Exam 3: Cancer Flashcards
(145 cards)
1
Q
_________ is defined as a neoplastic disorder characterized by abnormal cellular differentiation & proliferation
A
Cancer
2
Q
What word means “New Growth” ?
A
Neoplasm
3
Q
True or False: Cancer is a universal disease that affects people without regard, to race, sex, socioeconomic status, or culture ?
A
True
4
Q
True or False: Cancer is now treated as a chronic disease rather than a terminal disease ?
A
True
5
Q
________ are “just a growth” that can be either benign or malignant ?
A
Tumors
6
Q
What does it mean if cells are “well-differentiated” ?
A
They act & look like the normal cell
7
Q
What are characteristics of Benign tumors ?
A
- Limited growth
- Localized
- Cell’s are well-differentiated
- Does not invade surrounding tissue
8
Q
What are characteristics of Malignant tumors ?
A
- Rapid or Slow growth
- Spread throughout the body
- Invasive to distant sites
- Cells poorly differentiated
9
Q
What does it mean if cells are “ poorly differentiated” ?
A
They DON’T look like normal cells
10
Q
What are 3 examples of malignant tumors that have rapid growth ?
A
- Lung cancer
- Hematologic cancer
- Leukemic cancer
11
Q
What is an Example of a malignant tumor that has slow growth ?
A
Prostate cancer
12
Q
____________ are defined as a substance or agent that causes the development or increases the incidence of cancer ?
A
Carcinogens
13
Q
What are examples of different kinds of carcinogens that can cause cancer ?
A
- Chemical
- Physical
- Genetic susceptibility
- Viruses
14
Q
What type of a carcinogen is defined as “ repeated injury to tissue” ?
A
Physical carcinogen
15
Q
What are Examples of chemical carcinogens ?
A
- Benzine
- Arsenic
- Formaldehyde
16
Q
What types of cancers can be d/t Genetic Susceptibility ?`
A
- Breast cancer
- Colon cancer
- Ovarian cancer
- Pancreatic cancer
17
Q
What are examples of viruses that can be linked to cancer ?
A
- HPV
- HIV
- Hep B
18
Q
What viral cancer causes cancer of the cervix in women & cancer of the head and neck in both sexes ?
A
HPV
19
Q
What Virus can causes Kaposi Sarcoma ?
A
HIV
20
Q
What virus can increase the chance of Liver cancer ?
A
Hepatitis B
21
Q
Types of Cancer are classified how ?
A
By cell type and orgin
22
Q
What are the different types of cancer classifications ?
A
- Carcinoma
- Sarcoma
- Lymphoma
- Leukemia
23
Q
Carcinoma cancers usually originate where ?
A
- Skin
- Glands
- Mucosa linings
- lungs
- GI tract
- GU
24
Q
Lymphoma cancers are generally seen where ?
A
Lymphatic tissues
25
Leukemia's generally affect what ?
Bone Marrow
26
What grade of a tumor cannot be assessed ?
Grade V (5)
27
What grade of a tumor has "mild dysplasia (well-differentiated; low grade) ?
Grade I
28
The classification of tumors is based on what ?
The extent of the disease
29
What Classification System is used to assess tumors ?
TNM
30
What does the classification system TNM stand for ?
T - tumor
N - degree of regional spread to lymph nodes
M - metastasis
31
Staging of tumors/cancers Can Not be done until when ?
Until full diagnostic workups have been completed
32
What does " in situ" mean ?
Means the cancer has no tendency to invade other tissue
33
What stage is defined as "Cancer in situ" ?
Stage 0
34
In what stage is the tumor limited to the tissue of origin ?
Stage 1
35
In what stage is the cancer limited to local spread ?
Stage 2
36
In what stage does the cancer have extensive local and regional spread ?
Stage 3
37
In what stage of cancer is there widespread metastasis ?
Stage 4
38
What type of diagnostics are used to look for cancer ?
- Blood tests
- Pap Smear
- Proctoscopic Exams
- Radiologic exams
- Biopsy
39
What diagnostic test is considered a definitive test ?
Biopsy
40
What are goals of treatment for individuals with cancer ?
- Cure
- Control
- Palliation
41
What are Treatment options for cancer ?
- Surgery
- Radiation
- Chemotherapy
- Biologic therapy
- Targeted therapy
- Stem cell transplant
42
what are reasons why Surgical therapy is used ?
- Diagnosis
- staging
- cure
- palliation
- adjuvant tx
- oncological emergencies
- pain control
43
Why is surgical therapy used ?
To cure or control tumor growth
44
True or False: When using surgical therapy a margin of surrounding normal tissue must be removed at time of surgery "clean margins" ?
True
45
Radiation is used to do what ?
- Cure
- Control
- Palliate
46
True or False: Radiation therapy is used alone or in combination with other modalities ?
True
47
Why is radiation therapy used ?
Used for inoperable tumors to reduce size, control growth, and relieve pain or obstruction
48
What routes can radiation therapy be given ?
- External
| - Internal
49
What is the goal of Chemotherapy ?
To reduce the # of malignant cancer cells in the tumor site(s)
50
True or False: Chemotherapy is used both systemically and regionally ?
True
51
How is systemic chemotherapy usually given ?
through IV
52
How is regional chemotherapy given ?
Insert a catheter directly into the organ//area causing the cancer
53
Chemotherapy is used for most ______________ & _________________ ?
- Solid tumors
| - hematologic cancers
54
What type of therapy targets rapidly dividing cells which has the potential for toxicity to normal cells ?
Chemotherapy
55
True or False: Patients are usually treated with a combination of drugs to affect cancer at different cell stages ?
True
56
What are some side effects of chemotherapy ?
- sore throat
- difficulty swallowing
- esophagitis
- nausea
- vomiting
- diarrhea
57
Effects of radiation are very specific to what ?
the specific radiation field involved
| ex: Brain
58
The effects of chemo tend to be what ?
Generalized to the entire body or different parts of the body
59
What are the Hematologic side effects of chemo & radiation ?
- Neutropenia (low WBCs)
- Thrombocytopenia (low platelets)
- Anemia
60
What are the GI effects of chemo & radiation ?
- Nausea
- Vomiting
- Anorexia
- Diarrhea
- Stomatitis (inflammation of the mouth & lips)
- Mucositis (inflammation & ulceration of the mucous membranes lining the digestive tract)
- Esophagitis
61
What are integumentary side effects of chemo & radiation ?
- Skin changes
| - Alopecia (loss of hair)
62
What are pulmonary side effects of chemo & radiation ?
Pneumonitis
| general inflammation of lung tissue
63
What are Cardiovascular side effects of chemo & radiation ?
- Pericarditis
| - Cardiotoxicity
64
What are Genitourinary side effects of chemo & radiation ?
- Cystitis
- Nephrotoxicity
- Reproductive dysfunction
65
What are Nervous System side effects of chemo & radiation ?
- ICP
| - Cognitive & peripheral neuropathy
66
What is Neutropenia ?
Low neutrophil count (WBCs)
67
What neutrophil range is considered to put an individual at moderate risk for infection ?
500 - 1000
68
What neutrophil rage is considered to put an individual at severe risk for infection ?
Less than 500
69
Neutropenia is more common with patients receiving what type of therapy ?
Chemotherapy
70
With Neutropenia there is a risk for what ?
Serious life threatening infections
71
What things/areas do we want to make sure to assess is someone with Neutropenia ?
- skin
- mouth
- GI tract
- peri-rectal areas
- lungs
- urinary tract
72
What things do we want to monitor in pt's with Neutropenia ?
- WBCs
- Signs of infection
- Culture during fever spikes
(CXR, blood, UA, sputum, stool, drainage)
73
For pt's who are Neutropenic, they may receive what, to stimulate neutrophil production ?
Neupogen (filgrastim)
74
What are Pt teaching points for pt's with Neutropenia ?
- Avoid sources of infection
- People w/ infections
- People recently vaccinated with live attenuated viruses
- Avoid fresh fruits, plants, & flowers near bedside
- Avoid cleaning litter boxes
- Good personal hygiene
- bathe daily
- wash hands before eating & meal prep
- Keep nails short
- Avoid enemas, rectal suppositories, & thermometers
- Report signs of infection immediately!!
75
Pt's with Neutropenia should report signs of infection immediately. What are the signs ?
- Fever > 38ºC (100.4ºF)
- Cough
- Sore throat
- Shaking
- Chills
- Painful or frequent urination
- vaginal discharge
76
True or False: if a pt with Neutropenia has a fever they will have a fever workup including things such as CXR, 2 sets of blood cultures,
True
77
What is Thrombocytopenia ?
Low platelet count
78
The potential for spontaneous bleeding or injury is seen with what hematologic problem in cancer pt's ?
Thrombocytopenia
79
What should we assess for in pt's with Thrombocytopenia ?
Bleeding
80
With a platelet count of < 50,000/mm3 there is what ?
An increased risk for bleeding
81
With a platelet count of < 20,000/mm3 there is what ?
An increased risk for spontaneous cerebral bleeding or GI bleeding
82
In cancer pt's with Thrombocytopenia, what bleeding precautions should be taken ?
- No IM injections
| - Avoid veni-punctures
83
What are pt teaching points for cancer pt's who have thrombocytopenia ?
- Prevent trauma to skin & mucous membranes
- Avoid dental work or surgery
- Avoid enemas, rectal suppositories & thermometers
- Use toothettes or nonabrasive cleaning...
- Avoid straight edge razors
- Avoid drugs containing ASA
- Humidify air
- Use lotions & lubricants on skin & lips
84
________ is common with chemo & radiation, and typically has a later onset ?
Anemia
85
What does Anemia cause ?
Impaired oxygenation
86
Impaired oxygenation from anemia can cause what types of things ?
- Fatigue
| - Activity intolerance
87
How is anemia treated ?
Procrit (epoetin)
* Can Increase RBC's/production
88
What are pt teaching points for a pt with Anemia ?
- Avoid walking barefoot
- Plan rest periods
- Conserve energy
89
Pt's with Anemia should report what types of things ?
- Bleeding gums
- Increased bruising
- Petachiae
- Hypermenorrhea
- Tarry stools
- Blood in urine
- Coffee-ground emesis
90
_________ affects most cancer patients ?
Fatigue
91
When a pt has fatigue, we should assess for possible causes. What are some possible causes of fatigue ?
- Anemia
- Chronic pain
- Stress
- Depression
- Inadequate rest
- Poor nutrition
92
What are some pt teaching points for someone with fatigue ?
- Conserve energy
- Rest when tires
- Plan for rest periods
- Plan for gradual increase of activity
- Monitor dietary and fluid intake
(fluid intake: 2-3L per day)
93
In pt's with Anemia, what do we want to monitor ?
H&H
94
True or False: Cells in the mucosal lining of the GI tract are highly proliferative & are most sensitive to chemo & radiation ?
True
95
For patients who experience Nausea, vomiting, and anorexia, what do we want to do before treatment ?
Pre-medicate
- as much as 4hrs before coming to hospital, or 1hr. All Depends on the patient and how they've reacted previously
- Want to get ahead of Nausea before Tx is started/given
- May get a steroid before Tx
96
What do we want to monitor for in pt's who have Nausea, Vomiting, or Anorexia ?
Monitor fluid & electrolyte status
97
What type of medications are given for pt's who experience Nausea, Vomiting, or Anorexia ?
- Zolfran (blocks serotonin)
- Anxiolytic (Ex: Ativan)
- Compazine (anti-nausea)
98
When monitoring fluid & electrolyte status in somebody who has Nausea, Vomiting, or Anorexia, what are specifically looking at ?
- Potassium & Magnesium
| * these 2 affect cardiac & muscle function !
99
What are patient teaching points for cancer pt's who are experiencing Nausea, Vomiting & Anorexia ?
- Eat frequent small meals
- Avoid greasy, fatty foods, candy & sweet foods
- Avoid unpleasant sights, odors, and tastes
- With some pt's - hot foods are not tolerated well
- Cold foods, salty foods, & dry toast may be more tolerable !
- Report weight loss to healthcare provider
100
____________ is a reaction of the bowel mucosa to radiation and certain chemo ?
Diarrhea
101
What part of the bowel is more sensitive to chemo & radiation ?
Small bowel (AKA: small intestine)
102
What is a common medication that is used to slow down diarrhea in pt's receiving chemo & radiation ?
Loperamide (aka: Imodium)
103
For pt's who experiencing Diarrhea from chemo & radiation, what kind of diet do we want to encourage ?
Low fiber diet
(because, we want things to move more slowly through the GI tract)
- no fruits or vegetables. --> want to keep it bland
104
For pt's with Diarrhea, what foods do we want to tell them to avoid ?
Avoid...
- fried foods
- fatty foods
- dairy
105
for pt's experiencing Diarrhea as a side effect from treatment, what do we want them to have during treatment (radiation) ?
A full bladder
106
Why do we want pt's who are experiencing Diarrhea, to have a full bladder during radiation treatment ?
It helps move the small intestine out of the field of radiation
107
What things do we want to monitor in pt's who are experiencing Diarrhea, as a side effect of chemo & radiation ?
- Hydration
| - Electrolytes
108
True or False: If the bowel is in the Tx field (if pt has colon cancer, cervical cancer, etc), if the intestine is in that window, the pt will have GI side effects ?
True
109
True or False: In general chemo & radiation will cause GI effects ?
True
110
What GI effect is defined as Alterations in the mouth and tongue ?
Stomatitis
111
What is Stomatitis ?
erythema and dryness of the mouth
112
What is Mucositis ?
- erythema
- White layer
- thick at times
- white layer of mucous
(like gooo --> just like thick saliva)
- Pt's have trouble spitting it out
113
What is Candidiasis ?
White patches on the tongue, in the cheeks
(will look different than mucositis)
* needs Tx with Antifungals
114
What is Herpes Simplex ?
Can cause vesicles or blisters in the mouth
115
What are types of alterations in the tongue and mouth ?
- Stomatitis
- Mucositis
- Candidiasis
- Herpes Simples
116
In pt's with Stomatitis/ any alteration in the mouth and tongue what do we want to make sure to do ?
Assess & inspect the mouth with a flashlight every single day, probably even twice a day !
117
What are some pt teaching points for pt's with stomatitis/alterations in the mouth and tongue ?
- Soft toothbrush
- regular flossing
- Mouthwash with normal saline
- Avoid irritants
(tobacco, ETOH, spices, commercial mouthwash)
- Good nutrition/hydration !!
118
What do we want to teach patients who experience Diarrhea as a side effect of cancer treatment ?
Want to teach these pt's to take care of their rectal area when experiencing diarrhea
- Because: tissue is sensitive if it is coming into contact with stool
- The tissue can break down, causing a portal of entry or bacteria which could cause infection
119
What things can we suggest for pt's experiencing Diarrhea to utilize ?
- Warm baths
| - Steroid creams to the rectal area to reduce inflammation
120
What skin change can we see with Radiation ?
Erythema
121
What are the two things that we can see from Erythema from Radiation ?
- Dry desquamation
| - Wet desquamation
122
What is Dry desquamation ?
Peeling
123
What is Wet desquamation ?
Peeling of the skin with weeping serous (clear) fluid
* This greatly increases the risk for infection
124
Which cancer treatment causes skin changes that can look like sunburn type reactions ?
Radiation
125
What do we want to assess in pt's recieving cancer treatment in regards to the integumentary system ?
Want to assess the skin each day after Tx
- the skin will continue to get more red with each passing day with Tx
- There are times when we have to wait a day or two between treatments to allow the skin to recover a little bit from the injury
126
What is a side effect of chemotherapy in relation to the skin ?
Erythrodysesthesia syndrome
- Is a hand & feet syndrome that can cause
- redness, tingling, some skin breakdown, etc.
127
What are patient teaching points about the skin for patients receiving cancer treatment ?
- No deodorant
- No irritants
- No perfumes
- Keep the skin moist (no irritating lotions)
- Protect skin
128
What is Alopecia ?
Hair loss
129
True or False: In some cases the skin breakdown from cancer treatment is treated as a burn, with gasoline gauze ?
True
130
How long does it usually take for Alopecia to start if its from chemotherapy ?
within 3-4 weeks of the beginning of chemo
131
True or False: The degree of alopecia depends on the type and dose ?
True
132
What are patient teaching points for Alopecia ?
- Hair loss occurs 10-21 days after drug treatment
- Hair loss is temporary, and grows back when the drug is stopped
(for chemo, hair typically grows back in 3-4wks after chemo has been completed)
- hair loss may be sudden & in large amounts
- Select wig or cap before hair loss occurs
(depends on the pt. if they want to)
- Avoid hair dryers, curling irons, & harsh or frequent shampoos
- Keep head covered
- Summer - to prevent sunburn
- Winter - to prevent heat loss
133
True or False: Pulmonary side effects of chemo & radiation can be progressive & irreversible at times ?
True
134
Can pulmonary effects of chemo & radiation be acute and late ?
Yes
135
What are pulmonary effects of chemo & radiation ?
- Pneumonitis - r/t radiation
- Pulmonary toxicity - causing tissue damage
- Non-cardiogenic pulmonary edema
- d/t damage of the lung tissue from Tx's
136
Because pulmonary side effects can come on late, what types of things do we want to inform pt's to report ?
- SOB
- Difficulty breathing w/ activity
- etc,.
137
What types of Cardiovascular damage occur from chemo & radiation ?
- Damage to
- pericardium
- myocardium
- valves
Or
- coronary blood vessels
Such as....
- Pericarditis
- Cardiotoxicity
138
What types of things can Cardiotoxicity cause ?
- Dysrhythmias
- Left ventricular dysfunction
- Heart Failure
139
What is a medication that is used in pt's experiencing Cardiovascular effects from chemo & radiation ?
Adriamycin
140
What do we know about the drug Adriamycin ?
| (cardiovascular drug)
- It's cardiotoxic
| * there is a limited lifetime dose with this medication because of Cardiotoxicity
141
What do we want to monitor in pt's who are receiving the drug Adriamycin ?
the pt's ECG's before their started on the medication & throughout Tx.
(baseline & periodic ECG to monitor how the pt is handling the effects of the drug)
142
What types of cancer/diseases can cause cardiovascular effects from chemo & radiation ?
```
Radiation to the chest
- Lung cancer
- Breast cancer
- Hodgekin's disease
(there are some lymp nodes in the chest area that require radiation)
```
143
In regards to chemo & radiation and the bladder, what can we give sometimes ?
Sometimes there are meds we can give when we know they will be toxic to the bladder
144
When the kidneys are receiving chemo & radiation, what do we want to monitor ?
BUN & Creatinine
145
What do we know about chemo & radiation, but especially radiation and the effects it can have on the reproductive system ?
It can cause Sterility/Infertility
