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Cancer 102
Based on LU cancer notes, Lewis and Adams
| Question | Answer |
|---|---|
| radiation therapy | delivery of high energy beams generate free radicals to break chemical bonds of DNA, used locally for cancer cells may be lethal or sublethal |
| Uses of Radiation therapy | definitive (primary) therapy, adjuvant therapy (co therapy), prophylaxis, disease control, palliative |
| brachytherapy | internal radiation therapy, more direct uses a catheter to place radiation directly at the site of cancer |
| general effect of chemotherapy on normal tissue | fatigue, anemia, alteration of taste |
| effect of chemo on bone marrow | infection, bleeding, anemia (cells replace 6-24 hours) |
| effect of chemo on neutrophils | leukopenia, infection (cells replicate 12 hours) |
| effects of chemo on GI Tract Cells | anorexia, mucostitis (mouth sore are a type), Nausea and vomiting, diarrhea. (cells replicate 12-24hours) |
| effects of Chemo on hair follicles | alopecia (cells replicate 24 hours) |
| effects of Chemo on ova and testes | reproductive dysfunction (replicate 24-36 hours) |
| Chemotherapy | medication therapy used to treat solid tumors and hematologic malignancy |
| Factors affecting chemotherapy | mitotic rate of tissue (quicker cells divide, quicker they respond to chemo), size, age and location of tumor, presence of resistant tumore cells |
| Main sites for Cancer metastasis | bone, brain, lungs, liver, adrenal glands |
| Tumor angiogenesis | blood vessels formed within tumors |
| defects in cellular proliferation cancer cells | same rate as normal cells but don't follow rules of equalibrium, produce more than 2 cells, not |
| Cancer incidence rates | relatively stable since 1992. Some types have become more common, others less so but overall the numbers are the same |
| Increased cancers | non-hodgkins lymphoma, skin cancer |
| decreased cancers | colorectal, lung, oral and pharyngeal cancer |
| Fastest rising cancer in the US | melanoma |
| Cancer incidence male/female | higher in men than women |
| Cancer incidence culture/ethnic | African american males highest death rate of all, among women caucasian woman get cancer more often, but african american woman die from it more |
| Cause of death | Cancer is second, heart disease first |
| dynamic equilibrium (cells) | normally cell proliferation equals cell degeneration |
| contact inhibition | proliferation control, normal cells respect the boundaries and territory of other cells, will NOT invade |
| rapid cellular proliferation | bone marrow, hair follicle, epithelial lining of the GI tract |
| slow cellular proliferation | myocardium and cartilage |
| Cancer cell proliferation | proliferate at the same rate as normal cells, but do not respond to dynamic equilibrium and contact inhibition. sometimes produce two cells during mitosis |
| prootoncogenes | normal cellular genes, important regulators of normal cellular processes, promote growth |
| tumor suppressor genes | suppress growth, regulate cell growth |
| oncogenes | tumor inducing genes, are mutated prootoncogenes |
| Benign neoplasms | well differentiated, not invasive |
| malignant neoplasm | range from well differentiated to undifferentiated. Characterized by ability to invade and metastasize |
| Stages of cancer development | initiation, promotion, progression |
| Initiation | mutation in the cells genetic structure resulting from an inherited mutation or following exposure to a chemical radiation or viral agent. Can develop into clone (group of identical cells). Irreversible (does not always develop into a tumor) |
| carcinogens | cancer-causing agents capable of producing cellular alterations |
| Genetic Susceptibility | cancer related genes have been identified, but it is believed that only 10% of cancers have a strong genetic link |
| Promotion | characterized by the REVERSIBLE proliferation of altered cells |
| Prevention factors | diet, exercise, quitting drinking and smoking etc... |
| latent period | period of time, 1-40 years, between initial genetic alteration and clinical evidence of cancer |
| Progression | final stage of cancer, increased growth rate of tumor, increased invasiveness and spread of cancer |
| Metastasis | spread of cancer |
| Location where cancer metastasizes | brain and cerebrospinal fluid, lung, liver, adrenal glands, bone |
| tumor angiogenesis | formation of blood vessels within the tumor |
| tumor associated antigens | cancer cell surface antigens as a result of malignant transformation |
| immunologic surveillance | response of immune system to antigens, main job of immune system in regards to cancer |
| Escape mechanisms cancer has for immune surveillance | suppression of factors that stimulate T cells to react, weak surface antigens, development of tolerance of immune system, suppression of immune system, blocking antibodies |
| Classification of Cancers | anatomic site, histology (grading), extent of disease (staging) |
| Anatomic site classification | identified by it's tissue of origin, anatomic site, and behavior of tumor (benign or malignant) |
| Sarcoma | originate from mesoderm (connective tissue, muscle, bone, and fat) |
| carcinoma | originate from ectoderm (skin and glands) and endoderm (mucous membranes of Respiratory, GI and GU tracts) |
| Lymphomas and Leukemias | originate from the hematopoieteic system (blood cancers) |
| Histologic Grading | appearance of cells and degree of differentiation evaluated by a pathologist, Four grades. The poorly differentiated tumors have a worse prognosis |
| Grade 1 | mild dysplasia (slight difference) and well differentiated |
| Grade 2 | moderate dysplasia, moderately differentiated |
| Grade 3 | severe dysplasia, poorly differentiated |
| Grade 4 | immature and primitive cells (anaplasia)and undifferentiated, hard to determine cell of origin |
| staging | determines the anatomic extent of the malignant disease |
| stage 0 | cancer in situ |
| stage 1 | tumor only in tissue of origin, localized growth |
| stage 2 | limited local spread |
| stage 3 | extensive local and regional spread |
| stage 4 | metastasis |
| TNM Classification system | uses tumor size (T), spread to lymph nodes (N), and metastasis (M) to classify the cancer T-N-M- The letter is followed by 0-4 or x 0-no evidence, 1-4 ascending degrees, x cannot be determined |
| Prevention of Cancer | Reduce or avoid exposure to carcinogens, healthy balanced diet, exercise 5x a week, adequate rest, Health exam, reduce stress, know the warning signs of cancer, Have cancer screenings as warranted, do self-exams, seek medical care if a change is noticed |
| CAUTION | Change in the bowel or bladder habits, A sore throat that does not heal, Unusual bleeding or discharge from body orifice, Thickening or lumps, Indigestion or diffuculty swallowing, Obvious change of wart or mole, Nagging cough or hoarseness |
| biopsy | only definitive means of diagnosing cancer |
| Surgical Therapy for cancer | preventative, cure and control, supportive and palliative, rehabilitative |
| irritants | medication that damages the inside of the vein causing phlebitis and sclerosis and limiting the future vein access. Does NOT cause tissue damage if it infiltrates |
| vesicant | if infiltrated into skin, can cause severe local tissue damage breakdown and necrosis |
| CVAD | central venous access device, placed in large blood vessels. used for long term access. Three types tunneled catheters, PICC, and implanted ports |
| Tunneled catheter | single, double or triple lumen, inserted through a central vein (central line)into the superior vena cava or right atrium |
| PICC | peripherally inserted central venous catheters, single or double lumen. Inserted at or above Antecubital fossa. Good for 6 months |
| Implanted infusion ports | port implanted in the skin with a line running to a vein. Must use a huber needle with these |
| teletherapy | external beam radiation, most common form of radiation treatment |
| Nursing Management of Problems caused by treatment | |
| GI, stomatitis, mucositis, esophagitis | asses oral mucosa daily, artificial saliva, discourage use of irritants |
| Nausea and vomiting | antiemetics, diversional activities, tell patient to eat and drink when not nauseated |
| anorexia | monitor weight, encourage small frequent meals, high protein and high calorie foods, avoid nagging |
| diarrhea | low fiber, low residue, consume at least 3L of water |
| Constipation | stool softeners |
| Hematology | Monitor lab values of LFT's, Hemaglobin, Hematocrit, WBC, and platelets |
| Integumentary | avoid sun, avoid other irritants, discuss potential hair loss, use mild soap (dove, ivory) |
| GU tract | Monitor urinary changes, discuss reproductive choices before treatment, |
| nervous system | monitor mental status |
| respiratory | monitor for pneumontitis, dry hacking cough, fever, and exertional dyspnea |
| Cardiovascular system | Monitor Heart changes, EKG |
| Psychoemotional | Fatigue and depression, rest when neccessary |
| biologic therapy | agents that modify the relationship between the host and the tumor by altering the body's response to the tumor cells. 1. direct antitumor effects 2. restore, augment, modulate host immune system 3. other effects such as preventing metastisize |
| targeted therapy | targets specific cellular receptors and pathways that are important to tumor growth |
| stem cells | may become any type of cell |
| bone marrow transplants, stem cell transplants | sometimes used effectively for treatments of certain cancers. Desired outcome is cure |
| Malnutrition | suggest nutritional supplementation as soon as weight loss of 5% is noted. Monitor Albumin and prealbumin levels. High Protein foods |
| Altered taste sensation | believed to be caused by cancer cells stimulating the bitter taste buds. Affects most cancer patients |
| Infection | primary cause of death in cancer patients. Lungs, GU system, mouth, rectum, peritoneal cavity and blood. Compromised immune system makes these patients very susceptible to infection |
| Normal Values on a CBC | |
| RBC's | male 4.5-6 female 4-5 |
| Hematocrit | 3x hemoglobin if fluid volume is normal |
| Hemoglobin | Male 13.5-18 Female 12-16 |
| platelet count | 150-400 |
| WBC | 4.0-11.0 |
| Remember for Histologic Classification | lower number best prognosis, higher number harder to treat |
| debulking surgery | reduce tumor size |
| nadir | blood counts are wiped out by the treatment, when they are most prone to infection and other problems |
| Which cancer has the highest mortality rate? | Lung Cancer 28% of all cancer deaths |
| Glioma | cancer of interstital (glial) cells in the brain, spinal cord, pineal gland, posterior pit gland or retina |
| adjuvant chemotherapy | administering chemo after surgery or radiation therapy |
| growth fraction | measure of the number of cells undergoing mitosis in a tissue |
| alkylation (alkylating agents) | process of forming bonds or linkages with DNA, either kills cell (when it attempts to divide) or slows the replication of the tumor cell |
| antimetabolites | chemically resemble building blocks of cells, interfere with the metabolism of tumor cells, |
| antitumor antibiotics | drugs obtained from bacteria that have the ability to kill cancer cells. Not widely used. Very specific to a type of cancer, cytotoxic |
| vinca alkaloids | older drugs derived from the periwinkle plant. prevent division of cancer cells |
| taxanes | isolated from the yew tree, prevents division of cancer cells. bone marrow toxicity caution |
| topoisomerase I | an enzyme that helps repair DNA damage |
| Corticosteroids (glucocorticoids) | dexamethasone and prednisone, suppress cell division. also given with chemo to reduce nausea, weight loss and tissue inflammation |
| Gonadal Hormones | used to treat tumors that contain specific hormone receptors. |
| antiestrogens | used to treat tumors that depend on estrogen for growth |
| aromatase inhibitors | antiestrogens that block the enzyme aromatase |
| androgen antagonists | prescribed for advanced prostate cancer |
| biologic response modifiers | given with antineoplastics (chemo) to help limit the severity of the immunosuppressive effects of those meds |
| cancer is cured | when every malignant cell is removed or killed through surgery, chemo, radiation or pt.s immunes system |
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