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

Test 3 Flashcards

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1
Q

Adenocarcinomas, lymphomas, and leiomyosarcomas
2017: 28000 new cases, 17750 males and 10250 females; 10960 deaths
US has lowest mortality rate
Usually have advanced disease when symptoms start, not easily detected early
Adjuvant therapy doubles median survival but doesn’t affect 5 year survival

A

Stomach/gastric cancer

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2
Q

9 risk factors for gastric cancers

A

Lower socioeconomic status: eating, drinking, lifestyle, etc.
Diets low in fruits and vegetables
Ingestion of salt-preserved or smoked foods
Smoking
Chronic atrophic gastritis
Gastric adenomatous polyps
Hereditary
Pernicious anemia
Barrett’s esophagus and peptic ulcers of lower esophagus often with stricture

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3
Q

Inflammation of stomach lining

A

Gastritis

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4
Q

Premalignant gastric disease

A

Gastric adenomatous polyps

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5
Q

Body can’t absorb enough vitamin B-12, which is needed to make healthy red blood cells (RBCs)
Severe blood disease decreases RBCs
2-3 times higher risk of gastric cancer

A

Pernicious anemia

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6
Q

8 symptoms for gastric cancer

A 
Anorexia
Early satiety
Weight loss
Palpable abdominal mass
Dysphagia
Severe anemia
Weakness
Nausea and vomiting (N&V), hemoptysis
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7
Q

Coughing up of blood

A

Hemoptysis

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8
Q

5 tests for gastric cancer

A 
Upper GI
Flexible endoscopic gastroscopy
Tumor markers: carcinoembryonic antigen (CEA)
PET for staging
MRI & CT
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9
Q

Highly vascular layer of connective tissue under the basement membrane lining of a layer of epithelium, nourishes the mucosal epithelium and its associated mucosal glands

A

Lamina propria

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10
Q

4 treatments for gastric cancer

A

Complete surgical resection for cure, early stage; relapse within about 2 years
Radiation for palliation of pain and obstruction
Chemo and radiation show improved survival
Chemo is treatment of choice with metastatic gastric

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11
Q

90-95% of gastric cancers

A

Adenocarcinomas

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12
Q

Gastric cancer occurs most often from ___-___ years old, older patients; rare at less than ___ years old

A

55-90 years old

30 years old

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13
Q

Chemo and radiation for gastric cancer drug, dose, and survival

A

Drug: 5FU
Dose: 40-50 Gy
Survival: 5.9-12 months

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14
Q

Stomach empties too soon and can’t digest food properly leading to profuse sweating, nausea, dizziness, and weakness

A

Dumping syndome

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15
Q

Stage 1, 2, and 4 survival for gastric cancer and 5 year survival with and without LN involvement

A 
1 = 67%
2 = 31%
4 = 5%
With = 10-25%
Without = 75%
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16
Q

More common in males; more common and higher mortality rate in African Americans
2017: 53670 new cases, 27070 males and 25700 females; 43000 deaths

A

Pancreatic cancer/silent killer

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17
Q

Pancreatic cancer median and 5 year survival

A

Median: 9-12 months

5 year: 6%

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18
Q

Peak age of pancreatic cancer is ___-___ years old and is rare before ___ years old

A

60-80

45

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19
Q

8 risk factor of pancreatic cancers

A

Cigarette smoking and over 4 drinks a day
Diet high in fat and low in fruits and vegetables
Previous partial gastrectomy
Diabetes mellitus type 2 and obesity for over 5 years
Occupational exposure: petroleum compounds, beta naphthylamine (cigarettes), and benzene
Lower socioeconomic status
Hereditary pancreatitis
Coffee drinkers

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20
Q

95% if pancreatic cancer occurs in the _______ portion and 90-95% are ____________
Majority arise in proximal _______ and _______ of pancreas on right side

A

Exocrine, adenocarcinomas

Head and neck

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21
Q

Digestive system

A

Exocrine

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22
Q

8 symptoms of pancreatic cancer

A 
Abdominal pain: main
Anorexia, weight loss, and early satiety
Sleep problems and fatigue
Jaundice
Nausea and vomiting
Diarrhea or constipation
Ascitis
Courvoisier's sign
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23
Q

5 tests for diagnosis of pancreatic cancer

A 
Abdominal ultrasound
CT
Endoscopic retrograde cholangiopancreatography (ERCP)
Increased CA 19-9
Biopsy for histology
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24
Q

Palpably enlarged gallbladder

A

Courvoisier’s sign

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25
Q

3 treatments for pancreatic cancer

A

Whipple procedure
Chemo
Radiation after surgery or inoperable

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26
Q

6 organs removed and 1 nerve block during whipple procedure

A 
Head of pancreas
Duodenum
Distal stomach
Common bile duct
Gallbladder
Vagotomy sometimes
Celiac plexus block
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27
Q

Remove part of the vagus nerve, 50% alcohol at vagus nerve

A

Vagotomy

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28
Q

Injection of local anesthetic (50% alcohol) into or around celiac plexus bundle of nerves at xiphoid

A

Celiac plexus block

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29
Q

En-bloc resection doubles median survival of pancreatic cancer

A

Whipple procedure

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30
Q

Median survival of pancreatic cancer

A

15-19 months

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31
Q

Chemo for pancreatic cancer mets after surgery or for inoperable disease

A

Gemcitabine

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32
Q

10-20% of pancreatic cancers are resectable: stage 1 (T___-T___, no ___ or ___)

A

T1-T2, no N or M

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33
Q

Liver and bile duct cancer
High fatality rate
2017: 40710 new cases, 29200 males and 11510 females; 28920 deaths
Diagnosis: US, MRI, and CT

A

Hepatocellular carcinoma (HCC)

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34
Q

Most primary liver cancers in adults are __________ and are ___________

A

Hepatocellular, adenocarcinomas

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35
Q

Arise from hepatocytes

A

Hepatocellular

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36
Q

7 HCC risk factors

A

Chronic infection with hepatitis B, C with or without cirrhosis
Preexisting cirrhosis, almost always associated with cirrhosis: heavy drinker, infections, etc.
Aflatoxin
Hormones: oral contraceptives over 8 years or long-term use of androgen
Being male: 3/4 cases
Obesity and diabetes
Heavy alcohol use and tobacco

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37
Q

Steroid-type hormone like testosterone

A

Androgen

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38
Q

8 symptoms of HCC

A 
RUQ pain most common
Fatigue
Abdominal swelling
Weight loss
Unexplained fever
Jaundice
Elevated alpha-fetoprotein (AFP) tumor marker, 70% of patients
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39
Q

Mutated P53 tumor suppressor gene

A

Aflatoxin

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40
Q

5 treatments of HCC

A

Surgery is only cure/main treatment, only 15% are resectable
Hepatic intra-arterial infusion of chemo
Liver transplant
Radiation not curative
Single agent chemo: doxorubicin, 5FU, and cisplatin

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41
Q

5 year survival and 2 year recurrence for HCC with resected tumor

A

5 year: 33-47%

2 year: 55%

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42
Q

5 year and median survival for HCC with unresected tumor

A

5 year: less than 10 months

Median: 3-6 months

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43
Q

4 conditions gallbladder cancer is associated with

A

Cholecystitis and cholelithiasis associated with a majority of cases because irritation causes proliferation of cells
Ulcerative colitis
Age 60-70, older; rare before age 40
More common in females

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44
Q

2017: 11740 new cases, 5320 males and 6420 females; 3830 deaths
RT controversial; chemo for resected tumors to increase survival and unresected tumors show response but no evidence of increased quality of life (QOL) or cure

A

Gallbladder cancer

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45
Q

Cause of gallbladder cancer

A

Unknown

46
Q

Gallbladder cancer is usually _________ and _________ disease when found

A

Asymptomatic, advanced

47
Q

5 year survival of gallbladder cancer based on ______

A

Stage

48
Q

Gallbladder cancer spreads by ______________ to local areas like liver, stomach, duodenum, etc. and becomes unresectable

A

Direct extension

49
Q

Treatment of choice of gallbladder cancer

A

Surgery

50
Q

Most common type of gallbladder cancer

A

Adenocarcinoma

51
Q

5 year survival of stage 0, 1, 2, 3, and 4 gallbladder cancer

A

0: 80%
1: 50%
2: 28%
3: 7%
4: 2%

52
Q

Chemo regimen for gallbladder cancer

A

FAM

53
Q

FAM

A

5FU
Doxorubicin
Mitomycin

54
Q

3 chemo drugs that have shown some benefits of survival for advanced gallbladder disease

A

Gemcitabine
Fluoropyrimidine
Platinum-based agents

55
Q

7 common sites of gynecological (GYN) cancers

A 
Endometrial
Ovarian
Cervical
Fallopian tubes
Vagina
Vulva
Gestational neoplasms
56
Q

Epithelial surface, lining of uterus

A

Endometrium

57
Q

Average/median age of endometrial, ovarian, and cervical cancer

A

Endometrial: 55-70+ (postmenopausal)
Ovarian: 63, 50-70
Cervical: 48, 30-39 and 60-69

58
Q

Neoplasms related to pregnancy

A

Gestational neoplasms

59
Q

Staging for cervical cancer accepted by International Federation of Gynecology and Obstetrics (FIGO)

A

TNM

60
Q

Spaces between cervix past fornices in bony structure of pelvis

A

Parametrium

61
Q

Treatment for early stage 1 cervical disease, tissue removed by scalpels, etc. in cone-shape; lower morbidity and easier recovery

A

Cone biopsy

62
Q

2 types of cone biopsies

A

Endocervical

Exocervical

63
Q

Cervical disease higher up in surface, longer wedge piece removed

A

Endocervical cone biopsy

64
Q

Cervical disease in cervical oss, wider portion removed

A

Exocervical cone biopsy

65
Q

One of the only preventable cancer because of its long malignant/invasive state that can be detected on pap smears
External RT gives good survival rates for early disease; hysterectomy depends on stage of disease, patient’s health and age, etc.
Can be squamous, adenocarcinoma, adenosquamous, small, or glassy cell carcinomas
EBRT and implant due to the dose limits of surrounding structures
1.5% of new cancers in women and cancer deaths
2017: 12820 new cases, 4210 deaths

A

Cervical cancer

66
Q

Most common cervical cancer because it’s in direct contain with carcinogens

A

Squamous cell carcinomas

67
Q

6 risk factors of cervical cancers

A

Early coitus and more than 5 partners
Human papillomavirus (HPV) and warts
HIV
Low socioeconomic status: don’t have resources/screenings
Smoking causes precancerous changes in cervix
Oral contraceptives for over 5 years

68
Q

HPV responsible for ___% of cervical cancer patients

A

99%

69
Q

Intercourse before age of 18

A

Early coitus

70
Q

7 symptoms of cervical cancer

A 
Abnormal vaginal bleeding most common
Thin, watery vaginal discharge
Heavier menses
Post-coital spotting
Spontaneous, intermittent uterine bleeding
Back, flank, and leg pain
Lower extremity edema
71
Q

6 symptoms of late cervical disease

A 
Dysuria
Hematuria
Pelvic pressure
Rectal bleeding
Flank and leg pain
Cough (advanced moving disease)
72
Q

Foul-smelling fluid

A

Malodorous serosanguinous

73
Q

Pain during sex

A

Dyspareunia

74
Q

Tumors during pregnancy

A

Gestational trophoblastic disease (GTD)

75
Q

4 terms with a pap smear

A

Atypia
Dysplasia
Cervical intraepithelial neoplasia (CIN)
Squamous intraepithelial lesion (SIL)

76
Q

Structural abnormality in cell, not typical/atypical and doesn’t give much information

A

Atypia

77
Q

Distinct abnormality of cellular development, premalignant disease; rated mild, moderate, or severe based on deviation from normal appearance of cell

A

Dysplasia

78
Q

Identifies dysplastic category 1, 2, or 3; dysplasia increases with level

A

Cervical intraepithelial neoplasia (CIN)

79
Q

CIN when HPV is present in patient

A

Squamous intraepithelial lesion (SIL)

80
Q

Treatment of early cancer confined to cervix smaller than 4 cm, 4 cm and confined to cervix, and cancer beyond cervix into the parametria

A

Early cancer confined to cervix smaller than 4 cm: radical hysterectomy and LN dissection
4 cm and confined to cervix: radiation then simple hysterectomy
Cancer beyond cervix into the parametria: radiation and/or chemo

81
Q

2 ways to avoid hysterectomies in younger cervical cancer patients because of fertility

A

Trachelectomy/cervicectomy

Intracavitary treatment: tandem, ovoid, heyman’s capsules, etc.

82
Q

Remove cervix and leave uterus, still childbearing

A

Trachelectomy/cervicectomy

83
Q

3 types of hysterectomies

A

Extrafascial/simple
Modified radical
Radical

84
Q

Entire uterus and cervix removed, done vaginally or abdominally

A

Extrafascial/simple hysterectomy

85
Q

Remove uterus, cervix, small portion of upper vagina, and inner third of perimetria

A

Modified radical hysterectomy

86
Q

Outer serous layer of the uterus

A

Perimetria

87
Q

Removed upper 3 cm of vagina, most of perimetria, uterus, cervix, and regional LN dissection and ureters dissected out of urethral sacral ligaments

A

Radical hysterectomy

88
Q

Radical surgical procedure that involves the removal of the uterus, vagina, parametria, bladder (anterior), and rectum (posterior) for advanced disease
For recurrent cancer with curative intent leads to a loss of QOL and high rate of morbidity

A

Pelvic exenteration

89
Q

Fallopian tubes and ovaries removed

A

Salpingo-oophorectomy

90
Q

3 types of pelvic exenterations

A

Anterior
Posterior
Total

91
Q

Remove urethra, lower part of ureters, cervix, vagina, and bladder; stoma for urine

A

Anterior pelvic exenteration

92
Q

Remove lower part of large bowel, rectum, uterus, cervix, ovaries, fallopian tubes, vagina, and LNs may be removed

A

Posterior pelvic exenteration

93
Q

Remove bladder, rectum, and internal reproductive organs; permanent colostomy and urinary diversion

A

Total pelvic exenteration

94
Q

Radiation dose for cervical cancer

A

70-90 cGy with implants

95
Q

2 chemo drugs that increase radiosensitivity of cervical cancer

A

5FU

Cisplatin

96
Q

2.6% of new cancers and 5% of cancer deaths in women
No reliable tests for screening asymptomatic women
Most deadly of GYN diseases

A

Ovarian cancer

97
Q

7 ovarian cancer cells

A 
Epithelial carcinoma most common
Malignant germ cell tumors most common
Endometrioid
Clear cell
Brenner
Undifferentiated diseases
Sarcomas
98
Q

7 risk factors of ovarian cancer

A

Risk increases until age 70
Family history of ovarian, breast-ovarian, or breast-ovarian-endometrial-colon especially if two or more first degree relatives have disease
Incessant ovulation
Northern European ancestry or line in western industrialized countries
BRCA 1 and 2 accounts for 15% of ovarian diseases
Perineal talc powders
Low risk factors: high dietary fat and excessive coffee and alcohol consumption

99
Q

Proteins that repair damaged genes/DNA

A

Breast cancer susceptibility gene 1 and 2 (BRCA 1 and 2)

100
Q

Birth control _______ risk significantly by as much as 50% but ________ chance of cervical and liver disease

A

Lowers, increases

101
Q

8 symptoms of ovarian disease

A

Abdominal/pelvic pain and abdominal distension most common
Increased flatus
Changes in GI function
Abdominal girth: aggressive
Weight gain: aggressive
Pain: aggressive
Dyspepsia, anorexia, and early seity can be some of the first symptoms seen
Pressure and general discomfort in rectum, bladder, and pelvis

102
Q

Treatment of early stage 1 and stage 2-4 ovarian cancer

A

1: removal of one of ovaries with adjuvant chemo, 3-6 cycles of paclitaxal plus platinum based drug
2-4: involved surgical cytoreduction staging which can include hysterectomy, bilateral salpingo-oophorectomy, and omentectomy, and pelvic and paraaortic LN dissection; chemo

103
Q

7% of new cancers and 3.9% of cancer deaths i women

17: 61380 new cases, 10920 deaths

A

Endometrial cancer

104
Q

7 endometrial cancer cell types

A 
Adenocarcinoma/glandular epithelium most common: 75-80%
Adenosquamous
Squamous
Mucinous
Serous papillary
Clear cell
Undifferentiated
105
Q

7 risk factors for endometrial cancer

A

Unopposed exogenous estrogen
Nulliparity, infertility, and anovulation
Late menopause over 52 years old
Obesity: fat cells produce estrogen and reduce level of sex hormones
Diabetes mellitus and hypertension
Family history
Complex atypical hyperplasia

106
Q

Estrogen not combatted by progesterone leads to thickening of uterine lining, women with uterus removed don’t have to worry about progesterone

A

Unopposed exogenous estrogen

107
Q

6 symptoms of endometrial cancer

A 
Abnormal uterine bleeding most common: about 80%
Pap smear abnormality
Urinary changes
Yellow, watery vaginal discharge
Pyometra and hematometra
Hypogastric and lumbosacral pain
108
Q

Accumulation of pus in uterus

A

Pyometra

109
Q

Accumulation of blood in uterus

A

Hematometra

110
Q

4 symptoms of advanced endometrial disease

A

Uterine enlargement
Pelvic pressure
Leg swelling
SOB

111
Q

Body of womb/uterus

A

Corpus

112
Q

Wound ruptures/splits open

A

Wound dehiscence

RAD 390 - Radiation Therapy Oncology Nursing (7 decks)

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