Combo with ch 16 Cancer and 21 others
Acceptance
"I am ready." "Yes"
Denial
"No not me."
Anger
"Why me?"
Bargaining
"Yes, but..."
Depression
"Yes, me"
Mesenchyme
'Connective tissue' Fat, nerves, blood vessels, lymph nodes, bone marrow
physical carcinogenesis: viral carcinogenesis: oncoviruses
(HBV, HPV, Epstein Barr can cause Birkett's lymphoma)
Targeted Therapy: Monoclonal Antibodies: Trastuzumab
(Herceptin) binds to HER2 and inhibits the growth of breast cancer cells that overexpress the HER2/neu oncogene protein, which is associated with more aggressive disease in certain cancers, especially breast cancers. --rituximab (Rituxan)
Targeted Therapy: Monoclonal Antibodies
(MoAb) Anbs or immunoglobulins that are produced by B lymphocytes that are capable of binding to specific target cells, including tumor cells. There are a large number of these being investigated for dx and treatment capabilities. For dx use of them is to locate metastatic spread of disease. -rituximab (Rituxan)
tumor angiogenesis factor
(TAF) triggers capillaries and other blood vessels in area to grow new branches into tumor, ensure tumors continued nourishment
aspiration of fluid from body cavities or blood
(WBCs to eval hematopoetic, CSF, pleural fluid)
normal cells are contact inhibited
(a.k.a. density-dependent inhibition of cell growth), divides only when some of surface when not in direct contact w/another cell
needle aspiration of solid tumors
(breast, lung, prostate)
bone marrow transplants: harvest procedures: multiple bonemarrow aspirations
(iliac crest or sternum) to obtain specific quantity of cells -takes about 1-2 hrs -pt d/c following recovery -post harvest donor may experience pain at collection site, use mild analgesics -donor body will replenish marrow in a few weeks
Histologic Analysis Classification: Grade I
(mild dysplasia): differ slightly from normal cells, well differentiated
exfoliation from an epithelial surface
(pap smear, bronchial washings)
Malignant transformation
(the process of changing a normal cell into a cancer cell) occurs through the following steps: a. initiation b. promotion c. progression
clinical staging
-0: carcinoma in situ, in normal place w/o invasion -1: tumor limited to tissue of origin, localized growth -2: limited local spread -3: extensive local and regional spread -4: metastasis
Mitosis
-2 cells genetically identical to original cell -part of cell cycle -asexual reproduction -produces 2 daughter cells
Cell Cycle (Interphase)
-DNA replicates
Growth Factors
-G1 checkpoint (cell necessary to divide?) -survey cell environment for presence of proteins -"increases cell division"
Cell Death
-Immortality -"cellular clock" determines how long cell will live
Management of Cancer Pain: drug therapy
-NSAIDs, opiods -opiods for moderate to severe -analgesic meds s/b given regularly around the clock, w/ additional doses for breakthrough pain -oral administration is preferred -w/opiods appropriate dose is whatever is necessary to control pain w/ least side effects -fear of addiction is not warranted -nonpharmacologic interventions -relaxation therapy and imagery
Klinefelter's Syndrome
-XXY -extra sex chromosome -men are more female-like
cancer: Diagnosis
-Xray, CT, MRI, ultrasonography -only microscopic histologic exam reveals type of cell and difference from parent tissue -tissue acquired thru biopsy, pap smear, sputum, lymph nodes
Oncologic imaging:
-Xray: least expensive, least invasib/c physical assessment cannot detect cancer b4 risk for metastasis, important in early dx 1. X-ray imaging 2. Computed tomography (CT) 3. Magnetic resonance imaging (MRI) 4. Ultrasonography 5.Nuclear imaging
Management of Cancer: factors may influence how pt copes
-ability to cope w/stressful events in past -availability of significant others -ability to express feelings and concerns -age at time of dx -extent of dz -disruption of body image -past experience w/cancer -attitude assoc w/the cancer
Metabolic emergencies: syndrome of inappropriate antidiuretic hormone (SIADH): pathophysiology
-abnormal or sustained production of ADH -results in H2O retention and hyponatremia -occurs most frequently in lung cancer -cancer cells are able to manufacture, store, and release ADH -chemo agents, vincristine and cyclophosphanmide stimulate release of ADH from pituitary or tumor cells
cancer cells
-abnormal, no useful function, harmful to normal body tissues
Types of bone marrow transplants: allogeneic
-acquired from donor who has determined to be matched -done my HLA tissue typing (human leudocyte antigen) -HLA involves testing WBCs to identify genetically inherited antigens common to both donor and recipients that are important in compatibility of transplanted tissue -most often a family member -can be unrelated donor from bone marrow registry -offers eradication of tumor cells/w high does therapy and also potential stimulation of graft-versus tumor effect in which donor WBCs identify and attack malignant cells in recipient -commonly done for: leukemias, multiple myeloma, lymphoma i. the goal is to administer large doses of systemic therapy and then "rescue" the bone marrow through the engraftment and subsequent normal proliferation and differentiation of the donated marrow in the host
Diploid
-after sperm and egg cell fuse, fertilized cell (zygote) contains 2 sets of chromosomes
Autosomes
-all chromosomes except for x and y
Metabolic emergencies: hypercalcemia: clinical manifestations
-apathy -depression -fatigue -muscle weakness -EKG chgs -polyuria and nocturia -anorexia, N/V -serum calcium >12mg/dl often produce symptoms and can be life threatening
Histologic Analysis Classification
-appearance of cell and histological are evaluated
Management of Cancer: nurse should do the following:
-be available and continue to be available -exhibit a caring attitude -listen actively to fears and concerns -provide relief from distressing symptoms -provide essential information regarding cancer and cancer care
Complications Resulting from Cancer: Nutritional Problems: Altered taste sensation
-cancer cells release substances that stimulate bitter taste buds -pt may experience alteration in sweet taste, sour and salty taste -meat may also taste bitter -instruct pt to avoid food they dislike -experiment w/spices and other seasoning agents in attempt to mask taste alteration -lemon juice, onion, mint, basil, fruit juice marinades may improve taste of certain meats and fish -bacon bits, onion, and pices of ham my enhance taste of veggies -additional amt of spic or seasoning is usually not effective
Metabolic emergencies: hypercalcemia: pathophysiology
-cancer involving metastic dz of bone or multiple myeloma -when PTH-like substance is secreted by cancer cells in absence of bony metastasis -occurs most frequently in lung, breast, kidney, colon, ovarian or thyroid cancer -immobility and dehydration
Carcinogenesis / Oncogenesis
-carcinogens: chg activity of a cell's genes so that cells become cancer cells: --chemicals, physical, viruses - --anything that can penetrate cell, can damage DNA and genes, can turn on genes that s/b suppressed, can turn of normal genes
Infiltrative emergencies
-cardiac tamponade -carotid artery rupture
Limited Growth Factors
-cell division doesn't occur
Cancer: Nutritional Problems: protein intake
-characterized by fat and muscle depletion -increase intake to facilitate repair and regeneration of cells (milk, eggs, cheese, p306)
Chemotherapy
-chemicals injected into blood killing dividing cells
Cri Du Chat
-chromosome 5 (one short/ one long arm) -central nervous system impairment -malformed larynx (speech issues)
Sister Chromatids
-copied chromosome -each one is composed of one DNA molecule
Cell Cycle (Mitosis)
-copied chromosomes move into daughter nuclei
Cell Cycle (Cytokinesis)
-cytoplasm of parent cell splits
Multiple-Hit-Model
-describes process of cancer development -multiple mutations required for development and progression of cancer
mitotic cell division
-division occurs in well-recognized pattern, cell cycle -makes one cell divide into 2 cells, cells are identical to each other and original cell -cell cycle steps are tightly controlled, balance b/w protein promoting (cyclins) cell division and proteins (suppressor gene products) that inhibit
DNA Replication
-double-stranded DNA molecule is copied -occurs during interphase "S" phase -new nucleotides added resulting in 2 daughter DNA molecules -1/2 parental DNA and 1/2 new daughter DNA
Infiltrative emergencies: cardiac tamponade: treatment
-emergency management -reduction of fluid around heart -surgical estab of pericardial window or indwelling pericardial catheter −supportive therapy -administration of O2 -IV hydration -vasopressor therapy
Benign Tumors
-encapsulated -grow more slowly -not "intertwined" with near by tissues
Telomerase
-enzyme that maintains and rebuilds telomeres
Extent of Disease Classification
-extend and spread of dz is staging -based on description of extent of dz rather than cell appearance
superior vena cava syndrome: clinical manifestations
-facial edema, periorbital edema, distention of veins of head, neck and chest, headache, and seizures -mediastinal mass often visible on CXR
Carcinogenesis
-failure of genetic controls (due to mutations) --cells keep dividing (oncogenes/malfunctioning tumor suppressor genes) --produces tumore (lost contact inhibition/ angiogenesis/ telomerase produced) --cells metastasize (no anchorage dependence)
Infiltrative emergencies: cardiac tamponade: pathophysiology
-fluid accumulation in pericardial sac -constriction of pericardium by tumor -pericarditis secondary to radiation therapy to chest
third space syndrome: Treatment
-fluid, electrolyte, plasma replacement -during recovery hypervolemia can occur resulting in: -HTN -elevated central venous pressure -wt gain -SOB -tx for this involves reducing fluid administration and fluid balance monitoring
Meiosis
-form of cell division that only occurs in sex organs -produces cells that contain one chromosome for every pair -sexual reproduction and produces 4 daughter cells genetically different
Oncogenes
-genes become mutated "after" -causes cancer
Proto-Oncogenes
-genes encode proteins regulating cell cycle -enable organisms to regulate division "before"
Tumor Suppressors
-genes involved with cancer -carry instructions for producing proteins that suppress or stop cell division if condition unfavorable -proteins detect and repair damage to DNA
Infiltrative emergencies: cardiac tamponade: clinical manifestations
-heavy feeling over chest -SOB -tachycardia -cough -dysphagia -hiccups -hoarseness -N/V -excessive perspiration -decreased LOC -pulsus paradoxus -distant or muted heart sounds -extreme anxiety
Meiosis I
-homologous pairs randomly align -one way of creating genetic variation in gametes (offspring)
Apotosis
-if cell doesn't receive message it will "self-destruct"
cancer treatment: Radiation: Killing effects of radiation
-if does is high enough all cells are killed immediately, does not usually occur b/c cells absorb at different rates/intervals
Cancer: Nutritional Problems: enteral or parenteral nutrition
-if malnutrition cannot be tx w/dietary intake -may be necessary as adjunct nutritional measure
Personal Factors and Cancer Development: Immune Function
-immune system normally protects body from non-self cells, including cancer cells -cell-mediated immunity protects from cancer (NK and helper T) -organ transplant recipients take immunosuppressive drugs and therefore have higher incidences of cancer -clients w/AIDS have an 80% chance cancer 1. Cell-mediated immunity a. natural killer (NK) and helper T-cells 2. Organ transplant recipients
Infiltrative emergencies: carotid artery rupture: treatment
-in the case of blowout, pressure s/b applied to site w/finger −intravenous fluid management -fluid and blood products in attempt to stabilize pt for surgery -surgical management -ligation of carotid artery above and below rupture site and reduction of local tumor
Random Alignment
-increases number of genetically distinct types of gametes that can be produced of homologous pairs
bone marrow transplants: complications
-infections --bacterial, viral and fungal infections are common following HSCT -prophylactic antibiotic therapy --may reduce incidence - graft-versus-host disease
spinal cord compression: clinical manifestations
-intense back pain, localized and persistent -veterbral tenderness -aggravated by Valsalva maneuver -motor weakness and dysfunction -chg in bowel or bladder fxn reflects autonomic dysfxn
Metastasis
-intercellular space binding keeps cell in correct area -signals are continually sent to nucleus
biological response modifiers for cancer therapy
-interleukins (ILs) -interferons (INFs)
Direct Visualization
-invasive, but no use of radiography: 1.Sigmoidoscopy 2.Cytoscopy 3.Endoscopy 4.Bronchoscopy
Crossing Over
-involves exchange of proportions of chromosomes from one member of homologous pair to the other
tobacco
-is single most important source of preventable carcinogens -use both initiates and promotes cancer
Side effects of radiation therapy
-limited to exposed tissue and vary according to site -altered taste sensation -metallic taste -aversion to taste of red meats -fatigue r/t increased energy demands to repair damaged cells, debilitating and can last from wks to years -skin irritation -women who receive for uterine cancer, can develop constipation or obstruction --altered taste sensation --fatigue --damage to normal, tissues can start the inflammatory responses that cause tissue fibrosis & scarring
Dietary factors related to cancer development
-low fiber intake -high intake of red meats and animal fats -different preservatives, sweeteners, dyes
Chemotherapy: Rationale for cancer therapy
-major role in tx -used to cure and increase survival time -cancer cells are able to separate and metastasize to new areas, clients will die unless tx of these cells -effects are systemic -used along w/surgery or radiation (adjuvant) -chemo has some selectivity -killing effect is r/t ability of chemo to damage cancer cell DNA and interfere w/cell division -given systemically and exert cytotoxic effects (healthy and cancer cells) -normal cells most affected by chemo are rapidly dividing cells (skin, hair, intestinal, blood, sperm)
physical carcinogenesis: viral carcinogenesis
-many viruses are suspected -viruses can infect and break DNA chain
Metabolic emergencies: tumor lysis syndrome: clinical manifestations
-metabolic abnormalities and concentrated uric acid lead to acute renal failure if not tx -four hallmark signs -hyperuricemia -hyperphosphatemia -hyperkalemia -hypocalcemia -usually occurs w/in first 24-48 hours after chemo and may persist for 5-7 days
Centromere
-middle of a replicated chromosome
Management of Cancer Pain
-moderate to severe pain occurs in approx 50%, 80-90% w/advanced dz -vital signs and pt behaviors are not reliable indicators of pain -important to distinguish b/w persistent and breakthrough pain -comprehensive pain assessment includes a detailed history to determine persistent and breakthrough pain -pt s/b taught to keep a pain management diary -ongoing assessment of pain is needed to determine effectiveness -obtain and document initially and at regular intervals on location and intensity of pain, what it feels like, how it is relieved -patterns of change s/b assessed
Cancer: Nutritional Problems: albumin and prealbumin levels
-monitor -once a 10lb wt loss occurs, difficult to maintain nutritional status -use nutritional supplements in place of milk when cooking or baking -supplements can be added to eggs, pudding, custard, mashed potatoes, cereal, cream sauces -pkgs of instant breakfast can be used as indicated or sprinkled on cereals, desserts and casseroles
Infiltrative emergencies: carotid artery rupture: pathophysiology
-most frequent in pts w/cancer of head and neck secondary to invasion of arterial wall by tumor or erosion following surgery or radiation therapy
cancer: Laboratory Tests
-most test are used to rule out nutritional disorders or noncancerous conditions -used in conjuction w/other tests to confirm or validate
bone marrow transplants: harvest procedures
-multiple bonemarrow aspirations (iliac crest or sternum) - peripheral stem cell transplants -cryopreservation: umbilical cord blood
bone marrow transplants: preparative regimens
-myeloablative dosages of chemo w/or w/o radiation -total body radiation for immunosuppression -timing of reinfusion is critical -conditioning begins only after stem cells have been harvested -they are thawed and reinfused only after chemo has been eliminated from body
Chemotherapy: bone marrow suppression
-neutropenia causes immunosuppression -immunosuppression places the client at extreme risk for infection and is a major dose-limiting side effect of cancer chemotherapy -decreased numbers of circulating erythrocytes (anemia) and platelets (thrombocytopenia) also result from bone marrow suppression caused by some chemotherapy drugs -drug therapy −complementary and alternative therapies −protection from infection
Anchorage Dependence
-normal cells need contact with underlayer of cells to stay in place -if this is lost, cell may leave original tumor and move to blood, lymph, or tissues
Angiogenesis
-nutrients available for growth due to new blood vessels growing towards cells -very large tumors
Mesenchymal benign
-oma
Haploid
-only one member of each homologous pair present in a cell (egg and sperm cells)
Management of Cancer: Psychologic Support
-positive attitude of pt, family, and HCP can have effect on quality of life -positive attitude may also influence prognosis -help pt cope w/fears -different behavioral patterns may occur at any time during process
spinal cord compression: pathophysiology
-presence of malignant tumor in epidural space -commonly caused by breast, lung, prostate, GI and renal tumors and melanoma -lymphomas also pose risk if diseased lymph tissue invades epidural space
Nursing care of clients undergoing radiation therapy
-preserve site—no lotions or ointments in area unless radiologist prescribes -exposed skin care—avoid sun exposure for at least 1 year after radiation -a. preservation of radiation site markings -b. exposed skin care
cancer: Primary prevention
-prevent actual occurrence of cancer -skin protection during sun exposre, avoid tobacco, eliminate asbestos -stop drinking w/smoking, chg unhealthy diets (low in fiber, high in fats) -removing moles to prevent conversion, removing colon polyps -mega doeses of vit C, aspirin
Metabolic emergencies: tumor lysis syndrome: treatment
-prevent renal failure and severe electrolyte imbalances -increase urine production using hydration therapy -decrease uric acid concentrations using allopurinol
Contact Inhibition
-prevents cell from dividing when doing so would require them to pile up on each other -cancer cells continue to divide
superior vena cava syndrome: pathophysiology
-primarily caused by obstruction from tumor or thrombosis -commonly caused by lung cancer, non Hodgkins lymphoma, metastatic breast cancer
Complications Resulting from Cancer: Infection
-primary cause of death in pt w/cancer -usual sites of infection: lungs, GU system, mouth, rectum, peritoneal cavity, and blood -occurs as a result of ulceration and necrosis caused by tumor, compression of vital organs, and neutropenia -outpatients w/risk for neutropenia s/b instructed to call w/temp of 100.5F or greater -classic manifestations of infection are often not present in pt w/neutropenia and depressed immune system
Rationale for cancer treatment
-prolong survival times, improve quality of life -oldest form of cancer tx -involves removal dz tissue (rationale), if confined to removed tissue then surgery can cure
Telomeres
-protective caps on chromosomes that wear down during cell division -cell dies soon after cap wears off
Tumor Markers
-protein molecule that is detectable in serum or body fluids -used as biochemical indicator of presence of malignancy -small amts are found in normal body tissue or benign -high amts are suspicious, follow up dx studies (PSA) -PSA for men over 40, pap smears for women (not completely reliable)
Growth Factors Present
-proteins check if cell is big enough to divide
Personal Factors and Cancer Development: Genetic Risk
-proto-oncogene must be overexpressed to an oncogene for cancer to occur -in some people, sequence of proto-oncogene is different and it may allow some people to be predisposed
Cancer: Nutritional Problems: high-caloric foods
-provide energy and minimize wt loss (mayo, butter, sour cream, peanut butter, etc p.307) -supplement suggested as soon as 5% wt loss is noted or if pt has potential for protein and calorie malnutrition
bone marrow transplants: precautions during the pancytopenic period
-pt must be protected from exposure to infectious agens and supported w/electrolyte supplements, nutrition, and blood component transfusions as needed to maintain adequate levels of circulating RBCs and platelets
Types of bone marrow transplants: autologus
-pt receives own stem cells back following myeloablative chemo (destroying bone marrow) -aim is rescue -enables pt to receive intensive chemo and/or radiation by supporting them w/previously harvested stem cells until their marrow is generating blood cells again -restoration takes 4-6 wks -typically used to tx hematologic malignancies if no suitable donor or pt cannot undergo allogeneic
physical carcinogenesis
-radiation -chronic irritation -ionizing -ultraviolet (UV)
superior vena cava syndrome: treatment
-radiation therapy to site of obstruction -chemo to tumors more sensitive to this type of therapy
spinal cord compression: treatment
-radiation therapy w/prompt corticosteroids -surgical decompressive laminectomy (less common) -activity limitations -pain management
Metabolic emergencies: tumor lysis syndrome: pathophysiology
-rapid release of intracellular components in response to chemo -assoc w/tumors that have high groth rates and are sensitive to effects of chemo -release of intracellular components into bloodstream -potassium -phosphate -DNA and RNA components -rise in phosphate drives calcium levels down, hypocalcemia
Asexual Reproduction
-reproduction of exact copies via cell division -does not require genetic input from 2 parents -offspring identical to parent cell
Sexual Reproduction
-reproduction that requires genetic input from 2 parents
Nondisjunction
-result of too many/ too few chromosomes when failure of homologues (sister chromatids) separate during meiosis
third space syndrome: clinical manifestations
-s/s of hypovolemia -HoTN -tachycardia -low central venous pressure -decreased UOP
Mesenchymal malignant
-sarcoma
third space syndrome: pathophysiology
-shifting of fluid from vascular to interstitial -primarily occurs secondary to extensive surgical procedures, biologic therapy, or septic shock
Meiosis II
-sister chromatids split -4 haploid cells are formed -cells genetically different (same number of chromosomes and genes but alleles on chromosome may differ)
Turner's Syndrom (Monosomy X)
-smaller stature, lack of menstrual cycle -webbed neck missing sex chromosome
Gamates
-specialized sex cells produced during meiosis -contain 1/2 the number of chromosomes as somatic cells
Metabolic emergencies
-syndrome of inappropriate antidiuretic hormone (SIADH) -hypercalcemia -tumor lysis syndrome
two types of radiation delivery used for cancer treatment:
-teletherapy -brachytherapy
Patau's Syndrome
-trisomy 13 -3 "13" chromosomes -cleft lip and palate
Down's Syndrome
-trisomy 21 -3 "21" chromosomes
TNM: according to three parameters:
-tumor size (1-4) -degree of regional spread to lymph nodes -metastasis -staging can be done initially or at intervals, to estab dx and determine tx plan, extent of dz process
Metabolic emergencies: hypercalcemia: treatment
-tx of primary dz -hydration, 3L/day -diuretic (loop) -biophosphonate drug that inhibits action of osteoclasts (Zometa or Aredia)
Metabolic emergencies: syndrome of inappropriate antidiuretic hormone (SIADH): treatment
-tx underlying malignancy -measures to correct sodium-water imbalance -fluid restriction -IV administration of 3% sodium chloride
Types of bone marrow transplants: syngeneic
-type of allogeneic -involves obtaining stem cells from identical twin and infusing into other -identical twins have identical HLA types and are perfect match -neither graft-versus-host nor graft-versus-tumor effect occurs
bone marrow transplants: harvest procedures: cryopreservation
-umbilical cord blood is rich in stem cells and successful allogeneic transplants have been performed using this -cord blood can be HLAtyped and cryopreserved -disadvantage of cord blood is possibility of insufficient numbers of cells to transplant adults
cancer: Secondary prevention
-use of screening strategies to detect cancer early -regular screening: mammogram 40yo, breast self exam 40yo, colonoscopy 50yo, FOB test 50yo, PSA tests, DRE 50yo, -do not reduce incidence but can reduce deaths
Radiation Therapy
-uses high energy particles to injure or destroy cells by damaging DNA making it impossible for cells to continue growing and dividing -applied directly to tumor when possible
bone marrow transplants: post-treatment stem cell reconstitution or "rescue"
-usually 2-4 weeks are required for transplanted marrow to start producing hematopoietic blood cells -the infused stem cells reconstitute bone marrow elements, rescuing the pts hematopoeitic system
Alleles
-version of a gene
Cancer Etiology and Genetic Risk: Oncogene Activation: Carcinogen exposure
-when normal cell is exposed, proto-oncogenes are over-expressed and turned on oncogenes: --can cause cells to change from normal to cancer cell --gene in a virus that has the ability to induce a cell to become malignant --part of every cell's normal makeup --only a problem if activated after embryonic development --Oncogenes
Metabolic emergencies: syndrome of inappropriate antidiuretic hormone (SIADH): clinical manifestations
-wt gain -weakness -anorexia -N/V -personality changes -seizures -coma
Sex Chromosomes
-x and y chromosomes in organisms
seven warning signs of cancer:
1) change in bowel or bladder habits 2) a sore that does not heal 3) unusual bleeding or d/c 4) thickening or lump in breast or elsewhere 5) indigestion oe difficulty swallowing 6) obvious chg in wart or mole 7) nagging cough or hoarseness
Characteristics of Normal Cells
1. Have limited cell division 2. Undergo apoptosis 3. Show specific morphology 4. Have a small nuclear-cytoplasmic ratio 5. Perform specific differentiated functions 6. Adhere tightly together 7. Are non-migratory 8. Grow in an orderly and well-regulated 9. Are contact inhibited 10. Are euploid
Cancer Development
1. Malignant transformation (the process of changing a normal cell into a cancer cell) occurs through the following steps: a. initiation b. promotion c. progression
Oncologic emergencies
1. Obstructive emergencies --superior vena cava syndrome --spinal cord compression --third space syndrome 2. Metabolic emergencies --syndrome of inappropriate antidiuretic hormone (SIADH) --hypercalcemia --tumor lysis syndrome 3. Infiltrative emergencies --cardiac tamponade --carotid artery rupture
multiple myeloma
1. Tumors of these plasma cells cause an over-secretion of light chain immunoglobulins
B-HCG
1. Used in pregnancy tests for women, but released by neoplastic cells that have altered protein expression
cancer-related functions of INF include the ability to do the following two benefits:
1. When bone marrow suppresion is shortened or less severe, clients are at less risk for life threatening infections and anemia. 2. Because these factors allow more rapid bone marrow recovery, clients can rec their chemo on time and may even be able to tolerate higher doses improving outsome of chemotherapy. 3. Client rec interleukins have the potential for generalized and sometimes severe inflammatory reactions. The effects of BRM are limited to the period of the accute drug infusion so problems resolve when treatment is completed.
Characteristics of Benign Tumor Cells
1.Have continuous or inappropriate cell growth 2.Show specific morphology -morphology: look like tissues they come from, retain morphology of parent cells 3.Have a small nuclear-cytoplasmic ratio -have small nuclear-cytoplasmic ration 4.Perform specific differentiated functions -perform differentiated fxns: perform same as parent cells 5.Adhere tightly together -adhere tightly together, make fibrinectin to bind tightly 6.Are non migratory 7.Grow in an orderly manner -rate of growth is normal, do not invade 8.Are euploid: have 23 pairs of chromosomes
Characteristics of Cancer Cells
1.Have rapid or continuous cell division, nearly continuously 2.Do not respond to signals for apoptosis 3.Show anaplastic morphology w/o shape or differentiation -usually small and round, esp the more malignant 4.Have a large nuclear-cytoplasmic ratio nucleus is larger 5. Lose some or all differentiated functions -lose some or all of fxns, lose appearance of parent cell 6. Adhere loosely together 7.Are able to migrate -migratory b/c not bound together -many enzymes on cell surfaces, slip thru blood vessels and tissues -able to spread from main tumor site to other body sites 8.Grow by invasion -invasion and persistent growth make untx cancer cells deadly 9.Are not contact inhibited 10.Are aneuploid -aneuploid: lose or gain chromosomes, can have more or less than 23 pairs
Hgb Normal Female
12-16 g/dL
Hgb Normal Male
14-18 g/dL
Normal platelets
150,000 to 400,000/mm
Breast, lung and colorectal cancers
3 Cancers found in females in order of highest occurrence?
Chemotherapy Encourage them to drink fluids
3 liters per day is recommended. This should be done on day 3 of chemotherapy unless it is contraindicated. Rationale - it helps to flush waste materials from the cancer cells that were killed. Also it helps to flush antineoplastics agents.
...
3. Infiltrative emergencies a. cardiac tamponade i. pathophysiology -fluid accumulation in pericardial sac -constriction of pericardium by tumor -pericarditis secondary to radiation therapy to chest ii. clinical manifestations -heavy feeling over chest -SOB -tachycardia -cough -dysphagia -hiccups -hoarseness -N/V -excessive perspiration -decreased LOC -pulsus paradoxus -distant or muted heart sounds -extreme anxiety iii. treatment -emergency management -reduction of fluid around heart -surgical estab of pericardial window or indwelling pericardial catheter −supportive therapy -administration of O2 -IV hydration -vasopressor therapy b. carotid artery rupture i. pathophysiology -most frequent in pts w/cancer of head and neck secondary to invasion of arterial wall by tumor or erosion following surgery or radiation therapy ii. clinical manifestations −bleeding -can manifest as minor oozing - or spurting blood in the case of a blowout of the artery iii. treatment -in the case of blowout, pressure s/b applied to site w/finger −intravenous fluid management -fluid and blood products in attempt to stabilize pt for surgery -surgical management -ligation of carotid artery above and below rupture site and reduction of local tumor i. pathophysiology -abnormal or sustained production of ADH -results in H2O retention and hyponatremia -occurs most frequently in lung cancer -cancer cells are able to manufacture, store, and release ADH -chemo agents, vincristine and cyclophosphanmide stimulate release of ADH from pituitary or tumor cells ii. clinical manifestations -wt gain -weakness -anorexia -N/V -personality changes -seizures -coma iii. treatment -tx underlying malignancy -measures to correct sodium-water imbalance -fluid restriction -IV administration of 3% sodium chloride b. hypercalcemia i. pathophysiology -cancer involving metastic dz of bone or multiple myeloma -when PTH-like substance is secreted by cancer cells in absence of bony metastasis -occurs most frequently in lung, breast, kidney, colon, ovarian or thyroid cancer -immobility and dehydration ii. clinical manifestations -apathy -depression -fatigue -muscle weakness -EKG chgs -polyuria and nocturia -anorexia, N/V -serum calcium >12mg/dl often produce symptoms and can be life threatening iii. treatment -tx of primary dz -hydration, 3L/day -diuretic (loop) -biophosphonate drug that inhibits action of osteoclasts (Zometa or Aredia) c. tumor lysis syndrome i. pathophysiology -rapid release of intracellular components in response to chemo -assoc w/tumors that have high groth rates and are sensitive to effects of chemo -release of intracellular components into bloodstream -potassium -phosphate -DNA and RNA components -rise in phosphate drives calcium levels down, hypocalcemia ii. clinical manifestations -metabolic abnormalities and concentrated uric acid lead to acute renal failure if not tx -four hallmark signs -hyperuricemia -hyperphosphatemia -hyperkalemia -hypocalcemia -usually occurs w/in first 24-48 hours after chemo and may persist for 5-7 days iii. treatment -prevent renal failure and severe electrolyte imbalances -increase urine production using hydration therapy -decrease uric acid concentrations using allopurinol 3. Infiltrative emergencies a. cardiac tamponade i. pathophysiology -fluid accumulation in pericardial sac -constriction of pericardium by tumor -pericarditis secondary to radiation therapy to chest ii. clinical manifestations -heavy feeling over chest -SOB -tachycardia -cough -dysphagia -hiccups -hoarseness -N/V -excessive perspiration -decreased LOC -pulsus paradoxus -distant or muted heart sounds -extreme anxiety iii. treatment -emergency management -reduction of fluid around heart -surgical estab of pericardial window or indwelling pericardial catheter −supportive therapy -administration of O2 -IV hydration -vasopressor therapy b. carotid artery rupture i. pathophysiology -most frequent in pts w/cancer of head and neck secondary to invasion of arterial wall by tumor or erosion following surgery or radiation therapy ii. clinical manifestations −bleeding -can manifest as minor oozing - or spurting blood in the case of a blowout of the artery iii. treatment -in the case of blowout, pressure s/b applied to site w/finger −intravenous fluid management -fluid and blood products in attempt to stabilize pt for surgery -surgical management -ligation of carotid artery above and below rupture site and reduction of local tumor
Hct Normal Female
37-47%
Erythrocytes RBC Female Normal Value
4.2 to 5.4 million
Erythrocytes RBC Male Normal Value
4.7 to 6.1 million
Hct Normal Male
42-52%
How can Genetics cause cancer?
5 - 10% display a familial predispotion. Oncogenes.
How many stages does the clinical staging classification system use?
5 - from in situ to metastasis.
Normal value for Neutrophils
60% to 70%. 3000 - 7000/mm3
How many people are effected with fatique with chemotherapy and radiation?
70 - 100%.
External Factors Causing Cancer
80% of cancers in north America are result of environmental or external factors: 1. Types of environmental, or external, carcinogens: -a. chemical carcinogens -b. physical carcinogenesis -c. viral carcinogenesis 2. Dietary factors related to cancer development
Two major dysfunctions present in the process of cancer are:
:(1) defective cellular proliferation (growth) and (2) defective cellular differentiation.
A
A Sore throat that does not heal. Does not only have to be melanoma. Can be any sores
Cigarette smoking. Chronic cigarette smoking can produce elevated CEA levels.
A client has had blood drawn for carcinoembryonic antigen (CEA). What habits could produce a falsely elevated level?
Confusion
A client with hypercalcemia caused by malignant myeloma might exhibit what?
Risk of infection.
A client with leukemia is undergoing the "conditioning phase" for a bone marrow transplant (BMT). What is the priority nursing diagnosis?
Regional lymph nodes.
A common metastatic site for breast cancer?
Sealed
A container will be used and inserted into the body cavity at the site of the tumor. It is placed directly there.
What is the staging classification system based on?
A description of the extent of the disease rather than on cell apperance.
What are oncogenes?
A developmental gene expressed at an inappropriate time, capable of transforming a normal cell into a cancer cell.
What is Tumor Lysis Syndrome?
A metabolic oncologic emergency where large quantities of tumor cells are destroyed rapidly, releasing intracellular contents into the blood stream.
THF
A methyl donor that converts uracil into thymine
P-glycoprotein
A multi-drug resistant protein.
What is Initiation?
A mutation in the cells genetic structure resulting from an inherited mutation, an error that occurs during DNA replication or from an inherited mutation, an error that occurs during DNA replication, or following exposure to a chemical, radiation or viral agent.
Hormonal manipulation: Mechanism of action: Hormone inhibitors:
A new class of drugs used for hormonal therapy in breast cx. Aromatase inhibitors is an example-an enzyme in body that leads to production of estrogen in adrenal gland. Aromatase inhibitors prevent this production of estrogen therefore they reduce blood levels of estrogen therefore reducing recurrence breast cx.
Papanicolaou smear
A pelvic examination for women to detect cancer
uterine cancer. Postmenopausal bleeding is not normal, with or without pain.
A postmenopausal client experiencing painless vaginal bleeding is a sign of?
Diagnosis
A process
commonly caused by cancer
A sore that does not heal
Benign and malignant
A spectrum. Not all tumors are as malignant as others. Basal cell carcinoma is relatively non-malignant
Personal Factors and Cancer Development:
A. Immune Function B. Age C. Genetic Risk
Oncofetal proteins
AFP
Anaerobic glycolysis, falure of the sodium potasium pump, acute cellular swelling results
ATP depletion leads to:
Alkylating agents
Able to cross the BBB, therefore used in brain tumors
Neoplasm
Abnormal growth of tissue that is not beneficial.
WBC > 50,000/mm3
Abnormal range for circulating blasts that puts a client at risk for leukostasis?
How are Tumors classified?
According the anatomic site, histologic grading, and extent of disease (staging).
Labs
Acid Phosphatase, Prostate - Specific Antigen, CA - 125, CEA (Carcinoembryonic Antigen), WBC, Erythrocytes, Hgb, Hct, Thrombocytopenia
Cancer Etiology and Genetic Risk: Oncogene Activation
Activation of proto-oncogenesis appears to be the same, regardless of the specific cause, in the mechanism of carcinogenesis. These proto-oncogenes were the genes that directed normal early embryonic development. At about 8 days after conception, these genes should normally be controlled forever. They are turned off, controlled or suppressed by "suppressor genes" that can act directly at the DNA level, preventing the proto-oncogene from being over-expressed. Another way that the suppressor genes work is by preventing cells from dividing, or maintaining control over the cell cycle.
What are the general and drug specific adverse effects classified as?
Acute, delayed or chronic. Some fall into one or more categories.
External
Administered in high energy x-rays. Produces voltages- can range from millions. Higher the voltage- the deeper the penetration. Usually directed to a certain body area. Superficial lesions, or deeper structures within the body. Area on body is marked
Flourouracil - brand name is:
Adrucil
Reduce the potential for tumor resistance and tolerable treatment side effects.
Advantage of combination chemotherapy?
imaging
After the history, physical exam, and procedures
Alkylating agents
Alkyl sulfonates
How is hematopoetic stem cell transplantation categroized?
Allogenic, syngeneic, or autologous.
Information obtained from staging
Allows you to define the extend of the disease: localized, spreading from organ but regional, or as metastatic to distant sites
Micro-arrays
Allows you to test for a large number of biomarkers and create a tumor profile. This leads to individualized therapy.
Other cancer markers
Alpha-fetoprotein (AFP) Prostate specific antigen Lactate dehydrogenase
Oncofetal protein biomarker
Alpha-fetoproteins
Characteristics of Depression
Also called grief. They have yearning for things that maybe lost. Yearning for the future and things that they cannot do. Action - Cry. Do little activities. Introspective. Become withdrawn. Speak about things that are going to be left behind
X-Ray
Also known as radiography test. Images that can be taken of bone, chest. It is used to detect cancer of the lungs and cancer of the bone.
What are nursing diagnosis for Radiation Therapy?
Altered skin integrity - alopecia, desquamation, erythema. Fatigue and Fibrosis.
List the seven warning signs of cancer
An acronym called Caution
What is Hematopoietic Stem Cell Transplantation?
An effective life saving procedure for a number of malignant and nonmalignant diseases.
Acid Phosphatase
An enzyme that is in the blood. It is an enzyme that is used to look at prostate cancer.
What is Cardiac Tamponade?
An infiltrative oncologic emergency when there is a gradual or acute onset of fluid in the pericardial space.
What is Spinal Cord Compression?
An obstructive oncologic emergency when the tumor enters the spinal cord and the vertebral colomn collapses from tumor entry.
Blood vessels
Angioma Angiosarcoma
Common problems and the nursing care associated with cancer
Anorexia/Mucositis, Nausea/Vomiting, Diarrhea/Constipation Immunosupression, Fatigue, Alopecia, Pain, Fear
How do you manage grief?
Answer questions, clarify information, identify resources, help clarify concerns, encourage verbalization, support.
Nursing interventions Chemotherapy Side Effects Nausea and Vomiting
Antiemetics per MD order. Encourage patient to eat prior to treatment. Encourage patient to eat toast and crackers. Encourage to eat prior to arisal and prior to activity. Encourage small frequent feedings q3h to q4h. Encourage small frequent feedings of fluid q3h to q4h. Encourage - Foods that are bland, High calories, Make sure food is luke warm, Chewing gum, Sucking on a hard candy, Sour candy, Ice chips
Targeted Therapy: Monoclonal Antibodies: antisense drugs
Antisense drugs are a new form of cx therapy that targets the process of making protein in imported in cancer development pathway. They bind to particular mRNA that is made by specific cx cells and the binding prevents the cx cells from developing.
Taxanes
Are very specific for M phase. Inhibit mitosis ("frozen mitosis")
List of medications patient should stay away from for Thrombocytopenia
Aspirin, Motrin, Advil
What is nursing care for a pericardial effusion?
Assess VS, heart and lungs, neck vein filling, LOC, respirations, skin, I & O, review labs, elevate head of bed, minimize physical activity and encourage to cough and deep breathe.
Identify high risk people
Assess history, Lung, Breast, Colon, Uterine - cervical, Uterine - endometrial
Lumbar puncture
Assess spinal fluid
What are the nursing responsibilities for psychological support?
Assess the patient and families response and support and positive coping strategies. Hopful attiude about cancer and suppor the patient and family during various stages and process of cancer.
Genomic Analysis
Assessment of the whole genome, especially for hematopoeitic malignancies.
What is nurses key role with patient undergoing chemotherapy and radiation?
Assisting patients with the psychoemotional issues associated with receiving cancer treatment.
A
Asymmetrical
Nursing responsibilities for External Radiation
Avoid heat or cold application, avoid direct sunlight, Protein in diet, and increase fluid intake, Markings should not be washed off- marking guides radiologist, Area they want to do radiation to is specified- know because mark is there. Washing area- the area is not washed with soap anymore than is absolutely necessary throughout their treatment. Do not apply solutions to area. Ointments, lotions, powders - do not apply. Anything that contains heavy metals. Ex: zinc. Anything that has alcohol base in it- cause it dries. If area has to be washed in anyway- how should it be washed? When area is cleansed a mild unscented soap and tepid water is used. If area develop crust...do not remove crust from skin. If there is a dressing- keep dressings loose. Use non irritating tape. Avoid pulling on effected skin area
What are the oral interventions for nutritional support of a patient undergoing chemotherapy?
Avoid odors, small frequent meals, oral hygiene, medications.
What is the nursing care of the client on chemotherapy related to education with protection from bleeding?
Avoiding trauma, use electric razor, check skin, urine, and stool for blood.
Procedures
B. The objective is to get a direct look at the organ and see if there is an ulcer, lump, bump, mass, or stenosis there
Carmustine - brand name is:
BCNU
What are symptoms of Spinal Cord Compression?
Back pain and neurologic deficits.
Clinical staging
Based on physical exam, radiographs, CT scans, isotopic scans and other imaging procedures
Cancer Types
Based on where they come from. Usually the organ or the tissue that the cancer comes from. We usually see the suffix oma which relates to the tumor. The prefix tells us where it is arising from either the organ or tissue.
What does Secondary Prevention consist of?
Being knowledgeable with ongoing developments for clients at risk, planning education, prevention and screening programs.
Two categories of neoplasm
Benign and Malignant
How can Tumors be classified?
Benign or malignant.
Type of cancer
Benign vs malignant, epithelial vs. non-epithelial
Biological spectrum
Benign, malignant
Mesothelium
Benign/malignant mesothelioma
Prostate - Specific Antigen
Biological marker. It indicates elevated level of PSA. It indicates prostate cancer in men. It is done for men over 40.
What is the only definitive mean of diagnosing cancer?
Biopsy procedures.
Diagnostic
Biopsy, radiological studies, x-ray, CAT, radioactive scanning hot-spot, cold-stop endoscopy, lab tests, Alk. Phos/PSA/Tumor markers/Pap smears are all types of _______ procedures.
Signs and symptoms for colon rectum
Blood in stool. Alteration in bowel patterns. Constipation.
SE of chemotherapy
Bone Marrow Suppression, Cardiotoxicity, Neurotoxicity, Pulmonary toxicity, Hepatotoxicity, Nephrotoxicity, Ototoxicity
What is associated with biologic therapy?
Bone marrow depression and fatigue. Capillary leak syndrome and pulmonary edema are usually acute or dose limited and may require critical care.
anemia, neutropenia, or thrombocytopenia.
Bone marrow suppression can cause what?
B
Borders
Internal Radiation is also known as
Brachy Therapy.
Signs and Symptoms for breast
Breast problems. Lump in the breast. Nipple discharge. Thickening. Dimpling. Pain in the breast. Tenderness of the nipple
Alkylating agents
Broad range, used for solid tumors: colorectal and brain tumors
Alkylating agents
Broad spectrum activity against a range of solid and hematological malignancies. Typically used in combination regimens
How are antineoplastic drug dose calcuated?
By type of cancer and clients size.
Dexamethasone - Class, roll in cell cycle, MoA:
CCS for G1 phase, suppressed mitosis
Prednisone - Class, roll in cell cycle, MoA:
CCS for G1 phase, suppressed mitosis
Vinblastine - Class, roll in cell cycle, MoA:
CCS; M phase mitosis, binds to tubulin and prevent spindle apparatus formation
Vincristine - Class, roll in cell cycle, MoA:
CCS; M phase mitosis, binds to tubulin and prevent spindle apparatus formation
Nitrosoureas SE
CNS toxicity- dizzy, ataxia
Glycoprotein biomarker
Ca19, Ca15, Ca125
Glycoproteins
Ca19, Ca15, Ca125
Hormonal biomarker
Calcitonin and catecholamines
To do a biopsy
Call a surgeon! They are good at cutting stuff
How can chemotherapy affect fatigue?
Can be debilitating. The patient should plan activities and rest periods, restrict visitors if necessary.
Excisional biopsy
Can be done concurrently with treatment (such as a mastectomy)
Flow Cytometry
Can be used for aneuploidy assessment
Ovarian cancer marker
Cancer Antigen 125 (CA 125)
CA - 125
Cancer antigen detected in blood and Peritoneal ascities. It is a tumor marker. It can be used to confirm the diagnosis of cancer. It can also be used to look at the response to treatment. It can detect ovarian as well as a number of other cancers.
tumor-associated antigens
Cancer cells may display altered cell surface antigens and these antigens are termed ________-_________ __________.
TNM Staging Stage IV
Cancer invaded or metastasized to other parts of the body.
Lymphoma
Cancer of infection fighting organs or lymphoid tissues. Considered cancers that affect the blood forming system.
Leukemia
Cancer of the blood forming organs or hematological systems. Considered cancers that affect the blood forming system.
Sarcoma
Cancer of the bone, muscle, fat, and the connective tissue.
Carcinoma
Cancer of the epithelial cells such as skin, lining of the lungs, glands, lining of the digestive tract, urinary.
Chemotherapy Nutrition
Cancer patients suffer from Anorexia, Loss of appetite, Taste pattern can become altered. Weight loss, Occurs due to their body metabolizes their own proteins and they use the protein for energy. Main source of protein is carbohydrates. However in cancer patients this does not occur. Protein is also used in place of fat. Due to this high calorie, high protein food should be encouraged. Small frequent feeding is encouraged. Monitor I &O. Do a daily weight. Increase nutritional supplements. Hydrate patient. Monitor I & O
lymphomas and leukemia
Cancer that is found within the blood forming organs
Sarcomas
Cancer that is found within the bone, muscle & other connective tissue
Carcinomas
Cancer that is found within the epithelial tissue
melanomas
Cancer that is found within the pigment cells of the skin
Colon cancer marker
Carcinoembryonic antigen (CEA)
Types of malignant epithelial tumor types
Carcinoma (squamous cell, transitional cell, basal cell, adenocarcinoma)
Doxorubicin, Daunorubicin SE
Cardiomyopathy, alopecia, toxic extravasation
ErbB2
Carries a poor prognosis
What is a metabolic oncologic emergency?
Caused by production of ectopic hormone directly from the tumor or the presence of the tumor.
What is an obstructive oncologic emergency?
Caused by tumor obstruction of an organ or blood vessel.
Alkylating agents
Causes the DNA strands to break, preventing replication
What are the two major categories of chemotherapeutic drugs?
Cell cycle phase nonspecific and cell cycle phase specific drugs.
Flow cytometry
Cells are exposed to specific antibody and can be detected, while suspended in a fluid, by using a laser. Can also be used for aneuploid assessment.
Alkylating agents
Cells in S phase are most susceptible
Alkylating agents
Cells in late G1 and S phase most susceptible and cause G2 arrest
Classification of tumors
Cellular origin Biological spectrum
type of cell injured, the cell's current health status, the cell's adaptability
Cellular response to injury depend on:
dilation of the endoplasmic reticulum
Cellular swelling causes:
attributes of malignant cells
Cellularity
C
Change in Bowel or Bladder habits
What are the seven warning signs of cancer?
Change in bowel or bladder habits, a sore that does not heal, unusual bleeding or discharge from any body oriface, thickening or a lump in the breast or elsewhere, indigestion or difficulty swallowing, obvious change in a wart or mole, nagging cough or hoarseness.
commonly caused by cancer
Changes in bowel or bladder habits
Biology of Abnormal Cells
Characteristics of Benign Tumor Cells -when cell growth or fxn is changed, cells are considered abnormal -normal cells growing at wrong place or at wrong time -moles, fibroids, endometriosis, skin tags
Leukocyte and erythrocyte counts.
Chemotherapeutic agents cause some degree of bone marrow suppression which results in what decreased lab values
Cartilage
Chondroma Chondrosarcoma
Cytogenetics
Chromosomal preparation of the tumor to check for abnormal number or structure.
Cytogenetics
Chromosomal preparation of the tumor to check for abnormalities in either number or structure
Nephroxtoxicity/otoxicity are a particular concern with:
Cisplatin
staging
Classifying the extent and spread of disease is termed _______.
What is the nursing management in cancer surgery?
Client and family may be extremely anxious, combining other treatment methods may contribute to complications such as infection, impared wound healing, altered pulmonary or renal function and DVT.
painful spasms due to the wide diameter of the catheter and the retention balloon in the bladder
Client with a three-way Foley catheter usually experience what?
What are the different types of Staging?
Clinical, Surgical, and Pathologic.
Some histological abnormalities associated with malignancies
Collagen whirls deep in biopsy Multinucleated cells Abnormally large cells Evidence of mitosis Tissue disorganisation Metaplaysia
What is Hematopoeitic Growth Factors?
Colony stimulating factors stimualte the production, maturation, regulation and activation of cells of the hematologic system (bone marrow) after suppression by chemotherapy.
C
Color
urge to void. This is due to the pressure exerted by the balloon in the internal sphincter of the bladder and the wide diameter of the catheter that is used for the purpose of irrigation.
Common complaint from clients undergoing bladder irrigation after prostate surgery?
Dry mucous membranes, fatigue, and loss of hair
Common side effects of chemotherapy?
Differential diagnosis
Common things are common! List the most common causes, with the most dangerous one at the top
Extravasation of the chemotherapeutic agent, especially if the agen is a vesicant. Ensure patency of vein.
Complication of intravenous administration of chemotherapy?
A lung or mediastinal tumor can compress the superior vena cava, obstructing blood flow, leading to the early symptoms of facial and arm edema
Complication of superior vena cava syndrome?
thrombocytopenia
Condition of low platelets.
How does the patient need to be prepared during hematopoeitic stem cell transplantation?
Conditioning regimen prior to transplantation. It is critical for the patient to be protected from expsoure to infectious agents, and supported with electrolyte supplements, nutrition, and blood componenent transfusions.
What is Biologic Therapy?
Consists of agents that modify the relationship between the host and the tumor by altering the biologic response of the host to the tumor cells.
What are Benign Cells?
Continuous or inappropriate cell growth that show specific morphology and have a small nuclear cytoplasmic ratio. Normal cells that grow in the wrong place at the wrong time. Perform differentiated functions. Adhere tightly together. Are nonmigratory. Grow in an orderly manner.
Contrast X-Ray
Contrasts helps us visualize the structures better. Images are noted better. Images are noted with a contrast xray as liquid or dye moves through body system- allows you to visualize body structure. Example - Barium for GI
Signs and Symptoms of Death Peripheral circulation decreases
Cool dark appearance. Dusky appearance. Mottled. Diminished sensation in lower extremities
Since risks with cancer are magnified with smoking, what nursing intervention should be performed?
Counsel all patients regarding smoking cessation.
Flow Cytometry
Coupled with immunohistochemistry can be used for Kappa/Lambda ratio which indicates lymphomas.
What is an infiltrative oncologic emergency?
Cuased when tumors infiltrate vital orgrans.
What are the goals of cancer treatment?
Cure, control or palliation.
Genomic Analysis
Cytogenetics, FISH, PCR, mico-array
Tissue diagnosis
Cytology of body fluids Cytology of tissue scrapings Fine needle aspiration *CORE NEEDLE BIOPSY*
Cytarabine - brand name is:
Cytosar
Cyclophosamide - brand name is:
Cytoxan
Chemotherapy drugs
Cytoxan. Leukeran. Flurouracil. Methotrexate. All Corticosteroids (Prednisone, Megace). Navelbine
Genetic
DNA damage. Chromosomal problems in our genes can put us in the risk of certain cancers like down syndrome which is of higher risk for developing acute leukemia
Which is more potent, daunorubicin or doxorubicin?
Daunorubicin
Anthracyclines
Daunorubicin and Doxorubicin
Dexamethasone - brand name is:
Decadron
Chemotherapy Side effects Thrombocytopenia
Decrease platelets (thrombocytes) due to the depression of the bone marrow. Normal platelet values are 150,000 to 400, 000 mm3. When the platelet is less than 20,000 mm3 spontaneous bleeding can occur
Mercaptopurine
Decreased activity of HGPRT which is required for activation.
What are characteristics of bone marrow suppression?
Decreased leukocytes, erythrocytes and platelets.
What are the two major dysfunctions present in the process of Cancer?
Defective cellular proliferation (growth), and defective cellular differentiation.
What does regional treatment with chemotherapy involve?
Delivery of the drug directly to the tumor site.
Prednisone - brand name is:
Deltasone
What can influence adaptation and coping with a cancer diagnosis?
Demographic factors, prior coping skills and strategies, social support, and religious and spiritual beliefs.
Kubler - Ross Grieving Stages
Denial, Anger, Bargaining, Depression, Acceptance
Procedures
Designed to find the primary tumor or to find a metastatic tumor
External Radiation Side Effects General
Desquamation (Shedding of the skin), alopecia, bone marrow depression with leucopenia, anemia and thrombocytopenia)
Goal of radiation
Destroy the malignant rapidly dividing cells without permanently damaging the healthy surrounding tissues
What are chemotherapy side effects a result of?
Destruction of normal cells, especially those that are rapidly proliferating such as those in the bone marrow, lining of the GI system, and the integumentary system.
What does Staging do?
Determines the cancers exact location and degree of metastasis present at diagnosis.
What is the cancer survivor at risk for?
Developing secondary malignancies, such as leukemia, angiosarcoma and skin cancer.
Neoplasm
Develops from cancer cells. They do not develop from normal cells.
Cytologic diagnosis
Diagnosis tool which looks at a few cells from a target site. Specimen not is obtained from the core of a tissue.
Histologic diagnosis
Diagnosis tool which looks at a tissue not just the cells. Specimen is obtained from the core of a tissue.
D
Diameter. Anything greater than 6 mm should be evaluated further
External Radiation Side Effects Pelvis
Diarrhea, Cystis, Sexual dysfunction
What do injuries of the intestinal mucosa result in?
Diarrhea, mucositis, anorexia, nausea and vomiting because it is one of themost sensitive tissues to radiation and chemotherapy.
What do you assess with nutritional status of a patient undergoing chemotherapy?
Diet history, medication history, difficulty chewing or swallowing, monitoring weight and caloric intake, monitoring laboratory data.
Musicarmine stain
Differentiates between mucin and fluid. Stains mucus red
Trichrome stain
Differentiates collagen and muscle
Signs and symptoms for Uterine endometrial
Discharge. Unusual bleeding
Signs and symptoms for uterine cervical
Discharge. Unusual bleeding
How can hormonal agents cause cancer?
Disturbance in bodies own hormonal balance, and administration of hormones with oral contraceptives and esotrogen replacement therapy.
High risk people - Assess history
Do a screening. Get a history
ancillary tests
Done through histochemistry, immunohistochemistry, or molecular analysis
Histologic Diagnosis
Done with a tissue, not just cells
The toxicities of a particular drug
Dose limtations of chemotherapy are determined by which of the following client or drug-related factors?
What is the treatment for pericardial effusion?
Drainage, radiation and chemotherapy to control tumor growth. Prednisone and diuretics.
Herceptin
Drug used in treatment of breast cancer tissue expressing ErbB2 and HER2/neu.
Ibuprofen (Motrin). Medications that inhibit platelet aggregation should be avoided.
During the nadir period (the period of reconstruction), which of the following medications should be avoided?
Promoters
ETOH, cancer occurs at a faster rate in smokers who drink then smokers that do not drink.
What is nursing management of BRM therapy?
Educational needs, give support and guideance, and assist in planning and evaluating care.
What are Cell cycle phase nonspecific drugs?
Effect the cells during all phases of the cell cycle.
Platinums
Effective when used in combination with radiation
Reducing Risk of Cancer Vitamins A & C
Eggs, Carrots, Peaches, Apricots, Squash, Broccoli, Grapefruit, Oranges, Cantaloupe, Strawberries, Red and green peppers, tomatoes
Internal radiation side effects General
Elevated temp
What is Cancer?
Encompasses a broad range of diseases of multiple causes that can arise in any cell of the body capable of evading regulatory controls over proliferation and differentiation.
Nursing intervention Chemotherapy Side Effects Stomatitis
Encourage good oral hygiene. Use soft toothbrush or tooth sponge. Clean toothbrush with bleach or hydrogen peroxide which will help combat infect. Irrigate mouth with normal saline. Inspect the mouth for white patches, sores, or redness. Increase fluids cleans the body and causes them not to be so toxic.
Decrease vomiting for External Radiation
Encourage patient to lie still before and after meals. Increase in protein. Small frequent feedings throughout the day. Give them some sort of medication ordered by the doctor. Check with the dieticians about food preferences.
Chemotherapy Prevent Infection - Oral hygiene
Encourage patient to use a soft toothbrush. Do a mouth inspection daily to look for - Lesions, White plaque (leukoplaquia = white plaque in the mouth), Stomatitis (Inflammation of oral mucosa), Ulcers, Lip drying (Apply lip balm or lip lubricant)
Nursing Interventions for Chemotherapy Side Effects Anemia
Encourage rest periods. Encourage patients not to overwork themselves. Encourage diet high in iron. Encourage good nutrition
Prevention
Encouraging patient to quit smoking, protective measures when using cleaning agents, avoiding overexposure to sun, and educating the public.
Etoposide - Class, roll in cell cycle, MoA:
Epidophyllotoxin, blocks cell cycle in G2 phase
Cellular origin
Epithelium, mesenchyme
High risk people - Uterine endometrial
Estrogen therapy. Women who have had late menopause
Alkylating agents
Ethyleneimines
Hallmark of cancer
Evading Apoptosis
Aspirin, ibuprofen and indomethacin(
Examples of medications that inhibit platelet aggregation?
What are Cell cycle phase specific drugs?
Exert their most significant effects during specific phases of the cell cycle.
Risk factor - Radiation
Exposure to radiation such as, Sn - Nude beach not good. Melanoma, Basal cell and Squamous cell cancers can develop. Tanning booths. Sun lamps. Working in a environment that utilizes a lot of radiation
What is Teletherapy?
External beam radiation which is the most common form of radiation treatment delivery. The patient is exposed to radiation from a megavoltage treatment machiene.
What does the use of IV devices reduce the risk of?
Extravasation.
What happens when the immune system fails with cancer?
Failure to recognize the malignant cell, when tumor antigens hide, when the body becomes depleted or immune system drops, when abnormal concentrations of host suppresor T lymphocytes.
High risk people - Breast
Family history. Early menarche or late menopause. A woman who has never had children. A woman who has had their first child at the age of 30. Lengthy exposure to estrogen. People who are less educated and are of lower socio-economic status
What substances are throught to increase the risk of cancer related to dietary?
Fats, alcohol, salt cured or smoked meats, nitrates.
Cytological Diagnosis
Fine needle aspiration, scrapings, exfoliated cells and cells in fluids
Reducing Risk of Cancer Lean meat
Fish, Lean meat, Skinned poultry
When control is the goal what is the purpose of the treatment?
For cancers that cannot be completely eradicated but are responsive to anticancer therapies and can be mainted for long periods with therapy.
Communicaton to reduce possible anxiety caused by outcomes. Fear intense pain if not addressed first.
For post-test client what is the first priority following a full body scan?
Bense Jones proteins
Found in patients with multiple myeloma, cancer of plasma cells.
What is nursing care for muscoitis?
Frequent assessment, oral hygiene, medications, encourage fluid intake, encourage soft bland foods.
What is therapy for Bone Marrow Suppression?
Frequent monitoring and BRMs.
Risk factor - Environmental and Chemical
Fumes that we inhale like from rubber, chlorine, dust from cotton, fume from coal mines, fumes from nickel. Chromate, Asbestos, Vinyl chloride, Radium, Arscenic
Etoposide
G2 phase specific, inhib topoisomerase II, degrades DNA
How are chemotherapeutic drugs classified?
General groups according to their molecular structure and mechanism of action.
Fluorescence in situ hybridization (FISH)
Genomic analysis used in bladder and breast cancer.
What are the side effects of Radiation Therapy?
Gi irritation, chest pain, dysphagia, xerostomia, N/V, diarrhea, bone marrrow associated with anemia, leukopenia and thrombocytopenia.
Decrease effects of isolation in internal radiation patients
Give emotional and spiritual support, Do not make the patient feel that you are rushing them, Avoid rushing in and out of the room, Give them a phone, radio, TV, magazines, Promote comfort, Give them fresh water, Room should be made comfortable by adjusting the temperature, Give fresh linen, Bathing activities
Cancer Patient Teaching Referrals
Give referrals to certain supports groups like American Cancer Society, Ostomy Groups, Lung Associations, Susan Korman Group
CT (Computerized Tomography)
Gives cross sectional three dimensional view of various structures. It can look at cancers, joints, spines, tissue.
Imatinib mesylate - brand name is:
Gleevac
Genomic Analysis
Good for hematopoietic cells, soft tissue, and some epithelial malignancies, but mostly for hematopoietic cells
For many tumor cells, four grades are used:
Grade I (mild dysplasia) Grade 11 (moderate dysplasia) Grade III (severe dysplasia) Grade IV (anaplasia)
What is the first step in confirming cancer?
Grading.
euthanasia
Greek for "good death;" has evolved to mean the intentional killing by act or omission of a dependent human being for his or her alleged benefit
Malignant
Growing worse and resiting treatment
What is Invasion?
Growth of the primary tumor into surrounding host tissue. Mechanical pressure forces projections into the surrounding tissue moving everything out, and enzymes destroy the surrounding tissue allowing for more invasion.
What is Hypertrophy?
Growth that causes tissue to increase in size by enlarging the individual cells.
What are safety precuations for the healthcare time with Radiation Therapy?
Guided by time, distance, and sheilding. Client assigned to a private room. Staff members wear dosimeter badges. Do not assign client to pregnant healthcare worker. Prohibit children from visitng. Limit visits to 30 minutes and distance of 6 ft from source.
Virus/Immune
HIV, Hepatitis B, Papillomavirus, Herpes Simplex 2 Virus, Epstein Barr Virus.
What are substances thought to reduce risk of cancer related to dietary?
HIgh fiber food, cruciferous vegetables, carotenoids, possibly vitamins E, C, Zinc and Selenium.
What do you teach for a patient undergoing chemotherapy that is suffering from alopecia?
Hair loss is usually temporary, wigs scarves and hats can be used, protection.
Prevent infection for External Radiation
Hand-washing. Antibiotics ordered by the doctor. Teaching the patient and family concerning upper respiratory infections - cold, sinusitis. Hydration and nutrition. Encourage them to drink fluids about 2 to 3 quarts. Encourage rest periods.
Nursing Interventions Chemotherapy Side effects Thrombocytopenia
Handle patient gently. Apply adequate pressure to needlesticks venipencutre. Use soft toothbrush. Use electtrial razor. Do urine and fecal testing for blood. Look for bruising. Observe for bleeding in gums, petichae. Observe for tarry stools. Prevent them from falling or cuts. Avoid constipations. Encourage to drink fluid and eat roughage in the diet. Encourage stool softener. Use adequate lubrication and gentleness during sexual intercourse. Avoid anal sex. Avoid tight clothing and constricting shoes. Be careful of jewelry with sharp edges. Avoid anything forceful such as blowing their nose, picking their nose. Avoid contact sports, elective surgery and tooth extraction.
Signs and Symptoms of Death Cheyne-Stokes
Happens in respiratory. It will be shallow respirations followed by no respirations (apnea)
Cancer Patient Teaching Psychosocial & Spiritual Support
Have patient consider both these aspects
What does a diagnostic plan include for the person whom cancer is suspected?
Health history, idenification of risk factors, physical examiniation, and specific diagnostic studies.
High risk people - Lung
Heavy Smoking over 50 years old are more prone to developing cancer.Packs per day - is more prone to developing cancer. Anyone who started smoking at the age of 15 or before. Second hand smoking. Exposure to environmental smoke.
Alcohol consumption
Heavy alcohol consumption can cause dancer of oral cavity - larynx, throat, esophagus, liver.
ancillary tests
Helps in finding a diagnosis, prognosis, and making therapeutic decisions
Trastuzumab - brand name is:
Herceptin
attributes of malignant cells
High N/C ratios
Risk factor - Dietary habits
High fat diet increases chances of cancer - colon cancer, prostrate cancer, breast cancer. Diet high in fiber and low in fat is recommended to prevent the following types of cancer - colon, rectal, and breast cancers. Obesity puts you at risk for - breast, prostate, gallbladder, ovarian, uterine. Avoid charred foods. Excessive intake of both saturated and non saturated fats is not good.
Risk factor - Smoking
High percentage of cancer from smoking
Gemcitamine
High toxicity but only drug for pancreatic cancer
Hormonal manipulation: Mechanism of action: hormone agonists
Hormone manipulation can control some types of cx for many years usually this therapy doesn't lead to cure. The endocrine system usually maintains a very delicate hormone balance so when a large amt of one particular hormone is administered it upsets the balance and disturbs the uptake of other hormones as a result, tumor growth is slowed and survival time increases.
Characteristics of Anger
Hostility, Resentful, They have an understanding of the diagnosis and the prognosis, They think it is unfair to them, They are going to tend to blame others like family, friends, and health care givers. They will find fault. Even though they are angry we do want them to vent their feelings
Localized tumors are often treated with lumpectomy.
How are small tumors treated?
lipid peroxidation, fragmentation of polypeptide chains
How do free radicals cause injury?
Leukostasis occurs as the leukemic blast cells accumulate and invade the vessel walls,causing rupture and bleeding.
How does Leukostasis occurs?
Questions to ask a patient
How long? Associated symptoms? Ever had this before? Past medical history? Medications? Allergies? FAMILY HISTORY? SOCIAL HISTORY
Treatments for Pneumontitis
Humidify the air, Fluid intake, Coughing and deep breathing
What is treatment for Tumor Lysis Syndrome?
Hydration, diuretic therapy, medications, hemodialysis.
Hypercalcemia procudes a generalized slowing of functions through neuromuscular depression ie, constipation, increased urination, hyporeflexia and confusion.
Hypercalcemia causes what?
attributes of malignant cells
Hyperchromasia
increased functional demand, specific hormone stimulation
Hypertrophy can be caused by:
What are the renal systemic effects from chemotherapy?
Hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia.
decrease amount of 02 in the air, diseases of respiratory or cardiovascular systems, lack of RBCs, inadequate or disfunctional hemoglobin, ischemia
Hypoxia can result from:
Side effects of biological response modifier therapy: peripheral neuropathy
INF therapy can cause peripheral neuropathy. Some of the problems resulting from neuropathy, decreased sensory perceptions, visual disturbances, decreased hearing, unsteady balance, gait, hypostatic HTN, not sure if it's temporary or permanant.
How can chemotherapy be administered?
IV most common through CVAD, PICC, or inserted infusion ports.
What is the route for drug administration of antineoplastic drug?
IV route preferred.
Detection
Identification of high risk people--aggressive assessment and screening
What is nursing care for Tumor Lysis Syndrome?
Identify clients at risk, assess for electrolyte imbalance, assess urine pH, institute preventative measures (hydration).
Immunohistochemistry
If a cell expresses certain proteins, then it can be determined it is of a certain tissue
Death rattle
If collections of mucous occur in the throat, noisy respirations will be heard.
Benign - Resembles parent tissue
If it is a lung tissue it will look like a lung tissue, if it is a brain tissue it will look like a brain tissue
B-HCG
If present in a male, most likely had testicular tumor
initiate oxygen and IV access
Immediate interventions for the client with cardiac tamponade?
What are the different routes for Brachytherapy?
Implanted by needles, seeds, beads or catheters, or adminstered orally for thyroid cancer.
evaluate renal function studies.
Important consideration when adminstering gallium nitrate for a client with multiople myeloma is to?
histologic grading
In ____________ _________ of tumors, the appearance of cells and the degree of differentiation are evaluated pathologically.
Complications assoicated with leukostasis
In a client with chronic myelogenous leukemia (CML), the nurse should monitor for high white blood cell counts caused by which complications?
Steroid hormone receptors
In breast cancer, carries a better prognosis
Mercaptopurine
In patients without the enzyme (TPMT) that broke this down, the drug had a much longer half-life.
TNM Staging, Stage 0 In Situ
In place
Tumor type
In situ, invasive ductal/lobular, invasive tubular, colloid
Types of Biopsy
Incisional, Excisional, Needle/Aspiration
What is Hyperplasia?
Increase in number of cells of a tissue. Most often associated with rapid growth.
Nursing interventions specific to Radiation of the head and neck
Increase water - Rationale, It will alleviate dryness of mouth and tongue. Increase water which will help get rid of all the debris that has been destroyed during the treatment. Artificial saliva - Rationale helps mouth dryness. Helps soften and moist the mucous membrane. Decreases irritation of the oral mucosa. Frequent oral care. Soft toothbrushes, tooth sponges. They suffer from Mucositis and Stomatitis. Commercial mouth washes are not recommended here because it causes drying. Recommendation - Xylocane Viscous solution. They swish this solution and spit it out. This solution helps them eat better. We can also do irrigation of their mouth. Irrigation helps get rid of dead cells from radiation. It helps with acidity that may build up.Irrigation solution - normal saline, hydrogren peroxide (Lori)
Carcinoembryonic Antigen
Increased
Ca++ and phosphate tests
Indicates metastasis to the bone
PSA
Indicates prostatic cancer especially in the elderly
Prostate Specific Antigen (PSA)
Indicates prostatic cancer, especially in the elderly. It is used as a screening test or for follow up for patients who have prostate cancer.
Ki-67
Indicative of a fast growing tumor
Uses of tumor markers
Indicator of response to therapy Staging Prognosis Detection of relapse Diagnosis
commonly caused by cancer
Indigestion or difficulty in swallowing
I
Indigestion or swallowing difficulties. Many complaints about the GI system - Indigestion, dysphagia,
How do Cancer cells divide?
Indiscriminately and haphazardly and sometimes produce more than two cells at the time of mitosis.
What does Hematopoetic growth factors decrease the risk of?
Infection and anemia.
What is the primary cause of death in a cancer patient?
Infection.
What are complications with hematopoeitic stem cell transplantation?
Infections. In allogeneic transplants graft verses host disease.
Nursing intervention Chemotherapy Side Effects Mucositis
Inflammation of the oral mucous membrane. Xylocaine viscous can be used to swish in the mouth and spit it out
External Radiation Side Effects Chest
Inflammatory process in the lung tissue will predispose the person to infection
What are the side effects of Interleukins?
Inflammatory reactions, fluid shifts, tissue swelling that can be life threatening.
Pathologic staining
Information obtained during a surgical procedure
Vinca Alkaloids
Inhibit microtubule polymerization
Vinca Alkaloids
Inhibit topoisomerase 1and 2
Folic Acid Analogs
Inhibition of DHFR preventing formation of THF
What are the stages of cancer?
Initiation, promotion and progression.
Hallmark of cancer
Insensitivity to Antiproliferative Signals
Ports
Instruct patient not to lie on the port area. It can cause friction, it can cause it to be dislodged.
What is Targeted Therapy?
Interferes with cancer growth by targeting specific cellular receptors and pathways that are important in tumor growth.
2 categories of radiation
Internal and External
What is Brachytherapy?
Internal radiation treatment, consisting of the implantation or insertion of radioactive materials directly into the tumor or in close proximity adjacent to the tumor.
What is the function of Ionizing radiation?
Interrupts cellular growth by breaking strands of the DNA helix.
Keep the affected arm elevated above heart level.
Intervention for client following mastectomy for breast cancer?
Encourage daily hygienc, regular oral care, and perineal care after each stool to prevent infection.
Interventions should the nurse plan to use for a client experiencing neutropenia?
What are nursing management of the patient undergoing chemotherapy and radiation?
Interventions to counter the effects of myelosuppression, thrombocytopenia, anemia, nausea and vomiting, anorexia, stomatitis, diarrhea and constipation, mucositis, and skin reactions.
What are the most common methods of regional chemotherapy?
Intraarterial, intraperitoneal, intravesical bladder and intrathecal and intraventricular.
Routes for Internal Radiations
Intracavity, Interstitial, Parenteral, Oral.
What is Gene Therapy?
Investigational treatment that involves using genetic material to fight disease or replace missing genes to prevent development of disease.
Radionuclide Scans
Involves a radioactive substance. The radioactive substance is going to be taken up by specific body tissue. It can be given intravenously and after it is given the body is scanned. If the tissue is abnormally functioning the structure takes an abnormal amout of the substance. Structures that can be picked up - Thyroid, liver, lungs, breast problems, lymphomas, melanomas.
Camptothecins
Irinotecan and topotecan are best characterized.
What do chemotherapy and radiation both have the potential to cause?
Irreversible and progressive pulmonary and cardiac toxicities.
External Radiation Side Effects Head and Neck
Irritation of mucous membrane. More risk for infection. Loss of taste. Irritation of pharynx and esophagus. Nausea and indigestion. Increase Intracranial pressure.
Mutations
Is important when normal cells develop. It occurs at the cellular level.
Gleevec
It acts by inhibiting Bcr-abl kinase preventing a tyrosine kinase from being constitutively turned on
CEA (Carcinoembryonic Antigen)
It can look at recurrents of GI cancer, pancreatic cancer, and liver cancer. It can look at how the treatment is progressing along. It is a type of tumor marker.
PET (Positon Emission Tomography)
It is a nuclear scan that reveals patterns of tissue metabolism. Used to examine various body tissues to identify certain conditions Used to follow the progress of treatment of certain conditions It is given through intravenous. They start two IV lines and need isotopes. They need tiny amount of radioactive substance called radionuclide. Can detect tumors in the brain that are solid, can detect breast and how effective the cancer treatment is
Genomic Analysis
It is being done with impact to the prognosis and diagnosis of cancers and prediction of therapy
Nitrogen mustards
It is extremely toxic and is the active ingredient in nerve gas
Purpose of Biopsy
It is for microscopic studying of the tissue. They either confirm or disprove the malignancy. They will determine the type of cancerous cells. It also looks at the degree of cellular differentiation.
Radiation of the head and neck
It is going to produce inflammatory changes within the mouth. It is also going to affect the pharynx and esophagus.
Benign - Smooth
It is smooth, well defined; we can move it when we palpate it.
PSA
It is used as a screening test or for follow up for patients who have had prostate cancer
Immunohistochemistry
It is used for protein expression and is mostly done on fixed cells
How do Antineoplastic drugs work?
Kill malignant cells by interfering with cell replication and interfering with the supply and use of nutrients. Interfering with the genetic materials in the cell nucleus. Act during cells reproductive cycle. Each drug dose kills a specific percentage of cells. Most active against rapidly diving cells, both normal and malignant.
Laboratory Diagnosis
Knowing exactly if there is malignancy
Greiving Process
Kubler - Ross
Neutropenia
Lack of neutrophils. Neutrophil count less than 1000/mm3. Most often suppressed in differential WBC.
Smooth muscle tumor
Leiomyoma Leiomyosarcoma
Lymphomas
Leukocyte proliferation is characteristic of what?
Chemotherapy Side effects
Leukopenia, Thrombocytopenia, Anemia, Stomatitis, Mucositis, Nausea and Vomiting, Alopecia
Bense Jones proteins
Light chain proteins found in patients with multiple myeloma
Histology
Light microscopic examination of formalin fixed and hematoxylin and eosin stained slides remains the benchmark for pathological examination
Metastasis
Likes to go where there is a lot of vascularization, and where it can actually adhere (can adhere = can't spread)
What are characteristics of Normal Cells?
Limited cell division, show specific morphology, have a small nuclear cytoplasmic ratio, perform specific function, adhere tightly together, are non migratory, grow in an orderly and well regulated manner, and are contact inhibited.
Hallmark of cancer
Limitless Replicative Potential
Adipose tissue
Lipoma Liposarcoma
Hormones
Long term use of estrogen and DES (Diethyl Stilbestrol). DES is a hormone used to prevent miscarriage. DES made mothers more prone to reproductive forms of cancer.
Xerography
Looks at images of the soft tissue in detail. It can be used to detect soft tissue cancer.
Cystoscopy
Looks at the urinary bladder. It utilizes a cystoscope
Isotope scan
Looks for metabolically active sites in the body (Ex: PET scan)
Laparoscopy
Looks into the abdominal cavity. It utilizes a laparoscope
Bronchoscopy
Looks into the bronchi and lungs. It utilizes a bronchoscope
Colonoscopy
Looks into the entire colon
Sigmoidoscopy
Looks into the lower colon
Proctoscopy
Looks into the rectum
Gastroscopy
Looks into the stomach
Chemotherapy Side Effects Alopecia
Loss of hair due to the destruction of hair follicles.
attributes of malignant cells
Lost Cohesion
Reducing Risk of Cancer
Low fat dairy products. Avoid salt cured foods. Moderation in alcohol
What are the most frequent sites of metastasis?
Lungs, bone, brain, liver and adrenal glands.
leakage of lysosomal enzymes
Lysosomal swelling leads to:
Vincristine/Vinblastine
M phase, alkaloids, bind tubulin and block polymerization, no mitotic spindles, no division
Paclitaxel
M phase, binds tubulin, stabilizes and doesn't allow depolymerization
Trastuzumab (Herceptin)
Mab for HER2, antibody dependent cytotoxicity
Core needle biopsy
Mainstay. Allows adequate tissue to permit careful evaluation of the histology of the tumor
Cancer Patient Teaching Disease
Make sure that they are knowledge about the disease and treatment options. Make sure that we listen to their concerns and fears. Discuss this with the patient and their loved ones
Characteristics of Bargaining
Make up for what they did in the second stage. They make up for the difficult behavior. They become aware of the time that they have left. Actions elicted - Will bargain for more time with God or higher power. Make promises. They tend to try new treatments
Melanoma
Malignancy of the pigment cells of the skin. Acronym used to describe this type of cancer is ABCD. Report any significant skin changes to the MD or Rn
TNM Staging Stage I
Malignant cells confined to the tissue of origin. Localized tumor growth.
Hypercalcemia
Malignant myeloma may cause what?
What are tumor-associated antigens a result of?
Malignant transformation.
Complications Resulting from Cancer: Nutritional Problems
Malnutrition -protein intake -high-caloric foods -albumin and prealbumin levels -enteral or parenteral nutrition
* Painless swelling of scrotum * Dull pain in scrotum * Nodules in between testes and cord * Dragging senation in scrotum
Manifestations of testicular cancer?
carcinogens
Many ___________, or cancer-causing agents capable of producing cellular alterations, are detoxified by protective enzymes and are harmlessly excreted.
vesicants
Many chemotherapeutic agents can be either irritants or __________.
What are side effects of hormonal manipulation?
Masculinization or feminization, acne, hypercalcemia, liver dysfunction, sexual dysfunction.
How can chemotherapy effect the reproductive system?
May cause sterility, may cause chromosomal defects, banking of sperm and birth control is recommended.
Alkylating agents
Mechanism of resistance would be upregulation of DNA repair enzymes
What are the different classification of antineoplastic drugs?
Mechanisms of action (alkylating agents, antimetabolites), sources (plan alkaloids, antibiotics), immunostimulants, hormones, hormone inhibitors, cytoprotectants.
DHFR
Metabolizes folic acid to THF
M
Metastasis. Presence or absence of metastasis
Music therapy, and hypnosis
Mind-body therapy that is allow during radiation therapy and chemotherapy?
Tumor grade
Mitosis, tubular formation, nuclear features
Alkylating agents
Modifies the DNA by binding to the N7 guanine residues causing crosslinking
Nursing Interventions Chemotherapy Side effects Leukopenia
Monitor WBC count (lab value). Patient should be on precaution (neutropenic precaution). Strict aseptic technique should be enforced. Avoid sick visitors. Institute good hand washing technique. Avoid fresh fruits, fresh vegetables, fresh flowers and fresh plants. Patient should be in a private room. They should be in reverse or protective isolation which is protecting the patient from everyone else. We need to wear a mask, gown and gloves. When patient leaves the room they have to wear a mask.
What is nursing care for renal systemic effects from chemotherapy?
Monitoring levels, adequate hydration, alkalinization of urine, allopurinal to reduce uric acid levels.
nadir
Monitoring the complete blood count is critical in patients receiving radiation and/or chemotherapy. It is typical for patients to experience the lowest blood counts, called the ________, between 7 and 10 days after initiation of therapy.
How long is the patient after receiving radiation and chemotherapy at risk for late effects?
Months to years after the cessation of therapy and can affect every body system.
Differentiated
Most like the parent tissue
What is the goal of prevention and detection of cancer with public education?
Motivate people to recognize and modify behavior patterns that may negatively impact health, and to encourage awareness and partcipation in health promotiong behaviors.
Smokeless tobacco
Mouth cancer, cancer of the throat, larynx, and esophagus
Chemotherapy Side Effects Stomatitis
Mouth inflammation due to destruction of normal cells of the oral cavity.
Internal radiation side effects head and neck implant
Mucositis, oral pain, more at risk for infection, anorexia
Homogeneous immunoglobulin in the urin or serum
Multiple myeloma is characterized by what?
Cancer cells
Multiply beyond their normal limitations. They override their normal cellular production. They then become out of control. There is no cell division limit.
What is Metastasis?
Multistep process in which tumor cells travel to distant sites via lymphatic and hematogenous routes.
What are alternative treatments for nausea and vomiting?
Muscle relaxation, guided imagery, musci, acupressure, and distraction.
Invasion or metastasis
Must demonstrate to differentiate between benign and malignant
Alkylating agents
Mustard gas
Mechlorethamine - brand name is:
Mustargen
genes that encode growth factors, genes that encode growth factor receptors, genes that regulate apoptosis, genes taht regulate repair of damaged DNA
Mutations of which genes can lead to carcinogenesis?
oncogenes
Mutations that alter the expression of proto-oncogenes can activate them to function as
Methotrexate SE
Myelosuppression, macrovesicular fatty change in liver; don't take w/ NSAIDS, Sulfas
5FU SE
Myelosuppression, photosensitivity
ADRs of trastuzumab:
N/V/D (short) > anemia, neutropenia, infections, fatigue, infusion rxns, rash
N
Nagging cough or hoarseness
commonly caused by cancer
Nagging cough or hoarseness
What are symptoms of Tumor Lysis Syndrome?
Nausea and vomiting, fatigue and weakness, altered mental status, muscle cramps, seizures, hypertension, cardiac arrest.
What are side effects of chemotherapy?
Nausea and vomiting, mucositis, alopecia, hematopoetic system suppression of bone marrow.
External Radiation Side Effects Abdomen
Nausea, Vomiting, Diarrhea, Anorexia
What are symptoms of Cardiac Tamponade?
Neck vein distention during inspiration, abnormal heart sounds, tachycardia, increased venous and vascular pressures, SOB, weakness, chest pain, orthopenia, anxiety, diaphoresis, lethargy and altered conciousness.
multiple myeloma
Neoplastic process of plasma cells
What are neurological effects from chemotherapy?
Neuropathies, hearing loss.
Vinca alkaloid, Vincristine (Oncovin) and Vinblastine (Velban) cause neurotoxic effects of constipation
Neurotoxicity is a side effect of which chemotherapy drug classification and medication?
Process of cancer diagnosis (1)
Never treat cancer unless you're sure it's cancer. Need to be sure of the type to determine prognosis and appropriate therapy
After diagnosis
Next step is staging
Alkylating agents
Nitrogen mustards
Carmustine - Class, roll in cell cycle, Key Attribute:
Nitrosourea bases alkylating agent, CCNS, *highly lypophilic, ergo good for brain tumors
Alkylating agents
Nitrosureas
Unsealed
No container is used. They will take it orally, or parenternally. It goes into the body tissue that way. This type of radiation can be performed Oral, IV, or an implant can be placed in the body. The isotopes taken in can get excreted through urine, feces, perspiration. Urine, saliva, sweat, and feces will be affected.
Ultrasound
Non invasive procedure using high frequency sound waves to examine internal structures of the body. They are echoed sound waves. These sound waves are being interpreted as transducer passes over different structures and tissues
What are Protoonocogenes?
Normal cellular genes that are important regulators of normal cellular processes that keep them in their mature, functioning state.
WBC
Normal value is 5000 to 10000/mm3. When it drops it means there is some sort of infection. When it increases it also indicates infection.
Benign - Blood supply is less perfused
Not a lot of blood supply is needed. It uses the blood supply that is in that area. Does not go out of its area to get the blood supply.
Laboratory Diagnosis
Not really for cancer diagnosis as much as cancer therapeutic plans and prognosis
If patient needs emergency surgery or should die
Notify RSO or nuclear medicine dept. stat.
Tamoxifen - brand name is:
Novaldex
What are the diffreent classifications of oncologic emergencies?
Obstructive, metabolic or infiltrative.
O
Obvious change in wart or mole. Particularly when they become abnormal
commonly caused by cancer
Obvious changes in a wart or mole
Chemotherapy Side Effects Nausea and Vomiting
Occurs within or during the first 24 hours of the patient receiving chemotherapy
Personal Factors and Cancer Development: Age
Older adults must be aware of and report symptoms such as the seven warning signs of cancer: 1 change in bowel or bladder habits 2 a sore that does not heal 3 unusual bleeding or d/c 4 thickening or lump in breast or elsewhere 5 indigestion oe difficulty swallowing 6 obvious chg in wart or mole 7 nagging cough or hoarseness
glandular, benign
On what kind of cells would you find an adenoma? Is it malignant or benign?
Rarely recurs
Once it has been removed.
Vincristine - brand name is:
Oncovin
Rituxan
One of the first and most effective cancer antibody
What is Myelosuppresion?
One of the most common effects of chemotherapy and to a lesser extent with radiation. It can result in life threatening effects, including infection and hemorrhage.
When should erythopoiesis stimulating agents be used?
Only when treating anemia specifically caused by chemotherapy.
Prostate, lung and colorectal cancer
Order of the three most highest incidence in men?
Bone
Osteoma Osteosarcoma
Normal Cells
Our body is continuously changing from birth until we die. Our cells are also constantly changing. They are multiplying and then differentiate and then they become specific type of cells. After that they mature. As we get older and mature, and our cells get injured, they are constantly replaced with new cells. Cell continue and can become body systems, they can regenerate themselves.
Isoenzymes
PSA
cancer: Laboratory Tests: Protein tumor markers:
PSA, CEA
What are nursing problems with Cancer?
Pain, decrease in self esteem, and grief.
What is treatment for Spinal Cord Compression?
Palliative radiation, surgery, chemoterhapy and external back and neck braces.
A very common cytology test is
Pap Smear.
Types of benign epithelial tumor types
Papilloma (squamous cell, transitional, basal cell) Adenoma (glandular)
What is simulation with Radiation?
Part of radiation treatment planning used to determine optimal treatment method by focusing on accurately localizing the tumor and ensuring set up position reproducibility.
Characteristics of Acceptance
Patient accepted their fate. They feel that they have done everything necessary to approach death. Actions - May be very peaceful when you look at them. They may say very little. They may like dimness within the room setting
How to identify disease
Patient signs and symptoms Laboratory investigations Radiological investigations Pathological investigations
What is autologous transplantation?
Patients receive their own stem cells back following myeloablative (destroying bone marrow) chemotherapy.
High risk people - Uterine-cervical
People who have had frequent sex in the teens. People who have had many sexual partners. STDs - Herpes 2, HPV. Low socio-economic levels and lack of education. Contraceptives
What is nursing care for Spinal Cord Compression?
Perform neurologic assessment, control pain, prevent complications of immobility, maintain muscle tone, assist with bowel and bladder training, provide encouragement and support.
What is important with pain and a cancer patient?
Performing a comprehensive pain assessment on an ongiong basis and to enact a pain management plan that address both components of pain if they are present.
Signs and symptoms for lungs
Persistent cough. Blood in the sputum. Chest pain. Pneumonia. Bronchitis
Imatinib
Philadelphia chromosome BCR-ABL tyrosine kinase inhibitor
Describe the diagnostic procedures used to detect cancer
Physical test, Endoscopic Procedures, Biopsy
Cisplatin - brand name is:
Platinol
Alkylating agents
Platinums--very effective in combination with antimetabolites
attributes of malignant cells
Pleomorphism
Internal radiation side effects Chest
Pneumonitis.
extravasation. Drug administration should be stopped and attempt to aspirate.
Potential tissue irritation from chemotherapeutic agents is called?
Beta-human chorionic gonadotrophin (B-HCG)
Present in testicular and ovarian cancer. More accurately, it is for the diagnosis of germ cell tumors.
B-HCG
Present in testicular cancer and ovarian cancer
Chemotherapy Nursing Intervention
Prevent Infection. Tell family not to visit if they are ill like if they have a cold or flu. Any ill hospital worker should not provide care to chemo patients.
Aim of combinational therapies
Prevent resistance
Differential diagnosis of lung nodule
Primary bronchiogenic carcinoma Benign tumors Other primary tumors of the thorax Metastasis from other tumors Non-neoplastic disease Radiographic artifact
Cancer prevention activities can focus on:
Primary prevention or Secondary prevention
What is surgery used for with cancer?
Primary prevention used to eliminate or reduce the risk of cancer development in patients who have underlying conditions that increase their risk of developing cancer.
anemia
Procran, Epoeton Alpha Epogen , affect Erythrocytes and are indicated in chemo induced __________.
What can surgery do to the patient with cancer?
Produce a change in body image and function. It can be difficult for the patient to cope with these changes while attempting to maintain usual lifestyle patterns.
TNM Staging
Prognosis depends on the extent of the malignant cells and how they invade the body tissue. Tumor, Nodes, Metastasis
What is the purpose of cancer treatment?
Prolong survival time, improve quality of life.
What can surgery be prescribed for with cancer?
Prophylaxis, diagnosis, cure, control, palliation, determination of effectiveness of therapy, and reconstruction.
Isoenzyme biomarker
Prostate specific antigen
Neutropenic precaution
Protects the patient that is immunocompromised from exposure to potential pathogens
Cytokeratin
Protein antigen presented on tumor cells of epithelial origin.
Leukocyte Common Antigen (LCA)
Protein antigen presented on tumor cells of lymphoid tissue.
Desmin
Protein antigen presented on tumor cells of muscle origin.
Thyroid Transcription Factor (TTF)
Protein usually expressed in thyroid as well as lung tumors.
Why stage is important
Provides prognostic information Helps determine optimal treatment Permits a baseline against which response to treatment can be assessed Facilitates exchange of information between physicians and for research trials
Signs and Symptoms of Death Vital sign changes
Pulse will increase first and then it becomes weak and thread. BP will go down. Temperature decreases. Respiration will be decreased. It will become shallow and irregular.
Signs and Symptoms of Death Pupil changes
Pupils will become dilated and fixed
Mercaptopurine - brand name is:
Purinethol
brachytherapy
Radiation can also be delivered as _____________, which means "close" or internal radiation treatment.
External radiation is not
Radioactive therefore the patient will not contaminate other people. They are not considered radioactive. Teach the patient that the radiation is within the machine. The machine is what gives the radiation.
PET scan
Radiolabelled tracer taken up by fast metabolizing cells. Could be cancer (or could be infection)
How are malignant neoplasms differentiated?
Range from well-differentiated to undifferentiated.
What are Malignant Cells?
Rapid or continuous cell division, low specific appearance, have large nuclear cytoplasmic ratio, lose differentiated functions, adhere tightly together, are able to migrate, grow by invasion, and are not contact inhibited.
ischemic necrosis
Rapidly growing cancers often contain central areas of ________ _______ because the tumor's blood supply fails to keep pace.
differentation
Rate of growth of malignant tumors correlates with their level of _________
Malignant
Rate of growth varies: It is rapid and usually quick. Metastasized to some other area, Rarely encapsulated - It is rarely in one area. It cannot be contained, Irregular - It is immobile when we palpate, Little resemblance to parent tissue -Will look different from the parent. Invades normal tissue - takes away the nutrients. Competes for the nutrients and O2 from the normal cells. May reoccur after they have been removed. Fatal if not treated. They require greater than amount of blood supply.
cancer treatment: Radiation
Rationale for cancer treatment -destroy cancer cells w/minimal exposure to normal cells (rationale) -effects are seen only in tissue only in path of beam -ionizing radiation: cells die outright or become unable to divide -exposure: amount of radiation delivered to a tissue -dose: amount of radiation absorbed by recipient tissue -intensity of exposure, duration of exposure, closeness of radiation source to cells determine absorbed dose
How does the immune system combat cancer?
Recognizing tumor cell antigens and damaging or killing the cells with NK cells and T lymphocytes.
Leukopenia
Reduced WBC due to depression of bone marrow. Less than 4000/mm3. Common with patients of chemotherapy.
Thrombocytopenia
Reduction in circulating platelets due to depression of bone marrow.
Chemotherapy Side Effects Anemia
Reduction in the number of circulating RBCs, hemoglobin and or volume of packed RBCs hematocrit due to depression of the bone marrow
Chemotherapy Side effects Leukopenia
Reduction of leukocytes in the blood. Normal WBC - 5000 to 10000 mm3. 5000 or less would be considered Leukopenia
Stage
Refers to the localization of the neoplasm
State of cancer
Refers to the localization of the neoplasm
Characteristics of Denial
Refuse to believe the diagnosis and the prognosis that was given. They do not hear what was said like the descriptions and explanations. They are unable to deal with the problem presented to them. Unable to make decisions
N
Regional extent. Are nodes involved
Alpha-fetoprotein
Release by the liver and yolk sac. Increase in this indicates testicular germ cell neoplasm or hepatocellular carcinoma or yolk sac tumor. Elevated levels of this can also be seen in patients with cirrhosis or hepatitis.
When palliation is the goal, what is the purpose of the treatment?
Relief or control of symtpoms and the maintenance of a satisfactory quality of life.
Process of cancer diagnosis (2)
Relies most heavily on invasive tissue biopsy and should never be made without obtaining tissue! No noninvasive diagnostic test is sufficient to define a disease process as cancer
What is the objective of surgery with cancer?
Remova all or as much resectable tumor as possible while sparing normal tissue.
Biopsy
Removal of a small piece of tissue from the lining of the tissue or the organ.
Needle/Aspiration
Removal of fluid or a small wedge of the neoplasm. It will be done with a needle.
What systemtic effects can come from chemotherapy?
Renal, cardiopulmonary, reproductive, neurological and fatigue.
Abnormal cells
Replicate themselves. However when they replicate they became new cells and develop into neoplasm or develop into some sort of new tissue. The thing to keep in mind is that they are abnormal.
What do you teach the patient receiving chemotherapy about neurological symptoms?
Reporting symptoms and avoiding heat or trauma.
AFP
Representative of hepatocellular carcinoma
Pleomorphism
Representative of the least differentiated cells
AFP
Representative of yolk sac tumor
Folic Acid Analogs
Resistance by increased efflux of the drug out of the cell via P-glycoprotein
Folic Acid Analogs
Resistance by increased production of DHFR
Platinums
Resistance by upregulation of DNA excision repair mechanisms
Striated muscle tumor
Rhabdomyoma Rhabdomyosarcoma
** BRCA1 and BRCA2 gene mutation ** Client who had Hodgkin's disease **Smoker, age 40+
Risk for developing breast cancer?
Methotrexate MOA
S phase, folic acid analog, inhib dihydrofolate reductase, decrease dTMP
5FU MOA
S phase, pyrimidine analog, inhib thymidylate synthase
Tamoxifen, Raloxifene
SERMs, receptor antagonists in breast, agonist in bone, for ER pos breast cancer
What tumor markers are not good for
Screening
Methods for internal radiation
Sealed or Unsealed
Hallmark of cancer
Self-sufficiency in Growth Signals
How is nausea and vomiting treated for the patient undergoing chemotherapy?
Serotonin blockers, dopaminergic blockers, phenothiazines, sedatives, corticosteroids, and histamines.
myeloablation
Severe myelosuppression is called?
Laboratory Diagnosis
Showing the effect of a malignant neoplasm on the body
Flow Cytometry
Shows how the genome correlates to the normal number of chromosomes in the body
Diarrhea
Side effect of Fluorouracil (5-FU) and belomycin (Blenoxane)
Cause myelosuppression
Side effect of Gemcitabin (Gemzar) and mitoxantrone (Novantrone)?
dry mucous membranes
Side effects of fluorouracil (5-FU)?
Immune deficiency early in the disease. Immunosuppressive therapy makes the client more susceptible to infection and hemorrhage b/c of a compromised bone marrow function.
Signs exhibited by a client with Hodgkin's disease
Peak T waves, muscle spasm and increased gastric motility
Signs of Hyperkalemia?
The patient complains of burning, stinging, pain or any acute change at the injection site.Induration, erythema, venous discoloration or swelling is observed at the site. Slowed infusion rate. Blanching and coolness of skin area.
Signs of extravasation?
Sudden onset of high fever/low grade fever Abnormal bleeding (example: nosebleeds, gingival bleeding, purpura, ecchymoses, petechiae) Bruising (even if it's a minor trauma) Prolonged menses (females) Weakness Pallor ■Be alert for signs of serious bleeding, such as headache with change in responsiveness, blurred vision, hemoptysis, hematemesis, melena, hypotension, tachycardia, dizziness
Signs of leukemia?
altered gait, reflexes and ileus in client receiving chemotherapy
Signs of neurotoxicity?
Flow Cytometry
Similar to immunohistochemistry except instead of being done on a slide it is done in a fluid
well-differentiated
Similarity to host tissue
Signs and Symptoms of Death Skin
Skin is cool and clammy. Profuse diaphoresis may occur
Benign Characteristics
Slow and steady growth, they remain localized, encapsulated, smooth, resembles parent tissue, crowds normal tissue, rarely recurs, it is rarely fatal, it is harmless, blood supply is less perfused.
Seeded Internal Radiations
Small beads of radioactive material. Just like seeds are scattered these seeds are also scattered throughout the tumor and they may remain in that area indefinitely. The radioactive sources are going to be implanted within a tumor.
Risk factors related to cancer
Smoking, Dietary habits, Radiation, Environmental and Chemical, Smokeless tobacco, Alcohol consumption, Genetics, Hormones, Virus/Immune
Types of mesenchymal cell tumors
Smooth muscle, striated muscle, adipose tissue, blood vessels, bone, cartilage, mesothelium, synovium
How is the cardiopulmonary system effected by chemotherapy?
Some drugs are toxic to the heart and lungs.
benign tumors influenced by circulating hormone, pressure constraints
Some exceptions to the rule pertaining to growth rate differences between benign and malignant tumors
What is hormonal manipulation used for?
Some hormones can stimulate tumor growth, altering the availability of these hormones can directly effect the tumor growth. It is not a cure, slows tumor growht, may increase survival time.
What is mucositis?
Sores in the mucous membranes.
Cytologic Examination
Specimens are collected by three basic methods: a. exfoliation from an epithelial surface b. aspiration of fluid from body cavities or blood c. needle aspiration of solid tumors d. Tumor Markers -protein molecule that is detectable in serum or body fluids -used as biochemical indicator of presence of malignancy -small amts are found in normal body tissue or benign -high amts are suspicious, follow up dx studies (PSA) -PSA for men over 40, pap smears for women (not completely reliable)
When platelet count is less that 20,000
Spontaneous bleeding can occur
TNM Staging Stage II
Spread of cancer limited to local area.
Types of epithelial cell tumors
Squamous cell, transitional, basal cell, glandular
What is allogenic transplantation?
Stem cells are acquired from a donor who has been determined to be human leukocyte antigen (HLA) matched to the recipient.
High risk people - Colon-rectum
Strong family history of colorectal cancer and polyps. Inflammatory bowel disease problems.
Cytology
Study of cells. Looking at the cells without looking at the surrounding tissues. Cells are isolated placed under a microscope and examined.
Tumor markers
Substance (usually protein) found in blood or urine that can be elevated in certain cancers.
Cancer Patient Teaching Collaborate with other Health Team Members
Such as nutritionist. PT, OT. Social worker. Hospice. Pharmacy. Oncologist. Primary MD oncologist. Discuss grieving and dying process:
What do the oncologic emergencies usually include?
Superior vena cava syndrome, spinal cord compression, SIADH, hypercalcemia, tumor lysis syndrome, disseminated intravascular coagulopathy, and cardiac tamponade.
What are aspects for enteral route nutritional support of a patient undergoing chemotherapy?
Supplementations, NG, G and J tubes.
Epithelium
Surface, glandular
What different therapies can be used to treat cancer?
Surgery, radiation, chemotherapy, hormonal manipulation, immunotherapy, gene therapy, vaccine.
Treatment
Surgery, radiation, chemotherapy, hormone therapy, immunotherapy, gene therapy, and surgery are types of _____.
Excisional
Surgical removal of the entire tumor. This is done only if the tumor is small.
Incisional
Surgical removal of the tumor.
Hallmark of cancer
Sustained Angiogenesis
Can include fatigue (due to anemia), easy bruising (due to a low platelet count), and infections (occurring secondary to a low white blood cell count).
Symptoms of Bone Marrow Suppression?
•Bleeding problems •Bone or back pain •Increased susceptibility to infection •Symptoms of anemia (such as tiredness, shortness of breath, and fatigue) •Unexplained fractures
Symptoms of multiple myeloma
Synovium
Synovioma Synovial sarcoma
Cytological Diagnosis
Take a few cells (not the core of a tissue) from the target site, put them on a slide, spread, and stain them
How do you manage decrease in self esteem?
Take a positive approach, encourage independence, encourage participation, listen, counsel and refer.
Paclitaxel - brand name is:
Taxol
What is nursing management for the patient with radiation therapy?
Teach client to gently wash area each day, use hand instead of wash cloth, rinse soap well, pat dry, protect markings, avoid powders, ointments, lotions, or creams unless prescribed, wear soft clothing, avoid anything that binds, avoid exposure to the sun, avoid exposure to the heat.
Nursing responsibilities for Internal radiation
Teach patient and family. Establish some sort of routine for their care. The routine has to minimize the time we spent with the patient. The quality of care is not minimized. Radiation in use sign should be placed on the door. Nurse should wear lead apron and a radiation badge. It helps monitor the nurse's exposure to the radiation. Children younger than 18 years and pregnant women should not be allowed to visit implant patients. Visitors shall be instructed to limit visits to 10 minutes when with the patient, always standing as far away from the pelvic area as possible. Keep a long handled forcep. Patient should be told that they would be isolated. Patient must flush toilet 3 times. Men should sit down to urinate. Radioactive substance will be eliminated via bodily fluids - Urine, Feces, Perspire, vomit
Teaching
Teach patient to avoid constricting clothing. Avoid friction of any kind on the skin. Avoid exposure of the skin to extreme temperature such as heat and cold. Avoid sunlight. Check the skin and keep it clean.
What does Primary Prevention consist of?
Teaching the client to avoid known carcinogens, adopt dietary and lifestyle changes known to decrease risk, and participate in cancer prevention programs.
Alkylating agents
Temozolomide (Temodar)
25.) hematopoietic stem cell transpantation (HSCT)
Terminology is continually evolving, and bone marrow and peripheral stem cell transplantation are typically referred to in general as _____________ __________ _______ _______________.
•Blood chemistry levels of calcium, total protein, and abnormal kidney function •Complete blood count (CBC) reveals low numbers of red and white blood cells and platelets •Serum protein •Urine protein or Bence-Jones protein analysis • immunoglobulins (nephelometry) Bone x-rays show fractures or hollowed out areas of bone.
Tests and diagnosis used to identify multiple myeloma
A digital rectal examination and prostate cancer (PSA) yearly.
The American Cancer Society recommends what kind of screening for males over 50?
How are tumors identified in histologic grading?
The appareance of cells and the degree of differentiation are evaluated pathologically. Four grades are used to evaluated based on the degree to which the cells resemble the tissue of origin.
The site should be treated with the appropriate antidote and observed for 3-4 weeks
The best nursing action should an extravasation of a vesciant occur?
Chemotherapy interrupts
The cell functions. Cell functions are interrupted because it affects the multiplication and reproductive process of the cells. However it causes many side effects.
genes well differentiated, well, undifferentiated
The difference between benign and malignant tumors is that benign neoplasms are ______ differentiated and malignant neoplasms range from _____ differentiated to _________________.
What is Radiation?
The emission and distribution of energy through space of a material medium.
Staging definition
The extent of disease (cancer) in the body
What is Progression?
The final stage, characterized by increased growth rate of the tumor, increased invasiveness, and spread of the cancer to a distant site (metastasis). Tumor establishes a blood supply and forms colonies or subpopulations.
Immunosurveillance
The immune system's recognition and destruction of newly developed abnormal cells
Grade of cancer
The level of differentiation of the neoplasm
anaplastic
The more _______ a tumor, the less likely it is to have specialized functional activity
Myelosuppression since hematopoietic cells divide rapidly, the are most vulnerable to chemotherapy.
The most common and lethal side effect of chemotherapy?
Intracerbral hemorrhage
The most common and most lethal complication of leukostasis?
Activities that could result in injury and bleeding.
The nurse instructs the client receiving chemotherapy that which of the following should be avoided to reduce the risks assoicated with thrombocytopenia?
Paclitaxel (Taxol). When administering Paclitaxel, PVC bags and infusion sets should be avoided because of leaching of DEPH (plasticizer)
The nurse would avoid using IV solution bags and infusion sets made from polyvinyl choloride (PVC) when administer which chemotherapy agent?
What is immunologic escape?
The process by which cancer cells evade the immune system.
Carcinogenesis
The process by which normal cells are transformed into cancer cells
Metastasis
The process by which tumor cells are spread to distant parts of the body
What is Angiogenesis?
The process of developing new blood vessels.
tumor angiogenesis
The process of the formation of blood vessels within the tumor itself is termed _______ ___________.
metastasis
The progression, or final stage, of cancer is characterized by increased growth rate of the tumor, increased invasiveness, and spread of the cancer to a distant site. This process is known as _________________.
immunologic surveillance
The response of the immune system to antigens of the malignant cells is termed ____________________ _____________.
What is Promotion?
The second stage in development of cancer, is characterized by the reversible proliferation of the altered cells. Growth is enhanced, latency.
Neoplasm
The term for uncontrolled or abnormal growth of cells
Invasion or metastasis
The two main criteria or malignancies
chemottherapy
The use of chemicals as a systemic therapy for cancer is called __________________.
Antitumor antibiotics
These inhibit topoisomerase II, also DNA intercalation to interfere with replication
malignant
These tumors usually grow very fast, range from well-differentiated to totally undifferentiaed (anaplastic), and will never have a capsule
benign
These tumors usually grow very slowly, are well-differentiated and closely resemble their normal counterparts- they may retain some functionality and they can have a capsule
Antimetabolites
They act in either the G1 or S phase during DNA synthesis
Benign - Encapsulated
They are usually contained within a capsule. They have some sort of surrounding tissue to keep them in one area.
commonly caused by cancer
Thickening or lump in the breast or elsewhere
T
Thickening or lump in the breast or other tissue
Grade
This refers to the level of differentiation of the neoplasm
Radioactive isotopes can be used to treat
Thyroid cancer, Leukemia, Myelomo
Hallmark of cancer
Tissue Invasion and Metastasis
Benign
Tissue level: Encapsulated, homogenous Cellular level: Well differentiated, low mitotic rate Genetic level: diploid DNA, normal chromosomes
Malignant
Tissue level: irregular, heterogeneous Cellular level: Poorly differentiated, high mitotic rate Genetic level: Aneuploid DNA, abnormal chromosomes
How are tumors identified in anatomic classification?
Tissue of origin, the anatomic site, and the behavior of the tumor (malignant or benign).
Bone marrow
To assess the hematopoietic maturation and if there is metastasis in the bone
What is the purpose of Radiation Therapy?
To destroy cancer cells with minimum destruction of normal cells. Cells die or become unable to divide.
The purpose of the immunotherapy is
To discontinue the malignant growth. It focuses on the person's own immune system. It uses the person's own body natural immune system to defend against the cancer. This research is still developing.
What is the goal of chemotherapy?
To eliminate or reduce the number of malignant cells present in the primary tumor and metastic tumor sites.
Purpose of Radiation
To interrupt, slow cellular growth
What are antineoplastic drug doses scheduled?
To maximize cancer cell killing, and minimize damage to the normal cells.
What is the use of chemotherapy?
To treat systemic disease in combination with other treatments to reduce tumor size preoperatively, to destroy remaining cells postoperatively, to treat some forms of leukemia.
Chemotherapy Routes of administration
Topical, Oral, IV, Arterial, Intra cavitary, Intrathecal
Camptothecins
Topoisomerase I inhibition: DNA damage by single strand breaks arrests cell in S phase
What education should be given to patients receiving chemotherapy and radiation?
Treatment regment, supportive care options (antiemetics and antidiarrheals), and what to expect during the coure of treatment is important to help decrease fear and anxiety, encourage adherence, and guide at home self management.
When cure is the goal what is the purpose of the treamtent?
Treatment that is expected to have the greatest chance of disease eradication and may involve local therapy, alone or in combination with or without periods od adjunctive systemic therapy.
Alkylating agents
Triazines
Endoscopic Procedures
Tubes containing magnifying lens and light. It is a flexible tube and works like a telescope. It is a telescope like optical instrument. It looks like a small black rubber hose. The physician utilizes this small hose instrument to look at internal organs. The physician can not only look at the organs but can get biopsy as well. Based on the internal organ the physician will the name will be given to the scope
As cancer stage increases
Tumor burden increases Curability decreases
TNM Staging Stage III
Tumor larger, invade surrounding tissues. Extensive local and regional spread.
T
Tumor size (local extent)
What are the three parameters for the TNM classification system?
Tumor size and Invasiveness (T), presence of absence of regional spread to the lymph nodes (N), and metastasis to distant organ sites (M).
What are the altered cell surface antigens for cancer cells?
Tumor-assoicated antigens.
What is syngeneic transplantation?
Type of allogeneic transplant that involves obtaining stem cells from one identical twin and infusing them into the other.
B/C of the immunosuppression, the client is at severe risk of infection. Precautionary measures such as a private room and protective isolation must be instituted to protect the client from sources of infection.
Type of isolation for severely leukopenic client who is receiving radiation therapy?
What are Oncofetal antigens?
Type of tumor antigen that can be used as tumor markers that may be clinically useful to monitor the effect of therapy and indicate tumor recurrence.
True. Lying down can lead to reflux, casuing nausea.
T|F A client at risk for nausea should not lie down for at least 30 minutes after meals, to avoid aspiration.
True
T|F A client is a risk to others as long as the radiation implant is present?
True to avoid accidental cuts that will cause bleeding.
T|F A client with a decreased platelet count sould be counseled to avoid using razors?
True. A client's prior nausea history is indicative of her individual nausea threshold and is predictive o fhow chemotherapy-induced nausea will be handled.
T|F A person susceptibility to nausea is dependent on the past history.
True.
T|F An undescended testicle is one risk for testicular cancer.
True. Frozen, then stored until treatment.
T|F Bone marrow is usally harvested from the iliac crest?
True. Also late menopause.
T|F Early menstruation before the age of 12 is a risk factor for breast cancer.
True.
T|F Estrogen replacement may increase breast cancer risk?
True.
T|F External radiation poses no risk of radiation exposure to contacts, even during intimate physical contact?
true.
T|F For 6 hours following intravesicular chemotherapy, the toilet should be disinfected after each use to ensure that the biohazard of excreted chemotherapy drug is contained.
True
T|F Gallium nitrate can impair renal function as evidenced by elevated urea and creatinine levels.
True.
T|F In nursing the goal is to assist clients to perform as many normal daily activities as possible.
True
T|F In the elderly and immunocompromised client, even a slight elevation of temperature may indicate an infection and must be investigated and treated immediately.
False
T|F It is normal to have one testicle that does not remain descended into the scrotal sac.
True
T|F Lymph node biopsy is performed to assess any metastasis form the primary site of cancer
True
T|F Multiple myeloma is a neowplastic proliferation of the plasma cells.
True.
T|F Once stomatitis develops, meticulous oral hygiene must continue with a soft toothbrush or toothettes, fluoride-containing toothpaste, and rinsing with a dilute baking soda solution.
True.
T|F Physiological needs take priority over psychosocial and learning needs.
True. This promotes a more complete exhalation and facilitates removal of secretions from the bronchial tree.
T|F Pursed-lip breathing, back pressure is created to keep the airways open.
True.
T|F Radiation is palliative treatment for spinal cord compression to reduce the tumor size and relieve compression.
True. 67% of all cancer occurs in people over age 65, necessitating early screening and detection.
T|F Scrfeening the elderly for cancer is essential?
True.
T|F Un explained rapid weight loss may be the first symtpom assoicated wit cancer and immediate evaluation is required.
True, protocols should be in place to administer the antidote immediately after an extravasation is observed to neutralized the vesicant and minimized tissue trauma.
T|F Vesicant therapy will cause tissue irritation with eventual sloughing without the appropriate antidote.
True. Hair washing should be limited to 2 to 3 times per week.
T|F Washing the hair during chemotherapy treatment daily will promote further hair loss.
False. Progressive relaxation and guided imagery, hypnosis
T|F Yoga, acupuncture and chiropractic practieces are used in hospital settings?
True. No one should directly touch the implant. Should be placed into a lead container not a biohazard bag they do not offer protection from radiation.
T|F direct handling of a internal radiation implant causes exposure to radiation?
What is Neoplasia?
Uncontrolled cell growth that follows no physiologic demand.
U
Unusual bleeding or discharge
commonly caused by cancer
Unusual bleeding or discharge
Internal radiation side effects cervical implant
Urinary frequency, Diarrhea, Nausea, Vomiting, Anorexia
Histochemistry
Use of basic dye chemistry to identify components of a tissue
Histochemistry
Use of basic dye chemistry to identify components of a tissue.
Chemotherapy Prevent Infection - Avoid the following
Use of enemas, Rectal medications, Rectal thermometers
Radiation
Use of ionizing radiation to interrupt or slow cellular growth
Chemotherapy
Use of medications or chemicals (antineoplastics) to encourage death of cancerous cells.
Internal Radiations is Administered through
Use of temporary or permanent implants.
Flow Cytometry
Used for prognosis by assessing the ploidy to find the amount of cells in the S-phase of replication
FISH
Used in breast and bladder cancer
MRI
Used in magnetic field. Magnetic resonance imaging. Does not involve any exposure to radiation. Radio frequency energy waves processed by computer. Computer produces detailed images of organs and structures within the body
Fly Cytometry
Used to assess the amount of ploidy, which determines the amount of cells in the S-phase of replication.
Use of radiation
Used to cure problem, can control area/ tumor, Used to cure, control or relieve symptoms
Iron stain/melanin stain
Used to differentiate between pigmented cells
Ancillary analysis
Used when diagnosis is under the gray zone. Helps to find a diagnosis, prognosis and making therapeutic decisions. Includes histochemistry, immunohistochemistry or molecular analysis.
Internal Radiations
Uses a radioactive source. The radioactive source is going to be contained. They can be contained through - needles, seeds, wires, catheters.
Immunohistochemistry
Uses antibody-antigen specific binding to determine the histogenesis of a tumor.
Immunotherapy
Utilize agents or certain methods which will alter or change the immunological relationship between the tumor and the patient.
Internal Radiations Parenteral and oral
Utilize radioactive isotopes.
Reducing Risk of Cancer Vegetables
Vegetables from cabbage family (Cruciferous) such as - Broccoli, Cauliflower, Brussell sprouts, All types of cabbage and kale
Vinblastine - brand name is:
Velban
What are aspects for parenteral route nutritional support of a patient undergoing chemotherapy?
Venous access devices, to treat malabsorption.
Etoposide - brand name is:
Vepesid
Cellularity
Very cellular specimen
Immunohistochemistry
Very specific binding of tagged antibodies binding to specific epitopes on proteins
Vinca Alkaloids
Vinblastine, Vincristine, Camptothecins, Taxanes
What causes cancer?
Viruses or bacteria, physical agents, sunlight or radiation, chronic irritaiton, tobacco use, chemical agents, tobacco smoke, chemical substances found int he workplace, genetics, hormonal agents, obesity and dietary factors.
Signs and Symptoms of Death
Vital sign changes, Peripheral circulation decreases, Cheyne-Stokes, Pupil changes, Skin
National Cancer Institute
Wants us to implement 5 servings of fruit and vegetables from the above given list
Teaching for internal radiation
Wash hands, Flush the toilet, Separate utensils and towels, Laundry should be done separately from everyone else, Encourage fluids to flush the radioactive substance, Avoid kissing, sexual contact, Pregnant women should avoid contact to radioactive substances
Chemotherapy Prevent infection
Wash hands. Use good hand washing technique using antimicrobial tubes. Teach patient and family members to wash hands. Personal care items should not be shared such as - Razors, Toothbrushes, Toothpastes, Lipsticks, Washcloths. Clean toothbrush By soaking in bleach or hydrogen peroxide. Wash dishes and utensils with hot water. Patient should only drink fresh bottled water. Patient should avoided crowded place. Patient should eat only canned or cooked foods (No sushi). Leukocyte count - if it is very low patient should avoid salads, raw foods, raw vegetables, any undercooked meats. Do not handle garden flowers, plants or the soil. Do not clean out cat litter boxes, or bird cages. Report any infection to the doctor
What is nursing care of the client on chemotherapy related to education with prevention of infection?
Well balanced diet, avoid exposure, hand washing, daily hygiene, care of indwelling catheters and calling hcp when needed.
How are benign neoplasms differentiated?
Well-differentiated.
Side effect of Chemotherapy. Cells are constantly produced and grow rapidly in the bone marrow. As a result, they are sensitive to the effects of chemotherapy. Until bone marrow cells recover from chemotherapy damage, abnormally low numbers of WBCs, RBCs, and/or platelets. This is called bone marrow suppression or myelosuppression.
Whait is bone marrow suppression ?
The lowest point as, for example, the lowest blood count after chemotherapy, the lowest concentration of a drug in the body, etc. ,
What Is Nadir?
cells that show the most extreme disturbances in growth
What are anaplastic cells?
temperatures or atmospheric pressure, radiation, electrical
What are examples of environmental agents?
unstable, unpaired electrons
What are free radicals?
cells that show marked variation in size and shape
What are pleomorphic cells?
Genes that in their normal state lead to proliferation of cells.
What are proto-oncogenes?
decreased workload, loss of innervation, diminished blood supply, inadequate nutrition, loss of endocrine stimulation, aging
What are some causes of atrophy?
Xenobiotics, nitrates, lack of fiber, obesity, too much Omega-6 or not enough Omega-3 fatty acids
What are some causes of cancer found within the diet?
Pre-invasive epithelial tumors, have not yet broken through the basement membrane, may be non-invasive for variable periods before progressing to invasive, may be confused with benign tumors, often found in the cervix or breast
What are some characteristics of carcinoma in situ?
loss of uniformity (pleomorphic), loss of archetectual orientation, mitotic figures more abundant & in abnormal locations
What are some characteristics of dysplasia?
Advanced arteriosclerosis, evidence of previous cell injury, often causes organ dysfunction (heart valves)
What are some characteristics of dystrophic calcification?
differentiation, rate of growth, local invasion, metastasis (move from one area of body to another), capsule
What are some differences between benign and malignant tumors
infections, trauma, hypoxia, chemicals/drugs/toxins, environmental agents
What are some examples of extrinsic etiologies?
exhaustion of lipid reserves, inability to produce glucocorticoids and adrenaline, failure of electrolyte balance, cumulative structural or functional damage to vital organs
What are some of the causes of the collapse of vital systems in the exhaustion phase?
Increased permeability of membrane, loss of volume regulation, massive calcium influx, loss of proteins, coenzymes, ribonucleic acids
What are some of the things that can occur with cell membrane damage?
decreased mitochondrial oxidative phosphorlation, decreased ATP production, sodium pump failure, increased glycolysis, increased membrane permeability, increased calcium influx, release of enzymes
What are the cellular effects of hypoxia?
Combination of coagulative and liquefactive, dead cells disintegrate but the debris is not completely digested, caused by tuberculosis
What are the characteristics of caseous necrosis?
Protein denaturation in the kidneys and heart usually due to hypoxia
What are the characteristics of coagulative necrosis?
Area of coagulative necrosis becomes dried out, wrinkled, and dark black
What are the characteristics of dry gangrene?
Lipases degrade triglycerides and free fatty acids combine with calcium ions to form soaps. Occurs in the breast, pancreas, and other abdominal structures
What are the characteristics of fat necrosis?
Infection of necrotic tissue by Clostridium species
What are the characteristics of gas gangrene?
Solid tissue is dissolved into fluid by hydrolases in neural tissue, often due to hypoxia
What are the characteristics of liquefactive necrosis?
Neutrophils invade necrotic site causing secondary liquefaction
What are the characteristics of wet gangrene?
glucocorticoids
What are the dominant hormones during the resistance phase?
epinephrine and adrenaline
What are the dominant hormones in the alarm phase?
Generally causes no warning signs or symptoms in the early stages.
What are the early signs of Ovarian Cancer?
Hypoxic injury, free radicals and reactive oxygen species, chemical injury, tissue trauma
What are the general mechanisms of cell injury?
mobilize lipid and protein reserves, conserve glucose for neural tissues, elevate blood glucose concentrations, conservation of salts and water and loss of K+ and H+
What are the goals of the resistance phase?
glucocorticoids decrease inflammation and suppress the immune system, conservation of fluid cause high blood pressure, depletion of lipid reserves breakdown proteins
What are the problems that can occur in the resistance phase?
renin, ADH, glucocorticoids
What are the supporting hormones in the alarm phase?
epinephrine, growth hormone, thyroid hormone
What are the supporting hormones in the resistance phase?
compensatory hyperplasia, hormonal hyperplasia, pathologic hyperplasia
What are the three types of hyperplasia?
Genes that in their normal state stops excessive cell proliferation.
What are tumor supressor genes?
Plasma cells help the body's immune system fight disease by producing substances called antibodies. In multiple myeloma, plasma cells grow out of control and form tumors in the bone marrow. The excess growth of plasma cells interferes with the body's ability to make red blood cells, white blood cells, and platelets. This causes anemia, which makes a person more likely to get infections and have abnormal bleeding.
What causes multiple myeloma?
Both benign and malignant (harmless and cancerous) conditions can increase the CEA level. Benign conditions which can elevate CEA include smoking, infections, inflammatory bowel disease, pancreatitis, cirrhosis of the liver, and some benign tumors in the same organs in which an elevated CEA indicates cancer.
What conditions can cause an elevated CEA?
Sodium accumulates in the cell, potassium diffuses out of the cell, net gain in sodium results in an osmotic gain of H20
What happens when the sodium-potassium pump fails after ATP depletion?
Chronic myelogenous leukemia (CML) is a slow-growing bone marrow cancer resulting in too many white blood cells. CML is caused by a change in the genetic code of some of the cells in the bone marrow.
What is Chronic myelogenous leukemia (CML)?
distress
What is a bad stress?
mass on a hollow organ, benign
What is a cystadenoma? Is it malignant or benign?
eustress
What is a good stress
Removal of the tumor and surrounding tissues
What is a lumpectomy?
sarcoma
What is a malignant tumor on a connective tissue organ?
carcinoma
What is a malignant tumor on a epithelial organ?
leuchemia
What is a malignant tumor that originates in the bone marrow?
lymphoma
What is a malignant tumor that originates in the lymphatics?
Removal of breast tissue and lymph nodes under the arm
What is a modified radical mastectomy?
neoplasia or a tumor (interchangeable)
What is a new abnormal growth that could be either benign or malignant
stress
What is a non specific response of the body to any demand placed on it
Removal of the entire breast, underlying chest muscles, and lymph nodes
What is a radical mastectomy?
Removal of the complete breast only
What is a simple mastectomy?
stressor
What is an agent responsible for stress?
cells may be triggered to cycle more readily but do not complete the cycle more rapidly
What is doubling time?
Deposition of calcium in dead or dying tissues
What is dystrophic calcification?
seeping of blood, lymph, or serum into tissues. seeping of chemotherapeutic drugs into a tissue
What is extravasation?
anaplasia
What is it called when cells become less specialized?
autonomy
What is it called when cells gain independence from normal regulation?
Occurs in normal tissues whenever there is hypercalcemia
What is metastatic calcification?
Cancer of the plasma cells in bone marrow. In multiple myeloma, a group of abnormal plasma cells (myeloma cells) multiplies, raising the number of plasma cells to a higher than normal level. Since these cells normally make proteins, the level of abnormal proteins in your blood also may go up. Health problems caused by multiple myeloma can affect your bones, immune system, kidneys and red blood cell count
What is multiple myeloma?
A condition in which bone marrow activity is decreased, resulting in fewer red blood cells, white blood cells, and platelets. Myelosuppression is a side effect of some cancer treatments.
What is myelosuppression?
Radiation therapy is often used as a supplement to shrink tumors.
What is radiation therapy often used for?
Conditioning phase depresses bone marrow function, and infection is the major cause of death for clients with leukemia
What is the conditioning phase?
The proportion of cells within the tumor that are replicating
What is the growth fraction?
transformation
What is the name of the process by which a normal cell becomes a cancer cell?
To reduce the risk of edema after lymph node removal on the affected side. ROM can be started immediately after surgery.
What is the purpose of keeping the affected arm elevated above heart level?
The cells with the highest growth fraction (growing the most)
What kind of cells in chemo most effective?
Place in private room and visitors should maintain a distance of 6 feet and limit visits to 10 to 30 minutes.
What kind of precautions must be taken by the nurse to protect others when a client has a radiation implant ?
Long handled forceps
What should be used to pick up a dislodged internal radiation implant?
Irreversible mitrochondrial function, cell membrane damage
What two main things contribute to irreversible cellular injury?
multifactorial
What type of etiology has more then one factor?
idiopathic
What type of etiology has no understood cause?
inherited
What type of etiology is due to a genetic defect?
congenital
What type of etiology is present at birth?
iatrogenic
What type of etiology is treatment-induced?
lymphoma, melanoma
What types of cancer are two important exceptions to the "oma = benign" rule?
acute, subacute, chronic
What words are used to describe how fast disease appears?
focal or localized, multifocal, systemic or generalized
What words are used to describe the distribution of disease?
mild, moderate, severe
What words are used to describe the severity of disease?
radiation
When cells are exposed to a source of __________, damage occurs to one or both strands of DNA and has been shown to correlate with certain malignancies.
When tumors can cause ulcers
When it outgrows its blood supply because its replicating so fast.
Once per month, 1 week after beginning menstruation.
When should BSE be performed?
Monthly, at the same time each month to aid in remembering to do it regularly.
When should breast examinations be done?
Every 3 years.
When should females ages 20 - 39 get a breast examination?
Hormonal manipulation: Mechanism of action: Hormone antagonist:
When these hormone antagonist are given, they bind to specific hormone receptor on or in tumor cells and prevent the needed hormone from binding to the receptor. So if a particular tumor needs a certain hormone to grow, the hormone antagonist can slow down tumor growth.
Gray zone
When, during diagnosis, there is uncertainty whether a tumor is benign or malignant.
UV-light, x-rays, normal metabolism
Where do free radicals come from?
cardiac muscle, neurons, skeletal muscle
Which 3 cell types can't divide?
Antispasmodics
Which drug class is prescribed for clients with a three-way-irrigation catheter?
Nursing interventions Chemotherapy Side Effects Alopecia
Wigs, hands, bands, and turbans are recommended
Tissue
Without it we cannot know if the patient has cancer or not
Chemotherapy Prevent Infection - Teach patient about perineal hygiene
Women - Clean from front to back. Men - start at urinary meatus and go in a circular motion
Imaging Procedures
X - Ray, Mammography, Xerography, CT, MRI, Contrast X Ray, Ultrasound or sonography, Radio, PET
Mammography
X-Ray examination of the breast. Images, changes in the breast. It can also used to detect breast cancer. Baseline done from ages 35 to 39 than after that starting at age 40 and over every year mammogram has to be done.
What are examples of Teletherapy?
X-ray and kilovoltage, linear accelerators and betatron machienes,particle beam, and intraoperative radiation therapy.
o When cure is the goal__
__ treatment is offered that is expected to have the greatest chance of disease eradication and may involve local therapy (i.e., surgery or radiation) alone or in combination with or without periods of adjunctive systemic therapy (i.e., chemotherapy).
• In histologic grading of tumors__
__, the appearance of cells and the degree of differentiation are evaluated pathologically.
Bone marrow transplantation (BMT) and peripheral stem cell transplantation (PSCT)
________ _________ _____________ and ____________ ________ ______ ______________ are effective lifesaving procedures for a number of malignant and nonmalignant diseases.
tumor supressor genes
________ _____________ _________ function to regulate cell growth.
hyperplasia
________ is an increase in the number of individual cells in an organ or tissue
displasia
________ is not a true cellular adaption, it is always abnormal
targeted therapy
_________ _________ interferes with cancer growth by targeting specific cellular receptors and pathways that are important in tumor growth.
dysplasia
_________ is an abnormal change in the size, shape, and arrangement of mature cells in response to stimulus
etiology
_________ is the cause of disease
disease
_________ is the failure to maintain homeostatic conditions
hypertropy
_________ is the increase in the size of individual cells
pathogenesis
_________ is the sequence of events in the development of disease
pathophysiology
_________ study of functional changes caused by disease
biologic therapy
__________ _________, or biologic response modifier therapy, consists of agents that modify the relationship between the host and the tumor by altering the biologic response of the host to the tumor cells.
dysplasia
__________ is a disorderly but non-neoplastic proliferation of (usually epithelial) cells
carcinomas
__________ originate from embryonal ectoderm and endoderm.
sarcomas
__________ originate from embryonal mesoderm.
carcinoma in situ
___________ ___ ________ has its own designation in the system because it has all the histologic characteristics of cancer except invasion—a primary feature of the TNM staging system.
teletherapy
____________ (external beam radiation) is the most common form of radiation treatment delivery.
• The staging classification system is based on __
__a description of the extent of the disease rather than on cell appearance.
• Metastasis is __
__a multistep process in which tumor cells travel to distant sites via lymphatic and hematogenous routes.
• The general and drug-specific adverse effects of chemotherapy drugs are classified as__
__acute, delayed, or chronic
o Fatigue is a nearly universal symptom __
__affecting 70% to 100% of patients with cancer.
• Biologic therapy consists of __
__agents that modify the relationship between the host and the tumor by altering the biologic response of the host to the tumor cells
• Tumors can be classified according to__
__anatomic site, histologic grading, and extent of disease (staging).
• Tumors can be classified as__
__benign or malignant.
• Bone marrow depression and fatigue are associated with __
__biologic therapy
• In the anatomic classification of tumors, the tumor is identified by__
__by the tissue of origin, the anatomic site, and the behavior of the tumor (i.e., benign or malignant).
• Cancer cells may display altered cell surface antigens__
__called tumor-associated antigens, as a result of malignant transformation.
• The two major categories of chemotherapeutic drugs are__
__cell cycle phase-nonspecific and cell cycle phase-specific drugs.
Through differentiation__
__cells become capable of performing only specific functions.
• The goal of cancer treatment is __
__cure, control, or palliation.
• Regional treatment with chemotherapy involves the delivery of the drug __
__directly to the tumor site.
o Cell cycle phase-specific drugs exert their most significant effects __
__during specific phases of the cell cycle.
o The clinical staging classification system uses __
__five stages, from in situ to metastasis.
• The process by which cancer cells evade the immune system is termed __
__immunologic escape.
o Progression, the final stage, is characterized by __
__increased growth rate of the tumor, increased invasiveness, and spread of the cancer to a distant site (metastasis).
• The stages of cancer include__
__initiation, promotion, and progression.
• Targeted therapy__
__interferes with cancer growth by targeting specific cellular receptors and pathways that are important in tumor growth.
The most common methods of regional chemotherapy are__
__intraarterial, intraperitoneal, intravesical bladder, and intrathecal or intraventricular.
The most common delivery of chemotherapy is__
__intravenous, through central vascular access devices, peripherally inserted central venous catheters, or implanted infusion ports. The use of these means reduces the risk of extravasation.
Capillary leak syndrome __
__is when the number and size of the pores in the capillaries increases, causing leaking into tissue.
• Chemotherapy and radiation can produce __
__long-term sequelae months to years after the cessation of therapy that can affect every body system.
The most frequent sites of metastasis are __
__lungs, bone, brain, liver, and adrenal glands.
o The first stage, initiation, is a __
__mutation in the cell's genetic structure resulting from an inherited mutation, an error that occurs during DNA replication, or following exposure to a chemical, radiation, or viral agent.
Protooncogenes are__
__normal cellular genes that are important regulators of normal cellular processes that keep them in their mature, functioning state.
o Cell cycle phase-nonspecific drugs have their effect__
__on the cells during all phases of the cell cycle.
o Myelosuppression is __
__one of the most common effects of chemotherapy and, to a lesser extent, with radiation. It can result in life-threatening effects, including infection and hemorrhage.
cancer cells divide indiscriminately and haphazardly and sometimes__
__produce more than two cells at the time of mitosis
cancer cells divide indiscriminately and haphazardly and sometimes__
__produce more than two cells at the time of mitosis.
o With palliation__
__relief or control of symptoms and the maintenance of a satisfactory quality of life are the primary goals rather than cure or control of the disease process.
Immunologic surveillance is __
__response of the immune system to tumor-associated antigens.
• The cancer survivor is at risk for developing __
__secondary malignancies, such as leukemia, angiosarcoma, and skin cancer.
• Modalities for cancer treatment with all three goals include __
__surgery, chemotherapy, radiation therapy, and biologic and targeted therapy.
o Control is the goal of the treatment plan for many cancers __
__that cannot be completely eradicated but are responsive to anticancer therapies and can be maintained for long periods with therapy.
• Chemotherapy-induced side effects are the result of __
__the destruction of normal cells, especially those that are rapidly proliferating such as those in the bone marrow, lining of the gastrointestinal system, and the integumentary system (skin, hair, and nails).
• Since cancer cells arise from normal human cells__
__the immune response that is mounted against cancer cells may be inadequate to effectively eradicate them.
• Brachytherapy, or internal radiation treatment, consists of __
__the implantation or insertion of radioactive materials directly into the tumor (interstitial) or in close proximity adjacent to the tumor (intracavitary or intraluminal).
• Teletherapy or external beam radiation is __
__the most common form of radiation treatment delivery. With this technique, the patient is exposed to radiation from a megavoltage treatment machine.
o The intestinal mucosa is one of__
__the most sensitive tissues to radiation and chemotherapy. These injuries result in diarrhea, mucositis, anorexia, nausea, and vomiting.
o The biopsy procedure is __
__the only definitive means of diagnosing cancer.
o Promotion, the second stage in the development of cancer, is characterized by __
__the reversible proliferation of the altered cells.
When protooncogenes are mutated__
__they can begin to function as oncogenes (tumor-inducing genes).
o The TNM classification system uses 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).
o Malignant neoplasms range from__
__well-differentiated to undifferentiated.
o Benign neoplasms are __
__well-differentiated.
Medicare Hospice Benefit:
a Medicare entitlement that provides for comprehensive, interdisciplinary palliative care and services for eligible beneficiaries who have a terminal illness and a life expectancy of less than 6 months
Benign
a ______ tumor is an abnormal growth of tissue, usually harmless; problems if in an area that interferes with organs normal function encapsulated--stay in that area and do not invade surrounding tissue
Carcinogenic
a _______ produces or increases chances of developing cancer
Differentiated
a cell that looks different then the parent cell.
hospice
a coordinated program of interdisciplinary care and services provided primarily in the home to terminally ill patients and their families
biopsy
a diagnostic procedure to remove a small sample of tissue to be examined microscopically to detect malignant cells
cancer
a disease process whereby cells proliferate abnormally, ignoring growth-regulating signals in the environment surrounding the cells
Cancer
a malignant neoplasm.
Curative
a medicine, surgery or therapy that cures disease or relieves pain
Stomatitis
a mouth inflammation due to destruction of normal cells of the oral cavity
P-glycoprotein
a multi-drug resistance protein
Targeted Therapy: Monoclonal Antibodies: Side effects of targeted therapy
a. allergic reactions b. rare risk of anaphalaxis associated with the administration of MoAbs A risk of anaphylaxis so when being administered, make precautions for anaphylactic shock.
Types of bone marrow transplants
a. allogeneic b. autologus c. syngeneic
Primary prevention strategies
a. avoidance of known or potential carcinogens b. modification of associated factors c. removal of "at risk" tissues d. chemo-prevention
Types of environmental, or external, carcinogens:
a. chemical carcinogens b. physical carcinogenesis c. viral carcinogenesis
Chemotherapy: Mechanism of action
a. cytotoxic effects b. chemotherapy drugs are classified by the specific types of action they exert in the cancer cell:
Chemotherapy: Treatment issues
a. drug dosage b. drug schedule c. drug administration --intravenous --extravasation ---vesicants ---immediate treatment -----precautions for health care workers
Side effects of biological response modifier therapy
a. inflammatory reactions b. interferon therapy causes peripheral neuropathy c. skin rashes, dryness, itching and peeling d. interferon has been reported to increase depression
cancer treatment: Radiation: Mechanism of action
a. ionizing radiation b. exposure c. dose d. inverse square law
Mechanism of action, cancer surgery may be used for any of the following purposes:
a. prophylaxis b. diagnosis (biopsy) c. cure d. control (cytoreductive surgery) e. palliation f, determination of therapy effectiveness ("second look") g. reconstructive or rehabilitative surgery
cancer: Laboratory Tests: Protein tumor markers
a. prostatic-specific antigen (PSA) b. carcinoembryonic antigen (CEA) V. Classification of Cancer
Secondary prevention strategies
a. screening programs B. Public education related to the prevention and detection of cancer: -goal of public education is to motivate learner to change the pattern of behavior as necessary to achieve and maintain optimal state of health
cancer: Laboratory Tests: liver metastasis:
a.alanine aminotransferase (ALT) b.asparate aminotransferase (AST) c.lactic dehydrogenase (LDH)
normal cells grow in an orderly and well-regulated manner
a.cell cycle -divide when need for new cells, adequate nutrients, adequate space to divide b. mitotic cell division -division occurs in well-recognized pattern, cell cycle -mitotic cell division makes one cell divide into 2 cells, cells are identical to each other and original cell -cell cycle steps are tightly controlled, balance b/w protein promoting (cyclins) cell division and proteins (suppressor gene products) that inhibit
ADRs of imatinib include:
ab pain, N/V/D (short) > fatigue, joint pain, fluid retention, cramps, edema, rash (long)
neutropenia
abnormally low absolute neutrophil count
Imatinib mesylate use:
acute lympocytic leukemia and Ph+ chronic myeloid leukemia
Trastuzuman uses:
adjuvant in breast cancer, metastatic breast cancer with paclitaxel
pheochromocytomas
adrenal gland tumors
Computed tomography (CT)
advance effectiveness of traditional xray by applying computers and mathematics, allows visualization of cross sections of anatomy, reveals subtle diff in tissue density and provide greater accuracy in tumor dx, especially useful in lymph node involvement
Immunotherapy: Biological Response Modifiersa: Nelasta
affects neutrophils by stimulating the production of them in chemo induced neutropenia.
Colony stimulating factor: Enumega:
affects platelets and is indicated for chemo induced thrombocytopenia. This chemo therapy kills WBC so these stimulate the bone marrow to produce them quicker.
progression:
after detectable tumor is formed (1cm) other events must occur: --must develop own blood --metastasis occurs when cancer cells move from the primary location by breaking off from the original group and establishing remote colonies.
Factors on which will help patient cope is
age at the time of the diagnosis, availability of significant others, presence of symptoms
Intrinsic factors
age, sex, race, stress, diet are all examples of ________?
Nitrosoureas (Carbamustine, lomustine, semustine, streptozocine)
alkylate DNA, bioactivate, crosses BBB
Busulfan
alkylates DNA
Cyclophosamide - Class, roll in cell cycle, Key Attribute:
alkylating agent, nitrogen mustard derivative, CCNS * requires metabolic activation by P450
Mechlorethamine - Class, roll in cell cycle, Key Attribute:
alkylating agent, nitrogen mustard; CCNS (some preference for M/G1)
cyclophosphamide/ifosfamide
alkylating agents (interstrand links at Guanine), activated in liver
Bone Marrow Transplantation
allows for the safe use of very high doses of chemotherapy or radiation therapy to patients whose tumors have developed resistance or failed to respond to standard doses of chemotherapy and radiation
Hormonal
alter hormonal environment
graft-versus-host disease (GVHD):
an immune response initiated by T lymphocytes of donor tissue against the recipient's tissues (skin, gastrointestinal tract, liver); an undesirable response
Gray Zone
ancillary tests are used
Daunorubicin HCl - Class, roll in cell cycle, MoA;
antibiotic, anthracycline, CCNS, intercalates and binds DNA
Doxorubin HCl - Class, roll in cell cycle, MoA:
antibiotic, anthracycline, CCNS, intercalates and binds DNA
Methotrexate - Class, roll in cell cycle, MoA:
antimetabolite, folic acid analog, CCS, S phase; inhibits dihydrofolate reductase, blocking conversion of folic acid to tetrahydrofolate
Mercaptopurine - Class, roll in cell cycle, MoA:
antimetabolite, purine analog, inhibits purine interconversion, CCS, blocks purine synthesis in S phase
Flourouracil - Class, roll in cell cycle, MoA:
antimetabolite, pyrimidine analog, CCS - S Phase
Paclitaxel - Class, roll in cell cycle, MoA:
antimicrotuble, inhibits microtubule assembly, blocks cells in G2/M phase
interferons (INFs)
are cell produced proteins that protect non infected cells from viral infection and replication. Cancer related fx of INF include the ability to do the following: -1. slow down tumor cell division. -2. stimulate the growth and activation of NK cells. -3. help cx cells resume a more normal appearance during the changes, revert back to previous normal cell features. -4. they inhibit the expression of onca genes.
Allergic reactions
are issue with monoclonal abs bc They were developed originally in animals therefore they may express some of these animal proteins still. Recently they have removed a vast majority of these animal proteins and the allergic rx are deminished.
protooncogenes
are normal cellular genes that are important regulators of normal cellular processes.
promoters
are substances that enhance growth of initiated cancer cells, may be hormones, drugs, chemicals
determination of therapy effectiveness:
assess dz status in clients that have been tx
Genomic Analysis
assessment of the whole genome to assess it using different techniques
prophylaxis:
at risk tissue or organs removed to prevent cancer development
Liver function test
basal level of liver function
Chemotherapy: dosage
based on size, total body surface area
Cell
basic unit of structure and function in all living things
Colony stimulating factor: Mechanism of action
biological response modifiers for cancer therapy i. interleukins (ILs) Interleukins, they help differientiate the immune system cells by recognizing and destroying irregular or abnormal body cells. 1, 2 & 6 they charge up the immune system (enhance attacks on cx cells by macrophages by NK cells) and by various lymphocytes. ii. interferons (INFs) Interferons are cell produced proteins that protect non infected cells from viral infection and replication. Cancer related fx of INF include the ability to do the following: 1. slow down tumor cell division. 2. stimulate the growth and activation of NK cells. 3. help cx cells resume a more normal appearance during the changes, revert back to previous normal cell features. 4. they inhibit the expression of onca genes. -cancer-related functions of INF include the ability to do the following: b. biological response modifiers for cancer support i. colony-stimulating factors -these factors include more rapid recovery of the bone marrow after suppression by chemotherapy, thus having two benefits: Benefits Biological response modifiers: 1. When bone marrow suppresion is shortened or less severe, clients are at less risk for life threatening infections and anemia. 2. Because these factors allow more rapid bone marrow recovery, clients can rec their chemo on time and may even be able to tolerate higher doses improving outsome of chemotherapy. 3. Client rec interleukins have the potential for generalized and sometimes severe inflammatory reactions. The effects of BRM are limited to the period of the accute drug infusion so problems resolve when treatment is completed. 3. Side effects of biological response modifier therapy a. inflammatory reactions, mild inflammation immediately after rec drug fever, chills, rigors, flu-like general malaise. Fever is treated with tylenol Rigors are managed with demerol. INF therapy can cause peripheral neuropathy. Some of the problems resulting from neuropathy, decreased sensory perceptions, visual disturbances, decreased hearing, unsteady balance, gait, hypostatic HTN, not sure if it's temporary or permanant. Skin rashes, dryness, itching, peeling occur with many types of BRM. These reactions are temporary but can cause much discomfort and distress to client. Use moisturizers (perfume free) to skin, mild soap to clean skin. Important that involved areas are protected from sun. INF has been reported to increase depression in some pts, but not known if higher with client that had preexisting depression. a. inflammatory reactions b. interferon therapy causes peripheral neuropathy c. skin rashes, dryness, itching and peeling d. interferon has been reported to increase depression
dysplasia
bizarre cell growth resulting in cells that differ in size, shape, or arrangement from other cells of the same type of tissue
Vinblastine SE
blasts bone marrow
6-Mercaptopurine MOA
block denovo purine synth, activated by HGPRTase
blood vessel penetration
blood vessels can have large pores that allow tumor cells to enter blood and circulate
What cancers is obesity considered a risk factor
breast, prostate, gallbladder, ovarian and uterine
Screening
breast/testicular self-examination, stool for occult blood, mammography, pap-smears, PSA are all examples of ___________.
targeted therapies:
cancer treatments that seek to minimize the negative effects on healthy tissues by disrupting specific cancer cell functions such as malignant transformation, communication pathways, processes for growth and metastasis, and genetic coding
imaging
cannot tell you if the lesion is primary or metastatic without a histologic or cytological exam using a fine needle aspiration or biopsy
measures the amount of this protein that may appear in the blood of some people who have certain kinds of cancers, especially large intestine (colon and rectal) cancer. It may also be present in people with cancer of the pancreas, breast, ovary, or lung.
carcinoembryonic antigen (CEA) test?
Both anthracyclines are particularly:
cardiotoxic
Trastuzumab
cardiotoxic
Chemotherapy: anemia
causes fatigue, cardiac and resp may not maintain adequate oxygenation, low platelets can cause excessive bleeding -decreased numbers of circulating erythrocytes (anemia) and platelets (thrombocytopenia) also result from bone marrow suppression caused by some chemotherapy drugs -drug therapy −complementary and alternative therapies −protection from infection
promotion:
cell can become cancer cell if cellular chgs during initiation are enhanced by promotion,
CCNS:
cell cycle non specific
CCS:
cell cycle specific
normal cells have limited cell division
cell must perform in predictable manner for homeostasis: -divide, limited cell division -mitosis for: -- development of normal tissue --replace lost or damaged normal tissue --divide only when body conditions and nutrition are just right
Histologic Analysis Classification: Grade II:
cells more abnormal, moderately differentiated
anaplasia
cells that lack normal cellular characteristics and differ in shape and organization with respect to their cells of origin; usually, anaplastic cells are malignant
Histologic Analysis Classification: Grade III:
cells very abnormal, poorly differentiated
necrosis
changes that follow cell death in living tissue
Chemotherapy: vesicants:
chemical cause tissue damage on direct contact (pain infection tissue loss)
vesicants
chemicals causing tissue damage upon direct contact.
Chemotherapy: N/V:
chemo drugs are emetogenic, give Zofran, dehydration and electrolyte imbalances -comp: acupressure, music, guided imagery, muscle relaxation
invasion:
circulate thru blood and enter tissues at remote sites, secondary tumors
tobacco and alcohol
co-carcinogens
Direct Visualization: sigmoidoscopy:
colon with flexible, fiber optic scope
Therapies for Cancer Treatment: Targeted Therapy
combine biological therapy with gene therapy These therapies take advantage of one or more differences in a cx cell. Agents used are either Abs that target particular cellular element of cx cells or antisense drugs that work at gene level.
carcinoma in situ:
commonly used term, lesion w/all histological features of cancer w/o invasion, left untx will invade
interdisciplinary collaboration:
communication and cooperation among members of diverse health care disciplines jointly to plan, implement, and evaluate care
infections. The immunosuppression leading to an inability to fight infection is the priority to prevent complications leading to death.
complications associates with bone marrow suppression?
palliative care:
comprehensive care for patients whose disease is not responsive to cure; care also extends to patients' families
control
containment of the growth of cancer cells
metaplasia
conversion of one type of mature cell into another type of cell
Cytarabine - Class, roll in cell cycle, MoA:
converted to cytarabine triphosphate which inhibits DNA polyemerase, CCS - S phase
Cisplatin, carboplatin
cross link DNA
Determining cellular cohesion is ____ type of diagnosis.
cytologic
Determining cellularity of a specimen is ____ type of diagnosis.
cytologic
Determining hyperchromasia of a specimen is _____ type of diagnosis
cytologic
Determining pleomorphism of a specimen is ____ type of diagnosis.
cytologic
Antimetabolites
damage cell in S phase
Chemotherapy: antitumor abx:
damage cells DNA, interrupt DNA or RNA synthesis
control:
debulks by removing part of tumor, slows growth
thrombocytopenia
decrease in the number of circulating platelets; associated with the potential for bleeding
Antineoplastics
decrease the number of malignant cells or reduce the size of tumor
brachytherapy
delivery of radiation therapy through internal implants
cancer treatment: Radiation: type used
depends on health, site, size, and location of tumor to be radiated
Chemotherapy: immed tx:
depends on specific drug, cold compresses, warm conpresses, antidotes may be injected at site
Antimetabolites
derivatives of purines and pyrimidines
Stool Examination
detect hidden blood in the stools
Bone Scanning
detect metastatic tumors
Computed Tomography
detect the presence of any abnormal lesions
Magnetic resonance imaging
diagnosis of intracranial and spinal lesions and of cardiovascular and soft tissue abnormalities
Process of Metastasis
direct spread of tumor cells by diffusion to other body cavities, circulation by way of blood and lymphatic channels, transplantation or direct transport of tumor cells
cancer treatment: Radiation: teletherapy:
distant tx, radiation source is external to client, b/c source is external the client is not radioactive and poses no hazard to anyone, aka external beam radiation, exact location tumor is determined for greater accuracy
morphology
distinct and recognizable appearance, size, and shape
Self-control methods of pain management
distraction, massage, relaxation, biofeedback, hypnosis, imagery
cell cycle
divide when need for new cells, adequate nutrients, adequate space to divide
cold stop
does not go into effected area.
Two available treatment options for anemia related to chemotherapy
drugs like epogen or a transfusion
xerostomia:
dry oral cavity resulting from decreased function of salivary glands
atypical hyperplasia
dysplasia is often called:
Antimetabolites
either purine antagonists, folic acid antagonists, or pyrimidine antagonists
cancer: Laboratory Tests: Liver:
elevated ALT, AST, LDN
Unsealed-oral or injected
eliminated via secretions and excreta, shorter half life
Radiation
enables improved targeting so alkylating agents and others work well in combination with radiation therapy.
Gastroentroscopy
endoscope goes through the mouth and esophagus to look in the stomach and intestines
Alopecia is a concern with many chemotherapeutics, notably:
etoposide and paclitaxel
Grading
evaluates amt of differentiation, maturity, and estimates rate of growth based on mitotic rate -most differentiated are least malignant (grade I) -least differentiated are most malignant (grade IV)
When to get a medical examination
every 3 years
Part of a physical exam
examine uterus, skin, mouth, breasts, lungs, rectum, prostate, and thyroid
Excisional biopsy
excision of the whole organ occurs
teletherapy
external beam radiation
Oil red O/PAS
fat vs. glycogen
oncology
field or study of cancer
Imatinib SE
fluid retention
Paracentesis
fluids accumulating in the abdominal cavity
Thoracocentesis
fluids accumulating in the thorax
Leuocovorin:
folinic acid; protects normal cells from methotrexate
Radiation: divided dose administration
fractionation
Bleomycin
free radicals break DNA strands
Doxorubicin, Daunorubicin
free radicals, intercalates into DNA, strand breaks
Genetics
genetic markers for certain types of cancer such as Colon, breast cancer or leukemia.
cancer treatment: Radiation: divided dose:
give b/c cells take it differently, small doses given qdaily for a set period of time which allows greater destruction of cancer cells and minimizes harm on normal cells
hot spot
goes into the effected area
alopecia
hair loss
Chemotherapy: alopecia:
hair loss, whole body, temporary, regrowth about 1 month after tx, no tx to prevent, pt may nd to have a scarf or wig
Vinca Alkaloids
hard to synthesize, so they are usually isolated from plants
euploid
have 23 pairs of chromosomes
malignant
having cells or processes that are characteristic of cancer
Determining benign vs malignant is _____ type of diagnostic.
histologic
Determining the degree of differentiation is ____ type of diagnostic
histologic
Determining tumor size and type is _____ type of diagnostic
histologic
Incisional biopsy is ___ type of diagnostic
histologic
Tamoxifen - Class, roll in cell cycle, MoA:
hormone (antiestrogen) CCS for G1 phase, nonsteroidal antiestrogen; competitive inhibitor of estrogen receptors
Hormonal manipulation
hormones are naturally occuring chemicals secreted by endocrine glands pickup by capillaries. Some hormones make hormone sensitive tumors grow more rapidly (in general). Some tumors require specific hormones to divide and rationale for treatment is decreasing amt of these hormones to tumors can slow cx growth rate.
ADRs of tamoxifen include:
hot flashes, N/V visual disturbances (short) > hyperCa+ and vaginal bleeding (long)
Tamoxifen SE
hot flashes, risk of endometrial cancer
Differentiation
how the tumor looks like the parent's tissue from which it has arisen
a. clinical staging
i. stage 0 ii. stage I iii. stage II iv. stage III v. stage IV
surgical staging
i. tumor size (T) ii. degree of regional spread to the lymph nodes (N) iii metastasis (M) c. surgical staging d. carcinoma in situ
grading
identification of the type of tissue from which the tumor originated and the degree to which the tumor cells retain the functional and structural characteristics of the tissue of origin
Histologic Analysis Classification: Grade IV:
immature, primitive, undifferentiated, cell of origin difficult to determine
Immunohistochemistry
important for prognosis of a tumor
Immunohistochemistry
important in determining the histogenesis of malignant neoplasms and to recognize the different kinds of lymphoma and leukemia
Immunohistochemistry
important in the diagnosis of lymphoid tissue
palliation:
improve quality of life during survival time
physical carcinogenesis: chronic irritation:
incidence of skin cancer is higher in people w/burn scars, chronically irritated tissues undergo frequent cell division and are at increased risk for spontaneous DNA mutation
Three types of biopsy
incisional, excisional and needle aspiration
hyperplasia
increase in the number of cells of a tissue; most often associated with periods of rapid body growth
Serum Calcitonin
increased
reconstructive or rehabilitative:
increases fxn, enhances appearance or both
calcitonin
indicative of a thyroid C-cell tumor known as a medullary carcinoma of the thyroid
mourning:
individual, family, group, and cultural expressions of grief and associated behaviors
stomatitis
inflammation of the oral tissues, often associated with some chemotherapeutic agents
Immunotherapy: Biological Response Modifiersa: cytokines
inhance the immune system. Cytokines and other BOMs work as a cx treatment by stimulating the immune system to recognize cx cells and take actions to eliminate or destroy them. some of them are useful as a supporting role. Other BOMs such as colony stimulating factors stimulate faster recovery of bone marrow function after chemo/treatment induced bone suppression. Some of the colony stimulating factors
Cytarabine
inhib DNA pol
hydroxyurea
inhib Ribonucleotide reductase Rx: melanoma, CML, sickle cell (increase HbF)
Vinca Alkaloids
inhibit cell division
Antitumor Antibiotics
inhibits DNA and RNA synthesis
Chemotherapy: misc:
inhibits important enzyme systems nded for cell division, some compete for important substances
Dosimeter badge
instrument used to measure amount and type of radiation
inverse square law:
intensity of radation decreases w/distance from source -2ft from source is only ¼ received at a distance of 1ft
Dactinomycin
intercalates into DNA, for childhood tumors (Wilm's, Ewing's, rhabdomyosarcoma), SE: myelosuppress
Alkylating
interfere with DNA replication
Chemotherapy: alkylating agents:
interrupts ability of proper binding of DNA and RNA needed for division
Magnetic resonance imaging (MRI)
involves computerized mathematical technology, pt placed in strong magnetic field, radio waves directed at pt, signals are transmitted based on tissue characteristics that are analyzed and projected by computer, PET scans and SPECT create visual images by measuring electrical impulses from body structures
physical carcinogenesis: radiation:
ionizing and UV; ionizing radiation is found in rocks and soil, xrays; UV is type of solar radiation, tanning beds, UV do not penetrate as deeply as other, but can cause irritation -ionizing -ultraviolet (UV)
initiation:
irreversible event that can lead to cancer development provided does not interfere w/cell's ability to divide
cancer
is a group of more than 200 diseases characterized by uncontrolled and unregulated growth of cells.
TNM Classification System
is a standardization of the clinical staging of cancer used to determine the extent of the disease process of cancer
cancer treatment: Radiation: optimal dose of radiation
is one that can kill cancer cells and provide acceptable level of damage to normal cells
needle Aspiration
is the aspiration of fluid or tissue by means of a needle
Incisional Biopsy
is the removal of a portion of tissue for examination
Immunotherapy: Biological Response Modifiersa: Neupogen
it affects neutrophils by stimulating the production of them and is indicated in chemo induced neutropenis.
micro-arrays
it allows for individualized medicine
Her2/neu staining
it has a good prognosis because it will react with herceptin
B-HCG
it is for the diagnosis of germ cell tumors as they can be out of the testes such as the mediastinum or elsewhere
Mercaptopurine
it was one of the first cases where there was a pharmacogenetic disease associated with toxicity
extravasation
leakage of medication from the veins into the subcutaneous tissues
X-ray imaging
least expensive, least invasive, method of choice (breast, lung, bone) to identify chgs, does not reveal lung tumors until size is threat to pt
Cytarabine SE
leuko-, thrombocytopenia, megaloblastic anemia
Dangers of Leukopenia
life-threatening infections
Herceptin
likely to work in tissues with that express ErbB-2
Laparoscopy
look at the abdominal cavity
Bronchoscopy
look at the bronchial tree
Part of a physical exam
look for lumps, nodules, and ulcers
Sigmoidoscopy
look in the rectum and sigmoid
Lose some or all differentiated functions
lose appearance of parent cell
aneuploid:
lose or gain chromosomes, can have more or less than 23 pairs
Alopecia
loss of hair
Tamoxifen - Use:
lowers blood cholesterol, slows bone loss, approved for extrogen-receptor positive invasive breast cancers, adjunctive therapy, prevention of breast cancer in men
nadir
lowest point of white blood cell depression after therapy that has toxic effects on the bone marrow
What is the leading cause of cancer related to death
lung cancer
Cancer
malignant neoplasm
6-Mercaptopurine SE
marrow, GI, liver, metabolized by xanthine oxidase (toxic w/ allopurinol)
Hormonal manipulation: Side effects of hormone therapy
masculinizing effects in women taking androgens and antiestrogen receptor drugs Masculinizing affects in women taking androgens and also anti-estrogen receptor drugs. Chest and facial hair breast strink Heavy irregular menses Fluid retention Breast tenderness
cancer treatment: Radiation: brachytherapy:
method provides high does in tumor tissue and limited dose in surrounding tissue, same tissue effects as teletherapy, uses radioactive isotopes in solid form or w/in body fluids, radiation source is w/in client, client emits radiation for a period of time and is hazard to others.
Side effects of biological response modifier therapy: inflammatory reactions
mild inflammation immediately after rec drug fever, chills, rigors, flu-like general malaise. Fever is treated with tylenol Rigors are managed with demerol.
Miscellaneous Antineoplastic
mitotic inhibitor
Special interventions for the patient with neutropenia
monitor for fever, take VS every 4 hours. Good handwashing, avoid invasive procedures
Trastuzumab - Class, roll in cell cycle, MoA:
monoclonal antibody, binds humanized IgG1 monoclonal antibodies atHER-2 domain downregulating activity; CSS G1 arrest
Cancer development with aging
more cases, different types, early signs might be misdiagnosed, treatment
Opiods used to manage pain with cancer
morphine, hydromorphone, fentanyl and methadone
Chemotherapy: administration:
most IV, damaging to tissues
Chemotherapy: precautions:
most absorbed thru skin and mucus membranes, risk for absorbing them, strict guideline
Side effect of bone marrow suppression =
most if not all agents
the rate of production
most important aspect of why tissue starts looking different
Chemotherapy: estravasation:
movement of IV needle so that drug leaks into surrounding tissues (prevention)
cyclophosphamide/ifosfamide SE
myelosuppression, hemorrhagic cystitis (prevent w/ mesna)
Chemotherapy: topoisomerase inhi:
needed for DNA synthesis and cell division, prevents DNA from being properly replicated
Cisplatin, carboplatin SE
nephrotoxic, acoustic nerve damage
Vincristine SE
neurotoxic (peripheral neuropathy, areflexia), paralytic ileus
adhere tightly together
normal cells ____________ make proteins that protrude from cell surface, allowing binding
Perform specific differentiated functions
normal cells ______________ each has at least 1: ex. RBC make Hgb to carry O2
Are non-migratory
normal cells are _____________ do not wander from one tissue to another (except RBC, WBC)
small nuclear-cytoplasmic ratio
normal cells have_______________________ nucleus is small compared to rest of cell
Side effects of biological response modifier therapy: increase depression
not known if higher with client that had preexisting depression.
cancer cells have a large nuclear-cytoplasmic ratio
nucleus is larger
Chemotherapy: Side effects of chemotherapy
nursing care of clients undergoing chemotherapy: a. alopecia b. nausea and vomiting c. mucositis d. bone marrow suppression
bone marrow transplants: harvest procedures: peripheral stem cell transplants
obtained from peripheral blood in outpt procedure -use cell separator equipment that separates stem cells from blood circulating thru machine -machine returns remaining blood components to donor -takes 2-4 hours -often takes more than one procedure to obtain enough cells -fewer stem cells in blood than marrow -purging of bone marrow to remove cancer cells -autologous stem cells are tx to remove undetected cancer cells -many different pharmacologic, immunologic, physical, and chemical agents can be used
Side effects of biological response modifier therapy: Skin rashes, dryness, itching, peeling
occur with many types of BRM. These reactions are temporary but can cause much discomfort and distress to client. Use moisturizers (perfume free) to skin, mild soap to clean skin. Important that involved areas are protected from sun. I
graft-versus-host disease
occurs when T lymphocytes from donated marrow (graft) recognize the recipient (host) as foreign and attack organs such as skin, liver, and GI tract --occurrence and severity of posttransplant complications are also dependent on drugs comprising the pts particular conditioning regimen
metastasis
occurs when cancer cells move from the primary location by breaking off from the original group and establishing remote colonies. It occurs through many steps: -i. extension into surrounding tissues -ii. blood vessel penetration -iii. release of tumor cells -iv. invasion -v. local seeding -vi. blood-borne metastasis -vii. lymphatic spread
feminine manifestations
often appear in men who take estrogen, progestins, or antiandrogen receptor drugs Feminine manifestations appear in men who take estogens, progesterin and anti-androgen receptor drugs: Facial hair thins, dissappears. Body fat redistributed Gynocomastia Testicular atropy penile atrophy
Tumor lysis syndrome
oncologic emergency that occurs with rapid lysis of malignant cells
Incisional biopsy
organ is cut open and a lump is taken out
primary tumor:
original tumor, identified by tissue it came from (parent tissue)
bereavement
period during which mourning for a loss takes place
spirituality
personal belief systems that focus on a search for meaning and purpose in life, intangible elements that impart meaning and vitality to life, and a connectedness to a higher or transcendent dimension
cytotoxic
pertaining to poisoning of cells
Chemical Agents
pesticides, cleaning products, petroflurocarbons, asbestos, smoking.
early dx
physical assessment cannot detect cancer b4 risk for metastasis, important in _________.
Chemotherapy: antimitotic agents:
plant sources, interrupt mitosis and cannot continue to divide
Cisplatin - Class, roll in cell cycle, Key Point:
platinum compound, CCNS, *bialkylation of DNA
internal stressers
pneumonia, getting married, school are all examples of ________.
Methotrexate - Key Attributes:
poor CNS penetration, protein bound, excreted in urine
autolysis
postmortem dissolution and disintegration by enzymes
Immunohistochemistry
predictive for therapeutic response
P-glycoprotein
predictive of a tumor which will respond poorly to drug therapy
staging
process of determining the size and spread, or metastasis, of a tumor
carcinogenesis
process of transforming normal cells into malignant cells
apoptosis
programmed cell death
apoptosis
programmed cell death that occurs normally in developing and adult tissues
apoptosis
programmed cell death, when DNA is bad, to ensure each organ has adequate # of cells at fxn peak
terminal illness:
progressive, irreversible illness that despite cure-focused medical treatment will result in the patient's death
cure
prolonged survival and disappearance of all evidence of disease so that the patient has the same life expectancy as anyone else in his or her age group
tumor-specific antigen (TSA):
protein on the membrane of cancer cells that distinguishes the malignant cell from a benign cell of the same tissue type
diagnosis:
provides proof of cancer, all or part of lesion
Busulfan SE
pulmonary fibrosis, hyperpigmentation
Bleomycin SE
pulmonary fibrosis, skin changes?,
How is the risk of Candida infection managed
put on a prophylactic antifungal medication
brachytherapy
radiation source comes into direct, continuous contact with the tumor tissues fora specified period of time.
Physical Agent
radiation, viruses, UV rays
Chemotherapy: bone marrow:
reduces circulating number of leukocytes, erythrocytes, and platelets; decreased neutrophils; decreased erythrocytes and platelets cause hypoxia, fatigue, increased bleeding tendencies, most infections result from overgrowth of own normal flora
Sarcoma
refers to malignant tumors of connective tissues such as muscle or bone
Chemotherapy: schedule:
regular basis, one tx every 3-4 wks for a specific amt of time
lymphatic spread:
related to the number structure, and location of lymphatic nodes and vessels; primary sites rich in lymphatics have earlier spread
release of tumor cells
release of tumor cells b/c they are loosely held together
blood-borne metastasis:
released into blood stream (most common); clumps can become trapped in capillaries and damage wall and allow spread to surrounding tissue
palliation
relief of symptoms associated with cancer
Palliative
relieving or soothing the symptoms of a disease or disorder without effecting a cure by means of surgery.
Potential chemical carcinogens
rubber, chloride, dust from cotton, coal, nickel etc.
Ultrasonography:
safe and non-invasive, measures sound waves as bounce off body structures, gives image of normal anatomy or abnormalities, also used to guide needle biopsies, useful for detecting masses in dense breast tissues
Catecholamines
secreted by pheochromocytomas
extension into surrounding tissues:
secretion of enzymes that open up areas of surrounding tissue; pressure created as tumor increases in size can force cells to invade new territory;
autonomy
self-determination; in the health care context, the right of the individual to make choices about the use and discontinuation of medical treatment
local seeding:
shedding of cancer cells in local area of primary tumor
Utrasonographic tests
show the size, consistency and shape of the structure
External radiation
side effects of _____ peak 3 weeks after onset, subside 2 weeks after TX.
Chemotherapy: antimetabolite
similar to normal metabolites, most cells nd to continue normal cell division, disrupt division by fooling cancer cells
Internal radation
small amount of radiation directly with tumor tissue.
Chemotherapy: mucositis:
sores in mucous membranes or entire GI tract, stomatitis, painful, ulcerations, intereferes w/eating, frequent assessments and mouth care, rinse w/h20 or saline not mouthwash w/alcohol, swish and swallow preparations
metastasis
spread of cancer cells from the primary tumor to distant sites
tumor markers
stage tumors will tell us what to do for interventions, also mortality.
vesicant
substance that can cause tissue necrosis and damage, particularly when extravasated
Carcinogen
substances known to increase the risk for the development of cancer
cytokines
substances produced by cells of the immune system to enhance production and functioning of components of the immune system
myelosuppression
suppression of the blood cell-producing function of the bone marrow
cure:
surgery alone can result in cure about 27-30% of time if all is removed
Diagnostic
surgery used to tell what type of cancer is present, such as a biopsy.
Needle biopsy
take a core of tissue and you process it onto a slide
Synergy
targeting the same pathway in two different places
stool for occult blood
test used to look for colon cancer.
Excising
the actual removal of a lump.
graft-versus-disease effect:
the donor cell response against the malignancy; a desirable response
Biopsy
the only positive procedure to tell if a mass is cancerous.
grief
the personal feelings that accompany an anticipated or actual loss
Part of a physical exam
the regional lymph nodes and do a chest, abdomen, and neurological assessment
Excisional Biopsy
the removal of teh complete lesion
oncology
the sum of knowledge regarding tumors, a branch of medicine that deal with the study of tumors
-oma
the term _____ means tumor
Palliative
therapy designed to relieve or reduce intensity of uncomfortable symptoms, does not produce a cure
Why is excess bleeding a problem for cancer patients
they are already anemia
interleukins (ILs)
they help differientiate the immune system cells by recognizing and destroying irregular or abnormal body cells. 1, 2 & 6 they charge up the immune system (enhance attacks on cx cells by macrophages by NK cells) and by various lymphocytes.
External radiation
this is the most common and it is done to shrink tumor mass, so it either shrinks completely or makes it small enough to excise.
T131 uptake
thyroid scanning test for thyroid cancer
latency period:
time b/w initiation and development of overt tumor can range from months to years
Renal function tests
to ensure the body can handle cytotoxic drugs
chest x-ray
to look for metastasis in the lungs, abdomen, or bones
Bone marrow
to see the hematopoietic elements: to see if they are mature, immature, or suppressed
chemical carcinogens
tobacco and alcohol appear to be mildly carcinogenic, however, can act as co- carcinogens and enhance activity (30%)
What causes pain in the patient with cancer
tumor obstruction, pressure on the nerves, invasion of bone, phantom sensation
Imatinib mesylate - Class, roll in cell cycle, MoA:
tyrosine kinase inhibitor, inhibits Bcr-Abl tyrosine kinase, CCS at G1 phase
neoplasia
uncontrolled cell growth that follows no physiologic demand
Malignant
uncontrolled rapid growth, invade surrounding tissue do not look or behave like normal cells nucleus is large and irregular. (abnormal cell membrane--less cohesive)
What populations are at higher risk for cancers related to chemical exposure
urban areas and people who work with dyes, rubber and leather
Six guidelines for use in pain relief
use a variety of pain relief measures, use pain relief measures before the patient's pain becomes severe, determine the patient's ability or willingness to participate actively in the use of pain relief measures, rely on patient behavior to indicate pain severity, encourage the patient to try a pain relief measure at least two times before abandoning it, include pain relief measures that the patient believes will be helpful
biologic response modifier (BRM) therapy:
use of agents or treatment methods that can alter the immunologic relationship between the tumor and the host to provide a therapeutic benefit
radiation therapy:
use of ionizing radiation to interrupt the growth of malignant cells
chemotherapy
use of medications to kill tumor cells by interfering with cellular functions and reproduction
assisted suicide:
use of pharmacologic agents to hasten the death of a terminally ill patient; illegal in most states
palliative sedation:
use of pharmacologic agents, at the request of the terminally ill patient, to induce sedation when symptoms have not responded to other management measures. The purpose is not to hasten the patient's death but to relieve intractable symptoms.
interventions to reduce the risk associate with thrombocytopenia
use soft toothbrushes, keep mouth clean, avoid intrusions into rectum and use electric shaver
nuclear imaging:
use specific radio isotypes w/special scanners, invasive safe dx method for identifying tumors, used to check for bone or other organ metastasis,
Gleevec
used as a proof of principle in chronic myeloid leukemia
Staging:
used to classify solid tumor and refers to relative size of tumor and extent of dz
Immunohistochemistry
uses antibody-antigen reaction
Immunohistochemistry with a TTF-1
usually expressed in thyroid as well as lung tumors
Ca19
usually in patients with pancreatic cancer
Chemotherapy: combo:
usually successful involves giving more than one specific anti cancer drug in a tx, using more than one drug is more effective, selection based on tumor sensitivity to drug, to reduce immunosuppression combo chemo avoids using drugs w/similar nadir Nadir-bone marrow activity and WBC are at lowest level after chemo, occurs at different times for different drugs i. antimetabolites ii. antitumor antibiotics iii. alkylating agents iv. antimitotic agents v. topoisomerase inhibitors vi. miscellaneous chemotherapeutic agents vii. combination chemotherapy
Immunohistochemistry
very specific and sensitive test
Direct Visualization: bronchoscopy:
viewing tracheal bronchial tree -suction, cauterize, treatment can be done as well
Direct Visualization: endoscopy:
viewing upper gi tract
Direct Visualization:cystoscopy:
viewing urethra and bladder
Local irritation is noted on injection of:
vincristine
Both these agents are notably nephrotoxic:
vincristine and vinblastine
Endoscopy
visualize an internal structure
anaplastic morphology
w/o shape or differentiation -usually small and round, esp the more malignant
The reversible replacement of one cell type by another is response to a particular stress or stimuli
what is metaplasia?
metastasizes
when a caner cell ________ it can travel to other parts of the body where it can establish another colony.
Crosslinking
when one of the chlorides forms a complex via nucleophilic attack of the N7 guanine residue and alkylates it
lymph system
which system does cancer commonly travel through.
Anaplasia
without form and is an irreversible change in which the structures of adult cells regress to more primitive levels
DVT
women receiving estrogens or progestins Male and female clients who take estrogen or progestins are at incressed risk for_______.
micro-arrays
you test for large numbers of biomarkers that allow you to classify and profile tumors to see how they respond to therapy
Infiltrative emergencies: carotid artery rupture: clinical manifestations
−bleeding -can manifest as minor oozing - or spurting blood in the case of a blowout of the artery
