Exam 4- Oncology/GI Flashcards
(225 cards)
1
Q
Are proto-oncogene good or bad genes to have? and why?
A
Good- It control the growth of cells
2
Q
Are oncogene good or bad genes to have? and why?
A
Bad- Mutated proto-oncogene which leads to uncontrolled cell growth
3
Q
Are tumor suppressor genes good or bad genes to have and why?
A
- Good- slows down cellular division, cause cell death
4
Q
Are mutated tumor suppressor genes good or bad and why?
A
Bad– leads to uncontrolled cell growth
5
Q
Well differentiated cells resemble….. what?
A
- Normal cells
6
Q
Well differentiated cells function like?
A
“more like normal cells”
7
Q
What is a growth rate for a well differentiated cell?
A
- Grows at a slower rate
8
Q
True or false: Well differentiated cells are typically benign?
A
- True
9
Q
Poorly differentiated cells resemble…. what?
A
- Does not resemble normal cells
10
Q
Which cells are mature cells and which are immature out of a well differentiate and poorly differentiated cell?
A
- Well differentiated = mature
- Poorly differentiated = immature
11
Q
Poorly differentiated cells function likeeee…
A
- They lack structure (immature)/function and g
12
Q
True or false: Poorly differentiated cells a less aggressive than well differentiated?
A
False- Poorly differentiated are more aggresive
13
Q
True or false: Poorly differentiated cells are typically malignant?
A
True
14
Q
What is a benign tumor?
A
- Benign (not cancer) tumor cells grown only locally and cannot spread by invasion or metastasis
15
Q
What is a malignant tumor?
A
- Malignant (cancer) cells invade neighboring tissues, enter blood vessels, and metastasize to different sites
16
Q
what is the mode & rate of growth of a benign tumor with well differentiated cells?
A
- Expands, usually encapsulated
- usually slow growth
17
Q
What is the mode & rate of growth of a malignant tumor with undifferentiated cells?
A
- Sends out projections that infiltrate and destroy growth rate variable
18
Q
Do benign tumors metastasize?
A
no- not typical
19
Q
Can a malignant tumor metastasizes?
A
- Yes
20
Q
With benign tumors what are the general effects?
A
Usually localized to the area
21
Q
With malignant tumors what are the general effects?
A
- Generalized: anemia, weakness, weight loss
22
Q
With benign tumors what kind of destruction do we expect?
A
- Usually non unless blood flow is impaired
23
Q
With malignant tumors what kind of destruction do we expect to see?
A
- Often extensive; excretes toxins, uses up blood supply
24
Q
What is the morbidity of a benign tumors?
A
- Minimal- unless location interferes with vital function
25
What is the morbidity of a malignant tumor?
1. High- unless growth and spread controlled/halted
26
Review cancer prefixes
1. Adeno- gland
2. Chondro- cartilage
3. Erythro- red blood cell
4. hemangio- blood vessels
5. hepato- liver
6. lipo- fat
7. lympho- lymphocyte
8. melano- pigment cell
9. myelo- bone marrow
10. myo- muscle
11. Osteo- bone
27
What are two ways that cancer speads?
1. Locally invasive
2. Metastasis
28
What does it mean if a cancer spreads locally invasive?
1. "finger" of cancer cells invade surrounding tissues
29
What does it mean if a cancer metastasizes?
1. Malignant cells travel through blood or lymph system & invade other tissues or organs to form secondary tumor
30
What are four common sites of mets?
1. Brain
2. Lung
3. Liver
4. Bone
31
What are some risk factors for cancer?
1. Tobacco and smoking
2. Diet and obesity
3. Sedentary lifestyle
4. Occupational exposure
5. family history
6. Viruses
7. Perinatal factors/growth
8. Alcohol
9. Socioeconomic status
10. Pollution
11. UV radiation
12. Drugs & medical procedures
13. Salt, Food additives and contaminant
32
What do we need to know about family history as a risk factor of cancer?
1. Hallmark of hereditary cancer syndrome
2. Cancer in 2 or more relatives
3. Cancer in family members < 50 years old
4. Same type of cancer in multiple family members
5. Rare type of cancer in 1 or more family members
6. Family members with more than 1 type of cancer
33
What do we need to know about viruses as a risk factor of cancer?
1. Difficult to evaluate and isolate
2.May incorporate in the genetic structure of cells
3. Delay of many years form initial viral infection to the development of cancer
4. Must act in conjunction with other factors in order to develop into cancer
5. Number of persons infected with viruses is more larger than those numbers who develop cancer
34
The HPV virus can cause what type of cancer?
1. Cervical cancer
35
The hepatitis B/Hepatitis c virus can cause what type of cancer?
1. Liver cancer
36
The Epstein-Barr can cause what type of cancer?
1. Lymphoma
37
The human herpes virus 8 can cause what type of cancer?
1. Kaposi's sarcoma
38
The HIV virus can cause what type of cancer?
1. Lymphoma, kaposi's sarcoma
39
The h-pylori virus can cause what type of cancers?
1. Stomach ulcers, lymphoma in the stomach lining.
40
Hormone replacement therapy with estrogen and progestin showed to have an increase risk in developing what kinds of cancers?
1. Ovarian
2. Breast
3. Uterine
4. Lung
5. Brain
6. Colon
41
What is primary prevention?
1. Health promotion & illness prevention
2. Reduction of cancer mortality via reduction in the incidence of cancer
42
How is primary prevention accomplished?
1. Avoiding the carcinogen
2. Adequate & Proper nutrition
3. Stress reduction
4. Lifestyle changes
5. Dietary changes
43
What is secondary prevention?
1. Screening (self breast & testicular exams)
2. Diagnosis & Treatment of illness
44
What is the goal of secondary prevention?
1. Halt the progress of cancer through early screening & diagnosis.
45
What is tertiary prevention?
1. Disease treatment and rehabilitation
2. Health restoration
46
What is the goal of tertiary prevention?
1. Prevent further deterioration
47
What is chemoprevention?
1. The use of substances to lower risk of cancer
2. Selective estrogen receptor modulator (SERMs)
48
What are two examples of selective estrogen receptor modulators (SERMs)
1. Tamoxifen & raloxifene: reduce risk of breast cancer
2. Selenium: reduced risk of prostate cancer
49
What is the goal of cancer screenings?
Goal: find cancer in the early stages
1. Look for cancer before symptoms appear
50
What types of screening can they do for cancer?
1. Physical exam
2. Lab tests
3. Imaging procedures
4. Genetic testing
51
What are the colorectal screening guidelines?
1. Beginning at age 45, men & women should follow one of the examination schedules
- Fecal occult blood test (FOBT): yearly
- Flexible sigmoidoscopy: Every 5 years\
- Colonoscopy: every 10 years
52
What are some breast cancer screenings guidelines
1. 20+ monthly SBE
2. 40-44: Breast exam by HCP every 3 years
3. 45-54: HCP breast exam & mammo yearly
4. 55- every two years
5. Women at high risk for breast Ca: MRI/mammo yearly
53
What are the cervical cancer screening guidelines?
1. Age 21 or within 3 years of initiating vaginal intercourse
-pap test every 2-3 years
- if dysplasia notes- pap test annually
2. Age 30+
- Pap test & HPV every 5 years or every 3yrs with pap test only
3. 60+
- not necessary if all previous test negative
4. Hysterectomy
- Continue pap test to r/o vaginal or vulvar cancer
54
What are the 7 warning signs of cancer? (remember C-a-u-t-i-o-n )
1. C- change in bowel or bladder habits
2.A- A sore that does not heal
3. U- Unusual bleeding or discharge
4. T- Thickening or lump in breast or some where else
5. I- Indigestion or difficulty swallowing
6. O- obvious change in wart or mole
7. N- nagging cough or hoarseness
55
What is "grade" in terms of cancer?
1. Pathologist compares the appearance of cancer cells to the normal surrounding cells
56
What is staging in terms of cancer?
1. Classifying a malignancy by the extent of spread within the body
57
What are the different grades?
1. GX
2. G1
3. G2
4. G3
5. G4
58
What is a GX grade?
1. Can not be assessed
59
What is a G1 grade?
1. (low grade): well differentiated, slow growing
60
What is a G2 grade?
1. Moderate grade: Moderately differentiated growing slightly faster
61
What is a G3 grade?
1. High grade: poorly differentiated, growing faster
62
What is a G4 grade?
1. High Grade: undifferentiated, not distinct at all, very aggressive
63
What is a stage 1?
1. Small cancer found only in organs where it originated
64
What is stage 2?
1. Larger cancer that may/may not have spread to the lymph nodes
65
What is a stage 3?
1.Larger cancer also in the lymph nodes
66
What is stage 4
Cancer has spread from original site into other organs
67
TNM system of staging... what does T- N- M stand for?
1. T= size of primary tumor
2. N= Number of lymph nodes involved
3. M= extent of metastasis
68
What is TX in tumor size?
1. Tumor size can't be measured
69
What is TO in tumor sizing?
1. No primary tumor, or cant be found
70
What is "tis" in tumor sizing?
1. Tumor is "in situ"
71
What is T1 in tumor sizing?
Small or early stage
72
What is T2 in tumor sizing?
1. Confined to original area
73
What is T3 in tumor sizing?
1.Has spread t surrounding tissues
74
What is t4 in tumor sizing?
1. Large, advanced stage cancer
75
True or false: TNM classification reflects the depth of tumor infiltration
True
76
NX is what in staging number of nodes?
1. Nearby nodes can't be tested/evaluated
77
N0 is what in staging number of nodes?
1. Lymph nodes are cancer free
78
N1 is what in staging number of nodes?
1. Cancer cells have reached one node
79
N2 is what in staging number of nodes?
1. Cancer spread to more than one node
80
N3 is what in staging number of nodes?
1. Cancer in lymph nodes extensive/widespread
81
MX is what in staging extent of mets?
1. Unknown if cancer has spread
82
M0 is what in staging extent of mets?
1. No distant mets were found
83
M1 Is what in staging extent of mets?
1. Cancer has spread to one or more dsitant parts of the body
84
What does "In situ" mean?
1. Still in the original tissue layer
85
What does localized mean in terms of staging?
1. Still in original organ
86
What does regional mean in terms of staging?
1. Spread to nearby lymph nodes or organs
87
What does distant mean in term of staging?
1. Spread to distant body parts
88
What do we need to know about tumor markers?
1. Molecules associated with cancer cells
2. Found in blood, urine, tumor tissue
3. Different markers found in different tumors
89
What are tumor markers used for?
1. Screen
2. Diagnose (in conjunction with other tests)
3. Treat (determine if body responding to treatment)
4. Determine prognosis
5. Monitor for recurrence
90
What can Carcinoembryonic antigen CEA tell us?
1. Associated with tumors & developing fetus
2. Increased levels found in cancers of
- colon, pancreas, gastric, lung, breast
3. Increased levels found in certain conditions
- Cirrhosis, IBD, Chronic lung disease, pancreatitis
91
What are normal levels of CEA?
1. 0-2.5ng/mL in non-smoker
2. <5.0 ng/ML in smoker
92
What can Alfa-fetoprotein AFP tell us?
1. Major component of fetal plasma
2. Valuable as a screening tool
3. Increased levels in hepatocellular carcinoma
4. Increased found in certain conditions
- Pregnancy, hepatitis, cirrhosis
93
What is a normal range of AFP
1. <20 ng/mL
94
What can a Cancer Antigen 125 (CA-125) tell us?
1. Monitor tx or recurrence
2. Increased level found in cancers of
- Ovary, lung, breast, colon, pancreas
3. Increased levels found in certain condition
- Pregnancy, menstruation, endometriosis
95
What is a normal CA-125
1. <30 U/mL
96
What can cancer antigen (CA-19-9) tell us?
1. Not used for screening
2. Increased levels found in colon & pancreatic cancer
3. Increased levels found in certain conditions
-gallstones, cirrhosis, pancreatitis, cholecystitis
97
What are the risk factors of breast cancer?
1. Gender
2. Increasing age (40+)
3. Early menarche/late menopause
4. Family history
5. High fat diet
6. Obesity
98
What are the symptoms of breast cancer?
1. Painless and/or painful breast mass
2. Nipple discharge
3. Local edema
4. Nipple retraction
5. nipple crusting
99
What is the primary prevention of breast CA?
1. Wellness
2. Smoking cessation
3. Daily exercise
4. Healthy diet
-Low in saturated fat
- High in fiber
100
What is the secondary prevention of breast CA?
1. Mammogram
- beginning yearly after age 40
2. Breast self exam (BSE)
- after 20 years of age
- perform after menstruation
- Same time every month
101
What are tertiary prevention for breast CA?
1. Symptom control
-lymphedema
2. Rehabilitation
-Reconstruction
102
What is included in the assessment of breast CA
1. Mass felt during BSE
2. Mammogram
3. A non-moveable mass-typically painless
4. usually only one breast involved.
103
When assessing the breast we are looking for what change in size, ocuntour, or texture of breast?
1. Skin dimpling, puckering
2. Nipple discharge, retraction
3. Peau d'orange
104
What are some late signs of breast CA?
1. Pain
2. Ulceration
3. Cachexia
105
How do we diagnosis breast CA?
1. BSE
2.Clinical exam
3. Mammo
4. Ultrasound
-Consistency of breast mass-- cyst or dense mass
5. Biopsy
-aspiration
-incisional
- excisional
6.Axillary lumph node status
7. Diagnostic tests
-BRCA-1 or BRCA 2
-HER-2
-Estrogen and progesterone receptor -
106
What are some surgical treatments for breast CA?
1. Lumpectomy
2. Simple mastectomy
3. Radical or modified radical mastectomy
107
What are some nonsurgical treatments for breast CA?
1. Chemotherapy
2. Radiation
3. Hormonal manipulation
108
What are some radiation treatments for breast ca?
1. External (teletherapy)
- Using radiation beams to affected area
2. Internal (brachytherapy)
- Radium implants
- Pellets
-Seeds
109
What hormone therapy drug might be used in breast CA?
1. Tamoxifen
110
True or false: breast ca can be treated with forms of chemotherapy?
True
111
What does pre-operative care consist of for a breast ca patient?
1. emotional support
2. General preop teaching
3. Specific training
112
True or false: lymphedema is a complication of breast CA?
True
113
What should we know about the lymphedema complication of breast CA?
1. Lifelong potential complication
2. Importance of follow up
114
How can we prevent lymphedema?
1. Elevation, ROM, ADL's, protect
115
What is the treatment for lymphedema?
1. Intermittent compression sleeve, manual massage, elevation, diuretics
116
What is are the functions of the skin?
1. Protection
2. Body temp regulation
3. Psychosocial
4. Sensation
5. Vit D production
6. Immunological
7. Absorption
8. Elimination
117
What are skin assessment tools
1. Eyes???
2. Hands??
3. Ears???
1. History taking and data gathering
2. Braden Scale
3. Nutritional assessment tools
118
What are key steps for skin assessment?
1. Health history
2. Inspection and palpation
3. examination
3. documentation
119
What should our documentation include for skin assessments?
1. Document exactly what is observed or palpated
1. appearance
2. Texture
3. temp
4. Turgor
5. Color
6. Moisture
7. sensation
8. vascularity
9. leasions/rash
120
What are 3 types of skin cancer?
1. Melanoma
2. Basal cell skin cancer
3. Squamous cell skin cancer
121
What are risk factors of skin cancer?
1. Sunlight and UV radiation
2.Severe and or/blistering sunburns
3. Tanning (direct sunlight or tanning booths)
4. Family history
5. Fair (pale)skin that burns easily
6. Medical conditions or medications
122
What are s/s of skin cancer?
1. Change in shape, color, size or feel of an existing mole
2. Skin that is hard or lumpy
3. The surface of the skin oozes or bleeds easily and does not heal
4. Can be itchy, tender or painful
123
Using ABCDE how can we recognize skin cancer?
A- look for Asymmetry in a mole
B- assess for an irregular border
C- is the color a mixture of different colors or has it changed recently?
D- Is the diameter > 6mm
E- Has there been an evolution in the mole size, shape, color?
124
How is skin cancer diagnosed?
1. Biopsy: shave, punch, incisional, excisional
2. Labs and imaging:
-CBC,BMP, LFT's
- Chest x-ray, CT, MRI, PET scan
3. Sentinel node biopsy
125
How is skin cancered staged?
1. Size of growth
2. How deeply embedded in the layers
3. Whether it has metastasized
126
Treatment of skin cancer depends on?
1. Type and stage
2. Size and location of tumor
3. General health and medical history
127
How is skin cancer often treated?
1. Excision
2. Surgery
3. Chemotherapy
4. Radiation
5. Biologic therapy
128
What is prevention and education for skin cancer?
1. limit sun exposure
2. Stay away from sunlamps and tanning booths
3.. Avoid outdoor activities during the hottest part of the day
4. Wear long sleeves and long pants
5. Wear a hat with wide brim
6. use (SPF 30)
7. Regularly check your skin for changes in moles
129
What is lymphoma?
1. Cancers of the immune system
130
What does lymphoma primarily affect?
1. Lymphatic system
131
How is lymphoma classified?
1. Degree of cell differentiation
2. Ogrin of predominant malignant cell
132
What are two broad categories or lymphoma?
1. Hodgkin lymphoma
2. Non-Hodgkin lymphoma
133
Where can lymphoma originate in?
1. Lymph nodes
2. Spleen
3. Thymus gland
4. Tonsils
5. Adenoids
6. Adenoids
7. Bone Marrow
8. Digestive tract
134
What is stage 1 of lymphoomas?
1. Earliest stage; the lymphoma only involves a single lymph node group
135
What is stage 2 of lymphomas?
1. In several lymph nodes either above or below diaphragm
136
What is stage 3 of lymphomas?
1. In several lymph nodes both above and below diaphragm
137
What is stage 4 of lymphomas?
1. Widespread beyond lymph nodes and spleen; spread to 1 or more organs
138
Hodgkin lymphoma develops from what abnormal b cell?
1. Abnormal B cellls
139
What should we know about Hodgkin lymphoma?
1. Rare
2. 5 Subtypes
3. High cure rate
140
What are the s/s of Hodgkin lymphoma?
1. Firm, painless enlargement of 1+ lymph nodes
2. Fatigue, weakness, night sweats, wt loss greater than or equal two 10%
141
What two common age groups that are affected by Hodgkins lymphoma?
1. 16-34 years old
2. 55 and older
142
What are the risk factors of Hodgkin lymphoma
1. EBV
2. HIV
3. Weakened immune system
4. Family history
143
Non-Hodgkin's lymphoma develops from what type of abnormal cells?
1. Abnormal B or T cells
144
How many subtypes are there of Non-Hodgkin lymphoma are there ?
60
145
What age group in Non-Hodgkin lymphoma prevalent in
1. 50-70 years old
146
What are the risk factors of Non-Hodgkin lymphoma?
1. Viral infections
2. Autoimmune disease
3. Infection with H.Pylori
4. Exposure to chemicals
147
What are s/s of Non-Hodgkins lymphoma?
Same as HL except NO reed-sternberg cells
1. Firm, Painless enlargement of 1+ lymph nodes
2. Fatigue, weakness, night sweats, wt loss more than or equal to 10%
3. May have CNS involvement (neuropathy, H/A)
148
What are 3 types of Non-Hodgkin lymphoma?
1. Low grade or "indolent"
-Slow growing, Lifelong disease
2. Intermediate grade
-Moderately aggressive
3. High grade or "aggressive"
- very aggressive, Poor prognosis
149
What is the diagnostic testing that can be done for both HL and NHL?
1. CBC
2. CXR, CT Scans
3. Lymph node biopsy:
-Identify type of cell & pattern (B vs. T cells)
-Reed-sternberg cells in HL only
4. Bone marrow biospy
150
What is treatment for NHL based upon?
1. Type & Stage of disease, prior treatment, ability to tolerate therapy
151
What are the options for NHL treatment?
1 Watchful watching (only NHL low grade stage)
2. Chemotherapy
3. Radiation therapy
-Combo radiation/chemo in later stages?
4. Stem cell transplantation
152
How do manage fatigue with lymphoma?
1. Balance activity with rest
153
How do we manage nutrition with lymphoma?
1. Monitor weight, fluids and food intake
154
How do we manage the risk for infection with lymphoma?
1. Myelosuppression
155
How do we manage body image with lymphoma?
1. Weight loss, alopecia, sterility
156
How do we manage hopelessness with lymphoma?
1. Support groups, ACS, Family Planning options
157
What are some treatment options for lymphoma?
1. Surgery
2. Chemotherapy
3. Photodynamic therapy
-Use of drugs that become active when exposed to light
4. Biological therapy
-Monoclonal antibodies
-Growth factors
-Vaccines
5. Radiation
158
What are 3 treatment options for cancer?
1. Surgery
2. Radiation therapy
3. Chemotherapy
159
Surgery is often used in conjunction with chemotherapy or radiation for what 4 purposes?
1. Prevent
2. Diagnose
3. Stage
4. Treat
160
True or false: Surgery is the most frequent treatment method
True
161
What are types of surgery for cancer treatment?
1. Diagnostic
2. Primary
3. Prophylactic
4. Palliative
5. Reconstructive
162
Diagnostic surgery includes tissue biopsy... what are the 6 types of biopsies?
1. shave
2. Punch
3. Incisional
4. Excisional
5. Fine needle
6. Core needle
163
What is debulking in terms of surgery for cancer treatment?
1. Remove as much of tumor as possible
164
What is radical excisions in terms of surgery for cancer treatment?
1. Can be disfiguring and alter functioning
165
What is salvage surgery in terms of surgery for cancer treatments?
1. Extensive surgery to site at which previous therapies have failed
166
What is electrosurgery?
1. Electrical current to destroy tumor cells
167
What is cryosurgery?
1. Liquid nitrogen to freeze tissue
168
What is chemosurgery?
Chemical applied to tissue
169
What is laser surgery?
1. Precise high dose radiation therapy
170
What is prophylactic surgery?
1. Removal of non-vital tissues/organs that may develop cancer
171
What are some considerations for prophylactic surgery?
1. Family hx and genetic predisposition
2. Presence or absence of symptoms
3. Risk vs. benefits
4. Ability to detect cancers early
5. Patient's acceptance of post-op out come
172
What is palliative surgery?
1. Pain relief
2. Not intended to treat or cure
3. Goal is high quality of life
173
What is reconstructive surgery?
1. Plastic surgery
2. Trying to repair injury or loss of function from curative or radical surgeries
3. May take several procedures
174
Care of a surgical cancer patient includes?
1. Incision care
2. Prevent infection
3. Manage pain
4. Educate on
-Care of drains, s/s of infection, dietary intake to promote healing
175
What is the goal of radiation and chemotherapy?
1. Eliminate cancerous cells
176
What should we know about radiation and chemotherapy (generalized)?
1. Affects rapidly proliferating cells
2. Can cause wide range of symptoms
3. Death can result from symptoms
4. Benefits out weigh risk... in most cases
177
What do we need to know about radiation therapy?
1. Energy to kill tumors
2. Energy to shrink tumors
3. Energy to eliminate cancer cells
4. Damages cell's DNA
5. Healthy cells can also be damaged
6. Treatment of choice for localized cancer
178
What is a lethal tumor dose?
1. Amount required to eradicate 95% of tumor and simultaneously salvage normal tissue
2. Total is delivered over weeks to allow healthy tissue to recover
3. Repeated doses also allow periphery of tumor to re-oxygenate and become susceptible to radiation
179
What factors can affect dosage?
1. Radiosensitivity of the tumor,
2. Normal tissue tolerance
3. Volume of tissue to be irradiated
180
Why can radiosensitivity of the tumor affect the radiation dosage
1. Dependent on the presence of oxygen.
181
How can normal tissue tolerance affect radiation dosage?
1. Point at which normal tissues are irreparably damaged.
182
How can volume of tissue to be irradiated affect factors of radiation dosage?
1. total prescribed dose usually diveded into several smaller doses
2. Treatments are usually given daily, 5 days per week for an average of 25-30 treatments
183
What are the benefits of radiation therapy?
1. Used before surgery to shrink therapy
2. Intra-operative radiation
3. Given before, during or after chemo
4. Palliative
-Shrink tumors
-Reduce pressure, pain & other symptoms
184
What do we need to know about radiation toxicity
1. localized to area of treatment
2. May be higher if in conjunction w/chemo
185
Generalized effects of radiation toxicity include
1. Fatigue
2. Anemia
3. N/V
4. Thrombocytopenia
186
What should we know about sealed implants?
(brachytherapy)
1. Body usually does not give off radiation BUT pregnant women & small children should avoid exposure to patient.
187
What should we know about unsealed implants? (brachytherapy)
1. Body will give off radiation
2. body secretions may be contaminated
3. Isolation
188
What are the side effects of brachytherapy?
1. Fatigue
2. Anorexia
3. Immunosuppression
4. Other side effects similar to external radiation
189
What are some client education for temporary brachytherapy?
1. Avoid close contact with others until treatment is completed
2. No contact with pregnant women
3. Bed rest to prevent dislodging radioactive source
4. Maintain balanced diet, consider small, frequent meals
6. Maintain fluid intake to ensure adequate hydration: 2-3 liters/day
190
What are the side effects of radiation?
1. Fatigue
2. Skin changes
3. Alopecia
4. Immunosuppression
5. Radiation pneumonia
6. Ulceration of oral mucous membranes
7. GI: N/V, Diarrhea
8. Symptoms increase as treatment progresses
191
Patient education for radiation therapy includes?
1. Wash treated area only with tepid water & soft wash cloth
2. No application of heart or cold packs.
3. Use electric razor only
4. Do not remove treatment markings on skin
5. Do not use any products to the sites during treatment
6. Avoid wearing tight fitting, starched, or stiff clothing over treatment area
7. Do not use adhesive tape- use paper tape- apply outside treatment area
8. Protect skin from sun exposure
9. Get proper rest, diet, fluid intake for health and repair of normal tissues
-eat 5-6 small meals/day
-fat/fiber/lactose
-BRAT diet for diarrhea
10. If hair loss occurs protect hair
192
What is chemotherapy?
1. Use of anticancer drugs to eliminate cancer cells
- More than 100 drugs available
- Combination drugs frequently used
- Affects the entire body (Cancerous and non-cancerous)
-Side effects are numerous
-Death may occur due to side effects
193
What is the goal of chemotherapy?
1. Is to kill cancerous cells while preserving other, more healthy cells
- Not always possible
- High percentage of oncology patients die from treatment- not the cancer
194
How is chemotherapy administered?
In cycles- daily, weekly, monthly
195
What forms of chemo therapy are available?
1. Pill
2. Injection
3. IV
4. Topical
5. Directly into body cavity
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How is chemotherapy dosage calculated?
By body surface area
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What are some things we need to know about the administration of chemotherapy?
1. Excreted in body fluids up to 48 hours after treatment
2. Usually requires specialized ports
3. Monitor lab values closely
-WBC's, RBC's, H&H, Platelets, etc.
4. Chemo certified RN only
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What are some patient teaching guidelines for chemotherapy?
1. Handwashing-- family members & visitors as well
For 48-72 hours following chemo
1. Flush toilets twice
2. Rince toilets with bleach once/day
3. Caregiver should wear gloves if in contact with
-any body fluids
-contaminated laundry
4. Avoid sexual activity
- Use 2 forms of birth control
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What are the guidelines for handling cytotoxic drugs?
1. No safe exposure limit
2. Risk of exposure
-Handling body fluids of pt within 48 hours of chemo
- Always wear PPE
-Accidental spills
3. Routes of exposure
- Inhalation, absorption, ingestion
4. Follow agency guidelines for proper disposal
200
What should we know about immunotherapy?
1. Boosts the immune system. Which creates an environment that is not conductive for cancer cells to grow
2. Attacks cancer cells directly
201
What is targeted therapy for cancer?
1. Interferes with cancer growth. Targets specific receptors important in tumor development
202
What are side effects of targeted therapy for cancer?
1. Flu-like symptoms-headache, fever, chills, fatigue, extreme weakness, anorexia, and nausea
2. Tachycardia
3. Neurologic deficits- confusion, memory loss, insomnia
4. Bone marrow depression
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What are side effects of chemo?
1. N/V
2. Alopecia
3. Stomatitis
4. Pain
5. Enteritis
6. Diarrhea
7. Anemia
8. Fatigue
9. Myelosuppression
10. Pancytopenia
11. Leukopenia
12. Neutropenia
13. Thrombocytopenia
14. Granulocytopenia
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What should we know about fatigue as a side effect of cancer treatment?
1. Frequent side effect of cancer therapy
2. Can be debilitating
3. Unrelated to activity
4. Unrelieved with rest
5. Can be prolonged
6. Can affect health and quaility of life
7. Monitor thyroid levels
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What should we know about N/V as a side effect of cancer treatment?
1. More commonly associated with chemo
-Can affect patient receiving radiation
2. Emetogenic- nausea causing drugs
3. Directly related to type of chemo administered
4. Prevention is the key
5. Categories
-Acute- occurs within 24 hours
-Delayed- occurs within 2-5 days
- Anticipatory - occurs before chemo
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What medications can be given for N/V and what should we keep in mind with treatment?
1. Ondansetron
-Can be combined with dexamethasone or emend
3. Premedicate with antimetics before treatment
4. Use combination medications around-the-clock for 24-72 hours following treatment
5. Monitor dehydration
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What is anorexia-cachexia syndrome?
1. Loss of skeletal muscle & Fat- not starvation
2. Unexplained rapid weight loss
3. Altered smell and taste
Catabolic state
1. Body tissue and muscle proteins used to support cancer cell growth
2. May halt cancer treatment
3. Corticosteroids proven effective
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What are some immunosuppression risk factors?
1. Decreased ability to flight infection
2. Risk for infection increases when
- WBC decrease
- Neutrophils decrease
3. Risk for anemia increases when
- Red blood cell decrease
-Decreased H&H
4. Risk for bleeding increases when
-Decreased platelets
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What is NADIR?
1. Blood cell count at lowest point
2. Occurs at different times
3. WBC's and platelets day 7-14
4. RBC's may take several weeks
5. Immune system compromised
6. Treatments designed around NADIR
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What should we know about the levels of the absolute neutrophil count?
Calculation: (Total WBC) x [%neutrophils + % bands] divided by 100
1. >1500 = no increased risk of infection
2. 1000-1500 = slight increased risk
3. 500-999 = moderate increased risk
4. 100-449 = high risk
5. <100 = extremely high risk
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What are s/s of infection?
1. Fever of 100.5 or higher
2. Fatigue, body aches
3. Chill, sweating
4. Hypotension
5. Tachycardia
6. Lab Values
-WBC
- Neutrophil
7. Notify MD
- Obtain chest x-ray
- Blood and urine cultures
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Neutropenia is caused by?
1. Decreased production of WBC
2. Increased destruction WBC
213
What should we know about neutropenia?
1. Abnormally low ANC
2. No symptoms until onset of infection
3. Monitor CVC with differential
4. Treatment varies depending upon cause
214
What are some neutropenic precautions?
1. Wash hands frequently
2. Low bacteria diet
3. No fresh flowers, plants, pets
4. Avoid crowds
5. No visitors with infections
6. No immunizations
215
What is thrombocytopenia (decreased platelets) and what should we know about it?
1. PLT promote coagulation, vascular integrity, vasoconstriction, adhesion
2. Produced in bone marrow
-live 7-9 days
3. Reference values
-150,000-400,000
4. Critical values:
- < 50,000 or > 1 million
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What is patient education on thrombocytopenia?
1. Monitor stools/urine for bleeding
2. Use electric razor only,
3. APply ice to affected area if trauma occurs
4. Avoid dental work or other invasive procedures
5. Avoid aspirin and aspirin-containing products
6. Soft toothbrush and no flossing
7. No aspirin
217
What is the nursing management of thrombocytopenia?
1. Monitor platelet count
2. Monitor stools and urine for occult blood
3. Assess skin for ecchymosis, petechiae and trauma at least every shift
4. Educate client about bleeding safety precautions
5. Avoid IM injections and limit venipuncture
218
What is chemo-brain?
1. A "mental fog" caused by chemotherapy, radiation and some types of immunotherapy
219
What are some nursing interventions: Encourage with chemo-brain to:
1. Use a calendar or day planner
2. Write down every
3. Exercise the brain with crossword puzzles or other word or number games, jigsaw puzzles, play cards
4. Get physical exercise as tolerated
5. Ask for support (friends, family, support groups)
6. If it persists, some of the same drugs to treat Alzheimer's disease can be used
220
What is ascites?
1. Pathological accumulation of fluid within the abdominal cavity
221
What cancers is ascites common with?
1. Ovary
2. Breast
3. Colon
4. Stomach
5. Pancreas
5. End-stage liver disease regardless of cause
222
What are the symptoms of Ascities?
1. Abdominal distention
2.fullness
3.early satiety
4. Difficulty breathing
5. Decreased mobility
6. Edema
223
How is Ascites diagnosed?
1. Serum albumin/protein (CMP), a simultaneous diagnostic paracentesis checking ascitic fluid for WBC, Albumin, protein and cystology
224
How is ascites managed?
1. Low salt diet (reduces the associated water retention and helps reduce edema)
2. Diuretic therapy (monitor BP)
3. Paracentesis (usually palliative... fluid build up will return)
4. May place pleurx to enable patient to drain at home
5. Peritoneovenous shunts
225
True or false: Ascites is a late sign & usually a poor prognosis. Comfort is key in cancer patients?
1. True
