Cancer (4)

What are some risk factors for breast cancer?

- Female, age over 50 (or over 40 for mammograms)

- Family history of breast, colon, endometrial, or ovarian cancer

- Personal history of breast, colon, endometrial, or ovarian cancer

- Early menarche (before age 12)

- Late menopause (after age 55)

- First full-term pregnancy after age 30

- Nulliparity (no children)

- Benign breast disease with atypical epithelial - - hyperplasia

- Weight gain and obesity after menopause

- Alcohol consumption

- Physical inactivity

- Exposure to ionizing radiation

What are the common manifestations of breast cancer?

- Lumps in the breast

- Breast changes

- Irregular-shaped, firm, non-tender nodules

- Skin dimpling

- Nipple inversion

- Nipple discharge (yellow, green, brown)

What are some diagnostic methods for breast cancer?

Self-breast exam, mammogram (start at age 40), ultrasounds, biopsy, genetic testing (BRCA gene screening for high risk)

What are the main treatments for breast cancer?

Radiation, chemotherapy, surgery (including mastectomy)

What is standard post-operative care after a mastectomy?

- Weight restriction

- Post-placement care for chemotherapy

- Pain management

- TCDB (turn, cough, deep breathe)

- Monitor for signs of infection

- Psychosocial effects (body image disturbances)

- Report fever

- Report increased pain

- Report numbness/tingling

- Report decreased function in the affected arm

What is the arm care guideline after a mastectomy?

- Cannot use affected arm for needle sticks or blood pressure

- Support the affected arm with a sling

- Avoid laying on the affected side

- Avoid dependent arm position

- Initiate ROM (range of motion) exercises early (passive and active)

4o mini

How should drains be managed after a mastectomy?

- Assess drainage every shift (every 8 hours)

milk the drain if needed

- monitor for sudden increases/decreases in drainage

- keep drain clean and in place; wear loose-fitting clothing to prevent pressure

What are the psychosocial considerations for patients after a mastectomy?

- Support groups

- breast augmentation options

- breast prosthetics/implants

- managing body image disturbances

- providing emotional support

What are the risk factors for cervical cancer?

- Early sexual activity (before age 18)

- multiple sexual partners

- family history of cervical cancer

- chronic cervical inflammation/infections (PID, STDs), HPV infection (90% of cases)

- smoking

What are the signs and symptoms of cervical cancer?

- Asymptomatic in early stages

- leukorrhea

- intermenstrual bleeding

- thin, watery discharge progressing to dark and foul-smelling

- vaginal bleeding (spotting to heavier)

pain (late symptom)

- weight loss, anemia, cachexia

What is the diagnostic method for cervical cancer?

Pap smear (screening), pelvic exam (annually), biopsy (definitive)

What are the treatments for cervical cancer?

Surgical removal, hysterectomy, radiation, ablation, cryotherapy, chemotherapy

What are the risk factors for endometrial cancer?

- Age over 55

- obesity

- unopposed estrogen hormone replacement therapy

- nulliparity

- Use of tamoxifen for breast cancer

- late menopause

What are the signs and symptoms of endometrial cancer?

- Abnormal uterine bleeding (especially in postmenopausal women)

- bleeding between periods

- pain (late symptom)

- other symptoms related to metastasis

What is the diagnostic method for endometrial cancer?

Biopsy

What are the treatments for endometrial cancer?

Hysterectomy, radiation

What are the risk factors for ovarian cancer?

- Age over 40

- nulliparity or first pregnancy after 30

- family history of ovarian, breast, or colon cancer

- history of dysmenorrhea or heavy bleeding

- early menarche

- late menopause

- hormone replacement therapy (HRT)

- use of infertility drugs

What are the symptoms of ovarian cancer?

- Usually asymptomatic until advanced stages, abdominal pain/swelling

- discomfort (dyspepsia, indigestion, gas, distention)

- abdominal mass

- urinary frequency

What are the diagnostic methods for ovarian cancer?

Palpation, ultrasound (localization), CA-125 antigen test

What are the treatments for ovarian cancer?

Chemotherapy, surgery (oophorectomy, total abdominal hysterectomy with bilateral salpingo-oophorectomy), radiation

What is a hysterectomy (TAH)?

Removal of the uterus, and possibly ovaries and fallopian tubes; commonly performed surgery in women over 50 for conditions like uterine cancer, fibroids, endometriosis, and genital prolapse

What are the post-operative care instructions for a hysterectomy?

Monitor for infection, perform TCDB, prevent blood loss, DVT prophylaxis, monitor bowel sounds (risk for ileus), monitor vaginal bleeding, restrict activity (no heavy lifting, driving, or sexual activity for 4-6 weeks)

What is the most common cancer in males aged 15-34?

Testicular cancer

What are the risk factors for testicular cancer?

Genetics, undescended testis (cryptorchidism), male age 15-34

What are the manifestations of testicular cancer?

Lumps, heaviness, swelling (usually painless), enlarged inguinal lymph nodes

What are the diagnostic methods for testicular cancer?

X-rays, blood tests (tumor markers), biopsy, CT scan

What are the treatments for testicular cancer?

Surgery (orchiectomy), chemotherapy, radiation

What are the care considerations for chemotherapy?

Immunosuppression (risk for infection), hematology changes (decreased platelets, RBCs, WBCs), GI disturbances (nausea, loss of appetite, cachexia), alopecia, stomatitis

What are the care considerations for radiation therapy?

Internal (brachytherapy) and external therapy, tattooing for radiation markers, private room for internal radiation, skin care to prevent irritation, avoid sunlight and use sunscreen

What are the 7 warning signs of cancer?

Change in bowel or bladder habits a sore that does not heal unusual bleeding or discharge, thickening or lump in the breast or elsewhere, indigestion or difficulty swallowing, obvious change in a wart or mole, nagging cough or hoarseness

What is the purpose of histological grading in cancer?

To determine the degree of differentiation and predict the prognosis of cancer cells based on their appearance

What does Grade I in histological grading indicate?

Mild dysplasia; cells are slightly abnormal but well-differentiated and resemble normal tissue

What does Grade II in histological grading indicate?

Moderate dysplasia; cells are more abnormal with moderate differentiation

What does Grade III in histological grading indicate?

Severe dysplasia; cells are very abnormal and poorly differentiated

What does Grade IV in histological grading indicate?

Anaplasia; cells are immature, undifferentiated, and hard to identify; high grade with poor prognosis

What does the term "anaplasia" refer to in cancer grading?

The lack of differentiation in tumor cells, with primitive and undifferentiated characteristics

What does Stage 0 in cancer staging indicate?

Localized abnormal cells present but have not spread; in situ cancer

What does Stage I in cancer staging indicate?

Localized cancer, early stage, tumor is small and confined to the tissue of origin

What does Stage II in cancer staging indicate?

Intermediate stage, cancer has spread to nearby tissues or lymph nodes

What does Stage III in cancer staging indicate?

Advanced local spread, cancer has spread to regional lymph nodes or other nearby tissues

What does Stage IV in cancer staging indicate?

Distant metastasis, cancer has spread to distant parts of the body

What does the "T" in the TNM classification stand for?

Tumor (size, extent)

What does the "N" in the TNM classification stand for?

Regional lymph nodes (involvement)

What does the "M" in the TNM classification stand for?

Distant metastasis (presence/absence)

What is the purpose of the TNM classification system in cancer staging?

To determine the anatomic extent of disease involvement by three parameters: Tumor, Lymph nodes, and Metastasis

What is the significance of the "T" stage in TNM classification?

It indicates the size and extent of the primary tumor, including whether it has invaded nearby structures

What does a "T0" stage indicate in TNM classification?

No evidence of primary tumor

What does a "T1" stage indicate in TNM classification?

Small tumor, limited to the organ of origin

What does a "T2" stage indicate in TNM classification?

Tumor is larger or has spread into adjacent tissues or organs

What does a "T3" stage indicate in TNM classification?

Tumor is larger and may have spread to surrounding tissues or structures

What does a "T4" stage indicate in TNM classification?

Tumor has invaded nearby structures or distant organs

What is the significance of the "N" stage in TNM classification?

It indicates the extent of regional lymph node involvement, showing whether cancer has spread to nearby lymph nodes

What does an "N0" stage indicate in TNM classification?

No regional lymph node involvement

What does an "N1" stage indicate in TNM classification?

Regional lymph nodes are involved but limited in number or size

What does an "N2" stage indicate in TNM classification?

Regional lymph nodes are more significantly involved, with larger or more numerous lymph nodes affected

What does an "N3" stage indicate in TNM classification?

Extensive involvement of regional lymph nodes, with large, multiple, or distant lymph node involvement

What is the significance of the "M" stage in TNM classification?

It indicates whether cancer has metastasized to distant parts of the body

What does an "M0" stage indicate in TNM classification?

No distant metastasis

What does an "M1" stage indicate in TNM classification?

Distant metastasis is present

What is the purpose of histological grading in cancer staging?

To determine the degree of differentiation of tumor cells and predict prognosis

What does "Grade I" mean in histological grading?

Mild dysplasia, well-differentiated cells that closely resemble normal tissue

What does "Grade II" mean in histological grading?

Moderate dysplasia, moderately differentiated cells with some abnormal features

What does "Grade III" mean in histological grading?

Severe dysplasia, poorly differentiated cells with significant abnormalities

What does "Grade IV" mean in histological grading?

Anaplasia, undifferentiated cells with primitive characteristics, difficult to determine cell origin

What is the difference between a benign tumor and a malignant tumor?

Benign tumors are non-cancerous, typically do not spread to other tissues, while malignant tumors are cancerous and may spread (metastasize) to other parts of the body

What type of tumor does the TNM classification system primarily apply to?

Malignant tumors

What is the difference between carcinomas, sarcomas, and lymphomas?

Carcinomas originate from skin, glands, and mucus membranes; sarcomas come from connective tissues, muscle, bone, and fat; lymphomas arise from the hematopoietic system

What does "T1" vs "T4" indicate about a tumor's progression?

"T1" indicates a small, localized tumor; "T4" suggests a large, invasive tumor that has spread to surrounding structures or organs

What does the term "distant metastasis" mean in the TNM classification?

It refers to cancer that has spread from its primary site to distant organs or tissues in the body

What does an "N3" lymph node classification suggest about cancer spread?

It suggests extensive lymph node involvement, with large or numerous affected nodes that are farther from the primary tumor

What are the main components of the TNM system used to stage cancer?

Tumor size and extent (T), regional lymph node involvement (N), and distant metastasis (M)

How does the TNM classification impact cancer treatment?

It helps determine the stage of cancer, which guides treatment decisions such as surgery, radiation, chemotherapy, or targeted therapies

What is the overall goal of cancer staging using the TNM system?

To assess the extent of cancer spread, guide treatment choices, and predict prognosis

What would a stage "T1, N0, M0" mean in cancer staging?

A small primary tumor, no regional lymph node involvement, and no distant metastasis

How does the TNM classification system differ from cancer grading systems?

TNM classification focuses on the extent and spread of cancer (size, lymph node involvement, metastasis), while grading evaluates the appearance of cancer cells and their differentiation from normal cells

What does "Grade IV" in cancer grading indicate about the prognosis?

It indicates a poor prognosis due to the high degree of abnormality and undifferentiated cells, suggesting aggressive cancer behavior