Exam 4: Oncology/Lung Cancer/Colorectal Cancer/Liver Cancer/Pancreatic Cancer Flashcards
(93 cards)
1
Q
Cancer
A
Uncontrolled and unregulated growth of cells caused by defective cell proliferation (growth) and defective cell differentiation.
2
Q
Chemical carcinogens
A
Drugs that interact with DNA (alkylating drugs)
3
Q
Radiation
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UV light causing skin cancer
4
Q
Radiation can lead to higher incidences of bone cancer for
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Radiologists
Radiation chemists
X-ray
5
Q
Viral carcinogens include
A
Hepatitis
AIDS
6
Q
An immunosuppressed or weakened body increases the risk for
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Cancer
7
Q
Benign neoplasms
A
- Normally differentiated.
- Growth does not infiltrate other areas.
- Does not metastasize.
- Cells are fairly normal and similar to parent cells.
8
Q
Malignant Neoplasms
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- poorly differentiated
- EASILY INVADE AND METASTASIZE*
- cells are abnormal and different than parent cells
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Q
Cancer: Grade I Cells
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Mild dysplasia: differ slightly from normal cells
Low grade: well differentiated
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Q
Cancer: Grade II Cells
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Moderate dysplasia: more abnormal cells
Intermediate grade: moderately differentiated
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Q
Cancer: Grade III Cells
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Severe dysplasia: very abnormal
High grade: poorly differentiated
12
Q
Cancer: Grade IV Cells
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Anaplasia: Immature and primitive undifferentiated
High grade: cell of origin is difficult to determine
13
Q
Cancer: Grade X Cells
A
Grade cannot be assessed.
14
Q
Cancer Stages: Stage 0
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Cancer in situ (only in epidermis, same cell growth, just multiplying fast (precancerous))
15
Q
Cancer Stages: Stage 1
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Tumor limited to tissue of origin
Localized tumor growth
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Q
Cancer Stages: Stage 2
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Limited local spread
17
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Cancer Stages: Stage 3
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Extensive local and regional spread
18
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Cancer Stages: Stage 4
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Metastasis (spreads to different organ)
19
Q
Tumor Size and Invasiveness Classification: T0
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No evidence of primary tumor
20
Q
Tumor Size and Invasiveness Classification: T1-4
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Increase in tumor size and involvement
21
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Spread to Lymph Nodes Classification: N0
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No evidence of lymph nodes involved
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Spread to Lymph Nodes Classification: N1-4
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Increase in nodal involvement
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Metastasis Classification: M0
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No evidence of distant metastasis
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Spread to Lymph Nodes Classification: M1-4
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Increased metastatic involvement, including distant nodes
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Prevention of Cancer
- Smoking Cessation
- Use sunscreen with sun protection factor of 15 or higher
- Limit alcohol intake
- Eating a balanced diet
- Maintain normal body weight
- Regular exercise (30 minutes or more 5x a week)
- Adequate rest
- Screenings
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Warning signs of colorectal cancer
Changes in bowel or bladder habits
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Warning signs for liver cancer include
1. A sore that does not heal (d/t lack of prothrombin, clotting factors and vitamin K)
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Warning signs for leukemia include
Unusual bleeding or discharge from any body orifice
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Warning signs for breast cancer include
Thickening or a lump in the breast or elsewhere
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Warning signs for GI cancer
Indigestion or difficulty swallowing
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Warning signs for lung cancer include
1. Indigestion or difficulty swallowing
| 2. Nagging cough or hoarseness
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Warning signs for skin cancer include
Obvious changes in wart or mole
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Diagnostic Studies for Cancer
- cytology studies (sputum samples, bronchoscopy)
- Tissue Biopsy
- CXR
- Lab Work
- Liver Function Studies
- Endoscopic Examination or Colonoscopy
- Radiographic Studies: mammography, ultrasound, CT scan, MRI
- Radioisotope scans: bone, lung, liver, rain
- PET scan: indicates effects of therapy
- Tumor Markers (CEA, AFP, PSA, CA-125)
- Genetic Markers (BRCA1, BRCA2)
- Molecular receptor status (estrogen and progesterone receptors)
- Bone marrow examination
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Lab Work: Cancer
- CBC, chemistry profile
- WBC’s usually elevated
- RBCs usually decreased (prothrombin, clotting factors, vitamin K impaired for liver cancer; GI bleeding for colorectal cancer)
- Hb/Hct
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Liver Function Studies: Cancer
AST, ALT, usually elevated in liver cancer
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Goal for Cancer Treatment
Cure
Control
Palliative
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Surgical Treatment for Cancer
```
Cytoreductive Procedure (Debulking)
Neoadjuvant
```
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Cytoreductive Procedure
Surgically removing as much tumor as possible prior to chemotherapy and radiation therapy
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Neoadjuvant
Chemotherapy and radiation performed to help shrink tumor before surgery
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Post op care after surgery for cancer includes
Splinting incision (have pillow and hold it where incision is, during deep breathing and coughing)
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Chemotherapy Nursing Implications
- Only administered by properly trained personnel (oncology nurses)
- Our role is to care for medication sites
- Take care in handling body excretions first 48 hours, monitor and put in yellow containers.
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Radiation Therapy
Emission of energy destroys cancer cells.
| Once a day, 5 days a week
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Radiation Therapy: Nursing Implications
- Patient may wash themselves only with plain water and mild soap (no powders, lotions, scratching or scrubbing)
- Limit visitors for 10-30 minutes and stay 6 feet away from patient
- Bed rest is important
- Neutropenic precautions
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Radiation Therapy: Adverse Effect
Can lead to anemia (bone marrow suppression)
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Neutropenic Precautions include
- Strict hand washing
- No sick visitors or personnel
- No plants or fresh fruit or vegetables
- Pure bottled water (no tap)
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Biological Targeted Therapy
- Effective alone or with surgery, radiation and chemotherapy.
- Causes flu-like symptoms, increases fluid
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Biologic Therapy
Agents that alter biologic response to tumor cells
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Targeted Therapy
Targets and binds cell receptors important to tumor growth
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Hematopoietic Stem Cell Transplantation
Allows high doses for treatment:
1. Failing to respond to standard doses of chemotherapy or radiation.
2. Develops resistance
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Common Side Effects of Chemotherapy and Radiation
1. Bone Marrow Suppression
2. Fatigue
3. GI Disturbances: N/V/D, ulcers, anorexia, constipation
4. Integumentary and Mucosal Reactions: Alopecia, May cause thickened secretions, May cause tissue breakdown and infiltration
5. Pulmonary effects
6. Reproductive dysfunction
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Chemotherapy and Radiation Side Effects: Bone Marrow Suppression
- Neutropenia (decreased neutrophil count) -> risk for infection and sepsis
- Thrombocytopenia (decreased platelet count) -> risk for hemorrhage and bleeding
- Anemia (symptoms like fatigue and weakness)
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Chemotherapy and Radiation Side Effects: Fatigue is caused by
- Accumulation of toxic substances in the body
- Need for energy to repair and heal body damaged by treatment
- Lack of sleep from chemotherapy drugs
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Lung Cancer: Pathophysiology
Inhaled carcinogens -> damage cell’s DNA -> abnormal cell growth -> malignancy that is uncontrolled
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What are possible causes of lung cancer?
1. 80-90% caused by smoking (carbon monoxide and nicotine) - interferes with normal cells development
2. Second hand smoking
3. Environmental and occupational exposure
4. Genetics: African Americans - highest incidence
5. Dietary factors
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Types of Lung Cancer
1. Small Cell Lung Cancer
| 2. Non-Small Cell Lung Cancer
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Small Cell Lung Cancer
20%
- Most malignant form
- Very rapid growth rate
- Metastasizes early via lymphatics and bloodstream
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Non-Small Cell Lung Cancer
80%
| Includes adrenocarcinoma and large cell carcinoma
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Adrenocarcinoma
Moderate growth
| Early metastasis
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Large cell carcinoma
Rapid growth
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Clinical Manifestations of Lung Cancer
- Coughing (reported first)
- Hemoptysis and blood tinged sputum (bleeding caused by malignancy)
- Dyspnea or wheezing
- Chest and shoulder pain (may be localized or unilateral)
- Weakness, anorexia, weight loss, N/V
- Unilateral paralysis of the diaphragm
- Hoarseness, dysphagia (pressure on laryngeal nerve)
- Head and neck edema
- Fever
- Palpable lymph nodes in neck or axillae
- Pericardial effusion, cardiac tamponade, dysrhythmias
- Pleural effusion
- Symptoms of ectopic hormones
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Nursing Considerations: Goals for Lung Cancer Treatment
- Effective breathing patterns
- Adequate airway clearance
- Adequate oxygenation of tissues
- Minimal to no pain
- Realistic attitude about treatment and prognosis
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Nursing considerations for Lung Cancer Patients
- Encourage smoking cessation
- Emotional support and pain management
- Pneumenectomy (removal of entire long) or lobectomy (removal of one or more lobes)
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Pneumonectomy
- May require chest tube to keep fluid in and prevent air from entering (not continuous suction, stays clamped)
- Post op: splint incision
- Encourage incentive spirometer use
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Causes of Colorectal Cancer
- Diet
- Lifestyle
- Health Factors
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What kind of diet can lead to colorectal cancer?
- High in red or processed meat (nitrites)
| - Low in fruits and vegetables
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What kind of lifestyle leads to colorectal cancer?
- Obesity
- Physical inactivity
- Alcohol
- Long-term smoking
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What health factors leads to colorectal cancer?
- Genetic conditions such as FAP (polyps)
- History of IBD
- Individual or family history of colorectal cancer
- Colorectal polyps
- Age, and more common in men
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Pathophysiology of Colorectal Cancer
Tumor grows -> penetrates muscularis mucosae -> reaches lymph nodes and circulation -> metastasis
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Clinical Manifestations of Colorectal Cancer
- Iron-deficiency anemia
- Rectal bleeding (most common)
- Abdominal pain and tenderness
- Change in bowel habits (alternating constipation and diarrhea)
- Narrow, ribbon-like stool
- Sensation of incomplete evacuation
- Intestinal obstruction or perforation
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Early Symptoms of Colorectal Cancer
fatigue and weight loss (nonspecific)
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Advanced symptoms of Colorectal Cancer
abdominal tenderness
palpable abdominal mass
hepatomegaly
ascites
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Diagnostics for Colorectal Cancer
- Digital Rectal Examination
- Barium Enema
- CT and MRI abdomen
- Sigmoidoscopy & Colonoscopy (screening starts at 50 years old)
- Testing for stool occult blood
- Labs: CBC, liver functions tests, carcinoembryonic antigen
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Colonoscopy
Polyps can be removed during colonoscopy
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Bowel Prep for Colonoscopy and Sigmoidoscopy
- Clear liquid diet 24-48 hours prior to procedure.
- NPO after midnight.
- Golytely or Miralax 2 L nigh before and 2 L morning of procedure.
- Successful if stool is clear or yellowish liquid and indicates the colon is clean.
75
Nursing Considerations for Colorectal Cancer
- Decreasing risk of CRC (physical exercise, balanced diet, screenings)
- Temporary or permanent colostomy
- Proper bowel prep
- Reduce colonic bacteria and chance of intra-operative and post-operative infection (meticulous care)
- Emotional support and pain management
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Causes of Liver Cancer include
- Chronic liver disease
- Hepatitis B and C
- Cirrhosis of the liver
- Exposure to chemical and toxins
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Risk Factors for Liver Cancer
- Cigarette smoking
- Alcohol
- Aflatoxin (poison produced by mold on crops such as corn and peanuts)
78
Clinical Manifestations of Liver Cancer
Similar to Cirrhosis
- Dull, epigastric or RUQ pain
- Anorexia, weight loss, N/V
- Loss of strength
- Anorexia
- Anemia -> risk for bleeding (prothrombin, clotting factors, vitamin k impaired)
- Hepatomegaly
- Jaundice -> pruritis
- Ascites (increased abdominal girth)
- Peripheral edema
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Complications of Liver Cancer include
- Splenomegaly (blood backs up into spleen)
- Portal vein thrombosis (blood stasis above liver)
- Pulmonary emboli
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Nursing Considerations: Goals for Liver Cancer
Provide patient comfort and symptomatic management (similar to liver cirrhosis)
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Nursing Considerations for Liver Cancer
- Treatment of Hep B&C
- Decrease alcohol intake
- Correct Fluid Retention
- Jaundice and skin assessment
- Pruritus Management
- Transhepatic biliary tubes
- Radiofrquency ablation
- Chemoembolization
- Systemic chemotherapy
- Liver Transplant
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Transhepatic Biliary Tubes
-Allows decompression of obstructed extrahepatic bile ducts
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Transhepatic Biliary Tubes: Nursing Care
- Observe for bile leakage at insertion site
- Monitor for dark green mucous
- Only flush with MD order
- Cleansed daily with antiseptic
- Do not aspirate (to avoid pulling out fecal matter)
- Increased secretions after insertion indicate blockage
84
Radio frequency ablation
- Thin needle inserted into tumor and uses electrical energy to destroy tumors.
- Done percutaneously, laparoscopically or through open incision.
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Radiofrequency ablation: Complications include
Infection
Bleeding
Dysrhythmias
Skin Burn
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Chemoembolization
Minimally invasive
| Uses catheter to administer emboli agent and chemotherapy agents
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Alcohol injection
Insert liquid high concentration of alcohol, effective in small sized tumors..
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Pancreatic Cancer
Carcinomas of the head of the pancreas, the ampulla of Vater, the common bile duct and the duodenum
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Risk Factors for Pancreatic Cancer
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Chronic pancreatitis
DM
Age
Cigarette smoking
Diets high in fat
Exposure to chemicals (like gasoline)
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Clinical Manifestations of Pancreatic Cancer
- Abdominal Pain (dull and aching): can radiate to back
- Anorexia, rapid weight loss, N/V: eating aggravates symptoms (d/t lack of digestive enzymes form pancreas which leads to poor digestion and absorption)
- Jaundice -> pruritus
- Gray, pale, greasy stool (d/t lack of pancreatic juice going into the intestines for digestion)
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Nursing Considerations for Pancreatic Cancer
- Similar care as pancreatitis
- Emotional support and pain management
- Adequate nutrition (supplemental feedings might be necessary)
- Monitor for bleeding from body orifices and mucous membranes (decreased Vit K production)
- Surgical removal of Pancreas
- Radical Pancreaticodueodenectomy (Whipple Procedure)
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Whipple Procedure
- Removal of head of pancreas, distal pancreas, gallbladder, part of duodenum and regional lymph nodes
- Anastomosis of pancreatic duct, bile duct, and stomach to the jejunum
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Whipple Procedure: Complications include
- decreased insulin production, may become insulin dependent
| - common complication: pancreatic juices leaking, drainage system needed
