NRSG 326 Week 1 - Oncology

How many Canadians will be diagnosed with cancer in their lifetime?

2 in 5

How many Canadians will die of cancer?

1 in 4

What are the most common cancers to be diagnosed?

Lung, breast, prostate and colorectal

Examples of inequities in cancer care

Health literacy, geography, income/employment, language barriers, transportation, mental health, racism

Characteristics of healthy cells

Large cytoplasm, single nucleus, single nucleolus, fine chromatin

Characteristics of cancer cells

Small cytoplasm, multiple nuclei/nucleoli, coarse chromatin, disorganized/misshapen, multiply faster, do not die via apoptosis

Initiation

Initial mutation

Caused by inherited mutation, DNA error or exposure to carcinogen agent

Promotion

Reversible proliferation of altered cells, can take 1-40 years, impacted by promoting agents

Examples of agents that initiate and promote

Alcohol, tobacco, deli meats

Progression

Increased growth rate of tumor, increased invasiveness, metastasis

Metastasis

Not seen in all cancers, can be predictable with some cancers, invasion of neighboring tissues or vessels

Common sites: brain, bone, liver and adrenal glands

Colon cancer screening

50-75 @ avg risk = every 2 years with fecal immunochemical test

< 74 with hx= every 3-5 years with colonoscopy

Cervical cancer screening

Screen anyone 25-69, has had HPV, have had sex or have been through menopause

Pap every 3-5 years if 25-69, regularly if others

Can self test with q-tip in vagina

Lung cancer screening

Screen if 55-74, have smoked tobacco for 20 years currently or in the past or if having s/s

Low dose CT

Breast cancer screening

40-74 with first degree relative = mammogram yearly

40-49 w/o hx = consult

50-74 w/o hx = mammogram q2years

40+ w no s/s = mammogram every 2 years

Prostate cancer screening

45 w high risk, 50 low risk

Digital rectal exam or prostate specific antigen every check up or q 3 years

Warning signs for cancer (CAUTION UP)

Changes in bowel or bladder

A lesion that does not heal

Unusual bleeding or discharge

Thickening or lump

Indigestion or difficulty swallowing

Obvious changes in wart or mole

Nagging cough or persistent hoarseness

Unexplained weight loss

Pernicious anemia

What does histological grading look at?

How abnormal do the cells appear?

What does clinical staging look at?

Extent of the disease process

Stage 0

Cancer in situ

Stage 1

Tumor limited to tissue of origin

Stage 2

Limited to local spread

Stage 3

Extensive local and regional spread

Stage 4

Metastasis

Tx (TNM)

Unable to measure tumor

T0 (TNM)

No evidence of tumor

Tis (TNM)

Tumor has not grown into nearby tissue

T1-T4 (TNM)

Tumor has grown into nearby tissue

1-4 describes how much it has grown

Nx (TNM)

Unable to evaluate lymph nodes

N0 (TNM)

No cancer found in lymph nodes

N1-N3 (TNM)

Cancer has spread to lymph nodes

1-3 depend on how many nodes are involved and how much cancer is found in them

M0 (TNM)

Cancer hasn't spread to other parts of the body

M1 (TNM)

Cancer has spread to other parts of the body

Cause of fatigue d/t chemo and radiation

Accumulation of metabolic wastes and toxins or infection

Cause of anorexia d/t chemo and radiation

Suppresses appetite and causes nausea

Causes of hematological dysfunction d/t chemo and radiation

Causes decreased WBCs, RBCs and platelets

Integumentary changes d/t chemo and radiation

Drier skin, hair loss

Respiratory side effects d/t chemo and radiation

Pneumonitis, pulmonary edema, etc

GI side effects d/t chemo and radiation

Decreased saliva production, increased risk for oral infection, vomiting, diarrhea

Reproductive side effects d/t chemo and radiation

Infertility, decreased lubrication

How do biological therapies treat cancer?

Modify host-tumor relationship

Direct anti-tumor effects

Restore or augment host immune mechanisms

Interfere with cancer cell ability to metastasize or differentiate

Examples of biological therapies

Interferon, interleukins, monoclonal antibodies, growth factors

Possible complications of cancer

Pain, clotting, VTE, malnutrition, altered taste, infection

Superior vena cava syndrome

Obstruction from tumor which affects flow through left side of heart

S/s of superior vena cava syndrome

Back up of blood into face and neck

Facial edema, JVD, redness of upper body, progressive edema of arms/hands, dyspnea, decreased CO, hypotension, death

Diagnostics and treatment of superior vena cava syndrome

Dx: CT

Tx: radiation, chemo, surgery

Spinal cord compression

Tumor grows against spinal cord and compresses it

S/s of spinal cord compression

Pain, loss of function

Diagnostics and treatment of spinal cord compression

Dx: CT, MRI

Tx: surgery, radiation

3rd Space Syndrome

Fluid moves from intravascular space into interstitial space

S/s of 3rd space syndrome

Increase in weight, edema, changes in hemodynamics

Treatment and diagnostics of 3rd space syndrome

Dx: lab work (CBC, hematocrit)

Tx: based on what is causing problem, may give fluids (with caution so as to not fluid overload)

Intestinal obstruction

Tumor presses on GI tract or blocks off lumen of intestine

S/s of intestinal obstruction

NV, pain, fecal smelling vomit

Treatments and diagnostics of intestinal obstruction

Dx: X-ray

Tx: NG tube, surgery

Syndrome of inappropriate diuretic hormone (SIADH)

Increased or sustained ADH production

S/s of SIADH

Less urine, water retention, back-up of fluid into vessels

Treatment of SIADH

Watch sodium levels, monitor changes in LOC

Fluid restrictions

Hypercalcemia

Too much calcium in blood

Often a complication of bone cancer or stimulation of parathyroid

S/s of hypercalcemia

Depression, muscle weakness, ECG changes

Tx of hypercalcemia

Fluids, diurectics, biphosphate

Tumor lysis syndrome

Chemo causes cancer cells to die, releasing what is inside

Occurs 24-48h after chemo

S/s of TLS

High phosphate or calcium levels

Tx of TLS

Fluids

Septic shock

Distributive shock, vasodilation and leaky capillaries, infection

S/s of septic shock

Chills, confusion, delirium, tachycardia, fever

Dx and tx of septic shock

Dx: lactate levels, cultures

Tx: antibiotics

DIC (disseminated intravascular coagulation)

Simultaneous bleeding and clotting

D/t septic shock, liver cancer etc

S/s of DIC

Bleeding at wound sites, nose, gums or mouth

Blood in stool or urine

Petechiae

Dx and tx of DIC

Dx: labs (decreased platelets, increased D-dimer, decreased fibrinogen, increased clotting times)

Tx: blood products, heparin

Cardiac tamponade

Fluid in sac around heart

S/s of cardiac tamponade

Chest pain, anxiety, muffled heart sounds, tachycardia

Dx and tx of cardiac tamponade

Dx: ultrasound

Tx: needle decompression, pericardial window

Carotid artery rupture

Carotid artery ruptures or wall erodes, emergency

S/s of carotid artery rupture

Stroke symptoms, blood loss if rupture is external, massive hematoma on neck if internal

Treatment of carotid artery rupture

Pressure on bleeding if external

Emergency surgery ASAP