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Medical 7-MS28-Cancer Interventions


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Define metastasize?
Cancers that are left untreated cause the following?
impaired immune and hematopoietic (blood-producing) function..
altered GI tract structure and function...
motor and sensory deficits...
decreased respiratory function
Any cancer that invades the bone marrow (esp. leukemia and lymphoma) will cause impaired _______ and _______ function which increases risk of infection. WBCs, RBCs, and platelets are decreased.
Define thrombocytopenia?
decreased platelets
Define cachexia?
extreme body wasting and malnutrition...can develop from an imbalance between food intake and energy use
Anorexia can occur because of changes in taste due to (2)?
the cancer itself
treatment of the cancer
What kind of diet is recommended for a cancer client?
high protein
high carbohydrate

(controversial...may be feeding cancer cells too)
Motor and sensory deficits occur when cancer invades (3)?
nerve compression
The most common sites of metastasis are (9)?
What serious conditions can metastasis to bone cause which reduces mobility (3)?
spinal cord compression
The client with cancer may or may not always have pain?
may not
How do tumors decrease respiratory function?
cause airway obstruction..
lung capacity is decreased
when tissue is involved..
press on blood and lymph
vessels, blocking blood
flow, and may result in
thickens alveolar membrane
and damages blood vessels
reducing gas exchange
Regimen is the same thing as?
Cancer surgery may be used for any of the following purposes (7)?
determination of therapy
An example of prophylactic surgical removal is?
removing a premalignant mole because it's exposed to sunlight or irritation
An example of diagnostic surgical removal is?
removing all or part of a suspected lesion for exam and testing
Surgery alone can result in a cure rate of what percentage when all visible and microscopic surgeries are prescribed?
27% to 30%
Define control (cytoreductive surgery)?
"debulks" by removing part of the tumor and leaving a known amount of gross tumor.
Which surgery doesn't result in a cure, but decreases the number of cancer cells and increases the chances that other therapies can be successful?
control (cytoreductive) surgery
What kind of surgery is done to improve the quality of life during the survival time?
Which surgery is a "rediagnosis" after treatment and who's purpose is to assess the disease status in clients who have been treated and have no symptoms of remaining tumor?
determination of therapy effectiveness or "second look"
"Second look" surgery determines whether a specific therapy should be ______ or _____
The type of surgery that increases function, enhances appearance, or both is?
reconstructive or rehabilitative surgery
Breast reconstruction after mastectomy, replacement of esophagus after radiation damage, bowel reconstruction, revision of scars, release of contractures are examples of?
reconstructive or rehabilitative surgery
Needle biopsy requires _____ cells in a fluid or in very soft tissue.
Needle biopsy requires ____ a "core" of solid tissue by using a long needle or making a punch, scrape, or

What are some of the problems associated with a needle biopsy?
may biopsy only noncancerous cells in a tissue or organ resulting in a sample error...
sample size may not be adequate for accurate testing..
procedure may spread cancer by seeding it into surrounding tissues...
procedure may damaage healthy tissue
Which type of biopsy removes a wedge of suspected tissue from a larger tissue mass, leaving some tumor cells in the tissue?
Some problems associated with incisional biopsies are?
an error made in sampling
tumor seeding
damage to healthy tissue
Which type of biopsy completely removes an entire lesion without removing any adjacent normal tissues?
Some problems associated with excisional biopsies are?
tumor seeding
leaving micrometastasis
damage to healthy tissue
Which type of biopsy performs multiple needle or incisional biopsies in tissues where metastasis is suspected or likely?
Problems associated with staging biopsies are?
tumor seeding
sample error
damage to healthy tissue
Removal of all identifiable tumor along with a small margin of normal tissues is what type of surgery?
local excision
Which type of surgery is used for small, localized tumors?
local excision
Removal of identifiable tumor plus immediate tissue or adjacent tissue is which kind of surgery?
wide local excision (radical)
Which type of surgery is used for small tumors with only local tissue invasion?
wide local excision (radical)
Removal of tumor, surrounding tissue, adjacent structures, and usual lymph channels draining the area is which kind of surgery?
wide excision
Which surgery is used for small to moderate-size tumors with known local invasion?
wide excision
Removal of tumor, lymphatics, adjacent organs, and all tissues in the region is called?
extended radical excision
Which surgery is used for tumor infiltrate in a wide area but with no known distant metastasis?
extended radical excision
Most radiation therapy for cancer is _____ radiation.
Define exposure?
amount of radiation delivered to tissue
Define dose?
the amount of radiation absorbed by the recipient tissue...dose is always less than exposure
Because of the varying responses of all cancer cells within a given tumor, radiation is given as a series of _____ _______.
divided doses
Two types of radiation therapy are usually used for cancer therapy?
Define teletherapy (beam radiation)?
distant treatment...the radiation source is external to the client...
This source of therapy is external and client is not radioactive which poses no hazard to anyone?
teletherapy (beam radiation)
Define brachytherapy?
means "short" or "close" therapy...the radiation source comes into direct, continuous contact with the tumor tissues for a specific period of time...has same tissue effects as radiation delivered by external sources
Which method of therapy provides a high dose of radiation in tumor tissues and a limited dose in surrounding normal tissues
With all types of brachytherapy, the radiation source is within the client, therefore the client emits radiation for a period of time and is?
hazardous to others
Isotopes that can be suspended in a fluid are UNSEALED and given via _____ or _____ routes as an instillation into body cavities
ex: peritoneal cavity
spinal fluid space
UNSEALED isotopes are/are not
confined to any one body area and concentrate more in some body tissues than in others?
are not
UNSEALED isotopes are _____ and enter body fluids and are eventually eliminated in waste products, which are radioactive and can be harmful to others.
Concentration of radioactive iodine in the thyroid gland and eliminated within 48 hours leaving the client radioactive free is an example of?
SOLID or SEALED radiation sources are implanted _____ or very ____ the tumor.
What is a "hot implantation"?
needles and seeds are preloaded with the radioactive isotope and are radioactive at the time of insertion into the tumor
With SOLID implants, the client emits radiation while thh implant is in place, but the _____ are not radioactive.
What is the inverse law of radiation exposure?
less than one meter is
2 meters (1/4 exposure)
3 meters (1/9 exposure)
4 meters (1/16 exposure)
What might be two side effects of patient receiving external beam radiation?
altered taste sensations
ex: red meat
External beam radiation.
What are altered taste sensations attributed to?
metabolites released from dead and dying cells
External beam radiation.
What might fatigue be related to?
increased energy demands needed to repair damaged cells
Radiation-induced fatigue can be debilitating and may last for?
weeks to months
When caring for a patient with sealed implants of radioactive sources?

1. Offer private room with
private bath.
2. What goes on door?
3. What badge should be
worn to measure patient's
exposure to radiation
4. V
2. "Caution: Radioactive
3. dorsimeter film badge
4. 6 feet
5. forceps
6. dressings
What is patient teaching for radiation therapy for cancer?

1. Wash ____ area gently
each day with either
water alone or with
mild soap and water.
2. Use ____, not washcloth,
rinse soap well
3. Don't remove
1. irradiated
2. hand
4. Pat
5. radiologist
6. soft
Due to radiation, skin in the path of radiation becomes very ____ and may break down. Don't use lotions or creams unless radiologist prescribes them.
The normal tissues most sensitive to external radiation are?
bone marrow cells
gonadal tissues
hair follicles
mucous membranes
Head and neck radiation may damage ____ _____ and cause xerostomia (dry mouth).
salivary glands
Define xerostomia?
dry mouth
Chemotherapy used along with surgery or radiation is termed?
adjuvant therapy
Chemotherapy drugs are classified by the specific types of action they exert in the cancer 6 categories?
antitumor antibiotics
alkylating agents
antimitotic agents
topoisomerase inhibitors
miscellaneous chemothera-
peutic agents
What are antimetabolites?
"counterfeit" metabolites that fool cancer cells into using antimetabolites in cellular reactions...cannot function as proper metabolites, their presence impairs cell division
What are antitumor antibiotics?
damage cell's DNA and interrupt DNA or ribonucleic acid (RNA) synthesis
What are alkylating agents?
cross link DNA, making the two DNA strands bind tightly together...the tight binding prevents proper DNA and RNA synthesis, inhibiting cell division
What are antimitotic agents?
usually made from plant sources...interfere with formation of microtubules so cells cannot complete mitosis during cell division...cancer cell does not divide at all or divides only once, resulting in two daughter cells that cannot continue to divide
What are topoisomerase inhibitors?
topoisomerase is an enzyme needed for DNA synthesis and cell division...t. inhibitors prevent process, causing DNA breakage and cell death
What do miscellaneous chemo agents do?
inhibit important enzyme
compete for important
substances in metabolic
Damage caused to normal tissues increases with _____ chemo.
To reduce _____, combination chemo avoids using drugs with nadirs that occur at or near same time.
The doses of most chemo are calculated according to type of ____ and patient ____.
Calculations for chemo dosage are commonly based on?
TBSA...milligrams per square meter of total body surface area
Calculating TBSA?
height of client (in centimeters)
weight (in kilograms)
10,000 (move decimal point
four spaces to left)

68" woman (173 cm)
143 lbs (65 kg)
has a TBSA of 11,245 cm2 or 1.12 m2
Chemo is usually scheduled how often?
every 3 to 4 weeks for a specified number of times (on average, 6 to 12 times)
An ENTIRE planned schedule is the _____ of chemo.
What route are most chemo treatment given by and why are they given that way?

effects are rapid
many agents are irritating
or damaging to tissues
ex: extravasation
Define extravasation (suffusion)?
the escape of fluids into surrounding tissues...
results of extravasation include:
tissue loss
surgical intervention for extravasation is sometimes needed
Define vesicant?
chemicals that cause tissue damage on direct contact
Small extravasations resolve without extensive treatment if less than ___ of the drug has leaked into tissues
0.5 mL
Depending on the type of chemo drug, ______ or ______ compresses can be used at the site.
_______ may be injected into extravasation site.
Most chemo drugs are absorbed through ____ and _____ membranes.

(nurses are at risk for absorbing them)
Serious side effects of chemo are?
nausea and vomiting
mucous membranes sores
skin changes
sleep disturbances
bowel elimination altered
mobility decreased
Nonpharmacologic nursing interventions include?
guided imagery
Suppressive effects on blood-forming cells of bone marrow cause?
Drugs given with chemo agents that help protect healthy cells?
The most common reason for changing chemo agent dosages is?
side effect to hematopoietic system
Alopecia due to chemo is temporary, can be all over, and hair growth usually begins ___ month(s) after chemo...color, texture, thickness may differ
Define emetogenic?
vomiting inducing
Nausea and vomiting may continue up to ____ hours after chemo has stopped. Some drugs (cisplatin) can cause vomiting from ___ to ___ days after stopping it.
Elders can tolerate the same chemo doses as youngsters.

5 to 7
Define mucositis?
sores in mucous membranes...can be in entire GI tract, esp in mouth (stomatitis)
Define stomatitis?
sores in mucous membranes of mouth...symptoms may include:
increased flow of saliva
breath fetor
fever sometimes
Mouth care for clients with mucositis?

1. Examine patient's mouth
every ____ hours.
2. Document location, site,
size, character of
______, ______, ______,
or drainage.
3. Get an order to obtain
1. four
2. blisters, fissures, sores
3. culture
4. 8
5. 12
6. glycerin
7. antimicrobial
8. swish and spit
9. petrolatum jelly
Neutropenia is a decreased number of leukocytes (not erythrocytes or platelets :),
especially _____ which causes immunosuppression.
A decreased number of erythrocytes and platelets
(not leukocytes :)
causes the following symptoms (3)?
increased tendency to bleed
_____ places the client at extreme risk for infection and is the major dose-limiting side effect of cancer chemo.
The infectious processes that occur most commonly are (3)?

(most is patient's own flora overgrowing)
Platelet count less than ____ can cause a small trauma to increase to excessive bleeding.
If platelet count is less than _____, patient may have spontaneous and uncontrollable bleeding requiring ______ therapy.

How is immunosuppression managed?
BRMs...biological response
modifiers which stimulate bone marrow production...drawback is they're expensive and sometimes not covered by insurance
Complementary and alternative therapies that can boost immune system are (3)?
shark cartilage
megadoses of vitamin C
_______ manipulation is another way to slow down the growth of tumors.
Hormonal manipulation involves the use of drugs that are hormone ____ and _____.
A new class of drugs used for hormonal therapy in breast cancer is the ______
aromatase (enzyme)
Side effects of hormone therapy.
Androgens and antiestrogen receptor drugs cause _____
effects in women. The symptoms may include?

development of chest and
facial hair
menstrual periods stop
breast tissue shrinks
fluid retention possible
Androgen chemo may cause?
acne possible
hypercalcemia common
liver dysfunction over the
long run
Women receiving estrogens or progestins may have the following symptoms?
irregular but heavy menses
fluid retention
breast tenderness
Male and female clients who take estrogen or progestins are at increased risk for?
Feminine manifestations often appear in men who take _____, _____, or ______ receptor drugs.
With the use of estrogen, progestin, and antiandrogens, what changes are possible?
facial hair thins or disappears...
facial skin becomes smoother...
body fat is redistributed...
gynecomastia (breast enlargement)can occur...
testicular and penile atrophy...
erections more difficult
Define gynecomastia?
breast enlargement
What are BRMs?
biological response modifiers...
ex: cytokines
colony stimulating
interleukins (ILs)
interferons (INFs)

some agents can stimulate specific immune system cells to attack and destroy cancer cells; othe agents block cancer cell access to an essential function or nutrient
What are cytokines?
small protein hormones are made by WBCs
ex: macrophages
monocytes (monokines)
lymphocytes (lympho-
generally make immune system
work better
How do BRMs such as cytokines work as cancer treatment?
stimulate immune system to recognize cancer cells and take actions to eliminate or destroy them
How do BRMs such as colony stimulating factors work as cancer treatment?
stimulate faster recovery of bone marrow function after treatment-induced suppression
What is the MOA of cytokines?
similer to other peptide cell produces and secretes a cytokine, when then exerts its effects on other cells of the immune system...cells responding to the cytokine may be right next to the cytokine-secreting cell or quite remote from it...responder cells will change activity in response to the cytokine
How many ILs or interleukins have been identified?
How are some interleukins identified?
recominant DNA
How do interleukins work?
recognize and destroy abnormal body cells
IL-1, -2, and -6 appear to "charge up" the immune system and enhance attacks on cancer cells by?
natural killer cells (NK)
Define interferons (INFs)?
cell-produced proteins that can protect noninfected cells from viral infection and replication
ex: INF alfa-2b (most
What are cancer-related functions of INF?
slow down tumor cell division...
stimulate the growth and activation of NK cells...
help cancer cells resume a more normal appearance and revert to their previous normal cell features...
inhibit the expression of oncogenes
INFs have been effective to some degree in the treatment of (5)?
melanoma (malignant)
hairy cell leukemia
renal cell carcinoma
ovarian cancer
cutaneous T-cell lymphoma
Use colony stimulating factors cautiously in patients with (2)?
Colony stimulating factors induce more rapid recovery of _____ ______ after suppression by chemotherapy.
bone marrow
Colony stimulating factors have 2 benefits?
more rapid recovery of bone
marrow after suppression by
chemo (less risk for
infections and anemia)
bone marrow recovers more
rapidly, so patient gets
chemo on time and is able
to tolerate higher doses
1. One of the side effects of interleukins is generalized and sometimes severe _______ reactions.

2.Fluid shifts and ______ leak are widespread with edema forming in most tissues.
3. Tissue swelling affects the function of all _____ and c
1. inflammatory
2. capillary
3. organs
4. ICU or monitoring unit
5. side effects
Symptoms of MILD inflammation that are seen with BRMs are (4)?
fever (treat with
flu-like general malaise
rigors (treat severe ones
with meperidine (Demerol)
What is a long-standing diabetes-related condition that interferon therapy can cause?
peripheral neuropathy
Some of the problems resulting from the interferon-induced neuropathy include (5)?
decreased sensory perception
visual disturbances
decreased hearing
unsteady balance and gait
orthostatic hypotension

(it is not known whether the neuropathy is temporary or permanent)
Some side effects of BRM therapy are (4)?
skin rashes
Skin problems from BRM use are worse with higher doses and combination BRM therapies. Advise patient to apply 1.____-____ moisturizers to the skin and to use mild 2.____ to clean the skin. Avoid sun and use sunscreen. Avoid swimming and don't use topical


Gene therapy is ______.
One type of gene therapy is conducted by inserting a ____ ____ gene into brain tumor cells making the brain cells more susceptible to being killed by antiviral agents...some success in early phase trials
viral enzyme
Another type of gene therapy is conducted by inserting human _____ antigen (HLA)genes different from the patient's own HLAs into tumor cells....patient's immune system recognizes the cancer cells as foreign and takes steps to eliminate or destroy them...
Another gene therapy involves inserting additional genes for cytokines into client's own -1. ____ _____ cells.
These "charged-up" cancer-fighting immune system cells remain active for up to
2. __ ____ and can participate in cancer ce
1. immune system
2. 6 months
Cancer is caused by _____ or
____ changes in the genes of a normal cell, so gene therapy is being researched because planned changes in the genes may influence the cell to become normal again.
one or more
Research for gene therapy against cancer includes (4)?
inserting additional or healthy suppressor genes into cancer cells...

insertingn chemo resistant genes into normal cells so higher doses of chemo can be given without affecting normal cells...

removing damaged, mutated, or activated oncogenes...

inserting multiple genes into cancer cells to make them more easily recognized by immune system cells and more susceptible to other treatment modalities
What are target therapies a combination of?
biologic and gene therapy
Agents used as targeted therapies are either ____ that target a cellular element of the cancer cell or _____ drugs that work at the gene level.

Two antibodies used for target therapy are?
trastuzumab (Herceptin)
rituximab (Rituxan)
imatinib (Gleevec)
______ _____ are an issue in clients receiving monoclonal antibodies.
allergic reactions
How do monoclonal antibodies work?...usually antibodies are specific to a 1._____, _____, or _____ substance needed by cancer cell for growth. When the antibody binds to the target within a cancer cell, some process important to cancer cell 2._____ does
1. protein
2. survival
Clients with cancer are at greatest risk for ____ and ____.
What is DIC (disseminated intravascular coagulation)?
problem with blood-clotting process...
caused by:
release of thrombin or
(clotting factors) from
cancer cells
blood transfusions

extensive, abnormal clotting occurs throughout small blood vessels...the widespread clotting uses up existing clotting factors and platelets followed by extensive bleeding...blood flow to major organs blocked
DIC is most often seen in?
adenocarcinomas of lung,
pancreas, stomach, prostate
What are symptoms of DIC?
strokelike manifestations
bowel necrosis (tissue death)
What is given during the early phase of DIC?
anticoagulants (esp heparin)
Spinal cord compression is the result of a primary tumor or spread from other areas of the body such as?
Spinal cord compression often causes ____ pain before neurologic deficits occur.
Neurologic problems are specific to level of spinal compression and include?
loss of urethral
rectal sensation
muscle weakness
Treatment for spinal cord compression is often?
What is the treatment for spinal cord compression (4)?

high-dose corticosteroids given first to reduce swelling around spinal cord to relieve symptoms...
high-dose radiation given to reduce size of tumor and relieve compression..
radiation treats total disease...
surgery to remove tumor from area and rearrange bony tissue so less pressure is placed on spinal cord...
external back or neck braces to reduce weight borne by spinal column and to reduce pressure on the spinal cord or spinal nerves
Superior vena cava syndrome (SVC) is most often seen in patients with?
lymphomas and lung cancer...clients with cancer of breast, esophagus, colon, and testes may also be affected
Manifestations of SVC syndrome result from blockage of blood flow in ____ system of ____, _____,
and _____.

head, neck, upper trunk
Early manifestations of superior vena cava syndrome are?
edema of the face, esp
around eyes...
tightness of shirt or blouse
collar (Stokes' sign)
More severe manifestations of superior vena cava syndrome are?
edema in arms and hands
erythema of upper body
epistaxis (nosebleeds)
Late manifestations of superior vena cava syndrome are?
mental status changes from
lack of blood to brain
decreased cardiac output
If superior vena cava syndrome compression is not relieved, what may result?
SVC syndrome is usually _____.
Surgery is rarely performed with superior vena cava syndrome because?
the tumor may have increased intrathoracic pressure to such a level that it may be impossible to close the chest after the procedure
A metal _____ can be placed in vena cava in an interventional radiation department to relieve swelling. Follow-up angioplasty can keep this stent open for a longer period of time.
In tumor lysis syndrome (TLS), large numbers of tumor cells are destroyed ____.
Tumor lysis syndrome intracellular contents, including ____ and ___ are released into the bloodstream faster than the body can release them
(these are DNA components)
Unlike other oncologic emergencies, TLS is a ____
sign that cancer treatment is effective.
Severe or untreated TLS can cause severe ____ damage and death.
Serum potassium levels can increase to the point of ____
causing severe cardiac dysfunction.
The large amounts of released purines are converted in the liver to uric acid and released into the blood, causing 1._____.
These uric acid crystals precipitate in the kidney, forming a sludge in kidney tubules; this effect blocks tubules and leads
1. hyperuricemia
2. renal failure
What is the best management for prevention of tumor lysis syndrome?
Hydration can manage tumor lysis syndrome by (3)?
prevents precipitation of uric acid crystals...
increases excretion of potassium...
mechanically flushes any
renal tubular sludge
With tumor lysis syndrome, instruct clients to drink at least 1.______ mL the day before, the day of, and for 3 days after treatment.
Some fluids should be 2.____ ( ) to help prevent uric acid precipitation.
1. 3000 mL (5000 mL is more
2. alkaline (sodium bicarbonate)
With tumor lysis syndrome (TLS), some clients have 1.____ and _____ after cancer therapy and may not feel like drinking fluids, stress importance of following 2._____ regimen. 3.______ fluids may be necessary if n&v persist.
1.nausea and vomiting
2. antiemetic
3. parenteral
Treatment of TLS becomes more aggressive for patients who become _____ or _____.
With TLS, in addition to increased fluid intake (oral or parenteral), ____ (esp osmotic types) are given to increase urine flow through the kidney. Use with caution, to avoid dehydration.
With TLS, drugs that increase excretion of purines are?
allopurinol (Aloprim,
rasburicase (Elitek)
With TLS, to reduce serum potassium levels for mild to moderate hyperkalemia, sodium 1._____ _____ can be given orally or as a retention enema...does not immediately reduce serum potassium level. For more severe hyperkalemia, IV infusions of 2.____ and _
1 polystyrene sulfonate
2.glucose and insulin
More than ____%, of people diagnosed with cancer in North America each year are cured of their disease, and many others live __ years or longer.

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