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Med Surg > Cancer Development > Flashcards

Cancer Development Flashcards

1
Q

Grading Malignant Tumors

A

Gx: not determined
G1: well differentiated, low grade, slow growing
G2: moderately differentiated, malignant characteristics
G3: poorly differentiated, tissue established, few normal characteristics
G4: poorly differentiated, no normal characteristics, difficult tissue origin

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2
Q

Staging of Cancer

A

(T) Primary Tumor: x- cannot be accessed 1-4- increasing size
(N) Regional Lymph Nodes: x- cannot be accessed 1-3- increasing involvement
(M) Distant Metastasis: cannot be accessed 1- distant metastasis

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3
Q

Breast metastasis

A

Bone
Brain
Lung
Liver

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4
Q

Lung metastasis

A 
Brain
Bone
Liver
Lymph
Pancreas
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5
Q

Colorectal metastasis

A

Liver

Lymph

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6
Q

Prostate metastasis

A

Bone

Pelvis

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7
Q

Melanoma metastasis

A

GI
Lymph
Lung
Brain

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8
Q

Brain metastasis

A

CNS

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9
Q

External factors

A

Chemical carcinogenesis: tobacco 30%, alcohol
Physical: radiation and chronic irritation
Viral: oncoviruses
Dietary: decreased fiber, increased red meat
Immune fxn: immunosuppressed
Age: immune protection decreases and external exposure increases
Genetics: provide risk not diagnosis

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10
Q

Cancers associated with tobacco, virus, genetics

A

Tobacco: lung, oral cavity, pharynx, larynx, esophagus, pancreas, uterus, kidney, bladder, liver, stomach
Virus: Epstein Barr, hep b & c, HPV, lymphotropic 1 & 2

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11
Q

Dietary habits to decrease cancer risk

A

Decrease animal fat intake, avoid nitrites, decrease red meat, decrease alcohol, increase bran, increase cruciferous vegetable, increase vitamin A & C
Wash the fruits and veggies and salads

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12
Q

CAUTION

A 
Changes in bowel and bladder habits
A sore that does not heal
Unusual bleeding or discharge
Thickening or lump in breast tissue
Indigestion or dysphagia 
Obvious change in wart or mole
Nagging cough or hoarseness
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13
Q

Primary prevention

A

Use of strategies

Avoid carcinogens, modify associated factors, remove at risk tissue, chemoprevention, vaccination

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14
Q

Secondary prevention

A 
Screening strategies 
Yearly mammogram for 40 and older 
Clinical breast exam yearly for 40 and older, every 3 years for 20-39
Colonoscopy at 50 then every 10 years 
Yearly fecal occult blood all ages
Digital rectal exam for men 50 and older
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15
Q

Benign vs Malignant

A

Benign- harmless, doesn’t require intervention, doesn’t spread
Malignant- indicates cancer, serious and can lead to death without intervention

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16
Q

Pathophysiology of cancer cells

A

We’re once normal, underwent genetic mutations to no longer function normally

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17
Q

Hypertrophy vs Hyperplasia

A

Hypertrophy- increase in size by enlarging each cell

Hyperplasia- increase cell number

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18
Q

Cancer development

A

Other names = carcinogenesis and oncogenesis
Initiation- genes promoting cell division, irreversible
Promotion- enhanced growth by promoters such as insulin and estrogen
Progression- continue change of a cancer,more malignant over time
Metastasis- cancer cells move from primary location by breaking off and establishes remote colonies

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19
Q

Primary vs Secondary tumors

A

Primary- identified by the tissue from which it arose

Secondary- cancer cells move from primary location, additional tumors, still a cancer from altered tissue

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20
Q

Cancer classification

A

Grading- varies on malignancy
Ploidy- chromosome number and appearance
Staging- location and degree of metastasis at diagnosis
TNM- tumor, node, metastasis, anatomic extent of cancers

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21
Q

Solid vs hematologic

A

Solid- specific tissues, breast and lung

Hematologic- arise from blood cell forming tissues, leukemias and lymphomas

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22
Q

Which pathologic description of a clients to,or does the nurse interpret as being the most malignant or high grade cancer

A

Undifferentiated, mitotic index 50%, aneuploid

23
Q

The nurse is caring for a patient who is concerned about developing cancer. The nurse recognizes that cancer occurs how frequently in people currently living in North America

A

1 in every 3

24
Q

The nurse understands that normal cells and benign cells share which characteristics

A

No migration
Orderly growth
Tight adherence
Specific morphology

25
Q

An example of a primary prevention strategy for reducing cancer is

A

Regular physical exercise

26
Q

Related consequences of Cancer

A

Reduced immune and blood producing function- depends on CA & tx, decreases WBC & RBC causing infection and anemia
Altered GI structure and function- decreases absorption and elimination, increases metabolic rate, anorexia, increase protein and carbs
Motor and sensory deficits- compresses nerves, causes pain, “chemo brain”
Decreased respiratory function- disrupt oxygenation, death, hypoxia, pulmonary edema, dyspnea, poor gas exchange and tissue oxygenation

27
Q

Surgery as Treatment

A

Oldest form of tax
Removal of diseased tissue
Prolong survival time and improve QOL

28
Q

Types of surgery

A

Prophylaxis- removes at risk tissue
Diagnosis- removal of all or part of suspected lesion for exam and testing
Cure- remove all CA tissue
Control- remove part of tumor
Palliation- improve QOL, reduce pain
Reconstruction- increase fxn, appearance, or both

29
Q

Radiation therapy

A

Purpose is to destroy CA cells with minimal damaging effects of surrounding normal cells
Local tx
Cure, control or palliate disease

30
Q

Exposure vs Radiation dose

A

Exposure- Amount of radiation delivered
Radiation dose- Amount of radiation absorbed

Dose > Exposure

31
Q

Teletherapy

A

Delivered from source outside of patient

Radiation

32
Q

Brachytherapy

A

Short, close therapy
Isotopes
Dangerous to others
Private room, closed doors, lead apron, lead container
Do not have to take out, half life 2 weeks
Not absorbed or eliminated
Thyroid, ovarian,prostate

33
Q

Side effects of Radiation

A 
Acute and long term site specific changes 
Vary according to site 
Local skin changes and hair loss
Altered taste sensation and fatigue 
Bone marrow suppression 
Tissue fibrosis and scarring 
Infection
Avoid sun exposure during tx and 1 year after
34
Q

Patient centered care

A 
Provide accurate information 
Skin care- wash area daily, pat dry, use lotion, soft clothing, avoid exposure, avoid heat
Don't remove temporary marking
Avoid skin irritation
Skin will become dry and break down 
Nutrition 
Care for xerostomia
Teach about fractures
Exercise and sleep
35
Q

Chemotherapy

A

Treatment of CA with chemical agents
Used to cure and increase survival time
Adjunct therapy- surgery or radiation
Tumors with active growth are more sensitive
Normal cells that are affected most are ones that divide rapidly

36
Q

Chemo drugs

A

All affect a part of cell division or reproduction
Using more than one can be more effective in killing CA cells, but side effects and damage to normal tissues increase
Routes: IV, intrathecal, intraventricular, intraperitoneal, topical, intravesicular, intraarterial, oral

37
Q

Chemo tx issues

A

Dosage- based on total body surface, ht, wt
Scheduling- normal cells recover, not CA cells, every 3-4 weeks
Administration: extravasation- drug leaks into surrounding tissues
Vesicants- damage tissues on direct contact
Pain,infection, tissue loss
PREVENTION!!!

38
Q

Chemo side effects

A 
Anemia
Neutropenia- decreased leukocytes, causes immunosuppression
Thrombocytopenia- reduction in blood platelets 
N/V 
Alopecia
Mucositis
Skin changes
Anxiety 
Altered bowel
Change in cognitive function
39
Q

Protection for side effects

A

Neutropenia- reduce infection risk
Thrombocytopenia- bleeding precautions
Chemo induced N/V- many CA drugs are emetogenic, occurs 1-2 days after, give antiemetic

Growth factors- Neupogen & Neulasta

40
Q

Protection from side effects (cont)

A

Mucositis- sores in mouth, painful, interfere with eating, assess frequently, bone marrow suppression- risk bleeding
Alopecia- temporary, regrowth one month, avoid scalp injury, cope with body image change
Cognitive changes- decreases concentration, memory loss, difficult learning new info, “chemo brain”
Chemo induced peripheral neuropathy- no known interventions, loss of sensory or motor fxn, related to dosage, loss sensation in hands/feet, ortho hypoTN, erectile dysfunction, neuro pain, loss taste, constipation, long term- may be permanent

41
Q

Biological Response Modifiers

A

Modifys pts biological responses to tumor cells
Can have direct anti tumor activity
Can interfere with cancer differentiation, transformation, metastasis
Can improve immune fxn and enhance the body’s ability to repair or replace cells damaged by CA tx

42
Q

Photodynamic therapy

A

Selective destructive of cancer cells via by types of light
Used for non melanoma, skin CA, ocular tumors, GI tumors, and lunch CA in upper airways
May require one exposure or several days

43
Q

Hormonal therapy

A

Prostate, breast, ovary
Changes usual hormone response
Decreasing hormone amounts can slow CA growth rates
Doesn’t cure

44
Q

Side effects hormone therapy

A 
Masculinity effects in women
Femininity effects in men- gynecomastia
Fluid retention
Acne
Hypercalcemia
Liver dysfxn
Venous thromboembolism
45
Q

Sepsis

A

Risk for infection
Decreased WBC
impaired immune fxn
Pg 392

46
Q

Disseminated intravascular coagulation

A

Clotting problem
Triggered by CA, viral or bacterial infections, gram - sepsis, life threatening, increased mortality, PREVENTION, anticoags, clotting factors

47
Q

SIADH

A

Fluid overload
Low sodium
Pt safety, restore normal fluid balance, supportive care

48
Q

Spinal cord compression

A 
Pain
Neuros 
Recognize and tx
Corticosteroids decrease inflammation
Radiation or surgery
49
Q

Hypercalcemia

A

Bones dissolving

50
Q

Superior vena cava syndrome

A

Pain
Life threatening
Result from blockage of venous return
Facial edema, erythema, death

51
Q

Tumor lysis syndrome

A

End stage
Tissue damage
Kidney injury
Death

52
Q

Which order should the nurse implement first

A

Feed clear liquid diet
Apply stockings
Admin D51/2NS
Obtain labs

C

53
Q

What is the expected outcome related to hair loss undergoing chemo

A

Hair loss may be permanent
Viable txs exist
Hair regrowth begins 1 month after completion of chemo
New hair growth will likely be identical to previous hair

C

54
Q

A patient receiving radiation for breast cancer is likely to experience which side effect

A

Fatigue
Mucositis
Hair loss
N/V

A

Med Surg (11 decks)

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