Abnormal Cell Growth

Question 1

ABCD of moles

Answer 1

Asymmetry,
irregular Border,
uneven or multiple Colors,
large Diameter (>6 mm).

Question 2

nonmelanoma skin cancers (NMSCs) two types:

Answer 2

1. basal cell carcinoma (BCC)
2. squamous cell carcinoma (SCC)

Approximately 75% of skin cancers are BCC; SCC is the next most common skin cancer, followed in frequency by melanoma. More than 2 million cases of NMSC are diagnosed annually.

Question 3

Basal cell carcinoma

What is it and what are the 2 types?

Answer 3

BCC is a slow-growing neoplasm of cells of the basal layer of the epidermis. If rare metastasis occurs to the bone, brain, lung, and liver, the prognosis is grave. BCC is most frequently found on the head, neck, and skin that has hair.
two types of BCC.:
Nodular ulcerative - a small, flesh-colored, smooth nodule that enlarges over time
Superficial BCC is often seen on the chest or back and begins as a flat, nonpalpable, erythematous plaque that enlarges and becomes red and scaly with nodular borders.

Question 4

Squamous cell carcinoma

Answer 4

SCC leads to an invasive tumor that can metastasize to the lymph nodes and visceral organs.
Characterized by lesions on the squamous epithelium of the skin and mucous membranes. SCC appears as a red, scaling, keratotic, slightly elevated lesion with an irregular border, usually with a shallow chronic ulcer.

Question 5

What kind of cancer are bone cancers?

Answer 5

Bone cancers are sarcomas—that is, cancers of connective tissue.
Cancers originating in the osseous, cartilaginous (chondrogenic), or membrane tissue are classified as bone cancer.

Cancers originating from the bone marrow are usually classified as hematologic cancers.

Question 6

Esophageal cancer

Answer 6

Esophageal cancer is most common in males older than age 65 and is nearly always fatal. In most cases, the tumor partially constricts the lumen of the esophagus. Regional metastasis occurs early in disease progression in submucosal lymphatics, commonly fatally invading adjacent vital intrathoracic organs. If the patient survives primary extension, the liver and lungs are the usual sites of distant metastases.

Question 7

Symptoms of esophageal cancer

Answer 7

Feeling of fullness or pressure; Indigestion; Antacid use to relieve GI upset; Dysphagia (first occurs only after eating solid foods, especially meat; later causes difficulty swallowing coarse foods and, in some cases, liquids); Weight loss; Hoarseness; Chronic cough; Anorexia; Vomiting; Pain on swallowing; Pain that radiates to the back

Question 8

Liver cancer

Answer 8

Most liver cancer is secondary (metastatic).
Primary liver cancer strikes twice as many men as women, at an average age of 67.
Liver cancers include: Hepatocellular carcinoma (HCC) and Cholangiocarcinoma

Question 9

Hepatocellular carcinoma

Causes

Answer 9

accounts for most liver cancers.
More often in men than women. It is usually seen in people age 50 or older. In most cases, the cause of liver cancer is scarring of the liver (cirrhosis). Cirrhosis may be caused by:
Alcohol abuse
Autoimmune diseases of the liver
Hepatitis B or C virus infection
Inflammation of the liver that is long-term (chronic)
Iron overload in the body (hemochromatosis)

Question 10

Hepatocellular carcinoma symptoms:

Answer 10

Abdominal pain or tenderness, especially in the RUQ.
Easy bruising or bleeding
Enlarged abdomen
jaundice

Question 11

Cholangiocarcinoma

Causes:

Answer 11

cancerous growth in one of the ducts that carries bile from the liver to the small intestine. Cancerous tumors of the bile ducts are usually slow-growing and do not metastasize quickly. These tumors block off the bile ducts.
Increased risk for getting this:
Bile duct (choledochal) cysts
Chronic biliary and liver inflammation
History of infection with the parasitic worm, liver flukes
Primary sclerosing cholangitis
Ulcerative colitis

Cholangiocarcinoma is rare.

Question 12

Symptoms of Cholangiocarcinoma

Answer 12

Chills
Clay-colored stools
Fever
Pain in the upper right abdomen that may radiate to the back
Itching
Loss of appetite
Yellowing of the skin (jaundice)
Weight loss

Question 13

Prostate cancer

Answer 13

Prostate cancer is the most common type of cancer in men & the 2nd leading cause of death among men in the US. There may be local spread occurs to the seminal vesicles, bladder, peritoneum. It metastasizes to other sites via the hematologic and lymphatic systems, following a fairly predictable pattern. ACS advises screening beginning at age 40. (Annual digital rectal examination (DRE) beginning at age 40 and annual serum prostate-specific antigen (PSA) testing beginning at age 50.

Question 14

Two common side effects of prostatectomy

Answer 14

urinary incontinence and impotence.
The urinary incontinence usually resolves with time after performing Kegel exercises.
Impotence occurs in 85% to 90% of patients.

Question 15

Transurethral resection of the prostate (TURP)

Answer 15

may be recommended for men with more advanced disease. This procedure is not a curative surgical technique but does remove excess prostatic tissue that is obstructing the flow of urine through the urethra. The incidence of impotence is rare, although retrograde ejaculation almost always occurs.

Question 16

Renal cancer

Answer 16

also called nephrocarcinoma, renal carcinoma, hypernephroma, and Grawitz’s tumor.
About 85% of renal cancers originate in the kidneys. Others are metastasis.
Most renal tumors are large, firm, nodular, encapsulated, unilateral, and solitary.

Question 17

complications and post op treatment of breast surgery

Answer 17

infection, seroma, hematoma, limited ROM, sensory
changes, lymphedema. A seroma is usually prevented with the placement of a gravity drainage device (Hemovac, Jackson-Pratt) in the site for up to 7 days postop. Drains are usually removed when drainage has decreased to about 30 cc per day. ROM for the lower arm is begun within 24 hrs postop, and full ROM is ordered by the surgeon after the drains are removed. Sensory changes include numbness, weakness, skin sensitivity, itching, heaviness, or phantom sensations that may last a year.

Question 18

Post op treatment for brain surgery

Answer 18

careful monitoring for increased ICP.
Notify the surgeon if the bone flap becomes elevated, which is a sign of increased ICP.
The physician usually manages cerebral swelling and elevated ICP with fluid restriction (usually 1,500 mL or less in 24 hours), steroids, shunt placement, and osmotic diuretics such as mannitol.

Question 19

What is a seroma

Answer 19

A seroma is a pocket of clear serous fluid that sometimes develops in the body after surgery. This fluid is composed of blood plasma that has seeped out of ruptured small blood vessels and inflammatory fluid produced by the injured and dying cells.

Question 20

Uterine cancer most commonly occurs in which part of uterus?

Answer 20

in the endometrium. Endometrial cancer accounts for more than 95% of the diagnosed cases.

Question 21

Which kind of cancer is the leading cause of cancer death for men and women in the US?

Answer 21

Lung cancer

Question 22

There are two major types of lung cancer:

And describe both

Answer 22

Sometimes a lung cancer shows characteristics of both types and is labeled small cell/large cell carcinoma.

Small cell lung cancer (SCLC) accounts for 13% of all lung cancers and is almost always caused by smoking. characterized by small, round to oval cells in broncho-epithelium. Multiply quickly into large tumors and can spread to lymph nodes and other organs.

Non-small cell lung cancer (NSCLC) accounts for approximately 87% of all lung cancers and includes three subtypes: Squamous cell carcinoma, Adenocarcinoma, bronchioloalveolar.

Question 23

Systemic effects of the lung tumor that are unrelated to metastasis may affect which body systems?
Tumors can cause which complications?

Answer 23

the endocrine, hematologic, neuromuscular, and dermatologic systems. These changes may cause connective tissue and vascular abnormalities, referred to as paraneoplastic syndromes. In lung cancer, the most common endocrine syndromes are SIADH, Cushing’s syndrome, and gynecomastia.
Complications of lung cancer include emphysema, bronchial obstruction, atelectasis, pulmonary abscesses, pleuritis, bronchitis, and compression on the vena cava.

Question 24

Symptoms of pancreatic cancer

Answer 24

Symptoms may include weight loss, anorexia, fatigue, epigastric pain, jaundice.
patient may have difficulty digesting fatty foods; this will result in pale, bulky, greasy stools that tend to float in the toilet.
Assess for the presence of pruritus (buildup of bilirubin in the skin )
And dark urine (build up of bilirubin in blood)

Question 25

What are some of the surgeries for pancreatic cancer?

Answer 25

total pancreatectomy::the entire pancreas and spleen are removed.

pancreatoduodenectorny (Whipple procedure):: involves removal of the head of the pancreas, distal stomach, gallbladder, pancreas, spleen, duodenum, proximal jejunum, regional lymph nodes. The procedure induces exocrine insufficiency and insulin-dependent diabetes.
A pancreatojejunostomy hepaticojejunostomy, and gastrojejunostomy are performed with the Whipple procedure to reconstruct the GI system. A vagotomy is usually done in both procedures to decrease the risk of peptic ulcer. A stent may be used for bile duct obstruction.

Question 26

What are sarcomas?

Answer 26

Sarcomas are cancers of connective tissue.
can start in any part of the body, such as the bone or soft tissue.
Most often in children

Question 27

bone sarcomas or bone cancer. There are three types of bone sarcoma:

Answer 27

osteosarcoma;
Ewing’s sarcoma;
chondrosarcoma.

Question 28

Ewing’s Sarcoma

Answer 28

approximately 250 cases diagnosed a year, generally in children and young adults under the age of 30.
can be found in any bone, but is most common in the bones of the lower body- pelvis, tibia,fibula,femur. occasionally Ewing’s sarcoma may occur in soft tissues. It is an aggressive cancer treated with a combination of surgery, radiation, chemotherapy, with a good outcome for many cases.

Question 29

Chondrosarcoma

Answer 29

cancer that develops from the cells that produce cartilage. more common among older people than among children.
unlike the other bone cancers, chondrosarcoma is more often found in the spine and pelvis than in legs or arms.
Surgery is the most common treatment for chondrosarcoma, sometimes with radiation or chemotherapy.

Question 30

What is Dysgeusia?

Answer 30

Altered Taste Sensation - Cancer cells may release substances that stimulate the bitter taste buds.
patient may also experience an alteration in the sweet, sour, salty taste sensations.

Question 31

Why is infection such a risk for cancer patients?

Answer 31

Infection is a primary cause of death in the patient with cancer. The usual sites of infection include the lungs, GU system, mouth, rectum, peritoneal cavity, blood (septicemia). Infection occurs as a result of the ulceration and necrosis caused by the tumor, compression of vital organs by the tumor, and neutropenia caused by the disease process or the treatment of cancer. Instruct patients with a risk for neutropenia to call their health care provider if they have a temperature of 100.4° F or greater. For patients who are neutropenic, infection may be rapidly fatal if not treated promptly. The classic manifestations of infection are often subtle or absent in a patient with neutropenia and depressed immune system.

Question 32

Chemotherapeutic agents are classified as either vesicant or non-vesicant. Difference between vesicant or non-vesicant chemo.

Answer 32

Vesicants- when they enter the subcutaneous tissues cause tissue necrosis and damage to the underlying structures, such as the tendons, veins, arteries, and nerves.
This process of infiltration and damage is termed extravasation.

Question 33

Remember that all rapidly dividing cells (both normal and cancer cells) are affected by chemotherapy.

Answer 33

Mucous membranes, Hair follicles, Bone marrow component

Question 34

Biological therapy

Answer 34

Biological therapy (immunotherapy) use substances naturally produced by the immune system to fight cancer either directly or indirectly or to lessen the side effects that may be caused by some cancer treatments.

Question 35

Examples of biological agents

Answer 35

interferon, interleukins, vaccines, CSFs, monoclonal antibodies :used in conjunction with other cancer therapies.

Interferon alpha, Rituxan, Herceptin, bacillus Calmette-Guérin vaccine (BCG):: used to treat various cancers.

CSFs, such as erythropoietin for RBCs, oprelvekin for platelets, and Neupogen for WBCs:: used to manage side effects of cancer therapy.

Question 36

What are immunosuppressants used for and give examples

Answer 36

can suppress or prevent the immune response.
used to prevent rejection of a transplanted organ, treat autoimmune diseases such as psoriasis, rheumatoid arthritis, Crohn’s disease.
Some treatments for cancer act as immunosuppressants. Immunosuppressant drugs can be classified into four categories:
• azathioprine (Imuran)
• cyclosporine
• monoclonal antibodies, which include: basiliximab, daclizumab, muromona
• corticosteroids such as prednisone

Question 37

What is radiation used for and how is it used?

Answer 37

high-energy ionizing rays prevents cells from growing and dividing. considered a local treatment.
people with certain types of lung cancer may receive radiation to the brain because this is a common site of metastasis.
Radiation therapy may be externally or internally delivered.

Question 38

Difference between external and internal radiation

Answer 38

External radiation delivers high-energy rays directly to the tumor site from a linear accelerator external to the body. 
Internal radiation (brachytherapy) involves the implantation of a small amount of radioactive material in or near the cancer. 
Radiation used for cancer treatment is called ionizing radiation because it forms ions as it passes through tissues, causing cell death by genetic change.

Question 39

TYPES OF BRACHYTHERAPY (internal radiation)

3

Answer 39

Low-Dose Rate (LDR) Implants
• implants stay in for hours or days. Often are in for 1 to 7 days and then removed.
• Likely admitted to a special room in the hospital with limited visitation time.

High-Dose Rate (HDR) Implants
• stay in for a few minutes at a time and then removed.
• The holder or catheter may stay in place, or it may be put in place before each treatment.
• Either admitted or outpatient treatments.

Permanent Implants
• These implants stay in the body and are not removed.
• Over time the radiation gets weaker, but the implants stay in place.

Question 40

Side effects of radiation

Answer 40

Side effects often increase as therapy progresses and can be anticipated to begin about two weeks after treatment starts. Radiation therapy mainly affects rapidly dividing cells, such as the cells lining the GI tract, including the large and small bowel, resulting in radiation enteritis. Several factors determine the occurrence and severity of radiation enteritis. Patients with acute enteritis may complain of nausea, vomiting, abdominal cramping, the frequent urge to have a bowel movement, and watery diarrhea.
Skin: thinning, altered pigmentation, ulceration or necrosis

Question 41

What is Myelosuppression?

Answer 41

BONE MARROW SUPPRESSION -is one of the most common effects of chemotherapy and to a lesser extent, it can also occur with radiation. Treatment-induced reductions in blood cell production can result in life-threatening effects, including infection, hemorrhage, overwhelming fatigue.

Question 42

How is stomatitis treated?

How is nausea/ vomiting treated?

Answer 42

Stomatitis:
magic mouthwash
Nystatin, carafate,
Lidocaine

N/V:
Zofran, decadron, Benadryl

Question 43

How is Hodgkin’s diagnosed?

Answer 43

Presence of Reed-Sternberg cells.

Good prognosis with chemo and/ or radiation.

Question 44

What is the TNM staging system?

Answer 44

Tumor size
Nodal involvement
Metastatic process

Question 45

What are 5 cancer emergencies?

Answer 45

Superior vena cava syndrome, 
spinal cord compression, 
hypercalcemia, 
pericardial effusion, 
extravasation

Question 46

What is Superior vena cava syndrome?

Sx and tx?

Answer 46

Emergency.
Tumor in chest causing venous blood backing up.
Sx: sob, facial edema, JVD,
Tx: elevate HOB, notify md, oxygen

Question 47

What is spinal cord compression in relation to cancer?
Sx?
Dx and tx?

Answer 47

cancer metastasizes to bones of spine (sometimes the first symptom of cancer.)
Symptoms: back pain, that may radiate down legs or arms, weakness or tingling, a band-like sensation in chest, and/or bladder and bowel problems.

An MRI is the best test to diagnose the condition, though the entire spine should be examined.
Treatments: steroids, radiation, surgery, and more depending on the type of cancer. It occurs most commonly with cancers of the breast, lung, and prostate, though other cancers may cause the condition as well.

Question 48

Extravasation

Answer 48

is the leakage of intravenously (IV) infused, and potentially damaging, medications into the extravascular tissue around the site of infusion.

Question 49

Signs and symptoms of leukemia

Answer 49

Bleeding (nose bleeds common in children)
Bruising 
Fatigue
Infection 
Fever 
Bone pain
Fatal within 3 months if aggressive chemo isn’t started.
(Don’t give asa)