Caring for Patients with Cancer - emphasis on care r/t breast cancer
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| Common Male Cancers | Prostate, Lung/Bronchial, colorectal
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| Common Female Cancers | Breast, Lung/Bronchial, Colorectal
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| Cancers documented through Heredity | Breast & Colon Cancers
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| Cancers Risks: Age | 70% of all cancers occur in persons >65 years old
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| 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
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| Neoplasm | New tissue mass; tumor
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| Benign | Localized, encapsulated, stop at other tissue boundaries, respond to homeostatic controls, can damage other tissues through pressure and obstruction.
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| Primary tumor | Original tumor site
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| Secondary Tumor | areas where malignancy has spread (lymph nodes, liver, lungs, bones, brain) - only in malignancy
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| Malignant | Aggressive growth: progressive deviation with each generation; do not stop growing and die; irreversible. Not under body's homeostatic control. Destroy surround tissue.
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| Metastasize | Cells through blood or lymph circulation - most tumors have metastasized by diagnosis. Recur after surgical removal and other treatments.
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| Effects of Cancer | Loss of function; hematologic alteration; infection; hemorrhage; wasting syndrome; hormone changes; pain; physical stress; psychosocial,emotional,Spiritual stress
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| Cancer Diagnosis Grading & staging | Grading: least (1) to most (4) aggressive; Staging (0-4) T (tumor size)-N (lymph nodes)-M (metastases)
Tumor Markers
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| Chemotherapy | Action based on cell division; phase-specific and non-phase specific
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| 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.
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| Cancer Treatment - Chemotherapy | Often administered in combination
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| Cancer Treatment - Chemotherapy: Alkylating Agents | create defects in tumor DNA; nitrogen mustard (Mustargen); cisplatin
Toxic effects = renal, otic, myleosuppression
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| Cancer Treatment - Chemotherapy: Antimetabolites | Specific for S phase of cell division; methotrexate (MTX, Trexall); 5-fluorouracil (5-FU)
Toxic effects = stomatitis, leukopenia
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| Cancer Treatment - Chemotherapy: Antitumor Antibiotics | Non-phase specific; interefere with DNA
actinomycin D (Dactinomycin); blenoxane (Bleomycin)
Toxic effects = damage to cardiac muscle & lung tissue
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| Cancer Treatment - Chemotherapy: Miotic inhibitors | prevent M phase cell division
vincristine (Oncovin); vinblastine (Velban)
Toxic effects = affects neurotransmission, bone marrow depression
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| Cancer Treatment - Chemotherapy: Hormones | G1 specific; inhibit growth
corticosteroids: prednisone (Deltasone)
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| 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
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| Chemotherapy Routes | Oral, IV, intracavity
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| Chemotherapy Routes: Vascular access devices | Limit extravasation (leakage into tissues) & duration and frequency of therapy
PICC lines, Tunnelled catheters (Hickman, Groshong); Surgically implanted ports
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| Chemotherapy Effects | Myleosuppression: infection, bleeding
Hair & Skin: photosensitivity, alopecia
GI: Nausea, vomiting, diarrhea, stomatitis
Reproductive: low sperm count, menstrual changes, hormonal changes, infertility
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| Cancer Treatment: Surgery Indications | Diagnosis & staging; Treatment; palliation (debulking), reconstruction, prevention
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| Cancer Treatment: Radiation Therapy Delivery Methods | External beam, implants (mainly for prostate cancer), infused/ingested
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| Cancer Treatment: Radiation Therapy: Side effects | Inflammation: skin, mucus membranes & organs;
Fatigue; Bone marrow suppression; radiation pneumonia; GI: disturbances, bleeding,fistula formation
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| 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)
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| 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
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| Cancer Treatment for Side Effects: Nausea & Vomiting | prophylactic anti-emetics: most effective = ondansteron (Zofran), dolasteron (Anzemet), lorazepam (Ativan), metoclopramide (Reglan), prochlorperazine (Compazine)
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| Cancer Treatment for Side Effects: Neutropenia | antibiotics, postpone therapy, absolute neutrophil count <500/mm3 for more than a week should be hospitalized
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| Cancer Treatment for Side Effects: Anemia | epoetin alpha can improve hemoglobin level
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| Cancer Treatment for Side Effects: Fatigue | address cause (pain, emotional distress, sleep disturbances, etc), exercise program, emotional support, stress management techniques, nutrition, rest
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| Cancer Treatment for Side Effects: Nutrition | small frequent meals; nutrient dense; temperature; odor, flavors
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| 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
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| Cancer Emergencies | Hypercalcemia: address cause; fluids
Hyperuricemia: allopuroinal (Zyloprim)
SIADH: sodium supplementation (esp associated with Pulmonary Oat Syndrome)
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| 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)
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| Common Breast Cancer Locations | UPPER OUTER L QUADRANT = 50%; AROUND NIPPLE = 18%; UPPER INNER = 15%; OUTER LOWER = 11%; INNER LOWER = 6%
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| 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)
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| Breast Cancer Tx - Surgical | Lumpectomy; Mastectomy; Lymph Node dissection; Reconstruction
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| Breast Cancer Tx - Radiation therapy | Often w/ surgery; external beam; interstitial imiplant; brachytherapy
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| Breast Conserving procedures | Early small cancers: lumpectomy followed by radiation, chemotherapy and/or hormonal therapy
Stage II: chemo, then surgery & radiation
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| 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)
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| 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)
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| 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.
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| 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
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| 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
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| 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.
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| Symptom Management: Dyspnea | Chronic & acute; Non-reversible etiology; Low dose narcotics: titrated morphine; O2 supp; airway secretion mgmt, anxiolytics
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| 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
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| 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)
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| Dr. Elisabeth Kubler-Ross - Stages | Denial, Anger, Barganing, Depression, Acceptance
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| 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
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| Seen Weeks Before Death: Mental Changes | Mental Changes (sleep more, disorientated, pick at sheets, clothes; aimless mvmt, delusion, hallucinations
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| 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
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| 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
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