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RAD 390 - Radiation Therapy Oncology Nursing > Quiz 4 > Flashcards

Quiz 4 Flashcards

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1
Q

Second most common cancer in men and women, leading cause of cancer death in men and women second to heart disease
17% alive in 5 years

A

Lung cancer

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2
Q

8 risk factors of lung cancer

A 
Cigarette smoking most common
Radon second most common
Air pollution
Asbestos
Previous TB
Genetic predisposition
Occupational respiratory carcinogens
Nutritional factors: diets with fruits and vegetables protect against lung cancer, vitamin A helps prevent it
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3
Q

If people stopped smoking, cancer death would decrease by what percent?

A

25%

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4
Q

___% of all cancer deaths and ___% of all lung cancer deaths are associated with smoking

A

35%, 85%

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5
Q

9 symptoms of lung cancer

A 
Cough/change in cough most common
Hemoptysis
Dyspnea
Wheezing due to blocked airway
Weight loss
Fatigue
Chest or shoulder pain associated with pancoast tumor at apex of lung
Recurring pneumonia or bronchitis; if pneumonia not cleared up in 2 months, suspect lung cancer
Stridor
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6
Q

Blood in spetum

A

Hemoptysis

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7
Q

Difficulty breathing

A

Dyspnea

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8
Q

High-pitched, wheezing sound caused by disrupted airflow

A

Stridor

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9
Q

8 systemic symptoms of lung cancer

A 
Syndrome of inappropriate antidiuretic hormone (SIADH)
Hypercalcemia
Cushing's
Facial swelling from SVC syndrome
Anorexia
Headaches and seizures from brain mets
Pleural effusions
Hoarseness
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10
Q

6 late symptoms of lung cancer

A 
Pain from bone mets
Anorexia
CNS system changes due to brain mets
Dysphagia
Weight loss
Paraneoplastic syndrome
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11
Q

Syndrome caused by small cell lung disease that affects nervous system (NS)

A

Horner’s syndrome

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12
Q

2 symptoms of Horner’s syndrome

A

Ptosis

Miosis

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13
Q

Drooping of upper eyelid

A

Ptosis

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14
Q

Constricted pupil

A

Miosis

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15
Q

More common with lung cancers, degenerative disorder where patient’s immune system T cells start fighting/attacking normal cells

A

Paraneoplastic syndrome

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16
Q

Cancer fighting antibodies

A

T cells

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17
Q

9 ways to diagnose lung cancer

A 
History and physical (H&P)
Complete blood count (CBC)
Chest x-ray (CXR), CT, MRI, and PET
Sputum cytology
Fiberoptic examination
Fine needle aspiration
LN biopsy
Mediastinoscopy, thoracoscopy, or thoracotomy
Endobronchial US (EBUS)
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18
Q

Routine CXR often detects _______ lung cancer

A

Asymptomatic

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19
Q

___-___ of all pulmonary nodules are malignant

A

1/3-1/2

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20
Q

Examine upper chest wall between and in front of lungs with small incision

A

Mediastinoscopy

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21
Q

Incision inside patient to see inside of chest wall

A

Thoracoscopy

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22
Q

Open chest wall to biopsy/remove part of nodule for diagnosis

A

Thoracotomy

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23
Q

Bronchoscope inserted in trachea with US probe on end of it to examine LN and biopsy can be US-guided

A

Endobronchial US (EBUS)

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24
Q

2 major histologies of lung cancer

A

Non-small cell lung cancer (NSCLC)/non oat cell

Small/oat cell

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25
Q

___-___ of lung cancers are NSCLC, and ___-___% are small cell

A

80-85%, 10-15%

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26
Q

3 types and percentage of NSCLC

A

Adenocarcinoma: 40%
Squamous cell: 30%
Large cell: 10-15%

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27
Q

Most common NSCLC, women and younger people

A

Adenocarcinoma

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28
Q

More aggressive and shorter doubling time makes this lung cancer more sensitive to radiation and initially greater response but becomes aggressive again
Commonly goes to brain, about 10%
Prophylactic brain irradiation when symptoms arise, whole brain when patient in remission
Only about 10-15% survive 3 years
More systemic and advances so quickly, surgery not usually an option unless it’s caught early
90% relapse and die

A

Small/oat cell (SCLC)

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29
Q

Doubling time of NSCLC and small cell lung cancer

A

NSCLC: 90 days
Small: 45 days

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30
Q

Staging system of NSCLC and small cell lung cancer

A

NSCLC: TNM
Small: bimodal staging system

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31
Q

Which type of lung cancer is more radiosensitive and why?

A

Small cell due to rapid division

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32
Q

3 things radiation is used for in the treatment of lung cancer

A

Cure non-surgical candidates with NSCLC
Sterilize tumors preoperatively and treat LNs
Palliation by shrinking tumors

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33
Q

3 oncologic emergencies associated with lung cancer, need to treat quickly

A

Superior vena cava (SVC) syndrome
Airway obstruction: mediastinal tumor pressing against airway
Spinal cord compression from spinal mets

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34
Q

Most common emergency with lung cancer, usually advanced disease; causes cerebral edema, dizziness, etc. and can lead to death if untreated

A

Superior vena cava (SVC) syndrome

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35
Q

Tumor that has caused rib destruction and nerve root involvement (C7-T1), area located near the brachial plexus, thoracic vessels, and vertebral bodies
Primary location: apex of lung
Severe shoulder and arm pain (brachial plexus)
RT, neoadjuvant chemo, and possible rib resection (decreases QOL); pain management medication for arm and shoulder pain
Most common point of spread: brain mets

A

Pancoast tumor syndrome

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36
Q

6 prognostic factors of lung cancer

A

Weight loss greater than 10 pounds in 6 months is a poor indication of health
Size of tumor
Mets
Gender: women do better than men
Age: under 60-70 year olds do better, over 60-70 have poor response
Performance status

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37
Q

Average SCLC survival

A

9-11 months

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38
Q

4 common mets sites of lung cancer

A

Liver
Adrenals
Bone
Brain

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39
Q

Rare neoplasm caused by asbestos most commonly involves pleura but can also involve peritoneum
Shipyards, pipefitters, and brake repairs
No effective treatment: intrapleural chemo, RT, and surgery
Cisplatin gave 9 month survival; now: pemetrexed and cisplatin give longer survival

A

Mesothelioma

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40
Q

Decrease in mental function, confusion

A

Organic brain syndrome

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41
Q

Lung cancer screening method

A

No cost effective method; CT scans between 55-74 year olds who’ve smoked/had 30 pack years of 30 pack years in past and quit within 15 years
Initial then next based on what’s seen on CT
Symptoms don’t appear until disease has progressed by more likely in smokers than normal population

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42
Q

Smoked one pack of cigarettes daily for 30 years

A

30 pack years

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43
Q

Malignant tumor originating from melanocytes most commonly found in basal layer of epidermis
Unpredictable and deadly
Can be in any place that has melanocytes/pigment cells; ex: retina or iris
Symptoms include a mole that changes in size, elevation, color, surface, surroundings, and sensation

A

Malignant melanoma

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44
Q

7 risk factors of malignant melanoma

A

More than 20 congenital nevi/large number of moles
Family history of melanoma
History of severe sunburning: child having 2-3 severe burns
Light/sensitive skin type I and II, blue, gray, or green eyes, and blonde or red hair; inability to tan
Dysplastic nevus syndrome (DVS)
History of acute and intermittent exposure to sun or ultraviolet light
Personal history of melanoma

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45
Q

6 skin types (lower number increases risk)

A

I. Never tans, always burns, fair or red hairs, and many freckles
II. Burns easily, sometimes tans, freckles, and fair hair
III. Burns moderately; tans easily and rarely burns
IV. Burns minimally; always tans and very rarely burns
V. Rarely burns and brown skin
6. Never burns and black skin

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46
Q

Clinically atypical moles precursor to melanoma

A

Dysplastic nevus syndrome (DVS)

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47
Q

6 histologies of malignant melanoma

A 
Superficial spreading
Nodular melanomas
Lentigo maligna
Acral lentiginous
Uveal melanoma (rare)
Mucosal lentigines, desmoplastic melanoma, and varicose/warty type lesions less common
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48
Q

Most common melanoma histology, 70% of all cutaneous melanomas
More common in women than men, 40-50 year olds are the most commonly diagnosed age group
Variegated in color with areas appearing blue, black, gray, white, or pink; irregular pigmented plaque with areas of regression and notched borders, horizontal or radial extension
May appear scaly and crusty and itch
Increasingly more common in young adults

A

Superficial spreading

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49
Q

Small tan/brown/black, dark type of freckle that doesn’t fade
Appears as a large, flat, irregular lesion resembling a stain
Located o n face and neck of elderly, severely suntanned whites

A

Lentigo maligna/lentigo malignant melanoma

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50
Q

Extremities, relating to or affecting peripheral parts

A

Acral

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51
Q

Pigmented middle layer of eye

A

Uvea

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52
Q

Light brown spots on mucosal surface

A

Mucosal lentigines

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53
Q

Infiltrating melanoma with an abundance of fibrous matrix

A

Desmoplastic melanoma

54
Q

Patchy, different within itself

A

Veriegated

55
Q

Colorless, lacks pigment

A

Amelanotic

56
Q

Common sites of superficial spreading melanoma in men and women

A

Men: trunk/back
Women: lower extremities

57
Q

4 common sites of lentigo maligna melanoma

A

Face
Neck
Trunk
Dorsum of hands

58
Q

3 common sites of nodular melanoma

A

Trunk
Head
Neck

59
Q

4 common sites of acral-lentiginous melanoma

A

Palms of hands
Soles of feet
Nailbeds
Mucous membranes

60
Q

For deep skin lesions, excision through underlying fat; helps see tumor depth

A

Punch type biopsy

61
Q

ABCDE approach to early detection of melanoma

A

A: asymmetry in shape, color, and appearance; melanoma lesions are typically irregular shaped
B: bleeding or borders that are notched, uneven, ragged, or irregular
C: color of mole variegated blues, grays, pinks, reds, browns, varying shades of black, etc.
D: diameter of 6 mm or greater suspicious in any direction or change in size, growing
E: evolving/changing or elevation

62
Q

Mole is raised or has uneven surface

A

Elevation

63
Q

6 preventative measures of melanoma

A

Avoid peak time of intense UV radiation exposure at 10AM-4PM, UV radiation damages skin cells
Use sunscreen with minimum SPF 15
Wear protective clothing
Avoid tanning booths
Do regular self examinations of skin several times a year or at least annually for life and US anything suspicious

64
Q

Can stay outside 15 minutes longer than you normally would without burning

A

SPF 15

65
Q

7 common sites of melanoma mets

A 
Regional LN most common
Lungs second most common
Skin
Subcutaneous tissue just beneath skin
Liver commonly with ocular melanoma
Brain
Bone
66
Q

With melanoma mets, __________ elevated when cells are being damaged

A

Lactase dehydronaise

67
Q

LNs commonly involved with melanoma, isotope/dye to identify first place of drainage from disease for patients with lesions over 1 mm deep

A

Sentinel node mapping

68
Q

4 melanoma treatments

A

Surgery recurrence rates same for wide and small excision
Chemo (dacarbazine [DTIC]), immunotherapy, and targeted therapy
Radiation mainly for palliation for CNS or bone mets; 50% skin response, not cure
Alpha interferon

69
Q

Indication for post surgical adjuvant therapy in patients with melanomas over 4 mm in thickness and after LN dissection
Length of the therapy is about 1 year, 5 days a week; subcutaneous injection that can be done by patient or family
Biotherapy stimulates the body’s immune system to recognize and fight cancer

A

Alpha interferon

70
Q

Numbness due to nerve damage

A

Parethesia

71
Q

Damage from toxin

A

Ototoxicity

72
Q

5 year survival for localized melanoma, regional mets, and distant mets

A

Localized: 97%
Regional: 59%
Distant: 15-20%

73
Q

Melanoma follow-up for years 1-3, 4 and 5, and after 5 years

A

Years 1-3: every 3-4 months
4&5: every 6 months
After 5 years: annually

74
Q

Number one cancer in men besides skin because of early detection by prostate specific antigen (PSA), about 20% of patients have normal PSA
Third leading cause of cancer deaths in men; lung first and colon second
Urethra runs through this gland and when it’s enlarged it doesn’t allow men to urinate
Late symptom: pain from bone mets

A

Prostate cancer

75
Q

5 risk factors of prostate cancer

A 
Increasing age over 50 years old
African American
Family
Dietary fat
Genetics: BRCA 1&2 genetic mutations and lynch syndrome
76
Q

Median age of diagnosis of prostate cancer

A

66 years

77
Q

African Americans have ___% higher risk of being diagnosed with prostate cancer at an earlier age and more aggressive; have higher incidence and _______ the mortality rate
Asians have lowest incidence

A

50%, double

78
Q

Having 1 or 2 first degree relatives (dad or brother) with prostate cancer increases the patient’s risk by how much?

A

1: 3x
2: 9x

79
Q

What is the prostate cancer screening recommendation by the American Cancer Society (ACS) and the Urological Association?

A

ACS: digital rectal examination (DRE) and PSA annually for over 50 year olds for individual at normal risk and have a high life expectancy over 10 years, high risk individuals should start at 40 years old
Urological: over 50 years old annual PSA and DRE

80
Q

Protein produced by prostate

For positive disease use US guided rectal biopsy to see if it’s malignant

A

Prostate specific antigen (PSA)

81
Q

Normal and abnormal PSA range

A

Normal: 0-4 ng/ml
Abnormal: 4 or higher

82
Q

5 reasons PSA can give false negative (irritants)

A 
Prostatitis
Cystoscopy
Prostatic hypertrophy
Transurethral resection of prostate (TURP)
Needle biopsy
83
Q

Inflammation of prostate gland

A

Prostatitis

84
Q

Enlarged prostate

A

Prostatic hypertrophy

85
Q

Part of prostate removed

A

Transurethral resection of prostate (TURP)

86
Q

A system of grading prostate cancer tissue based on how it looks under a microscope, 2-10
Grade

A

Gleason score (GS)

87
Q

PSA _______ with age

A

Increases

88
Q

PSA range for ages 40-49, 50-59, 60-69, and 70-79

A

40-49: 0-2.5
50-59: 0-3.5
60-69: 0-4.5
70-79: 0-6.5

89
Q

7 signs and symptoms of prostate cancer similar to urinary obstruction

A 
Nocturia
Hesitancy
Straining to void
Urgency and frequency
Dysuria
Feeling of incomplete voiding
Hematuria or hematospermia
90
Q

Excessive urination at night

A

Nocturia

91
Q

Blood in semen

A

Hematospermia

92
Q

5, 10, and 15-year relative survival rate of prostate cancer

A

5: 99%
10: 98%
15: 96%

93
Q

5 year survival for stage 1-3 prostate cancer and distant mets

A

1-3: 100%

Mets: 31.9%

94
Q

2 parts of obtaining a GS

A

1st number from primary histology/grade

2nd from highest grade

95
Q

Formula to evaluate risk of seminal vesicle (SV) involvement with prostate cancer

A

(GS-6)10 + PSA

96
Q

If evaluation of SV and LN involvement is over ___%, treat them

A

15%

97
Q

Formula to evaluate risk of LN involvement with prostate cancer

A

2/3(GS-6)10 + PSA

98
Q

Low risk for involvement of SV from calculation, PSA, and GS

A

Calc: 15% or less
PSA: 10 or less
GS: 6 or less

99
Q

High risk for involvement of SV from calculation, PSA, and GS

A

Calc: over 15%
PSA: over 10
GS: over 6

100
Q

Why don’t we want to treat the SVs?

A

They’re close to rectum

101
Q

4 treatments of prostate cancer

A

Surgery
Radiation
Hormone
Chemo not curative

102
Q

Removal of entire prostate, SVs, and a portion of the bladder neck through perineal or retropubic area

A

Radical prostatectomy

103
Q

Between scrotum and anus

A

Perineal area

104
Q

8 problems that can be caused by radical prostatectomy

A 
Atelectasis
Wound infection
Bleeding
Edema of penis if LN dissection included
Edema of lower extremities
Deep vein thrombosis (DVT)
Stress incontinence and incontinence (5%)
Impotence
105
Q

Bladder leaks urine during physical activity or exertion.

A

Stress incontinence

106
Q

Airless/collapsed lung, usually from anesthesia after radical prostatectomy and can lead to PE

A

Atelectasis

107
Q

What percent of men are potent after bilateral and single nerve sparing surgery?

A

Bilateral: 68%
Single: less

108
Q

5 times radiation is used for prostate cancer

A 
Any stage from I-III
Organ confined disease
Patients that are a poor surgical risk
Positive margins: adjuvant
Alone or in conjunction with hormonal therapy
109
Q

When are seed implants used for prostate cancer?

A

10 or less PSA/advanced disease

110
Q

3 brachytherapy sources for prostate cancer

A

Iodine-125 seeds
Palladium seeds
Iridium catheter

111
Q

3 types of EBRT for prostate cancer

A

5-7 field IMRT or VMAT
4 field for LNs
Protons

112
Q

Prostate EBRT dose

A

74-81.6 Gy

113
Q

7 side effects of prostate irradiation, brachytherapy effects more intense than EBRT

A 
Cystitis
Diarrhea
Incontinence
Lymphedema
Impotence: 30-50%, will resolve
Fecal and urinary urgency
PSA decreases when treatment ends
114
Q

Blocks testosterone production for patients with symptomatic, metastatic disease and mainly palliative
Medically or orchiectomy
$100-$20,000

A

Hormonal therapy

115
Q

Removal of testes

A

Orchiectomy

116
Q

5 side effects of prostate hormonal therapy

A 
Hot flashes
Weight gain
Loss of bone density
Gynecomastia
Impotence
117
Q

Abnormally large mammary glands

A

Gynecomastia

118
Q

4 treatments for impotence from prostate hormonal therapy

A

Implants
Drugs
Injections
Vacuums

119
Q

3 treatments for hot flashes from prostate hormonal therapy

A

Megace
Vitamin E
Clonidine patches for hypertension

120
Q

Oral steroid hormone most effective in treating hot flashes from prostate hormonal therapy

A

Megace

121
Q

2 RT treatments for prostate bone mets

A

Teletherapy palliative radiation to local area

Strontium-89 or samarium-153 IV for excessive bone mets

122
Q

Follows calcium route in bones and treats from inside out
40-80% response rate
Only 1 injection
Beta emitter like electrons and positrons from nuclei
IV for excessive bone mets

A

Strontium-89

123
Q

Second most common histology of malignant melanoma often resembles a “blood blister”
Appears as a symmetric, raised, dome-shaped lesion with vertical growth patterns
Blue-black in color but can be amelanotic

A

Nodular melanoma

124
Q

Usually flat, irregular melanoma with an average diameter of 3 cm
Blue or black discoloration or a tan or brown stain occurs on palms and soles or under nailbeds

A

Acral lentiginous melanoma

125
Q

Present at birth and result from a proliferation of benign melanocytes in the dermis, epidermis, or both

A

Congenital nevi

126
Q

5 semirigid penile protheses

A 
Simple
Hinged
Malleable
Positionable
Mechanically activated
127
Q

GS with sharply circumscribed aggregate of small, closely packed, uniform glands

A

1

128
Q

GS with greater variation in glandular size, more stroma between glands, and more infiltrative magins

A

2

129
Q

GS with further variation in glandular size, glands more widely disperse in stroma, and distinctly infiltrative margins with loss of circumpscription

A

3

130
Q

GS with “fused gland” pattern and infiltration of prostatic stroma

A

4

131
Q

Irregular masses of neoplastic glands coalescing and branching

A

“Fused gland” pattern

132
Q

GS with diffusely infiltrating tumor cells with only occasional gland formation

A

5

RAD 390 - Radiation Therapy Oncology Nursing (7 decks)

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