Flashcards in Cancer Deck (254):
To become progressively worse and to potentially result in death
The process of programmed cell death that may occur in multicellular organisms
Cells with an exact multiple of the haploid number
Two cells whose membranes join tightly together, forming a virtually impermeable barrier to fluid
What is the protein that allows for the binding in cells with tight adherence?
Ratio of the size of the nucleus to the size of the cytoplasm of the cell
Loose binding of a cell to the surface or substrate
A relationship that the chromosome number is not an exact multiple of the cardinal characteristic of a particular plant or animal species
The creation of cancer
Process by which normal cells are transformed into cancer cells
A process by which normal cells are changed so that they are able to form tumors
A process by which various factors permit the descendants of a single initiated cell to survive and expand in number
The number of sets of chromosomes in the nucleus of a cell
The point in chemotherapy when blood count cells are at their lowest after a treatment
What are the top three cancers diagnosed for women?
Breast, lung and bronchus, and colon and rectum
What are the top three cancers diagnosed for men?
Prostate, lung and bronchus, and colon and rectum
Which cancer diagnosis is the leading cause of cancer death?
Lung and bronchus
Genetic portion of DNA that regulates normal cell growth and repairs mutations, allowing cells to proliferate beyond the body's needs
Genetic portion of DNA that stops, inhibits, or suppresses cell division
Tumor Suppression Gene
Abnormal mutated genes responsible for transformation of normal cells to cancer cells
What are the most common cancers?
Basal and squamous cell cancers of the skin
What are the characteristics of a cancer cell?
Abnormal cell structure and proliferation, uncontrolled growth, ability to spread, ability to invade normal tissue, immortality, accelerated by the use of nutrients, and angiogenesis
What are the cellular division characteristics of a malignant cell?
Rapid or continuous
What is the appearance of a malignant cell?
What is the nuclear-to-cytoplasmic ratio of a malignant cell?
How many differentiated functions does a malignant cell have?
Some or none
What is the cellular adherence of a malignant cell?
What are the migratory characteristics of a malignant cell?
They migrate and invade other cells
How do malignant cells grow?
By invading other cells
What are the chromosomal characteristics of malignant cells?
What is the mitotic index of a malignant cell?
Why can malignant cells grow so quickly?
Because they are not density dependent and have no contact inhibition
Why are malignant cells able to metastasis?
Because the adhesion between cancer cells is poor and easily dislodged
Lots and lots of extra cells
Increased size of cells already present in the body
When are benign tumors bad?
When it causes pressure in an enclosed space like the brain
How are malignant cells able to invade normal tissue?
They secrete cell-dissolving enzymes
How do malignant cells undergo angiogenesis?
They secrete angiogenesis factors, which promotes the building of new capillaries to support and supply the tumor
Where do adeno- tumors originate?
Where do chondro- tumors originate?
Where do fibro- tumors originate?
Fibrous connective tissue
Where do glio- tumors originate?
The glial cells of the brain
Where do hemangio- tumors originate?
Where do hepato- tumors originate?
Where do leiomyo- tumors originate?
Where do lipo- tumors originate?
Where do lympho- tumors originate?
Where do melano- tumors originate?
In the pigment-producing skin
Where do meningioma tumors originate?
Where do neuro- tumors originate?
Where do osteo- tumors originate?
Where do renal tumors originate?
Where do rhabdo- tumors originate?
Where do squamous tumors originate?
The epithelial layer of the skin, mucous membranes, and organ linings
Why is grading necessary?
Because some cancer cells are more malignant than others and require different treatments
What are the gradings of malignant cells based on?
Cell appearance and activity
Determines the exact location of the cancer and its degree of metastasis at diagnosis
What is the staging system?
What does TNM stand for?
Primary tumor, Regional lymph nodes, and distant metastasis
What are the steps in carcinogenesis?
Initiation, promotion, and progression
Increasing genetic instability/mutations occur which provides tumor cells with growth advantage
In which phase of carcinogenesis are carcinogens introduced, causing cancer?
Name the six causes of cancer
Radiation, exposure to chemical carcinogens, virus, genetics, failure of immune surveillance, and stress
How does radiation cause cancer?
Cellular DNA is damaged by a physical release of energy
Which viruses can cause cancer?
HIV, H Pylori, and HPV
How do viruses cause cancer?
They infect DNA and RNA which results in oncogene formation and interferes with cell cycle regulation and apoptosis
What areas are susceptible to genetic tumors?
FAP, breast, renal cells and Wilms
What are the theories of the causation of pathophysiology of cancer?
Proto-oncogene, oncogenes, ras-proto-oncogenes, and tumor suppression genes
Substances which, when normally functioning, promote cellular growth but when they aren't, can allow cells to proliferate unrestrained
Genetic portion of DNA that stops, inhibits, or suppresses cell division
Tumor suppression genes
Normally a tumor suppressor which functions to stop proliferation allowing damaged DNA to repair
A differentiation of cancer cells leads to what?
A proliferation of cancer cells leads to what?
What tests are done to stage tumors?
Biopsies, blood tests, X-Rays, CT scans, PET scans, MRIs, nuclear medicine, bone marrows, and flow cytometry
How do PET scans help in diagnosing cancer?
By injecting a glucose dye which tumor cells do not use efficiently it evaluates isotope uptake and decay
Which is more accurate, a MRI or CT?
Study of chromosomes
What does a Grade 1 tumor mean?
Tumor is well-differentiated and confined to the organ of origin
If a patient has a Grade 1 tumor, what is their rate of survival?
What is a Grade 2 tumor?
Tumor is moderately differentiated with local spread and close nodal involvement
If a patient has a Grade 2 tumor, what is their rate of survival?
What is a Grade 3 tumor?
Tumor is poorly differentiated with extensive nodal involvement
If a patient has a Grade 3 tumor, what is their rate of survival?
What is a Grade 4 tumor?
Tumor is undifferentiated and has metastasized to other organs and tissues
If a patient has a Grade 4 tumor, what is their rate of survival?
In the anatomic classification of tumors, what is the tumor identified by?
The tissue of origin, the anatomic site, and the behavior of the tumor
What are the only two reasons normal cells divide?
To develop normal tissue or to replace lost or damaged normal tissue
How do benign tumors grow?
How do malignant tumors grow?
How do cancers generally metastasize?
Through the blood or lymph nodes
What does grading classify tumors by?
Cellular aspects of cancer
What does staging classify tumors by?
Clinical aspects of cancer
What does the TNM system describe?
The general anatomic extent of the cancer
How is tumor growth assessed?
Doubling time and the mitotic index
The percentage of actively diving cells within a tumor
What are the goals of cancer treatment?
Cure, control, and palliative
Creation of own blood supply
What is the oldest form of cancer treatment?
What is the purpose of radiation therapy for cancer?
To destroy cancer cells with minimal damaging effects of surrounding normal cells
Radiation therapy that is administer at a distance from the body
A procedure that involves placing radioactive material inside the body to treat cancer
Amount of radiation delivered to tissue
Amount of radiation absorbed by tissue
What are the side effects of radiation treatment for cancer?
Local skin changes and hair loss, altered taste, fatigue, and tissue fibrosis and scarring
What causes the fatigue seen in radiation treatment for cancer?
Increased energy demands
What causes the tissue fibrosis and scarring seen in radiation treatment for cancer?
What is the nursing care for patients undergoing radiation for treatment of cancer?
Teach accurately and objectively, do not remove markings, administer skin care, avoid direct sunlight, and prevent bone fractures
Why is radiation therapy an effective treatment for cancer?
It causes a decreased cellular production
When administering radiation, besides the skin what else can be affected?
The underlying tissues and structures
Treatment of cancer with chemical agents
What kinds of cells does chemotherapy most affect?
Fast growing cells
What is the goal of chemotherapy?
To reduce the number of cancer cells to that which the immune system can take care of
How is chemotherapy classified?
By the pharmacological action of effect on cellular reproduction
Cancer drugs that cross link DNA, making the two DNA stands bind tightly together, preventing proper DNA an RNA synthesis, thus inhibition cell division
Cancer drugs that damage the cell's DNA and interrupts DNA or RNA synthesis
Cancer drugs causing cells to become unable to complete mitosis during cell division
Cancer drug in which "counterfeit" metabolites fool cancer cells, interfering with cell division
Cancer drugs that disrupt an enzyme needed for DNA synthesis and cell division by nicking and straightening the DNA helix, preventing proper DNA maintenance and causing DNA breakage and cell death
Giving more than one specific anticancer drug in a timed manner
In what ways can chemotherapy drugs be administered?
IV, PO, SQ, IM, intra-arterial, intra-hepatic, intrathecal, intraventricular, intraperitoneal, intrapleural, and intravesicular
What PPE should be worn while administering chemotherapy?
Eye protection, masks, chemo gloves and gown
How long does extreme caution need to be taking in handling the excrement of a patient after receiving chemotherapy?
What is the number one priority for a patient receiving chemotherapy?
Reduce the risk of infection
Why is the risk of infection so high in patients receiving chemotherapy?
Because their bone marrow is suppressed
How can mucositis be avoided?
What kind of changes in cognition do patients receiving chemotherapy undergo?
Short term memory impairment
What are the types of targeted therapies for cancer?
Hormonal therapy, biotherapy, immunotherapy, monoclonal antibodies, radio-immunotherapy, anti-angiogenesis, and cellular therapy
The manipulation of external events indicating to cells that mitosis is needed in an effort to slow cancer growth
How does hormone manipulation therapy work to treat cancer?
Some hormones make hormone sensitive tumors grow rapidly, so decreasing these hormone amounts slows cancer growth
Selective destruction of cancer cells via chemical reaction trigged by different types of laser light
What do patients receiving photodynamic therapy for cancer treatment need to be taught?
They will have general sensitivity to light for up to 12 weeks after the injection of the drug
Modification of the patient's biological response to tumor cells
What are used in immunotherapy for cancer treatment?
Cytokines, interleukins, and interferons
What are the side effects of immunotherapy?
Severe inflammatory reactions, peripheral neuropathy, and skin rashes
What are the side effects of tyrosine kinase inhibitors?
Fluid retention, electrolyte imbalances, and bone marrow suppression
Cancer drug that blocks epidermal growth factor from binding to a cell surface receptor
Epidermal Growth Factor/Receptor Inhibitor
Name an epidermal growth factor/receptor inhibitor
Cancer drug that binds to vascular endothelial growth factor, preventing the binding of VEGF with its receptors on the surfaces of endothelial cells present in blood vessels
Vascular Endothelial Growth Factor/Receptor Inhibitors
Cancer drug that inhibits the activity of specific kinases in cancer cells and tumor blood vessels
Cancer drug that prevents the formation of a large complex of proteins into cells
Cancer drug that binds to target antigens to prevent proteins from functioning, thus preventing cell division
If a patient is going to be given a monoclonal antibody, what do they need to be pretreated with?
Benadryl and possibly a steroid
What is the symptom of a monoclonal antibody?
How is an autologous bone marrow transplant administered?
As a rescue treatment
What is the goal of a bone marrow transplant?
Empty the marrow and replace it
Damage to stem cells in bone marrow by chemo and radiation
What grows in the bone marrow of patients with myelosuppression?
Solid tumors metastasized from hematological malignancies
What are the types of myelosuppression?
Neutropenia, anemia, and thrombocytopenia
What are the manifestations of neutropenia caused by myelosuppression?
Fever >100.4, cough, SOB, skin redness or tenderness, urinary symptoms, and sepsis
How are patients with neutropenia caused by myelosuppression treated?
Massive amounts of fluids
Where would the skin of a patient with neutropenia caused by myelosuppression be red?
Around the mouth, perianal, and rectal areas
What is the most reliable indicator of a patient's ability to resist infection?
Absolute Neutrophil Count
What is the normal WBC?
What is the normal percentage of neutrophils in the WBC?
What needs to be done to prevent infection of patients with neutropenia caused by myelosuppression?
No fresh fruits or veggies, no live plants or potting soil, no live vaccines, no exposure to pet excreta, strict hand washing and personal hygiene, mouth care at least 4 times daily, no invasive procedures, and the prevention of constipation and pressure sores
How often do patients with neutropenia caused by myelosuppression need to take their temperature?
At least twice a day
Bleeding with no clotting due to a decrease in the number of platelets
What is the normal platelet count?
What kind of diet should a patient with thrombocytopenia caused by myelosuppression be on?
High fiber, high fluid
What does the systolic blood pressure of patient with thrombocytopenia caused by myelosuppression be kept at?
Decreased red blood cells
What are the normal red blood cell values?
What is the normal hemoglobin?
What is the normal hematocrit?
How is anemia managed?
Rest, slow position changes, oxygen, iron, transfusions and growth factors
What are the risk factors for anemia?
Chemotherapy, kidney damage, tumor infiltration of bone marrow, bleeding, hemorrhage, and age
Which type of chemotherapy drugs especially put that patient at risk for anemia?
Platinum based treatments
What are the risk factors for thrombocytopenia?
Chemotherapy, radiation, and medications
What are the risk factors for neutropenia?
Age, decreased renal and liver function, poor nutrition, medications, and chemotherapy
Glycosylated proteins that function to regulate the reproduction, mutation, and function of blood cells
Hematopoietic Growth Factors
Muscle or general wasting that does not improve or go away with eating
What are the signs of cachexia?
Decreased threshold for bitter, increased threshold for sweet, increased desire for salts, decreased desire for sours, and metallic taste
What should a patient with cachexia be eating?
High protein foods
How many cancer patients experience nausea and vomiting?
How is the cycle of malnutrition stopped?
Only by treating the tumor
How many cancer patients experience diarrhea?
Which chemotherapy drug causes diarrhea?
Why does chemotherapy cause diarrhea?
Chemotherapy affects cells with rapid turnover in the vili and microvilli of the GI tract
How many cancer patients experience constipation?
How many cancer patients develop mouth soars?
What do the mouth soars cancer patients experience cause?
Mucositis, esophagitis, and stomatitis
How can the mouth soars associated with chemotherapy drugs be treated?
NSS mouth rinses with 0.5 tsp salt and 8 oz of water
What skin reactions can be associated with cancer patients?
Hypersensitivity, hyper-pigmentation, photo sensitivity, radiation recall, ulceration, and palmar-plantal erythrodysestheses
What is the most common and distressing symptom of cancer patients?
Why do patients with cancer often experience fatigue?
Biochemical imbalances, deconditioning, stress, poor sleep quality, nutrition, altered sleep patterns, depression, or anxiety
What are the metabolic oncological emergencies?
Hypercalcemia, sepsis, tumor lysis syndrome, disseminated vascular syndrome, and SIADH
What are the structural oncological emergencies?
Spinal cord compression, Superior Vena Cava syndrome, pleural effusion, pericardial effusion, and increased ICP
How does spinal cord compression occur in caner patients?
The tumor encroaches on the cord or the caudal equine or the vertebrae collapse from bone degradation
What is the sign of spinal cord compression in cancer patients?
Severe back pain
What are the signs of Superior Vena Cava syndrome?
SOB, cough, hoarseness, facial and upper body swelling, headache, epistaxis, dizziness, erythema, Stoke's sign, and visual changes
Superior Vena Cava is compressed or obstructed by tumor growth
Superior Vena Cava Syndrome
What are the signs of a pleural effusion in cancer patients?
SOB, coughing, dull, sharp, or aching pain in chest, and accumulation of fluid in the pleural space
How is the pain associated with a pericardial effusion different from that of a pleural effusion?
It is relieved by sitting up
What are the signs of a pericardial effusion in cancer patients?
Epigastric or chest pain, weakness, SOB, dysphagia, edema in the legs, and N/V
What are the signs of increased ICP in cancer patients?
Change in LOC, drowsiness, lethargy, MS changes, speech changes, vision changes, memory loss, personality changes, and headache
What are the signs of hypercalcemia in a cancer patient?
Nausea, vomiting loss of appetite, constipation and abdominal pain, extreme fatigue or muscle weakness, bone pain, increased thrust or excessive urination, sleepiness and difficulty thinking or concentrating
What is the hallmark of hypercalcemia?
Constipation and abdominal pain
What are the signs of sepsis in a cancer patient?
Fever, chills, shakes, SOB, drop in BP, decreased urination
What are the signs of tumor lysis syndrome?
Weakness, muscle cramps, twitching, nausea, diarrhea, decreased urine, edema, dizziness, and decreased blood pressure
Breakdown of tumors in cancer patients cause the release of harmful products into the blood
Tumor Lysis Syndrome
What are the signs of Disseminated Intra-Vascular Coagulation in a cancer patient?
Bleeding, SOB, increased HR and abdominal tenderness
What are the signs of SIADH in a cancer patient?
Thirst, headache, muscle cramps, tiredness, nausea and vomiting, weight gain, confusion and seizures
What does advanced care planning for cancer patients have to take into account?
Current health status, values and goals, and the patient's priorities
Hospice for patients with suspected imminent death (1-3 days)
Virtual Inpatient Hospice
Hospice for patients with suspected imminent death (7-10 days) with the goals of transition and pain and symptom management
Hospice for patients with less than 6 months to live
What drugs are given with chemotherapy to protect normal tissue?
When giving chemotherapy, how often does the venous access device need to be assessed?
Every 30-60 minutes
Which cancer most commonly causes SIADH?
Carcinoma of the lung
When does hypercalcemia occur in cancer patients?
When there is bone metastasis
When is chemotherapy administered in adjunct therapy?
After surgery to shrink anything missed
When is chemotherapy administered in neo-adjunct therapy?
Before surgery to shrink the tumor to an operable size
What is the goal of palliative surgery?
Relief of symptoms to to improve quality of life
What intervention is most helpful for a patient with mucositis?
Providing oral care with a disposable mouth swab
What is the nursing priority for a client experiencing chemotherapy-indueed peripheral neuropathy?
Risk for injury related to sensory and motor deficits
The nurse is caring for a client who is receiving riuximab (Rituxan) for treatment of lymphoma. It is essential for the nurse to observe for what side effect?
What intervention will be most helpful in preventing disseminated intravascular coagulation?
Using strict aseptic technique to prevent infection
The nurse anticipates administering what medication to treat hyperuricemia associated with tumor lysis syndrome?
What finding would alarm the nurse when caring for a client receiving chemotherapy who has a platelet count of 17,000?
Change in mental status
What teaching is most appropriate for a client with chemotherapy-induced neuropathy?
Consume a diet high in fiber
Which medication does the nurse plan to administer to a client before chemotherapy to decrease the incidence of nausea?
The outpatient client is receiving photodynamic therapy. What environmental factor is a priority for the client to adjust for protection?
Reducing all direct and indirect sources of light
A client diagnosed with widespread lung cancer asks the nurse why he must be careful to avoid crowds and people who are ill. What is the nurse's best response?
When lung cancer is in the bones, it can prevent production of immune system cells, making you less resistant to infection
What prevention is most important for the nurse to teach to a client receiving radiation therapy for head a neck cancer?
See you dentist twice yearly for the rest of your life
A client receiving high-does chemotherapy who has bone marrow suppression has been receiving daily injections of epoetin alfa (Procrit). Which assessment finding indicates to the nurse that today's dose should be held and the health care provider notified?
Blood pressure change from 130/90 to 148/98
Which action is most important for the nurse to implement to prevent nausea and vomiting in a client who is prescribed to receive the first round of IV chemotherapy?
Administer antiemetic drugs before administering chemotherapy
A client being treated for advanced breast cancer with chemotherapy reports that she must be allergic to one of her drugs because her entire face is swollen. What assessment does the nurse preform?
Examine the client's neck and chest for edema and engorged veins
A 72-year-old client recovering from lung cancer surgery asks the nurse to how she developed cancer when she had never smoked. What is a possible cause?
The nurse reviews the chart of the client admitted with a diagnosis of glioblastoma with a T1NXM0 classification. What does that terminology mean?
The brain tumor measures about 1 to 2 cm and shows no regional lymph nodes and no distant metastasis
The client has a diagnosis of lung cancer. To which areas does the nurse anticipate that this client's tumor may metastasize?
Brain, bone, lymph nodes, and liver
The nurse is conducting a community health education class on diet and cancer risk reduction. What should she include?
Avoid beed and processed meats, increase consumption of whole grains, and eat "colorful fruits and vegetables," including greens
The nurse presents a cancer prevention program to teens. What will have the greatest impact in cancer prevention?
Do not smoke cigarettes
The Epstein-Barr virus causes which malignancies?
Burkitt's lymphoma, B-cell lymphoma, and nasopharyngeal carcinoma
The Hepatitis B virus cause which malignancy?
Primary liver carcinoma
The Hepatitis C virus causes which malignancies?
Primary liver carcinoma and possibly B-cell lymphomas
The Human Papilloma Virus causes which malignancies?
Cervical carcinoma, vulvar carcinoma, and other anogenital carcinomas
The Human Lymphotrophic Virus type 1 causes which malignancy?
Adult T-cell leukemia
The Human Lymphotrophic Virus type 2 causes which malignancy?
Hairy cell leukemia
Which cancers are inherited?
Breast, prostate, and ovarian
Which cancers have familial clustering?
Breast and melanoma
Which cancer is associated with Bloom syndrome?
Which cancer is associated with familial polyposis?
Which cancer are associated with chromosomal aberrations like Down syndrome?
Which cancer is associated with Klinefelter syndrome?
Which cancers are associated with Turner's syndrome?
Leukemia, gonadal carcinoma, meningioma, and colorectal cancer
What are the warning signs of cancer?
Persistent constipation, scab present for 6 months, and axillary swelling
The nurse is assessing a client with lung cancer. Which symptom does the nurse anticipate finding?
A 52-year-old client relates to the nurse that she has never had a mammogram because she is terrified that she will have cancer. Which response by the nurse is therapeutic?
Finding a cancer in the early stages increases the change for a cure
Which information must the organ transplant nurse emphasize before each client is discharged?
Taking immune suppressant medications increases your risk for cancer and the ned for screenings
A client who is scheduled to undergo radiation for prostate cancer is admitted to the hospital. Which statement by the client is most important to communicate to the physician?
My legs and numb and weak
What do insulin and estrogen do to the process of malignant transformation?
Insulin and estrogen enhance the division of an initiated cell during the promotion phase