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NURSING NR 324 Oncology Study Guide 2 Complete Graded A

NURSING NR 324 Oncology Study Guide 2 Oncology Chapter 16 Male Female Prostate – 29% Breast – 26% Lung/Bronchus – 15% Lung/Bronchus – 15% Colon/Rectum – 10% Colon/Rectum – 11% Urinary Bladder – 7% Uterine Corpus – 6% Non-Hodgkin Lymphoma – 4% Non-Hodgkin Lymphoma – 4% Melanoma of the skin – 4% Melanoma of the skin – 4% Kidney/Renal Pelvis – 4% Thyroid – 3% Leukemia – 3% Ovary – 3% Oral Cavity/Pharynx – 3% Kidney/Renal Pelvis – 3% Pancreas – 3% Leukemia – 3% • Factors contributing to morbidity/mortality – economics, education, access to health care, and other issues not fully understood  Cancer – a disease process that begins when an abnormal cell is transformed by the genetic mutation of the cellular DNA, clones itself and produces abnormally; infiltrates and gains access to lymph and blood vessels o Hyperplasia – increase in the # of cells of a tissue; most often associated with periods of rapid body growth o Metaplasia – conversion of one type of mature cell into another type of cell o Dysplasia – bizarre cell growth resulting in cells that differ in size, shape, or arrangement from other cells of the same type of tissue o Anaplasia – cells that lack normal cellular characteristics and differ in shape and organization with respect to their cells of origin; usually malignant; determines malignant potential o Neoplasia – uncontrolled cell growth that follows no physiologic demand o Malignant Neoplasia – cancerous o Benign Neoplasia – non cancerous  Malignant Cells o Tumor-specific Antigen (CEA/PSA) - develop as the cell becomes less differentiated ; distinguish malignant from benign  Invasion/Metastasis o Malignant disease processes have the ability for spread/transfer of the cancerous cells from one organ to another o Invasion - the growth of the primary tumor into the surrounding host tissues  Mechanical pressure  Collagenases  Plasminogen activators  Lysosomal hydrolyses • These enzymes destroy surrounding tissues; mechanical pressure can quicken the process o Metastasis – the dissemination/spread of malignant cells from the primary tumor to distant sites by direct spread of tumor cells to body cavities or through lymphatic and blood circulation  Tumors may spread cells/emboli  travel within body  seed to other body surfaces  Lymphatic/Hematogenous Spread o Lymphatic – most common; tumor emboli enter lymph by interstitial fluid/invasion  lodge in lymph nodes or pass between lymphatic/venous circulation metastasis through lymph channels *breast cancer o Hematogenous – dissemination of malignant cells via the bloodstream & is directly r/t the vascularity of the tumor; surviving malignant cells attach to endothelium  attract fibrin, platelets, & clotting factors; seal themselves from the immune system  endothelium retracts  malignant cells can now enter basement membrane and secrete lysosomal enzymes  implantation  Angiogenesis – growth of new capillaries from the host tissue by release of growth factors and enzymes; VEGF;  rapid formation of new blood vessels  helps malignant cells get the nutrients and oxygen they need o Vascular network  Carcinogenesis – 3 step process 1. Initiation – carcinogens (chemicals, physical factors, biologic agents) escape the normal enzymatic mechanisms and alter the genetic structure of chromosomal DNA 2. Promotion – repeated exposure to the carcinogens  expression of abn genetic information even after latency periods which vary with type of agent/dosage for the target cells a. Apoptosis – innate cellular process of programmed cell death 3. Progression – altered cells exhibit increased malignant behavior  propensity to invade adjacent tissues to metastasize Viruses/Bacteria o Viruses are difficult b/c their hard to isolate – change cells genetic structure  affecting future cells o Infections – cancer clusters o Epstein-Barr o Bacteria – little evidence, chronic inflammation which leads to carcinogenic metabolites Physical Agents o Sunlight; radiation; chronic irritation/inflammation; tobacco use o Radiation exposure – leukemia, mult. Myeloma, lung, breast, bone, thyroid o Background radiation – lung Chemical Agents o Tobacco smoke – lung, head, neck, esophagus, stomach, cervix, pancreas, kidney, bladder & acute myeloblastic leukemia o Aromatic amines & aniline dyes; pesticides & formaldehydes; arsenic; soot; tars; asbestos; benzene; betel nut & lime; cadmium; chromium compounds; nickel/zinc ores; wood dust; beryllium compounds; polyvinyl chloride Genetics o Burkitt lymphoma, chronic myelogenous, leukemia, meningiomas, acute leukemias, retinoblastomas, Wilms tumor, & skin cancers o Genetic mutations – extra, too few, or translocated chromosomes o Cancer in 2 1st/2nd degree relatives, early onset <50y/o; individuals w/ more than 1 type of cancer; several generations Dietary o Proactive/ carcinogenic/ or cocarcinogenic o Increase risk w/ long term carcinogenic/cocarcinogenic ingestion o Fats, alcohol, salt-cured/smoked meats, nitrate containing/nitrite containing foods, o Alcohol – mouth, pharynx, larynx, esophagus, liver, colorectum, breast o ↑ fruits/veggies - ↓ risk for lung, esophageal, stomach, and colorectal o Obesity – endometrial, post menopausal breast, colon, esophagus, kidney pancreas, kidney, gallbladder, thyroid, ovary, cervix, prostate, mult myeloma, Hodgkin Lymphoma Hormonal o Disturbances either endo/exogenous o Endogenous – breast, prostate, uterus o Diethylstilbestrol (DES) – vaginal carcinomas o Oral contraceptive/prolonged estrogen therapy –hepatocellular, endometrial, breast, ↓ ovarian Immune System Role o Detects the development of malignant cells and destroys them before they get out of control o Immunocompromised – increased risk o Organ transplant recipients on antirejection meds – lymphoma, Kaposi’s sarcoma, squamos cell cancer of the skin, cervical, and anogential cancers o Immunodeficient Diseases (HIV/AIDS) - Kaposi’s sarcoma, lymphoma, rectal, head/neck o Alkylating chemotherapeutic agents 2nd malignancies o Autoimmune Diseases (RA, Sjogren Syndrome) – increased cancer development o ↓ organ function, ↑ chronic diseases, diminished immunocompetence Normal Immune Response • Macrophages, t cells – recognize tumor associated antigens • Lymphokines – produced by lymphocytes kill/damage malignant cells • B lymphocytes – defend the body against the malignant cells • Natural Killer cells – subpopulation of lymphocytes that act directly by destroying cancer cells or produce lymphokines and enzymes that help cell destruction Primary Prevention • Help patients avoid known carcinogens • Dietary/Lifestyle changes – quit smoking, decrease cal intake, increase physical activity • Patient education/support • Clinical trials Secondary Prevention • Self breast/testicle exam • PAP smear • Prostate exams • Mammograms • Digital rectal exam/ FOBT • PSA blood test Diagnostic Testing Aids • Tumor Marker Identification –breast, colon, lung, prostate, ovarian, testicular • Genetic Profiling – breast, lung, kidney, ovarian, brain, leukemia, lymphoma • Mammography – breast • MRI – neurologic, pelvic, abdominal, thoracic, breast • CT – neurologic, pelvic, skeletal, abdominal, thoracic • Fluroscopy – skeletal, lung, GI • Ultrasound – abdominal, pelvic • Endoscopy – bronchial, GI • Nuclear Medicine – bone, liver, kidney, spleen, brain, thyroid • PET scan/PET fusion – lung, colon, liver, head/neck, pancreatic, Hodgkin/Non-Hodgkin Lymphoma, melanoma • Radioimmunoconjugates – colorectal, breast, ovarian, head/neck, lymphoma, melanoma Diagnosis • Testing 1. Determine presence and extent of tumor 2. Identify possible spread of disease or invasion of other body tissues 3. Evaluate function of involved/uninvolved body systems and organs 4. Obtain tissue/cells for analysis; tumor stage/grade • Physical , imaging studies, lab tests (blood, urine, other body fluids), surgical/path reports • Nurse o Encourages family/pt to express their fears o Supports the patient/family o Clarifies information o Encourage pt/family communication, share concerns, questions Tumor Staging/Grading • Staging – size of tumor, existence of local invasion/distant metastasis (Tumor, Nodes, Metastasis system) o T – extent of primary tumor  Tx – primary tumor can’t be assessed  T0 – no evidence of primary tumor  Tis – Carcinoma in situ  T1, T2, T3, T4 – increasing size &/or local extent of primary tumor o N – absence/presence & extent of regional lymph node metastasis  Nx – regional lymph nodes can’t be assessed  N0 – no regional lymph node metastasis  N1,N2, N3 – increasing involvement of regional lymph nodes o M – absence/presence of distant metastasis  Mx – distant metastasis can’t be assessed  M0 – no distant metastasis  M1 –distant metastasis • Grading – classification of tumor cells o Helps predict behavior and prognosis o Grade 1 – closely resemble the original tissue o Grade 4 – tissues that don’t resemble the original tissue; more aggressive/less responsive to tx Management • Cure – complete eradication of malignant disease • Control – prolonged survival/containment of cancer growth • Palliation – relief of symptoms • Surgery – prophylactic, palliative, reconstructive o Primary treatment – remove entire tumor or as much as possible, any involved surrounding tissue  Local excision – small masses • Removal of mass, small margins  Wide/Radical Excision – removal of primary tumor, lymph nodes, adjacent involved structures, surrounding tissues that may be at high risk for tumor spread  Salvage Surgery – extensive approach to treat local reoccurring after a less extensive primary approach • Ex. Mastectomy after lumpectomy/radiation  Electrosurgery  Cyrosurgery  Chemosurgery  Laser Surgery  Photodynamic Therapy  Radiofrequency Ablation o Prophylactic  Family History/genetic predisposition  Presence/absence of symptoms  Potential risks/benefits  Ability to detect cancer at early stage  Patient acceptance of postop outcome  Offered selectively; discussed thoroughly w/ pt & family  Preop teaching/counseling  Long term followup o Palliative  No cure possible, making the patient as comfortable as possible; promotes quality of life  Relieve complications of cancer  Honest/informative communication w/ pt & family about the goal of surgery o Reconstructive o Nursing Management  Thorough pre op assessment o Education/emotional support for pt & family o Encourages pt/family to be active in decision making o Explain/clarify information o Make sure than information being given to pt/family is consistent  Post op o Assess pt response to surgery o Monitor for possible complications – infection; bleeding; etc o Provide comfort o Post op teaching for wound care, activity, nutrition, med information  Plans for d/c, follow-ups, home care, tx plan • Biopsy – analysis of tissue o Excisional – used for easily accessible tumors of the skin, breast, upper/lower GI & upper resp.  Surgeon can remove entire tumor and surrounding margins – decrease in reoccurrence  Decreases chance of the tumor seeding  Endoscopy o Incisional – tumor mass is too large to be removed  Wedge of tissue removed for analysis  Endoscopy o Needle – sample suspicious masses that are easily accessible such as growths on breast, thyroid, lung, liver, & kidney  Outpatient  Decreases risk of seeding cancer cells Radiation Therapy o May be used to cure, control malignant diseases, prophylactically prevent spread of primary cancer, o 2 types 1. Ionizing – breaks the strands of the DNA helix  cell death; free radicals , irreversibly damage DNA 2. Particulate o Tissues that are sensitive – bone marrow, lymphatic tissue, epithelium of GI tract, hair cells, & gonads; well oxygenated tissue o Less sensitive tissue – muscle, cartilage, connective tissue o Localized treatment o Radiosensitive tumor – can be destroyed by a dose of radiation that still allows tissue regeneration in normal tissue o Dosage – sensitivity of target tissues, size of tumor, tissue tolerance, critical structures near the target area o Administration o Teletherapy – external beam radiation  Most common  Gamma rays  Sterotactic body radiotherapy – higher doses for deep seated tumors 1-5 days/wk 6-8wks  Proton therapy – high energy dose to deep-seated tumor w/ no energy exiting through healthy tissue behind the tumor o Brachytherapy – internal radiation  High dose, localized area  Based on half life  Needles, seeds, beads, or catheters into body cavities/interstitial compartments  Temporary/permanent implant – high dose/short period; low dose/long period  Intraluminal – insertion or catheters, hollow tubes into lumens or organs  Intracavitary – gynecologic cancers, High Dose/Low Dose Radiation  Interstitial Implants – prostate, pancreatic, breast • Temporary/permanent • Seeds, needles, wired , small cath • Farther tissue is from surface, lower the dosage o Systemic – radioisotopes

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