oncologic disorders

Question 1

biology of cancer

Answer 1

cancer does not response correctly to signals to regulate cell proliferation/cell death

cells should go from immature to mature

cells should not dedifferentiate

Question 2

development of cancer

Answer 2

intiation

promotion

progression

Question 3

initiation

phase of cancer

Answer 3

mutation occurs

causes:
genetic
enviornmental factors

usually our body stops it at this phase

Question 4

promotion

phase of cancer

Answer 4

altered cell proliferates (grows)

may be accelerated (smoking, high fat diet)

latent period occurs

Question 5

progression

phase of cancer

Answer 5

growth, invasion, and metastasis

tumor increase in size and forms blood vessels

tumor cells detach and invade other tissues (metastasis)

Question 6

types of neoplasm (tumor)

Answer 6

benign:
*well differentiated tumor
*localized (do not metastasize)(encapsulated)
*recurrence unusual after excision
*usually harmless

malignant:
*rapid growth
*metastasis common
*recurrence common

Question 7

classification of cancer

Answer 7

site
histology (grading)
extent of disease (staging)

Question 8

clasification by site

Answer 8

carcinoma:
*skin/glands/mucous linings

sarcoma:
*connective tissue
*muscle
*bone, fat

lymphoma/leukemia:
*blood/bone marrow

Question 9

histologic grading and staging of cancer

Answer 9

histologic grading:
*amount of dysplasia (difference from normal cell)
*1-4 (4 is worst)

staging based on spread:
*extent/spread of disease
*0:in situ (unlikely to spread)
*I,II,III: growing/ may be in lymph nodes
*IV: metastasis (spread to other areas)

Question 10

main sites of metastasis

Answer 10

brain and cerebrospinal fluid:
*headaches

lung

liver:
*jaundice

Adrenals:
no symptoms

bone:
fracture without a fall

Question 11

cancer preventions

Answer 11

primary

secondary

tertiary

Question 12

primary prevention ***

Answer 12

p=prevent

dont have cancer yet

physical activity
diet recommendations
sunscreen
limit ETOH (2 drinks or less/day men and 1 for women)
HPV vaccination (cervical and neck cancer)

Question 13

secondary prevention ***

Answer 13

early detection/screenings

middle of getting it or having

Question 14

tertiary prevention ***

Answer 14

management of disease

attempts to slow progression
*tx

Question 15

breast cancer screening ***

Answer 15

mammogram (gold standard)

clinical breast exam

self breast exam

Question 16

colon cancer screening ***

Answer 16

colonoscopy

FIT test (fecal immunochemical testing)
*if positive then colonoscopy

multitarget stool DNA testing
*ex: cologuard

stool guiac
*from stool sample

Question 17

prostate cancer screening ***

Answer 17

high incidence of false positive

PSA (blood test) is the only test
*prostate specific antigen

Question 18

testicular cancer screening ***

Answer 18

age 20-40 y/o monthly self ecam

Question 19

cervical cancer screening ***

Answer 19

PAP: age 21-29

HPV testing: age 30-65

Question 20

lung cancer screening ***

Answer 20

low dose chest CT

pack years: #yrs smoked x packs/day

Question 21

warning signs of cancer ***

Answer 21

CAUTION
C=change in bowel/bladder habits
A=a sore that does not heal
U=unusual bleeding/discharge
T=thickening or lump in breast or elsewhere
I=indigestion or difficulty swallowing
O=obvious change in wart/mole
Nagging cough or hoarseness

Question 22

skin cancer

Answer 22

ABCDE
Asymmetry
Border
Color
Diameter
Evolution

Question 23

cancer diagnosis ***

Answer 23

biopsy: collecting cells and looking under microscope

PET scan: shows places of high metabolic activity
*tells us we have spread or metastasis

invasive procedures: if you have to do surgery to get biopsy

Question 24

cancer treatment goals ***

Answer 24

cure (eradicate)

control (slow progression)

pallitation (alleviate symptoms)

Question 25

cancer treatment

Answer 25

main:
surgery
chemo
radiation

immunotherapy and target therapy
bone marrow transplant

Question 26

surgery for cancer

Answer 26

cure: remove tumor
ex: thyroidectomy

palliative: help manage symptoms, alleviate pain
ex: feeding tube to maintain nutrition

Question 27

chemotherapy
Types of tumors
Types of tx
What it does

Answer 27

mainstay for solid tumors and hematologic cancers

can use for cure or palliation

disrupts the cell cycle

systemic adverse effects

Question 28

chemo administration ***

Answer 28

must be trained/certified

PO, IM, IV, topical
*IV most common (big risk of extravasation)

regional administration:
*intraperitoneal
*intrathecal (injected into subarachnoid space for CNS)
*intravesicular (into bladder via f/c)

Question 29

effects of chemo on normal tissue

Acute
Delayed
Chromic

Answer 29

acute toxicity: during and after admin
*anaphylaxis, hypersensitivity, extravasation, N/V

delayed effects: numerous
*N/V, alopecia, rashes, bone marrow suppression, diarrhea/constipation

chronic toxicities: damage to organs
*heart, liver, kidneys, lungs

Question 30

hematologic effects of chemo

Answer 30

bone marrow suppression
*neutropenia (infection)
*thrombocytopenia (bleeding)
*anemia (bad perfusion/fatigue)

usually lowest 7-10 days after chemo

Question 31

radiation therapy

External
Internal

Answer 31

high energy beams damage DNA -cell death

external beam: most common
* exposed to radiation from tx machine

internal radiation (aka brachytherapy)
*radioactive material goes into pt
*pt can emit radiation
*sealed source: stays where you put it (do not touch)
*unsealed: IV/oral radiation drug (bodily fluids are contaminated

Question 32

radiation safety for internal radiation

Answer 32

-reduce time
-keep distant
-shielding (lead shields)
-caregivers should wear film badge (patch to turn colors if exposed to too much radiation)
-NO pregnant staff should care for these pts

Question 33

fatigue

Answer 33

multifactorial
*anemia
*insomnia
*depression/anxiety
*dehydration

tx: balance rest/activity

Question 34

GI effects to radiation and chemo

Answer 34

anorexia:
*nausea, stomatitis (inflammation of mouth), appetite suppressant
tx:monitor wt, small freq meals, topical analgesia for stomatitis

consitpation:
tx: stool softeners, high fiber, fluid intake, activity

Diarrhea: replace fluids

N/V: prophylactic tx before sessions

Question 35

skin effects: alopecia

Answer 35

2-3 weeks after first tx
may or may not grow back
may grow back different

interventions:
support groups
avoid excessive shampooing
wigs, scarves

Question 36

skin effects radiation

Answer 36

photosensitivity
*protect from sun 1 year
*soft clothing

skin reactions:
ranging from mild rash to second degree burn
*avoid extreme temps
*gentle soaps/detergent

Question 37

other effects

Answer 37

neuro:
chemo brian
peripheral neuropathy

pulomnoary: pulmonitis

cardiac: dysrhythmias

reproductive: may lose fertility
*discuss preservation of ova/sperm

Question 38

cancer pain management

Answer 38

undertreatment is common
inadequate assessment is Huge barrier
*VS/ nonverbal signs of pain are not reliable in chronic pain
*always believe pt

management:
Nsaids
Opioids
nerve blocks, epidural anesthesia

Question 39

self care

Answer 39

coping strategies
family support
palliatige care/hospice

Question 40

hematopoietic growth factors

Answer 40

colony stimulating factos

to stimulate plts, neutrophils or macrophages

ex:
filgrastim (neupogen)=stimulate WBC production

Oprelvekin (neumega)=stimulate plt production

epoeitin (procrit) stimulate RBC production
*most common (helps with fatigue)

Question 41

biologic response modifiers

Answer 41

create environmet that is not conducive for cancer cells to grow (stimulating immune system)

attack cancer cells directly
(ex: monocolonal antibodies-attack specici antigens)

Question 42

hematopoietic stem cell transplantation

Answer 42

high dose chemo to clear the bone marrow
*healthy stems then transplanted

autologous: pt own stem cells
syngeneic: identical twin
allogenic: from a donor

used to treat: leukemia, multiple myeloma, lymphoma

Question 43

harvest procedures: 2 methods

Answer 43

bone marrow aspiration:
going to bleed and have pain
under local anesthesa
taken from iliac crest
higher risk

from peripheral blood

Question 44

complications of treansplace of hematopoietic stem cells

Answer 44

graft vs host disease

pancytopenia until transplanted marrow begins to work (2-4 weeks)
*high risk of infection (will be in isolation)

Question 45

spinal cord compression

Answer 45

cause:
cancer in epidural space or spinal cord

s/s:
-back pain, verebral tenderness
-motor weakness/sensory loss
-autonomic dysfunction (bowel/bladder)
*(looks like retention or incontinence)

management:
ER, radiation/surgery

Question 46

superior vena cava syndrome

Answer 46

obstruction of superior vena cava by tumor

s/s:
facial/periorbital edema
distention of veins of head, neck, chest
HA, seizures
mediastinal mass on CXR

management:
ER
radiation at site
more sensitive chemo

Question 47

hypercalcemia

Answer 47

metastatic disease of bone or multiple myeloma
*causes release ca from bone

s/s:
fatigue/weakness
hyporeflecia
cardiac dysrhythmias
kidney stones

management:
hydration (dilute it)
bisphosphates
diuretics

Question 48

tumor lysis syndrome

Answer 48

rapid release of cellular contents
(tumor open up and the intracellular electrolytes get out)

hallmark signs:
hyperuricemia (gout)
hyperphosphatemia
hyperkalemia
hypocalcemia
watch for cardiac due to these
within 24-48 hours after starting chemo

management:
hydration
allopurinol (decreases uric acid)
electrolyte correction