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RAD 390 - Radiation Therapy Oncology Nursing > Quiz 3 > Flashcards

Quiz 3 Flashcards

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1
Q

Most common cancer in women, 1 in 8 women will get this
29-30% of new cancers in women
2017: 255,180 new cases (over 252,000 females, 24-2,500 males)
African American women more likely to present with regional/distant disease than white women
Family member with bilateral disease or diagnosed premenopause increases risk
Left most common
Treated with tangents, IMRT, or hybrid of both; usually chemo first
Stop using birth control
Rare to other breast (mets 0.5-1%) but 1-2 times more likely to develop new tumor in contralateral breast
Ovaries, spleen, and stomach
TNM staging

A

Breast cancer

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2
Q

10 risk factors of breast cancer

A

Gender: female increases risk
Early menarche
Increased age of birth of first child
Late menopause over 50-55 years old
Use of exogenous hormones: birth control increases risk with prolonged use over 5 years
History of atypical hyperplasia
Family history
Radiation exposure: avoid wedge because of scatter
Increasing age and history of breast cancer
Obesity/high fatty diets: fat cells produce estrogen

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3
Q

Menarche

A

Menstration

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4
Q

Benign breast disease proliferates and turn malignant

A

Atypical hyperplasia

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5
Q

___-___% of breast cancer occurs from altered genes
BRCA 1 & 2 mutations account for ___-___% of breast cancer
1 first degree relative with disease increases risk, 2 _______ risk

A

5-10%
5-6%
Triples

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6
Q

Protein promotes growth of breast cancer, 1 in 5 cancers have this more aggressive mutation

A

Human epidermal growth factor receptor 2 (HER2)

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7
Q

6 signs and symptoms of breast cancer

A

Most common sign of early benign disease: non-painful, mobile mass; malignant: firm, nontender, irregular, non-movable and fixed mass
Skin dimpling
Nipple retraction
Erythema coincides with peau d’orange
Nipple discharge
Enlarged axillary/supraclavicular (scv) LN

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8
Q

Dimpling on the skin commonly mistaken as infection, 50% have lump or mass
Clinical/pathological diagnosis, can be lymphatic

A

Peau d’orange/inflammatory

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9
Q 
Upper outer breast cancer = \_\_\_%
Upper inner = \_\_\_%
Central = \_\_\_%
Lower outer = \_\_\_%
Lower inner = \_\_\_%
A 
Upper outer breast cancer = 50%
Upper inner = 15%
Central = 17%
Lower outer = 11%
Lower inner = 6%
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10
Q

7 diagnostic methods for breast cancer

A 
Mammogram
Biopsy: fine needle; guided biopsy (mammotome/stereotactic biopsy) for deep tumor
Breast self examinations (BSE)
Clinical self exam (CBE)
Digital radiography
MRI defines extent of disease
PET for staging
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11
Q

When is it recommended for patients 40-44 years old, 45-54 years old, and 55 or older to get a mammogram?

A

40-44: patient’s choice
45-54: yearly
55: every 2 years

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12
Q

Excision of tumor with small margin of normal tissue around it; with LN dissection and RT, gets as good a result as mastectomy
Excisional, remove mass in breast

A

Lumpectomy

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13
Q

Median age of diagnosis of breast cancer

A

61

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14
Q

8 histologic types of breast cancers

A 
Invasive/infiltrating ductal
Infiltrating lobular
Medullary: 5-7%
Tubular
Mucinous
Comedo
Paget's disease
Inflammatory/peau d'orange
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15
Q

70-80% of breast cancers; in ducts

Squamous, angiosarcoma, etc.

A

Invasive/infiltrating ductal

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16
Q

10-15% of breast cancers, second most common in glands that secrete milk

A

Infiltrating lobular

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17
Q

Uncommon disease of nipple

A

Paget’s disease

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18
Q

Average doubling time of breast cancer

A

60-90 days, but can be as fast as 15 days or up to 600 days

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19
Q

LN involvement in ___-___% of breast cancers

A

40-60%

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20
Q

Lateral lesions usually go to _______ or _______ LNs

Medial lesions usually go to _______, _______, or _______ LNs

A

Lateral lesions usually go to axillary or supraclavicular LNs
Medial lesions usually go to internal mammary, mediastinal, or supraclavicular LNs

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21
Q

Biopsy first LNs that receive drainage from tumor; if disease present, complete biopsy

A

Sentinel node biopsy

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22
Q

5 year survival of stage 1, 2, 3, and 4 breast cancer

A

1: 99%
2: 84%
3: 65%
4: less than 26%

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23
Q

60% estrogen receptor (ER) status; slower-growing, better prognosis
Usually postmenopausal
Use tamoxifen

A

ER positive

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24
Q

Anti-estrogen therapy, 60% response rate for ER positive

Standard adjuvant therapy for ER positive patients

A

Tamoxifen

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25
Q

More aggressive, postmenopausal women

A

ER negative

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26
Q

More aggressive and dividing breast cancer

A

Elevated S phase

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27
Q

Malignant cellular proliferation has not extended through basement membrane into surrounding tissue

A

Carcinoma in situ for breast cancer

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28
Q

Examine DNA count/microscopic particles to see amount of DNA

A

Flow cytometry

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29
Q

Unusual number of chromosomes, more aggressive

A

Aneuploid

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30
Q

3 surgical options for breast cancer

A

Lumpectomy
Axillary node dissection
Modified radical mastectomy

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31
Q

Removes all breast tissue and axillary node dissection; remove breast, LNs, and sentinel node biopsy

A

Modified radical mastectomy

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32
Q

4 things post-mastectomy radiation is recommended for

A

Patients with tumors over 5 cm
Skin or chest involvement
Positive surgical margins
Over 4 positive LNs

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33
Q

Intact breast and removed breast typical dose

A

Intact: 4680 cGy and 1400 cGy boost = 6080 cGy
Removed: 5040 cGy and 1000 cGy = 6040 cGy (initial dose higher because we don’t have to worry about cosmesis)

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34
Q

Chemo given to patients before surgery, have locally advanced or inflammatory breast cancer
Get tumor shrinkage, node negative less than 1 cm

A

Neoadjuvant

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35
Q

Chemo given after primary treatment, recommended for all with positive LNs

A

Adjuvant

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36
Q

3 side effects of tamoxifen

A

Increase calcium bone uptake (decrease osteoporosis)
Decrease cholesterol and heart disease
Increase risk of uterine tumors

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37
Q

7 common chemo drugs for breast cancer

A 
Doxorubicin
Epirubicin
Paclitaxal
Docetaxal
5FU
Cyclophosphamide
Methotrexate
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38
Q

2 factors for breast cancer patients to receive bone marrow transplant (BMT), have shown prolonged survival but still investigational

A

No mets

4 or less positive LNs

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39
Q

8 common sites of breast cancer mets (most to least common)

A 
LN 40-76%
Bone 71%
Lung 69%
Liver 65%
Pleura 51%
Adrenals 49%
Skin 30%
Brain
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40
Q

5 labs for breast cancer

A 
CAAD
Elevated CA 15-3
Serum liver function studies
Bone scans
Chest x-ray
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41
Q

5 things patients and families can suffer from

A 
Depression
Impaired marital relationships
Lowered self-esteem
Developmental delays in children
Behavioral problems with adolescents
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42
Q

6% of all cancers, 8% of all cancer deaths
Third most common cancer for both genders, second leading cause of cancer deaths
Rate 50 times higher for people over 60-79 years old, environmental
Higher incidence in African Americans
Equal in men and women, rectal higher in men
Lower in people who have a lot of vegetables in diet, high fiber; 5 servings of fruit and vegetables a day
Direct extension most common, LN and blood, and implantation and seeding
Neoadjuvant chemo before surgery, 5FU radiosensitizes and enhances leucovorin

A

Colorectal cancer (CRC)

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43
Q

Median age of diagnosis of CRC

A

60-65 years old

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44
Q

Most common histology of CRC

A

Adenocarcinoma (90%) arises from constantly-secreting

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45
Q

65%, 25%, less than 10%, and less than 5% of anal cancers

A

65%: squamous
25%: transitional
Less than 10%: adenocarcinoma
Less than 5%: miscellaneous

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46
Q

9 contributing factors to CRC

A 
Alcohol, especially beer
Tobacco
History of colon cancer
Sedentary employment: inactive
GYN radiation
Inflammatory bowel disease (ex: Crohn's, etc.)
Polyposis
Family history
Irritation of anal canal
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47
Q

3 irritations of anal canal

A

Condyloma
Rectal intercourse
Fistulas, tears/fissures, abscesses, hemorrhoids, etc.

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48
Q

Anal warts

A

Condyloma

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49
Q

Grade identifies adenocarcinoma: ___% of disease is well-differentiated, ___% moderately differentiated, and ___% poorly differentiated

A

10% of disease is well-differentiated
70% moderately differentiated
20% poorly differentiated

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50
Q

5 year survival for stage I, II, IIIA-C, and IV CRC

A

I: 93%
II: 85%
IIIA-C: 83-44%
IV: 8%

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51
Q

6 signs and symptoms of right/ascending colon disease

A 
Abdominal pain
Melena
Weakness due to anemia, common
Obstruction uncommon
Palpable abdominal mass
Anorexia
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52
Q

Bleeding dark or mahogany red

A

Melena

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53
Q

3 signs and symptoms of transverse colon disease

A

Blood in stool
Change in bowel pattern
Potential bowel obstruction

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54
Q

12 signs and symptoms of left/descending colon disease

A 
Colicky pain
Bleeding red mixed with stool
Obstruction common
Weakness due to anemia, uncommon
Nausea and vomiting
Constipation alternating with diarrhea
Decreased caliber of stool
Tenesmus
Fatigue
Anorexia
Failure to thrive
Right upper quadrant (RUQ) pain (common hepatic duct leads to liver mets)
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55
Q

Caliber

A

Size

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56
Q

Feeling you have to go to the bathroom due to narrowing, ineffective and painful straining during a bowel movement (BM)

A

Tenesmus

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57
Q

9 signs and symptoms of rectal disease

A 
Steady pain
Bleeding bright red, coating stool
Change in bowel movements
Pencil stools
Rectal urgency
Fecal incontinence
Spasmodic contractions
Peineal and buttock pain
Tenesmus
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58
Q

4 signs and symptoms of anal disease

A

Bleeding
Pain
Sensation of a mass
Severe anal itching

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59
Q

6 signs and symptoms of CRC

A 
Change in bowel habitus
Blood in stool
Abdominal pain
Anorexia
Flatulence
Indigestion
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60
Q

3 late signs and symptoms of CRC

A

Weight loss
Fatigue
Decline in general health

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61
Q

CRC percent in descending and sigmoid, ascending, and transverse colon

A

Descending and sigmoid: 52%
Ascending: 32%
Transverse: 16%

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62
Q

Glycoprotein elevates with CRC

A

Carcinoembryonic antigen (CEA)

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63
Q

3 common sites of mets for colon

A

Liver: venous drainage through colon
Lungs
Peritoneum

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64
Q

Colon cancer goes through bowel wall and sheds into bowel cavity

A

Peritoneal seeding

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65
Q

Common mets site of rectal disease

A

Lung: venous drainage through hemorrhoidal veins

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66
Q

3 common sites of mets for anus

A

Liver
Lungs
Inguinal nodes

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67
Q

4 complications due to CRC

A

Bowel perforation
Obstruction of surrounding genitourinary organs
Hemorrhage
Liver failure

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68
Q

Start screening for CRC at ___ years old, high risk at ___-___ years

A

50

40-45

69
Q

6 ways CRC is diagnosed with no symptoms

A 
Fecal occult blood test (FOBT)
Fecal immunochemical test (FIT)
Flex sigmoidoscopy
Double contrast barium enema (BE)
Colonoscopy
Digital rectal examination (DRE)
70
Q

Sample for blood in stool at home in clean container and spread on card
False positives with red meat, iron, tomatoes, etc.; false negatives with low fiber diet 72 hours before test

A

Fecal occult blood test (FOBT)

71
Q

Sample for blood in stool at home with long-handled brush smeared on card, no dietary restrictions

A

Fecal immunochemical test (FIT)

72
Q

How often should FOBT and FIT, flex sigmoidoscopy, BE, and virtual CT, colonoscopy, and DRE be done?

A

FOBT and FIT: annually
Flex sigmoidoscopy, BE, and virtual CT: every 5 years
Colonoscopy: every 10 years
DRE: not recommended as only test

73
Q

6 diagnostic workups for CRC

A

H&P: palpate abdomen, breast, and rectum
CBC, liver function test, coagulation profile, CEA, etc.
Endoscopic examination: flex-sig, colonoscopy, biopsy
Transrectal ultrasound for staging
Double contrast BE (noninvasive)
Diagnostic studies: CT chest, abdomen, and pelvis; MRI for soft tissue of abdomen and pelvis

74
Q

4 ways high fiber diet protects colon

A

Decreasing transient time in intestine
Diluting carcinogens in stool
Altering pH in colon
Decreasing ammonia concentrations in intestine

75
Q

_______ is primary treatment of CRC, over _______ of patients can be cured with surgical resection

A

Surgery, half

76
Q

Treatment of choice for anal disease because of sphincter

A

Chemo and RT

77
Q

5 ways colostomy is managed

A

Clean the peristomal skin with soap and water, don’t submerge self down to stoma
Apply disposable pouch over the stoma
Empty the pouch when it’s 1/3 full of stool and/or flatus
Change the pouch every 4-7 days if there’s no leakage
Adequate fluids, no nuts or seeds, avoid beans, cabbage, and brussel sprouts (flatulence), avoid heavy lifting and pulling, etc.

78
Q

3 pre-op RT indications for CRC

A

Reduce bulky rectal cancers
Improve rate of resectability
Eradicate microscopic disease

79
Q

Advantage of pre-op RT for CRC

A

Better blood flow

80
Q

4 post-op RT indications for CRC

A

Prevent local recurrence in stage B or C rectal cancers
Remove remaining disease if positive surgical margins
Disease invades other organs
Palliatively to decrease painful mets or control bleeding

81
Q

About ___% of CRC patients require surgical colostomy, every patient after this surgery require colostomy to rest area

A

15%

82
Q

8 CRC related complications from RT

A 
Skin irritation: erythema, dry or moist desquamation, and hyperpigmentation
Proctitis
Nausea/vomiting
Diarrhea
Bone changes: obstruction, fibrosis, adhesions, and fistulas
Sexual dysfunction
Myelosuppression
Fatigue
83
Q

Inflammation of rectal lining

A

Proctitis

84
Q

Inflammation of bladder

A

Cystitis

85
Q

About ___% of CRC patients die of mets due to left behind disease, chemo important

A

50%

86
Q

2 CRC chemo regimens

A

FOLFOX

FOLFIRI

87
Q

FOLFOX

A

5FU, leucovorin, and oxaliplatin

88
Q

FOLFIRI

A

5FU, leucovorin, and irinotecan

89
Q

Secrete/produce hormones directly into the bloodstream for transport throughout the body

A

Endocrine glands

90
Q

Excessive secretion of hormones directly into the bloodstream for transport throughout the body
2017: 59250 new cases, 3010 deaths

A

Endocrine neoplasms

91
Q

6 common endocrine tumors

A 
Pituitary/master gland
Thyroid
Parathyroid
Adrenal glands: benign or malignant
Pancreatic/silent killer
Carcinoid: slow-growing, surgery is treatment of choice
92
Q

Four posterior to thyroid, controls calcium

A

Parathyroid

93
Q

Secretes large amounts of hormones but not endocrine gland, 90% in intestines
Slower growing but have mets potential
Arises from cells
Most common site: appendix

A

Carcinoid tumors

94
Q

7 hormones secreted by pituitary gland

A 
Growth
Prolactin
Thyroid stimulating
Follicle stimulating
Luteinizing
Melanocyte stimulating
Adrenocorticotropic
95
Q

Controls body growth

A

Growth hormone

96
Q

Initiates milk production

A

Prolactin

97
Q

Controls thyroid gland

A

Thyroid stimulating hormone

98
Q

Stimulates egg and sperm production

A

Follicle stimulating hormone

99
Q

Stimulates other sexual and reproductive activity

A

Luteinizing hormone

100
Q

Hormone that relates to skin pigmentation

A

Melanocyte stimulating hormone

101
Q

Influences the action of the adrenal cortex

A

Adrenocorticotropic hormone

102
Q

Cell that produces growth hormone and prolactin

A

Acidophils

103
Q

Cell that produces thyroid stimulating, follicle stimulating, luteinizing, melanocyte stimulating and adrenocorticotropic hormones

A

Basophils

104
Q

4 pituitary tumors

A

Growth hormone
Prolactinomas
Corticotropin (ACTH)-producing tumors
Gonadotropin-producing tumors

105
Q

2 syndromes with growth hormone tumors

A

Gigantism is kids

Acromegaly in adults

106
Q

Enlarged extremities and organs

A

Acromegaly

107
Q

3 syndromes with prolactinomas

A

Galactorrhea
Amenorrhea
Impotence

108
Q

Abnormal milk discharge, men and infants can develop milk

A

Galactorrhea

109
Q

Cessation of menstration

A

Amenorrhea

110
Q

Inability to get erection

A

Impotence

111
Q

Syndrome with corticotropin (ACTH)-producing tumors

A

Cushings disease

112
Q

10 clinical features of cushings disease

A 
Central obesity
Facial plethora
Moon face
Buffalo hump
Purple striae
Easy bruising
Muscle weakness
Emotional lability
Hypertension
Diabetes mellitus
113
Q

Oversecretion of cortisol

A

Corticotropin (ACTH)-producing tumors

114
Q

Stress hormone

A

Cortisol

115
Q

Excessive abdominal fat around center of body/stomach area

A

Central obesity

116
Q

Excess of blood in face

A

Facial plethora

117
Q

Face develops rounded appearance due to fat deposits on side of face

A

Moon face

118
Q

Excess deposit of fat localized on the back of the neck

A

Buffalo hump

119
Q

“Stretch marks”

A

Purple striae

120
Q

Rapidly changing mood

A

Emotional lability

121
Q

High blood pressure (BP)

A

Hypertension

122
Q

Body’s ability to produce or respond to insulin reduced

A

Diabetes mellitus

123
Q

Syndrome with gonadotropin-producing tumors
Reduction of absence of hormone secretion or other physiological activity of the gonads (testes or ovaries), don’t have enough sex hormone to testes or ovaries

A

Hypogonadism

124
Q

Usually benign histologically and rarely metastasize
Can invade local structures such as optic nerves, cavernous sinus, CNS, cervical LNs, liver, and bone
Severe headaches, visual defects, vascular thrombosis, and hydrocephalus
Surgery treatment of choice, incision through nose/sphenoid bone; large invasive tumors: surgery and radiation (SRS)
Prolactinomas: medications

A

Pituitary tumor

125
Q

7 primary tumors that metastasize to pituitary

A 
Breast
Lung
Kidney
Prostate
Liver
Pancreas
Nasopharynx
126
Q

2 types of thyroid cancers

A

Follicular cells

Parafollicular cells

127
Q

Synthesize thyroid hormones

A

Follicular cells

128
Q

3 histologies of follicular cell tumors

A

Papillary 70%
Follicular 15%
Anaplastic 0.5-1.5%

129
Q

Produce calcitonin for calcium and bone metabolism

Medullary carcinomas develop from these cells, 5-8%

A

Parafollicular cells

130
Q

Painless thyroid mass
Diagnosis: fine-needle aspiration biopsy
Good prognosis
2017: 56870 new cases, 2010 deaths

A

Thyroid cancers

131
Q

4 symptoms that suggest thyroid tumor is malignant

A

Size greater than 3 cm
Rock-hard consistency
Lymphadenopathy
Hoarseness due to vocal cord paralysis

132
Q

Papillary and follicular cure rate and 10 year survival and medullary 10 year survival

A

Papillary: cure rate over 90%, 95% 10 year survival
Follicular: cure rate over 90%, 90% 10 year survival
Medullary: 75% 10 year survival

133
Q

More invasive follicular disease, loss of differentiation

Patients die within 6 months-1 year of diagnosis

A

Anaplastic

134
Q

Treatment for papillary and follicular thyroid disease

A

Near total thyroidectomy and daily suppression therapy; I131 treatment, stop L-thyroxine (LT4) 4-6 weeks before
LT4

135
Q

Thyroid hormone replacement

A

L-thyroxine (LT4)

136
Q

Treatment for medullary thyroid carcinoma

A

Total thyroidectomy and suppression therapy

137
Q

Treatment for anaplastic thyroid carcinoma

A

Total thyroidectomy, suppression therapy, and sometimes EBRT and doxorubicin chemo

138
Q

Neck mass with lymphadenopathy, hypercalcemia
Elevated levels of parathyroid hormone (PTH), need tissue sample to confirm
Treat with aggressive neck dissection, chemo and RT rarely help

A

Parathyroid carcinoma

139
Q

5 and 10 year survival of parathyroid carcinoma

A

5: 88%
10: 49%

140
Q

2 parts of adrenal gland

A

Adrenal cortex

Adrenal medulla

141
Q

Outer part of adrenal gland that produces steroid hormones

Tumors produce excessive cortisol, testosterone, and aldosterone; large amounts of cortisol leads to cushings

A

Adrenal cortex

142
Q

Inner part of adrenal gland that makes catecholamines

A

Adrenal medulla

143
Q

Controls potassium and sodium in blood

A

Aldosterone

144
Q

Manifestations of adrenal tumors if producing aldosterone (2), androgen (2), pheochromocytomas (4), and nonsecreting tumors (2)

A

Aldosterone: hypertension and hypokalemia
Androgen: virilization in women, asymptomatic in men
Pheochromocytomas: hypertension, sweating, palpitations, and irregular heartbeat
Nonsecreting: pain or weight loss

145
Q

Deficiency of potassium in blood

A

Hypokalemia

146
Q

Masculine secondary sex; changes: deep voice, balding, facial hair, etc.

A

Virilization

147
Q

2 treatments of adrenal tumors

A

Surgery for nearly all hormone secreted tumors and nonsecreting tumors over 6 cm; good prognosis for benign tumors, better in younger patients and smaller localized disease: complete resection and nonfunctioning/nonsecreting
Chemo with mitotane (adrenal hormone) in malignant tumors, RT not effective

148
Q

5 year survival for stage 1 & 2, 3, and 4 adrenal tumors

A

1 & 2: 65%

3: 40%
4: 10%

149
Q

Endocrine system cells

A

Islet

150
Q

Digestive enzymes

A

Exocrine

151
Q

3 hormones produced by pancreas

A

Insulin
Glucagon
Somatostatin

152
Q

Causes body to take up glucose/sugar

A

Insulin

153
Q

Liver converts glycogen to glucose

A

Glucagon

154
Q

Controls release of insulin/glucagon

A

Somatostatin

155
Q

3 common types of pancreatic islet tumors

A

Gastrinoma
Insulinoma
Glucagonoma

156
Q

Islet tumor that produces gastrin

A

Gastrinoma

157
Q

Gastric acid usually created in stomach

A

Gastrin

158
Q

Produce excessive amounts of insulin

A

Insulinoma

159
Q

Produce excessive amounts of glucagon

A

Glucagonoma

160
Q

2 symptoms of pancreatic tumors caused by excessive amounts of gastrin

A

Multiple or recurrent peptic ulcers

Zollinger-Ellison syndrome

161
Q

Chronic watery diarrhea

A

Zollinger-Ellison syndrome

162
Q

4 symptoms of pancreatic tumors caused by excessive amounts of insulin

A

Hypoglycemia
Confusion
Convulsions
Coma

163
Q

___% of gastrinomas are malignant and ___% benign; true for all other pancreatic tumors except for insulinomas where ___% are malignant and ___% are benign

A

80%, 20%

20%, 80%

164
Q

Can palpate gallbladder due to obstruction of pancreas

A

Courvoisier’s sign

165
Q

4 treatments of islet cell tumors

A

Surgical resection treatment of choice: whipple procedure
Small meals help with hypoglycemia
Administration of some medications, ex: for ulcers
Chemo: doxorubicin or 5FU and other agents

166
Q

Remove head of pancreas, distal stomach, duodenum, common bile duct, and gallbladder, and vagotomy

A

Whipple procedure

167
Q

Remove vagus nerve for pain

A

Vagotomy

168
Q

Symptoms of cutaneous flushing, diarrhea, and wheezing
May develop fibrosis of right heart valves, endocardium, pleura, peritoneum, and retroperitoneum
Advanced carcinoid tumors, mets

A

Carcinoid syndrome

RAD 390 - Radiation Therapy Oncology Nursing (7 decks)

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