Week 13: Solid Tumors

general warning signs of cancer (CAUTION)

change in bowel/bladder, a sore that doesn’t heal, unusual bleeding/discharge, thickening lump, indigestion/difficulty swallowing, obvious change in wart/mole, nagging cough/hoarseness

carcinoma definition

malignant tumor originating from skin, glands, or linings of organs

sarcoma definition

malignant tumor originating from muscle, bone, or fat.

cancer grades

1-4. 4 - immature, primitive cells, highly aggressive

cancer clinical staging

0 - in situ (local), 1 - limited to tissue, 2 - limited local spread, 3 - extensive local/regional spread, 4 - metastasis

TNM class system

tumor size/invasiveness (situ-4), spread to lymph nodes (0-3), metastasis (0-1)

general cancer dx studies

cytology, biopsy, tumor markers - proteins/genetic material found in fluids/tissues. genetic markers - alterations in genes, ex. BrCA1/BrCA2. chests xray, liver, CBC, chem, endoscopy, radioisotope scans, PET.

cancer collab care

surgery, radiation, chemo, hormone therapy, photodynamic therapy, immunotherapy, targeted therapy, personalized medicine

photodynamic therapy

cytotoxic compound injection activated by a laser beam, SE sensitivity to light for up to 12 weeks

targeted therapy

drugs/substances used to precisely identify and attack cancer cells, SE are acute and dose limited

personalized medicine

treatment that works with a person’s specific genetic information

cancer surgery purposes

prophylaxis, diagnosis, curative, control, palliation, second-look, reconstruction, rehabilitation

brachytherapy nursing interventions

radiation implant - private room, visitors 30 minutes + 6 ft away, use long forceps and store implant in lead container

teletherapy nursing interventions

don’t wash marking off skin, ensure nutrition + rest, monitor skin for irritations/burns, no skin irritants

radiation side effects

anorexia, taste changes, fatigue, tissue fibrosis/scarring - esp lungs, dry mouth (xerostomia), wet/dry desquamation.

chemotherapy side effects

rapidly dividing cell dmg - skin, hair, intestines, spermatocytes, blood forming.

chemo nursing interventions

PPE, ensure no infiltration/extravasation, skin, vitals, nutrition, emotional status. N+V - administer antiemetic 30-60 min before tx, neutropenic precautions, monitor low blood counts. mucositis/stomatitis - anesthetic prior to meals.

types of chemo

nonspecific - damages DNA. cell cycle specific - interferes with metabolism or mitosis

chemo side effects

bone marrow suppression - give epoetin alfa, filgrastim (W), oprelvekin (P). n+v, mucositis, alopecia, peripheral neuropathy, anxiety, fatigue, long term - organ dmg

chemo collab care

differentiate toxic drug SE vs. malignant progression, report serious reactions, treat SE, manage alopecia, support patient + family, neutropenic precautions, pain mgmt.

breast cancer risk factors

genetics, hx, females, 65+, oral contraceptives/hormone replacement, high fat low fiber diet, alcohol, smoking obesity

breast cancer manifestations

lump - fixed + nontender, discharge, dimpling/retraction, ulcerations, enlarged lymph nodes.

breast cancer screening/dx

self exam, mammogram, BRCA1, BRCA2, HER2, US, biopsy

breast cancer treatment

hormone, selective estrogen, chemo, radiation. surgery - lumpectomy, mastectomy, radical mastectomy.

breast cancer nursing mgmt

HOB elevated, wound + drain care, sling, supportive bra. lymphedema → nerve pain, swelling. mgmt arm exercises, compression, limb alert

lung cancer risk factors

genetics, smoking, radiation, environmental irritants

lung cancer manifestations

chronic cough, hemoptysis - crackles, chest pain, fatigue, fever, hoarseness, dyspnea, altered breath sounds, clubbing

lung cancer dx

sputum test, thoracoscopy, bronchoscopy, CXR, CT, pulmonary function test

lung cancer treatment

bronchodilators + corticosteroids, chemo, radiation, thoracentesis. surg - thoracotomy, lobectomy, pneumonectomy.

lung cancer nursing mgmt

monitor airway, lungs, nutrition, fluids, fowler’s position.

kidney cancer risk factors

smoking, obesity, genetics, HTN, chemical exposure

kidney CA manifestations

anemia, hematuria, HTN, flank/lower back pain, fatigue, weight loss, fever, lump

kidney CA dx

BUN, creatinine, I+O, CT, US, renal function

kidney CA tx

chemo, radiation, immunotherapy, targeted therapy, nephrectomy, drain

kidney CA nursing mgmt

I+O, pain, VS, electrolyte mgmt, drain + wound care. home - quitsmoking, weight mgmt, BP control

bladder CA risk factors

genetics, age, smoking, environmental irritants, radiation, chronic UTI

bladder CA manifestations

hematuria, frequency, dysuria, back pain.

bladder CA dx

UA, cytology, cystoscopy w/ biopsy, CT

bladder CA tx

radiation, immunotherapy, targeted therapy, chemo. trans-uretheral removal bladder tumor (TURBT), cystectomy.

bladder CA nursing mgmt

I/O, CBI cath care, encourage fluid intake, stool softener, check for surg complications - bladder spasm, incontinence, hemorrhage, infection. may need cath at home.

skin cancer risk factors

sunburn tendency, family hx, lack of skin pigment, hormonal + immunologic, indoor tanning.

skin cancer manifestations

melanoma ABCDE. basal cell - papule w/ eroded center

skin cancer tx

remove cancerous lesions, melanoma requires chemo, basal - regular removal, cryosurgery, electrosurgery, phototherapy.