Oncologic Nursing/Surgery

Question 1

Describe the normal cell life cycle.

Answer 1

Interphase
Mitosis - prophase, metaphase, anaphase, telophase
Cytokinesis

Question 2

Define cancer.

Answer 2

Phenotypic end result of a whole series of changes that may have taken a long time to develop

Question 3

How does cancer arise?

Answer 3

Accumulation of genetic mutations - eliminates normal cell constraints
Increased longevity of life allows more of these mutations to accumulate

Question 4

What are some environmental causes of cancer?

Answer 4

Chemical carcinogens e.g. smoke, pesticides
Physical agents e.g. sunlight, radiation
Hormones e.g. neutering
Cancer-causing viruses e.g. papilloma virus, retroviruses (FeLV)

Question 5

How can mutations in DNA cause deviation in normal cell cycle?

Answer 5

Sustained proliferative signalling
Evade growth suppressors
Resist cell death
Enable replicative immortality
Induce angiogenesis
Activate invasion and metastasis

Question 6

Define neoplasia.

Answer 6

Formation of new abnormal growth that is not responsive to normal physiologic control mechanisms
May be benign or malignant

Question 7

What are the 7 main goal types of chemotherapy?

Answer 7

Primary induction
Primary neoadjuvant
Adjuvant
Consolidation
Maintenance
Rescue or salvage
Palliative

Question 8

Describe multimodal chemotherapy plans.

Answer 8

Maximal cell kill within range of tolerable host toxicity
Broader range of interaction between drugs and tumour cells
Slows development of tumour drug resistance
Preferably drugs with non-overlapping toxicities
Use drugs at optimal doses and schedules, at consistent intervals

Question 9

Name some specific chemotherapy agents.

Answer 9

Alkylating agents
Antitumour antibiotics
Antimetabolites
Antimicrotubule agents
Corticosteroids
Platinum
L-Asparginase
Targeted agents

Question 10

What is the CHOP protocol?

Answer 10

Cyclophosphamide
Hydroxydaunorubicin (Doxorubicin)
Oncovin (Vincristine)
Prednisolone
Discontinuous protocol

Question 11

What are some possible side effects of the CHOP protocol?

Answer 11

All dividing cells affected by cytotoxic drugs
Bone marrow toxicity
GI toxicity

Question 12

How do we administer chemotherapy?

Answer 12

Quiet area, IV catheter placement ‘clean stick’, double check dose and draw up drug
Bolus injection/infusion - check IV placement, connect syringe, administer

Question 13

Describe haemopoietic tumours.

Answer 13

Leukaemia - in blood-forming tissues, acute and chronic
Lymphoma - in cells that make up part of immune system, B-cell and T-cell
Treated with chemotherapy

Question 14

Describe osteosarcomas.

Answer 14

Typically distal radius/top of femur
Metastatic - usually has occurred by time of presentation
Surgery to remove affected limb
Chemotherapy, bisphosphonates, radiation therapy useful

Question 15

Describe haemangiosarcomas.

Answer 15

Spleen, heart (blood vessels)
Treated with combination of surgery and chemotherapy

Question 16

Describe soft tissue sarcomas.

Answer 16

Tumour of connective tissue

Question 17

Describe carcinomas.

Answer 17

Tissue that covers any body surface, line a body cavity or makes up an organ
‘Adeno’ = arises from a gland

Question 18

Describe squamous cell carcinomas.

Answer 18

Common in cats - mouth, nose, ears
Surgery to remove
Locally invasive
Radiation therapy/chemotherapy useful

Question 19

Describe mast cell tumours.

Answer 19

Most common malignant skin tumour in dogs
Manifests in many ways anywhere on the body
Range from almost benign to highly malignant with high rate of spread
In skin layers = hard and firm, under skin layers = mobile and soft
Cats can have splenic/GI presentation
Often need surgical removal - appropriate margins can be curative
Radiation therapy/chemotherapy useful

Question 20

Describe melanomas.

Answer 20

Sometimes pigmented black
Mouth, toes, skin
Surgery to improve quality of life - mass painful and can bleed
Immunotherapy to slow spread - melanoma vaccine

Question 21

Describe benign tumours.

Answer 21

Slow-growing, tend not to metastasise
Lipoma, haemangioma, adenoma

Question 22

Describe paraneoplastic syndrome and lymphoma.

Answer 22

Cancer-associated alterations not directly related to tumour or metastases
Lymphoma - e.g. hypercalcaemia, anaemia, neutrophilic leucocytosis, thrombocytopaenia

Question 23

What can PNS signify?

Answer 23

Occurrence may signify malignancy - can result in greater morbidity than tumour itself causes
Successful treatment of tumour leads to disappearance of many PNSs
Recurrence of PNS may signify return of tumour

Question 24

Describe tumour sensitivity to chemotherapy.

Answer 24

High sensitivity e.g. lymphoma, some leukaemias
Moderate sensitivity e.g. high grade sarcomas, mast cell tumours
Low sensitivity e.g. slow growing sarcomas, carcinomas, melanomas

Question 25

What factors can affect treatment of a tumour?

Answer 25

Benign/malignant
Staging and grading
Chemotherapy/surgery best option
Resectable/non-resectable
Owner expectation e.g. disfiguring surgery, cost
Patient temperament

Question 26

What treatments can be used for cancers?

Answer 26

Chemotherapy
Radiation therapy
Cryotherapy
Hyperthermic therapy
Photodynamic therapy
Immunotherapy
Surgery

Question 27

What surgical treatment options are available for tumours?

Answer 27

Complete excision, wide, radical
Excisional biopsy
Incisional biopsy
Trucut biopsy
FNA

Question 28

What are the principles of staging a tumour?

Answer 28

TNM system
T - primary tumour size
N - level of lymph node involvement
M - presence of metastasis

Question 29

How can we stage a tumour?

Answer 29

Physical exam and history-taking
Urinalysis
Bloods - haem/biochem
Thoracic radiographs
Abdo u/s - aspirate liver, spleen, lymph nodes
Imaging - echocardiogram, CT, MRI

Question 30

How are tumours graded?

Answer 30

Histologic findings
Appearance under microscope
Mitotic index
How well organised the cells are
Evidence of cancer cells invading blood vessels
Low, intermediate, high - important prognostic indicator

Question 31

What specific nursing considerations should we have for oncologic patients?

Answer 31

May be hospitalised for long periods of time
Can be anorexic
May have impaired immune function
Chemotherapy drugs - barrier nursing, excreted in urine/bodily fluids for 3-5 days
Chemotherapy should be given with care using specific equipment