What's the first step in changing a normal cell in to a cancer cell?
What is initiation?
it is a mutation in the cell's genetic structure which has the potential for developing in to a clone (group of identical cells) of neoplastic cells
Errors that can occur in DNA replication
When does an initiated cell become a tumor cell?
When it has the ability to self replicate and grow
What is the reversible proliferation of an altered cell?
What is key to preventing cancer?
What is promotion?
it is an alteration in gene structure plus "promoting agents" which will increase the chance for additional mutations as well as increase the chances of malignancies developing
Name some promoting factors
- dietary fat
What is a "Complete Carcinogen"?
a carcinogen that is capable of initiating and promoting the development of cancer
What is progression?
increased growth rate of a tumor, becoming invasive and metastsizing
Unique capabilities of cancer cells
- can develop its own blood supply
- transportation around the body via lymph and blood
When will you see evidence of disease?
What is the gene that regulates cell growth?
Embryonic and Malignant cell-cell division
Embryonic and Malignant cell appearance
Embryonic and Malignant cell differentiated functions
Embryonic and Malignance cell adherence
Embryonic and Malignant cell growth
- embryonic-well regulated
Embryonic and Malignant cell chromosomes
Embryonic and malignant cell mitotic index
both are high
Differences between embryonic and malignant cells are:
- differentiated functions
- chromosome make up
Once a cell is mutated 3 things can happen....
- the cell will die
- the cell will recognize the damage and repair itself
- the cell will survive and pass along the damage to its daughter cells
- continuous growth of a tumor mass
- 1x2x4x8x16 and so on
The time required for a tumor mass to double is known as
- genes at are now tumor producing
- "lock is now unlocked"
2 proteins produced by cancer cells
- CEA-carinoembryonic antigen
- AFP-alpha fetal protein
*these are proteins that are located on the cell membrane which are characteristic of embryonic and fetal periods of life
CEA and AFP
**but there are also other reasons for these to be present other than cancer
Tumor suppressor genes....
BRAC-1 and BRCA-2 increase a persons risk for
breast and ovarian cancer
APC gene increases a persons risk for
Mutation of P53 gene makes a person at risk for
Nurses role in prevention of cancer
- ID risk factors and eliminate if possible
- early detection/treatment
7 warning signs of cancer
- Change in bladder/bowel habits
- A sore throat that doesn't heal
- Unusual bleeding/discharge from body orifice
- Thickening/lump in breast or elsewhere
- Indigestion or difficulty swallowing
- Obvious change in a wart or mole
- Nagging cough or hoarseness
You are at risk to get these cancers just by being over 50
Breast and Prostate
What makes a person a candidate to be screened for lung cancer?
- 55-74 y/o
- 30 pack/yr hx...and still smoking or quit in past 15 yrs
done when tissue can be safely reached thru the skin
When do you get an endoscopic biopsy?
to look at lung, esophageal, colon or bladder tissues
Fine needle aspiration
a small gauge aspiration needle is inserted and takes out cells from the mass for cytologic examination
Large core biopsy
cutting needles that will deliver an actual piece of tissue (core) that can be analyzed
surgical removal of the entire lesion, lymph node, nodule or mass
*Both therapeutic and diagnostic
4 Stages of Cancer
- 0-in situ
- 1 localized growth only
- 2 limited local spread
- 3 extensive local and regional spread
- 4 metastasis
- tells the extent of the disease
- Tumor size and invasiveness
- Nodes....has it spread to nodes
- Metastasized....is it in distant organs
Surgery as prevention for cancer....
removal of non vital organs to reduce the risk
surgical removal of a part of the tumor because it is attached or too near to a vital organ
What kind of margins do you want?
Goal of radiation therapy
deliver maximal doses to target area while sparing critical structures and minimal damage to surrounding tissues
When does a person usually get radiation?
M-F for 2-8 weeks
Goal of chemotherapy
to destroy or reduce the number of malignant cells without excessive destruction of normal cells
What can chemo be used for?
- in combo with adjuvant or neoadjuvant therapy
adjuvant vs. neoadjuvant
adjuvant-treatment (chemo) given after surgery to kill any cancer cells left in the body
neoadjuvant-treatment (chemo) given before the surgery to shrink the cancer before it is surgically removed
Cell Cycle Specific Chemo
kills/damages cells when they are dividing
Cell Cycle Non Specific Chemo
kills/damages cells when they are dividing and resting
Before giving Chemo....
- check labs
- 2 certified RN's calculate dosage
- pt. is on chemo precuations
What are chemo precautions
- in place from the start of the chemo till 48 hours after it is done
- *wear gown and double gloves
- *all body fluids are contaminated
- *double flush toilet
- *dispose everything in biohazard bag
External Beam Teletherapy Radiation
- delivered from a source at a distance from target site
- 5 days a week for 30 min. for 2-8 weeks
- *treatment simulation
- *must be in exact same position every time
- *tattoo as a market
Brachytherapy Internatl Radiation
- radioactive device put in to tumor or close to it
- *purpose is to expose the cancer to radiation with minimal contact or side effects to normal tissue
Brachytherapy Sealed Source
radioactive seed put directly in to the tumor and it emits low energy with limited tissue penetration
Brachytherapy Sealed Source is used to treat:
Brachytherapy Temporary Implants are....
- inserted in to the cervix.
- Pt. on bedrest and has a foley
Fatigue from radiation usually occurs when?
3rd to 4th week of treatment
Creams to use on persons with skin issues from radiation
How is blood affected from radiation?
Chemo causes anemia...what do I need to watch?
- H&H levels
- encourage foods that promote RBC production
- Admin epogin/procrit
When does chemo get stopped due to Hgb levels?
Person on chemo will have leukopenia....what do I monitor?
- WBC-especially neutrophils
- teach to avoid large crowds and people with infections
- teach good hand hygiene
When is a sign to watch for with a person who is neutropenic to prevent sepsis?
temperature of 99.5-100
- time when the neutrophil count is the lowest
- typically 7-14 days after the patient has chemo
*Time when they are at the highest risk for infection
If a person has thrombocytopenia what do I monitor?
- Platelet count (normal 150-450,000)
Medication to improve platelet count.
What do I teach patient
- watch for falling
- sneezing/coughing can cause a brain bleed
- don't strain with BM
- No rectal temps
How long does it take for a transdermal pain patch to take effect?
24-48 hours....so don't stop PO meds till it is working
People on chemo need to have this assessed daily....
For a person on chemo how do I help them manage nausea?
- eat when you aren't nauseated
- eat small and frequent meals
- take antiemetics
- use diversional therapy
When can you see heart issues after chemo?
Up to 1 year later
*monitor ECG and Cardiac Ejection Fractions
When can hair loss be permanent?
When radiation is done to the brain
Nursing interventions for a person on Cytoxam
- Take med early in day
- empty bladder often
- 3L fluid/day
- Monitor urine for blood
Nursing interventions for a person on Adriamycin
- urine may be red
- watch for cardiotoxicity-EKG and Echo
- monitor WBC, platelets H&H
- watch for bleeding
How do you calculate the ANC
10% seg and 2% bands
2000 x .12=240 ANC
Severe risk for infection
3000 x .60= 1800
- 1500 relatively safe
- 1000 risk for infection
- 500 severe risk for infection
Superior Vena Cava Syndrome
- result of chemo
- obstruction occurs causing an engorgement
S/S of superior vena cava syndrome
- facial edema
- c/o tight collar
SIADH is typically seen in patients with
lung and brain tumors
Tumor lysis syndrome causes
- cardiac arrhythmias
- renal failure
How do you prevent kidney damage?
- aggressive hydration
- forced diuresis
- alkilinization of urine
- prompt correction of metabolic alterations
Medication that prevents kidney stones?
High K labs give
- kayexelate or
- insulin and glucose
To prevent kidney damage run IV's at .....mL/hr
150-300 to keep hydrated
High phosphorous levels give patient
phosphate binders like Amphojel
fluid accumulates in cardiac sace
Carotid Artery Rupture
occurs in patients with head and neck cancer from invasion of ther tumor in to the arterial wall
Mild non opioid pain relievers
Moderate Opioid pain relievers
Sever Pain Opioid Pain relievers
Progressive route of administration of analgesic....
When a person is on pain meds be prepared for....
breathrough pain and side effects treatments
Side effects of pain meds
- sedation respiratory depression
Non pharmacologic pain relief techniques
- therapeutic touch
- application of heat/cold