Clin med/pathophys

Question 1

issues of treatment effects for cancer survivors

Answer 1

from surgery, radiation, chemo: body may be different due to scarring, hormonal changes, functional loss, termination of bone growth, cognitive disfunction, other cancers, infertility, etc

Question 2

fertility issues for cancer survivors

Answer 2

some treatments may cause infertility, or genetic counseling may be necessary for those who have genetic abnormalities increasing risk for cancer

Question 3

secondary malignancy risks for cancer survivors

Answer 3

leukemia is most common d/t bone marrow damage from treatment.

Question 4

long term burdens of illness for cancer survivors

Answer 4

treatment affects can diminish QOL, at higher risk for a secondary malignancy, etc

Question 5

cultural biases issues for cancer survivors

Answer 5

jobs, insurance, etc

Question 6

legal concern issues for cancer survivors

Answer 6

insurance, custody battles

Question 7

education issues for cancer survivors

Answer 7

may have missed vital time during education (lots of school days missed); effects of chemo/rad to brain

Question 8

healthcare issues for cancer survivors

Answer 8

importnat to follow specific screening guidelines.
Ex: Breast cancer: H&P: Q3-6mo x 3yrs; then Q6-12mo x 2yrs; then annual; Counsel on signs and symptoms of recurrence (lumps, pain, dyspnea, headaches); Genetic counseling: Ashkenazi Jew, ovarian cancer (pt, 1st, 2nd degree relatives), breast cancer (bilateral, 1st degree<age 50, 2+ 2nd degree, male relative); Breast self-exam: monthly; Mammography: Q6-12mo; Pelvic exam: regular; NOT Recommended: routine blood tests, imaging (CXR, bone scans, liver US, CT scans, breast MRI), tumor markers (ASCO)

Question 9

palliative care

Answer 9

to lessen disease symptom severity without removing the cause. Physical symptoms, psychological symptoms, social needs including interpersonal relationships/caregiving/econmic concerns, spiritual needs

Question 10

multidisc nature of palliative care

Answer 10

physicians; pharmacists; nurses; social workers; respiratory therapist; PTs; OTs; chaplains

Question 11

hospice

Answer 11

an interdisciplinary program of palliative are and supportive services that addresses the physical, social, spiritual, economic needs of terminally ill pts and their fams. invented in the UK in the 60s; nd to have a 6 month prognosis; nd referral from provider; symptom (not treatment) based; medicare benefit

Question 12

Oncologic emergency: Spinal cord compression

Answer 12

back pain! also, musc weakness, bladder/bowel dysfunction possible. nd to get MRI. initial pain control w opioids, corticosteroids, then radiation therapy, or surgery.

Question 13

oncologic emergency: hypercalcemia

Answer 13

produces an osmotic diuresis, so some symptoms can be due to hypovolemia. sxs: lethargy, confusion, anorexia, nausea, constipation due to reduces intestinal motility. initial tx is IV isotonic saline to restore intravascular volume.

Question 14

oncologic emergency: hyperuricemia/tumor lysis syndrome

Answer 14

hyperuricemia occurs as part of tumor lysis syndrome. tumor lysis syndrome = metabolic crisis resulting from massive cytolysis and release of intracellular contents into systemic circulation. occurs most often w hematologic malignancies. pts may develop lethargy, seizures, N/V, and eventually sxs of volume overload. renal failure is common cause of morbidity. tx is preventative by trying to decrease uric acid prodction with allopurinol and increase solubility in urine

Question 15

oncologic emergency: PE/DVT

Answer 15

sxs: DVT: edema, pain, tenderness.
PE: pleuritic chest pain, SOB, sense of doom, palpitations, hemoptysis, syncope, tachycardia, tachypnea. LMWH preferred tx, then VKA therapy.

Question 16

oncologic emergency: superior vena cava syndrome

Answer 16

usually insidious onset, neck and facial swelling, venous distention of neck and chest wall venous system, dyspnea, HA, hoarseness, dysphagia, cough. most of the time from lymphoma. if airway obstruction, emergency. otherwise, nd to tx underlying cancer.

Question 17

oncologic emergency: febrile neutropenia

Answer 17

focal or generalized infectious symptoms of any sort, but the most common presentation is that of an asymptomatic pt with hyperthermia, sepsis, low BP, fever. neutrophil count low, temp 38 for >1hr or >38.3. blood culture, CXR, UA, urine cultures, inspect lines, skin, mouth, sinuses, perineum. begin empiric tx immediately.