cancer

Peripherally Inserted Central Venous Catheter

(PICC)- Peripherally inserted central catheters (PICCs) are central venous catheters inserted into a vein in the arm rather than a vein in the neck or chest. They are single- or multiple-lumen, nontunneled catheters that are up to 60 cm in length with gauges ranging from 24 to 16. PICC lines are inserted at or just above the antecubital fossa (usually cephalic or basilic vein) and advanced to a position with the tip ending in the distal one third of the superior vena cava. They are intended for patients who need vascular access for 1 week to 6 months but can be in place for longer periods of time.

Tumor associated antigen

(TAA) Cancer cells may display altered cell surface antigens as a result of malignant transformation. These antigens are termed tumor-associated antigens. It is believed that one of the functions of the immune system is to respond to TAA.

Doubling time

- The time required for a tumor mass to double in size. Lewis pg 263 cellular differentiation -normally an orderly process that progresses from a state of immaturity to a state of maturity in the cell.

Pyramid affect

A common misconception regarding the characteristics of cancer cells is that the rate of proliferation is more rapid than that of any normal body cell. In most situations, cancer cells proliferate at the same rate as the normal cells of the tissue from which they originate. The difference is that proliferation of the cancer cells is indiscriminate and continuous. In this way, with each cell division creating two or more offspring cells, there is continuous growth of a tumor mass: 1 ÷ 2 ÷ 4 ÷ 8 ÷ 16 and so on.

Intensity modulated radiotherapy

A specific type of radiation delivery that keeps the dosage within boundaries as to not damage surrounding healthy tissues. This spares critical structures: spinal cord, small bowel, carotid arteries, parotid gland, optic chiasm and other important structures as much as possible.

Low-dose rate

A type of brachytherapy, where continuous therapy over several hours or days. Common for: head and neck, lung, breast and gynecologic malignancies.

Acute toxicity

Acute toxicity occurs during and immediately after drug administration and includes anaphylactic and hypersensitivity reactions, extravasation or a flare reaction, anticipatory nausea and vomiting, and cardiac dysrhythmias. Lewis pg 277 delayed effects- are numerous and include delayed nausea and vomiting, mucositis, alopecia, skin rashes, bone marrow suppression, altered bowel function (diarrhea or constipation), and a variety of cumulative neurotoxicities depending on the affected component of the nervous system (i.e., central or peripheral nervous system or cranial nerves).

Administration

Chemotherapy can be administered by multiple routes. The intravenous (IV) route is most common. Advances in drug formulation techniques are driving the reemergence of oral antineoplastic agents. Major concerns associated with the IV administration of antineoplastic drugs include venous access difficulties, device- or catheter-related infection, and extravasation (infiltration of drugs into tissues surrounding the infusion site) causing local tissue damage. Many chemotherapeutic drugs may be either irritants or vesicants. Irritants will damage the intima of the vein, causing phlebitis and sclerosis and limiting future peripheral venous access, but will not cause tissue damage if infiltrated. Vesicants, however, if inadvertently infiltrated into the skin, may cause severe local tissue breakdown and necrosis. It is extremely important to monitor for and promptly recognize symptoms associated with extravasation of a vesicant and to take immediate action if it occurs. The infusion should be immediately turned off, and protocols for drug-specific extravasation procedures should be followed to minimize further tissue damage

Infusion pump

Electronic infusion pumps are necessary when administering small hourly volumes (e.g., less than 20 mL/hr) and for clients who are at risk for volume overload such as neonatal, pediatric, and geriatric clients. In addition, when infusing high volumes of IV fluids (more than 150 mL/hr) to clients with impaired renal clearance, older adults, or pediatric clients, or when infusing drugs or IV fluids that require specific hourly volumes, electronic infusion devices permit accurate infusion. Electronic infusion pumps deliver the infusion via positive pressure. A rate controller used on gravity infusions regulates the infusion, but unlike the electronic pump, is affected by many mechanical and client factors. Recent advances in infusion technology have resulted in a variety of devices available for use to ensure accurate delivery.

Teletherapy

External beam therapy, most common type of radiation. This technique exposes the patient to a megavoltage machine. There is a linear accelerator which generates ionized radiation from electricity and has multiple types of energy: Gamma knife-localized and stereotactic proton therapy. Two-dimensional plan-uses bone landmarks, x-rays and simple beam arrangement (simplest). Three-dimensional plan-uses CT-scan technology, this improves target intensity. Four-dimensional plan-this incorporates physiologic changes like weight loss or tumor shrinkage.

Fractionation

Fractions are total doses to be delivered split into daily amounts (usually 180-200cGy). There are several types of fractionation: Standard fractionation-figuring the maximum dose and spreading it over 5 of the week for 2-8 weeks. Hypofractionated: higher doses given with fewer fractions (less days). Hyperfractionated: lower doses given but may be given multiple times a day. Accelerated fractionation: standard doses delivered twice a day over a shorter time period.

Retreatment staging

If additional treatment is needed, or if treatment fails, retreatment staging is done to determine the extent of the disease process before retreatment it would be "Restaging" classification.

Mucositis

Inflammation of the mucous membranes

Simulation

Is a part of radiation planning. During the simulation, the patient is placed under a X-ray machine to detect the exact location, size and shape of the tumor(s) sometimes the outline is even tattooed onto the skin. They use immobilization devices to ensure no movements will happen, while using fluoroscopy, they can see the tumor against healthy skin so they have an outline of where to stop the radiation so damage is less likely to occur. (Lewis page 278) Neoadjuvant therapy: With or without chemotherapy, given before operation to minimize tumor burden and increase likelihood of removing everything during surgical resection. This makes an inoperable tumor, operable.

Nadir

It is typical for patients to experience the lowest blood cell counts (called the nadir) between 7 and 10 days after initiation of therapy.

cell cycle phase specific chemotherapeutic

Mimic naturally occurring substances, that interfering with enzyme function or DNA synthesis. Primarily act during S phase. Purine and pyrimidine are building blocks of nucleic acids needed for DNA and RNA synethesis.

Protoocogenes

Normal cellular genes that are important regulators of normal cellular processes. They promote growth, whereas tumor suppressor genes, such as the gene for tumor protein p53 suppress growth.

pre-determined stem cell

Normally, most tissues of the human adult contain a population of predetermined, undifferentiated cells known as stem cells. Predetermined means that the stem cells of a particular tissue will ultimately differentiate and become mature, functioning cells of that tissue and only that tissue.

Oncofetal antigens

Oncofetal antigens are a type of tumor antigen. They are found on both the surfaces and the inside of cancer cells, as well as fetal cells. These antigens are an expression of the shift of cancerous cells to a more immature metabolic pathway, an expression usually associated with embryonic or fetal periods of life. The reappearance of fetal antigens in malignant disease is not well understood, but it is believed to occur as a result of the cell regaining its embryonic capability to differentiate into many different cell types.

Regional chemotherapy

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

Maximal tolerated dose

The highest amount of radiation that can be given without damaging surrounding healthy tissues. Doing this, avoids long-term complications and serious toxicity. A specific type of radiation for keeping within the boundaries is the intensity-modulated radiotherapy (IMRT).

Contact inhibition

The inhibition of cell division caused by the close contact of similar cells, a natural brake in the healing of wounds.

Immunologic escape

The process by which cancer cells evade the immune system. Theorized mechanisms by which cancer cells can escape immunologic surveillance include (1) suppression of factors that stimulate T cells to react to cancer cells, (2) weak surface antigens allowing cancer cells to "sneak through" immunologic surveillance, (3) the development of tolerance of the immune system to some tumor antigens, (4) suppression of the immune response by products secreted by cancer cells, (5) the induction of suppressor T cells by the tumor, and (6) blocking antibodies that bind TAAs, thus preventing their recognition by T cells.

Tumor angiogenesis

The process of the formation of blood vessels within the tumor itself is termed tumor angiogenesis and is facilitated by tumor angiogenesis factors produced by the cancer cells. As the tumor grows, it can begin to mechanically invade surrounding tissues, growing into areas of least resistance.

Immunologic surveillance

The response of the immune system to antigens of the malignant cells is termed immunologic surveillance. In this process lymphocytes continually check cell surface antigensand detect and destroy cells with abnormal or altered antigenic determinants. It has been proposed that malignant transformation occurs continuously and that the malignant cells are destroyed by the immune response. Under most circumstances, immune surveillance will prevent these transformed cells from developing into clinically detectable tumors.

Cell generation time

The time from when a cell enters the cell cycle to when the cell divides into two identical cells.

Temporary implant

These are supplied in the form of seeds or ribbons. With a temporary implant is a source of radiation for brachytherapy that may be placed into a special catheter or metal tube that has been inserted into the tumor area. It is left in place until the prescribed dose of radiation has been reached in the calculated number of hours.

Surgical staging

This staging system refers to the extent of the disease as determined by surgical excision, exploration, and/or lymph node sampling.

TNM classification system

Used to determine the anatomic extent of the disease involvement according to three parameters: tumor size and invasiveness (T), presence or absence of regional spread to the lymph nodes (N), and metastasis to distant organ sites (M). TNM staging cannot be applied to all malignancies.

Physiologic late effect

a side effect that occurs more than five years after the diagnosis of cancer because of the related treatments such as chemotherapy, radiation and surgery.

Bradytherapy

"Close" or internal radiation therapy. This consists of an implantation of radioactive materials directly into the tumor or close proximity. This allows minimal exposure to surrounding tissues. Brachytherapy is commonly used in conjunction with external radiation therapy as an extra boost. Examples: temporary: iridium-192 or cesium-137. Permanent: iodine-125, gold-198 or palladium-103. With temporary, they use a catheter to insert into the tumor area and left in place until a certain amount of radiation is reached. (Lewis page 279-280) high dose rate (HDR): A type of brachytherapy, where several doses are administered at varying intervals over a few minutes each time. Common for: head and neck, lung, breast and gynecologic malignancies.

Malignant neoplasm

ability of malignant tumor cells invade and metastasize. Rarely encapsulated, poorly differentiated, capable of metastasizing, possible recurrence, moderate to marked vascularity, infiltrative and expansive, cells are abnormal, become more unlike parent cells.

Central Venous Access Device

access devices that are placed in large blood vessels and permit frequent, continuous or intermittent administration of chemotherapy.

Thrombocytopenia

can result in spontaneous bleeding or major hemorrhage.

Carcinogens

cancer-causing agent capable of producing cellular alterations. Many are detoxified by protective enzymes and are harmlessly excreted.

Vesicant

chemotherapy drug that if inadvertantly infiltrated into the skin, may cause severe local tissue breakdown or necrosis.

Anemia

common in patients undergoing either radiation therapy or chemotherapy and generally has a later onset (about 3 to 4 months after treatment initiation).

Implanted infusion port

consist of a central venous catheter connected to an implanted, single or double subcutaneous injection port. The catheter is placed into the desired vein and the other end is connected to a port that is surgically implanted in a subcutaneous pocket on the chest wall. The port consists of a metal sheath with a self-sealing silicone septum. Drugs are injected through the skin into the port. After being filled, the reservoir slowly releases the medicine into the bloodstream.

biologic therapy/biologic response modifier therapy

consists of agents that modify the relationship between the host and the tumor cells; biologic agents may affect host-tumor responses in 3 ways: (1) they have direct antitumor effects; (2) they restore, augment, or modulate host immune system mechanisms; (3) they have other biologic effects, such as interfering with the cancer cells' ability to metastasize or differentiate

Irritant

damage the intima of th vein, casing phlebitis and scleroris and limiting future peripheral venous attacks, but will not cause tissue damage if infiltrated.

Anorectic effect

dry desquamation- Dry scales of skin, wet desquamation- occurs with the exposure of the dermis and weeping of serous fluid; produces pain, drainage, and increased risk for infection.

Radiopharmaceutical therapy

employs unsealed liquid radioactive sources that are administered orally as a drink, such as iodine-131 for thyroid cancer, or intravenously as with yttrium-90 given for refractory lymphomas or samarium-153 used to treat bone metastases.

Initiating

first stage of cancer development. 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 a viral agent. Has the potential to develop into a clone (group of identical cells) of neoplastic cells. It is irreversible, but not all develop tumor due to apoptosis (programmed cell death). The DNA alteration may remain undetected throughout the lifetime of an individual unless further events stimulate development of a tumor.

Extravasation

infiltration of drugs into tissues surrounding the infusion site.

Targeted therapy

interferes with cancer growth by targeting specific cellular receptors and pathways that are important in tumor growth; work at sites that are on the cell surface, at the intracellular level, or in the extracellular domain; more selective for specific molecular targets than cytotoxic anticancer drugs, thus, are able to kill cancer cells with less damage to normal cells compared with chemotherapy.

Chronic toxicities

involve damage to organs such as the heart, liver, kidneys, and lungs. Chronic toxicities can be either long-term effects that develop during or immediately following treatment and persist or late effects that are absent during treatment and manifest later. Some side effects fall into more than one category.

Radiation therapy

local treatment modality for cancer. Along with surgery, it is one of the oldest methods of cancer treatment, having been first employed by Emil Grubbe (at the time a medical student) to treat an ulcerating breast cancer in 1896 (although the patient responded locally, she died later of metastatic disease). The observation that radiation exposure caused tissue damage led scientists in the early twentieth century to explore the use of radiation to treat tumors. The hypothesized association was that, if radiation exposure resulted in the destruction of highly mitotic skin cells, it could be used in a controlled way to prevent the continued growth of highly mitotic cancer cells. It was not until the 1960s that sophisticated equipment and treatment planning facilitated the delivery of adequate radiation doses to tumors and tolerable doses to normal tissues. Currently, approximately half of all cancer patients receive radiation therapy at some point in the treatment of their disease.

Neutropenia

most common in patients receiving chemotherapy and can place them at serious risk for life-threatening infection and sepsis.

Oncogenes

mutations that alter the expression of protooncogenes can active them to function as oncogenes or tumor-inducing genes.

Latent period

now theorized to comprise both initiation and promotion stages in natural history of cancer. Period of time 1 to 40 years between initial genetic alteration and actual clinical evidence of cancer.

anticipatory N&V

occurring before a new cycle of chemotherapy in response to conditioned stimuli, such as the smells, sights, and sound of the treatment room. It usually occurs after the person has experienced acute nausea and vomiting

Fatigue

persistent subjective sense of tiredness associated with cancer and its treatment that interferes with usual day-to-day functioning.

Promotion

second stage in cancer development. Characterized by the reversible proliferation of the altered cells. With an increase in altered cell population, the likelihood of additional mutations is increased. Distinction between initiation and promotion is activity of promotion is reversible. Key concept is prevention.

Metastasis

spread of the cancer to a distant site. Certain cancers seem to have an affinity for a particular tissue or organ as a site of metastasis (e.g., colon cancer spreads to the liver). Other cancers are unpredictable in their pattern of metastasis (e.g., melanoma). The most frequent sites of metastasis are the lungs, brain, bone, liver, and adrenal glands.

Permanent implant

such as for prostate brachytherapy, involve the insertion of radioactive seeds directly into the tumor tissue, where they remain permanently. As interstitial seeds used for treatment emit low energies with limited tissue penetration, patients are not considered radioactive.

Tumor suppressor genes

suppress growth function to regulate cell growth Lewis 263 benign neoplasms - well differentiated tumors usually encapsulated, metastasis absent, recurrence rare, slight vascularity, expansive mode of growth, cell characteristics are fairly normal, similar to parent cells.

Bone marrow

suppression is related to the life span of the type of blood cell. WBCs (especially neutrophils) are affected most acutely (within 1 to 2 weeks), platelets in 2 to 3 weeks, and red blood cells (RBCs), with a longer life span of 120 days, at a later time.

delayed N&V

that can develop 24 hours and up to a week following treatment

Radiation

the emission and distribution of energy through space or a material medium. Delivery of high-energy beams, when absorbed into tissue, produces ionization of atomic particles. The local energy in ionizing radiation and resultant generation of free radicals act to break the chemical bonds in DNA. Damage to cellular DNA may be either lethal or sublethal. Lethal damage causes sufficient chromosomal disruption that the cell is unable to replicate, or may also impair protein synthesis functions necessary for survival. When sublethal DNA damage occurs, there is potential for repair in between radiation doses, or potential for accumulated damage to occur with repetitive doses, which ultimately leads to cell death. Cancer cells are more likely to be permanently damaged by cumulative doses of radiation because they are less capable of repairing sublethal DNA damage than healthy cells.

Progression

the final stage in the natural history of a cancer. This stage is characterized by increased growth rate of the tumor, increased invasiveness, and metastasis—spread of the cancer to a distant site.

Cell proliferation

time of cell birth to the time of cell death

Chemotherapy

use of chemicals as a systematic therapy for cancer. The goal of therapy is to eliminate or reduce the number of malignant cells in the primary tumor and metastic tumor site. cell cycle phase non-specific chemotherapeutic drugs - damage DNA by causing breaks in the double-stranded helix;if repair does not occur, cells will die immediately (cytocidal) or when they attempt to divide (cytostatic).

Multimodality therapy

when you use two or more of the treatment modalities, which are surgery, radiation therapy, chemotherapy, and biological and targeted therapy. debulking/cytoreductive procedure - this is done when the tumor cannot be completed removed (ie, a tumor attached to a vital organ). When this occurs, as much tumor as possible is removed and the patient is given chemotherapy and/or radiation therapy. This type of surgical procedure can make chemotherapy or radiation therapy more effective since the tumor mass is reduced prior to the initiation of treatment.