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Med Surg > Cancer > Flashcards

Cancer Flashcards

1
Q

Type of cell growth for malignant cells vs benign cells

A

Benign = non neoplastic growth:
- hypertrophy
- hyperplasia
- dysplasia

Malignant = neoplasia (new growth)
- anaplasia

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2
Q

Mutations in cellular differentiation that occur with cancer

A

Proto-oncogenenes (regulate normal cell growth) get turned to oncogenes

Tumor suppressor genes (suppress growth) are mutated to become inactive

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3
Q

3 stage theory of mutation and what happens in each stage

A

Stage 1: initiation (changes in cell DNA from carcinogens)
Stage 2: promotion (reversible changes from promoters - unhealthy lifestyle)
Latent period: 1-40 yrs
Stage 3: progression (malignancy occurs, angiogenesis, tumor cells can metastasize)

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4
Q

Known risk factors that increase cancer risk

A

Cigarette smoke and smoking tobacco
Infections
Radiation (UV rays)
Immunosuppressive medicines after organ transplant

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5
Q

7 warning signs of cancer

A

Change in bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge
Thickening or lump in breast, testicle, or elsewhere
Indigestion or difficulty swallowing
Obvious change in size, color, shape, or thickness of
wart, mole, or mouth sore
Nagging cough or hoarseness

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6
Q

Classification of cancer using Grading and what each grade means

A

Grade 1: cells differ slightly from normal cells and are well differentiated
Grade 2: cells are more abnormal and moderately differentiated
Grade 3: cells are very abnormal and poorly differentiated
Grade 4: cells are immature and primitive and undifferentiated. Cell of origin difficult to determine

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7
Q

Classification of clinical staging and what each stage means

A

0: cancer in situ
1: tumor limited to tissue of origin, localized tumor growth
2: limited local spread
3: extensive local and regional spread
4: metastasis

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8
Q

What does TNM stand for?

A

Tumor size
Lymph node status
Metastasis

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9
Q

List the two classes of cancer drugs we need to know for class

A

Platinum drug
Anti tumor antibiotic

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10
Q

Prototype platinum drug

A

Cisplatin (Platinol)

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11
Q

Side effects of Cisplatin (Platinol)

A

Nephrotoxic
Ototoxic
Peripheral neuropathy
N/V

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12
Q

Nursing management for pts taking Cisplatin (Platinol)

A

Hydration and diuretics (for neurotoxicity)
Monitor I&O, renal labs (for neurotoxicity)
Antiemetics (for N/V)
Monitor hearing (for Ototoxicity)

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13
Q

Prototype anti tumor antibiotic

A

Doxorubicin (Adriamycin)

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14
Q

Side effects of Doxorubicin (Adriamycin)

A

Cardiotoxic
Myelosuppression
Vesicant
Alopecia
(Life time max cumulative dose)

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15
Q

Nursing management for pts taking doxorubicin (Adriamycin)

A

Monitor cardiac function
Monitor for signs of CHF
Teach pt urine and sweat may be discolored red

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16
Q

What is nadir?

A

Point at which blood cell counts are at their lowest
(7-10 days after chemo admin)
*Time pts are most likely to get an infection

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17
Q

Preferred rout for chemo administration

A

Intravenous (*CVAD)

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18
Q

Potential complications of chemotherapy administration

A

Infection
Extravasation

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19
Q

What is radiation used for?

A

Primary tumors
Metastatic lesions
Palliation

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20
Q

Most common type of radiation

A

External radiation (Teletherapy)

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21
Q

What should nurses teach pts when they’re receiving external radiation?

A

1 = skin reactions/ dermatitis

(Monitor and wash with plain water)
#2 = fatigue (Cumulative)
(Monitor hemoglobin level, tell to moderate exercise)

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22
Q

What is internal radiation called?

A

Brachytherapy

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23
Q

WBC count indicating neutropenia

A

<4,000

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24
Q

Usual sites of infection when a pt has neutropenia

A

Lungs (pneumonia)
Genitourinary system (UTI)
Mouth, rectum
Peritoneal cavity
Blood (sepsis)

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25
Q

If pt has myelosuppression, how can you figure out if they can have chemo?

A

By calculating their ANC (absolute neutrophil count)

WBC x [% of bands + % of segs] / 100

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26
Q

Normal ANC range that indicates a pt can be given chemo

A

1,500 - 8,000 / mm3

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27
Q

When should neutropenia precautions be used for a pt?

A

When their ANC is <1000
And if it’s <500, they’re severely neutropenic

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28
Q

When should the provider be notified immediately when a pt is on neutropenic precautions?

A

If pt has any slight symptoms of infection
(Fever >100.4, chills, any hot, redness, swelling)

Should anticipate diagnostic testing and antibiotics

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29
Q

Category of meds given to treat myelosuppression

A

Colony stimulating growth factors
(Stimulates bone marrow to produce blood components)

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30
Q

Med to stimulate growth of neutrophils

A

Filgrastin (Neupogen)

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31
Q

Meds to stimulate growth of erythrocytes

A

Epoetin (Procrit)
darbepoetin (Aranesp)

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32
Q

Med to stimulate growth of platelets

A

Oprelvekin (Neumega)

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33
Q

Symptoms of thrombocytopenia

A

Bruising
Petechia
Prolonged bleeding if cut
Blood in urine, stool
Spontaneous bleeding nose, gums

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34
Q

Platelet count indicating thrombocytopenia

A

<50,000

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35
Q

What platelet count would a pt likely need a platelet transfusion?

A

<20,000

36
Q

Nursing considerations for pts with GI symptoms from cancer/chemo

A

Monitor for alkalosis, dehydration
Monitor I&O, weight at least 2x/week
Small, frequent, nonirritating meals
Low-fiber, high-calorie, high-protein diet
Nutritional supplements (ensure)
Assess for taste loss and dysphagia
Monitor albumin and prealbumin levels

37
Q

Chemo drug used to stimulate appetite

A

Megace (synthetic progesterone)

38
Q

List the oncologic emergencies

A

Hypercalcemia
Superior vena cava syndrome
Tumor lysis syndrome
Syndrome of inappropriate antidiuretic hormone (SIADH)
Spinal cord compression
Sepsis

39
Q

Calcium level indicating Hypercalcemia

A

> 12 mg/dl

40
Q

Causes of Hypercalcemia

A

Bone metastasis (cancer in bone)
Increase in parathyroid hormone/tumor
Immobility

41
Q

Signs and symptoms of Hypercalcemia

A

Fatigue
Loss of appetite
N/V
Constipation
Polyuria

Serious S/S:
Severe muscle weakness
Loss of DTRs
Paralytic ileus
Dehydration
ECG changes

42
Q

Treatment for Hypercalcemia

A

Hydration (3L/day)
Loop diuretics (NOT thiazide)

43
Q

Cause of SVC syndrome

A

SVC compressed by growing tumor

44
Q

S/S of SVC syndrome

A

Early:
- Facial edema then distended neck, chest veins
- Mediastinal mass seen on CXR
Later:
- Edema in arms, hands
- Dyspnea
- Erythema of upper body
- Epistaxis
Late:
- Hemorrhage
- Cyanosis
- Lack of perfusion to brain (decreased LOC)

45
Q

Treatment of SVC syndrome

A

Radiation, chemo, or surgery to reduce tumor size

46
Q

Cause of tumor lysis syndrome

A

Release of:
- uric acid
- potassium
- phosphorous
Into blood stream when excessive cancer cells destroyed by chemo

47
Q

S/S of tumor lysis syndrome

A

Weakness
N/V

Can lead to AKI (acute kidney injury)

48
Q

Treatment for tumor lysis syndrome

A

Hydration (to protect kidneys)
Allopurinol (for elevated uric acid)

49
Q

What causes SIADH?

A

Elevated ADH level - from tumor or chemotherapy
(Pt retaining too much water = low sodium)

50
Q

S/S of SIADH

A

Hyponatremia:
- weakness
- weight gain (from too much H2O absorption)
- muscle cramps
- fatigue
- decreased appetite
- *Altered mental status, headache, confusion
- extreme muscle weakness
- seizures, coma, death

51
Q

Treatment for SAIDH

A

Fluid restriction
Oral salt tablets
Lasix
IV NS

52
Q

Causes of spinal cord compression

A

Lung, breast, prostate, GI, renal, lymphomas, melanoma metastasis to spinal cord

53
Q

S/S of spinal cord compression

A

Persistent back pain*
Weakness - decreased motor neuron function
Decreased sensory neuron function
- change in bowel or bladder function

54
Q

Treatment of spinal cord compression

A

Steroids (to decrease inflammation in area)
Surgery

55
Q

Cause of sepsis (in cancer pts)

A

Infection in blood stream due to tumor or myelosuppression

Most at risk during nadir

56
Q

S/S of sepsis

A

Fever
Elevated HR
Decreased BP

Would need to do lab work and blood cultures to see what pathogen is causing infection

57
Q

Skin cancer in order of least to most lethal

A

Basal cell
Squamous cell
Melanoma

58
Q

Precancerous form of squamous cell carcinoma

A

Actinic keratosis

59
Q

Most common skin cancer

A

Basal cell

60
Q

Skin cancer with slow growth and rarely metastasizes

A

Basal cell

61
Q

What does basal cell cancer look like and where is it typically found

A

Flat, firm, pale
Sun-exposed areas

62
Q

Skin cancer that can spread to blood or lymph but isn’t super aggressive

A

Squamous cell

63
Q

What does squamous cell carcinoma look like?

A

Red, scaly, rough patch
Can scab or bleed

64
Q

Risk factors for melanoma

A

20-45 years
Fair complexion
Freckles
Red hair, blue eyes

65
Q

ABCDE’s of mole or skin lesion assessment

A

Asymmetry
Border irregular?
Color varied?
Diameter >6mm?
Evolving?

66
Q

Risk factors for Hodgkin’s Lymphoma

A

Age 15-35 and >55
Family history
Male
Prior Epstein Barr infection
HIV infection

67
Q

Symptoms of HL

A

One or more painless, enlarged lymph nodes (usually starts in cervical. Or mediastinal, axillary, inguinal)
*Fever>100.4
*10% weight loss in 6 months
*Drenching night sweats
Anorexia
Fatigue
Spleen, liver enlargement
Alcohol = pain (rare)

68
Q

How is a pt diagnosed with HL?

A

Biopsy of lymph node(s)
- presence of *Reed-Sternberg cells
CXR, CT, MRI, PET scan
CBC
ESR (erythrocyte sedimentation rate)

69
Q

Most common malignant lymphocytes with NHL

A

B cell most common (80%)
T cell (15%)
NK cells

70
Q

Diagnosis of NHL

A

Biopsy showing *no Reed Sternberg cells
May need more diagnostic test than HL to determine everywhere it is:
PET/CT
HIV/ Hep B & C tests to see if they instigated it

71
Q

Risk factors for NHL

A

Age 60+, male, AA, Asian American
Immunocompromised
Viral infection (Epstein Barr)
Autoimmune disease (RA)
Chemicals (Pesticides)
Drugs (chemo therapy)
Other (radiation)

72
Q

S/S of NHL

A

Painless, hard, enlarged lymph nodes
Fever, night sweats, weight loss
Neuro: HA, vision, sensory, or motor changes
Unpredictable spread (blood>lymph)
Other organ involvement possible
Unexplained anemia, low platelets (if in bone marrow)

73
Q

Staging of HL & NHL

A

Stage 1: one lymph node
Stage 2: two or more lymph nodes on one side of diaphragm
Stage 3: above and below diaphragm
Stage 4: widespread disease, multiple organs

74
Q

Tx for HL

A

Chemotherapy
Radiation
Immunotherapy
Stem cell therapy

75
Q

Tx for NHL

A

Chemotherapy
Monoclonal antibodies (Rituximab)
Radiation
CAR-T cell therapy
Chimeric antigen receptor (CAR)
- Blood drawn, add CAR receptor to T cells, put back in to seek out cancer cells

76
Q

When someone is having monoclonal antibody tx, what does the nurse need to watch for?

A

Flu like symptoms
Infusion reactions

77
Q

Nursing considerations for HL & NHL

A

Resp status (large tumors on lymph nodes)
Immune: prevent infection
Pain
GI issues (nutrition/chemo)
Skin issues (radiation)
Sterility (chemo/radiation)
Secondary cancers (chemo/radiation)

78
Q

What occurs with multiple myeloma?

A

Cancerous plasma cells (type of B cell) invade bone marrow and destroy bone
Causes immune deficiency

79
Q

Risk factors for MM

A

Male
Over age 40
AA

80
Q

What proteins are specific to MM and where are they found?

A

Monoclonal proteins (M proteins) found through biopsy in bone marrow

Bence-Jones proteins found in urine
M proteins also found in urine

81
Q

Symptoms of MM

A

Bad skeletal pain (often in back/spine, hips/pelvis, skull, ribs)
Weakened bones - osteoporosis
Anemia, leukopenia, thrombocytopenia (pancytopenia)
Hypercalcemia (bone breaking down and Ca+ entering blood)

82
Q

S/S of Hypercalcemia

A

Acts like a sedative = muscles and nerves less excitable
Lethargy, weakness, fatigue, depressed reflexes, confusion, decreased memory, constipation

Elevated BP, bone pain, fractures, renal stones, seizures, coma

83
Q

Nursing actions for Hypercalcemia

A

Stop meds that increase calcium
Low calcium diet
Increase weight bearing activity
Ensure adequate hydration (3-4L/day)
Furosemide to promote renal excretion
Cardiac monitor (telemetry)

84
Q

Examples of meds that increase calcium

A

IV lactated ringers
Thiazide diuretics
Antacids
Vit D

85
Q

MM treatment

A

Chemotherapy
Corticosteriods

86
Q

MM nursing considerations

A

Due to increased M proteins and chemo, pt is at risk for:
Renal problems (M proteins affect kidneys)
Fluid and electrolyte imbalance
Uric acid build up from cell break down (Hyperuricemia)
- Allopurinol (for elevated uric acid)

Pt at risk for pathologic fractures
(Fall precautions, but pt should still move to help with Hypercalcemia)
Pt may have peripheral neuropathy

Med Surg (12 decks)

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