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hyperplasia: tumor cells, growth in size of tissue due to extra cells. (this is cancer) hypertrophy: enlargement of the tissue due to enlargement of existing cells. (this is not cancer) anaplsia: less differentiated cells results in less maturity of the cells, which results in increased malignancy
Carcinogenesis: malignant formation 1. initiation: contact with a carcinogen 2. promotion: repeated exposure to carcinogen, results in mutant cells that can reproduce 3. progression: altered cells have increased malignancy, invade other tissues Carcinogenic agents and factors. 75% of all cancer is associated with environment 1. viruses and bacteria: some viruses do exists, bacteria itself most likely does not cause cancer, but the inflammation process associated with bacteria can cause cancer. 2. physical factors: sunlight, radiation ect. 3. chemical: smoke 4. genetic and familial factors: almost all cancer run in families to some degree 5. diet: fats, nitrates, red meats, alcohol 6. hormones: oral contraceptives 7. role of immune system: designed to catch bad cells and destroy them, when immune system fails, cancer follows Prevention: primary prevention is key, approx 1/3 of all cancers can be prevented using primary prevention women over age of 20 should do self breast exams. men and women over 50 should rectal exam women greater than 18 need pap smears
Cancer management:
1. cure: early detection is key 2. control: limit metastases 3. palliation Surgery is almost always primary treatment, if available. 1. tumor removal 2. prophylactic surgery: removing non-vital tissue that are at a increased risk 3. reconstructive surgery 4. palliative surgery: removing tissue that may affect other vital organs even though cancer is non-removable
Radiation therapy:
1. Cure, control, palliative 2. External radiation: most common 3. Internal radiation, aka brachytherapy, like implanted seeds. Low does radiation patients remain on bed rest to make sure not to displace the internal seeds 4. Radiation effects: can be toxic to surrounding tissue: Fast mitosis cells are more effected by radiation, this is why bone marrow, lymph tissue, hair, GI, and reproductive organs become effected by radiation. Well oxygenated tumors are more effected by radiation Nursing care for patient with radiation therapy: 1. limit visitor activity: cant be within 6 ft, limit time frame ect. 2. no pregnant women 3. wear dosimeters to record level of radiation exposure
Chemotherapy:
agents used to destroy tumor cells that interfere with cellular function and replication 1. treats mostly systemic disease 2. goals include: cure, control and palliative 3. often used with radiation due to synergistic effects 4. need prolonged treatment for necessary eradication of tumor so patients own immune system may take over and remove the rest of tumor 5. like radiation, active mitosis type cells are most sensitive to chemo. 6. do not need to know specific drug names that correlate with chemo agent types, so smile. Administration 1. can be IV or PO 2. problem of extravasation: when the IV blows the vein, huge problem with IV chemo, can cause severe damage to interstitial tissue. on test: first thing nurse does is turn off IV if one suspects a blown IV (such as redness, swelling, pain ect) 3. fluid and electrolyte imbalances: from vomiting, replace as needed. 4. risk for infection 5. Risk for bleeding 6. protection of caregivers
Bone Marrow Transplants: used for hematological cancers (like luekemia) and solid tumors
Types: 1. Allogeneic: outside donor (specific tissue type), destroy all bone marrow first, then replace with someone elses marrow 2. Autologous: self donation (with a transplant after) 3. Syngeneic: identical twin Graft versus host disease: number one problem is rejection of new bone marrow from an allogeneic transplant Liver dysfunction: number 1 cause of death
Onocoligic Emergencies:
1. Superior vena cava syndrome: tumor occludes SVC, which leads to back up into head 2. spinal cord compression: permanent neurological impairment 3. Pericardial effusion/ cardiac tamponade: from radiation and chemo 4. Syndrome of inappropriate secretion of antidiuretic hormone: from pituitary tumor 5. Tumor lysis syndrome: development of acute renal failure.
Prevention: 1. Standard precautions 2. Safe sex 3. Do not share injection equipment 4. blood screening and treatment of blood products HIV life cycle: dont need to know the specifics 1. effects the treatment of HIV 2. effective treatment means interrupting this lifecycle at as many places at a time, due to the high mutation of the disease 3. enzyme immuno assay: detects antibodies against HIV. 4. viral lobe test: detects HIV-RNA in blood plasma
Breast Disorders
Risk factors: 1. female 2. age
3. personal and family history including genetic mutations 4. hormonal factors 5. exposure to radiation 6. history of benign breast disease 7. obesity 8. obesity, not sure why I wrote that twice, but I dont want to renumber the list. 9. high-fat diet 10. alcohol intake 11. early menarche 12. nuliparity. 13. first birth after age of 30 14. radiation exposure 15. late menopause Guidelines for early detection 1. women in 20 - 30s breast exam every 3 years 2. mammography annually beginning at age 40 3. breast exam perfromed days 5 - 7 after frist day of menses Benign: breast pain, cysts, fibroadenomas, benign proliferative breast disease Malignant: breast cancer Treatment: Surgery: many forms Non-surgical management of Breast cancer: 1. radiation, hold off till 6 weeks after surgery 2. chemo 3. hormonal therapy Key points: 1. metastasis usually occurs through the lymph system 2. common systems affected by metastasis: liver, bone, brain. 3. more differentiated cells, like all cells, is a good thing. 4. regular border are better than irregular borders 5. moveable is better than not-movable 6. smaller is better than bigger
Ovarian cancer
Facts: 1. threefold increase risk for breast cancer 2. BRCA-1 gene: increased risk for breast and ovarian cancer 3. BRCA-2 gene: increased risk for male and female breast cancer and ovarian cancer 4. 75% are detected in late stages, because it is deep in cavity and therefore is found late Risk factors: same as breast cancer . oral contraceptives, however, are a protective measure for ovarian cancer Clinical Manifestations: 1. increase abdominal girth 2. pelvic pressure 3. bloating 4. back pain 5. indigestion 6. flatulence
7. leg and pelvic pain Medical management: 1. Surgical: hysterectomy 2. Chemo, radiation, brachytherapy
Uterine Cancer
Risk Factors: 1. Age 2. Postmenopausal bleeding 3. Obesity 4. Estrogen therapy: oral contraceptives, HT 5. Nulliparity 6. Late menopause Testing: annual exam, need to evaluate for irregular bleeding Medical management: 1. Total abdominal hyterectomy with bilateral salpingo-oopherectomy 2. CA-125: genetic marker 3. Radiation, Chemotherapy, Brachytherapy
Cervical cancer:
Ranked number 3 female cancer Risk factors: 1. sexual activity 2. HPV 3. HIV 4. smoking 5. low socioeconomic status 6. nutritional deficiencies 7. chronic cervical infection Prevention: primary intervention is education and smoking cessation 1. pelvic exams 2. eduation 3. smoking cessation 4. HPV immunization Clinical manifestations: 1. rare to have symptoms in early stage 2. watery thin discharge 3. irregular bleeding Late stage manifestations: 4. leg pain 5. dysuria 6. rectal bleeding 7. edema of extremities Medical Management: For preinvasive: LEEP, conization Invasive: Brachytherapy (this will be on the test), surgery