Cancer Flashcards
Hypertrophy
– growth that causes tissue to increase in size by enlarging each cell.
Hyperplasia
growth that causes tissue to increase in size by increasing the number of cells.
Neoplasia
– any new or continued cell growth not needed for normal development or replacement of dead and
damaged tissues.
Cell growth
Most types of altered cell growth are benign, but nearly 1.5 million people in U.S. and Canada diagnosed with cancer each year (ACS, 2008).
longer life span
increase in exposure to carcinogens
Benign Tumors
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What are the steps in carcinogenesis?
Initiation – Step 1 in carcinogenesis. Exposure to carcinogen which penetrates cell, damage DNA, and change or mutate the cell. Irreversible, but only leads to cancer if cell division is not impaired.
Promotion – enhancement of growth of initiated cell. Normal hormones and body proteins, like insulin and estrogen, can cause altered cells to divide more frequently. Shortens the latency period.
Progression – increasing malignancy over time. To become a health problem, tumor must develop it’s own blood supply: TAF; less resemblance to original initiator, increasing malignancy.
Metastasis – breaks away from primary location and establishing remote colonies
True or false
80% of cancer come from external factors
True
Top four common sites of cancer
BBLL
- Brain
- Breast
- Lung
- Liver
How do you grade a tumor?
Initiation – Step 1 in carcinogenesis. Exposure to carcinogen which penetrates cell, damage DNA, and change or mutate the cell. Irreversible, but only leads to cancer if cell division is not impaired.
Promotion – enhancement of growth of initiated cell. Normal hormones and body proteins, like insulin and estrogen, can cause altered cells to divide more frequently. Shortens the latency period.
Progression – increasing malignancy over time. To become a health problem, tumor must develop it’s own blood supply: TAF; less resemblance to original initiator, increasing malignancy.
Metastasis – breaks away from primary location and establishing remote colonies
What are oncogenes?
Oncogenes are not abnormal genes – part of every cell’s make-up. Oncogenes are activated by External and
Personal factors.
External factors for cancer
External Factors – 80% of all cancers in North America
Chemical – 30% related to tobacco, single most preventable source. Tobacco is an initiator and a promoter.
Physical – Radiation, chronic irritation, and tissue trauma, scars. (frequent cell division increases risk for mutation)
Viral – when viruses infect body cells and break DNA strands, mutation may activate the oncogene or damage
suppressor cells. Oncoviruses are viruses known to cause cancer: EBV, HBV, HCV, HPV,
Cancer prevention
Avoidance of carcinogens
Skin cancer – sunscreen; avoid sun exposure
-Lung cancer – eliminate tobacco; environmental asbestos
-Modifying associated factors
-alcohol,
-Diet
-Multiple sex partners
-Removal of ‘at-risk’ tissues
-moles
-polyps
-breasts
Chemoprevention – drugs, chemicals, natural nutrients to disrupt cancer development
ASA, Celebrex – reduce risk of colon cancer
Vit D, Tamoxifen – reduce risk of breast cancer
Lycopene – prostate cancer
Vaccincation – Gardasil for HPV
Cancer Screening
Regular Screening does not reduce incidence but can reduce types of cancer death - mammography (over 40) clinical breast exam colonoscopy (50) PSA (50)
Features of early embryonic cells
Rapid and continuous cell division
Anaplasia
Large nuclear-to-cytoplasmic ratio
Pluropotency
Loose adherence
Migration
No contact inhibition
Normal chromosomes(23 pairs)
Day 8, commitment: oncogenes suppressed(off) or expressed (on) in
different cell typesFeatures of benign tumors
Continuous or inappropriate cell growth Specific morphology Small nuclear-to-cytoplasm ratio Specific differentiated functions Tight adherence No migration Orderly growth Normal chromosomes(23 pairs)
Features of cancer cells
-Rapid or continuous cell division
-Anaplasia
-Large nuclear-to-cytoplasmic ratio
-Specific functions lost
-Loose adherence
-Migration
-No contact inhibition
-Abnormal chromosomes (aneuploidy)
lost (23), or broken
Cancer development: initiation
Initiation – Step 1 in carcinogenesis. Exposure to carcinogen which penetrates cell, damage DNA, and change or mutate the cell. Irreversible, but only leads to cancer if cell division is not impaired.
Cancer development: promotion
Promotion – enhancement of growth of initiated cell. Normal hormones and body proteins, like insulin and estrogen, can cause altered cells to divide more frequently. Shortens the latency period.
Cancer development: Progression
Progression – increasing malignancy over time. To become a health problem, tumor must develop it’s own blood supply: TAF; less resemblance to original initiator, increasing malignancy.
Cancer development: Metastasis
Metastasis – breaks away from primary location and establishing remote colonies
Common sites of metastasis
- Breast
- Lung
- Colorectal
- Prostate
- Melanoma
- Brain cancer`
Grading
Grading – compares the cancer cell with the normal cell from which it arose. Classifies cellular aspects of the cancer. Some cancer cells are more malignant than others, vary in aggressiveness and sensitivity to treatment.
Ploidy
Ploidy – description of cancer cells by chromosome number and appearance. Aneuploidyincreases with the degree of malignancy
Staging
Staging – determines the exact location and degree of malignancy at diagnosis. Influences the selection of therapy. Clinical; Surgical; Pathologic.
T – Primary tumor: Tx, To, Tis, T1, T2, T3, T4
N – Regional lymph node involvement: Nx, No, N1, N2, N3,
M – Distant metastasis: Mx, Mo, M1
Mitotic index
Mitotic Index – percentage of cells actively dividing.
Malignant tumor (endings)
Carcinoma, blastoma, and sarcoma
Oncogenes
Oncogenes are not abnormal genes – part of every cell’s make-up. Oncogenes are activated by External and
Personal factors.
Regular Screening does not reduce incidence but can reduce types of cancer death
TRUE
- mammography
- clinical breast exam
- colonoscopy
- PSA
The client wishes to become pregnant but has a family member with cystic fibrosis. She asks about the need for genetic testing. How does the nurse respond?
Refers the client to a genetic counselor
Correct: The nurse is not expected to be the final source of definitive information on genetic issues. However, the nurse can help ensure that the client is appropriately referred to a genetic counselor
When teaching the client and family about genetic counseling, what information does the nurse include in the teaching plan?
Diagnostic genetic testing determines the risk for a specific disorder.
Correct: Diagnostic genetic testing determines whether the client has or does not have a mutation that increases the risk for a specific disorder.
The client with a family history of polycystic kidney disease, an autosomal dominant disorder, states to the nurse, “I would like to be genetically tested for the disease, but I don’t want my family to know the results.” How does the nurse respond?
Assures the client that confidentiality will be maintained
Correct: The results of a genetic test must remain confidential to the client. These results cannot be given to a family member, another health care provider, or an insurance carrier without the client’s permission.
What is the purpose of genetic testing?
Determines whether a mutation exists
Correct: Genetic testing can determine the risk of disease before symptoms develop.
A 23-year-old female client has a BRCA1 gene mutation, which heightens her risk for developing breast cancer. She says, “I do not want to cut off my breasts!” What is the nurse’s response?
“Let’s discuss some other options.”
Correct: Yearly mammography and ovarian ultrasound can detect cancer at an early stage, when it is more easily cured.
The daughter of the client diagnosed with bilateral breast cancer has been counseled about genetic testing. She has decided not to be tested, despite the client’s insistence. How does the nurse respond to the daughter’s decision
“It is your decision. You can always call if you change your mind.”
Correct: The final decision to have or not have genetic testing rests with the daughter. This is a tough decision, so it is good to allow her the opportunity to change her decision at some later time.
Which statement is true about the structure and forms of DNA?
Every time a cell divides, it must replicate its DNA.
Correct: DNA must reproduce itself (replicate) every time a cell divides (undergoes mitosis). For each new cell to have exactly the right quantity of DNA and genes, the DNA in the dividing cell must replicate exactly.
Which statement is true about the role of a gene in the synthesis of a specific protein?
A gene contains the code for a specific protein.
Correct: A gene is a specific segment(s) of DNA that contains the code (recipe) for a specific protein.
Which statement is consistent with an autosomal dominant pattern of inheritance for a specific trait or characteristic?
The genotype cannot be predicted from the phenotype.
Correct: This is a true statement.
The 36-year-old client with a suspicious mammogram tells the nurse that her mother died of bone cancer at the age of 40. In assessing the client for cancer risk, what question does the nurse ask next?
“Did your mother ever have any other type of cancer?”
Correct: Breast cancer is considered an autosomal dominant trait disorder and is caused by the BRCA1 and BRCA2 genes and autosomal dominant transmission. Bone cancer can be a complication of breast cancer because of metastasis.
What is the effect of gene mutation and amino acid sequencing on insulin and blood sugar control?
Ineffective insulin is produced.
Correct: If some of the amino acids are missing or are in the wrong position, the protein made would be different from real insulin and could not reduce blood glucose levels. The actual order of the amino acids is critical for the final function of any protein
In analyzing a three-generation pedigree for the client, which questions help determine the genetic implications of a health trait? Select all that apply.
Do affected or unaffected individuals have children affected by the trait? Correct
B. Is the trait expressed equally among male and female family members or is it expressed unequally? Correct
C. Is the trait present in every generation, or does it skip one or more generations?Correct
D. Is a pattern evident, or does the trait appear to be sporadic?
Which condition might require genetic counseling for the client?
Huntington disease
Correct: The gene for Huntington disease (HD) has an autosomal dominant pattern of transmission. Therefore, a person who has one HD allele is at risk for developing HD.
The nurse is teaching the client about genetic counseling. Which statement by the client indicates that the teaching has been effective?
“Just because I have the trait does not mean that I will get the disease.”
Correct: A genetic trait may be recessive or may be controlled, which means that the person may never contract the disorder.
Which activity related to genetic counseling best illustrates the role of the medical-surgical nurse?
Ensures that the client understands the consequences of having a genetic test performed
Correct: The nurse can emphasize to the client and family the importance of using genetic testing as a preventive measure and for early detection of diseases related to genetic defects.
The nurse is giving a group presentation on cancer prevention and recognition. Which statement by an older adult client indicates understanding of the nurse’s instructions?
“I need to report the pain going down my legs to my health care provider.”
Correct: Pain in the back of the legs could indicate prostate cancer in an older man.
The nurse is teaching the 47-year-old female client about recommended screening practices for breast cancer. Which statement by the client indicates understanding of the nurse’s instructions?
My mother and grandmother had breast cancer, so I am at risk.”
Correct: A strong family history of breast cancer indicates a risk for breast cancer.
A 72-year-old client recovering from lung cancer surgery asks the nurse to explain how she developed cancer when she has never smoked. Which factor may explain the possible cause?
Advancing age
Correct: Advancing age is the single most important risk factor for cancer. As a person ages, immune protection decreases.
The nurse reviews the chart of the client admitted with a diagnosis of glioblastoma with a T1NXM0 classification. Which explanation does the nurse offer when the client asks what the terminology means?
“The brain tumor measures about 1 to 2 cm and shows no regional lymph nodes and no distant metastasis.”
Correct: T1 means that the tumor is increasing in size to about 2 cm, and that no regional lymph nodes are present in the brain. M0 means that no distant metastasis has occurred.
The client has a diagnosis of lung cancer. To which areas does the nurse anticipate that this client’s tumor may metastasize? Select all that apply.
Brain, bone, liver and lymph nodes
The nurse manager in a long-term care facility is developing a plan for primary and secondary prevention of colorectal cancer. Which tasks associated with the screening plan will be delegated to nursing assistants within the facility?
Testing of stool specimens for occult blood
Correct: Testing of stool specimens for occult blood is done according to a standardized protocol and can be delegated to nursing assistants.
The nurse is conducting a community health education class on diet and cancer risk reduction. What should be included in the discussion?
Avoid beef and processed meats. Correct
C. Increase consumption of whole grains. Correct
D. Eat “colorful fruits and vegetables,” including greens
The nurse presents a cancer prevention program to teens. Which of the following will have the greatest impact in cancer prevention?
Do not smoke cigarettes.
Correct: Tobacco is the single most important source of preventable carcinogenesis.
The nurse is teaching a group of clients about cancers related to tobacco or tobacco smoke. Identify the common cancers related to tobacco use. Select all that apply.
lung cancer, cancer of the tongue, cancer of the larynx
The nurse suspects metastasis from left breast cancer to the thoracic spine when the client has which symptom?
A.
Back pain
Correct: Typical sites of breast cancer metastasis include bone, manifested by back pain, lung, liver, and brain.
The nurse explains to the client that which risk factor most likely contributed to his primary liver carcinoma?
Infection with hepatitis B virus
Correct: Hepatitis B and C are risk factors for primary liver cancer
The nurse is caring for an adult client with Down syndrome who reports fatigue and shortness of breath. Which type of cancer has been identified in clients with Down syndrome?
Leukemia
Correct: Leukemia is associated with Down syndrome and Turner syndrome.
The nurse includes which of the following in teaching regarding the warning signs of cancer?
Persistent constipation Correct
B. Scab present for 6 months
Axillary swelling
The nurse is assessing a client with lung cancer. Which symptom does the nurse anticipate finding?
Dyspnea
Correct: Dyspnea is a sign of lung cancer, as are cough, hoarseness, shortness of breath (SOB), bloody sputum, arm or chest pain, and dysphagia.
Which activity performed by the community health nurse best reflects primary prevention of cancer?
Teaching a class on cancer prevention
Correct: Primary prevention involves avoiding exposure to known causes of cancer; education assists clients with this strategy.
A 52-year-old client relates to the nurse that she has never had a mammogram because she is terrified that she will have cancer. Which response by the nurse is therapeutic?
“Finding a cancer in the early stages increases the chance for cure.”
Correct: Providing truthful information addresses the client’s concern.
Which information must the organ transplant nurse emphasize before each client is discharged?
Taking immune suppressant medications increases your risk for cancer and the need for screenings.
Correct: Use of immune suppressant medications to prevent organ rejection increases the risk for cancer.
The home health RN is caring for a client who has a history of a kidney transplant and takes cyclosporine (Sandimmune) and prednisone (Deltasone) to prevent rejection. Which assessment data would be most important to communicate to the transplant team?
D. A lump is palpable in the client’s axilla.
Correct: Clients taking immune suppressive drugs to prevent rejection are at increased risk for development of cancer; any lump should be reported to the physician.
A client who is scheduled to undergo radiation for prostate cancer is admitted to the hospital by the registered nurse. Which statement by the client is most important to communicate to the physician?
My legs are numb and weak.”
Correct: Numbness and weakness should be reported to the physician because paralysis caused by spinal cord compression can occur.
When the nurse is counseling a 60-year-old African-American male client with all of these risk factors for lung cancer, teaching should focus most on which risk factor?
Tobacco use
Correct: Although all of these are risk factors for lung cancer, the client’s tobacco use is the only factor that he can change.
The registered nurse is teaching a group of nursing students about malignant transformation. Which statement about the process of malignant transformation is true?
Insulin and estrogen enhance the division of an initiated cell during the promotion phase.
Correct: These promoters increase cell division.
The nurse receives report on a client with a glioblastoma. Recognizing that cancers are classified by their tissue of origin, the nurse begins to plan care for a client with which type of cancer?
Brain
Correct: The prefix “glio-“ is used when cancers of the brain are named.
Which of these does the nurse recognize as the goal of palliative surgery for the client with cancer?
Relief of symptoms or improved quality of life
Correct: The focus of palliative surgery is to improve quality of life during the survival time.
Which statement made by the client allows the nurse to recognize whether the client who is receiving brachytherapy for ovarian cancer understands the treatment plan?
“I will have a radioactive device in my body for a short time.”
Correct: Brachytherapy refers to short-term insertion of a radiation source.
Which potential side effects should be included in the teaching plan for a client undergoing radiation therapy for laryngeal cancer?
Fatigue, change in taste, changes in skin of the neck, difficulty swallowing
The client receiving chemotherapy will experience the lowest level of bone marrow activity and neutropenia during which period?
Nadir
Correct: The lowest point of bone marrow function is referred to as the nadir.
The nurse teaches the client that intraperitoneal chemotherapy will be delivered where?
Into the abdominal cavity
Correct: Intraperitoneal chemotherapy is placed in the peritoneal cavity or the abdominal cavity.
