Flashcards in Oncology Deck (59):
growth that causes tissue to increase in size by enlarging each cell (heart muscle cells)
growth that causes tissue to increase in size by increasing the number of cells ( skin, hair, bone marrow, ...)
any new or continued cell growth not needed for normal development or replacement of damaged tissue.
Benign tumor cells
• Continuous or inappropriate cell growth
• Specific morphologic features
• Small nuclear-to-cytoplasmic ratio
• Differentiated functions
• Tight adherence
• No migration
• Growth- Expansion
• Normal chromosomes(eupliod)
• Low mitotic index
Examples of benign tumor cells
uterine fibroid tumors; moles; skin tags; endometriosis; nasal polyps
Rapid or continuous cell division
• Anaplastic appearance
• Large nuclear-to-cytoplasmic ratio
• No differentiated function
• Loose adherence
• Growth –Invasion
• Abnormal chromosomes (aneuploid)
• High mitotic index
Metastasis: Malignant transformation
some normal cuboidal cells undergone malignant transformation and have divided - forming tumorous area within cuboidal epithelium
Metastasis: Tumor vascularization
cancer cells secrete tumor angiogenesis factor (TAF) stimulating the blood vessels to bud and form new channels that grow into the tumor
Metastasis: Blood vessel penetration
cancer cells broken off from main tumor - enzymes make holes in blood vessels - cancer cells enter - travel around the body
Metastasis: Arrest and invasion
cancer cells clump up in blood vessels walls and invade new tissue areas- new tumors will form. (if conditions are right).
Staging of cancer - TNM Classification
1. Primary Tumor
2. Regional Lymph Nodes
3. Distant Metastasis
Grading of malignant tumors
Gx ( cannot be determined ), G1, G2, G3, G4
External factors ( environmental carcinogenesis)
1. Chemical : tobacco...
2. Physical : radiation, chronic irritation (tissue trauma)
3. Viral : viruses infect body cells and break the DNA strands
1. Immune function: cell mediated immunity - natural killer NK and T-cells . At risk: immunosuppressed, older than 60;
2. Advancing age: most important risk factor for cancer;
3. Genetics: testing foe cancer predisposition is available to confirm or rule out persons genetic risk.
Caution: Seven Warning Signs of Cancer
• Change in bowel or bladder habits
• A sore that doesn’t heal
• Unusual bleeding or discharge
• Thickening (lump) in the breast or elsewhere
• Indigestion or difficulty swallowing
• Obvious change in a wart or mole
• Nagging cough or hoarseness
• Protein tumor markers (PSA, CEA)
• X-ray/ MRI/ CT
• Endoscopy/ Laparoscopy
Treatment & Management: Goal:
Prolong Survival Time or Improve Quality of Life
Treatment & Management:
o Radiation Therapy
o Hormonal Manipulation
o Immune Therapy
o Photodynamic therapy
o Biologic Response Modifiers (BMRs)
o Targeted Therapy
Types of Surgery
1. Diagnostic: removal of leison
2. Prophylactic: removal at risk tissue
3. Curative: removal all cancerous tissue
4. Cytoreductive : part of cancerous tissue
5. Palliative: improve quality of life
6. Reconstructive/ Rehabilitative : increase of function
Radiation Therapy: purpose (local treatment)
destroy cancer cells with minimal exposure of the normal cells to the damaging action of radiation.
Gamma rays (used most commonly); beta particles; alpha particles (not used in cancer treatment); Inverse square law.
depends on the patients general health, and on the shape , size and location of the tumor.
distant treatment ; radiation source is external to the patient - patient is not radioactive and is not a hazard to others.
short or close therapy; radiation source comes into direct, continuous contact with the tumor tissue for specific period of time; uses radioactive isotopes ( solid form or within body fluids( radioactive iodine)); patient is hazard to others.
eliminated in wastes products within 48 hrs (which are radioactive);
Side effects of radiation therapy
1. skin changes and hair loss ( local)
2.altered taste sensations and fatigue ( external radiation)
3. tissue fibrosis and scaring
LDR and HDR
low dose radiation and high dose radiation
Radiation: priority nursing intervention
teaching patient about skin care
used to cure and increase survival time ; has some selectivity for killing cancer cells over normal cells. ; damage DNA and interfere with cell division.
Normal cells affected by chemotherapy
cells that divide rapidly - skin, hair, intestinal tissue, spermatocytes, blood forming cells.
Chemotherapy : methods of delivery most common
PO and IV; assess for extravasation (infiltration of drug into tissue)- pain, infection, tissue loss.
cross link DNA - making two DNA strands bind together which prevent proper DNA and RNA synthesis; Side effects: Nausea, vomiting, alopecia , anemia, bone marrow suppression, cystitis .
damage the cells of DNA; interrupt DNA or RNA synthesis ; side effects: alopecia, N&V, stomatitis, leukopenia, thrombocytopenia.
interfere with formation of microtubules so cells cannot complete mitosis during cell division. cancer cell cannot divide or divides only once.
"counterfeit metabolites" fool cancer cells into using them; impair cell division. SE: bone marrow supression, stomatitis; N&V, alopecia, hepatic and renal dysfunction.
block cellular division; derived from natural plants; SE: leukopenia, allergic reaction, alopecia, N&V, constipation, diarrhea.
decreased level of circulating RBC;
Assess: respiratory status: SOB; weakness, fatigue, dizziness, pale skin color, TX: epoetin alfa (Procrit);
Anemia : Teaching
• Get Rest/ Stand slowly to prevent dizziness when changing positions
• Limit activities
• Eat a well-balanced diet
decrease number of circulating WBC; At risk for infection: fungal, bacterial, viral;
- Washing your hands with soap and water and carry sanitizer for
times when you can’t
• Stay away from people who are sick
• Stay away from crowds
• Be careful around animals, do not clean litter boxes, pick up dog
• Do not get a flu shot or other vaccine b/c it may contain a live virus
• Wash raw foods & vegetables before eating them
• Don’t eat raw or undercooked fish, seafood, meat, chicken or eggs
decreased number of circulating platelets; Risk for excessive bleeding when platelet count is less than 50000; less than 20000 - at risk for spontaneous uncontrolled bleeding ; Avoid injury !!!
- Brush your teeth with a soft toothbrush
o Men- use an electric shaver, not a razor
o Blow your nose gently
o Be careful when using scissors, knives or other sharp objects
o Wear shoes all the time, even in the house
- Use dental floor or toothpicks
o Play sports or participate in other activities which you could
o Use tampons, enemas, suppositories or rectal
Nausea/Vomiting/ Appetite Changes
- Eat small meals & snacks (5-6), instead of 3 large meals
o Eat bland, not spicy foods, salty and/or acidic foods
o Provide anti-emetics before, during and after treatment
o Set a daily schedule for eating your meals and snacks
- Visit dentist at least 2 weeks before starting Chemotherapy
• Check your mouth and tongue daily
• Keep your mouth moist
o Clean your mouth, teeth , gums & tongue
o Be careful what you eat when your mouth is sore
o Stay away from things that can hurt, scrape or burn your mouth
Assess: sores, fissures, blisters, redness, tissue swelling, dry mouth, white patches.
Rinse mouth half peroxide half NS twice a day ( don't use commercial mouthwash)
Before Hair Loss
• If you plan to buy a wig, do so before you lose your hair
• Be gentle when you wash your hair
• Do not use items that can hurt your scalp
• Curling irons/ Brush rollers or curlers
• Hair Dyes/ Perms to relax hair
o After Hair Loss
• Protect your Scalp
• Sleep on satin pillow case (less friction)
• Talk about your feelings
teach how to prevent injury to the scalp; coping with body image change
Loss of sensory or motor function of peripheral nerves
Presentation: Tingling, Burning, Weakness, Numbness in Hands or Feet
o Priority: Injury Prevention
• Trouble Picking up Objects
• Shaking/ Trembling
Cancer Prevention: Primary
use of strategies to PREVENT the actual occurrence of cancer (most effective when there is known cause for cancer type)
Cancer prevention: Secondary
use of SCREENING strategies to detect cancer early, at a time when cure or control is more likely.
1. Sepsis or septicemia + DIC (disseminated intravascular coagulation)
2. SIADN : syndrome of inappropriate antidiuretic hormone
3. Spinal cord compression
5.Superior Vena Cava Syndrome SVC
6. Tumor Lysis Syndrome
problem with blood clotting ; Clots block blood vessels and decrease blood flow to major organs and result in pain, strokelike manifestations, dyspnea, oliguria, bowel necrosis - TX: anticoagulants.
Bleeding from many sites - clotting factors are given - Hemorrhage is the primary problem.
Water is reabsorbed - hyponatremia, , weakness, fatigue, fluid retention, muscle cramps, confusion, seizures, coma, death.
TX: fluid restriction, sodium intake + drug therapy; immediate cancer therapy. Safety - prevent fluid overload - pulmonary edema - heart failure.
Spinal cord compression
damage occur either when a tumor directly enters the spinal cord or when vertabre collapse from tumor degradation of the bone.
Back pain (paralysis) , muscle weakness, numbness, tingling, unsteady gait. TX: Palliative
occurs when SVC is compressed or obstructed by tumor growth or by formation of clots in vessel . Blockage of blood flow in the venous system of the head , neck, upper trunk.
S/s: edema of face, tightness of the shirt collar (Stokes sign); TX: high dose radiation therapy to provide temporary relief
Tumor Lysis Syndrome (positive sign - cancer treatment is effective)
large number of tumor cells are destroyed rapidly - intracellular content ( K + purines) released into bloodstream faster than body can eliminate them .
s/s: hyperkalemia - severe cardiac dysfunction ;
purines - liver - uric acid - hyperuricemia - block tubules - ARF . TX: Hydration 3000-5000 ml of water day before, day of, 3 days after treatment.
extreme body wasting and malnutrition
most dangerous type of skin cancer