Oncologic Conditions

Question 1

Cardinal signs of cancer

Answer 1

Unusual mass or swelling, unexplained paleness or loss of energy, sudden tendencies of bruising or bleeding, persistent localized pain or limping, prolonged unexplained fever or illness, frequent headaches, vision changes, weight loss

Question 2

Oncologic emergencies (6)

Answer 2

Acute tumor lysis syndrome
Hyperleukocytosis 
Superior vena cava syndrome 
Septic shock
Bone marrow suppression (if severe)
Disseminated intravascular coagulation (DIC)

Question 3

Acute tumor lysis syndrome

Answer 3

Results from rapid release of intracellular metabolites during initial treatment of cancer - causes hypercalcemia, hyperuricemia, hyperphosphatemia, hyperkalemia

Question 4

Acute tumor lysis syndrome signs

Answer 4

Altered LOC, lethargy, nausea, vomiting, pruritus, flank pain, oliguria, tetany

Question 5

Acute tumor lysis syndrome treatment

Answer 5

Includes administration of allopurinol

Question 6

Hyperleukocytosis

Answer 6

WBC > 100,000

Can lead to capillary obstruction, micro-infarction, organ dysfunction

Question 7

Hyperleukocytosis signs

Answer 7

Cyanosis, respiratory distress, altered LOC, vision disturbances, ataxia, delirium

Question 8

Hyperleukocytosis treatment

Answer 8

Massive cytoreduction with chemotherapy, hydration, urinary alkalinization, allopurinol
Leukophoresis or exchange infusion may be warranted

Question 9

Superior vena cava syndrome

Answer 9

Results from compression of mediastinal structures - space-occupying lesions
Causes cyanosis of face, neck, and upper torso, upper extremity edema, jugular vein distention

Question 10

Disseminated intravascular coagulation (DIC)

Answer 10

May occur due to release of procoagulant material in blood

Question 11

DIC signs

Answer 11

Clots, chest pain, SOB, headaches, dizziness, paralysis

Question 12

Leukemia

Answer 12

Proliferation of abnormal WBCs - leukemic cells invade and cause bone barrow suppression, resulting in anemia, neutropenia, and thrombocytopenia
Types - acute lymphocytic leukemia (ALL), acute myeloid leukemia (AML)

Question 13

Leukemia signs

Answer 13

Anemia - fatigue, pallor, tachycardia
Neutropenia - fever, infection, poor wound healing
Thrombocytopenia - petechiae, purpura, hematuria, epistaxis, tarry stools
Enlarged of reticuloendothelial organs (spleen, liver, lymph glands) due to infiltration, eventually causes fibrosis

Question 14

Brain tumors

Answer 14

Intracranial, space occupying lesions - obstructs circulation of CSF when tumor enlarges, resulting in increased ICP

Question 15

Brain tumor signs

Answer 15

Most common = headache, usually after waking up or with sneezing/coughing/straining
Projectile vomiting, usually occurring in the morning
Ataxia, hypotonia, decreased reflexes, dexterity, weakness, spasticity, paralysis, slurred speech, seizures, increased BP, decreased pulse rate, vision problems

Question 16

Lymphomas

Answer 16

Neoplastic diseases that develop from the lymphoid and hemopoietic systems
Humoral immunity remains normal but cellular immunity is altered
Spreads from lymph nodes to non-lymph node sites such as spleen, liver, bone, bone marrow, lungs, and mediastinum
Types - Hodgkin’s lymphoma, non-Hodgkin’s lymphoma

Question 17

Hodgkin’s lymphoma

Answer 17

Begins in single lymph node or group of lymph nodes, usually in the neck, chest, or underarms
Characterized by giant, multi-nucleated Reed-Sternberg cells - unusually large mature B cells

Question 18

Non-Hodgkin’s lymphoma

Answer 18

Proliferation of B or T cells, can occur in any lymph nodes throughout the body

Question 19

Lymphoma signs

Answer 19

Painless enlargement of lymph nodes - firm, non-tender, mobile nodes
Fever, anorexia, nausea, weight loss, night sweats, pruritus
Metastasis to bone narrow or CNS (more common in non-Hodgkin’s) may produce symptoms of leukemia

Question 20

Lymphoma stages

Answer 20

Stage I - one lymph node affected
Stage II - 2 or more lymph nodes affected on the same side of the diaphragm
Stage III - Lymph nodes affected on both sides of the diaphragm
Stage IV - Bone marrow or organs outside of lymphatic system affected

Question 21

Wilm’s tumor

Answer 21

Malignant neoplasm of the kidney

Associated with genitourinary anomalies - cryptorchidism (undescended testicle), hypospadias, double collecting system

Question 22

Wilm’s tumor stages

Answer 22

Stage 1 - confined in one kidney and has intact capsule, can be resected
Stage 2 - extends beyond kidney into surrounding fat, soft tissue, or blood vessels - can be resected
Stage 3 - confined within the abdomen, cannot be removed in one piece
Stage 4 - distant metastases - lungs, liver, brain, bones, lymph nodes beyond the abdomen
Stage 5 - involves both kidneys (each tumor staged differently)

Question 23

Wilm’s tumor signs

Answer 23

asymptomatic abdominal mass (usually discovered during routine assessment), fever, abdominal pain, hematuria, hypertension

Question 24

Do not ____ the abdomen if Wilm’s tumor is suspected

Answer 24

Palpate - can rupture encapsulated tumor and cause dissemination to adjacent and distant sites