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Health Assessment > Oncology > Flashcards

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
Q

Anemia: when & Tx

A
  • 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
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26
Q

Nausea/vomiting: when and Tx

A
  • 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
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27
Q

Diarrhea: why & Tx

A
  • 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
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28
Q

Nutrition effects

A
  • loss of appetite, inability to eat secondary to side effects from chemo i.e. metallic taste in mouth, loss of taste.
29
Q

Body image effects

A

Body Image Disturbance – from surgery, weight gain from steroid treatment.

30
Q

at what ANC can bacteria naturally present in the mouth or digestive tract can cause infection

A

ANC < 500

31
Q

febrile neutropenia

A
  • 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
Q

febrile neutropenia: Tx

A

May or may not be admitted to hospital – broad spectrum antibiotics are given.

33
Q

Febrile Neutropenia: preventative Tx

A

colony stimulating factors (Neulasta) given 24 hours after certain chemotherapy treatment.

34
Q

Risk factors that increase chance of admission for febrile neutropenia

A
  • 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
Q

Factors that increase chance of outpatient Tx of febrile neutropenia

A
  • no comorbid illness,
  • short time neutropenia,
  • creatinine
  • LFTs < 3 times ULN,
  • good functional status
  • even low risk probably admitted at least 24h
36
Q

Common effects of radiation therapy

A

mucositis, thrush, xerostomia, skin burn, trauma to areas in radiation field

37
Q

Mucositis

A

– painful inflammation and ulceration of the mucous membranes lining digestive tract.

38
Q

Mucositis Tx

A
  • 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
Q

Thrush: definition & Tx

A
  • Thrush – patchy white coating in mouth
  • Nystatin s/s, Diflucan
40
Q

Xerostomia: definition & Tx

A
  • – dry mouth with lack of saliva.
  • Salagan or Evoxac to increase saliva production. Good oral care.
41
Q

Skin burn: characteristics & Tx

A
  • 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
Q

Effect on areas in the radiation field, e.g. chest & lower spine/abdomen

A
  • Chest radiation – may have difficulty eating secondary to mucositis. (esophagitis). Scar tissue may lead to stricture
  • Spine/Lower abdominal radiation – may develop diarrhea.
43
Q

Cancer Related Fatigue (CRF)

A
  • 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
Q

CRF Assessment

A
  • 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
Q

CRF Tx - exercise & education

A
  • 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
Q

CRF Tx, Cog/behavioral interventions

A
  • Cognitive-Behavioral Interventions – manage anxiety and depression, sleep disturbance, stress reduction.
47
Q

CRF Tx, sleep disturbanes

A

Sleep disturbance/insomnia – sleep hygiene, consider TCA, antihistamines, benzodiazepines, Ambien/Luenesta

48
Q

CRF Tx, Depression

A

Depression – counseling, SSRI’s

49
Q

CRF Tx, anemia

A

Anemia – Iron studies, Transfusion, Procrit, Aranesp

50
Q

CRF Tx, pain

A
  • Mild - NSAID/Tylenol/short acting opioid,
  • Moderate to severe – combination of long and short acting opioid (use opiods asap, long good)
51
Q

Medication/pharmaceutical interventions for cognitive impairment

A

(effectiveness not established)

  • Ritalin (methylphenidate)
  • Aricept (donepezil) (at this point say doesn’t work, gives diarrhea)
  • Provigil (modafinil)
52
Q

CAM Tx for cognitive impairment

A

Exercise – potential benefit
Vitamin E - unsure

53
Q

Hot flashes as a side effect of Ca treatment

A
  • 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
Q

Which Txs most likely to cause hot flashes?

A

Most common side effect from agents used to suppress ovarian function/cause estrogen withdrawal (tamoxifen, aromatase inhibitors, androgen deprivation, hormonal therapies, surgical castration).

55
Q

Ca Tx and hot flashes: incidence

A
  • 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
Q

Tx for hot flashes

A

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
Q

CAM for hot flashes

A
  • Acupuncture
  • Black Cohosh – herb. Evidence shows may or may not help.
  • Hypnosis
  • Relaxation therapy
  • Vitamin E (weak study results)
  • Yoga
58
Q

Skin reactions to chemo or biotherapy

A
  • mild, moderate, severe. Rarely life threatening but affects quality of life.
  • Two Major Types Rash:
    • Acneform
    • Maculopapular
59
Q

Acneform

A

– diffuse erythema face body progressing to follicular papules/pustules resembling acne
(clinical manifestation of rash d/t chemo / biotherapy)

60
Q

Maculopapular

A

– flat macules and elevated papules associated with pruritus.

(clinical manifestation of rash d/t chemo / biotherapy)

61
Q

Carboplatin and rashes

A

– allergic reactions (rash, urticaria, erythema, pruritus)

(clinical manifestation of rash d/t chemo / biotherapy)

62
Q

Interleukin-2 and rashes

A

– erythematous rash, pruritus, dry/peeling skin. (Sarna lotion)

(clinical manifestation of rash d/t chemo / biotherapy)

63
Q

Palmar-Plantar Erythrodysesthesia (Hand foot syndrome)

A
  • 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
Q

Xerosis

A

– abnormally dry, flaky, dull skin (moisturizer, emollients)

(clinical manifestation of rash d/t chemo / biotherapy)

65
Q

Paronychia

A

– painful inflammation of tissue around fingernails/toenails more commonly great toes and thumbs. (Antibiotics)

(clinical manifestation of rash d/t chemo / biotherapy)

66
Q

Photosensitivity

A

– erythematous response to ultraviolet or visible light.

(Retinoids, topical steroids, topical antiseptics)

(clinical manifestation of rash d/t chemo / biotherapy)

67
Q

Pruritis

A
  • – 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
Q

Prevention of skin reactions d/t chemo / biotherapy

A
  • 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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