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1- neoplastic cells in ORIGINAL site, well differetiated 2- metastatic cell in ORIGINAL site AND LOCAL LYMPHATICS moderately differentiated cells 3-cells in ORIGINAL site AND DISTANT LYPHATICS poorly differentiated 4- METASTIC cells are found in MANY body AREAS very poorly differtiated

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cancer staging

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-area where malignant cells first form

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Primary site

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-Surgery procedure where not all tumor is removed -As much as possible is removed

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Cytoreductive surgery

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-Prolonged exposure to sunlight -radiation -Pillutants

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Environmental Carcinogens

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-after extensive surgery to correct defects caused by original surgery

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Reconstructive Surgery

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when there is a local recurrence of cancer.

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Prophylactic or preventive surgery may be done:

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Breast, lung, and colon.

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cancer most commonly affect women :

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prostate, lung, and colon.

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Common cancers in men include:

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...half of all men and one third of all women will develop cancer during their lives -Lung cancers account for the most both men and women

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Cancer is the second leading cause of death in the United States...

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... liquid nitrogen to freeze tissue, which destroys cells.

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Cryosurgery uses...

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... electric current to destroy tumor cells.

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Electrosurgery uses...

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-Don't cause death -Unless location impairs function of vital organs (brain)

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Benign Tumors

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-Cell changes that virus incorporates may cause cancer cells to form

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When virus and bacteria are implicated in cancer:

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-Tumors are confined and did not invade vital organs -Surgery is curative

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Primary treatment

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Carcinogens account for 75% of all cancers: -tobacco -asbestos -coal dust -pesticides -formaldahyde

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Chemical agents

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Time, distance, and shielding

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Radioisotopes are used to Tx Cancer - what are the three safety prinicipals to keep in mind?

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Surgery that relieves uncomfortable Sx's or prolong life

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Palliative

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Specialized tests that ID: -Specific proteins -Antigens -hormones -genes -enzymes that Cancer cells release

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Tumor markers

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-Involves shaving off thin layer of skin - layer by layer -each layer is examine microscopically - Surgery ends when all cells look normal

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Mohs surgery

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-new growth of abnormal tissue

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Neoplasm

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cancers originating from epithelial cells

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Carcinoma

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cancer originating from organs that fight infection

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Lymphoma

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cancers originating from organs that form blood

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Leukemia

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cancers originating from connective tissue - like bone or muscle

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Sarcoma

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-not invasive or spreading -remain at site of development

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Benign

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-invasive and capable of spreading -likely to metastasize

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Malignant

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- high-energy x-rays aimed at specific body location- turn up energy for deeper penetration

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External Radiation Therapy -Location/Source

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x-rays, gamma rays, radioactive particles (alpha and beta particles, neutrons, and protons) destroy cancer cells, shrink tumors, relieve symptoms.

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External Radiation Therapy -Method

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breaking a strand of the DNA molecule in the cell ->preventing cell from growing and dividing

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External Radiation Therapy -Outcome

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short-distance therapy-> direct application of a radioactive source on or within a tumor ->deliver a high dose of radiation to a small area

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Internal Radiation Therapy - Location/Source

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high-energy ionizing radiation(x-rays, gamma rays, and radioactive particles -alpha and beta particles, neutrons, and protons) to destroy cancer cells, shrink tumors, relieve symptoms.

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Internal Radiation Therapy - Method

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breaking a strand of the DNA molecule in the cell, preventing cell from growing and dividing.

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Internal Radiation Therapy - Outcome

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Uses antineoplastic agents

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Chemotherapy - Location/Source

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alone or combined with other therapies -> cure , prevent metastasizing, slow growth, destroy tumors, relieve symptoms

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Chemotherapy - Method

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interfering with cellular function/reproduction

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Chemotherapy - Outcome

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obtained from bone marrow/peripheral blood

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Stem Cell (immature cells/hematopoietic) Transplantation - Location/Source

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Used to replace bone marrow destroyed by cancer or cancer treatments.

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Stem Cell Transplantation - Method

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ENGRAFMENT = WBC's from donor ID remaining cancer cells -> destroy them ->new stem cells develop into healthy blood cells-> settling into bone marrow and producing new blood cells

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Stem Cell Transplantation - Outcome

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client's own immune system stimulates body's natural immunity to restrict and destroy cancer cells

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Immunotherapy - Location/Source

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manipulate the natural immune response by restoring, modifying, stimulating, or augmenting the natural defenses.

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Immunotherapy - Method

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the body's natural immunity, a process of surveillance, recognition, and attack on foreign cells, is a defense against cancer.

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Immunotherapy - Outcome

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Hyperthermia or thermal therapy uses temperatures greater than 106.7ºF (41.5ºC) to destroy tumor cells.

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Hyperthermia - Location/Source

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ALTERS CELL MEMBRANE PERMEABILITY -> uptake of chemotherapy is increased ->enhances the function of immunotherapeutic agents.

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Hyperthermia - Method

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W/ radiation therapy tumor cells are more sensitive to the radiation and cannot repair themselves at all.

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Hyperthermia - Outcome

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photoactive drug, porfimer (Photofrin) is stored in higher concentrations in malignant tissues.

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Photodynamic Therapy - Location/Source

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after the drug administered laser light applied to the tumor ->activates drug -> destroys malignant cells

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Photodynamic Therapy - Method

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treats lung cancer

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Photodynamic Therapy - Outcome

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many cancers result from gene alterations.

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Gene Therapy - Location/Source

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replacing altered genes w/ correct genes º inhibiting defective genes º introducing substances that destroy genes / cancer cells

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Gene Therapy - Method

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being researched for Tx of brain tumors, melanoma, renal, breast, ovarian, lung, colon cancers

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Gene Therapy - Outcome

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many types of cancer cells need an anti-cell-death molecule (called BCL-2) to survive- specifically designed drugs could INHIBIT THE ANTI CELL DEATH MOLECULES -> cancer cells die

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Apoptosis - Location/Source

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rids the body of cells that are no longer needed because there are already enough of them, or they are damaged or abnormal in some way.

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Apoptosis - Method

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Although cancer cells are abnormal and have damaged DNA, the anti-cell-death molecules block the self- destruct checks.

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Apoptosis - Outcome

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o cell division / reproduction o Abnormal changes in cells o abnormal cells reproduce -No regulatory mechanisms o abnormal cell growth proliferates uncontrolled

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Cell regeneration occurs through:

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o direct extension to adjacent tissues -from lymph vessels to tissues adjacent o from blood or lymph systems o diffusion within body cavity o binding w/ molecules in certain tissues

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Cancer can metastasize by:

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... the body repairs such damage; in cancer cells, the DNA remains damaged.

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Damage to cellular (DNA) causes cancer cells to develop...

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o photoablation and photocoagulation lasers to aim light and energy o aimed directly at an exact tissue location and depth to vaporize cancer cells o destroying tissue o sealing tissues / vessels.

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Laser surgery uses:

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º T indicates the size of the tumor ºN stands for the involvement of regional lymph nodes ºM refers to the presence of metastasis.

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The American Joint Committee on Cancer developed a grading system referred to as the TNM classification:

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Compared w/ normal cells. o Well-DIFFERENTIATED cells are those that most closely resemble the tissue of origin. o UNDIFFERENTIATED cells bear little resemblance to the tissue of origin.

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Basically there are two classifications:

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o higher the number -> less differentiated the cell type o Tumors with poorly differentiated cells are graded IV → these tumors are very aggressive and unpredictable-> do not respond well to treatments.

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Cell differentiation is graded from I to IV:

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o Defective genes are responsible for diverse cancers. o Some types of leukemia, retinoblastoma (an eye tumor in children), and skin cancer are associated with genetic factors. o Breast, prostate, and colorectal cancers are also associated with defective genes.

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Inherited cancers occur when the damaged DNA passes to the next generation:

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o one malignant cell can give rise to a metastatic lesion o treated aggressively o spread to the lymph nodes that drain tumor area. o malignant tumor is removed-> lymph node dissection usually is done along with tumor

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Metastasis is one of cancer's most discouraging characteristics because:

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• responsible for biotransformation/ excretion of chemicals.

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Why are the lungs, liver, and kidneys most affected by chemical carcinogens?

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• Foods high in fat and those smoked or preserved with salts, 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 cantaloupe). Vitamins A, C, and E also seem to have anticancer value.

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How is diet related to cancer?

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• 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.

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The tissues most susceptible to chemotherapy are those with rapidly growing cells, such as epithelial tissue, hair follicles, and bone marrow. Adverse effects associated with this susceptibility include:

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• Recognizing tumor-associated antigens • Producing macrophages / T lymphocytes • Generating interferon • Making antibodies • Producing natural killer cells

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An intact immune system fights cancer in the following ways:

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• change in bowel/bladder function.• Sores do not heal.• Unusual bleeding/discharge.• Thickening lump in breast/other body parts.• Persistent indigestion/difficulty swallowing.• change in a wart/mole.• persistent nagging cough or hoarseness.

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The seven warning signals of cancer include:

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• Learn and regularly practice self-examination techniques. • See physician or nurse practitioner regularly. • Include periodic colon examinations, mammograms, Pap smears, testicular examinations, and prostate-specific antigen testing as indicated. • Eat a healthy diet. • Abstain from smoking or using tobacco products. • Avoid overexposure to the sun, use sunscreen with SPF 15 or greater. • Maintain weight within suggested limits. • Exercise regularly. • Practice safety in the workplace to avoid exposure to chemicals and radiation. • Limit alcohol intake.

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Healthy lifestyle habits that reduce the risk of cancer include:

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• Laboratory tests. • Radiologic and imaging tests. • Other types of studies that may be used include: biopsy, frozen section, endoscopy, and cytology.

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A client's history, physical examination, and evaluation of the client's risk factors contribute to the diagnosis of cancer. Many diagnostic studies are used to establish a diagnosis of cancer. The physician, using information obtained during the history and physical examination, selects tests that help to establish a diagnosis and may include:

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- destruction of normal cells- Effects are cumulative - decreased blood supply and normal tissue destruction- changes are irreversible - can cause: fibrosis in small intestine, lungs, and bladder; cataracts; disturbances in blood cell formation; sterility; new cancers

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What are S/E of radiation therapy? Why do clients experience chronic long term side effects after completing?

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• Medications, treatments, and procedures. • Adverse effects associated with treatment. • Possible changes in body image or function. • Resources for support. • Follow-up needed after discharge from the hospital.

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The focus of client and family teaching for clients with cancer include:

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• It must include both client and family. • The nurse must carry out tasks gently to reduce the possibility of pain and discomfort and to keep the client as comfortable as possible. • The nurse pays attention to controlling pain, providing adequate fluid and nutrition, keeping the client warm and dry, and controlling odors (when present). • An important part of nursing care is to help the client maintain dignity, despite an illness that often requires dependence on others for activities of daily living.

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Nursing management of the terminally ill client can be both physically and emotionally difficult.

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MOH'S + CHEMO

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chemosurgery

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-Monitor for signs of bone marrow suppression = decreased leukocyte, erythrocyte, platelet counts.

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NI when Pt receives radiation Tx:

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...connective tissue, such as bone or muscle

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sarcomas are cancers originating from ...

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... organs that fight infection

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lymphomas originate from...

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... organs that form blood

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leukemias originate from...

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... epithelial cells.

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carcinomas originate from...

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- results with higher numbers indicating that the tumor is of greater size (T) -the spread of cancer is to nearby lymph nodes (N) / organs near the primary tumor (M)

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Stage I, II, and III cancers involve:

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-cancer is in situ - the malignant cells are confined to where they began - no signs of metastasis.

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Stage 0 cancer

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• Reed-Sternberg cells consistently express antigens (CD30 & CD15) • CD30- marker of lymphocyte activation- is expressed by reactive and malignant lymphoid cells • CD15- marker of late granulocytes, monocytes, activated T cells - is not normally expressed by cells of B lineage

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Hodgkin Patho

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• Nodular sclerosis Hodgkin disease • Mixed-cellularity Hodgkin disease • Lymphocyte-depleted Hodgkin disease • Lymphocyte-rich classic Hodgkin disease • Nodular lymphocyte-predominant Hodgkin disease

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Types of Hodgkins

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• hematopoietic stem-cell transplantation • radiation therapy [XRT] and chemotherapy

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Hodgkin Lymphoma Medication/Tx

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• benzopyrones (coumarin & flavonoids) combined w/complex PT • skin care & debridement • lose weight, avoid minor trauma, no constrictive clothes • exercise w/support applied to affected extremity

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Lymphedema Treatment & Management

Med Surg Unit 5 – Flashcards

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