cancer Flashcards
CA and prevention
Chemoprevention: in early stages of carcinogenesis:
Tamoxifen or Ralozifen for up to 5 years reduces indigence of breast cancer in high risk women
Propecia lowers incidence of prostate CA
Ibuporfen, Meloxicam, Indomethacin: may reduce colon CA (cardiovascular risk may preclude their usefulness
Risk factors for CA
Tobacco use
sun exposure
Physical activity: colorectal CA, postmenopausal beast CA, endometrial CA
Diet: Fruits and non starchy lower mouth, esophagus, stomach
Fruits lower lung cancer
High fiber lower risk of colon cancer
fat and red meat up risk of colon cancer
Obesity: linked to postmenopausal breast CA, esophagus,
pancreas, colorectal,endometrium and kidney, and gallbladder
No proven benefit to vitamin and dietary supplements
Alcohol: up risk for mouth, esophagus, beast and colorectal (in
men )as well as liver and colorectal cancer in women
ionizing radiation up risk should be limited
infections:
HPV/cervical CA
Hep B and C /liver CA
Epstein-Barr /brukitt Lymphoma
H.Pylori / gastric cancer
CA prevention info
Breast: women 20+, BSE - reg or irregular
CBE (clinical) yearly after 40
mammogram: yearly after 40
Cervix: 21+ pap, HPV. increase after 30 after 3 normal then 2-3 yr (get pap w/in first 3 years of intercourse
colorectal: m/f increases at 50, fecal occult blood annual at 50
colonoscopy: every 10 years
endometrial: @ menopause or with abnormal or irregular bleeding
Annual Normal Pysical: assessed thyroid, testicles, ovaries, lymph nodes, oral, and skin
reactions to CA Dx
allow expression of feelings Limit teaching reactions to tx reactions to recurrence survivorship
Staging of CA
Classifying the extent and spread of disease–based on description of the extent of disease vs. cell appearance. Helps guild therapy and prognosis
Determine by physical exam, imaging (CT, MRI, etc) and biopsy
Clinical Staging of CA
Stage 0 (T): caner still in original cell (situ)
Stage 1: Turmor limited to tissue of origin-localized tumor growth
State 2: Limited local growth
Stage 3: Extensive loca and regional spread
State 4: Metastasis
TNM Staging of CA
Determine anatomic extension based on 3 parameters
T: Tumor: size and invasiveness
N: lymph-node: presence or absence of spread
M: Metastasis: to distant organ sites
This cannot be used with leukemia as it is not a solid tumor
Carcinoma in situ has its own designation T – as it is not invasive
Radiation therapy
Internal Radiation: Bracytherapy
implantation or insertion of radioactive material in or near
tumor
temporary implants: common with gynecologic and head
and neck and lung CA (Pts are hospitalized)
Permanent implants: small seeds placed in tumor–such low doses pt not considered ratioactive
Radiopharmaceuticals: injected or ingested–body fluids
radioactive
good skin care, hand washing
Separate bathrooms, flush twice, separate laundry disposal
private room
External Radiation: symptoms R/T where radiation is directed
(skin and underlying organs)
tattoos– for directing radiation do not scrub off.
Information related to Radiation Therapy
Time: distance-shielding–major principles
ALARA: as low a reasonably achievable (exposure)
Limit patient contact: cluster care, takes good planning
Private room: separate laundry disposal
Dosimeter (Film badge) do not share: because this measures
amount of radiation, and when reach max amount you will
not do radiation for a while.
Teach- pt and family
before tx about any restrictions (bathroom, laundry, etc
Skin Reaction to Radiation
Changes could be temp or perm.
redness, second degree burn
vasodilation–may be permanent
flaking, peeling, thickening, dry desquamation(peeling)
hair loss, loss of sweat glands
heat/cold. sun sensitive–no ice or heat
avoid tight fitting clothes
Skin management with Radiation
Management depends on severity of skin reaction
moisture dry skin–hypoallergenic cream or lotion
No creams/ ointment during tx (or two hours before)
Severe reaction: moist desquamation
treat like a burn, with a dressing, ointments, debride PRN
Mouth reaction
will produce no saliva, give ice chips, hard candies, artificial saliva
Chemo
Choose drug for tumor type
Mulitple drugs for cell cycle coverage
cell kill–goal 100% within minimal destruction of normal cells
Multiple tx: maximize cell kill, minimize S/E
Timing–to avoid regrowth between Rx, allow for recovery of S/E
Multiple cycles: recovery lower and slower (teach)
Clinical Trails: informed consent required
