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RAD 390 - Radiation Therapy Oncology Nursing > Test 2 > Flashcards

Test 2 Flashcards

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1
Q

Malignant proliferation of plasma cells that results in an overproduction of the specific immunoglobulin, monoclonal (M) proteins
Generally detected in blood and protein by detecting M protein (1-2% don’t have M protein)
Accounts for 14% of all malignancies
Slow-growing neoplasm typified by long, asymptomatic period
Poor prognosis, increases for younger patients; survival range from few months to 10 years

A

Multiple myeloma (MM)

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2
Q

No known cause of MM but 6 factors that correlate with it

A

Increases with age (predominant factor)
More common in men and African Americans because they have higher immunoglobulin than caucasians
Exposure to low level radiation
Occupational exposure: agricultural pesticides/chemicals, rubber plants, and leather tanner chemicals
Chemical exposure to benzene for cleaning
Genetics and obesity

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3
Q

4 signs and symptoms of MM

A

Systemic bone disease
Renal disease: hydration very important
Increased calcium, anemia, and/or infections
Sometimes abnormal protein in blood or urine: M protein

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4
Q

Plasma cells develop and take/”punch” out density of bones and develop lytic lesions (black spots on radiographs); if continuous patient may end up with osteoporosis
70%; leads to bone pain, weak bones can lead to fractures, and spinal compression

A

Systemic bone disease

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5
Q

2 renal diseases caused by MM

A

Hypercalcemia

Hyperuricemia

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6
Q

Calcium enters blood through lytic lesions; lytic bone disease and immobility
Treated with vigorous hydration, dialysis, and using corticosteroids to block osteoclast activity

A

Hypercalcemia

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7
Q

High uric acid in blood

A

Hyperuricemia

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8
Q

5 MM diagnostic studies

A

Urinary analysis: M protein
Immunoglobulin test
Skeletal survey: degree of bone marrow involvement, plasmacytoma, and lytic lesions (metastatic, treated with RT or surgery)
CBC
Chemical studies: renal function and hypercalcemia

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9
Q

Discrete, solitary mass of neoplastic monoclonal plasma cells in bone or soft tissue can develop into MM; treated with RT or surgery

A

Plasmacytoma

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10
Q

How does MM metastasize?

A

Hematogenous spread by blood

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11
Q

2 treatments of MM

A

Radiation

Chemo

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12
Q

Treatment for local controld of MM

A

Radiation

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13
Q

Can see long term remission of MM over over ___ years with radiation treatment

A

5 years

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14
Q

MM response to RT

A

75% reduction in rate of MM protein production

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15
Q

Patients over 70 years old with MM treated symptomatically (slow growing, indolent tumor); traditional chemo, etc. to prolong life by about ___ years

A

3 years

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16
Q

Reduces temporary remission of MM, incurable but patients may go into remission
Alkylating agents and prednisone (steroid)
High dose with stem cell transplant

A

Chemo

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17
Q

Specific biological agents for immune system

A

Thalidomide

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18
Q

3 side effects of MM treatment

A

Drug resistance
Infection
Leukemia (alkylating agents)

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19
Q

Bone marrow transplants for MM patients over ____ years old

A

60 years old

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20
Q

5 year survival of MM; ___-___% achieve disease free survival over 5 years

A

45-50%

25-30%

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21
Q

9 disease related complications of MM

A 
Thrombocytopenia
Severe anemia
Leukopenia and renal failure
Spinal cord compression
Hypercalcemia
Dehydration
Lytic bone lesions
Pathologic fractures because of deterioration of bone
Repeated infections
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22
Q

5 treatment related complications of MM

A 
Myelosuppression
Renal insufficiency
Mental status changes
Neuropathy: biological agents
Cardiopulmonary toxicities
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23
Q

Measures tumor burden by the number of myeloma-related bone lesions seen on a radiograph and the concentrations of serum calcium, serum M protein, ect.

A

Durie-Salmon system

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24
Q

4 oncologic emergencies of MM

A

Spinal cord compression can become permanent damage if not handled fast
Hypercalcemia
Sepsis causes death in 20-50% of patients
Hyperviscosity

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25
Q

Thickening of blood because of too many red blood cells (RBCs) caused by large amounts of M protein
Neurological and cardiac complications, visual disturbances, headaches, confusion, and drowsiness

A

Hyperviscosity

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26
Q

Median survival of MM

A

3 years

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27
Q

Stage 1 MM 5 year survival and median survival

A

5 year survival = 50%

Median survival = 60 months

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28
Q

Stage 2 MM 5 year survival and median survival

A

5 year survival = 40%

Median survival = 41 months

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29
Q

Stage 3 MM 5 year survival and median survival

A

5 year survival = 10-25%

Median survival = 23 months

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30
Q

Arises from lymphoid tissues, may develop anywhere
Caused by a malignant clonal expansion of one of the elements of a lymph node (LN)
Elderly white males
May begin in a LN, spleen, liver, and marrow and can be in skin, GI tract, pharynx, and CNS
Painless enlarging LN unless infected, feel rubbery
Heterogenous and sporadic spread; no Reed-Sternburg cells, non-biomodal age distribution
Advanced not considered curable

A

Non Hodgkin’s lymphoma (NHL)

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31
Q

Median age of diagnosis of NHL; NHL incidence increases ____% over 75 years old

A

67; 400%

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32
Q

LN suspicious for NHL

A

Supraclavicular LN

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33
Q

4 sites for NHL lymphadenopathy

A

Neck
Armpit
Groin
Abdomen

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34
Q

________ LN involvement common in adults; kids present with ________ or ________ involvement and high grade disease (usually have B-symptoms)

A

Peripheral

GI or mediastinal

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35
Q

4 clinical features of NHL

A

Generalized painless lymphadenopathy
Vague abdominal discomfort
Back pain
Gastrointestinal complaints

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36
Q

6 risk factors for NHL

A

Inherited immunodeficiency disease
Acquired immunodeficiency disease
Viral exposure
Occupational exposure
Environmental factors: cotton, hair dye, etc.
Therapy factors: chemo, organ transplant, RT

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37
Q

3 viruses associated with NHL

A

HIV
EBV associated with Burkitt lymphoma cases
Human T-cell lymphoma

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38
Q

RT latent period of NHL

A

5-6 years

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39
Q

6 diagnostic workups for NHL

A 
H&P
CBC
Sedimentation rate
CT: thorax and abdominal area
MRI
Biopsy involved LNs
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40
Q

Cells can have different appearance (small, large, cleaved or noncleaved, vehicular, etc.)

A

Heterogenous

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41
Q

4 chemo drugs for NHL

A

Cyclophosphamide
Doxorubicin
Vincristine
Prednisone (CHOP)

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42
Q

5 adverse prognostic factors of NHL

A 
Age over 60
Stage III or IV
Two or more extranodal sites
Intermediate or high grade histology
Masses greater than or equal to 10 cm
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43
Q

5 year and median survival of NHL

A

5 year = 60%

Median survival = up to 10 years if indolent tumor type

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44
Q

3 emergency procedures of NHL

A

Tumor lysis syndrome
SVC syndrome
Spinal cord compression by enlarged LN

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45
Q

When patients develop multiple electrolyte abnormalities due to the release of chemicals in the blood from the dying blast cells causes cardiac problems

A

Tymor lysis syndrome

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46
Q

LN pressing against SVC and compromising venous drainage of head, neck, and upper extremities can cause swelling, headaches, SOB, CP, and septic shock

A

SVC syndrome

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47
Q

Evolution of low grade lymphoma to high grade/diffuse large cell lymphoma

A

Richter’s transformation

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48
Q

Most common NHL in kids

Treatment with high dose chemo, intrathecal chemo for CNS, radiation for bulky tumors, and bone marrow transplant

A

Lymphoblastic lymphoma

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49
Q

Rare, chronic, and progressive form of NHL arising in skin

Treatment: TSEI, topical chemo, UV light, and extracorporeal photopheresis for advanced disease

A

Mycosis fungoides

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50
Q

Form of apheresis and photodynamic therapy in which blood is treated with a photosensitizing agent and subsequently irradiated with specified wavelengths of light to achieve an effect

A

Extracorporeal photopheresis

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51
Q

Radioactive iodines (conjugant) target B-cells

A

Rituxan/zevalin

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52
Q

3 disease related complications of NHL

A

SVC syndrome
CNS involvement
Spinal cord involvement

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53
Q

Unhealthy pale appearance; change in color

A

Pallor

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54
Q

Anemia with a mean corpuscular volume (MCV) of 80–100 which is the normal range; however, the hematocrit and hemoglobin is decreased

A

Normocytic anemia

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55
Q

Form of anemia in which the concentration of hemoglobin in the red blood cells is within the standard range; however, there are insufficient numbers of red blood cells

A

Normochromic anemia

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56
Q

Displacement of hematologic bone marrow in blood

A

Myelophthisis

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57
Q

Minute red spots caused by the escape of small amounts of blood

A

Petechiae

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58
Q

Escape of blood into the tissues, causing large, blotchy areas of discoloration

A

Ecchymosis

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59
Q

Way cell looks

A

Grade

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60
Q

5 year survival rate of low grade NHL (more favorable; long term natural course without treatment, not curable

A

50-70%

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61
Q

Treatment of stage 1 & 2 and 3 & 4 low grade NHL

A

Stage 1 & 2 = RT and chemo

Stage 3 & 4 = watching and waiting, chemo when symptoms start

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62
Q

5 year survival rate of intermediate NHL

A

33-45%

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63
Q

Treatment of stage 1 & 2 and 3 & 4 intermediate NHL

A

Stage 1 & 2 = RT and chemo

Stage 3 & 4 = chemo with local radiation for local control

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64
Q

5 year survival rate of high grade NHL; best treatment is same as stage 3 & 4 intermediate CHOP or CVP chemo

A

23-32%

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65
Q

3 chemo drugs of CVP

A

Cyclophosphamide
Vincristine
Prednisone (no doxorubicin)

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66
Q

NHL has a ___-___% remission rate but high recurrance

A

60-80%

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67
Q

Disease of spinal cord

A

Myelodysplasia

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68
Q

7 aids related malignancies

A 
Kaposi's sarcoma
NHL
Invasive cervical cancer: HIV and human papilloma virus (HPV) increases risk
Anal cancer increases in men 80 times
Hodgkin's
Lung cancer
Melanoma
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69
Q

More common in men with HIV, bi- or homosexual men
1872, older men of eastern European or Mediterranean descent
Purple, red, brown, or black blotches on lower legs
Younger men and women aggressive in involved lymph nodes
Compromised immune system: HIV and organ transplant
Caused by infectious agent, herpes: cytomegalovirus, EBV, HPV
Multifocal, widespread lesions involving skill, oral mucosa, lymph nodes, or visceral organs including lungs, liver, spleen and GI tract
Skin lesions that appear as flat or raised plaques ranging in size (mm to cm); have colors from blue-purple to red-brown
Lower extremities
Treat when symptoms arise and start causing problems; not considered curative, palliation

A

Kaposi’s sarcoma

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70
Q

3 reasons immunosuppression predisposes malignancy

A

Absence of protective immune surveillance to eliminate abnormal clones
Dysregulation of cell proliferation and differentiation; immunocompromised leads to cell dysregulation
Chronic antigenic bombardment of the immune system by various infections

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71
Q

Usually high grade B-cell
More aggressive, extranodal sites involved: CNS, bone marrow, and GI tract
Can be immunoblastic (B-cells affected); noncleaved small lymphoma, usually intermediate grade large cell lymphoma

A

NHL with AIDS

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72
Q

4 symptoms/clinical features of NHL with AIDS

A

Painless lymphadenopathy that may involve the abdominal nodes (most common)
Low CD4 lymphocyte counts (less than 50, typical = 500-1000)
Persistent generalized lymphadenopathy
B-symptoms: fevers, chills, and weight loss

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73
Q

Glycoprotein that helps identify immune system in HIV patients

A

Cluster of differentiation (CD4)

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74
Q

5 types of Kaposi’s based on where they arise

A

Classic-non-African
Endemic-African: all ages, more common in men than women
Transplant: all ages and types of people
HIV: AIDS related
Nonepidemic gay-related: homosexuals with no evidence of HIV

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75
Q

Indolent-type tumor shows up as nodule on skin, primarily men
88% appear distal to knee

A

Classic-non-African Kaposi’s

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76
Q

Belong/native to

A

Endemic

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77
Q

More than one spot

A

Multifocal

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78
Q

3 diagnostic tests for Kaposi’s, helps determine treatment

A

Biopsy of skin lesion
Lab work: HIV, immunocompromised (CD4), etc.
Physical examination: history of lesions, skin, mouth, lymphadenopathy, etc.

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79
Q

Mouth involved in ____% of Kaposi’s cases

A

30%

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80
Q

Kaposi’s tumor confined to skin and/or lymph node
CD4 over 200
No opportunistic infections, thrush, or B-symptoms
Karnofsky status of 70 or greater

A

Good risk

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81
Q

Infection someone gets because they’re immunosuppressed; normal, healthy person wouldn’t get

A

Opportunistic infections

82
Q

Extensive oral, GI, or other visceral Kaposi’s disease
Tumor associated with edema or possible ulcerations (lesions, stones, etc.)
CD4 less than 200
History of opportunistic infection and B-symptoms
Performance status less than 70

A

Poor risk

83
Q

Limited cutaneous Kaposi’s lesion, less than 10 in one anatomic area

A

Stage I

84
Q

Disseminated cutaneous Kaposi’s lesion, greater than 10 or in more than one anatomic area

A

Stage II

85
Q

Visceral Kaposi’s lesions only, GI lymph node

A

Stage III

86
Q

Cutaneous and visceral Kaposi’s lesions

A

Stage IV

87
Q

2 subtypes of Kaposi’s staging

A

A

B

88
Q

Asymptomatic, no systemic signs or symptoms of Kaposi’s

A

A

89
Q

B-symptoms of Kaposi’s; night sweats, chills, and fever over 37.8 F

A

B

90
Q

7 indications of treatment for Kaposi’s

A

Cosmetic control
Painful, bulky lesion
Oral lesions interfering with eating or swallowing
Lymphedema from lymph node or vessel infiltration; ex: node pressing on spinal cord
Pulmonary involvement
Extensive GI involvement causing obstruction
Rapidly progressive disease

91
Q

2 types of treatment for Kaposi’s

A

Local

Systemic

92
Q

3 local treatments of Kaposi’s

A

Radiation therapy
Intralesional therapy (topical cream: vincristine injected into lesion)
Cryotherapy

93
Q

Treatment with liquid nitrogen

A

Cryotherapy

94
Q

4 systemic treatments of Kaposi’s

A

Single agent chemo
Multi agent chemo
Alpha-interferon: protein enhances immune system, best response rate
RT and chemo for advanced disease where surgery can’t be done

95
Q

Chemo for Kaposi’s in immunocompetent patient response rate

A

About 80%

96
Q

Kaposi’s long-term survival

A

40%

97
Q

Kaposi’s AIDS patient response and survival

A 
Response = 50%
Survival = 5-6 months
98
Q

New cases and deaths from bladder cancer in 2017

A

New: 79,033
Deaths: 16,870

99
Q

Bladder cancer affects men ___ times more than women; white men affected ___ times more than African Americans

A

4 times

2 times

100
Q

Bladder cancer affects older people with the average age of diagnosis at ___ years

A

65 years

101
Q

5 risk factors for bladder cancer (environmental)

A

Exposure to aromatic amines and smoking cigarettes; smokers 4 times more likely to develop disease
Schistosoma haematobium parasite infections
Chronic irritation from bladder stone or chronic indwelling of foley catheter
Family history
Aniline dye (cleaning, printers, etc.) increases risk
Chemo drugs cyclophosphamide and pelvic irradiation

102
Q

2 signs and symptoms of bladder cancer

A 
Painless hematuria (80%)
Irritative symptoms (20%)
103
Q

4 irritative symptoms

A

Urgency
Frequency
Dysuria
Altered stream, change in stream/not constant

104
Q

4 signs and symptoms of advanced bladder disease/cancer

A

Palpable mass
Bone pain
Pelvic or rectal pain
Acute renal failure

105
Q

5 workup tests for bladder cancer

A

H&P
CBC and chemical profile
IVP or IVU
Cystoscopy and transurethral resection of bladder tumor (TURBT)
CT/MRI looking at muscle invasion, high grade tumors, etc.

106
Q

4 pathologies of bladder cancer

A

Transitional cell carcinoma
Squamous cell carcinoma
Adenocarcinoma
Small cell disease

107
Q

Most common histology of bladder cancer; 90% of bladder made of transitional epithelium cells
Constantly being exposed to carcinogens because it’s where toxins/waste in urine goes

A

Transitional cell carcinoma

108
Q

Second most common histology of bladder cancer; 3% of bladder cancer in US

A

Squamous cell carcinoma

109
Q

2 subgroups of bladder cancer

A

Superficial

Muscle invading

110
Q

Lower grade noninvasive bladder cancer

A

Superficial

111
Q

Cancer moves from bladder to muscle, more aggressive

A

Muscle invading

112
Q

3 prognostic factors of bladder cancer

A

Tumor grade
Muscle invasion
Blood vessel or lymphatic invasion

113
Q

3 stages of superficial bladder cancer

A

Ta
Tis
T1

114
Q

3 stages of invasive bladder cancer

A

T2-T4

115
Q

5 year survival for all stages of bladder cancer combined, localized, regional, and distant disease

A 
All = 77%
Localized = 69%
Regional =  34%
Distant = 6%
116
Q

___% survival for stage T0 bladder cancer (no evidence of primary tumor)

A

90%

117
Q

___% survival for stage T4 bladder cancer (tumor invades any of the following: prostate, uterus, vagina, pelvic wall, abdominal wall)

A

23%

118
Q

3 treatments of superficial bladder tumors; intravesical agents

A

Bacillus Chalmette-Guerin (BCG)
Chemo drugs placed within 24 hours of resection
Photodynamic therapy

119
Q

Instill drugs directly into bladder

A

Intravesical

120
Q

Bacteria causes immune system to respond to and fight cancer cells
Side effects: fever; lower side effects than chemo
Can’t be given to immunocompromised patients
Given weekly for about 6 weeks

A

Bacillus Chalmette-Guerin (BCG)

121
Q

3 chemo drugs for the treatment of superficial bladder tumors

A

Doxorubicin
Mitomycin
Thiotepa

122
Q

3 treatments for muscle invading transitional cell bladder carcinoma

A

Radical cystectomy
Chemo in high risk patients to decrease recurrence and increase cure rate
Radiation

123
Q

Treatment of choice for muscle invading transitional cell bladder carcinoma; remove all parts of bladder with local pelvic lymph nodes

A

Radical cystectomy

124
Q

In men, remove all parts of bladder with local pelvic lymph nodes, prostate gland, and seminal vesicles

A

Cystoprostatectomy

125
Q

In women, remove all parts of bladder with local pelvic lymph nodes, uterus, fallopian tubes, ovaries, urethra, and segment of interior vaginal wall

A

Anterior exenteration

126
Q

5 common combo chemo drugs for the treatment of muscle-invading transitional cell carcinoma

A 
DDMVAC
CMV
Gemcitabine and cisplatin
5FU (radiosensitizer) and cisplatin
Mets: MVAC
127
Q

DDMVAC

A

Dose-dense methotrexate
Vinblastine
Doxorubicin
Cisplatin

128
Q

CMV

A

Cisplatin
Methotrexate
Vinblastine

129
Q

MVAC

A

Methotrexate
Vinblastine
Doxorubicin/adriamycin
Cisplatin

130
Q

Made from terminal ileum and proximal ascending colon; turned in on itself and sewn together
Ureters removed from bladder and positioned to drain into new pouch
Stoma made with small intestine
Sterilely catheterized to empty every 4-6 hours
Can create impedance in men and vaginal shrinkage in women

A

Indiana reservoir/Kock pouch

131
Q

Common sites of mets from bladder cancer

A 
Lungs
Bones
Liver
Lymph nodes
Brain most common in patients successfully treated with combination chemo/RT
132
Q

5 common sites bladder cancer goes invasively (regional structures)

A 
Sigmoid
Rectum
Prostate
Uterus
Vagina
133
Q

Develops in connective tissue; most common soft tissue sarcoma (STS) in kids, over 85% occur in kids
Common sites: arms, legs, H&N, and urinary and reproductive organs
Dose levels lower because it usually occurs in kids; treat kids at lower doses because they’re developing

A

Rhabdomyosarcoma

134
Q

Fleshy growths that develop in connective tissue
Can be in muscles, tendons, fibrous tissues, and bone and cartilage
Less than 1% of all cancer and cancer deaths

A

Sarcomas

135
Q

5 risk factors for sarcoma

A

Some genetically transmitted diseases increase risk
Certain herbicides (kill plants)
Radiation induces 10 years after in treated area
Some chemotherapy alkylating agents and cumulative chemicals
Lymphedema develops into angiosarcomas

136
Q

Disorder of nervous system, benign fibrous growths on nervous tissue that can develop into STS

A

Recklinghausen disease

137
Q

Sarcomas of inner lining of blood vessels

A

Angiosarcomas

138
Q

2 classifications of sarcoma

A

Soft tissue sarcomas (STS): 50-70 types, very rare

Bone sarcomas

139
Q

4 most common sarcomas in adults

A

Osteosarcoma most common
Malignant fibrous histiosarcoma
Liposarcoma
Leiomyosarcoma

140
Q

Sarcoma of fat

A

Liposarcoma

141
Q

3 most common sarcomas in kids

A

Rhabdomyosarcoma
Ewings
Osteosarcoma most common in 2nd decade of life

142
Q

Level of differentiation, very important in evaluating the aggressiveness of sarcomas and is included in the pathology report along with the exact histologic type
High = bad, poor survival; low = good survival

A

Grade

143
Q

Appearance of cell histology

A

Differentiation

144
Q

Varying in size and shape of cell; cellular makeup, etc.

A

Pleomorphism

145
Q

3 signs and symptoms of sarcomas

A

Mild pain
Mild soft tissue swelling
Palpable mass

146
Q

Poorly differentiated

A

Anaplastic

147
Q

STS staging uses the __________ staging system, while bone depends on _______ (surgical staging more often used)

A

Tumor, node, metastasis (TNM)

Grade

148
Q

Low grade bone sarcoma

A

Stage I

149
Q

High grade bone sarcoma

A

Stage II

150
Q

Any grade bone sarcoma with regional and/or distant metastasis

A

Stage III

151
Q

Well diffentiated STS, no nodes or metastasis

A

Stage I

152
Q

Moderately differentiated STS, no nodes or metastasis

A

Stage II

153
Q

Poorly differentiated/anaplastic STS, no nodes or metastases

A

Stage III

154
Q

Any differentiation STS with nodes and/or metastases

A

Stage IV

155
Q

2 subclassifications of stage I-III STS

A

A less than 5 cm

B greater than 5 cm

156
Q

2 subclassifications of stage I & II bone sarcoma

A

A intracompartmental

B extracompartmental

157
Q

Stage I-IV sarcoma 5 year survival rates

A 
I = 90%
II = 70-81%
III = 20-56%
IV = less than 20%
158
Q

High grade sarcoma greater than 5 cm have over ___% chance of recurrence, less than 2 cm has cure rate of about ___% (excellent prognosis)

A

50%

90%

159
Q

When sarcomas originate somewhere other than arms or legs, ______ prognosis

A

Worse

160
Q

5 areas where STS most commonly arise

A 
Extremities 60%; lower (legs) more common than upper (arms)
Trunk 19%
Retroperitoneal area 15%
Head and neck region 9%
Viscera/GI tract very small percentage
161
Q

Behind abdominal lining

A

Retroperitoneal area

162
Q

3 most common mets sites of STS

A 
Lung = 33%
Bone = 23%
Liver = 15%
163
Q

STS spreads via ______, not common by lymph nodes (less than ___%, very rare)

A

Blood

10%

164
Q

Treatment for low grade STS

A

Complete surgical resection for local disease

165
Q

Treatments for small and larger STS

A

Chemo (doxorubicin) and radiation
Small: surgery
Larger tumors over 5 cm: multimodality approach with chemo to shrink, surgery to remove, and RT to prevent spread/recurrence

166
Q

Malignant tumor usually arising in the bone that are characterized by bone or osteoid production
Most common form of bone cancer; 35% of bone cancers in US
Knee/distal femur most frequently affected site
Spindle cell type
Most common in 2nd decade of life
Bimodal age distribution: adolescents and 65 years or older; occurs in young patients 10-20 years old, peaks at adolescence
Men and blacks more commonly affected
Skip mets
Treatment was amputation; now chemo, limb-sparing surgery (80-90%), and more chemo and radiation for high grade disease to prevent recurrence
75% cure rate, 5-10% recurrence with bad prognosis
Mets survival rate = 20%

A

Osteosarcomas

167
Q

Primary tumor in bone, another tumor appears in same bone but not connected to first tumor; high grade disease

A

Skip mets

168
Q

4 indications for amputation for osteosarcoma; focus on mobility

A

Only way to remove all malignant disease
Amputation would be more functional than limb sparing
Couldn’t undergo rehab for limb-sparing
High morbidity rate with limb-sparing

169
Q

Rare tumor of bone mainly in adolescents, usually in diaphysis
Most common in 1st decade of life, 2nd to osteosarcoma in 2nd decade
3rd most common sarcoma, 16%
Small, round, blue cells
Treatment: preoperative chemo, limb-sparing surgery, and more chemo; disease-free survival = 10% and radiation for disease unresponsive to treatment, palliation, and local control; avoid because of retardation of growth and secondary malignancies

A

Ewing’s sarcoma

170
Q

Diaphysis, epiphysis, and metaphysis

A

Diaphysis: midshaft of bone
Epiphysis: knoblike portions at either end of bone
Metaphysis: growth plate, narrow portion of long bone between epiphysis and diaphysis

171
Q

Second most common form of bone cancer; most common in adults, 40%
30% of primary bone cancer, 2nd most common
40-75 year olds
Surgery is the preferred primary treatment, radiation for high grade disease or positive margins after limb-sparing surgery; chemo has limited to no benefit
Grade 1 & 2 = 80-90% 5 year survival, grade 3 = 20% 5 year survival
More common to have late recurrence (like breast cancer) 10-15 years (diseases usually occur within months)

A

Chondrosarcoma

172
Q

Cam be benign (less aggressive) or malignant (more aggressive); difference is the aggressiveness of tumor histology
Cause unknown but RT causes them
Affects people of all ages (bimodal age distribution of 3-8 and 40-60 years old), men more commonly affected, and patients with Hippel-Lindau disease (vascular tumors in CNS, spinal cord, etc.) , neurofibromatosis/von Recklinghausen’s, and hemangioblastomas (vascular tumors put patients at high risk)
Usually can’t drive, duty to report if they are

A

Brain tumors

173
Q

5 types of brain tumors

A 
Gliomas
CNS lymphomas
Medulloblastoma
Ependymoma
Oligodendroglioma
174
Q

Most common brain tumors arise from glial cells in brain

A

Gliomas

175
Q

Nourish and protect neurons, compose over half of CNS cells

A

Glial cells

176
Q

Most common subtype of gliomas, primary CNS (brain and spinal cord) cancers

A

Astrocytomas

177
Q

Brain tumors that commonly arise from B-cells in AIDS patients

A

CNS lymphomas

178
Q

Most common brain tumors in kids, 20% of childhood CNS disease
Median age of diagnosis = 5-6, 50% 5 year survival rate
More common in boys

A

Medulloblastoma

179
Q

Glial tumor; 2 peak ages = 3-8 and 4th and 5th decades of life

A

Ependymoma

180
Q

Brain tumors that originate in oligodendrocytes; 6% of CNS gliomas
Most common between 20-40 years old

A

Oligodendroglioma

181
Q

Cells that support neurons

A

Oligodendrocytes

182
Q

3 types of tumors caused by neurofibromatosis/von Recklinghausen’s

A

Meningiomas
Astrocytomas
Schwannomas

183
Q

Tumors that form on membranes that cover brain and spinal cord

A

Meningiomas

184
Q

Brain tumors that originate from schwann cells that cover myelin sheath

A

Schwannomas

185
Q

5 signs and symptoms of brain tumors; tumor infiltration causes pressure on brain

A

Headaches most common, bifrontal/bioccipital area when patient wakes up
Seizures also most common (anticonvulsants)
Motor or sensory loss
Fatigue
Nausea and vomiting

186
Q

2 most common signs of glial tumors

A

Headaches

Seizures

187
Q

4 cognitive signs and symptoms of brain tumors; usually hardest signs and symptoms for patient to control

A

Reasoning and judgement
Lack of initiative and awareness
Short term memory deficit
Personality change

188
Q

Small, discrete pigmented skin lesions that develop into multiple along the course of peripheral nerves and may undergo malignant transformation

A

Neurofibromatosis/von Recklinghausen’s

189
Q

Difficulty speaking

A

Aphasia

190
Q

Sensorium

A

Perception

191
Q

Most aggressive brain tumors

Prognosis without treatment = weeks, with treatment = 12-18 months whether adult or child

A 
Astrocytoma, grade IV
Glioblastoma multiforme (GBM)
192
Q

3 brain tumor treatment methods

A

Surgery: remove as much of tumor as safely possible and consider location, aggressiveness, etc. for quality of life; total resection can be attempted depending on location, treat positive margins with radiation if partial resection
Radiation usually after surgery, regular fractionation
Chemo not commonly used, usually palliative; portacath because of blood-brain barrier (BBB)

193
Q

5 forms of radiation therapy for brain tumors

A 
IMRT/conformal therapy reduces dose to surrounding good brain tissue
Hyperfractionated radiotherapy
Stereotactic radiosurgery/gamma knife
Brachytherapy
Boron neutron capture
194
Q

Higher fractions with less dose usually BID with 4-6 hours between, reduces side effects

A

Hyperfractionization

195
Q

RT for small, well-defined tumors, small dose of 1-2 fractions
Fewer fractions than SRT
CT, MRI, and angiogram
Narrow beams to treat small area and reduce dose to normal tissue

A

Stereotactic radiosurgery/gamma knife

196
Q

3 long-term problems with treating brain tumors in kids with RT

A

Delay radiation after 2-years old reduces risk
Cognitive deficits
If pituitary treated, reduce production of growth hormone; can affect sexually as well

197
Q

Drowsiness, lethargy, loss of appetite, etc. 4-6 weeks after radiation

A

Radiation somnolence syndrome

198
Q

Chemo used at diagnosis of astrocytoma and for recurrence

A

Diagnosis: temozolomide
Recurrence: nitrosourea

199
Q

Most common: dexamethasone/decadron
Reduces intracranial pressure to control symptoms
Different anabolic steroids; cortisol hormone produced by renal cortex
Side effects/problems: retention of fluid and weight gain, increased likelihood of infection, upset stomach, irritable mood changes, muscle weakness in proximal extremities, bone disease, and cataracts

A

Corticosteroids

200
Q

Prognosis for astrocytoma grade II, anaplastic astrocytoma grade III, and glioblastoma (grade IV astrocytoma)

A

Astrocytoma grade II = 6-7 years
Anaplastic astrocytoma grade III = 18-24 months
Glioblastoma (grade IV astrocytoma) = 12-18 months

201
Q

5 other treatment options for brain tumors

A 
Localized brachytherapy (place source in balloon), hyperthermia, and hyperfractionization
Localized and high-dose chemo
Tumor vaccines (preventative)
Gene therapy: use DNA to treat disease
Interruption of BBB to allow chemo to pass

RAD 390 - Radiation Therapy Oncology Nursing (7 decks)

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