prostate

lung and bronchus

colon and rectum

breast (26%)

lung and broncus (14%)

colon and rectum (10%)

- disease free

- in remission

- under treatment

- does not include people who are cured of cancer

2nd cancer

organ malfunction

cognitive impairments

- transformatino of a normal cell to an unregulated cell

- defects in regulatory circuits that control cell division and function (mitosis)

- mitosis

- cell division

- defective cellular proliferation

- defective cellular differentiation

- cancer cells respond differently than normal cells to intracellular signals regulating equilibrium

- divide indiscriminatley

- immortal

- orderly process progressing from a state of immaturity to a state of maturity

- stable and will not change

- exact mechanism of normal cellular differentiation is not completely understood

- cells have specific function: kidney cells, heart cells

proto-oncogenese: regulate normal cellular processes such as promoting growth

tumor suppressor genes: suppress unchecked growth of genes

- loses appearance and function of parent cell

- proto-oncogenese to oncogenese

- tumor suppressor genes are rendered inactive

- well differentiated

- usually encapsulated

- expansive mode of growth

- characteristics similiar to parent cell

- metastasis is absent

- rarely recur

- may range from well differentiated to undifferentiated

- able to metastasize

- infiltrative and expansive growth

- frequent recurrence

- moderate to marked vascularity

- rarely encapsulated

- becomes less like a parent cell

- viruses

- hormones

- radiation

- chemicals

- genetic factors

- unknown factors

- evidence of clinical disease

- evidence of regional spread and metatastis

- tobacco use

- unhealthy diet

- physical inactivity

- obesity

- response is to reject or destroy cancer cells

- may be inadequate as cacncer cells arise from normal human cells

- genetics

- chemicals

- environmental

- virus or immune problem

- causes yet to be determined

- confirm diagnosis

- assess response to therapy

- predict prognosis: higher tumor markers indicated increased mortaility

CA-125: ovarian cancer

CA-19-9: pancreatic and gallbladder cancer

Prostate specific antigen (PSA): prostate cancer

A-fetoprotein (AFP): malignant liver cells

Carcinoembryonic antigen (CEA): cancers of GI tract

- CBE/SBE

- Mammography

- MRI

- Pap Smear

- HPV test

- PSA test

- Fecal Occult Blood test

- Fecal immunochemical test

- Double contrast barium enema

- Sigmoidoscopy

- Colonoscopy

- DRE

- definitive means of diagnosis

- needle

- incisional

- excisional

- CBC: showed increased immature cells

- looks for increased enzymes: lipase, amaylse

- blood cancer

- taken from hip or sternum

- biopsy

- imaging

-blood studies

- bone marrow aspiraiton

-oscopies

- appearance of cells and degree of differentitation are evulauated to determine how closely cells resemble tissue or origin

- poorly differentiated tumors have a worse prognosis than those close in appearance to normal cells

- tumor/node/metastisis

- tumor: how big

- nodes: how many lymph nodes affected

- metastisi: how many organs has it metastisized to

cure: total kill or eradication

control: slow growth of tumor

palliation: releive symptoms, bleeding, obstruction, helps with psychological well being

- surgery

- radiation therapy

- chemotherapy

- biological and targeted therapies

- diagnosis/biopsy

- palliation of symptoms

- rehibilitation/reconstruction

- supportive care/prophylactic

- cure and or control of cancer, removal of local cancer tissues (primary and metz sites)

- determine diagnostic and treatment plan, clinical staging

- tumor solid, slow growing, in a specific area?

- can surrounding tissue be removed w/o causing loss of physical function?

- what is individuals pre-surgical function

- ability to remove malignant tissue w/ most effective technique to decrease recurrence or spread

- obtaining detailed informed consent

- priority of pt wishes

- bone marrow transplant

- peripheral stem cell transplantation

- extensive radiation, sometimes chemo

- most cancers

- allogenic: different species

- syngenetic: same species

- auologous: from self

- bone marrow: people typed to be matched

- cord blood: often insuficient # of stem cells from transplant

- peripheral blood

- hodgkins/non-hodgkins lymphoma

- kids in 1st remission of acute lymphacitic luekemia

- acute myologous

- stage 4 neuroblastoma

- chronic aplastic anemia

- immune deficiency syndrome

- bacterial, viral, and fungal infections (prophylactic antibiotic therapy)

- graft vs host disease: T lymphocytes from donor stem cells regonize receipent as foreign, attack organs such as skin, liver, GI tract

- bacteria or virus

- stem cells from cord blood

- curative

- control

- adjunctive

- palliative

- implantation or insertion of radioactive materials into or close to tumor

- minimal exposure to healthy tissue

- used in combo w/ teletherapy

- pt is emitted radioactiviy

- limit amount of time near pt being treated: organize care, use shielding, wear film badge to monitor exposure

- consider time, distance, and shielding

- don't put anything on

- wash and let air dry

- deep underlying tissue damage

- may need further treatment

- cure

- control

- palliation

- alkalating, anti tumor, hormones, hormon inhibitors

- used at different phases and different chemo agents usually in combo

- drugs given in combination

- dosages are carefully calculated according to body surface area

- selecting drugs with different modes of action minimizes occurences and severity of adverse side effects

- specific: kills at specific place in cell cycle

- non-specific: kills at all phases of reproductive cycle

- synergestic effect when used togethere

- glucocortoids: cortisone, decodron, prednisone, solumendrol

- androgens

- estrogens

- progestins

arimidex

femera

- antagonists

- antiestrogens

- aromatase inhibitors

- GnRH agnoists

- antiandrogens

n/v/d or constipation, anorexia, stomitis, mucositis, esphogaitis

hepatoxicity

- integumentary system: alopecia

- occurs in 85% of pts

What are side effects of chemo and radiation in the resp and cardio systems?

- resp system: pleural effusion, pnemonitis, pulmonary edema

- cardio: pericarditis, cardiotoxicity (andreomycin)

- anemia

- luekopenia

- thrombocytopenia

- hemorrhagic cystitis

- reproduction dysfunction

- <2000 WBC

- private room

- limited visitors

- no fresh fruits/veggies

- no pepper

- no plants

- nupogen

- cachexia: tissue breaks down, decreased proteins, pt looks ill and loses weight

- anorexia: pt should be given cold foods, and foods they don't ahve to chew

- xerostomia: pt should be given good mouth care for dry mouth

platlets: newmega

WBCs: nupagen

RBCs: arocet

- check chart for order

- obtain consent

- IV access line of 20 g or larger as blood must be infused w/in 4 hours

- do not put in refrig if delayed

- attach Y tube and bag of NSS

- ID checks w/ 2 RNs

- no other meds while blood is being infused

- stay with pt for first 15 minutes

- 75 ml/hr for first 15 minutes, up to 100ml/hr

- VS according to policy

- usually given for HGB <9.0

- lasix sometimes order d/t volume being infused

- febrile: fever, chills, h/a

- hemolytic: fever, chills, h/a, flushed face, lower back pain

- allergic: hives, itching, anaphylaxis

- stop transfusion

- KVO w/ NSS

- notify physician

- treatm symptoms per protocol

- if hemolytic: save blodo bag, send to lab, send blood and urine specimen to lab

- increase rate after 15 minutes

- infuse in 4 hours or less

- VS per protocol

- monitor for other ractions such as fluid volume excess

- after transfusion flush line with NSS

- cancer: bone invsasion, nerve compression, GI obstruction

- treatments: surgery, diagnostic tests, chemo and radiation

- relief frm pain

- improved quality of life

- pharmacologic: analgesic, opiod, non-opiod; adjuvants

- non-pharmacologic: comfort measures, surgery, radiation

- begin with non-narcotics

- use adjuvants

- po

- sq

- im

- iv

- topical

- around the clock

- prn

- MS Contin

- Fentanyl patch

- Morphine; continued IV infusion

- Dilaudid

- PCA pump

- Epidural infusion

- TENS

- pediatric: frequently undermedicated, assess carefully

- elderly: more susceptible to S/E, drug interactions

- assess pain and communicate with other health caer providers

- ensure initiation of adequate pain relief measures

- evaulate effectiveness of interventions

- advocate for those in pain

- pt report should always be believed and accepted as primary source for pain assessment data

- drug therapy should be used to control pain

- fear of addiction is unwarranted

- non-pharmacologic intervetions including relaxatino therapy and imagery can be effectively used

- 5% weight loss is noted

- patient has potential for protein and calorie malnutrition

- protein and albumin levels

- calcium, HGB, RBC, potassium

- may be required

- very limited d/t fugal infections, etc, from decreased immunity

- oral: hormones, meds w/o many side effects

 - IM: targeted therapies, biological response modifier

 - IV: usually once every 2-3 weeks

- intracavity: inside specific cavity, ie, thoracid, brain

- intrathecal: in the spinal cord

- intraarterial: arteries do not tolerate chemo well

- perfusion drip: into muscles

- sub q: procrit, nupragen, newmega

- topical: skin cancers

- may pose an occupational hazard

- drugs may be absorbed through skin or inhalation during preparation, transportation and administration

- only properly trained personnel should handle drugs

- can be used for frequent, continuous or intermittent administration

- can be used to administer other fluids (blood, electrolytes, etc)

- decreased risk of infection and infilitration

- Tunneled: central lines (CVC), jugular and subclavian most common

- PICC: know length of catheter before it goes in; most common is basilic; power PICC (bubble) vs. reg PICC

- infusion port: can't be accessed with regular needle, needs to be well flushed with saline and Heparin

- obstructive

- metabolic

- infiltrative

- disfigurement, emaciation

- dependency

- disruption of relationships

- pain

- financial depletion

- abandonment

- death

- being available

- exhibiting a caring attitude

- listening actively to fears and concerns

- providing relief from distressing symptoms

- provide information about cancer

- maintain relationship based on trust and confidence

- be honest

- use touch to exhibit caring

- assist patient in setting realistic short-term and long-term goals

- assist in maintaining usual lifestyle

- maintain hope

- lung cancer

- breast cancer

- non-hodgkin's

- lymphoma

- SVC-thrombus

- facial/peri-oribital edema, worse in am

- distended veins in head, chest, and neck

- dyspnea

- seizures

- sever headache

- hypotension

- resp difficulty

- confusion

- radiation is gold standard

- may use chemo for sensitive tumors

- for thrombus, anti-coagulants

- elevate HOB

- monitory airway, keep open

- diuretics used with caution

- steroids to decrease inflammation

- prostate cancer

- lung cancer

- breast cancer

- lymphomas, GI, renal tumors, melanoma

- intense, localized, persistent back pain

- motor weakness

- sensory paresthesia and loss

- change in bladder or bowel function

- initial treatment is steroids

- radiation in sensitive tumors

- sometimes surgery

- bisphosphonates used to inhibit bone resporbtion

- depends on primary whether primary/metz, onset of symptoms, level of compression, degree and duration of blockage, physical condition of pt

- early detection key: once autonomic symptoms occurs prognosis is poor

- assess pain, sensory and motor function

- abnormal or sustained production of ADH

- cancer cells are able to manufacture, store, and release ADH

- some chemotherapeutic agents stimulate release

 - bronchogenic cancer, especially small cell lung cancer

- luekemia

- breast

- prostate

- dilutional hyponatremia

- personality changes, irritability, confusion

- n/v, h/a, fatigue

- weight gain w/o edema

- seizures, death

- early: fluid restrictions

- moderate: demeclocyline and fluid restriction

- severe: administer hypertonic saline and lasix

- strict i&o

- monitor electrolytes, especially serum NA levels

- fluid restriction

- weight

- watch for seizures

- lung cancer

- breast cancer

- lymphoma's

- thyroid cancer

- neck cancer

- colon cancer

- ovarian cancer

- EKG changes

- weakness, lethargy, apathy, depression

- hyporeflexia as CA continues to rise

- neurological symptoms

- progress to seizures, coma, death

- major personality changes

- bone fractures

- polyuria, nocturia, anorexia, n/v

- biphosphonates are used to inhibit bone resorbtion

- treatment is aimed at primary disease

- acute hypercalcemia is treated by hydration (3L/day), diuretic admins

- calcitron

- mobilization when possible

- monitor Ca, albumin, phosphate levels

- monitor EKG

- wathc for changes in mental status

- i and o, agressive hydration

- luekemias

- lymphomas

- hyperkalemia

- hyperuricemia

- hyper phosphatemia

- hypocalcemia

- usually occurs 24-48 hours after therapy

- primary goal: preventing renal failure and sever electroylte imbalances

- primary treatment: increase urine production with hydration therapy

- decrease uric acid concentrations

- urinary alkalinization

- loop diuretics or ostomic diuretics

- allopurinal

- rasburicase

- i&o aggressive hydration

- monitor EKG

- daily weights

- monitor labs

- monitor diet

- bleeding

- petechia

- prupura

- hematoma

- acral cyanosis (mottling of extremeties)

- hypotension

- tachycardia

- decreased urine output

- marked decrease in hct

- hematuria

- mental status changes

- treat underlying cause

- all coagulation studies monitored

- administer heparine

- supportive therapy: platley transfusion, fluid replacement, prevent shock, prevent acidosis

- vital signs

- O2

- i and os

- monitor hemodynamic status