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tumor is confined to one area, surgery is the primary treatment

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Curative

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tumor is removed along with small margin of healthy tissue (whipple procedure)

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Local Excision

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remove primary tumor, lymph nodes, involved adjacent tissues and surrounding tissues that pose a risk for metastasis

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Radical (Wide) Excision

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more extensive done when there is recurrence of cancer at same site

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Salvage

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when there is family history or genetic predisposition ex; mastectomy, hysterectomy counseling and teaching pre-op; aware of consequences

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Prophylatic

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relieve uncomfortable symptoms ex; paracentesis, thoracentesis to remove excess fluid relieve pain

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Palliative Surgery

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correct defects caused by original surgery

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Reconstructive or Plastic Surgery

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electric current

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Electrosurgery

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light and energy

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Laser

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topical chemotherapy with layer-by-layer surgical removal

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Chemosurgery

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liquid nitrogen to freeze tissue

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Cyrosurgery

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single high dose of radiation and precise administration for some types of brain, head and neck tumors ( have to be masked)

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Steriotacitic radiosurgery (SRS)

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Used to treat rapidly growing tumors Attack when cancer cells enter a specific phase of cell reproduction Administered in multiple repeated doses to produce a greater cell kill and halt growth of tumor cells

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Cell Cycle Specific Drugs

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Effective during any phase of the cell cycle Used for large, slow growing tumors More prolonged effects More cell damage and destruction Amount of drug given more important than frequency

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Cell Cycle Nonspecific Drugs

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when the drug leaks into surrounding membranes

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Extravasation

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Cause tissue necrosis of underlying tendons, nerves and blood vessels Sloughing and ulceration of skin ---client may need skin grafts

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Vesicants

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original site of malignancy

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Primary

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regions to which cancer cell have spread --may spread to lymph nodes that drain the tumor area

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Secondary

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CBC= may indicate anemia Occult blood in stool-may indicate colorectal cancer

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Lab test

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Tumor Markers released by cancer cells -specific proteins -antigens -hormones -genes -enzymes

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Lab test

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once the TNM description are established, they are grouped together in a simpler set of stages that include tumor size, evidence of metastasis and lymph node involvement

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TNM

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indicates size of tumor

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T

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stands for involvement of regional lymph nodes

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N

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refers to the presence of metastasis

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M

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type and extent depends on extent of disease, pathology, client's age, and physical condition, anticipated results

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Surgery

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Used to treat cancer locally and systemically

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Antineoplastic Agents

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Nausea/ Vomiting Diarrhea Stomatitis Alopecia Myelosuppression Fatigue

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Adverse Effects of Chemotherapy

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come from the client him-self or herself, either from bone marrow or circulating blood. The stem cells are removed before other cancer treatments and frozen to be reinfused after cancer treatment is complete

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Autologous stem cell transplants

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uses stem cells from a donor whose tissue type matches the client's. The donor can donate additional stem cells if required because they are obtained from peripheral blood. Donor stem cells produce immune cells that can destroy any remaining cancer cells. Engraftment may not occur with allogeneic transplantation. Recipients are also prone to infections carried by the donor, although donors are carefully screened. Another risk is graft-versus-host disease (GVHD), in which the donor cells produce new immune cells that attack the recipient's body. To prevent GVHD, clients receive immunosuppressant drugs.

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Allogeneic stem cell transplantation

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is rarely done because it is possible only if the client has an identical twin with identical tissue type. Syngeneic stem cell transplant does not cause GVHD—a distinct advantage. However, all cancer cells must be destroyed prior to transplantation because the donor stem cells cannot destroy any remaining cancer cells.

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Syngeneic stem cell transplantation

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New growths of abnormal tissue, tumor

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neoplasms or tumors.

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not invasive or spreading, Benign tumors remain at their site of development. They may grow large, but their growth rate is slower than that of malignant tumors.

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benign

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invasive and capable of spreading, Malignant tumors have uncontrolled growth and, unless completely removed, are likely to undergo metastasis (spreading).

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malignant

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proteins located in the cell membrane, which develop as cells become less differentiated. These antigens categorize benign and malignant cells from the same tissue type. In addition, there are genetic differences that promote cellular mutation, proliferation, and growth

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tumor- specific antigens

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These are mutated forms of specific normal genes known as proto-oncogenes that control cell growth and replication. When a proto-oncogene mutates, it acti-vates out-of-control cell growth and causes cancer.

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Oncogenes

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These are normal genes that slow cell growth, repair DNA mistakes, and promote nor-mal cell death. When tumor suppressor genes mutate, the functions are inactivated and cell growth becomes out ofcontrol and causes cancer

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Tumor suppressor genes

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in the environment are believed to ac-count for 75% of all cancers.

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Chemical agents

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include prolonged exposures to sunlight, radiation, and pollutants. Electromagnetic fields from microwaves, power lines, and cellular phones are other possible carcinogens,

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Environmental factors

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is an important variable. Foods high in fat and those smoked or pre-served with salt, alcohol, or nitrates are associated with an increased cancer risk. Foods believed to reduce cancer risk are high in fiber, cruciferous (e.g., cabbage, broccoli), and high in carotene (e.g., winter squash, carrots, and canta-loupe). Vitamins A, C, and E also seem to have anticancer value. There is some evidence that obesity is associated with endometrial and postmenopausal breast cancers as well as colon, gallbladder, and kidney cancers

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Diet

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The cell changes that a virus incorporates into the genetic information may cause cancerous cells to form. An example of a viral connection to cancer is Kaposi's sarcoma, which is associated with HIV (see Chap. 35). Helicobacter pylori (see Chap. 45) is associated with gastric cancers.

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Viruses and bacteria

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such as immuno-suppressive drugs, hormone replacements, and anticancer drugs have been associated with increased incidence of cancer in people or their offspring exposed in utero.

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Medically prescribed interventions

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Public education focuses on periodic physical examinations and cancer screening programs. Healthcare providers must emphasize and teach self-examination of the breasts, testicles, and skin. Avoidance of factors that predis-pose people to cancer and early detection of cancer increase the chances of cure

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Assessment Findings

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specific proteins, antigens, hormones, genes, or enzymes that cancer cells release (Table 18-3). Normally, tumor markers are not present in or not found in large quantities in the blood.

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tumor markers

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X-rays are quick and painless tests that produce images of body structures. These images are pro-duced based on absorption of the x-rays. Bones absorb the most; soft tissues much less. Air absorbs very little, and thus lungs show up as black on the radiograph. For some tests, a contrast medium, such as iodine or barium, is used to highlight, outline, or provide more detail. A barium enema is an example of a study done with contrast medium.

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X-ray Imaging.

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provides three-dimensional cross-sectional views of tissues to determine tumor density, shape, size, volume, and location as well as highlighting blood vessels that feed the tumor. Contrast medium may be used to better define boundaries between organs and/or tumors. CT is useful in diagnosing many types of cancer.

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Computed Tomography. (CT)

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Producing detailed sec-tional images, magnetic resonance imaging (MRI) uses radio waves in the presence of a magnetic field to differentiate diseased tissue from healthy tissue and to study blood flow. It helps to visualize tumors hidden by bone or other structures.

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Magnetic Resonance Imaging

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Clients ingest or receive intravenous (IV) radioisotopes (also known as tracers). After specific time intervals, images are taken of tissues that are affected by cancer or other diseases; the images distinguish tissues or portions of tissues that absorb more or less of the tracer. "Hot spots" show on an image of a tumor that has increased concentrations of the tracer, whereas "cold spots" can be the image of a tumor that has decreased concentration of the tracer.

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Nuclear Imaging

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Ultrasound uses high-frequency sound waves to detect abnormalities of a body organ or structure. The sound wave reflections (echoes) are projected on a screen and may be recorded on film. These studies help differenti-ate solid and cystic tumors of the abdomen, breasts, pelvis, and heart

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Ultrasound

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type of imaging used to show continuous x-ray images on a monitor. The move-ment of a body structure can be viewed or the examiner can view the movement of contrast agent or a specific instrument within a body structure. An example of fluoroscopy is a barium study (to view the movement of barium through the gastrointestinal [GI] system)

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Fluoroscopy.

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Tissue samples excised from the body are directly examined microscopically for malignant or premalignant processes. Tissue samples may be obtained during surgery, via insertion of a biopsy needle under local anesthesia, or by endoscopic procedures. A biopsy provides the most defini-tive method for diagnosing cancer.

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Biopsy

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During some surgeries, when a tumor or node is removed, it is taken to the pathologist for immedi-ate examination. The specimen is quickly frozen and then sliced into very thin pieces so that it may be examined under a microscope. Once the preliminary findings are known, the surgeon decides the type of surgery needed.

answer

Frozen Section.

question

Fiberoptic instruments are flexible tubes that contain optical fibers, which enable light to travel in a straight line or at various angles and illuminate the area being examined. Specific body areas can be examined with gastroscopy, bronchoscopy, and colonoscopy. Tissue biop-sies may be done if a malignancy is suspected.

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Endoscopy

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Microscopic examination of cells from various body areas may be used to diagnose malignant or prema-lignant disorders. Cells are obtained by needle aspiration, scraping, brushing, or sputum. An example of a cytologic test is the Papanicolaou (Pap) smear

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Cytology

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are those that most closely resemble the tissue of origin.

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Well-differentiated cells

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ear little resemblance to the tissue of origin. Cell differentiation is graded from I to IV. The higher the number, the less differentiated the cell type.

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Undifferentiated cells

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(1) surgery, (2) radiation therapy, and (3) chemotherapy. Other methods, such as bone marrow transplantation and stem cell trans-plants, are used for selected cancers. Immunotherapy, gene therapy, and other alternative therapies also may be used.

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Three basic methods are used to treat cancer:

question

uses liquid nitrogen spray or a very cold probe to freeze and kill abnormal cells

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Cryosurgery

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uses a high-frequency electric current to destroy tumor cells

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Electrosurgery

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uses photoablation and photocoagulation lasers to aim light and energy directly at an exact tissue location and depth to vaporize cancer cells, destroying tissue or sealing tissues or vessels

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Laser (light amplification by stimulated emission of radia-tion) surgery

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involves shaving off one thin layer of skin at a time. Each layer is examined microscopically. Surgery ends when all cells look normal. Chemosurgery involves the use of topical chemi-cals as layers are removed but is not part of Mohs surgery

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Mohs surgery (formerly called chemosurgery)

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uses high-energy ionizing radiation, such as high-energy x-rays, gamma rays, and radioactive particles (alpha and beta particles, neutrons, and protons), to destroy cancer cells, shrink tumors, and relieve symptoms. Radiation destroys cells by breaking a strand of the DNA molecule in the cell, thereby preventing the cell from grow-ing and dividing. Cell death can occur immediately or when the cell can no longer reproduce. The goal of radiation therapy is to destroy malig-nant, rapidly dividing cells without permanently damaging surrounding healthy tissues.

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Radiation therapy

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uses high-energy electromagnetic radiation aimed at a specific body location. Higher energy levels are used to achieve deeper penetration into the body.EBRT enables treatment of targeted tumors and nearby lymph nodes. Clients usually have daily radiation treat-ments over several weeks on an outpatient basis. Their skin is marked with a marker or tattoo to identify the reference points for the treatment plan.

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External beam radiation therapy (EBRT)

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refers to the direct application of high doses of radiation therapy to a small or localized site. The advantage of brachytherapy is that it applies less radiation to adjacent normal tissues. It may be used alone or combined with surgery, chemo-therapy, and external radiation therapy. The most common methods of brachytherapy include interstitial implants, intracavitary implants, and systemic therapy. Clients must stay away from other people for a few days while the radiation is most active.

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Internal radiation therapy (brachytherapy)

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• Wash hands carefully after going to the bathroom. • Flush toilet several times after each use. • Use separate eating utensils and towels. • Wash laundry separately. • Drink plenty of fluids to help flush radioactive substances away. • Avoid kissing and sexual contact. • Minimize contact with infants, children, and women who are pregnant.

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Radiation. To reduce exposure, clients are asked to;

question

that work by interfering with cellular function and reproduction. These agents may be used alone or combined with other therapies to cure cancer, prevent it from metastasizing, slow its growth, de-stroy tumor cells that have metastasized, or relieve symptoms.Antineoplastic agents are classified according to their relationship to cell division and reproduction

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Chemotherapy uses antineoplastic agents

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Cell cycle-specific drugs are used to treat rapidly growing tumors because they attack cancer cells when they enter a specific phase of cell reproduction

answer

Cell Cycle-Specific Drugs

question

are effective during any phase of the cell cycle, whether reproducing or resting. They are used for large, slow-growing tumors. The amount of drug given is more important than the frequency. Cell cycle-non-specific drugs have more prolonged effects on cells, which results in cell damage and destruction

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Cell Cycle-Nonspecific Drugs

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• Nausea and vomiting are common during the first 24 hours after chemotherapy administration; use of concurrent anti-emetics helps to reduce the incidence and severity. • Stomatitis and mouth soreness or ulceration may result from destruction to the epithelial layer. • Alopecia develops because chemotherapy affects rapidly growing cells of the hair follicles. • Myelosuppression results from inhibition of the manufacture of red and white blood cells and platelets. Severe anemia, bleeding tendencies, leukopenia, neutropenia ( decreased neutrophils), and thrombocytopenia are possible if bone marrow depression is profound. Blood transfusions may be necessary as well as protection of the client from infections. • Fatigue results from the aforementioned effects, the che-motherapy itself, and the increased metabolic rate that accompanies cell destruction.

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Common adverse effects associated with chemotherapy are as follows:

question

of gout, which include increased uric acid levels, joint pain, and edema. Allopurinol may be prescribed to decrease the uric acid level. Encourage the client to increase fluid intake (up to 2000 mL/day) if his or her condition permits.Most antineoplastic agents are teratogenic. Female clients taking these drugs must use birth control measures throughout therapy. If a client suspects pregnancy, she must notify the primary healthcare provider immediately

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Monitor the client taking an antineoplastic agent for symp-toms

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alter the interac-tion between the immune defenses and cancer cells. This interaction serves to "boost, direct, or restore the body's ability to fight the disease"

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Biologic response modifiers (BRMs)

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uses temperatures greater than 106.7° F (41.5° C) to destroy tumor cells. Heat is in the form of radio waves, ultrasound, microwaves, magnetic waves, hot water baths, or immersion in hot wax. Hyperthermia alters cell membrane permeability so that up-take of chemotherapy is increased. It enhances the function of immunotherapeutic agents. Clients receiving hyperther-mia may experience local burns and tissue damage, electro-lyte imbalances, fatigue, GI disturbances, and neuropathies.

answer

Hyperthermia or thermal therapy

question

uses a pho-toactive drug, porfimer (Photofrin), that, when administered intravenously, is stored in higher concentrations in malignant tissues. Several days later, laser light applied to the tumor activates the drug and destroys the malignant cells. Damage to healthy tissues is minimal

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Photodynamic therapy (PDT) or phototherapy

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vaccine that is approved for use in the United States , which is given to prevent women from getting cervical cancer

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human papillomavirus (HPV)

question

may be done if the client is at considerable risk for cancer. According to Smeltzer et al. (2010), prophylactic surgery may be discussed when: there is a family history or genetic predisposition; the ability to detect cancer is at an early stage; or the client is able to accept the postoperative outcome regardless of the find-ings. Examples of prophylactic surgery include mastectomy and hysterectomy. Clients who choose prophylactic surgery require careful preoperative counseling and teaching so that they are fully aware of the consequences of surgery

answer

Prophylactic or preventive surgery

question

Clients who develop taste alterations from chemo-therapy often complain that meat tastes "bad" or " rotten." Offer cold protein alternatives such as cheese, cottage cheese, protein beverages, and sandwiches. Assure the client that eating meat is not the only way to consume adequate protein. Sucking on hard candy during chemotherapy infusion may prevent a bitter or metallic taste

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Changes in taste

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Tumor size and depth (To-T4) Nodule Involvement (No o N4) Metastasis (Mo-M4)

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Staging TNM

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Stage 0= in situ to Stage 4= Metastasis

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Clinical Staging

question

I-IV how fast the cells are multiplying

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Clinical Grading

question

programmed cell death or cell suicide

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Apoptosi

question

external beams or internally

answer

Brachytherapy

question

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

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Nursing care for nausea and vomiting

question

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.

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Whipple procedure

question

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).

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Development of Cancer

question

Have their effect on cells during all phases of the cell cycle

answer

cell cycle phase-nonspecific drugs

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Exert their most significant effects during specific phases of the cell cycle

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Cell cycle phase-specific drugs

question

Cells in the body normally repair and reproduce themselves in the same way. Sometimes the process gets out of control and cells carry on dividing and develop a lump called a tumor.

answer

Explain how cancer happens (to Patient)

question

tenderness, pain, swell-ing, and induration

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thrombophlebitis

question

third step of carcinogenesis, in which cells show a propensity to invade adjacent tissues and metastasize.

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Progression

question

repeated exposure to promoting agents causes the expression of abnormal genetic information even after long latency periods

answer

promotion

question

initiators such as chemicals, physical factors, and biologic agents, escape normal enzymatic mechanisms and alter the genetic structure of cellular DNA

answer

initiation

question

is performed to relieve complications of cancer

answer

Palliative surgery

question

involves removing non-vital tissues or organs that are likely to develop cancer

answer

Prophylactic surgery

question

may follow curative or radical surgery and is carried out in an attempt to improve function or obtain a more desirable cosmetic effect

answer

Reconstructive surgery

question

is an additional treatment option that uses an extensive surgical approach to treat the local recurrence of a cancer after the use of a less extensive primary approach

answer

Salvage surgery

question

cells are malignant. cells lose the morphological characteristics of mature cells and their orientation with respect to each other and to entothelial cells.

answer

anaplastic cells

Cancer Chapter 18 – Flashcards

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