Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

RAD 390 - Radiation Therapy Oncology Nursing > Test 1 > Flashcards

Test 1 Flashcards

You may prefer our related Brainscape-certified flashcards:
Nursing Mental Health flashcards Nursing Management of Care flashcards NCLEX-PN® flashcards NCLEX-RN® flashcards Nursing Fundamentals flashcards Nursing Pediatrics flashcards Nursing Safety & Infection flashcards Nursing Pharmacology flashcards Nursing Maternity flashcards Family Nurse Practitioner (FNP) flashcards
1
Q

6 cancer treatments

A 
Surgery
Radiation therapy
Chemotherapy
Hormonal therapy
Immunotherapy
Hyperthermia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Oldest method of cancer treatment

Useful for treatment (removing tumor), diagnosis/pathology, staging (histology), palliation (debulking), and cosmesis

A

Surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

____% of cancer treated with surgery alone and ____ cured

A

40%, 1/3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

____% of cancers receive RT; first treatment in 1809 on basal cell

A

60%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Changing levels of hormones in body to slow or stop growth of tumor; ex: prostate, blood, etc.

A

Hormonal therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

As early as 1500s: very heavy, toxic metals; still toxic
Systemic treatment works well with systemic disease; most systemic but also topical for skin disease
GIven through installation (IV); ex: CSF through meninges, pericardium for malignancy of pericardium, intraperitoneal for ovarian disease, intraarterial for direct flow to disease, etc.

A

Chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Removal of large tumor even if some tumor is left behind due to inaccessibility because of vascular structures (palliation)

A

Debulking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Killing cells of the primary tumor and those that may be circulating through entire body

A

Systemic treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Uses body’s immune system to attack/fight cancer

A

Immunotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Process of increasing the temperature of an area in conjunction with an effort to increase cell kill; applying heat to an area to increase radiation sensitivity
Add heat to intensify affect of radiation with hot bags, radio-frequencies, microwaves, etc.; problem: hard to get heat to treatment area

A

Hyperthermia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

6 ways to establish a rapport with the patient

A 
Listen
Connect
Compassion
Honesty
Get the patient involved (help them select appointment time)
Communicate (educate patient)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Communication between two people

A

Rapport

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Provides structure for the delivery of difficult information

A

SPIKES protocol (setting, perception, invite/information, knowledge, empathy, summarize and strategize)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

4 important steps before treatment

A

Positive diagnosis: biopsy
Stage
Goal of therapy set (adjuvant, palliative, etc.)
Treatment plan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Step-by-step process to determine the size and location of a tumor and the degree to which it has spread; extent of disease
Essential in determining treatment options; tumor size and extension, regional lymph node involvement, presence of distant metastasis, and tumor grade or differentiation

A

Stage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Know how we are going to treat based on patient preference, extent of disease, age, protocols, etc.

A

Treatment plan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

2 aims of treatment

A

Curative

Palliative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Eradicate disease, very aggressive

A

Curative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Alleviate symptoms and improve quality of life; may extend survival

A

Palliative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Use of combination therapy, therapy given after primary treatment has been given (ex: chemo); aim to increase cure rate

A

Adjuvant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Therapy given before treatment; done to reduce extensiveness of disease before primary treatment (ex: chemo before lung treatment)

A

Neoadjuvant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Neo-

A

Before

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

6 cancers with microscopic disease that can be cured with chemotherapy

A

Testicular
Hodgkin’s disease
High-grade non-Hodgkin’s lymphoma
Acute leukemia
Small cell lung (nonmetastatic; spreads fast)
Ovarian (widespread once found in peritoneum)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

4 responses to therapy

A

Complete
Partial
Stable
Progressive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Disappearance of all measurable disease for 1 month or more

A

Complete

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

At least 50% decrease in measurable tumor mass without appearance of new lesion for 2 months or more

A

Stable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Increase of tumor mass by more than 25% or appearance of new lesion/tumor

A

Progressive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Usually primary recurs within ___-___ months, buts sometimes breast disease has a slow doubling time and can show up way later, not as common after ____ years

A

18-24 months, 5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Patient alive 5 years post-treatment; good

A

5 year survival

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Chemo doses based off body size/surface area; loss of ___-___ pounds can change treatment
Weigh patient weekly; weight change can affect therapy dose distribution

A

5-10 lb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

8 goals of surgery in cancer treatment

A 
Prophylactic
Diagnostic
Staging
Definitive/curative
Palliative
Adjuvant/supportive
Reconstructive/rehabilitative
Salvage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Preventative treatment given there’s no evidence of disease but the risk is high; surgery for precancerous lesions
Ex: remove organ that may have disease; breast, cervix, polyps, etc.; brain irradiation for small cell lung CA
Surgery: mastectomy or oophorectomy

A

Prophylactic surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Removal of tissue for histologic examination

A

Biopsy (diagnostic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Surgery involves removal of entire primary CA, including a margin of normal tissue surrounding the CA
Need to find it as early and encapsulated as possible before surgery (ex: breast, skin, etc.)

A

Definitive/curative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Take whole tumor with margins and nodes

A

Final/conclusive surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Surgery to treat symptoms; ex: obstruction, fistula, tumor compressing spinal cord, etc.

A

Palliative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Surgery after treatment; ex: debulking, feeding tube, tracheostomy, etc.

A

Adjuvant/supportive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Plastic surgery for cosmesis

A

Reconstructive/rehabilitative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Surgery for recurrence

A

Salvage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

6 facts to consider before surgery

A

Cancer facts: growth rate, invasiveness, metastatic potential (high = don’t do surgery), location (brain is hard area), etc.
Patient’s health
General health habits
Nutritional status: can affect wound healing, blood (anemia), infections; increase morbidity rate
Rehabilitation potential
Age (harder recovery if older)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

___-___% of patients show malnutrition; weigh patient weekly

A

30-50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

7 surgical biopsy techniques

A 
Fine-needle aspiration
Percutaneous needle aspiration: take lung tissue sample
Core needle
Incisional
Excisional
Endoscopic
Laparoscopic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Small sample biopsy

A

Fine-needle aspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Core of tissue collected by needle in tumor; larger than fine but still a small chunk

A

Core needle biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Remove small portion of lesion

A

Incisional biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Removal of an entire tumor/lesion

A

Excisional biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Go into organ from inside-out
Flexible biopsy tool passed through scope and tiny pincers used to collect suspicious tissue sample; ex: bronchoscopy, colonoscopy, etc.

A

Endoscopic biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Scope to view outside of organ; scope and cutting utensil for tissue samples (ex: laparoscopy)

A

Laparoscopic biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

___-___ weeks after surgery, chemo/radiation can start to allow healing

A

3-6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Cancer has spread in surgical area

A

Seeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Normal surgical margin

A

2-5 cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Surgical method in which tumor (usually skin) is removed one layer at a time and examined microscopically
Doctor starts removing tumor and margin around it; pathologist views margins under microscope and says if cells are normal or not
If not, keep removing until they’re gone or can’t remove anymore tissue
Make sure there’s clear margin before closing

A

Mohs procedure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Goal of radiation therapy

A

Destroy tumor cells while sparing normal cells; breaks chromosomes so cells cannot divide and then they die

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

3 stages of rad-bio leading to cell destruction

A

Physical: ionization of atoms
Radiochemical: formation of free radicals
Biologic: DNA damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

5 roles of radiation in CA treatment

A

Curative/definitive: early head and neck (lymph nodes), cervical, anal, prostate, and early stage larynx CA
Neoadjuvant
Adjuvant
Prophylactic: treat brain for small cell lung CA
Palliative: usually larger dose in first few days of treatment (goes faster); reduce bleeds, pain, seizures, obstruction, mass or node against spinal cord, etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Radiation before primary treatment; esophageal and rectal CA debulking before surgery

A

Neoadjuvant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Radiation after surgery; ex: remove affected testicle and treat inguinal lymph nodes, lumpectomy, and treat breast, remove lung tumor and hilar nodes, etc.

A

Adjuvant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

2 types of radiation

A

Teletherapy/external beam RT

Brachytherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Treatment at a distance, linac generates ionizing radiation by accelerating electrons along a tube

A

Teletherapy/external beam RT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

4 types of teletherapy/external beam RT

A

3D CRT
IMRT
IGRT
VMAT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Treatment at short distance; temporary or permanent placement of a radioactive source within a body cavity, interstitially, or on the body’s surface (implants, inject source, etc.)
Used as boose
Can be used alone or in conjunction with EBRT, ex: treatment of cervical or endometrial CA’s
Prime advantage is ability to deliver high doses of radiation delivery to tumor

A

Brachytherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

2 types of brachytherapy

A

Low dose rate (LDR)

High dose rate (HDR)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Brachytherapy takes 24-144 hours to give treatment
Inpatients; nurses instructed to observe the important precautions of time, distance and shielding to protect themselves from radiation
Ex: oral cancers, prostate “seeds” of iodine-125 or palladium-103, etc.

A

Low dose rate (LDR)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Minutes for brachytherapy treatment, no staff exposure
Commonly use iridium; early stage disease
Usually bi-daily (BID), have to have 6 or more hours between

A

High dose rate (HDR)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Place source inside cavity

A

Intracavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Place source directly in patient

A

Interstitial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Bowl in eye with sources

A

Plaque therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Source in lumen or vessel

A

Intraluminal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Source in bronchiole

A

Endobronchial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

2 cancers that use intracavitary radium and cesium

A

Endometrial

Cervical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Cancer that uses interstitial iodine and gold

A

Prostate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Cancer that uses interstitial iridium

A

Breast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Cancer that uses plaque therapy cobalt, iodine, and palladium

A

Ocular melanoma

74
Q

Cancer that uses interstitial thermal iridium and cesium

A

head and neck

75
Q

Cancer that uses interstitial cesium

A

Rectal

76
Q

Cancer that uses intraluminal cesium

A

Esophageal

77
Q

Cancer that uses endobronchial iridium and iodine

A

Bronchogenic

78
Q

How many sources does cobalt-60 have?

A

192-196 sources

79
Q

Cobalt-60, emits gamma rays

SRS has a very confined fractionated dose

A

Gamma knife

80
Q

Largest field size that can be treated with gamma knife

A

18 mm (1.8 cm)

81
Q

4 steps in planning RT

A

Construction of patient immobilization or positioning devices: breast board, wings, alpha cradle, etc.
Simulation: accuracy and reproducibility of 1-2 mm
Delineation of tumor volume and evaluation of field arrangements: treatment field larger than tumor volume to include lymph nodes, microscopic disease, etc.
Organ shielding a beam modification: MLC’s, port film used to verify accuracy

82
Q

4 R’s of rad bio

A

Repair
Repopulation
Redistribution (reassortment)
Reoxygenation

83
Q

Cancer cells can’t fix themselves, normal can; why fractionation is important (if we allow too much time between treatments, cancer cells have time)

A

Repair

84
Q

Mitosis and proliferation of cells

A

Repopulation

85
Q

Division delay results in cells in interphase at the time of irradiation to be delayed in G2
Cell delay of RT, delays CA cells from moving into mitosis (phase)
Cells become partially synced; CA cells all in mitosis at same time and more sensitive to radiation
Redistribution (reassortment)

A

Mitotic delay

86
Q

Side effects of RT that occur during treatment and can be predicted from the volume of normal tissue exposed to the beam, the total dose delivered, and the sensitivity of the normal tissue to radiation
Usually clear up after the completion of treatment
Within region being treated, usually site specific
Know how to prepare patient mentally, before and during treatment
A lot can be managed with medication (ex: give patient with diarrhea imodium)

A

Acute side effects

87
Q

Inflammation of bladder

A

Cystitis

88
Q

Man can’t keep an erection

A

Impotence

89
Q

Swelling of brain caused by the presence of excessive fluid

A

Cerebral edema

90
Q

Late side effects of RT are local, usually permanent reactions that may develop several months to years after radiation
Daily fraction tends to predict severity, increase with increased daily dose; normal tissue doesn’t repair like with low doses
Occur from 2 months to years after RT
Constantly happening

A

Chronic side effects

91
Q

Disease of the spinal cord

A

Myelopathy

92
Q

Irradiated bone doesn’t heal correctly

A

Osteonecrosis

93
Q

Scar tissue causes obstruction

A

Bowel adhesions

94
Q

3 things to be considered radiation-induced secondary malignancy (5%)

A

New primary/different histology from first CA
Must take place/occur in previously irradiated/treated area
Must occur 10-15 years after original tumor was treated (takes time for radiation to cause malignancy, doesn’t happen in short time)

95
Q

4 ways to encourage patients

A

Educate them about treatment and disease
Acknowledge their feelings
Include them as primary members or planners in their healthcare
Provide nonjudgemental support

96
Q

3 radiosensitizers

A

5FU (common)
Cisplatin
Mitomycin C

97
Q

Chemo drugs enhance effects of radiation on cells and CA used before or along with exposure based on type of treatment, doctor, etc. (mostly by IV)
Usually see complications with skin problems (erythema, moist desquamation, etc. treated with corn starch, airing out, fan)
Patient may be able to take break if symptoms too severe (2-3 days)

A

Radiosensitizers

98
Q

7 treatments for oral side effects of swelling and irritation

A

Rinse with baking soda/saline: keep mouth clean because at greater risk for infection
Liquid NSAIDs reduce swelling and pain to help with swallowing (ex: swish and swallow, Brompton cocktail, etc.): nutritional issues arise and affect immune system, maintain calorie intake and weight; patient may need gastrostomy (G-) tube
Mylanta and lidocaine for heart burn
Some may need a break
Refer to dentist for prophylactic treatment before oral RT to reduce dental decay/caries
Inform patient of how challenging treatment can be and maximize nutritional status before treatment
Stop smoking and drinking

99
Q

4 assessments of patient

A

Daily assessment for potential reactions: therapists
Weigh patient weekly unless indicated more by doctor
Dietitian: a lot of times for head and neck patients
Blood counts weekly on doctor day or more frequently if counts rapidly falling

100
Q

3 things we focus on with skin reactions

A

Patient comfort
Promotion of healing, reduce side effects
Prevention of infection

101
Q

3 treatments of dry desquamation (leads to moist if untreated)

A

Creams with aloe
Lanolin
Vitamin A and D

102
Q

4 treatments of moist desquamation

A

Antibiotics
Silver sulfadiazine cream
Rinse with peroxide
Keep open to air

103
Q

Treatment for pruritus

A

1% hydrocortisone cream

104
Q

Severe itching

A

Pruritus

105
Q

6 factors that contribute to fatigue

A 
Pain
Anemia
Insufficient intake/dehydration
Decreased activity (balance between rest and activity)
Fever
Anxiety/depression
106
Q

RT to reduce tumor volume/pain control
Open airway of esophagus, brain irradiation for headaches, seizures, loss of motor control, spine to relieve pain/paralysis, and relieve bleeding/obstruction
Weigh benefits with side effects and amount of treatment time (high dose, low fractions)
If total dose reached in area, may have to look into other treatment

A

Palliative radiation

107
Q

7 considerations of childhood radiation

A

Need to be very careful
Greater risk of toxicity because cells are more mitotic/developing
Developmental problems
Chance of second cancer because of longer lifespan (10-15 years); ex: sarcoma, meningioma, thyroid CA, etc.
Usually requires sedation
Hyperthermia
TBI for bone marrow transplant or leukemia treatment

108
Q

4 patient teaching priorities

A

Explain process: consultation, simulation, treatment planning, treatment, and follow-up
Time frame for all procedures
Side effects to expect from treatment
How to minimize treatment side effects

109
Q

3 geriatric considerations

A

Side effects can develop sooner and with greater severity
Increased fatigue
Social concerns: transportation, fixed income (expensive)

110
Q

Malignancy of unknown etiology usually arising in lymph nodes
Very curable, good survival rate
Common among young people, higher incidence in males
Associated with Reed-Sternburg cell
1832: Thomas discovered nodes in cadaver lymph nodes
Bimodal age distribution

A

Hodgkin’s disease/lymphoma (HL)

111
Q

Giant abnormal, high- or multinucleated center

Must be present to be considered cancerous HL

A

Reed-Sternburg cell

112
Q

3 viral infections HL correlates with

A

Epstein-Barr (EBV) in the herpes family and causes mono; often asymptomatic
HIV or measles
Dysregulatory inflammatory response

113
Q

Peaks at two different age groups

A

Bimodal age distribution

114
Q

2 peaks of incidence of HL

A

15-34 years old

50

115
Q

HL rarely diagnosed in kids ___ years or younger; median age of diagnosis is ____ years

A

5 years

32 years

116
Q

HL represents about ____% of all lymphomas and ___% of all cancers; ____% of population diagnosed with HL in lifetime

A
  1. 2%
  2. 6%
  3. 2%
117
Q

HL greatest in age range ___-___ years with ___% or more of all new cases

A

20-34 years

31%

118
Q

Between ___-___% of cases involved kids younger than 17

A

10-15%

119
Q

HL has a ___-fold increase in same sex siblings and ___-fold increase in opposite genders; first degree relative with Hodgkin’s has a ___-fold increase

A

9
5
3

120
Q

2 categories of HL

A

Classic Hodgkin lymphoma (CHL)

Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL)

121
Q

4 subcategories of CHL

A 
Lymphocyte-rich/predominant (LRHL)
Mixed cellularity (MCHL)
Nodular sclerosis (NSHL)
Lymphocyte-depleted (LDHL)
122
Q

Main characteristic of Reed-Sternberg cells, 95% of HL

A

Classic Hodgkin lymphoma (CHL)

123
Q

Early stage I-II CHL, 5%
Infrequent systemic symptoms = 10%
More frequent in males
Usually diagnoses in upper body above diaphragm

A

Lymphocyte-rich/predominant (LRHL)

124
Q

Percentage of CHL that is MCHL and NSHL (most common)

A

80-90%

125
Q

Mixture of cell types within histology: combination of lymphocytes, epithelioid histiocytes, eosinophils, neutrophils, and plasma cells (inflammatory cells in blood)
Associated with EBV and HIV
More prominent in males, usually presents in abdomen and spleen (below diaphragm)
Less common than NSHL)
Average age of 38 years

A

Mixed cellularity (MCHL)

126
Q

Most common CHL = 75%
Ages 20-30’s and 50-55 years or older
Closer to equal distribution between sexes
Usually presents in chest and neck

A

Nodular sclerosis (NSHL)

127
Q

Less than 5% of all subtypes of CHL, rarest of the four
More common in men
Affects patients in 30’s especially with HIV
Usually presents with worst prognosis; advanced disease and B-symptoms
Patient usually presents with abdominal adenopathy; spleen, liver, and bone marrow often involved

A

Lymphocyte-depleted (LDHL)

128
Q

Large or swollen lymph nodes

A

Adenopathy

129
Q

5%, asymptomatic young men
Usually identified in cervical, axillary, and inguinal lymph nodes but no mediastinal involvement
30-50 year olds
Early stage disease, longer survival times
Popcorn cell (variant of Reed-Sterburg cell)

A

Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL)

130
Q

Direct contact, touching

A

Contiguous

131
Q

9 signs and symptoms of HL (routine spread)

A

Cervical, supraclavicular, mediastinal lymph node splenomegaly
B-symptoms
Elevated sedimentation rate (detects inflammation in body, blood cells drop in test tube fast because inflammation attached) and elevated alkaline phosphatase/alk-phos (shows blockages and inflammation)
Puritis
Fatigue
Malaise
Weakness
Erythematous rash/reddening of skin
Pain in lymph node after drinking alcohol

132
Q

General feeling of discomfort/uneasiness

A

Malaise

133
Q

About ___% of time HL above diaphragm, about ___% have subdiaphragm spread (bad)

A

80%

10%

134
Q

4 ways to diagnose HL

A

History and physical: enlarged lymph nodes, family history, blood counts, B-symptoms if they have any and how long
X-rays: chest x-ray, CT chest and abdomen, PET, etc.
Labs: CBC’s sedimentation rate, HIV, etc.
Biopsy of large lymph node: bone marrow more likely involved in stages 1B, 2B, 3, and 4

135
Q

3 treatments of HL based on stage and prognostic factors

A

Radiation involved field
Chemo intensive
Combination yields 90% cure rate (greatest)

136
Q

About ___% if early stage HL curable and about ___% of advanced stage curable

A

90%

80%

137
Q

8 radiation of HL side effects

A 
Hypothyroidism (treat with hormones)
Myelosuppression
Pericarditis
Pneumonitis
Myelopathy
Transient aspermia
Secondary CA's from treatment
Lhermitte syndrome
138
Q

Reduction in bone marrow/RBC’s

A

Myelosuppression

139
Q

Patient lacks ability to ejaculate semen

A

Transient aspermia

140
Q

7 chemo of HL side effects

A 
Nausea and vomiting
Alopecia
Sterility
Myelosuppression
Neuropathy
Cardiomyopathy
Aseptic necrosis of femoral head
141
Q

HL radiation field when treating lymph nodes above diaphragm

A

Mantle field

142
Q

HL radiation field when treating wherever disease is and with chemo

A

Involved field irradiation

143
Q

HL radiation field when treating ipsilateral testicular disease

A

Hockey stick

144
Q

HL radiation field when treating box pelvic field

A

Chimney

145
Q

Newer chemotherapy treatment of HL with reduced risk factors of secondary leukemia but increased heart toxicity because of adriamycin

A

ABVD: adriamycin (doxorubicin), bleomycin, vinblastine, dacarbazine

146
Q

Chemotherapy treatment of HL that is more toxic but risks outweigh benefits especially with younger patients with aggressive disease

A

BEACOPP: bleomycin, etoposide, adriamycin, cyclophosphamide, oncovin (vincristine), procarbazine, and prednisone

147
Q

Older chemo for HL

A

MOPP: mechlorethamine (nitrogen mustard), oncovin (vincristine), procarbazine, and prednisone

148
Q

Breast CA in ___-___% of patients 15 years post-radiation for HL more common in girls and young women who’ve received a mantle field

A

20-50%

149
Q

Cancer of the blood forming elements that clones abnormal hematopoietic cells within blood; overproduce and mess up function of blood (clotting, etc.)
More common in men
Lympho- or myelocytic cells

A

Leukemia

150
Q

2 types of leukemia

A

Acute

Chronic

151
Q

Mature and functioning cells, unregulated proliferation of mature cells
Blast cells can be present
Mainly in myeloid stem cells

A

Chronic leukemia

152
Q

2 types of acute leukemia that arise in bone marrow, thymus and lymph

A

Acute myelocytic leukemia (AML)/acute nonlymphocytic leukemia (ANLL)
Acute lymphocytic leukemia (ALL)

153
Q

Most common leukemia
Myeloid or monocytic stem cells
Incidence increases exponentially after 40 years old, median age of diagnosis is 67
40% cure rate, only survive months if left untreated (aggressive)
Frequency equal among all decades of life but more common at older than 50 years
More common in whites and older men
Treatment with induction and consolidation chemo; bone marrow transplant

A

Acute myelocytic leukemia (AML)/acute nonlymphocytic leukemia (ANLL)

154
Q

Most common in kids; 30% of all new cases in kids, most common childhood CA = 25% of all childhood malignancies
Bimodal peaks between ages 2-4 and again after age of 50
Ages 1-4 have 9x the incidence rate compared to ages 20-24
More common in males
If identical twin has it, 100% risk the other will develop it
Sometimes goes to brain; prophylactic radiation of brain or intrathecal chemo to prevent spread through CNS
Before prophylactic treatment, 40% used to have brain involvement
CNS involvement in 5% of kids, less than 10% develop CNS involvement
Treatment with induction, consolidation/intensification, and maintenance chemo; CNS prophylaxis, whole brain irradiation
Causes unknown, but some correlation to factors of radiation exposure (atomic bomb), genetic disorders, and viruses
20% could have Philadelphia (Ph) chromosome

A

Acute lymphocytic leukemia (ALL)

155
Q

5 risk factors for AML

A

Exposure to ionizing radiation: 50-fold increase as a result of atomic bomb, continued for 14 years after bombing in all decades of life; increase in radiologists and HL treated patients
Exposure to chemicals: benzene used in paint shops, cleaning chemicals, gas, etc.; 20% of cases associated with cigarette smoke (older than 60 years)
Chemotherapy: alkylating agents (melphalan, cyclophosphamide, and mechlorethamine) correlate to development of leukemia especially with RT
Genetics: down syndrome = 20-fold increase in incidence; falconi and rickett’s (kids have soft bones that fracture easily) anemia, bloom syndrome (rare disease, short stature and high voice), etc.
Viruses: EBV, HIV, etc.

156
Q

Rapid heart rate

A

Tachycardia

157
Q

3 most common symptoms affected by acute leukemia

A

Oropharynx
Lungs
Perianal area

158
Q

4 ways to diagnose acute leukemia

A

Abnormal blood count
Bone marrow aspiration and biopsy
Chest x-rays show masses within chest
Lactic dehydrogenase (LDH) elevated reflects high tumor burden and at greater risk for CNS involvement

159
Q

Diagnosis of acute leukemia given with greater than ___% blast cells present; ALL and AML considered hypercellular with greater than ___% blasts

A

30%

50%

160
Q

5 prognostic factors of acute leukemia

A

Older patients that are ill do worse
Elevated BC’s; WBC counts over 50,000 per mm^3 (normal = 5,000-10,000)
Sepsis: severe blood infection because WBC’s not functioning correctly
CNS involvement
Leukemia from myelodysplastic syndrome/preleukemia

161
Q

Heterogenous stem cell disorder; causes unknown, without identifiable predisposing factors
Median age is 60-70 years old
Symptoms typically develop gradually and are usually seen with advanced disease; asymptomatic (low stage) to fatigue, malaise, etc.
Treatment: curative stem cell transplant
Cause of death: transforms into AML or cytopenia, hemorrhage, infection, etc.
Ineffective blood cells in body; group of bone marrow disease involuntary stem cell that can be treated with infusions

A

Myelodysplastic syndrome/preleukemia

162
Q

Peripheral greater than 50,000-100,000 per mL, greater than 50% blasts
End up with leukostasis (poor blood flow) because large cells clog arteries and infiltrate perivascular tissue
Can be fatal if it travels to brain or lungs
Headaches due to increased cranial pressure
Can treat with corticosteroids and high dose chemo

A

Blast crisis

163
Q

5 year survival rate of acute leukemia in adults in kids

A 
Adults = 67%
Kids = 90%
164
Q

Results from a reciprocal translocation between chromosomes 9 and 22; the DNA transfer results in 1 chromosome 9 that’s longer and 1 chromosome 22 that’s shorter than normal

A

Philadelphia (Ph) chromosome

165
Q

Accounts for 7-20% of all leukemias
Correlation of Ph chromosome
Median age of 64, slight male preference
10% of ages 5-20 (3% of childhood leukemias)
Risk of ionizing radiation: atomic bomb and RT (cervix and ankylosing spondylitis); most haven’t received radiation
Signs and symptoms: usually asymptomatic but can see fatigue, anorexia, early satiety due to splenomegaly, weight loss, excessive sweating, priapism, gout, abdominal pain, and mental status change
Time from diagnosis of CML to blast crisis = 5 years; if blast crisis infiltrates, can occur in CNS, lymph nodes, bone, and skin
Primary mets sites: bone marrow and peripheral blood
Treatment: tyrosine kinase inhibitors (TKI) [imatinib mesylate, nilotinib, or dasatinib]; bone marrow transplant reserved for those who fail TKI, usually for younger patients
Overall survival = 4-5 years
Patients usually have inefficient/compromised immune system, increased risk of infection

A

Chronic myelogenous leukemia (CML)

166
Q

Feeling full/loss of appetite

A

Early satiety

167
Q

Prolonged erection

A

Priapism

168
Q

Uncosciousness

A

Stupor

169
Q

3 stages of CML

A

Chronic phase
Accelerated phase
Blast phase

170
Q

Asymptomatic, most patients in this phase at diagnosis = 95%
WBC’s above 25,000-100,000, less than 10% blast cells
Median survival of 5-6 years
Infiltration to CNS, lymph nodes, bones, skin, bone marrow, and peripheral blood (not as common)

A

Chronic phase

171
Q

10-19% blasts in peripheral blood or bone marrow
Over 30% blase and myelocyte cells (young cells of granulocytic series in bone marrow)
Over 20% basophils and less than 100,000 platelets
Median survival = 6-9 months

A

Accelerated phase

172
Q

Resembles acute leukemias with over 20% blasts
Worst and most aggressive phase
Increased weight loss, fevers, sweats, and bone pain
Tumors develop
Median survival of less than 6 months

A

Blast phase

173
Q

4 treatments for CML

A

Chemotherapy: ALL treatment, hydroxyurea can help relieve symptoms but doesn’t increase survival
Splenectomy only done in chronic phase to control hypertension
Bone marrow transplantation treatment for CML best done within one year of diagnosis
Interferon works with immune system

174
Q

Spectrum of electrolyte abnormalities that can occur after the initiation of cytotoxic therapy that causes the breakdown of large numbers of malignant cells
Metabolic imbalance because dying CA cells give off potassium which affects and creates arrhythmias of heart

A

Tumor lysis syndrome (TLS)

175
Q

Accumulation of lymphocytes in marrow, blood, and lymph
Age 55 or greater, rare in younger than 30 years old; median age of diagnosis is 71
Affects whites more than blacks and men more than women
Correlation to smoking and increased age, no known cause
Risk factors: positive family history for leukemias (first degree relatives), inherited, acquired immunodeficient syndromes and lymphoproliferative neoplams
Constitutional symptoms (group of symptoms that can affect many different body systems): fatigue, malaise, weakness, lymphadenopathy, abdominal pain, enlarged lymph node, and infection
Major symptoms: hepatosplenomegaly, pancytopenia specific with bone marrow packed with malignant cells (transfusion), autoimmune anemia, and thrombocytopenia
Goes to liver and spleen after bone marrow and lymph nodes
Good survival: low risk median survival greater than 10 years, intermediate = 1-7 years, and high = 1 year
Treatment usually pretty conservative because patients are usually older; decision depends on the patient’s functional status, symptoms, prognostic factors, stage of disease, disease recurrence, and response to prior therapies
No cure; chemotherapy (alkylating agents with or without prednisone for first treatment), radiation and splenectomy for palliation (local control), and bone marrow transplants investigational

A

Chronic lymphocytic leukemia (CLL)

176
Q

When symptoms of CLL start and when RT is started

A 
Symptomatic anemia
Symptomatic adenopathy (enlarged lymph node)
177
Q

Duplication

A

Clonality

178
Q

Suspend cells in a stream of fluid and passing them through an electronic detection apparatus

A

Flow cytometry

179
Q

2 common complications of leukemias

A

Infection treated with antibiotic therapy

Bleeding treated with transfusion when platelets are below 10,000 per mm^3 or active bleed

180
Q

Subtype of CLL
No known cause, rare
Usually diagnosed in middle aged patients
Less than 2% of all leukemias, 500-600 cases annually

A

Hairy cell leukemia (HCL)

RAD 390 - Radiation Therapy Oncology Nursing (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions