Cancer

out of the cell cycleNeurons, cardiac muscle cell

Dormant/Resting (G0)Liver, kidney

continuously dividing GIT cells, Skin, endometrium , Blood cells

Hyperplasia

a cell turns into a different cell. This is the dangerous kind.-leads to cancer

dysplasia, anaplasia

Cancer Development 4 STAGES

The degree to which a cell resembles its cell of origin in morphology and function. Cancer cells usually do not achieve same level of differentiation as normal cells- They are autonomous, excessive and disorganized

the result of abnormal cell proliferation…abnormal cell differentiation.

Latent period

3 characteristics of Neoplasia

Benign

Malignant

most common spread of cancer:

spread of cancer: Blood-borne, commonly to Liver and Lungs

spread of cancer: Seeding of tumors

Second most common cause of death in the United States after heart disease

Biggest risk of cancer:

Age is the single most important factor related to the development of cancer
>65 yrs
Hormonal changes
Altered immune system
Accumulation of damage

Susceptability differences between men and women

Cancer rates

China (liver)
UK (lung)
Japan (stomach)
Canada (leukemia)
Australia (skin)
Brazil (cervical)
US?

Most forms of cancer are _______, and have no basis in heredity. There are, however, a number of recognized genetic risk factors.

Epstain Barr virus causes

HPV causes

Hepatitis B virus causes

Human T cell lymphotrophic virus causes

Chemical agents that cause cancer

Here the goal is to protect healthy people from developing a disease or experiencing an injury in the first place. For example:* education about good nutrition, the importance of regular exercise, and the dangers of tobacco, alcohol and other drugs* education and legislation about proper seatbelt and helmet use* regular exams and screening tests to monitor risk factors for illness* immunization against infectious disease* controlling potential hazards at home and in the workplace

These interventions happen after an illness or serious risk factors have already been diagnosed. The goal is to halt or slow the progress of disease (if possible) in its earliest stages; in the case of injury, goals include limiting long-term disability and preventing re-injury. For example:* telling people to take daily, low-dose aspirin to prevent a first or second heart attack or stroke* recommending regular exams and screening tests in people with known risk factors for illness* providing suitably modified work for injured workers

This focuses on helping people manage complicated, long-term health problems such as diabetes, heart disease, cancer and chronic musculoskeletal pain. The goals include preventing further physical deterioration and maximizing quality of life. For example:* cardiac or stroke rehabilitation programs* chronic pain management programs* patient support groups

The four most important risk factors for cancer are:

Avoid or reduce exposure to known or suspected carcinogens
Cigarette smoke,
excessive sun exposur
eEat a balanced diet
Exercise regularly
Obtain adequate rest

Utilize the ACS 7 Warning Signals

screening ages for :
Breast
colon
uterine
prostate

Diagnostic exams will:

Biopsy method

Tumors can be classified by:

Factors that determine treatment modality and goals:

Treatment options

Surgery
Diagnosis
Biopsy
Grading/Staging

Treatment
--Alone- It is limited by tumor accessibility, patient’s medical condition, tumor’s extent
--In combination with other modalities-RT and/or chemo
--Cure or palliative goals

Emerging field – only used for 30 years

Chemotherapeutic drugs are administered orally, injected, intraarterially (infusion pump), intracavitary, intraperitoneal, intrathecal (space containing CSF)

Can be used alone or in combination with surgery and RT

Combinations of drugs are usually used vs. single agents

Combination of drugs kill cells in different phases of the cell cycleLimited by amount of normal cell death

What do therapists have to be careful of with patients on chemo?

growth that causes tissue to increase in size by increasing the number of cells:

any new or continued cell growth not needed for normal development or replacement of dead and damaged tissues is called ___

Programmed cell death is _____

Withouth specific shape or differentiation

carcinogenesis/oncogenesis are other names for ___

steps in carcinogenesis:

30% of all cancers is caused by

primary/secondary prevention?
-avoidance of known carcinogens
-modifying risk factors
-removal of "at risk" tissues
-chemoprevention

Yearly mammogram for women older than ___

Yearly breast exams for women older than ___

Colonoscopy at age ____ yrs and then every ___ years

Yearly prostate exam for men over ____

Extreme body wasting and malnutrition

A diet high in ___ and ___ is recommended for cancer pts.

Early cancer may not have ____ _____

Biggest complication of chemo:

________ Therapy
-most often used
-each drug effective against the cancer
-minimally overlapping toxicities
-synergystic effect
-decreased possibility of drug resistance
-increased percent of cells killed at one time

removal of all cancer tissue is called _____ surgery.

______ surgery is focused on improving quality of life, not cure.

___ therapy


-May pose an occupational hazard

-Drugs may be absorbed through Skin and Inhalation during preparation, transportation, and administration

-Only properly trained personnel should handle drugs

____therapy

-Drugs may be irritants or vesicants

-Damage intima of vein, but not tissue damageSevere local tissue breakdown and necrosis

predictable; usually resolution is rapid

Requires little to no change in treatment

Expect nausea and vomitting, hair loss, problems with GI tract, toxic effects monitored to determine if therapy is effective.

Serious and even life-threatening

Treatment change required

discontinue drugdose reduction

Occurs during and immediately after drug administration

NauseaVomiting

Allergic reactions

Dysrhythmias

Extravasation (flare reaction)Give corticosteroids- the inflammatory response is basically an “allergic” response

Mucositis

Alopecia

Bone marrow suppression

Delayed nausea and vomiting

Skin rashes

Bone marrow suppression-common side effect

Altered bowel function

Cumulative neurotoxicities-damage to nerve cells, neuropathy, monitor for progression

Nursing management of pt. under chemo involves:

Report serious reactions of chemo because some toxicities are ___

Can be used alone or in combination with other modalities – 50% of all cancer patients receive RT

Cure and palliationCan preserve organ function - larynx, prostate-less impotence and incontinence than surgery

Better Cosmesis-skin cancers

Limited by critical structures

Patient must be able to endure treatment

Local treatment modality

One of the oldest nonsurgical methods of cancer treatment

Up to 60% of all cancer patients will receive radiation therapy

Cellular damage may be lethal or sublethal

Normal tissues are usually able to recover

Cancer cells are more likely to be permanently damaged

Total doses divided into fractions

Typically delivered once a day for 5 days a week for 2 to 8 weeks

Number and strength of doses is determined by mitotic rate of target tissue with rapidly growing tumors being more sensitive

Most common radiation treatment

Patient exposed to radiation from a megavolt machine

Cobalt 60 machine—gamma rays

Cyclotron—neutrons or protons

Linear accelerator—ionizing radiation

Implantation or insertion of radioactive materials into or close to tumor

Minimal exposure to healthy tissue

Used in combination with teletherapy

Patient is emitting radioactivity

Limit amount of time near patients being treated

Organize care

Shielding should be used

Wear film badge to monitor exposure

common side effects of radiation and chemo

Integumentary and mucosal reactions

Pulmonary effects

Reproductive effects

Purpose of this therapy is to destroy cancel cells with minimal exposure of the normal cells to the damaging actions of radiation

Most radiation therapy for cancer is

In this therapy, the patient emits radiation for a period of time and is a hazard to others.

side effects of: ___
altered taste sensation
fatigue
aversion to taste of red meat

skin care need is a priority nursing intervention for pts. receiving

dry mouth is also called

when can you start seeing adverse effects of chemo?

theray that uses the body’s own immune systemB and T cells and natural killer cell lymphocytes:

In Biotherapy: Produce protein molecules or antibodies that attack and destroy foreign substances such as cancer

in Biotherapy: Mature into killer cells once they make contact with the antigen on a foreign substance

Scavenge and kill tumor cells

Able to kill tumor cells without damaging normal cells:

Tyrosine kinase inhibitors
Monoclonal antibodies
Vascular endothelial growth factor receptor inhibitors
Proteasome inhibitors

-Interferon inhibits DNA and protein synthesis
-Cytokines (enhance the immune system) with antiviral, antiproliferative, and immunodulatory properties

Spontaneously attack and kill foreign substances

Produced to react to a specific antigen

Cytotoxic agent can be attached-more cell kill action

Naturally occurring proteins that can kill cancer cells

Can help identify the antigen of cancer cells

Stimulate more T cell production (killer cells)

help regulate inflammationa and immune protection

Spinal cord compression

Superior vena cava syndrome

DIC

Cardiac Tamponade

damage that occurs either when a tumor directly enters the spinal cord or when the vertebrae collapse from tumor degradation of the bone.

if paralysis occurs: it is usually permanent

-make sure to assess neurologic changes. back pain, muscle weakness, numbness, tingling, unsteady gait

compression/obstruction by the tumor growth or by formation of clots in the vessel

early signs occur when a patient wakes up after a nights sleep and include edema of the face, esp. around the eyes, and tightness of shirt or collar

Cardiac tamponade is compression of the heart that occurs when blood or fluid builds up in the space between the myocardium (heart muscle) and
the pericardium (outer covering sac of the heart).

Anxiety, restlessness, Chest pain, Radiating to the neck, shoulder, back, or abdomen, Sharp, stabbing Worsened by deep breathing or coughing

an estimation of life expectancy based on all information about the tumor and from tumor trials

Prognosis is only an

If a patient is disease free for 5 years , he/she is considered cured.

1. Do not talk too much. Use silence to stimulate the patient to talk.
2. Pain is a model for the assessment of other symptoms
.3. Believe the patient
.4. Routinely assess severity by using a validated tool
.5. Most people also grieve in anticipation of loss.

name this drug:
side effect are seizures, bradycardia, shock, cardiac arrest, respiratory depression

common: constipation
notify doctor if respiration >12/min
do not bcc
physical dependency may result from long term use

Name this drug:
an antiemetic

side effects: headache, dizziness, diarrhea, constipation
adverse: bronchospasm

headache requiring analgesic is common

Name this drug:
used to treat nausea and vomiting caused by chemotherapy in people who have already taken other medications to treat this type of nausea and
vomiting without good results

weaknes,ssudden warm feeling,stomach pain,nausea,vomiting,memory loss,anxiety confusion,dizziness,unsteady walking

_____ therapy works by changing the level of hormones in the body, or by blocking the hormones so they can't help cancer cells to grow. (Some
cancers need hormones to help them grow and multiply.)

side effects: nausea, vomiting, dvt, PE, bleeding, stroke

biggest risk factor for colon cancer is:

radiation therapy is now done on a:

what are the most common metastatic sites of cancer cells?

A client receives a sealed radiation implant to treat cervical cancer. When caring for this client, the nurse should have the pt:

What personal protective equipment (PPE) does the nurse wear when administering chemotherapy to the client?

Used to treat nausea and vomiting caused by chemotherapy in people who have already taken other medications to treat this type of nausea and vomiting without good results.

It is usually taken 1 to 3 hours before chemotherapy and then every 2 to 4 hours after chemotherapy, for a total of 4 to 6 doses a day. Swallow the capsule, do not BCC.

side effects of Marinol/Dronabinol

major side effect of Zofran/Ondasteron

In this type of therapy, the pt. DOES NOT lose his/her scalp hair:

therapy given as a series of divided doses because of varying responses of all cancer cells within a given tumor:

type of radiation therapy: distant treatment where patient is not radioactive and is not a hazard to others.

close therapy where radiation source comes into direct, continuous contact with the tumor tissues for a specific period of time.

in _______, when the isotopes are unsealed they enter body fluids and eventually are elmininated in waste products, which are radioactive and should not be directly touched by other people

in _____, once the isotope is eliminated (as waste product), neither the patient nor the body wastes are radioactive. Most of this isotope is elmininated within 48 hrs.

altered taste sensation and fatigue are common complains of pts. receiving ____

true or false:
wash the irradiated area each day with either water or a mild soap and water as prescribed by your radiologist.
True False

true or false:
It is ok to wash and remove ink or dye markings that indicate exactly where to focuse radiation beams.
True False

Chemotherapy used along with surgery or radiation is termed ____.

Therapy that usually lasts for 3-4 weeks and are given through IV.

a major complication of IV infusion during chemo is ____ , or the movement of the IV needle so that the drug leaks into the surrounding tissues.

The most impt. nursing intervention for extravasation is:

common distressing side effects of ____ include the ff:
nausea
vomiting
alopecia
mucositis
anxiety
sleep disturbance
altered bowel movement

This critical problem is the major dose limiting side effect of cancer chemo and a common cause of death for pts. during treatment:

major side effect of Neumega/Oprelvekin used to treat thrombocytopenia:

Therapy done by decreasing the amount of hormones to hormone-sensitive tumors which can help slow the cancer growth rate:

side effects of hormonal manipulations: