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What's the first step in changing a normal cell in to a cancer cell?
Initiation
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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
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Errors that can occur in DNA replication
Inherited mutation
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When does an initiated cell become a tumor cell?
When it has the ability to self replicate and grow
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What is the reversible proliferation of an altered cell?
Promotion
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What is key to preventing cancer?
PREVENTION
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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
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Name some promoting factors
- dietary fat
- obesity
- cigarettes
- alcohol
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What is a "Complete Carcinogen"?
Name one
a carcinogen that is capable of initiating and promoting the development of cancer
Cigarette smoke
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What is progression?
increased growth rate of a tumor, becoming invasive and metastsizing
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Unique capabilities of cancer cells
- can develop its own blood supply
- transportation around the body via lymph and blood
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When will you see evidence of disease?
Progression
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What is the gene that regulates cell growth?
"genetic lock"
Proto-oncogene
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Embryonic and Malignant cell-cell division
both continuous
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Embryonic and Malignant cell appearance
both anaplastic
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Embryonic and Malignant cell differentiated functions
- embryonic-none
- malignant-some/none
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Embryonic and Malignance cell adherence
both loose
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Embryonic and Malignant cell growth
- embryonic-well regulated
- malignant-invasion
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Embryonic and Malignant cell chromosomes
- embryonic-diploid
- malignant-anaploid
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Embryonic and malignant cell mitotic index
both are high
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Differences between embryonic and malignant cells are:
- differentiated functions
- growth
- chromosome make up
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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
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Pyramid effect
- continuous growth of a tumor mass
- 1x2x4x8x16 and so on
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The time required for a tumor mass to double is known as
doubling time
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Oncogene
- genes at are now tumor producing
- "lock is now unlocked"
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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
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Tumor markers
CEA and AFP
**but there are also other reasons for these to be present other than cancer
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Tumor suppressor genes....
suppress growth
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BRAC-1 and BRCA-2 increase a persons risk for
breast and ovarian cancer
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APC gene increases a persons risk for
colorectal cancer
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Mutation of P53 gene makes a person at risk for
- bladder
- breast
- colorectal
- esophageal
- liver
- lung
- ovarian
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Nurses role in prevention of cancer
- ID risk factors and eliminate if possible
- early detection/treatment
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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
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You are at risk to get these cancers just by being over 50
Breast and Prostate
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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
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Percutaneous biopsy
done when tissue can be safely reached thru the skin
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When do you get an endoscopic biopsy?
to look at lung, esophageal, colon or bladder tissues
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Fine needle aspiration
a small gauge aspiration needle is inserted and takes out cells from the mass for cytologic examination
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Large core biopsy
cutting needles that will deliver an actual piece of tissue (core) that can be analyzed
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Excisional biopsy
surgical removal of the entire lesion, lymph node, nodule or mass
*Both therapeutic and diagnostic
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4 Stages of Cancer
- 0-in situ
- 1 localized growth only
- 2 limited local spread
- 3 extensive local and regional spread
- 4 metastasis
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TNM
- tells the extent of the disease
- Tumor size and invasiveness
- Nodes....has it spread to nodes
- Metastasized....is it in distant organs
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Surgery as prevention for cancer....
removal of non vital organs to reduce the risk
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Debulking
surgical removal of a part of the tumor because it is attached or too near to a vital organ
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What kind of margins do you want?
negative margins
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Goal of radiation therapy
deliver maximal doses to target area while sparing critical structures and minimal damage to surrounding tissues
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When does a person usually get radiation?
M-F for 2-8 weeks
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Goal of chemotherapy
to destroy or reduce the number of malignant cells without excessive destruction of normal cells
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What can chemo be used for?
- cure
- palliation
- in combo with adjuvant or neoadjuvant therapy
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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
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Cell Cycle Specific Chemo
kills/damages cells when they are dividing
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Cell Cycle Non Specific Chemo
kills/damages cells when they are dividing and resting
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Before giving Chemo....
- check labs
- 2 certified RN's calculate dosage
- pt. is on chemo precuations
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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
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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
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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
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Brachytherapy Sealed Source
radioactive seed put directly in to the tumor and it emits low energy with limited tissue penetration
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Brachytherapy Sealed Source is used to treat:
- PROSTATE
- lung
- breast
- gynecologic
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Brachytherapy Temporary Implants are....
- inserted in to the cervix.
- Pt. on bedrest and has a foley
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Fatigue from radiation usually occurs when?
3rd to 4th week of treatment
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Creams to use on persons with skin issues from radiation
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How is blood affected from radiation?
- anemia
- leukopenia
- thrombocytopenia
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Chemo causes anemia...what do I need to watch?
- H&H levels
- encourage foods that promote RBC production
- Admin epogin/procrit
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When does chemo get stopped due to Hgb levels?
at 12
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Person on chemo will have leukopenia....what do I monitor?
- WBC-especially neutrophils
- temperature
- teach to avoid large crowds and people with infections
- teach good hand hygiene
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When is a sign to watch for with a person who is neutropenic to prevent sepsis?
temperature of 99.5-100
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What's Nadir
- 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
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If a person has thrombocytopenia what do I monitor?
- H&H
- Platelet count (normal 150-450,000)
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Medication to improve platelet count.
What do I teach patient
Neumega IL11
- watch for falling
- sneezing/coughing can cause a brain bleed
- don't strain with BM
- No rectal temps
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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
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People on chemo need to have this assessed daily....
oral mucosa
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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
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When can you see heart issues after chemo?
Up to 1 year later
*monitor ECG and Cardiac Ejection Fractions
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When can hair loss be permanent?
When radiation is done to the brain
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Nursing interventions for a person on Cytoxam
- Take med early in day
- empty bladder often
- 3L fluid/day
- Monitor urine for blood
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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
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How do you calculate the ANC
WBC 2000
10% seg and 2% bands
Or
WBC 3000
60% granulocytes
2000 x .12=240 ANC
Severe risk for infection
3000 x .60= 1800
Relatively safe
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ANC breakdown
- 1500 relatively safe
- 1000 risk for infection
- 500 severe risk for infection
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Superior Vena Cava Syndrome
- result of chemo
- obstruction occurs causing an engorgement
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S/S of superior vena cava syndrome
- dyspnea
- orthopnea
- facial edema
- c/o tight collar
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SIADH is typically seen in patients with
lung and brain tumors
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Tumor lysis syndrome causes
- cardiac arrhythmias
- renal failure
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How do you prevent kidney damage?
- aggressive hydration
- forced diuresis
- alkilinization of urine
- prompt correction of metabolic alterations
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Medication that prevents kidney stones?
Allopurinol
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High K labs give
- kayexelate or
- insulin and glucose
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To prevent kidney damage run IV's at .....mL/hr
150-300 to keep hydrated
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High phosphorous levels give patient
phosphate binders like Amphojel
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Cardiac Tomponade
fluid accumulates in cardiac sace
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Carotid Artery Rupture
occurs in patients with head and neck cancer from invasion of ther tumor in to the arterial wall
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Mild non opioid pain relievers
- aspirin
- acetaminophen
- NSAIDS
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Moderate Opioid pain relievers
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Sever Pain Opioid Pain relievers
- Morphine
- Oxycodone
- Dilaudid
- Fentanyl
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Progressive route of administration of analgesic....
- oral
- rectal
- transdermal
- im
- iv
- intraspinal
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When a person is on pain meds be prepared for....
breathrough pain and side effects treatments
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Side effects of pain meds
- constipation
- nausea
- sedation respiratory depression
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Non pharmacologic pain relief techniques
- therapeutic touch
- application of heat/cold
- massage
- distraction
- imagery
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