Chapter 19: Concepts Of Cancer Development

Question 1

A client asks the nurse why his colorectal cancer is being tested for genetic mutations even though no one else in the family has ever had cancer. What is the nurse’s best response?
A. “Colorectal cancer is rare and most cases are caused by a genetic mutation.”
B. “The results of this testing will indicate what caused your cancer so you can avoid further exposure.”
C. “Many tumors have one or more genetic differences that can help determine the most effective treatment options.”
D. “Genetic testing of tumor cells can help determine the stage of your cancer and whether it has spread to other organs.”

Answer 1

Answer: C
Rationale:
Genetic testing of tumor cells (not the client with cancer) can indicate genetic mutations that would increase the susceptibility of the tumor to being killed off or having its growth controlled by targeted therapy. It does not indicate cause, stage, or degree of metastasis. Colorectal cancer is very common. Although some colorectal cancers are caused by a genetic mutation, these cancers “run in families.”

Question 2

Which specific cancer types have a higher rate of occurrence among the Hispanic/Latino population of the U.S. compared with the nonHispanic white population? Select all that apply.
A. Breast
B. Colorectal
C. Gall bladder
D. Liver
E. Lung
F. Prostate
G. Stomach

Answer 2

Correct Answers: C, D, G
Rationale:
The most common cancers in the United States among nonHispanic whites are breast, colorectal, lung, and prostate cancers. These occur at lower rates among Hispanic/Latino adults living in the U.S. However, the infection-associated cancers (gall bladder, liver, stomach) occur in this population at a higher rate.

Question 3

How does a mutation is a suppressor gene, such as BRCA1, increase the risk for cancer development?
A. Converting a proto-oncogene into an oncogene
B. Removing the control over proto-oncogene expression
C. Reducing the amount of cylins produced by the oncogenes
D. Inhibiting the recognition of abnormal cells through immunosurveillance

Answer 3

Correct Answer: B
Rationale:
Suppressor genes make products that control proto-oncogenes and prevent them from being over expressed, which would increase cell division. Thus when suppressor genes are mutated cellular regulation is lost and the increased cell division can result in cancer development. Conversion of a proto-oncogene to an oncogene requires a mutation in the proto-oncogene, not the suppressor gene. Health suppressor genes do control the amount of cyclins produced by either oncogenes or proto-oncogenes, so a mutated suppressor gene would lose this function. Suppressor genes do not interfere with the immunosurveillance performed by certain immune system cells to detect the presence of abnormal cells.

Question 4

A client’s cancer is staged as T1, N2, M1 by the TNM classification system. How does the nurse interpret this report?
A. The client has two tumors that are nonresponsive to treatment.
B. The client has leukemia confined to the bone marrow.
C. The client has a 2 cm tumor with one regional lymph node involved and no distant metastasis.
D. The client has a small primary tumor extension into 3 lymph nodes and one site of distant metastasis.

Answer 4

Correct Answer: D
Rationale:
T = primary tumor. A T1 indicates a primary tumor is detectable but still relatively small. N = regional lymph nodes. An N2 indicates regional lymph nodes are involved. M = distant metastasis. M1 indicates there is evidence of distant metastasis in at least one site.

Question 5

Which statements made by a 62-year old client alerts the nurse to the possibility that the he may be at increased genetic risk for cancer development? Select all that apply.
A. An older aunt died from a brain tumor while she had breast cancer
B. He had two benign colon polyps removed during his most recent routine colonoscopy
C. His sister died from cancer of the appendix
D. His brother is being treated for breast cancer
E. His daughter 32-year-old daughter has been recently diagnosed with cervical cancer
F. One person in each of the previous three generations of his family has died from lung cancer

Answer 5

Correct Answers: C, D
Rationale:
Lung cancer and cervical cancers are considered environmentally-induced cancers and really do not have a specific genetic predisposition. The fact that one person in each of three family generations developed lung cancer is not considered excessive. Breast cancer in older women is common and often spreads to the brain. Two benign colon polyps are common for the age group and do not indicate a genetic predisposition. The brother has a cancer that is rare for the gender and the sister has an extremely rare cancer type. Both of these cancers in first degree relatives are “red flags” for the possibility of an increased genetic risk for cancer.

Question 6

A nurse is giving a group presentation on cancer prevention and factors that cause cancer. Which statement by a client indicates understanding the education provided?

A. “Nearly 1/3 of cancers in the United States are related to tobacco use.”
B. “Red meat helps to prevent cancer development.”
C. “If I eat a healthy diet and exercise I will not develop cancer.”
D.“Most cancer is hereditary.”

Answer 6

Correct: A

“Nearly 1/3 of cancers in the United States are related to tobacco use.”
Tobacco can be linked directly to the development of about 30% of all cancers in North America.

Question 7

How will the nurse interpret the finding on a client’s pathology report that indicates a cancerous tumor is aneuploid?
A. The tumor is completely undifferentiated.
B. The tumor is fast growing.
C. Metastasis has already occurred.
D. The tumor has an abnormal number of chromosomes.

Answer 7

Correct: D

The tumor has an abnormal number of chromosomes.
A tumor that is aneuploid has an abnormal number of chromosomes. It is not related to how fast the tumor cells divide or whether any differentiated functions remain. The presence or absence of metastasis cannot be determined by the ploidy. Although usually less differentiated cancers are aneuploid, that is not the definition.

Question 8

Which cancer type does the nurse interpret from a client’s pathology report that indicates “stage 2 rhabdomyosarcoma”?
A. Muscle
B. Brain
C. Bone
D. Breast

Answer 8

CORRECT: A

Muscle
The term “rhabdomyo” refers to bone and “sarcoma” refers to connective tissue. Thus an osteogenic sarcoma arises from actual bone tissue. Brain cancers are neurogenic or glial; breast cancer is a type of carcinoma; bone cancer is an osteogenic sarcoma.

Question 9

What effect does a “passenger” mutation in a gene have on cancer development?
A. Passenger mutations do not affect cancer development but can serve as targets for specific cancer therapies.
B. These mutations enhance the effectiveness of carcinogens causing direct DNA damage of a normal cell, increasing the likelihood of cancer development.
C. These mutations protect against cancer development by reversing the effects of initiation.
D. Passenger mutations are another term for proto-oncogene gene mutations.

Answer 9

Correct: A

Passenger mutations do not affect cancer development but can serve as targets for specific cancer therapies.

Question 10

When educating a client with B-cell lymphoma, a nurse tells the client that a virus can contribute to the development of their cancer. Which virus is linked with B-cell lymphoma?
A. Human lymphotrophic virus type II
B. Human papilloma virus
C. Epstein-Barr virus
D. Hepatitis B virus

Answer 10

Correct: C

Epstein-Barr virus
The Epstein-Barr virus has been associated with B-cell lymphoma, Burkitt lymphoma, and nasopharyngeal carcinoma. Hepatitis B, human papilloma virus, and human lymphotrophic virus type II are associated with other cancers, but are not associated with B-cell lymphoma

Question 11

How will the nurse interpret the finding on a client’s pathology report that a cancerous tumor has a mitotic index of 8%?
A. The tumor has not yet undergone carcinogenesis.
B. The tumor is slow-growing.
C. Metastasis has already occurred.
D. The tumor has an abnormal number of chromosomes.

Answer 11

Correct: B
The tumor is slow-growing.
A mitotic index of 8% means that only 8% of the cells within the tumor sample are actively dividing, which represents a low or slow growth rate. The presence or absence of metastasis cannot be determined by the mitotic index. By definition, a cancerous tumor has already undergone carcinogenesis, which is not determined by the mitotic index. When a tumor has an abnormal number of chromosomes, it is aneuploid, which is not related to the mitotic index.

Question 12

Which client circumstance would prompt the nurse to create a three-generation pedigree to more fully explore the possibility of increased genetic risk for cancer?
A. Smoked for 20 years but quit 5 years ago
B. Personal history of excessive sun exposure
C. Most family adult members are overweight
D. Strong family history of breast cancer

.

Answer 12

Correct: D
Strong family history of breast cancer
Breast cancer can be sporadic, familial, or inherited. A strong family history of breast cancer should be explored for ages of breast cancer discovery and any discernable pattern of inheritance to determine whether genetic counseling is appropriate. Smoking, sun exposure, and being overweight are all considered environmental or lifestyle risks for cancer, not an increased genetic risk.

Question 13

The nurse recognizes that a client’s hemangiosarcoma originated in which tissue?
A. Epithelial tissue
B. Blood vessel
C. Skeletal muscle
D. Cartilage

Answer 13

Correct: B

Blood vessel
The prefix “hemangio-” is included when cancers of the blood vessel are named.
The prefix “rhabdo-” is used when cancers of the skeletal muscle are named. The prefix “chondro-” is included when cancers of cartilage are named. The prefix “adeno-” is included when cancers of epithelial tissues are named.

Question 14

A 74-year-old client recovering from lung cancer surgery tells the nurse, “I don’t understand why I have lung cancer. I have never even touched a cigarette.” Which factor may explain the cause?
A. A history of cardiac disease
B. Advancing age
C. A history of military service
D. A diagnosis of diabetes

Answer 14

Correct: B
Advancing age
Advancing age is the single most important risk factor for cancer. As a person ages, immune protection decreases and therefore risk for overgrowth of cancer cells increases.

Question 15

Which actions or behaviors represent to the nurse that a client is engaging in secondary cancer prevention practices? (Select all that apply.)
A. Eating a diet high in fiber and low in animal fat
B. Having a health checkup, including chest x-ray, annually
C. Obtaining a colonoscopy every 5 years
D. Electing to have both ovaries removed a person who has a BRCA2 mutation
E. Getting a mammogram or breast MRI annually
F. Having a mole removed from the neck

Answer 15

Correct: B, E

Having a health checkup, including chest x-ray, annually
Removal of at-risk tissue or a precancerous lesion (such as a mole, colon polyp, or ovaries when a person has a specific mutation in a BRCA2 gene) represents primary cancer prevention, as does eating a diet that is high in fiber and low in animal fats. Mammograms and health check-ups represent secondary prevention in the form of possible early detection.

Getting a mammogram or breast MRI annually
Removal of at-risk tissue or a precancerous lesion (such as a mole, colon polyp, or ovaries when a person has a specific mutation in a BRCA2 gene) represents primary cancer prevention, as does eating a diet that is high in fiber and low in animal fats. Mammograms and health check-ups represent secondary prevention in the form of possible early detection.

Question 16

Which conditions does the nurse teach a client are some of the seven warning signs of cancer? (Select all that apply.)
A. Heavy nosebleeds independent of trauma to the nasal mucosa
B. Menstrual bleeding that has decreased
C. Increased pigmentation with deeper coloring in a mole
D. Difficulty starting the stream of urine for the past 6 months
E. Indigestion regardless of food type eaten
F. Thickening of breast tissue in one area

Answer 16

Correct: A, C, D, E, F

Heavy nosebleeds independent of trauma to the nasal mucosa
The seven warning signs of cancer include persistent changes in bladder habits, unusual bleeding without trauma, obvious change in a wart or mole, chronic or persistent indigestion (especially if not associated with any food type), and the presence of a lump or thickening (often in the breast but can be anywhere). Reduced menstrual flow is not associated with a malignancy.

Increased pigmentation with deeper coloring in a mole
The seven warning signs of cancer include persistent changes in bladder habits, unusual bleeding without trauma, obvious change in a wart or mole, chronic or persistent indigestion (especially if not associated with any food type), and the presence of a lump or thickening (often in the breast but can be anywhere). Reduced menstrual flow is not associated with a malignancy.

Difficulty starting the stream of urine for the past 6 months
The seven warning signs of cancer include persistent changes in bladder habits, unusual bleeding without trauma, obvious change in a wart or mole, chronic or persistent indigestion (especially if not associated with any food type), and the presence of a lump or thickening (often in the breast but can be anywhere). Reduced menstrual flow is not associated with a malignancy.

Indigestion regardless of food type eaten
The seven warning signs of cancer include persistent changes in bladder habits, unusual bleeding without trauma, obvious change in a wart or mole, chronic or persistent indigestion (especially if not associated with any food type), and the presence of a lump or thickening (often in the breast but can be anywhere). Reduced menstrual flow is not associated with a malignancy.

Thickening of breast tissue in one area
The seven warning signs of cancer include persistent changes in bladder habits, unusual bleeding without trauma, obvious change in a wart or mole, chronic or persistent indigestion (especially if not associated with any food type), and the presence of a lump or thickening (often in the breast but can be anywhere). Reduced menstrual flow is not associated with a malignancy.

Question 17

Which common cancers will the nurse inform clients are related to tobacco use? (Select all that apply.)
A. Lung cancer
B. Cancer of the larynx
C. Bladder cancer
D. Cancer of the tongue
E. Cardiac cancer

Answer 17

Correct: A, B, C, E

Lung cancer
Organs exposed to the carcinogens in tobacco (lungs, tongue, larynx) are most likely to develop cancer. Bladder cancer is also associated with cigarette smoking because many of the carcinogens in tobacco are filtered into the urine and come into contact with the urinary bladder. Oral cancer is also a risk with “smokeless” tobacco.

Cancer of the larynx
Organs exposed to the carcinogens in tobacco (lungs, tongue, larynx) are most likely to develop cancer. Bladder cancer is also associated with cigarette smoking because many of the carcinogens in tobacco are filtered into the urine and come into contact with the urinary bladder. Oral cancer is also a risk with “smokeless” tobacco.

Bladder cancer
Organs exposed to the carcinogens in tobacco (lungs, tongue, larynx) are most likely to develop cancer. Bladder cancer is also associated with cigarette smoking because many of the carcinogens in tobacco are filtered into the urine and come into contact with the urinary bladder. Oral cancer is also a risk with “smokeless” tobacco.

Cancer of the tongue
Organs exposed to the carcinogens in tobacco (lungs, tongue, larynx) are most likely to develop cancer. Bladder cancer is also associated with cigarette smoking because many of the carcinogens in tobacco are filtered into the urine and come into contact with the urinary bladder. Oral cancer is also a risk with “smokeless” tobacco.

Question 18

Which client assessment findings indicate to the nurse that leukemia may be present? (Select all that apply.)
A. Multiple bruises
B. Night sweats
C. Severe epistaxis
D. Fever
E. Frequent colds
F. Fatigue

Answer 18

Correct: A, B, D, E, F

Multiple bruises
All of the answers can be linked to leukemia, especially when they occur together. (Other issues can account for any one of them when they occur singly). Leukemia is a blood and bone marrow cancer. Prolonged bleeding (bruises and epistaxis) can be caused by immature white cells crowding the client’s platelets. Night sweats are often caused by fevers that are common with leukemia. Fatigue can be caused by the presence of persistent infection or by the cancer itself as it grows. Decreased ability to fight infection (frequent colds) is caused by the lack of mature white blood cells, as leukemic cells cannot function properly. Fever is associated with an increased rate of metabolism among the leukemic cells and the presence of any infection.

Night sweats
All of the answers can be linked to leukemia, especially when they occur together. (Other issues can account for any one of them when they occur singly). Leukemia is a blood and bone marrow cancer. Prolonged bleeding (bruises and epistaxis) can be caused by immature white cells crowding the client’s platelets. Night sweats are often caused by fevers that are common with leukemia. Fatigue can be caused by the presence of persistent infection or by the cancer itself as it grows. Decreased ability to fight infection (frequent colds) is caused by the lack of mature white blood cells, as leukemic cells cannot function properly. Fever is associated with an increased rate of metabolism among the leukemic cells and the presence of any infection.

Fever
All of the answers can be linked to leukemia, especially when they occur together. (Other issues can account for any one of them when they occur singly). Leukemia is a blood and bone marrow cancer. Prolonged bleeding (bruises and epistaxis) can be caused by immature white cells crowding the client’s platelets. Night sweats are often caused by fevers that are common with leukemia. Fatigue can be caused by the presence of persistent infection or by the cancer itself as it grows. Decreased ability to fight infection (frequent colds) is caused by the lack of mature white blood cells, as leukemic cells cannot function properly. Fever is associated with an increased rate of metabolism among the leukemic cells and the presence of any infection.

Frequent colds
All of the answers can be linked to leukemia, especially when they occur together. (Other issues can account for any one of them when they occur singly). Leukemia is a blood and bone marrow cancer. Prolonged bleeding (bruises and epistaxis) can be caused by immature white cells crowding the client’s platelets. Night sweats are often caused by fevers that are common with leukemia. Fatigue can be caused by the presence of persistent infection or by the cancer itself as it grows. Decreased ability to fight infection (frequent colds) is caused by the lack of mature white blood cells, as leukemic cells cannot function properly. Fever is associated with an increased rate of metabolism among the leukemic cells and the presence of any infection.

Fatigue
All of the answers can be linked to leukemia, especially when they occur together. (Other issues can account for any one of them when they occur singly). Leukemia is a blood and bone marrow cancer. Prolonged bleeding (bruises and epistaxis) can be caused by immature white cells crowding the client’s platelets. Night sweats are often caused by fevers that are common with leukemia. Fatigue can be caused by the presence of persistent infection or by the cancer itself as it grows. Decreased ability to fight infection (frequent colds) is caused by the lack of mature white blood cells, as leukemic cells cannot function properly. Fever is associated with an increased rate of metabolism among the leukemic cells and the presence of any infection.

Question 19

Which warning signs of cancer would the nurse specifically teach in a wellness course directed to a group of older adults? (Select all that apply.)
A. Persistent hoarseness
B. Severe heartburn
C. Chronic diarrhea
D. Loss of skin turgor
E. Curd-like vaginal discharge
F. Difficulty swallowing with meals

Answer 19

Correct: A, B, C, F

Persistent hoarseness
Change in bowel habits, persistent hoarseness, indigestion or difficulty swallowing are all potential warning signs of cancer. A curd-like vaginal discharge represents a yeast infection. Loss of skin turgor is a normal response to aging.

Severe heartburn
Change in bowel habits, persistent hoarseness, indigestion or difficulty swallowing are all potential warning signs of cancer. A curd-like vaginal discharge represents a yeast infection. Loss of skin turgor is a normal response to aging.

Chronic diarrhea
Change in bowel habits, persistent hoarseness, indigestion or difficulty swallowing are all potential warning signs of cancer. A curd-like vaginal discharge represents a yeast infection. Loss of skin turgor is a normal response to aging.

Difficulty swallowing with meals
Change in bowel habits, persistent hoarseness, indigestion or difficulty swallowing are all potential warning signs of cancer. A curd-like vaginal discharge represents a yeast infection. Loss of skin turgor is a normal response to aging.

Question 20

A client is diagnosed with melanoma. Which areas would the nurse anticipate that this client’s tumor might metastasize? (Select all that apply.)
A. Kidneys
B. Liver
C. Gastrointestinal tract
D. Lymph nodes
E. Brain
F. Lungs

Answer 20

Correct: C, D, E, F

Gastrointestinal tract
Typical sites of metastasis for melanoma include brain, lymph nodes, lungs, and the gastrointestinal tract. Liver and kidneys are not typical sites for melanoma metastasis.

Lymph nodes
Typical sites of metastasis for melanoma include brain, lymph nodes, lungs, and the gastrointestinal tract. Liver and kidneys are not typical sites for melanoma metastasis.

Brain
Typical sites of metastasis for melanoma include brain, lymph nodes, lungs, and the gastrointestinal tract. Liver and kidneys are not typical sites for melanoma metastasis.

Lungs
Typical sites of metastasis for melanoma include brain, lymph nodes, lungs, and the gastrointestinal tract. Liver and kidneys are not typical sites for melanoma metastasis.

Question 21

Which cancer screening or prevention activity is most important for the nurse to include when assessing a 20-year-old client who has Down syndrome?
A. Assessing his skin for bruises and petechaie
B. Teaching him how to perform self-testicular examination
C. Testing his stool for occult blood
D. Encouraging him to eat more fruit and leafy, green vegetables

Answer 21

Correct: A

Assessing his skin for bruises and petechaie
All of the screening and prevention activities are appropriate; however, people with Down syndrome have an increased life-time risk for the development of leukemia.

Question 22

An 85-year-old client tells the nurse that she does not perform breast self-exam because there is no history of breast cancer in her family. What is the nurse’s best response?
A. “Because your breasts are no longer as dense as they were when you were younger, your risk for breast cancer is now decreased.”
B. “Breast cancer can be found more frequently in families; however, the risk for general, nonfamilial breast cancer increases with age.”
C. “You are correct. Breast cancer is an inherited type of malignancy and your family history indicates a low risk for you.”
D. “Examining your breasts once per year when you have your mammogram is sufficient screening for someone with your history.”

Answer 22

Correct: B

“Breast cancer can be found more frequently in families; however, the risk for general, nonfamilial breast cancer increases with age.”
The risks for all types of sporadic (noninherited, nonfamilial) cancers increase with age. An 85-year-old woman is two to three times more likely to have breast cancer than is a 30-year-old woman.