Cancer

Question 1

Most common cancer types in male/females?

Answer 1

M- prostate, lung, colorectal
F- breast, lung, colorectal

Question 2

What is cancer?

Answer 2

Abnormal cell growth/loss of cellular regulation that results in new tissues that serve no useful purpose. They are harmful to normal cells/organs and can lead to death if untreated.

Question 3

Risk factors for cancer?

Answer 3

Environment (exposure to chemicals, radiation, nuclear power explosions, chronic irritation/tissue trauma- burn, viruses). Diet (low fibre, high red meat intake, preventatives/additives). Immunity (lower immune system), age, genetics (breast cancer gene).

Question 4

Characteristics of normal cells?

Answer 4

Has a distinct size/shape/appearance. Small nucleus to cytoplasm ratio. Has a function and don’t wander through body (except RBC). Divide only to replace old/damaged tissue. They die at appropriate times. Balance of 2 protocol-oncogenes (cell growth) to suppressor genes (inhibit growth).

Question 5

Characteristic of cancer cells?

Answer 5

Normal cells that undergo genetic mutation and don’t look like parent cell (anaplasia). Nucleus is large/cell size is smaller. Don’t serve a purpose and break off easily. They divide even when touching other cells (contact inhibition). Unlimited life span (rapid/continuous cell division) and chromosome numbers can be different.

Question 6

Cancer cell development stages general?

Answer 6

Initiation, promotion, progression, and metastasis.

Question 7

What is initiation?

Answer 7

Mutation in cells genetic structure, irreversible event, proto-oncogenes change to oncogenes (loss of suppressors gene function), cells can die/repair itself/continue to grow.

Question 8

What is promotion?

Answer 8

Growth of altered cells, they replicate, and this stage is r/t risk factors.

Question 9

What is progression?

Answer 9

Continued change/growth of cancer, tumour develops its own blood supply.

Question 10

What is metastasis?

Answer 10

Spread of cancer to another location in body, ability of cancer cells to penetrate lymphatic system and then it can spread around the body.

Question 11

What does benign and malignant mean?

Answer 11

B- non cancerous cells, grow locally, don’t spread
M- cancer cells, invade neighbouring tissues/enter blood vessels, metastasize to different sites

Question 12

How are tumours classified?

Answer 12

According to tissue of origin (location), cellular aspects (grading, compare appearance of cancer cell to parent tissue), number/structure of tumour chromosomes, location/spread of tumour.

Question 13

Grading of cells?

Answer 13

How abnormal cells look under a microscope. Higher #= cells are worse. G1 (differs slightly than normal cells, look and behave like normal cells). G2 (cells more abnormal, moderately differentiated). G3 (cells very abnormal and poorly differentiated). G4 (tumours cells are undifferentiated).

Question 14

What is primary tumour grading?

Answer 14

Higher # is badder (tumour size increases). X means not being able to determine size, 0 means no evidence of primary tumor.

Question 15

Different types of surgery for cancer?

Answer 15

1. Prophylactic- prevent cancer development,
2. Diagnostic- excisional biopsy to rule out cancer
3. Curative- removes all cancer
4. Debunking- removes part of cancer tissue
5. Palliative- provides symptom relief
6. Reconstructive- increase function/appearance

Question 16

What is radiation therapy for cancer?

Answer 16

High dose radiation to a local area that’s given as a series of doses over time. Side effects are radiation dermatitis (healthy tissue becomes red/starts to stuff), altered tastes, fatigue, bone marrow suppression. Patients given speak lotion to protect surrounding skin.

Question 17

What is chemotherapy?

Answer 17

Drug therapy (oral or IV) to kill cancer cells/disrupt their cellular regulation. It will also destroy healthy cells as well. Given on regular schedule to maximize cell death/minimize damage to normal cells.

Question 18

Side effects of chemotherapy?

Answer 18

Side effects- bone marrow suppression (monitor blood cell counts, symptoms of infection), nausea/vomit (give antimetics, monitor for weight/dehydration, eat slow and serve food at cold/room temperature). Muscositis (oral hygiene, inspect mouth/gums, good nutrition). Alopecia (temporary, all hair on body, avoid sun on scalp). Changes in cognitive function (decreased concentration, memory loss, avoid drugs/alcohol). Peripheral neuropathy (loose sensation in limbs, impaired mobility/balance, erectile dysfunction, loose tastes, constipation).

Question 19

Order of pain meds for cancer?

Answer 19

Start with non opioid/adjuvants (ASA, NSAIDS, adjuvants- muscle relaxants, anti-depressants). Opioids for mild to moderate pain (codeine/morphine). Highest level is opioids for moderate to severe pain (fentanyl, hydro-morphine). Goal is freedom from cancer pain.

Question 20

What is colorectal cancer?

Answer 20

Mix of genetic/environmental factors cause cells in lining of bowels to turn cancerous. Most are in recto sigmoid area. Arise from polyps (small bulges of abnormal cells from bowel wall).

Question 21

Risk factors for colorectal cancer?

Answer 21

Age (50+), personal hx of colorectal polyps, fam hx of colorectal cancer, personal hx of IBD (ulcerative colitis), fam/personal hx of familial adenomatous polypsis (need to remove large intestine or else they’ll get colorectal cancer).

Modifiable- physical inactivity, obesity, smoking, heavy alcohol consumption, diet high in fats/calories

Question 22

Colorectoral screening?

Answer 22

For ages 50-74 collect stool sample. FIT test (fecal immunochemical test will test for blood in stool). Done every 2 years and if positive, then further testing is required. Colonoscopy done every 10 yrs.

Question 23

Symptoms of colorectal cancer?

Answer 23

No symptoms in early stages, vary depending on cancer location, blood in/on stool, change in bowel habits, narrow stools, general abdominal discomfort, feeling of bowel not emptying, urgency with BM, weight loss/tired.

Question 24

Lab assessments for colorectal cancer?

Answer 24

FIT test, fecal occult blood test, colonoscopy is golden standard (small tube with light/camera that inserted into anus into large intestine).

Question 25

Therapy for colorectal cancer?

Answer 25

Chemotherapy, radiation therapy (only in rectal area), polyp removal (done in early stages, it eliminates risk for col. cancer), surgical (primary treatment), and ostomies (bowel is brought through an opening in abdomen, edges are sutured and inner lining of bowel is exposed).

Question 26

Ostomy care?

Answer 26

Assess stoma (colour- beefy red, pale/brack means necrotic edema), protect peristomal skin (surrounding skin), contain odour of stool, assess effluent (amount, colour, consistency). First 49-72 hrs there will be no output of stool after the surgery. Consistency of stool depends on type of bowel brought up to surface.

Question 27

Ostomy pouch system and care?

Answer 27

Empty when 1/3 to 1/2 full, make sure it’s intact, change pouch every 4-7 days or if it starts to leak, make sure there’s no gas. Refer to enterostomal therapist (they help/consult, help with ordering supplies).

Question 28

What is abdominal perineal resection?

Answer 28

Assess both of the 2 incisions, monitor drainage from wound, make sure the anus/rectum is surgically close, normal for people to have phantom BM (those will decrease over time but they can remain).