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Module 1: Chapter 19 Cancer Developement Flashcards

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1
Q

1What is cancer?

A

2also called malignancy , is a type of abnormal cell growth in
which cellular regulation is lost, resulting in new tissues that serve no
useful function, are harmful to the function of normal cells and organs,
and can lead to death if left untreated.

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2
Q

How does risk for cancers differs for each adult?

A

differs by genetic, immunologic, and environmental factors.

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3
Q

What is Celluar Regualtion ?

A

Cellular regulation
is the genetic and physiologic processes that control cellular growth,
replication, differentiation, and function to maintain homeostasis. All steps
in the processes of cellular regulation are the result of gene interactions

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4
Q

What tissue continues to grow in the body?

A

Tissues that continue to grow by undergoing mitosis in adulthood include
cells of the skin, hair, mucous membranes, bone marrow, and linings of
organs such as the lungs, stomach, intestines, bladder, breast ducts, and
uterus. These tissues are located in areas in which constant damage or
wear is likely and continued cell growth is needed to replace dead tissues.

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5
Q

What is Neoplasia?

A

Any new or continued cell growth not needed for normal development
or replacement of dead and damaged tissues is called neoplasia. This cell
growth is abnormal even if it causes no harm (is benign).

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6
Q

Biology of Normal Cells?

A

Specific morphology is the feature in which each normal cell type has a
distinct and recognizable appearance, size, and shape

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7
Q

Differentiated Function of a normal cells

A

Differentiated function means that every normal cell has at least one
function it performs to contribute to whole-body function. For example,
skin cells make keratin, liver cells make bile, cardiac muscle cells contract,
and red blood cells make hemoglobin

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8
Q

What is tight adherence?

A

Tight adherence occurs because normal cells make sticky cell adhesion
molecules (CAMs) that protrude from the membranes, allowing cells to
bind closely and tightly together.

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9
Q

Do RBC produce tight adherence ?

A

Red blood cells and white blood cells produce no
CAMs and do not usually adhere together.

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10
Q

Nonmigratory on normal cells

A

Nonmigratory means that normal cells do not wander throughout the
body (except for blood cells). Normal cells are nonmigratory because they
are tightly bound together with CAMs, which prevents cells from
wandering from one tissue into the next.

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11
Q

What are important features of normal cells?

A
  • Orderly and well-regulated growth by cellular regulation is a very important feature of normal cells.
  • They divide (undergo mitosis) for only
    two reasons: (1) to develop normal tissue or (2) to replace lost, damaged,
    or aged normal tissue.
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12
Q

Why are cells termed the name G, 0 ?

A

-Living cells not actively reproducing are in reproductive resting state.
-During G, 0 period, cells actively carry out their functions but do not divide.
- Normal cells spend most of their lives in the G, O state rather than the reproductive state.

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13
Q

What is contact inhibition ?

A

Contact inhibition is the part of cellular regulation that stops further
rounds of cell division when the dividing cell is completely surrounded
and touched (contacted) by other cells.

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14
Q

What is Apoptosis ?

A

Apoptosis is programmed cell death.

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15
Q

What is Euploidy ?

A

Euploidy, having a complete set of chromosomes, is a feature of most
normal human cells.

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16
Q

What is the correct number of chromosomes for humans ?

A

23 pairs of chromosomes

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17
Q

Characteristics of a Normal Cell

A

-Cell division: none or slow
-Appearance : Specific morphologic feature
-Small nuclear to cytoplasmic ratio
-many differentiated cell function
-tight adherence
-no migratory
-well-regulated growth
Diploid ( euploid) chromosome
-low index mitotic index

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18
Q

Characteristics of Benign Tumor Cell

A
  • Continuous or innappropriate cell division
    -Specific morphologic features
  • Smaller nuclear to cytoplasmic ratio
  • Many different function
  • tight adherence
  • no migratory
  • Expansion growth
    -Diploid ( Euloid)
  • Low mitotic index
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19
Q

Characteristics of Malignant Cell

A

Rapid and continious
-Anaplastic appearance
-Larger ratio
-some or none diff funct
-loose adherence
-yes migratory
- invasion growth
-Aneuploid chromosomes
- High mitotic index

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20
Q

What alters body cells?

A

Body cells are exposed to a variety of conditions that can alter how cells
grow or function. When either cell growth or cell function is changed, the
cells are considered abnormal.

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21
Q

What are Benign Tumor Cells

A

Benign tumor cells are normal cells growing in the wrong place or at the wrong time as a result of a problem with cellular regulation.
- Examples include moles, uterine fibroid tumors, skin tags, endometriosis, and nasal polyps. Benign tumor cells have these characteristics:

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22
Q

Feature of Benign Tumor

A

Specific morphology occurs with benign tumors. They look like the
tissues they come from, retaining the specific morphology of
parent cells.
* A smaller nuclear-to-cytoplasmic ratio is a feature of benign tumors
just like completely normal cells.
* Specific differentiated functions continue to be performed by benign
tumors. For example, in endometriosis, a type of benign tumor, the
normal lining of the uterus (endometrium) grows in an abnormal
place (e.g., on an ovary or elsewhere in the abdominal or even the
chest cavity). This displaced endometrium acts just like normal
endometrium by changing each month under the influence of
estrogen. When the hormone level drops and the normal
endometrium sheds from the uterus, the displaced endometrium,
wherever it is, also sheds.

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23
Q

Benign Tumor Cells Features

A

Tight adherence of benign tumor cells to one another occurs because
they continue to make cell adhesion molecules.
* No migration or wandering of benign tissues occurs because they
remain tightly bound and do not invade other body tissues.
* Orderly growth with normal growth paerns occurs in benign
tumor cells even though their growth is not needed. The fact that
growth continues beyond an appropriate time or occurs in the
wrong place indicates some problem with cellular regulation , but
the rate of growth is normal. The benign tumor grows by
expansion. It does not invade.
* Euploidy (normal chromosomes) are usually found in benign tumor
cells, with a few exceptions. Most of these cells have 23 pairs of
chromosomes, the correct number for humans.

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24
Q

Features of Cancer Cells

A

Cancer (malignant) cells are abnormal, serve no useful function, and are harmful to normal body tissues

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25
Cancer Cell Features
Anaplasia is the cancer cells’ loss of the specific appearance of their parent cells. As a cancer cell becomes more malignant, it becomes smaller and rounded. Thus many different types of cancer cells look alike under the microscope, rather than looking like their parent cells. * A larger nuclear-cytoplasmic ratio occurs because the cancer cell nucleus is larger than that of a normal cell and the cancer cell is smaller than a normal cell. The nucleus occupies much of the space within the cancer cell, especially during mitosis, creating a large nuclear-to-cytoplasmic ratio.
26
Cancer Cell Features
* Specific functions are lost partially or completely in cancer cells. Cancer cells serve no useful purpose. * Loose adherence is typical for cancer cells because they do not make cell adhesion molecules. As a result, cancer cells easily break off from the main tumor. * Migration occurs because cancer cells do not bind tightly together and have many enzymes on their cell surfaces. These features allow the cells to slip through blood vessel walls and between tissues, spreading from the main tumor site to many other body sites. The ability to spread by undergoing metastasis is unique to cancer cells and is a major cause of death. Cancer cells invade other tissues, both close by and more remote from the original tumor. Invasion and persistent growth make untreated cancer deadly.
27
Terms used to for cancer development
-Carcinogenesis, oncogenesis, and malignant transformation are different terms for cancer development, which is the process of changing a normal cell into a cancer cell. -This process occurs through loss of cellular regulation leading to the steps of initiation, promotion, progression, and metastasis.
28
First step in cancer developement
Initiation is the first step in carcinogenesis. Normal cells can become cancer cells if they lose cellular regulation by having their genes promoting cell division (proto-oncogenes) turn on excessively (are overexpressed), becoming oncogenes, and produce more cyclins.
29
What happens after a cell becomes intiated
After initiation a cell can become a cancer cell if the cellular regulation loss that occurred during initiation continues.
30
What are carcinogens?
Substances that change the activity of a cell’s genes so the cell becomes a cancer cell are carcinogens. Carcinogens may be chemicals, physical agents, or viruses. More than 62 agents, substances, mixtures, and exposures are known to cause cancer in humans, and about another 186 are suspected to be carcinogens
31
What is the 2nd process in cancer development?
Promotion . Promotion is the enhanced growth of an initiated cell by substances known as promoters. -. Once a normal cell has been initiated by a carcinogen and is a cancer cell, it can become a tumor if its growth is enhanced. Many normal hormones and body proteins, such as insulin and estrogen, can act as promoters and make cells divide more frequently. The time between a cell’s initiation and the development of an overt tumor is called the latency period, which can range from months to years. Exposure to promoters can shorten the latency period.
32
What is latency period ?
The time between a cell’s initiation and the development of an overt tumor is called the latency period, can last for months to years.
33
What is the 3 process in cancer development?
Progression Progression is the continued change of a cancer, making it more malignant over time. After cancer cells have grown to the point that a detectable tumor is formed (a 1-cm tumor has at least 1 billion cells in it), other events must occur for this tumor to become a health problem. -- First the tumor must develop its own blood supply. The tumor makes vascular endothelial growth factor (VEGF) that triggers nearby capillaries to grow new branches into the tumor, ensuring the tumor’s continued nourishment and growth.
34
What is a primary tumor?
The original group of cancer cells or tumor caused by carcinogenesis is called the primary tumor . It is usually identified by the tissue from which it arose (parent tissue) such as in breast cancer or lung cancer. When primary tumors are located in vital organs such as the brain or lungs, they can grow and either lethally damage the vital organ or interfere with thatorgan’s ability to perform its vital function.
35
What is the last process in cancer development?
metastasis. Metastasis occurs when cancer cells move from the primary location by breaking off from the original group and establishing remote colonies. -These additional tumors are called metastatic tumors or secondary tumors. Even though the tumor is now in another organ, it is still a cancer from the original altered tissue. For example, when breast cancer spreads to the lung and the bone, it is still breast cancer in the lung and bone—not lung cancer and not bone cancer.
36
Ways a tumor can spread
-Tumors first extend into surrounding tissues by secreting enzymes that open up areas of surrounding tissue. Pressure, created as the tumor increases in size, forces tumor cells to invade new territory. -Spread to distant organs and tissues requires cancer cells to penetrate blood vessels. Bloodborne metastasis (tumor cell release into the blood) is a common cause of cancer spread. -Enzymes secreted by tumor cells also make large pores in the patient’s blood vessels, allowing tumor cells to enter the blood and circulate. Because tumor cells are loosely held together, clumps of cells break off from the primary tumor into blood vessels for transport.
37
Another way tumor can spread...
-Another way cancers metastasize is by lymphatic spread. Lymphatic spread is related to the number, structure, and location of lymph nodes and vessels. Primary sites that are rich in lymphatics have earlier metastatic spread than areas with few lymphatics.
38
NCLEX Practice Question 19.1
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.”
39
How is cancer classified?
- Cancers are classified according to the type of tissue from which they arise (e.g., glandular, connective) (McCance et al., 2019), as described in Table 19.3. Other ways to classify cancer include biologic behavior, anatomic site, and degree of differentiation. - Cancers are either solid or hematologic. Solid tumors develop from specific tissues (e.g., breast cancer and lung cancer). Hematologic cancers arise from blood cell–forming tissues (e.g., leukemias and lymphomas).
40
Why have cancer grading been developed ?
Systems of grading and staging have been developed to help standardize cancer diagnosis, prognosis, and treatment.
41
What is grading relating to cancer?
Grading of a tumor classifies cellular aspects of the cancer.
42
What is Ploidy relating to cancer grading?
Ploidy classifies the number and structure of tumor chromosomes as normal or abnormal.
43
What is Staging relating to cancer grading ?
Staging classifies clinical aspects of the cancer. -Staging determines the exact location of the cancer and whether metastasis has occurred. - Cancer stage influences selection of therapy. Staging is done by clinical staging, surgical staging, and pathologic staging. Clinical staging assesses the patient’s symptoms and evaluates tumor size and possible spread. -Surgical staging assesses the tumor size, number, sites, and spread by inspection at surgery. -Pathologic staging is the most definitive type, determining the tumor size, number, sites, and spread by pathologic examination of tissues obtained at surgery.
44
What is Ploidy ?
Ploidy is the description of cancer cells by chromosome number and appearance. Normal human cells have 46 chromosomes (23 pairs), the normal diploid number (euploidy).
45
Common sites of Metastasis for Breast Cancer
-Bone -Lung -Liver -Brain
46
Lung cancer metastasis
-Brain -Bone -Liver -Lymph Nodes -Pancreas
47
Prostate Cancer Metastasis
-Bone ( especially spine and legs) -Pelvic nodes
48
Melanoma Metastasis
- GI tract -Lymph nodes -Lung -Brain
49
Primary Brain Cancer Metastasis
Central Nervous System
50
What is benign?
Abnormal cell growth
51
What is malignant?
Indicates cancer ( Prostate, lung colon, breast) - all cells that are not normal
52
Normal Features of a Cell
Specific morphology ( form of organisms) Small nuclear-to-cytoplasmic ratio Differentiated function Regulated cell growth Tight adherence
53
Abnormal Cell features
Malignant: Anaplasia Large nuclear-to-cytoplasmic ratio Specific functions lost Loose adherence Migration (metastasis) Rapid or continuous cell division
54
Phases of Cancer Developement
- Initiation- cancer really not detected in this phase - promotion- where pt find out about cancer -progression -Metastasis
55
What is Primary tumor?
Primary: Identified by the original tissue location
56
What is a secondary tumor?
Secondary (metastatic) Cancer cells move from primary location to another location -Additional tumor(s) , more than 1
57
Where does carcinoma and adenocarcinoma originate from ?
Originates from skin, glands, mucous, membranes lining of respiratory, gastrointestinal, and genitourinary tracts
58
Where do lymphomas originate from?
lymph system
59
Wher do leukemia originate from?
Originates from Hematopoietic System
60
What contributes to cancer development?
-carcinogen -genetic predisposition -Immunityv -Advanced Aged
61
What are some of the Most Common Diagnostic for cancer interpretation ?
Most Common: -Bone Marrow Aspirations -Tumor markers -Genetic testing -Imaging (CT, MRI) -X-ray -Endoscopy
62
What does grade 1 tell us about cancer?
it is least aggressive
63
What does a grade 4 tells us about cancer?
It is most aggressive
64
What does staging tell us about cancer ?
Staging: Classifies clinical aspects of the cancer -Determines exact location of the cancer and its degree of metastasis at diagnosis.
65
What is TMN Classification in cancer?
T=Primary Tumor N=Regional Lymph Nodes M=Distant Metastasis
66
TMN Examples
1 T, 2N, 0M= 1 tumor, 2 nodes,no metastasis
67
Severe warning signs of Cancer
CAUTION C - Changes in bowel or bladder A- A sore that does not heal U- Unusal bleeding T- Thickening or lump in the breast I-Indigestion/ difficulty in swallowing O- Obvious changes in warts N- Nagging cough/ Hoarseness
68
Genetic RF for Cancer
-Chemical carcinogenesis -Physical carcinogenesis -Viral carcinogenesis -Dietary factors -Immune function -Genetic Risk
69
Primary Prevention of Cancer
-Avoid/Modify known or potential carcinogens -Removal of “at-risk” tissue -Vaccination: Gardasil (human papillomavirus vaccine (HPV)
70
Secondary prevention for cancer
-Genetic screening -Breast Cancer - Colon screen -Cervical screen -prostate screeen
71
What are 5 standard treatment options for cancer
Local: Surgery and radiation Systemic: Hormone Therapy, chemical therapy, Targeted Therapy
72
Surgery used for Cancer
-Prophylactic surgery ( if there is a strong genetic of a cancer such as a breast it is removed before diagnosed ) -Diagnostic surgery (biopsy) -Curative surgery -Cancer Control surgery -Palliative surgery
73
What is external radiation?
-Radiation source is external to the patient. -The patient is not radioactive -Not hazardous to others.
74
What is Brachytherapy ?
Brachytherapy (Internal) -Radiation isotopes that are in direct contact with the tumor -High dose of radiation to tumor tissues -Patient emits radiation -Hazardous to others
75
Internal Radiation Nursing Action: Never take care of a patient with Brachytherapy due to ______.
Pregnancy
76
What are the safety rules for Internal Radiation?
-Caution Sign -Exposure Badge -Lead Apron -Visitors -Pregnancy -Disposal - Radioactive Source
77
What does hormone therapy change?
Changes the specific hormone’s normal response - cancer can change the pt facial hair, male characteristics may look like women characteristics
78
How does antineoplastics helps cancer ( Chemotherapy) ?
Antineoplastic: -Cures or increases survival time -Effects are systemic -Combinations of drugs - Given IV or PO
79
What are types of Drug Therapy for Cancer?
Induction: Intense and consists of combination chemotherapy started at the time of diagnosis Consolidation: Another course of either the same drugs used for induction at a different dosage Maintenance: Prescribed for months to years after successful induction and consolidation
80
True or false? Oral chemo is toxic?
True
81
Who can give chemo drugs? Where is this medication given in the hospital?
Trained and Certified nurse - Speciality Units _myelosupression units
82
What are implanted ports in chemotherapy?
-Prolonged IV Therapy -Surgically inserted -Implanted ports are accessed by using a non-coring needle (a common brand name is Huber)
83
Chemo is never given by which route___?
IV - Can be very hazardous if so
84
What are side effects of Chemotherapy?
Neutropenia: Risk for Infection r/t decreased white blood cells (Infection) Thrombocytopenia: Risk for injury related to decreased platelets (Perfusion) Anemia: Fatigue related to decreased red blood cells (Perfusion)
85
What is the function of WBC?
The major function of WBC’s are to fight infection and react against foreign bodies or tissues.
86
What is the Adult range for WBC
Adults: 5,000-10,000/mm3
87
What are the different type of WBC with Diff?
"Never Let Monkey Eat Bannans " Differential Counts Granulocytes Neutrophils Eosinophils Basophils Lymphocytes Monocytes
88
What are RBC?
RBC’s are molecules that permit the transport and exchange of oxygen to the tissues and remove carbon dioxide from the tissue
89
Normal Range for RBC?
Adults: Male: 4.7-6.1 Female: 4.2-5.4
90
What are Types of RBC's ?
-Hemoglobin (Hgb) -Hematocrit (HCT) -Red blood cell indices -Mean corpuscular volume (MCV) -Mean corpuscular hemoglobin (MCH) -Mean corpuscular hemoglobin concentration (MCHC)
91
Why are platelets needed?
Platelet are needed for adequate blood clotting
92
What is the normal range for PLT's ?
Adults: 150,000-400,000/mm3
93
Name some reasons for PLT defects...
Defect in clotting related to: Clotting processes (vascular) Platelet production Clotting factor levels Drug induced Suppressed Bone Marrow
94
When is Blood products needed?
- When there is Excessive blood loss: PRBCs,Platelets,Albumin Anemia: PRBCs -Coagulation Problems -Fresh Frozen Plasma -Platelets -Clotting Factors (Factor VIII)
95
What are types of Carcinoma and Adenocarcinoma Cancers?
Breast Cancer -Colon cancer -Lung cancer -Prostate cancer
96
What are types of lymphoma cancers?
- Hodgkin's lymphoma -Non-Hodgkin's Lymphoma
97
What are types of Leukemia cancer?
Chronic lymphocyctic
98
Where do blood Donations come from ?
-Donor Blood (Lifeblood, Red Cross) Autologous: Own blood collected in anticipation of needing it Designed for and can only be used for the client Eliminates compatibility problems; reduces risk for transmission of bloodborne disease -Intraoperative Blood Salvage: Blood recycled from blood loss in surgery Cell-saver machine used Blood re-transfused intra/post operatively
99
What are nursing responsibilities before giving blood ( Pre- Transfusion) ?
Verify Consent Verify Orders Assess labs History of reactions NPSG (Two RN Verification) Verify donor’s/recipient’s blood for compatibility with ABO and Rh compatibility, and expiration Verify blood product label, and attached requisition slip with patient’s identification band
100
What are nursing responsibilities before giving blood ( Pre- Transfusion) ? ( Part 2)
Provide patient education Appropriate IV access Obtain baseline VS Prime setup with NS only Administer pre-transfusion medications (Benadryl, Tylenol)
101
What are the nursing responsibilities During Blood Transfusion?
Document Vitals per Protocol Begin transfusion slowly, and stay with patient first 15 to 30 minutes Administer blood product per protocol Monitor for complications Circulatory Overload Blood acute transfusion reaction Document in electronic medical record (EMR) Blood products should be infused within four hours
102
What are Interrelated concepts that affect anemia?
-Cellular regulation -Perfusion - Gas Exchange -Nutrition
103
What do you check for with Anemia ( Noticing ) ?
Assess for: **Integumentary Pallor Coolness Brittle, spoon-shaped , or thin nail beds Smooth, bright red tongue (B12 Deficiency) **Cardiovascular Manifestations Tachycardia, murmurs **Respiratory Manifestations Dyspnea on exertion Decreased oxygen saturation level **Neurologic Manifestations Increased fatigue
104
What labs are used for interpreting Anemia?
**Complete Blood Count (CBC) Red Blood Cells RBC Indices Mean corpuscular volume (MCV) Mean corpuscular Hgb concentration (MCHC) Hemoglobin Hematocrit **Iron Studies Serum ferritin Serum Iron
105
What are some treatment options for anemia?
Iron Ferrous sulfate Epoetin alfa (erythropoietin) Vitamin B12 Folic Acid
106
What are ways Cancer metasisize?
-Tumors first extend into surrounding tissues by secreting enzymes that open up areas of surrounding tissue. - Bloodborne metastasis (tumor cell release into the blood) is a common cause of cancer spread. Enzymes secreted by tumor cells also make large pores in the patient’s blood vessels, allowing tumor cells to enter the blood and circulate. -Cancers metastasize is by lymphatic spread. Lymphatic spread is related to the number, structure, and location of lymph nodes and vessels.
107
What does clinical staging assesses?
Clinical staging assesses the patient’s symptoms and evaluates tumor size and possible spread.
108
What does surgical staging assess?
Surgical staging assesses the tumor size, number, sites, and spread by inspection at surgery
109
What does pathological staging assess?
Pathologic staging is the most definitive type, determining the tumor size, number, sites, and spread by pathologic examination of tissues obtained at surgery.
110
what system is used to describe the anatomic extent of cancer?
-The TNM system is used. -The TNM staging systems have specific prognostic value for each solid tumor type. -TNM staging is not useful for leukemia or lymphomas
111
What staging system is used colon and rectal cancer?
Dukes Staging System
112
What staging system is used for skin cancer?
Clark Levels
113
External factors that causes cancer?
Environmental carcinogens are chemical, physical, or viral agents that cause cancer
114
What is chemical carcinogenesis?
Chemical carcinogenesis can occur from exposures to many known chemicals, drugs, and other products used in everyday life.
115
Examples of chemical carcinogenesis?
-tobacco and alcohol -these two substances can act as co￾carcinogens, meaning that when they are taken together, they enhance each other’s carcinogenic activity
116
What is the single most preventable source of carcinogenesis?
Tobacco
117
Physical carcinogenesis from physical agents or events causes cancer by _____ ?
DNA damage
118
What are two physical agents that are known to cause cancer?
Radiation and chronic irritation
119
What is viral carcinogenesis?
Viral carcinogenesis occurs when viruses infect body cells and break DNA strands.
120
What are dietary factors related to cancer?
-Dietary factors related to cancer are poorly understood but are suspected to increase cancer risk. Suspected dietary factors include low fiber intake and a high intake of red meat or animal fat. -Preservatives, preparation methods, and additives (dyes, flavorings, sweeteners) may have cancer-promoting effects.
121
Which are two important cell-mediatated immunity?
Natural Killer cells and Helper T-Cells
122
High Cancer risk due to immunity
-Organ tarnsplant recipient taking immunosuppressants -HIV lll disease -Adults older than 60
123
_____ is the single most important RF for cancer.
Advanced Age -
124
What is Impaired Immunity
Impaired immunity and decreased production of healthy bone marrow can occur when cancer starts in or invades the bone marrow, where blood cells are formed.
125
Altered GI FUnction
-Tumors of the GI tract or advanced cancers increase the metabolic rate and the need for nutrients; however, many patients develop disease-related and treatment-related appetite loss, and alterations in taste that have a negative impact on nutrition, leading to weight loss -Abdominal tumors may obstruct or compress structures anywhere in the GI tract, reducing the ability to absorb nutrients and eliminate wastes.
126
Altered Peripheral Nerve Function
Patients with chemotherapy-induced peripheral neuropathy (CIPN) report loss of sensation, especially in the lower extremities. Symptoms include numbness, tingling, neuropathic pain, and changes in gait and balance

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