Oncology Part 3 Flashcards by Christina Stafstrom

uncontrollable growth of WBC (immature/blasts) in bone marrow

leukemia

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describe leukemia

overcrowding of immature, nonfunctioning cells in bone marrow (decrease in normal production)

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what are the types of leukemia

acute, chronic, lymphocytic, myelocytic

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immature cell

blast

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describe acute leukemia

immature cells

no function

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most common acute in adults

AML

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10% adult onset
common in kids
Philadelphia chromosome

ALL

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sudden onset, short duration
progress to death without intervention
S/S within weeks

ALL

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what is the major cause of death in leukemia pts

INFECTION- gram bacteria are most common problem

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s/s of acute leukemia

*vague overall symptoms
cardiovascular
respiratory
bleeding
wt loss, nausea
organ enlargement

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20% of adult onset

insidious onset

CML

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phases of CML

1) slow progressing (10% blast)
2) accelerated (10-30% blast): spleen enlarges, fever, wt loss (6-12 mos)
3) blast (30% blast) spread to other tissue

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this type of leukemia RARE
> 50 yo
survival time= <19 mo for advanced
vague symptoms

CLL

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phases in acute drug treatment

induction, consolidation, maintenance

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induction stage of acute drug treatment

aggressive chemo
causes severe bone marrow suppression (kill ALL cells)
s/s of chemo
2-3 wks then look at ANC levels (how susceptible to infection)

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consolidation stage of acute drug treatment

course of same or different drug to put in remission

GOAL=decrease in blast cells (CURE)

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maintenance stage of acute drug treatment

months-years (maintain remission)

low dose chemo as needed

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lab tests for leukemia

bone marrow biopsy to identify an increase blast and immature cells
antigens on cells mark type of leukemia
Hb and HCT decrease
platelet count decrease
WBC normal or increase

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WBC count in leukemia pt if cells are mature

decrease

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chronic drug therapy for leukemia

don’t need to know

just watch and wait

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describe bone marrow transplant

pt gets new bone marrow
kill existing marrow, attempt to reset
HSCT
*treatment for leukemia pt

where does bone marrow come from in a transplant

allogenic-matched donor HLA
autogoes- own stem cells
syngenic-identical sibling

what is HSCT

hematopoietic stem cell transplant

phases of bone marrow transplant

1) obtain stem cells
2) conditioning
3) transplantation
4) engraftment

describe conditioning phase

wipe out additional cells void of immune system NEED transplant or die of infection

describe transplantation

day 0 infused through central line s/s: fever, HTN

describe engraftment

successful take 12-28 days for bone marrow to take **want ANC >500 ONLY donor cells present

what does oma mean

tumor

BMT complications

infection, bleeding failure to engraft VOD GVHD

what is VOD

veno occlusive disease blocks liver blood vessels by clotting/inflammation 20% of pts develop this

what is GVHD

graft vs host disease graft cells attack host cells of skin, GI tract, and liver visible side effects (NOT DEATH) *means body is reacting to transplant

describe multiple myeloma

- bone disease - WBC cancer that involves either B or T cells - overproduce antibodies-become ineffective

multiple myeloma is cancer of what

- plasma cells that fight infection | - produce cytokines that cause bone destruction

elevated paraprotein and plasma cells uncommon NOT good prognosis

multiple myeloma

describe malignant lymphomas

cancers of lymphoid tissue SOLID TUMOR (clumped up lymph cells) PAINLESS growth/lump

types of malignant lymphomas

Hodgkins (HL) | Non-Hodgkins (NHL)

describe HL

``` treatable external radiation Reed Sternberg cell confined to lymph nodes orderly to progression ```

describe NHL

``` more difficult to treat chemo, radiation travels no Reed S non orderly progression classified as B or T cells ```

more common in transplant and HIV patients | nodes are in GI, skin, bone marrow, sinuses, thyroid

NHL

what do you treat NHL with

chemo, radiation, antibodies, stem cell transplants and vaccine therapy

clinical symptoms of malignant lymphomas

large, painless lymph nodes begin on neck fever, night sweats, wt loss

diagnosis of malignant lymphomas

biopsy of lymph nodes | staging= PET and CT scan

what is Hb and normal levels

hemoglobin | 12.1-17.2 g/dL

what is the key to remember for sickle cell disease pts

PREVENT crisis

describe sickle cell disease

- hereditary disorder (genetic) - affects African American pts most - leads to chronic anemia - pain, disability, organ damage

what are you at risk for if sickle cell disease

increase risk for infection

what is different in sickle cell disease

beta cell chains (HbS) | HbS make up about 40% of blood

describe HbS in sickle cell pts

sensitive to low Oz content of RBC this causes cells to pile together, become sticky, rigid and clump together FRAGILE

HbS cause what

poor blood flow | clumping up ALL over body (not just one area)

what is the big sign of sickle cell crisis

*diffuse widespread PAIN | crisis or vasocclusive event

what can occur if sickle cell crisis or vasocclusive event occur often

can cause organ damage, muscle destruction | *long term management is VITAL

how long do HbS cells live

12-15 days