Ms2, Exam 1, Oncological Problems

Front 1

What is the time from when a cell enters the cell cycle to when the cell divides into two identical cells?

Back 1

Generation time of the cell

Front 2

Normal cells respecting the boundaries of cells surrounding them is...

Back 2

Contact inhibition

Front 3

How fast do cancer cells proliferate?

Back 3

Same rate as the cells of the tissue they originated from

Front 4

Which type of cancers metastasize?

Back 4

Malignant

Front 5

Stages of development of cancer

Back 5

Initiation - cell mutation
Promotion - reversible cancer. Promoting factors - obesity, cigerrettes, alcohol, dietary fat
Progression - metastasis, increased growth of tumor

Front 6

Viruses linked to cancer

Back 6

Burkitt's lymphoma from Epstein Barr virus
AIDS - Kaposi's sarcoma
Hep B - hepatocellular cancer

Front 7

What is tumor angiogenesis?

Back 7

Formation of blood vessels within the tumor itself.

Front 8

What kind of proteins do cancer cells secrete?

Back 8

The cancer cells don't mature past the fetal stage - alpha fetoprotein and carcinoembryonic antigen

Front 9

Suffixes for benign and malignant tumors

Back 9

benign - oma
malignant - sarcoma, carcinoma

Front 10

Characteristic of grade IV cancer

Back 10

Cells are immature and primitive (anaplasia). Difficult to determine cell of origin.

Front 11

What is used to determine the anatomic extent of the cancer?

Back 11

TNM system.

T - tumor size/invasiveness
N - nodal involvement
M metastases

T0, M0, N0 = no evidence of tumor in nodes, metastasis

T1-4, M1-4, N1-4 = ascending degrees of tumor, metastasis, nodal involvement

Front 12

7 warning signs of cancer

Back 12

C - change in bowel/bladder habits
A - a sore that does not heal
U - unusual bleeding or discharge
T - thickening or lump in breast or elsewhere
I - indigestion or difficulty swallowing
O - obvious change in wart/mole
N - nagging cough or hoarseness

Front 13

When do colonoscopies begin?

Back 13

Age 50 and q10years thereafter

Front 14

Four ways we treat cancer

Back 14

Surgery
Chemo
Radiation
Biologic targeted therapy

Front 15

Sign of extravasion and what do we do about it

Back 15

swelling, redness, vesicles, uceration, necrosis

STOP THE INFUSION IMMEDIATELY

Front 16

What normal tissues are typically affected by chemo?

Back 16

Ones that divide quickly - bone marrow (anemia, bleeding), neutrophils (infection), GI tract (N/V, diarrhea, stomatitis, esophagitis), hair (hair falls out), reproductive cells

Front 17

Acute effects of chemo

Back 17

Hypersensitivity, extravasation

Front 18

Delayed effects of chemo

Back 18

N/V, alopecia, skin rashes, diarrhea, constipation

Front 19

Chronic effects of chemo

Back 19

Heart, liver, kidney, lung damage

Front 20

Low - energy radiation...

Back 20

targets superficial skin lesions (electrons)

Front 21

High - energy radiation...

Back 21

targets deeper tissues (photons)

Front 22

What is the standard fraction of radiation delivery?

Back 22

Once a day, M-F for 2-8 weeks

Hypofractionated - less than this
Hyperfractionated - more than this
Accelerated fractionated - doses twice daily over shortened period of time

Front 23

Simulation is...

Back 23

When they figure out exactly where the radiation should be directed and mark it with a tattoo.

Front 24

What is it called when radiation is delivered externally?

Back 24

Teletherapy

Front 25

What is it called when radiation is delivered internally?

Back 25

Brachytherapy

Front 26

What are the most frequent places cancer metastasizes?

Back 26

Lungs, Brain, Bone, Liver, Adrenals

Front 27

What precautions should be taken when providing care to a pt with brachytherapy radiation?

Back 27

Consolidate tasks so as little time as possible is spent in the room and wear a film badge (only in hospital and don't share it). Film badge measures levels of radiation.

Front 28

Hematologic interventions for radiation and chemo pts

Back 28

Monitor H and H. Administer iron/erythropoietin, report any temp eleations, pt should avoid lg crowds and people with infections, observe for signs of bleeding

Front 29

Management of fatigue in chemo/radiation pts

Back 29

Arrange activities after rest periods, walking program, good nutrition/hydration

Front 30

How can nurses help with radiation/chemo related N/V?

Back 30

Give antiemetics before the tx, light meal 1 hr before tx

Front 31

Diet for chemo/radiation pts that are nauseated

Back 31

high-protein, high-calorie

Front 32

What foods do you avoid when chemo/radiation pts have diarrhea?

Back 32

High fiber, fatty, gas producing foods. Avoid milk.

Front 33

How does the nurse help with dry mouth/difficulty swallowing in chemo/radiation pts?

Back 33

Oral care before and after meals and before bedtime, 1 tsp salt or baking soda in 1L H2O rinses, analgesics, artificial saliva, soft moist bland foods

Front 34

How does nurse handle anorexia associated with cancer?

Back 34

Pleasant environment for high-calorie, high-protein food and avoid nagging

Front 35

What is radiation-recall dermatitis?

Back 35

Skin desquamation that occurs months to years after the radiation.

Front 36

What is palmar-plantar erythrodyesthesia?

Back 36

Hand-foot syndrome. Redness/tingling, moist desquamation, ulceration, blistering, pain of hands and feet r/t chemo.

If severe, hold the chemo for 1-2 weeks.

Front 37

How can the nurse help with the skin reactions to radiation?

Back 37

Aloe vera, hydrocortisone, saline rinses, expose area to air, wear light-weight cotton, gentle detergents to launder clothes like Dreft and Ivory Snow, avoid sun exposure, no heat pads/sunlamps, ice bags, no swimming, no shaving in affected area, no deoderents/perfumes to tx field

Front 38

When should we expect the pt's hair to grow back?

Back 38

3-4wks after chemo/radiation is over

Front 39

How does the nurse help the pt with hair loss?

Back 39

Suggest wigs/scarves/hair pieces, cut long hair before therapy, avoid excessive shampooing/brushing/combing/hair dryers/curlers, discuss impact of hair loss on body image

Front 40

How does the nurse help with the chemo related pneumonitis that occurs 1-3months after radiation?

Back 40

Bronchodilators, expectorants, bed rest, O2. NO CORTICOSTEROIDS! Immune system is already depressed.

Cough suppressants at night.

Front 41

How can the nurse help with the sexual effects of chemo/radiation?

Back 41

Counsel about erectile dysfunction, lubricants for women, sperm and egg banking

Front 42

What can we say to ease the anxiety of remission?

Back 42

We will follow and support you ongoing.

Front 43

Who is at the highest risk for lung cancer?

Back 43

White women and African American men

Front 44

Smallest lung cancer lesion detectable on x-ray

Back 44

1cm

Front 45

What is the most malignant form of lung cancer?

Back 45

Small cell carcinoma - chemo is the mainstay of tx

Front 46

What is the most common lung cancer?

Back 46

Adenocarcinoma - surgical resection attempted b/c doesn't respond well to chemo

Front 47

What is paraneoplastic syndrome?

Back 47

SIADH, anemia, hypercalcemia, leukocytosis, hypercoagulable disorders, neurologic syndromes due to hormone secretion of cancer cells or the immune response of the body to them.

Associated with small-cell lung carcinoma

Front 48

Symptoms of lung cancer

Back 48

Usually silent killer b/c the chronic cough may be attributed to smoking.

Earliest manifestation - persistant pneumonitis b/c of obstructed bronchi (chills, cough, fever)

Most common symptom - cough that produces sputum

Front 49

Stages of lung cancer (non-small cell)

Back 49

IA - 3A have good prognosis

3B and IV have poor prognosis. Usually inoperable.

Front 50

Small cell lung cancer staging

Back 50

Limited or extensive

limited - tumor confined to the chest and regional lymph nodes (usually live about 2 years)

extensive - tumor has spread past the chest (usually live 7-10months)

Front 51

Small cell lung cancer tx adjunct

Back 51

Prophylactic cranial radiation

Chemo drugs won't cross blood-brain barrier so, radiation to prevent metastases

Front 52

Lung cancer therapies

Back 52

Prophylactic cranial radiation, bronchoscopic laser therapy, phtodynamic therapy (Porfimer IV then tumor exposed to light after 48 hours), airway stenting (to support airway against collapse), cryotherapy

Front 53

Late symptoms of lung-cancer

Back 53

hemoptysis, dysphagia, bone pain, pleural effusions, dysrhythmias, muscle wasting

Front 54

Nursing dx for lung cancer

Back 54

Ineffective airway clearance
Anxiety
Acute pain
Imbalanced nutrition:less than body requirements
Ineffective self-health management
Ineffective breathing pattern

Front 55

What is a hamartoma?

Back 55

Benign lung tumor, congenital, composed of fibrous tissue, fat, and blood vessels

Front 56

Who is most at risk for colorectal cancer?

Back 56

African Americans
Men
People with it in their family

Front 57

What is Lynch syndrome?

Back 57

Inherited form of heredity colorectal cancer

Autosomal dominant. These people need to be MONITORED.

Front 58

Risk factors for colorectal cancer

Back 58

Obesity, smoking, alcohol, large intake of processed and/or red meat

Front 59

What can we do to decrease the risk of colorectal cancer?

Back 59

Eat whole grains, fruits and vegetables, excercise

NSAIDS and HRT also reduces the risk

Front 60

Most common site of metastasis of colorectal cancer

Back 60

Liver (b/c blood leaves through the portal vein)

Front 61

Colorectal cancer complications

Back 61

Obstruction, bleeding, perforation, peritonitis, fistulas

Front 62

Left vs Right sided colon cancer

Back 62

Left - Bright red blood in stool, alternating constipation and diarrhea, change in stool caliber (narrow, ribbonlike), sensation of incomplete evacutation

Right - Cramping, colicky discomfort, anemia from occult bleeding, weakness, fatigue

Front 63

Tests for colon cancer

Back 63

q5years -
Flexible sigmoidoscopy, double-contrast barium enema, CT colonagraphy

q10years -
Coloscopy

every year -
fecal occult blood test, fecal immunochemical test

Other - stool DNA test

Front 64

Colonoscopies should begin at age

Back 64

50

or 45 for African Americans

Front 65

People with a first degree relative that developed colon cancer before age 60 should have...

Back 65

colonoscopy q 5 years beginning at age 40 or 10 years before that family member developed cancer

Front 66

Important tests once the colon cancer dx is made

Back 66

Liver function, test for anemia, carcinoembryonic antigen test (produced by 90% of all colon cancers)

Front 67

The only cure for colon cancer is...

Back 67

surgery

Front 68

Pre-op colon cancer surgery

Back 68

Cleanse the bowel with goLYTELY or Miralax. Oral antibiotics.

Front 69

Complications of colorectal surgery

Back 69

Persistent perineal sinus tracts, infections, UTI, sexual dysfunctions, hemorrhage, delayed wound healing

Front 70

Capecitabine (Xeloda) - chemo used for colon cancer drug alert

Back 70

Teach pt not to get immunizations and to report fever >100.5

Front 71

Risk factors for breast cancer

Back 71

Female, >50 years old, family history, hx of breast/colon/endometrial/ovarian cancer, menarche before 12yo or menopause after 55yo, nulliparity or 1st pregnancy after age 30, obesity after menopause, radiation, >1 alcoholic drink/day, sedentary

Front 72

Breast cancer marker

Back 72

HER-2

Front 73

Clinical manifestations of breast cancer

Back 73

usually upper outer quadrant of breast, nonmobile, nontender, irregularly shaped, hard, unilateral nipple discharge, nipple retraction, peau d'orange

Front 74

Most important prognostic factor in breast cancer

Back 74

Lymph node involvement

Front 75

What does estrogen receptor status mean in breast cancer?

Back 75

Positive - responsive to hormone therapy, better prognosis

Front 76

What does ploidy status mean in breast cancer?

Back 76

Diploid - better prognosis

Front 77

What is triple negative status in breast cancer?

Back 77

Negative for estrogen, progesterone, and HER-2. Poorer prognosis.

Younger women, BRCA-2 mutation, African Americans, and Hispanic

Front 78

Lymphedema is worst with...

Back 78

breast cancer.

Front 79

Is lymphedema curable?

Back 79

No

Front 80

Where does lymphedema swell first?

Back 80

Thighs. Not feet like cardiac edema.

Front 81

How is lymphedema managed?

Back 81

Compression stockings if in thighs. Elevate arms if that's wear it is.

Front 82

How long does it take radiation SE to take place?

Back 82

About 3 weeks.

Front 83

What is internal radiaion's purpose?

Back 83

Get the cancer cells they didn't get with surgery.

Front 84

What do we watch with diarrhea in radiation?

Back 84

Look out for orthostatic hypotension due to fluid volume deficit.

Front 85

Most common symptom of ovarian, uterine, cervical cancer...

Back 85

Abdominal distension is the first time.
Then lots of bleeding.

Front 86

Grade is...

Back 86

from the path report. More important then staging.

Front 87

What does grade tell you about?

Back 87

The tissue

Front 88

What does staging tell you about?

Back 88

The spread.

Front 89

Gene associated with breast/ovarian cancer...

Back 89

BRCA gene

Front 90

People of what descent are at higher risk of breast cancer?

Back 90

Jewish (E. European)

Front 91

What cancer is melanoma associated with?

Back 91

Pancreatic cancer (which usually looks like gallbladder disease)

Front 92

What is usually prescribed with Taxol and why?

Back 92

Benedryl, steroids, and Zofran b/c there is usually an allergic reaction due to the ethanol they use to extract the drug from the

Front 93

What drug given for neuropathy?

Back 93

Gabapentin (Neurontin)

Front 94

Drugs most likely to cause neuropathy...

Back 94

platin drugs

Front 95

IMRT

Back 95

type of radiation directed to the area in pulses

Front 96

What is taxatear toes?

Back 96

Toenails fall off.

Front 97

Avastin

Back 97

Increases risk for HTN
Stop before surgery
Risk for bleeding

Front 98

Herceptin

Back 98

Cardiac myopathy

Front 99

Palliative care vs Hospice Care

Back 99

Palliative care relieves symptoms of pain and suffering.

Hospice care is end-of-life care. Includes palliative care, but does not include curative treatments.

Front 100

To be eligible for hospice care...

Back 100

physician must certify pt has <6 months remaining.