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what are the three ways cancer can grow?
- 1. direct growth
- 2. gravity/seeding to another area
- 3. grow to invade lymphatic/blood vessels and get carried to another location (metastasis)
what is neoplasm?
what does it mean if a tumor is benign?
it will not cause death or interfear with vital function
what does it mean if a tumor is malignant?
will cause death if not controlled
describe acancer cell
- large irregular nuclei
- fast dividing
- not well differentiated (don't look like parent cell)
what does it mean for cancer cells to be encapsulated?
their growth is restricted by a capsule
generally what are the two types of malignant tumors?
- epithelieal (carcinoma)
- connective tissue (sarcoma)
explaion how cancer is named
- named for parent tissue type with "oma" suffix added (fibroma, neuroma)
- can also be names for schientists (wilm's-kidney, hodgkin's-lymph nodes)
explain the three tumor staging/classification types (T, N, & M)
- 1. Primary Tumor (T)
- - T0 = no tumor present
- - T1-4 = increase in tumor size
- 2. Regional Lymph Nodes (N)
- - N0 = no lymph node involvement
- - N1-3 = increasing involvement
- 3. Distant Metastasis (M)
- - M0 = no metastasis
- - M1 = distant metastasis
explain how tumors are greaded (1-4)
- 1. cells well differentiated (look like parent cells)
- 2. cells are moderately different from parent cells
- 3. poorly differentiated (don't look like parent cells)
- 4. no normal characteristics
cancer is the ___________ cause of death in the US
what are some risk factors for cancer
- exposure to carcinogens (smoke, asbestos, pollutants)
- radiation exposure (MRI, CT, etc)
- genetic risk factors
- virus (hepatits B, HPV)
- hormonal changes
- health practices (ETOH, nutrition, sexual practices)
- psychological state (stress, depression, lack of support)
at what age do cancer rates increase? why?
- 3/4 of deaths from cancer occur over age 55
- chances increase over age 60 and every 10 years following
- this may be due to decreased immunity or increased exposure to carcinogens
what ethnic group has an increased rate for cancer? what are some possible reasons?
- african americans
- may be due to: environmental or social factors, genetics, deficient knowledge of warning signs, lack of access to medical care
what type of cancer is more common in the US than in other countries?
what is the most common type of cancer in women in the US? how do you detect it?
breast (32% of cancer cases) - lump in breast (pt should do self breast exams monthly after period, and have yearly mamogram after 40-50 years of age)
what is the second most common type of cancer in men and women? how is it detected?
lung - causes caugh, hoarseness, SOB, change in color of mucous membranes. seen on chest x-ray but can go unnoticed until then. 85% of cases could be eliminated if pt quit smoking
what is the third most common type of cancer in men and women? how is it detected?
colorectal - blood in stool (can be occult or visible). pt over 50 years old should get annual OB on stool, digital exam, and colonoscopy
what is the 4th most common type of cancer in women? how is it detected?
Uterus (cervix) - abnormal bleeding/discharge. women should get annual PAP smear
what is the leading cause on cancer in men? how is it detected?
prostate (33% of cases) - causes change in urine output and back pain. pt should have annual exams and PSA testing
what is PSA testing?
Prostate Spacific Antigen - increase can show presence of cancer but low amounts are normal
what is the 4th most common type of cancer in men? how is it detected?
urinary bladder - causes pain on urination, occult blood, frequency, urgency, cloudy urine. pt should have anual exams, UA, and bladder scan
what are the 7 early warning signs of cancer? (CAUTION)
- C-change in elimination habbits
- A-a sore that doesn't heal
- U-unusual bleeding/discharge
- T-thickening or lump in breast/elsewhere
- I-indigestion or difficulty swallowing
- O-obvious change in wart or mole
- N-nagging caugh or hoarseness
what are the late warning signs of cancer?
- weight loss/muscle wasting
- local effects
- (best to prevent pt from getting this far)
what sort of a prognosis does a pt with cancer have if they start to experience the late warning sign of weight loss and muscle wasting?
te worst prognosis because this means they are very late into metastasis
what can cause ulceration in cancer pts?
what is a common sites for metastasis? why
the brain due to large amounts of blood circulation to bring cancer cells
what are the diagnostic tests for cancer?
- biopsy/cytology- look for cell differentiation
- labs- CBC to look for bleeding/abnormal cells, UA
- body scanning/ imaging (mammogram) to look at soft tissue
- Nuclear Magnetic Resonance (MRI) to look at soft tissue
- computer imaging
- CT- X-ray + computer to look at small sections
- contrast media- barium enema, upper GI series
- nuclear scan- radioisotoped accumulate in fast deviding cells
- ultrasound- shows tissue of different density
what is a tumor board?
a team of MDs that decide the best reatment for a particular pt
what are the two way treament is clasified?
- Curative: removes all cancer cells from body (or enough to allow immune system to take care of the rest)
- Palliative: relieves symptoms
what are the 4 major types of treatment for cancer?
what does it mean to debulk a tumor?
to decrease the size of a tumer in surgery if it is too big to be removed completely
how does radiation work to treat cancer?
it destroys/stops the growth of all rapidly growing cells in that area
what are the three types of Radiation? explain them
- 1. External: rays are applied by machine to a spacific area of the body. no lingering radiation is present.
- 2. Internal: cobolt/gold is sealed into a body cavity. rays can leak so others must use sfety precautions and minimize pt contact.
- 3. Unsealed: PO or placed into body cavity. others must use precausetions with direct contact with pt, discharge, or urine.
what two things effect the amount of radiation someone is exposed to?
distance and length of exposure
what are some reactions (general and late) that occure with external radiation?
- general-itch, tingling, burning of the skin (limit sunexposure) that can cause oozing/sloughing of skin, N/V, anorexia, ,alaise, diarrhea
- late- atrophy/necrosis (can happen years after treatment)
how does chemotherapy work in treating cancer?
it targets cells in cycle phases
how is chemo classified?
by action (cell cycle spacific vs non-spacific)
how do the two types of chemo work?
- cell cycle spacific- targets cells in one spacific cell cycle
- non-spacific- targets cells in many stages of replication
what are the possible routs for chemo? what is the best and what is the worst? why?
- PO (best)
- IV (must use PICC, Hickman, Broviac, or Port-a-Cath)
- IM (worst route due to muscle damage)
- local instill (by chest tube or lumbar puncture)
what shouldn't a rgulat IV be used for chemo?
must use PICC, Hickman, Broviac, or Port-a-Cath because a regular IV may infiltrate
what must always be done to a port-a-cath after injection?
heparin must be used to keep it patent
what tissues usually experience side effects of chemo?
rapid dividing tissues (bone marrow, GI tract, hear etc.)
what are the side effects of chemo to the GI tract, bone marrow, skin, and hair?
- GI- diarrhea, stomatitis, N/V, fungal infections
- bone marrow- decreased WBC, Hgb, PLT (prone to infection)
- skin- IV infiltrates cause necrosis, nail changes, photosensitivity
- hair- hair loss initially but it is not permanent
what are epogen and neupogen?
drugs to help reform blood cells. epogen increases RBCs and neupogen increases WBCs
what is alopecia?
what are two other side effects that chemo can have on internal organs?
- organ toxicity: can effect the heart, liver, lungs, and kidneys so watch labs (liver prteins, BUN, Cr, K) and ensure hydration
- sterility: so pt may want to harvest eggs/sperm before treatment
what is the theory behind immunological enhancement to treat chemo pts?
boosts body's natural cellular immune response in order to fight off cancer cells (can handle 10 million cells at a time but not >100 million)
what is another name for immunological enhancement?
biological response modifier
describe how the body's immune system fights tumor cells?
- cytokines carry messages for the immunesystem
- the body produces lymphocytes to destroy tumor
- then the immune response creates antibodies against tumor cells
what are the two types of biological response modifiers? what do they do?
- 1. Interferons: destroy tumor/suppress growth and metastasis
- 2. Interleukins: boost general immune resistance
what are some other alternative treatments for cancer?
- guided imagery
- hormone manipulation
- gene therapy
- targeted therapy
- nutritional therapy
is pain a common symptom of cancer?
no, 60% of pts report mild or no pain
what is usually a late or last symptom of cancer?
what are 5 changes that pain may be due to?
- 1. bone destruction
- 2. obstruction of lumens increases pressure (urinary, GI)
- 3. peripheral nerve involvement
- 4. pressure of growing tumors
- 5. Claudication- inflammation, infection, and necrosis of tissue
what is claudication?
pain in lower extremities from lack of 02 and circulation
what are some types of treatment for pain in cancer patients?
- surgery, nerve blocks, TENS (trans cutanial nerve stimulation- blocks pain signal)
- diversion, imagery
what meds are givin to treat what level of pain in cancer pts?
- mild to moderate = tylenol/ASA
- moderate = codine
- severe/chronic pain = opiates
what happens with prolonged codine use?
codine use >6 months results in decreased effectiveness
what can we do to decrease pt anxiety that medication won't relieve their pain?
- start doses high and taper down until the right dose is found
- dose around the clock, not prn
what is another name for wilm's tumor?
what is staging?
the extent of a disease at diagnosis
what does the term primordial mean?
what is wilm's tumor?
primordial malignant cancer of the kidney where cells don't mature and then grow out of control
what usually prevents the spread of wilm's tumor?
usually encapsulated, however if ruptured, it can seed down to the abdomen
why is more at risk for wilm's tumor?
children under 6 years old, girls, and african americans
what are the 5 stages of wilm's tumor?
- stage 1 - tumor is limited to one kidney, completely curable with removal of effected kidney
- stage 2 - tumor extends beyond kidney, completely curable with removal of effected tissue
- stage 3 - confined to abdomen, requires chemo and does not have as good of a prognosis as stage 1 or 2
- stage 4 - hematogeneous metastasis to lung, liver, bone, or brain
- stage 5 - bilateral kidney involvement (most often due to metastasis) bad prognosis
what are signs and symptoms of wilm's tumor? the #1 s/s?
- #1 = blood in urine
- tight/enlarged abdomen
- non-tender firm/round lump in belly
what is done to diagnose wilm's tumor?
- abdominal ultra sound
- bone scan
- IV pyelogram
- biochemical/hematologic studies (UA for blood/CBC)
what is the #1 thing to keep in mind when assessing an infant with wilm's tumor?
do NOT palpate abdomen