Adult Health 2: Test 1

Tumor classification systems provide a standardized way to

(1) communicate the status of the cancer to all members of the interprofessional care team, (2) assist in determining the most effective treatment plan, (3) evaluate the treatment plan, (4) predict prognosis, and (5) compare like groups for statistical purposes

The goals of public education are to

(1) motivate people to recognize and modify behaviors that may negatively affect health and (2) encourage awareness of and participation in health-promoting behaviors. When you teach about cancer, try to minimize the fear that surrounds the diagnosis

The pathologist examines the tissue to determine

(1) whether it is benign or malignant, (2) the anatomic tissue from which the tumor arises (histology), and (3) the degree of cell differentiation (histologic grade). Other information that can be obtained includes the extent of malignant involvement (size of tumor and depth), evidence of invasiveness (extracapsular, lymphatic), adequacy of surgical excision (positive or negative surgical margin status), nuclear grade (mitotic rate), and special staining techniques that may provide insight into responsiveness of the tumor to treatment or disease behavior (receptor status, tumor markers)

tumor suppressor genes include

BRCA1 and BRCA2; APC gene; p53

reproductive dysfunction

Discuss possibility with patients before treatment initiation. Offer opportunity for sperm and ova banking before treatment for patients of childbearing age.

leukopenia

Monitor WBC count, especially neutrophils. Tell patient to report temperature elevation and any other manifestations of infection. Teach patient to avoid large crowds and people with infections. Administer WBC growth factors

pneumonitis

Monitor for dry, hacking cough; fever; and exertional dyspnea.

intracranial pressure

Monitor neurologic status. May be controlled with corticosteroids.

originate from embryonal mesoderm (connective tissue, muscle, bone, and fat)

sarcomas

chemotherapy induced skin changes

Alert patient to potential skin changes. Encourage patient to avoid sun exposure. Implement symptomatic management as needed depending on specific skin effect (e.g., application of lotions, benzoyl peroxide for acne, corticosteroid creams).

stomatitis, mucositis, esophagitis

Assess oral mucosa daily and teach patient to do this. Encourage nutritional supplements (e.g., Ensure, Carnation Instant Breakfast) if intake decreasing. Be aware that eating, swallowing, and talking may be difficult (may require analgesics). Instruct in avoidance of irritating spicy or acidic foods or too hot or too cold food (extremes in temperature). Instruct on how to select moist, bland, and softer foods. Encourage patient to keep oral cavity clean and moist by performing frequent oral rinses with saline or salt and soda solution. Encourage patient to use artificial saliva to manage dryness (radiation). Discourage use of irritants such as tobacco and alcohol. Apply topical anesthetics (e.g., viscous lidocaine, oxethazaine).

have their effect on the cells during all phases of the cell cycle, including the process of cell replication and proliferation and the resting phase (G0)

Cell cycle phase-nonspecific chemotherapy drugs

exert their most significant effects during specific phases of the cell cycle (i.e., when cells are in the process of cell replication or proliferation during G1, S, G2, or M)

Cell cycle phase-specific chemotherapy drugs

the use of chemicals as a systemic therapy for cancer. In the 1940s nitrogen mustard, a chemical warfare agent used in World Wars I and II, was used in the treatment of lymphoma and acute leukemia. In the 1970s chemotherapy was established as an effective treatment modality for cancer. Chemotherapy is now a mainstay of cancer treatment for most solid tumors and hematologic malignancies (e.g., leukemias, lymphomas). Chemotherapy can offer cure for some cancers, control other cancers for long periods, and in some instances offer palliative relief of symptoms when cure or control is no longer possible

Chemotherapy (antineoplastic therapy)

hemorrhagic cystitis

Encourage increased fluid intake 24-72 hr after treatment as tolerated. Monitor manifestations such as urgency, frequency, and hematuria. Administer cytoprotectant agent (mesna [Mesnex]) and hydration. Administer supportive care agents to manage symptoms (e.g., flavoxate [Urispas]).

N&V

Encourage patient to eat and drink when not nauseated. Administer antiemetics prophylactically before chemotherapy and also on as-needed basis. Instruct patient to take antiemetics on a scheduled basis for 2-3 days after highly emetogenic chemotherapy. Use diversional activities (if appropriate).

diarrhea

Give antidiarrheal drugs as needed. Encourage low-fiber, low-residue diet. Encourage fluid intake of at least 3 L/day.

constipation

Instruct patient to take stool softeners as needed, eat high-fiber foods, and increase fluid intake. Instruct patient to increase activity (e.g., walking) if tolerated.

originate from the hematopoietic system

Lymphomas and leukemias

nephrotoxicity

Monitor BUN and serum creatinine levels. Avoid potentiating drugs. Alkalinize the urine by adding sodium bicarbonate to IV infusion and administer allopurinol (Zyloprim) or rasburicase for TLS prevention.

peripheral neuropathy

Monitor for these manifestations in patients on these drugs. Consider temporary chemotherapy dose interruption or reduction until symptoms improve. Antiseizure drugs (e.g., gabapentin [Neurontin]) may be considered.

anemia

Monitor hemoglobin and hematocrit levels. Administer iron supplements and erythropoietin. Encourage intake of foods that promote RBC production

Anorexia

Monitor weight. Encourage patient to eat small, frequent meals of high-protein, high-calorie foods. Gently encourage patient to eat, but avoid nagging. Recommend keeping a food diary to track daily calories and fluids. Serve food in pleasant environment.

thrombocytopenia

Observe for signs of bleeding (e.g., petechiae, ecchymosis). Monitor platelet counts.

involves delivery of the drug directly to the tumor site. The advantage of this method is that higher concentrations of the drug can be delivered to the tumor with reduced systemic toxicity. Several regional delivery methods have been developed, including intraarterial, intraperitoneal, intrathecal or intraventricular, and intravesical bladder chemotherapy

Regional treatment with chemotherapy

alopecia

Suggest ways to cope with hair loss (e.g., hair pieces, scarves, wigs). Cut long hair before therapy. Avoid excessive shampooing, brushing, and combing of hair. Avoid use of electric hair dryers, curlers, and curling rods. Discuss impact of hair loss on self-image

used to determine the anatomic extent of the disease involvement according to three parameters: tumor size and invasiveness (T), presence or absence of regional spread to the lymph nodes (N), and metastasis to distant organ sites (M)

TNM classification system

cognitive changes (chemo brain)

Teach patients to do the following: • Use detailed daily planner. • Get enough sleep and rest. • Exercise brain (learn something new, do word puzzles). • Focus on one thing (no multitasking).

occurs during and immediately after drug administration and includes anaphylactic and hypersensitivity reactions, extravasation or a flare reaction, anticipatory nausea and vomiting, and cardiac dysrhythmias

acute toxicity

Tumors can be classified according to

anatomic site, histology (grading), and extent of disease (staging)

encapsulated, differentiated, no metastasis, rare recurrence, slight vascularity, expansive in growth, cells are fairly normal and similar to parent cells

benign

the removal of a tissue sample for pathologic analysis

biopsy

alterations in tumor suppressor genes (BRCA1 and BRCA2) can lead to

breast and ovarian cancer

group of diseases characterized by uncontrolled and unregulated growth of cells; incidence rate higher in men then women

cancer

second most common cause of death in US

cancer

refers to a neoplasm whose cells are localized and show no tendency to invade or metastasize to other tissues; has its own designation in the system (Tis) because it has all the histologic characteristics of cancer except invasion—a primary feature of the TNM staging system

carcinoma in situ (CIS)

originate from embryonal ectoderm (skin and glands) and endoderm (mucous membrane linings of the respiratory tract, GI tract, and genitourinary [GU] tract)

carcinomas

carcinogens may be

chemical, radiation or viral

involve damage to organs such as the heart, liver, kidneys, and lungs. Chronic toxicities can be either long-term effects that develop during or immediately after treatment and persist or late effects that are absent during treatment and manifest later

chronic toxicities

may be used if the tumor cannot be completely removed (e.g., a tumor attached to a vital organ). When this occurs, as much tumor as possible is removed and the patient is given chemotherapy and/or radiation therapy. This type of surgical procedure can make chemotherapy or radiation therapy more effective, since the tumor mass is reduced before treatment is initiated. Other times, a patient may need to receive neoadjuvant (treatment before surgery) chemotherapy and/or radiation therapy to reduce tumor burden and improve the surgical outcome

debulking or cytoreduction procedure

two major dysfunctions in the process of cancer development are

defective cell proliferation (growth) and defective cell differentiation

are numerous and include delayed nausea and vomiting, mucositis, alopecia, skin rashes, bone marrow suppression, altered bowel function (diarrhea or constipation), and a variety of cumulative neurotoxicities

delayed effects

the time required for a tumor mass to double in size

doubling time

may be used for lung or other intraluminal lesions (esophageal, colon, bladder)

endoscopic biopsy

mutations in this tumor suppressor gene (p53) have been

found in many cancers, including bladder, breast, colorectal, esophageal, liver, lung, and ovarian cancers

Cells differ slightly from normal cells (mild dysplasia) and are well differentiated (low grade)

grade 1

Cells are more abnormal (moderate dysplasia) and moderately differentiated (intermediate grade)

grade 2

Cells are very abnormal (severe dysplasia) and poorly differentiated (high grade)

grade 3

Cells are immature and primitive (anaplasia) and undifferentiated; cell of origin is difficult to determine (high grade)

grade 4

grade cannot be assessed

grade 5

he appearance of cells and degree of differentiation are evaluated pathologically. For many tumor types, four grades are used to evaluate abnormal cells based on the degree to which the cells resemble the tissue of origin

histologic grading

alterations in tumor suppressor gene (APC) can

increase a person's risk for familial adenomatous polyposis, which is a precursor for colorectal cancer

gene mutation can occur in 2 different ways

inherited or acquired

stages of cancer

initiation, promotion and progression

will damage the intima of the vein, causing phlebitis and sclerosis and limiting future peripheral venous access but will not cause tissue damage if infiltrated

irritants

rarely encapsulated, poorly differentiated, capable of metastasis, possible recurrence, moderate or marked vascularity, infiltrative and expansive in growth, cells abnormal and become more unlike parent cells

malignant

hepatotoxicity

monitor liver function tests

any change in the usual DNA sequence

mutation

commonly performed for tissue that can be safely reached through the skin

percutaneous biopsy

the study of genomic variation associated with drug responses

pharmacogenomics and pharmacogenetics

normal cell genes that are important regulators of normal cell processes and promote growth; the genetic lock that keeps the cell in its mature functioning state

protooncogenes

two types of normal genes that can be affected by mutation are

protooncogenes and tumor suppressor genes

produce more than two cells at the same time of mitosis

pyramid effect

energy that is emitted from a source and travels through space or some material. Delivery of high-energy beams, when absorbed into tissue, produces ionization of atomic particles. The energy in ionizing radiation acts to break the chemical bonds in DNA. The DNA is damaged, resulting in cell death. Different types of ionizing radiation are used to treat cancer, including electromagnetic radiation (i.e., x-rays, gamma rays) and particulate radiation (alpha particles, electrons, neutrons, protons). High-energy x-rays (photons) are generated by an electric machine, such as a linear accelerator.

radiation

cancer in situ

stage 0

tumor limited to the tissue of origin; localized tumor growth

stage 1

limited local spread

stage 2

extensive local and regional spread

stage 3

metastasis

stage 4

Classifying the extent and spread of disease; this classification system is based on the anatomic extent of disease rather than on cell appearance

staging

When a tumor is not easily accessible, ____ ____ (laparotomy, thoracotomy, craniotomy) is often necessary to obtain a piece of the tumor tissue

surgical procedure

diagnostic plan for the person suspected of having cancer includes

the health history (including a history of present illness), identification of risk factors, the physical examination, and specific diagnostic studies. For many people, cancer is initially diagnosed after the findings of an abnormal screening test (e.g., mass on mammogram). For others, they are alerted to the presence of cancer by a presenting symptom or cluster of symptoms (e.g., cough and hemoptysis, anorexia and weight loss)

In the anatomic classification of tumors, the tumor is identified by

the tissue of origin, anatomic site, and behavior of the tumor (i.e., benign or malignant)