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Chapter 16- Cancer

Terms in this set (79)

What is the largest cancer killer of men and women
lung
Cancer incidence overall is higher in men or women?
Men
Risk factors
-Age
-Gender
-Race
-Genetic disposition
-Exposure to chemicals, tabacco, alcohol
-Exposure to certain viruses and bacteria
-Diet high in fat and red meat and low in fiber
-Sun, UV, radiation exposure
-Sexual lifestyles
Normal cells
have boundaries and proliferation
Cancer cells
have a loss of boundaries or contact inhibition and no proliferation
Cancer cells usually proliferate
at the same rate as normal body cells
The time required for a tumor mass to double in size is its
doubling time
Chemical carcinogens
chemicals/drugs identified as cancer causing agents
Radiation
dose of radiation that causes cancer is not known. Leukemia, lymphoma, thyroid cancer increased in general population after atomic bombs in Hiroshima and Nagasaki
Viral Carcinogens
The presence of some viruses appear to be linked to cancerous conditions.
-AIDS is linked to Kaposi sarcoma;
-Hepatitis B virus is linked to hepatocellular carcinoma
Genetic Susceptibility
presence of some genes increase individual's susceptibility to develop certain cancers (BRCA 1 or BRCA 2 increases risk of breast cancer by 40-80%
Stem cell theory
-Initiation stage
-Promotion stage
-Progression stage
Initiation stage
mutation occurs in stem cell's genetic structure mutation irreversible
Promotion stage
the odds of cancer development are increased with the presence of promoting agents
Promoting agents
dietary fat, obesity, cigarette smoking, alcohol consumptions
The activity of promoters is
reversible
Progression (last stage)
Increased growth rate of the tumor, increased invasiveness, and metastasis (spread of the cancer to a distant site)
The most frequent sites of metastasis are the
-lungs
-brain
-bone
-liver
-adrenal gland
Tumor angiogenesis
formation of blood vessels within the tumor which is critical to survival and growth of the tumor
Hematogenous metastasis
tumor cells enter the circulation, travel through the body, and adhere to small blood vessels of distant organs. Tumor cells that survive must establish vascularization
Neoplasm
new growth (tumor)
another name for cancer
Breast adenocarcinoma
Bone, brain, adrenal
Prostate adenocarcinoma
Bone
Lung small cell carcinoma
Bone, brian, liver
Skin cutaneous melanoma
Brain, liver, bowel
Kidney clear cell carcinoma
Bone, liver, thyroid
Benign
- No metastasis
- Encapsulated
- Rare recurrence
- Expansive: Crowds out surrounding tissues
- Cells similar to parent cells (well differentiated, which means the cells are closer in appearance to normal tissue of origin)
Malignant
- Invades; metastasizes to bone, lung, brain, liver, adrenals
- Possible recurrence
- Infiltrates organs/ tissues
-Cells are unlike parent cells (undifferentiated)
- Rapid growth
- Fatal without treatment (Poor prognosis)
Stage 0:
Stage I:
Stage II:
Stage III:
Stage IV:
-Cancer in situ
-Tumor limited to the tissue of origin; localized tumor growth
- Limited local and regional spread
- Extensive local and regional spread
-Metastasis
Tissue biopsy
Tissue sample for microscopic examination.
Chest x-ray
radiographic image of the thoracic cavity
CBC
complete blood count with differential: screening for leukemia
Radiographic studies
Mammography, ultrasound, CT scan, MRI
Pet scan
a visual display of brain activity that detects where a radioactive form of glucose goes while the brain performs a given task
Endoscopic examination
Colonoscopy, sigmoidoscopy, upper GI
Genetic Makers
BRCA 1, BRCA 2: mutations in these genes predispose for breast cancer
Bone marrow biopsy
Used for hematopoietic tumors: multiple myeloma, lymphocytic or myelogenous leukemia
Decrease exposure to known carcinogens
Promoting agents: cigarettes, alcohol, obesity..)
Eat balanced diet:
-High fiber/fruits/veggies/decreased fat
Diets high in fat/low in fiber=
higher risk for colon cancer
High fat diets=
-increased breast cancer risk in . females
-increase prostate colon in males
Decrease intake of smoked , salt-cured meats
High content increases esophageal/ stomach cancer
Breast cancer
Women 40-44 yearly mammogram (optional)
-45-54 yearly mammogram; 55 and older mammogram every 2 years
Family history may warrant testing sooner
Colon cancer
colonoscopy at age 50 with yearly fecal occult blood test
Cervical cancer
Females 21-65 should have a PAP test every 3 years
Endometrial (uterine) cancer
The The American Cancer Society recommends that at the time of menopause, all women should be told about the risks and symptoms of endometrial cancer. Women should report any unexpected vaginal bleeding or spotting to their doctors.
Prostate cancer
males age 50 should get a PSA blood test. African American males or those who have a father or brother who had prostate cancer before age 65, should have this talk with a health care provider starting at age 45.
Seven warning signs of cancer
-Change in bowel or bladder habits
-A sore that does not heal
-Unusual bleeding or discharge
-Thickening or a lump in breast or elsewhere
-Indigestion or difficulty in swallowing
-Obvious change in wart or mole
-Nagging cough or hoarseness
Additional sign/symptoms of possible Cancer
Unexplained weight loss
Night sweats
Fatigue/weakness
Nausea/anorexia
Pain
Cancer Treatments
-Radiation
-Chemotherapy
-Bone marrow or peripheral stem cell transplant
-Surgery
-Biological and targeted therapy
Radiation Oncology
side effects
-Fatigue
-Skin irritation
-Dry Mouth
-Anorexia
-Nausea/vomiting
Brachytherapy
is a form of radiotherapy where a sealed radiation source is placed inside or next to the area requiring treatment.
Chemo may be used to:
Keep the cancer from spreading
Make the cancer grow slower
Kill cancer cells that may have spread to other parts of the body (metastasized)
Make side effects from cancer better, like pain or blockages
Cure cancer
It can be given in a pill, injection, intravenously, or
intracavitary
intrathecal—
brain & spinal cord
intraperitoneal—
ovarian, liver, stomach
intrapleural—
lung related cancers
intravesical—
bladder cancer
Reasons to have an internal port-a-cath placed:
-Some chemotherapy is very abrasive to the blood vessels
-Patients may have poor venous access
-Long-term treatment expected
Geriatric considerations
Age is the greatest risk factor for developing cancer. In fact, 60% of people who have cancer are 65 or older. Cancer mortality rate is exceedingly high in the elderly, with 70% of all deaths due to malignancies occurring in those over 65
Reasons for hesitancy:
-Increase age ("Why bother!)
-Accept is as part of aging process
-Fear they will not tolerate side effects of treatments
Side effects of chemotherapy and nursing care
Decreased production of bone marrow cells.
RBC
—anemia
Monitor for fatigue, pallor, dizziness, or shortness of breath
Teach scheduling of activities with rest periods
Monitor Hgb
WBC
- neutropenia (infection)
Avoid crowds & avoid sick people
Avoid eating fresh fruits/veggies that could contain bacteria
No fresh flowers
Avoid working with soil (yard work, gardening, liter boxes)
Encourage frequent hand washing
Wear gloves when washing dishes-avoid sharp objects in the water
You do not want to get sick, few 'good' cells to fight illness
Platelets
—thrombocytopenia
Monitor platelet counts - 1st priority**
Monitor for petechia, ecchymosis, nosebleeds
Use electric razor
Use soft toothbrush to avoid gum irritation / risk for bleeding / no flossing ever!
Pancytopenia
An abnormally low level of red blood cells, white blood cells, and platelets in the circulating blood
Neutropenia
*Neutropenia is an abnormally low level of neutrophils in the blood.
*Neutrophils are white blood cells (WBCs) produced in the bone marrow that ingest bacteria.
*Neutropenia is sometimes called agranulocytosis or granulocytopenia because neutrophils make up about 60% of WBCs and have granules inside their cell walls.
*Neutropenia is a serious disorder because it makes the body vulnerable to bacterial and fungal infections.
Thrombocytopenia
Thrombocytopenia is an abnormal drop in the number of blood cells involved in forming blood clots. These cells are called platelets.
Hematocrit (Hct):
-Normal
Male: 40-54%
Female: 36-48%
Hemoglobin (HgB):
-Normal
Male: 14-18 g/dL
Female: 12-16 g/dL
-Anemia
Male: <13.5
Female: <12.0
Platelets:
-Normal
150,000-450,000
-Thrombocytopenia
<150,000
WBC:
-Normal
4,000 -11,000
-Neutropenia
<4,000 cells/cc
Side effects of chemotherapy and nursing care
-Gastrointestinal Tract
Nausea/Vomiting
Prophylactic anti-emetics
Avoid odiferous foods that may stimulate nausea
Nutritional supplements
Several small meals throughout the day

Diarrhea

Mouth Sores
Mouth care before and after eating
Non-alcohol mouthwash
Do not floss: risk for infection and bleeding
Metallic Taste of food
Integumentary System
Alopecia (hair loss)
Skin irritation (dry, itchy, rash)
Nail become brittle
Nervous and Muscular System
"Chemo brain"
Weakness
Peripheral neuropathy
Urinary System (kidneys and bladder)
Monitor urine output
Encourage increased fluid intake
Monitor edema
Skeletal System
Monitor calcium levels
Osteoporosis
The most common areas of the body to suffer breaks are the spine and pelvis, hips, and wrists.
Pain
Sexual/Reproductive System
Temporary or permanent infertility
Hormonal fluctuations
Psychological/Emotional
Financial concerns
Depression
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