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Applied Clinical Veterinary Nursing > Oncology > Flashcards

Oncology Flashcards

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1
Q

what are the basic tumour types seen in animals?

A

haemopoietic tumours

solid tumours

round cell tumours

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2
Q

give some examples of haemopoietic tumours

A

lymphoma

leukaemia

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3
Q

give some examples of solid tumours

A

sarcoma

carcinoma

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4
Q

what do sarcomas effect?

A

skeletal and connective tissues

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5
Q

what do carcinomas effect?

A

organs

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6
Q

give some examples of round cell tumours

A

mast cell tumours

melanomas

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7
Q

what does benign mean?

A

will not spread

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8
Q

what does malignant mean?

A

risk of spreading

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9
Q

what is a metastatic tumour?

A

secondary tumour that grows in a different location to the primary tumour

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10
Q

where do metastatic tumours typically grow?

A

in areas of high blood flow e.g. lymph nodes

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11
Q

what type of tumour is leukaemia?

A

haemopoietic

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12
Q

where does leukaemia occur?

A

in the blood-forming tissues

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13
Q

what are the main types of leukaemia?

A

acute and chronic

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14
Q

which type of leukaemia is more commonly diagnosed?

A

acute - chronic is usually an incidental finding

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15
Q

where does lymphoma occur?

A

in the cells which make up part of the immune system - B and T cells

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16
Q

how are haemopoietic tumours treated?

A

chemotherapy - highly responsive

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17
Q

how are sarcomas classified?

A

according to their parent tissue

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18
Q

where are osteosarcomas typically found?

A

distal radius
proximal femur

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19
Q

are osteosarcomas typically benign or metastatic?

A

metastatic - usually has occurred by the time of presentation

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20
Q

how is osteosarcoma treated?

A

surgery to remove affected limb

chemotherapy, biphosphates, radiation therapy all useful

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21
Q

what are the main types of sarcoma?

A

osteosarcoma

haemoangiosarcoma

soft tissue sarcoma

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22
Q

where do haemangiosarcomas typically affect?

A

spleen, heart/blood vessels

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23
Q

how are haemangiosarcomas treated?

A

combo of surgery and chemotherapy

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24
Q

what is a soft tissue sarcoma?

A

tumour of the connective tissue

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25
Q

what is a carcinoma?

A

a tumoiur involving a tissue that covers any body surface, lines a body cavity or makes up an organ

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26
Q

what prefix is used for carcinomas which arise from a gland?

A

adeno-

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27
Q

what does adeno- refer to?

A

arises from a gland

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28
Q

which species typically get squamous cell carcinomas?

A

common in cats

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29
Q

where do squamous cell carcinomas typically affect?

A

mouth, nose and ears

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30
Q

how are squamous cell carcinomas treated?

A

surgery to remove

radiation therapy or chemotherapy useful

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31
Q

what is the most common malignant skin tumour in dogs?

A

mast cell tumour

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32
Q

what do mast cells do?

A

involved in inflammatory and allergic mechanisms

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33
Q

where do mast cell tumours manifest?

A

anywhere on the body

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34
Q

how do mast cell tumours manifest (severity)?

A

range from almost benign to highly malignant with a high rate of spread

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35
Q

what do mast cell tumours feel like in the skin layers?

A

hard and firm

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36
Q

what do mast cell tumours feel like under the skin layers?

A

mobile and soft

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37
Q

what are mast cell tumours under the skin often mistaken for?

A

lipomas

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38
Q

how are mast cell tumours treated?

A

often need surgical removal - with appropriate margins can be curative

radiation therapy or chemotherapy can be useful

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39
Q

what does melanoma look like?

A

sometimes pigmented black tumour

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40
Q

where does melanoma typically affect?

A

mouth, toes or skin

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41
Q

how can melanoma be treated?

A

surgery to improve QOL - mass painful and can spread

immunotherapy to slow down spread (vaccine)

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42
Q

how does the melanoma vaccine work?

A

human melanoma proteins given transdermally

immune system develops antibodies to melanoma proteins

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43
Q

what are the most common benign tumour types?

A

lipoma

haemangioma

adenoma

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44
Q

what is a paraneoplastic syndrome?

A

cancer-associated alterations not directly related to the tumour or metastasis

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45
Q

what are the paraneoplastic syndromes associated with lymphoma?

A

hypercalcaemia

anaemia

neutrophilia

thrombocytopaenia

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46
Q

how are paraneoplastic syndromes resolved?

A

successful treatment of tumour

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47
Q

what can recurrence of paraneoplastic syndromes indicate?

A

return of tumour

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48
Q

what can occurrence of paraneoplastic syndromes indicate?

A

may signify malignancy

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49
Q

how can paraneoplastic syndromes affect prognosis?

A

may result in greater morbidity than the tumour itself causes

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50
Q

which tumour have high sensitivity to chemotherapy?

A

lymphoma

some leukaemias

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51
Q

which tumours have moderate sensitivity to chemotherapy?

A

high grade sarcomas

mast cell tumours

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52
Q

which tumours have low sensitivity to chemotherapy?

A

slow growing sarcomas

carcinomas

melanomas

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53
Q

how does tumour location affect treatment?

A

determines whether resectable or not

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54
Q

how do owner expectations affect treatment?

A

ability to accept possibly disfiguring surgery

cost of treatment

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55
Q

how does patient temperament affect treatment?

A

ability to cope with disfiguring surgery

ability to cope with repeated therapies e.g. chemo admin or repeated GAs for radiation

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56
Q

what is the principle of radiation therapy?

A

dividing cells are more prone to injury via radiation

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57
Q

what are the concerns with radiation therapy?

A

requires specific equipment

radiation-induced cellular injury

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58
Q

what are some of the less commonly used non-surgical tumour therapies?

A

cryotherapy

hyperthermic therapy

photodynamic therapy

immunotherapy

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59
Q

what are the surgical treatment options for tumours?

A

complete excision - wide and radical

debulking surgery (excisional)

preventative surgery

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60
Q

what types of biopsy might be taken of a tumour?

A

excisional biopsy

incisional biopsy

trucut biopsy

FNA

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61
Q

when might oncologic emergency surgery be performed?

A

bleeding
pathologic fracture
infection
bowel perforation
bowel obstruction

62
Q

when might we perform preventative surgery?

A

when pre-empting a cancerous change e.g. retained testicles, white cat pinnas

63
Q

why do we stage a tumour?

A

to find out how much tumour there is present in the body at that particular moment

information used to formulate rational decisions for treatment

64
Q

what system is used for staging a tumour?

A

TNM system

65
Q

what is the TNM system?

A

T - primary tumour size

N - level of lymph node involvement

M - presence of metastasis

66
Q

when is tumour staging performed?

A

before start of treatment

to assess response to treatment

before recommencing treatment after relapse

67
Q

what steps are involved in staging a tumour?

A

physical exam and history taking

urinalysis

bloods

chest x-rays

abdominal US

advanced imaging - echo, CT, MRI

68
Q

what bloods might be done during tumour staging?

A

complete count

chemistry profile

specialised bloods

69
Q

what samples might be taking under AUS for tumour staging?

A

aspiration of liver, spleen, lymph nodes

70
Q

why is advanced imaging useful in tumour staging?

A

echo - doxorubicin can cause cardiac changes

CT for lung mets

MRI for neurological tumours

71
Q

what is involved in grading a tumour?

A

histological findings

appearance under the microscope

mitotic index

how well-organised the cells are

evidence of cancer cells invading blood vessels

72
Q

what can help us achieve a holistic nursing approach to oncologic patients?

A

nursing ability model - orpet and jefferies

73
Q

what are the areas of the orpet and jefferies ability model?

A

eat
drink
urinate
defecate
breathe normally
maintain normal body temperature
groom and clean itself
mobilise adequately
sleep and rest
express normal behaviour

74
Q

when can the assessment phase of the ability model be revisited?

A

regularly - ward rounds, handovers, more frequently when needed

75
Q

what are SMART goals?

A

specific, measurable, attainable, relevant, timely

76
Q

what medical model interventions are valuable for the patients?

A

assessment of body systems, physiological problems

administering medication

77
Q

what nursing model interventions are valuable for the patients?

A

EDUF activities

psychological, environmental and sociocultural activities

78
Q

what is important during the implementation phase of a nursing care plan?

A

giving and documenting interventions -what it is, how much, how often

79
Q

why is the evaluation stage of a nursing care plan so important?

A

to show that nursing interventions are working

to show that goals have been achieved

picking up on any other issues that have developed

80
Q

which evaluations should be done the most regularly with the care plan?

A

need for pain relief

ability to feed themselves

ability to groom themselves

81
Q

what needs to be considered in terms of caregiver safety when interacting with chemotherapy patients?

A

dangerous - excreted in urine and some bodily fluids for 3-5 days

barrier nursing required

82
Q

what do we need to consider in terms of patient immunity?

A

immune function may be compromised - reverse barrier nurse

83
Q

what are the stages of a normal cell life cycle?

A

interphase
mitosis
cytokinesis

84
Q

what is involved in interphase?

A

cell matures and makes copies of DNA

85
Q

what are the steps of mitosis?

A

prophase
metaphase
anaphase
telophase

86
Q

what occurs during prophase?

A

preparation to split, chromosomes form

87
Q

what occurs during metaphase?

A

chromosomes line up

88
Q

what occurs during anaphase?

A

chromosomes split

89
Q

what occurs during telophase?

A

chromosomes stretch out

90
Q

what occurs during cytokinesis?

A

cell splits into two new cells

91
Q

how many times do cells replicate?

A

cells replicate a set number of times in their life cycle and then go into apoptosis

92
Q

which type of genes help prevent cancer?

A

tumour suppressor genes

93
Q

does cancer arise in a simple way?

A

no - phenotypic end result of a whole series of changes that may have taken a long time to develop

94
Q

how does cancer arise?

A

accumulation of genetic mutations - these eliminate normal cell constraints

95
Q

how quickly does cancer arise?

A

typically a very slow process, may not arise in the lifetime of the animal

96
Q

why do older animals tend to get cancer?

A

increased longevity of life simply allows more of these mutations to accumulate

97
Q

what are the main categories of cancer-causing agents?

A

chemical carcinogens

physical agents

hormonal factors

cancer-causing viruses

inherited cancers

98
Q

what are some examples of chemical carcinogens?

A

tobacco smoke

pesticides, herbicides and insectisides

cyclophosphamide

99
Q

what are some examples of physical agents which cause cancer?

A

sunlight

trauma/chronic inflammation

magnetic fields

radiation

surgery and implanted devices

asbestos

100
Q

how do hormonal factors affect development of cancer?

A

neutering - can be protective against some types (e.. mammary cancer) but has been shown to increase risk of others e.g. lymphoma

101
Q

what are some examples of cancer-causing viruses?

A

papilloma virus

retroviruses (FeLV)

102
Q

do we see inherited cancers in animals?

A

recognised in humans but not animals

103
Q

how do mutations in DNA cause deviation from the normal cell cycle?

A

sustain proliferative signalling

evade growth suppressors

resist cell death

enable replicate immortality

induce angiogenesis

activate invasion and metastasis

104
Q

how does cancer resist cell death?

A

cell loses ability to recognise damage

105
Q

how does cancer induce angiogenesis?

A

promotes growth of blood vessels through the tumour

106
Q

how does cancer enable replicative immortality?

A

suppresses telomerase

107
Q

how many mutations are required to cause cancer?

A

5-6 critical mutations are the minimum theoretical number required to cause cancer

108
Q

what does the term ‘tumour’ refer to?

A

neoplasm - benign or malignant

109
Q

what does the term ‘neoplasia’ refer to?

A

formation of new abnormal growth that is not responsive to normal physiologic control mechanisms

110
Q

what does the term ‘cancer’ refer to?

A

refers specifically to metastatic neoplasms

111
Q

what are the hallmarks of a malignant tumour?

A

locally destructive - may metastasise and may cause death if untreated

112
Q

how does chemotherapy function?

A

targets dividing cells - major classes of drug work at various stages in cellular DNA replication and cell division

113
Q

what was done by the National Cancer Institute (1955)?

A

set a framework for cancer chemotherapy development - many agents still in clinical use today

114
Q

what are the different goals of therapy according to type of treatment plan?

A

primary induction chemotherapy

primary neoadjuvant therapy

adjuvant chemotherapy

consolidation chemotherapy

maintenance chemotherapy

rescue/salvage chemotherapy

palliative chemotherapy

115
Q

what is the goal of a multimodal treatment plan?

A

maximal cell kill within the range of tolerable host toxicity

116
Q

what are the advantages of multimodal treatment plans?

A

broader range of interaction between drugs and tumour cells

slows development of tumour drug resistance

117
Q

what are the main principles of multimodal treatment plans for cancer?

A

only drugs with known single use efficacy against tumour type used

preferably drugs with non-overlapping toxicities

use drugs at optimal doses and schedule

use consistent intervals

118
Q

how do alkylating agents work?

A

mode of action is to bind alkyl groups to cellular macromolecules, cross linking the DNA

119
Q

give some examples of alkylating agents

A

cyclophosphamide, chlorambucil

lomustine

120
Q

how do antitumour antibiotics work?

A

via a multimodal action of cellular toxicity

121
Q

give some examples of antitumour antibiotics

A

doxorubicin
mitoxantrone

122
Q

how do antimetabolites work?

A

inhibit use of cellular metabolites in cellular growth and division

123
Q

how do antimicrotubule agents work?

A

interfere with cellular function replication

124
Q

give some examples of antimicrotubule agents

A

vinca alkaloids such as vincristine, vinblastine

125
Q

how do corticosteroid affect tumour growth?

A

induction of apoptosis in haematologic cancers

126
Q

how does platinum affect tumour growth?

A

binds dna

127
Q

give some examples of platinum drigs

A

cisplatin, carboplatin

128
Q

how does L-asparginase affect tumour growth?

A

induction of apoptosis in tumour cells

129
Q

how do tyrosine kinase inhibitors work?

A

block receptors on the cell surface

130
Q

give some examples of tyrosine kinase inhibitors

A

palladia, masivet

131
Q

where does lymphoma commonly arise from?

A

lymph nodes, spleen, bone marrow

132
Q

how common is lymphoma?

A

one of the most common tumours in dogs

133
Q

what form of lymphoma is the most common?

A

multicentric

134
Q

what type of lymphoma do cats tend to get?

A

intestinal presentation

135
Q

what does lymphoma treatment usually consist of?

A

chemotherapy cycles

136
Q

what type of cancer is the CHOP protocol used for?

A

lymphoma

137
Q

what drugs form the CHOP protocol?

A

cyclophosphamide

hydroxydaunorubicin (doxorubicin)

oncovin (vincristine)

prednisolone

138
Q

what is the timeframe of the CHOP protocol?

A

given via a schedule over a few months - discontinuous protocol

139
Q

are preds always given as part of the CHOP protocol?

A

not necessarily given if patient is systemically well

140
Q

which drug should not be given alongside the CHOP protocol?

A

care if giving NSAIDs for a concurrent/pre-existing issue

141
Q

why does chemotherapy have so many side effects?

A

the drugs do no selectively target tumour cells - all dividing cells are affected by cytotoxic drugs

142
Q

how do chemotherapy drugs have more of an effect on cancer cells than normal cells?

A

cancer cells are perpetually dividing, whereas only a small percentage of normal cells are actively dividing

143
Q

what types of toxicity does chemotherapy produce?

A

bone marrow toxicity - results in immunosuppression

GI toxicity

144
Q

during what stages do we need to consider nursing care for chemotherapy patients?

A

pre-diagnosis

illness during treatment

end of life care

145
Q

how is chemotherapy administered?

A

bolus injection or infusion

146
Q

what are the considerations for preparation of chemotherapy?

A

quiet area

accurate IVC placement

double check dose

draw up drug carefully

147
Q

what are the considerations for administration of chemotherapy?

A

check IVC placement and patency

connect syringe
administer

keep checking IVC placement throughout

148
Q

what should you do if there is an issue with the IVC and the chemotherapy goes extravascular?

A

leave IVC in place and aspirate as much as possible

flush thoroughly with saline to dilute

inject hyaluronidase around area

apply heat compression

149
Q

what advice should we given to an owner about dealing with contaminated urine/faeces?

A

wear gloves to handle

double bag and dispose of in normal waste

encourage urination away from walkways or areas with high footflow

urination in the garden should be washed away to help dilute it

150
Q

how can we help support the owner through the treatment of their pet?

A

keep owners involved in treatment - chemo leaflet, treatment ‘passport’

give owners things they can do at home to support their pet

build confidence to discuss around this topic through good knowledge and understanding of the condition

consider compassion fatigue

151
Q
A

Applied Clinical Veterinary Nursing (31 decks)

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