oncology Flashcards
1
Q
Radiation side effects
A
Alopecia Desquamation Ulceration Stomatitis Xerostomia Bone marrow suppression Anemia Leukopenia Thrombocytopenia fatigue/malaise Anorexia Radiation burns
2
Q
Tx of radiation side effects
A
Cleanse area with lukewarm water No harsh soaps, talc powder, perfumes, or alcohol wipes -Can use very thin layer of A&D ointment Dont shave area dont expose to the sun Don't use bandaids or tape
3
Q
Problems with extravasations
A
compartment syndrome
peripheral neuropathy
4
Q
mediports
A
SASH
if no blood return, turn head to side and cough
5
Q
Chemotherapy S/E
A
-N/V/D/A (Zofran around the clock, corticosteroids increases appetite) Mylosupression-leukopenia, anemia, thrombocytopenia, -anemia. (Neupogen, Epogen, Neumega) -Renal toxicity -Renal failure -Electrolyte imbalance -Irreversible cardiac toxicity -Rt and Lt sided heart failure -Pulmonary fibrosis -Early menopause -Sterility -Peripheral neuropathies -Fatigue
6
Q
Absolute neutrophil count
A
WBC (%neutrophils+%bands)/100
normal >1500
moderate 1000-1500
<500: severe neutropenia!!
7
Q
NADIR
A
lowest ANC after chemo or radiation
stop tx until numbers go up
8
Q
Ovarian cancer Risk factors
A
nulliparity infertility family Hx early menses and late menopause (Increased exp to estrogen) high fat diet mumps before 1st period
9
Q
Ovarian cancer protective factors
A
use or oral contraceptives
multiparity
breastfeeding
10
Q
S&S ovarian cancer
A
vague and nonspecific Palpable ovary in postmenopausal woman Bloating/flatulence Abd swelling/pain/ascites Pelvic pressure/mass Backache/leg pain
11
Q
Dx of Ovarian cancer
A
Biopsy Pelvic exam Transvaginal ultrasound Laparotomy Ca 125 maker/antigen
12
Q
Dx findings of Ovarian of cancer
A
Benign
Borderline (proliferation, no invasion)
Malignant
13
Q
Staging of ovarian cancer
A
Stage 1: limited to ovary
Stage 2: limited to pelvis
Stage 3: limited to and cavity (not the liver)
Stage 4: metastasis to liver, lungs, etc
14
Q
Management of Ovarian cancer
A
TAHBSO (total abd hysterectomy with bilateral salpingo oophrectomy) Omentectomy Liposomal therapy (encapsulated chemo) Radiation chemo
15
Q
NI Ovarian cancer
A
Control pain
drainage tubes, abdominal binders
Diuretics for ascites
Assist with paracentesis
16
Q
Cervical Cancer Patho
A
Easiest GYN cancer to prevent thru screening (pap smear)
17
Q
Risks of Cervical cancer
A
HPV (STI)--cause had sex > 1 partner Early sexual activity Early child bearing (NO ESTROGEN) smoking immunocompromised no yearly pap smear younger women
18
Q
S&S of Cervical cancer
A
Abnormal bleeding between periods and intercourse or after (CONTACT BLEEDING)
Unusual vaginal discharge (foul/smelling)
Leg/pack pain
Pelvic pain after intercourse
19
Q
Dx of Cervical cancer
A
-Papsmear: Atypia: mild changes low grade: dysplasia high grade: malignant -punch biopsy -D&C -CT -Colcoscopy (vinegar solution) -Pelvic exam
20
Q
Stages of cervical cancer
A
Stage 1: in cervix
2: surrounding tissues
3: lymph nodes and pelvic area
4: bowel/bladder/etc
21
Q
Management of Cervical cancer
A
Cryotherapy (no intercourse 3 weeks)
LEEP procedure
Cone biopsy
hysterectomy
Radical trachelectomy (cervical os removed)
radiation (external, intraoperative, internal)- Radiation enteritis, vaginal stenosis
teach S&S mets: wt loss, pelvic pain and leg edema.
22
Q
Breast cancer risk factors
A
(long exposure to estrogen) > age Family Hx of cancer BRCA1 and 2 Early menses. late menopause. nullipara, contraceptives Benign proliferate breast disease obesity Exposure to Ionizing radiation (young adults, kids) Excessive alcohol
23
Q
Breast cancer protective factors
A
Exercise breastfeeding not smoking no excessive alcohol full preg before 30
24
Q
Screening and prevention breast cancer
A
BSE age 20
Mammography 35 high risk 40 no risk
Bilateral Prophylactic Mastectomy: if person has BRCA 1 and 2
25
S&S Breast cancer
Upper Outer Quadrant palpable mass (fixed, painles)
Skin dimpling (like orange)
skin irritation (peeling, flaking, eczema)
skin color changes and texture
Nipple retraction (inverted/flat) pain
Skin ulceration
Spontaneous bloody discharge from nipple area
26
Dx and assessment breast cancer
```
mammography
biopsies (incisional and excisional)
MRI
CA15-3
staging 1-4
```
27
Tx of breast cancer
```
Sentinel Lymph node biopsy
total mastectomy
Radical mastectomy
Modified radical
lumpectomy
chemo/radiation
```
28
Preop/post op breast cancer
More prone to hematomas and lymphedema due to lymph nodes removed
-Wall hand climbing, broomstick lifting, rope/doorknob turning, stress balls (helps lymphedema)
-No heavy lifting for 4-6 weeks
Drainage tubes (monitor, empty
Wear gloves when gardening and baking
If get a scrape on arm, Bacitracin ointment
No BP, blood draws, IVs or tourniquet on side
29
lymphedema NI breast ca
elevate arms on pillow for 45 minutes
| wear special stockinette over arm
30
S/E of hormonal therapy
```
hot flashes, vaginal dryness
risk for cataracts
N/V
Dizzy, headache
osteoporosis
uterine cancer risk
```
31
Testicular cancer at risk
```
ages 15-40
highly treatable and curable
usually germinal
cryptorchidism
Family Hx
Caucasian
Occupational exposure
Exposure to DES
```
32
S&S of testicular cancer
```
Mass or lump in testes
Painless enlargement of testes
Heaviness in scrotum, inguinal area, low abd
Backache-retroperitoneal node extension
Mets (abd pain, wt loss, weakness)
```
33
Dx and screening testicular ca
```
Monthly testicular exam
HCG and AFP
Intravenous urography
Ultrasound
CT (mets) to lungs
INGUINAL ORCHIECTOMY
```
34
Management of testicular cancer
- orchiectomy with possible retroperitoneal dissection
- Discuss prosthetic device implantation
- counsel about sperm banking (sterility)
- the other testes must be protected
- Radiation
- conventional tx
35
Bladder cancer risk factors
```
Recurrent UTIs
Bladder and kidney stones
smoking
chronic exposure to dyes, leather, paint, hairdressing.
High diet and fried foods
Prostate, colon or rectal
```
36
S&S of bladder cancer
painless hematuria
UTI S&S
alteration in voiding patterns
Pelvic/lower back pain (Mets: BONES)
37
Dx of bladder cancer
- cystoscopy together with cytologic exam (look, flush wit saline and biopsy) collect fresh urine
- excretory urography (entire renal system) dye!!
- CT scan
38
Medical Management bladder ca
Transurethral resection (remove area) goal patency
Intravesical therapy (inject BCG thru foley) push fluids
Cystectomy with ileal conduit
Radiation (cystitis)
chemo
39
Prostate cancer risk factors
African american
high fat, dairy and red meat diet
>age
40
Prostate Dx
DRE and PSA
| TRUS with biopsy
41
Tx of prostate cancer
watchful waiting
prostatectomy (radical)-sexual impotency and urinary incontinence
-Transurethral, suprapubic and retropubic removal
-Radiation (brachytherapy, tele therapy) no contact with preg women or young children for 2 months, use condoms for 2 weeks
-Hormonal therapy
-Chemotherapy
42
Colorectal Cancer risk factors
```
genital or breast cancer
high fat and protein, low fiber diet
IBD
polyps
>age
```
43
Colorectal cancer S&S
change in Bowel habits
Blood in stool
unexplained anemia
wt loss
fatigue
Rt sided: dull abd pain, dark blood in stool (melena)
Lt sided: severe abd pain, constipation, cramps, distention, bright red blood, very thin stool (pencil-like)
Sigmoid-rectal area: tenesmus, rectal pain.
44
Dx colorectal cancer
```
Proctosigmoidoscopy
Abd & rectal exam
Stool for occult blood
Barium enema
CEA (blood test: check to see reoccurrence)
```
45
Complications of Colorectal Ca
```
Bowel obstruction
Hemorrhage
Perforation in abdomen
Tumor extension
Peritonitis
```
46
Classification Colorectal Ca
Dukes (A best, D worst)
47
Tx of colorectal cancer
```
Segmental resection with anastamosis
Temporary or permanent colostomy
Abdominal resection
Permanent colostomy
If intestinal obstruction (NG suction, IV fluids, Blood products)
Chemo, radiation
```
48
S&S of lung cancer
change in cough (hacking, nonproductive)
hemoptysis
chest pain
wt loss
49
tx of lung cancer
radiation (esophagitis, pneumonitis, fibrosis)
- Lobectomy (2 chest tubes)
- Pneumonectomy (no chest tubes, DONT position on UNAFFECTED side)
- wedge resection
- Segmental resection
50
Laryngeal risk factors
smoking and drinking
manufacturing plants
forcing voice
laryngitis
51
S&S laryngeal cancer
```
hoarseness>2 weeks
graspy low pitch voice
persistent cough, pain, burning in throat
lump in neck
dysphagia
foul breath
we loss
dyspnea
ear pain (mets)
```
52
Dx Laryngeal cancer
```
Direct laryngoscopy
P53 tumor marker
CT scan
MRI
Laryngography
```
53
Medical Management laryngeal ca
```
Radiation (xerostomi, desguesia, dysphagia, loss of smell.
Partial laryngectomy (voice is kept)
Total laryngectomy (no voice ever, permanent tracheal stoma)
```
54
Total laryngectomy NI
How do you want to communicate? can't whistle
Assess Resp status
Speech therapist
suction PRN
Humidified 02 and oral suction
encourage Fluid intake
-deflate shiley teach every 2h
-change inner canula q8h
-Avoid irritants from stoma (powder)
-Tub bath or hand held shower (cover stoma)
-swallow test (2-3 days postop, stay with them, thick liquids, suctioning equip.)
-avoid sweet foods
-cleanse stoma with NS daily, asses swell and retraction
-pad and pencil (magic slate)
-electric pharynx
COMP: resp distress, hemorrhage, INF, wound breakdown, aspiration.
-no swimming.
55
Endometrial Cancer Risk factors
```
menopause
obesity
HTN
diabetes
estrogen use
```
56
Endometrial ca S&S
ENDOMETRIAL HYPERPLASIA
| Abnormal bleeding
57
Dx of endometrial Ca
```
Transvaginal ultrasound
endometrial biopsy (aspiration)
```
58
Tx endometrial ca
```
TAHBSO
hysterectomy
vaginal brachytherapy
hormonal therapy/chemo
pelvic radiotherapy
```
59
Liver cancer risk factors
```
Chronic liver disease
Hep B&C
Chemical toxin exposure
Cigarette smoking and ALCOHOL
older men
```
60
S&S liver Ca
```
Pain in RUQ and throughout abdomen, back and neck
extreme weight loss
anorexia (get full fast)
Ascites
Jaundice
Hepatosplenomegaly
Anemia
```
61
Dx liver Ca
```
Liver function tests (increased levels)
CBC (leukocytosis)
AFP and CEA
Angiography
Liver scans, Ct scan, MRI
```
62
Tx liver Ca
```
Lobectomy
Cryosurgery (nitrogen liquid over tumor)
Liver transplant
Radiation (doesn't improve survival)
Internal (seeds, beads)
chemo
Percutaneous biliary drainage (relieves jaundice, itching, pain)
COMP: hemorrhage, infections
```
63
NI Liver Ca
Monitor CBC (hemorrhage)
hypothermia (cryosurgery)
clean biliary drainage, it won't fall out. skin care for pruritus
oat meal based lotions
64
Pancreatic Ca Risk factors
```
older
smoking
exposure to chemicals
high meat, fat, nitrates diet
chronic pancreatitis
DM type 2
obesity
```
65
S&S of Pancreatic Ca
```
Pain (when laying down is worse)
Jaundice
Severe wt loss
mid abd discomfort
Insulin deficiency (DM)
Ascites
hepatomegaly
```
66
Dx pancreatic Ca
CA 19 & CEA
endoscopic ultrasound
ERCP (endoscopic retrograde cholangiopancreatography)
67
Tx Pancreatic Ca
```
Excision procedure
Biliary stent placement
whipple procedure
radiation
Chemo
high protein diet high pancreatic enzymes
Pain relief
```
