Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
NSG 308 Adult Health
Cancer Management
| Question | Answer |
|---|---|
| Cancer Epidemiology | - 57% dx occur in age 65+ Males: Lung, prostate, colorectal Females: Lung, Breast, Colorectal - Slightly higher incidence in females |
| Cancer Carcinogenesis pathophysiology | Initiation -> Promotion -> Progression - Genetic disease -> multiple gene mutations (inherited or acquired) - Initial altered cell forms clone and evade growth regulation/immune response - spread via lymphatic and hematogenous routes - 5-10% cancers w/ familial predisposition (BRCA1/2, MEN1/2 etc) |
| Initiation phase | carcinogens cause DNA mutation -> repair/apoptosis suppression |
| Promotion phase | Proliferation of initiated cells - reversible if removed |
| Progression phase | cells acquire malignant behavior -> metastasize + invade |
| Benign cells | - well differentiated (resemble normal cells) - slow expansion in local tissue w/o tissue damage - Damage to body only if impinging on vital site |
| Malignant cells | - undifferentiated (little resemblance to normal cells) - variable rate of growth - gains access to lymphatic/blood channel or grow across body cavities -> metastasis - cause generalized effects (eg. anemia, wt loss, inflammation) - tissue damage when tumor outgrows blood supply or secrete toxins |
| Anaplastic cells | undifferentiated cells that have lost function of normal cells (cancerous) |
| Cancer classifications | - Carcinoma (epithelial cells; 80-90% of cancers) - Sarcoma (connective/supportive tissue) - Myeloma (plasma cells) - Lymphoma (lymphocytes) - Leukemia (hematopoietic cells/WBCs/Lymphocytes/RBCs) |
| Adenocarcinoma | Glandular epithelial cells (organs/glands capable of secretion) |
| Squamous cell carcinomas | Squamous epithelial cells (covering/lining internal or external body surfaces) |
| Osteosarcoma | Bone cancer - Most common form of bone cancer |
| Chondrosarcoma | Cartilage tissue - Rare, arise from within bone |
| Liposarcoma | Adipocytes (from deep soft tissue) |
| Leiomyosarcoma | Smooth muscle cells - very rare |
| Rhabdomyosarcoma | Skeletal muscle cells - most common in children |
| Mesothelial Sarcoma/Mesothelioma | Membrane tissue lining body cavities - asbestos - Eg. pleura/peritoneum |
| Angiosarcoma | Blood vessels - possibly d/t occupational vinyl chloride if liver involvement |
| Myeloma | Plasma cells (B-cell lymphocytes) - plasma cells produce Ab |
| lymphoma | Hodgekin vs Non-Hodgekin - involve lymph nodes or body organs |
| Myelogenous leukemia | White blood cells AML (acute myelogenous leukemia) |
| Lymphocytic Leukemia | Lymphocytes - ALL (acute lymphocytic leukemia) |
| Erythremia | RBC leukemia - Eg. Polycythemia vera - Overproduction of RBC w/ association to increase WBC/PLT - Risk of additional bone marrow disease |
| Cancer modifiable risk factors | - Smoking (most lethal, ~30% cancer deaths) - EtOH - poor diet (processed/red meat, low fiber) - sedentiary/obesity - UV - Occupational (eg. Asbestos/vinyl chloride) - Infection (HPV, HBV, EBV, HP) |
| Cancer nonmodifiable risk factos | - Age (most at 50+) - Genetics (BRCA1/2, MEN 1/2) - Race/Sex/Ethnicity - Hormonal (early menarche, menopause, nulliparity) - FHx (3 gen pedigree) - immunocompromised (transplant status/HIV+AIDS) |
| Drivers of Cancer Health Disparities | - low income/poor socioeconomic status - Cultural/dietary - Environmental exposure - Biological/genetics - Geographic location |
| Highest Burden Groups of Cancer | - Non-hispanic black = highest CA mortality rate - Hispanic/Latino = lower incidence but higher mortality - Rural/underserved - Low socioeconomic status |
| Primary Cancer Prevention | RISK REDUCTION - Lifestyle + health promotion/counseling - Nutrition + physical activity (>150 min/week moderately) - Vaccinations (HPV, HBV) - Smoking/EtOH cessation |
| Secondary Cancer Prevention | SCREENING (early detection) - ACS recommended screenings - Identify precancerous lesions - Reduce advance disease morbidity - Address access barriers |
| Tertiary Cancer Prevention | SURVIVORSHIP/SURVEILLANCE - Monitor for recurrence - Screen for secondary malignancy - Health promotion/Lifestyle modification |
| Breast CA Screening guidelines | Mammogram Start age 45 |
| Cervical CA screening guidelines | HPV or PAP co-test start age 25` |
| Colorectal CA screening guidelines | Colonoscopy or stool test 45-75 age |
| Lung CA screening guidelines | LDCT for high risk 50+ with 20/pack year age 50-80 |
| Prostate CA screening guideline | Shared decision making (PSA/US) Start age 50 |
| PET scans | evaluate biologic activity of organ |
| Fluoroscopy | real time X-Ray for dense tissue |
| Vascular imaging | contrast for blood flow |
| Nuclear medicine | imaging with radioisotopes |
| Radioimmunoconjugates | mAb + radioisotopes irradiated antibody specifically bind to cancerous sites to kill malignancy |
| Types of tissue Biopsies | Excisional - an entire lump or abnormal tissue is removed Incisional -small portion of a suspicious tissue or lesion is removed Needle - thin needle is used to remove a small sample of tissue |
| TNM Tumor Staging | "how far has the cancer spread" T = Primary tumor size/local tissue invasion (Tis = in situ, T1-T4) N = regional lymph node (N0-N3) M = distant metastasis (M0-M1) - "x" suffix = cannot be assessed (Eg. Tx, Nx, Mx) |
| TNM Tumor Grading | "how abnormal do the cells look" I - Well differentiated (resemble tissue of origin) II - Moderately differentiated III - Poorly differentiated IV - Anaplastic/aggressive (poor prognosis) |
| Carcinoma in situ definition | group of abnormal cells that are localized and have not spread - looks like cancerous cells but may be precancerous |
| Anatomic stage grouping | I = Small, localized II = Larger or minor spread III = Regional spread IV = Distant metastasis |
| Treatments for cancer | - Surgery (diagnostic, primary, ppx, palliative, reconstructive) - () - Chemotherapy (cell cycle specific/nonspecific, combination regimens) - HSCT (allogeneic, autologous, syngeneic stem cell transplant) - Immunotherapy (CAR-T, mAb, cytokines) - Targeted (molecular targets eg. TKI, mAb, hormonal) |
| HSCT | hematopoietic stem cell transplant |
| SLNB | sentinel lymph node biopsy - minimally invasive nodal staging |
| Nursing management for surgery (cancer) | Pre-op = assessment + verbal/written teaching Post-op = monitor pain/nutrition/activity/wound Discharge = F/U, home care, community resource - watch for complications - Lymphedema precaution w/ axillary dissection - Body image/psychosocial support |
| EBRT | - External beam radiation therapy (most common radiation therapy) - intensity modulated radiotherapy - high power radiation to tumor (specialized EBRT) - stereotactic modulated radiotherapy (few large doses) |
| Brachytherapy | - internal implant placed next to tumor HDR (high dose rate) vs LDR (low dose rate) Safety: TIME, DISTANCE, SHIELDING |
| Systemic radioisotopes | radiation therapy via radioisotopes - Eg. I-131, Ra-223 |
| Radiation therapy | EBRT, brachy therapy, systemic radioisotopes, IMRT/IGRT - Lethal dose = 95% tumor killed (normal tissue spared) - Fractionation/SBRT minimize healthy tissue injury - EBRT < IMRT < SBRT |
| Toxicity and implant safety (RT) | - Acute toxicity (<6 wks) = radiodermatitis, mucositis, N/V, fatigue - Late = fibrosis, atrophy, ulceration, 2ndary malignancy - Most sensitive tissues are bone marrow, lymph, GI, hair follicle, gonads - Private room, signage, dosimeter, <30 min visit, 6 ft distancing - Pregnant staff/children not assigned |
| IGRT | image guided radiotherapy; basically IMRT with CT/XR imaging for mobile organs |
| Chemotherapy safe handling | - Class II/III biological safety cabinet (BSC) - Closed system transfer device + leak proof IV bag PPE: double layer gloves, gown, N95, eye protection Disposal: chemo-hazardous containers - ONS/ASCO standards (quality program w/ monitoring) |
| Chemotherapy acute risks | - Extravasation: leakage into tissue (irritant vs vesicant) - Vesicants => tissue necrosis (need trained staff + antidotes) - Hypersensitivity - IgE or non IgE - Immediate (5-6 mins) or delayed Action: STOP infusion + follow emergency protocol |
| SVC Syndrome | Oncologic emergency Superior vena cava syndrome = obstruction/compression of SVC S/S: Dyspnea, cough, angioedema, dilated chest veins Tx: Radiation/Chemo/AC; avoid upper extremity sticks |
| Spinal cord compression | Compression by cancer metastasis to bone (it shatters) S/S: Back/neck pain, motor loss, urinary retention Tx: MRI, steroids, radiation, surgery |
| Hypercalcemia (oncologic emergency) | S/S: fatigue, confusion (Ca >10.4 mg/dL) Tx: IV hydration, biphosphonates |
| Tumor lysis syndrome | Oncologic emergency Tumor death release a lot of electrolytes + uric acid into body S/S: hyperkalemia, hyperuricemia, AKI Tx: fluids, allopurinol, electrolyte correction |
| Chemotherapy nadir | lowest point of blood cell count in chemo therapy - 7-14 days usually |
| Oncologic emergencies | - SCV Syndrome - Spinal cord compression - Hypercalcemia - Tumor lysis syndrome |
Created by:
sleepingbear