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T4: Cancer

Ch. 16 Cancer

Group of more than 200 diseases; characterized by uncontrolled and unregulated growth of cells; occurs in people of all ages. cancer
Most cancers do not result from inherited genes but are acquired from? Damage to genes occurring during life. An acquired mutation is passed to all cells developing from that cell. The damaged cell may die or repair itself. If cell death/repair doesnt occur before cell division, the cell will replicate to daughter cells.
These drugs are capable of interacting with DNA and have the potential to cause cancer. alkylating agents and immunosuppressive agents
The use of this drug, either alone or in combination w/radiation therapy, has been associated w/an increased incidence of acute myelogenous leukemia in persons treated w/Hodgkin's lymphoma, non-hodgkins lymphoma, & multiple myelomas. alkylating agents such as cyclophosphamide (Cytoxan)
This can cause cancer in almost any human tissue and damage occurs to the DNA. radiation
What is the most common type of cancer among whites in the US? skin cancer
This is associated with melanoma and squamous and basal cell carcinoma. ultraviolet radiation
What are the stages of cancer? initiation, promotion, progression
This is the final stage of cancer and is characterized by? increased growth rate of tumor; invasiveness; metastasis
This is the spread of the cancer to a distant site. metastasis
What are the most frequent sites of metastasis? lungs, brain, bone, liver, and adrenal glands
Describe the pathogenesis of cancer metastasis. Tumor cells detach from primary tumor, enter circulation, survive in circ. to arrest in capillary bed, adhere to cap. basement membrane, gain entry in organ parenchyma, respond to growth factors, proliferate & induce angiogenesis & evade host defenses.
Tumors can be classified as? benign or malignant
What is the main difference b/t benign tumor cells and malignant tumor cells? Malignant tumor cells have the ability to invade and metastasize.
Carcinomas originate from? embryonal ectoderm (skin, glands); endoderm (mucous membrane of respiratory tract, GI, and GU tracts)
Sarcomas originate from? embryonal mesoderm (connective tissue, muscle, bone, & fat)
Lymphomas and leukemias originate from? hematopoietic system
Four grades of abnormal cells: Grade I Cells differ slightly from normal cells (mild dysplasia) and are well differentiated (low grade).
Four grades of abnormal cells: Grade II Cells are more abnormal (moderate dysplasia) and moderately differentiated (intermediate grade).
Four grades of abnormal cells: Grade III Cells are very abnormal (severe dysplasia) and poorly differentiated (high grade).
Four grades of abnormal cells: Grade IV Cells are immature & primitive (anaplasia) and undifferentiated; cell of origin is difficult to determine (high grade).
What is Grade X? grade cannot be assessed
Classifying the extent and spread of disease is termed. staging
This classification system is based on what? The anatomic extent of disease rather than on cell appearance. Determines the anatomic extent of the malignant disease process by stages 0-4.
Clinical stage 0 cancer in situ
Clinical stage 1 Tumor limited to tissue of origin; localized tumor growth.
Clinical stage 2 Limited local spread.
Clinical stage 3 Extensive local and regional spread.
Clinical stage 4 Metastasis
The TNM classification system classifies the anatomic extent of disease based on these three parameters. Tumor size and invasiveness (T); spread to lymph nodes (N); metastasis (M)
TNM staging cannot be applied to all malignancies such as? leukemias b/c they are not solid tumors and therefore cannot be staged by using these guidelines
Carcinoma in situ has its own designation in the system (Tis) since it has all the histologic characteristics of cancer except? invasion - a primary feature of the TNM staging system
Diagnostics for cancer. Depends on site of cancer. cytology studies; chest x-ray; CBC, chemistry profile; liver function studies; endoscopic exams; radiographic studies; raidoisotope scans; PET scan; tumor markers; genetic markers; bone marrow exam; biopsy
What are the warning signs of cancer? fatigue, unexplained weight loss/gain, fever, pain, change in appetite, N/V, skin changes
What are some lifestyle habits to reduce the risks of cancer? cancer screenings, self-exam, know warning signs, avoid carcinogens (smoke, sun), eat a balanced diet, limit alcohol, exercise regularly, maintain healthy weight, adequate rest, reduce stress, regular health exams
What are the goals for cancer treatment? cure; control; palliation
What are the primary factors that determine what therapy is used? cell type, location and size of tumor, extent of disease, physiologic and psychologic status, expressed needs and desires
When cure is the goal, treatment is offered that is expected to have the greatest change of disease eradication and may involve what? Local therapy (surgery or radiation) alone or in combination with or without periods of adjunctive systemic therapy (chemotherapy, biologic, and targeted therapy).
What are some examples of curative therapy? Basal cell carcinoma of the skin: surgical removal of the lesion &/or several weeks of radiation therapy. Acute promeylocytic leukemia: chemotherapy for months to years. Testicular cancer can be cured w/a combo of surgery, chemo, & radiation.
This is the goal treatment plan for many cancers than cannot be completely eradicated but are responsive to anticancer therapies and can be maintained for long periods of therapy. control
What are some examples of control treatment? Multiple myeloma and chronic lymphocytic leukemia
Evidence of this may warrant consideration of changing to an alternative therapy. tumor resistance (e.g. disease progression)
What is the goal of palliation treatment? Relief or control of symptoms and the maintenance of a satisfactory quality of life. There is an emphasis on minimizing treatment-related toxicity to the greatest extent possible.
Examples of palliation treatment. Using radiation therapy or chemotherapy to reduce tumor size and relieve subsequent symptoms such as the pain of bone metastasis.
This is the oldest form of cancer treatment and meets a variety of goals. surgery
Prevention surgery is used to eliminate or reduce risk of cancer in at-risk patients by? Prophylactic removal of nonvital organs has been successful in reducing the incidence of some malignancies and usual sites of regional spread may be removed.
Examples of surgical therapy for prevention of cancer. Pts with adenomatous familial polyposis may benefit from a total colostomy to prevent colorectal cancer. Ladies w/genetic mutations of BRCA-1 or BRCA-2 & a strong family hx of early onset breast cancer may have a prophylactic mastectomy.
How is surgical therapy used to cure and control cancer? Removes only as much tissue as necessary annd spares normal tissue. The debulking procedure may be used if tumor can't be completely removed, then followed by chemo or radiation therapy.
Examples of surgical procedures used for cure or control of cancer include. Radical neck dissection, mastectomy, orchiectomy, thyroidectomy, nephrectomy, and hysterectomy, and oophorectomy.
How is surgical therapy used for supportive and palliative care? Supportive: gastric feeding tube, placement of CVAD, prophylactic surgical fixation of bones at risk for pathologic fracture. Surgery: debulking tumor to relieve pain/pressure; colostomy for bowel obstruction; laminectomy for spinal cord compression.
Use of chemicals given as a systemic therapy for cancer and is the mainstay for most solid tumors and hematologic cancers. It can offer cure, control, or palliative care. chemotherapy
Preparation and handling of chemotherapy agents may pose an occupational hazard b/c they may be absorbed through? Skin, inhalation during preparation, transportation, and administration
What are the different methods of administration for chemotherapy? oral, IM, IV (most common), intracavitary, intrathecal, intraarterial
What is the most common IV administration?/ CVADs, PICCs, or implanted infusion ports
Why are CVADs, PICCs, and implanted infusion ports the mo common form of IV administration of chemotherapy agents? reduces the risk of extravasation
Many chemotherapy drugs are either? irritants or vesicants
These will damage the intima of the vein, causing phlebitis and sclerosis and limiting future peripheral venous access, but will not cause tissue damage if infiltrated. irritants
What are the major concerns associated with the IV administration of antineoplastic drugs? venous access difficulties, device- or catheter-related infection, and extravasation causing local tissue damage
Infiltration of drugs into tissues surrounding the infusion site. extravasation
What are the s/s of extravasation? Pain is the cardinal symptom but it can occur w/o pain. Swelling, redness, and the presence of vesicles on the skin. After a few days, the tissue may begin to ulcerate and necrose.
What are some complication of extravasation? sepsis, scarring, contractures, joint pain, or nerve loss
These are placed in large blood vessels and are used for frequent, continuous, or intermittent admnistration and can be used to administer other fluids (blood, electrolytes, etc.). CVADs
Chemotherapy-induced side effects are the result of what? The destruction of normal cells especially those that are rapidly proliferating such as those in the bone marrow, lining of the GI system, and the integumentary system (skin, hair, & nails).
This is used to treat a carefully defined area of the body. It is not a primary treatment for systemic disease and may be used by itself or with chemo or surgery (primary tumors, palliation of metastatic lesions). radiation therapy
What is the major difference b/t radiation and chemotherapy? Radiation (a local therapy) only bone marrow w/i the treatment field will be affected, whereas chemotherapy (a systemic therapy) affects bone marrow function throughout the body.
What is the most common side effect of chemotherapy? myelosuppression
Treatment induced reductions in RBCs and WBCs can result in? infection; hemorrhage; overwhelming fatigue
The onset of bone marrow suppression is related to the life span of the type of blood cell. WBCs w/i 1-2 wks; platelets 2-3 wks; and RBCs after 3 wks
This is most common in patients receiving chemotherapy. neutropenia
What are some interventions for battling fatigue? Encourage conservation strategies (rest before activity, get assistance w/activity, remain active during periods of time pts feel better); maintain nutritional & hydration status; assess for reversible causes of fatigue.
What are some causes of fatigue? anemia; r/t accumulation of toxic substances that are left in the body after cells are killed by cancer tx; need for extra energy to repair & heal body tissue damaged by tx; lack of sleep caused by some chemo drugs.
This is one of the most sensitive tissues to radiation and chemotherapy? the intestinal mucosa
What are some GI affects of chemotherapy? N/V/D, mucositis, anorexia
What are some meds used for GI side effects? antidiarrheal, antimotility, and antispasmodics
With radiation, these occur only in the treatment field. They can be acute or chronic depending on the area irradiated, dosage, and technique. skin reactions
Skin reactions are particularly evident where? In areas of skinfolds or where skin is subjected to pressure, such as behind the ear and in gluteal folds, perineum, breast, collar line, and bony prominences.
Erythema is an acute response followed by what? dry desquamation
Dry reactions are uncomfortable and result in? pruritus
How should you treat dry reactions? Lubricate the dry skin with a nonirritating lotion emollient (such as aloe vera) that contains no metal, alcohol, perfume, or additives that can be irritating to the skin.
If the rate of cell sloughing is faster than the ability of the new epidermal cells to replace dead cells, this occurs with exposure of the dermis and weeping of serous fluid. wet desquamation
How should you care for wet reactions? Must be kept clean and protected from further damage.
Wet desquamation of tissues generally produce what? pain, drainage, and increased risk of infection
What are some interventions for skin reactions? Prevent infection; facilitate wound healing; protect irritated skin temperature extremes; avoid constricting garments, harsh chemicals, & deodorants; help patients deal with hair loss.
These should not be used in the treatment field? heating pads, ice packs, and hot water bottles
What are some pulmonary effects of radiation and chemotherapy? Cough, dyspnea, pneumonitis, pulmonary edema; may be progressive and irreversible
What is the treatment for pulmonary side effects? bronchodilators, expectorants/cough suppressants, bed rest oxygen
Created by: eblanc1