Oncology Nursing – Flashcards
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Leading sites of new cancer cases
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Male- prostate Female- Breast
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Leading cause of cancer deaths
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Male- lung and bronchus Female- lung and bronchus
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without shape or differentiation, small and round
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Anaplastic
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A Developmental gene expressed at an inappropriate time, capable of transforming a normal cell into a cancer cell
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Oncogene
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cancer development; also called carcinogenesis
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Oncogenisis
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substances that change the activity of a cell's genes so that the cell becomes a cancer cell. May be chemicals, physical agents, or viruses
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Carcinogen
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COMMON CARCINOGENS
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Alcohol Steroids Arsenic Asbestos Benzene Chemotherapy drugs Diesel exhaust formaldehyde
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new cell growth not needed for normal body growth
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Neoplasm
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new, nonmalignant cell growth not needed for normal body growth
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Benign neoplasm
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cancerous, new growth of cells by invasion that is not needed for normal growth and development
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Malignant neoplasm
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a tumor formed in a specific tissue as a result of a carcinogenic agent or event
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Primary tumor
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a tumor formed as a result of breaking off from a primary tumor and spreading to distant sites (metastisis)
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Secondary tumor
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cell division by exact duplication -Most tissues and organs stop growing by cell division after development is complete
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Mitosis
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growth that causes tissue to increase in size by enlarging each cell-normal cells
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Hypertrophy
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growth that causes tissue to increase in size by increasing the number of cells- cancer
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Hyperplasia
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the amount of time it takes for a tumor to double in size by mitotic cell divisions
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Doubling time
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the low white blood cell counts that occur after cancer chemotherapy- usually 7 to 10 days after administration
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Nadir
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chemicals that can cause tissue damage on direct contact
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Vesicant
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the period of time necessary for one cell to enter and complete one round of cell division by mitosis
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Generation time
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Characteristics of normal cells
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-Limited cell division 1. to develop normal tissue 2. to replace lost or damaged normal tissue
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to ensure that each organ has adequate number of cells at their functional peak
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Apoptosis
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specific appearance, size, shape
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Show specific morphology
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Characteristics- continued
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-Small nuclear-cytoplasmic ratio- size of nucleus is small -Perform specific differentiated functions -Adhere tightly together -Are nonmigratory -Grow in an orderly and well-regulated manner
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Characteristics- continued
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-Contact inhibited- each cell divides only when some of its surface is not in direct contact with another cell -Euploid- having 23 pairs of chromosomes
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Characteristics of abnormal cell growth -Benign tumor cells
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-Have inappropriate or continuous cell growth -Show specific morphology- of parent cells -Have a small nuclear-cytoplasmic ratio -Perform specific differentiated functions -Adhere tightly together- encapsulated -Are nonmigratory -Grow in a orderly manner -Are euploid
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Cancer cells
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-Have rapid or continuous cell division -Do not respond to signals for apoptosis- unlimited life span—"immortal" -Show anaplastic morphology- as cancer cells become more malignant, they become smaller and rounded -Have a large nuclear-cytoplasmic ratio
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Cancer cells 'cont.
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-Lose some or all differentiated functions -Adhere loosely together -Are able to migrate -Grow by invasion -Are not contact inhibited -Are aneuploid- more than or less than 23 pairs of chromosomes
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Key concepts related to cancer development
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-Neopalstic cells originate from normal body cells -Transformation of a normal cell into a cancer cell involves mutation of the DNA of the normal cell -Early embryonic genes that are overexpressed can cause a cell to develop into a tumor -Only one cell has to undergo malignant transformation for cancer to begin
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Key concepts related to cancer 'cont.
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-Benign tumors grow by expansion, whereas malignant tumors grow by invasion -Most tumors arise from cells that are capable of cell division -A key feature of cancer cells is "infinite" life span of loss of apoptosis
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Key concepts related to cancer 'cont.
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-Primary prevention involves avoiding exposure to known causes of cancer -Secondary prevention involves screening for early detection -Tobacco use is a causative factor in 30% of all malignant neoplasms -Tumors that metastasize from the primary site into another organ are still designated as tumors of the originating tissue
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Carcinogenesis: Initiation
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-Proto-oncogenes- specific early embryonic genes that controlled or regulated early rapid growth; remain as normal cellular genes, but have limited function after early embryonic life- usually "turned off" -Initiation involves these proto-oncogenes being turned back on
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Carcinogenesis: Initiation 'cont.
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-Carcinogens can penetrate a cell, change the DNA, and turn the genes off or on- inflicts mutations at specific sites on the cell's DNA -A cancer cell must be able to divide to become a threat
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Carcinogenesis: Promotion
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-Enhancement of growth -Latency period- the time between a cell's initiation and the development of a tumor -Latency may range from months to years -Promoters may be hormones, drugs, or chemicals
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Carcinogenesis: Progression
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-The tumor must develop its own blood supply -Tumor angiogenesis factor(triggers blood vessel growth)
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Carcinogenesis: Metastasis
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-Cells break off and establish their own colonies 1. extension into surrounding tissues 2. blood vessel penetration 3. release of tumor cells 4. invasion -Local seeding- shedding of cancer cells in the local area of the primary tumor -Bloodborne metastasis -Lymphatic spread
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Common sites of metastasis
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-Breast- bone, lung, liver, brain -Prostate- bone, pelvic nodes -Lung- brain, bone, liver, lymph nodes -Colorectal- liver, lymph nodes -Melanoma- GI, Lymph, lung, brain
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Classification of tumors by tissue type: Adeno
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from epithelial glands
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Classification of tumors by tissue type: Chondro
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from cartilage
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Classification of tumors by tissue type: Fibro-
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from fibrous connective tissue
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Classification of tumors by tissue type: Gilo-
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from glial cells in the brain
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Classification of tumors by tissue type: Hemangio-
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from blood vessels
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Classification of tumors by tissue type: Hepato-
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from the liver
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Classification of tumors by tissue type: Leiomyo-
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from smooth muscle
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Classification of tumors by tissue type: Lipo
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from fat/adipose
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Classification of tumors by tissue type: Lympho
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from lymph tissues
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Classification of tumors by tissue type: Melano-
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from the pigment producing cells in the skin
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Classification of tumors by tissue type: Meningio-
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From the meninges in the brain
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Classification of tumors by tissue type: Neuro
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from the nerve tissue
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Classification of tumors by tissue type: Osteo
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from the bone
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Classification of tumors by tissue type: Renal-
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from the kidney
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Classification of tumors by tissue type: Rhabdo-
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from the skeletal muscle
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Classification of tumors by tissue type: Squamous-
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from the epithelial layer of skin, mucous membranes,and organ linings
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Cancers are divided into 2 major categories:
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solid and hematologic
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Oncogene activation
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-Oncogenes are proto-oncogenes that are turned on -There are about 70 different proto-oncogenes that can be activated by carcinogens -They are turned off, controlled, or suppressed by "suppressor genes"- control the expression of oncogenes
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External factors causing cancer
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-70 to 80 percent may be the result of environmental factors -Chemical carcinogenesis- 30% from tobacco use -Physical carcinogenesis: ---Radiation- ionizing and ultraviolet ---Chronic irritation
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External factors causing cancer 'cont.
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-Viral carcinogenesis- oncoviruses (Epstein-Barr, Hepatitis B)- these damage DNA -Dietary factors- low fiber, red meat, fat, preservatives, additives
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Personal factors and cancer development
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-Immune function -Natural killer cells and helper T cells -Adults 60 and older have decreased immune systems -Organ transplant recipients -AIDS patients -Age
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Assessment considerations in the older client: Colorectal cancer-
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any change in bowel habits, bloody stool
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Assessment considerations in the older client: Bladder cancer-
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pain, burning, blood, cloudy urine or increased frequency or urgency
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Assessment considerations in the older client: Prostate cancer-
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hesitancy, change in size of urine stream, pain in back or legs, history of UTI
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Assessment considerations in the older client: Skin cancer-
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ask about changes in moles
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Assessment considerations in the older client: Leukemia-
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Observe skin for color, petechiae, ecchymosis, fatigue, bleeding tendency, history of infections, night sweats, unexplained fever
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Assessment considerations in the older client: Lung cancer-
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-skin and mucous membranes, how many words between breaths, cough, hoarseness, smoking, exposure, SOB, activity intolerance, frothy sputum, pain, difficulty swallowing
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Genetic risk: Inherited cancers
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breast, prostate, ovarian
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Genetic risk: Familial clustering
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breast, melanoma
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Genetic risk: Bloom syndrome
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leukemia
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Genetic risk: Familial polyposis
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colorectal
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Genetic risk: Chromosomal
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leukemia, breast
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Blood testing-
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expensive, does not diagnose the presence of cancer
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Racial differences in cancer development- most common
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-White- lung, breast -Asian- breast, colorectal -African American- lung, prostate -Hispanic- prostate, breast
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Primary prevention
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-Avoid known or potential carcinogens -Modification of associated factors -Removal of "at risk" tissues -Chemoprevention- using drugs, chemicals, natural nutrients, or other substances to disrupt one or more steps important to cancer development -Vaccination- Gardasil may prevent HPV
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Primary prevention: Chemoprevention may:
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-Prevent formation of a carcinogen -Block the action of a carcinogen on DNA -Enhance elimination of a carcinogen -Suppress carcinogenic action -Antipromotion activity -Suppression of progression
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Target populations for chemoprevention
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-Healthy people with no known specific cancer risk --People at greater than normal risk because of increased environmental exposure or decreased immune function -People with precancerous lesions -People with a history of cancer
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Secondary prevention: Screening programs-
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-Screening programs- -Yearly mammogram and breast exam over 40 -Colonoscopy at age 50 and q 10 years -Yearly fecal occult blood for all adults -Yearly PSA and DRE for men over 50 -Pap smears every 2-3 years over 30 if they have had 3 normal tests in a row
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Yearly mammogram and breast exam over
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40
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Colonoscopy at age
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50 and q 10 years
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Yearly fecal occult blood for
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all adults
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-Yearly PSA and DRE for men over
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50
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-Pap smears every 2-3 years over
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30 if they have had 3 normal tests in a row
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Prevention
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-Seek healthcare advice whenever one of the 7 warning signs of cancer are present -Compliance with the treatment regimen -Follow-ups are important -Continue recommended screening practices -Avoid carcinogens -Exercise regularly -Obtain adequate rest -Reduce stress -Assist clients to quit smoking -Teach to limit dietary fat, smoked meats, & red meat
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THE SEVEN WARNING SIGNS OF CANCER: C-A-U-T-I-O-N
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C- Changes in bowel or bladder habits A- a sore throat that does not heal U- unusual bleeding or discharge T- thickening or lump I- indigestion or difficulty swallowing O- obvious change in a wart or mole N- nagging cough or hoarseness
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Diagnostic tests
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-Cytology- helps to identify cellular changes -Radiological studies -Hematological studies -Endoscopic studies -Nuclear studies -biopsy
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Types of biopsy: Needle
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aspirating cells, boring a "core"
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Types of biopsy: Incisional-
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removing a wedge of tissue from a larger tissue mass
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Types of biopsy: Excisional-
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completely removing an entire lesion without removing any adjacent normal tissues
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Types of biopsy: Staging-
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performing multiple needle or incisional biopsies
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GRADING: cannot be determined
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GX
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GRADING: tumor cells are well differentiated and closely resemble normal cells
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G1
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GRADING: moderately differentiated
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G2
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GRADING: poorly differentiated- tissue of origin can be established
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G3
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GRADING: undifferentiated, no normal cell characteristics
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G4
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STAGING
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Determines the exact location and degree of metastasis
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STAGING: carcinoma in situ
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Stage 0
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STAGING: tumor limited to the tissue of origin; localized tumor growth
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Stage 1
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STAGING: limited local spread
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Stage 2:
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STAGING: extensive local and regional spread
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Stage 3:
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STAGING: metastasis
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Stage 4:
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Primary tumor: cannot be assessed
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TX
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Primary tumor: no evidence of tumor
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T0
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Primary tumor: carcinoma in situ
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Tis
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Primary tumor: increasing in size and extent
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T1, T2, T3, T4
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Regional lymph nodes: cannot be assessed
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NX
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Regional lymph nodes: no metastasis
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N0
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Regional lymph nodes: Increasing involvement
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N1, N2, N3
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Distant Metastasis: cannot be assessed
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MX
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Distant Metastasis: no distant metastasis
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M0
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Distant Metastasis: distant metastasis
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M1
