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NUR 131 > TLO 103c Neoplastic > Flashcards

TLO 103c Neoplastic Flashcards

1
Q

Neoplastic

neoplasm?

A

Neoplasm:
any abnormal growth of new tissue, benign or malignant
Also called tumor

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2
Q

How does cancer spread, two ways?

A

Invasion:
cancer cells grow in an unrestricted disorderly way at site of origin
Metastasis:
cancer cells grow in other sites than that of which it originated

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3
Q

Malignant of cancer

A

Malignant of cancer
A group of >200 diseases characterized by uncontrolled and unregulated growth of cells

Characteristic of malignant neoplasm
Poorly differentiated
Capable of metastasis
Possible reoccurrence
Moderate to marked vascularity
Infiltrative and expansive mode of growth
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4
Q

Benign characteristic, noncancerous

A 
Usually encapsulated
Normally differentiated
No metastasis
Rare reoccurrence
Slight vascularity
Expansive growth
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5
Q

Development of cancer

A

Development of cancer
Initiation:
mutation in cells genetic structure so that it can develop a clone
Promotion:
Reversible proliferation of the altered cells
Progression:
Increased growth rate of the tumor, increased invasiveness, increased metastasis

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6
Q

Carcinogens defined

A

Carcinogen:

Cancer causing agents capable of producing cellular alterations

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7
Q

Immune system

A

Immune system:
Role: recognition and destruction of tumor cells

Can distinguish normal from abnormal cells

  • transplant organs can be recognized as foreign, rejection can occur
  • because cancer cells develop from normal human cells that mutate, the response against cancer cells may not be sufficient to kill cells

Immune response to malignant cells:
Cytotoxic T cells: role in resisting tumor growth by killing tumor cells. Produce cytokines which stimulate T cells, natural killer cells, B cells and macrophages

Natural killer cells: directly lyse tumor cells

Macrophages: nonspecific lytic of tumor cells

B lymphocytes: produce antibodies that bind to tumor cells and kill them; detects in serum/saliva

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8
Q

Oncofetal Antigens, tumor markings

A

Oncofetal antigens: useful marker for cancers
Found on both the surfaces/inside of cancer cells and fetal cells
Cells shift to immature metabolic path associated with fetal period of life. Cell regains embryonic capability to differential into many different cell types

Carcinoembryonic (CEA): useful marker for cancers
Found on surface of cancer cells from the GI tract, fetal gut, liver, pancreas, normally disappears in last 3 months of fetal life.
Monitor therapy

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9
Q

Developmental of cancer in children

A

Alterations in normal DNA predispose the child to cancer or chromosomal abnormalities cause an inherited disposition
Failure of the immune system to distinguish between normal and abnormal cells
Inactivation of tumor suppressor genes

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10
Q

Oncofetal antigens tumor markers

A

Oncofetal antigens tumor markers
A-fetoprotein (AFP) is produced by malignant liver cells and fetal liver cells
AFP detection is of value in tumor detection and tumor progression
Elevated in testicular carcinoma, viral hepatitis and nonmalignant liver disorders
Diagnostic is primary cancer of the liver, hepatocellular
Produced with metastatic liver growth

Other oncofetal antigens:
CA 125: ovarian carcinoma
CA 19-9 pancreatic and gallbladder cancer
CA 15-3 and CA 27-29 breast cancer

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11
Q

Cancer classifications of tumors provide a standardized method

A

Classification of tumors provide a standardized method to:
Communicate the status of the cancer to health care team
Assist in determining the most effective treatment plan
Evaluate the treatment plan
Predict prognosis
Compare like groups for statistical purposes

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12
Q

Carcinogens

Chemical

A

Carcinogens
Chemical
Chemical: drugs that interact with DNA

Chemical:
Drugs: alkylating agents (Cytoxan): secondary leukemias are refractory to induction of remission with combination chemotherapy

Immunosuppressive agents: secondary leukemias has been observed in patients with transplant surgery or immunosuppressive drugs.

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13
Q

Carcinogens

Radiation

A

Carcinogens
Radiation
The dose of radiation that causes cancer is unknown
Debate surrounding the effects of low dose exposure over time
Leukemia, lymphoma, thyroid cancer and others increased in Hiroshima and Nagasaki after atomic bomb
More bone cancer in occupations as radiologists, radiation chemists and uranium miners.
More thyroid cancer in person who received radiation to the head/neck area
Ultraviolet radiation, more melanoma, squamous and basal cells cancers

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14
Q

Carcinogens

Viral

A

Carcinogens
Viral
person with AIDS have a high incidence of Kaposi sarcoma
Hepatitis B has been linked to hepatocellular carcinoma
Human papilloma virus induces lesions that are capable of progressing to cervical cancer

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15
Q

Cancer tumors are classified by anatomic site

A

Cancer tumors are classified by anatomic site

Identified by the tissue of origin:
Behavior of the tumor (benign or malignant):

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16
Q

Extent of disease (staging)

A

Clinical staging
Determined the anatomic extent of the malignant disease
Determines the treatment options
Stage 0: cancer is situ
Stage I: localized tumor growth with cells of tissue of origin
Stage II: limited local spread
Stage III: extensive local and regional spread
Stage IV: metastasis

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17
Q

Cancer early warning signs

CAUTION

A 
Change in bowel or bladder
A lesion that does not heal
Unusual bleeding or discharge
Thickening or lump in breast or elsewhere
Indigestion or difficulty swallowing
Obvious changes in wart or mole
Nagging cough or persistent hoarseness
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18
Q

Cancer classification TNM

A

TNM classification system: determines the anatomic extent of disease and tumor involvement according to 3 parameters
T: Tumor, how many 1-4
N: lymph nodes, how many are positive 1-4
M: metastasis, how many areas spread to 1-4

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19
Q 
Cardinal s/s of cancer in children
Overt signs (obvious signs)
A 
Overt signs:
A mass
Purpura (A rash of purple spots due to small blood vessels leaking blood into the skin, joints, intestines, or organs)
Pallor
Weight loss
Whitish reflex in eye
Vomiting in early morning
Recurrent or persistent fever
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20
Q

Cardinal s/s of cancer in children

Covert (not openly acknowledged or displayed)

A

Covert: (not openly acknowledged or displayed)
Bone pain
HA
Persistent lymphadenopathy (inflammatory)
Change in balance, gait or personality
Fatigue, malaise

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21
Q

Diagnostic studies

A 
Bone, liver, lung brain scan
US
CT
MRI
PET
Mammography
Chest x-ray
Endoscopic exam, UGI, colonoscopy
Cytology, Pap test
Tissue biopsy
CBC
Liver function
Tumor markers
Genetic markers
Bone marrow exam
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22
Q

Therapies for pediatric cancer

A 
Chemo
Radiation
Surgery
Hematopoietic stem cell transplant: allogenic (matched donor), autologous (child's own)
Biologic response modifiers
Steroid
Complementary, alternative medicine
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23
Q

Chemo nursing inplications

A

The use of chemicals as a systemic treatment for cancer. Chemo therapy drugs non selectively kill rapidly dividing cells. Tumors can develop immunity to chemo agents

Chemo agents in addition to killing cancer cells
Affect bone marrow production
GI tract and the integumentary system

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24
Q

Radiation therapy nursing implications

A

Radiation therapy nursing implications
Causes damage to the cells and stops them replicating
In a developing child normal cells develop may not be complete
Radiation to the brain causes alteration in cognitive level
Bone growth is altered if radiation is delivered to the areas of growth potential

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25
Q

Chemo side effects

A 
Chemo side effects:
Bone marrow suppression
Alopecia
Malaise/fatigue
Nausea
Vomiting
Anorexia
Stomatitis (oral, rectal sores)
26
Q

Radiation side effects

A 
Radiation side effects:
Skin reactions (burns, redness)
Fatigue
Bone marrow suppression
Nausea
Vomiting
Anorexia
Mucositis (oral sores)
27
Q

Leukemia

A

Broad term for group of malignant disease of bone marrow and lymphatic system
Most common childhood cancer
Peak onset 2-6 years old
> in males and Caucasians
Lymphoid leukemia 80% survival rates
Acute nonlymphoid leukemia has 50% survival rate

28
Q

Leukemia defined

A

Leukemia is an abnormal proliferation of immature white blood cells which compete with normal cells for space and nutrients
Bone marrow production is suppressed which results in low numbers of WBC, RBC and platelets

29
Q

Leukemia clinical manifestations

A 
Liver and spleen are most effected (vascular organs)
Acute form: leukocyte count is low
S/S:
Anemia
Neutropenia
Thrombocytopenia
30
Q

Leukemia diagnostic

A

H&P
Peripheral blood smear: contains immature forms of leukocytes, low blood count
Bone marrow aspirate/biopsy: flow cyometry of cells in bone marrow
Lumbar puncture to determine CNS involvement

31
Q

Brain tumor signs

A

Infant may be irritable, lethargic, feed poorly, have increased head, bulging fontanels
Young child loss of developmental milestones
School age have declining academic performance, fatigue, personality changes, seizures
Older children: HA upon waking, vomiting

32
Q

Consequences of bone marrow disfunction

A

Decrease RBC= anemia; neutropenia= infection

Decrease platelets= bleeding tendencies

33
Q

What are the clinical manifestations related to bone marrow dysfunction?

A

Pallor, fatigue, fever, hemorrhage, fractures, pain

34
Q

How are the liver, spleen and lymph glands effected?

A

Infiltration, enlargement, eventual fibrosis (scarring)

Manifestations: hepatomegaly, splenomegaly, lymphadenopathy

35
Q

How does leukemia impact CNS?

A

Increased ICP, meningeal irritation

36
Q

What are the manifestation of hypermetabolism caused by leukemia?

A

Cell deprivation of nutrients by invading cells lead to muscle wasting, weight loss, anorexia, fatigue

37
Q

Brain tumor diagnostic

A 
MRI
CT
EEG
Lumbar puncture
Biopsy
38
Q

Osteosarcoma what is it

A

The most common primary bone lesion in children
Originates from the bone producing cells that invade the medullary canal of the bone, incidence is higher in the most rapidly growing bones in adolescence
Goals of therapy: remove tumor, prevent spread

39
Q

Leukemia four phases?

A

Induction therapy:
achieves complete remission or less than 5% leukemia cells in bone marrow

CNS prophylactic therapy:
prevents leukemia cells form invading CNS

Consolidation/intensification therapy:
eradiation prevents emergence of resistant leukemic clones

Maintenance therapy:
maintain remission phase

40
Q

Osteosarcoma sites

A

Primary tumor sites are in the metaphysis adjacent to the epiphyseal plate of long bones
Other sites: tibia, humerus, pelvis, jaw, phalanges
Higher in lower extremities

41
Q

Leukemia treatment

A

Hematopoietic stem cells transplant: success with ALL and AML. Capable of differentiating into specialized calls.

Donors: 
antigen matched related donors
matched unrelated
mismatched donors
obtained from related or unrelated donors or umbilical cord blood
Transplant cons:
Significant morbidity and mortality
Graft vs host disease
Overwhelming infection
Severe organ damage
Prognosis: long term survival depend on the following
initial WBC count
Child's age at diagnosis
Type of cell involved
Gender of child
Karyotype analysis
42
Q

Osteosarcoma clinical findings

A

Pain, mass, limping, limited ROM, pathological fractures

43
Q

Osteosarcoma treatment

A

Surgery: biopsy, limb salvage or amputation
Chemo
Radiation, used only in the palliative pain control in the advanced patient

44
Q

Osteosarcoma nursing care

A 
Depend on type of surgery
Post-op; emotional support
Prepare for alopecia
Permanent prosthesis fitting 6-8 wk posts op
Elavil for phantom leg pain
Physical therapy
Planning for return to school
45
Q

Ewing’s sarcoma

A

Arises in the marrow spaces of the bone
Tumor originates in the shaft of long and trunk bones
Most common site: femur, tibia, fibula, humerus, ulna, vertebrae, scapula, ribs, pelvic and skull
2nd most common bone tumor seen in children

46
Q

Ewing’s sarcoma treatment

A

Radiation, chemo
Amputation if radiation causes deformity, loss of function
Vincristine, actinomycin D, cyclophosphamide, ifosfamide, etoposide, doxorubicin
Prognosis:
new chemotherapy agents have increased 3 years survival to 80%

47
Q

Ewing’s sarcoma nursing care

A

Psychological adjustment
Prepare pt and family for bone marrow aspiration, surgical biopsy, radiation
Skin care
Encourage loose fitting clothing
Protect site from sunlight/temperature changes
Physical therapy
Prepare for alopecia, N/V, peripheral neuropathy, possible cardiotoxic side effects

48
Q

Wilm’s tumor what is it? diagnostic

A 
Wilm's tumor or nephroblastoma (kidney cancer)
One or both kidneys involved
Diagnostic:
H&P
Ab swelling/mass
Ab US
Ab/chest CT
Hematologic studies
Urinalysis
Determine kidney function on opposite side
49
Q

Wilm’s tumor pre-op and post-op

A 
Pre-op:
Surgery in 24-48 hr of admit
BP, hypertension due to excess in renin production
Do not palpate ab, post sign above bed
Radiation/chemo teaching
Post-op:
Recover is rapid
GI activity
BP, urine output, signs of infection
Pulmonary hygiene
Protect kidney that is left
50
Q

Hodgkin’s

A

A neoplastic disease that originates in the lymphoid system

Most common: asymptomatic enlarged cervical or supraclavicular lymphadenopathy

51
Q

Hodgkin’s classified

A 
A= asymptomatic
B= 3 symptoms:
Fever 100.4 or higher for 3 days
Drenching night sweats
Unexplained loss of body weight over 6 mo
Cough
Ab discomfort
Anorexia
N/V
Pruritus
Fatigue
Non painful lymph node enlargement
52
Q

Hodgkin’s treatment

A 
Radiation
Chemo
Splenectomy in some cases:
Prophylactic antibiotics
Immunizations against pneumococci and meningococci
53
Q

Retinoblastoma

A

Can be unilateral or bilateral
Caused by mutation in gene
Hereditary retinoblastomas are transmitted as an autosomal dominate trait

54
Q

Retinoblastoma diagnostic

A

Ophthalmologist exam under general anesthesia

US, CT

55
Q

What is the most common signs of retinoblastoma?

A

White eye reflex

56
Q

What is the 2nd most common sign of retinoblastoma

A

Strabismus

condition in which the eyes do not properly align with each other when looking at an object

57
Q

What is another sign, often with glaucoma?

A

Red, painful eye

58
Q

What is the late sign of retinoblastoma?

A

Blindness

59
Q

Retinoblastoma nursing management

A

Pre and post op teaching
Post op care of eye/socket care
Preparing parents for post op facial appearance
Post op enucleation (removal of the eye that leaves the eye muscles and remaining orbital contents intact):
Facial features return to normal w/in 3 wk of prosthesis

60
Q

Retinoblastoma prognosis

A 
Survival rate 90%
Long term concerns:
decreased visual acuity
facial disfiguration
secondary tumor
61
Q

Two forms of leukemia in children?

A

Two forms of leukemia in children?
Classified by the type of WBC affected

Acute lymphoid leukemia (ALL) **most common:
Stem cell or blast cell
Lymphatic
Lymphocytic
Lymphoblastic
Lymphoblastoid
Acute nonlymphoid leukemia (ANLL):
Granulocytic
Myelocytic
Monocytic
Myelogenous
Monoblastic
Monomyeloblastic

NUR 131 (38 decks)

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