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