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How is cancer classified?
- The tissue or blood cells where it starts
- The type
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What are the two types of cancer
- solid tumors
- hematologic malignancies
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Types of solid tumors
- Arise from specific tissue:
- Sarcomas
- Carcinomas
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Sarcoma
- Begins in the connective tissues - tissues the body uses to connect or support other tissue
- Ex: bones, muscle, fat, etc.
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Carcinomas
- MOST COMMON TYPE
- Originate from epithelial tissue, which is what lines the organs
- These cancers originate in the lining of organs like the lungs or liver, breast, colon, or prostate
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Hematologic malignancies
- Originate from blood or lymphatic cells
- Begins with one abnormal cell that starts growing and dividing out of control, so it takes time to develop
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Metastasis
- means it has the ability to travel or spread
- The primary cancer travels to other sites of the body
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How does metastasis occur?
- Can occur by:
- direct invasion
- blood system
- lymphatic system
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Risk factors for cancer
- Low fiber diet - as food sits longer in GI tract with cancerous ingredients in food
- Increased red meat & animal fat
- Nitrites - found in processed sandwich meats
- Alcohol
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Most important risk factor
Age! with higher incidence over age 60
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Who has the greatest incidence of cancer?
African Americans followed by Caucasians
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What is primary prevention?
- Ways to help prevent the actual occurrence of cancer:
- No smoking
- Exercise and good nutrition
- Maintain normal body weight
- Limit or eliminate alcohol
- Get vaccines for preventable diseases such as Hep B and HPV
- Avoid exposure to known carcinogens
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What is secondary prevention?
Using screening to pick up on cancer early, when there is a greater chance for cure or control
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Secondary prevention for females
- Breast self awareness
- Mammogram
- Pap smears
- colonoscopy
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When should women start doing self breast exams
- beginning in their 20's
- best time during menstrual cycle is between day 7 - 12. Do at end or just before end of period
- *Post-menopausal or women who have had hysterectomy should perform same day every month
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When should clinical breast exams be recommended
- Yearly for women greater than 40
- Once every three years for women 20-39
- Mammogram should be annually at age 40
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What should be taught before mammogram?
- No lotion, powder, or deodorant
- this can be picked up at calcium deposit in mammogram, which is otherwise a sign of cancer
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When should pap smears be done?
Every 3 years beginning at age 21, as long as there are no problems
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When should women get colonoscopy?
starting at age 50, and then every 10 years if there are no problems
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When should women have stool tested for occult blood
Yearly beginning at age 50, unless previous problems or positive family history
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What type of secondary prevention should be provided for males?
Info on breast self-awareness and yearly testicular exams
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Testicular tumors
- Grow very fast, so should recommend monthly testicular self exams
- Major age group for testicular cancer is young males ages 15 - 36
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What about secondary prevention in males with prostate?
Should get digital rectal exam and be tested for prostate specific antigen (PSA) annually after age 50
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When should colonoscopy be recommended for males?
- At age 50 and then every 10 years
- Fecal occult blood testing should be done yearly
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What is the tertiary prevention
- Focuses on management of long term care for clients with complex treatment for cancer
- Examples are support groups and rehabilitation
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General S/S of caner
- CAUTION:
- C: Change in bowel/bladder habits
- A: A sore that doesn't heal
- U: Unusual bleeding/discharge
- T: Thickening or lump in breast or elsewhere
- I: Indigestion or difficulty swallowing
- O: Obvious change in wart or mole
- N: Nagging cough or hoarseness
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What happens when cancer invades the bone marrow
leads to anemia, leukopenia, and thrombocytopenia
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Other s/s of cancer
- Unexplained weight loss.
- Cachexia is a common term, means extreme wasting and malnutrition.
- Fever - first sign of leukemia
- Fatigue - Duh
- Pain
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Blood tests for cancer
- Blood test are big for diagnoses:
- Abnormal CBC w diff
- Most concerned about neutrophils!!
- Elevated liver enzymes and AST/ALT
- Tumor markers
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What is involved in a total laryngectomy?
removal of vocal cords, epiglottis, and thyroid cartilage
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What is neoadjuvant treatment?
- Time specific therapies.
- so not done together.
- Rather, one comes before the next.
- Ex: Surgery and then chemo
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2 types of radiation therapy
- Internal radiation (brachytherapy)
- External radiation
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Brachytherapy
- Used to get radiation close to cancer or target tissue
- Is INSIDE the body.
- Pt emits radiation for a period of time so is a hazard to others
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Two varieties of brachytherapy
either sealed or unsealed
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Unsealed brachytherapy
- Client and body fluids emit radiation
- Radioisotope is given either IV or PO
- Radioactive for 24 to 48 hours
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Sealed brachytherapy
- Also known as solid
- Client emits radiation
- Body fluids are NOT radioactive
- Can be temporary or a permanent implant that is placed close to or inside tumor
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General radiation precautions for internal radiation:
- Time, Distance, and Shielding
- Nurse assignments should be rotated daily
- Will wear film badge
- Limit visitors to 30 min daily, must stay at least 6 ft away for at least 2-3 days after
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External radiation
- Involves a carefully focused beam of high energy rays delivered by a machine outside the body
- Client is NOT radioactive!
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Side effects of external radiation
- Erythema
- Shedding of skin
- Altered taste
- Fatigue - Duh
- Pancytopenia (All blood components are decreased.)
- *Pan means everything.
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Education for external radiation pt's
- Don't wash off markings!
- Don't use lotion
- Protect site from sunlight or UV exposure for 1 yr after completion of therapy - skin is very fragile
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