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138 Cards in this Set

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Carcinogensis?
newly reproduced cells change shape, lose ability to function, make no contribution
Cellular features of cancer cells?
local increase in number
loss of normal cellular
arrangement
variation in cell shape and
size
increase nuclear size and
density of staining
increased mitotic activity
abnormal mitosis and mutation
of chromosomes
Benign tumors?
neoplasm/nonmalignant
grows slowly
usually encapsulated
usually treated
Malignant tumors?
cancer
grows rapidly
carried by blood or lymph
not encapsulated
various therapies
Characteristics of a malignant tumor?
loss of topoinhibition
malignant transformation
tumor establishment
Important Basic Concepts
carcinogenesis is...
cancer is a disease of the...
cells in a tumor are
asynchronous...
rapidly cycling cells...
carcinogenesis is mutagenesis?
carcinogenic insult must affect...
progeny of a malignant cell is also malignant
Cancer is a disease of the cell?
cell membranes alterations:

decreased number cell
junctions
increased sialomucoproteins
increased fibrinolysin
changes in antigenicity
changes in receptors (growth
factors)
Increase in sialomucoproteins?
malignant cells display
increased number of
sialomucoprotein on their
cell membrane
sialomucoproteins are acidic
proteins
increased acidity enhances
cell motility
increased motility
potentiates metastasis
Increase in fibrinolysin?
malignant cells display
increased number of
fibrinolysin molecules on
their cell membrane
fibrinolysin (=plasmin) is
substance with strong
proteolytic action capable
of destroying intercellular
proteins
increased fibrinolysin
enhances local invasiveness
Changes in antigenicity?
natural (self) antigens are
not "seen" by the host's
immune system
as cells become malignant
new antigens are produced
malignat cells are now seen
as foreign
immune system then destroys
them
Changes in receptors?
commands for cell growth
(multiplication) require
cell membrane receptors
malignant cells have
increased numbers of such
receptors
malignant cells have greater
growth potential
Changes in the cell that becomes cancerous?
microtubular disorganization
rounded mitochondria
changes in size and shape
abnormal karyotype and
mitotic figures
Tumor establishment?
transformed cell
cell division - malignant
clone
stroma
tumor growth
Tumor Establishment?
factors influencing tumor
growth...
continued, unrestricted
growth
size of growth fraction
(% dividing cells)
cell growth increased
cell loss (death or
metastasis)
Types of Malignant Tumors?
solid tumors and liquid
cancers
epithelial tissue:
carcinomas
non-hematopoietic mesenchy-
mal (connective) tissue:
sarcomas
hematopoietic and lymphoid
tissue: leukemias and
lymphomas
neural tissue: gliomas,
choroid plexus tumors,
peripheral nerve tumors,
retinal tumors etcet
miscellaneous: melanoma,
neuroblastoma, etc
Metastasis?
pre-requisite: primary in
invasive phase
influencing factors:
mechanical forces
decreased cell-to-cell
adhesiveness
increased cell motility
Metastasis...dissemination routes?
cerebrospinal pathway
hematogenous spread
lymphatic spread
transcelomic spread
Metastasis...mechanisms of formation?
cells detach from primary...
cells gain access to
distributive system
cells able to survive in the
distributive system
cells adhere to vascular
endothelium and form a
fibrin coat (nidation)
cells break through endothe-
lium, secure vascular
supply and stroma
unopposed tumor growth
Metastasis...general characteristics?
agreement with primary tumor...
cells usually less differentiated than primary...
mets may appear several years
after primary...
site is usually a well-
vascularized area or organ
How is a tumor classified?
by type of tissue from which it grows
Where does carcinoma grow?
develops in tissues covering
or lining organs of body
orginate in epithelial cells
such as skin, uterus, lung
breast
Where does adenocarcinoma grow?
involves lining of organs
Where does basal cell carcinoma grow?
most common form of skin cancer...
squamous cell carcinoma
Where does melanoma grow?
type of skin cancer, very
aggressive
Where does sarcoma grow?
form of cancer that arises
in supportive/connective
tissues such as:
bone (osteosarcoma)
cartilage
fat (lipoma)
muscle
What is leukemia a cancer of?
cancer of blood forming tissues
What is non-Hodgkin's lymphoma a cancer of?
cancers originating in immune/infection-fighting organs...
form of lymphatic cancer, very aggressive
What is Hodgkin's lymphoma?
form of lymphatic cancer
Staging?
extent of primary which based on:
type
depth
penetration
invasion

presence, extent and location of

presence or absence of

distant and degree of dissemination

in place, localized and
confined to one area, earliest stage of cancer

i.e. DCIS (ductal carcinoma in situ - early stage of
breast cancer in milk ducts)
Grading?
GX-grade cannot be assessed

G1-well differentiated

G2-moderately well differentiated

G3 & G4
Target points
cell-cycle specific?
S phase-specific drugs interfere with synthesis of
DNA, RNA, proteins

M phase-specific drugs interfere with assembly of mitotic spindle
What happens in mitosis?
mitotic spindle assembled in
metaphase
chromosomes align along the
spindle
chromatids separate in
anaphase
chromatids (new chromosomes)
move to
chromatids (new chromosomes)
move to opposite poles
and new daughter cells
receive equal numbers
How to kill cells in mitosis?
mitotic inhibitors stop assembly of the mitotic spindle:
vincristine, vinblastine,
VP-16
equal distribution of
chromosomes is disrupted
cell proliferation is
arrested
How to kill cells in S phase?
Stop DNA replication
Stop transcription
(DNA--RNA)
Stop translation
(RNA--protein)
fragment already formed
proteins
Events in DNA replication?
original DNA molecule unwinds...
original DNA molecule splits...
nucleotides are available
inside nucleus...
nucleotides pair to BOTH half-molecules:
A---T C---G
DNA polymerase unites new
nucleotides
result: 2 "new" DNA
molecules re-unite
Important concept #1?
cells in the cell cycle are?
Important concept #2-A?
rapidly cycling cells are easy to kill (and cells in G-0 are resistant)
Important concept #3?
Cytotoxic agents kill both rapidly proliferating malignant and normal cells

Evidence: side-effects in
normal tissues?
alopecia
GI disturbances
myelosuppression
sterility (males)
Health care team consists of?
clergy
dietician
occupational therapist
pharmacist
physical therapist
physician
psychiatrist
psychologist
radiologist
respiratory therapist
social worker
speech therapist
vocatonal counselor
Oncotip: "preparing for the first oncology consultation"?
forward all recent medical records, including operative reports, path reports and radiology reports to your oncologist

make sure you have any necessary referrals prior to seeing your oncologist

consider bringing a tape recorder and asking permission to tape the conversation with your physician so you can review the details of your consultation

consider having your consultation at a multi-disciplinary clinic if this is available to your area

make sure your oncologist's secretary has received all of the necessary information beforehand

bring a list of all your medications and allergies to medicines

bring a list of the physicians and addresses that you want reports of the consult sent

make sure you bring your health insurance id card if you have one

make sure you have the phone number of your oncologists secretary

do not become frustrated if additional blood tests, x-rays or other procedures are necessary prior to getting a final recommendation
Treatment modalities...the most common cancer treatments include?
growth factors
novel treatments - monoclonal
antibodies vaccines
shrink the tumors
alleviate pain and other
complications associated
either with the cancer or
the treatment
Principles of cancer
treatment?
disease gone forever
extend life of patient;
disease will never go away
completely
provide comfort, relief of
symptoms, and improve
quality of life
no disease but person at
high risk for disease
development
What is curative surgery?
excision of all of the tumor, involved surrounding tissue and regional lymph nodes

most effective in early dx
What is palliative surgery?
since 70% of clients with cancer show metastasis at diagnosis cure is not always possible

palliative surgery is done to relieve complications such as obstructions

or to surgically interrupt nerve pathways for intractable pain
What is reconstructive surgery?
follows durative or radical surgery

goal is to produce a better function or a better cosmetic effect, to minimize deformity
What is radiation therapy?
uses high energy ionizing radiation to kill cancer cells

the intense energy of the ionizing radiation causes
Radiotherapy goal?
eradicate malignant cells without harm to healthy tissues
Which cells are more sensitive to radiation?
vascular
Radiotherapy is usually combined with other?
treatment modalities
Radiotherapy may be done before surgery to ______ the size of the tumor
shrink
Postoperatively, radiotherapy is hoped to decrease risk of local __________
recurrence
Unit of dose for measuring radiation may be referred "rad" which stands for?
radiation absorbed dose
or gry
The actual dose of radiotherapy is determined by the radiologist and is dependent on?
sensitivity of the tumor, tissue tolerance, amount of tissue to irradiated
External radiation is given with?
specialized equipment
External radiation treatments are usually given on an _______ basis and divided over days or weeks
outpatient
With external radiation, special care is taken to minimize risk to healthy?
tissue
With external radiation, customized shielding ________
may be created
blocks
What is placed on the skin and is used to identify and maintain the exact reference points
dye "tattoos"...the nurse should instruct the client not to wash or rub off these markers, not to wear restrictive clothing, or put any type of ointment over the skin
What are the complications or side effects of external radiation?
GI discomforts
cramping
diarrhea
anorexia
How does internal radiation deliver radioactive isotopes?
directly within the body
What are 7 isotopes used to deliver internal radiation?
cesium
cobalt
gold
iodine
iridium
radium
How are internal radiation isotopes introduced?
either in a sealed or unsealed source
What are sealed sources in which internal radiation isotopes are delivered?
encapsulated radioactive elements in special containers -
tubes
wires
needles
seeds
capsules
Internal radiation isotoopes are implanted close to cancer cells to deliver ____ ____ ______?
high concentrated doses
Depending on the type of internal radiation, implants may be ______ or _______?
permanent or temporary
What is required to prevent dislodgement of an internal radiation implant?
bedrest
With internal radiation, body fluids are not _____ because the source is sealed.
radioactive
Unsealed sources of internal radiation may be given orally, parenterally, or instilled into ______-_____
or peritoneal spaces
intra-pleural
Unsealed sources may be eliminated in _____ ______
body fluids
With internal radiation, care must be taken not to expose ______ ______ workers, hospital personnel, visitors.
health care
What would the nurse do if patient is receiving brachytherapy and an UNSEALED source falls out?
?
What is the universal symbol indicating radiation is used to indicate caution?
?
What are the toxic effects of therapy?
?
What are precautions to be taken with radiation?
?
What is the purpose of chemotherapy?
cure
prevent
relieve
What are the drugs used in chemotherapy called?
antineoplastics
Unfortunately, anticancer drugs are cytotoxic and kill both cancer cells and ______ cells.
healthy
What are the phases of human studies related to drug development?
Phase 1 trials - determine
toxicity
Phase 2 trials - determine
efficacy to diseases
Phase 3 trials - compare to
standard treatment...
drug is approved for use
by FDA
Phase 4 trials - determine
other uses for drug
What is Phase 1 of drug development?
pharmacokinetics
MTD
DLT
15-20 subjects, without other
options
not disease - specific
What is Phase II of drug development?
firm starting dose and
schedule
spectrum of activity
breast, lung, colon,
melanoma, lymphoma,
leukemia
effectiveness in specific
tumors
18-30 subjects, progressed on
standard therapy
What is Phase III of drug development?
drug compared to conventional, standard therapy...
for specific cancers..
extent and duration of response, and toxicities evaluated...
quality of life assessment
mandatory
About how many years does it take for a drug to go through Phases I-III?
13 years
What is Phase IV of drug development?
post-marketing, after FDA approval..
other uses, doses or schedules...
use in combination with other
therapies
Cancers highly sensitive to chemotherapy?
Hodgkin's disease
ALL
non-Hodgkin's lymphoma
(children)
Burkitt's lymphoma
testicular cancer
gestational trophoblastic
tumors
Wilms tumor
osteogenic sarcoma
rhabdomyosarcoma
Tumor cell kill fraction depends on?
tumor sensitivity
tumor growth rate
tumor size
vascular supply
host immunity
nutrient supply
Factors affecting response (3)?
patient factors
tumor factors
drug factors
Patient factors affecting response?
oorgan dysfunction
previous treatment
ototoxicity
Tumor factors affecting response?
histology
growth rate
size (Tumor Burden)
hormone receptor status
Drug factors affecting response?
antineoplastic activity
pharmacokinetics
dose and schedule
combination vs single agent
therapy
administration schedule
dose category
drug resistance
Which term is no longer used that refers to cancer that is temporarily inactive?
"remission"
A cancer patient is having a tumor response (not in remission) if the following are met?
absence of all tumor for at least one month...
greater than 50% reduction in measurable tumor for at least one month...
less than 50% reduction or less than 25% increase in cancer size...
greater than 25% growth of tumor...
subjective response
Antineoplastic are given IV because?
these drugs are irritating and may cause tissue necrosis
Most IV antineoplastics are given through two types of special devices called?
explantable
implantable
What is an example of an explantable venous access device (EVAD)?
triple lumen, inserted into the subclavian vein
What does an implantable venous access device (IVAD) include?
self-sealing implanted ports
What are types of antineoplastic administration (4)?
bolus therapy - IV push or
piggyback
infusional therapy (runs over
a number of hours)
--multiple agents in
different bags
--multiple agents in same
bag
sequential infusions
combined modality therapy-
chemo given with radiation
to increase response rate
Cancer treatments are most effective against cells that reproduce?
rapidly
Cancer treatments are most effective in ____ stages and diagnosis?
early
A single drug treatment is less toxic to normal tissue, but also less toxic to the _____ cells.
cancer
A single dose treatment has an overall lower ______ rate.
response
With single drug treatments, there are exceptions:
Fludarabine
Rituxan
Targretin
Temodar
Fludarbine for CLL
Rituxan for NHL
Targretin for Cutaneous
T-cell lymphoma
Temodar for Glioblastoma
How is combination therapy beneficial?
most often used..
each drug effective against
cancer
minimally overlapping
toxicities
drugs have different
mechanisms of action
drugs may maximize the other
drug's effect (synergy)
decrease possibility of drug
resistance
increase percent of cells
killed at one time
What are 2 types of drug resistance?
intrinsic
acquired
What is intrinsic drug resistance?
resistance occurs prior to exposure to antineoplastics
P-glycoprotein
Topoisomerase
What is acquired drug resistance?
malignant cells become resistant after being exposed to antineoplastic agent
If a patient is on a high dose treatment, patient will need supportive?
therapies
Dose intensification is how many times higher than standard dose?
10 to 200
Treatment doses can be given in single dose, divided doses, or continuous ___ over several days
IV
_________ differ depending on length of time of administration
toxicities
How does chemotherapy effect cellular reproduction (2)?
some drugs are cell-cycle specific and some drugs are cell-cycle non-specific
How do cell-cycle specific drugs work?
work in a certain phase of cell growth...
work best given continuously
or frequently...
antimetbolites, plant alkaloids, miscellaneous
How do cell-cycle non-specific drugs work?
work in all phases of cell
cycle...
used to treat slow-growing
tumors...
cell kill proportional to
amount of drug given...
aklkylating agents, antitumor
antibiotics, nitrosources,
hormones
How do alkylating agents (CCNS) work?
break up DNA strands, prevent mitosis
How do antimetabolites (CCS) work?
block essential enzymes necessary for DNA synthesis
How do antibiotics (CCMS) work?
interrupt DNA transcription, because these drugs are highly toxic they are not used for infections
How do nitrosureas (CCNS) work?
inhibit DNA, RNA synthesis
How do vinca alkaloids (CCS) work?
bind to proteins during specific phase, causing cell to lose ability to divide
How do hormones (CCNS) work?
alter "cellular environment"-creating a "hostile" environment and changing cellular permeability
How do miscellaneous CCCS or CCNS meds work?
variety of routes - most often PO or IV, but may be given intrathecally or instilled into body cavity
What is patient teaching to monitor closely for side effects and toxic effects?
alopecia
anorexia
bone marrow suppression
fatigue
fungal infections
nausea and vomiting (Zofran given prior)
peeling skin, rash
Instruct client to report signs and symptoms of?
hypersensitivity...
loss of taste...
tingling in face, fingers,
toes (signs of peripheral
neuropathy...
dizzines, headache,
confusion,
slurred speech, convulsions
(signs of CNS toxicity)...
unusual bleeding, bruising,
fever, sore throat, mouth
sores (myelosuppression)
jaundice, yellowing of eyes,
clay colored stools, dark
urine (hepatic toxicity)
continued cough, shortness of
breath (pulmonary fibrosis)
peripheral edema, pulmonary
congestion, cough (CHF -
cardiotoxicity)
chemotherapy may need to be
discontinued or patient may
need to be placed in
protective isolation -
protected environment
What are signs of peripheral neuropathy?
tingling in face, fingers, toes
What are signs of CNS toxicity?
dizziness
headache
confusion
slurred speech
convulsions
What are signs of myelosuppression?
unusual bleeding
bruising
fever
sore throat
mouth sores
Signs of hepatic toxicity?
jaundice
yellowing of eyes
clay colored stools
dark urine
Signs of CHF or cardiotoxicity?
peripheral edema
pulmonary congestion
cough
What are radiation sensitizers?
chemo cytoreduction improves oxygen supply...
affect different cell subpopulations...
tumor growth post-XRT is slowed...
agents used: 5FU, CDDP, etoposide...
tumors treated: head and neck, rectal, pancreas, lung...
optimum dosing and scheduling not defined
A local reaction for an IV route might be an irritant which may or may not cause symptoms of ______ and there may or may not be _______
pain
inflammation
ex: DTIC
BCNU
Etoposide
A local reaction for an IV route might be a vesicant (extravasant)which is?
extravascular and causes subcutaneous tissue damage
ex: vincas
mitomycin C
anthracyclines
HN2
Examples of vesicants are?
vincas
mitomycin C
anthracyclines
HN2
Signs and symptoms of extravasation?
lack of blood return
pain (stinging, burning)
redness
swelling
If extravasation occurs, aspirate residual from ______?
tubing
If extravasation occurs, instill antidote, if residual aspirated...name 4 agents?
hyaluronidase (plant alkaloids)...
hydrocortisone (anthrcyclines)...
Na thiosulfate (alkylating
agents)
DMSO
Explain steps if extravasation occurs?
aspirate residual from tubing...
instill antidote...
remove needle..
apply a sterile occlusive
dressing...
elevate extremity...
application of warm pack or
ice (for anthracyclines)
for 24 hours
close followup for 3-4 weeks
Proper documentation of infusion (7)?
needle size, type
symptoms
site
drug sequence
amount infused
interventions
patient instructions and
follow up
What is photodynamic therapy (PDT)?
inject photosynthesizing agent, concentrates in cancer cells, then a laser is used to destroy cell
What are biologic response modifiers (BRMs)?
agents that stimulate body's natural immune system...
most are in trial studies...
ex: interferon
monoclonal antibodies
interleukin-2
tumor necrosis factor
BCG
monoclonal antibodies