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Galen College of Nursing Advanced Med Surg Exam 4, cance

Cancer is the _______ leading cause of death in the US

2nd

Who can cancer affect?

any age, gender, ethnicity, geographic region

What is cancer?

when normal cell is transformed into an abnormal cell by a genetic mutation of cellular DNA

What is an oncogene?

Mutated genes that cause cancer

Who can make oncogenes?

We all have the potential

Normal cells can become cancer cells when exposed to?

carcinogens

What is a carcinogen?

any agent that causes normal cells to mutate into cancer cells

Cancers cells do not self _________.

destruct

Types of Carcinogens

Ionizing radiation, chemicals, viruses, hormones, bacterial infections, diet, physical factors, hereditary predisposition

Name 2 Ionizing Radiation carcinogens:

Xrays, UV light (sunlight)

Name 2 Chemical carcinogens:

smoking, asbestos (think jobs)

Name a virus carcinogen:

HIV

Name a bacterial infection carcinogen:

UTI

When thinking about hormone carcinogens think about:

endocrine imbalances because they promote tumor growth

Is cancer hereditary?

only one cancer is proven, breast. Genes are inherited and those genes may be more susceptible to carcinogens

What percent of cancers are related to the environment?

75

What is the single most lethal carcinogen?

smoking

What is the leading cause of all cancer deaths of men and women?

lung cancer

The process of carcinogenesis

Normal cell, DNA damage, Uncontrolled growth, malignant tumor

If patient is immuno-compromised or repeatedly assaulted by carcinogens what will happen?

some damaged DNA cells will get through (won't be repaired by DNA repair) then cancer or oncogenes will be produced and make a tumor.

If your tumor suppressor genes can't destroy a tumor what will happen?

cancer will develop

Cancer cells are

wild little suckers, they divide out of control, form new cells for no reason

Cancer should be predicted if ICP exists without...

head injury or blood flow obstruction

Cell proliferation

uncontrolled growth with the ability to destroy tissue and cause cell death, replicate out of control

Metastasis

ability to spread to other areas of the body (goes wherever it wants to go)

Angiogenesis

cancer cells reach out to the blood supply nearby and make their own branch/network system of blood supply, this makes the organ nearby have less blood supply.

Primary Cancer prevention

Reducing cancer risk in healthy people (education for prevention).

Secondary Cancer prevention

Identification of people at high risk for cancer (screenings).

What type of cancer is the most treatable?

Colon cancer

Diagnostic test for skeletal, lung and GI cancer

CT

Diagnostic test for brain, pelvic, abd and thoracic cancer

MRI

Diagnostic test for abd and pelvic cancer

Ultrasound

Diagnostic test for GI and bronchial cancer

Endoscopy and bronchoscopy

PET Scan

good after cancer diagnosis, to see if cancer has metastasized, the cancer cells are recognized now so you go look for more just like them

Lab tests for cancer are used because

enzymes & hormones isolated by research tell us that cancer is present

CEA, amylase and lipase will be high with what cancer?

Pancreatic

What lab test is for prostate cancer only?

PSA

Cancer treatment is determined by what?

staging and grading

TNM staging and grading is what?

T - assessment of primary tumor, N - number of lymph nodes involved; indicates metastasis or spread, M - metastasis or spread to another location

Describe a benign neoplasm?

Localized, slow growth; well defined borders, frequently encapsulated, easily removed, does not reoccur

Describe a malignant neoplasm?

invasive, rapid growth, lots of angiogenisis, metastasizes to distant siges, not easily removed, can recur, invades and destroys surrounding tissues.

Common sites of metastasis for lung cancer

liver, bones, spinal cord, brain

Common sites of metastasis for breast cancer and malignant melanoma

liver, bones, lymph nodes, brain, lung

Common sites of metastasis for colon cancer

liver, bones, lung, brain, ovary

Common sites of metastasis for prostate cancer

liver, bones, blader

When thinking about where cancer will metastasize to think about

what is the closes organ

Liver and bones are common sites for cancer to metastasize to because of what?

liver's blood supply and bones are close to everything

cancer treatment options

chemo, radiation, surgery, biotherapy, bone marrow transplant, stem cell transplant

Prophylactic surgery for cancer

past hx of breast cancer, have them removed before getting breast cancer

Diagnostic surgery for cancer

biopsy - look at suspicious tissue for cancer cells

Treatment surgery for cancer

removal of tumor, local or wide incision.

Palliative surgery for cancer

no way to get rid of the cancer but remove the tumor for comfort reasons

Chemotherapy is

agents used to destroy tumor cells by interfering with cellular function and replication

What is chemotherapy designed around?

The kind of cancer cells

What are the goals of chemotherapy?

Cure (get rid of it), control (make it liveable), palliation (total comfort)

Important phases of the cell cycle for chemo?

S phase and mitosis phases

What is the S phase of the cell cycle?

DNA synthesis phase (when the cell is taking a picture of itself)

What is the Mitosis phase of the cell cycle?

When the cell is dividing, when it is at its weakest.

Primary type of chemo

only one treatment, goal is to cure the cancer

Adjuvant type of chemo

more than one treatment, most used, combination of chemo and radiation, used to reduce the size of a tumor and make surgery more effective

Palliative type of chemo

Comfort measures, slow tumor growth and give symptom relief

A complete cycle of therapy is generally repeated every

21-28 days

Why is Chemo treatment is given in cycles?

To produce maximum kill of tumor cells AND allow the body the maximum recovery time between cycles.

Cell cycle specific chemotherapeutic agents

agent attacks the cancer cell at a specific time during the cell replication cycle (s phase or mitosis)

Cell Cycle non specific chemotherapeutic agents

agent attacks cells at any time during the cell replication cycle (getting at all phases in cell cycle)

What is the preferred route of chemo administration?

central line or port

Why is the central line or port a preferred route of chemo administration?

larger blood supply, don't want it to infiltrate into the tissues

When should a chemo infusion be stopped?

anytime there is any concern about infiltration or extravasation

Should you be cautious about stopping a chemo treatment?

NO!

What kind of system should be used for chemo admin?

closed and needle-less

Chemo admin PPE's:

double gloves, goggles, gown

Most seen side effect from chemo?

N & V

Other adverse effects from chemo other than N & V?

mucositis, stomatitis, renal damage, hair loss, skin and nail flakiness, neurologic (Chemo brain), psychological effects, cardiac toxicity

What test should be performed on all chemo patients to watch for cardiac toxicity?

an echo (checking ejection fraction)

What cells are the most vulnerable with chemo?

rapidly dividing cells - hair, skin, nails, bone marrow (changes make up of RBC's), mucous membranes

Why is renal damage an adverse effect of chemo?

the toxic waste of the dead cancer cells goes through the filtration system

How can renal damage be prevented with chemo?

hydrate before and after chemo treatments

Radiation therapy

delivers lethal injury to the DNA of rapidly dividing cancer cells

Types of radiation therapy

External (outpatient), internal (seed implants)

Side effects of Radiation GI

N & V and diarrhea

Side effects of Radiation Bone Marrow

Decreased WBC, decreased Platelets

Side effects of Radiation Systemic

Fatigue, anorexia, decreased vascular supply

When are side effects of radiation seen?

could be as long as 2-4 weeks later, and can be chronic

What does radiation feel like?

a sunburn

What should a person avoid after radiation?

lotion, soap, antibacterials, just cover with something clean and dry

What is the body's best defense against cancer?

A strong immune system

What was biotherapy designed to do?

enhance a person's immune system, create extra immune cells to fight

What is a bone marrow transplant?

Infusion of bone marrow cells from donor to patient.

Allogenic

Bone marrow from a family member

Autologous

Bone marrow banked from self

Syngeneic

Bone marrow from an identical twin

What are Bone Marrow transplants most commonly used for?

Leukemias

What is a Peripheral Blood Stem Cell Transplant?

Removal of circulating cells from the peripheral blood through apheresis and then returning the cells to the patient after high dose chemotherapy

Apheresis

a procedure in which blood is drawn and separated into its components by dialysis

Which has fewer side effects, shorter hospitalization and decreased cost BMT or PBSCT?

PBSCT

How long can stem cells be frozen?

Indefinately

Problems that occur with cancer treatment:

Pain, Infection, Bleeding, Hypercalcemia, GI disturbances, pericardial effusion, DIC, Superior Vena Cava Syndrome

Nadir period

14 days after Chemo, WBC's are dropping

What med is given for Nadir period?

Neupogen - to replenish the WBC's

If WBC's are below 1000 what should a nurse do?

Put the patient on Neutropenic or Reverse Isolation

Neutropenic precautions

also called reverse isolation, protective isolation, no fresh flowers, no fresh fruit or veggies, caregivers wear masks.

Hypercalemia Oncologic Emergency

Most common oncologic emergency, calcium is released from the bones, serum calcium exceeding 11

Infection/sepsis oncologic emergency

Nadir period, vulnerable to infection, fever

Tumor lysis syndrome oncologic emergency

large tumor is destroyed by treatment, Potassium, Phosphorus and Uric acid are released into circulation which leads to electrolyte imbalances and acute renal failure, symptoms start 1-2 days after cancer treatment starts, muscle cramps twitching

Colon Cancer

60% of deaths could be avoided with screening, most treatable

Esophageal cancer

Patients with GERD are at a high risk

Oral Cancer

Incidence increasing, caused by HPV 16

Wilm's tumor

Malignant tumor in the kidney; occurs in children age 3-4

Breast cancer

Beginning mestruation before age 12 is an increased risk factor

Lung cancer

Primary cause is smoking

Ovarian cancer

"silent killer"; symptoms include bloating, indigestion, vaginal bleeding, bowel changes

Liver cancer

Caused by Hep B or C; also increased risk with diabetes and alcohol consumption

Brain tumors

70% are glioblastomas

Endometrial and cervical cancer

Prevention = regular PAP tests and vaginal exams

Skin cancer

Prevention = use of sunscreen

Gastric-Stomach cancer

Increased risk = diet high in salt and nitrates

Nitrate foods

Ham, bacon, pepperoni

Uterine Cancer

Symptoms = sudden onset of menstruation after greater than 12 weeks menopause

Bladder cancer

More common in men; smoking and exposure to paint increases risk (lead)

Pancreatic cancer

Aggressive cancer, 2 types; exocrine and endocrine; there has been no increase in survival rates

Prostate cancer

Increased in African American men, usually at an advanced stage when found in African American men

Testicular cancer

"Lads check your Nads"

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