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NSB236 > Week 4: Cancer Care > Flashcards

Week 4: Cancer Care Flashcards

(59 cards)

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1
Q

What are common psychological issues in response to cancer?

A
  • Body image
  • Sexuality
  • Interpersonal problems
  • New relationships post diagnosis
  • Stress and adjustment reactions / severe emotional distress
  • Anxiety, depression, PTSD
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2
Q

What are common practical issues in response to cancer?

A
  • Cost
  • Reconstructive surgery
  • Lymphoedema
  • Travel and accommodation
  • Other support needs
  • Loss of income
  • Difficulties with business dealings
  • Legal issues related to advanced disease
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3
Q

What are common physical issues in response to cancer?

A
  • Nausea and Vomiting
  • Pain
  • Fatigue
  • Fertility
  • Lymphoedema
  • Disfigurement
  • Odour
  • Incontinence
  • Bowel dysfunction
  • Cognitive problems
  • Communication difficulties
  • Malnutrition
  • Respiratory symptoms
  • End of life concerns
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4
Q

What are the 1st possible clinical course of cancer?

A 
Suspicious symptoms 
Workup for cancer 
Diagnosis 
Primary treatment 
Adjuvant therapy 
Rehab
Disease free (no evidence)
Long-term survival / cure
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5
Q

What is the 2nd possible clinical course of cancer?

A 
Suspicious symptoms
Workup for cancer
Diagnosis
Adjuvant therapy
Rehab
Disease free (no evidence)
Recurrence or dissemination
Progressive disease
Palliative treatment
Terminal Illness
Death
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6
Q

What is the 3rd possible clinical course of cancer?

A 
Suspicious symptoms
Workup for cancer
Diagnosis
Adjuvant therapy
No rehabilitation possible
No disease free interval
Progressive disease
Palliative
Terminal illness
Death
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7
Q

What is the 4th possible clinical course of cancer?

A 
Suspicious symptoms
Workup for cancer
Diagnosis
No primary treatment possible
Palliative treatment
Terminal Illness
Death
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8
Q

What is the scope of the problem with cancer?

A

Cancer is a group of more than 200 disease characterized by unregulated growth of cells

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9
Q

In 2007 how many people were diagnosed with cancer in Australia?

A

108,368

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10
Q

How many of those diagnosed with cancer in 2007 were over the age of 60?

A

68%

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11
Q

Which groups are worse off ?

A

Indigenous
Those living in remote areas
Low socioeconomic status individuals

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12
Q

Cigarette smoking is estimated to have directly caused ___% new cases of cancer and __% deaths in 2005

A

11%

21%

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13
Q

Alcohol consumption is estimated to have directly causes __% of new cases of cancer and __% of deaths in 2005

A

3%

3.5%

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14
Q

Obesity is consistently associated with what cancers?

A

Adenocarcinoma of the oesophagus
Kidney Cancer
Colon Cancer (men)
Breast & endometrial cancer in post menopausal women.

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15
Q

T/F there is sufficient evidence associating obesity with prostate cancer

A

False

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16
Q

T/F preventative effects increase with increasing physical activity in terms of duration and intensity

A

True

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17
Q

About __% of all cancer is attributable to lifestyle or environmental factors and is thus potentially preventable

A

75%

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18
Q

What are examples of primary prevention of cancer?

A

Sun smart campaigns
Tobacco Control Programs
Healthy lifestyle programs

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19
Q

What are examples of secondary prevention of cancer?

A

Breast screening
Cervical screening
Bowel cancer screening

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20
Q

How is cancer characterized and how does it arise?

A

Cancer can arise from any cell of the body capable of evading regulatory controls.
Cancer is characterised by defective cellular proliferation (cell growth) and defective cellular differentiation (cell maturation).

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21
Q

What is the process of cancer development?

A

Initiation: chemical, radiation, viral, genetic
Promotion: dietary fat, obesity, smoking, alcohol, stress(?)
Progression: increased growth and invasiveness

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22
Q

What does the cell undergo throughout cancer?

A

Cells undergo a series of genetic mutations and/or alterations which result in their inability to respond normally to intracellular and/or extracellular signals that control proliferation, differentiation and ultimately death

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23
Q

What are 5 mechanisms / processes that the body utilizes ?

A
  1. Contact inhibition
  2. Apoptosis
  3. Immune response
  4. Proto-oncogenes regulate normal cell processes
  5. Tumour suppressor genes suppress growth
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24
Q

What can result from genetic alterations?

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A

Genetic alterations can result from such factors as inherited gene mutations, chemical or radiation induced DNA damage, viruses or random errors during DNA synthesis

25
What is metastasis?
It is the spread of cancer from initial or primary site to a distant site.
26
What is the multistage process of cancer invasion?
Tumour angiogenesis Mechanical invasions Detaching and invading surrounding tissue and walls
27
What are the 3 stages of cancer classification?
Anatomic site = tissue is identified by tissue of origin, anatomic sit, and behaviour of the tumour (carcinoma - tumours of skin and mucous membrane) (Sarcoma - tumours of connective tissue, bone) (Lymphoma/leukaemia - haematopoetic system) Histologic analysis (grading) Extent of disease (staging)
28
What is the classification system for staging / grading the cancer?
Primary tumour (T) = - T0 no evidence of primary tumour - T1 carcinoma insitu - T2-T5 ascending degrees of increase in tumour size and involvement Regional lymph nodes (N) = - N0 no evidence of disease in lymph nodes - N1-N4 ascending degrees of nodal involvement - NX regional lymph nodes unable to be assessed clinically Distant Metastases = - M0 no evidence of distant metastases - M1-4 ascending degrees of metastatic involvement
29
How is cancer diagnosed?
- Cytology studies - Radiographic investigations (x-ray, mammogram, CT, MRI, PET, ultrasound, bone scan, isotope scans) - Endoscopy - Bone marrow aspiration - Surgery / biopsy - Blood studies (LFT, FBC) - Oncofetal antigens and other tumour markers
30
What are the goals of cancer treatment?
- Cure - Control - Palliate
31
What are the options for cancer treatment?
- Surgery - Radiotherapy - Chemotherapy - Biotherapy and molecular targeted therapy - Haematopoetic stem cell transplantation
32
What factors will influence treatment decisions?
- Tumour factors - Treatment factors - Patient factors
33
What is the basis for clinical trials?
They are designed with the intent of determining efficacy of new treatments
34
What is the role of surgery in cancer?
- Diagnosis and staging - Cur and / or control - Rehab - Supportive care - Palliation of symptoms
35
What is the role of radiotherapy in cancer?
- Radiation therapy is the use of ionising radiation to treat cancer - The absorption of irradiated energy in the tissues results in complex reactions affecting biochemical and molecular structures of the cells - Primary treatment for some cancer, adjuvant treatment for others - It's used for cure, control or palliation of cancer
36
What is adjuvant therapy?
Also known as add on therapy, it is therapy that is given in addition to the primary or initial therapy to maximise its effectiveness
37
What equipment is used in radiotherapy?
Ionising radiation is formed using a linear accelerator. Teletherapy (delivered externally from a distance) Brachytherapy (administered internally close to the target) Unsealed sources
38
What are the principles of radiation safety?
As low as reasonable achievable principle. - Shielding - Time - Distance
39
What are nursing considerations for radiotherapy?
- Pt education and support | - Side effect management (early/late effects) = depends on treatment fields
40
What are common side effects of radiation therapy?
- Fatigue - Skin reactions (pruritis, erythema, dry desquamation, moist desquamation) - Anorexia - Mucositis - Nausea - Diarrhoea
41
What are 3 irritations that commonly occur from radiotherapy?
Mechanical irritation Thermal irritation Chemical irritation
42
What are intervention strategies to avoid irritations
``` Mechanical = avoid tight clothing, rubbing Thermal = avoid extreme temperatures Chemical = avoid topical application containing metal or alcohol bases ``` General care strategies
43
T/F chemotherapy is a systemic treatment
True
44
What is the history of cancer chemotherapy?
It originated as a biological weapon (derived from mustard gas). It led to the development of a number of single agent drugs and combination therapies. It is used as a primary treatment (e.g. leukaemia) or as adjuvant treatment to treat micrometastases
45
What is cell cycle specific drugs?
most effective against cells that are rapidly dividing; given in divided doses or continuous infusion
46
What is cell cycle non specific drugs?
effective against large slow growing tumours; given as a bolus dose
47
What is the benefit of endocrine therapies?
effective against hormone receptor positive cancers
48
What is combination chemotherapy?
Use of several drugs with different mechanisms of action, times of onset of action and recovery, side effects and onset of side effects
49
What are the priority interventions for patients receiving chemotherapy?
- Pt assessment and monitoring factors - Calculation of dose and drug check procedures - Routes of administration (principles of vascular access) - Pt education - Preventing, identification and management of extravasation - Side effect management - Safe handling procedures
50
Regarding safe handling, how can exposure occur?
- inhalation of drug aerosols or droplets - absorption through direct contact with skin - ingestion through contact with contaminated food, food containers
51
What are certain procedures required for?
Preparing, administering, disposing, transporting, cleaning up spills, handling excretions
52
What are common chemotherapy side effects?
- Neutropaenia - Thrombocytopaenia - Anaemia - Toxicities = cardiotoxicity, nephrotoxicity, pulmonary toxicity - Menopausal symptoms - Increased bone loss
53
What are nursing interventions for neutropaenia?
Potential for sepsis - septic shock is an oncological emergency Nursing actions = prevention and management
54
What are nursing interventions for thrombocytopaenia?
Potential for spontaneous bleeding. | Nursing actions = prevention and management
55
What is biotherapy and molecular targeted therapies?
Agents derived from biological sources, or agents or approaches that affect the body's biological responses: - interferons and interleukins - Haemopoeitic growth factors (e.g. erythropoietin, GCSF) - Experimental vaccines "Targeted therapies" - preferentially attack molecular flaws e.g. loss of tumour suppression; metastatic potential; angiogenesis; resistance to apoptosis: - Monoclonal antibodies - Tyrosine kinase inhibitors - Gene therapy
56
What are biotherapy side effects and nursing interventions for cytokins?
Patient education and support. Fatigue, flue like symptoms (chills / fever), bone pain (haemopoeitic growth factors)
57
What are nursing interventions and biotherapy side effects of interleukins?
Patient education and support - Cardiovascular - Pulmonary - GI - Renal - Haematologic - Flu like symptoms - Hepatic - Integumentary - Neurologic - Psychosocial
58
What are nursing interventions for biotherapy and molecular targeted therapies side effects?
Monoclonal antibodies: - Infusion reactions and hypersensitivity reactions - Cardiotoxicity - Bone marrow suppression (less) - Fatigue Tyrosine kinase inhibitors - Skin eruptions - Diarrhoea, nausea, vomiting
59
What are examples of transplantation?
- Autologous - Allogeneic - BMT & PBSCT

NSB236 (5 decks)

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