MDC2 EXAM 1 Study Guide 1 PDF

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● WHAT INFLUENCES CANCER GROWTH? ○ Exposure to carcinogens (tobacco, radiation, chemo, hormone drugs, pollution) ○ Genetic predisposition (BRCA gene, family history) ○ Immunity ○ Factors that cause cancer can be divided into: ■ External: chemical, physical, viral ■ Personal: immunity, age, genetic risk ● WHAT IS INCIDENCE? ○ The number of new cases reported by the American Cancer Society ■ Women have the highest incidence of breast cancer ■ Men have the highest incidence of prostate cancer ■ 2nd highest for both men and women is lung cancer ■ 3rd highest for both is colon and rectal cancer ● THREE CONTRIBUTING FACTORS TO INCIDENCE ○ Hereditary ■ 10-15% of cancers are inherited (breast, ovarian, colon, prostate, Wilm’s, retinoblastoma) ○ Environment ■ Air pollutants (vinyl chloride, lead insecticides) ■ Work environment (welders, chrome platers, leather tanners) ■ Water pollutants ■ Bacteria, viruses, asbestos, medical drugs, hormones ■ Radiation (UV, sun, x-ray, radioactive chemicals) ○ Lifestyle ■ Cigarettes, red meat, fat, estrogen, obesity, radiation, viruses, drugs, etc. ● Biochemical research: ○ Identify prevention ○ Screening ○ Treatments (chemo and radiation) ○ Management of symptoms ● RISK FACTORS FOR CANCER (Opposite = prevention) ○ Smoking ○ Poor nutrition ○ Excessive weight ○ Sedentary lifestyle ○ Exposure to environmental carcinogens ○ Genetics

● PREVENTION ○ Primary goal: to reduce the risk for cancer development

■ Sunscreen, vaccinations, elimination of tobacco, modification of diet, etc. ○ Secondary goal: early detection; participation in screening ■ Routine screenings ○ Tertiary goal: prevention of recurrence through chemo-preventive agents - Prevention strategies in order to lower chance of developing cancer: Maintain a healthy lifestyle - Reduce exposure to cancer-causing substances - Adhere to medication regimen - Routine screenings - Vaccinations ● CANCER WARNING SIGNS (C.A.U.T.I.O.N) ○ Change in bladder/bowel habits ○ A sore that does not heal ○ Unusual bleeding or discharge of any body orifice ○ Thickening or presence of lump ○ Indigestion or difficulty swallowing ○ Obvious change in wart or mole (color, size, texture) ○ Nagging cough or hoarseness that is prolonged ● BENIGN ○ Harmless, does not usually require intervention ○ Slowx, steady growth ○ Remains localized ○ Smooth, well defined, and moveable when palpated ○ Resembles parent tissue ○ Ex: adenomas, fibroids, hemangiomas, lipomas ● MALIGNANT ○ Indicates cancer ○ Has migrated ○ Fatal without intervention ○ Usually rapid growth ○ Rarely contained within a capsule ○ Irregular, immobile when palpated ○ Little resemblance to parent tissue (anaplasia) ○ May come back after removal ○ Ex: carcinomas, sarcomas, lymphoma/leukemia, blastomas ● SLNB PROCEDURE ○ Sentinel node is identified, removed, and examined for the type of cancer cells present ○ It is used in people who have already been diagnosed with cancer ● LEUKEMIA ○ Arise from organs that form the blood and invade the production of normal blood

cells ● LYMPHOMA ○ Affect the lymphocytes, which fight infections and produce enlarged lymph nodes in the armpits, chest, abdomen, and groin ● CARCINOMAS ○ Originate in the epithelial cells of the skin, lungs, liver, kidneys, stomach, breast, prostate, and thyroid ■ Are likely to metastasize ● SARCOMAS ○ Originate in the soft tissues such as the muscles, blood vessels, bone, and connective tissue ● STEPS OF CARCINOGENESIS ○ INITIATION: 1st step, changes in gene expression caused by anything that can damage cellular DNA, leading to loss of cellular regulation; normal cells become damage, which is irreversible and leads to cancer development ○ PROMOTION: Enhanced growth of and initiated cell by substances known to cause cancer, this is when it becomes a tumor; repeat exposure enhances cell growth which leads to mutation ○ PROGRESSION: 1cm tumor has billion of cells and contains its own blood supply; increase in the production of malignant cells ○ METASTASIS: Occurs when cancer cells move from primary location to other location; EX: Liver cancer (Primary) metastasis to the stomach (secondary); movement of cells from the primary site ● PRIMARY/ SECONDARY TUMORS ○ Primary: Identified by the tissue from which it arose (Parent tissue) ○ Secondary: Cancer cells move from primary location (Additional tumor) ■ Metastatic ● DIAGNOSTIC TESTING: ○ Lab tests: ■ CBC (Complete blood count) ■ Blood protein testing ■ Tumor marking testing ■ Circulating tumor cell test ○ Radiographic tests ■ CT ■ MRI ■ XRAY ■ PET scan ■ Ultrasound

■ Mammograms ○ Biopsy ■ Organ tissue specific ■ Breast biopsy ■ Bone marrow aspiration ○ Scope exams: ■ Bronchoscopy ■ Colonoscopy ■ Endoscopy ■ Cystoscopy ● GRADING ○ The degree of malignancy or cell differentiation of the tumor cells ● STAGING: ○ The extent of spread of the tumor within the body from the site of origin ● STAGING AND GRADING SCALE: ○ Primary Tumor (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 ○ Regional Lymph Nodes (N) ■ Nx = Regional lymph nodes cannot be assessed ■ N0 = No regional lymph node metastasis ■ N1, N2, N3 = Increasing involvement of regional lymph nodes ○ Distant Metastasis (M) ■ Mx = Presence of distant metastasis cannot be assessed ■ M0 = No distant metastasis ■ M1 = Distant metastasis ● DEVELOPING A TREATMENT PLAN: ○ 1st step after diagnosis ○ Treatment is determined by the type and stage of cancer ○ Can include a combination of different treatments ● PLANNING AND IMPLEMENTATION: ○ Treatment alternatives ■ Multiple choices (surgery, radiation, chemo) ○ Goal = control, cure, or palliation ● SURGERY (Most common treatment for cancer) ○ Diagnose- biopsy- remove ○ Insert hardware

○ Relieve discomfort ● RADIATION (External) ○ Kill or reduce tumor size, or relieve obstruction ○ Effects rapidly dividing cells ○ May be given before chemo to shrink the tumor ● RADIATION (Internal) ○ Brachytherapy - implanted into affected tissue or body cavity by implantation of seeds, rods; short and long term; used commonly with cervical, prostate, breast, and skin cancer ○ Radiopharmaceuticals - given IV or PO; E.g. bone and thyroid cancer ● SIDE EFFECTS OF RADIATION THERAPY (Vary according to site) ○ Local skin changes and hair loss ○ Altered taste sensations ○ Fatigue ○ Bone marrow suppression ● CHEMOTHERAPY ○ Principles of treatment ■ Agent selection ■ Dosage ■ Cycle of administration ○ Nursing diagnoses ■ Fatigue or altered comfort ■ Altered nutritional status ■ Altered body image ■ Risk for injury ○ Pharmacology ■ Treatment choices for disseminated cancers ● Leukemia, lymphomas, metastases ■ Localized cancers ● Choriocarcinomas, testicular carcinoma ■ Adjunct to surgery and radiation ● Kill cells that are left behind to reduce recurrence and improve survival ○ Cytotoxic ■ Treatment for cancer with chemical agents ■ Used to cure and increase survival time ■ Adjuvant therapy = chemo + surgery or radiation ■ Effect on healthy cells and cancer cells ● CHEMO SIDE EFFECTS ○ Hair loss

○ Dry mouth/mouth sores ○ Difficulty swallowing ○ N/V ○ Diarrhea ○ Fatigue ○ Bleeding ○ Susceptibility to infection CHEMO PRECAUTIONS/ EDUCATION: ● Immunosuppression ● Stay away from sick people/large crowds ● Sanitize everything ● Wear a mask in public spaces ● Have a clean-up kit at home for accidents with chemo drug ● WASH HANDS ● EXTRAVASATION ○ Escape of fluid or drugs into the subcut. tissue; a complication of IV infusions ● VESICANTS ○ Chemicals or drugs that can cause severe tissue damage on direct contact or extravasation ■ EX: Phenergan ● ONCOLOGICAL EMERGENCIES ○ Hypercalcemia ○ Tumor lysis syndrome ■ METABOLIC EMERGENCY ■ Large number of tumor cells are rapidly destroyed and the intracellular contents of damaged cancer cells are released into the bloodstream faster than the body can eliminate them ■ Positive sign that cancer treatment is effective in destroying cancer cells ■ Results in a release of large amounts of intracellular products (i.e. uric acid, calcium, phosphates, and potassium); products disrupt the body’s homeostasis and destroy the cell’s nucleus ■ Associated with hematologic malignancies, acute leukemia, and high grade lymphoma ■ Signs and symptoms: ● Azotemia ● Acidosis ● Hyperphosphatemia ● Hyperkalemia ● Acute renal failure ● Hypocalcemia ○ SIADH - the body makes too much antidiuretic hormone (ADH), causing the body

to retain too much water ○ Febrile neutropenia - development of fever in a patient with low neutrophils ○ Hyperviscosity syndrome- group of symptoms triggered by an increase in the

viscosity of the blood. Symptoms include spontaneous bleeding from mucous membranes, visual disturbances due to retinopathy, and neurologic symptoms ranging from headache and vertigo to seizures and coma. ○ Superior vena cava syndrome ■ STRUCTURAL EMERGENCY ■ The superior vena cava returns all blood from the head, neck, and upper extremities to the heart. It has thin walls and compression or obstruction by tumor growth or by clots in the vessel leads to the congestion of blood ■ Occurs due to compression of the SVC walls by a tumor, which prohibits the return of blood to the heart ■ Associated with lung cancer, metastatic mediastinal tumors, lymphoma, and indwelling venous catheters ■ Signs and symptoms: ● Swelling of the face and neck ● Swelling of the arms ● Dysphagia ● Cough ■ Treatment: ● Radiation ● Chemotherapy ○ Malignant pericardial effusion ■ STRUCTURAL EMERGENCY ■ Cancer causes extra fluid to collect inside the sac around the heart; extra fluid causes pressure on the heart, which keeps it from pumping normally; lymph vessels may be blocked, which can cause infection ■ Most often associated with metastatic lung and breast cancer, melanoma, leukemia, lymphoma, and chemotherapy to the chest wall ■ Develops due to fluid accumulation around the pericardial sac, which compresses the heart; can lead to cardiac tamponade (life-threatening emergency) ■ Prompt treatment to remove the fluid must be performed to avoid death ■ Signs and symptoms: ● Dyspnea ● Fatigue ● Distended neck veins ● Distant heart sounds ● Tachycardia ● Orthopnea ● Narrow pulse pressure ● Pulsus paradoxus ○ Spinal cord compression- External compression of the spinal cord causing

neurological symptoms.

● PALLIATIVE CARE ○ Supports patients and family from time of diagnosis, throughout their treatment ○ Psychological, social, and spiritual care ○ Goal = improve quality of care ● HOSPICE CARE ○ End-of-life care ○ Provides care to patients who are facing an incurable disease in which treatment is no longer an option for possible cure ○ Goal= improve quality of life for the patient in their final days ○ Also provides support system for patient and family ● HOMEOSTASIS: ○ Proper functioning of all body systems (requires fluid and electrolyte balance) ■ Extracellular fluid ■ Intracellular fluid ■ Interstitial fluid ■ Transcellular fluid ● INTRACELLULAR ELECTROLYTES ○ Potassium - 3.5-5.0 mEq/L ○ Magnesium - 1.3-2.1 mEq/L ○ Phosphate - 3.0-4.5 mg/dL ● EXTRACELLULAR ELECTROLYTES ○ Sodium - 136-145 mmol/L ○ Bicarb - 23 to 30 mEq/L ○ Chloride - 98-106 mEq/L ● INTERSTITIAL ○ Located between the cells and the outside of the blood vessels (extra = edema) ● INTRAVASCULAR ○ Plasma within the blood ● TRANSCELLULAR ○ Includes specialized fluids like epithelial cells such as cerebrospinal, pleural, peritoneal, and synovial

● HORMONAL REGULATION OF FLUID BALANCE ○ Aldosterone ○ Antidiuretic hormone ■ Produced by posterior pituitary ■ Tells the kidneys to keep h2o ■ Initiates thirst response ○ Natriuretic peptides ● SIGNIFICANCE OF RENIN-ANGIOTENSIN II PATHWAY ○ Kidneys are major regulator of water, sodium balance, and maintain blood perfusion pressure to all tissues/organs ○ Kidneys secrete renin when they sense it is low ○ Greatly stimulated with shock, or with stress response ● ACE (Angiotensin-converting enzyme) INHIBITORS ○ Disrupt renin-angiotensin pathway but reducing amount of ACE produced = less vasoconstriction and peripheral resistance ○ Greater excretion of water and sodium in urine ○ Lowers bp ● DEHYDRATION ○ Fluid intake/retention does not equal body’s needs ○ Physical assessment/clinical manifestations ■ Cardiovascular - hypotension, Increased HR, flattened neck veins ■ Respiratory - Tachypnea ■ Skin - dry, dry mucous membranes, decreased turgor ■ Neuro ■ Renal ○ Causes ■ Vomiting/ Diarrhea ■ Fever ■ Burns/ severe wounds ■ Hyperventilation ■ Diabetes insipidus ■ Npo status ■ Decreased thirst sense (decreased with age) ○ 1 L OF WATER = 2.2LBS ● DEHYDRATION INTERVENTIONS ○ Restore fluid balance ■ Fluid replacement (Oral: water, gatorade) ■ Drug therapy ● IV fluids (NS 0.9% or LR) ● Antidiarrheal (imodium) ● Antimicrobial

● Antiemetic ● Antipyretics ○ Preventing injury ■ Fall risk ● FLUID VOLUME EXCESS (HYPERVOLEMIA) ○ Causes ■ Excessive fluid replacement ■ Kidney failure ■ Heart failure ■ SIADH ■ Water intoxication - Common cause of hypokalemia: - Diuretics - Corticosteroids - Diarrhea - Vomiting - Wound drainage - Kidney disease - Water intoxication - Common causes of hypercalcemia: - Hyperparathyroidism - Malignancy - Immobility - Dehydration - Hyperthyroidism - Use of steroids - Kidney failure - Common cause of hypomagnesemia: - Ethanol ingestion (alcoholism) - Malnutrition - Starvation - Diarrhea - Steatorrhea Celiac disease Crohn’s disease Citrate - Diuretics...