39 notecards = 10 pages (4 cards per page)
What is cancer? What is the fastest growing cancer?
Uncontrolled group of cells.
Melanoma – fastest growing cancer rate.
What are the two biologic processes behind the growth of cancer?
1) Defect in Cellular Proliferation:
A. Usually activated because of cell degeneration or death.
B. Contact Inhibition - Normal cells don’t invade the territory of another. It's like a fence between the cell's territory.
Cancer cells divide haphazardly, indiscriminately & continuously. Where a normal cell divides into two cells, a cancer cell can divide into many more cells in one division. The rate of division is not faster, per say, but the cell divides haphazardly and can't control how it grows.
Pyramid Effect: Each cell division causes a mass of cells, abnormal division where the cell can't control anything.
Doubling Time: Time it takes for cancer mass to double.
2) Defective Cellular Differentiation:
2 genes affected by differentitaion mutations
Protooncogenes – Promote growth.
Oncogenes – Protooncogenes that have mutated and do not understand how growth is supposed to occur.
Tumor Suppressor Genes – Suppress growth of tumors.
Difference between malignant & nonmalignant –ability to invade & metastisize.
What are the 3 phases of cancer development?
Mutation occurs in the DNA of a cell.
DNA is permanently rearranged. It can either:
Options 1 and 2 are great and do not turn into cancer. Option 3 turns into cancer.
Cell has potential to clone self.
If not destroyed before cloning & reproducing then proliferation can occur.
Reversible proliferation: at this point, our bodies can reverse the process in theory. IF the mass is small enough, the body can destroy it.
Lifestyle habits: Play a large role in whether or not the body can fight off cancer on its own.
Complete carcinogen: Cigarette smoke is a complete carcinogen (it can cause cancer all by itself).
Latent period – time between genetic alteration & clinical evidence. If it's short, the cancer is probably a fast-growing one.
Critical Mass: the point at which cancer cells become evident.
Increased growth rate of tumor & by increased invasiveness & metastasis.
Metastasis: Goes from one place to a distant place
Is a multistep process.
Tumor Angiogenesis: Tumor's ability to cells to establish its own blood supply away from the original site. No angiogenesis, no metastasis.
Invades surrounding tissues.
What are the roles of the immune system in fighting against cancer?
Identifies self from non-self
Immunologic Surveillance – identifies antigens on surface of malignant cells
Oncofetal Antigens – type of tumor antigen
What are the purposes of classification of cancer?
Relays information to healthcare team.
Determines the best treatment plan.
Evaluates treatment plan.
How is a tumor identified anatomically?
Tumor is identified by:
1. Tissue of origin
2. Anatomic Site
3. Tumor behavior (benign or malignant)
How is a tumor graded histologically?
Appearance & degree of differentiation are evaluated.
Poorly differentiated tumors - worse prognoses.
Grade I –Slightly different from normal (mild dysplasia) & well differentiated (low grade).
Grade II –More abnormal (moderate dysplasia) & moderately differentiated (intermediate grade).
Grade III – Very abnormal (severe dysplasia) & poorly differentiated (high grade).
Grade IV – Immature & primitive (anaplasia) & undifferentiated; cell of origin is difficult to determine (high grade).
Grade X – Cannot be assessed.
How is a tumor staged clinically?
Based on extent of disease rather than cell appearance.
Stage 0 – Cancer in situ (localized to specific site of origin).
Stage I – Tumor limited to original tissue with localized growth.
Stage II – Limited local spread (has gone to other surrounding tissues).
Stage III – Extensive local & regional spread.
Stage IV – Metastasis (spread to distant site).
What is the TNM classification for cancer?
N – Spread to lymph nodes
M – Metastasis
What are the methods of prevention and detection of cancer?
What are the 7 warning signs of cancer?
C – hange in bowel or bladder habits.
A – sore throat that doesn’t heal.
U – nusual bleeding or discharge from any body orifice.
T – hickening or a lump in the breast or elsewhere.
I – ndigestion or difficulty in swallowing.
O – bvious change in a wart or mole.
N – agging cough or hoarseness.
What are the ACA's recommendations for early detection of cancer?
Colon & rectum
How is cancer diagnosed? What is the only definitive way to diagnose cancer?
ID Risk Factors
Specific Diagnostic Studies:
Biopsy is the only definitive of cancer diagnosis.
Histologic exams on tissue.
Needle – Needle aspiration
Incisional – Scalpel or dermal punch
Excisional – Entire tumor
What are the goals of cancer treatment?
Palliation: Relief & control of symptoms
All goals are achieved through 4 treatment modalities:
4. Biologic therapy
What are the benefits of surgical therapy?
Cure & Control
Palliative Care – makes person comfortable
What is the goal of chemotherapy? How do cancer cells respond to chemotherapy?
Goal of chemotherapy
Cancer cell response factors to chemo:
Brain tumors do not respond well to almost anything. Can't get most therapeutic agents through the BBB. Most the time have to radiate brain tumors.
What are the different types of chemo?
Cell cycle-nonspecific chemotherapeutic drugs
Cell cycle phase-specific chemotherapeutic drugs
What should a nurse know about chemo preparation and administration?
Dangerous to healthcare workers: Only chemo trained nurses should handle, prepare and administer.
Methods of Administration:
Oral & peripheral IV – most common methods. MUST WATCH IV SITE. If it infiltrates, it will destroy all surrounding tissue in a short period of time.
Central Vascular Access Device: usually for long-term chemo.
Can cause systemic infection.
Monitor temp and CBC frequently
Regional Chemotherapy Administration:
What are some side effects of chemo?
What is the treatment plan regarding chemo?
Most given in combination with radiation.
Calculated according to body wt.
Chosen based on responsiveness of the tumor.
Principles of combination therapy:
All given according to a schedule with times of rest.
May be repeated several times.
What are the principles of radiation therapy?
Breaks DNA bond of cells.
Cumulative doses best.
Most normal tissue can recover.
GI tissues, oral tissues, bone marrow respond best.
Cartilage, bone, & kidney cells respond poorly.
Simulation – Fluoroscopy identifies the structures to be radiated & marks are placed.
Goals of Radiation Therapy:
How do chemo and radiation affect bone marrow?
Bone Marrow Suppression
Causes infections, hemorrhage and fatigue.
Potentially life threatening
Chemo – systemic / Radiation - local
Bone marrow effected at same rate as the life span of the cell in question.
WBC’s – 1-2 wks.
Platelets – 2-3 wks.
RBC’s – 2-3 months.
Monitor blood counts carefully.
Nadir usually comes at 7-10 days after initiation of therapy.
How should a nurse manage fatigue as a side effect of chemo and radiation?
Begins during 3rd to 4th wk.
Encourage rest before activity and activity when feeling more energetic.
Remain active as much as possible.
What are GI effects of chemo and radiation?
GI Effects – due to sensitivity of GI tissues:
Nausea & Vomiting
Mucositis: Irritation, inflammation, and/or ulceration of mucosa.
Xerostomia – due to damaged salivary glands
Dysgeusia – loss of taste, progressive during therapy.
Odynophagia: painful swallowing
Careful oral assessments vital.
Teach patient to examine oral cavity.
Teach meticulous oral care.
Kepivance – given IV and stimulates cells on surface layer of the mouth to grow.
What are some skin reactions caused by chemo and radiation?
Erythema - 1-24 hrs after treatment.
Wet Desquamation –Dermis is exposed & oozing occurs. Keep area clean & protected. No lotions or applications. Burow’s solution soaks.
Dry Desquamation – associated with pruritus. Lubricate.
No heating pads, ice packs, hot water bottles on irradiated area. Could cause tissue damage. They lose sensation on radiated area.
Palmar-plantar erythrodyesthesia (PPE) – hand/foot syndrome
Radiation – effects are local
Chemo – effects are systemic
What are some pulmonary and cardiovascular effects of chemo and radiation?
What are the effects of chemo and radiation on the reproductive system?
Permanent Aspermia – recovers in 2-5 years or not at all.
No avenue of repair for ovarian function. Use shielding.
Prior counseling is advised & banking of sperm or ova may be desired.
Recommend men and women to bank sperm and eggs before chemo if having abd or pelvic radiation. If not pelvic or abd radiation, could just use shield to protect it. But chemo also causes reproductive ramifications.
What are some late risks of chemo and radiation?
Cancer survivors at risk for leukemias & other secondary malignancies.
Secondary malignancies = usually resistant to therapy.
Multisystem organ dysfunction
How does biologic therapy treat cancer? Target therapy?
Biologic therapy modifies the relationship between the host & tumor:
1. Direct antitumor effects.
2. Restore or improve host immune mechanisms.
3. Can interfere with cell’s ability to metastasize or differentiate.
Targets and disables pathways important in tumor growth.
Targets cancer cells without damaging normal cells.
What are some symptoms of biologic and target therapy?
Stimulate the release of other endogenous biologic agents.
Causes systemic immune and inflammatory responses.
Symptoms directly related to dose and schedule.
What are some nursing management principles a nurse should implement when caring for a patient on biologic or targeted therapy?
More severe symptoms
Tylenol before treatment and q 4 hrs as ordered for flu-like symptoms.
Demerol IV as ordered: Control chills
Plan periods of rest.
Assist with ADLs.
Monitor adequate oral intake.
Why are hematopoietic growth factors used in conjunction with chemo and radiation?
What are the principles of hematopoietic stem cell transplantation?
AKA “bone marrow transplant”.
Goal is cure.
Has many risks & some pts die from complications.
Types of Marrow Transplants:
2) Autologous: Receive own marrow. Marrow is treated and reinfused.
3) Syngenic: Stem cells from an identical twin are infused.
What should a nurse know about the stem cell harvesting procedure?
Done in an OR under general or spinal anesthesia.
Multiple bone marrow aspirants
Donor - pain at the collection site
After harvest, autologous bone marrow treated.
After allogenic procedures bone marrow can be infused within a few hours.
Goal is to kill cancer cells with large doses of chemo/radiation & “rescue” the bone marrow.
Complications are multiple infections from the immunosuppression & graft-versus-host disease.
What are some nutritional complications of cancer?
Altered Taste Sensation:
What is the primary cause of death complication in cancer patients?
Infection – primary cause of death in CA pts.
Can result d/t:
Notify doctor for temp > 100.4.
What are some emergent complications of cancer and what are their treatments?
Superior Vena Cava Syndrome
Spinal Cord Compression
Third Space Syndrome
Syndrome of Inappropriate Antidiuretic Hormone
Tumor Lysis Syndrome
Septic Shock & Disseminated Intravascular Coagulation.
Carotid Artery Rupture
What are the principles of management of cancer pain?
Inadequate pain assessment - single greatest barrier to effective pain mgt.
Always believe the patient.
Fear of addiction is not warranted.
Analgesics should be given round the clock with additional doses as needed.
Appropriate opioid doses are whatever is necessary to control the pain with the least side effects.
How should a nurse assist a patient in coping with the diagnosis of cancer?
Assess support systems.
Give written information about condition.
Help set realistic short & long term goals.
Assist with maintaining usual lifestyle patterns.