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Clinical Nursing May Exam > Oncology > Flashcards

Oncology Flashcards

1
Q

define cancer

A

persistent, purposeless proliferation of host cells, often to detriment of host

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2
Q

what are different behaviours cancers can show?

A

benign
highly malignant
metastasis

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3
Q

list features of cancer

A 
evading apoptosis
self sufficiency in growth signals
insensitive to anti-growth signals
sustained angiogenesis
limitless replicative potential
tissue invasion and metastasis
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4
Q

what is the cause of cancer?

A

alteration of genes

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5
Q

what changes to genetics lead to cancer?

A

overactive oncogens which are tumour promoting

loss of tumour suppression genes

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6
Q

how are cancers named?

A

tissue of origin

status- benign or malignant

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7
Q

define metastasis

A

development of tumour away from primary tumour

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8
Q

define benign

A

neoplasm that forms solid cohesive tumour without metastasis

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9
Q

define malignant

A

neoplasm with capacity for local invasion and metastasis

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10
Q

list clinical features of cancer

A

effect on host
response to treatment
reflection of tumour growth, grade and behaviour

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11
Q

what is meant by tumour behaviour?

A

local behaviour

metastatic and PNS effects

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12
Q

why are most cancers advanced before they are detected?

A

most of growth has taken place before this time

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13
Q

when can tumours be detected?

A

1cm diameter
1g weight
10^9 cells

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14
Q

define growth fraction

A

proportion of actively dividing cells which determines tumour growth

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15
Q

define tumour

A

swelling inferred to be neoplastic

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16
Q

why are tumours susceptible to treatment when in early stages?

A

tumour cells are rapidly dividing so sensitive to chemo and radiation

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17
Q

what determines response to chemo and radiation?

A

growth fraction

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18
Q

why is treatment likely to be toxic for treating detectable tumours?

A

growth fraction reaching plateau so tumour is less susceptible than rapidly dividing healthy tissues such as intestinal epithelium and bone marrow

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19
Q

what makes tumours heterogenous?

A

cancer cells modify properties as they grow by small sequential mutations

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20
Q

what determines tumour grade?

A

mitotic rate

cellular and nuclear characteristics

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21
Q

how does rate of growth differ between benign and malignant tumours?

A

benign- slow

malignant- rapid

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22
Q

describe how benign and malignant tumours grow in space

A

benign- expansive with well defined boundaries

malignant- invasive with poorly defined boundaries

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23
Q

which type of tumour has often serious effects on adjacent tissues?

A

malignant

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24
Q

what is the effect of surgery on benign and malignant tumours?

A

benign- curative with complete resection

malignant- curative if complete resection and no mets

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25
Q

which tumour type has potential to metastasise?

A

malignant

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26
Q

when can benign tumours be dangerous to the host?

A

if causes bleeds

located in vital organ

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27
Q

which types of tumour can cause paraneoplastic effects?

A

benign and malignant

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28
Q

how do malignant tumours grow?

A

local invasion and may extend microscopically into surrounding tissues

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29
Q

list indicators of local invasion

A

diffuse and indistinct boundaries
fixation of tumour in one or more planes
thickening of adjacent tissue
spontaneous bleeding

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30
Q

what is meant by metastatic potential?

A

ability to spread to distant tissues

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31
Q

list ways of metastatic spread

A

blood
lymphatics
transcoelomic across pleural or peritoneal space
iatrogenic

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32
Q

what is the effect of metastasis via blood?

A

secondary tumours can form in any body cavity

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33
Q

how does cancer metastasise via lymphatics?

A

spreads to local then regional lymphnodes

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34
Q

what are examples of iatrogenic spread?

A

biopsies and seeding

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35
Q

where is the most common site for secondary tumours to develop?

A

lungs

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36
Q

name common places for secondary tumours to develop and why

A 
liver
spleen
kidneys
bone
CNS
high blood flow
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37
Q

define paraneoplastic syndrome/PNS

A

signs from indirect effect of tumours production and release of biologically active substances

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38
Q

what is the impact of PNS?

A

may be first evidence of neoplastic disease

may be life threatening before cancer kills patient

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39
Q

list the types of hematologic PNS and signs of these

A

anaemia- weakness, lethargy, tachypnoea
thrombocytopenia- bleeding
leukopenia- susceptible to infection

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40
Q

what is hyper viscosity syndrome?

A

PNS with increased blood cell numbers with sludging blood and poor circulation

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41
Q

list causes of hyper viscosity syndrome

A

primary polycythaemia
leukaemia
excess gamma globulins
secondary polycythaemia due to excess erythropoietin secretion

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42
Q

what are clinical signs of hyper viscosity syndrome?

A 
lethargy
tremors
thromboembolism
bleeding
ataxia
seizures
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43
Q

what causes hyperhistaminaemia PNS?

A

mast cell tumours often release histamine and vasoactive amines

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44
Q

what are local affects of hyperhistaminaemia?

A

oedematous swelling with erythema and pruritis
tendency for localised bleeding due to heparin release
delayed wound healing, dehiscence after surgery due to released proteases

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45
Q

what are systemic effects of hyperhistaminaemia?

A

anaphylactic shock

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46
Q

what is meant by immune mediated reactions due to PNS?

A

cross reactivity between cancer and healthy cells

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47
Q

what causes endocrine related PNS?

A

non-endocrine tumours release hormones or hormone like substances which have paraneoplastic effects

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48
Q

what causes hypercalcaemia PNS?

A

tumours release parathormone-like substance increasing total and ionised calcium concentration

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49
Q

what types of cancer most commonly causes PNS hypercalcaemia?

A

lymphoma

myeloma and carcinoma with skeletal metastasis

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50
Q

what are clinical signs of hypercalcaemia?

A 
PUPD
anorexia
vomiting
lethargy
depression
muscle weakness
bradycardia
renal effects and failure
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51
Q

how does hypoglycaemia PNS happen?

A

pancreatic insulinoma produces insulin
release of insulin like factor called leiomyoma
excess glucose consumption

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52
Q

what causes cancer cachexia PNS?

A

abnormal metabolism due to enhanced catabolism

reduced food intake

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53
Q

what causes fever PNS?

A

pyrogens

cytokines

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54
Q

what are the aims of cancer investigations?

A

make histological diagnosis of type and grade
determine stage of disease
investigate and treat tumour related or other complications

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55
Q

state investigations carried out for cancer diagnosis

A 
history
physical exam
lab testing
imaging
biopsy for cytology and histopathology
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56
Q

what is the only way to accurately diagnose cancer?

A

microscopic exam of tissue or cells

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57
Q

how can you produce samples for cytology?

A

touch/impression preparations
fine needle aspirations
samples of effusion or body fluid in EDTA tube

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58
Q

define neoplasia

A

new growth, inferring abnormal growth

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59
Q

what are negatives of cytology samples for cancer diagnosis?

A

may not be definitive diagnosis
false negatives possible
can be hard to differentiate inflammation and neoplasia

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60
Q

what can be shown by large biopsies of tumours?

A

cellular features of malignancy
tumour architecture
invasion of adjacent tissues
evidence of metastasis

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61
Q

define incisional biopsy

A

small piece of tumour taken with some healthy tissue for comparison

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62
Q

define excisional biopsy

A

whole tumour including margins removed

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63
Q

how can you provide a representative sample of a tumour for biopsy?

A

avoid superficial ulceration, inflammation or necrosis
ensure adequate depth
include boundary between tumour and normal tissue

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64
Q

when are biopsies not done?

A

too dangerous location

biopsy wont affect treatment

65
Q

why is staging of tumours used?

A

determines feasibility of treatment and prognosis

66
Q

what are the aims of tumour staging?

A

identify grade, local invasion and metastatic spread

67
Q

what is assessed in tumour staging

A

tumour size and invasiveness
nodes- spread to local draining lymph nodes
metastasis

68
Q

how is tumour assessed in staging?

A

T0- no evidence of primary tumour

T1-4 depending on extent and size of primary tumour

69
Q

how are lymph nodes assessed in staging?

A

N0- no regional lymph node involvement

N1-4- involvement of regional lymph nodes, number and extent of spread

70
Q

how is metastasis assessed in staging?

A

M0- no distant mets
M1- single distant met present
M2- multiple distant mets present

71
Q

state how distant spread of tumours is assessed

A 
history
physical exam
imaging- thorax, abdomen
FNA- lymph nodes, spleen, liver
bone marrow aspiration
observe lymph node metastasis and routes of drainage
72
Q

what is the purpose of tumour staging?

A

used to decide treatment along with grade and behaviour of tumour

73
Q

how are treatment options chosen?

A

informed based on nature of disease, treatment options, potential side effects, prognosis, cost

74
Q

state the different aims for treating cancer

A

cure
remission
palliation

75
Q

what is meant by cure?

A

all cells with capacity for tumour regeneration eradicated usually by excision

76
Q

what is meant by remission?

A

all clinical evidence of cancer disappeared but occult cancer cells remain and relapse will happen at some point

77
Q

what is the aims of palliation?

A

reduce pain
improve wellbeing
correct physiological malfunctions

78
Q

what is meant by palliation?

A

treating patient without aim of curing patient, cancer still clinically identifiable

79
Q

list the main treatment options for cancer

A

surgical excision
radiation
chemotherapy

80
Q

what is the aim of surgical excision?

A

complete removal of tumour cells

81
Q

when is surgical excision most effective?

A

solid tumours

82
Q

what are lumpectomies used for?

A

truly benign tumours such as lipoma, fibroma, mammary tumour

83
Q

describe wide local excisions

A

wider margins and 2 tissue planes deep of normal tissue excised to remove all of tumour and prevent regrowth

84
Q

what types of tumours are wide local excisions used for?

A

locally invasive tumours such as basal or squamous cell carcinoma, mast cell tumour

85
Q

when can wide local excision be difficult?

A

insufficient normal tissue to close wound

need excision of underlying bone

86
Q

what is meant by compartmental excision?

A

removing all tissue compartment involved in tumour

87
Q

when is compartmental excision done and why?

A

soft tissue tumours as they infiltrate tissues more widely

88
Q

when does excisional surgery fail?

A

regrows due to incomplete resection of margins
cant remove all as involved in vital structures
already metastasised
is systemic

89
Q

what is surgical debulking?

A

surgically removing as much of a incurable malignant neoplasm before using other therapy to treat

90
Q

what needs considering when planning surgical excision?

A

margins
cutting deep and large
2 sets of instruments

91
Q

what needs to be included on lab forms to send with tumours?

A

clinical history
margin concerns
orientate and identify samples
submit whole tumour

92
Q

what are general post op considerations?

A

nutrition
analgesia
wound care
functionality

93
Q

what is the problem of excess tension when closing wounds?

A 
compromise circulation
ischemia if artery compromised
if veins or lymphatics compromised oedema
slow healing
wound breakdown
necrosis
distortion of anatomy
94
Q

what patient factors can lead to wound breakdown?

A 
concurrent disease
nutrition 
chemotherapy
steroids
radiotherapy
95
Q

what wound factors can lead to wound breakdown?

A 
neoplasia
tissue handling
haemostasis
tension
motion around joint
sutures 
infection
patient interference
96
Q

if wounds breakdown how should they heal?

A

classed as dirty so heal by second intention

97
Q

how can you prevent seromas following surgical excision?

A

reduce dead space
place drains
rest as motion creates fluid

98
Q

how are seromas following excision treated?

A

leave alone
pressure bandage
drainage

99
Q

how are infections post excision managed?

A

antibiotics after culture and sensitivity
drainage
heal via second intention
explore wound if needed

100
Q

what is meant by radiation therapy?

A

ionising radiation to kill or control malignant cells

101
Q

when is radiation therapy used and why?

A

when surgery is incomplete

is the least toxic and most effective local treatment

102
Q

state how radiation therapy is given to patients

A

brachytherapy
external beam radiation
teletherapy

103
Q

what type of radiation is used in radiation therapy?

A

electrons which absorbed by tissue or easily shielded

high energy x-rays which are highly penetrating and harmful

104
Q

what is meant by brachytherapy?

A

radioactive substance emits gamma rays or beta particles close to tumour

105
Q

how is brachytherapy administered?

A

surface of tumour
implanted in tumour
systemically but concentrated in tumour

106
Q

how is radioiodine treatment used to treat thyroid cancer?

A

systemically administered and concentrated in tumour

beta cells kill local cancer cells

107
Q

how is external beam radiation therapy given?

A

external radiation source at distance from body with multiple doses over 4-6 weeks

108
Q

what are side effects of external beam radiation?

A 
skin reddening
vesiculation
desquamation
severe exfoliative dermatitis
localised hair loss
depigmentation
dermal fibrosis
osteonecrosis 
neural necrosis
109
Q

why is chemotherapy so dangerous?

A

highly toxic

110
Q

what are chemo drugs most effective against and what are examples?

A

growing and dividing cells
cancer
bone marrow
GI tract

111
Q

why are chemo drugs effective against dividing and growing cells?

A

acts on processes involved in cell growth and division such as DNA replication, mitotic spindle and metabolism

112
Q

state factors affecting response to chemo

A

tumour growth rate and drug resistance

113
Q

what is the main consideration when using chemo?

A

use highest possible dose with maximum fractional kill with minimal side effects

114
Q

when is the best time to use chemo?

A

tumour burden lowest and growth fraction highest so in early stages or after debulking

115
Q

how are chemo dose calculated?

A

function of body surface area

116
Q

how often is chemo normally given?

A

3 week cycles

117
Q

state cancers highly sensitive to chemo

A

lymphoma
myeloma
leukaemia

118
Q

state cancers with moderate sensitivity to chemo

A

high grade sarcoma

mast cell tumour

119
Q

what cancers are poorly sensitive to chemo?

A

slow growing sarcoma
carcinoma
melanoma

120
Q

why is combination chemotherapy preferred?

A

more effective
less side effects
less resistance

121
Q

describe combination chemotherapy

A

combining different classes of chemo agents with different mechanisms of action

122
Q

what is the cat and dog protocols for lymphoma

A

cats- COP

dogs- CHOP

123
Q

when is chemo used as first line therapy and why is it usually effective?

A

systemic disease- lymphoma, leukaemia, multiple myeloma

high growth fraction

124
Q

why is adjunctive chemotherapy used?

A

solid tumours rarely respond to chemo alone so used with surgery and radiation

125
Q

why is chemo used along with surgery?

A

reduce mass to allow resection

delay metastasis

126
Q

what is meant by metronomic chemo?

A

palliative low doses of chemo daily targeting endothelium or tumour stroma

127
Q

what is the purpose of metronomic chemo?

A

minimise toxicity
slow progression
anti-angiogenic- stops new vessels growing in tumour

128
Q

what is meant by chemoembolization?

A

local direct delivery of chemo and embolization to treat inoperable solid tumours

129
Q

how is chemoembolization done?

A

chemo injected to blood vessel supplying tumour

synthetic material placed in blood vessel trapping chemo in tumour

130
Q

what safety measures need to be in place when using chemo?

A 
PPE- gloves, mask, glasses, apron
sealed injection system
cleaning and disposal protocols
chemo room- fume cupboard for drawing up, surfaces covered, chemo waste bins
no use by pregnant women
131
Q

what are nursing considerations for chemo patients?

A

excretions may have drugs or metabolites in
kennel states chemo is used
PPE when with patient
use cytotoxic waste bins

132
Q

what measures should be in place for chemo patients at home?

A 
wash hands after contact with pet
keep children and pets away
wash food and toys separately
wash bedding separately and run empty cycle after
latex gloves to clean up excretions
double bag all rubbish
clean then disinfect with bleach
133
Q

what makes chemo have toxic effects?

A

affects dividing cells in normal tissue

134
Q

how does chemo cause GI toxicity?

A

death and loss of intestinal epithelial cells

135
Q

what are the signs of GI toxicity from chemo?

A

stomatitis, vomiting, diarrhoea usually 5-10 days after admin

136
Q

how is GI toxicity from chemo treated?

A

IVFT
antiemetics
gastroprotectants for ulceration
parenteral antibiotics if haemorrhagic diarrhoea or immunosuppressed

137
Q

what are the effects of chemo on patients coats?

A

cats- lose whiskers

dogs- not major problem, can be in breeds such as poodle, shih tzu, bichon

138
Q

define myelosuppression

A

decreased bone marrow activity resulting in fewer WBC, RBC and platelets

139
Q

what needs to be done before cytotoxic drugs are given in case of myelosupression?

A

routine haematology

140
Q

what happens if chemo patients experience myelosuppression?

A

treatment is delayed or reduced

141
Q

what is the effect of myelosuppression?

A

neutropenia
thrombocytopenia
anaemia

142
Q

what effects management of neutropenia as a result of myelosuppression?

A

absolute cell count

clinical signs

143
Q

what does neutropenia indicate when using chemotherapy?

A

maximum dose tolerated being reached

better prognosis

144
Q

what should you do if have reaction to chemo drugs?

A 
stop admin
IVFT
soluble corticosteroids
epinephrine
antihistamines
145
Q

describe chemo drugs being irritants and state an example

A

local inflammatory reactions at infusion site

carboplatin

146
Q

what is meant by chemo drugs being vesicants and state examples

A

severe irreversible tissue injury and necrosis

vincristine, vinblastine, cisplatin

147
Q

how can you reduce risk of extravasation of chemo drugs?

A

keep in sealed system
good patient restraint
give through clean stick IV
flush catheter before and after

148
Q

what effect do chemo drugs have if extravasate or go on patient topically?

A

irritant

vesicant

149
Q

how is perivascular leakage of chemo drugs treated?

A

stop infusion
leave in catheter
aspirate drug through catheter then give intralesional saline to dilute
draw back blood and remove catheter
give IV hydrocortisone and antidote if available
cold compress

150
Q

what causes sterile haemorrhagic cystitis?

A

metabolites of cyclophosphamide in urine irritate bladder causing cystitis and haematuria

151
Q

how do you minimise risk of sterile haemorrhagic cystitis?

A

give drugs in morning so not retained in bladder
good fluid intake
frequent urination
monitor for blood and protein by urine dipstick after every admin

152
Q

what acute cardiotoxicity can be caused by chemo and how is this reduced?

A

tachyarrhythmias

infuse over 15 minutes

153
Q

what chronic cardiotoxicity can be a result of chemo and what affects its prevalence?

A

irreversible cardiomyopathy

dose dependent

154
Q

what is the impact of hepatotoxicity as a result of chemo?

A

cumulative and irreversible effects

155
Q

what should you do if increased liver enzymes indicating hepatotoxicity as a result of chemo?

A

delay or stop treatment

156
Q

how can you prevent hepatotoxicity from chemo?

A

monitor biochemistry before each treatment

157
Q

how does nephrotoxicity happen due to chemo?

A

platinum compounds cause necrosis of proximal tubular cells

158
Q

how do you manage nephrotoxicity as a result of chemo?

A

monitor urea and creatinine

159
Q

how can you reduce likelihood of nephrotoxicity as a result of chemo?

A

administer drugs slowly with IV diuresis

Clinical Nursing May Exam (22 decks)

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