Cancer I

1. lung

2. colorectal

3. breast

4. cervical, endometrial, ovarian

5. prostate

Most prevalent cancers in Canada: [5]

metastasis (METS)

cancer cells spread to other areas of the body

onset of new findings

when are mets diagnosed?

in lymph (everything drains)

How is cancer most often spread?

1. reduce/eleminate smoking and sun

2. balanced diet

3. regular physical activity

4. healthy body weight

5. limit alcohol

how to prevent cancer:

◦C - Change in bowel or bladder habits

◦A – A sore that doesn’t heal

◦U – Unusual bleeding or discharge

◦T – Thickening or lump

◦I – Indigestion or difficulty swallowing

◦O - Obvious change in wart or mole (colour size shape)

◦N – Nagging cough or hoarsenes

seven warning signs of cancer (has for a number of weeks)

Biopsy

definitive means of cancer diagnosis

1. MRI

2. cat scan

3. mammogram

4. endoscopy

5. colonoscopy

6. chest xray

other diagnostic tests for cancer: [5]

1. cigarette smoking

2. inhaled carcinogens

risk factors for lung cancer [2]

•Silent

•Persistent cough

•Persistent pneumonitis

•Chest pain

•Dyspnea

Anorexia, fatigue, weight loss

S+S of lung cancer [6]

persistent cough

typically first sign of lung cancer:

Penumonitis

inflammation of the lung

•History & Physical

•Chest x-ray

•CT scan

•Sputum specimens

•Bronchoscopy – biopsy

diagnostic tests for lung cancer:

biopsy via bronchoscopy

definitive diagnosis of lung cancer:

when gag reflex returns

when can a patient eat by mouth again after bronchoscopy?

larynx, trachea, and bronchi

what is visualized with bronchoscopy?

Higher risk for hypoxemia during procedure because airways are so small. Monitor O2 status the whole time

why is bronchoscopy higher risk in kids?

It is the body’s natural instinct to respod. Fever normal for the first 24 hours but after that needs treatment

Why is fever after bronchoscopy normal?

Surgical resection

Ideal treatment for lung cancer

lobectomy

surgery where entire lobe of the lng is resected

pneumonectomy

surgery where full lung is removed

Pain and positioning.

positioning: turn onto operated side to let fluid go to that area to not get collapsed lung

What is important after lobe/pneumonectomy?

1. coughing up blood

2. fatigue getting progressively worse

3. worsening SOB

4. lung infection

Educate patient with lung cancer to report onset of these symptoms: (4)

keep away from open flames

no petroleum products

have enough before leaving the house

sign on the door for visitors

Education for home O2: [4]

make sure they can breathe

Goal for nursing care for pt with lung cancer:

1. high fowlers to maximize ventillation

2. adequate airway clearance

   1. thin secretions

   2. deep breathing and coughing

   3. incentive spirometer

nursing care so that patients can breathe:

40+ years old every 2-3 years

When are mammograms recommended?

surgery

primary treatment for breast cancer:

lumpectomy

cancer to remove breast cancer tumour

Mastectomy

surgery to remove entire breast and associated lymph nodes

Brachytherapy

internal radiation for breast cancer. inset little seed of radiation, leave it, then remove it. normally a catheter is placed into the breast, leave for a few days, then take out.

Block estrogen (estrogen feeds 2/3 of cancer)

hormone therapy for breast cancer:

BRCA1/2

breast cancer gene where patients may opt to have prophylactic double mastectomy

Sentinel lymph node biopsy (SLNB)

Procedure wher surgeon injects radioactive blue dye.They look for where nodes are stained blue, that is where the tumour is draining

Sentinel node

first node a tumour drains to, where cancer may spread

lymphedema

after mastectomy (with lymph node removeal) patients are at risk for what?

1. elevate arm post-op

2. physio and compression to promote return

3. no blood pressure/ injections/IV taken on that arm

4. medication

Care after breast cancer surgery to avoid and reduce lymphedema [4]

•Diet

•Physical inactivity

•Alcohol

•Age greater than 50

•Long-term smoking

•Colorectal polyps

•Chronic inflammatory bowel disease

risk factors for colorectal cancer [7]

1. Fecal occult blood test

2. FIT test

two non-invasive tests for colorectal cancer

no preparation

advantages of FIT test screening tool for colorectal cancer

can detect blood from high up in the colon (cons: no red meat or insence beforehand)

advantages of fecal occult blood test

1. anemia (bleeding)

2. liver function tests (high correlation of metastasis to the liver)

lab values that could indicate colorectal cancer:

if lymph node involvement or metastasis

when to start chemo in colorectal cancer

1. can ressect part of the bowel and reconnect

2. may need permanent or temporary ostomy

surgeries for colorectal cancer:

Enhanced recovery after surgery (ERAS)

stnadard aproach after surgical resection. Best practice guidelines. Peole encouraged to chew gum right away to stimulate peristalsis, less fluids in operating room. Decreases average length of hospital stay

Start with clear fluids then diet as tolerated

What can patient eat after bowel surgery?

1. cnstipation

2. anxiety

3. coping

Nursing priority after bowel surgery (3)

•Female

•Advancing age (60 and above)

•Family history

•Hormone use

•Personal history of cancer

•Early menarche, late menopause (more estrogen for longer)

•Weight gain

•Sedentary lifestyle

•Diet

risk factors for breast cancer

BRCA1/2

gene that normally repairs breast tissue. mutation on this gene can increase risk of breast and uterine cancer

•Non-specific

•Rectal bleeding

•Change in bowel habits

•Abdominal cramps

•Gas, bloating

•Loss of appetite

•Lethargy

•Sensation of incomplete evacuation

S+S of colorectal cancer: [8]

•Lump

•Hard, irregular shape, non-mobile, non-tender

•Nipple discharge

•Nipple retraction

S+S of breast cancer [4]

•Low socioeconomic status

•Early sexual activity

•Multiple partners

•Infection with HPV

•Immunosuppression

•Smoking

risk factors for cervical cancer: [6]

•Asymptomatic

•Unusual discharge, abnormal bleeding

•Pain (late symptom)

•Weight loss

•Anemia

Cachexia

S+S of cervical cancer:

every 3 years starting at 21

when to get pap smears and how often

1. conization

2. laser treatment

3. cautery (hot) and cyrosurgery (cold)

treatments for cervical cancer that preserve fertility [3]

Conization

resection of cone-shaped margin around cervical cancer

•Estrogen

•Age

•Nulliparity (no break from estrogen)

•Obesity

•Smoking

•Family history

•Early menarche, late menopause

Risk factors for endometrial cancer [7]

•Abnormal bleeding

•Pain (late)

S+S of uterine cancer [2]

•Pelvic/abdominal pain

•Bloating

•Urinary frequency/urgency

•↑abd. girth (late)

•Weight loss or gain (late)

S+S of ovarian cancer [5]

•Asymptomatic

•Dysuria

•Hesitancy

•Dribbling

•Urgency

•Hematuria

•Retention

•Interruption of urinary stream

S+S of prostate cancer [9]

digital rectal exam

diagnostic tests for prostate cancer [2]

•Age over 50

•African Ethnicity

•Family history

•Diet

•Overweight

risk factors for prostate cancer: [5]

PSA

good indicator of BPH but not reliable for prostate cancer

Gleason scale

measures how quickly the prostate cancer is growing. Low means slow growing, high means fast

Active surveillance (watch and wait)

treatment for prostate cancer where treatment would be riskier than the cancer itself. Wait to see how it progresses

Androgen deprivation therapy (risk for osteoporosis and fractures)

medication therapy for prostate cancer