Health Alterations class 15:

Most often way cancer spreads to other areas of the body

Lymph

How can cancer spread

Lymph and blood

When is cancer often diagnosed

At the onset of new findings (may not know until it’s spread)

Prevention and detection of Cancer

1. Early detection and prompt treatment leads to a better prognosis

2. Reduce/eliminate smoking and sun exposure

3. Balanced diet and regular physical activity

4. Healthy body weight

5. Limit alcohol

6. Self examine

7 warning signs of cancer

CAUTION (usually have for weeks without improvement)

C- change in bowel or bladder habits (frequency,colour, consistency, hesitancy etc)

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

N-nagging cough or hoarseness

Only definitive means and cancer diagnosis

Biopsy, guides treatment decisions. Sample of the growth is taken

Diagnosis of cancer

1. History and physical

2. Diagnostic study depends on site (endoscopy, mammogram, colonoscopy, blood work, scans)

3. Biopsy

Most preventable cancer

Lung cancer

Lung cancer risk factors

1. Cigarette smoking

2. Inhaled carcinogens (improper PPE)

Lung cancer prognosis

Poor prognosis, early detection is key

Lung cancer signs and symptoms

1. No symptoms

2. Persistent cough

3. Persistent pneumonitis (lung inflammation)

4. Chest pain

5. Dyspnea

6. Anorexia, fatigue, weight loss

Diagnosis of lung cancer

1. History and physical (risk factors, symptoms…)

2. Chest x ray, CT scan and sputum specimens (not diagnostic, looking at new growths)

3. Bronchoscopy-biopsy

Normal finding in the first 24 hours after a bronchoscopy

Fever, concerning after 24 hours

Bronchoscopy

1. Larynx, trachea and bronchi visualized

2. Takes 30-45 minutes

3. Throat sprayed with local anesthetic

4. Inserted into nose or mouth

5. Biopsy taken if abnormal finding found

Bronchoscope post op

NPO until gag reflex returns (aspiration risk)

Bronchoscopes in children

Have smaller airways so increased risk of hypoxia, careful monitoring of airway status and O2 sat

Pneuomonectomy

Removal of the full lung

Pneumonectomy and lobectomy considerations

Pain control and positioning to let fluid into area

Lobectomy

Removal of 1 lobe of the lung

Lung cancer and smoking cessation

After 10 years of no smoking risk of cancer reduces by ½

Lung cancer signs and symptoms to report

1. Coughing up blood

2. Increased fatigue

3. Worsening SOB

4. Infection

Goals of lung cancer treatment

1. Effective breathing (high Fowlers can help)

2. Adequate airway clearance (hydration, deep breathing, incentive spirometer)

3. Adequate oxygenation of tissues

4. Pain control

5. Realistic attitude towards treatment and prognosis

Colorectal cancer

Malignant disease of colon ,rectum or both

Colorectal cancer risk factors

1. Diet (alcohol, not enough fruit/veg or fibre, processed meat, greasy food)

2. Physical inactivity

3. Alcohol

4. Age (over 50 increases risk)

5. Long term smoking

6. Colorectal polyps (routine screening if have history)

7. Chronic inflammatory bowel disease

Signs and symptoms of colorectal cancer

1. Non specific

2. Rectal bleeding (may not be visible at first)

3. Change in bowel habits

4. Abdominal cramping

5. Gas and bloating

6. Lack of appetite

7. Lethargy

8. Sensation of incomplete evacuation

Diagnosis of colorectal cancer

1. History and physical

2. Fecal occult blood test (FOB) Fecak immunochemical test (FIB)

3. Colonoscopy-biopsy

4. CT, MRI, ultrasound

5. Lab values (CBC-anemia, LFTs-high correlation of liver and colorectal cancer)

Fecal occult blood test (FOB)

Stool sample smeared on paper with solution, lab tests for presence of blood. Tests all over intestinal tract

FOB food restrictions

Avoid red meat and NSAIDs before

Fecal immunochemical test (FIT)

Stool sample (often through mail). Looking for bleeding in lower GI

FIT food restrictions

No food restriction, so commonly sent out in mail

Colonoscopy prep

1. Clear fluids

2. Bowel prep (laxatives)

3. NPO

Why might someone have gas or bloating after a colonoscopy

Because air is sometimes used to better visualize colon

Colorectal cancer treatment

1. Surgical resection

2. Chemotherapy

3. Radiation

Colorectal cancer surgical resection

May take part of bowel out and reconnect or may have temporary or permanent ostomy

When is chemo used for colorectal cancer

When lymph nodes or metastases are involved

ERAS

Enhanced recovery after surgery. Standardized and used by hospitals

Screening for colorectal cancer

FIT/FOB test every 2 years

Why should a pt chew gum after surgical resection for colorectal cancer

Stimulates peristalsis, can have food after

Positioning post surgical resection with colorectal cancer

Want pt to pass gas and have peristalsis

Ostomy care

Teach how to care for it at home. Big body image change

Diet after surgery for colorectal cancer

Clear fluids and chew gum,move to food as tolerated

Goals of treatment for colorectal cancer

1. Appropriate treatment

2. Normal bowel elimination

3. QOL appropriate to prognosis

4. Pain relief

5. Feelings of comfort and wellbeing

Breast cancer and estrogen

2/3 need estrogen to grow

Breast cancer risk factors

1. Female

2. Age (>50/60)

3. Family history (BRCA 1 or 2 mutation)

4. Hormone use

5. Personal history of cancer

6. Early menarche or late menopause (prolonged exposure to estrogen)

7. Weight gain

8. Sedentary lifestyle

9. Diet

Signs and symptoms of breast cancer

1. Lump (hard, irregular shape, non mobile, non tender)

2. Nipple discharge

3. Nipple retraction

Diagnosis of breast cancer

1. History and physical

2. Mammogram

3. Ultrasound (if mammogram shows unusual findings or if not enough breast tissue for mammogram)

4. Biopsy

Mammogram

1. X ray of breast

2. 10 minutes

3. Moderate discomfort (pressure)

4. Cultural considerations

5. Over 40 should have one every 2-3 years

Breast cancer treatment

1. Surgery

2. Radiation

3. Chemo

4. Hormone therapy

5. Brachytherapy

Mastectomy

Breast and lymph node removal, may be prophylactic, may have reconstruction during surgery

Lumpectomy

Removal of lump from breast

Primary treatment of breast cancer

Surgery

Breast cancer hormonal therapy

Block estrogen

Brachytherapy

Internal radiation, catheter into site and left for a few days

Goals of breast cancer treatment

1. Patient has active participation in decision making

2. Adhere to plan

3. Manage adverse effects

4. Access support

Sentinel lymph node biopsy

Looking where tumor is draining, inset blue dye and take out blue lymph nodes

Breast cancer post op lymphedema prevention

1. Elevate arm

2. No blood work, IVs or blood pressure in affected arm

3. Massages

4. Compression therapy

5. Exercises Medications

Most common breast cancer post op complication

Lymphedema (because removing lymph nodes)

Complications of lymphedema

Loss of function, infection and skin irritation risk

Cervical cancer risk factors

1. Low socioeconomic status

2. Early sexual activity (before 17)

3. Multiple partners

4. Infection with HPV (vaccine decreases risk)

5. Immunosuppression

6. Smoking

Peak age of cervical cancer incidence

30

Signs and symptoms of cervical cancer

1. Asymptomatic

2. Unusual discharge, abnormal bleeding

3. Late symptoms:

4. Pain

5. Weight loss

6. Anemia

7. Cachexia

Diagnosis of cervical cancer

1. History and physical

2. Pap test (every 3 years after 21)

Cervical cancers treatments that preserver fertility

1. Conization (removing cone shaped section of cells)

2. Laser treatment

3. Cautery (heat) and cryosurgery (cold)

cervical cancer prevention

Early detection, vaccines for HPV

Cervical cancer treatments that are invasive and may affect fertility

1. Surgery

2. Radiation

3. Chemo

Fertility considerations for cervical cancer

Typically at child bearing age, may want to freeze eggs

Cancer that often goes undetected

Ovarian cancer, unspecific symptoms

Risk factors for Endometrial/uterine and ovarian cancer

1. Estrogen

2. Age

3. Nulliparity (bc pregnancy is high progesterone)

4. Obesity

5. Smoking

6. Family history

7. Early menarche, late menopause

Signs and symptoms of endometrial cancer

1. Abnormal bleeding

2. Pain (late sign)

Signs and symptoms of Ovarian cancer

1. Pelvic/abdominal pain

2. Bloating

3. Urinary frequency/urgency

4. Increased abdominal girth (late sign)

5. Weight loss or gain (late)

Diagnosis of endometrial and ovarian cancer

1. History and physical

2. Biopsy

3. Pelvic exam

4. Ultrasound (external or internal)

Prostate cancer risk factors

1. Age (over 50)

2. Ethnicity (African ancestry)

3. Family history

4. Diet (high fat)

5. Overweight

Prostate cancer growth

Slow growing

Signs and symptoms of prostate cancer

also signs of BPH

1. Asymptomatic

2. Dysuria

3. Hesitancy

4. Dribbling

5. Urgency

6. Hematuria

7. Retention

8. Interruption of urinary stream

Diagnosis of prostate cancer

1. Digital rectal exam

2. Biopsy

Prostate specific androgen

Tells how large prostate is, good for detecting BPH but not prostate cancer

Prostate cancer grading scale

Gleason scale

Prostate cancer active surveillance

Slow growing so may not need intervention ever or right away

Prostate cancer treatment

1. Active surveillance

2. Radiation therapy

3. Medication therapy

4. Androgen deprivation therapy

Risks associated with androgen deprivation therapy

Increased risk of OP and fractures

When is surgery used for prostate cancer

When cons outweigh pros, because it’s slow growing

Prostate cancer patient education

1. Catheter care

2. Signs and symptoms of bladder infection

3. Kegel exercises