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Group of disease characterized by uncontrolled and unregulated cell growth Cancer What are 5 examples of types of cancer? Breast, lungs, colon/rectum, uterus, melanoma, thyroid, kidney, renal, pelvis, pancreas, leukemia, ovary, brain Is cancer incidence higher in men or woman? Woman What are the defect in proliferation and differentiation stages? Initiation, promotion, progression Mutation in cell's genetic structure Initiation stage What ways can mutation occur? Inherited, acquired, carcinogens Heritable mutation-mutation passed from one generation to the next Inherited mutation
Acquired mutation-mutation caused by carcinogens - chemicals, radiation, viral Acquired mutation Carcinogen-cancer-causing agents capable of producing cell alterations Carcinogen Promotion stage-reversible proliferation of the altered cells (alterations š³ risk for mutation) Promotion stage What are promoting factors for cancer? Obesity, smoking, alcohol use, What can a patient do to reduce the chance of cancer development? Lifestyle change to modify the potential risk factors What are the main sites of metastasis?
- Brain & cerebrospinal fluid Lungs Liver Bone
Immune response suppression by products produced and secreted by the tumor cells Step# 4 of the tumor cell's immunological escape Induction of suppressor T cells by tumor Step# 5 of the tumor cell's immunological escape Blocking antibodies that bind TAAs, thereby blocking the TAAs recognition by T cells Step# 6 of the tumor cell's immunological escape What 3 things are included in the anatomical classification of tumors?
- Tissue of origin
- Anatomic site
- Behavior of the tumor - benign or malignant What 2 things are included in the histologic classification of tumors? Appearance, degree of differentiation What is included with degree of differentiation of a tumor? Grade 1, 2, 3, 4, and X. Grade X cannot be assessed What 3 things are included in the extent of disease for tumors? Clinical staging, TNM classification Classifying the extent and spread of disease Clinical staging (0-4)
Cancer in situ Clinical staging: stage 0 Tumor confined to the tissue of origin; localized tumor growth Clinical staging: stage 1 Limited regional spread Clinical staging: stage 2 Disseminated regional and possibly some distant spread Clinical staging: stage 3 Dissemination has taken place Clinical staging: stage 4 An international classification system concerned with the extent of dissemination and the degree of cellular differentiation, two major determinants in cancer management and prognosis. TNM classification Tumor size and invasive potential TNM classification: T No regional lymphatic involvement TNM classification system: N Involvement of lymph nodes TNM classification system: M
What diagnostics are used for cancer? Biopsy Removal of a tissue sample for pathogenic analysis Biopsy What are the types of biopsy? Percutaneous, endoscopic, fine-needle aspiration, large-core biopsy, excisional biopsy, Incisional biopsy T/F? Pathogenic evaluation of a tissue sample is the only definitive way to diagnose cancer. True What 3 things does a biopsy examine?
- Benign or malignant
- Anatomic tissue from which the tumor arises (histology)
- Degree of cell-differentiation (histologic grade) What are the treatment goals for cancer?
- Cure
- Control
- Palliation Eradication of cancer through radiation, surgery, chemotherapy or a combination. Cure
What cancer is more likely to recur than cancers with slower mitotic rates> Cancers with higher mitotic rates Goal for cancers that we cannot fully eradicate but are responsive to anticancer therapies. Control What do you need to monitor for during the control goal of treatment? Early S/Sx of cancer recurrence or progression and the cumulative effects of therapy Symptom control or relief and maintaining a satisfactory QOL. Palliation What are the treatment methods for cancer? Surgical, chemotherapy, radiation, immunotherapy, target therapy, others What is the goal of surgical treatment method for cancer? Prevention, cure/control, support Goal is to reduce the risk for cancer development Surgical prevention for cancer Goal is to remove or all or as much respectable tumor as possible while sparing normal tissue Surgical cure/control for cancer
Alkylating Bind directly to DNA, thus inhibiting the synthesis of DNA and interfering with transcription of RNA. Antitumor Antibiotics Break DNA helix, interfering with DNA replication. Cross blood-brain barrier. Nitrosoureas Bind to DNA and RNA, miscoding information and/or inhibiting DNA replication, and cells die. Platinum Drugs What chemotherapies are cell cycle phase-specific? Antimetabolites, mitotic inhibitors, topoisomerase inhibitors Antimetabolites Mimic naturally occurring substances, thus interfering with enzyme function or DNA synthesis. Primarily act during S phase. Purine and pyrimidine are building blocks of nucleic acids needed for DNA and RNA synthesis. cladribine, clofarabine (Clolar), fludarabine, mercaptopurine (Purixan), nelarabine (Arranon), pentostatin (Nipent), thioguanine Interfere with purine metabolism capecitabine (Xeloda); cytarabine, floxuridine, fluorouracil, gemcitabine (Gemzar) Interfere with pyrimidine metabolism
methotrexate (Trexall), pemetrexed (Alimta) Interfere with folic acid metabolism hydroxyurea (Hydrea, Droxia) Interfere with DNA synthesis Antimicrotubule agents that interfere with mitosis. Act during the late G2 phase and mitosis to stabilize microtubules, thus inhibiting cell division. Taxanes Act in M phase to inhibit mitosis. Vinca Alkaloids Inhibit topoisomerases (normal enzymes) that function to make reversible breaks and repairs in DNA that allow for flexibility of DNA in replication. Topoisomerase Inhibitors Which are the routes of administration for chemotherapy? Oral, intraarterial, intracavitary, intramuscular, intrathecal, intravenous, perfusion, subcutaneous, topical What are major concerns for chemotherapy? Venous access problems, device or catheter-related infection, and extravasation What do we monitor during chemotherapy? S/Sx of phlebitis, vesicants, extravasation T/F? Chemotherapy drugs cannot selectively distinguish between normal cells and cancer cells. True What is the goal of chemotherapy? Eliminate or reduce the number of cells in the primary and metastatic sites
Effect of cell destruction on bone marrow stem cells? Myelosuppression (infection, bleeding, anemia) Effect of cell destruction on epithelial cells lining the GI tracts? Anorexia, mucositis, N/V/D Effect of cell destruction on hair follicle cells? Alopecia Effect of cell destruction on neutrophils? Leukopenia, infection Effect of cell destruction on ova and testes? Reproductive problems general principles of radiation? Uses low-energy and high-energy beams Expand energy quickly on impact with matter, penetrate only a short distance. Low-energy beams Greater depth of penetration not reaching full intensity until they reach a certain depth High-energy beams What does radiation limited to? Maximal tolerated dose Centigray (cGy) = 1 rad 100 cGy = 1 gray
- Doses between are considered normal fractionation 180 - 200cGy/day Most common, Pt. exposed to radiation from a megavoltage External radiation Implantation or insertion of radioactive materials directly into tumor (interstitial) or near the tumor (intracavitary or intraluminal) Internal radiation "brachytherapy" What are the sources for radiation? Temporary sealed sources and permanent sealed sources Patient with temporary implants are only while the source is in place. Radioactive Uses the immune system, the body's main defense against infection and disease, to fight cancer Immunotherapy Interfere with the tumour growth by acting on cellular receptors and specific pathways essential to tumour growth Target therapy Side effects of target therapy Flu-like symptoms, HA fever chills myalgias, fatigue, malaise, generalized weakness, photosensitivity, anorexia, nausea
tissue typing, has been found to be HLA matched to the recipient (host). Allogenic transplantation Type of allogeneic transplant where the stem cells are taken from one identical twin and infused into the other Syngeneic transplantation Patients receive their own stem cells back after myeloablative Autologous transplantation Destroying bone marrow Myeloablative What are the complications of the stem cell treatment for cancer? Bacterial, viral, and fungal infections, post-transplant complications, graft-versus-host disease š³ Uric acid levels due to chemotherapy-induced cell destruction. Hyperuricemia What is the nursing management for hyperuricemia?
- Monitor uric acid levels.
- Allopurinol may be given as a prophylactic measure.
- Maintain increased fluid intake. Some chemotherapy drugs, particularly anthracyclines and taxanes, can cause ECG changes and rapidly progressive heart failure.
Cardiotoxicity What is the nursing intervention for cardiotoxicity?
- Monitor heart with ECG and cardiac ejection fractions.
- Drug therapy may need to be changed for symptoms or deteriorating cardiac function studies.
- Administer antidysrhythmic drugs as ordered. Inflammation from radiation injury. Complication from chest wall radiation. May occur up to 1 year after treatment. Side effect of some chemotherapy drugs. Pericarditis and Myocarditis What is the nursing management for pericarditis and myocarditis?
- Monitor for manifestations of these problems (e.g., dyspnea). Anabolic processes result in accumulation of metabolites from cell breakdown. Fatigue What is the nursing intervention for fatigue?
- Assess for reversible causes of fatigue and address them as indicated.
- Reassure patient that fatigue is a common side effect of therapy.
- Encourage patient to rest when fatigued, to maintain usual lifestyle patterns, as much as possible, and to pace activities in accordance with energy level.
- Encourage moderate exercise as tolerated.
- Give antidiarrheal drugs as needed.
- Encourage low-fiber, low-residue diet.
- Encourage fluid intake of at least 3 L/day. Toxic effects from chemotherapy drugs (usually transient and resolve when drug is stopped). Hepatotoxicity What is the nursing intervention for hepatotoxicity?
- Monitor liver function tests. Release of intracellular breakdown products stimulates vomiting center in brain. Drugs stimulate vomiting center in brain. Radiation and chemotherapy destroy lining of GI tract. Nausea and vomiting What is the nursing intervention for nausea and vomiting?
- Encourage patient to eat and drink when not nauseated.
- Give prophylactic antiemetics before chemotherapy and on as-needed basis.
- Teach patients to take antiemetics on a scheduled basis for 2 - 3 days after highly emetogenic chemotherapy.
- Apply diversional activities if it is appropriate. Chemotherapy or radiation treatment kill epithelial cells in the field, for instance, head and neck, stomach, esophagus. Rapid destruction of cells results in inflammation and ulceration. Stomatitis, Mucositis, and Esophagitis
What is the nursing intervention for Stomatitis, Mucositis, and Esophagitis?
- Check oral mucosa daily and educate the patient about this.
- Utilize nutrition supplements like Ensure, Boost, if intake is decreasing.
- The patient may find eating, swallowing, and talking difficult and analgesics may be a necessity.
- Instruct the patient to avoid irritating spicy or acidic foods or too hot or too cold food because of extreme temperature.
- Instruct patient how to select foods that are moist, bland, and softer.
- Oral cavity is to be kept clean and moist with frequent oral rinses with saline or salt and soda solution.
- Artificial saliva may be used in conditions of dryness, especially radiation.
- Discourage the use of irritants such as tobacco and alcohol.
- Apply topical anesthetics (eg, viscous lidocaine, oxethazaine). Chemotherapy (eg, cyclophosphamide, ifosfamide) destroys cells lining the bladder Side effect of radiation when in the treatment field. Hemorrhagic Cystitis What is the nursing intervention for Hemorrhagic Cystitis?
- Increase fluid intake 24 - 72 hr after treatment as tolerated.
- Monitor for urgency, frequency, and hematuria.
- Give cytoprotectants (mesna [Mesnex]) and hydration.
- Provide supportive care to manage symptoms (e.g., flavoxate). Exposure to nephrotoxic drugs (cisplatin and high-dose methotrexate) directly damages renal cells. Precipitation of metabolites of cell breakdown (tumor lysis syndrome [TLS]). Nephrotoxicity
