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Caring for Patients with Cancer - emphasis on care r/t breast cancer

Common Male Cancers Prostate, Lung/Bronchial, colorectal
Common Female Cancers Breast, Lung/Bronchial, Colorectal
Cancers documented through Heredity Breast & Colon Cancers
Cancers Risks: Age 70% of all cancers occur in persons >65 years old
Cancer Risks: Diet preservatives, high-fat, low-fiber foods, fried or charred (recommended to marinate 1st (vitamin c) or eat with alot of Vit C
Neoplasm New tissue mass; tumor
Benign Localized, encapsulated, stop at other tissue boundaries, respond to homeostatic controls, can damage other tissues through pressure and obstruction.
Primary tumor Original tumor site
Secondary Tumor areas where malignancy has spread (lymph nodes, liver, lungs, bones, brain) - only in malignancy
Malignant Aggressive growth: progressive deviation with each generation; do not stop growing and die; irreversible. Not under body's homeostatic control. Destroy surround tissue.
Metastasize Cells through blood or lymph circulation - most tumors have metastasized by diagnosis. Recur after surgical removal and other treatments.
Effects of Cancer Loss of function; hematologic alteration; infection; hemorrhage; wasting syndrome; hormone changes; pain; physical stress; psychosocial,emotional,Spiritual stress
Cancer Diagnosis Grading & staging Grading: least (1) to most (4) aggressive; Staging (0-4) T (tumor size)-N (lymph nodes)-M (metastases) Tumor Markers
Chemotherapy Action based on cell division; phase-specific and non-phase specific
Cell-Kill hypothesis with each cell cycle a % of cancerous cells are killed; multiple sequential chemotherapy treatments kill more and more cells until immune system can handle those that remain.
Cancer Treatment - Chemotherapy Often administered in combination
Cancer Treatment - Chemotherapy: Alkylating Agents create defects in tumor DNA; nitrogen mustard (Mustargen); cisplatin Toxic effects = renal, otic, myleosuppression
Cancer Treatment - Chemotherapy: Antimetabolites Specific for S phase of cell division; methotrexate (MTX, Trexall); 5-fluorouracil (5-FU) Toxic effects = stomatitis, leukopenia
Cancer Treatment - Chemotherapy: Antitumor Antibiotics Non-phase specific; interefere with DNA actinomycin D (Dactinomycin); blenoxane (Bleomycin) Toxic effects = damage to cardiac muscle & lung tissue
Cancer Treatment - Chemotherapy: Miotic inhibitors prevent M phase cell division vincristine (Oncovin); vinblastine (Velban) Toxic effects = affects neurotransmission, bone marrow depression
Cancer Treatment - Chemotherapy: Hormones G1 specific; inhibit growth corticosteroids: prednisone (Deltasone)
Cancer Treatment - Chemotherapy: Hormone Antagonist block hormones on hormone binding tumors (breast, prostate, endometrium) to cause tumor regression. tamoxifen (Breast); flutamide (Eulexin) for prostate Toxic effects = altered secondary sex characteristics
Chemotherapy Routes Oral, IV, intracavity
Chemotherapy Routes: Vascular access devices Limit extravasation (leakage into tissues) & duration and frequency of therapy PICC lines, Tunnelled catheters (Hickman, Groshong); Surgically implanted ports
Chemotherapy Effects Myleosuppression: infection, bleeding Hair & Skin: photosensitivity, alopecia GI: Nausea, vomiting, diarrhea, stomatitis Reproductive: low sperm count, menstrual changes, hormonal changes, infertility
Cancer Treatment: Surgery Indications Diagnosis & staging; Treatment; palliation (debulking), reconstruction, prevention
Cancer Treatment: Radiation Therapy Delivery Methods External beam, implants (mainly for prostate cancer), infused/ingested
Cancer Treatment: Radiation Therapy: Side effects Inflammation: skin, mucus membranes & organs; Fatigue; Bone marrow suppression; radiation pneumonia; GI: disturbances, bleeding,fistula formation
Cancer Treatments alpha interferon, interleukin-2 (may experience delirium); Monoclonal antibodies; Stem Cell Transplants; Photodynamic Therapy (light to increase amount of heat); Hyperthermia ("cook abnormal cells"); Vascular endothelial growth factor inhibitors )starve)
Cancer Treatment: Pain Control Start w/ non-narcotics (NSAIDs), add narcotic/opioids; increase dose and/or adjust frequency; scheduled doses w/ additional med for breakthrough pain; surgery, radiation, biofeedback,antidepressants, anticonvulsants may help
Cancer Treatment for Side Effects: Nausea & Vomiting prophylactic anti-emetics: most effective = ondansteron (Zofran), dolasteron (Anzemet), lorazepam (Ativan), metoclopramide (Reglan), prochlorperazine (Compazine)
Cancer Treatment for Side Effects: Neutropenia antibiotics, postpone therapy, absolute neutrophil count <500/mm3 for more than a week should be hospitalized
Cancer Treatment for Side Effects: Anemia epoetin alpha can improve hemoglobin level
Cancer Treatment for Side Effects: Fatigue address cause (pain, emotional distress, sleep disturbances, etc), exercise program, emotional support, stress management techniques, nutrition, rest
Cancer Treatment for Side Effects: Nutrition small frequent meals; nutrient dense; temperature; odor, flavors
Cancer Emergencies Pericardial/Pleural Effusion: pericardiocentesis; Superior Vena Cava syndrome: respiratory support & tumor debulking; Sepsis: Abx; Spinal cord compression: decompression; Obstructive Uropathy: clear or reroute
Cancer Emergencies Hypercalcemia: address cause; fluids Hyperuricemia: allopuroinal (Zyloprim) SIADH: sodium supplementation (esp associated with Pulmonary Oat Syndrome)
Breast Cancer Risks 1 in 8 lifetime risk in women; rare in men Inherited mutation in BRCA1or2; estrogens & progestine can stimulate; most women over age 65; family hx: mom or sister increase risk ( 15-20% of all breast Ca cases)
Common Breast Cancer Locations UPPER OUTER L QUADRANT = 50%; AROUND NIPPLE = 18%; UPPER INNER = 15%; OUTER LOWER = 11%; INNER LOWER = 6%
Cancer Screening Mammo > age 40; US (esp younger women); MRI; Tumor markers = CA125 (ovarian Ca), CA 15-3 & 27-29 (breast Ca) CEA "carcinoembryonic antigen" (ovarian, lung, breast, pancreas, & GI tract Ca); PSA (prostate Ca)
Breast Cancer Tx - Surgical Lumpectomy; Mastectomy; Lymph Node dissection; Reconstruction
Breast Cancer Tx - Radiation therapy Often w/ surgery; external beam; interstitial imiplant; brachytherapy
Breast Conserving procedures Early small cancers: lumpectomy followed by radiation, chemotherapy and/or hormonal therapy Stage II: chemo, then surgery & radiation
Breast Ca Treatment: Hormonal (for estrogen receptor positive) SERMs (selective estrogen receptor modulators: block the estrogen receptor: tamoxifen (Soltamox, Nolvadex) ERDs (estrogen receptor downregulators: destroy the estrogen receptor: fulvestrant (Faslodex)
Breast Ca Treatment: Hormonal (for estrogen receptor positive) Aromatase inhibitors: reduce the amt of estrogen produce in post-menopausal women= anastrozole (Arimidex), letrozole (Femara), exemestane (Aromasin); Pre-menopausal women: ovarian estrogen suppresors= Zoladex (goserelin), Lupron (leuprolide)
Breast Ca Treatment: Hormonal (for estrogen receptor positive) - pre-menopausal women Radiation to the ovaries can also stop their estrogen production; surgical removal of the ovaries lowers the amount of estrogen in the body.
Breast Ca Treatment: Immune( for HER2-positive breast Cancers) Human Epiderman Growth factor Receptor 2 = 25% of breast cancers; used w/ chemo; Herceptin (trastuzumab) & lapatinib (Tykerb): antibody blocks the HER2 protein in cancer cells; Side effects=flu like, possible lung & heart damage
Complementary Therapies for Breast Ca Usually directed at helping the body to heal itself: unblocking blocked energies, correcting 'imbalances' - acupuncture, massage, biofeedback,hypnosis,visualization,laying on of hands, prayer, medication, music, movement, diets (macrobiotic vegetarian raw
Problems with herbal remedies in Breast Ca Black cohosh may make breast ca more aggressive & increase metastasis; Herbal therapies to treat menopause may accelerate the spread of breast cancer.
Symptom Management: Dyspnea Chronic & acute; Non-reversible etiology; Low dose narcotics: titrated morphine; O2 supp; airway secretion mgmt, anxiolytics
Symptom Management: Anorexia & weight Loss Provoke anticipatory grief & guilt; anorexia often accompanies the dying process; supplemental feeding; appetite stimulants= megestrol acetate (Megace) & low dose steroids
Symptom Management: Nausea & Vomiting Constipation should be considered as cause; Ileus w/o constipation is common; NG-tube, Surgery; Tx: antiemetics = prochlorperazine (Compazine), promethazine (Phenergan), haloperidol (Haldol)
Dr. Elisabeth Kubler-Ross - Stages Denial, Anger, Barganing, Depression, Acceptance
Seen months before Death withdrawn, decline visits & convo, contemplate life & revisit memories, sleep more, food less appealing as body begins to slow down (altered body chemistry produces mild euphoria), neither hungry nor thirsty
Seen Weeks Before Death: Mental Changes Mental Changes (sleep more, disorientated, pick at sheets, clothes; aimless mvmt, delusion, hallucinations
Seen weeks before Death: physical changes body temp decreases one or more degrees; BP lowers; irregular pulse; increased perspiration; skin, lips & nails: pale & cyanotic; breathing changes; congestion/rattle; speaking decreases & stops
Seen days to hours before death Short sudden burst of energy: want to get out of bed, move, talk, eat; Previous signs more pronounced: irreg breathing=cheyne-stokes: rapid breaths followed by apnea; death rattle; mottling; unresponsive; hearing believed to be last sense to go
Created by: iloveraven
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