oncology review Flashcards
cancer is the ___ leading cause of mortality in the US
2nd
neoplasia
any new or continued cell growth that occurs which is not necessary for normal development and replacement cells
characteristics of malignant cells
demonstrate rapid cell division show anaplastic morphology have a large nuclear cytoplasmic ratio lose some or all differentiated functions adhere loosely together able to migrate grow by invasion are not contact inhibited
MALIGNANT vs benign tumors
rapid growth not encapsulated irregular shape poorly differentiated cells recurrence is common harmful variable prognosis
malignant vs BENIGN tumors
slow growth encapsulated round shape differentiated cells recurrence is unusual less harmful good prognosis
intrinsic risk factors for cancer
immune function (ie HIV)
age (the single most significant risk factor for cancer)
genetic predisposition
extrinsic risk factors for cancer
chemical carcinogens
physical carcinogens (radiation exposure-ionizing and UV)
viruses (oncoviruses-HBV & liver)
Dietary factors (excessive animal fats, red meats, nitrates, alcohol)
Reducing risk factors
adopt a physically active lifestyle maintain a healthful weight and diet avoid tobacco products wear sunscreen avoid environmental exposures; asbestos, pesticides, etc
7 warning signs of cancer
change in bowel/bladder habits a sore that does not heal unusual bleeding/discharge from body or orifice thickening/lump in breast ingestion/difficulty swallowing obvious change in wart/mole nagging cough/hoarseness
normal cell cycle
mitotic phase gap 1 interphase s phase gap 2 gap 0
mitotic phase
cell divides into 2 identical cells
gap 1 interphase
from end of mitosis to beginning of DNA synthesis “active state” RNA/Protein synthesis
S phase
synthesis of DNA
Gap 2
premitotic phase, end of DNA synthesis
Gap 0
quiescent phase or resting phase
initiation
mutation occurs causing irreversible damage (carcinogen-chemicals, viruses, radiation)
promotion
promote or enhance; initiates cell growth, repeated exposure (smoking)
progression
uncontrolled growth of cancer growth, need for TAF (tumor angiogenesis factor)
metastasis
cancer cells move from their original location and establish remote colonies (cancer still named after primary site of invasion)
routes for metastatic spread
direct invasion
local seeding
blood borne metastasis
lymphatic spread
local seeding
distribution of shed cancer cells in local are of primary tumor
blood borne metastasis
most common route of spread; tumor cells are released into the blood and travel
lymphatic spread
primary site that has many lymph nodes proximal to tumor, tumor cells are released into the lymphatic system and spread
grading
rates tumor cells according to cellular characteristic (G1-G4)
Staging
TNM determines cancers location and degree of metastasis at diagnosis for treatment and diagnostic purposes
current cancer treatments
surgery radiation therapy chemotherapy hormone therapy immunotherapy/biotherapy
goals of treatment
cure/control
adjuvant
palliative
cure/control
removal of all cancer from the body - varies for different cancers
adjuvant
treatment administered in conjunction with other treatment with the goal of destroying micro-metastasis
palliative
relieving symptoms
considerations for treatment
type of tumor
location of tumor
rate of growth
stage, size, metastasis
criteria for radiation
- must be rapidly dividing
- tissue of origination must be sensitive
- degree of cell differentiation, rate of mitosis, degree of oxygenation/vascularization are all considered
- used for primary, adjuvant, or palliative therapy
types of radiation
internal (brachytherapy, radiopharmaceutical)
external beam
brachytherapy
(implants) uses sealed sources to place radioactive material close to tumor for 1-3 days (prostate, cervical, breast cancers)
radiopharmaceutical therapy
radioactive material is given by injection or ingestion (thyroid cancers)
external beam
initial stimulation (placement of tattoo/dye markings)
session take about 30 minutes
usually given in daily “fractions” based on the phase of cells
side effects of radiation
(often dependent on the site of radiation) fatigue GI reactions myelosuppression alopecia respiratory complications sexual problems skin (limited to tissue directly exposed to radiation)
growth fraction
chemotherapy
ratio of cells in growth vs resting
increased percentage of cells in growth phase
high growth fraction
chemo is generally more toxic to tissue that have a high growth fraction
solid tumors
chemotherapy
generally have a low growth fraction
disseminated cancer
generally have a high growth fraction
tissues with high growth fraction
bone marrow
hair follicles
GI Epithelium
Sperm forming cells
effects of chemotherapy on hair follicles
alopecia
effects of chemotherapy on GI epithelium
n/v, anorexia, diarrhea, stomatitis (mouth inflammation)
effects of chemotherapy on sperm forming cells
decreased fertility
effects of chemotherapy on bone marrow
myelosuppression (depression of bone marrow which produces red blood cells)
meds to treat chemo causing n/v/diarrhea
antiemetics as ordered- zofran (ondansetron), anzemet (dolasetron)
also used: decadron (glucocorticoid), ativan (sedative), marino (marijuana)
myelosuppression affects
all cells
erythrocytes (anemia)
thrombocytes (thrombocytopenia)
leukocytes (leukopenia)
greatest effects of chemo
7-10 days following treatment (outpatient)
hospitalization for side effects not treatment of chemo
interventions for anemia
monitor Hgb, Hct,
transfuse if Hgb
Interventions for thrombocytopenia
Monitor thrombocytes 150,000 to 400,000
Transfuse platelets less than 10,000 to 20,000
Monitor for bleeding (gums, epistaxis, hematuria, melena, spontaneous bruising, ecchymosis)
Avoid injections (apply pressure if injection is given)
Avoid rectal temps/trauma
Interventions for leukopenia
Monitor wbc’s 5000 to 10,000
Determine ANC = absolute neutrophil count
ANC= WBC x %Neutrophils + %Bands/100
Neutropenic precautions
Initiate precautions for ANC less than 1000
Private room keep door closed
Restrict visitors (no kids less than 12, Persons with cold, URIs etc)
Meticulous hand washing
Monitor temp Q4 hours
Notify Dr. for a temp greater than 101
Avoid rectal temps, exams, or enemas
Teach patients not to floss
Inspect orifices or signs of breakdown or superinfection
Management of oral candidiasis (thrush)
Medications include Diflucan (fluconazole), Mycostatin (nystatin), baking soda rinses or saline rinses
Biologic therapy
Agents that alters the response of the host to the tumor cells; example into look into stimulates T and B cells and activate NK cells
