Cancer Flashcards
(60 cards)
1
Q
What are characteristics of benign neoplasms?
A
- Grows by expansion, no infiltration of adjacent cells
- Slow growth
- No metastasis
- Localized effects
- Rarely causes tissue damage
- Death is rare
2
Q
What are the characteristics of malignant neoplasms?
A
- Grows at the periphery, invades surrounding tissues
- Variable growth rate
- Uses blood and lymph channels to invade other areas
- Generalized effects/symptoms
- Frequently causes tissue damage
- Can result in death
3
Q
What is the three step process of carcinogenesis?
A
Malignant transformation
1. Initiation: carcinogens cause mutations in cellular DNA, normal cell cycle interrupted
2. Promotion: Initiated cells are prompted to grow and survive
3. Progression: Proliferation and differentiation; angiogenesis occurs
4
Q
What is angiogenesis?
A
The development of new blood vessels
Malignant neoplasms do this during the progression stage of carcinogenesis
5
Q
Which viruses are known to be carcinogenic?
A
- Human Papillomavirus (HPV) (Cervical and head and neck cancers)
- Hepatits B/C Viruses (HBV and HCV) (liver cancer)
- Epstein Barr Virus (EBV) (lymphomas, nasopharyngeal cancers)
6
Q
Which bacteria are known to be carcinogenic?
A
- H. pylori (stomach cancer)
7
Q
What are some common carcinogenic chemical agents?
A
- Tobacco
- Asbestos
- Many others…
8
Q
What are some carcinogenic physical agents?
A
- Sunlight (cumulative UV exposure)
- Radiation (x-ray, radon)
- Chronic irritation/inflammation
9
Q
What are some carcinogencic lifestyle factors?
A
- Diet (long term ingestion of carcinogens/co-carcinogens)
- Obesity
- Sedentary lifestyle
10
Q
What are some carcinogenic hormonal agents/factors?
A
- Early onset of menses
- Hormone Replacement Therapy
11
Q
How do cancer cells evade the normal immune system defenses?
A
- Some have altered cell membranes that interfere with T-cell and B-cell lymphocytes
- Some release cytokines that inhibit APCs (Antigen Presenting Cells), so they are not recognized
- Some may combine with the antibodies produced by the immune system to hide/disguise themselves from normal immune defense mechanisms
12
Q
What is Primary Prevention for cancer?
A
Health promotion/risk reduction strategies
Examples:
- Achieve/maintain a healthy weight
- Lead a physically active lifestyle
- Healthy diet focused on plant sources
- Limit alcohol
- Public Programs: increase access to healthy foods, provide safe, accessible environments for physical activity
13
Q
What is Secondary Prevention for cancer?
A
Screening and early detection activities
Examples:
- Annual mammograms for ages 40-54, every two years for 55 and over
- Pap smears to screen for cervical cancer
- Colonoscopy every 10 years for ages 45-75
- Low dose CT scans for current or former smokers (quit within the last 15 years) with at least a 30 pack-year history
- DREs for prostate cancer - men age 50+
14
Q
What is Tertiary Prevention for Cancer?
A
Monitoring and preventing recurrence of primary cancer and screening for secondary malignancies
Examples:
- PET scans
- Endoscopies
- Ultrasounds
- MRIs
- Mammograms
- Tumor Marker monitoring
- Fluoroscopies
15
Q
What are some common clinical manifestations of
Cancer?
A
- Change in bowel or bladder habits
- A sore that does not heal
- Unusual bleeding or discharge (from any orifice)
- Thickening or lump in the breast or elsewhere
- Indigestion or difficulty in swallowing
- Obvious change in a wart or mole
- Nagging cough or hoarseness
16
Q
What is involved in
Staging a cancer?
A
Stages 1-4
- Size of tumor
- Existence of local invasion
- Lymph node involvement?
- Distant metastasis?
17
Q
What is involved in
Grading a tumor?
A
Grade I-IV
Defining type of original tumor tissue and the degree of differentiation of the tumor cells from the orginal tissue
18
Q
What is the TNM Classification System?
A
T: The extent of the primary tumor (Tx, T0, Tis, T1, T2, T3, T4)
N: The absence or presence and extent of regional lymph node metastasis (Nx, N0, N1, N2, N3)
M: The absence or presence of distant metastasis (Mx, M0, M1)
X = cannot be assessed, 0 = no evidence, is = In Situ
19
Q
What are the different type of surgical treatments associated with cancer?
A
Diagnostic:
- Fine Needle Biopsy: Sample suspicious masses that are easily and safely accessible
- Excisional Biopsy: Removal of small, easily accessible tumors, and a small margin of surrounding tissue
- Incisional Biopsy: When entire tumor mass is too large to be entirely removed - sample is taken
Tumor Removal:
- Local excision: Small mass, done outpatient
- Wide excision: Removal of primary tumor, lymph nodes, adjacent tissue; frequently results in disfigurement; requires rehabilitation, reconstruction
Prophylactic Surgery:
- removal of non-vital tissues or organs that are at increased risk of developing cancer
Palliative Surgery:
- To relieve symptoms, promote comfort, improve quality of life
Reconstructive Surgery:
- After breast, head/neck, skin tumor removal surgeries
20
Q
How does radiation kill cancer cells?
A
- Works locally
- Damages DNA within the cells
- More effective on faster growing cells (bone marrow, lymphatic tissue, GI tract, gonads)
- Less effective on slower growing tissues (muscle, nervous system, connective tissue)
21
Q
What is
External Beam Radiation Therapy (EBRT)?
A
- Delivers tightly targeted radiation beams directed from different angles and different planes from outside the body
- Involves several daily treatments (fractions) over a few days to a few weeks
This is the most commonly used form of radiation
22
Q
What is Stereotactic Body Radiotherapy (SBRT)?
A
A form of External Beam Radiation Therapy
* Higher doses of radiation than EBRT over a shorter time period (1-5 days)
* Penetrates very deeply into the body for tumors that cannot be treated by surgery
23
Q
What is Brachytherapy?
A
Internal Radiation
- Placement of radioactive sources within or immediately next to the cancer site
- Intense, highly targeted
- Seeds, beads, or ribbons placed in body cavities or interstitial tissues
- Used in prostate, testicular, pleura, breast, pancreatic and other cancers
24
Q
What are some of the side effects of
Radiation?
A
Toxicity is often localized unless concomitant chemo is used
Local Side Effects:
- Radiation dermatitis
- Alopecia
- Xerostomia (dry mouth)
Systemic Side Effects:
- Fatigue, malaise, anorexia
- Long term effect: Loss of elasticity and changes secondary to a decreased vascular supply (decreased oxygenation)
- Dysphagia
- Incontinence
- Cognitive impairment
- Sexual dysfunction
Fatigue is one of the biggest side effects - up to 99% of patients will experience it
25
What are the nursing interventions for a patient undergoing
**Radiation Therapy**?
* Manage symptoms to promote healing, patient comfort, and quality of life
* Assess: Skin, nutritional status, well-being
* Suggest mild soap for skin & pat dry
* Low fat, high protein - *small, frequent meals* *(surprise!)*
* Protect self/caregivers/visitors
26
What are some ways to protect one's self and caregivers/visitors during **Brachytherapy**?
* Private room
* Appropriate notices
* Dosimeter badges
* Pregnant staff not assigned
* Restrict visits by children or pregnant women
* Limit visits to 30 minutes/day
* Maintain a 6 ft distance
27
What is **chemotherapy**?
The use of antineoplastic drugs to destroy cancer by interfering with cellular functions, including replication and DNA repair.
Typically used to treat systemic disease.
**Neoadjuvant:** May be used before surgery to decrease the size of the tumor
**Adjuvant:** May be used postoperatively to destroy any remaining tumor cells
**Primary:** To treat some forms of leukemia and lymphoma
28
What is a **Nadir**?
* When white blood cell levels are at their lowest point
* Typically 7-10 days after the last dose of a chemo treatment/round
## Footnote
WBCs typically return to normal levels 3-4 weeks after - just in time for the next chemo cycle to start
29
How are chemo doses determined?
* Patient's body surface area *(BSA)*
* Weight
* Pt's response to previous radiation or chemotherapy treatment is considered
* How their major organ systems are functioning is also taken into consideration
30
What is extravasation?
When irritants or vesicants inadvertently leak from a vein into the surrounding tissue
## Footnote
**Irritants cause a local inflammatory reaction - but not typically permanent tissue damage**
31
What is a **vesicant**?
Agents that can cause inflammation, tissue damage, and possibly necrosis of tendons, nerves, muscles, and blood vessels if extravasation occurs
32
What are some ways to prevent extravasation via vesicants?
* Chemo is only given by those trained in extravasation by vesicants management
* No peripheral veins of the hands or wrist are used
* PIV is only for short term chemo
* Prolonged chemo requires a central line *(Peripherally Inserted Central Catheters PICCs, Implanted Ports, Tunneled Central Lines)*
33
What are **Hypersensitivity Reactions (HSRs)** associated with chemo administration?
* Unexpected, adverse drug reactions associated with mild or progressively worsening signs and symptoms
* Repeated exposure increases the likelihood of a reaction
34
What are some ways to prevent **Hypersensitivity Reactions** with chemo administration?
* Desensitization procedures *(start low, increase gradually)*
* Premedication *(benadryl, corticosteroids, tylenol)*
35
What are the
**Nursing Management Interventions**
for Chemotherapy
* Assessing fluid and electrolyte status
* Assessing cognitive status
* Modifying risks for infection, bleeding
* Administering chemotherapy
* Preventing nausea and vomiting
* Managing fatigue
* Protecting caregivers *(teaching to flush the toilet 2x and close lid, double glove, etc)*
36
What is a
**Hematopoietic Stem Cell Transplant (HSCT)**?
**Transplantation of stem cells in order to treat several malignant and nonmalignant diseases**
Examples:
* Malignant myeloma
* Acute leukemia
* Non-Hodgkin's Lymphoma
37
What is an
**Allogeneic HSCT**?
Stem Cell transplant from:
**Matched donor**
38
What is an
**Autologous HSCT**?
Stem Cell Transplant from:
**Self**
38
What is a
**Syngeneic HSCT**?
Stem Cell transplant from:
**Identical Twin**
39
What is
**Graft vs Host Disease (GVHD)**?
***Major cause of morbidity and mortality in the allogeneic transplant population***
* Occurs when the donor lymphocytes initiate an immune response against the recipients tissues during the beginning of engraftment
* Acute: within first 100 days
* Chronic: Occurring after 100 days
## Footnote
**To prevent GVHD: pts receive immunosuppressant drugs**
40
What is the **Nursing Managment** for HSCTs?
* Implementing pre-transplantation care: *Blood work, assessments, history*
* Providing care during treatment: *Close monitoring of VS, especially fever and temp*
* Providing post-transplantation care: *Caring for recipients and donors*
* Monitoring for and managing hyperthermia
41
What are some **Nursing Interventions to Prevent Infection** for patients with **Cancer**?
* **Neutropenic precautions**: no live flowers, no fresh/unwashed fruits or vegetables, strict hand hygiene for everyone, use electric razor, avoid anyone with infection
* Avoid rectal, vaginal procedures *(rectal temps, tampons, suppositories)*
* Assess IV sites routinely
* Report fever, chills, sweating
* Avoid IM injections
* Avoid urinary catheters
* Administer granulocyte colony-stimulating factors when ordered *(Neupogen - filgrastim, Neulasta - pegfilgrastim)*
* Administer stool softeners
* Change water daily
**Fever may be only sign of infection**
* One time temp of 101°F/38.3°C OR
* Any temp greater than 38°C/100.4°F for more than an hour
## Footnote
**Typical signs of infection - swelling, redness, drainage, pain - may not occur in myelosuppressed patients**
42
What are some **Nursing Interventions to Promote Nutrition** for patients with **Cancer**?
*Due to nutritional impairment, anorexia, malabsorption, cancer-related anorexia-cachexia syndrome*
* Initiate referrals to help manage factors that inhibit oral intake
* Suggest high calorie and high protein foods
* Limit fluids at mealtime, but encourage fluid intake at other times
* Encourage nutritional supplements and high protein snacks
* Address nausea and vomiting
* Encourage frequent oral hygiene - especially before meals
* Collaborate with dietician
43
What are some **Nursing Interventions to Decrease Fatigue** for patients with **Cancer**?
* Encourage balance of rest and activity
* Collaboratively manage anemia, depression, pain, electrolyte imbalance
* Encourage protein, fat, and calorie intake
* Encourage use of relaxation techniques and guided imagery
* Encourage participation in planned exercise programs *(ranging from 10 minutes of light exercise or stretching to 30 minutes of moderate to vigorous exercise)*
* Collaborate with PT/OT
44
What are some **Nursing Interventions for Relieving Pain** for **Cancer** patients?
* Assess pain frequently
* Administer analgesics
* Consult with palliative care team
* Assure patient you know their pain is real and will help to reduce it
* Explore nonpharmacologic strategies to relieve pain
45
What are some **Nursing Interventions** for patients with **Cancer**?
* Promoting Nutrition
* Relieving Pain
* Decreasing Fatigue
* Improving Self Image
* Preventing infection
* Monitor for early signs of septic shock
* Prevent/monitor for bleeding, hemorrhage
46
List the different modalities commonly used to treat cancer
* Surgery *(if possible, most ideal and most commonly used)*
* Radiation Therapy
* Chemotherapy *(antineoplastics)*
* HSCT - Hematopoietic Stem Cell Transplant
* Immunotherapy
* Targeted Therapy
47
What are the
**Risk Factors**
for
**Breast Cancer**?
* Combination of genetic, hormonal, and environment
* 80% occurs sporadically with no family history
* Long term smoking
* Night Shift Work
* Age
48
What are some interventions for patients at **High Risk of Breast Cancer**?
**Chemoprevention:**
* Tamoxifen
* Raloxifene
**Prophylactic Mastectomy**
**Yearly mammograms**
**Clinical breast exams twice a year after age 25**
49
What are the clinical manifestations of
**Breast Cancer**?
* Can be found anywhere, but typically in the **upper outer quadrant**
* Lesions are non-tender, hard, fixed, with irregular borders
**Advanced signs:**
* Skin Dimpling
* Nipple retraction
* Skin ulceration
50
What are some non-invasive diagnostics for
**Breast Cancer**?
* Yearly mammograms for women of average risk after age 40
* Breast self-exam: *should be done 5-7 days after period*
* Ultrasound
* MRI
51
What are some invasive diagnostic tests for
**Breast Cancer**?
* **Percutaneous Biopsy:** *needle or core biopsy that obtains tissue by making a small puncture in the skin*
* **Fine-needle aspiration (FNA):** *syringe is inserted, suction is applied to remove tissue - for palpable nodules*
* **Core needle biopsy:** *similar to FNA, uses larger gauge needle*
* **Sterotactic core biopsy:** *patient is prone, uses a computer to locate tumor*
* **Ultrasound-guided core biopsy:** *uses ultrasound to locate tumor*
* **MRI core biopsy:** *For tumors too small to be felt, uses MRI to locate tumor*
52
What is a **Modified Radical Mastectomy**?
Removal of breast tissue, including the nipple-areola complex
Includes a portion of the axillary lymph nodes dissection (ALND)
## Footnote
Typically used to treat invasive breast cancer, chest wall muscles are left intact
53
What is a **Total Mastectomy**?
* Removal of the breast and nipple-areola complex
* DOES NOT include the ALND *(axillary lymph node dissection)*
## Footnote
Typically performed in patients with non-invasive breast cancer
54
What is **Breast Conservation Treatment**?
* Includes lumpectomy, wide excision, partial or segmental mastectomy, quadrantectomy.
* The goal is to excise the tumor in the breast completely and obtain clear margins while achieving an acceptable cosmetic result.
* In noninvasive breast cancer, lymph node removal is not necessary
* With invasive breast cancer, a separate SLNB or ALND is performed
* Contraindicated for multiple tumors in more than one quadrant
## Footnote
**Could end up being more disfiguring**
55
What is a **Sentinel Node Biopsy**?
* Standard of care for the treatment of early stage breast cancer
* Sentinel node is the first lymph node a tumor would drain into
* If biopsy of the sentinel node is negative, an axillary node dissection is not needed
* If biopsy of the SN is positive, results are known during surgery, and an ALND is performed
56
What are some of the complications of an Axillary Lymph Node Dissection (ALND)?
* Lymphedema
* Cellulitis
* Decreased arm mobility
* Sensory changes
57
What are the nonsurgical medical management treatments for
**Breast Cancer**?
* Radiation Therapy: External beam and Brachytherapy
* Chemotherapy
* Hormonal Therapy: *estrogen and progesterone receptor assay, selective estrogen receptor modulators, aromatase inhibitors*
* Targeted Therapy
58
What are some complications of chemotherapy?
* Infection due to neutropenia
* Thrombocytopenia (< 100)
* VTE, DVT, PE
* Nausea/Vomiting
* Body image issues
* Fatigue
* Toxicity to cells with rapid growth rates
* Cognitive impairment
59
What is **Hyperthermia Treatment**?
***AKA Thermotherapy, Thermal Therapy, or Thermal ablation***
* Body tissue is heated to as high as 113°F to help damage and kill cancer cells with little or no harm to normal tissue
* Heating fluids such as blood or chemotherapy drugs and putting them into the body
* Placing the entire body in a heated chamber or hot water bath or wrapping with heated blankets
* Can be local or regional
* May be microwaves, radiowaves, ultrasound, laser, or perfusion
