Oncology Lecture #1

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Oncology Lecture #1
2013-12-07 13:22:46
N172 Oncology

N172 Oncology Lecture 1
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  1. What's the first step in changing a normal cell in to a cancer cell?
  2. What is initiation?
    it is a mutation in the cell's genetic structure which has the potential for developing in to a clone (group of identical cells)  of neoplastic cells
  3. Errors that can occur in DNA replication
    Inherited mutation
  4. When does an initiated cell become a tumor cell?
    When it has the ability to self replicate and grow
  5. What is the reversible proliferation of an altered cell?
  6. What is key to preventing cancer?
  7. What is promotion?
    it is an alteration in gene structure plus "promoting agents" which will increase the chance for additional mutations as well as increase the chances of malignancies developing
  8. Name some promoting factors
    • dietary fat
    • obesity
    • cigarettes
    • alcohol
  9. What is a "Complete Carcinogen"?
    Name one
    a carcinogen that is capable of initiating and promoting the development of cancer

    Cigarette smoke
  10. What is progression?
    increased growth rate of a tumor, becoming invasive and metastsizing
  11. Unique capabilities of cancer cells
    • can develop its own blood supply
    • transportation around the body via lymph and blood
  12. When will you see evidence of disease?
  13. What is the gene that regulates cell growth?
    "genetic lock"
  14. Embryonic and Malignant cell-cell division
    both continuous
  15. Embryonic and Malignant cell appearance
    both anaplastic
  16. Embryonic and Malignant cell differentiated functions
    • embryonic-none
    • malignant-some/none
  17. Embryonic and Malignance cell adherence
    both loose
  18. Embryonic and Malignant cell growth
    • embryonic-well regulated
    • malignant-invasion
  19. Embryonic and Malignant cell chromosomes
    • embryonic-diploid
    • malignant-anaploid
  20. Embryonic and malignant cell mitotic index
    both are high
  21. Differences between embryonic and malignant cells are:
    • differentiated functions
    • growth
    • chromosome make up
  22. Once a cell is mutated 3 things can happen....
    • the cell will die
    • the cell will recognize the damage and repair itself
    • the cell will survive and pass along the damage to its daughter cells
  23. Pyramid effect
    • continuous growth of a tumor mass
    • 1x2x4x8x16 and so on
  24. The time required for a tumor mass to double is known as
    doubling time
  25. Oncogene
    • genes at are now tumor producing
    • "lock is now unlocked"
  26. 2 proteins produced by cancer cells
    • CEA-carinoembryonic antigen
    • AFP-alpha fetal protein

    *these are proteins that are located on the cell membrane which are characteristic of embryonic and fetal periods of life
  27. Tumor markers
    CEA and AFP

    **but there are also other reasons for these to be present other than cancer
  28. Tumor suppressor genes....
    suppress growth
  29. BRAC-1 and BRCA-2 increase a persons risk for
    breast and ovarian cancer
  30. APC gene increases a persons risk for
    colorectal cancer
  31. Mutation of P53 gene makes a person at risk for
    • bladder
    • breast
    • colorectal
    • esophageal
    • liver
    • lung
    • ovarian
  32. Nurses role in prevention of cancer
    • ID risk factors and eliminate if possible
    • early detection/treatment
  33. 7 warning signs of cancer
    • Change in bladder/bowel habits
    • A sore throat that doesn't heal
    • Unusual bleeding/discharge from body orifice
    • Thickening/lump in breast or elsewhere
    • Indigestion or difficulty swallowing
    • Obvious change in a wart or mole
    • Nagging cough or hoarseness
  34. You are at risk to get these cancers just by being over 50
    Breast and Prostate
  35. What makes a person a candidate to be screened for lung cancer?
    • 55-74 y/o
    • 30 pack/yr hx...and still smoking or quit in past 15 yrs
  36. Percutaneous biopsy
    done when tissue can be safely reached thru the skin
  37. When do you get an endoscopic biopsy?
    to look at lung, esophageal, colon or bladder tissues
  38. Fine needle aspiration
    a small gauge aspiration needle is inserted and takes out cells from the mass for cytologic examination
  39. Large core biopsy
    cutting needles that will deliver an actual piece of tissue (core) that can be analyzed
  40. Excisional biopsy
    surgical removal of the entire lesion, lymph node, nodule or mass

    *Both therapeutic and diagnostic
  41. 4 Stages of Cancer
    • 0-in situ
    • 1 localized growth only
    • 2 limited local spread
    • 3 extensive local and regional spread
    • 4 metastasis
  42. TNM
    • tells the extent of the disease
    • Tumor size and invasiveness
    • Nodes....has it spread to nodes
    • Metastasized....is it in distant organs
  43. Surgery as prevention for cancer....
    removal of non vital organs to reduce the risk
  44. Debulking
    surgical removal of a part of the tumor because it is attached or too near to a vital organ
  45. What kind of margins do you want?
    negative margins
  46. Goal of radiation therapy
    deliver maximal doses to target area while sparing critical structures and minimal damage to surrounding tissues
  47. When does a person usually get radiation?
    M-F for 2-8 weeks
  48. Goal of chemotherapy
    to destroy or reduce the number of malignant cells without excessive destruction of normal cells
  49. What can chemo be used for?
    • cure
    • palliation
    • in combo with adjuvant or neoadjuvant therapy
  50. adjuvant vs. neoadjuvant
    adjuvant-treatment (chemo) given after surgery to kill any cancer cells left in the body

    neoadjuvant-treatment (chemo) given before the surgery to shrink the cancer before it is surgically removed
  51. Cell Cycle Specific Chemo
    kills/damages cells when they are dividing
  52. Cell Cycle Non Specific Chemo
    kills/damages cells when they are dividing and resting
  53. Before giving Chemo....
    • check labs
    • 2 certified RN's calculate dosage
    • pt. is on chemo precuations
  54. What are chemo precautions
    • in  place from the start of the chemo till 48 hours after it is done
    • *wear gown and double gloves
    • *all body fluids are contaminated
    • *double flush toilet
    • *dispose everything in biohazard bag
  55. External Beam Teletherapy Radiation
    • delivered from a source at a distance from target site
    • 5 days a week for 30 min. for 2-8 weeks
    • *treatment simulation
    • *must be in exact same position every time
    • *tattoo as a market
  56. Brachytherapy Internatl Radiation
    • radioactive device put in to tumor or close to it
    • *purpose is to expose the cancer to radiation with minimal contact or side effects to normal tissue
  57. Brachytherapy Sealed Source
    radioactive seed put directly in to the tumor and it emits low energy with limited tissue penetration
  58. Brachytherapy Sealed Source is used to treat:
    • lung
    • breast
    • gynecologic
  59. Brachytherapy Temporary Implants are....
    • inserted in to the cervix.
    • Pt. on bedrest and has a foley
  60. Fatigue from radiation usually occurs when?
    3rd to 4th week of treatment
  61. Creams to use on persons with skin issues from radiation
    • non perfume
  62. How is blood affected from radiation?
    • anemia
    • leukopenia
    • thrombocytopenia
  63. Chemo causes anemia...what do I need to watch?
    • H&H levels
    • encourage foods that promote RBC production
    • Admin epogin/procrit
  64. When does chemo get stopped due to Hgb levels?
    at 12
  65. Person on chemo will have leukopenia....what do I monitor?
    • WBC-especially neutrophils
    • temperature
    • teach to avoid large crowds and people with infections
    • teach good hand hygiene
  66. When is a sign to watch for with a person who is neutropenic to prevent sepsis?
    temperature of 99.5-100
  67. What's Nadir
    • time when the neutrophil count is the lowest
    • typically 7-14 days after the patient has chemo

    *Time when they are at the highest risk for infection
  68. If a person has thrombocytopenia what do I monitor?
    • H&H
    • Platelet count (normal 150-450,000)
  69. Medication to improve platelet count.
    What do I teach patient
    Neumega IL11

    • watch for falling
    • sneezing/coughing can cause a brain bleed
    • don't strain with BM
    • No rectal temps
  70. How long does it take for a transdermal pain patch to take effect?
    24-48 hours....so don't stop PO meds till it is working
  71. People on chemo need to have this assessed daily....
    oral mucosa
  72. For a person on chemo how do I help them manage nausea?
    • eat when you aren't nauseated
    • eat small and frequent meals
    • take antiemetics
    • use diversional therapy
  73. When can you see heart issues after chemo?
    Up to 1 year later

    *monitor ECG and Cardiac Ejection Fractions
  74. When can hair loss be permanent?
    When radiation is done to the brain
  75. Nursing interventions for a person on Cytoxam
    • Take med early in day
    • empty bladder often
    • 3L fluid/day
    • Monitor urine for blood
  76. Nursing interventions for a person on Adriamycin
    • urine may be red
    • watch for cardiotoxicity-EKG and Echo
    • monitor WBC, platelets H&H
    • watch for bleeding
  77. How do you calculate the ANC
    WBC 2000
    10% seg and 2% bands


    WBC 3000
    60% granulocytes
    2000 x .12=240 ANC

    Severe risk for infection

    3000 x .60= 1800

    Relatively safe
  78. ANC breakdown
    • 1500 relatively safe
    • 1000 risk for infection
    • 500 severe risk for infection
  79. Superior Vena Cava Syndrome
    • result of chemo
    • obstruction occurs causing an engorgement
  80. S/S of superior vena cava syndrome
    • dyspnea
    • orthopnea
    • facial edema
    • c/o tight collar
  81. SIADH is typically seen in patients with
    lung and brain tumors
  82. Tumor lysis syndrome causes
    • cardiac arrhythmias
    • renal failure
  83. How do you prevent kidney damage?
    • aggressive hydration
    • forced diuresis
    • alkilinization of urine
    • prompt correction of metabolic alterations
  84. Medication that prevents kidney stones?
  85. High K labs give
    • kayexelate or
    • insulin and glucose
  86. To prevent kidney damage run IV's at .....mL/hr
    150-300 to keep hydrated
  87. High phosphorous levels give patient
    phosphate binders like Amphojel
  88. Cardiac Tomponade
    fluid accumulates in cardiac sace
  89. Carotid Artery Rupture
    occurs in patients with head and neck cancer from invasion of ther tumor in to the arterial wall
  90. Mild non opioid pain relievers
    • aspirin
    • acetaminophen
    • NSAIDS
  91. Moderate Opioid pain relievers
    • Vicodin
    • Percocet
  92. Sever Pain Opioid Pain relievers
    • Morphine
    • Oxycodone
    • Dilaudid
    • Fentanyl
  93. Progressive route of administration of analgesic....
    • oral
    • rectal
    • transdermal
    • im
    • iv
    • intraspinal
  94. When a person is on pain meds be prepared for....
    breathrough pain and side effects treatments
  95. Side effects of pain meds
    • constipation
    • nausea
    • sedation respiratory depression
  96. Non pharmacologic pain relief techniques
    • therapeutic touch
    • application of heat/cold
    • massage
    • distraction
    • imagery