What is cancer?
when normal cell is transformed into an abnormal cell by a genetic mutation of cellular DNA
Types of Carcinogens
Ionizing radiation, chemicals, viruses, hormones, bacterial infections, diet, physical factors, hereditary predisposition
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
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.
uncontrolled growth with the ability to destroy tissue and cause cell death, replicate out of control
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.
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
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 breast cancer and malignant melanoma
liver, bones, lymph nodes, brain, lung
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
Palliative surgery for cancer
no way to get rid of the cancer but remove the tumor for comfort reasons
agents used to destroy tumor cells by interfering with cellular function and replication
What are the goals of chemotherapy?
Cure (get rid of it), control (make it liveable), palliation (total comfort)
What is the S phase of the cell cycle?
DNA synthesis phase (when the cell is taking a picture of itself)
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
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)
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
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
What should a person avoid after radiation?
lotion, soap, antibacterials, just cover with something clean and dry
What was biotherapy designed to do?
enhance a person's immune system, create extra immune cells to fight
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
Problems that occur with cancer treatment:
Pain, Infection, Bleeding, Hypercalcemia, GI disturbances, pericardial effusion, DIC, Superior Vena Cava Syndrome
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
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
"silent killer"; symptoms include bloating, indigestion, vaginal bleeding, bowel changes
Aggressive cancer, 2 types; exocrine and endocrine; there has been no increase in survival rates
Increased in African American men, usually at an advanced stage when found in African American men