNS cancers,hematologic cancers, and malignant melanomas are not well described by the TNM system

Front 31

Grading

Back 31

refers to the classification of the tumor cells, the tumor is assigned a numeric value range from 1-4
Grade 1: well-differentiated (closely resembles the tissue of the origin in structure and function)
Grade 2: moderately differentiated
Grade 3: poorly differentiated
Grade 4: poorly differentiated or undifferentiated, these tumors are more aggressive and less responsive to tx than well-differentiated tumors

Front 32

Diagnostic tests used to detect cancer

Back 32

Tumor marker identifications, MRI, CT, fluoroscopy, ultrasound, endoscopy, nuclear medicine imaging, PET scan, radioimmunoconjugates

Front 33

Management of cancer

Back 33

Treatments should be based on realistic and achievable goals for each specific type of cancer. The range of possible treatment goals may include complete eradication of malignant disease (cure), prolonged survival and containment of cancer cell growth (control), or relieve symptoms assoc with the disease (palliative). Options include surgery, radiation, chemo, and targeted therapies.

Front 34

Cancer surgery

Back 34

surgical removal is the ideal and most frequently used treatment method, diagnostic surgery is the definitive method of identifying the cellular characteristics that influence all treatment decisions, surgery may be the primary method of treatment, or it may be prophylactic, palliative, or reconstructive.

Front 35

Diagnostic surgery

Back 35

Ex: biopsy, performed to obtain tissue sample for analysis of cells suspected to be malignant, taken from the actual tumor, and in some situations tissue is taken from the lymph nodes near the tumor.
3 biopsy types:
- excisional: most frequently used for easily accessible tumors of the skin, breast, upper and lower GI, and upper respiratory tract, in many cases the entire tumor and surrounds tissues are removed.
- incisional: performed if the tumor mass is too large to be removed, a wedge of the tissue is removed for analysis.
- needle: aspirating tissue fragments through a needle guided into a suspected area of bearing disease.

Front 36

Treatment surgery

Back 36

when surgery is the primary approach in treating cancer the goal is to remove the entire tumor or as much as feasible (debulking), and any surrounding tissue involved, including regional lymph nodes

Front 37

Prophylactic surgery

Back 37

removing nonvital tissue or organs that are likely to develop cancer.
Factors considered:
- family hx and genetic predisposition
- presence or absence of symptoms
- potential risks and benefits
- ability to detect cancer at an early stage
- patient's acceptance of the postoperative outcome
Ex: colectomy, mastectomy, oophorectomy

Front 38

Palliative surgery

Back 38

performed to make the patient as comfortable as possible and to promote a satisfying and productive life for as long as possible. Peformed to relieve complications of cancer such as, ulcerations, obstructions, hemorrhage, pain, and malignant effusions.

Front 39

Reconstructive surgery

Back 39

may follow curative or radical surgery and attempts to improve function or obtain a more desirable cosmetic effect. May be indicated for breast, head and neck, and skin cancers.

Front 40

Radiation therapy

Back 40

ionizing radiation used to interrupt cellular growth, may be used to cure the cancer (Hodgkin's, testicular seminomas, thyroid carcinomas, head and neck cancers, and cancers of the uterine cervix. Can also be used to control malignant disease when a tumor cannot be removed surgically or when local nodal metastasis is present or can be used prophylactically to prevent leukemia infiltration to the brain or spinal cord. Palliative radiation is used to relieve the symptoms of metastatic disease, especially when the cancer has spread to brain, bone, or soft tissue - or to treat onocologic emergencies.

Front 41

Prophylactic surgery

Back 41

removing nonvital tissue or organs that are likely to develop cancer.
Factors considered:
- family hx and genetic predisposition
- presence or absence of symptoms
- potential risks and benefits
- ability to detect cancer at an early stage
- patient's acceptance of the postoperative outcome
Ex: colectomy, mastectomy, oophorectomy

Front 42

Palliative surgery

Back 42

performed to make the patient as comfortable as possible and to promote a satisfying and productive life for as long as possible. Peformed to relieve complications of cancer such as, ulcerations, obstructions, hemorrhage, pain, and malignant effusions.

Front 43

Reconstructive surgery

Back 43

may follow curative or radical surgery and attempts to improve function or obtain a more desirable cosmetic effect. May be indicated for breast, head and neck, and skin cancers.

Front 44

Radiation therapy

Back 44

ionizing radiation used to interrupt cellular growth, may be used to cure the cancer (Hodgkin's, testicular seminomas, thyroid carcinomas, head and neck cancers, and cancers of the uterine cervix. Can also be used to control malignant disease when a tumor cannot be removed surgically or when local nodal metastasis is present or can be used prophylactically to prevent leukemia infiltration to the brain or spinal cord. Palliative radiation is used to relieve the symptoms of metastatic disease, especially when the cancer has spread to brain, bone, or soft tissue - or to treat onocologic emergencies.

Front 45

External radiationq

Back 45

most common radiation therapyq

Front 46

Internal radiation

Back 46

brachytherapy, delivers a high dose of radiation to a localized area, can be implanted by means of needles, seeds, beads or catheters into body cavities (vagina, abd, pleura).
Intracavity radioisotopes are frequently used to treat gyn cancers, they are inserted into a specifically applicators after the position is verified by x-ray. The patient is maintained on bed rest and log-rolled to prevent displacement of the device, an indwelling urinary catheter is inserted to ensure that bladder remains empty.Low reside diets and antidiarrheals (Lomotil) are provided to prevent BM during therapy to prevent displacement of the radioisotopes.
Interstitial implants for prostate, pancreatic or breast cancer may be temporary or permanent depending on the radioisotopes used. These implants consist of seeds, needles, wires, or small catheters positioned to provide a local radiation source and are less frequently dislodged.87b[4h32

Front 47

Guidelines for internal radiation therapy

Back 47

contact with the health care team are guided by principles of time, distance, and shielding to minimize exposure to personnel to radiation. The patient will be assigned to private room with postings of notices about radiation therapy, staff will wear dosimeter badges, pregnant staff will no be assigned these patients, no children or pregnant visitors are allowed, visits will be limited to 30 mins daily, and visitors maintain a 6 foot distance from the radiation source.

Front 48

Radiation toxicity

Back 48

Localized to the region being radiated, body tissues that proliferate rapidly (skin, epithelial lining of GI, oral cavity and bone marrow) are the most effected. Altered skin integrity is common, as well as alopecia, erythema, and shedding of skin. Alterations in oral mucosa secondary to radiation therapy include stomatitis, xerostomia (dry mouth), change and loss of taste, and decreased salivation. Anorexia, nausea, n/v can occur is the stomach or colon are radiated. If site of bone marrow production (iliac crest, sternum) are radiated anemia, leukopenia (decreased WBC), and thrombocytopenia (decrease in platelets) may result.

Front 49

Nsg care with radiation therapy

Back 49

Assess the patient's skin, nutritional status, and general feeling of well-being. Assess the oral mucosa for frequent changes, instruct patient to avoid ointments, lotions,and powders on the area. Gentle oral hygiene is needed to remove debris, prevent irritation, and promote healing. The patient may need help with ADL's due to weakness and fatigue. Offer reassurance that the symptoms are a result of the treatment and not deterioration or progression of the disease.

Front 50

Chemotherapy

Back 50

antineoplastic agents used to destroy tumor cells by interfering with cellular functions, including replication. Used to treat systemic disease rather than localized lesions that are removable by surgery or radiation. It may be combined with surgery, radiation therapy or both, to reduce the tumor size preoperatively, to destroy an remaining tumor cells post-op, or to treat some forms of leukemia. Goals (cure, control, palliation) must be realistic because they will define the meds to be used and aggressiveness of the treatment plan.

Front 51

Administration of chemo

Back 51

may be administered in the hospital, clinic or home setting by topical, oral, IV, IM, SQ, arterial, intracavity, and intrathecal route. The route of admin depends on the type of drug, required dose; and the type, location, and extent of tumor being treated. The dosage of chemo is based on the patient's total BSA, previous response to chemo or radiation, and function of major organ systems. Usually starts with the maximum dose. Special care must be taken when IV chemo is administered, vesicants are those agents that if deposited into the SQ tissue (extravasation) causing tissue necrosis and damage to underlying tendons, nerves, and blood vessels. If extravasation is suspected the med is stopped immediately, and ice is applied to the site. The physician may aspirate any infiltrated med from the tissues and inject a neutralizing solution into the area to reduce tissue damage.

Front 52

Toxicity of chemo

Back 52

cells with rapid growth rates (skin, bone marrow, hair follicles, sperm) are very susceptible to damage.
N/V and fatigue to the most common side effects of chemo.

Front 53

GI toxicity from chemo

Back 53

N/V may persist for as long as 24-48 hrs after admin. Delayed N/V may last for as long as 1 week after admin. Meds used to treat N/V are Zofran and Reglan. The entire GI tract is susceptible to mucositis.

Front 54

Hematopoietic toxicity from chemo

Back 54

most chemo agents cause myelosupression (depression of the bone marrow function), resulting in decreased production of blood cells. Myelosuppression decreases the number of WBCs (leukopenia), RBCs (anemia), and platelets (thrombocytopenia), and increases the risk of infection and bleeding.

Front 55

Renal toxicity from chemo

Back 55

chemo can damage the kidneys because of their direct effects during excretion and the accumulation of end products after cell lysis. Rapid tumor cell lysis after chemo results in increased urinary excretion of uric acid, which can cause renal damage. Monitoring BUN, creatinine, and electrolyte levels is essential. Adequate hydration, alkalinization of the urine to prevent formation of the uric acid crystals, and the use of allopurinol are frequently indicated to prevent these side effects.

Front 56

Reproductive toxicity from chemo

Back 56

testicular and ovarian function can be affected by chemo, resulting in possible sterility.

Front 57

Nsg with chemo

Back 57

nurses involved with handling chemo may be exposed with low doses of the meds by direct contact, inhalation, or ingestion. It is known that chemo meds are assoc with secondary formation of cancers and chromosome abnormalities. N/V, alopecia, dizziness, and nasal mucosa ulcerations have been reported in health care personnel who have handled chemo meds.

Front 58

Hyperthermia

Back 58

temperatures greater than 106.7 has been used to destroy tumors, because malignant cells lack the mechanisms necessary to repair damage cause by elevated temps.

Front 59

Infection in the cancer patient

Back 59

the nurse monitors lab results to detect early changes in WBC (neutrophil) counts. Common sites of infection such as the pharynx, skin, perianal area, urinary tract, and resp tract are assed frequently. The typical signs of infection (swelling, redness, drainage and pain) may not occur in immosuppressed patients, fever may be the only sign of infection. Nadir is the lowest ANC (absolute neutrophil count) after myelosupression chemo or radiation.

Front 60

Bleeding in the cancer patient

Back 60

Common bleeding sites: skin, mucous membranes, intestinal tract, urinary tract, resp tract, and brain. Gross hemorrhage, blood in stools, urine, sputum, or vomit, oozing at injection sites, bruising, petechiae and changes in mental status are monitored and reported.

Front 61

Nsg with chemo

Back 61

nurses involved with handling chemo may be exposed with low doses of the meds by direct contact, inhalation, or ingestion. It is known that chemo meds are assoc with secondary formation of cancers and chromosome abnormalities. N/V, alopecia, dizziness, and nasal mucosa ulcerations have been reported in health care personnel who have handled chemo meds.

Front 62

Hyperthermia

Back 62

temperatures greater than 106.7 has been used to destroy tumors, because malignant cells lack the mechanisms necessary to repair damage cause by elevated temps.

Front 63

Infection in the cancer patient

Back 63

the nurse monitors lab results to detect early changes in WBC (neutrophil) counts. Common sites of infection such as the pharynx, skin, perianal area, urinary tract, and resp tract are assed frequently. The typical signs of infection (swelling, redness, drainage and pain) may not occur in immosuppressed patients, fever may be the only sign of infection. Nadir is the lowest ANC (absolute neutrophil count) after myelosupression chemo or radiation.

Front 64

Bleeding in the cancer patient

Back 64

Common bleeding sites: skin, mucous membranes, intestinal tract, urinary tract, resp tract, and brain. Gross hemorrhage, blood in stools, urine, sputum, or vomit, oozing at injection sites, bruising, petechiae and changes in mental status are monitored and reported.

Front 65

Skin problems in cancer patients

Back 65

maintaining skin integrity imposes a problem for patients with cancer because of the effects of chemo, radiation, surgery, and invasive procedures. The nurse identifies which of these predisposing factors are present and assesses the patient for other risk factors, including nutritional deficits, bowel and bladder incontinence , immobility, immunosuppression, multiple skin folds,and changes related to aging.

Front 66

Hair loss in cancer patients

Back 66

The nurse notes the presence of alopecia in patients who receive chemo or radiation. In addition the psychological impact of this side effect on the patient and family.

Front 67

Nutritional concerns in cancer patients

Back 67

impaired nutritional status may contribute to disease progression, decreased survival, immune incompetence, increased incidence of infection, delayed tissue repair, diminished functional ability, decreased capacity to continue therapy, increased length of hospital stay, and impaired psychosocial functioning. Altered nutritional status, weight loss, and cachexia (muscle wasting, emaciation) may be secondary to decreased protein and calorie intake, metabolic or mechanical effects of the cancer, systemic disease, side effects of the treatment, or the patient's emotional status. The patient's weight and caloric intake are monitored on a consistent basis. Other info obtained by assessment includes diet history, any episode of anorexia, changes in appetite, situations and foods that aggravate or relieve anorexia, and med history. Difficulty chewing or swallowing is identified, and the presence of N/V or diarrhea is noted.

Front 68

Pain in cancer patients

Back 68

Pain and discomfort may be related to underlying disease, pressure exerted by the tumor, diagnostic procedures, or the cancer treatment itself. The nurse also assess the factors that increase the patient's perception of pain, such as fear and apprehension, fatigue, anger, and social isolation. Pain scales are useful for assessing the patient's pain before pain-relieving interventions are instituted.

Front 69

Fatigue in cancer patients

Back 69

To make an accurate assessment the nurse must distinguish between acute fatigue, which occurs after an energy demanding experience, and chronic fatigue, which is often overwhelming, excessive, and not responsive to rest.The nurse assesses for feelings of weariness, weakness, lack of energy, inability to carry out necessary and valued daily functions, lack of motivation, and inability to concentrate. The patient may become less verbal and may appear pale, with relaxed facial musculature. The nurse assesses physiologic and psychological stressors that can contribute to fatigue, including pain, nausea, dyspnea, constipation, fear and anxiety.