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out of the cell cycleNeurons, cardiac muscle cell
Dormant/Resting (G0)Liver, kidney
continuously dividing GIT cells, Skin, endometrium , Blood cells
more cells (callous)
a cell turns into a different cell. This is the dangerous kind.-leads to cancer
leads to cancer
Cancer Development 4 STAGES
- Initiation (mutation in DNA)
- Promotion (repeated exposure)
- Progression (benign to metastatic)
The degree to which a cell resembles its cell of origin in morphology and function. Cancer cells usually do not achieve same level of differentiation as normal cells- They are autonomous, excessive and disorganized
the result of abnormal cell proliferation…abnormal cell differentiation.
May range from 1 to 40 years-For disease to be clinically evident, tumor must reach a critical mass that can be detected
3 characteristics of Neoplasia
- Slow growth
- Does NOT metastasize (does not go into bloodstream)
- Undifferentiated-no specific function
- Erratic and Uncontrolled Growth
- Expansive and Invasive
- Secretes abnormal proteins
most common spread of cancer:
spread of cancer: Blood-borne, commonly to Liver and Lungs
spread of cancer: Seeding of tumors
Second most common cause of death in the United States after heart disease
Biggest risk of cancer:
Age is the single most important factor related to the development of cancer
Altered immune system
Accumulation of damage
Age as highest risk factor for cancer
Susceptability differences between men and women
- Female: breast, lung and colon.
- Male: prostate, lung and colon.
- All races, cancer 541.8 per 100,000 men
- All races 408.5 per 100,000 women
cancer risk by geographic location
Most forms of cancer are _______, and have no basis in heredity. There are, however, a number of recognized genetic risk factors.
Epstain Barr virus causes
Hepatitis B virus causes
Human T cell lymphotrophic virus causes
Adult T cell leukemia
Chemical agents that cause cancer
- Tobacco smoking is associated with lung cancer and bladder cancer.
- Exposure to asbestos fibers (mesothelioma)
- Thousands of chemicals have been identified as carcinogens.
Here the goal is to protect healthy people from developing a disease or experiencing an injury in the first place. For example:* education about good nutrition, the importance of regular exercise, and the dangers of tobacco, alcohol and other drugs* education and legislation about proper seatbelt and helmet use* regular exams and screening tests to monitor risk factors for illness* immunization against infectious disease* controlling potential hazards at home and in the workplace
These interventions happen after an illness or serious risk factors have already been diagnosed. The goal is to halt or slow the progress of disease (if possible) in its earliest stages; in the case of injury, goals include limiting long-term disability and preventing re-injury. For example:* telling people to take daily, low-dose aspirin to prevent a first or second heart attack or stroke* recommending regular exams and screening tests in people with known risk factors for illness* providing suitably modified work for injured workers
This focuses on helping people manage complicated, long-term health problems such as diabetes, heart disease, cancer and chronic musculoskeletal pain. The goals include preventing further physical deterioration and maximizing quality of life. For example:* cardiac or stroke rehabilitation programs* chronic pain management programs* patient support groups
The four most important risk factors for cancer are:
- tobacco use,
- lack of physical activity
- , exposure to ultraviolet light,
- and poor nutrition
Avoid or reduce exposure to known or suspected carcinogens
excessive sun exposur
eEat a balanced diet
Obtain adequate rest
lifestyle habits to reduce cancer risk
Utilize the ACS 7 Warning Signals
- C- Change in bowel/bladder habits
- A- A sore that does not heal
- U- Unusual bleeding
- T- Thickening or lump in the breast
- I- Indigestion
- O- Obvious change in warts
- N- Nagging cough and hoarseness
screening ages for :
- Breast cancer screening: age 40
- Colon cancer screening: age 50
- Uterine/cervical cancer screening:starting at sexual activity, age 20, yearly pap smear
- Prostate cancer screening:40 years
Diagnostic exams will:
- Provide the general health status of the pt
- Type of tumor, location, size, amount of tissue involved, Lymph node involvement ,metastasis
- Workups vary depending on the type of tumor suspected
- Lung, breast, prostate, colon
- What is a biopsy?
- How do we get the tissue sample?
- Fine need aspiration
- Core needle
Tumors can be classified by:
- Anatomic site
- Ploidy (#chromosomes)
- Histology (level of differentiation)
- Grading severityG1-G4 (as number increases the less differentiated the cell and the more advanced or aggressive is the cancer)
- Extent of disease (TNM-tumor node metastasis)
Factors that determine treatment modality and goals:
- Cell type
- Location and size of tumor
- Extent of disease
- Physiologic and psychologic status
- Expressed needs and desires
- Above will determine goals:
- Radiation Therapy
- Bone marrow transplant
- All of these modalities can be used to “cure” the patient or, with the exception of biotherapy and bone marrow transplant, can be used for palliation.
--Alone- It is limited by tumor accessibility, patient’s medical condition, tumor’s extent
--In combination with other modalities-RT and/or chemo
--Cure or palliative goals
Emerging field – only used for 30 years
Chemotherapeutic drugs are administered orally, injected, intraarterially (infusion pump), intracavitary, intraperitoneal, intrathecal (space containing CSF)
Can be used alone or in combination with surgery and RT
Combinations of drugs are usually used vs. single agents
Combination of drugs kill cells in different phases of the cell cycleLimited by amount of normal cell death
What do therapists have to be careful of with patients on chemo?
growth that causes tissue to increase in size by increasing the number of cells:
any new or continued cell growth not needed for normal development or replacement of dead and damaged tissues is called ___
Programmed cell death is _____
Withouth specific shape or differentiation
carcinogenesis/oncogenesis are other names for ___
steps in carcinogenesis:
30% of all cancers is caused by
-avoidance of known carcinogens
-modifying risk factors
-removal of "at risk" tissues
Yearly mammogram for women older than ___
Yearly breast exams for women older than ___
Colonoscopy at age ____ yrs and then every ___ years
Yearly prostate exam for men over ____
Extreme body wasting and malnutrition
A diet high in ___ and ___ is recommended for cancer pts.
protein and carbs
Early cancer may not have ____ _____
Biggest complication of chemo:
-most often used
-each drug effective against the cancer
-minimally overlapping toxicities
-decreased possibility of drug resistance
-increased percent of cells killed at one time
removal of all cancer tissue is called _____ surgery.
______ surgery is focused on improving quality of life, not cure.
-May pose an occupational hazard
-Drugs may be absorbed through Skin and Inhalation during preparation, transportation, and administration
-Only properly trained personnel should handle drugs
-Drugs may be irritants or vesicants
-Damage intima of vein, but not tissue damageSevere local tissue breakdown and necrosis
predictable; usually resolution is rapid
Requires little to no change in treatment
Expect nausea and vomitting, hair loss, problems with GI tract, toxic effects monitored to determine if therapy is effective.
Expected effects of chemotherapy
Serious and even life-threatening
Treatment change required
discontinue drugdose reduction
Toxic effects of Chemotherapy
Occurs during and immediately after drug administration
Extravasation (flare reaction)Give corticosteroids- the inflammatory response is basically an “allergic” response
Acute toxicity from chemo
Bone marrow suppression
Delayed nausea and vomiting
Delayed effects of chemo
Bone marrow suppression-common side effect
Altered bowel function
Cumulative neurotoxicities-damage to nerve cells, neuropathy, monitor for progression
Delayed effects of chemo
Nursing management of pt. under chemo involves:
knowing difference between tolerable side effects and toxic side effects
Report serious reactions of chemo because some toxicities are ___
Can be used alone or in combination with other modalities – 50% of all cancer patients receive RT
Cure and palliationCan preserve organ function - larynx, prostate-less impotence and incontinence than surgery
Better Cosmesis-skin cancers
Limited by critical structures
Patient must be able to endure treatment
Local treatment modality
One of the oldest nonsurgical methods of cancer treatment
Up to 60% of all cancer patients will receive radiation therapy
Cellular damage may be lethal or sublethal
Normal tissues are usually able to recover
Cancer cells are more likely to be permanently damaged
Total doses divided into fractions
Typically delivered once a day for 5 days a week for 2 to 8 weeks
Number and strength of doses is determined by mitotic rate of target tissue with rapidly growing tumors being more sensitive
Most common radiation treatment
Patient exposed to radiation from a megavolt machine
Cobalt 60 machine—gamma rays
Cyclotron—neutrons or protons
Linear accelerator—ionizing radiation
Implantation or insertion of radioactive materials into or close to tumor
Minimal exposure to healthy tissue
Used in combination with teletherapy
Patient is emitting radioactivity
Limit amount of time near patients being treated
Shielding should be used
Wear film badge to monitor exposure
common side effects of radiation and chemo
- Bone marrow suppression
- GI disturbances
Integumentary and mucosal reactions
common side effects of radiation and chemo
Purpose of this therapy is to destroy cancel cells with minimal exposure of the normal cells to the damaging actions of radiation
Most radiation therapy for cancer is
In this therapy, the patient emits radiation for a period of time and is a hazard to others.
side effects of: ___
altered taste sensation
aversion to taste of red meat
skin care need is a priority nursing intervention for pts. receiving
dry mouth is also called
when can you start seeing adverse effects of chemo?
in 2-3 weeks
theray that uses the body’s own immune systemB and T cells and natural killer cell lymphocytes:
In Biotherapy: Produce protein molecules or antibodies that attack and destroy foreign substances such as cancer
in Biotherapy: Mature into killer cells once they make contact with the antigen on a foreign substance
Scavenge and kill tumor cells
Able to kill tumor cells without damaging normal cells:
Tyrosine kinase inhibitors
Vascular endothelial growth factor receptor inhibitors
types of Targeted therapy
-Interferon inhibits DNA and protein synthesis
-Cytokines (enhance the immune system) with antiviral, antiproliferative, and immunodulatory properties
Biologic and targeted therapies
Spontaneously attack and kill foreign substances
Produced to react to a specific antigen
Cytotoxic agent can be attached-more cell kill action
Naturally occurring proteins that can kill cancer cells
Can help identify the antigen of cancer cells
Stimulate more T cell production (killer cells)
help regulate inflammationa and immune protection
Spinal cord compression
Superior vena cava syndrome
damage that occurs either when a tumor directly enters the spinal cord or when the vertebrae collapse from tumor degradation of the bone.
if paralysis occurs: it is usually permanent
-make sure to assess neurologic changes. back pain, muscle weakness, numbness, tingling, unsteady gait
spinal cord compression
compression/obstruction by the tumor growth or by formation of clots in the vessel
early signs occur when a patient wakes up after a nights sleep and include edema of the face, esp. around the eyes, and tightness of shirt or collar
superior vena cava syndrome
Cardiac tamponade is compression of the heart that occurs when blood or fluid builds up in the space between the myocardium (heart muscle) and
the pericardium (outer covering sac of the heart).
Anxiety, restlessness, Chest pain, Radiating to the neck, shoulder, back, or abdomen, Sharp, stabbing Worsened by deep breathing or coughing
an estimation of life expectancy based on all information about the tumor and from tumor trials
Prognosis is only an
If a patient is disease free for 5 years , he/she is considered cured.
5 year survival rule
1. Do not talk too much. Use silence to stimulate the patient to talk.
2. Pain is a model for the assessment of other symptoms
.3. Believe the patient
.4. Routinely assess severity by using a validated tool
.5. Most people also grieve in anticipation of loss.
name this drug:
side effect are seizures, bradycardia, shock, cardiac arrest, respiratory depression
notify doctor if respiration >12/min
do not bcc
physical dependency may result from long term use
Name this drug:
side effects: headache, dizziness, diarrhea, constipation
headache requiring analgesic is common
Name this drug:
used to treat nausea and vomiting caused by chemotherapy in people who have already taken other medications to treat this type of nausea and
vomiting without good results
weaknes,ssudden warm feeling,stomach pain,nausea,vomiting,memory loss,anxiety confusion,dizziness,unsteady walking
_____ therapy works by changing the level of hormones in the body, or by blocking the hormones so they can't help cancer cells to grow. (Some
cancers need hormones to help them grow and multiply.)
side effects: nausea, vomiting, dvt, PE, bleeding, stroke
biggest risk factor for colon cancer is:
radiation therapy is now done on a:
what are the most common metastatic sites of cancer cells?
Liver is one of the most metastatic sites.The others are the lymph nodes, lung, bone, and brain.
A client receives a sealed radiation implant to treat cervical cancer. When caring for this client, the nurse should have the pt:
maintain the client on complete bed rest with bathroom privileges only to prevent dislodgement of the implant.
What personal protective equipment (PPE) does the nurse wear when administering chemotherapy to the client?
Used to treat nausea and vomiting caused by chemotherapy in people who have already taken other medications to treat this type of nausea and vomiting without good results.
It is usually taken 1 to 3 hours before chemotherapy and then every 2 to 4 hours after chemotherapy, for a total of 4 to 6 doses a day. Swallow the capsule, do not BCC.
side effects of Marinol/Dronabinol
- sudden warm feeling
- stomach pain
- memory loss
major side effect of Zofran/Ondasteron
In this type of therapy, the pt. DOES NOT lose his/her scalp hair:
therapy given as a series of divided doses because of varying responses of all cancer cells within a given tumor:
type of radiation therapy: distant treatment where patient is not radioactive and is not a hazard to others.
close therapy where radiation source comes into direct, continuous contact with the tumor tissues for a specific period of time.
in _______, when the isotopes are unsealed they enter body fluids and eventually are elmininated in waste products, which are radioactive and should not be directly touched by other people
in _____, once the isotope is eliminated (as waste product), neither the patient nor the body wastes are radioactive. Most of this isotope is elmininated within 48 hrs.
altered taste sensation and fatigue are common complains of pts. receiving ____
external beam radiation
true or false:
wash the irradiated area each day with either water or a mild soap and water as prescribed by your radiologist.
true or false:
It is ok to wash and remove ink or dye markings that indicate exactly where to focuse radiation beams.
False. Do not remove these markings!
Chemotherapy used along with surgery or radiation is termed ____.
Therapy that usually lasts for 3-4 weeks and are given through IV.
a major complication of IV infusion during chemo is ____ , or the movement of the IV needle so that the drug leaks into the surrounding tissues.
The most impt. nursing intervention for extravasation is:
common distressing side effects of ____ include the ff:
altered bowel movement
This critical problem is the major dose limiting side effect of cancer chemo and a common cause of death for pts. during treatment:
Infection placing an extreme risk for sepsis. (also related to bone marrow suppresion)
major side effect of Neumega/Oprelvekin used to treat thrombocytopenia:
fuid retention, increases risk for CHF and pulmonary edema
Therapy done by decreasing the amount of hormones to hormone-sensitive tumors which can help slow the cancer growth rate:
hormone manipulation therapy
side effects of hormonal manipulations:
- women develop male characteristics.
- men develop femal characteristics (gynecomastia; dev't. of breasts among men)