- no single event

- combination of genetic and environmental influences

- chemical agents

- chemotherapeutic agents

- viruses

- radiation

- immunologic deficiencies

acute: clonal proliferation of immature hemoatopoietic cells

chronic: mature forms of WBC and onset is more gradual

- acute lymphocytic luekemia (ALL)

- acute myelogenous leukemia (AML), also called acute nonlymphoblastic leukemia (ANLL)

- chronic myelogenous leukemia (CML)

- chronic lymphocytic leukemia (CLL)

- abrupt, dramatic onset

- serious infectinos or abnormal bleeding

- uncontrolled proliferation of myeloblasts

- hyperplasia of bone marrow and spleen

- most common type of leukemia in children

- 15% of acute leukemia in adults

- may appear abruptly

- fever, bleeding

- insidious with progressive weakness and fatigue

- CNS manifestations especially common in ALL and can be a serious problem

- excessive mature neoplastic granulocytes in bone marrow

- move in peripheral blood in massive numbers

- ultimatley infiltrate liver and spleen

- production and accumulation of functionally inactive by long-lived, mature appearing lymphocytes

- B cell involvement

- early-stage complications are rare

- may develope as disease advances

- pain, paralysis from pressure caused by enlarged lymph nodes

- anemia

- thrombocytopenia

- decreased number and function of WBCs

- splenomegaly

- hepatomegaly

- lymphadenopathy

- bone pain

- menigeal irritation

- oral lesions

- solid masses known as chloromas

- peripheral blood evaluation

- bone marrow evaluation

- morphologic

- histochemical

- immunologic

- cytogenic methods

- attein remission, either complete, partial, or molecular

- prognosis is directly related to ability to maintain a remission

- decrease drug resistance

- decrease drug toxicity using multiple drugs

- interrupt cell growth and numerous points

HLA matched

- sibling

- volunteer

- identical twin

- own stem cells

- stem cells from bone marrow

- obtained from peripheral blood

- umbilical cord blood which is rich in hematopoeitic stem cells

- graft vs. host disease

- failure to engraft

- infection

- understand and cooperate with treatment plan

- experience minimal side effects and complications of the disease and treatment

- feel hopefuly and supported during periods of treatment, relapse, and remission

- many physical and physchological needs: cancer evokes great fear, equate with death, the family may need help

- patient is empowered by knowledge of disease and treatment can have a more positive outlook and improved quality of life

- ongoing care is necessary to monitor for signs and symptoms of disease control or relapse

- diligence in disease management

- need for follow up care

- when to seek medical attention

- female

- age 50+

- personal hx of breast cancer, colon cancer, endometrial cancer, ovarian cancer or lobular carcinoma in situ

- benign breast disease w/ atypical hyperplasia

- early menarche <12

- late menopause >55

- full term pregnancy after age 30; nuliparity

- weight gain after menopause

- exposure to ionizing radiation

- CBC, platelet count

- calcium and phosphorus levels

- liver function tests

- chest x-ray

- if indicated, for staging: bone scane, CT scane (chest, abdomen, pelvis) and MRI

T1 N0 M0

- tumor < 2 cm

- no nodes

- no metastases

T1-2 N0-1 M0

- tumor > 2cm, < 5cm

- no nodes +, not fixed

- no metatases

T 3-4 N 2-3 M0

- tumor >5 cm --any size to skin, chest wall

- nodes: + fixed above or below clavicle

- not metastases

T any N any M1

Tumor: any

Nodes: + or -

Metastases: + for distant

- therapeutic regiment dictated by clinical stage classification of cancer

- single most powerful prognostic factor afer primary therapy is presence or absence of malignant cells in lymph nodes

- collaborative care includes: surgery, radiation therapy, chemotherapy, hormonal therapy, biologic and targeted therapy

- lumpectomy

- quadrectomy

- simple mastecomy

- modified radical mastectomy

- radical mastectomy

- reconstructive plastic

- assess for hemorrhage: vital signs, check under pt, check dressings, check drains

- relieve pain

- promote activity: T, C, DB, IS and hand/arm exercises

- psychologic concerns

- prevent lymphedema

- accumulation of lymph in soft tissues

- can occur as a result of excision or radiation of lymph nodes

- when axillary nodes cannot return lymph fluid to central circulation, fluid accumulates in arm, causing obstructive pressure on veins and venous return

- nurse should use and teach patient to take measures to prevent or decrease lymphedema after ALND

- blood pressure readings, venipunctures, and injections should not be done on affected arm

- elastic bandages should not be used in early postoperative period

- one of most important post op goals

- place in semi-Fowler's position with arm on affected side elevated on a pillow

- flexing and extending fingers should begin in recovery room and progressive increase in activity should be encouraged

- postoperative arm and should exercises are insituted gradually at surgeon's direction

- postoperative discomfort can be minimized by administering analgesics around 30 minutes prior to exercise

- when showering is appropriate, warm water has a soothing effect and decreaes joint stiffness

- exercises are designed to prevent contractures and muscle shortening, maintain muscle tone, and improve lymph and blood circulation

- radiation therapy after breast conservation surgery

- systemic therapies: chemotherapy or hormonal therapy

- primary treatment

- adjuvant therapy

- palliative treatment for pain caused by local recurrence and metastases

- GI

- bone marrow

- hair follicles

- block or destroy estrogen receptors

- suppress estrogen synthesis through aromatase

- adjuvant to primary treatment

- patients with recurrent or metastatic cancer

- monoclonal antibody to HER-2

- once antibody attaches to antigen, it is taken to cells and eventually kills them

- can be used alone or in combinatino with other chemotherapies

- fear of mutilation

- disfigurment

- loss of sexuality and attractiveness

- fear of death

- nursing: encourage, inform, identify, support systems and groups

- 3000 new cases

- 5000 deaths

- dropped by 74%

- PAP screening

- squamous cell, 80-90%

- adenocercinoma, 10-20%

- multiple sexual partners

- family hx

- immunosuppression

- multiple pregnancies

- low socio-economic status

- poor nutrition

- smoking

- HPV

- 6, 11, 16, 18

- 70% cases of cervical cancer, 90% cases of genital warts

- warts on genitals

- asymptomatic

- may clear on its own

- may develop changes in the cells of cervix (dysplasia) that left untreated will go on to become cervical cancer

- progression of normal cells to abnormal cells

- left untreated, can progress to cervical carcinoma in situ

- precursor lesions

- dysplasia: not cancer, can be treated with cryotherapy or laser therapy

- sever dysplasia

- carcinoma in situ, conization

- radical hysterectomy w/ lymph nodes

- radiation

- monitor VS

- check for infection, hemorrhage

- leg exercises

- DVT prophylaxis

- monitor for urinary retention and ileus

- pad counts to check for hemorrhage

- internal intracavitary

- applicator inserted in OR

- loaded

- bedrest

- foley

- packing

- low residual diet

- no peri-care

- turn, leg exercises, hob elevated 15 degress

- assess for increase in temp, n/v

- check applicator

- relieve anxiety

- understand, allow to verbalize

- id strengths

- explanation of pre-op, prep, and post-op routines

- accept self as altered: concerns, fears, questions, reassurance, sexual relations, emotional stability

- family or personal hx of colorectal cancer

- increased age

- colorectal polyps: inflammatory bowel disease, adult onset diabetes

- lifestyle factors: obestiy, smoking, alcohol, lg amounts of red meat, diet with increased fat and decreased fiber, limited physical activity

- change in bowel habits, diarhhea alternating with constipation

- change in size, shape, consistency, or frequency of bowel habits

- blood in stool, usually occult

- anemia, pallor, fatigue, wt loss

- dull abd pain

- melena

- obstruction

- pain

- cramps

- narrow stool (ribbon like)

- constipation

- distention

- bright red blood

- tenesmus (painful straining when passing stool)

- rectal pain

- incomplete evacuation

- bloody stools

- alt const/diarrhea

- rectal exam

- stool

- barium enema

- sigmoidoscopy

- colonoscopy

- CEA

- DREs

- tissue biopsies

- lab studies: CBC, coag studies, liver function tests

- CT scan or MRI helpful in detecting liver metastases, retroperitoneal and pelvic disease, depth of penetration of tumor in bowel wall

- partial colectomy

- hemi-colectomy

- perineal resection

- diverting colostomy

- assess pt and family

- help pt and family with grieving, guilt, change in body image, loss of self-esteem, social isolation, job worries, sexual concerns

- very individualized, some need information, some don't want to know anything

- plan of care

- enterstomal therapist

- ostomy support group

- bowel prep to reduce amount of stool in bowel

- antibacterial - given to decrease po in intestinal flora

- correct anemia

- vs

- i and o s

- ngt

- foley

- dvt prophylaxis

- wound care

- colostomy care

- check for edema

- paralytic ileus

- obstruction

- infection

- dehiscence

- evisceration

- fistula, stoma prolapse, retraction

- post op to lower risk of recurrence

- treat known metasases

- shrink tumor

- decrease risk of recurrence

- relieve symptoms

- cigarette smoking (age, inhalation, type, PPD, # years)

- secondary smoke

- environmental

- occupational exposure

- diet

- radon

- non-small cell lung cancer

- small cell lung cancer

- location and size of tumor

- metastases

- cough (dry, non productive)

- wheeze

- blood tinged sputum

- fever

- pain

- chest x-ray

- CT scan

- MRI

- PET

- diagnosis id by malignant cells

- sputum specimens obtained for cytologic studies: fiberoptic bronchoscope, metiastinoscopy, video-assisted thoracoscopy, pulmonary angiography

- bone scan

- bone marrow aspiration

- liver scan

- brain scan

- CT scan/MRI

- pulmonary function tests

- surgical therapy

- radiation therapy

- chemotherapy

- biologic and targeted therapy

- may cure small percentage

- controls lesions

- palliation

- esophagitis

- pneumonitis

- pulmonary fibrosis

- heart issues

- manipulate tumor growth

- treat metastasis

- SCLC

- combination therapy

- pneumonectomy

- lobectomy

- segmental resection

- thoraccscopy or VATS

-know baseline data for respiratory and cardiovascular systems

- stop smoking

- teach C& BD/incentive spirometry

- pain management

- possiblity of chest tubes

- improve understanding of surgical procedure and self care techniques

- relieve anxiety

- effective breathing pattern

- adequate airway clearance

- adequae oxygenation of tissues

- minimal to no pain

- realistic attitude toward treatment and prognosis

- increase in incidence with advancing age

- peak age b/t 60-70 years of age

- risk of infection

- weakness

- fatigue

- liver pain

- spleen pain

- headache

- lymphadenopathy

- vomiting

- bone pain

- chemotherapy

- administration of blood products

- bone marrow transplant

- before 4 years of age

- peak incidence b/t 2-9

- leukopenia

- anemia

- thrombocyteopenia

- low platelets

- low erythrocytes

- 25-60 yrs of age

- peak incidence around 45 yrs of age

- same as AML, but less severe

- leukocytosis

- spelnomegaly

- 50-70 yrs of age

- rare below 30 years

- predominance in men

- same as ALL, but is often mild

- maybe asymptomatic

- often none

- enlarged lymph glands

- anemia risk of infection

- lung cancer

- bronchiectasis

- TB

- emphesematous bullae

- benign lung tumors

- fungal infections

- most common lung surgery

- two chest tubes inserted post-operatively

- remaining lung tissue expands to fill up space

- lung cancer

- extensive TB

- bronchiesctasis

- lung abscess

- done only when lobectomy or segmental resection will not remove all diseased lung

- drainage tubes are not generally used

- fluid gradually fills space where lung has been removed

- position on back or operative side only

- bronchiesctasis

- TB

- technically difficult

- done to remove lung segment

- chest tubes inserted

- remaining lung tube expands to fill space

- lung biopsy

- excision of small nodules

- biopsy

- excision of peripheral or mediastinal lung lesions