WEEK 1 Oncology Nursing

Question 1

Define Cancer

Answer 1

A class of diseases characterised by uncontrolled cell division

Question 2

Identify the two forms of growth within cancer

Answer 2

Direct growth into adjacent tissue (invasion) OR migration of cells to distant sites (metastasis)

Question 3

Why are cancer cells referred to as “rapidly dividing”

Answer 3

They do not rest and they do not die

Question 4

Define Carcinogenesis

Answer 4

Normal healthy cells transform into cancer cells as they have had a change in programming and have made it through checkpoints where abnormalities would normally be picked up

Question 5

Define Carcinogen

Answer 5

A cancer causing agent e.g. Cigarette smoking, UV exposure, Alcohol

Question 6

Define Well Differentiated tumour cells

Answer 6

Tumour cells reproduce these features well e.g. Breast cells (Clear to tell what the cell is)

Question 7

Define Poorly Differentiated tumour cells

Answer 7

Tumour cells reproduce these features poorly e.g. Difficult to tell the cell of origin (Where it has come from)

Question 8

Define Undifferentiated tumour cells

Answer 8

Cannot tell where the cell has come from (No maturation)

Question 9

What are Proto-oncogenes

Answer 9

Normal growth promoting genes e.g. Growth factors, Cell cycle controlling genes

Question 10

What are Oncogenes

Answer 10

Mutated form of Proto-oncogenes. Body cells are exposed to personal/environmental conditions that can mutate the genes and alter how the cells function and grow

Question 11

Describe the process of tumour growth

Answer 11

• Cells normally only divide when needed to replace dying/damaged cells
• Cells are programmed so that they die when no longer needed (Apoptosis)
• With good communication, cells proliferate when required/stop dividing when required
• In cancer cells, something is wrong (genetic code mix up = Cancer cell born)
• Cancer cell divides to produce daughter cells which also divide = Uncontrolled growth and spread

Question 12

Describe cancer cells “loss of cellular surface contact inhibition”

Answer 12

Normal tissues have balance between cell birth and cell death, tumour cells have an inability to proceed to the resting phase, causing cell birth>cell death = TUMOUR

Question 13

Define tumour suppressor genes

Answer 13

Function by encoding proteins that block growth promoting proteins “Off switch”. Mutation occurs = No off switch

Question 14

Identify and describe a common tumour supressor gene mutation

Answer 14

p53 gene “Gate keeper”. Prevents cells that should not be dividing from entering the cell cycle (e.g. those with damaged DNA). When mutated, cells are able to replicate = uncontrolled abnormal cell growth

Question 15

Define growth fraction

Answer 15

Ratio of the total number of cells to the number of dividing cells. The higher the growth fraction, the more rapidly a tumour mass increases

Question 16

Define doubling time

Answer 16

Time taken for tumour to double in volume (Average time 2-3 months)

Question 17

When are tumours usually clinically detectable?

Answer 17

Usually not clinically detectable until they have doubled around 30 times

Question 18

Describe the Gompertzian Tumour Growth Curve

Answer 18

Describes the decrease in cells doubling time as tumour progression occurs

Question 19

Describe the Metastatic Cascade

Answer 19

• Growth and progression of primary tumour
• Cells detach and motile cancer cells invade and enter the bloodstream/lymphatic vessels
• If successful, blood/lymph transports them to distant sites where they extravasate and lodge in bones/lungs/liver
• Angiogenesis occurs
• Blood supply to tumour established = Further aggressive growth

Question 20

Identify the 8 stages of the Metastatic Cascade

Answer 20

1. Tumour initiation
2. Progression
3. Proliferation
4. Angiogenesis
5. Invasion/Intravasation
6. Extravasation
7. Colony Formation
8. Evasion of host defences

Question 21

Define intravasation/extravasation

Answer 21

Transport of cancer cells into/out of a blood/lymphatic vessel

Question 22

Define Prevelance

Answer 22

Measurement of all cancer cases
No. of people with cancer / Total no. of people

Question 23

Define Incidence

Answer 23

Number of newly diagnosed cases in specified period of time
No. of people developing cancer in period of time/Total population

Question 24

Define Mortality

Answer 24

Number of deaths attributed to cancer in period of time in a defined population
No. of people dying of cancer in period of time/Total population

Question 25

What 6 aspects does staging include

Answer 25

1. Location of tumour
2. Type of cells
3. Tumour grade (How abnormal cells look)
4. Measurement of tumour size
5. Lymph-node spread of tumour cells
6. Metastatic spread of cancer cells

Question 26

Identify the most common staging system

Answer 26

TNM System:
T (Tumour): Size and Extent of primary tumour
N (Nodes): No. of nearby lymph-nodes that contain cancer/cells
M (Metastasis): Spread to other sites/organs

Question 27

Define Screening

Answer 27

Performance of tests on apparently well people to detect a medical condition that would otherwise be detected at a later stage

Question 28

Define Neoplastic disease

Answer 28

Malignant and Benign Growths

Question 29

Define Benign Growths

Answer 29

Generally slow growing, where the tumour is localised to one area of the body e.g. Fibroids in uterus

Question 30

Define Malignant Growths

Answer 30

Tumour is consistently growing, made up of poorly differentiated tissue and has the potential to involve other areas of body e.g. Breast, Prostate, Ovarian Cancers

Question 31

Identify 3 aspects of the emotional response to a cancer diagnosis

Answer 31

Shock, Anger, Depression

Question 32

Identify 3 aspects of the physical response to cancer diagnosis

Answer 32

Sleep disturbance, Appetite changes, Altered sexual interest

Question 33

Clinical Distress may be related to?

Answer 33

Disease Status, Treatment tolerance, Symptom intensity/frequency

Question 34

Identify 3 psychosocial issues associated with cancer

Answer 34

Adjustment disorders to illness/changes in care, Feelings of isolation and Decreased quality of life

Question 35

Identify 3 treatments of psychosocial issues associated with cancer

Answer 35

Education, Support groups, Psychotherapy/Relaxation/medication

Question 36

Identify 3 practical issues associated with cancer

Answer 36

Transportation issues, Financial issues, Occupational problems

Question 37

Identify 3 treatments of with practical issues associated with cancer

Answer 37

Education, Support from community agencies, Referrals

Question 38

Define supportive care

Answer 38

Embraces the full range of issues that emerge for an individual within a cancer diagnosis

Question 39

Define sensitive care

Answer 39

Required to help the individual cope with what is happening and maintain or improve the persons quality of life

Question 40

What are some risk factors which increase the likelihood of heightened emotional distress/recovery adjustment

Answer 40

Being very old/very young, female, single, poor marital functioning, socially isolated people

Question 41

What are 3 key principles of supportive care

Answer 41

Person centred, System wide and team approach and focus on quality of care

Question 42

Identify 3 barriers to the delivery of psychosocial care

Answer 42

No access (Geographically)
Don’t ask for help due to stigma
Lack of provider familiarity within community resources

Question 43

Identify 2 sexual and 2 cultural issues related to a cancer diagnosis

Answer 43

1. Lack of sexual interest/Intimacy = Impacting on relationship
2. Fertility issues
3. Provider miscommunication = Impact on understanding/education
4. Lack of cultural awareness/sensitivity by HCP