Medsurge cancer

prostate, lung, colorectal, urinary bladder, melanoma 

what are the most common cancers in men

breast, lung, colerectal, endometral and uterus, thyroid

what are the most common cancers in women

Defective cell proliferation

dysfunction that is uncontrolled cell growth → keep dividing. Form tumors that may metastasize 

Defective cell differentiation

dysfunction where cells lose their specialized functions and revert to undifferentirated state 

oncogenese

mutated forms of proto-oncogenes (which normally regulate cell growth). When mutated they promote uncontrolled growth

carcinogens

exposure causes acquired cancer: include Chemical - tobacco spine, benzene; Radiation - UV, x-rays, nuclear and Viral - HPV, hepatitis, EPV

HPV vaccine, smoking cessation, diet, avoid too much sun. reduce pollution, be phsyically active, limit alcohol, screening

what are some primary preventions of cancer

early warning signs for cacner

• Change in bowel or bladder 

• A lesion that does not heal 

• Unusual bleeding or discharge 

• Thickening or lunp (breast, testicle etc) 

• Indigestion or difficulty swallowing 

• Obvious changes in wart of bole 

• Nagging cough or persistent hoarseness 

• Unexplained weight loss 

• Pernicious anemia 

tumor markers

Proteins or substances produced by cancer cells, e.g.:

•  PSA (Prostate-Specific Antigen) – Prostate cancer

• CA-125 – Ovarian cancer

• AFP (Alpha-fetoprotein) – Liver/testicular cancer

genetic markers

Identifies hereditary cancer risk (e.g., BRCA1/BRCA2 for breast/ovarian cancer).

endoscopy

Used to visualize internal organs and obtain biopsies. ex) colonoscopy, bronchoscopy, gastroscopy

biopsy

the ONLY definitive test to diagnose cancer 

benign

type of cancer that is slower, well-defined capsule, doesnt spread

carcinomas

cancer of the epithelial cells- breast, lung, colon 

sarcomas

cancer of the connective tissue - bone, cartilage, muscle fat

hematopoietic

cancer of the blood- leukemia, lymphoma, myeloma

historic classigication

how differentiated the tumor cells are compared to normal cells

• Grade 1(well differentiated), 2(moderately),3(poor), 4(undifferentiated or anaplastic), 

staging

how advanced the cancer is: 0(precancer), 1 (small localised), 2(larger tumor), 3(advanced, spread to lymph), 5 (distant metastasis, spread to organs)

surgery

waht is the oldest form of cancer tx. Not completely affective if cancer already spread. Use for prevention, control cure, palliation

chemotherapy

 use of drugs to destroy cancer cells. Systemic treatment targets rapidly dividing cells.

use gloves, double flush, wash hands, avoid pregnant caregivers, PPE

what are some special precautions for patients getting chemo

cyclophosphamide

Alkylating Agents chemo drug may cause neutropenia, hemorrhagic cystitis

methotrexate, hydroxyurea

Antimetabolites chemo drug that may cause renal, liver probelms. bone marrow suppression and anemia. (keep pt hydrated)

cisplatin

platinum agents that may cause neurotoxicity - peripheral neuropathy and visual disturbances. Ototoxicity- tinnitis, hearing loss, and vertigo

doxorubicin

antitumor antibiotics that may cause cardiotoxicity leading to electrophysiology dysfunction and/or muscle damage (HF), dysrhythmias, reduced pumping

vincristine, paclitaxel, docetaxel

mitotic inhibitors- may cause peripheral neuropathy and liver failure, bradycardia

tamoxifen

estrogen receptor blocker may cause visual acuity changes, hot flashes, heart disease, clots, endometrial cancer

dexamethasone, hydrocortisone, methylprednisolone, prednisone

corticosteroids for cancer. cayuses increased appetite, weight gain, edema, hyperglycemia, mood swings, and insomnia

bleomycin

chemo drug that often causes pulmonary fibrosis

phlebitits

irritants can cause the inflammation of a vein, often causing pain, redness, and swelling

vesicants

dangerous medications that, if they leak out of the vein (extravasation), can cause severe tissue damage, including blistering and even tissue necrosis (tissue death)

PICC

for long term chemo, lower risk of tissue damage bc drug is diluted quickly in large central vein 

tunnelled catheters

(Hickman, broviac) are better bc of the decreased risk of infection

scrub the hub, aspirate, flush 

what should you do when using infusaport for chemo drugs

PIV

inserted into vein in arm. For short term and less irritating drugs. can get complications like phlebitis or vesicants

N/V, allergic reaction, anaphylaxis extravasation, cardiac arrhythmias (doxorubicin)

what are some acute toxicities that may happen shortly or immediately after chemo admin

bone marrow suppression, alopecia, mucositis, n/v, neurotoxicity(tingling, numbness), constipation or diarrhea 

what are some delayed effect toxicities that may happen days to weeks after chemo admin

cardiotoxicity (doxorubicin-> HF), pulmonary toxicity(bleomycin and fibrosis), nephrotoxicity (cisplatin), hepatotoxicity, infertility, secondary malignancies 

what are some chronic toxicities that may happen longterm - months to years from chemo

radiation therapy

use of high-energy rays to destroy cancer. Local targeted treatment. Damages DNA of cells making them unable to grow or divide. internal vs external

pancytopenia

decrease in white cells, red cells, and platelets. caused by bone marrow suppression from chemo

neutropils

cells that are first affected by bone marrow suppression Will be at risk for infection 

Neupogen and neulasta

neutrophil boosting meds

>100

what temp needs to be reported when on chemo do to neutropenia

thormbocytopenia

why should we be aware of bleeding. Be careful with invasive procedures when on chemo

120 days

Anema - happens within _______ of chemo/radiation

Provrit

medicine that helps treat anemia

nutrition, rest, cluster care 

what nursing interventions for fatigue in cancer pts

reglan, zofran, kytril, anzemet, aloxi 

what drugs can be given for nausea and vomiting

inflammation, N/V, diarrhea, mucositis, xerostomia, loss of taste, difficulty swallowing, anorexia

what are common GI effects from chemo

mucositis

red, sore, painful mouth bc of inflammation- need soft food, viscous lidocaine orally, 

xerostomia

term for no saliva: tx is saliva subsidies, sugarless gum or candy sipping on water

high protein, high cal diet, nutritional supplements, check prealbumins 

what diet/care for cancer patients due to nutrition risk

dry dessquamation

a sunburn basically. treat with alloe vera, stay out of sun and no swimming. 

wet dequamation

skin reaction that becomes open wound: tx is dressing change, antibiotics potentially

Pneumonitis, pleural effusion, pulmonary fibrosis

pulmonary effects from chemo drugs.

turn cough deep breath, bronchodilators and oxygen as needed

what nursing interventions to help the pulmonary effects from chemo drugs

Lymphedema(some swelling), cardiac toxicity, secondary malignancies

what are some Late effects from chemo

immunotherapy

medical treatment that helps the patients own immune system fight the cancer. cancer cells might mutate bc of this

• Monoclonal antibodies: end in –mab = most effective

• Interferon: Side effects = flu-like symptoms, confusion, capillary leak syndrome

targeted therapy

medical treatment that target cancer-specific genetic changes use to slow tumor growth and/or kill cancer cells. less damge to normal cells

hormone therapy

block the effects of the hormone and stop cancer growth 

• Prostate and breast cancer can be hormone-positive therefore the hormones promote cancer growth 

stem cell transplant

Eradicate diseased cells and replace with healthy cells . Cure or remission, referred to as their bday. Starting from scratch

marinol (syntehtic marajuana) and magave 

appetite stimulants to help with malnutrition bc of cancer GI issues

Superior Vena Cava Syndrome

Obstructive oncologic emergency where blood flow is blocked due to cancer

Spinal Cord Compression

obstructive oncologic emergency with numbness, tingling, decreased mobility caused by tumor pressing on cord

third space syndrome

an obstructive oncologic emergency where fluid moves out of vessels- edema, pleural and pericardial effusion

SIADH

a metabolic emergency treated with fluid restrictions and lasix

Hypercalcemia

metabolic emergency that is  potentially from bone metastisis,

tumor lysis syndrome

metabolic emergency where cancer cells break down rapidly releasing contents into bloodstream. high potassium., low ca, high phos. All chemistries will be messed up 

combo of opioids, tylenol, NSAIDS

Manage persistent and breakthrough pain with

women >50, early menarche before 12. Late pregnancy after 30, Hormone use(estrogen after menopause), smoking, alcohol, family hx,

what are risk factors for breast cancer

noninvasive

breast cancer where the cells have not spread beyond the ducts or lobules 

invasive ductal carcinoma

Breast cancer where the cancer broken through ducts and invaded surrounding breast tissue  

invasive lobular carcinoma

breast cancer that starts in lobules and spread to nearby tissue

inflammatory

breast cancer that looks like mastitis. Rare but aggressive 

hard nontender lump(lemon seed), nipple discharge, nipple retraction, orange peel appearance, breast or nipple pain 

clinical manifestations of breast cancer

mammogram(encourage annually at 45), MRI, ultrasound

imaging tests for breast cancer

TNM

tumor, Nodes, Metastasis, a widely used cancer staging system

sentinel node biopsy

lymph node that drains near breast tumor is removed and examined for cancer cells 

Her 2 status

a protein that plays a role in cell growth and divisionIn some breast cancers, HER2 is overexpressed or amplified, meaning there are too many HER2 proteins.  

surgery

primary tx for breast cancer. Can have before, after, or in combination with chemo

lumpectomy

cut out tumor from breast. Increased risk of breast cancer since they still have tissue left. 

mastectomy

removal of breasts. simple vs modified radical. will do Breast implants and tissue expansion(water balloon under skin), TRAM flap (takes tissue from lower abdomen)

radiation therapy, chemotherapy, hormone therapy, targeted therapy

Adjacent therapies  for breast cancer

lymphedema (larger arm), phantom pain/pain syndromes, coping and body image, grieving and fear, recurrance

what are common complications from breast cancer treatment

Men- African American. Diet high in red meat, age>50, family hx, inflammatory bowel disease

what are risk factors for colorectal cancer

change in bowel habits, and unexplained weight loss. usually nonspecific ss that do not appear till advanced, iron deficiency anemia, rectal bleeding, abdominal pain, intestinal obstruction/perforation 

what are common clinical manifestations for corectal cancer

colonoscopy

gold standard screening for colorectal cancer that should be started at age 45

H and P, colonoscopy, fecal occult blood tests, stool DNA test, Biopsy, CT or MRI, Carcinoembryonic antigen (CEA)

diagnostic studies for colorectal cancer

liver

what is a common metastatic site from colorectal cancer seen in CT or MRIs

polypectomy

urgical procedure to remove a polyp using a snare: a loop. will get sent to the lab

Bowel Resections (Colectomy)

depending on staging, theyll do a a surgical procedure to remove all or part of the colon (large intestine). stoma care is important

stoma assessment: want it to be pink and moist, ostomy care education

what should the nurse to postop after an ostomy

psychological preparation

what should the nurse to preop for an ostomy

chemo, targeted therapy to shrink tumor

what is the Primary tx for non-resectable colorectal cancer 

after/during chemotherapy or surgery or palliative 

radiation therapy for colorectal cancer is done:

priority nursing concepts for colorectal cancer

Diarrhea or constipation, acute pain, fear, ineffective coping: Patient needs to demonstrate interest and initiative in caring for his- or herself, especially with any ostomy care

chemotherapy, radiation, immune deficiencies, pesticides, Epstein-Barr virus. Can be a secondary cancer that develops bc of chemo and radiation.

what are risk factors for leukemia

myeloid cells

cells that  develop into RBCs, platelets, and some WBCs (like neutrophils, eosinophils, basophils, monocytes)

lymphoid cells

cells that develop into lymphocytes (B cells, T cells, and natural killer cells).

Acute myeloid leukemia  (AML)

Rapid growth of myeloid cells; common in adults.

•  causes Fatigue, anemia, infection