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RAD 390 - Radiation Therapy Oncology Nursing > Test 4 (H&N, RCC, and Testicular) > Flashcards

Test 4 (H&N, RCC, and Testicular) Flashcards

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1
Q

3% of all new cancers
Includes all areas of the head and neck: lips, oral cavity, etc.
17: 49670 new cases, 9700 deaths
Treatment depends on disease site
Sarcomas rare; carotid rupture rare but can be caused by RT or chemo and can be fixed by surgery and pressure

A

Head and neck (H&N) cancers

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2
Q

Occurs in younger age group more than other H&N disease, 20% under 30 years old
More common in Chinese than caucasians

A

Nasopharynx disease

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3
Q

3 parts of the pharynx

A

Nasopharynx
Oropharynx
Hypopharynx

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4
Q

Upper part of pharynx connecting with nasal cavity above soft palate

A

Nasopharynx

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5
Q

Part of pharynx between soft palate and hyoid bone

A

Oropharynx

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6
Q

Laryngeal part of pharynx extending from hyoid to lower margin of cricoid cartilage

A

Hypopharynx

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7
Q

5 risk factors of H&N cancer depending on site

A

Tobacco use and alcohol most important risk factor for disease site, smokeless tobacco
Advancing age over 50, older people
Epstein-Barr virus (EBV)
Occupational: asbestos, wood dust, leather, and metal breathed in nasal conchae turbinates, and sun exposure
Males, about 3:1 ratio

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8
Q

___% of lip cancer patients have outdoor occupation

A

31%

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9
Q

No known cause of salivary or thyroid, but risk factor for thyroid

A

Radiation exposure

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10
Q

Histology that makes up the majority of all H&N cancers, comes in direct contact with carcinogen

A

Squamous cell carcinomas

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11
Q

4 early symptoms of H&N cancers

A

Changes in facial appearance
Sight and smell
Swallowing and speech
Ulceration and pain at primary site

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12
Q

5 H&N diagnostic tests

A

History and physical (H&P)
CT, MRI, and PET (recurrence and unknown primary): diagnostic information, lymph node (LN) involvement, etc.
Thyroid scans for thyroid cancer: thyroid tissue swelling and growth versus (vs) nodules
Lab studies
Biopsy for diagnosis, histology to determine treatment method

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13
Q

5 types of H&N skin cancer

A 
Basal cell: common
Squamous: common
Merkel: more lethal than melanoma, consider LN involvement
Skin appendage: consider LN involvement
Melanoma: consider LN involvement
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14
Q

H&N skin cancer treatment

A

Mohs wide excision surgery

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15
Q

7 indications for thyroid cancer

A 
History of low dose radiation exposure
New nodule in patients over 40 years old
Nodule fixation if thyroiditis is excluded
Rapid growth
Onset of hoarseness
Palpable LN in neck
Solitary nodule in any age male
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16
Q

Must have thyroid diagnosis before _______ or _______ done

A

Thyroidectomy or Iodine-131 (I-131)

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17
Q

Thyroid cancer treatment and treatment for advanced disease/mets

A 
Radical surgery (thyroidectomy) and RT
Chemo for advanced disease/mets
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18
Q

3 lips cancers and sites

A

Squamous cell most common on lower lip because sun directly hits it
Basal cell most common on upper lip and overall
Minor salivary gland cancers usually advanced or high grade

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19
Q

Treatment of squamous and basal cell cancer of lip and minor salivary gland cancer

A

Squamous and basal cell: surgery or RT, most concerned with cosmesis
Minor salivary gland: wide exision

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20
Q

3 major glands and number of minor glands

A

Parotids
Submandibular
Sublinguals
About 600 minor glands

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21
Q

2 types of oral and pharyngeal cancers

A

95% squamous cell if on mucosal surfaces

Minor salivary glands remainder

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22
Q

Treatment and treatment of advanced cases of oral and pharyngeal cancers

A

Tx: RT or surgery have same cure rate
Advanced: combination of surgery, RT, and chemo

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23
Q

H&N cancer mets usually by way of what and why?

A

LNs because 1/2 of body’s LNs in H&N area

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24
Q

Most common mets site of H&N cancer

A

Lungs

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25
Q

3 treatments for speech production affected by a laryngectomy

A

Artificial larynx
Esophageal speech
Tracheoesophageal puncture (TEP)

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26
Q

Learn to burp sounds, can take up to 6 months

A

Esophageal speech

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27
Q

Surgically created hole between esophagus and trachea with voice prosthesis inserted

A

Tracheoesophageal puncture (TEP)

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28
Q

6 H&N radiation side effects

A

Watch for malnutrition: sore throat, hardest treatment for patients to tolerate
Radionecrosis and mandibular bone loss if in treated site
Mucositis
Redness of skin
Dysphagia
Xerostomia: watch parotids

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29
Q

Inflammation and ulceration of mucous membranes, smoking and drinking make it worse
Softer toothbrush, swish and swallow, antiseptic mouthwash, etc.

A

Mucositis

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30
Q

Difficulty swallowing

A

Dysphagia

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31
Q

3 xerostomia treatments

A

Sodium bicarbonate/baking soda helps fight infection and moistens mouth
Artificial saliva
Water bottle

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32
Q

Go to treatment for H&N cancer and mets treatment

A

Go-to: surgery and RT

Mets: chemo

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33
Q

4 factors of H&N cancer prognosis

A

Stage
Histology
Extent of LN involvement
Future lifestyle: quit smoking and drinking

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34
Q

5 year disease free survival of H&N cancer

A

60%

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35
Q

Ratio of males to females for renal cell carcinoma (RCC)/kidney cancer

A

Males 2 to 1 over females

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36
Q

Median age of RCC

A

64 (older)

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37
Q

7 risk factors for RCC

A

Smoking
Exposure to asbestos: main filtration
Von Hippel-Lindau syndrome (VHL)
Renal cystic disease while on hemodialysis
Genetic predisposition
Increasing age, rare under 45 years old
Obesity, cadmium and uranium exposure, and use of prescription diuretics (association)

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38
Q

Compared to non-smokers, risk of RCC increases ___% in males and ___% in female smokers

A

50%

20%

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39
Q

Angiomatosis in retina leads to angiomas in blood and lymph vessels

A

Von Hippel-Lindau syndrome (VHL)

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40
Q

Obesity especially in women accounts for ___% of kidney cancer in general

A

30%

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41
Q

6 RCC histopathology subtypes and percentages

A 
Clear cell: 75-80%
Papillary: 10-15%
Chromophobe: 5-10%
Medullary: less than 1%
Collecting duct: less than 1%
Oncocytoma: uncommon
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42
Q

90% of RCCs arise from _______

A

Renal parenchyma

43
Q

Where ureter enters kidney and expands, about 10% of kidney disease here

A

Renal pelvis

44
Q

90% of renal pelvis disease are _______ and about 8% are _______

A

Transitional, squamous

45
Q

Kidney cancer in 1 of 200-250,000 kids
Peak age of 3, rare after 8
90% cure rate for localized tumor

A

Wilms tumor

46
Q

3 signs and symptoms of RCC

A

Hematuria most common
Flank pain and mass
Hypertension, anemia, cachexia, weight loss, fever, and other symptoms

47
Q

Triad of symptoms that are a sign of advanced renal disease in about 10% of patients

A

Hematuria
Flank pain
Flank mass

48
Q

Side of person’s body between ribs and hips

A

Flank

49
Q

Buildup of protein in body

A

Amyloidosis

50
Q

Increased RBCs

A

Erychrocytosis

51
Q

Intestinal disease

A

Enteropathy

52
Q

Disease of nerves and associated muscle tissue

A

Neuromyopathy

53
Q

Fever

A

Pyrexia

54
Q

Excessive or inappropriate production of milk

A

Galactorrhea

55
Q

Mets affects about ___% (__/__) of all RCC cases

A

33% (1/3)

56
Q

7 sites and percentages of RCC mets

A 
Lung most common: 50-60%
Liver: 30-40%
Bones: 30-40%
LN: 30-40%
Adrenal glands: 20%
Opposite kidney: 10%
CNS system: 5%
57
Q

8 RCC workups

A 
H&P
CBC and chemical profile
Ultrasound (US)
CT of pelvis abdomen
Abdominal (IVC involvement) or brain (mets) MRI
KUB/IVP
Cystoscopy for hematuria
Biopsy
58
Q

Layer of connective tissue encapsulating the kidneys and adrenal glands

A

Gerota’s fascia

59
Q

5 factors RCC prognosis is dependent on

A 
Grade: important predictor for mets especially for groin and even more powerful with depth of tumor invasion
Stage
Size
Histologic type
Mets
60
Q

5 year survival of stage I, II, III, and IV RCC

A

I: 81%
II: 74%
III: 53%
IV: 8%

61
Q

5 RCC treatments

A

Surgery for early stage, only cure
Immunotherapy for relapsed patients or patients who have inoperable stage 4 clear cell disease
Targeted therapy: tyrosine-kinase inhibitor (TKI) and antibodies
Radiation for palliation, recurrence, and brain mets
Chemo used when immuno- or targeted therapy has failed; no real benefit for survival and uncommon

62
Q

RCC immunotherapy that forces immune system to fight cell

A

Interleukin 2 (Il-2)

63
Q

Why is RCC considered a radioresistant disease?

A

There’s a high level of differentiation in cell

64
Q

Radiosensitive disease, 1% of all cancers in men
Most common age is 20-39
Rising in US and Europe, less common in African Americans and Africans
4-5% mortality rate
Most curable solid tumor in adults, over 90% cure rate for stages I and II and even late stages can be cured
Unknown cause

A

Testicular cancer

65
Q

5 risk factors of testicular cancer

A 
History of cryptorchid testis
Klinefelter's syndrome
History of previous testis tumor
HIV and HPV
Family history of first degree relative (dad or brother)
66
Q

Testicle doesn’t drop into scrotum

A

Cryptorchid testis

67
Q

Suture testicle into scrotum; before age 6 decreases risk of testicular cancer, after 13 increases risk

A

Orchiopexy

68
Q

Congenital endocrine disease where primary testicular function doesn’t take place, not secreting hormones, etc.

A

Klinefelter’s syndrome

69
Q

2 histologies and percentages of testicular cancer

A

Germ cell tumors: 95%

Non germ cell type: 5%

70
Q

Reproductive cells

A

Germ cells

71
Q

___-___% of germ cell tumors are bilateral (in both testes) which leads to infertility

A

1-2%

72
Q

2 types and percentages of germ cell tumors, 50% mixed

A

Seminoma: 50%
Nonseminoma: 50%

73
Q

5 subcategories of nonseminomas

A 
Embryonal
Teratomas
Teratocarcinoma: one of the least aggressive non seminomas
Yolk sac in kids
Choriocarcinoma
74
Q

Tumor composed of tissues not normally present at site, one of the least aggressive nonseminomas

A

Teratomas

75
Q

Rare seminoma but most aggressive

A

Choriocarcinoma

76
Q

2 types of non germ cell tumors

A

Sertoli

Leydig

77
Q

8 symptoms of testicular cancer

A 
Mass with or without swelling in scrotum, most common presenting symptom
Swelling
Varicocele
Hydrocele
Spermatocele
Torsion
Epididymitis
Gynecomastia and lower back pain less common
78
Q

Vein engorgement within scrotum

A

Varicocele

79
Q

Accumulation of scrotal fluid

A

Hydrocele

80
Q

Irregular grapelike sac, cystic distension of the epididymis to testicle

A

Spermatocele

81
Q

Spermatic cord twists, cutting of testicle’s blood supply; swelling

A

Torsion

82
Q

Inflammation of empididymis

A

Epididymitis

83
Q

4 symptoms of advanced testicular cancer

A

Cough
Dyspnea
Headache
Seizure

84
Q

Combination of 3 symptoms that are a sure sign of testicular disease

A

Gynecomastia
Swollen left supraclavicular LN
Testicular mass

85
Q

5 diagnostic tests for testicular cancer

A

Testicular examination with physician: evaluate testicles and inguinal nodes
US
Orchiectomy/orchidectomy
Tumor markers: AFP for seminomas and lactate dehydrogenase (LDH [spread because it identifies tissue damage within organs])
Chest x-ray (CXR), chest, abdomen, and pelvis CT to evaluate LNs

86
Q

Testicular cancer staging system

A

TNM with serum tumor markers

87
Q

3 serum tumor markers for testicular disease

A

AFP
LDH
HCG: pregnancy

88
Q

LDH 1, 2, and 5

A

1: heart tissue
2: lung
3: liver

89
Q

2 routes of spread of seminoma (more orderly)

A

Retroperitoneal LNs usually first

Rarely and late it can spread to lung, bone, liver or brain via blood (hematogenous)

90
Q

3 sites of spread of nonseminomas

A

LNs
Lungs
Liver

91
Q

Choriocarcinomas usually mets to this early in disease process

A

Brain

92
Q

3 treatments of testicular cancer

A

Observation following orchiectomy with retroperitoneal LN dissection (RPLD) which can limit ejaculate/ability to have offspring
Radiation: seminomas radiosensitive
Chemo for bulky/systemic disease: nonseminomas more sensitive to chemo

93
Q

Stage I and II and III treatment after inguinal orchiectomy

A

I and II: RT

III: commonly cisplatin-based chemo or RT to abdominal and pelvic LNs

94
Q

Overall cure rate and survival of testicular cancer

A

95%

95
Q

80% of testicular cancer patients with mets/stage 4 disease have a ___% survival rate

A

95%

96
Q

About ___% of testicular cancer patients are able to father kids

A

33%

97
Q

Deficiency of sperm about one year after chemo

A

Oligospermia

98
Q

Absence of sperm about one year after chemo

A

Azoospermia

99
Q

Chemo regimen for stage III and bulky stage II testicular cancer

A

3-4 cycles BEP, surgery if BEP fails

100
Q

BEP

A

Bleomycin
Etoposide
Cisplatin

101
Q

3 acute toxicities associated with chemo for testicular cancer

A

Gastrointestinal effects: nausea and vomiting
Renal effects: decreased ceatinine clearance and tubular loss of sodium, potassium, and magnesium
Bone marrow depression

102
Q

5 long-term toxicities associated with chemo for testicular cancer

A

Bleomycin pneumonitis (rarely fatal if under 400 U are given)
Peripheral neuropathies
Cisplatin-induced hearing loss
Sterility
Secondary acute myelogenous leukemia (AML) related to etoposide (typically shows 11q23 translocation, under 5% incidence at 5 years)

103
Q

Sperm not maturing

A

Spermatogenesis deficiency

RAD 390 - Radiation Therapy Oncology Nursing (7 decks)

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