Cancer

NURS 4301

What are the 4 most common nonskin cancer sites in men?

• prostate

• lungs & bronchus

• colon & rectum

• bladder

What are the 4 most common nonskin cancer sites in women?

• breast

• lung & bronchus

• colon & rectum

• uterus

What cancer is responsible for the most deaths in the US?

lung & bronchus

What are the top 5 deadliest cancer sites?

• lung & bronchus

• prostate

• colon & rectum

• pancreas

• breast

Which race has the most cancer?

White

Which race has the least cancer?

Hispanic

Which race has the highest prevalance of prostate cancer

Black

What are the risk factors for cancer?

• tobacco smoking

• excess body weight

• alcohol

• UV

• diet

• cancer causing pathogens

• physical inactivity

What is the nurses role in preventing cancer?

Primary Prevention

• patient education on how to modify risk factors

Secondary Prevention

• screening for people who don’t have cance

Tertiary Prevention

____% of cancers are associated with modifiable risk factors

40%

What are the screenings guidelines for breast cancer for average risk women?

• when should screening start?

• what screening should they get and how often?

• start screening at 45-54 yrs

• mammogram every year

What are the screenings guidelines for breast cancer for high risk women?

• when should they start screening?

• what screening should they get and how often?

• start screening at 30 yrs

• mammogram every year 

• breast MRI

What are screening guidelines for cervical cancer?

• when should screening begin

• what screening test should be used and how often?

• screening can be done at 25 yrs

• HPV test and pap smear every 3 years

What are screening guidelines for lung cancer?

• when should screening begin

• what test is used for screening and how often should screening happen?

• start screening between 50-80 years old

• LDCT scan (x-ray) yearly

What are screening guidelines for prostate cancer for average risk peope?

• what age should screening begin

• what test is used for screening and how often should screening happen?

• start at 50 years

• PSA (prostate specific antigen) blood test every 2-2.5 years

• sometimes DRE digital rectal exam

What are screening guidelines for people at high risk for prostate cancer?

• who is at high risk

• what age should they start screening

• what screening test is done and how often

• african amerian, first degree relative diagnosed with prostate cancer

• 45 years

• PSA blood test every 2-2.5 year

• sometimes DRE

What are screening guidelines for people at the highest risk for prostate cancer?

• who is at the highest risk

• what age should they start screening

• what screening test is done and how often

• more than one first degree relative with prostate cancer

• start at 40 years

• PSA blood test every 2-2.5 years

• sometimes DRE

What are the 2 ways cancer can happen? (explain defective cell proliferation and defective cell differentiation)

• Defective cell proliferation

  • cells divide uncontrollably, ignore signals that tell them to stop

• Defective Cell differentiation 

  • cells remain immature so they fail to perform normal function

What are the 2 genes affected by a mutation in cancer

• proto-onco genes mutate to oncogene (so these genes become permanently activated and causes cells to grow out of control → like pressing on gas)

• tumor suppressor genes (these genes slow down cell division, repair DNA mistakes, tell cells when to die) so when these genes are inactivated the cell division gets out of control → no brake, nothing stopping them

Differentiate the three phases of cancer development: initiation, promotion, and progression

Initiation

• initial cell mutation

Promotion

• stage where cancer can be stopped or promoted, they become proliferated

Progression

• cancer is irreversible, bigger, invasive

Latent period: time between initiation and promotion

How does the immune system identify and destroy cancer

Cancer cells develop in our body everyday and are taken out by the immune system. They have antigens on them and other cells present those antigens to T cells and those T cells are what destroy the cancer

What are the 4 methods for classifying and determining the extent and spread of cancer?

• By site of origin

• By tissue type

• By histological grade

• By stage/spread

Explain classifying cancer according to site of origin

some common sites are breast, prostate, lung, colorectal, uterus, bladder, melanoma

What are the 5 categories the cancers are grouped into when classified by tissue of origin.

• carcinoma: malignant cancer originating in epithelial tissue

• sarcoma: cancer originating in connective tissue (bones, tendons, cartilage, muscle, fat)

• myeloma: cancer originating in plasma

• leukemia: cancer originating in bone marrow

• lymphoma: cancer originating in lymphatic system

Explain the grades when classifying cancer by histological grade

Grade 1: cancer cells look like other cells. Well differentiated cancer cells

Grade 2

Grade 3

Grade 4: cancer cells look nothing like normal cells. Poorly differentiated cancer cells

Explain the stages when classifying cancer by the stage/spread.

Stage 0: abnormal cells that could grow into cancer but have not spread to nearby tissue

Stage I: cancer is present but has not spread

Stage II - III: cancer is present and has spread to nearby tissue

Stage IV: cancer spread to distant parts of the body (metastatic cancer)

What is carcinoma in situ?

It is pre-cancer

It is when abnormal cells that could grow into cancer are present but have not spread to nearby tissue

What is the TNM classification and what does each letter stand for?

• this classification describes the extent of the disease

• T: tumor size and extent of invasion to tissues

• N: number of nearby nodes that have cancer

• M: metastasis or if cancer has spread to distant tissue/organs

What does the following TNM classification describe?

T1, N1, M0

• Tumor is small

• Cancer spread to 1 lymph node

• No distant metastasis

What are the 6 major classes of chemotherapy drugs aka anti-cancer or cytotoxic agents? Include prototype and side effects

• Alkylating Agents

• Anti-metabolites

• Anti-tumor

• Mitotic Inhibitors (anti-mitotic)

• Topoisomerase Inhibitors

• Miscellaneous

Give both the prototype and side effect of the following chemotherapy drug:

Alkylating Agents

• Cyclophosphamide and Cisplatin

• Peripheral neuropathy, renal failure, severe nausea & vomiting

Give both the prototype and side effect of the following chemotherapy drug:

Anti-metabolites

• Methotrexate and 5-Flurouracil

• diarrhea, mucositis, neutropenia

Give both the prototype and side effect of the following chemotherapy drug:

Anti-tumor Antibiotics

• Doxorubicin

• cardiac & pulmonary toxicity

• it is a vesicant so tissue damage with extravasation

Give both the prototype and side effect of the following chemotherapy drug:

Mitotic Inhibitors (anti-mitotic)

• Vincristine and Vinblastine

• peripheral neuropathy, extreme constipation

Give both the prototype and side effect of the following chemotherapy drug:

Topoisomerase Inhibitors

• topotecan

• significant diarrhea

What is myelosuppression? And 3 consequences of it

Myelosuppression is a side effect of chemotherapy and is when bone marrow is impaired (bone marrow is the site of blood cell production)

• anemia (low RBCs)

• leukopenia (low WBC)

• thrombocytopenia (low platelets)

What is nadir in oncology and when does it happen?

It is the period when bone marrow suppression is the greatest (immune system is the weakest) and happen 7-10 after chemotherapy. Consequence of myelosuppression

Describe nursing intervention to prevent/minimize side effect of chemotherapy; nausea & vomiting (CINV) chemotherapy induced nausea and vomiting

Non-pharmacologic

• ginger, maintaining hydration/nutrition, light meal before chemo and cool drinks throughout

Pharmacologic

• Aprepitant + Dexamethasone + 5HT3 agonist (Ondasetron)

What are some safety considerations for administering ondasetron?

Given for CINV

• Torsades de pointes (dysrhythmia that prolongs QT interval)

• Serotonin syndrome

• Fall risk

What are the 3 meds to give for CINV

Aprepitant + Dexamethasone + 5HT3 agonist (ondasetron)

What are nursing interventions to prevent/minimize mucositis?

Pain Management

• topical anesthetics “magic mouthwash”

• OTCs acetaminophen or prescription narcotics

• Oral hygiene (regular, soft, gentle)

• Eating modification (small frequent meals, adequate hydration using straws, avoid painful foods)

What is mucositis?

This is a side effect of chemotherapy and is when there is inflammation of the mucous membranes that line the mouth and GI tract. Symptoms: redness, soreness, heat, swelling, dry mouth, extra thick saliva, mouth ulcer