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Nursing > Oncology > Flashcards

Oncology Flashcards

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1
Q

Hypertrophy

A

growth that causes tissue to increase in size by enlarging each cell (heart muscle cells)

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2
Q

Hyperplasia

A

growth that causes tissue to increase in size by increasing the number of cells ( skin, hair, bone marrow, …)

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3
Q

Neoplasia

A

any new or continued cell growth not needed for normal development or replacement of damaged tissue.

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4
Q

Benign tumor cells

A
  • Continuous or inappropriate cell growth
  • Specific morphologic features
  • Small nuclear-to-cytoplasmic ratio
  • Differentiated functions
  • Tight adherence
  • No migration
  • Growth- Expansion
  • Normal chromosomes(eupliod)
  • Low mitotic index
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5
Q

Examples of benign tumor cells

A

uterine fibroid tumors; moles; skin tags; endometriosis; nasal polyps

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6
Q

Cancer cells

A 
Rapid or continuous cell division
• Anaplastic appearance
• Large nuclear-to-cytoplasmic ratio
• No differentiated function
• Loose adherence
• Migration 
• Growth –Invasion
• Abnormal chromosomes (aneuploid)
• High mitotic index
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7
Q

Metastasis: Malignant transformation

A

some normal cuboidal cells undergone malignant transformation and have divided - forming tumorous area within cuboidal epithelium

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8
Q

Metastasis: Tumor vascularization

A

cancer cells secrete tumor angiogenesis factor (TAF) stimulating the blood vessels to bud and form new channels that grow into the tumor

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9
Q

Metastasis: Blood vessel penetration

A

cancer cells broken off from main tumor - enzymes make holes in blood vessels - cancer cells enter - travel around the body

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10
Q

Metastasis: Arrest and invasion

A

cancer cells clump up in blood vessels walls and invade new tissue areas- new tumors will form. (if conditions are right).

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11
Q

Staging of cancer - TNM Classification

A
  1. Primary Tumor
  2. Regional Lymph Nodes
  3. Distant Metastasis
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12
Q

Grading of malignant tumors

A

Gx ( cannot be determined ), G1, G2, G3, G4

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13
Q

External factors ( environmental carcinogenesis)

A
  1. Chemical : tobacco…
  2. Physical : radiation, chronic irritation (tissue trauma)
  3. Viral : viruses infect body cells and break the DNA strands
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14
Q

Personal factors

A
  1. Immune function: cell mediated immunity - natural killer NK and T-cells . At risk: immunosuppressed, older than 60;
  2. Advancing age: most important risk factor for cancer;
  3. Genetics: testing foe cancer predisposition is available to confirm or rule out persons genetic risk.
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15
Q

Caution: Seven Warning Signs of Cancer

A
  • Change in bowel or bladder habits
  • A sore that doesn’t heal
  • Unusual bleeding or discharge
  • Thickening (lump) in the breast or elsewhere
  • Indigestion or difficulty swallowing
  • Obvious change in a wart or mole
  • Nagging cough or hoarseness
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16
Q

Diagnostic Studies

A
  • CBC
  • Chemistry
  • Protein tumor markers (PSA, CEA)
  • X-ray/ MRI/ CT
  • Ultrasound
  • Biopsy
  • Endoscopy/ Laparoscopy
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17
Q

Treatment & Management: Goal:

A

Prolong Survival Time or Improve Quality of Life

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18
Q

Treatment & Management:

A 
Surgery
o Radiation Therapy
o Chemotherapy
o Hormonal Manipulation
o Immune Therapy
o Photodynamic therapy
o Biologic Response Modifiers (BMRs)
o Targeted Therapy
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19
Q

Types of Surgery

A
  1. Diagnostic: removal of leison
  2. Prophylactic: removal at risk tissue
  3. Curative: removal all cancerous tissue
  4. Cytoreductive : part of cancerous tissue
  5. Palliative: improve quality of life
  6. Reconstructive/ Rehabilitative : increase of function
    • Second-look
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20
Q

Radiation Therapy: purpose (local treatment)

A

destroy cancer cells with minimal exposure of the normal cells to the damaging action of radiation.

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21
Q

Radiation therapy:

A

Gamma rays (used most commonly); beta particles; alpha particles (not used in cancer treatment); Inverse square law.

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22
Q

Radiation delivery:

A

depends on the patients general health, and on the shape , size and location of the tumor.

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23
Q

Teletherapy

A

distant treatment ; radiation source is external to the patient - patient is not radioactive and is not a hazard to others.

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24
Q

Brachytherapy

A

short or close therapy; radiation source comes into direct, continuous contact with the tumor tissue for specific period of time; uses radioactive isotopes ( solid form or within body fluids( radioactive iodine)); patient is hazard to others.

25
Q

Radioactive isotopes

A

eliminated in wastes products within 48 hrs (which are radioactive);

26
Q

Side effects of radiation therapy

A
  1. skin changes and hair loss ( local)
  2. altered taste sensations and fatigue ( external radiation)
  3. tissue fibrosis and scaring
27
Q

LDR and HDR

A

low dose radiation and high dose radiation

28
Q

Radiation: priority nursing intervention

A

teaching patient about skin care

29
Q

Chemotherapy (systemic)

A

used to cure and increase survival time ; has some selectivity for killing cancer cells over normal cells. ; damage DNA and interfere with cell division.

30
Q

Normal cells affected by chemotherapy

A

cells that divide rapidly - skin, hair, intestinal tissue, spermatocytes, blood forming cells.

31
Q

Chemotherapy : methods of delivery most common

A

PO and IV; assess for extravasation (infiltration of drug into tissue)- pain, infection, tissue loss.

32
Q

Alkylating agents

A

cross link DNA - making two DNA strands bind together which prevent proper DNA and RNA synthesis; Side effects: Nausea, vomiting, alopecia , anemia, bone marrow suppression, cystitis .

33
Q

Antitumor antibiotics

A

damage the cells of DNA; interrupt DNA or RNA synthesis ; side effects: alopecia, N&V, stomatitis, leukopenia, thrombocytopenia.

34
Q

Antimiotic agents

A

interfere with formation of microtubules so cells cannot complete mitosis during cell division. cancer cell cannot divide or divides only once.

35
Q

Antimetabolites

A

“counterfeit metabolites” fool cancer cells into using them; impair cell division. SE: bone marrow supression, stomatitis; N&V, alopecia, hepatic and renal dysfunction.

36
Q

Plant alkaloids

A

block cellular division; derived from natural plants; SE: leukopenia, allergic reaction, alopecia, N&V, constipation, diarrhea.

37
Q

Anemia

A

decreased level of circulating RBC;

Assess: respiratory status: SOB; weakness, fatigue, dizziness, pale skin color, TX: epoetin alfa (Procrit);

38
Q

Anemia : Teaching

A
  • Get Rest/ Stand slowly to prevent dizziness when changing positions
  • Limit activities
  • Eat a well-balanced diet
39
Q

Neutropenia

A

decrease number of circulating WBC; At risk for infection: fungal, bacterial, viral;

40
Q

Neutropenia: Teaching

A
  • Washing your hands with soap and water and carry sanitizer for
    times when you can’t
    • Stay away from people who are sick
    • Stay away from crowds
    • Be careful around animals, do not clean litter boxes, pick up dog
    waste etc…
    • Do not get a flu shot or other vaccine b/c it may contain a live virus
    • Wash raw foods & vegetables before eating them
    • Don’t eat raw or undercooked fish, seafood, meat, chicken or eggs
41
Q

Thrombocytopenia

A

decreased number of circulating platelets; Risk for excessive bleeding when platelet count is less than 50000; less than 20000 - at risk for spontaneous uncontrolled bleeding ; Avoid injury !!!

42
Q

Thrombocytopenia: Do

A
  • Brush your teeth with a soft toothbrush
    o Men- use an electric shaver, not a razor
    o Blow your nose gently
    o Be careful when using scissors, knives or other sharp objects
    o Wear shoes all the time, even in the house
43
Q

Thrombocytopenia: Don’t

A
  • Use dental floor or toothpicks
    o Play sports or participate in other activities which you could
    get hurt
    o Use tampons, enemas, suppositories or rectal
    thermometers
44
Q

Nausea/Vomiting/ Appetite Changes

A
  • Eat small meals & snacks (5-6), instead of 3 large meals
    o Eat bland, not spicy foods, salty and/or acidic foods
    o Provide anti-emetics before, during and after treatment
    o Set a daily schedule for eating your meals and snacks
45
Q

Mucositis/Stomatitis/Xerostomia

A
  • Visit dentist at least 2 weeks before starting Chemotherapy
    • Check your mouth and tongue daily
    • Keep your mouth moist
    o Clean your mouth, teeth , gums & tongue
    o Be careful what you eat when your mouth is sore
    o Stay away from things that can hurt, scrape or burn your mouth
    Assess: sores, fissures, blisters, redness, tissue swelling, dry mouth, white patches.
    Rinse mouth half peroxide half NS twice a day ( don’t use commercial mouthwash)
46
Q

Alopecia

A

Before Hair Loss
• If you plan to buy a wig, do so before you lose your hair
• Be gentle when you wash your hair
• Do not use items that can hurt your scalp
• Curling irons/ Brush rollers or curlers
• Hair Dyes/ Perms to relax hair
o After Hair Loss
• Protect your Scalp
• Sleep on satin pillow case (less friction)
• Talk about your feelings

47
Q

Alopecia: priority

A

teach how to prevent injury to the scalp; coping with body image change

48
Q

Peripheral neuropathy

A

Loss of sensory or motor function of peripheral nerves
 Presentation: Tingling, Burning, Weakness, Numbness in Hands or Feet
o Priority: Injury Prevention
 Assess:
• Balance
• Trouble Picking up Objects
• Shaking/ Trembling

49
Q

Cancer Prevention: Primary

A

use of strategies to PREVENT the actual occurrence of cancer (most effective when there is known cause for cancer type)

50
Q

Cancer prevention: Secondary

A

use of SCREENING strategies to detect cancer early, at a time when cure or control is more likely.

51
Q

Oncologic Emergencies

A
  1. Sepsis or septicemia + DIC (disseminated intravascular coagulation)
  2. SIADN : syndrome of inappropriate antidiuretic hormone
  3. Spinal cord compression
  4. Hypercalcemia
  5. Superior Vena Cava Syndrome SVC
  6. Tumor Lysis Syndrome
52
Q

DIC

A

problem with blood clotting ; Clots block blood vessels and decrease blood flow to major organs and result in pain, strokelike manifestations, dyspnea, oliguria, bowel necrosis - TX: anticoagulants.
Bleeding from many sites - clotting factors are given - Hemorrhage is the primary problem.

53
Q

SIADH

A

Water is reabsorbed - hyponatremia, , weakness, fatigue, fluid retention, muscle cramps, confusion, seizures, coma, death.
TX: fluid restriction, sodium intake + drug therapy; immediate cancer therapy. Safety - prevent fluid overload - pulmonary edema - heart failure.

54
Q

Spinal cord compression

A 
damage occur either when a tumor directly enters the spinal cord or when vertabre collapse from tumor degradation of the bone.
Back pain (paralysis) , muscle weakness, numbness, tingling, unsteady gait.  TX: Palliative
55
Q

SVC

A

occurs when SVC is compressed or obstructed by tumor growth or by formation of clots in vessel . Blockage of blood flow in the venous system of the head , neck, upper trunk.
S/s: edema of face, tightness of the shirt collar (Stokes sign); TX: high dose radiation therapy to provide temporary relief

56
Q

Tumor Lysis Syndrome (positive sign - cancer treatment is effective)

A

large number of tumor cells are destroyed rapidly - intracellular content ( K + purines) released into bloodstream faster than body can eliminate them .
s/s: hyperkalemia - severe cardiac dysfunction ;
purines - liver - uric acid - hyperuricemia - block tubules - ARF . TX: Hydration 3000-5000 ml of water day before, day of, 3 days after treatment.

57
Q

Cachexia

A

extreme body wasting and malnutrition

58
Q

Melanoma

A

most dangerous type of skin cancer

59
Q

“Debulking” surgery

A

cytoreductive surgery or cancer control; removing part of the tumor and leaving a known amount of gross tumor; alone cannot result in a cure.

Nursing (18 decks)

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