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Oncology Flashcards

1
Q

Carcinoma

A

begins in skin or tissue that line or cover internal organs.

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2
Q

Sarcoma

A

– begins in bone, cartilage, fat, muscle, blood vessels, connective or supportive tissue.

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3
Q

Leukemia

A

– starts in blood-forming tissue such as bone marrow (large number of abnormal cells produced and enter the bloodstream)

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4
Q

Lymphoma and myeloma

A

– begin in the cells of the immune system

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5
Q

Ca of Central nervous system

A

– begin in tissues of brain and spinal cord

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6
Q

Which cancers could be prevented by vaccination, behavioral changes, and antibiotics?

A

Cancers related to Hepatitis B, HPV, HIV, H. pylori

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7
Q

Screening prostate ca

A

ACS: PSA at age 50, 45 if AA, consider risks/benefits (false +s, too much intervention)

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8
Q

screening lung cancer

A

Lung cancer – low-dose CT scan (high risk individuals) more and more evidence, now paid for by insurance.

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9
Q

4 oncologic emergencies

A

spinal cord compression, SVC syndrome, hypercalcemia, tumor lysis syndrome

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10
Q

Spinal cord compression

A

– due to metastatic disease, back pain early, neurologic deficit of legs late sign. MRI needed. Treated with corticosteroids, RT, surgery, treat underlying malignancy.

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11
Q

Superior vena cava syndrome: cause

A
  • caused by mediastinal tumors, venous catheters, clots (basically impaired blood flow).
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12
Q

SVC syndrome: symptoms

A

Symptoms neck ,facial, periocular swelling, dyspnea, cough, head pressure, hoarseness, nasal congestion, syncope.

facial swelling may subside after up all day

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13
Q

SVC syndrome: Dx

A

CT scan needed, CXR may be beneficial. US for clots (gold standard).

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14
Q

SVC syndrome: Tx

A

Chemo, pericardial window or stripping.
HOB elevated. Lasix, steroids, chemo or RT, warfarin for clot.

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15
Q

Hypercalcemia: cause

A

– bone mets, parathyroid hormone related protein production, calcitroil excretion.

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16
Q

hypercalcemia Sx

A

Symptoms confusion, lethargy, sleepiness.

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17
Q

hypercalcemia: dx & Tx

A

Lab tests for calcium and electrolytes.

IV hydration (flush system) and bisphosphonates treatment.

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18
Q

Tumor lysis syndrome

A

– rapid tumor cell destruction from chemo, multiple electrolyte abnormalities.

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19
Q

Tumor Lysis Syndrome: symptoms

A

Nausea, weakness, myalgia, dark urine, arrhythmias.

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20
Q

Tumor Lysis Syndrome: Dx & Tx

A
  • Test electrolytes and uric acid.
  • Prevent by hydration, allopurinal, zyloprim.
  • Treat imbalances, acidosis.
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21
Q

alopecia: cause

A

caused by chemo 7 – 10 days after treatment (hair thinning) but really kicks in 3-4 weeks post.

Some people don’t lose – after 1st month usually indicates how much

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22
Q

alopecia mgmt

A
  • Cut hair short, shave head. Wigs/scarves.
  • Can write prescription for cranial prosthetic.
  • Get wig before so can match to current hair.
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23
Q

Bone marrow suppression leads to…

A

neutropenia, anemia, thrombocytopenia

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24
Q

neutropenia: when and Tx

A

nadir at 7-10 days after treatment.

Give GCSF and/or dose reduce

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25
Anemia: when & Tx
* several weeks after treatment start. * R/o other causes (bleeding, hemolysis, nutritional deficiency). * Transfuse if necessary. Give Epogen, Aranesp per guidelines. * Be aware of religious beliefs. * Transfusion more common for solid tumor pts
26
Nausea/vomiting: when and Tx
* Differs with emetogenic potential of the therapy. * Cisplatin tends to be most emetogenic but we have good treatments – let ppl know they shouldn’t be suffering overly
27
Diarrhea: why & Tx
* may be side effect of treatment or disease. * Obtain stool bacterial culture (C. diff), * if positive Flagyl (metronidazole), * if negative antimotility agent Imodium or Lomotil. * Manage fluids, skin breakdown
28
Nutrition effects
* loss of appetite, inability to eat secondary to side effects from chemo i.e. metallic taste in mouth, loss of taste.
29
Body image effects
Body Image Disturbance – from surgery, weight gain from steroid treatment.
30
at what ANC can bacteria naturally present in the mouth or digestive tract can cause infection
ANC \< 500
31
febrile neutropenia
* oncologic emergency * fever of 101.0+ *(may not be able to mount fever)* * Low white count ~ ANC \< 1500 (cut-off varies) * Most often no definitive infxn source
32
febrile neutropenia: Tx
May or may not be admitted to hospital – broad spectrum antibiotics are given.
33
Febrile Neutropenia: preventative Tx
colony stimulating factors (Neulasta) given 24 hours after certain chemotherapy treatment.
34
Risk factors that increase chance of admission for febrile neutropenia
* serum Cr \> 2 mg per dL, * LFT \> 3x upper limit normal, * uncontrolled/progressive cancer, * pneumonia, * significant comorbid illness, * prolonged severe neutropenia (ANC \<100 or \<500 x 7 days) - likely admission.
35
Factors that increase chance of outpatient Tx of febrile neutropenia
* no comorbid illness, * short time neutropenia, * creatinine * LFTs \< 3 times ULN, * good functional status * *even low risk probably admitted at least 24h*
36
Common effects of radiation therapy
mucositis, thrush, xerostomia, skin burn, trauma to areas in radiation field
37
Mucositis
– painful inflammation and ulceration of the mucous membranes lining digestive tract.
38
Mucositis Tx
* Saline/bicarb lavage, Magic Mouthwash/Dukes Solution (viscous lidocaine, benadryl, Mylanta), Carafate slurry. * Can disrupt eating.. Can even give opioid if really having trouble swallowing
39
Thrush: definition & Tx
* Thrush – patchy white coating in mouth * Nystatin s/s, Diflucan
40
Xerostomia: definition & Tx
* – dry mouth with lack of saliva. * Salagan or Evoxac to increase saliva production. Good oral care.
41
Skin burn: characteristics & Tx
* can be dry (sunburn) or wet desquamation (blistered oozy sunburn) * Moisturize with Aquaphor. NO non water based products – will disrupt RT field. Monitor for cellulitis and treat with antibiotics.
42
Effect on areas in the radiation field, e.g. chest & lower spine/abdomen
* Chest radiation – may have difficulty eating secondary to mucositis. (esophagitis). Scar tissue may lead to stricture * Spine/Lower abdominal radiation – may develop diarrhea.
43
Cancer Related Fatigue (CRF)
* Subjective feeling of tiredness or exhaustion prompted by cancer or cancer treatment disproportionate to level of recent exertion. * Possible causes – pain, emotional distress, sleep disturbance, anemia, nutrition, activity level, other comorbidities.
44
CRF Assessment
* Rate fatigue on scale from 0-10 over past 7 days. (1-3 mild, 4-6 moderate, 7-10 severe). * Multiple tools available: * Symptoms Distress Scale, Rotterdam Symptoms Checklist, MD Anderson Symptoms Inventory. Focus on detecting presence or absence of CRF. * Challenge – separating CRF from other related conditions (depression, anemia, effects of chemo/RT).
45
CRF Tx - exercise & education
* Exercise – strong evidence supports a 20 – 30 minute sessions 3 – 5 times weekly. Start low intensity and duration. * Education – strategies for energy conservation, activity management, prioritizing. * Massage, healing touch, relaxation
46
CRF Tx, Cog/behavioral interventions
* Cognitive-Behavioral Interventions – manage anxiety and depression, sleep disturbance, stress reduction.
47
CRF Tx, sleep disturbanes
Sleep disturbance/insomnia – sleep hygiene, consider TCA, antihistamines, benzodiazepines, Ambien/Luenesta
48
CRF Tx, Depression
Depression – counseling, SSRI’s
49
CRF Tx, anemia
Anemia – Iron studies, Transfusion, Procrit, Aranesp
50
CRF Tx, pain
* Mild - NSAID/Tylenol/short acting opioid, * Moderate to severe – combination of long and short acting opioid (use opiods asap, long good)
51
Medication/pharmaceutical interventions for cognitive impairment
(effectiveness not established) * Ritalin (methylphenidate) * Aricept (donepezil) (at this point say doesn’t work, gives diarrhea) * Provigil (modafinil)
52
CAM Tx for cognitive impairment
Exercise – potential benefit Vitamin E - unsure
53
Hot flashes as a side effect of Ca treatment
* Subjective sensation of heat that is associated with objective signs of cutaneous vasodilation and subsequent drop in core temperature. * Associated with facial flushing, perspiration, chills, heart palpitations, night sweats, anxiety. * Characterized as mild, moderate, severe.
54
Which Txs most likely to cause hot flashes?
Most common side effect from agents used to suppress ovarian function/cause estrogen withdrawal (tamoxifen, aromatase inhibitors, androgen deprivation, hormonal therapies, surgical castration).
55
Ca Tx and hot flashes: incidence
* Occurs in 78% breast Ca patients * Chemotherapy can cause premature ovarian failure with temporary or permanent amenorrhea. * Occur in 35 – 80% of men treated with androgen deprivation therapy (prostate Ca).
56
Tx for hot flashes
Effexor (SSRI) * SSRI’s (selective serotonin reuptake inhibitors) may be effective in elevating hot flashes however drug interactions may exist with tamoxifen (CYP 2D6 interaction -\> decreased efficacy of tamoxifen and increased risk of relapse).
57
CAM for hot flashes
* Acupuncture * Black Cohosh – herb. Evidence shows may or may not help. * Hypnosis * Relaxation therapy * Vitamin E (weak study results) * Yoga
58
Skin reactions to chemo or biotherapy
* mild, moderate, severe. Rarely life threatening but affects quality of life. * Two Major Types Rash: * Acneform * Maculopapular
59
Acneform
– diffuse erythema face body progressing to follicular papules/pustules resembling acne *(clinical manifestation of rash d/t chemo / biotherapy)*
60
Maculopapular
– flat macules and elevated papules associated with pruritus. ## Footnote *(clinical manifestation of rash d/t chemo / biotherapy)*
61
Carboplatin and rashes
– allergic reactions (rash, urticaria, erythema, pruritus) ## Footnote *(clinical manifestation of rash d/t chemo / biotherapy)*
62
Interleukin-2 and rashes
– erythematous rash, pruritus, dry/peeling skin. (Sarna lotion) ## Footnote *(clinical manifestation of rash d/t chemo / biotherapy)*
63
Palmar-Plantar Erythrodysesthesia (Hand foot syndrome)
* Mild redness at first with discomfort on palms and soles * tingling sensation at fingertips progressing to more intense burning pain/tenderness, swelling, desquamation, crusting, ulceration, epidermal necrosis. * (Bag Balm, cooling pads) *(clinical manifestation of rash d/t chemo / biotherapy)*
64
Xerosis
– abnormally dry, flaky, dull skin (moisturizer, emollients) *(clinical manifestation of rash d/t chemo / biotherapy)*
65
Paronychia
– painful inflammation of tissue around fingernails/toenails more commonly great toes and thumbs. (Antibiotics) ## Footnote *(clinical manifestation of rash d/t chemo / biotherapy)*
66
Photosensitivity
– erythematous response to ultraviolet or visible light. (Retinoids, topical steroids, topical antiseptics) *(clinical manifestation of rash d/t chemo / biotherapy)*
67
Pruritis
* – intense itching that may lead to scratching. * Consider thick non-alcohol moisturizer/emollients; Benadryl, Atarax (antihistamine); topical steroid cream or Elidel (immune modulator). *(clinical manifestation of rash d/t chemo / biotherapy)*
68
Prevention of skin reactions d/t chemo / biotherapy
* Minimize exposure to sunlight/UV light * Sunscreen with zinc oxide/titanium dioxide * Protect skin: Avoid temperature extremes to skin, avoid long hot showers or baths, washing dishes or cold compresses. * Avoid constrictive clothes, shoes, jewelry. * Keep skin moisturized with alcohol free products.

Health Assessment (14 decks)

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