Cancer

Question 1

What are some characteristics of cancer cells?

Answer 1

Large number of dividing cells. Large, variably-shaped nuclei. Large nucleus to cytoplasm ratio. Variation in size and shape. Loss of normal cell features. Disorganized arrangement. Poorly defined tumor boundary. Don’t respond to apoptosis. Adhere loosely together and migrate.

Question 2

How is cancer classified?

Answer 2

Tissue of origin. Anatomic site. Biologic behavior. Degree of differentiation.

Question 3

TNM classification of cancer?

Answer 3

T: anatomic size of primary tumor
N: extent of lymph note involvement
M: presence or absence of metastasis

Question 4

Staging of cancer?

Answer 4

0: Cancer in situ
1: Localized
2: Limited local spread
3: Extensive local and regional spread
4: Metastasis

Question 5

Degree of malignancy grading?

Answer 5

X: grade not determined

0: normal tissue
1: most differentiated
2: cells more abnormal
3: cells very abnormal
4: cell origin difficult to determine. Poor prognosis

Question 6

What factors contribute to the development of cancer?

Answer 6

Age is the most important. Genetics and heredity. Hormonal factors, HRT. Immunologic factors. Drugs and chemicals. Radiation. Viruses.

Question 7

Prevention concerned with reducing cancer risk in healthy people.
Prevention that involves detection, screening to achieve early diagnoses, intervention.

Answer 7

Primary

Secondary

Question 8

What are some helpful things to do for cancer prevention?

Answer 8

Avoid known carcinogens. Modify risk behaviors. Remove at risk tissue. Chemoprevention. Screening (breast, testicular, pap). Vaccination

Question 9

Seven warning signs of caner: CAUTION?

Answer 9

C: change in bowel or bladder habits 
A: sore that does not heal
U: Unusual bleeding or discharge
T: thickening or lumps
I: indigestion or difficulty swallowing 
O: obvious change in warts or moles
N: nagging cough or hoarseness

Question 10

What are goals for cancer treatment?

Answer 10

Prevention, early diagnosis, cure, control, palliative, determine of therapy effectiveness, reconstruction

Question 11

Diagnostic surgery for cancer?

Answer 11

Biopsy: excisional, needle, incisional

Tumor removal with a wide or local excision: prophylactic surgery, palliative surgery, reconstructive surgery

Question 12

Movement of energy through a space or medium. Based on the concept that rapidly reproducing malignant cells are more sensitive to radiation than normal cells. Types?

Answer 12

Radiation therapy.
External or teletherapy
Internal or brachytherapy
Can be curative, control, or palliative.

Question 13

What things does radiation therapy affect? Factors that influence the side effects?

Answer 13

Effects on the Gi system, bone marrow cell production, systemic effects. Long-term effects, tissue changes, altered taste sensation and fatigue. Scalp: hair, head and neck: salivary glands, chest and lungs, swallowing, abdomen sterility, pelvis.

Question 14

Factors that influence the side effects of radiation therapy?

Answer 14

Influenced by body site irradiated, dose of radiation given, extent of body treated, method of radiation

Question 15

Ways to minimize skin damage from radiation therapy?

Answer 15

Avoid the sun, trauma to the skin, adhesive tape, bath salts, perfumes, ointments, lotions, strong soaps, heat lamps, heating pads, ice packs.
Wear soft, lightweight cotton clothing.

Question 16

General precautions for internal radiation?

Answer 16

Private room, radioactive sign on the door, dosimeter badge. Encourage self-care, rotate care givers, limit visitors, precautions if implant is dislodged.

Question 17

Affect rapidly dividing cells. May be used alone or as adjutant therapy to radiation and/or surgery.

Answer 17

Chemotherapy.

Cell cycle specific and non-cell cycle specific.

Question 18

Usually more successful but may have more varied side effects.

Answer 18

Combination chemotherapy.

Decreased resistance and t toxicity. Increased therapeutic effect. Increased cancer cell destruction,

Question 19

Routes of administration for chemotherapy?

Answer 19

PO, IM, IV, intracavity, intraperitoneal, intrathecal, intrapleural, intravesical, topical, intraarterial

Question 20

Side effects of chemotherapy?

Answer 20

Pancytopenia which consists of leukopenia or neutropenia, anemia, and thrombocytopenia

Question 21

The impact of chemotherapy at its peak effect.

Answer 21

Nadir effect. WBC will be lower 7-10 days after treatment. RBC will be lowest 7-10 days after treatment. Platelets will be lowest 10 days after treatment. Each drug has a different nadir.

Question 22

Some important things about nursing care of the immunosuppressed patient?

Answer 22

Good handwashing, private room, limit number of people going in and out, monitor temp especially, avoid indwelling catheters. Keep fresh flowers and potted plants out of the room. Avoid raw plant foods. Prevent exposure to known infections. Aseptic technique. Careful observation for infection. Possible reverse isolation.

Question 23

Drug that increases the production of WBC in bone marrow.

Answer 23

filgrastim (Neupogen)
Side: leukocytosis, pain at the injection site, headache.
Adverse: bleeding, fever, dyspnea
Implications: Monitor WBC counts frequently

Question 24

Nursing care for a patient with anemia?

Answer 24

Observe for s/s of anemia. Monitor O2 sat. Plan rest periods. Assist pt with activities. Administer oxygen, meds that stimulate RBC production and blood transfusions. Promote good hygiene. Assess for s/s of MI, stroke.

Question 25

Med that prevents anemia by stimulating red blood cell growth and maturation in the bone marrow. Growth factor.

Answer 25

epoetin alfa (Epogen, Procrit)
Side: headache, body aches, diarrhea, irritation at the injection site
Adverse: chest pain, dyspnea, HTN, rapid weight gain, peripheral edema, MI
Implications: monitor frequent hemoglobin levels, SQ/IV admin, reduces need for transfusions. Dosing based on HBG levels.

Question 26

Nursing care of a patient with thrombocytopenia?

Answer 26

Observe for s/s of bleeding. Neurologic status. Avoid IM injections, venipuncture, rectal temp. Test urine/stool for blood. Platelet transfusion. Avoid aspirin/antiplatelet agents/NSAIDs. Admin oprelvekin to stimulate platelet production. Handle pt gently. Firm pressure for needle sticks. Ice for areas of trauma. Measure ab girth.

Question 27

Med that increases the production of platelets in bone marrow. Growth factor.

Answer 27

oprelvekin (Neumega)
Side: pain at injection site, red eyes, dizziness
Adverse: fluid retention, heart failure, DVT, sudden weight gain, peripheral edema, tachycardia
Implications: monitor platelet counts, provide safe environment, instruct pt to report s/s of bleeding

Question 28

Treatment for the complications of chemotherapy: stomatitis and pharyngitis?

Answer 28

Mouth care with mild baking soda, magic mouthwash (avoid commercial mouthwash). Nystatin swish and swallow. Viscous lidocaine. Soft toothbrush, no floss. Lubricant to the lips. Avoid hot, spicy food. Good fluid intake.

Question 29

Explain anorexia due to the effect of chemo? Treatments?

Answer 29

Impacts hunger in the hypothalamus. N/v, stomatitis.
Pt may need enteral feedings to TPN. Offer small, frequent, high caloric feedings. Minimize food odors. Ask pt what they like to eat.

Question 30

Occurs due to the effect of chemo on the emesis center in the thalamus. A normal side effect of chemotherapy.

Answer 30

CIN: chemotherapy induced nausea.
Drugs are emetogenic. Offer small, frequent feedings. Dietary counseling. Cold, bland foods. Give antiemetic meds liberally. Zofran.

Question 31

Med that prevents chemotherapy induced nausea by blocking chemotrigger zones in brain and intestines.

Answer 31

odansetron (Zofran)
Side: headache
Adverse: bradycardia, hypotension, vertigo
Implications: Teach to change positions slowly. Administer prior to meals. Instruct on the importance of taking the med as needed and prophylactically so they can eat/drink.

Question 32

Nursing care for alopecia caused by chemo?

Answer 32

Discuss potential hair loss and regrowth with the pt and family. Explore potential impact of hair loss on self-image, interpersonal relationships, and sexuality. Prevent trauma to the scalp. Encourage pt to wear own cloths, retain social life. Hair growth begins again a month after therapy is completed.

Question 33

Seen with nerve damaging chemo agents. May have rapid onset and be severe.

Answer 33

Peripheral neuropathy (PN).
Seen long term or may be permanent. Prevention of injury is the most important implication.

Question 34

More research for this condition is needed, the causes are unknown but it causes cognitive impairment and memory loss.

Answer 34

Chemo brain/brain fog.

Listen to the patient and be supportive. Know that this is real to them.

Question 35

Meds interrupt uptake of hormones that may contribute to certain types of cancers; upsets normal hormone balance; hormone agonists bind to specific sites to block hormones to reach specific receptors. Is an anti-estrogen hormone antagonist used in the treatment of breast cancer & some forms of prostate cancer.

Answer 35

tamoxifen (Nolvadex)
Side: androgens (cause masculine effects in women). Hypercalcemia. Estrogens (heavy menstrual bleeding, breast tenderness, gynecomastia)
Adverse: DVT
Implications:Should not be given with pregnancy or breast feeding. Women should use non hormonal contraception during treatment.

Question 36

Meds that boost the pt’s own immune system. May also be given as supportive therapy when pt receives chemo. What two types?

Answer 36

Biological response modifiers.
Interleukins help the body to recognize and destroy abnormal cells.
An interleukin called interferons helps to slow tumor growth.

Question 37

Cell Cycle Non-Specific Alkylating Agent; effective during entire cell cycle; mutates cancer cells; takes away the cancer cell’s ability to multiply.

Answer 37

cyclophosphamide (Cytoxan)
Side: n/v
Adverse: Nephrotoxicity, hemorrhagic cystitis, CIN
Implications: Monitor BUN & creatinine. Encourage ↑ oral fluid intake; Maintain hydration. Observe for signs of dysuria, hematuria

Question 38

Cell-cycle specific antimetabolite med.

Answer 38

methotrexate (Mexate)
Side: n/v
Adverse: reproductive toxicity
Implications: Some agents are teratogenic. Educate patients in sperm banking & birth control; women should have a pregnancy test prior to starting therapy.

Question 39

Antitumor antibiotic. Cell-cycle nonspecific med.

Answer 39

doxorubicin (Adriamycin)
Side: n/v
Adverse: Cardio toxicity, has a cumulative effect on the cardio system
Implications: Obtaining a baseline EKG will allow the HCP to detect changes in cardiac function. Observe for sign of CHF

Question 40

What should be watched for as far as nutrition with patients on chemo? What are some nursing interventions for nutrition?

Answer 40

Anorexia, malabsorption, cachexia. Increase roughage in diet, adequate fluid intake, laxatives, stool softeners, enemas, prevention.

Question 41

Venous congestion caused by obstruction of venous drainage in upper thorax. Slow and progressive. Oncologic emergency.

Answer 41

Superior vena cava syndrome (SVCS)

S/s include SOB, headache, visual disturbances, and facial edema.

Question 42

An increased accumulation of fluid in the cardiac sac due to the tumor invasion or pericardial thickening after radiation.

Answer 42

Pericardial effusion

Question 43

Decreased cardiac contraction. S/s?

Answer 43

Cardiac tamponade

Hypotension, tachycardia, muffled heart tones

Question 44

Caused by direct pressure on spinal cord with compromised vascular supply to the area leading to spinal cord infarction or vertebral collapse. S/s?

Answer 44

Spinal cord compression.
Symptoms depend on the site of compression. Early ones will be localized back pain and weakness in the lower extremities.