Cancer Flashcards
1
Q
Which cells promote cell division?
A
Proto-oncogenes
2
Q
Which gene slows down cell division and cause cells to die?
A
tumor-suppressor genes
3
Q
What are the top three cancers in children?
A
- Leukemia*
- Brain/Spinal cord
- Lymphoma
*broad term for cancers of the blood cells
4
Q
What does it mean to be cured from cancer?
A
There are no traces of your cancer after treatment and the cancer will never come back.
5
Q
What does it mean to be in remission from cancer?
A
- Remission can be partial or complete.
- In a complete remission, all signs and symptoms of cancer have disappeared. After a certain amount of years complete remission can transition to “cured” status.
6
Q
Why would a doctor use a variety of chemo drugs instead of just using one for a single patient?
A
Tumors possess ability to develop resistance to chemo; if a variety of drugs are used treatment will be less likely resisted.
7
Q
What are the three causes of childhood cancer?
A
- Genetics*
- Failure of immune system to distinguish abnormal cells
- Carcinogens
abnormal proto-oncogenes and non-functioning tumor suppressor gene
8
Q
- What are anti-neoplastic drugs?
- What is a known side effect?
A
- Chemo drugs designed to destroy abnormal tissue cells (cancer)
- Can target normal healthy rapidly dividing cells too (e.g., hair cells)
Alopecia
9
Q
When would you expect to see peak bone marrow suppression in a child on chemotherapy?
A
7 to 10 days
after beginning treatment.
10
Q
What risk factors occur during peak bone marrow suppression while going through chemotherapy?
A
- Risk for infection (neutropenia)
- Risk for bleeding (thrombocytopenia)
11
Q
What are the 4 gastrointestinal side effects of chemotherapy?
A
- Mucosal ulcerations
- Nausea and vomiting
- Esophagitis
- Constipation
12
Q
Why would you place a central line in a patient requiring chemotherapy?
A
peripheral veins cannot tolerate chemotherapy medications
13
Q
What are the two central lines discussed for chemotherapy?
A
- Broviac
- Portacath
14
Q
- Describe a Port cath?
- What are the pros?
- What are the cons?
A
- Surgically implanted catheter under the skin of the chest connected to a large vein.
- Less risk of infection and minimal care required
- Can be difficult to access and uncomfortable
Numbing cream can be used to reduce discomfort
15
Q
- Describe a Broviac cath?
- What are the pros?
- What are the cons?
A
- Cather connected to a large vein
- Contains a double lumen*
- Requires sterile dressing and changes.
Different meds, fluids, and blood can be infused at the same time.
16
Q
What are four specific sides effect related radiation?
A
- Alterted bone growth and skeletal malformations in children.*
- Cranial radiation can affect cognitive development
- Increased risk of other cancers
- Impair skin integrity
Not as common in adults, because they are fully grown already
17
Q
What is a debulk and resect?
A
Surgical removal of as much of a tumor as possible.
18
Q
What is biotherapy?
A
uses of the body’s immune system to fight cancer.
19
Q
- What is Bone Marrow and Stem Cell transplant indicated for?
A
- Indicated for malignancies that cannot be cured by other means (e.g., chemo, radiation, surgery)
- Cancer relapse.
20
Q
What are the three types of Bone Marrow and Stem Cell Transplants?
A
- Syngenic
- Autologous
- Allogenic
21
Q
What type of Bone Marrow & Stem Cell Transplant comes from an identical twin?
A
Syngenic
22
Q
What type of Bone Marrow & Stem Cell Transplant comes from yourself?
A
Autologous
23
Q
What type of Bone Marrow & Stem Cell Transplant comes from a matching donor?
A
Allogenic
24
Q
How is bone marrow & stem cell administered into a patient?
A
IV administration
25
1. What is engraftment?
2. When does engrafting usually occur?
1. When your transplanted cells are working properly and start to rebuild*.
2. Occurs usually within 2-4 weeks after transplant.
| WBC, RBC, and platelet production begins
26
What is Graft vs. Host Disease?
When graft or bone marrow (WBC) from donor identify patient’s as foreign and attacks them.
27
1. What **type** of bone marrow & stem cell transplant causes graft v. host disease (GvHD)?
2. What are the interventions for GvHD?
1. Allogenic
2. Immunosuppresants and steroids*
| steroids are for severe GvHD experiences.
28
# Signs and symptoms of **Graft vs. Host Disease**
1. Gastrointestinal
2. Liver (hepatic)
3. Integumentary
4. Ocular
1. Nausea, vomiting, diarrhea
2. **Elevated** liver enzymes
3. Skin rash
4. Ocular toxicity (*e.g., blurry vision*)
29
1. What are example of neutopenic diet?
2. Who would be prescribed to be on this diet?
1. Ø raw vegetables, Ø fruits that cannot be peeled, Ø soft cheese, food must be cooked thoroughly.
2. Patients on immunosuppresants due to foodborne pathogens.
30
1. Which growth factor medication increases production of WBC?
2. Which one increases RBC?
1. **Neuopogen** is for WBC production
2. **Epogen** is for RBC production
31
What is the formula for Absolute Neutrophil Count (ANC)?
Total % of neutrophils × White Blood Cell Count = ANC
32
How is total % neutrophils calculated in ANC?
poly/segs + bands
33
Mature neutrophils are referred to as?
Immature neutrophils are reffered to as?
| For ANC calculation
* “**polys or segs**” = **mature** neutrophils
* “**bands**” = **immature** neutrophils
34
What is tumor lysis syndrome?
The lysis of tumor cells and **rapid release** of contents of _intracellular compartment_ into _extracellular fluid (blood)_.
35
What three things does tumor lysis syndrome elevate in the ECF?
| intravascular fluid (blood) of ECF
1. Uric acid
2. Potassium (K+)
3. Phosphate
| Elevated levels in Blood
36
What are the interventions for tumor lysis syndrome?
Elevated uric acid, potassium, and phosphate.
1. **Allopurinol** for uric acid
2. **Sodium bicarbonate w/ IV insulin dextrose** for potassium
3. **Phosphate binder** for phosphate
37
What two things can cause tumor lysis syndrome?
1. Cancer itself
2. Side effect of treatment
38
Which two cancers commonly cause tumor lysis syndrome?
1. Acute lymphocytic leukemia (ALL)
2. Non-Hodgkin’s Lymphoma
39
What is Acute Lymphocytic Leukemia (ALL)?
the proliferation of *immature* white blood cells.
40
What is the most common **childhood** cancer?
Acute Lymphocytic Leukemia (ALL)
41
1. Which gender is more likely to develop acute lymphocytic leukemia?
2. What age does it peak in **childhood**?
1. Males
2. Ages 2-6
42
Which geographic areas are acute lymphocytic leukemia more common?
Industralized areas
43
Which antineoplastic* drugs is associated with acute lymphocytic leukemia development?
| *Chemotherapy drugs
Alkylating agents
44
What is the role of genetics in acute lymphocytic leukemia (ALL)?
90% of those diagnosed w/ ALL have some kind of abnormal chromosomal on the cell itself. (*e.g., Philadelphia*)
45
Exposure to what may cause acute lymphocytic leukemia (ALL)?
Ionizing radiation & certain chemical toxins
46
What are the expected changes in CBC with acute lymphocytic leukemia (ALL)?
1. White blood cell ↑
2. Anemia (RBC ↓)
2. Thrombocytopenia (Platelet ↓)
47
What are the effect of acute lymphocytic leukemia (ALL) on normal cells?
Normal cells are deprived of essential nutrients of metabolism → cellular destruction
48
What is the definitive diagnosis for acute lymphocytic leukemia (ALL)?
Bone marrow aspiration
49
Why is a lumbar puncture performed after a definitive diagnosis of acute lymphocytic leukemia (ALL)?
If infiltration of WBC occurred in the CNS
50
# Favorable prognostic factors for acute lymphocytic leukemia (ALL)
1. Leukocyte count
2. Age
3. Immunologic subtype
4. Sex
5. Cytogenetics
1. WBC < 50,000/mm²
2. Age 2-10
3. CALLA positive precursor B
4. Female
5. No chromosomal abnormality
51
When does remission usually occur for acute lymphocytic leukemia (ALL)?
1st month of chemo
52
What is the diagnosis for remission in acute lymphocytic leukemia (ALL)?
Less than 5% blast cells
| *immature WBC*
53
Where is chemotherapy administered for acute lymphocytic leukemia (ALL)?
Central and Intrathecal* (*spinal cord*)
| prevent spread of ALL to CNS.
54
What can occur with vaccines during chemotherapy?
antibodies may be wiped and boosters may be indicated
55
What must be observed when chemotherapy is given for the first time?
anaphylactic reactions
| severe, potentially life-threatening allergic reaction
56
What is the most common solid tumor?
| an abnormal mass of tissue that does not contain cysts or liquid areas.
Brain tumor
57
What is the cause of brain tumor?
unknown
but suspected to be cranial radiation
58
Where do most brain tumors occur?
Posterior Fossa
| includes cerebellum, brain stem and fourth ventricle
59
What is the most common type of brain tumor in children?
Medulloblastomas
| starts in the lower back part of the brain, cerebellum.
60
What is the **hallmark symptom** of brain tumor?
headache with morning vomiting related to child rising
61
What two factors are the symptoms of brain tumors affected by?
1. Tumor size
2. Location of tumor
62
How are brain tumors diagnosed?
CT scan or MRI w/ contrast
63
When is surgery not advised as treatment for brain tumor?
if the brain tumor is located near the brain stem
| Risk of nervous system damage
64
What age is cranial radiation avoided w/ brain tumor treatment?
Children < 3
65
What are the three possible treatments for brain tumors?
1. Surgery
2. Cranial radiation
3. Chemotherapy
66
What is indicated if a tumor is inteferring w/ drainage of cerebral spinal fluid in ventricles?
| risk for hydrocephalus
Ventriculoperitoneal (VP) shunt
| monitor VP shunt for infection and obstruction
67
What is the most common malignant extracranial solid tumor of childhood
Neuroblastoma
68
What two interventions are indicated to reduce cerebral edema s/p brain tumor?
1. Osmotic diuretic (Mannitol)
2. Hypertonic IV solution
69
What is the most common cancer in **infancy** and **may be found at birth**?
Neuroblastoma
70
What is the treatment for neuroblastoma for children under 12 months?
no treatment is indicated due to possible **spontaneous** **remission**
71
Which cells do neuroblastoma originate from?
Neural crest cells
| develop into sympathetic nervous system & adrenal medulla
72
Raccoon eyes are associated w/ which disease?
Neuroblastoma
73
Most neuroblastoma cells have genetic abnormalities involving which chromosome?
Chromosome #1
74
Which three parts of the body are scanned for neuroblastoma?
1. Chest
2. Abdomen
3. Pelvis
75
How long must infants be in remission for neuroblastoma to be considered cured?
1 year
76
Which cancer is most common in **adolescence** and **young adult**?
Hodgkin's Disease
77
What is the positive finding for Hodgkin's Disease w/ a biopsy?
Sternberg-Reed cells
| (looks like owl eyes)
78
What three things does Anne Arbor staging look for in Hodgkin's disease?
1. Spread to other site
2. Which lymph nodes are involved*
3. Presence of other symptoms
| *above or below diaphragm
79
What is the most common bone cancer?
Osteogenic Sarcoma
80
Where does ostogenic sarcoma usually develop?
areas where the bone is growing quickly, such as near the ends of the long bones.
| (metaphysis of femur)
81
Which type of cancer treatment is not indicated for ostogenic sarcoma?
Radiation
82
What is the common site of metastasis for osteosarcoma?
Lungs
83
# Which Hodgkin's stage is characterized by
wide spread, including multiple involvement at one or more extranodal (sites such as the bone marrow).
Stage 4
84
# Which Hodgkin's stage is characterized by
lymph node regions on **both sides of the diaphragm** are affected.
Stage 3
85
# Which Hodgkin's stage is characterized by
**two or more lymph node** regions on **same side of diaphragm**
Stage 2
86
Progressive, insidious or intermittent **pain** at tumor site **relived by position change** is a symptom of which cancer?
Osteogenic Sarcoma
87
Urine excretion of ____ is an indicator for neuroblastoma
catecholamines
88
What is the two most common clinical manifestation for neuroblastoma?
1. abdominal mass
2. protuberant firm abdomen.
89
What clinical manifestations are associated with Hodgkin's Disease "B"
1. Low grade fever
2. Weight loss
3. Night sweats
90
What is a prognosis indicator for Osteogenic Sarcoma?
**Elevated** levels of ALP and LDH is high **risk for Tx failure**
| Alkaline Phosphatase (ALP) and Lactate Dehydrogenase (LDH)
91
What % of blasts (immature WBC) in indicative of acute lymphocytic leukemia?
30% ≥
