Colorectal Cancer
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Risk factors for prostate cancer-age (more common in men older than 65) -african americans (jamaican) -family history -increased exposure to androgens -high fat diet (red meats) -obesityNot risk factors-BPH -alcohol -sexual activityPrevalence-incidence + mortality + survival -total number of cases in a disease population -incidence: newly diagnosed cases -mortality: number of deaths -survival: percentage of people that are living after diagnosis (usually 5 years)Gleason score-cells slowly become undifferentiatedProstate cancer symptoms-early stages are asymptomatic -later stages can cause hematuria, painful urination, pelvic pain, groin pain, spine pain -diagnosed based on routine exam rather than symptomsProstate Cancer: Detection-DRE: recommended for all men greater than 50 and high risk men greater than 40 -Prostate Specific Antigen: increased risk for values greater than 4; this does not mean you have cancer, levels increase with ageRecommended testing-50 year olds with average risk -45 year old with higher risk (first degree relatives or african americans/jamaicans) -40 year olds with very high risk (genetic predisposition) -not recommended for men with less than 10 year life expectancy -PSA less than 2.5 every 2 years, PSA greater than 2.5 every yearProstate cancer treatment-watchful waiting -treatment of choice for non-aggressive tumorBrachytherapy-radioactive seed implants into tissue (implanted 10 mm apart) -fewer side effects -can be combined with radiation for more aggressive tumors -CT scan shows proper placement avoiding urethra and surrounding tissueNursing care for brachytherapy-strain urine for 2 weeks -no sitting on lap for 6 months -reduce activity for about 48 hours -not allowed to be around pregnant women or children -use condom for 2 weeksBrachytherapy potential side effects-bleeding in urine or penis -burning -clots -frequent urination -MAIN: impotence, incontinence, diarrheaProstatectomy-important to get out all urine! -side effects: impotence (60%) and incontinenceNursing care after prostatectomy-monitor urine output -foley catheter -risk for infection -potential for bleeding -patency of catheterProstate cancer: hormone therapy-used to decrease androgen levels, which reduce tumor growth -side effects: gynecomastia, decrease libido, hot flashes, and impotenceProstate cancer: external beam radiation-used with other things -about 5x week for 6 weeks -can cause impotence, incontinence, and diarrhea (long term) -short term: cystitis, fatigue, diarrheaProstate therapy: chemo-Provenge: immune cells removed and exposed to cells in the lab and then put back in -Jevtana: used for advanced disease that is not responding to other treatmentProstate cancer survival rates-10/15 years is about 80-90% -5 years is almost 100%Lung Cancer-second most common cancer in men and women -survival rate at 5 years is only 14% -more women die of lung cancer than breast cancer -more common in men -more common in african americans -most preventable cancer NO SMOKINGTypes of lung cancer-small cell: 14% -non small cell: adenocarcinoma, squamos cell, and large cell (85%)Clinical presentation of lung cancer-cough -weight loss -SOB and hemoptysis -chest pain -voice change -recurrent pneumonia or bronchitisLung cancer treatment-small cell (limited and extensive): chemo, radiation, combination -large cell (stage I-IV): surgical removal with chemo, chemo/radiation in later stages (Avastin or Erbitux)Lung cancer survival rates-1 year: 43% -5 year: 16% -SCLC: 6% -NSCLC: 17%Paraneoplastic syndrome-unknown mechanism causes problems that are not directly related to the local effects of the tumor -hyponatremia -hypercalcemia -venous thrombosisNursing considerations-PREVENTION: offer smoking cessation when appropriate -smoking is common in adolescence; important time to educate! -avoid second hand smoke -PAIN -SOB, anorexia, stomatitis, cough, weakness, fatigue, neuropathy (from chemo), sleep disturbance, fear and anxiety, balance issues -symptoms usually occur togetherAnorexia issues-give corticosteroids, progestins, and megace to increase appetite -dietary counseling -increase proteinsBreast cancer risk factors-increased after age 60 -family history (inherited genes of BRCA1 and BRCA2) -sex: WOMEN -geographic: westerners -higher incidence in whites -nulliparity or older age with first birth -late menopause/early menstruation -prior exposure to radiationTypes of Breast Cancer-adenocarcinoma -in situ or invasive -lobular -invasive ductal carcinoma is the most common -lobular carcinoma in situ has no treatmentLess common types-inflammatory breast cancer: red, swollen, inverted nipple (due to swelling), orange peel appearance -Paget's disease: crusty exudate around nipple, nipple is retracted, rapid disease process (early warning signs are important)Classifications of breast cancer-estrogen and progesterone -HER 2 status: high HER2 indication BRCA -BRCA1 (80%) (average 55-65%) -BRCA2 (45%)Screening recommendations-American Cancer Society agrees that you should be able to do a self breast exam -USPTF against breast exams and against mammograms if you have no risks for breast cancer -American Cancer Society says that you should have a mammogram and MRI if you have a family hx, BRCA1/BRCA2, exposed to chest radiation 10-30 years, or LiFraumeni Syndrome (person presents with all sorts of cancers)Sizing-1 cm: pea -2 cm: peanut -3 cm: strawberry -5 cm: orangeBreast cancer locations-50% upper out quadrant (underneath armpit) -17% nipple -15% upper middle -11% lower outer -6% lower middleBreast cancer treatment-Lumpectomy (removal of tumor and margins, followed by radiation, involves axillary node resection, can be just as good as a MRM) -Radiation (cyberknife, 28 treatments over 6 weeks, after lumpectomy or mastectomy, can be used for palliative, can be used before surgery to shrink the tumor)Radiation side effects-fatigue -sun burn (used sylvadine or aloe gel) -esophagitis and tracheitis (problems eating) -breast edemaChemotherapy for breast cancer-used for those with high risk of metastasis (aggressive tumor, premenopausal, more than one site within the breast-multifocal) -used with axillary node involvementProblems with chemotherapy-GI: stomatitis, mucositis, esophagitis, constipation, diarrhea, anorexia, hepatotoxicity -Hematologic: bone marrow suppression, leukopenia, thrombocytopenia, anemia -Integumentary: sun burn, alopecia -Cardiovascular: pericarditis and myocarditis, cardiotoxicity -Respiratory: pneumonia -Nervous system: increased ICP, peripheral neuropathy, chemo brain -GU: nephrotoxicity, reproductive dysfunction, hemorrhagic cystitis -Biochemical: hyperurecemia -Psychoemotional: fatigue, spiritual distress, caregiver burdenAnti-estrogen therapy-some tumors are ER+, which promotes breast cell division -use TAMOXIFEN -side effects are those seen with menopauseAromatase inhibitors-block tumor growth by reducing the amount of estrogen -better for post-menopausal disease -EXPENSIVE and side effects -Anastrazole, Exemestane, LetrozoleNursing care: Before and After-information overload (NOT too much!) -understand treatment options -what is going to happen to family -what is best? -what will this do to my appearanceNursing care: pre op-provide info as desired -learn how to empty drain -what to expect going home -teach arm exercises if having mastectomyNursing care: post op-dressing changes -s/s infection -may have drain up for a week -reinforce exercises -prepare for going home -social/emotional supportLymphedema-occurs when lymph fluid accumulates in the interstitial space (damage to the lymph system)Lymphedema management-no BP/draws/procedures on injured arm -exercise arm -elevate arm -good skin care and pain mgmt -no constricted clothing on affected side -can wear compression garments -treat/manage infectionBreast reconstruction-implants -transverse rectus -musculocutaneous flap