Oncological and Hematological Problems Flashcards
1
Q
Cancer
A
- a malignant neoplastic disorder that can involve all body organs with manifestations that vary according to the body system affected and type of tumor cells.
- cells lose their normal growth-controlling mechanism, and the growth of cells is uncontrolled.
- cancer produces serious health problems such as impaired immune and hematopoietic (blood-producing) function, altered GI tract structure and function, motor and sensory deficits, and decreased respiratory function.
2
Q
Metastasis
A
- cancer cells move from their original location to other sites.
- routes:
= local seeding: distribution of shed cancer cells occurs in the local area of the primary tumor.
= bloodborne metastasis: tumor cells enter the blood, which is the most common cause of cancer spread.
= lymphatic spread: primary sites rich in lymphatics are more susceptible to early metastatic spread.
3
Q
Cancer classification
A
- solid tumors: associated with the organs from which they develop, such as breast or lung cancer.
- hematological cancers: originate from the blood cell-forming tissues, such as leukemias, lymphomas, and multiple myeloma.
4
Q
Cancer grading and staging
A
- grading and staging are methods used to describe the tumor.
- these methods describe the extent of the tumor, the extent to which malignancy has increased in size, the involvement of regional nodes, and metastatic development.
- grading a tumor classifies the cellular aspects of the cancer and is an indicator of tumor growth rate and spread.
- staging classifies the severity and clinical aspects of the cancer and degree of metastasis at diagnosis.
5
Q
Grading
A
- Grade I: cells differ slightly from normal cells and are well differentiated (mild dysplasia).
- Grade II: cells are more abnormal and are moderately differentiated (moderate dysplasia).
- Grade III: cells are very abnormal and are poorly differentiated (severe dysplasia).
- Grade IV: cells are immature (anaplasia) and undifferentiated; cell of origin is difficult to determine.
6
Q
Staging
A
- Stage 0: carcinoma in situ.
- Stage I: tumor limited to the tissue of origin; localized tumor growth.
- Stage II: limited local spread.
- Stage III: extensive local and regional spread.
- Stage IV: distant metastasis.
7
Q
Factors that influence cancer development
A
Environmental factors:
- chemical carcinogen include industrial chemicals, meds, and tobacco.
- physical carcinogen include ionizing radiation, UV radiation, chronic irritation, and tissue trauma.
- viral carcinogen (also known as oncoviruses) include Epistein-Barr virus, Hep B virus, and human papillomavirus.
- Helicobacter pylori infection is associated with an increased risk of gastric cancer.
- obesity and dietary factors, including preservatives, contaminants, additives, alcohol, and nitrates.
- genetic predisposition, age, and immune function.
8
Q
Early detection
A
- mammography
- papanicolau test
- rectal exams and stools for occult blood
- sigmoidoscopy, colonoscopy
- breast self-examination and clinical beast examination
- testicular self-examination
- skin inspection
9
Q
Warning signs of cancer - CAUTION
A
Change in bowel or bladder habits Any sore that does not heal Unusual bleeding or discharge Thickening or lump in breast or elsewhere Indigestion Obvious change in wart or mole Nagging cough or hoarseness
10
Q
Diagnostic tests
A
- Biopsy (needle, incisional, excisional, staging)
- bone marrow examination
- chest radiograph
- complete blood count
- CT; PET
- cytological studies (papanicolaou)
- evaluation of serum tumor markers (carcinoembryonic antigen and alpha-fetoprotein)
- liver function studies
- MRI
- proctoscopic examination
- radiographic studies (mammography)
- radioisotope scanning (liver, brain, bone, lung)
- tumor markers
11
Q
Pain control
A
- Causes: bone destruction, obstruction of an organ, compression of peripheral nerves, infiltration, distension of tissue, inflammation, necrosis, psychological factors (such as fear or anxiety).
- Interventions: adm pain meds (severe pain is treated with opioids), monitor VS and effectiveness of meds, provide nonpharmacological techniques of pain control.
12
Q
Surgery
A
- indicated to diagnose, stage, and treat certain types of cancer.
- Prophylactic: performed in clients with an existing premalignant condition or a known family history or genetic mutation that strongly predisposes to the development of cancer.
- Curative: all gross and microscopic tumor is removed or destroyed.
- Control (cytoreductive or debulking): consists of removing a large portion of a locally invasive tumor; decreases the number of cancer cells (therefore increases the chance that other therapies will be successful.
- Palliative: performed to improve quality of life; to reduce pain, relieve airway obstruction, relieve obstructions in the GI or urinary tract, relieve pressure on the brain or spinal cord, prevent hemorrhage, remove infected or ulcerated tumors, or drain abscesses.
- Reconstructive or rehabilitative: performed to improve quality of life by restoring maximal function and appearance (such as breast reconstruction).
13
Q
Adverse effects of surgery
A
- loss of function of a specific body part
- reduced function as a result of organ loss
- scarring or disfigurement
- grieving about altered body image or imposed change in lifestyle.
- pain, infection, bleeding, thromboembolism.
14
Q
Chemotherapy
A
- kills or inhibits the reproduction of neoplastic cells and kills normal cells; effects are systemic.
- normal cells mos profoundly affected include those of the skin, hair, and lining of the GI tract; spermatocytes; and hematopoietic cells.
- usually used a combination therapy to increase the therapeutic response and is planned by the PHCP so that meds with overlapping toxicities and nardis are not adm at or near the same time.
- may be combined with other treatments, such as surgery and radiation.
- common side effects: fatigue, alopecia, nausea, vomiting, mucositis, skin changes, and myelosuppression (neutropenia, anemia, and thrombocytopenia).
15
Q
Radiation Therapy
A
- destroys cancer cells, with minimal exposure of normal cells; the damaged cells die or become unable to divide.
- is effective on tissues directly within the path of the radiation beam.
- side effects include local skin changes and irritation, alopecia, fatigue, and altered taste sensation (vary according to site).
16
Q
Radiation Therapy: External beam radiation
A
- also called teletherapy.
- radiation source is external to the client.
- instruct the client regarding self-care of the skin.
- client does not emit radiation and does not pose a hazard to anyone.
17
Q
Radiation Therapy: Brachytherapy
A
- radiation source comes into direct, continuous contact with tumor tissues for a specific time.
- source is within the client for a period of time, therefore emits radiation and can pose a hazard to others.
- includes an unsealed source or a sealed source of radiation.
- unsealed: adm is via the oral or IV route or by instillation into body cavities; source is not confined completely and eventually is eliminated via various excreta (which are radioactive and harmful); most of the source is eliminated within 48h.
- sealed: temporary or permanent radiation source (solid implant) is implanted within the tumor target tissues; client emits radiation while the implant is in place, but the excreta are not radio active.
18
Q
Hematopoietic Stem Cell Transplantation: description
A
- bone marrow transplantation (BMT) and peripheral blood stem cell transplantation (PBSCT) are procedures that replace stem cells that have been destroyed by high doses of chemotherapy and/or radiation therapy.
- BMT and PBSCT are most commonly used in the treatment of leukemia and lymphoma but are also used to treat other cancers, such as neuroblastoma and multiple myeloma.
- goal of treatment is to rid the client of all leukemic or other malignant cells through treatment with high doses of chemotherapy and whole-body irradiation.
- because these treatments are damaging to bone marrow cells, without the replacement of blood-forming stem cell function through transplantation, the client would die of infection or hemorrhage.
19
Q
Hematopoietic Stem Cell Transplantation:
Types of Donor Stem Cells
A
- Allogenic: stem cell donor is usually a sibling, a parent with a similar tissue type, or a person who is not related.
- Syngeneic: stem cells are from an identical twin.
- Autologous: most common type; client receives their own stem cells, which are harvested during disease remission and are stored frozen to be reinfused later.
20
Q
Hematopoietic Stem Cell Transplantation: Procedure
A
- Harvest: stem cells used in PBSCT come from the bloodstream in a 4-6h process called apheresis or leukapheresis (blood is removed through a CVC and an apheresis machine removes the stem cells and returns the remainder of the blood to the donor); in BMT, marrow is harvested through multiple aspirations from the iliac crest to retrieve sufficient bone marrow; marrow from the client is filtered for residual cancer cells; allogenic marrow is transfused immediately; autologous is frozen for later use; harvesting is done before the initiation of the conditioning regimen.
- Conditioning: refers to immunosuppression therapy regimen used to eradicate all malignant cells, provide a state, and create space in the bone marrow for the engraftment of the new marrow.
- Transplatation: stem cells are adm through the client’s CVC similar to a blood transfusion (ma be adm by IV infusion or by push).
- Engraftment: transfused stem cells move to the marrow-forming sites of the recipient’s bones; engraftment occurs when the WBC, erythrocyte, and platelet counts begin to rise; when successful, the engraftment process takes 2-5 weeks.
21
Q
Hematopoietic Stem Cell Transplantation: Complications
A
- infection, bleeding, or neutropenia and thrombocytopenia are major concerns until engraftment occurs.
- failure to engraft: client will die unless another transplantation is attempted and successful.
- graft x host disease in allogeneic transplants: the immune-competent cells of the donor recognize the recipient’s cells as foreign and mount an immune offense against them; managed with immunosuppressive agents.
- hepatic veno-occlusive disease: involves occlusion of the hepatic venules by thrombosis or phlebitis; treated with fluids and supportive therapy (early detection is critical because there is no known way to open the vessels); sings include abd pain, jaundice, ascites, weight gain, and hepatomegaly.
22
Q
Leukemia: description
A
- are a group of hematological malignancies involving abnormal overproduction of leukocytes (usually at a immature stage, in the bone marrow).
- 2 major types are lymphocytic and myelocytic or myelogenous.
- may be acute, with a sudden onset, or chronic, with a slow onset and persistent symptoms over a period of years.
- affects the bone marrow causing anemia, leukopenia, the production of immature cells, thrombocytopenia, and a decline in immunity.
- cause is unknown and appears to involve genetically damaged cells.
- risk factors: genetic, viral, immunological, and environmental factors and exposure to radiation, chemicals, and medications, such as previous chemotherapy.
- infection is a major cause of death and bleeding a major concern.
- chemotherapy: induction, consolidation, and maintenance.
23
Q
Leukemia: assessment
A
- anorexia, fatigue, weakness, weight loss, anemia, overt bleeding, occult bleeding, ecchymoses, petechiae, prolonged bleeding after minor trauma, elevated temp, enlarged lymph nodes, spleen, and liver, palpitations, tachycardia, orthostatic hypotension, pallor and dyspnea on exertion, headache, bone pain and joint swelling, normal, elevated or reduced WBC count, decreased Hb and Ht levels, decreased platelet count, positive bone marrow biopsy.
