Ch 16: Cancer

What is the defining characteristic of cancer?

uncontrolled and unregulated cell growth

what factors can contribute to the problems experienced by a cancer patient?

the cancer itself, the treatment, or a combination of both

What role do nurses play in cancer education and prevention?

Nurses lead efforts to change public attitudes, promote risk reduction, encourage screening, manage treatment side effects, and provide supportive care.

Why is it important for nurses to support cancer patients and their caregivers?

To help them cope with cancer, adhere to treatment plans, and improve their quality of life.

Which age group accounts for the majority of cancer diagnoses?

People over the age of 55.

What emotional reactions are commonly associated with a cancer diagnosis?

Anxiety and fear

What areas of a patient’s life are impacted by cancer?

physiologic, psychologic, and social aspects

What are carcinogens?

cancer-causing agents capable of producing cell alterations that can lead to DNA damage and cancer

what happens if protective enzyme mechanisms fail to detoxify carcinogens?

carcinogen may enter the cell nucleus and alter DNA, leading to malignancy

what are 3 common chemical carcinogens?

Benzene, arsenic, formaldehyde.

Why is it difficult to identify specific cancer-causing chemicals?

because of the long latency period between exposure and cancer development

What effect does radiation have on cells?

It damages DNA, increasing cancer risk.

Which professions are at higher risk of radiation-induced cancer?

Radiologists, radiation chemists, aircrew members, uranium miners.

What type of cancer is most associated with ultraviolet radiation?

Skin cancer (melanoma, squamous cell, and basal cell carcinoma).

What are common sources of ultraviolet radiation?

Sunlight (UVA and UVB rays) and tanning beds.

How are tumors generally classified?

benign or malignant

What is a key characteristic of benign neoplasms in terms of cell differentiation?

benign neoplasms are well differentiated

do benign tumors invade or metastasize?

benign tumors do NOT invade or metastasize.

How do malignant neoplasms vary in differentiation?

They range from well differentiated to undifferentiated.

What is the major distinguishing feature of malignant tumors?

Their ability to invade and metastasize.

How much physical activity is recommended weekly to help prevent cancer?.

at least 30 minutes of moderate activity, 5 times per week

what is the recommended amount of sleep for cancer prevention?

6 to 8 hours of rest per night

Which common lifestyle habit is essential to avoid in cancer prevention?

cigarette smoking and all tobacco use

What screenings are recommended for early cancer detection?

colorectal screenings, mammograms, and Pap tests

What is the recommended sun protection measure?

use sunscreen with SPF 15 or higher and avoid tanning beds

why is knowing family history important in cancer prevention?

it helps identify personal cancer risk factors

What dietary recommendations support cancer prevention?

Eat vegetables, fruits, whole grains, and fiber; reduce fat, preservatives, and smoked or salt-cured meats.

How can managing stress help in cancer prevention?

By reducing or changing perception of stressors and enhancing coping ability.

Why are regular physical exams important in cancer prevention?

they help with early detection and monitoring of risk factors

What is one of the most important roles of a nurse in cancer care?

prevention and early detection of cancer

How has the incidence of smoking-related cancers been reduced?

Through reduced smoking rates due to public education and prevention efforts.

How does a colonoscopy help reduce colon cancer mortality?

By detecting cancer early and removing adenomatous polyps before they become cancerous

What are two main goals of public education about cancer?

• motivate people to recognize health-risk behaviors

• promote participation in healthy behaviors

what should nurses encourage patients to do to support early cancer detection?

Be familiar with their bodies, perform self-exams, and report any abnormal changes.

Why is it important for nurses to address fear when teaching about cancer?

to reduce anxiety, promote early action, and encourage compliance with screenings

which national organization provides cancer screening guidelines for breast, colon, cervical, and prostate cancers?

The American Cancer Society (ACS)

What does the "C" in the CAUTION acronym for cancer warning signs stand for?

Change in bowel or bladder habits

What does the "A" in the CAUTION acronym for cancer warning signs stand for?

A sore that does not heal

What does the "U" in the CAUTION acronym for cancer warning signs stand for?

unusual bleeding or discharge from any body orifice

What does the "T" in the CAUTION acronym for cancer warning signs stand for?

thickening or a lump in the breast or elsewhere

What does the "I" in the CAUTION acronym for cancer warning signs stand for?

indigestion or difficulty in swallowing

What does the "O" in the CAUTION acronym for cancer warning signs stand for?

obvious change in a wart or mole

What does the "N" in the CAUTION acronym for cancer warning signs stand for?

nagging cough or hoarseness

what are the 3 primary goals of cancer treatment?

cure, control, palliation

What determines the cancer treatment plan?

Tumor histology, staging outcomes, physiologic status, psychologic status, and patient preferences (e.g., active treatment vs. palliation)

What is the goal of cancer treatment when the intent is to completely eradicate the disease?

cure

What types of therapy might be used when the goal is cure?

Local therapies (surgery, radiation) and/or systemic therapy (chemotherapy), sometimes in multimodality combinations

What is the term for using multiple treatment types together to improve outcomes?

Multimodality therapy or combined modality therapy

Why is multimodality therapy often used, and what is a trade-off?

It increases effectiveness by using different mechanisms of action, but often causes greater toxicity

When cure isn’t possible but the cancer can respond to therapy, what is the treatment goal?

control

What cancers are often managed with control as the primary goal?

Multiple myeloma, chronic lymphocytic leukemia

When is palliation the primary goal of cancer treatment?

When the focus is on symptom relief and maintaining quality of life

Can palliative care and curative treatment be provided at the same time?

yes, palliative care can occur concurrently with curative or control treatment

What is chemotherapy?

the use of chemicals as systemic therapy to treat cancer (also called antineoplastic therapy)

What types of cancer is chemotherapy commonly used for?

Most solid tumors and hematologic cancers, such as leukemias and lymphomas.

What are the three main goals of chemotherapy?

• Cure certain cancers

• Control cancer for long periods

• Provide palliative relief when cure/control is not possible

Is chemotherapy considered a local or systemic treatment?

Systemic treatment — it affects the entire body, not just one area.

When might chemotherapy be used as palliative treatment?

When the cancer is not curable, but symptoms (e.g., pain, obstruction) can be relieved or reduced.

Why does chemotherapy cause side effects in normal tissues?

Because it cannot distinguish between normal rapidly dividing cells and cancer cells, leading to destruction of normal tissues like bone marrow, GI tract lining, and hair follicles.

What are the three categories of chemotherapy-induced adverse effects?

• Acute toxicity

• Delayed effects

• Chronic toxicities

What is the effect of destroying bone marrow stem cells?

Myelosuppression: infection, bleeding, and anemia.

What is the effect of chemotherapy on epithelial cells lining the GI tract?

anorexia, mucositis, nausea, vomiting, diarrhea

What results from the destruction of hair follicle cells by chemotherapy?

alopecia

Destruction of neutrophils leads to what complication?

Leukopenia and increased risk of infection

What reproductive problems may result from chemotherapy?

Infertility or reduced fertility due to damage to ova and testes

What is the most common method of radiation treatment delivery?

What is the most common method of radiation treatment delivery?

What machine is most commonly used to deliver external beam radiation?

linear accelerator

What is gamma knife technology used for?

Delivering stereotactic radiation to a localized area, typically for brain tumors.

What does "brachytherapy" mean?

It means “close therapy,” or internal radiation delivered inside or near a tumor.

What are common forms of sealed brachytherapy sources?

Seeds or ribbons containing isotopes like iodine-125, cesium-137, or iridium-192.

What types of cancer are commonly treated with brachytherapy?

Head and neck, breast, lung, and gynecologic cancers.

Are patients with permanent implants radioactive?

No, they emit low-energy radiation, and exposure to others is minimal

What systemic radioactive drug is commonly used for thyroid cancer?

Iodine-131, taken orally.

What are the three key principles for internal radiation safety?

• Time – limit time spent near the source

• Distance – maintain safe space from the source

• Shielding – use protective barriers when possible

What is a film badge (dosimeter) used for?

To monitor cumulative radiation exposure in healthcare staff.

True or False: Nurses can share their radiation film badge with others.

False – badges are personal and should only be used at work.

What causes hyperuricemia during chemotherapy, and how is it managed?

Cell destruction increases uric acid; managed by monitoring levels, giving allopurinol, and increasing fluids.

What causes fatigue during treatment and how can nurses manage it?

Metabolite accumulation; assess causes, encourage rest, moderate exercise, and pacing activities.

What GI symptoms can result from chemotherapy or radiation, and how are they managed?

Anorexia, N/V, diarrhea, constipation, mucositis; managed with antiemetics, diet changes, oral care, hydration, and stool softeners.

How is hemorrhagic cystitis managed in patients undergoing cancer treatment?

Increase fluids, monitor for hematuria, administer mesna and hydration.

What is the nursing management for stomatitis or mucositis?

Oral assessments, soft/moist/bland diet, saline rinses, topical anesthetics, avoid irritants.

What integumentary changes might chemotherapy cause?

Alopecia, hyperpigmentation, photosensitivity, skin eruptions; provide coping strategies and protect from sun.

How does chemotherapy affect the nervous system?

Chemo brain (memory/concentration issues), peripheral neuropathy; manage with planners, brain exercises, gabapentin.

How is pneumonitis from treatment managed?

Monitor for cough, fever, dyspnea; encourage activity and respiratory exercises.

What are the most affected cells in myelosuppression, and in what order?

1st - WBCs (1–2 wks), 2nd - platelets (2–3 wks), 3rd - RBCs (later, ~120 days).

What is the nadir, and when does it occur?

Lowest blood cell count, usually 7–10 days after starting therapy.

What is the main intervention for neutropenia?

Strict hand hygiene, monitor for infection/fever, give WBC growth factors (e.g., filgrastim), treat fever as emergency.

At what platelet count does the risk for serious bleeding increase?

≤20,000/μL. Avoid invasive procedures, give platelet transfusions.

How is anemia managed in cancer patients?

Give RBC growth factors (e.g., epoetin), iron supplements, RBC transfusions if symptomatic.

Why is chemotherapy more likely to cause systemic myelosuppression than radiation?

Because chemotherapy affects bone marrow throughout the body; radiation affects only the treatment field.

What causes radiation-induced skin changes and where do they occur?

Radiation skin changes occur locally in the treatment field due to radiation dose, technique, and body area.

When does erythema typically develop after radiation therapy?

1 to 24 hours after a single treatment; progresses with cumulative dosing.

What is the difference between dry and wet desquamation?

• Dry desquamation: Skin becomes dry, itchy, flaky due to epidermal damage.

• Wet desquamation: Dermis exposed, serous fluid weeps, occurs when sloughing > regeneration

Which areas are most vulnerable to radiation skin reactions?

Skin folds, pressure areas: behind ears, gluteal folds, perineum, breast, collar line, and bony prominences.

What are essential skin care principles during radiation therapy?

• Avoid temperature extremes (no heating pads or ice packs)

• Use nonirritating, alcohol/perfume-free lotions

• Avoid rubbing, harsh chemicals, constrictive garments, deodorants

What products help manage radiation dermatitis?

Calendula ointment, hyaluronic acid cream, and aloe vera gel.

How do you manage wet desquamation?

• Clean with normal saline or Burow’s solution

• Cover with moisture vapor–permeable dressings or Vaseline gauze

What is hand-foot syndrome and what causes it?

A chemotherapy-related condition with redness, tingling, desquamation, ulcers, and pain on hands and feet.

What is alopecia, and how do radiation and chemotherapy differ in causing it?

• Radiation: Hair loss is local.

• Chemotherapy: Hair loss is systemic (entire body).

How can nurses support patients emotionally coping with hair loss?

• Validate feelings (anger, grief, embarrassment)

• Offer wigs, scarves, and support resources like ACS’s Look Good, Feel Better program