oncology + hematology Flashcards
what is it
cancer
malignant neoplastic disorder, cells lose their normal growth-controlling mechanism (growth of cells is uncontrolled)
what is it + routes
metastasis
cancer cells move from orginal location to other sites
- local seeding = shed of cancer cells outside local area of tumor
- bloodborne metastasis = tumor cells enter blood (most common cause of spread)
- lymphatic spread = primar sites rich in lymphatics are more susxeptible to early mestatic spread
factors influencing cancer development
- chemical carcinogens: industrial chemcials, medicationsm alcohol, tobacco
- physical carcinogens: ionizing radiation (x-ray), ultraviolet radiation (sun, tanning bed, germicidal lights), chronic irritation, tissue trauma
- viral carcinogen: aka oncoviruses (hep B, human paillomavirus)
- helico bacter pylori - associated with an increased risk of gastric cancer
- lifestyle: obesity, smoking, diet (preservatives/contaminents/additives/alcohol/nitrates)
- genetic predisposition
- advancing age
- immunosuppression
1 - 4
tumor grades
- cells differ slightly from normal cells, well differentiated (mild dysplasia)
- cell more abnormal, moderately differenctiated
- cells are very abnormal, poorly differentiated (anaplasia)
0 to 4
cancer stages
stage 0: carcinoma in situ
stage 1: tumor lumuted to tissue of origin, localized growth
stage 2: limited local spread
stage 3: extensive local/regional spread
stage 4: distant metastasis
CAUTION-US
cancer warning signs
Changes in bowel/bladder habbits
Any sore that does not heal
Unusual bleeding/dishcarge
Thickening/lump
Indigestion
Obvious change in wart/mole
Nagging cough/hoarseness
Unexplained anemia
Sudden weight loss
diagnostic tests
- biopsy - provides histological proof of malignancy (needle/incision/excisional where lesion removed)
- bone marrow examination
- chest radiograph
- Complete Blood Count
- Computed Tomography
- Positron Emission Tomography
- Cytological studies (papanicolaou test)
- Endoscopic exam (upper GI, sigmoidoscopy, colonoscopy)
- evaluation of serum tumor markers (cacinoembryonic antigen, alphafetoprotein)
- liver function tests
- Magnetic Resonance Imaging
- proctoscopic examination
- radiographic studies (mamography)
- radioisotope scanning (liver, brain, bone, lung)
- stool test for occuly blood
causes of pain
- bone destruction
- pathologic fractures
- lytic lesions (holes where bone tissue is destroyed)
- organ obstruction
- compression of peripheral nerves/spinal cord
- infiltration
- tissue distention
- inflammation
- necrosis
- tumor lysis
- psychological factor (fear/anxiety)
- surgical/neurpathic pain from treatment
pain meds
- mild/moderate: salicylates, acetaminophen/NSAIDS
- severe: opioids
- neuropathic: anticonvulsants, antidepressants
surgery types
- prophylactic: attempt to remove tissue/organ at risk
- curative: all gross + microscopic tissue is removed or destroyed
- control (cytoreductive/debulking): removing large portion of cells
- palliative: reduce pain, relieve airway/GI/urinary obstruction, relieve pressure on the brain/spinal cord, prevent hemorrhage, removed infected/ulcerated tumors, drain abscesses
- reconstructive: restore maximal function + appearance (ex. breast reconstruction)
what it does + common side effects
chemotherapy
kills/inhibits reproduction of neoplastic cells, kills normal cells (mostly skin, hair, GI tract lining, spermatocytes, hematopoietic cells)
side effects: fatigue, alopecia, nausea/vomiting, skin changes, myelospression
what it does
radiation
destroys cancer cells, with minimal exposure of normal cells to the damaging effects (cells die/unable to divide)
- external beam radiation aka teletherapy (radiation source external to client - no radiation emitted + no hazard to anyone else)
- internal radiation aka brachytherapy (source comes in direct + continuous contact with tumor tissues, client emits radiation + is hazardous - capsules, seeds, microspheres)
- permanent brachytherapy = radioactive elements inserted + remain in patient
- temporary = radioactive material removed after minutes or days
- unsealed radiation source: administration via oral/IV route (source enters body fluids + is eliminated via excreta within 48 hours - radioactive + harmful to others)
side effects: fatigue (most common), skin irritation, alopecia, altered taste
what is it
hematopoietic stem cell transplant
bone marrow transplantation + peripheral blood stem cell transplantation replace stem cells destroyed by chemo/radiation (needed to prevent infection + hemorrhage)
donor stem cell types
allogeneic: stem cell donor is usually sibiling/parent/someone with similar tissue type
synegeneic: cells from identical twin
autologous: person’s own stem cells are harvested during disease remission, stored + frozen
what it is + classifications
leukemia
group of hematological malignancies involving abnormal overproduction of leukocytes in bone marrow
classifiaction:
- acute lymphocytic leukemia: mostly lymphoblasts, age of onset younger than 15 years
- acute myelogenous leukemia: mostly myeloblasts, onset 15-39 years
- chronic myelogenous leukemia: mostly granulocytes in bone marrow, onset in 4th decade
- chronic lymphocytic leukemia: mostly lympocytes, onset after 50 years
symptoms
leukemia
- anorexia, fatigue, weakness, weight loss
- anemia (decreased hemoglobin/hematocrit) - palpitactions, tachycardia, orthostatic hypotension, pallor + dyspnea
- decreased platelet count - overt bleeding (nose/gums/rectal/hematuria), eccymoses + petechiae, prolonged bleeding
- elevated temp
- enlarged lymph nodes, spleen, liver
- headache
- bone pain/join swelling
- positive bone marrow biopsy
what is it
hodgkin’s lymphoma
abnormal proliferation of lymphocytes + malignancy of lymph nodes (usually involves lymph nodes, tonsils, spleen, bone marrow)
multile myeloma
malignant proliferation of plasma cells in bone (invade bone marrow + destroy bone)
- decreased production of immiunoglobulin + antibodies, increased uric acid + calcium (can lead to kidneyy failure)
cervical cancer treatments
- laser therapy: vaporizes tissues
- cyrosurgery: freezing tissues
- conization: cone-shaped area of cervix is removed
- hysterectomy
- pelvic exenteration: removal of all pelvic contents (bowel, vagina, bladder) can be anterior/posterior/total, ileal conduit/colostomy may be needed
risk factors
breast cancer
- greater than 65 year
- family history
- early menarche, late menopause
- previous breast/uterus/ovary cancer
- nulliparity (no children)
- late first birth
- oral contraceptie use
- hormone replacement therapy
- obersity
risk factors
endometrial/uterine cancer
- estrogen replacement therapy
- birth control pills
- IUD
- nulliparity
- polycystic ovary disease/endometrial hyperplasia
- increased age
- early menarche/late menopause
- family history
- obestiy
- hypertension
- diabetes mellitus
risk factors
lung cancer
- exposure to cigarette smoke
- exposure to environmental/occupational pollutants
what is it
contiuous bladder irrigation
three way irrigation is used to decrease bleeding + prevent clots (3 lumens, for balloon inflation + instillation + outflow)
interventions:
- urine must be kept pink, run rapidly if bright red/clots
- if obstructed turn off CBI + irrigate with normal saline
oncological emergencies
- sepsis - cancer at increases risk for infection + disseminated intravascular coagulation (can progress to hemorrhage)
- syndrome of inappropriate ADH - tumors can secrete substances that mimic ADH (serum sodium levels decrease)
- spinal cord compression - tumor enters spinal cord, vertebral column can collapse
- hypercalcemia - from bone releasing calcium into bloodstream with metastasis
- superior vena cava syndrome - vena cava is compressed by tumor
- tumor lysis syndrome - large quantities of tumor cells are destroyed rapidly, potassium + uric acid are released faster than the body can eliminate them (can lead to acute kidney injury)
- anemia - blood lacks healthy RBCs/hemoglobin (blood loss/faulty RBC production/RBC destruction)
- iron-deficiency anemia: iron stores are depleted for hemoglobin manufacturing
- vit b12 deficiency anemia: macrocytic anemia (RBCs too big), lack of intrinsic factor (secreted by gastric mucosa) needed for vit b12 absorption in intestines
- folate-deficiency anemia: macrocytic anemia, RBCs too big + oval
- aplastic anemia: deficiency of circulating erythrocytes
- pancytopenia - deficiency of RBCs, leukocytes, thrombocytes
antineoplastic meds (chemo)
kill/inhibit neoplastic cell reproduction, can be cell cycle phase specific meds (only affects cells during specific phase of reproduction cycle) or cell cycle phase nonspecific (works whenever)
alkylating meds
break DNA helix (interfere with DNA replication)
nonspecific cell cycle phase
antitumor antibiotic meds
interfere with DNA + RNA synthesis
nonspecific
antimetabolite meds
halt synthesis of cell protein = no cell division
cycle specific - S phase
mitotic inhibitor meds
no mitosis = dead cell
cell cycle phase specific - M phase
topoisomerase inhibitor meds
block enzyme needed for DNA synthesis + cell division
cycle specific - G2 + S phase
hormonal meds + enzymes
suppress immune system + block normal hormones for hormone sensitive tumors, change hormonal balance + slow growth of certain tumors
immunomodulator meds
stimulate immune system to recognize cancer cells + destroy them
targeted therapy meds
monoclonal antibodies + small molecular inhibitors that target a cellular element of the cancer cell or antisense meds that work at gene level
