Cancer

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16.

7 Warning Signs of Cancer

A change in bowel or bladder habits A sore that does not heal Unusual bleeding or discharge Indigestion or difficulty in swallowing Thickening or a lump in the breast or elsewhere Obvious change in a wart or mole Nagging cough or hoarseness as low as reasonably achievable - Time, distance, and shielding are vital to health care professional safety when caring for a patient with a source of internal radiation stem cells are acquired from a donor who has been determined to be human leukocyte antigen (HLA)matched to the recipient patients receive their own stem cells back following myeloablative (destroying bone marrow) chemotherapy. Used for colorectal, some lung cancers, and breast cancer Pancreatic enzymes eating into suture material Painless hematuria smoking BCG activates the immune system to kill cancer. Instill via foley and let it dwell and do it every 3-6 months. IF bladder wall invaded, partial or total cystectomy with urinary diversion External beams or internally Family history, estrogen, obesity, sedentary lifestyle, increasing age, hormone replacement with just estrogen, mutations in the BRCA1 gene,

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Cancer Survivorship Risks

greater risk of functional impairment, noncancer-related death and comorbidities, including heart disease, diabetes, osteoporosis, and others. Cancer that originates from embroyonal ectoderm (skin, glands, mucous membranes, linings of respiratory tract, GI tract, GU tract Have their effect on cells during all phases of the cell cycle Exert their most significant effects during specific phases of the cell cycle Thin, watery discharge and then spotting Tingling, burning, weakness, numbness, feeling cold, pain when walking, weakness, soreness, achy muscles, being clumsy and losing balance, shaking/rambling, confusion Catheter is placed in an artery going to the tumor site and an embolic agent and some chemo are given Best given through a central venous access device Remove as much tumor while sparing as much normal tissue as normal Polyp can invade and penetrate the muscular wall of the colon; tumor cells then have access to regional lymph nodes and vascular system Surgical resection of the colon, maybe colostomy, chemo if metastasis, biologic therapy with avastin Exam of the cervix with binocular microscope along with a biopsy Cores out of the cervix; maintains fertility Done every 3-4 weeks once remission is reached. Freezes the bad tissue Removal of as much tissue as possible, even if it all cannot be removed for risk of damaging vital tissue (this makes chemo and radiation more effective because it has less cancer to attack)

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Carcinoma

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cell cycle phasenonspecific drugs Cell cycle phasespecific drugs Cervical cancer first sign Chemo confusion

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ALARA

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Allogenic Transplantation

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Chemoembolization

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Autologous Transplantation

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Chemotherapy Clear margins goal Colorectal cancer

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Avastin

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Biggest danger of pancreaticoduodenectomy Bladder cancer most common clinical finding Bladder cancer risk factor Bladder cancer treatment

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Colorectal treatment

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Colposcopy Cone biopsy Consolidation Chemotherapy Cryotherapy Debulking

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Brachytherapy Breast cancer risk factors

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135.

Decongestive Therapy Development of Cancer

Massage may be done if lymphedema is severe The first stage, initiation, is a mutation in the cell's genetic structure resulting from an inherited mutation, an error that occurs during DNA replication, or following exposure to a chemical, radiation, or viral agent. o Promotion, the second stage in the development of cancer, is characterized by the reversible proliferation of the altered cells. o Progression, the final stage, is characterized by increased growth rate of the tumor, increased invasiveness, and spread of the cancer to a distant site (metastasis). Normal screenings, examination of abnormal cells in biopsy, labs, markers, radiology studies, endoscopic exams, bone marrow biopsy Mammogram, ultrasound or CT or MRI

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First symptom of multiple myeloma First symptom of pancreatic cancer Goal of nursing care after breast surgery Goals of cancer treatment Goals of cancer treatment

Skeletal pain usually in the pelvis, spine, and ribs

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Jaundice

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Full range of motion within 4-6 weeks

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Cure, Control, Palliation

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Diagnosis can be done by Diagnosis of breast cancer diagnosis of endometrial cancer Diagnosis of head and neck cancer Diagnosis of lung cancer Diagnosis of ovarian cancer Diagnosis of pancreatic cancer Diagnosis of testicular cancer Endometrial Cancer risk factor Endometrial cancer treatment Epogen (Procrit) First sign of endometrial cancer

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endometria biopsy

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visualization, CT to see spread, and biopsy to confirm Chest x-ray, CT may show tumor and/or lymph enlargement, PET scan Abdominal or transvaginal ultrasound, CA125 tumor marker Ultrasound, CT Grade I Classification Grade II Classification Grade III Classification Grade IV Classification Harvesting Herceptin

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When cure is the goal, treatment is offered that is expected to have the greatest chance of disease eradication and may involve local therapy (i.e., surgery or radiation) alone or in combination with or without periods of adjunctive systemic therapy (i.e., chemotherapy). Control is the goal of the treatment plan for many cancers that cannot be completely eradicated but are responsive to anticancer therapies and can be maintained for long periods with therapy. With palliation, relief or control of symptoms and the maintenance of a satisfactory quality of life are the primary goals rather than cure or control of the disease process. Cells differ only slightly from normal cells and are well differentiated Cells are more abnormal and moderately differentiated (And a little bizarre) Cells are very abnormal and appearance and are poorly differentiated Cells are immature and primitive and undifferentiated (hard to tell origin) Retrieval of bone marrow or stem cells Monoclonal antibody that attaches to antigens in breast cancer cellsa nd is taken intot he cells and eventually kills them

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Ultrasound of testicle. Blood may show increased levels of AFP.

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Unopposed estrogen, increasing age, nulliparity, late menopause, obesity hysterectomy

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Stimulate bone marrow to produce more red blood cells uterine bleeding

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66.

Hodgkin's lymphoma

Proliferation of abnormal, giant, multinucleated cells. In 2/3 of people, painless swelling of cervical lymph nodes or maybe swelling in axilla or groin. There is a multifactorial cause, but exposure to the EpsteinBarr Virus may be a contributing cause as well as HIV. There is a quiet onset. In retrospect, there may have been a little weight loss, low grade temp, fatigue, weakness, chills, night sweats. Small amounts of alcohol may cause pain in the affect nodes. Lymph node biopsy, bone marrow exam, CT Epithelial lining of the milk ducts

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Infection nursing care for cancer patients

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Hodgkin's lymphoma diagnosis How do most cases of breast cancer arise? How does chemotherapy cause constipation and diarrhea? How does liver cancer present How does ovarian cancer spread? How is cancer initiated? How is cancer progressed? How is cancer promoted? How to treat hypercalcemia in mulitple myeloma Immunologic escape Important to assess after laryngeal surgery Induction Chemotherapy

Use sanitizing wipes to clean surfaces touched (phone, TV, remote, ATM, elevator buttons), be gentle when wiping after bowel movements (use baby wipes), stay away from people who have the cold or flu, stay away from children with drippy noses or who have had "live" vaccines, and stay away from crowds. Be careful not to cut or nick yourself as you're shaving or washing dishes, check temperature everyday and alert the doctor if it is more than 100.5, do not take tylenol, ibuprofin, or aspirin without talking to the ddoctor first, watch for infection around ports, clean cuts right away, perform skin care (especially feet) Used for leukemia, melanoma, kidney cancer, ovarian cancer, multiple myeloma Sleeve may be worn for compression Lung cancer

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Interferon Jobst stocking Leading cause of cancer death Leading cause of death for lymphomas Leading cause of head and neck cancers Leukemia

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Chemotherapy destroys the cells in the GI tract which inhibit gastric motility

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Infection

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Like cirrhosis, hepatomegaly, splenomegaly, jaundice, weight loss, peripheral edema, ascites, RUQ pain, anorexia Metastasis by shedding malignant cells which may implant on the uterus, bladder, bowel, and omentum. Also metastasizes by lymphatic spread Genetics, Radiation, Chemicals, Viruses Metastasis Dietary fats, obesity, smoking, alcohol Hydration (want 1-2 liters of urine/day), diuretics, careful ambulation to prevent pathologic fractures, and allopurinol to protect kidneys from uric acid (released from dead cells) Process by which cancer cells evade the immune system AIRWAY

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Prolonged tobacco and alcohol use, HPV

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A group of malignant disorders affecting the White Blood Cells. They impact blood, blood-forming tissues of the bone marrow, lymph system and spleen. White blood cells proliferate and crowd out other cells in bone marrow. It is fatal if not treated aggresively. Red Blood Cells and platelets are 'squeezed' to death in crowded bone marrow. There is no single cause and it can be acute or chronic. They are named for the type of white blood cell affected. Ultrasound, CT, MRI, percutaneous biopsy Surgical resection, radiofrequency ablation, cryoablation, chemo, chemoembolization Removes superficial cervical tissues and allows more comprehensive exam of the cells

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Liver cancer diagnosis Liver cancer treatment Loop Electrosurgery Excision Procedure (LEEP) Lumpectomy

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Very high dose for 6 weeks or more, continuously. Requires hospitalization.

Removal of the entire tumor along with a margin of normal surrounding tissue. Radiation to the entire breast with a boost to the tumor card.

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Lung cancer

Most arise in bronchial epithelial cells. Takes 8-10 years for a tumor to reach 1 cm in size. Silent for the most part. Found on routine x-ray 10% of time. Symptoms don't appear until late in the disease. Chronic cough or blood in sputum or pneumonitis are often earliest signs. Later symptoms include anorexia, fatigue, and weight loss. Difficulty breathing is possible if the tumor is large or encroaches on bronchi. Hoarseness may occur if cancer involves laryngeal nerve. Surgical resection, radiation, chemo, biologic therapy, avastin Acccumulation of lymph fluid in soft tissues Amount of radiation tolerated by a type of tissue Lung, bone, liver, brain

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Multiple Myeloma

Proliferation of the plasma cells in the bone marrow. They grow out of control and squeeze and kill WBCs, RBCs, and platelets. As malignant plasma cells grow, the push calcium out of bones and diffuse osteoporosis develops. Bone marrow biopsy, x-rays (show bone erosions), general thinning of bones, and even fractures Chemo confusion, avoiding falls, extra rest, and antidepressants may help Abnormal reduction of white blood cells that occurs when normal white blood cells are killed by chemotherapy Primarily B or T lymphocytes involved. Can be abrupt onset or slowly growing disease. Incidence has increased by 2-3% each year due to aging population and incidence of HIV. Usually further advanced and not just confined to lymph nodes. Swelling may have waxed and waned over years. There is not as good prognosis and relapse is common. Medication that stimulates bone marrow to produce platelets Pain management, jackson-pratt tubes, restoring the affected arm to full function, gently flex the arm on a pillow to provide elevation after surgery, begin wiggling fingers, moving wrist and elbow slightly even in PACU, progressive increases in arm activity and exercises (But medication must be given 30 min before) Provide anticipatory guidance. Tell the patient that this is the best time to get a wig and insurance will pay for it. Many people shave their hair to have more control. Protect the tender scalp with a hat, turban, or sunscreen. They may feel colder than normal. Sleep on a satin pillow for less friction than cotton. Experiment with hats, scarves, or even extra make-up to look pretty Accept help from friends, keep a wellbalanced diet with plenty of calories and proteins, stand up slowly, take Epogen, have blood transfusions Eat 5-6 small meals a day, eat foods that are high in salt and potassium to replace lost nutrients, eat low fiber and low residue foods (Ex: bananas, white rice, white toast, plain yogurt, chicken, cooked cereals, cottage cheese, eggs, noodles, canned fruits) and medications like immodium

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Multiple Myeloma diagnosis Nervous system changes Neutropenia

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Lung cancer treatment Lymphedema Maximal tolerated dose Metastasis sites of endometrial cancer Modified radical mastectomy Most common site of prostate cancer metastasis Most important risk factor in lung cancer Mouth and throat changes

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NonHodgkin's Lymphoma

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Removal of the breast and axillary nodes but preserves the pectoralis major muscle. Done if the tumor is too large to excise with good margins. Bone

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Numega Nursing Care after Breast Surgery

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Smoking

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Many people experience an increased sensitivity to hot or cold foods, infections of gums or teeth or tongue changes in taste and smell, dry mouth. Tell patients to see the dentist before starting chemo and get all the necessary dental work done. Check mouth and tongue every day looking for sores or white. Keep the mouth moist with water, ice, sugar-free candy, or gum, use alcohol-free mouth wash or warm water, baking soda, and salt. Choose foods that are moist, soft, easy to chew and swallow. Soften foods with gravy, sauces, broth, and yogurt. Avoid citrus! Avoid foods that may scrape the mouth such as chips.

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Nursing care for alopecia as a side effect of chemotherapy

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Nursing care for anemia and fatigue Nursing care for diarrhea as a side effect of chemotherapy

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79.

Nursing care for laryngeal surgery

A new trach will have copious bloody drainage, suction as needed. Speech therapy will help with swallowing. Tube feedings and hydration with IV. Elevate head of bed to prevent aspiration and decrease swelling in the neck, Jackson-Pratt in place so blood from deep muscles can escape. Saliva may be decreased or absent so increase fluid intake, sugarless gum/candy, always have water bottle. An artificial larynx is used for communication. Prior to surgery, establish how to communicate with a patient with a trach. Make sure the secretary and everyone on the unit knows that this patient cannot speak. If they ring the call light, go to the room. Put in a room near the nursing station. Chemo triggers both nausea and vomiting. Antiemetic drugs should be given one hour before chemotherapy and for a few days after. Bland foods and drinks such as crackers, toast, and gelatin help. Plan the best time to eat. Eat 5-6 small meals a day. Do not drink a lot during the meals. Do not lie down after eating. Cold foods are better tolerated since they have no odor. Allow fizz to leave carbonated drinks. Small bites of popsicles or fruit ices help. Sugar on sugar-free mints or tart candies if mouth is no sore. Deep breathing, cold on head/neck helps. Drugs such as Zofran, Compazine, and Decadron helps. Focused on neutropenia, thrombocytopenia, and anemia

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Pain Ladder

OTC, short acting narcotics, long acting narcotics by mouth, patches, IV Push, IV drip, instant release Give pain meds on a regular schedule, don't skip doses, remember the pain ladder, combinations will likely be given, there is no pain that cannot be controlled Common bile duct gets obstructed and jaundice occurs PAP tests should be done within first 3 years of first sexual intercourse, colposcopy, cone biopsy, cryotherapy, LEEP, Vaccine (Gardasil, Cervarix), hysterectomy No blood pressure or venipuncture or injections in the affected arm, instruct to protect arm from even minor injury, decongestive therapy, jobst stocking Bimanual pelvic exams Tell patient to protect skin from temperature extremes, no tight clothing, no rubbing, no chemicals, no deodorants, and lubricate with approved lotion Thin needle is inserted into the core of the tumor and electrical energy (heat) destroys cancer cells The delivery of high energy beams generates free radicals which breaks chemicals in DNA (cells can't replicate) Landmark of Hodgkin's Lymphoma Used for non-hodgkin lymphoma and chronic leukemia Cancer that originates in the embryonal mesoderm (Connective tissue, bone, muscle, fat) Decrease in blood supply to the penis, damage to nerve that control the pain, make sure to give permission to ask about it, stress importance of not getting pregnant while taking chemo, vaginal creams relieve dryness, water-based lubricant are helpful, encourage openness with spouse or partner, explore new ways to show love, encourage counseling with psychologist, social worker, marriage counselor, or sex therapist redness and irritation (1-24 hours after first dose), usually red, dry, itchy, sore

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Pain management

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Pancreatic Cancer Preventing cervical cancer

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Nursing care for nausea and vomiting

Prevention of lymphedema

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Prevention of ovarian cancer Radiation nursing care

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Radiofrequency ablation Radiotherapy

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Nursing care of Leukemia Nursing diagnoses with prostate cancer Ommaya reservoir Oncology Emergencies

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Decisional conflict related to numerous alternative treatment options, sexual dysfunction, anxiety related to possible sexual and urinary dysfunction and incontinence dome-shaped disk that is surgically implanted through the cranium Chemotherapy infiltration/extravasation, superior vena cava syndrome, hypercalcemia, tumor lysis syndrome, inappropriate adh secretion syndrome, spinal cord compression, septic shock, cardiac tamponade, pleural effusion painless growth in the mouth or an ulcer that doesn't heal (Pain is a late symptom) Nerve damage can cause burning, numbness, tingling, shooting pains. Mouth sores, headaches, muscle pains, stomach pain can all accompany chemo. Moderate to severe pain occurs in over 50% of people who are receiving active cancer treatment.

Reed-Sternberg cells Rituxin Sarcoma

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Sexual changes

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Oral cancer Pain

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Side effects of radiation

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Side effects of surgery of prostate cancer Single greatest barrier to effective pain management Stage 0 Stage 1 Stage 2 Stage 3 Stage 4 Symptoms of ovarian cancer

impotence and incontinence

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Inadequate pain ASSESSMENT

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What do you do if patient is having pain during chemotherapy? What does inadequate nutrition lead to? What is pt teaching regarding bleeding for cancer patients?

STOP THE CHEMO

Fat and muscle depletion

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Cancer in situ Cancer is limited to tissue of origin Cancer is limited local spread in one region of the body Extensive local and regional spread Spread to distant sites has occurred Vague. Accumulation of fluid (ascites), abdominal distension, pelvic pain, bloating, urinary frequency, difficulty eating jaundice, anorexia, rapid weight gain, pruritis, unrelenting pain type of allogeneic transplant that involves obtaining stem cells from one identical twin and infusing them into the other Blocks the source of estrogen which promotes tumor regression Tumor Nodes Metastasis tumor size and invasiveness (T), presence or absence of regional spread to the lymph nodes (N), and metastasis to distant organ sites (M). Total abdominal hysterectomy with bilateral salpingo-oophorectomy, and debulking, IV chemo and/or intraperitoneal chemo and radioisotopes radial prostatectomy, external radiation, internal radiation, hormone deprivatino therapy Orchiectomy with regional lymph node removal. Chemo. Radiation. Medications that alter the relationship between the host and the disease. They can actually inhibit cell proliferation and promote cell death. Nausea, mouth, and throat pain
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Brush teeth with a baby toothbrush, blow nose very gently,wear comfortable shoes, be careful using scissors and knives, use electric razors only, apply pressure for five minutes on any cut or stick, do not use dental floss or toothpicks, do not use tampons, do not take rectal temperatures or enemas or suppositories, and notify the doctor of any unexplained bruising Drink at least 8 cups of liquid a day, be as active as possible, eat high fiber foods (Ex: whole grains, cereals, dried beans, peas, raw veggies, fresh fruits, dried fruits, nuts, and seeds), may need stool softeners, observe for distension and firmness, have nurse assess bowel sounds, and keep close track of bowel movements Sepsis

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Symptoms of pancreatic cancer Syngeneic Transplantation Tmaoxifen (Nolvadex) TNM TNM

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What is pt teaching regarding constipation for cancer patients?

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What is the biggest risk of transplantation What kind of cells does chemo work best on? What occurs in surgery to remove breast cancer? What pt teaching regarding diet must be done for cancer patients? What to watch out for in multiple myeloma What, other than chemotherapy, could cause fatigue?

Rapidly dividing ones

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Treatment of ovarian cancer

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Sentinel lymph node is removed and pathologist looks at it while the patient is in the OR Teach the importance of eating 5-6 small meals a day. Use plastic utensils to help prevent a metallic taste. Do something active. Nutrient density is importance. Milkshakes or smoothies or juice are a good substitute if you cannot eat solid foods hypercalcemia -- causes neurologic, renal, and GI problems (changes in LOC, constiaption, and elevated BUN) Pain medications, pain, lack of sleep

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Treatment of prostate cancer Treatment of testicular cancer What are biologic and targeted therapies What can prevent adequate intake?

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When does graft. vs. host disease occur? Whipple procedure Why is bleeding a potential side effect of chemotherapy?

When the t-lymphocytes from donated marrow recognize the recipient as foreign and begin to attack skin, liver, and the GI system Resection of proximal pancreas, adjoining duodenum, distal stomach, and distal common duct. Anastamosis of the pancreatic duct, common bile duct, and stomach to the jejunum. Chemotherapy destroys platelets, therefore the blood cannot clot properly.

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