Info to know Mod 1

Question 1

is CELLULAR REGULATION that stops further rounds of cell division when the dividing cell is completely surrounded and touched (contacted) by other cells. Of the normal cells that can divide, each cell divides only when some of its surface is not in direct contact with another cell. Once a normal cell is in direct contact on all surface areas with other cells, it no longer undergoes mitosis. Thus normal cell division is contact inhibited.

Answer 1

Contact inhibition

Question 2

• having a complete set of chromosomes, is a feature of most normal human cells. These cells have 23 pairs of chromosomes, the correct number for humans.

Answer 2

Euploidy

Question 3

• ) An abnormal karyotype with more or fewer than 23 pairs of chromosomes. Some cancer cells gain or lose whole chromosomes and may have structural abnormalities of the remaining chromosomes. (aneuploidy) are common in cancer cells as they become more malignant. Chromosomes are lost, gained, or broken; thus cancer cells can have more than 23 pairs or fewer than 23 pairs. Cancer cells also may have broken and rearranged chromosomes with mutated genes

Answer 3

Aneuploidy

Question 4

classifies clinical aspects of the cancer.

determines the exact location of the cancer and whether metastasis has occurred.

Cancer influences selection of therapy. It is done by clinical staging, surgical staging, and pathologic staging.

Answer 4

Staging

Question 5

? staging assesses the patient’s symptoms and evaluates tumor size and possible spread.

Answer 5

Clinical

Question 6

? staging assesses the tumor size, number, sites, and spread by inspection at surgery.

Answer 6

Surgical

Question 7

? staging is the most definitive type, determining the tumor size, number, sites, and spread by pathologic examination of tissues obtained at surgery.

Answer 7

Pathologic

Question 8

? system is used to describe the anatomic extent of cancers.

The staging system has specific prognostic value for each solid tumor type.

Answer 8

The tumor, node, metastasis (TNM) staging system

Question 9

classifies cellular aspects of the cancer.

is needed because some cancer cells are “more malignant” than others, varying in their aggressiveness and sensitivity to treatment.

Some cancer cells barely resemble the mature tissue from which they arose (are “poorly differentiated”), are aggressive, and spread rapidly. These cells are a “high-grade” cancer.

It also allows health care professionals to evaluate the results of management.

Clinical groups have established specific ____systems for different types of cancer cells, but overall, they resemble the standard system listed in Table 21-4.

This system rates cancer cells with the lowest rating given to those cells that closely resemble normal cells and the highest rating given to cancer cells that barely resemble normal cells.

Answer 9

Grading

Question 10

What are the key features of benign cells?

Answer 10

Benign tumor cells are normal cells growing in the wrong place or at the wrong time as a result of a problem with CELLULAR REGULATION.

Examples include moles, uterine fibroid tumors, skin tags, endometriosis, and nasal polyps.

(Table 21-1) Key features:
• Specific morphology occurs with benign tumors. They look like the tissues they come from, retaining the specific morphology of parent cells.

• A smaller nuclear-to-cytoplasmic ratio is a feature of benign tumors just like completely normal cells.
• Specific differentiated functions continue to be performed by benign tumors. For example, in endometriosis, a type of benign tumor, the normal lining of the uterus (endometrium) grows in an abnormal place (e.g., on an ovary or elsewhere in the abdominal or even the chest cavity). This displaced endometrium acts just like normal endometrium by changing each month under the influence of estrogen. When the hormone level drops and the normal endometrium sheds from the uterus, the displaced endometrium, wherever it is, also sheds.
• Tight adherence of benign tumor cells to each other occurs because they continue to make fibronectin.
• No migration or wandering of benign tissues occurs because they remain tightly bound and do not invade other body tissues.
• Orderly growth with normal growth patterns occurs in benign tumor cells even though their growth is not needed. The fact that growth continues beyond an appropriate time or occurs in the wrong place indicates some problem with CELLULAR REGULATION, but the rate of growth is normal. The benign tumor grows by expansion. It does not invade.
• Euploidy (normal chromosomes) are usually found in benign tumor cells, with a few exceptions. Most of these cells have 23 pairs of chromosomes, the correct number for humans.

Question 11

What are the key features of malignant cells?
Cancer (malignant) cells are abnormal, serve no useful function, and are harmful to normal body tissues. Cancers commonly have these features:

Answer 11

• Anaplasia is the cancer cells’ loss of the specific appearance of their parent cells. As a cancer cell becomes more malignant, it becomes smaller and rounded. Thus many different types of cancer cells look alike under the microscope.
• A larger nuclear-cytoplasmic ratio occurs because the cancer cell nucleus is larger than that of a normal cell and the cancer cell is smaller than a normal cell. The nucleus occupies much of the space within the cancer cell, especially during mitosis, creating a large nuclear-to-cytoplasmic ratio.
• Specific functions are lost partially or completely in cancer cells. Cancer cells serve no useful purpose.
• Loose adherence is typical for cancer cells because they do not make fibronectin. As a result, cancer cells easily break off from the main tumor.
• Migration occurs because cancer cells do not bind tightly together and have many enzymes on their cell surfaces. These features allow the cells to slip through blood vessel walls and between tissues, spreading from the main tumor site to many other body sites. The ability to spread (metastasize) is unique to cancer cells and is a major cause of death. Cancer cells invade other tissues, both close by and more remote from the original tumor. Invasion and persistent growth make untreated cancer deadly.
• Contact inhibition does not occur in cancer cells because of lost CELLULAR REGULATION, even when all sides of these cells are in continuous contact with the surfaces of other cells. This persistence of cell division makes the disease difficult to manage.
• Rapid or continuous cell division occurs in many types of cancer cells because they do not respond to check-point control of cell division because of gene changes that reduce the effectiveness of CELLULAR REGULATION and re-enter the cell cycle for mitosis almost continuously. In addition, these cells also do not respond to signals for apoptosis. Most cancer cells have a lot of the enzyme telomerase, which maintains telomeric DNA. As a result, cancer cells do not respond to apoptotic signals and have an unlimited life span (are “immortal”).
• Abnormal chromosomes in which the chromosome number and/or structure is not normal (aneuploidy) are common in cancer cells as they become more malignant. Chromosomes are lost, gained, or broken; thus cancer cells can have more than 23 pairs or fewer than 23 pairs. Cancer cells also may have broken and rearranged chromosomes with mutated genes.

Question 12

Briefly explain the tumor, node, metastasis (TNM) classification system

Answer 12

The TNM system is the most widely used cancer staging system. It is used to describe the anatomic extent of cancers. The TNM staging systems have specific prognostic value for each solid tumor type. The N refers to the number of nearby lymph nodes that have cancer. The M refers to whether the cancer has metastasized. This means that the cancer has spread from the primary tumor to other parts of the body.

TNM Classification Primary Tumor
(T) Tx Primary tumor cannot be assessed, T0 No evidence of primary tumor Tis Carcinoma in situ T1, T2, T3, T4 Increasing size and/or local extent of the primary tumor

Regional Lymph Nodes (N) Nx Regional lymph nodes cannot be assessed N0 No regional lymph node metastasis N1, N2, N3 Increasing involvement of regional lymph nodes

Distant Metastasis (M) Mx Presence of distant metastasis cannot be assessed M0 No distant metastasis M1 Distant metastasis

Tumor growth is assessed in terms of doubling time (the amount of time it takes for a tumor to double in size) and mitotic index (the percentage of actively dividing cells within a tumor).

Question 13

modifiable risk factors for cancer

Answer 13

Modifiable- diet, obesity, tobacco use, and alcohol use

Diet: Avoid excessive intake of animal fat. • Avoid nitrites (prepared lunch meats, sausage, bacon). • Minimize your intake of red meat. • Keep your alcohol consumption to no more than one or two drinks per day. • Eat more bran. • Eat more cruciferous vegetables such as broccoli, cauliflower, Brussels sprouts, and cabbage. • Eat foods high in vitamin A (e.g., apricots, carrots, leafy green and yellow vegetables) and vitamin C (e.g., fresh fruits and vegetables, especially citrus fruits).

Question 14

Non modifiable risks for cancer

Answer 14

Non-modifiable-genetics, family history, age, gender, race, and ethnicity.

Question 15

Primary classifications of cancer prevention and examples

Answer 15

Avoidance of known or potential carcinogens is an effective prevention strategy when a cause of cancer is known and avoidance is easily accomplished.

1. For example, teach adults to use skin protection during sun exposure to avoid skin cancer.
2. Most lung cancer can be avoided by not using tobacco and eliminating exposure to loose asbestos particles. Teach all adults about the dangers of cigarette smoking and other forms of tobacco use
3. the use of vaccines and health counseling
4. limit the drinking of alcohol to 1 or less drinks per day

Question 16

Secondary classifications of cancer prevention and examples

Answer 16

secondary prevention:
Regular screening for cancer does not reduce cancer incidence but can greatly reduce some types of cancer deaths. Teach all adults the benefits of participating in specific routine screening techniques annually as part of health maintenance.

1. The choice of annual mammography for women 40 to 44 years of age, annual mammography for women 45 to 54 years of age, and annual or biennial mammography for women over 55 years of age
2. Annual clinical breast examination for women older than 40 years; every 3 years for women age 20 to 39 years.
3. Colonoscopy at age 50 years and then every 10 years
4. Annual fecal occult blood for adults of all ages
5. Digital rectal examination (DRE) for men older than 50 years

Question 17

Tertiary classifications of cancer prevention and examples

Answer 17

?

Question 18

5.What is CAUTION (warning signs) 21-7

Answer 18

C Changes in bowel or bladder habits
A A sore that does not heal
U Unusual bleeding or discharge
T Thickening or lump in the breast or elsewhere
I Indigestion or difficulty swallowing
O Obvious change in a wart or mole
N Nagging cough or hoarseness should

Question 19

What nursing interventions can be done to help chemo induced nausea and vomiting?

Answer 19

Many antiemetics are available to relieve nausea and vomiting.

These drugs vary in the side effects they produce and how well they control CINV. One or more antiemetics are usually given before, during, and after chemotherapy.

Drugs commonly used short term to control CINV Medications include:

Serotonin Antagonists, benzodiazepines, Neurokinin Receptor Antagonists, corticosteroids, and Prokinetic Agents.

Patient response to antiemetic therapy is variable, and the drug combinations are individualized for best effect

Drug therapy for CINV works best when given before the nausea and vomiting begin.

The nursing priority is to coordinate with the patient and cancer health care provider to ensure adequate control of CINV.

Ensure that antiemetics are given before chemotherapy and are repeated based on the response and duration of CINV.

When patients are receiving dose-dense chemotherapy, the intensity of CINV also increases, and more aggressive antiemetic therapy is needed.

Teach patients to continue the therapy, even when CINV appears controlled.

When the patient stops taking the drug(s), teach him or her to start retaking the drug at the first sign of nausea to prevent it from becoming uncontrollable.

Question 20

List four major complications of cancer

Answer 20

Major complications of cancer include:

sepsis and disseminated intravascular coagulation, syndrome of inappropriate antidiuretic hormone, spinal cord compression, hypercalcemia, superior vena cava syndrome, and tumor lysis syndrome

Question 21

What are key questions to ask for in:
Colorectal cancer-

​Bladder cancer-

​Lung cancer-

Answer 21

Colorectal cancer- Are there any persistent change in bowel habits such as diarrhea, constipation, or blood in stool.
​Bladder cancer- Is there any blood in your urine?
​Lung cancer- Do you have a cough that doesn’t get better or go away?

Question 22

What is key patient education regarding internal radiation?

Answer 22

Skin in the radiation path becomes photosensitive, increasing the risk for sunburn and sun damage.

Advise against direct skin exposure to the sun during treatment and for at least 1 year after completing radiation therapy.

Wash the irradiated area gently each day with either water or a mild soap and water as prescribed by your radiation therapy team.

• Use your hand rather than a washcloth when cleansing the therapy site to be gentler.
• Rinse soap thoroughly from your skin.
• If ink or dye markings are present to identify exactly where the beam of radiation is to be focused, take care not to remove them.
• Dry the irradiated area with patting rather than rubbing motions; use a clean, soft towel or cloth.
• Use only powders, ointments, lotions, or creams that are prescribed by the radiation oncology department on your skin at the radiation site.
• Wear soft clothing over the skin at the radiation site.
• Avoid wearing belts, buckles, straps, or any type of clothing that binds or rubs the skin at the radiation site.
• Avoid exposure of the irradiated area to the sun:
• Protect this area by wearing clothing over it.
• Try to go outdoors in the early morning or evening to avoid the more intense sun rays.
• When outdoors, stay under awnings, umbrellas, and other forms of shade during the times when the sun’s rays are most intense (10 AM to 7 PM).
• Avoid heat exposure.

Question 23

safety priorities for cancer patients

Answer 23

Common safety priorities for cancer patients include immunity and clotting, GI function, peripheral nerve sensory perception, central motor and sensory function/falls, psychosocial issues, respiratory and cardiac function and comfort and quality of life/pain.

It is important to provide adequate lightening

remove throw rugs/cords

ensure proper foot gear for cancer patients at high risk for falls.

Question 24

A client’s tumor was staged using the TNM system. The tumor was staged as T4N1Mx. The nurse interprets this staging as which of the following?

Answer 24

Large tumor, single node involvement and unable to assess metastasis

Question 25

The client receiving chemotherapy has a platelet count of 73,000. Which of the following should the nurse do to assist the client?

Answer 25

Assess for bruising and frank bleeding**

Question 26

While collecting a health history on a patient admitted for colon cancer, which of the following questions would be a priority to ask this patient?

Answer 26

Have you noticed any black tarry stools?**