1. How is cancer classified?
    • The tissue or blood cells where it starts
    • The type
  2. What are the two types of cancer
    • solid tumors
    • hematologic malignancies
  3. Types of solid tumors
    • Arise from specific tissue:
    • Sarcomas
    • Carcinomas
  4. Sarcoma
    • Begins in the connective tissues - tissues the body uses to connect or support other tissue
    • Ex: bones, muscle, fat, etc.
  5. Carcinomas
    • 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
  6. 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
  7. Metastasis
    • means it has the ability to travel or spread
    • The primary cancer travels to other sites of the body
  8. How does metastasis occur?
    • Can occur by:
    • direct invasion
    • blood system
    • lymphatic system
  9. 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
  10. Most important risk factor
    Age! with higher incidence over age 60
  11. Who has the greatest incidence of cancer?
    African Americans followed by Caucasians
  12. 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
  13. What is secondary prevention?
    Using screening to pick up on cancer early, when there is a greater chance for cure or control
  14. Secondary prevention for females
    • Breast self awareness
    • Mammogram
    • Pap smears
    • colonoscopy
  15. 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
  16. 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
  17. 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
  18. When should pap smears be done?
    Every 3 years beginning at age 21, as long as there are no problems
  19. When should women get colonoscopy?
    starting at age 50, and then every 10 years if there are no problems
  20. When should women have stool tested for occult blood
    Yearly beginning at age 50, unless previous problems or positive family history
  21. What type of secondary prevention should be provided for males?
    Info on breast self-awareness and yearly testicular exams
  22. Testicular tumors
    • Grow very fast, so should recommend monthly testicular self exams
    • Major age group for testicular cancer is young males ages 15 - 36
  23. 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
  24. When should colonoscopy be recommended for males?
    • At age 50 and then every 10 years
    • Fecal occult blood testing should be done yearly
  25. 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
  26. 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
  27. What happens when cancer invades the bone marrow
    leads to anemia, leukopenia, and thrombocytopenia
  28. 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
  29. 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
  30. What is involved in a total laryngectomy?
    removal of vocal cords, epiglottis, and thyroid cartilage
  31. What is neoadjuvant treatment?
    • Time specific therapies. 
    • so not done together.
    • Rather, one comes before the next. 
    • Ex: Surgery and then chemo
  32. 2 types of radiation therapy
    • Internal radiation (brachytherapy)
    • External radiation
  33. 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
  34. Two varieties of brachytherapy
    either sealed or unsealed
  35. Unsealed brachytherapy
    • Client and body fluids emit radiation
    • Radioisotope is given either IV or PO
    • Radioactive for 24 to 48 hours
  36. 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
  37. 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
  38. External radiation
    • Involves a carefully focused beam of high energy rays delivered by a machine outside the body
    • Client is NOT radioactive!
  39. Side effects of external radiation
    • Erythema
    • Shedding of skin
    • Altered taste
    • Fatigue - Duh
    • Pancytopenia (All blood components are decreased.)
    • *Pan means everything.
  40. 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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