Oncology Flashcards
Risk Factors
most important RF: AGING
TOBACCO is the #1 cause of preventable cancer
SMOKING AND TOBACCO are CO-CARCINOGENIC
Dietary: Low fiber, increased Red meat, increased fat, ALCOHOL, nitrites (processed meat), preservatives and additives
INCREASED INCIDENCE: in the immuno suppressed (thats why higher incidence over age 60)
decreasing risk: cruciferous vegetables (broccoli, cauliflower, cabbage, vitamin A foods (foods with orange color), Vitamin C
Also regular physical activity
AFRICAN AMERICANS have increased risk
CHRONIC irritation increases risk of abnormal cell growth. (smoking, reflux, scarring, rubbing
Primary prevention:
prevent actual occurrences - sun screen, proper diet, no smoking, no alcohol, exercise
Secondary prevention:
using screenings to detect cancer at early stage (greater chance to cure or control)
Female prevention
monthly SELF breast exams over age 20
YEARLY clinical breast exams over age 40 (ages 20-39, every 3 years)
annual pelvic exam, Pap smear every 3 years if no problem -prior to pap exam NO sex, NO douching
Mammogram: yearly at age 40 (2 views) -no deodorant or lotion
Colonoscopy: at age 50, every 10 years after (if results are good) fecal occult sample
Male prevention:
Monthly self breast exam, monthly self testicular exam (very fast growing tumors)
Over age 50: yearly digital exam and yearly prostate specific antigen
colonoscopy at 50 YO then every 10
General S/S
CAUTION: Change in elimination habits (bowel/bladder) A sore that does not heal Unusual bleeding or discharge Thickening or lump in breast or elsewhere Indigestion or difficulty swallowing Obvious change in wart of mole Nagging cough or hoarseness
Ca can invade bone marrow> anemia (hypoxia), thrombocytopenia (bleeding pro cautions: electric razer, soft TB, no IM)
Cachexia- extreme wasting & mal-nutrition associated with Ca
Internal Radiation
1) internal radiation (brachytherapy)- radioactive source is inside the client; radiation is being emitted.
unsealed- client AND body fluid emits radiation. Isotope is given IV or PO. Radioactive for 24-48 hours (thiroidectomy)
sealed or solid: clients emit radiation; body fluids do not. Implanted close to or in the tumor for hours or days. (cervical cancer- rice/bead implanted)
CONCEPT- time, distance, shielding
nursing assignments should be rotated daily, nurse should only have 1 radiation implant client per shift - protect nurses
PRECAUTIONS: private room, wear film badge at all times, restrict visitios (limit to 30 min/day), no visitors under 16, must stay at least 6’ from sours( patient -get act together before entering room), no pregnant nurses/visitors, mark room with instructions for specific isotope, wear gloves for ALL body fluids.
prevent dislogement of implant- bed rest, low fiber diet (decrease chance of bowel distention), prevent bladder distention
if implant becomes dislodged -gloves, forceps, place in lead lined box, call radiation docs.
DONT FORGET client is IMMUNOSUPPRESSED -NO fresh fruit, flowers, stagnent water, don’t place infectious Pts in same room
General Tx
Radiation (internal & external), chemotherapy, surgery (electrosurgical excision, laser, cryosurgery)
External Radiation:
symptomatic at site
Side Effects: dry skin, erythema (redness & itching), shedding of skin, altered taste, fatigue, Pancytopenia (all blood levels decreased)
many S/S are location and dose related
DONT mess with markings Docs use to provide therapy
1 yr post therapy client must protect site from sun.
good skin care after therapy is important, but NO skin care during
Chemotherapy:
works on cell cycle -some drugs are cell cycle specific some are non-specific. If using both, its called combination chemo
scheduled 3-4 weeks, client must rest in between & EAT WELL.
chemo drugs absorb through skin and mucous membrane; use caution & proper handling (gloves)
usual SIDE EFFECTS: alopecia (hair loss), N/V, mucositis (mouth sores), immunosuppression, anemia, thrombocytopenia.
VESICANT - type of chemo that causes NECROSIS if it INFILTRATES (extravasation). nurse must stay with patient during the whole infusion time
S/S of extravasation: pain, swelling, no blood return. PREVENT this from happening
Tx of extravasation: stop infusion, vasoconstriction (prevent spreading) - ice packs to promote vaso-constriction. inject surrounding site with Bicarb to neutralize it & inject with faso constriction drugs.
(usually during infiltration heat therapy is used instead of cold therapy, but extravasation is different)
General ways to prevent infection
private room, wash hands, have own supplies in room (cup, steth, BP cuff), limit people (nurses & visitors), CHANGE DRESSING & IV DAILY, cough and deep breath, no fresh flowers or potted plants, avoid crowds, do not share toiletries, bathe warm moist areas TWICE daily (groin & underarms), wash hands after touching pet & anything else, avoid raw fruits & veggies, drink only fresh water ( less than 15 minutes old).
SLIGHT increase in temp may mean SEPSIS,
absolute NEUTROPHIL count is MOST IMPORTANT lab value
Cervical Cancer:
RF: #1 is HPV, repeated STD (irritation), many sexual partners (which also is STD and HPV territory), smoking & 2nd hand smoke, nutritional deficiencies -Folate, Beta-Carotene & Vitamin C, prolonged hormonal therapy (moms who took DES during pregnancy put daughter at risk), Family Hx, Immunosuppression, sex at young age & multiple pregnancies, young age at first pregnancy.
S/S: asymptomatic in pre-invasice cancer, invasive cancer (spread beyond the layer of tissue in which it developed and is growing into surrounding, healthy tissues) - painless vaginal bleeding. General Sx -watery, blood tinged vaginal discharge, pelvic pain (may occur with sex), leg pain, along sciatic nerve (pressure), and flank/back pain
100% cure if detected early
Dx: Pap test -repeat if the test is abnormal.
Tx: electrosurgical excision, laser, cryosurgery, radiation & chemo for late stages, conization -remove part of cervix (preserve fertility), hysterectomy
Uterine Ca:
RF: age greater than 50, taking estrogen therapy w/o progesterone, family Hx, late menopause, null parity
S/S: major -POST MENOPAUSAL BLEEDING (50%of the time it is Uterine Ca). General Sx - watery/bloody vaginal discharge, low back/abd pain pelvic pain
Dx: CA- 125 (blood test) to Rule Out Ovarian involvement
Test for metastasis: CXR, IVP (intra venous pyelogram -Xray contrast medium to see urinary system, including the kidneys, ureters, and bladder), BE (barium enema), CT, and Liver & Bone Scan.
Dilation & Curettage (dilate cervix and scrape uterus) Endometrial biopsy -MOST DEFINITIVE Dx test
Tx: SURGERY: Hysterectomy TAH (total abd hysterectomy) = uterus and cervix ONLY! bilateral oophorectomy -ovaries bilateral salpingectomy -tubes
Radical Hysterectomy (abd & perineal dressings)
may remove all the pelvic organ, may have colostomy or ileal conduit (bladder), greatest time for hemorrhage is FIRST 24 HOURS, major complications w/ abdominal hysterectomy -BLEEDING, major complications w/ vaginal hysterectomy -INFECTION, must void in the next 8 hours -check for bladder abstention (we do not want tension on the suture line)
Dehiscence: separation of sutures
Evisceration: organs visible> sterile saline 4X4>call doctors>don’t leave Pt
Avoid high fowlers to prevent blood pooling in pelvis
AT RISK FOR: pneumonia, thrombophlebitis (blood clot causing swelling in vein), constipation -EARLY AMBULATION
Avoid: sex, driving, girdles, douches (abdominal destination), exercise that causes pelvic congestion (heaving lifting)
Hemorrhage possible 10-14 days after surgery
whitish vag discharge is ok (other colors are bad)
showers are ok baths lead to ascending infection
RADIATION: intra-cavitary radiation to prevent vaginal recurrence
CHEMOTHERAPY: adriamycin, platinol-AQ
ESTROGEN INHIBITORS: Depo-Provera, Nolvadex/soltamox (if tumor is estrogen dependent)
Breast Ca
RF: If a 1st DEGREE relative (mom, sis, kid) had premenopausal BrCa then you have a 3 FOLD RISK INCREASE, high dose radiation to thorax before 20 YO, period onset before 12 YO, Menopause after 50 YO, Null parity, 1 kid after 30 YO.
S/S: Change in boob appearance (orange peal, dimpling, retraction, discharge) or lump. Tail of Spence is where 48% of tumors occur -upper outer quadrant
Tx:
SURGERY:
Post op- bleeding>check dressings, back (pooling of blood underneath tissue), hemovac, JP drain (increased amount of blood output than normal). Elevate arm on AFFECTED/surgical side (removal of lymph tissue inhibits ability to drain). STAY AWAY from affected limb for LIFETIME (no BP, injections, wear gloves when gardening -Pt, watch cuts, no nail biting, sunburn). On affected side- brush hair, squeeze tennis balls, wall climbing, flex and extend elbow to promote collateral circulation. Make Pt look at incision -helps them adapt and cope (how willing to participate in care). rehab/support groups, Lymphedema - fighting infection and promote drainage is not occurring.
CHEMO: Taxol, Adriamycin
HORMONAL THERAPY:
Estrogen receptor blocking agents- Nolvadex/soltamox
Estrogen synthesis inhibitors- Lupron, Zoladex
RADIATION
Lung Ca:
RF: leading cause of Ca death world wide, five year survival rate is 16%, MAJOR rf is SMOKING (smoking cessation for 15 years is similar to that of non smoker)
S/S: hemoptysis (coughing up blood), dyspnea (SOB -may be confused with TB, but TB has night sweats also), hoarseness, cough, change in endurance, chest pain, pleuritic pain on inspiration, displaced trach. May metastasize to bone.
Dx:
Bronchoscopy- NPO pre and until gag reflex returns, watch for respiratory depression (resp should ALWAYS be in perfect parameters 12-20), hoarseness, dysphagia, SQ emphysema (EMERGENCY -AIR UNDER TISSUE means lung is perforated and sounds like rice crisps). decreased reap rate is NOT the same as resp depression (breaths under 12/min)
Sputum specimen- obtain in morning, rinse mouth out with water first (decrease bacterial count), STERILE procedure (mouth can not touch cup).
other Dx tests: CXR, CT, MRI
Tx:
Surgery- main treatment for Stage I & II
Lobectomy- take out part of lung. Place Pt with chest tubes and surgical side up! (prevent fluid accumulation in empty lung space)
Pneumonectomy- remove ENTIRE lung. Position Pt on AFFECTED side (surgical side down, good lung UP - keeps only healthy lung from accumulation fluid). No chest tubes because whole lung is gone, so no plural space left. AVOID severe lateral positioning - could cause mediastinal shift!
