Oncology Part 3 Flashcards
uncontrollable growth of WBC (immature/blasts) in bone marrow
leukemia
describe leukemia
overcrowding of immature, nonfunctioning cells in bone marrow (decrease in normal production)
what are the types of leukemia
acute, chronic, lymphocytic, myelocytic
immature cell
blast
describe acute leukemia
immature cells
no function
most common acute in adults
AML
10% adult onset
common in kids
Philadelphia chromosome
ALL
sudden onset, short duration
progress to death without intervention
S/S within weeks
ALL
what is the major cause of death in leukemia pts
INFECTION- gram bacteria are most common problem
s/s of acute leukemia
*vague overall symptoms cardiovascular respiratory bleeding wt loss, nausea organ enlargement
20% of adult onset
insidious onset
CML
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
this type of leukemia RARE
> 50 yo
survival time= <19 mo for advanced
vague symptoms
CLL
phases in acute drug treatment
induction, consolidation, maintenance
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)
consolidation stage of acute drug treatment
course of same or different drug to put in remission
GOAL=decrease in blast cells (CURE)
maintenance stage of acute drug treatment
months-years (maintain remission)
low dose chemo as needed
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
WBC count in leukemia pt if cells are mature
decrease
chronic drug therapy for leukemia
don’t need to know
just watch and wait
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
