Oncology Flashcards

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1
Q

Risk Factors

A

most important RF: AGING

TOBACCO is the #1 cause of preventable cancer

SMOKING AND TOBACCO are CO-CARCINOGENIC

Dietary: Low fiber, increased Red meat, increased fat, ALCOHOL, nitrites (processed meat), preservatives and additives

INCREASED INCIDENCE: in the immuno suppressed (thats why higher incidence over age 60)

decreasing risk: cruciferous vegetables (broccoli, cauliflower, cabbage, vitamin A foods (foods with orange color), Vitamin C
Also regular physical activity

AFRICAN AMERICANS have increased risk

CHRONIC irritation increases risk of abnormal cell growth. (smoking, reflux, scarring, rubbing

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2
Q

Primary prevention:

A

prevent actual occurrences - sun screen, proper diet, no smoking, no alcohol, exercise

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3
Q

Secondary prevention:

A

using screenings to detect cancer at early stage (greater chance to cure or control)

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4
Q

Female prevention

A

monthly SELF breast exams over age 20

YEARLY clinical breast exams over age 40 (ages 20-39, every 3 years)

annual pelvic exam, Pap smear every 3 years if no problem -prior to pap exam NO sex, NO douching

Mammogram: yearly at age 40 (2 views) -no deodorant or lotion

Colonoscopy: at age 50, every 10 years after (if results are good) fecal occult sample

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5
Q

Male prevention:

A

Monthly self breast exam, monthly self testicular exam (very fast growing tumors)

Over age 50: yearly digital exam and yearly prostate specific antigen

colonoscopy at 50 YO then every 10

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6
Q

General S/S

A
CAUTION:
Change in elimination habits (bowel/bladder)
A sore that does not heal
Unusual bleeding or discharge
Thickening or lump in breast or elsewhere
Indigestion or difficulty swallowing
Obvious change in wart of mole
Nagging cough or hoarseness

Ca can invade bone marrow> anemia (hypoxia), thrombocytopenia (bleeding pro cautions: electric razer, soft TB, no IM)

Cachexia- extreme wasting & mal-nutrition associated with Ca

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7
Q

Internal Radiation

A

1) internal radiation (brachytherapy)- radioactive source is inside the client; radiation is being emitted.
unsealed- client AND body fluid emits radiation. Isotope is given IV or PO. Radioactive for 24-48 hours (thiroidectomy)
sealed or solid: clients emit radiation; body fluids do not. Implanted close to or in the tumor for hours or days. (cervical cancer- rice/bead implanted)
CONCEPT- time, distance, shielding

nursing assignments should be rotated daily, nurse should only have 1 radiation implant client per shift - protect nurses

PRECAUTIONS: private room, wear film badge at all times, restrict visitios (limit to 30 min/day), no visitors under 16, must stay at least 6’ from sours( patient -get act together before entering room), no pregnant nurses/visitors, mark room with instructions for specific isotope, wear gloves for ALL body fluids.

prevent dislogement of implant- bed rest, low fiber diet (decrease chance of bowel distention), prevent bladder distention

if implant becomes dislodged -gloves, forceps, place in lead lined box, call radiation docs.

DONT FORGET client is IMMUNOSUPPRESSED -NO fresh fruit, flowers, stagnent water, don’t place infectious Pts in same room

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8
Q

General Tx

A

Radiation (internal & external), chemotherapy, surgery (electrosurgical excision, laser, cryosurgery)

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9
Q

External Radiation:

A

symptomatic at site

Side Effects: dry skin, erythema (redness & itching), shedding of skin, altered taste, fatigue, Pancytopenia (all blood levels decreased)

many S/S are location and dose related

DONT mess with markings Docs use to provide therapy

1 yr post therapy client must protect site from sun.

good skin care after therapy is important, but NO skin care during

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10
Q

Chemotherapy:

A

works on cell cycle -some drugs are cell cycle specific some are non-specific. If using both, its called combination chemo

scheduled 3-4 weeks, client must rest in between & EAT WELL.

chemo drugs absorb through skin and mucous membrane; use caution & proper handling (gloves)

usual SIDE EFFECTS: alopecia (hair loss), N/V, mucositis (mouth sores), immunosuppression, anemia, thrombocytopenia.

VESICANT - type of chemo that causes NECROSIS if it INFILTRATES (extravasation). nurse must stay with patient during the whole infusion time

S/S of extravasation: pain, swelling, no blood return. PREVENT this from happening

Tx of extravasation: stop infusion, vasoconstriction (prevent spreading) - ice packs to promote vaso-constriction. inject surrounding site with Bicarb to neutralize it & inject with faso constriction drugs.

(usually during infiltration heat therapy is used instead of cold therapy, but extravasation is different)

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11
Q

General ways to prevent infection

A

private room, wash hands, have own supplies in room (cup, steth, BP cuff), limit people (nurses & visitors), CHANGE DRESSING & IV DAILY, cough and deep breath, no fresh flowers or potted plants, avoid crowds, do not share toiletries, bathe warm moist areas TWICE daily (groin & underarms), wash hands after touching pet & anything else, avoid raw fruits & veggies, drink only fresh water ( less than 15 minutes old).

SLIGHT increase in temp may mean SEPSIS,
absolute NEUTROPHIL count is MOST IMPORTANT lab value

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12
Q

Cervical Cancer:

A

RF: #1 is HPV, repeated STD (irritation), many sexual partners (which also is STD and HPV territory), smoking & 2nd hand smoke, nutritional deficiencies -Folate, Beta-Carotene & Vitamin C, prolonged hormonal therapy (moms who took DES during pregnancy put daughter at risk), Family Hx, Immunosuppression, sex at young age & multiple pregnancies, young age at first pregnancy.

S/S: asymptomatic in pre-invasice cancer, invasive cancer (spread beyond the layer of tissue in which it developed and is growing into surrounding, healthy tissues) - painless vaginal bleeding. General Sx -watery, blood tinged vaginal discharge, pelvic pain (may occur with sex), leg pain, along sciatic nerve (pressure), and flank/back pain

100% cure if detected early

Dx: Pap test -repeat if the test is abnormal.

Tx: electrosurgical excision, laser, cryosurgery, radiation & chemo for late stages, conization -remove part of cervix (preserve fertility), hysterectomy

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13
Q

Uterine Ca:

A

RF: age greater than 50, taking estrogen therapy w/o progesterone, family Hx, late menopause, null parity

S/S: major -POST MENOPAUSAL BLEEDING (50%of the time it is Uterine Ca). General Sx - watery/bloody vaginal discharge, low back/abd pain pelvic pain

Dx: CA- 125 (blood test) to Rule Out Ovarian involvement
Test for metastasis: CXR, IVP (intra venous pyelogram -Xray contrast medium to see urinary system, including the kidneys, ureters, and bladder), BE (barium enema), CT, and Liver & Bone Scan.
Dilation & Curettage (dilate cervix and scrape uterus) Endometrial biopsy -MOST DEFINITIVE Dx test

Tx: SURGERY: 
Hysterectomy
TAH (total abd hysterectomy) = uterus and cervix ONLY! 
bilateral oophorectomy -ovaries
bilateral salpingectomy -tubes

Radical Hysterectomy (abd & perineal dressings)
may remove all the pelvic organ, may have colostomy or ileal conduit (bladder), greatest time for hemorrhage is FIRST 24 HOURS, major complications w/ abdominal hysterectomy -BLEEDING, major complications w/ vaginal hysterectomy -INFECTION, must void in the next 8 hours -check for bladder abstention (we do not want tension on the suture line)
Dehiscence: separation of sutures
Evisceration: organs visible> sterile saline 4X4>call doctors>don’t leave Pt
Avoid high fowlers to prevent blood pooling in pelvis
AT RISK FOR: pneumonia, thrombophlebitis (blood clot causing swelling in vein), constipation -EARLY AMBULATION
Avoid: sex, driving, girdles, douches (abdominal destination), exercise that causes pelvic congestion (heaving lifting)
Hemorrhage possible 10-14 days after surgery
whitish vag discharge is ok (other colors are bad)
showers are ok baths lead to ascending infection

RADIATION: intra-cavitary radiation to prevent vaginal recurrence

CHEMOTHERAPY: adriamycin, platinol-AQ

ESTROGEN INHIBITORS: Depo-Provera, Nolvadex/soltamox (if tumor is estrogen dependent)

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14
Q

Breast Ca

A

RF: If a 1st DEGREE relative (mom, sis, kid) had premenopausal BrCa then you have a 3 FOLD RISK INCREASE, high dose radiation to thorax before 20 YO, period onset before 12 YO, Menopause after 50 YO, Null parity, 1 kid after 30 YO.

S/S: Change in boob appearance (orange peal, dimpling, retraction, discharge) or lump. Tail of Spence is where 48% of tumors occur -upper outer quadrant

Tx:
SURGERY:
Post op- bleeding>check dressings, back (pooling of blood underneath tissue), hemovac, JP drain (increased amount of blood output than normal). Elevate arm on AFFECTED/surgical side (removal of lymph tissue inhibits ability to drain). STAY AWAY from affected limb for LIFETIME (no BP, injections, wear gloves when gardening -Pt, watch cuts, no nail biting, sunburn). On affected side- brush hair, squeeze tennis balls, wall climbing, flex and extend elbow to promote collateral circulation. Make Pt look at incision -helps them adapt and cope (how willing to participate in care). rehab/support groups, Lymphedema - fighting infection and promote drainage is not occurring.

CHEMO: Taxol, Adriamycin

HORMONAL THERAPY:
Estrogen receptor blocking agents- Nolvadex/soltamox
Estrogen synthesis inhibitors- Lupron, Zoladex

RADIATION

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15
Q

Lung Ca:

A

RF: leading cause of Ca death world wide, five year survival rate is 16%, MAJOR rf is SMOKING (smoking cessation for 15 years is similar to that of non smoker)

S/S: hemoptysis (coughing up blood), dyspnea (SOB -may be confused with TB, but TB has night sweats also), hoarseness, cough, change in endurance, chest pain, pleuritic pain on inspiration, displaced trach. May metastasize to bone.

Dx:
Bronchoscopy- NPO pre and until gag reflex returns, watch for respiratory depression (resp should ALWAYS be in perfect parameters 12-20), hoarseness, dysphagia, SQ emphysema (EMERGENCY -AIR UNDER TISSUE means lung is perforated and sounds like rice crisps). decreased reap rate is NOT the same as resp depression (breaths under 12/min)

Sputum specimen- obtain in morning, rinse mouth out with water first (decrease bacterial count), STERILE procedure (mouth can not touch cup).

other Dx tests: CXR, CT, MRI

Tx:
Surgery- main treatment for Stage I & II
Lobectomy- take out part of lung. Place Pt with chest tubes and surgical side up! (prevent fluid accumulation in empty lung space)
Pneumonectomy- remove ENTIRE lung. Position Pt on AFFECTED side (surgical side down, good lung UP - keeps only healthy lung from accumulation fluid). No chest tubes because whole lung is gone, so no plural space left. AVOID severe lateral positioning - could cause mediastinal shift!

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16
Q

Laryngeal Ca

A

RF: SMOKING, alcohol, voice abuse, chronic laryngitis, industrial chemicals. Smoking + Alcohol = Increased risk

S/S: hoarseness, lump in neck, persistant sore throat, Cough, problems breathing, earache, weight loss, no early signs

Dx: Laryngeal exam (look at vocal cords) & MRI

Tx:
SURGERY- TOTAL laryngectomy (removal of vocal cords, epiglottis, thyroid cartilage). Because the client has not epiglottis they must have a permanent tracheostomy/laryngectomy (breath out of stoma).
Post-Op- position HOB 35-45 deg semi-fowlers.
NG feedings to protect suture line (peristalsis could disrupt suture). monitor drains (prevent fluid accumulation). watch for carotid artery rupture -HEMORRHAGE (could have nicked the carotid) Same with the rupture of innominate artery -MEDICAL EMERGENCY & must call doc. Frequent mouth care to decrease bacterial count and helps prevent pneumonia . NPO -pneumonia is common. Pts often wear a bib to protect stoma and because of stigma (should be made of non-plastic and non-fibirous material). as time passes secretions will decrease. Humidified environment helps. ABC is the number one priority - reinsert dirty trach if you must to maintain airway.
Radiation:
Chemo:

Emergency: Reinsert dirty trach, emergency trach uses a layrengectomy tube (its longer??)

Speech Rehab: Major life change, Teaching should begin pre-op, community resources are available, communication devises should be set up before surgery & put IV in non-writing hand.

Speech Devises:
Electrolarynx- hand held devise that is held to cheek or neck. Robo voice
Blom-Singer- MOST COMMON. connection is made between trachea and esophagus. plastic tube is inserted to divert air from esophagus out through mouth to make words. One way valve, no infection risk.
Swallow air and burp method is also used

Suctioning: STERILE, hyper-oxygenate before & after, stop advancing catheter when meeting resistance, apply suction when pulling out, intermittent suction, no longer than 10 SECONDS, arrhythmias indicate vagus nerve stimulation (also decreased HR). If vagus nerve is stimulated you must hyper oxygenate (even though the client likely isn’t hypoxic -also with hypoxia the HR will initially increase).

17
Q

Colorectal cancer:

A

RF: start as a polyp, 2/3 occur in the rectosigmoid region, most common site of metastasis is LIVER (jaundice, can’t metabolize meds, bleeding precautions).
Other problems to watch for - bowel obstruction, perforation, fistula to bladder/vagina (eating away at other organs)
Additional RF- INFLAMMATORY BOWEL DISEASE, genetic, dietary factors (refined carbs, low fiber, high gat, red meat, fried & broiled foods), First degree relative with CRC than 3 fold increase, 95% of people who get CRC are 50 YO

Dx:
Screening- fecal occult blood testing should begin at 50 YO.
Flexible sigmoidoscopy EVERY 5 YEARS after age 50 YO OR colonoscopy every 10 years after 50 YO
DEFINITIVE TEST for CRC is colonoscopy

S/S:
Change isn bowel habits, constipation, diarrhea, NARROWING of STOOL. Other- blood in stool, cramping abdominal pain (BM w/o relief), weakness, fatigue, anemic (bleeding), abdominal fullness, unexplained weight loss (hypermetabolic state of cancer). Obstructed bowels (visible peristatic waves with high pitched tinkling bowel sounds)

Tx: Surgery, radiation, and Chemo (5FU is med)
May have colonstomy post op. COLECTOMY - part of colon removed (may not need colostomy). ABDOMINOPERINEAL RESECTION - removal of the colon, anus, rectum (no rectal temps!!)

**no rectal temp if thromboctopenic, abdominoperineal resection, immunosuprpressed.

18
Q

Bladder Ca

A

RF: Greatest risk is SMOKING + other chemicals (nicotine goes to bladder)

S/S: Major symptom is Painess intermittent gross/microscopic hematuria

Dx: Cystoopy (catheter incerted)

Tx: surgery (all/part of bladder)> urinary diversion (urostomy)
Chemo can be directly injected to bladder.
Ileal conduit (piece of ileum is turned into bladder: ureters are placed in one end, the other end is brought to the abdominal surface as stoma)- always a chance for impotents, may cut nerves.
HOURLY out puts are measured (never want a decrease in UO)
Increase fluids (2000-3000 ml of fluid per day) - flushes out conduit.
Mucus is normal - intestines always make mucus.
Change appliance in morning (when output is lowest)

19
Q

Prostate Ca:

What drug do you give for bladder spasms?

A

S/S: client has Sx of benign prostatic hyperplasia (BPH)- Hesitancy, frequency, frequent infections (because bladder isn’t completely emptied), nocturia, urgency, dribbling. Also many Pts are asymptomatic.
Most common Sign is PAINLESS hemeturia.
Digital rectal exam done and prostate is hard/nodular

Dx:
LAB WORK -PSA will be increased. PSA is protein that is produced in prostate. Normal is Less than 4 ng/ml. if 2 or more first degree relatives with prostate CS, start PSA by age 45. Change in PSA may be significant even if within normal range.
Alkaline phosphatase (if increased, means bone metastasis) test for all cancers. prostate Ca likes to go to spine, sacrum, pelvis.
Increased acid phosphatase (increase means bone metastasis)
BONE PAIN is late sign of cancer

BIOPSY -When Prostate Ca suspected biopsy is done to confirm before surgery.

Tx:
WATCHFUL WAITING - in the very old with early stage (asymptomatic) Tx could result in very poor QOL.
SURGERY-
RADICAL PROSTATECTOMY- done with localized prostate Ca. Take out the prostate and client is cancer free (if no metastasis). Possible erectile dysfunction due to pudendal nerve damage. may have incontinence (kegel or wear urine bag). client is sterile. If NO lymph involvement, no increase in acid phosphatase, no metastasis surgeon will try to preserve pudendal nerve.

PROSTATECTOMY: TURP (transurethral resection of the prostate)- Usually reserved for BPH to help urine flow, NOT CURE for prostate CA**. No incision (go through urethra). Most common complication is BLEEDING. Bleeding is normal, but too much can clog up kidneys. Continuous Bladder Irrigation maintains latency, flushes out lots. 3 way catheter - no kinks, subtract irrigant from output. Keep up with amount of irrigant instilled (worried about Kidney Damage).

What drug do you give for bladder spasms: B&O suppository, & Ditropan.

**NEVER manually irrigate catheter with FRESH surgery W/O physicians order -too fragile of state.

**ALWAYS assess prior to selecting an implementation answer. Always assess a client FIRST.

When catheter is removed, WATCH for urine retention. Temporary innocence is expected (perineal Kegel). AVOID sitting, driving, strenuous exercise, do not lift too much - to prevent bleeding.

**Docusate to avoid straining - bleeding
Increase fluids to flush out blood (keep patent kidneys). TURP is used for symptomatic relief of symptoms -allows urine to flow out NOT cure for prostate Ca.

RADIATION
CHEMO
HORMONE THERAPY:
May decrease testosterone through bilateral orchiectomy, Estrogens, Lupron (decrease tester one)

20
Q

Stomach Ca:

A

RF:
H-Pylori ASSOCIATED with stomach cancer, Pernicious anemia & achlorhydria (no stomach acid) -higher instance of Stomach Ca in people with these.
Related to- pickled foods, salted meats/fish, nitrates, increased salt. Billroth II (partial gastrectomy with anastomosis -atrophic gastritis). Tobacco & Alcohol Act synergistically.

S/S: Most common - heart burn & Abdominal discomfort.
other- loss of appetite, weight loss, bloody stools, coffee-ground vomitus, jaundice ( liver metastasis), epigastric and back pain, feeling of fullness, anemia, stool + for occult blood, achlorhydria (no HCl in the stomach), obstruction (S/S of ane obstruction- abdominal distention, N/V, pain. Tx for obstruction: NPO, NG tube to suction for abd decompression).

Dx: Upper GI, CT, EGD (Esophagogastrodudenoscopy - scope)

Tx: either cure or (more likely) debunk tumor, which means to leave part of the stomach.
SURGERY- (preferred) Gastrectomy. Fowlers position (decrease stress on suture line). Will have NG tube (for decompression) - do not reposition or touch for at least 24 hours, it is too fragile.

2 MAJOR COMPLICATIONS:
Dumping syndrome - N/V, abd cramps, feeling of fullness, Diarrhea, flushing, lightheadedness/dizzy, heart palp/ rapid HR. late signs (due to hypoglycemia)- hunger, sweating, fatigue, heart palp/ rapid rate, fainting, dizziness/confusion, light headed.

B-12 DEFICIENT ANEMIA (pernicious anemia): schillings test - measures urinary excretion of Vitamin B-12 for diagnosis of pernicious anemia.

NO STOMACH> NO INTRINSIC FACTOR> CANT ABSORB ORAL B12> CANT MAKE GOOD RBC> CLIENT IS ANEMIC (tired, increase HR) - get B-12 shots.

CHEMO: 5-FU, Adriamycin, Mitomycin-C, Platinol-AQ

RADIATION: