Oncology Flashcards
Extravasation
The escape of blood or lymph from their proper vessels into surrounding tissues.
Vesicants
An agent that causes blistering.
Nadir
The point at which blood cell counts are at their lowest after a chemotherapy treatment.
thrombocytopenia
A blood disease characterized by an abnormally low number of platelets in the bloodstream
leukopenia
when the levels of WBCs in your blood are lower than average.
desquamation
The shedding of the outer layers of the skin
intrathecal
- within a sheath. 2. through the theca of the spinal cord into the subarachnoid space.
Uncontrolled cell growth
Cancer
2nd leading cause of death in the U.S.
Cancer
Causes of cancer
some genetic tendencies, some related to environmental expose, some related to infectious agents
Infectious agents that can cause cancer
human papillomavirus (HPV), hepatitis B virus (HBV), hepatitis C virus (HCV), and Helicobacter pylori (H. pylori),
Cancer can be prevented through
behavioral changes, vaccination, or treatment of the infection.
A process that begins when an abnormal cell is created by the genetic mutation of a cell’s DNA
Cancer pathophysiology
Increased cell growth
proliferation
Cancer cells that don’t always multiply rapidly, but do increase & spread without cell “boundaries”
proliferation
Cells should grow into the mature type- if not they remain like immature or fetal cells…
differentiation
UN-LIKE the mature cell
undifferentiated
Pre-malignant or malignant
differentiation
Number 1 Carcinogen
Tobacco smoke
Environmental Carcinogens:
tobacco, exposure to occupational chemicals, asbestos, benzene
30% of cancer can be traced to
Smoking and 2nd hand smoke
Environmental Carcinogen drugs
pesticides
Environmental Carcinogens viruses
Epstein-Barr, HPV, h. pylori
Environmental Carcinogen: radiation
sun, treatment, radon, nuclear exposure
Potential causes of mutations from diet
eating too many animal proteins/fats, alcohol, and cured foods
Epstein-Barr is linked to
mononucleosis
Potential causes of mutation relating to immune response
Autoimmune disorders and medications
Potential causes of mutations in genetics
chromosome/genes (BRCA1 &2?)
TAA’s (proteins)
Tumor associated antigens on surface of cancer cells
lymphokines& Tumor Necrosis Factors=
CELL DEATH
cytotoxic B lymphocytes & Killer T cells kill cells with
TAA
7 Warning Signs: CAUTION
C hange in bowel/bladder
A sore does not heal
U nusual bleeding
T thickening or lump
I indigestion
O bvious change in wart
N agging cough
Change in bowel/bladder could indicate
Colon, prostate, or bladder cancer
A sore that does not heal could indicate
Leukemia or lymphoma
Unusual bleeding could indicate
Leukemia
Thickening or a lump could indicate
Breast cancer or lymphoma
Indigestion could indicate
Cancer of the GI tract
Obvious change in a wart could indicate
Skin cancer
A nagging cough could indicate
Lung cancer or lymphoma
Baseline breast screening is done at age
35
Breast screening is performed
mammo over 40y annually
Colon screening is performed
starting at age 45: colonoscopy every 10 years
occult blood is tested
yearly
Virtual colonography is performed
Every 5 years
Prostate exam is performed
PSA & digital exam is done annually starting at age 50
PSA
Prostate specific antigen
What is PSA?
PSA is a protein produced by the prostate gland
Pap smear is performed:
Every 3 years when over 21 yrs of age
Americans are too sedentary and their diet is too high in
saturated fats
Prevention education includes the dangers of
smoking and excessive alcohol use
Primary cancer health action
Prevent
Primary cancer promotions
Educate about risks
Diet & lifestyle changes
Cancer prevention programs
Secondary cancer health action
Find early
Secondary cancer health action
Identification of at risk groups
Cancer Screening
Classification of cancer:
from embryonic skin, gland, mucous membranes of resp. tract, GI & GU
Carcinomas
Known as “solid tumors”
Carcinomas
Classification of cancer:
connective tissue, muscle, bone, fat
Sarcomas
Classification of cancer:
hematopoietic system (bone marrow)
Lymphoma, leukemia, and Hodgkins/Non Hodgkins
Known as “liquid” or “blood” tumors
Lymphoma, leukemia, and Hodgkins/Non Hodgkins
Glandular tumors
adenocarcinomas
Tumors of the bone
Osteosarcoma
Grading and staging of tumors is determined by
A pathologist
pattern of growth in which cells lack normal characteristics and differ in shape and
organization with respect to their cells of origin; usually, anaplastic cells are malignant (Grade IV)
anaplasia
The presence of cells of an abnormal type within a tissue, which may signify a stage
preceding the development of cancer (grades I-III)
dysplasia
Grading by cell appearance:
I
slightly different (dysplagia)
Grading by cell appearance:
II
moderate dysplagia
Grading by cell appearance:
III
very abnormal -poor differentiation
Grading by cell appearance:
IV
Immature, fetal, not same as mature cell (anaplastic)
Grade IV is sometimes difficult to identify
Cell origin
cells or tissues that have lost their mature or specialized features
Anaplastic
How different is the cell?
Well differentiated
Similar
How different is the cell?
Moderately differentiated
Less similar
How different is the cell?
Extremely differentiated
Anaplastic
Stage 0
in situ
In situ
the earliest stage, non-invasive
Stage 1
local- in tissue of origin
Stage 2
limited, local
Stage 3
extensive, regional lymph node or tissue extent
Stage 4
metastasis
Staging:
present, not invading
stage 0
Staging:
In tissue of origin, potential for motion
Stage 1
Staging:
Great potential to spread
Stage 2
Staging:
extensive but no evidence of metastasis
Stage 3
Staging:
Travelled to different area of body
Stage 4
Grading scale used for prostate
Gleason scale
The lymph system can be an indicator of
where the tumor is
Tumor is sometimes washed towards
lymph nodes closest to origin
metastasis
cancer has spread to a different body part than where it started
Common symptoms of brain metastasis
Headaches, seizures, vertigo, vision problems
Common symptoms of respiratory metastasis
Cough, hemoptysis, dyspnea
Common symptoms of lymph node metastasis
lymphadenopathy
Common symptoms of liver metastasis
Hepatomegaly, jaundice
Common symptoms of skeletal metastasis
fractures, pain, spinal cord compression
CEA
carcinoembryonic antigen (associated with bowel cancer)
CA125
ovarian cancer indicator
Immature Cells
blast or stem cells
cells that look like “fetal” or immature cells can be found
in the blood with certain cancers
Diagnostic labs
CBC, WBC
diagnostic tests
Biopsy-
MRI
CAT
Endoscopy
Xray
PET scans
the 3 goals
CURE
CONTROL
PALLIATION
the 4 treatments
SURGERY
RADIATION
CHEMOTHERAPY
BIOLOGIC AGENTS
Types of cancer surgery
debulk, radical, supportive
Types of radiation
internal or external
Curative surgery
Completely removes all cancer/tumor
Type of surgery such as colostomy for obstruction, insert drainage tubes, PEG’s etc
Supportive (palliative)
Surgery for prevention
Prophylactic
If there is numbness, there may be ______ of the spine
compression
Lung and breast cancer can be found in the
brain
abnormal size or consistency of the lymph nodes
lymphadenopathy
Colon cancer will first travel to
Liver
Prostate and breast cancer will travel to
the bones
TNM
Tumor, Node, Metastasis
TNM Classification:
T
Tumor size
TNM Classification:
N
Lymph nodes involved
TNM Classification:
M
metastasis
Gold standard of cancer diagnostics
biopsy
cells that look like “fetal” or immature cells can be found
in the blood with certain cancers
diagnostic labs
CBC, WBC
Abnormal PSA test could be benign but suspicious if
number drastically changes
Tumor markers
Tumor specific antigens (CEA, PSA)
Tumor specific antigens can be used to
diagnose or determine treatment success
CEA can be used to determine
uterine or colon cancer
PET
Positron emission tomography
This test uses a safe injectable radioactive chemical called a radiotracer and a device called a _____ scanner.
PET scan uses a PET scanner
Diagnostic test can be used all over body and can see organ function in real time
PET scan
Non invasive 3D imagine diagnostic test
MRI
Diagnostic test:
cross section x-ray of body
CAT scan
Immature cells in blood are usually a sign of
Leukemia
Diagnostic test done annually after remission
CAT scan
Curing cancer can be difficult in people with
comorbidities
Controlling side effects of tumor
Palliation
Examples of palliation
pain control or colostomy for colon cancer
Clear margins indicate
tumor was within surrounding tissue
sometimes tumor is removed with
surrounding tissue
giving drugs at a certain point of the cell cycle causes a profound effect on
the cell
CELL CYCLES:
G1
dormant
CELL CYCLES:
S
DNA & RNA synthesized
CELL CYCLES:
G2
RNA made
CELL CYCLES:
M
Mitosis
CELL CYCLES:
G 0
resting
Energy used in high doses to break the DNA chain in cancer cells
Ionizing radiation
2 kinds of radiation
Internal & External
Radiation effects cells in certain
CELL CYCLES
Some tumors are more sensitive then others to
radiation
treatment that is good for Hodgkin’s, Testicular cancer
radiation
Treatment that has poor results with Gliomas, Melanoma
radiation
External radiation uses ______ radiotherapy
Beam
Internal radiation uses
implants
Internal radiation is also called
brachytherapy
External Radiation is also called
teletherapy
Patient is alone in room during external radiation. EXACT spot to radiate is marked with identification such as
TATOO, PERMANENT INK MARKERS
Wet Desquamation care:
wash gently & prevent infection
Slough of upper layer of skin
Wet Desquamation
Happens to 30% of patients 3 weeks after treatment
Wet Desquamation
treatment includes cleaning and covering skin with a light, non-stick dressing
Wet Desquamation
Erythema from radiation
Dry Desquamation
Treatment includes cleaning skin with cool or warm water. no alcohol on skin
Dry Desquamation
Fluids should be given to patients with dry or wet desquamation?
both
type of ointment that is safe for dry desquamation
vitamin ointment
Patient teaching for radiation:
Must avoid strong ______esp. over site of radiation
Sunlight. Wear sunscreen
Patient teaching for radiation:
Eat ____ hours BEFORE treatment to decrease nausea:
2-3 hours
Patient teaching for radiation:
Type of meal that can be eating before radiation
high protein, high carb, low residue
Patient teaching for radiation:
Crowds are…..
sources of infection!!
Patient teaching for radiation:
Women should avoid _____ during course of treatment
pregnancy
Patient teaching for radiation:
Patients are tired because …….
WBC and RBC are destroyed
A patient receiving radiation for breast cancer would experience which of the following side effects?
A. severe fatigue
B. mucositis
C. alopecia
D. vomiting
A. severe fatigue
(Brachytherapy) Internal forms of radiation:
Source is placed inside tumor (seeds)
Interstitial
(Brachytherapy) Internal forms of radiation:
Source is placed inside body cavity (cervical, breast, lung)
Intracavity
(Brachytherapy) Internal forms of radiation:
Meds that are p.o. or IV that act as systemic radiation (I-131)
Radiopharmaceutical agents
Brachytherapy commonly used to treat prostate cancer
interstitial
All forms of brachytherapy emit ______ & carry specific safety precautions
radiation
Internal radiation type:
Source of radiation is a sealed form of radium, cesium, etc. Placed in cavity or next to tumor
Intracavity
Internal radiation type:
Used for local tumors such as mouth, cervix, testes, prostate
Intracavity
Internal radiation type:
Bedrest is recommended to help avoid displacing implant
Intracavity
Internal prostate seeds are kept in the body for how long?
Permanently
When getting treatment with prostate seeds, avoid being around children for
the length of treatment
Cervical Brachytherapy Procedure:
Give enema, douche & foley before insertion to avoid
BM and voiding
Cervical Brachytherapy Procedure:
Implant remains in for _____ hours! After removal -enema & douche & remove catheter
48-144 hours
Cervical Brachytherapy Procedure:
Patient is in hospital for ____ days
1-3 days
Cervical Brachytherapy Procedure:
After removal of implant
enema & douche & remove catheter
Cervical Brachytherapy Procedure:
Side effects
Fatigue, diarrhea, bladder irritation, decreased blood count, vaginal dryness
Cervical Brachytherapy Safety:
Wear lead apron if ___ min with patient
> 30 min
Cervical Brachytherapy Safety:
Stay greatest distance from pt. ___ ft is preferred in room
> 6 ft
Cervical Brachytherapy Safety:
Trash, linen & food trays must be
screened by radiation officer before removal
Cervical Brachytherapy Safety:
Patient must have private room with _____ to minimize exposure
bathroom
P.O. radiation
UNSEALED INTERNAL RADIATION= Radiopharmaceuticals= I-131
Unsealed internal radiation safety and procedure:
Isolate patient, ID room as radiation
Use ______, dispose of in trash which is left in room with linens for radiation officer to clear
paper plates
Unsealed internal radiation safety and procedure:
Rotate staff to minimize exposure
Don double _____, _______, and _______
shoe covers, gown, and gloves
Unsealed internal radiation safety and procedure:
No need for
lead apron (too restrictive, not effective for this type of radiation)
Unsealed internal radiation safety and procedure:
Body fluids can go in toilet & be
flushed several times to clear with lid down
Unsealed internal radiation safety and procedure:
2 weeks prior patient must start a _____ diet
low iodine diet
Unsealed internal radiation safety and procedure:
Patient is hospitalized for _____ days to keep them isolated
2-3 days
Unsealed internal radiation is commonly used for
Thyroid cancer
Principles of Gamma radiation:
TIME: minimize exposure to
patient and limit family/visitors
Principles of Gamma radiation:
Pregnant nurses
CANNOT take care of patient-
Principles of Gamma radiation:
SHIELDING:
private room, lead lined walls good
Principles of Gamma radiation:
DISTANCE:
maintain distance needed from patient. 6ft or greater is preferred
Principles of Gamma radiation:
if implant falls out it must be handled with _______
FORCEPS & placed in lead lined garbage- Radiation officer is responsible for radiation monitoring
Goal of chemotherapy
to destroy a % of tumor & allow body to destroy the rest
Chemotherapy can affect normal cells with high rate of growth/cell turnover such as
hair follicles, lining of GI tract & bone marrow
Chemotherapy can cure:
A.L.L., Hodgkins, Testicular
A.L.L.
Acute lymphocytic (or lymphoblastic) leukemia
Chemo can control:
Non-Hodgkins, ovarian, breast
Chemo palliation:
to decrease size of tumor causing pain/obstruction
Chemo for non-Hodgkins is _______
aggressive
Chemo routes
oral
intramuscular
Intravenous
Subclavian catheters
implanted ports
intracavity
Intrathecal
implanted ports are good because
patients require a lot of blood draws and frequent IV therapy
inhibiting or preventing the growth and spread of tumors or malignant cells.
antineoplastic
cytotoxic B lymphocytes and Killer T cells use these TSA’s to
identify and kill abnormal cells
melanomas are very
aggressive cancers
arising from plasma cells
myeloma
chemo that bind with DNA or cell proteins to kill cells
Alkylating Agents
Chemo drug:
good for slow growing leukemias, lympomas, breast/ovarian, testicular, pancreas
Alkylating Agents
Chemo drug:
need to check BUN and creatinine before taking
cisplatin
Chemo drug:
must be very hydrated before hanging
Alkylating Agents
Chemo drug:
can cause renal toxicity and is an irritant
cisplatin
Chemo drug:
Amifostine(Ethyol) and Mesna are protectant (rescue meds) and given
before chemo
Chemo drug:
Protectant drug given to prevent h. cystitis
mesna
Chemo drug:
ifosfamide is damaging to the kidneys and is given concurrently with
mesna
Number 1 chemo drug is
Mustargen
Chemo drug:
Replace necessary cellular metabolites = folic acid
Antimetabolites
Chemo drug:
Antimetabolites that causes renal and liver toxicity
5-FU and methotrexate
Chemo drug:
is the rescue med, protects the normal body cells from the toxic effects of methotrexate
leucovorin
Chemo drug:
need folic acid supplements(1000 mg/day min)
Antimetabolites
Chemo Drug:
blocks folic acid uptake
Antimetabolites
Chemo Drug:
vesicants that cause necrosis
Antineoplastic Antibiotics
Chemo drug:
infiltration can cause infection
vesicants
Chemo drug:
side effects are cardiotoxicity and left ventricular disfunction, turns urine and body fluids red
bleomycin
Chemo drug:
toxic to respiratory; causes pulmonary fibrosis
Antineoplastic Antibiotics
Chemo drug:
cell cycle specific
Mitotic Inhibitors/Plant Alkaloids
Chemo drug:
kill cells as mitosis begins
Mitotic Inhibitors/Plant Alkaloids
chemo drug:
treats breast, small cell lung, sarcomas, hodgkin’s, ovarian
Mitotic Inhibitors/Plant Alkaloids
Chemo drug:
The higher the dose the higher the chance of nerve damage
Mitotic Inhibitors/Plant Alkaloids
Chemo drug:
causes a ton of side effects; alopecia and myelosuppression being the main ones
Mitotic Inhibitors/Plant Alkaloids
How to prevent extravasation
Use central line or a recently placed IV; monitor infusion continuously
A subcutaneous wash out involving injections of normal saline to the extravasation area.5,9This must be performed by appropriately trained professionals and may require multiple treatments
Flush out technique
How to treat extravasation
Use cold or heat pack; cold to reduce swelling, heat to increase reabsorption
Drug class:
specific to tissue/hormone; they decrease the amount of hormone or block receptor sites in tumor
Hormone modulator
Drug:
slows rate of growth and spread of disease but can cause blood clots
Hormone Modulator
Drug:
hormone regulator sometimes given for years
Tamoxifen
Drug class:
when using an estrogen blocker the female patient will experience menopause very quickly
Hormone modulator
Drug class:
block very specific proteins in cancer cells
with no effect on normal cells
Protein Tyrosine Kinase Inhibitors
Drug :
treats chronic myelogenous leukemia; PO med that is very expensive
gleevec (imatinib)
B lymphocyte antibodies that are created in response to lab antigen= kill cancer cells
monoclonal antibodies
Drug:
monoclonal antibodies treatment for leukemias, RA, non-hodgkins
Rituxan (rituximab)
Drug:
monoclonal antibodies treatment for breast cancer for HER2 +
Herceptin (trastuzumab)
A group of potentially life-threatening conditions that may happen within hours after cancer treatment. Dying cells release large amounts of potassium, phosphate, and uric acid into the blood
Tumor lysis syndrome
ANT
anemia, neutropenia, thrombocytopenia
Using a lower dose but a combination of drugs
synergic effect
When WBC does down to lowest level 1-2 weeks after treatment
myelosuppression
Fever and low BP is sign of
systemic infection
Patient with low platelet (thrombocytopenia) is at risk for
internal bleeding
Monitoring temp for fever and signs of Nadir
100.4 3x in 24rs
101.3 1x in 24 hrs
If absolute neutrophil count is <1000/mm
Reverse isolation is needed; minimum mask and gloves
neutropenic precautions
Avoid flowers, produce, raw meats, razors, injections, manicures, pedicures, sick people and crowds
Stomatitis and alopecia are side effects of
both chemo and radiation
Care for stomatitis
soft toothbrush, mouth care q2h; normal saline or baking soda rinses (not commercial mouthwashes), lidocaine rinse
If taking Adriamycin
keep out of sun
chemo is very drying so skin care involves
moisturizing
Zofran has 80% success with
Preventing nausea and vomiting
Number 1 complaint is
fatigue
Medication that blocks neurokinin (vomiting control center)
Emend
SE Clotting/ bleeding:
Monitor lab values for
DVT, embolism, unusual bleeding,
SE Clotting/ bleeding:
Assess for
petechiae, gum bleeding, OB stool, altered mental status
SE Clotting/ bleeding:
Do not use or give
razors, rectal thermometers, aspirin, or ibuprofen
Hormone regulator and some cancers can cause high risk of
clotting
Precautions for Administration of Chemo:
when preparing chemo
Wear double gloves & mask
Do not spray chemo in syringes
into the air
a man-made form of granulocyte colony-stimulating factor; stimulates the growth of white blood cells in the body
NEUPOGEN
a man-made form of granulocyte colony-stimulating factor; stimulates the growth of red blood cells in the body
Epogen
Neupogen stimulates the bone marrow to produce
WBC
Medical emergency; obstruction of superior vena cava by tumor- SOB, facial edema, headache, seizures
Superior vena cava syndrome
Signs and symptoms of Hypercalcemia
lethargy, muscle weakness, EKG changes
Ca > 12mg
Treat: Fluids!
Allopurinal(zyloprim)
treatment that reduces uric acid in body
Med that causes diarrhea to reduce potassium level in blood
kayexalate
Which of the following findings are possible in a patient with tumor lysis syndrome?
A. hypernatremia
B. edema of face and arms
C. epistaxis
D. hyperuricemia
D. hyperuricemia
Several kinds of analgesics can be used because pain is
difficult to control
Care with goal of symptom treatment
palliative care
What statement indicates that the client understands teaching about neutropenia?
A. “I need to use a soft toothbrush.”
B. “I have to wear a mask at all times.”
C. “My grandchildren may get an infection from me.”
D. “I will call my doctor if I have an increase in temperature.”
D. “I will call my doctor if I have an increase in temperature.”
A client is undergoing radiation therapy and asks the nurse about skin care for the exposed area. Which statement by the nurse is most accurate?
A. “No products work well to reduce the skin reactions you get from radiation.”
B. “No one product works best, so you can choose what you would like to use.”
C. “The only medication that works well for skin reactions is very expensive.”
D. “No good studies on skin care with radiation have been conducted to date.”
A. “No products work well to reduce the skin reactions you get from radiation.”
In evaluating dietary teaching for a client with chemotherapy-induced neutropenia, the nurse becomes concerned when the client makes which food choice?
A. Fruit salad
B. Applesauce
C. Steamed broccoli
D. Baked potato
A. Fruit salad
What teaching is essential for a client who has received an injection of iodine-131?
A. “Do not share a toilet with anyone else or let anyone clean your toilet.”
B. “You need to save all your urine for the next week.”
C. “No special precautions are needed because this type of radiation is weak.”
D. “Avoid all contact with other people until the radiation device is removed.”
A. “Do not share a toilet with anyone else or let anyone clean your toilet.”
A client’s radiation implant has become dislodged overnight, and the nurse finds it in the client’s bed. What does the nurse do first?
A. Assess the client’s skin for radiation burns.
B. Use tongs to put the implant into the radiation container.
C. Notify the safety officer and move the client to a different room
D. Don gloves and attempt to replace the implant.
B. Use tongs to put the implant into the radiation container.
client is receiving a chemotherapeutic agent intravenously through a peripheral line. What is the nurse’s first action when the client reports burning at the site?
A. Check for a blood return.
B. Slow the rate of infusion.
C. Discontinue the infusion.
D. Apply a cold compress
C. Discontinue the infusion.
A client receiving intravenous chemotherapy asks the nurse the reason for wearing a mask, gloves, and gown while administering drugs to the client. What is the nurse’s best response?
A. “These coverings protect you from getting an infection from me.”
B. “I am preventing the spread of infection from you to me or any other client here.”
C. “The policy is for any nurse giving these drugs to wear a gown, gloves, and mask.”
D. “The clothing protects me from accidentally absorbing these drugs.”
D. “The clothing protects me from accidentally absorbing these drugs.”
A client’s spouse reports that the last time the client received lorazepam (Ativan) before receiving chemotherapy, the client was extremely drowsy and didn’t remember the trip home. Which is the nurse’s best action?
A. Hold the dose of lorazepam for this round of chemotherapy.
B. Explain that this is a normal response to the drug.
C. Perform a Mini-Mental State Examination.
D. Document the response in the client’s chart.
A. Hold the dose of lorazepam for this round of chemotherapy.
A client is on chemotherapy and has a platelet count of 25,000. Which intervention is most important to teach this client?
A. “Eat a low-bacteria diet.”
B. “Take your temperature daily.”
C. “Use a soft-bristled toothbrush.”
D. “Avoid alcohol-based mouthwashes.”
C. “Use a soft-bristled toothbrush.”
A woman with chemotherapy-induced bone marrow suppression has received filgrastim (Neupogen). Which laboratory finding indicates that this therapy is effective for the client?
A. Hematocrit is 35%.
B. Hemoglobin is 14/dl
C. Red blood cells 5/mcl
D. White blood cells (neutrophils) 3500
D. White blood cells (neutrophils) 3500
What is the priority problem for a client experiencing chemotherapy-induced anemia?
A. Risk for injury related to fatigue Correct
B. Fatigue related to decreased oxygenation
C. Body image problems related to skin color changes
D. Inadequate nutrition related to anorexia
A. Risk for injury related to fatigue Correct
B. Fatigue related to decreased oxygenation
