Case Studies - Week 3 Cancer by Mélanie Filion

1. The physicians say the would need to do a biopsy to determine if the tumor is benign or malignant. What does that mean?

kelligruhl — 2020-01-21 15:18:30 UTC

A biopsy will allow us to look at the cells under a microscope and determine if the tumor is benign or malignant.

Benign tumours are not considered cancer, they are encapsulated, do not invade nearby tissue and does not spread throughout the body

Malignant tumours are consider cancer, they are not encapsulated, will invade local tissue and travel by lymph or blood to spread to other areas of the body.

2. Why did the physician test for Prostate Specific Antigen (PSA)?

kelligruhl — 2020-01-21 15:19:49 UTC

Prostate Specific Antigen (PSA) is a tumor marker that is produced by a prostate tumor and can provide information of the tumor presence and growth. Does not tell us if the tumour is cancerous, PSA will show up if the prostate is enlarged (such as in benign tumor growth)).

Tested through presence in blood.

3. How does cancer cell differ from a regular cell?

2020-01-21 15:19:53 UTC

Cancer cells divide more rapidly and have mutations on them. Invade other tissues, remain immature when they grow, do not obey signals form other cells.

4. How does a regular cell transform into a cancer cell?

2020-01-21 15:20:37 UTC

It mutates to silence the genes that regulate cell proliferation

5. Besides a mutation, what can influence the development of cancer?

2020-01-21 15:21:38 UTC

Lifestyle, exposure different toxins (i.e. cigarette smoke).
Genetics
Chronic or persistent inflammation

#1. what can you explain about "breast cancer gene"?

2020-01-21 15:28:50 UTC

BRCA1 and BRCA2 gene mutations
-5-10% are believed to be hereditary
-Risk of mutations in the two genes have 0 increase with age
-genetic testing can be done to see;
if genes are mutated
if genes are present
connecting in genetic counsellor can be helpful to determined the above.

6. How do tumours spread and what is metastasis?

2020-01-21 15:29:11 UTC

Metastasis is the spread of cancer from a primary site of origin to a distant site. Cancer cells spread through the bloodstream and start to develop a tumour elsewhere in the body.

#2 Clinical manifestations:

2020-01-21 15:31:47 UTC

pain - can be caused by pressure on the surrounding tissues or can be exacerbated by fear, anxiety, sleep loss, fatigue, overall physical deterioration.
Fatigue - can be caused by stress, sleep disturbance, nutritional status.

7. What does his staging and grading indicate? What is the TNM system?

2020-01-21 15:33:09 UTC

Stage I: tumour limited to the tissue of origin; localized tumour growth.

Grade II: Cells are more abnormal & moderately differentiated.

T: Size
N: Node
M: Metastasis

#3 Explain the link between hypercalcemia and her cancer.

2020-01-21 15:33:39 UTC

Hypercalcemia - increase serum Ca+.
In breast cancer patients with hypercalcemia in the absence of skeletal metastasis, an increased incidence of primary hyperparathyroidism has been found which has been attributed to the parathyroid hormones.
Lack of physical activity
Bone metastases

#4 Main treatment modalities for cancer? what are the links to patho?

2020-01-21 15:35:59 UTC

Surgery, Radiation, Chemotherapy

Linked by location, grading, staging, the type of cancer, and how it metastasized ?

1. What are Mary's risk factors?

kelligruhl — 2020-01-21 18:39:01 UTC

Age (>60 years)
Family Hx (mother)
Early menarche (before 11 years old)
Hormone replacement therapy
Never given birth
Weight
Higher risk in North America

2. What are the main clinical manifestations of breast cancer?

kelligruhl — 2020-01-21 18:43:15 UTC

Lump or mammographic abnormality in upper, outer quadrant of breast
Dense with glandular tissue
Ductal and invasive
Hard, irregular, poorly delineated, non-mobile, and non-tender
Small % have nipple discharge
Peau d'orange
Infiltration, induration, dimpling of overlying (large cancers)
Breast asymmetry

3. Classify Mary's tumour according to the Tumor Nodes Metastasis (TNM) system of classification. What is the survival rate for this classification?

2020-01-21 18:45:02 UTC

T1= Lession <2cm in size
N0= No axillary nodes involved
M0= No metastasis

Survival Rate: 80-90% (reoccurance free)

4. Why is Mary ordered a combination of chemotherapy agents?

2020-01-21 18:56:15 UTC

Drugs given in combination: different actions and synergistic.
Also minimizes occurrences and severity of side effects.

5. What further assessments would you carry out?

2020-01-21 19:35:33 UTC

Vitals
Neuro assessment
Skin assessment
Lab values
Intake & Output

8. What are the abnormal lab values, vital signs, and important findings for this person?

2020-01-21 19:38:26 UTC

Hypotension
Vomiting
Nausea
Impaired mucous membrane
Diarrhea
Poor skin tugor
Malnutrition
Increased heart rate
Swelling of the arm
8/10 pain
High pH
High creatinine
Low protein
Low platelets
Low WBC
Low neutrophils
High HCO3-

9. What are your priorities for care? (nursing diagnosis)

2020-01-21 19:42:53 UTC

Acute pain
Risk for infection
Fluid volume deficit
Nausea
Diarrhea
Disturbed body image
Impaired oral mucous membrane
Risk for bleeding