Test #5: Oncology Flashcards
What is The most important risk factor for lung cancer?
Smoking
What percentage of deaths from lung cancer are caused by smoking?
90% of men/80% of women
What is the most effective non-invasive way to evaluate lung cancer?
CT scan
What are the 7 warning signs of cancer represented by the acronym “CAUTION”?
C-hange in bladder or bowel habits
A-sore that does not heal
U-nusual bleeding or discharge from any body orifice
T-hinkening or a lump in the breast or elsewhere
I-ndigestion or difficulty swallowing
O-bvious change in a wart or mole
N-agging cough or hoarseness
Why is the TNM staging system not used in small-cell lung cancer?
Because small cell is very aggressive and is always considered systemic.
In addition to chemotherapy, what treatment would be used in a patient with small-cell lung cancer to prevent cerebral metastases?
Prophylactic Cranial Radiation
Most lung cancer arise from which type of cells?
Bronchial epithelial cells
An organ/transplant from one’s own body is called?
Allogenic
How many men develop prostate cancer
1 out of 5
chemotherapeutic drugs can be divided into….
Irritants and vesicants
When can a cancerous lesion be detected on an X-ray?
At 1cm diameter. Cells grow slowly and take about 8-10years to become 1cm.
What are the two types of lung cancer?
NSCLC-80% and SCLC-20%
How does cancer metastasize?
By direct extension and via blood and lymph system
What are the s&s of Lung cancer?
Cough that is producing sputum, persistent pneumonitis r/t obstruction causing fever chills and cough, blood tinged sputum, dyspnea and wheezes
How is Lung cancer most commonly caught?
Chest X-ray
What is the most effective non-invasive evaluator of Lung cancer?
CT
What is the only definitive diagnosis of lung cancer?
Biopsy
How is NSCLC staged?
With TNM. T=tumor size, N=regional lymph node involvement, M=the presence or absence of metastasis
How is SCLC staged?
Limited and extensive. (Limited – confined to the chest and regional lymph nodes) (Extensive – extends to chest wall or other parts of the body)
CAUTION - C
Change in bowel or bladder habits
CAUTION - A
A sore that does not heal
CAUTION - U
Unusual bleeding or discharge
CAUTION - T
Thickening or lump in the breast, testicles, or elsewhere
CAUTION - I
Indigestion or difficulty swallowing
CAUTION - O
Obvious change in the size, color, shape, or thickness of a wart, mole, or mouth sore
CAUTION - N
Nagging cough or hoarseness
What race has the highest incidence of lung cancer?
African-American
after smoking cessation how much does risk of lung cancer decrease
30-50%
which gender is at the greatest risk for lung cancer
women (greater risk, younger age, and more likely to have SCLC)
what are the common site for metastatic growth of Lung cancer
liver, brain, bones, scalene lymph nodes, and adrenal glands
what is a paraneoplastic syndrome
consequence of the process of cancer in the body but not due to the local presence of cancer cells or direct invasion of strutcural metastasis
what are examples of paraneoplastic syndrome
hypercalcemia, SIADH, anemia,leukocytosis, hypercoagulable disorders, and neurological syndromes
which type of cancer is most associated with paraneoplastic syndrome
SCLC
how does a PET scan reveal lung cancer
measures metabolic activity in tissue. (Malignant tissue is more metabolicly active than normal tissue so it shows up readily
what type of lung cancer is more common in people who haven’t smoked
adenocarcinoma
what is the prognosis of SCLC
only 10% of people who receive aggressive treatment survive 2 years or more. on average pt’s only survive 7-10 months
what is treatment of choice for NSCLC of stages 1 and 2
surgical resection
what percentage of NSCLC patients are diagnosed too late surgery
50%
when is radiation used as a primary therapy
in a patient who is unable to tolerate surgical resection due to comorbidities
what symptoms are relieved by radiation
dyspnea and hemoptysis from bronchial obstructive tumors. Treats pain by metastatic bone lesions or cerebral metastasis. Also treats superior vena cava syndrome.
why is radiation used before surgery
to shrink tumor mass
what are common complication of radiation therapy?
esophogitis, skin irritation, and radiation pneumonitis
what is stereotactic radiotherapy
new type of radiation therapy that delivers high doses very accurately
which part of population are most benefited by stereotactic therapy
geriatric, pt’s with severe lung or heart disease. (anyone who is not a canadate for surgery
what is the primary treatment for SCLC
chemotherapy (usually a combination of two or more drugs)
which chemotherapy drugs are frequently used to treat lung cancer
vepesid, paraplatin, platinol, taxol, navelbine, cytoxin, efex, taxotere, gemzar, alimta
what is “biologic and targeted” therapy
the use of drugs the block the growth of molecules involved in specific aspects of tumor growth (less toxic than chemotherapy)
MOA of tarceva (biologic and targeted therapy)
treatment of NSCLC by blocking growth stimulating signal
MOA of avastein (biologic and targeted therapy)
inhibits angiogenisis thereby preventing the growth of cancer cells
why is prophylactic cranial radiation important in addition to chemotherapy
because most chemotherapy agents do not cross the blood brain barrier
what is photodynamic therapy
photofrin is injected IV - percolates 48 hrs - laser light turns O2 toxic to destroy tumor - necrotic tissue removed via bronchoscope
priority goal in patient with lung cancer
- effective oxygenation
2 pain management
3 realistic attitude
Nursing interventions should include
recognizing stresors/anxiety and offering support
what symptoms should a patient during treatment be taught to report
hemoptysis, dysphagia, chest pain and hoarsness
nursing goal should include
1 - cure
2 - control
3 - palliative
How will the nurse teach a quitting-smoker to avoid relapse?
Teach pt to recognize and avoid stressors.
How will the nurse teach quitting smoker to deal with the urge to smoke?
Teach distraction techniques (like shower or exercise)
What are risk factors for Breast cancer?
Family history, age (50+), history of cancer, early menarche (before 12), late menopause (after 55), first pregnancy after 30
What lifestyle increases risk of breast cancer?
Weigh gain during adulthood, high fat intake, obesity and alcohol intake
At what age should women begin yearly mammograms?
Age 40
When should the nurse teach women to perform breast self-exam?
At the same time each month, after menses
What is the goal for range-of-motion after axillary node dissection or modified mastectomy?
ROM restored within 4-6 weeks
What can a woman do to make a mammogram less painful?
Restrict caffeine and salt intake for 1 week prior to exam
What risk does a woman with a BRCA1 gene mutation have of breast cancer?
A 40-80% lifetime chance of breast cancer
In women with BRCA1 or BRCA2 mutations, what treatment can reduce their risk?
Prophylactic bilateral oophorectomy
For a woman who is high risk for breast cancer (family history or biopsy), what elective treatment will reduce the risk 90%?
Bilateral mastectomy
What are women with hereditary breast cancer (non-BRCA related) at a high risk for?
Secondary breast cancer in the unaffected breast
What treatment may women women at risk for secondary breast cancer choose?
Prophylactic removal of the unaffected breast at the same time as the removal of the cancerous breast
What are risk factors for breast cancer in men?
Hyperestrogenism, family history of breast cancer, and radiation exposure
What is the most frequent cause of breast lumps in women under 25 years of age?
Fibroadenoma
What % of breast cancers are related to BRCA gene mutations?
5-10%
What is a side effect of Herceptin?
Heart failure/Ventricular dysfunction
What is a side effect of tamoxifen?
Changes in visual acuity
What are the vaccines for HPV?
Cervarix and Gardasil
What is the difference between a total hysterectomy and a radical hysterectomy?
A “total” = cervix and uterus
A “radical” = cervix, uterus, ovaries and Fallopian tubes
What is the early sign of endometrial cancer?
Abnormal uterine bleeding (in the post-menopausal woman)
What is the late sign of endometrial cancer?
Pain
What is the major risk factor for ovarian cancer?
Family history
What factors reduce the risk of ovarian cancer?
Breastfeeding, multiple pregnancies, oral contraceptive use (greater than 5 years) and early age at first birth.
What screen tests are recommended for ovarian cancer?
No official screening test exists–yearly bimanual pelvic exam should be performed. Abdominal or transvaginal US may also be done.
For women with high risk for ovarian cancer, screening should include what?
CA-125 tumor marker (in combination with US)
What age group has the highest incidence of vulvar cancer?
Women in their 70’s
What percent of men will develop prostate cancer in their lifetime?
1/5; 20%
What factor does age play in prostate cancer?
More than 75% of cases occur in men older than 65
What are normal PSA levels?
0-4
What are the recommendations of for prostate cancer screening?
Yearly digital rectal exam and prostate specific antigen starting at age 50
When would a patient with prostate cancer be given chemotherapy?
It is generally limited to those who don’t respond to hormone therapy in the late stage of the disease.
African-Americans and men with a family history of prostate cancer should begin annual PSA and DRE screening at what age?
45
What age is testicular cancer most common in?
15-34
What factor does ethnicity play in incidence of testicular cancer?
Incidence is 4x higher in Caucasians than African americans
When should testicular self-exam begin?
At puberty and monthly thereafter
What should be discussed and recommended for the man diagnosed with testicular cancer before treatment begins?
Cryopreservation of sperm in a sperm back (due to the treatment causing infertility)
What would the blood of a patient with AML look like?
Drop in RBCs, drop in platelets and normal WBCs
What are the 4 stages of chemotherapy?
- Induction
- Intensification
- Consolidation
- Maintenance
What is the normal range for myeloblasts?
None in peripheral blood, less than 5% in bone marrow aspirate.
What is the normal range for WBC count?
5,000-10,000
What is “Leukocytosis” and what is it caused by?
WBC count >10,000. Caused by infection, tissue necrosis, inflammation, and leukemic neoplasia
What is “Leukopenia” and what is it caused by?
WBC count <4,000. Caused by bone marrow failure (chemo, radiation, autoimmune disease)
How high would a WBC count be for Leukapheresis and Hydroxyurea to be considered?
> 100,000
If a patient received an “allogenic” stem cell donation–who did the cells come from?
Sibling or volunteer donor
If a patient received an “autologous” stem cell donation–who did the cells come from?
Removed from self before radiation
If a patient received an “syngenic” stem cell donation–who did the cells come from?
An identical twin
