Oncology Flashcards
How often are Pap smears recommended for women 30-65 yo?
Every 5 years
What type of cancer is MOST COMMON in men? In women?
Prostate
Breast
What type of cancer is the most deadly in both sexes?
Lung
Second most common type in both sexes but most deadly
What is the cell proliferation stage?
Stem cells (undifferentiated cells) start process of growth and division and cell death (apoptosis)
How do cancer cells differ than normal cells in the proliferation phase?
They do not stay within their normal boundaries and infringe on space of normal cells.
They do not go through normal cycle of growth and apoptosis (death).
What are protooncogenes?
Normal cell genes that control growth of cell. Think of this as the lock that controls the cell.
What are oncogenes?
Protooncogenes mutate to become oncogenes (tumor inducing genes).
They change a normal cell to a malignant one.
—The reason for the change can be varied but examples are carcinogens, virus exposure, etc.—Think of this as the key that unlocks the cell to go to malignancy.
What is the significance of alpha-fetoprotein (AFP) and carncinoembryonic antigen (CEA) in labs in cancer patients?
When the oncogene becomes active the cell reverts back to a fetal appearance and function. Proteins like AFP and CEA are produced in patients blood as detectors of cancer cells.
What are tumor suppressor genes?
Good! These are genes that suppress cancer growth. Mutations to these genes are bad. These mutations allow cancer cells to grow. Examples include:
BRCA 1 and 2
APC (colon cancer)
p53 (affects lots of organs)
What are the 3 stages of cancer development?
Initiation
Promotion
Progression
What is involved in the initiation stage of cancer development?
Mutation of cells DNA
How do mutations to cell DNA (initiation in cancer stage) occur?
Gene mutations can be:
1. Inherited
2. Acquired (carcinogens)
What are the types of carcinogens?
Chemical
Radiation
Viral
What is involved in the promotion stage of cancer development?
In this phase the mutated cell will either grow and divide or die. The mutated cell will continue to grow and divide if conditions are right. Promoting agents (lifestyle choices) are the deciding factor. This stage of cancer development is reversible.
What is the progressive stage of cancer development?
Increase in growth and invasiveness.
Metastasis happens.
What is angiogenesis? What is the significance in cancer growth?
Forming new blood supply to tumor.
Critical for tumor growth and development.
What are the steps in metastasis?
Rapid growth of tumor
Angiogenesis
Detachment from primary site
Penetrate lymph or blood vessels
Travel to new site
Adhere to new site (most cells don’t survive this)
If successful, the cells must develop angiogenesis to survive in new location.
What is the sentinel lymph node?
First lymph node the cancer spreads to. Sometimes they get trapped here, sometimes they spread to new sites.
What are tumor associated antigens?
Markers on cells to notify immune system they need to be purged.
This surveillance prevents survival of cancer cells.
What are cytokines?
Protein signals that notify the immune system to kick in and kill baddies.
Examples are interleukin, interferon, tumor necrosis factor and colony stimulating factor.
Cytokines are produced by T cells and macrophages.
What are some of the differences between benign and malignant growths?
Benign are usually encapsulated, slightly vascular, differentiated cells that look like parent cells. Malignant growths are highly vascular, irregular, and poorly differentiated.
What are the grades of tumor classification?
Grades 1-4, then X grade
Explains amount of differentiation under microscope. More differentiation the worse.
Grade1-Low grade, cells only slightly different
Grade 4-Cells immature, primitive, undifferentiated. High grade
Grade X-Can’t be determined
Malignant tumor names can end in what 3 suffixes?
—–carcinoma
——sarcoma
——oma
Benign tumor names end in what suffix?
–oma
What does tumor staging tell us?
The extent of the spread of cancer.
Stage 0= in situ
Stage 1=Localized tumor growth
Stage 2=-Limited to closest lymph node
Stage 3=Extensive spread to lymph nodes
Stage 4=Metastasized to organ, sometimes called metastatic cancer
What is the TNM classification system stand for?
T=Tumor size
N=Nodes (how many)
M=Metastasis (how many sites)
What does Tis stand for?
Tumor in situ
What does Tx or Mx or Nx mean in TNM classes?
The tumor, nodes or metastasis sites can’t be measured.
What type of cancers does the TNM classification not work for?
Cancers that are not solid tumors like leukemia or lymphoma.
Can stages of cancer decrease during remission?
No. If remission happens they just put an “r” in front of the TNM class.
Example rT2N1M1
What is surgical staging?
Exploratory surgery to determine cancer stage
When is the risk for cancer to return the greatest?
Immediately after treatment completion
What is a debulking or cytoreductive procedure?
Surgical removal of as much of the tumor as possible, then chemo and/or radiation to finish.
What is neoadjuvant therapy?
Chemo/radiation before surgery
What is meant by tumor radiosensitivity?
How effective radiation is against that type of cancer
What is preferred route of admin of chemo drugs?
Central line or port
What is extravasation?
Infiltration of drugs into tissues surrounding IV
What is meant by term vesicant?
Irritant
Blistering chemical agent
What is intrathecal mean?
Into brain
What is an Ommaya reservoir?
It provides access to brain to give chemo.
Surgically implanted into cranium with access catheter.
What are two classes of chemo drugs?
Cell cycle phase nonspecific
Cell cycle phase specific
—A patient will usually be on a multimodal chemo regimen–
What is Mesna?
A bladder protectant
Given as a preventative injection when certain chemo is given.
Ifosfamide (the bad bladder irritating chemo)
Common chemo drugs
Methotrexate
fluorouracil
doxorubicin
What is high and low radiosensitivity?
How well a cancer responds to radiation
High is good
Low is bad
How is radiation measured?
Grays or centigrays in daily fractions
What is an average daily fraction of radiation?
180—-200 centigray/daily
What is brachytherapy?
Internal radiation implanted in location of cancer
What is external beam radiation?
Most common
Machine called a linear accelerator delivers radiation
What are precautions when caring for patients undergoing radiation?
Organize care to limit time in presence
Use shielding
Wear a film badge (dosimeter)
What is Epogen?
Erythropoietin stimulating agent
Used for treatment of anemia in cancer patients (also used in ESRD patients)
Watch for hemoglobin and RBC counts to rise.
What is one of the most common dangerous side effect of chemo and radiation?
Myelosuppression
Especially with chemo-systemic effect on bone marrow
Radiation-lesser effect because localized to area of radiation
This will present as overwhelming fatigue, infection, hemorrhage.
Low WBCs, Low platelets, Low RBCs
What is life span of WBC?
1-2 weeks
What is life span of platelet?
2-3 weeks
What is life span of RBC?
120 days
Why is life span of blood components significant in chemo?
Understanding timing of after effects of chemo treatment
WBC count first to drop (1-2 weeks)
Platelets next to drop (2-3 weeks)
RBCs last to drop (120 days)
Where is the most active bone marrow production area of adults?
Pelvis
Thoracic and lumbar vertebrae
–When radiation is given in these areas expect major bone marrow suppression–
What are leukopenic precautions?
Keep their exposure to germs low
What is the nadir in cancer patient labs?
The lowest point in blood cell count
What is neutropenia?
Low WBC count
This will prevent them from getting chemo treatment
How serious is fever in a neutropenic cancer patient?
Medical emergency
What is Neupogen given for?
Prophylactic treatment
WBC growth factor
Promotes growth of WBCs
Causes bone pain
What is thrombocytopenia?
Decreased platelet count
What is considered a low platelet count?
Anything under 20,000
What part of the body is the most sensitive to radiation and chemo?
Mucosal lining of GI tract
This leads to all of the symptoms like:
Diarrhea/Constipation
N/V
Mucositis
Anorexia»weight loss
What are cancer patients given prophylacticly before treatment?
Zofran
What is dry mouth called?
Xerostomia
What is taste loss called?
Dysgeusia
–Dis-gyoo-see-uh–
What is difficulty swallowing called?
Dysphagia
What is painful swallowing called?
odynophagia
–Ow-din-nuh-fay-jee-uh—
What should patient gargle with to care for oral mucosa?
Saline mixture of 1 tsp/1L water
or 1 tsp of soda/1 L water
What is recommended for patients having anorexia?
Small frequent meals high in proteins and calories
How much weight loss would prevent cancer treatment from continuing?
25% of body weight
What are some of the effects of chemo/radiation on the lungs?
Pulmonary edema
Pneumonitis
What are some effects of chemo/radiation on the heart?
Pericarditis
Pericardial effusion (fluid buildup)
–Watch for EKG changes–
What are some effects of chemo/radiation on the cognition?
Chemo brain
What do monoclonal antibody class of drugs typically end in?
—-mab
How do immunotherapy drugs work?
Make environment not conducive to cancer growth
Kill cancer cells directly
What is targeted therapy?
Type of immunotherapy that can interfere with cancer growth by working on specific cell receptors and pathways of growth.
What are common side effects of immunotherapy and targeted therapy?
Flu like symptoms
Capillary leak syndrome»pulmonary edema
What are hallmark signs of Tumor Lysis syndrome?
hyperuricemia
hyperphosphatemia
hyperkalemia
hypocalcemia
What is tumor lysis syndrome caused from?
Rapid breakdown of cells leads to dump of cell components
Occurs within 1-2 days of chemo
What are some onocologic emergencies?
Spinal cord compression
Superior vena cava syndrome
Third space syndrome
Hypercalcemia
SIADH
Tumor lysis syndrome
Cardiac tamponade
Carotid artery rupture
What is an early sign of superior vena cava syndrome?
Periorbital edema
What is a late sign of hypercalcemia?
EKG changes
What is best time of month to do a breast self exam?
One week after period starts
