Chapter 16 Oncology Cancer Refer to a disease whereby cells mutate into abnormal cells that proliferate abnormally and

nd do not perform the normal body functions Anatomic Classification of Tumors and Tumor-Associated Angtigens on Cell Surface o A tumor is classified by the tissue of origin, anatomic site, and the behavior of the tumor (benign or malignant). o Malignant Aggressive growths that invade and destroy surrounding tissues o Benign, Slow growing, encapsulate and can destroy surrounding tissues Should we be worry about it? It depends. i.e. if it is benign brain tumor and cause nothing, we might leave it alone. Normally brain tumor are secondary to primary tumor Treat the primary site first then secondary site

Common sites of cancer and their sites of metastasis o Lungs, bone, brain What is priority of cancer? Psycho problem More important in breast cancer Pain Infection S/e of treatment A lot of question will be on Touchy feeling Screening What would you do with it. Eg drug o Zofran- anti-emesis Do not infuse it to quickly b/c it cause severe headache o Reglan S/E is severe headache Patient with hx of migraine be careful o Benadryl common questions on broad exam Helpful with n/v

Helps equalize equilibrium Helps p.t relax, drowsiness Watch for paradox effect in elderly and children Psychotic effect in mental patient

Cancer incidence o Male = prostate o Female = breast o Strongly link to family hx Cancer site of metastasis Prioritization with lung cancer o Breathing o Complications COPD, empyema O2 at lowest as possible o Assessment Lungs sounds Patient skin, appearance, how patient breathing o Make sure that the cancer is primary or secondary Pathophysiology Need to know the ending term o Questions will be like fibrilesarcoma o What is it? Is it matasize, where it the location, what would you do. Risk factors o Family hx Genetics prediposure o Viral HIV, Esin Barr o Chemical o Chronic illness Pancreatic cancer o Age Increase risk for people over age of 65 o Hormones Hormones change Estrogen Warning sings o CAUTION Change in bowel or bladder habits A sore that does not heal Unusual bleeding or discharge Do stool occulting Thickening or lump in breast or elsewhere Indigestion or difficulty in swallowing Obvious change in wart of mole Nagging cough or hoarseness Ask how much they are smoking Exposure to smoke and chemical

Intervention o How would you response type of questions are the majority in the first exam Staging of cancer o T0 = no evidence of primary tumor o N0= indicates lymph node involvement o M= indicate distant metastases o There are 5 stages Stage 0: carcinoma in situ Stage 1: tumor limited to the tissue of origin; localized tumor growth Stage 2: limited local spread Stage 3: extensive local and regional spread Stage 4: distant metastasis

Diagnostic o Biopsy is the best test to determine whether patient have cancer of not o Depends on location Prostate, PSA Digital rectal exam o Mammography o PAP smear o Stools for occult blood o Sigmoidoscopy, colonoscopy o Breast self-examination Once a month, 7-10 days after menses Postmenopausal pt pick same day each month to it

Testicular self-examination Once a month, same day Skin inspection Treatment Goal is to cure If there is no cure best is to control the spreading through; o 1.Surgical Know where the surgical site and what would be intervention Colon cancer o 2. Chemotherapy Involves the administration of cytotoxic medications and chemicals to promote tumor cell death It is vital for the Cather be in the VEINS or portable cap, because if it infiltrate it will destroy skin Types Oral o RN: need to have glove on when giving med o Empty urine RN needs to have glove, face mask and grown Flush twice IV PICC line o 3. Radiation- Know types we do with Radiation The goal of this treatment is to cure, control and palliate External Teletherapy o Perform by radiation therapist at the radiation room Internal Brachytherapy o Seed implanted in specific part of body Prostate/ bladder RN: monitor I&O, and protect them self when collecting urine o Don Mask, Grown, Glove o ALARA-Know As low as reasonably achievable Time o Cluster care Distance o Aim at the site Shielding o Shield the part the un-effected part Chest radiation shield gonad Assess patients before and after radiation

4. Gene Therapy o Missing or altered genes may lead to cancer. o Transfer of exogenous genes into cells of patients in an effort to correct defective gene 5. Bone marrow transplant o Goal is to restart the blood production for leukemia patient 6. Medication Know for quiz o Why giving it o S/E o Intervention Noting medical can do then palliative care o Keep them as comfortable as possible and to keep pt. alive as long as we can S/E Of Chemotherapy and medication o Apical Priory is self-esteem Provide wigs, Bandana o Dirrhea Give med that bulk up stool Ducasate Assess p.t perineum area Encourage dient low in fiber residue prior to treatment with chemo o Vomiting Admit Zofran Admit as slow as possible to prevent severe headache o Anorectic Ask What they want to eat Sore throat Give mouth wash to numb the throat If admit Lidocaine o Watch out for S/E of the heart o Neutropenia No fresh flowers, fruits or veggies in the room Look at WBC counts Infection precaution o Respiratory Resp distress Give O2 check O2 sat Incubate is a last resource o Done by MD or NP o Watch for chest to rise and fall o Watch out for aspiration o Skin Skin break down Rash o Reproductive Priority is to be able to reproduce Harvest the eggs or sperms

Patient and Caregiver Teaching Guide Coping o Grief issues Loss of healthy self Preparation for death o Anxiety o Uncertainties o Support groups Complications Resulting From Cancer-Need to know for the test!! Malnutrition Altered taste sensation Infection Oncology emergencies o Superior vena cava syndrome Obstruction of the SVC by tumor S&S Facial edema, periorbital edema , headache, seizure o Spinal cord compression Presence of tumor in epidural space S&S Bowel and bladder dysfunctions o Third space syndrome o Intestinal obstruction Metabolic emergency o Syndrome of Inappropriate Antidiuretic hormone (SIADH) Sustained production of ADH (antidiuretics hormone) o Hypercalcemia o Tumor lysis syndrome (TLS) Metabolize imbalance can lead to renal failure Phophase, cal Neuro issue o Seizure o Septic shock o Disseminated intravascular coagulation (DIC) o Cardiac tamponade o Carotid artery rupture

Nutritional Therapy o Need to have sufficient nutrition Hi calories, Hi protein o Not eating- intervene start from less invasive to most NG tubePPN (vein)TP Pain o Subjective o Pain assessment-Vital in cancer patient

Breast Cancer
Most important is mental health of patient Incidence o Most common malignancy in American for women (except skin) o 40 K deaths year in women o Morbidity and mortality is slowly decreasing o 5 year survival rate is 98% if there is not axillary node involvement o Survival rate for advanced breast Ca is only 17% Cultural Disparities o AA women have lower survival rates than white women o White women have higher incidence than non-whites o Incidence and mortality rates lower among Hispanics and Asian/Pacific Islander than white/Black women o Mexican/American have lowest rate of cancer screening of any ethnic group Etiology o Genetics o BRCA-1 and BRCA-2 Mutated genes that can lead to breast cancer Family hx is increase risk of having it Risk Factors o Female o Increasing age Age 50 or over o Family history o Personal history o Early menarche & late menopause o Full-term pregnancy after age 30 o Benign breast disease o Weight gain and obesity after menopause Types of Breast Cancer o Non-invasive breast Ca Localized in one spot o Invasive breast Ca Spread in more than one spot o Pagets disease Rare breast malignancy lesion of nipple and areola S&S Itching, burning, bloody nipple discharge

Inflammatory breast Ca Most malignant form of all breast cancers S&S An orange peel appearance What is a best way to screen-Test!! Age 20-30 do BSE, Once a month, same day, after period CBE by HP Q3Ys Age> 40 o CBE and mammogram Q1Y

Clinical Manifestations o Lump in upper outer quadrant RN: If p.t felt a lumpTell patient get it check out Screening by Ultrasound and mammogram Determination by biopsy o Firm, non-mobile, irregularly shaped and non-tender o Nipple discharge o Nipple retraction o Dimpling of skin Complications o Recurrence-main complication Come back after initial treatment o Metastasis Spread to other organ Diagnosis-Test o History including risk factors o Physical examination including breast and lymphatics o Mammography o Ultrasound o Biopsy o MRI if indicated Surgical Treatment o Tumor needs to be staged before treatment options are made-Quiz Questions o Mastectomy The deeper and the more tissue taken out more complications Lymphedema Need to preserve breast tissue and nipple as much as possible for breast feeding o Breast conservation surgery (lumpectomy) Remove just tissue around the tumor o Modified radical mastectomy Removal of breast and axillary nodes but preserves pectoralis major muscle

Taking more than just breast, taking more than just one procedure May or may not have breast reconstruction Surgical follow- up is vital

Axillary lymph node dissection (ALND) Dissection of axillary lymph node at the same side often performed Complication Lymphedema-KNOW!!! o Accumulation of lymph fluid in the tissue after cancer treatment Question Treatment Axillary Node Dissection Lymphatic mapping with sentinel lymph node dissection (SLND) o DO: is planned for a patient undergoing a modified radical mastectomy Massage, compression for breast cancer. The nurse understands that: Elevate, avoid trauma A. If one sentinel lymph node is positive for malignant cells, o Do NOT: all of the sentinel lymph nodes will be removed. B. Lymphatic mapping indicates which lymph nodes are IV, blood pressure most likely to have metastasis and all of those nodes are Any invasive procedure
C. removed. if malignant cells are found in any sentinel nodes, a complete axillary lymph nodes dissection will be done. Lymphatic mapping with sentinel lymph node dissection provides metastatic lymph nodes to test for responsiveness to chemotherapy.

Breast Conservation Therapy D. o Involves removal of entire tumor with a margin of normal tissue o Radiation therapy is delivered to entire breast, ending with a boost to tumor bed o Evidence of systemic disease may warrant chemotherapy before radiation o Goal of combined surgery and radiation Maximize benefits of cancer treatment Maximize cosmetic outcome Minimizing risks o Main advantage is that it preserves the breast and nipple For breast feeding Post mastectomy Nursing care-Test Questions are from this picture!!!!!

Postoperative Exercises
Question During the immediate postoperative period following a mastectomy, the nurse initially institutes exercises for the affected arm by: A. Having the patient brush or comb her hair with the affected arm. B. Performing full passive range-of-motion (ROM)exercises to the affected arm. C. Asking the patient to flex and extend the fingers and wrist of the operative side. D. Having the patient crawl her fingers up the wall, raising her arm above her head. Question A patient undergoing a modified radical mastectomy for cancer of the breast is going to use tissue expansion and an implant for breast reconstruction. The nurse knows that: A. Weekly injection of water or saline into the expander will be required. B. The expander cannot be placed until the healing from the mastectomy is complete. C. This method of breast reconstruction uses the patients own tissue to replace beast tissue. D. The nipple from the affected breast will be saved to be grafted onto the reconstructed breast.

Adjuvant therapy o Chemotherapy o Radiation o Brachytherapy Seeds that contain medication are implanted near the cancer site and will release medication as schedule o Hormonal therapy Estrogen blocker Steroid can help with inflammation o Biologic and targeted therapy Biologic Targeted Aim at specific sites Nursing Process-Look at difference type of nursing dx-TEST!! o Nursing Assessment Subjective Question A patient undergoing surgery and radiation for Past health hx treatment of breast cancer has a nursing Med hx diagnosis of disturbed body image related to Surgery/ other treatment absence of the breast. An appropriate nursing Objective intervention for the patient is to: A. Provide the patient with information Palpate by MD about surgical breast reconstruction. Assessment after surgery B. Restrict visitors and phone calls until o Pain, edema, infection the patient feels better about herself. o Post Op care C. Arrange for a Reach to Recovery Pain, elevation, self visitor or similar resource available or similar resource available in the esteem community. o Nursing Diagnosis D. Encourage the patient to obtain o Goals or Planning permanent breast prosthesis as soon as
she is discharged from the hospital.

o o

Nursing Intervention: Acute Evaluation

Gerontologic o Major risk for breast cancer is increased age. o More than half of all breast cancers are diagnosed in women age 65 or older. o 48% diagnosed with metastatic disease are 65 years or older. Because of commodity and other chronic disease o Older women are less likely to have mammograms.

Leukemia and Lymphoma

Leukemia-too much production of WBC

o A group of malignant disorders affecting the blood and blood-forming tissues of Bone marrow Lymph system Spleen Occurs in all age groups Results in an accumulation of dysfunctional cells because of a loss of regulation in cell division Causing anemia, leukopenia, the production of immature cells, thrombocytopenia, and a decline in immunity Fatal if untreated

o o

Etiology of Leukemia o Genetic Down syndrome and adult are more prone to leukemia o Environmental Chemical agent Chemotherapeutic agents Viruses Radiation o Immunologic deficiencies Have all been associated with the development of leukemia in susceptible hosts Types of Leukemia o Acute or chronic o Type of leukocyte involved Myelogenous Lymphocytic o Acute lymphocytic leukemia (ALL) Board exam will be on S&S Most common in pediatric patients Very immature cells S&S Fever, bleeding, fatigue, immunosuppressed Think of S&S and touchy feeling, what you do as RN , assessment, out come o o Acute myologenous leukemia (AML) Effects mostly adults A combination of younger and mature cells

Chronic lymphocytic leukemia (CLL) Mostly granulocytes present in bone morrow Age onset is in 40s Phililadephia chromosome markers o Chronic myologenous leukemia (CML) Mostly lymphocytes present in bone marrow Age onset is after 50 years old Things to know Treatment o Blood transfusion as slow as possible within 4 hours, to prevent fluid overload o Can tell the blood bank to send out only haft of blood first then another half Assessment o Occult blood in stool and urine o Low platelets increase risk for bleeding Soft bristle brush, electric save etc. Complications of Acute Leukemia o Petechial (smooth and flash rash) suspects DIC, thrombocytopenia, HIT o Anemia o Organ rejection Clinical Manifestations o Relate to problems caused by Leukemic cells infiltrate patients organs: Splenomegaly Hepatomegaly Lymphadenopathy Bone pain Meningeal irritation Massive weight loss with N/V Oral lesions Use soft tooth brush, non alcohol mouth wash, hydrogen peroxide + H2O, magic mouth wash Solid masses (chloromas) can form Diagnostic Studies o To diagnose and classify Peripheral blood evaluation High WBC, low every thing else Bone marrow evaluation o To identify cell subtype and stage Morphologic, histochemical, immunologic, and cytogenic methods o LP and CT scan o Best is bone marrow biopsy and CBC to determine what is going on

Treatment Goal o

Goal is to attain remission Complete remissionno evidence on exam, bone marrow or blood samples Partial remissionno symptoms, some evidence in bone marrow The patients progress is directly related to the ability to maintain a remission

Treatment with Chemotherapy o Combination chemotherapy is the first line treatment of Leukemia Decrease drug resistance Minimize drug toxicity Interrupt cell growth at multiple points in the cell cycle Treatment of Leukemia-Know drugs o Alkylating agents o Antitumor antibiotics o Antitumormetabolites o Corticosteroids o Biologic/targeted therapy o Radiation may be used to prepare a patient for bone marrow transplantation (BMT) Bone Marrow/Stem Cell Transplant o The goal is to totally eliminate leukemic cells from the body using combinations of chemotherapy with or without total body irradiation o This therapy eradicates the patients own hematopoietic stem cells o Replaced with those of an HLA-matched Sibling, volunteer, identical twin or the patients own stem cell removed before transplant BMT Complications o Graft-versus-host disease Body rejects graft from other sources, managed with immunosuppressive agents S&S Abdominal pain or cramps and nausea, vomiting, and diarrhea Dry or irritated eyes Jaundice (yellow coloring of the skin or eyes) Skin rash, itching, redness on areas of the skin o Relapse of leukemia o Infection Outcomes for Patients With Leukemia o Cope effectively with diagnosis o Attain and maintain adequate nutrition o Experience no complications related to the disease or its treatment What complication they can go through: TLS, DIC o Feel comfortable and supported throughout treatment

Question: Induction period of chemotherapy is when chemo destroy both good cells and bad cells Type of AHII questions are best, Chemo drugs preparation: priority and first Pre-hydrationZofran at >4mgIV about 15 minutes chemo drugsPost-hydration Radiation preparation Wrap effected areaSedate themstart procedure

Lymphoma
Malignant neoplasms originating in the bone marrow and lymphatic structures Result in the proliferation of lymphocytes Fifth most common type of cancer There are two types o Hodgkin's Disease o Non-Hodgkin's Lymphoma Worse b/c it can be anywhere Hodgkins Lymphoma o Accounts for 12% of all lymphomas o Occurs most frequently between 15-35 years and after age 50 o Predisposing factors: Epstein Barr Virus (EBV) Genetics Exposure to occupational toxins o Twice as prevalent in men Hodgkins Disease o Malignant condition Characterized by proliferation of abnormal giant, multinucleated cells Characterized by the present of Reed-Sternberg cells o Located in the lymph nodes Clinical Manifestations o Enlargement of cervical, axillary, or inguinal lymph nodes o Can spread to lungs, spleen and liver Organ removal might be part of treatment Spleen removed be aware of infectious situation o Nodes remain moveable, non-tender o Painless unless nodes exert pressure on adjacent nerves o May experience Weight loss, fatigue, weakness, fever, chills, tachycardia=>100, night sweats Diagnostics o Peripheral blood analysis Need to know blood drawn procedure o Lymph node biopsy o Bone marrow examination Sedate the patient before hand b/c the blood will be taken form bone marrow

Look at reed-stern berg cell Radiologic evaluation To look at other organs if they are effected Stages of Hodgkins Lymphoma-KNOW!!! o

Stage one- only one nodes Stage two two nodes above diaphragm Stage three- more than three nodes above and lower diaphragm Stage four all over the body, involve organs

Treatment o Chemotherapy Maintenance chemo does not contribute to increased survival rate once remission is achieved o Possible radiation Nursing Care o Mange problems related to the disease Pain Anxiety Pancytopenia o Skin care if receiving radiation o Psychological support Non-Hodgkins Disease (NHL) o Heterogeneous group of malignant neoplasms of B or T cell origin affecting all ages o Classified according to Different cellular characteristics Lymph node characteristics o Aging population o HIV & individuals taking immunosuppressant medications have increased risk o Occupational exposure to carcinogens Clinical Manifestations o Majority of patients have widely disseminated disease at time of diagnosis o Painless lymph node enlargement Primary clinical manifestation Can wax and wane o Patients with high grade lymphomas can have B symptoms (fever, night sweats & weight loss)!!!!

Airway obstruction, hyperurecemia, G/I complaints or renal failure from tumor lysis syndrome

Diagnostic studies o Diagnostic studies similar to Hodgkins disease o MRI, barium enema or CT o Lymph node biopsy establishes the cell type and pattern o Staging guides therapy o Prognosis for NHL is generally not as good as that for Hodgkins disease Treatment o Chemotherapy and sometimes radiation Chemotherapy usually primary then radiation Patient with chemo therapy will be very tired, lethargy appearance, as RN we need to do cluster care** o More aggressive lymphomas are more responsive to treatment More likely to be cured Indolent (low grade) have naturally long course but are difficult to effectively treat

Multiple Myelomas
Multiple Myelomas o Neoplastic plasma cells (B cells) invade and kill bone marrow and bone o Usually effects people over the age of 40 o Exposure to radiation, organic chemicals, herbicides, insecticides and certain viruses may play a role Clinical Manifestations o Appear late o Bone pain-big thing for them!! Pelvis, spine, ribs o Pathologic fractures (30%) o Hypercalcemia o Pancytopenia Diagnostics o X-rays Areas of bone erosion, thinning, collapse o Blood Pancytopenia, hypercalcemia, Monoclonal antibody protein can be found in urine and blood o Presence of Bence-Jones protein in urine o Elevated serum (blood) creatinine At risk for renal failure Treatment o Aimed at remission and prolonging life Ambulation, hydration, pain control Corticosteroids Drug ending -One Test!!! o Infection and glucose o Will increase the glucose level will be on insulin (sliding scale) o Even they are not diabetes

Chemotherapy Biologic therapy Hematopoietic stem cell transplant (HSCT) Nursing Care o Aimed at symptom control Pain Pathologic fracture prevention Implement fall precautions Hydration to combat hypercalcemia Assess psychosocial needs o Nursing Diagnosis ADPINE Biggest cause of lung Lung cancer cancer = cigarette smoking o Leading cause of cancer-related deaths o Leading cause of death in women o Survival rates are lower than for most other cancers. Etiology o Cause by smoking, chemical Pathophysiology o Carcinogens (smoking, chemical) turns good cells to bad cells in the lungs spread throughout body Clinical Manifestations o Hoarseness Diagnostic Studies o Biopsy is the definite o Scans o Diagnosis identified by malignant cells o Sputum specimens obtained for cytologic studies o Staging- QUIZ o Screenings Stop smoking, Tidal volume, peak flow, chest X-ray Nursing Management o Nursing Assessment Priority is breathing, airway Risk factors Commodity Asbestos exposure COPD, diabetes, obesity, heart Cigarette smoking disease, emphysema Exposure to uranium o Nursing Diagnosis Chronic institial fibrosis = Base on assessment scar tissue in the lungs and o Planning or goals will not be able to expand o Implementation-Acute and homecare Collaborative Care o Surgical therapy Lopectomy Pneunmoectomy Hook to chest tube

Lung, Colon, pancreas and liver cancer

o o o o o Radiation therapy Chemotherapy

Cannot clink the tube, no sings of crepitus (crackles or pops)

RN Important things to improve patient outcome Support, education, what to expect

Biologic and targeted therapy Other therapies

Colorectal Cancer
Colon Cancer and Polyps

More common in men Mortality rates are highest among AAs (men and women) Major risk factors Increasing age (90% are over 50) Family history of colorectal Ca Inflammatory or irritable bowel disease for >10 years Cigarette use Obesity 1/3 have a FH of colorectal Ca Clinical Manifestations o Hematochezia Bright red blood in poop lower end of colon o Melana Dark blood color in poop upper end of colon o Abdominal pain/cramping o Changes in bowel habits o Constipation diahrrea Signs and Symptoms by Location

Gold standard DX of colorectal cancer = colonoscopy o Need to sedate first o Clear out stuffs in the colon o After colposcopy= patient will fart a lot, b/c they need to rid of air in colon before they can go home

Diagnostics o History o Fecal occult blood test (FOBT) o Double contrast enema o Sigmoidoscopy o Colonoscopy

Who gets screened? Any body particate

Ostomy Need to burp (let gas out of the bag) it to prevent feces from oozing out

Treatment o Surgery Polypectomy Abdominal-peritoneal resection Lower anterior resection o Chemotherapy For patients who have positive lymph nodes at the time of surgery or have metastases o Radiation Adjunct to surgery and chemo Palliative measure Both chemotherapy and ration are often use Goals of Surgical Treatment of Colon Ca o Tumor resection with adequate margins of health tissue o Explore the abdomen to assess whether the cancer has spread o Remove the lymph nodes that drain the area where cancer is located o Restore bowel continuity o Prevent surgical complications Chemotherapy for Colon Ca o Used if patients have positive lymph nodes or metastatic disease** o Can also be used to shrink tumor before surgery o Palliative treatment for unresctable tumors Goals for Patients With Colon Ca o The patient will have: Normal bowel elimination patterns Quality of life appropriate to disease progression o Pain relief o Feelings of comfort and well-being

Liver Cancer
Primary Liver Ca o Fourth most common Ca in world o 80% have cirrhosis of the liver o Hepatitis C is responsible for about 50-60% of all liver cancers o Hepatitis B is responsible for about 20% of liver cancers o Rare in people under 40 in US o Metastatic liver cancer is more common than primary liver cancer Where is my Liver

Before surgery and on aspirin Check PTT&PT and give platelets, FFP, (fresh frozen plasma)
Care before surgery Education, check labs Intervention to alleviate anxiety Education Post op what to expect Pain, might have a bag

Education for family- post-op care

Clinical ManifestationsKNOW for TEST!! o He

o o o o

o o o o

patomegaly/splenomegaly Jaundice Weight loss, Anorexic Peripheral edema Ascites Do peracentesis At risk for infection, hypovolemic shock b/c fluid shift form vascular to the abdominal space Portal HTN Dull abdominal pain RUQ pain N/V

Diagnostics o Difficult to diagnose and differentiate between cirrhosis and liver Ca o Liver scan/ biopsy is a definite o CT o MRI o Endoscopic retrograde cholangiopancreatography (ERCP) o Liver biopsy o AFP Collaborative Care o Prevention and identification of high risk individuals is key o Lobectomy o Liver transplant o Radiofrequency ablation Zap the cancerous part off Complications of liver problem o Cryoablation Toxicity level of drugs o Percutaneous ethanol injection (PEI) Nutrition imbalance o Chemotherapy Nursing Care for Patients With Liver Ca o Keep the patient comfortable o May have GI bleed or hepatic encephalopathy o Prognosis is poor

Pancreatic cancer

Pancreatic Ca o 42,500 are diagnosed and 35,300 die o Fourth leading cause of death from Ca in US o Risk increases with age (peaks between 65 and 80 years) o Half in head of pancreas o As tumor grows common bile ducts becomes obstructed an jaundice develops o Usually metastasized at time of diagnosis o Signs and symptoms similar to pancreatitis o Prognosis is poor o Majority of patients die within 5-12 months o 5 year survival rate is less than 5% Who Gets Pancreatic Ca? o Patients with DM and chronic pancreatitis o Cigarette smoking o Family history of pancreatic Ca o High fat diet o Exposure to benzidine Signs and Symptoms- KNOW TEST!! o Abdominal pain o Anorexia o Rapid and progressive weight loss o Nausea o Jaundice Diagnostics for Pancreatic Ca o Transabdominal ultrasound (u/s) o CT o MRI o Endoscopic Retrograde Cholangiopancreatography (ERCP) o Endoscopic ultrasound (EUS) o Tumor markers (CA 19-9) Treatment for Pancreatic Ca o Surgery is best option Whipple procedure o Only 15-20% are resectable o Radical pancreaticoduodenectomy or Whipple procedure o Experimental chemo o Radiation may be used for pain relief Collaborative Care o Pain relief o Psychological support o Nutritional support o Relief from n/v o Asses for bleeding tendencies o Support patient and family through the grieving process