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Terms in this set (118)
What is the metastatic process?1) Normal Cells
2) Malignant Transformation (normal cells undergo malignant transformation and have divided enough times to form a tumorous area within the epithelium)
3) Tumor Vascularization (cancer cells secrete tumor angiogenesis factor, stimulating blood vessels to bud and form new channels that grow into the tumor)
4) Blood vessel penetration (cancer cells have broken off from the main tumor; enzymes on the surface of the tumor cells make holes in the blood vessels, allowing cancer cells to enter blood vessels and travel around the body)
5) Arrest and Invasion (cancer cells clump up in blood vessel walls and invade new tissue areas; if the new tissue areas have the right conditions to support continued growth of cancer cells, new tumors (metastatic tumors) will form at this site)Why can cancer cells metastasize?Cancer calls have the ability to create own blood supply (angiogenesis); which provides them with O2 and nutrients needed to grow and an avenue to enter the blood stream and travel to other parts of the bodyWhat causes cancer?-malignant transformation
-changes to the DNA of a cell (mutations) lead to cellular damage
-mutations enable the cancer cells to divide continuously, but without normal mechanisms to control growth
-carcinogenesis (normal cells that transform into cancer cells by exposure to radiation, viruses, or chemicals)What causes mutations that lead to cancer? What types of mutations occur?1) Somatic (acquired) mutations: environmental or host factors and genetic predisposition
2) Germline (hereditary) mutationsWhat is the difference in a proto-oncogene and an oncogene?proto-oncogene: normal gene that controls the rate of cell growth
oncogene: a proto-oncogene that has been mutated and allows the cell to grow rapidly out of control with no apoptosisWhat is an example of an oncogene in breast cancer?HER-2/neu gene is amplified in 30% of breast cancersWhat is the role of the normal tumor suppressor gene? What occurs with a mutated tumor suppressor gene?NORMAL
1) DNA damage, cell cycle abnormalities, hypoxia
2) Gene is activated and causes cell cycle arrest that can either lead to apoptosis (programmed cell death) or DNA repair
3) Cell cycle restarts/resumes
MUTATED
1) DNA damage, cell cycle abnormalities, hypoxia
2) Gene is not activated; Cell cycle continues
3) Cell becomes cancerous and continues to divideWhat are examples of carcinogens?Tobacco/tobacco smoke
UV Radiation
Coal tar
Formaldehyde
Benzene
Arsenic
Aflatoxins
Hormones (DES and estrogen)
Infections ( HPV, HCV, HBV, EBV)
Immune conditions (HIV)
Chronic inflammation (UC & Crohn's disease)True or false:
Carcinogenesis is multi-step process that can take 1 - 40 years and it can have a latent period.trueWhat is the type of cancer that begins in the lining layer (epithelial cells) of organs?carcinomaWhat is the type of cancer that occurs in the connective tissues like in cartilage, fat, muscle, or bone?sarcomaWhat is a carcinoma in situ?earliest phase/stage of a cancerWhy are brain and CNS cancers important?whether a tumor is benign or malignant, it can cause serious issues in the brainAre precancerous conditions treated?yes, but mildlyWhat is cancer of the lymphatic system? two types?Lymphoma:
-non-hodgkin's lymphoma
-hodgkin's lymphomaWhat is cancer of the blood forming cells/bone marrow?Leukemia
-can be acute or chronic
-can be of lymphoid or myeloid
-can be adult or pediatricWhat is cancer that is a plasma cell malignancy?Myeloma (mutliple myeloma)What are types of treatments for cancers?-Surgical (to treat primary tumor)
-Systemic Therapy (chemo; hormonal therapy; immunotherapy; targeted therapy; hematopoietic stem cell transplant)
-Radiation therapyWhat is the main principle of cancer treatment?fewer the cancer cells; better the drugs will work (which is why they surgically remove the primary tumor)What is important to note about the cell cycle and chemotherapy?-Chemo Medications hit on a specific part of the cell cycle, leading to different side effectsWhat side effects would you expect during chemotherapy, knowing that it targets the cell cycle?-hair is always growing, so it is effected
-skin is affected
-GI system is affected
-immunosuppression
-blood cells and bone marrow low (affected)
-low RBCs (anemia)
-low WBS (leukopenia)
-low platelets (thrombocytopenia; bleeding)What are common side effects of chemotherapy?-bone marrow suppression (anemia, thrombocytopenia, neutropenia)
-nausea and vomiting
-fatigue
-alopecia
-constipation, diarrhea
-mucositisWhat are targeted therapies?Drugs made from monoclonal antibodies that affect some protein on the cell surface (does not interact with cell cycle)
**The thought is that targeted therapies have much less side effects than chemotherapies, but they just have different side effects and can still be severe and significantWhat are common side effects of targeted therapies?-Dermatologic (rash with pruritus; dry skin; nail and hair changes)
-Ocular toxicities
-Hypertension
-Diarrhea
-Interstitial lung disease
-Infusion and drug reactionsWhat is external beam radiation therapy?a device that delivers radiation from an external source to a tumor that a patient hasWhat is brachytherapy?internal radiation
implants of radioactive substances
often used to treat prostate cancer
(implanted surgically via long radioactive wires guided by rectal ultrasonography)
can treat endometrial cancer (probe goes thru cervix into endometrial portion of the uterus)What are common side effects of radiation: head and neck?xerostomia
mucositis
dental caries
dysphagia
odynophagiaWhat are common side effects of radiation: brain?alopecia
cognitive changes (late)
N/VWhat are common side effects of radiation: Chest?cough
pneumonitis
fibrosis (late)What are common side effects of radiation: abdomen?n/v
GERDWhat are common side effects of radiation: pelvis?diarrhea
cystitis
infertility
menopause
sexual dysfunctionWhat are common side effects of radiation?-depends on the part of the body being treated
-fatigue is commonWhat are common side effects of radiation: skin?erythema
dry and moist desquamationHow will the RAD site influence nursing care?so you can anticipate the different side effects to expect and be prepared to care forWhat are skin effects of radiation?-some are temporary, others more permanent
-skin irritation caused by the cumulative effects of radiotion therapy
-Most skin reactions slowly go away after completion of treatment but some pigment changes can be permanentTrue or False:
Hair loss is defined to the area of treatment.true (can be widespread; however)What are important patient education points when teaching a patient about radiation therapy?-light exercise (Can help manage fatigue, enhance sleep, and help appetite)
-diet high in protein (with adequate oral hydration)
-yoga, meditation (can help with some symptoms and stress reduction)
-skin care (loose clothing; avoid friction to skin; avoid sun exposure; wash skin with warm water and mild soap; keep skin dry and do not use fragranced products; use moisturizing lotion without fragrance and one that is hypoallergenic)Why is staging cancer important?1) information is used to plan treatment (where the tumor is located; the size of the tumor; whether the cancer has spread to nearby lymph nodes or a different part of the body)
2) helps predict a person's outlook (prognosis; chance of survival)What are AJCC tumor grading recommendations?How are tumors graded?-grade of tumor tells you have aggressive or differentiated the cancer cells are
-Grade 1 to grade 4 (better to worse)Do you treat cancer by age (ex: if older, do you treat or not)?no, not dependent on age; should look at how healthy a person isHow is the TNM staging and clinical staging of cancer done?Stage 0: cancer in situ
Stage I: tumor limited to the tissue of origin; localized tumor growth
Stage II: limited local spread
Stage III: extensive local and regional spread
Stage IV: metastasis
**higher number indicates a more serious cancer
T: size and extent of tumor (TX, T0, T1, T2, T3, T4)
N: number of nearby lymph nodes with cancer (NX, N0, N1, N2, N3)
M: Metastasis (MX, M0, M1)What are colorectal cancer (CRC) risk factors?Intrinsic:
-older age
-personal hx of CRC or polyps
-family hx of CRC (in parent or sibling)
-inflammatory bowel disease
-race/ethnicity (AA)
-inherited syndrome (FAP; HNPCC)
*intrinsic factors will impact a person the most; cannot do much about these
Extrinsic:
-diet (high in red meat or fats)
-physical activity
-obesity
-smoking
-alcohol
-type II DMWhat are the colorectal cancer average risk screening guidelines?Beginning at age 50, both men and women at average risk for developing colorectal cancer should use one of the screening testsWhat is the gold standard for colorectal cancer screening and diagnosis?colonoscopyWhat are cancer prevention tests? (tests that detect polyps and cancer)-high quality colonoscopy ever 10 years
-flexible sigmoidoscopy (FSIG) every 5 years
-double contrast barium enema (DCBE) every 5 years
-CT colonography (CTC) every 5 yearsWhen is a colonoscopy done?if gFOBT or other test results are positiveWhat are tests that primarily detect colon cancer?-annual guaiac-based fecal occult blood test (gFOBT) with high test sensitivity for cancer
-annual fecal immunochemical test (FIT) with high test sensitivitiy for cancer
-stool DNA test (sDNA) with high sensitivity for cancer, interval uncertain
**For gFOBT or FIT used as a screening test, the take-home multiple sample method should be used. gFOBT or FIT done during a digital rectal exam in the doctor's office is not adequate for screeningWhat is detection?finding disease before symptoms occur.What is screening?strategy used to identify disease in individuals without signs or symptoms.What are screening guidelines for those with higher risk of colorectal cancer?screening earlier and more often
different than those at average riskWhat staging system is used for most cancers?TNM staging:
T: size of tumor
N: how far cancer has spread to nearby nodes
M: whether cancer has spread to other organs (metastasis)What are the benefits and risks of screening and early detection?Screening tests have risks. Some screening tests can cause serious problems.
False-positive and false-negative test results are possible.
Finding the cancer may not improve the person's health or help the person live longer.True or False:
Survival rates for those with colorectal cancer increases when the cancer is localized vs regional or distant.trueTrue or False:
Post-menopausal breast cancers are typically not the inherited/hereditary type of cancers.trueWhat is a stereotactic biopsy?-a biopsy of the breast
-done radiographically
-surgeon can see exactly where the tumor is to extract tissue cells from the tumorWhy do we biopsy?to make a diagnosisWhen we biopsy breast tissue, what do you want to know?Cell type and gradeWhy do we determine if the patient has disease in their lymph nodes?-now, only biopsy the sentinel lymph node and vessel to determine presence of CA in the lymph
-done for diagnostic person when person had been diagnosed with breast CA
-arm lymphedema can result from removing too many lymph nodes when biopsying the breast for cancerWhy is estrogen and progesterone receptor status important to know?We can use drugs that can target estrogen and progesterone receptors if the patient is ER+ and PR+
-would use hormonal therapy as treatment (anti hormonal therapy) (tamoxifen)Why is HER-2 status important to know?Over-expression of HER-2 (a positive HER-2) can help guide the patients treatment
-can treat with herceptinWhat is breast conserving surgery?remove tumor without removing the breastWhat might you tell your patient who is trying to decide if she should have a
mastectomy or breast conserving surgery? She is concerned about living to see her children graduate from college.It is the women's choice;
survival rates for both choices are the same and recurrence rates for both choices are the same, based on studiesWhat is adjuvant therapy?-therapy additional to surgery, in presence of no evidence of disease (b/c removed all of the disease)
-prophylaxis and prevent from the tumor of coming back (high % and risk of cancer coming back)What are grade B USPSTF recommendations for breast cancer screening?Women aged 50-74 years: biennial screening mammography for women aged 50-74 yearsWhat are grade C USPSTF recommendations for breast cancer screening?Women less than 50 years: decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harmsWhat are grade I USPSTF recommendations for breast cancer screening?Women age 75+: current evidence is insufficient to assess the benefits and harms of screening mammography in women 75 years and olderWhich women are considered to be at a high risk of breast cancer? what factors put women at a higher risk?Women who:
-Have a lifetime risk of breast cancer of about 20% to 25% or greater
-Have a known BRCA1 or BRCA2 gene mutation
-Have a first-degree relative with a BRCA1 or 2 gene mutation, and have not had genetic testing
-Had radiation therapy to the chest between the ages of 10 and 30 years
-Have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or have first-degree relatives with one of these syndromeWhat are recommendations for women who are at high risk for breast cancer?Women who are at high risk for breast cancer based on certain factors should get an MRI and a mammogram every year.What is the single most important strategy for reducing the number of people who die from lung cancer?Smoking cessationWhat are the primary risk factors for developing lung cancer?-tobacco use
-secondhand smokeWhat is the treatment for lung cancer?combined approach of surgery, chemotherapy, and radiationWhat are the two types of lung cancers? What are the 5-year survival rates for both?1) non-small cell lung cancer
2) small cell lung cancer
*if we diagnose it early, better survival rates
*non-small cell (worse outcomes than small cell)True or false
By the time lung cancer is seen on CXR, lung cancer is too far progressed to treat.trueWhat are grade A USPSTF recommendations for lung cancer screenings?Done for those with HIGH risk onlyTrue or False:
Not everyone with lung cancer has smoked.TrueWhat patient population is hodgkin lymphoma most common in?younger populations between 15-40
ages 55+What are risk factors for hodgkin lymphoma?EBV infection
Family history (reason unclear)
HIV infectionWhat regions are hodgkin lymphoma most common in?Most common in US, Canada, and North EuropeWhat is the Ann Arbor Staging of lymphoma?Stage I: nodes in 1 lymph node
Stage II: nodes in 2 or more grStge I- lymph node(s) in only 1 region / 1 area of a single organ outside the lymph system. Groups on same side of diaphragm/ extends locally from a single group of nodes into a nearby organ.
Stage III: nodes on both sides of the diaphragm/ extension into an organ next to lymph nodes or spleen
Stage IV: spread to marrow, liver, brain, spinal cord or pleura
E - organ involved outside the lymphatic systemHow do you stage a lymphoma? (picture)look at disease in relation to the diaphragm and the level of involvementWhat is the treatment of stage I hodgkin's lymphoma?radiation therapyWhat is the treatment of stage II-IV hodgkin's lymphoma?Chemotherapy+ biologic therapy [ABVD (adriamycin, bleomycin, vinblastine, dacarbazine) + Rituximab]What are late adverse effects of chemotherapy?-fertility (no pregnancies for at least 2 years post chemo)
-secondary cancers
-cardiomyopathies
-pulmonary fibrosisDoes a person with leukemia have enough infection fighting cells? What cells would cause this?-No, usually low neutrophils, eosinophils, and basophils
-at risk for infectionWhat is the infection risk for patients with leukemia based on ANC levels?-No significant risk: 1500-2000
-Minimal risk: 1000-1500
-Moderate risk: 500-1000
-Severe: <500Hematopoietic stem cell differentiation (picture)What is an LP done for in leukemics?-to test for presence in CNSWhat is a bone marrow biopsy bone for? How is it done?-diagnostic for leukemia
-done with patient either curled up on side or prone
-placement: posterior iliac crestWhat are the treatment phases for patients with leukemia?1) Induction: hyperfractionated cyclophosphamide, vincristine, doxorubicin, dexamethasone; alternating with high dose methotrexate and cytarabine; plus CNS prophylaxis and treatment
2) Consolidation: chemotherapy or allogenic hematopoietic cell transplantation
3) Maintenance: chemotherapy for 2-3 yearsWhat are common side effects from leukemia treatment?-Nausea and vomiting (CINV)
-Fatigue
-Bone marrow suppression: anemia, thrombocytopenia, neutropenia
-Alopecia
-Mucositis, esophagitis, proctitis
-Cognitive impairment
-Constipation/diarrhea
-NeuropathiesWhat are nursing care tips for caring for a patient with leukemia to minimize the risk of infection and bleeding?-Neutropenic and thrombocytopenic precautions
-no fresh fruits or live flowers
-avoid large crowds
-keep in private room
-good hand hygiene
-soft bristled toothbrush
-do not blow nose hard
-use electric razorWhat are nursing care tips for caring for a patient with leukemia to monitor for side effects and symptom management?-labs
-vital signs
-weight
-I&OsWhat are nursing care tips for caring for a patient with leukemia?-maintain safe environment and provide safety education
-education about what to expect and how to manageHow is nausea and vomiting treated? (due to chemotherapy)-combination of antiemetics
-premedicate the patient with antiemetics before chemotherapy
-change diet/eating during nausea period
-encourage liquids and patient preferences
-resume eating preferences past nausea period
-avoid strong smellsWhat are common types of nausea and vomiting?anticipatory
acute
delayed breakthrough
refractoryHow is fatigue, related to chemotherapy, treated?-treat underlying cause
-prioritize what is most important to nursing care and delegate
-include regular physical activity
-stress reduction techniquesWhat is fatigue, related to chemotherapy?-a very different kind of fatigue; doesn't get better with rest or sleep
-exact mechanims unknown with many contributing factors (depression, obesity, treatment toxicities, pain, anemia, infection, anorexia, sleep disorder)
-affects a majority of paitentsWhat kind of bone marrow transplant does a patient with leukemia receive?allogenic bone marrow (from someone else)What is an autologous transplant?stem cells removed from the patient and reinfused to patient after being "cleaned"What is an allogenic transplant?stem cells are donated from a healthy person using HLA matchingWhat is an syngeneic transplant?transplant from an identical twinTransplants can come from what 3 sources?-peripheral blood
-umbilical cord
-bone marrow aspirationWhat are the indications for a bone marrow transplant: Malignant?-multiple myeloma
-high grade, relapsed lymphomas (NHL; HL)
-acute leukemias (AML; ALL)
-refractory CML
-high risk myelodysplastic syndrome MDS)
-high risk testicular cancerWhat are the indications for a bone marrow transplant: Non-Malignant?-aplastic anemia
-sickle cell disease
-thalassemia
-severe combined immunodeficiency disease
-functional t-cell deficiency
-miscellaneous genetic disordersWhat regimen and medications are given before, during, and after a BMT to prepare the patient?1) Conditioning: chemotherapy and TBI; killing all her stem cells
2) Day 0: stem cell transplant (usually 1-2 days after conditioning; similar to blood transfusion-- need to premed and monitor for reactions)
3) Engraftment: 10-20 days after transplant (monitor for infection; transfusion support; ANC >500)What are common post-transplant complications?-side effects from conditioning regimen
-organ injury or dysfunction
-infection: Bacterial; Viral-- CMV/EBV/HSV/Zoster/Shingles/Respiratory Virus; Fungal-- thrush/aspergillosis/PCP
-Graft versus host disease (immune response of the donor cells attacking recipient cells; can affect the skin/GI/liver/mouth/eyes/lungs/joints; can cause graft failure; 1st line treatment is steroids)What are nursing implications when caring for a patient with leukemia?-frequent vital signs
-strict I/os
-daily weights
-symptom management
-transfusion support
-neutropenic precautions
-central line care
-discharge preparation
-lab monitoring and electrolyte replacement
-chemo administration
-stem cell administration
-education
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