benign tumors

characteristics

well differentiated

usually slow growing

do not metastisize

usually well encapsulated

usually harmless unless vital function impaired

malignant tumor

characteristics

anaplastic

rapidly growing

metastasize

invades adjacent tissue

kills host if not treated

cancer spreads

-invasion ( direct extension)

cells lose contact inhibition

send projections to adjecent tissue

can infiltrate into a body cavity

-seeding

cancer spread

-metastasize

cells break away from original neoplasms

- travel in the blood or lymph and grow there

cancer spread

metastasize

lymph

tumor markers

normally only produced during ___________

_____________

tumor markers

produced by tumors:

tumor markers

tumor marker levels increase:

CEA

a small amount is secreted by:

CEA

increased amount are secreted r/t what disease?

inflammatory bowel disease

-use CEA levels to monitor response to Rx

PSA

prostate specific antigen

used for:

proteins

hormones

potency

dosage

initiation

promotion

progression

cancer stages

initiation

r/t DNA damage

-may be r/t:

defective oncogene

absent suppressor genes

P53( familial cancer)

initiation stage:

at this stage cancer

cancer phases

promotion

cancer phases

promotion

requires:

continuous contact with an initated cell to cause growth

* this is a gradual process*

cancer phases

promotion

harmful effects can be reversed by:

-removal of the promotor

-reversing factors before neoplasm occurs

cancer phases

promotion stage can last for:

prolonged periods of time

* but cancer has not yet occursed*

anticarcinogens

antooxidants

certain drugs enzymes and food additives being studied

vitamin A

beta carotene

vitamin C

vitamin E

selinum

cancer phases

Progression

evolution of metastatic potential by the cells undergoing further genetic changes

ex. tumor may develop its own blood supply so it doesnt starve and die --> robbing normal cells blood of supply

cancer phases

progression

the mutated cell takes on ?

at what point does the person have cancer?

promotion stage

once the malignant cells invade adjecent tissues and metastasize

tumor markers

CBC, stool for guiac

various x-rays

CT, MRI, PET

radioisotope scans

ultrasound

biopsy- excision, needle, open, closed

endoscopy

-frozen section, cytology (PAP, sputum)

early warning signs of cancer

-caution-

C- change in bowel or bladder

A- a lesion that does not heal

U-  unusual bleeding or discharge

T- thickening or lump in breast or elsewhere

I- indegestion or difficulty swallowing

O- obvious changes in wart or mole

N- nagging cough or persistant hoarseness

cancer assessment

-persistant hoarseness means it lasts:

hoarseness that last two weeks or longer

can be indicative of cancer

Physical screening exams

PAP frequency

Q2 years for 18 y/o or sexually active

after 3 normal it is at the MD discretion

physical screening exams

prostate

frequency

annual DRE at 40 y/o

PSA at 50 y/o (earlier if high risk)

physical screenings

Colon

DRE annual at 40 y/o

guiac annual at 50 y/o

signmoidoscopy Q5 years at 50 y/o

physical screenings

breast

MD exam- Q3 years 20-40 y/o

annual at 40 y/o

physical screenings

mammogram

baseline 35 y/o

annual at 40 y/o

physical exams

DRE?

self exams

BSE

breast self exams should be doone monthly by both men and women

* men often over look the need to screen and thus have a much higher mortality rate r/t late detection

self exams

TSE

testicular self exams should be done monthly

esp. young men- more common in younger men

self exams

skin exams

should be done every month

may need to use a mirror to see all surfaces

heredity

age

gender

sun

dietary/weight control

environment and occupational

lifestyle/ personality

the necessary amount of permanat genetic damage to occur

around the age of 55

which is when the prevalency of most cancers increases

dietary guidelines

-American cencer society

maintain desireable weight

limit red meats

wide variety of fruits and veggies daily

high fiber

low total fat

limit ETOH

limit salt cured, smoked and nitrate cured foods

environmental/ occupational

minimize exposure to:

industrial fibers such as:

asbestos and dust

- need special masks and suits

personality/ lifestyle risk factors

smoking/ ETOH/ drugs

exercise

rest/stress management

infections

systemic

cytotoxic

-disrupts cell development and reproduction

rapidly growing and replicating cells

GI, bone marrow, hair, fetal, malignant

cell cycle specific

or

cell cycle nonspecific

chemotherapy

cell cycle specific agents:

chemotherapy

cell cycle nonspecific agents:

courses of chemo

usually at least ___ courses of chemotherapy are given

- allow normal cells to recover

* cancer cells cant repair themselves

- allow cancer cells to move into proper phase if cell cycle specific are used

lower doses can be used!

-fewer side effects

-attacks several differnt fronts

chemo

drug of choice depends on:

tumor size

type

stage

pt. condition

before surgery to shrink tumor

after surgery

- prevent metastasis r/t surgical trauma

breast

colon

lung

bone

cure

control

palliative

topical

IV

PO

IM

SQ

intrathecal

intra-arterial

intrapleural

intraperitoneal

nurses who have completed a chemotherapy and biotherapy trainer course

*not just by any nurse*

maybe special requirements are necessary to keep the nurse safe from the drugs

the urine of nurses and pharmacist who handle chemotherapy drugs

* incidence of poor reproductive outcomes/cancer in these personnel

side effects

GI

interferes with nutrition, hydration, and comfort

side effects

n/v related to:

stimulate of emetic center of the brain

need meds

-zofran

imagery

biofeedback

distraction

side effects

GI

dietary considerations

small, frequent, low fat meals

side effects

medications

ATC=

around the clock

refers to the need for antiemetics

n/v center in brain stimulated by chemo

side effects

mouth

stomatitis occurs r/t:

side effects of chemo

ulcers and dry mouth:

-oral care frequently

normal saline rinses

chemotherapy side effects

mouth:

avoid?

mouth washes containing alcohol

*may need viscous xylocaine

soft toothbrush

sponge toothettes to scoop out thick secretions

artificial saliva, lip balms

push PO fluids

popsicles

aviod irritating foods/ ETOH/ hot and spicy/ acidic

narcotic anagesic PRN

may need TPN if oral intake inadequate

chemo side effects

managing diarrhea

dietary

avoid fatty, gassy, irritating foods

avoid high residue/fiber foods and lactose

need high protein and CHO

small frequent meals

chemo side effects

managing diarrhea

meds

antidiarrheals

antispasmotics

topical perianal anesthetic

chemo

ememas, rectal or suppository meds:

must be avioded!!!!

r/t rectal trauma

chemo side effects

skin

pigmentation changes-melena stimulation

erythematous rashes- capillary dilitation

radiation recall- r/t chemo agent

photosensitivity

chemo side effects

skin

teach

teach sunscreen SPF > or = 15

wide brimmed hat

cover skin with clothes

avoid sun between 1000 - 1600

explain and offer support r/t altered body image

chemo side effects

alopecia

weakening of the hair shaft

temporary- grows back 4-6 months after treatment

-may grow back a differnt color or texture

chemo side effects

alopecia

management

use mild shampoo, avoid vigorous brushing

protect scalp from sunburn and frostbite

chemo side effects

hematologic

bone marrow suppression (myelosuppression)

decreased RBC's--> anemia and fatigue

chemo side effects

hematologic

management

fall risk r/t fatigue and orthostatic hypotension

teach to:

stand slowly, use handrails, ask for help

planned rest!

*increase proteins, vitamins, and iron diet

transfusions

chemo side effects

leukopenia

decreased platelets--> bleeding tendencies

thrombocytopenia

nursing considerations

guiac all body fluids

teach pt to aviod ASA and NSAIDS

 no injections and decrease venipunctures

soft tooth brush

electric razor

* no NT suction

prevent vomiting and straining at stool

handle gently

** check for increased bruising, bleeding (nose and gums)

thrombocytopenia

hold venipuncture sites:

> 3 mins

by the clock!

thrombocytopenia

hold arterial punctures:

> 5 mins

by the clock!

chemo side effects

renal

less common!!!

but still occur

monitor: I&O, BUN and creat

hydrate well before the chemo dose

chemo side effects

pulmonary

causes fibrosis and inflammation

moitor and assess resp. function

teach pt and family to report resp. clinical manifestations

chemo side effects

cardiac

premanent damage to cardiac cells

monitor for arrhythmias and CHF

chemo side effects

neuro

some chemo drugs are neurotoxic and manifest:

sensory and perceptual

chemo side effects

neuro

nursing considerations

decreased coordination and weakness

fall risk!

parathesias- no heating pads, caution with bath water to aviod burns

incontinence--> impaired skin integrity

hearing loss

LOC changes