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Advanced Med Surg Exam 4 Cancer

Galen College of Nursing Advanced Med Surg Exam 4, cance
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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"