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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
If pt has myelosuppression, how can you figure out if they can have chemo?
By calculating their ANC (absolute neutrophil count) WBC x [% of bands + % of segs] / 100
26
Normal ANC range that indicates a pt can be given chemo
1,500 - 8,000 / mm3
27
When should neutropenia precautions be used for a pt?
When their ANC is <1000 And if it’s <500, they’re severely neutropenic
28
When should the provider be notified immediately when a pt is on neutropenic precautions?
If pt has any slight symptoms of infection (Fever >100.4, chills, any hot, redness, swelling) Should anticipate diagnostic testing and antibiotics
29
Category of meds given to treat myelosuppression
Colony stimulating growth factors (Stimulates bone marrow to produce blood components)
30
Med to stimulate growth of neutrophils
Filgrastin (Neupogen)
31
Meds to stimulate growth of erythrocytes
Epoetin (Procrit) darbepoetin (Aranesp)
32
Med to stimulate growth of platelets
Oprelvekin (Neumega)
33
Symptoms of thrombocytopenia
Bruising Petechia Prolonged bleeding if cut Blood in urine, stool Spontaneous bleeding nose, gums
34
Platelet count indicating thrombocytopenia
<50,000
35
What platelet count would a pt likely need a platelet transfusion?
<20,000
36
Nursing considerations for pts with GI symptoms from cancer/chemo
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
Chemo drug used to stimulate appetite
Megace (synthetic progesterone)
38
List the oncologic emergencies
Hypercalcemia Superior vena cava syndrome Tumor lysis syndrome Syndrome of inappropriate antidiuretic hormone (SIADH) Spinal cord compression Sepsis
39
Calcium level indicating Hypercalcemia
>12 mg/dl
40
Causes of Hypercalcemia
Bone metastasis (cancer in bone) Increase in parathyroid hormone/tumor Immobility
41
Signs and symptoms of Hypercalcemia
Fatigue Loss of appetite N/V Constipation Polyuria Serious S/S: Severe muscle weakness Loss of DTRs Paralytic ileus Dehydration ECG changes
42
Treatment for Hypercalcemia
Hydration (3L/day) Loop diuretics (NOT thiazide)
43
Cause of SVC syndrome
SVC compressed by growing tumor
44
S/S of SVC syndrome
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
Treatment of SVC syndrome
Radiation, chemo, or surgery to reduce tumor size
46
Cause of tumor lysis syndrome
Release of: - uric acid - potassium - phosphorous Into blood stream when excessive cancer cells destroyed by chemo
47
S/S of tumor lysis syndrome
Weakness N/V Can lead to AKI (acute kidney injury)
48
Treatment for tumor lysis syndrome
Hydration (to protect kidneys) Allopurinol (for elevated uric acid)
49
What causes SIADH?
Elevated ADH level - from tumor or chemotherapy (Pt retaining too much water = low sodium)
50
S/S of SIADH
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
Treatment for SAIDH
Fluid restriction Oral salt tablets Lasix IV NS
52
Causes of spinal cord compression
Lung, breast, prostate, GI, renal, lymphomas, melanoma metastasis to spinal cord
53
S/S of spinal cord compression
Persistent back pain* Weakness - decreased motor neuron function Decreased sensory neuron function - change in bowel or bladder function
54
Treatment of spinal cord compression
Steroids (to decrease inflammation in area) Surgery
55
Cause of sepsis (in cancer pts)
Infection in blood stream due to tumor or myelosuppression Most at risk during nadir
56
S/S of sepsis
Fever Elevated HR Decreased BP Would need to do lab work and blood cultures to see what pathogen is causing infection
57
Skin cancer in order of least to most lethal
Basal cell Squamous cell Melanoma
58
Precancerous form of squamous cell carcinoma
Actinic keratosis
59
Most common skin cancer
Basal cell
60
Skin cancer with slow growth and rarely metastasizes
Basal cell
61
What does basal cell cancer look like and where is it typically found
Flat, firm, pale Sun-exposed areas
62
Skin cancer that can spread to blood or lymph but isn’t super aggressive
Squamous cell
63
What does squamous cell carcinoma look like?
Red, scaly, rough patch Can scab or bleed
64
Risk factors for melanoma
20-45 years Fair complexion Freckles Red hair, blue eyes
65
ABCDE’s of mole or skin lesion assessment
Asymmetry Border irregular? Color varied? Diameter >6mm? Evolving?
66
Risk factors for Hodgkin’s Lymphoma
Age 15-35 and >55 Family history Male Prior Epstein Barr infection HIV infection
67
Symptoms of HL
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
How is a pt diagnosed with HL?
Biopsy of lymph node(s) - presence of *Reed-Sternberg cells CXR, CT, MRI, PET scan CBC ESR (erythrocyte sedimentation rate)
69
Most common malignant lymphocytes with NHL
B cell most common (80%) T cell (15%) NK cells
70
Diagnosis of NHL
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
Risk factors for NHL
Age 60+, male, AA, Asian American Immunocompromised Viral infection (Epstein Barr) Autoimmune disease (RA) Chemicals (Pesticides) Drugs (chemo therapy) Other (radiation)
72
S/S of NHL
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
Staging of HL & NHL
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
Tx for HL
Chemotherapy Radiation Immunotherapy Stem cell therapy
75
Tx for NHL
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
When someone is having monoclonal antibody tx, what does the nurse need to watch for?
Flu like symptoms Infusion reactions
77
Nursing considerations for HL & NHL
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
What occurs with multiple myeloma?
Cancerous plasma cells (type of B cell) invade bone marrow and destroy bone Causes immune deficiency
79
Risk factors for MM
Male Over age 40 AA
80
What proteins are specific to MM and where are they found?
Monoclonal proteins (M proteins) found through biopsy in bone marrow Bence-Jones proteins found in urine M proteins also found in urine
81
Symptoms of MM
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
S/S of Hypercalcemia
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
Nursing actions for Hypercalcemia
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
Examples of meds that increase calcium
IV lactated ringers Thiazide diuretics Antacids Vit D
85
MM treatment
Chemotherapy Corticosteriods
86
MM nursing considerations
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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