Medical Terminology Alara as low as reasonably achievable Alopecia hair loss Anaplasia cells that lack normal cellular

lar characteristics and differ in shape and organization with respect to their cells of origin; usually, anaplastic cells are malignant Apoptosis programmed cell death Benign not cancerous; tumors may grow but are unable to spread to other areas 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 Biopsy a diagnostic procedure to remove a small sample of tissue to be examined microscopically to detect malignant cells Brachytherapy delivery of radiation therapy through internal implants Cancer a disease process whereby cells proliferate abnormally, ignoring growthregulating signals in the environment surrounding the cells Carcinogenesis process of transferring normal cells into malignant cells Chemotherapy use of medications to kill tumor cells by interfering with cellular functions and reproduction Control containment of the growth of cancer cells 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 Cytokines substances produced by cells of the immune system to enhance production and functioning of components of the immune system

Dysplasia bizarre cell growth resulting in cells that differ in size, shape, or arrangement from other cells of the same type of tissue Extravasation leakage of medication from the veins into the subcutaneous tissues Grading identification of the type of tissues from which the tumor originated and the degree to which the tumor cells retain the functional and structural characteristics of the tissue of origin Graft versus host disease (GVHD) an immune response initiated by T lymphocytes of donor tissue against the recipients tissue (skin, GIT, liver) Graft versus tumor effect the donor cell response against the malignancy Hyperplasia increase in the number of cells of a tissue; most often associated with periods of rapid body growth Malignant having cells or processes that are characteristics of cancer Metaplasia conversion of one type of mature cell into another type of cell Metastasis spread of cancer cells from the primary tumor to distant sites Myelosuppression suppression of the blood cell-producing function of the bone marrow Nadir lowest point of white blood cell depression after therapy that has toxic effects on the bone marrow Neoplasia uncontrolled cell growth that follows no physiologic demand Neutropenia abnormally low absolute neutrophil count Oncology field or study of cancer Palliation relief of symptoms and promotion of comfort and quality of life

Radiation therapy use of ionizing radiation to interrupt the growth of malignant cells Staging process of determining the extent of disease, including tumor size and spread or metastasis to distant sites Stomatitis inflammation of the oral tissues Targeted therapies cancer treatments that seek to minimize the negative effects on healthy tissues by disrupting specific cancer cell functions Thrombocytopenia decrease in the number of circulating platelets; associated with the potential for bleeding Tumor specific antigen protein o the membrane of cancer cells that distinguishes the malignant cell from a benign cell of the same tissue type Vesicant substance that can cause tissue necrosis and damage, particularly when extravasated xerostomia dry oral cavity resulting from decreased function of salivary glands

Golgi complex a packaging plant Lysosome this is composed of digestive enzyme Peroxisome endogenous Mitochondria powerhouse of the cell Catalase enzyme found in wounds Stages of mitosis: 1. Prophase - The DNA molecules progressively shortenand condense by coiling, to form chromosomes. The nuclear membrane and nucleolus are no longer visible. - The spindle apparatus has migrate to opposite poles of the cell. 2. Metaphase The spindle fibres attach themselves to the sentromeres of the chromosomes and align the chromosomes at the equatorial plate. 3. Anaphase The spindle fibres shorten and the centromere splits, separates sister chromatids are pulled along behind the centromeres. 4. Telophase The chromosomes reach the poles of their respective spindles. Nuclear envelope reform before the chromosomes uncoil. The spindle fibres disintegrate.

Biology of the cell Cell membrane Covers the cell Separates internal and external part of the cell

Gated theory ideal behavior of the cell Nucleus command center of the cell DNA blueprint Endoplasmic reticulum: Rough ER w/ ribosome Smooth ER w/o ribosome Ribosome responsible for synthesis

Cellular aberration Cellular proliferation Loss of contact inhibition Cell biopsy Cancer cells synthesize protein and glucose

Nuclei of cancer cells are abnormally large Attracts greater number of growth factors

Top 10 cancers: 1. Prostate 2. Breasts 3. Lung and bronchus Major dysfunction in the cell Pathophysiology of cancer Proliferative patterns Characteristics of malignant cells Invasion and metastasis Lymphatic and hematogenous spread Angiogenesis formation of new blood vessel through VEGF(vascular endothelial growth factor) Tumors(neoplasms) Benign Malignant Vascular system Lymphatic system Implantation Seeding Cancer classification 1. Solid tumor 2. Hematological cancer Route of metastasis 1. Local seeding 2. Blood borne metastasis 3. Lymphatic spread Common sites for metastasis Brain Liver Lungs Spinal cord Bones Epidemiology and etiology 1. Bacteria 2. Protozoans

3. Fungi 4. Viruses Physical agents 1. Chronic irritation or inflammation 2. Radiation 3. Over exposure to sunlight 4. Tobacco/cigar use Chemical agents Dye Asbestos Tar Smoke Note: most often affected areas: Liver Lungs Kidneys Genetic predisposition Familial factor Dietary factors (long term) Fats and oils from animal sources Alcoholic beverages Salt-cured Smoked meats Nitrate and nitrite containing foods Hormonal agents Prolonged estrogen replacement therapy (ERT) Diethylstilbestrol (DES) Oral contraceptives Idiopathic Breast, colon, rectal, lymphatic, bone marrow, and pancreas cancers arise spontaneously from unknown cause

Immune system failure Tumor associated antigens Tumor antigen-antibody complexes Hypoglubulinemia and ammaglobulinemia Ten steps of cancer prevention 1. Increase intake of fresh vegetable 2. Increase fiber intake 3. Increase intake of vitamin A 4. Increase intake of foods rich in vitamin c

5. Keep weight in normal range 6. Reduce amounts of intake of dietary fat 7. Avoid intake of salt cured, smoked and nitrate containing foods 8. No cigarette smoking 9. Reduce alcohol intake 10. Avoid overexposure to sunlight Secondary prevention 1. Pap test confirmative test 2. Digital rectal examination 3. Proctosigmoidoscopy 4. Guiac test or fecal occult blood test (FOBT) Blue: (+) occult blood Brown/yellow: (-) occult blood 5. Mammography 6. Breast self examination 7. Colposcopic examination confirmative test 8. Testicular self examination Seven Ps method or breast self examination 1. Postion Inspect and palpate in front of the mirror Lying with pillows under the shoulder 2. Perimeter Examine the entire breast including the nipple extending to the axillary tail 3. Palpation Use finger pads without lifting fingers 4. Pressure Light, moderate, firm 5. Pattern Vertical strip moving fingers up and down Pie wedge pattern starts nipple moving outward Circular moving fingers in concentric circles from the nipple outward 6. Practice be familiar with the breast

7. Plan you should know if you suspect something Classifications of malignant tumors: 1. 2. 3. 4. 5. 6. Carcinoma Adenocarcinoma Sarcoma Embryonal Lymphomas Leukemias

Grading and staging the tumors Grading: Grade 1: cells differ slightly from normal cells and are well differentiated (mild dysplasia) Grade 2: cells are more abnormal and are moderately differentiated (moderate dysplasia) Grade 3: cells are very abnormal and are poorly differentiated (severe dysplasia) Grade 4: cells are immature (anaplasia) and undifferentiated, cell of origin is difficult to determine

Staging: Stage 0: carcinoma insitu Stage 1: tumor limited to the tissue of origin: located tumor growth Stage 2: limited local spread Stage 3: extensive local and regional spread Stage 4: distant metastasis

Modalities of cancer treatment Types of donor: Allogeneic coming from parents, siblings Autologous coming from self

 Syngeneic coming from identical twin

Obtain tissues and cells for analysis, including evaluation of tumor stage and grade

Bone marrow transplant procedure: 1. Harvest collection of healthy stem cells PBSCT(peripheral blood stem cell transplantation) Source: blood stain Processing: 4-6 hours Machine: apheresis or leukapheresis machine that collects stem cells 2. Conditioning immunosuppresion of the client 3. Transplantation 4. Engraftment No increase in blood components Watch over for 2-5 weeks Complications: 1. Failure to engraft 2. Graft versus host disease in allogeneic transplant 3. Veno-occlusive disease Types of patient isolation: 1. Protective isolation a.k.a. Reverse isolation Positive pressure 2. Source isolation Negative isolation Supporting tests Diagnosis of cancer Pt. with suspected cancer undergo extensive testing to: Determine the presence and extent of tumor Identify possible spread(metastasis) of disease or invasion of other body tissues Evaluate the function of involved and uninvolved body systems and organs

Cancer screening guidelines for asymptomatic clients: 1. Colorectal cancer (males and females) Digital rectal examination ANNUALY beginning at the age 40 Fecal occult blood test ANNUALLY beginning at age 50 Sigmoidoscopy EVERY 5 YRS beginning at age 50 Colonoscopy EVERY 10 YRS or double contrast barium enema EVERY 5-10 YRS 2. Breast cancer (females) MONTHLY breast self examination beginning at age 20 Clinical breast examination EVERY 3 YRS from age 20-40, and ANNUALLY at age 40 and over 3. Cervical and uterine cancer Papanicolaou (pap) smear ANNUALLY for all women who have been sexually active or have reached age 18 (after a woman has had three (3) or more consecutive satisfactory normal annual examination. This pap test may be performed less frequently at the discretion of her physician) Pelvic examination EVERY 1-3 YRS with pap test beginning at age 18-40 Endometrial tissue sample at menopause and if high risk and thereafter at the discretion of the physician 4. Prostate cancer Prostate specific antigen(PSA) and digital rectal examination ANNUALLY beginning at age 50 for men who have at least a 10

yr life expectancy and for younger men who are at high rish.

Treatment of cancer: Diagnostics Common cancer diagnostic studies Mammography Lymphagiography Tumor markers Colposcopic exam of cervix direct visualization Sputum Stool analysis X-ray computerized axial tomography cytology studies Radionuclear imaging Magnetic resonance angiography Contraindicated: pacemaker

- Apply pressure to prevent bleeding 2. Incisional - For large tumor to be removed 3. Excisional 4. Endoscopic Goals of cancer therapy: Cure Control Palliative common to hospice care Prophylaxes

Indications for palliative surgery: 1. Pleural damage tube placement Pleural effusion 2. Peritoneal damage tube placement Ascites 3. Abdominal shunt placement (Levine shunt) Ascites 4. Pericardial drainage tube placement Pericardial effusion 5. Colostomy or ileostomy Upper gastrointestinary tract obstraction 6. Bone stabilization Displaced bone fracture r/t metastatic dse 7. Excision of solitary metastatic lesion Metastatic lung, liver or brain lesion 8. Ureteral stent placement Ureteral obstraction Factors to consider for prophylactic surgery Family history and genetic prophylactic surgery Presence and absence of symptoms Potential risks and benefits Ability to detect cancer at an early stage The patients acceptance of the post operative outcome Modalities of cancer: treatment Surgery 1. Diagnostic surgery

Selected techniques used to remove or destroy tumors: 1. Electrosurgery use of an electric current to destroy tumor cells 2. Cryosurgery use of liquid nitrogen or very cold probe to freeze tissue and cause cell destruction 3. Chemosurgery use of chemical or chemotherapy applied directly to tissue to cause destruction 4. Laser surgery use of light and energy aimed at an exact tissue location and depth to vaporize cancer cells 5. Photodynamic therapy intravenous administration of a lightsensitizing agent (hematoporphyrin derivative) 6. Radiofrequency ablation (RFA) uses localized application of thermal energy that destroys cancer cells through heat Different forms of Biopsy: 1. Needle

2. 3. 4. 5.

Staging surgery Curative surgery Palliative surgery Reconstructive surgery - Restores the clients image 6. Preventive surgery Side effects of surgery: 1. Loss of function of a specific body parts 2. Reduced function as a result of organ loss 3. Scarring or disfigurement 4. Grieving about the altered body image or imposed change in lifestyle Antineoplastic agents Chemotherapy: antineoplastic agents Overall goal: destroy the cancer cells without excessively damaging the normal cells Classification of chemotherapeutic agents Cell cycle specific S phase M phase: vinca or plant alkaloids Cell cycle- no specific Other: (will vary): too complex to categorize Administration of chemotherapeutic agents Settings: hospital, outpatient center, or home setting, clinic Route Topical Oral Intravenous Arterial muscular Intracavitary Intrathecal Dosage Preliminary based on: Total body surface are

Previous response to chemotherapy or radiation therapy Functions of major organs Special problems: extravasation Absence of blood return from the intravenous catheter Resistance to flow of intravenous fluid Swelling pain, or readness at the site Notable vesicant, antineoplastic agents a. Dactinomycin, daunorubicin b. Dexorubucin (adriamycin), nitrogen mustard c. Mitomycin d. Vinblastin,vincristine vindesine Neutralizing solutions for extravasated tissues a. Sodium thiosulfate b. Hyaluronidase c. Sodium bicarbonate Hypersensitivity reactions 5% overall incidence Skin testing (prevention) Nurse should have a clear understanding of which agents have the potential for precipitating hypersensitivity reactions Provide appropriate premedication before administering the agents Emphasize the importance of adherence of prescribed selfadministered premedication before presenting to the infusion center Report signs and symptoms to the nurse once the infusion has started Hypersensitivity reactions can be immediate or delayed

Signs and symptoms of anaphylaxis Generalized itching with localized or generalized urticaria Flushing of the face, hands, and feet Chest tightness Agitation Nausea and vomiting Dyspnea and bronchospasm Difficulty speaking Feeling of impending doom Hypotension Antineoplastic agents: causing hypersensitivity but necessary to treatment plan 1. Desentisization procedures 2. Reduced dosages 3. Slower infusion rates Premedication regimes 1. Corticosteroids 2. Histamine 1 and histamine 2 antagonist 3. Antipyretics, routinely administration Toxicity Gastrointestinal system Hematopoietic system Renal system Cardiopulmonary system Reproductive system Neurologic system Other: fatigue Gastrointestinal system Nausea and vomiting common s/e May persist for as long as 24 to 48 hrs after its administration Delayed N+V persist one week after chemotherapy Initiated by: Activation of chemoreceptor triggering zone (CTZ) of the medulla

Stimulation of the peripheral autonomic and vestibular pathways Cognitive stimulation Combination of factors Medications: decrease nausea and vomiting Serotonin blockers Ondasetron (Xofran) Granisetron (Kytril) Dolasetron (Anzemet) Palomosetron (Aloxi)