Oncology Nursing

Question 1

What is cancer?

Answer 1

Malignant neoplasms
More than 100 different types of cancers
Refers to diseases where abnormal cells divide without control + are able to invade other tissues

Question 2

What are cancer cells derived from?

Answer 2

They are derived from normal cells that have undergone neoplastic transformation
This is an irreversible process leading to transformation of healthy cell to cancer cell

Question 3

What are the two characteristics of cancer cells?

Answer 3

Uncontrolled proliferation + uncontrolled spread

Question 4

What is the growth fraction of tumour cells

Answer 4

The ratio of the total number of cells to the number of dividing cells
So; the ↑ the growth fraction the more rapidly tumour mass ↑

Question 5

What is doubling time of tumour cells?

Answer 5

The time taken for the tumour to double its volume
Average time for solid tumours being 2-3 months

Question 6

When are tumours clinically detectable?

Answer 6

When they have doubled around 30 times
About 1 Cm in size + 1 gram in weight

Question 7

What is the Gompertzian Tumour Growth Curve?

Answer 7

Describes the decrease in cell doubling time as tumour progression occurs
Useful in describing tumour response to treatments

Question 8

what is metastasis?

Answer 8

Cancer cells invade lymph nodes + blood vessels near a tumour + spread to other parts of the body
Cancer cells have the capacity to intravasate and extravasated, or enter and leave the circulatory + lymphatic systems

Question 9

Describe the metastatic cascade

Answer 9

Tumour initiation → progression of primary tumour → proliferation → cells detach + enter the bloodstream or lymphatic system → successfully evade immune system → invasion / intravasation → extravasation → angiogenesis → colony formation

Question 10

What is clinical distress related to?

Answer 10

Disease status, treatment to.seance, symptom intensity and frequency, lifestyle effects of symptom intensity and frequency, quality of life,

Question 11

Examples of psychosocial problems in cancer patients and family

Answer 11

Adjustment to illness and changes in care, feeling isolated from family, family conflict , decreased quality of life, decisions around advanced care directives, abuse/ neglect, coping difficulties (overwhelmed, irritable and angry, inability to cope with pain, fatigue and nausea), mental health issues, disturbances in body image, sexual problems

Question 12

Treatments for psychosocial problems

Answer 12

Education materials, support and education groups, resource lists, community resources, relationship counselling, grief counselling
Patient counselling, psychotherapy, medication, community responses

Question 13

Examples of practical problems

Answer 13

Transportation issues and parking costs, financial issues, school problems, food/ clothing problems

Question 14

Treatments for practical problems

Answer 14

Education, support groups, counselling for patients and family

Question 15

Describe supportive care

Answer 15

Facilitating a patient or family with the necessary services that they require to meet their physical, social, emotional, informational, psychological, spiritual and practical needs during the journey of a cancer patient

Question 16

Risk factors that increase the likelihood of heightened emotional distress

Answer 16

Being very old or very young, being single, separated, widowed, female, having children younger than 21, past psychiatric treatment, having cognitive impairment

Question 17

What is involved in screening + triage of a cancer patients + families journey

Answer 17

Adequate level of care for level of distress of family + pt
Referral to services required by pt
Education, peer support, counselling

Question 18

What are the key principles of supportive care?

Answer 18

Person centred, system wide + team approach, developing + supporting the workforce to improve their ability to respond to the needs of cancer patients, focus on quality of care by providing evidence based protocols etc, population based planning to identify needs of population

Question 19

Barriers to the delivery of psychosocial care

Answer 19

Do not have access to care (geographically), lack health insurance / coverage that includes mental Health Services, do not ask for help due to stigma, patient-provider miscommunication, inexperience, poor coordination of complex care

Question 20

What are oncogenes?

Answer 20

The mutated form of proto-oncogenes, which are the normal growth promoting genes (growth factor, cell survival genes, cell cycle controlling genes)
They become oncogenes when inappropriately activated by mutations in themselves or other genes controlling them
When mutation occurs, the resulting oncogene causes excessive production of growth factors responsible for tumourorigenesis

Question 21

What are some mediators of cell growth?

Answer 21

PDGF - platelet derived growth factor = one of the numerous proteins that regulate cell growth and division
EGF- epidermal growth factors = protein with 53 amino acid residues and 3 intramolecular disulphide bonds, plays role in cell growth and proliferation
TGF - transforming growth factor = role in tissue development, cell differentiation, embryonic development
VEGF - vascular endothelial growth factor = signal protein involved in angiogenesis

Question 22

what are some tumour suppressor genes?

Answer 22

Function by encoding proteins that block growth promoting proteins, when function is lost uncontrolled growth occurs, so when mutation occurs in tumour suppressor gene, the cell loses its switch off and the cell growth continues with a cease, most common one is in the p53 gene

Question 23

What are the staging systems of cancer diagnosis?

Answer 23

TNM
T- tumour = size and extent of primary tumour
N - nodes = number of nearby lymph nodes that contain cancer cells
M - metastasis = spread to other sites

Question 24

Describe breast screen

Answer 24

Women aged over 40 (focus 50-69)

Question 25

What is the forefront concept in providing exemplary cancer care?

Answer 25

Multidisciplinary care - focuses on continuity of care, development of care pathway and referral networks, and involving the multidisciplinary team at all stages of care

Question 26

What are the benefits of having multidisciplinary meetings?

Answer 26

Clinician benefits through positive outcomes because of improved communication, education + cooperation, patient benefits as they know their treatment providers are working as a team

Question 27

Chemotherapy side effects

Answer 27

Fatigue, nausea, vomiting, pain or soreness, sores in throat or mouth, changes to skin (itch, red, dry, acne), diarrhoea, constipation, weight gain / loss, hair loss, change to libido, change to concentration + memory, emotional changes, blood cell disorders ( result in anaemia, dizziness, SOB, ↑ risk infection, effects on nervous system ( tingling, burning)

Question 28

Side effects of radiotherapy

Answer 28

Skin problems (dryness, itch, peeling, blistering), fatigue Other potential side effects depend on where radiation is given: Head / neck → dental problems Chest → stiffness Stomach + belly → nausea, vomit, diarrhoea Pelvis → diarrhoea, urination problems, reproductive problems

Question 29

What is the order of cancer treatment?

Answer 29

Neo-adjuvant treatment → all treatments that are administered before primary cancer treatment ( eg radiotherapy/chemo before surgery) Adjuvant treatment → therapy administered after primary treatment ( eg chemo administered after radiation)

Question 30

What is the goal of multimodal treatment approach to cancer treatment?

Answer 30

Increase effectiveness of treatment whilst minimising the adverse effect of primary treatment

Question 31

What is chemotherapy?

Answer 31

Targets rapidly dividing cells, works by interfering with the process of DNA replication or by damaging DNA so the cell must undergo apoptosis It cannot distinguish between normal + malignant cells

Question 32

What is the cell kill hypothesis?

Answer 32

States that a chemo concentration given for a defined period of time kills a constant fraction of cells in the population, independent of the number of cells Therefore repeated doses must be administered to reduce size of tumour This fractional killing is due to the cell-cycle specificity of chemo

Question 33

Classifications of chemo according to cell cycle activity

Answer 33

Cell cycle specific → agents act on cells in a specific phase, most effective against rapidly growing cancer Cell cycle non-specific → agents act on cells no matter what phase of cell cycle they are in, because they are in effect in resting phase (G0) they are effective against slow growing tumours + rapidly dividing tumours

Question 34

Why is chemo given in cycles?

Answer 34

Gives normal cells time to recover between doses

Question 35

What occurs due to bone marrow suppression?

Answer 35

Anaemia ( low RBC count) → less oxygen carried around body, pt becomes fatigued, SOB, tachycardia + anaemic Lencapenia ( low white blood cell count) → WBC fight infection so pt can become immunocompromised Thrombocytopenia (low platelet count) → function of platelets to maintain homeostasis, pt at risk of bruising + bleeding

Question 36

What is radiation therapy?

Answer 36

Uses ionising radiation to destroy or deactivate cancer cells, while attempting to preserve the integrity of normal tissue Ionising radiation kills by damaging the nucleus of cells which in turn damages DNA synthesis → causes cells to lose their ability to reproduce

Question 37

Side effects of radiotherapy

Answer 37

Depend on area being treated, volume of tissue, fractionation + total dose, type of radiation, health + age of individual Risk of fatigue + skin reactions

Question 38

What is internal radiotherapy ?

Answer 38

Gives radiation from inside the body, delivers high dose of radiation with fewer side effects than external radiotherapy

Question 39

What is external radiotherapy?

Answer 39

A beam of radiation is pointed at a specific part of the body and radiation is applied to that part of the body/from the outside, does not make a person radioactive

Question 40

What are the 5 ontological emergencies that patients are at risk of developing

Answer 40

Neutropenia sepsis Spinal cord compression Tumour lysis syndrome Superior vena cava obstruction Hyperglycaemia

Question 41

What is superior vena cava obstruction / syndrome

Answer 41

Causes: bronchogenic carcinoma, small cell lung cancer, squamous cell lung cancer, lymphoma Symptoms: facial oedema, periorbital oedema, distension of veins in head + neck + chest, headache Risk increased by CVC insit, previous radiotherapy to mediastinum

Question 42

What is spinal cord compression?

Answer 42

Usually caused by malignant tumour in epidural space Usually associated with breast, lung, GI, renal tumours + melanoma Symptoms: intense, localised back pain, vertebral tenderness, motor weakness / dysfunction, paraesthesia, autonomic dlysfunctor

Question 43

What is tumour lysis syndrome?

Answer 43

Large tumours that are rapidly growing, their intercellular contents(K DNA etc) released due to cellular breakdown which leads to hyperuricemia, hype-phosphatemia, hypercalcemia + hyperkalemia Symptoms → weakness, muscle cramps, diarrhoea, nausea + vomiting Prophylaxis → aggressive hydration , strict FBC to maintain renal function, allopurinol administration ( reduce uric acid crystallisation), blood + urine monitoring If TLS + allopurinol replaced with rasburicase

Question 44

What is hypercalaemia?

Answer 44

Caused by metastatic bone disease, multiple myeloma or parathyroid hormone like substance secreted by cancer cells Symptoms → apathy, fatigue, muscle weakness, ECG changes, polyuria + nocturia , anorexia, nausea + vomit Treat → hydration + bisphosphonates

Question 45

What is neutropenic sepsis?

Answer 45

Most common oncological emergency + leading cause of acute deterioration Neutrophils → type of granular WBC, vulnerable to cytotoxic agents With out enough neutrophils pt are susceptible to infection + severity of sepsis Every hour the pt remains untreated = higher mortality rate

Question 46

How to respond to an oncological emergency

Answer 46

Nurse in single room Recognise deterioration → pt assessment React / respond → early intervention, MET call, antibiotics, fluid resus, investigation (blood, CXR MSU) Review → frequent monitoring