Cancer Part 1 Flashcards
(38 cards)
Cancer Etiology and Genetic Risk
- Oncogene activation
— External Factors
— Chemical carcinogenesis – exposure to tobacco
— Physical carcinogenesis – exposure to radiation
— Viral carcinogenesis –exposure to oncoviruses
— Dietary factors – low fiber high fat (bad for you)
— Personal factors - immune function, advancing age, genetic risk
Risk Factors
External Factors
*Know what to teach
Responsible for 80% of cancer in North America
- Smoking (30% of cancer are related to tobacco use)
- Alcohol
- Radiation (uranium, UV lights) (avoid tanning beds)
- Viral (Epstein-Barr virus, hepatitis, HPV) Table 21-7 pg 366
- Diet (low fiber with a high intake of red meat, preservatives)
Genetic considerations for predisposition for cancer
See Chart 15 -1 Example of Ca influenced by genetics
- Genetic risk overall is small
- But people who have a genetic predisposition are at very HIGH risk for developing cancer.
- Genetic Testing available – expensive, not usually covered by ins. Do not diagnose, only provide risk info
Genetic considerations for predisposition for cancer
- Hallmarks of families with hereditary cancer syndrome include:
— Cancer in two or more first degree relatives
— Onset of cancer in family member younger than 50
— Same type of cancer in several family member
— Individual family members with more than one type of cancer
— Rare cancer in one or more family members.
*Cancer prevention and screening Chart 15-2 Health Promotion
Primary
- Avoidance of known or potential carcinogens
- Modification of associated factors (diet/ no smoking/ etc.)
- Removal of “at-risk” tissues (mole removal)
- Chemoprevention (chemo prior to diagnosis)
- Vaccination
Secondary
- Regular screening – eg. mammogram
- Genetic screening – eg. BRCA1
Tertiary Screening
- Treatment and prevention of *reoccurrence and secondary cancers
Question
*Is the following statement true or false?
Primary prevention involves detection and screening to
achieve early diagnosis and intervention.
FALSE – This is Secondary Prevention because 2nd is screening
The Nurse’s Role in Cancer Prevention and Screening
The 7 Danger Signs
C = Changes in bowel or bladder habits (not yeast infection)
A = A sore that does not heal
U = Unusual bleeding or discharge
T = Thickening or lump in the breast or elsewhere
I = Indigestion or difficulty swallowing
O = Obvious change in a wart or mole
N = Nagging cough or hoarseness
Name Dietary Habits to Reduce Cancer Risk
- Avoid excessive intake of animal fat and red meat
- Avoid nitrites (prepared lunch meats, sausage, bacon).
- Keep alcohol consumption to no more than 1 to 2 drinks per day.
- Eat more bran.
- Eat more cruciferous vegetables eg. broccoli, cauliflower, Brussels sprouts, and cabbage. Eat foods high in vitamin A (e.g., apricots, carrots, leafy green and yellow vegetables) and vitamin C (e.g., fresh fruits and vegetables, especially citrus fruits)
The nurse includes which factors in teaching regarding the typical warning signs of cancer? (Select all that apply)
- A. Persistent constipation
- B. Scab present for 6 months
- C. Curd like vaginal discharge
- D. Axillary swelling
- E. Headache
A, B, D
Cancer Classification
- Staging – Provides common language for accurate communication between healthcare providers. (4 stages)
- Grading – pathologic classification of tumor cell
- TNM (tumor, node, metastasis) Chart 15-3 pg. 334
Cancer Development
Step 1
- Initiation – loss of cellular regulation
Step 2
- Promotion – enhanced the growth
Step 3
- progression – continued change
Step 4
- Metastasis – Moves from primary location
Metastasis
- Metastasis occurs through a progression of steps:
- Extension into surrounding tissues
- Blood vessel penetration (most common cause of spread)
- Release of tumor cells
- Invasion of local areas
- Local seeding
- Bloodborne metastasis
- Lymphatic spread
Cell Growth & the Pathophysiology of Cancer
Hypertrophy- cells swell
Hyperplasia- cells multiply
Features of Normal Cells
- Limited cell division
- Apoptosis – programmed death of cells
- Specific morphology – same shape, size and look
- Small nuclear-to-cytoplasmic ratio
- Differentiated function
- Tight adherence
- Nonmigratory
- Contact inhibition – stops from over dividing
- Normal chromosomes – 23 pairs
Features of *Benign Tumor Cells
Features of Cancer Cells (Malignant)
- Rapid or continuous cell division
- Anaplasia – loss of look of parent cell
- Large nuclear-to-cytoplasmic ratio – large nucleus
- Specific functions lost
- Loose adherence
- Migration
- No contact inhibition
- Abnormal chromosomes
A 65-year-old client tells the nurse she does not have mammograms because there is no history of breast cancer in her family. What is the nurse’s best response?
- A “Breast cancer is an inherited type of malignancy and your family history indicates a low risk for you.”
- B “Performing breast self-examination monthly at home is sufficient screening for someone with your family history.”
- C “Because your breasts are no longer as dense as they were when you were younger, your risk for breast cancer is now decreased.”
- D “Breast cancer can be found more frequently in families; however, the risk for general, nonfamilial breast cancer increases with age.”
D. breasts get denser with age
Consequences of Cancer
- Physical and Psychological functioning changes
- Destruction of normal tissue
- Impaired immune and blood-producing function
- Altered GI structure and function
- Motor and sensory deficits
- Decreased respiratory function
Cancer Treatments
- Surgery
- Radiation
- Chemotherapy
Surgery as Cancer Treatment
- Oldest form of cancer treatment used for:
- Cure – Removal of all Cancer
- Control – Removes partial (debulking)
- Palliation- improve quality of life eg, pain mngt.
- Prophylaxis- removes at risk tissue
- Diagnosis - biopsy
- Second-look surgery – after treatment
- Reconstruction or rehabilitation – enhance function and appearance
- Requires collaborative care
How does radiation affect patients?
Radiation Causes Ionizations of ATOMS
- which may affect MOLECULES
- which may affect CELLS
- which may affect TISSUES
- which may affect ORGANS
- which may affect THE WHOLE BODY
radiation is external & internal beam
- external:
— tattoo
Radiation Therapy for Cancer
- Purpose—to destroy cancer cells with minimal exposure of the normal cells to the damaging actions of radiation
- EBRT – (teletherapy) - outside the body
— External beam radiation therapy - Brachytherapy - inside the body
— Sealed Sources – Interstitial, Intracavity
— Unsealed Sources. Liquid via oral/injection/etc
— Pt emits radiation and can be hazardous
— Dosages in units called grays (Gy) - Radiation Safety:
- distance, time, shielding, use of film badge (dosimeter)
Side Effects of Radiation Therapy
- Vary according to the site
- Local skin changes and hair loss that will likely be permanent depending on the total absorbed dose
- Altered taste sensations - common
- Fatigue related to increased energy demands - common
- Inflammatory responses that cause tissue fibrosis and scarring
- Each patient’s experience is different
Brachytherapy: Sealed
Prostate Brachytherapy
