Cancer

When should the test be initiated and what is the ongoing timing for screening: Skin Cancer

-As often as desired - Annual

Secondary b. suggested screening schedule

-annual mammography for women older than 40 -yearly breast exam for women older than 40 -colonoscopy at age 50 and then every 10 years -yearly fecal occult blood for adults of all ages -annual prostate specific antigen test and digital rectal exam for men older than 50

Primary a. Avoidance of known or potential carcinogens

-i.e. use skin protection during sun exposure -avoid using tobacco, smoking cessation information -eliminate asbestos exposure or utilize PPE

Discuss and prepare to teach patients about cancer prevention and detection.

Adeno gland, chondro cartilage, erythro red blood cell, hemangio blood vessels, hepato liver, lipo fat, lympho lymphocyte, melano pigment cell, myelo bone marrow, myo muscle, osteo bone

Articulate the relationship between aging and cancer.

Aging is the single biggest risk factor for developing cancer. Older adults have had prolonged exposure to carcinogens due to their longer lifespan. Exposures have time to accumulate, genetic damages have time to occur and tumors have time to manifest. Cells in older adults also lose some functioning, such as the ability to undergo apoptosis which is necessary to rid the body of cancer cells or at least prevent abnormal cell growth. Other reasons cancer is higher in older adults is that aging impairs immunity, reduces DNA repair and causes loss of cell regulation, which may amplify injury by carcinogens. In addition, manifestations of cancer in older adults are often overlooked or attributed normal aging.

When should the test be initiated and what is the ongoing timing for screening: Prostate Cancer

Annually beginning at age 50 to men who have a life expectancy of at least 10 more years. High risk men should begin testing at age 45 (African American)

Stage III

Any level of tumor invasion and up to 4 regional lymph nodes

Stage IV

Any level of tumor invasion; many lymph nodes affected with distant metastases

What is apoptosis and what will it mean for the development of cancer?

Apoptosis is programmed cell death. Cells have a certain lifespan depending upon the type of cell and they know when they are no longer needed in the body and will selfdestruct. Apoptosis keeps tissue sizes in check (regulates number of cells in the body). In normal adult tissues, cell death (apoptosis) exactly balances cell division. Loss of apoptosis in cancer cells leads to an "infinite" lifespan of those cells. Cancer cells are able to ignore signals of apoptosis which allows those cells to grow rapidly and create tumors. They obtain this ability to ignore apoptosis through mutations of DNA. One example is the downregulation of p53, a tumor suppressor gene, which results in reduced apoptosis and enhanced tumor growth and development.

Understand and differentiate between the different levels of cancer prevention. Primary Prevention -

Avoid carcinogens (education) Modify behavior/make healthy choices Remove at risk tissues Vaccinations

Define and describe the meaning of cancer from a physiological perspective.

Cancer is the general name for a group of more than 100 diseases. Although there are many types of cancer, all cancers start because ​abnormal cells grow out of control​. Cells become cancerous because of DNA damage; a normal cell with DNA damage either repairs the damage or dies, whereas in cancer cells the damaged DNA is not repaired but the cell doesn't die like it should and instead makes new cells (that have the same damaged DNA) that the body doesn't need. Mutations cause increased growth and decreased death of cells (most often mutated are: tumor suppressors brake pedal, oncogenes gas pedal, and DNA repairoil change)

Secondary prevention​:

Cancer screening Chemoprevention (ex. tamoxifen for breast cancer) Medications, surgery Assessing tumor markers

How are various cancers detected and what is the role of the nurse in preparing the patient for diagnostic studies related to cancer detection?

Colonoscopy, xrays, ultrasound, MRI, CT, FOBT, pap smears, other screenings and selfexams. Nurses role: lots of patient teaching!

Colorectal cancer: Signs and symptoms

Depends on location of tumor. But, most common signs are rectal bleeding, anemia, and a change in in stool consistency and shape. Mahogany or bright red colored stools.

When should the test be initiated and what is the ongoing timing for screening: Colorectal cancer

FOBT annually starting at 50 (men and women) Fiber optic scope based on patient's history and family history - Every 10 years Flexible sigmoidoscopy - Every 5 years Colonoscopy - Every 10 years

Screen Test: Colorectal cancer

Fecal Occult Blood Test (FOBT) should happen yearly for men and women beginning at age 50 Fiber optic scope based on patient's history and family history OR Flexible sigmoidoscopy OR Colonoscopy

How and when does metastasis occur?

First, cancer cells invade local normal tissue. Then they move through the walls of nearby lymph or blood vessels (intravasation). These cancer cells then circulate through the lymphatic system and bloodstream to other parts of the body. They then arrest in capillaries at distant locations and migrate through the capillary walls into surrounding tissues (extravasation). Cancer cells will then multiply (proliferate) at this new location and form small tumors called micrometastases. Finally these micrometastases will stimulate the growth of new blood vessels (angiogenesis) to obtain the blood supply/oxygen needed to continue growing. Metastasis can occur almost anytime including 5, 10, or 15 years after the original diagnosis.

Primary d. Vaccinations

Gardasil for HPV/cervical cancer (only vaccination approved for cancer prevention)

Develop a general understanding of the role genetics play in cancer development.

Genetic risk for cancer occurs in a small percent of the population; however, people who have a genetic predisposition are at very high risk for cancer development. Mutations in suppressor genes or oncogenes can be inherited which increases the offspring's cancer risk. Patterns of genetic risk for cancer have been identified, including: inherited predisposition for specific cancers, inherited conditions associated with cancer, familial clustering, and chromosomal aberrations. **There are several racial differences in cancer development (Iggy pg. 406)

Nurses role in preparing the patient for screening tests: Prostate Cancer

Get PSA done before DRE because levels of PSA could be falsely elevated by the DRE

Correctly interpret cancer grading and staging.

Grading = How malignant is the cancer? (under the microscope) Staging = Where did it start and how far has it spread? (clinical manifestations)

Breast Cancer Screen Test?

Mammogram Selfbreast exam MRI

When should the Breast Cancer test be initiated and what is the ongoing timing for screening? Mammogram Selfbreast exam MRI

Mammogram -Yearly starting at 40 (most current recommendations start at 50, every 2 years until 74) Selfbreast exam - Monthly starting in early 20s MRI - Occasionally for high risk women

How would you describe what is happening with a cancer patient if you see documentation in an EHR using the TNM nomenclature? M:

Metastasis​ MX: unable to evaluate distant metastasis MO: no evidence of distant metastasis M1: presence of distant metastasis Example: T2, N3, MX: size of the tumor is level 2, 3 regional nodes are involved, can't determine whether it has metastasized or not. TNM ​is ​NOT​ useful for leukemia or lymphomas.

Colorectal cancer: Pathophysiology pg. 1245

Most CRCs are adenocarcinomas, which are tumors that arise from the glandular epithelial tissue of the colon. They develop as a multi-step process, resulting in a number of molecular changes, such as loss of key tumor suppressor genes and activation of certain oncogenes that alter colonic mucosa cell division. The increased proliferation of the colonic mucosa forms polyps that can transform into malignant tumors. Most CRCs are believed to arise from adenomatous polyps that present as a visible protrusion from the mucosal surface of the bowel.

Do all tumors metastasize?

No, benign (noncancerous) tumors cannot invade surrounding tissues/vessels and therefore do not metastasize.

How would you describe what is happening with a cancer patient if you see documentation in an EHR using the TNM nomenclature? N:

Node​ NX: unable to evaluate regional lymph nodes NO: no evidence of regional node involvement N1, N2, and N3: number of nodes that are involved and/ or extent of spread

Are all tumors cancerous?

Not all tumors are cancer. Tumors that aren't cancer are called benign. Benign tumors can cause problems - they can grow very large and press on healthy organs and tissues and cause damage that way, but they can't invade other tissues. Because they can't invade, they also can't metastasize. These tumors are seldom life threatening, but can cause issues with their localized unchecked growth.

How would you embrace the nurse's role in Hospice care?

Not focused on curing, but rather keeping them comfortable (DNR status for everyone).

Tertiary prevention​:

Nutritional rehabilitation PT/OT physical rehabilitation

Screen Test: Prostate Cancer

PSA (prostatespecific antigen) test & DRE (digital rectal examination)

What are the patient's and family's endoflife care needs most likely? As a professional nurse how will you manage these?

Pain management. Family is very involved. Hospice at home, or in another facility? Social worker and chaplain are important aspects of endoflife care. Establish will and endoflife wishes. Living will/health care directives should be carried out. Find out if the patient is an organ donor, or would like to be (if appropriate).

How will you assist the cancer with coping with sleep disturbances through pharmacological and nonpharmacological interventions?

Pharmacologica​l: Ambien, benzodiazepines (lorazepam, tirazolam), antidepressants, antihistamines, antipsychotics... control pain!! Nonpharmacological:​ Least invasive measures first: skin care, supportive touch, caring for the patient by keeping the bed clean, regulating fluid intake to avoid frequent awakening for elimination, nutritional support before bed, avoid caffeine, loose, soft sleep clothing, dim lighting, repositioning, encouraging exercise, regular bedtime and awakening hours, and minimizing bedtime contacts for inpatients. Encourage meditation/relaxation techniques before bed.

What are the basic principles of cancer treatment?

Prolong survival time and improve quality of life through chemo, surgery, radiation

Prioritize nursing care needs for clients experiencing oncologic emergencies:

Sepsis Disseminated Intravascular Coagulation Syndrome of Inappropriate Antidiuretic Hormone Spinal Cord Compression Increased intracranial pressure Hypercalcemia Superior Vena Cava Syndrome Tumor Lysis Syndrome

A tissue toxic chemotherapy agent infiltrates the peripheral IV site. Prioritize the actions the professional nurse should take.

Stop the IV immediately, d/c the drip, aspirate to pull back any amount of drug you can, collect kit, call doctor, mark area with pen, follow drug specific regulations (hot or cold), elevate limb and administer pain relief. Every vesicant has an antidote so intradermal (ID) or subdermal (SD) injections of the antidote are made around the site (using 1/10 of a CC, make 510 injections around the site), this will chemically neutralize the vesicant. Heat or cold can then be applied and the choice of which to use is specific to the drug that has infiltrated.

Colorectal cancer: Risk Factors

Strong evidence that long-term smoking, increased body fat, physical inactivity, and heavy alcohol

Nurses role in preparing the patient for screening tests: Skin Cancer

Teach about protection from the sun ABCDE for moles (asymmetry, border, color, diameter, evolution) Any new moles after age 20 should be checked immediately

Colorectal cancer: Etiology pg. 1245

The major risk factors for the development of colorectal cancer (CRC) include being older than 50 years, genetic predisposition, personal or family history of cancer, and/ or diseases that predispose the patient to cancer such as familial adenomatous polyposis (FAP), Crohn's disease, and ulcerative colitis (McCance et al., 2010). Only a small percentage of colorectal cancers are familial and transmitted genetically.

How does the nurse help to recover patients for cancer detection processes?

Therapeutic communication

Stage II

Tumor invades other organs or perforates peritoneum

Stage I

Tumor invades up to muscle layer

What is the purpose of cancer markers? What does CEA help to diagnose? How about CA 125 and PSA?

Tumor or cancer markers are substances found in tissue, blood, or other body fluids that may be a sign of cancer or certain benign (noncancerous) conditions. Most tumor markers are made by both normal cells and cancer cells, but they are made in larger amounts by cancer cells.​ A tumor marker may help to diagnose cancer, plan treatment, or find out how well treatment is working or if cancer has come back. Examples of tumor markers include CEA (in colon cancer and many, many other types of cancers), CA125 (in ovarian cancer, measures the amount of protein in the blood), PSA (in prostate cancer), and HCG (testicular cancer).

How would you describe what is happening with a cancer patient if you see documentation in an EHR using the TNM nomenclature? T:

Tumor​ TX: unable to evaluate the primary tumor TO: no evidence of primary tumor Tis: tumor in situ (situ=in place, has not moved elsewhere) T1, T2, T3, and T4: size and extent of the tumor

How will you, the nurse, professionally, independently, safely, and expertly assist the cancer patient manage pain. This includes all aspects of pharmacological and nonpharmacological pain management.

Utilize pharmacological and nonpharmacological methods of pain management. "Keep up" with pain rather than "catch up" to pain; educate pt regarding this phenomenon. Fox Box; nonopioids, opioids for breakthrough pain, fentanyl, roxanol, percocet, then spinal taps for most extreme pain. Antinausea and antiemetic medications as well (zofran). Keep a pain journal at home, what you did for it etc. Ice, heat, therapeutic touch, guided imagery, music, good food, movement, family visits, rest periods, pet therapy, and conversation.

Screen Test: Skin Cancer

Visual observation done by patient Skin checks by PCP (especially if patient notices an abnormality during their own checks)

Nurses role in preparing the patient for screening tests: Breast Cancer

Warn that may be uncomfortable. Inform patient to wash off deodorant (esp aluminumbased)

Nurses role in preparing the patient for screening tests: Colorectal cancer

[FOBT] Remind the patient to avoid aspirin, vitamin C, and red meat for 48hrs before giving a stool specimen due to the chance of a false positive result 2 or 3 separate stool samples should be tested on 3 consecutive days GoLYTELY clear liquid diet day before (avoid red, orange, purple beverages) NPO 46 hours before procedure (except water) NPO after until peristalsis begins (passing flatus)