oncology Flashcards
characteristics of normal cells
- intracellular mech that determines proliferation
- dynamic equilibrium
- well differentiated
- contact inhibition
characteristics of malignant cells
- grow uncontrollably
- no contact inhibition
- poorly differentiated
- ADAPT, SPREAD, CHANGE
explain contact inhibition
cells stop growing when in contact with each other (not shown in malignant cells)
stages of metastatic process (4)
- tumor growth
- angiogenesis
- entry into capillaries + lymph
- circulation to other organs
what are carcinogens
substances that can contribute to abnormal cell growth and cancer dev
chemical carcinogens
benzene, arsenic, pesticides, asbestos
radiation carcinogens
xrays, atomic waste, UV radiation
viral carcinogens and what they can develop to
EBV –> lymphoma
HIV –> kaposi’s sarcoma
Hep B/C –> hepatocellular cancers
HPV
cancers r/t genetic predisposition
breast, colon, uterine cancer,
cancer r/t chronic inflammation
esophageal cancer
steps to classify cancer (3) and what they mean
- tissue of origin - type of growth
- grade - degree of malignancy (how abnormal)
- stage - extent of disease (how far has it spread?)
types of tissue of origin classifications
carcinoma: glandular epithelium
sarcoma: growth in CT, bone, muscle, fat
lymphoma: leukemia, hemapoietic
explain tumor grade?
grade: how abnormal; degree of malignancy
- grade I: differs slightly but still well differentiated
- grade IV: can’t tell origin; undifferentiated
explain tumor stage?
stage: extent of disease
- stage 0: carcinoma in situ
- stage 4: distant metastasis
TNM tumor staging?
t = tumor
n = nodes (lymph)
m = metastasis
dx tests for definitive dx of cancer?
cytology and biopsy
t/f: earlier detection and dx allows for better results and more tx options?
true
goals of cancer tx (4)
cure
control
palliation
rehabilitation
what is targeted tx?
target certain genetic parts of cancer cells; target cells helping cancer growth
what is immunotherapy tx?
- what are 2 types?
boost the body’s own immune response to help fight cancer
- biologic therapy: interferons
- monoclonal antibodies: herpicept for breast cancer
side effects of targeted and immunotherapy treatments
capillary leak syndrome –> pulmonary edema
rashes
flu like symptoms (watch for fever 100.4+)
confusion, insomnia
explain the following types of surgical management:
- prophylactic/preventative
- diagnostic surgery
- surgery for cure (resection)
- surgery for control (debulking)
- surgery for palliation
- reconstructive surgery
- prophylactic/preventative: fam hx of predisposing genes
- diagnostic surgery: collect specimens for dx
- surgery for cure (resection): remove tumor
- surgery for control (debulking): shrinking before radiation exposure
- surgery for palliation: remove tumor sitting on nerve for comfort
- reconstructive surgery: restore fx or appearance post tx
explain radiotherapy
- what it is
- good for _____
- MOA:
- what it is: low doses under supervision = target and kill cancer
- good for targeted tx
- MOA: ionizing radiation destroy cell reproduction (all rapidly dividing cells) –> O2 free radicals destroy cancer
principles of radiation therapy (3) and explain how to demo each
time: rotate shifts, 30min in room for 6hrs then swap
distance: avoid foot of bed
shielding: proper lead aprons/covers
what to do if an implant becomes dislodged?
use forceps to pick up and place in lead line box
2 types of radiation therapy?
internal (brachytherapy) and external beam radiation
internal beam radiation
- how is the procedure done?
- how long is the seed in place?
- short term or long term?
seeds/rods are placed into tissue or cavity to target corresponding tumor
seed in place for 30-60min
can be used for short term or permanent therapy (going back to get another seed)
sealed internal radiation
- what is it
- is the pt radioactive?
- other education?
pills/seeds encased in nonradioactive covering
pt is not radioactive
can be left in place for days or reapplied each visit
unsealed internal radiation
- what is it
- is the pt radioactive?
- other education?
liquid/IV systemic radiation therapy
pt is radioactive for 2-3 days after tx (secretions radioactive)
drink extra fluids to flush, avoid sex, separate bathroom/utensils, don’t sleep or sit right next to each other
external beam radiation
- what is it
- how does the procedure work? (repeated___)
outside source of radiation accelerator
- skin area is marked for aim
- repeated doses 5x/wk for few wks
- immobilization device if aiming for head
complications of external beam radiation
dry + wet desquamation, fatigue
what is dry + wet desquamation?
skin peeling, burning, blistering effect of radiation
education with external beam radiation
- when does full effect take place?
pt is not radioactive, expect skin markings
- full effect 10-14 days (where SE are worse)
no tight/rough clothing
no excessive heat or cold
use mild soap, ask Dr before any topical
explain chemotherapy
- good for ____
- MOA:
using cytotoxic agents to destroy cancer cells
- good for widespread tx
- MOA: impacts cell repro, affects rapidly dividing cells
what are cell cycle specific chemo drugs?
–> act on cells undergoing division (1+ areas of replication)
5 fluorouracil (5-FU)
vincristine (Periwinkle)
paclitaxel (Taxol)
5 fluorouracil (5-FU)
C:
MOA:
I:
SE:
watch for _____
C: antimetabolite, cell cycle specific
MOA: stop DNA synthesis, inhib RNA
I: GI cancers
SE: bleeding, infection, myelosuppression, stomatitis, alopecia, hyperpigmentation, rash
watch for Nadir
what is nadir?
lowest point of PLT and WBCs when taking a chemo drug
vincristine (Periwinkle)
C:
MOA:
I:
SE:
C: plant alkaloid, cell cycle specific
MOA: prevent mitosis
I: leukemia, lymphoma, neuroblastoma
SE: neurotoxicity, strong vesicant
paclitaxel (Taxol)
C:
I:
SE:
C: taxanes, cell cycle specific
I: hormonal cancer: ovarian, breast
SE: myelosuppression, alopecia, hypersensitivity, n/v
what are non cell cycle specific drugs?
act on dividing and resting cells, more toxic
cyclophosphamide (Cytoxan)
carmustine
doxarubicin (Adriamycin)
cyclophosphamide (Cytoxan)
C:
MOA:
SE:
when to hold?
C: alkylating agent, non cell cycle specific
MOA: given based on PLT count
SE: severe myelosuppression, hemorrhagic cystitis, SIADH, cardiomyopathy, sterility, alopecia, anorexia, n/v
hold when PLT count too low
carmustine
C:
C: nitrosourea, non cell cycle specific
doxarubicin (Adriamycin)
C:
I:
SE:
how is it admin?
C: antibiotic, non cell cycle specific
I: larger tumors not actively dividing
SE: myelosuppression, mucositis, cardiotoxicity, vesicant, alopecia
admin as single bolus inj
what are estrogen hormone agonists and antagonists
estrogen can make some tumors grow faster
Tamoxifen
fulvestrant (Faslodex)
Aromatase inhibitors
Tamoxifen
C:
I:
C: anti-estrogen, selective estrogen receptor modulator
I: 1st line tx for breast cancer in post menopausal women
fulvestrant (Faslodex)
C:
I:
C: selective estrogen receptor degrader
I: advanced breast cancer in post menopausal women
aromatase inhibitors
C:
MOA:
C: anti-estrogen
MOA: block aromatase: enzyme in tissue that makes estrogen
side effects of all estrogen hormone agonists/antagonists
infertility risk, hot flashes, acne, blood clots, weight gain
what are different hormone therapies for prostate cancer?
luteinizing hormone releasing hormone agonists
androgen receptor blockers
androgen synthesis inhibitors
luteinizing hormone releasing hormone agonists
MOA:
SE:
goserelin (Zoladex), leuprolide = got these from book
MOA: block androgen release in prostate
SE: gynecomastia
Prednisone and Decadron
C:
I:
C: adrenocorticoids
I: dec inflammation, improve appetitie, inc sense of wellbeing
why should a patient on Taxol have ice packs on their hands
keep nail beds from separating during Taxol therapy
phase I clinical trial
checking for safety, kinetics, interactions
phase II clinical trial
refine dose range, kinetics, effectiveness
phase III clinical trial
testing on larger scale for efficacy
phase IV clinical trial
post marketing surveillance after FDA approval
questions a non-chemo certified nurse should ask
when was the pts’s last tx
rxn to chemo drugs, interactions
how to handle body secretions
gloving, handling, disposal
need for IV fluids?
what is better for chemotherapy: PICC/central lines or peripheral IVs and why?
PICC/central lines are better = less risk of extravasation of toxic chemo drug
explain extravasation
drug infused leaks into vein –> blistering and necrosis of tissue from toxic chemo drug
explain myelosuppression
SE of chemo
bone marrow activity decrease = dec Hgb, WBCs, PLTs
explain Nadir
SE of chemo
lowest level of PLT and WBCs (7-14days past tx)
what does it mean to be neutropenic and what lab is monitored?
- neutropenic protocol
low neutrophil count
ANC - absolute neutrophil count < 1000 = neutropenic
protocol: positive pressure room, restrict outside items/visitors, full PPE, monitor temp
what to do if chemo pt has a fever
fever = 100.4+ ONCOLOGICAL EMERGENCY
admin filgrastim (Neupogen) : bone marrow stimulant to make WBCs, prevent infection in chemo pt
what is thrombocytopenia and what lab is monitored?
- thrombocytic protocol
low platelet count
PLTs < 20,000 = thrombocytopenia
protocol: fall precautions, monitor for bleeding, avoid straight razors, no rectal/IM
some pt education for neutropenia/thrombocytopenia
avoid crowds, sick ppl, pox immunizations, contact sports, injuries, razors
protect skin from breakdown
check for bleeding s/s and PICC line for redness
care with blowing nose
when should a chemo pt call the MD?
dizziness, chills, loose stools, fever, abd pain
what is cancer cachexia (wasting syndrome)
- tx?
anorexia and/or unintended weight loss and appetite loss
- treat the cancer, muscle growth should return; encourage high cal and high protein foods
- admin Megace: appetite stimulant
cancer cachexia/anorexia recommendations
small, freq meals (high cal, high protein)
eat with company
loose fitting clothing
ice cubes/mints/tart candy = stim saliva
talk with dietician/dentist
mucositis
- what is it
- C/M
- what to avoid
- protocol
chemo complication; cold/canker sore
C/M: redness, white lesions, dry mouth, low grade fever, difficulty swallowing
avoid listerine/alcohol based mouthwash = burn the mouth
protocol: mouth care before/after meals, topical mouth rinses, artificial saliva, non carbonated fluids, soft foods
diarrhea
- C/M:
- protocol
C/M: electrolytie imb (K+), get stool sample
protocol: BRAT diet
what is the BRAT diet
bananas, rice, applesauce, toast
radiation recall
–> admin??
skin reaction; severe sunburn after chemo/radiation
–> admin steroids
hand foot syndrome
skin reaction; redness + tingling in palms + soles of feet, moist desquamation, blistering
when does alopecia start / when does new hair growth start
starts: 2-3 weeks after 1st dose
new growth: 4-6 weeks after last dose
pulmonary effects of tx
- radiation
- chemo
radiation: cough, dyspnea, pneumonitis, fibrosis
chemotherapy: pulmonary edema, pneumonitis, fibrosis
cardiovascular effects of tx
- radiation
- chemo
radiation: pericardial effusion, pericarditis
chemo: EKG changes, HF, ventricular dysfxn
how to help reduce fatigue
prioritization of activities, activity mgmt, relaxation, massage, sleep quality
metabolic oncological emergencies (3)
hypercalcemia: breakdown of bone (twitches and confusion)
SIADH: retain fluid, hyponatremia
Tumor Lysis Syndrome: hyperkalemia, high uric acid, hyperphosphatemia, hypocalcemia
tx of tumor lysis syndrome
kayexalate, insulin, allopurinol, sodium bicarb
obstructive oncological emergencies (4)
superior vena cava syndrome
sepsis (dec BP, inc HR, fever, lactic acid)
3rd space syndrome: lung/abd cancer pleural effusion
spinal cord compression: tumor on spine “can’t feel or move feet”
infiltrative oncological emergencies (2)
cardiac tamponade
coronary artery rupture
disseminated intravascular coagulation
abnormal clotting, something consuming all of the clotting factors = excessive bleeding
palliative vs hospice care
palliative: relief from symptoms, done during dx, tx, and follow up, paid by self or insurance, in hospital
hospice: for terminal illness w/in prognosis of < 6months , no curative tx, paid insurance, Medicare or Medicaid, wherever pt wants
