-
cancer
- leading cause of cancer deaths - lung cancer
- most common in women - breast cancer
- most common in men - prostate cancer
- most at risk for prostate cancer - AA men
- most at risk for multiple myeloma - AA men
- most at risk for bladder cancer - white men
- most at risk for melanoma - white people (fair skin)
- % over 55 - 76%
-
cancer risk - increased age
- longer exposure
- change in immune response
- hormone changes
- severe cumulative losses
- increased cell mitosis
-
cancer cells
- dysregulation of cell division
- divides without limits
-
cancer risk factors
- smoking
- alcohol
- sun exposure
- drug use
- stress
- occupation
- infection - mono, HPV
-
cancer terms
- highly differentiated: cell looks like parent
- undifferentiated: no resemblance to parent
- intravasation: cancer gains access to blood
- extravasation: cancer leaves circulation and implants in new tissue
- angiogenesis: cancer creates own blood supply
- **no heat over tumors**
-
benign vs malignant
- benign
- --encapsulated
- --localized
- --non-metastasized
- --slow growth
- --contact inhibition
- --well differentiated
- ----lipoma
- ----hemangioma
- ----neurofibroma
- malignant
- --non-encapsulated
- --irregular shape
- --poorly differentiated
- --invasive spread – through blood and lymphatics
- ----carcinoma: epithelial tissue (lung, breast, prostate, colon, rectum, pancreas)
- ----sarcoma: supportive tissue (bone, cartilage, fat, muscle, vascular,
- ----leukemia: blood/bone marrow
- ----lymphoma: lymphocytes
- ----melanoma: skin
- angiogenesis (grows new blood vessels)
-
cancer s/s
- depends on site
- pressure on other structures
- pain usually late sign
- weakening of structures
- hypercatabolism -> hyperurecemic (allopurinol, fluids)
- metastasis
-
cancer effects
- infection
- hemorrhage
- anorexia cachexia
- pain
- physical/psychological stress
-
paraneoplastic syndrome
- indirect effects of cancer
- endocrine - cancer sets up ectopic sites
- neurologic - cancer damages nervous system
- breast, ovarian, renal - ectopic PTH sites - hypercalcemia
- oat cell/lung - ectopic insulin, PTH, ADH, ACTH
-
SVC syndrome
- tumor pressing on SVC
- blood backs up
- increased venous pressure, venous stasis, engorgement of veins
- facial, periorbital, arm edema
- resp distress, dyspnea, cyanosis, tachypnea, LOC, neuro defecits
- **resp support - possible trach**
- monitor VS
- steroids, antifibrinolytic/anticoagulant
- seizure precautions
- chemo/radiation later
-
chemotherapy
- destroys hair, GI, oral mucosa
- bone marrow suppressed (intented for some cancers) - pancytopenia
-
ANC
- absolute neutrophil count
- WBC x % neutrophils
- ANC > 500 needed to fight infection
- NADIR - lowest point that ANC drops
-
immuno-incompetent
- ANC < 500
- unable to mount immune response - reduced s/s of infection (no sputum, reduced temp)
- pancultre: urine, stool, sputum, lines, blood, CXR
- assess for PNA
-
neutropenic precautions
- Avoid people who have colds or the flu
- Do not visit crowded areas such as malls or movie theaters
- Avoid anyone who has received a live vaccination (shot) within the last three weeks
- Maintain a well-balanced diet and eat healthy foods, but avoid raw or uncooked foods, including raw vegetables and fruits
- Speak with your doctor before having any dental work done
- Do not have fresh flowers in your hospital room or house
- Limit exposure to pet feces (e.g., litter box)
- Do only as much activity as you can tolerate
- Wash your hands frequently with soap and water
- Take your temperature when you have chills or are not feeling well
- Take a bath or shower daily
- Do not get cuts, punctures or scratches on your skin
- Rinse your mouth with warm salt water
- Use a soft toothbrush
- Prevent constipation
- Wipe front to back after a bowel movement
- Drink lots of fluids (water, juice, etc.) to prevent dehydration
- Use sanitary napkins (pads) rather than tampons
-
hypercalcemia
- excessive ectopic production of PTH
- breast, lung, esophageal, thyroid, head, neck CA, bone mets and multiple myeloma
- rate of calcium from bones exceeds renal excretion
- calcium is bound to albumin in serum - can displace meds
- corrected calcium - albumin low 1 gram, add 0.8 calcium
-
hypercalcemia
- s/s: fatigue, anorexia, nausea, polyuria, constipation, muscle weakness, lethargy, apathy, diminished reflexes
- without tx: changes in mental status, psychotic behavior, cardiac arrhythmias, seizures, coma, death
- lasix
- calcitonin/Zometa
- dialysis
-
tumor lysis syndrome
- side effect of chemo
- destroyed cancer cells empty contents into body - cannot be excreted fast enough
- **combination of 2 or more metabolic abnormalities**
- --hyperuricemia - allopurinol, IV fluids
- --hyperphosphatemia - phos-lo
- --hyperkalemia - kayexalate, lasix, IV calcium gluconate, insulin, D5W (push potassium back into cells)
- --hypocalcemia - "dates phosphate"
- s/s: abnormal labs, N&V, SOB, arrythmia, cloudy urine, lethargy, joint pain
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