Med-Surg (Chapter 15 - Oncology)

Distant metastasis staging

(M) - Mx - Distant metastasis CANNOT be ASSESSED - M0 - No distant metastasis - M1 - Distant metastasis

Regional lymphnode staging

(N) -Nx - Regional lymph nodes CANNOT be ASSESSED -N0 - No regional lymphnode metastasis -N1, N2, N3 - Increasing involvement of regional lymph nodes

Primary tumor staging

(T) -Tx - Primary tumor CANNOT be ASSESSED -T0 - No evidence of primary tumor -Tis - Carcinoma in situ - T1, T2, T3, T4 - INcreasing size and /or local extent of the primary tumor

Etiology (Cause) of Cancer -> Viruses and Bacteria

-11% of cancer is caused by viral infection -after infecting an individual -> DNA viruses insert a part of their own DNA near the infected cell genes -> cell division with viral DNA -> lack of growth control i.e., -Human papillomavirus (HPV) -> cervical and head and neck cancers -Hepatitis B virus (HBV) -> liver cancer -Epstein-Barr virus (EBV) -> Burkitt lymphoma and nasopharyngeal cancer -Bacter pylori -> gastric cancer

Epidemiology

-700,000 new cancer cases in America -600,000 deaths in America -second leading cause of death in the united states (1 in 4 deaths are caused by cancer) -most common in men -> lung, prostate, colorectal -most common in women -> lung, breast, colorectal -death rates highest in African Americans possibly due to comorbidities (CVD) and poverty

Hunter Hospitality house

-A free place to stay for family members of sick clients

Types of Hematopoietic Stem Cell Transplantation (HSCT)

-Allogeneic: From a donor OTHER than the patient -Autologous: From the patient -Synergetic: From and identical twin -Myeloablative: Consists of giving patients HIGH-dose chemotherapy and, occasionally, total-body irradiation -NONMyeloablative: Also called mini-transplants; does NOT completely destroy bone marrow cells

Nursing management with Chemotherapy

-Assess fluids and electrolytes -> AVOID dehydration -Assess cognitive status -> make sure there are no fall hazards or unsafe environments -DECREASE risk for infection and bleeding -> stay away from crowds and the sick. proper hand hygiene. Aseptic IV care. -CLOSE observation of client while they are on chemotherapy -Preventing Nausea and Vomiting - >identify causative factors and select effective antiemetics in collaboration with oncology. Education of patient and family about antiemetic regimen -Managing cognitive changes -> orient client as needed, keep the client SAFE -Managing fatigue -> limit muscle tension, pace clients, make client aware of the signs AND symptoms of fatigue, alert client of physical limitations, organize week and plan rest periods, activity prioritization, Identify environmental situations that can cause fatigue, SHORT FREQUENT rest periods, exercise regularly (yoga)

Hematologic malignancies

-BONE MARROW SUPPRESSION ->>> -Anemia -> fatigue -Leukopenia -> INCREASED risk of infection -thrombocytopenia -> INCREASED risk of bleeding

Precautions

-Bed rest, log roll, private room -Indwelling catheter, low-residue diet, antidiarrheal medications -lead-lined apron /30 minutes a day of nurse exposure to client/ -family/staff -> stay 6 feet away from client -Lead lined shielding walls

Chemotherapy toxicity - Neurologic system

-Chemotherapy-induced neurotoxicity (potentially dose limiting) -> can affect the CNS, PNS and/or the Cranial nerves -Neurotoxicity characterized by metabolic encephalopathy can be caused -With repeated doses of some chemo drugs -> cumulative peripheral nervous system damage with sensory alterations in the feet and hands -can be described as tingling, prickling, or numbness of the extremities; burning or freezing pain; sharp, stabbing, or electric shock-like pain; and EXTREME sensitivity to touch -Severe peripheral neuropathies may lead to a diminished quality of life -> dose reductions, change in chemotherapy regimens, or early cessation of treatment -Oxiplatin -> exposure to cold -> pharyngolaryngeal dysesthesia consisting of lip paresthesia, discomfort or tightness in the back of the throat, inability to breath, and jaw pain -These side effects are reversible but may take many months to resolve or may just persist indefinitely

Hospice

-For an end stage illness (less than 6 months to live) -Service lasts 13 months -interdisciplinary approach (nurse, nurse aids, spiritual, pharmacist, physician, volunteers). -Focuses on quality of life; palliation of symptoms; and provision of physical, psychosocial, and spiritual support for patients and family when cure and control of the disease is NO LONGER POSSIBLE -Often delivered through coordination of specialty services provided by hospitals, home care programs, and the community

Chemotherapy toxicity - Renal system

-Impaired water secretion -SIADH (syndrome of inappropriate secretion of antidiuretic hormone), -DECREASED renal perfusion -interstitial NEPHRITIS -precipitation of end products after cell lysis -INtra cellular contents are released into the circulation -> HYPERkalemia, HYPERphosphatemia, and HYPOcalcemia -Obstructive nephropathy

Internal Radiation (Brachytherapy)

-Implantation of radioisotopes into affected tissue or body cavity by implantation of seeds, rods. -LOCALIZED/highly targeted effect -spares exposure to normal surrounding tissue -CT or MRIs are used to guide placement of needles, rods, seeds, beads, ribbons, or catheters placed in body cavities, lumens within organs, or interstitial tissue compartments (breast, prostate) -may be temporary HDR/LDR (High OR Low dose radiation) or permanent LDR (Low dose radiation)

Biologic response modifiers (BRM)

-Involves the use of NATURALLY OCCURRING or recombinant (reproduced through genetic engineering) agents or treatment methods that can alter the immunologic relationship between the tumor and the patient with cancer

Cancer-related checkup

-Men AND women, age 20+ -ON the occasion of periodic health examination, the cancer-related checkup should include examination of cancers of the: -thyroid -testicles -ovaries -lymph nodes -oral cavity -skin -Health counseling is included about: -tabacco -sun exposure -diet AND nutrition -risk factors -sexual practices -environmental AND occupational exposures

Guaiac-based fecal occult blood test (gFOBT) with at least 50% sensitivity or fecal immunochemical test (FIT) with at least 50% sensitivity (Colorectal Cancer Screening)

-Men and women ages 50+ -annual spontaneous testing - FIT is more patient-friendly than FOBT and has the same sensitivity

Digital Rectal Examination (DRE) and prostate -specific antigen (PSA) test (Prostate Cancer Screening)

-Men, age 50+ -Men who have at least a 10 year life expectancy should have an opportunity to make an informed decision with their PCP after being informed about the potential benefit, risks, and uncertainties associated with prostate cancer screening -SHOULD NOT occur without an informed decision-making process

Toxicity

-Most often in the region being irradiated and may be increased if concomitant chemotherapy is given. Acute toxicity most often begins within 2 weeks of the initiation of treatment occur when normal cells within the treatment area are damaged and cellular death exceeds regeneration. -Body tissues most affected are those that normally proliferate rapidly, such as the skin, epithelial lining of the GI tract, and bone marrow. -Alopecia, radiation dermatitis, stomatitis (inflammation of the oral tissues), decreased salivation and xerostomia (dryness of the mouth), mucositis (inflammation of the lining of the mouth, throat, and GI tract), anorexia, N, V, D, leukopenia, thrombocytopenia, fatigue, malaise. -Late effects (approximately 6 months to years after treatment) may occur in body tissues that were in the field of radiation. These effects are chronic, usually due to permanent damage to tissues, and loss of elasticity. Severe late effects include fibrosis, atrophy, ulceration, and necrosis, and may affect the lungs, heart, CNS, and bladder.

Hyperthermia

-The use of hyperthermia, which is the generation of temperatures greater than physiologic fever range (greater than 106.7F), has been used for many years to destroy cancerous tumor -Most effective when combined with radiation, chemo, or biologic therapy. It is thought to alter cellular membrane permeability when used with chemotherapy, allowing for an increased uptake of the chemotherapeutic agent. -Heat can be produced by using radio waves, ultrasound, microwaves, magnetic waves, hot-water baths, or even hot-wax immersions.

Excisional Biopsy

-Used for small, easily accessible tumors of the skin, upper and lower GI tract, and Upper respiratory tract -removal of tissue surrounding the tumor decreases chance of remaining microscopic malignant cells causing the recurrence of cancer -decreases chance of seeding tumor cells in surrounding tissue -provides entire tissue specimen for the pathologist to stage and grade tumor

Surgery as a Primary treatment

-Used to remove entire tumor or as much as possible (debulking) as well as surrounding tissue including regional lymph nodes

Chemotherapy Toxicity - Reproductive system

-Women may develop problems with ovulation or EARLY menopause -Men may develop permanent azoospermia (absence of spermatozoa) -testicular and ovarian function affected -> possible sterility in men AND women -banking of sperm (for men) and freezing (cryopreservation) of oocytes, embryos, or ovarian tissue may be suggested

Mammography (Breast Cancer Screening)

-Women, ages 40-54 -regular screening mammography starting at age 45 -women 45-54 should be screened annually -Women 55 + -transition to biennial screening or the option to continue annual screening

Primary prevention

-about reducing the risks of disease through health promotion and risk reduction strategies -examples include immunization to reduce the risk of cancer through prevention of infections associated with cancer

Nutrition and physical activity for cancer prevention

-achieve and maintain a healthy weight throughout life -Adopt a physically active lifestyle -Consume a healthy diet, with emphasis on plant sources -Community action

Etiology (Cause) of Cancer -> Chemical agents

-alter the DNA structure -Tobacco smoke -> most lethal chemical carcinogen -> myeloblastic leukemia -Passive (second-hand) smoke -> 20-30% increased risk of cancer -> linked to childhood cancer -smokeless tobacco products -> increased risk of oral, pancreatic, esophageal cancer -many chemical substances in the workplace are carcinogens or co-carcinogens -includes: -aromatic amines -aniline dyes -pesticides -formaldehyde -arsenic -soot -tars -asbestos -benzene -cadmium -chromium compounds -nickle and zinc ores -wood dust -beryllium compounds -polyvinil chloride -betel nut and lime are chewed as stimulants in some cultures

Etiology (Cause) of Cancer -> Hormonal agents

-can be caused by imbalances due to endogenous or exogenous hormonal changes or hormone replacement therapy -Diethylstilbestrol (synthetic form of the female hormone estrogen) -> risk factor for clear cell adenocarcinoma of the LOWER GENITAL TRACT -estrogen after menopause -> INCREASED RISK of ovarian cancer -Combination estrogen and progesterone therapy -> INCREASED RISK of breast cancer -the longer therapy is used -> HIGHER the risk -cancers found in hormonal supplement taking women are usually more advanced (more likely to metastasize) than in females not taking hormonal supplements

Administration of chemotheraputic agents

-can be give in the hospital, outpatient center, or home setting by multiple routes depending on the type of agent, the required dose; and the type, location, and extent of malignant disease being treated -IV, IM, PO, Topical, Intracavity

Protecting Caregivers

-contact with the healthcare team is guided by principles of time, distance, and shielding to minimize exposure of personnel -assign client to appropriate room -post appropriate notices about radiation -staff members wearing dosimeter badges -make sure that NO pregnant staff members are assigned to patients care -PROHIBIT VISITS from children, pregnant women -visits only for 30 minutes a day -6-foot distance from radioactive sources -Patients with seed implants typically are able to return home because exposure is minimal

Low-dose helical CT (LDCT) (Lung Cancer Screening)

-current OR FORMER smoker (quit within the past 15 YEARS), ages 55-74 in good health with at-least a 30 pack-year history -Process of informed AND SHARED decision making with a clinician related to the potential benefits, limitations, and harms related to screening should occur before any screening for lung cancer takes place -smoking cessation counseling is still a high priority

Colonoscopy (Colorectal Cancer Screening)

-every 10 years

CT Colonography (Colorectal Cancer Screening)

-every 5 years

Double-contrast barium enema (DCBE) (Colorectal Cancer Screening)

-every 5 years

Video assisted endoscopic surgery

-example of minimally invasive surgery -uses and endoscope with intense lighting and an attached multichip mini-camera that is inserted into the body through a SMALL incision about 3 cm in length -the camera transmits the image of the involved area to a monitor so that the surgeon can manipulate the instruments to perform the necessary procedure -used for may abdominal and thoracic procedures

Etiology (Cause) of Cancer -> Physical Agents

-exposure to sunlight/ultraviolet light (esp with fair skinned people) -radiation (repeated x-ray procedures or radiation therapy to Tx certain diseases or natural decay causing radiation -> area should be well ventilated) -chronic irritation or inflammation -tobacco carcinogens -industrial chemicals -asbestos

Tertiary prevention

-focuses on monitoring for and preventing recurrence of the primary cancer as well a screening for the development of second malignancies in cancer survivors (such as lymphoma and leukemia)

Extravasation

-inadvertent leakage of medication from a vein in to subcutaneous or surrounding tissue -can cause inflammation; tissue damage; and possible necrosis of the tendons, muscles, nerves, and blood vessels.

Wide/Radical Incision (enbloc dissections)

-include removal of primary tumor, lymph nodes, adjacent involved structures, and surrounding tissues that may be at high risk for tumor spread -may result in disfigurement and altered functioning, necessitating rehabilitation, reconstructive procedures OR both -considered ONLY if the tumor can be removed COMPLETELY and the chances of cure or control are good

Gene therapy

-includes approaches that correct genetic defects, manipulate genes to induce tumor cell destruction, or assist the body's immune defences -Tumor directed therapy - introduction of a therapeutic gene (suicide gene) into tumor cells in an attempt to destroy them. It is difficult to identify the gene that will cause the most damage and those with wide spread disease would need multiple injections to treat EVERY SITE of the disease -Active immunotherapy - administration of genes that will invoke the anti-tumor responses of the immune system -Adoptive immunotherapy is the administration of genetically altered lymphocytes that are programmed to cause tumor destruction

Minimaly invasive surgical techniques

-increasingly replacing traditional surgery Advantages include: -minimization of surgical trauma -DECREASED blood loss -DECREASED incidence of wound infection -DECREASED surgical time -DECREASED anesthesia requirements -DECREASED post-op pain/limited mobility - shorter periods of recovery

Intraluminal HDR brachytherapy

-insertion of catheters or hollow tubes into the lumens of organs so that the radioisotopes can be delivered as close to the tumor bed as possible -used for lesions in the bronchus, esophagus, rectum, or bile duct -Contact or surface application is used for tumors of the eye, such as retinoblastoma in children or ocular melanoma in adults

External radiation

-invisible beam of highly charged protons or gamma rays to penetrate the body and target the tumor with pinpoint accuracy -CT, MRI, and PET scans provide a 3D image allowing the beam to be sent around the tumor at different angles -treat ment enhancements allow the ability to control the intensity and energy levels of different beams from different angles -> IMRT (intensity-modulated radiation therapy) -can be given in fractions OR hyperfractions (twice a day) which shortens the duration of treatment

Secondary prevention

-involves screening and early detection activities that seek to identify precancerous lesions and early-stage cancer in individuals who lack s/sx of cancer. -Early detection can reduce cost, resources, and morbidity rate

Etiology (Cause) of Cancer -> Genetics and Familial factors

-may be due to genetics, shared environments, cultural or lifestyle factors -associated with extra chromosomes, too few chromosomes, or translocated chromosomes -HALLMARKS of hereditary cancer syndrome -cancer in two or more first-degree relatives -onset of cancer in family members younger than 50 -the same type of cancer in several family members -individual family members with MORE THAN ONE TYPE of cancer -rare cancer in one or more family members

Reconstructive surgery

-may follow curative or extensive surgery in an attempt to IMPROVE FUNCTION or obtain a more desirable COSMETIC -depends on the impact that altered function and body image have on quality of life -may be indicated for: -breast -head -neck -and skin cancers

Local excision (surgery)

-outpatient basis -warranted when the mass is SMALL -includes removal of mass and a small margin of normal tissue that is easily accessible

Hematopoietic Stem Cell Transplantation (HSCT)

-peripheral blood cell collection using the process of apheresis -the cells are collected, specially processed, then reinfused into the patient -stem cells can also be collected from the umbilical cord blood harvested from the placenta of newborns at birth

Etiology (Cause) of Cancer -> Lifestyle/ Dietary factors

-poor diet, obesity, insufficient physical activity -tobacco is the largest cause of cancer -Dietary substances: fats, alcohol, salt-cured or smoked meats, nitrates and nitrate containing foods, and red and processed meats

Chemotherapy toxicity - Cardiopulmonary system

-some kinds can be VERY cardio-toxic (esp when dosages reach 300 mg/m2 and 550 mg/m2) -Increased cardiopulmonary toxicity RISK in those over 70, history of a preexisting cardiac disease, hypertension, tobacco use, renal or hepatic dysfunction, and longer survival time -> in these events a lower dose is USUALLY used - cardiac ejection fraction (volume of blood ejected from the heart with each beat) and other signs of HF must be monitored -Some drugs just have a toxic effect on the lung function including: alveolar damage, bronchospasm, pneumonitis, and pulmonary fibrosis -> MONITOR CLIENT CLOSELY -Capillary leak syndrome -> pulmonary edema -> subtle onset of dyspnea and cough may progress rapidly to acute respiratory distress -> respiratory failure -monitor those at risk for capillary leak syndrome CAREFULLY

Cytokines

-substances produced primarily by cells of the immune system to enhance or suppress the production and functioning of components of the immune system -used to treat cancer or the adverse effects of cancer

Monoclonal antibodies

-targeted antibodies for specific malignant cells. -theoretically SPARES normal cells

Diagnostic or staging laparotomy

-the surgical opening of the abdomen to assess malignant abdominal diseases -may be necessary to assess malignancies such s gastric OR colon cancer

Laparoscopic procedures with robotics

-the use of robotics permits the removal of tumors with more precision and dexterity than can be accomplished by laparoscopic surgery alone -used for prostate and GYN (gynecologic) cancers

Interstitial HDR implants

-tx malignancies such as prostate, pancreatic, or breast cancer -may be temporary or permanent depending on the site and radioisotope used -may consist if seeds, needles, wires, strands, or small catheters positioned for local radiation

Chemotherapy toxicity - Fatigue

-unusual, persistent, and subjective sense of tiredness that IS NOT proportional to recent activity and interferes with normal functioning -occurs during treatment and many months after treatment -Health care team works together to achieve non/pharmacologic management of fatigue

Needle biopsy

-used to sample suspicious masses in the breast, thyroid, lung, liver,and kidney -fast, relatively inexpensive, outpatient basis, local anesthetic -surrounding tissues are minimally disturbed -> DECREASED risk for seeding cancer cells -CT, MRI, Ultrasounds are all used to find the suspicious area for the biopsy -Fine needle aspiration (FNA) involves aspirating cells rather than intact tissue -> can only be analyzed by cytological examination (viewing only cells, not tissue) -Core needle biopsy -> when a FNA dosent yield enough material to permit an accurate diagnosis -uses a specially designed needle to obtain a small core of tissue that permits histologic analysis -USUALLY is sufficient enough to permit an accurate diagnosis

Intracavity radioisotopes

-used to tx GYN (gynecologic) cancers -positioned in to specially positioned applicators within the vagina -applicator placement is verified by X-ray -HDR or LDR depending on extent of the disease -LDR requires hospitalization because the patient is treated over several days -HDR intraoperative radiotherapy (IORT) has been used for advanced gynecologic cancer that has spread to the para-aortic area or pelvic wall

Palliative surgery

-when surgical cure is not possible anymore -goals of surgical interventions are to relieve symptoms, make the patient as comfortable as possible, and promote quality of life as DEFINED BY PATIENT AND FAMILY removes symptoms such as: -ulceration -obstruction -hemorrhage -pain -malignant effusions

Incisional Biopsy

-when tumor is too large for removal, a wedge of the tumor tissue is removed for analysis -If the specimen does NOT contain representative tissue and cells, a negative biopsy DOES NOT guarantee the absence of cancer

WHO 3-step ladder approach for managing cancer pain

1. Non-opioid +/- adjuvant -If pain still persists or increases 2. Opioid for mild -to- moderate pain +/- Adjuvant, +/- Non-Opioid -If pain still persists or increases 3. Opioid for moderate to severe pain +/- Adjuvant, +/- Non-Opioid

Tumor marker identification

Analysis of substances found in tumor tissue, blood, or other body fluids that are indicative of cancer cells. -These substances may also be found in some normal body tissues -Breast, colon, lung, ovarian, testicular, prostate cancers

Endometrial Cancer screening

At the TIME OF MENOPAUSE, women at average risk should be informed about risks and symptoms of endometrial cancer and encouraged to report andy unexpected bleeding or spotting to their PCP (primary care provider)

Malignant tumors

CELL -Cells are differentiated and may bear little resemblance to normal cells of the tissue from which they arose MODE OF GROWTH -Grows at the periphery and overcomes contact inhibition to invade and infiltrate surrounding tissues RATE OF GROWTH -The rate of growth is variable and depends on the level of differentiation -the more ANAPLASTIC the tumor, the faster the growth METASTASIS -Gains access to the blood and lymphatic channels and metastasizes to other areas of the body or grows across the body cavities such as the peritoneum GENERAL EFFECTS -often causes generalized effects such as: -anemia -weakness -systemic inflammation -weight loss -CACS (coronary artery calcium scoring) TISSUE DESTRUCTION -often causes EXTENSIVE tissue damage as the tumor outgrows its blood supply or encroaches on blood flow to the area -may also PRODUCE SUBSTANCES that cause cell damage ABILITY TO CAUSE DEATH -Eventually causes death unless growth can be controlled

Benign tumors

CELL -well differentiated cells, resemble normal cells of the tissue from which the tumor originated MODE OF GROWTH -Tumor grows by expansion and does not infiltrate the surrounding tissues, usually encapsulated RATE OF GROWTH -usually slow METASTASIS -does not spread by metastasis GENERAL EFFECTS -Usually a localized phenomenon that does NOT cause generalized effects unless its location interferes with blood flow TISSUE DESTRUCTION -Does not usually cause tissue damage unless its location interferes with blood flow ABILITY TO CAUSE DEATH -Does not usually cause death unless its location interferes with vital functions

Chemotherapy toxicity - Cognitive impairment

Chemo brain -> decline in the information-handling process of attention and concentration, executive function, information processing speed, language, visual-spatial skill, psychomotor ability, and learning ability. -there are MANY factors that contribute to cognitive impairment that are related to the chemotherapy

Endoscopy

Direct visualization of a body cavity or passageway by insertion of an endoscope into a body cavity or opening; allows tissue biopsy, fluid aspiration,and excision of small tumors. - Used for diagnostic AND therapeutic purposes -Bronchial, GI cancers

Ultrasonography (Ultrasound)

High-Frequency sound waves echoing off body tissues are converted electronically into images; used to assess tissues deep within the body -Abdominal and pelvic cancers

Nursing care for Clients with cancer

Maintain tissue integrity -Stomatitis, skin impairment, skin lesions, alopecia -Oral hygiene, mouth rinse, handle skin gently, wig/scarf -dont use mouthwash with alcohol, it dries the mouth. Instead use sodium bicarbonate Promote nutrition -Antiemetic before meal, appetite stimulant, daily weight Relieving pain -Make sure to find out what kind of pain, severity of pain, and location of pain -ATC (around the clock)dosing, WHO 3-step ladder approach, titrate -Adjuvant medications -Improve body image/self esteem -Addressing sexuality (counseling) -Assist in grieving process (5 stages of grief, support group) -Monitor AND manage complications (bleeding, fatigue, increased risk of infection, risk of recurrence

Side effects of Hyperthermia

May include: -burns, fatigue, hypotension, peripheral neuropathies, thrombophlebitis, nausea, vomiting, diarrhea, and electrolyte imbalances -Cardiovascular stress when hyperthermia is being received in a large area or the whole body due to changes in pulse and Blood pressure

Chemotherapy toxicity - Hematopoietic system

Myelosuppression -> -anemia(resulting in fatigue) -leukopenia, neutropenia (resulting in INCREASED risk of infection) -thrombocytopenia (resulting in INCREASED risk of bleeding)

Chemotherapy toxicity - GI system

Nausea, Vomiting, stomatitis

Nursing management With HSCT

PRE-TREATMENT -extensive evaluation before transplant - Nutritional assessments, extensive physical examinations, organ function tests, and psychological evaluations are conducted -Blood work includes assessing past infectious antigen exposure -social support services and financial/insurance resources are also evaluated INTRA-TREATMENT -close monitoring of vitals and O2 saturation and symptom management -Avoidance of infection (neutropenic diet to DECREASE the risk of foodborne infections) POST-TREATMENT -Detecting late effects of therapy after HSCT: infections, restrictive pulmonary abnormalities, and recurrent pneumonias -Provide education, support, and information about resources CARING FOR DONORS -donors may experience mood alterations, decreased self-esteem, guilt, and failure if the transplantation fails -Donors and their families must be educated and supported to reduce anxiety and promote coping

Nursing management

Preoperatively -verbal and written info to patient AND family about surgical procedure -Instruction about prophylactic antibiotic requirements, diet, and bowel preparation -Give the patient and the family time and assist them with processing the information -encourage the patient and the family to be active in decision making -PROVIDE CONSISTENT INFORMATION to patient and family to reduce confusion and anxiety POSToperatively -assessment of patients response to surgery -monitor for complications (infection, bleeding, thrombophlebitis, wound dehiscence, fluid and electrolyte imbalance, and organ dysfunction) DISCHARGE -plans for discharge, follow-up, home care, and subsequent treatment and rehabilitation are initiated as EARLY as possible -Encourage patient and family to use community resources (such as ACS for support and information)

Prophylactic surgery

Removing non-vital tissues or organs that are at increased risk for developing cancer Factors considered when discussing possible prophylactic surgery -Family history/genetic predisposition -Presence OR absence of signs AND symptoms -Potential risks and benefits -Ability to detect cancer at and early stage -Alternative options fro managing increased risk -The patients acceptance for the post-op outcome -i.e., Colectomy, Mastectomy, oophorectomy

Targeted therapies

Specifically target (like a lock and key mechanism) receptors, proteins, signal transduction pathways, and other processes to prevent the continued growth of cancer cells.

Stool DNA test, or Flexible sigmoidoscopy (FSIG) (Colorectal Cancer Screening)

Stool DNA test -> every 3 years FSIG -> every 5 years -can be performed every 5 years in conjunction with a highly sensitive gFOBT or FIT annually

Positron emission tomography (PET)

Through use of a tracer, provides black-and-white or color-coded images of the biologic activity of a particular area, rather than its structure. Used in DETECTION of cancer OR ITS RESPONSE to treatment -Lung, colon, liver, pancreatic, head, and neck cancers; Hodgkin and non-Hodgkin's lymphoma and melanoma

Mammography

Use of X-ray images of the breast Breast cancer

Fluoroscopy

Use of X-rays to identify contrasts in body tissue densities; may involve the use of contrast agents -Skeletal, lung, GI cancers

Magnetic resonance imaging (MRI)

Use of magnetic fields and radiofrequency signals to create sectioned images of various body parts -Neurologic, pelvic, abdominal, thoracic cancers -MAKE SURE TO ASK ABOUT METAL IN THE BODY

Computed Tomography (CT) scan

Use of narrow-beam x-ray to scan successive layers of tissue for a cross-sectional view -neurologic, pelvis, skeletal, abdominal, thoracic cancers -MAKE SURE TO ASK ABOUT IODINE OR SHELLFISH ALLERGY -make sure to monitor kidney function (BUN/Creatinine)

Nuclear medicine imaging

Uses IV injection or ingestion of radioisotope substances followed by imaging of tissues that have concentrated the radioisotopes -Bone, liver, kidney, spleen, brain, thyroid cancers

Pap test and NPV DNA test (Cervical Cancer Screening)

Women ages 21-29 -screening should be done every 3 years with conventional or liquid-based pap tests -screening should be done every 5 years wit pap test and HPV test or every 3 years with pap test alone Women ages 30-60 -Pap test and HPV DNA test -Women 66+ who have had 3 or more consecutive NEGATIVE pap tests or 2 or more negative pap tests and HPV tests in the past 10 years with the most recent test within the first 5 years should stop cervical cancer screening -Women who have had a TOTAL HYSTERECTOMY should STOP cervical cancer screening

Cancers found in hormonal supplement taking women ->

are usually more advanced (more likely to metastasize) than in females not taking hormonal supplements -colorectal cancer is less likely but usually more advanced

Emaciated

excessivley thin; wasted

Salvage surgery

is an additional treatment option that uses an extensive surgical approach to treat the local recurrence of a cancer after the use of a less-extensive primary approach. -i.e., Mastectomy AFTER primary lumpectomy or radiation to treat the local recurrence of cancer

Graft-versus-tumor effect

is an advantage of Allo HSCT. The transplanted cells should not be immunologically tolerant of a patient's malignancy and should cause a GRAFT-VS-TUMOR lethal effect, in which the donor cells recognize the malignant cells and act to eliminate them.

Cancer vaccines

purpose is to mobilize the body's immune response to prevent or treat cancer -vaccines contain either portions of cancer cells alone or portions of cancer cells in combination with other substances that can augment or BOOST immune responses

Bereavement

state of being sad because a family member or friend has died

Cachexia

state of ill health, malnutrition, and wasting

apheresis

the removal of blood plasma from the body by the withdrawal of blood, its separation into plasma and cells, and the reintroduction of the cells

Wasting

weak, ineffective, causing loss of strength or size