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Health Assessment > Oncology > Flashcards

Flashcards in Oncology Deck (68):
1

Carcinoma 

begins in skin or tissue that line or cover internal organs.

2

Sarcoma

– begins in bone, cartilage, fat, muscle, blood vessels, connective or supportive tissue.

3

Leukemia

– starts in blood-forming tissue such as bone marrow (large number of abnormal cells produced and enter the bloodstream)

4

Lymphoma and myeloma

– begin in the cells of the immune system

5

Ca of Central nervous system 

– begin in tissues of brain and spinal cord 

6

Which cancers could be prevented by vaccination, behavioral changes, and antibiotics? 

Cancers related to Hepatitis B, HPV, HIV, H. pylori

7

Screening prostate ca

ACS: PSA at age 50, 45 if AA, consider risks/benefits (false +s, too much intervention)

8

screening lung cancer

Lung cancer – low-dose CT scan (high risk individuals) more and more evidence, now paid for by insurance. 

9

4 oncologic emergencies

spinal cord compression, SVC syndrome, hypercalcemia, tumor lysis syndrome

10

Spinal cord compression

– due to metastatic disease, back pain early, neurologic deficit of legs late sign. MRI needed. Treated with corticosteroids, RT, surgery, treat underlying malignancy.

11

Superior vena cava syndrome: cause

  • caused by mediastinal tumors, venous catheters, clots (basically impaired blood flow).

12

SVC syndrome: symptoms

Symptoms neck ,facial, periocular swelling, dyspnea, cough, head pressure, hoarseness, nasal congestion, syncope. 


facial swelling may subside after up all day

13

SVC syndrome: Dx 

CT scan needed, CXR may be beneficial. US for clots (gold standard).

14

SVC syndrome: Tx

Chemo, pericardial window or stripping. 
HOB elevated. Lasix, steroids, chemo or RT, warfarin for clot.

15

Hypercalcemia: cause

– bone mets, parathyroid hormone related protein production, calcitroil excretion.

16

hypercalcemia Sx

Symptoms confusion, lethargy, sleepiness.

17

hypercalcemia: dx & Tx

Lab tests for calcium and electrolytes.

IV hydration (flush system) and bisphosphonates treatment.

18

Tumor lysis syndrome

– rapid tumor cell destruction from chemo, multiple electrolyte abnormalities.

19

Tumor Lysis Syndrome: symptoms

Nausea, weakness, myalgia, dark urine, arrhythmias.

20

Tumor Lysis Syndrome: Dx & Tx

  • Test electrolytes and uric acid.
  • Prevent by hydration, allopurinal, zyloprim.
  • Treat imbalances, acidosis.

21

alopecia: cause

caused by chemo 7 – 10 days after treatment (hair thinning) but really kicks in 3-4 weeks post. 

Some people don’t lose – after 1st month usually indicates how much

22

alopecia mgmt

  • Cut hair short, shave head. Wigs/scarves.
  • Can write prescription for cranial prosthetic.
  • Get wig before so can match to current hair.

 

23

Bone marrow suppression leads to...

neutropenia, anemia, thrombocytopenia

24

neutropenia: when and Tx

nadir at 7-10 days after treatment.

Give GCSF and/or dose reduce

25

Anemia: when & Tx

  • several weeks after treatment start.
  • R/o other causes (bleeding, hemolysis, nutritional deficiency).
  • Transfuse if necessary. Give Epogen, Aranesp per guidelines.
    • Be aware of religious beliefs.
    • Transfusion more common for solid tumor pts

26

Nausea/vomiting: when and Tx

  • Differs with emetogenic potential of the therapy.
  • Cisplatin tends to be most emetogenic but we have good treatments – let ppl know they shouldn’t be suffering overly

27

Diarrhea: why & Tx

  • may be side effect of treatment or disease.
  • Obtain stool bacterial culture (C. diff),
    • if positive Flagyl (metronidazole),
    • if negative antimotility agent Imodium or Lomotil.
  • Manage fluids, skin breakdown

28

Nutrition effects

  • loss of appetite, inability to eat secondary to side effects from chemo i.e. metallic taste in mouth, loss of taste.

29

Body image effects

Body Image Disturbance – from surgery, weight gain from steroid treatment.

30

at what ANC can bacteria naturally present in the mouth or digestive tract can cause infection

ANC < 500

31

febrile neutropenia

  • oncologic emergency
  • fever of 101.0+ (may not be able to mount fever)
  • Low white count ~ ANC < 1500 (cut-off varies)
  • Most often no definitive infxn source

32

febrile neutropenia: Tx

May or may not be admitted to hospital – broad spectrum antibiotics are given. 

33

Febrile Neutropenia: preventative Tx

colony stimulating factors (Neulasta) given 24 hours after certain chemotherapy treatment.

34

Risk factors that increase chance of admission for febrile neutropenia

  • serum Cr > 2 mg per dL,
  • LFT > 3x upper limit normal,
  • uncontrolled/progressive cancer,
  • pneumonia,
  • significant comorbid illness,
  • prolonged severe neutropenia (ANC <100 or <500 x 7 days)  - likely admission.

35

Factors that increase chance of outpatient Tx of febrile neutropenia

  • no comorbid  illness,
  • short time neutropenia,
  • creatinine
  • LFTs < 3 times ULN,
  • good functional status 
  • even low risk probably admitted at least 24h

36

Common effects of radiation therapy

mucositis, thrush, xerostomia, skin burn, trauma to areas in radiation field

37

Mucositis 

– painful inflammation and ulceration of the mucous membranes lining digestive tract.

 

38

Mucositis Tx

  • Saline/bicarb lavage, Magic Mouthwash/Dukes Solution (viscous lidocaine, benadryl, Mylanta), Carafate slurry.
  • Can disrupt eating.. Can even give opioid if really having trouble swallowing

39

Thrush: definition & Tx

  • Thrush – patchy white coating in mouth
  • Nystatin s/s, Diflucan

40

Xerostomia: definition & Tx

  • – dry mouth with lack of saliva.    
  • Salagan or Evoxac to increase saliva production. Good oral care. 

41

Skin burn: characteristics & Tx

  • can be dry (sunburn) or wet desquamation (blistered oozy sunburn)
  • Moisturize with Aquaphor. NO non water based products – will disrupt RT field. Monitor for cellulitis and treat with antibiotics.

42

Effect on areas in the radiation field, e.g. chest & lower spine/abdomen

  • Chest radiation – may have difficulty eating secondary to mucositis. (esophagitis). Scar tissue may lead to stricture
  • Spine/Lower  abdominal radiation – may develop diarrhea.

43

Cancer Related Fatigue (CRF)

  • Subjective feeling of tiredness or exhaustion prompted by cancer or cancer treatment disproportionate to level of recent exertion.
  • Possible causes – pain, emotional distress, sleep disturbance, anemia, nutrition, activity level, other comorbidities. 

44

CRF Assessment

  • Rate fatigue on scale from 0-10 over past 7 days.  (1-3 mild, 4-6 moderate, 7-10 severe).
  • Multiple tools available:
    • Symptoms Distress Scale, Rotterdam Symptoms Checklist, MD Anderson Symptoms Inventory. Focus on detecting presence or absence of CRF.
  • Challenge – separating CRF from other related conditions (depression, anemia, effects of chemo/RT).

45

CRF Tx - exercise & education

  • Exercise – strong evidence supports a 20 – 30 minute sessions 3 – 5 times weekly. Start low intensity and duration.
  • Education – strategies for energy conservation, activity management, prioritizing.
  • Massage, healing touch, relaxation

46

CRF Tx, Cog/behavioral interventions

  • Cognitive-Behavioral Interventions – manage anxiety and depression, sleep disturbance, stress reduction.

 

47

CRF Tx, sleep disturbanes

Sleep disturbance/insomnia – sleep hygiene, consider TCA, antihistamines, benzodiazepines, Ambien/Luenesta
 

48

CRF Tx, Depression

Depression – counseling, SSRI’s
 

49

CRF Tx, anemia


Anemia – Iron studies, Transfusion, Procrit, Aranesp
 

50

CRF Tx, pain

 

  • Mild - NSAID/Tylenol/short acting opioid,
  • Moderate to severe – combination of long and short acting opioid (use opiods asap, long good)

51

Medication/pharmaceutical interventions for cognitive impairment

(effectiveness not established)

  • Ritalin (methylphenidate)
  • Aricept (donepezil) (at this point say doesn’t work, gives diarrhea)
  • Provigil (modafinil)

52

CAM Tx for cognitive impairment

Exercise – potential benefit
Vitamin E  - unsure

53

Hot flashes as a side effect of Ca treatment

  • Subjective sensation of heat that is associated with objective signs of cutaneous vasodilation and subsequent drop in core temperature.
  • Associated with facial flushing, perspiration, chills, heart palpitations, night sweats, anxiety.
  • Characterized as mild, moderate, severe.

54

Which Txs most likely to cause hot flashes?

Most common side effect from agents used to suppress ovarian function/cause estrogen withdrawal (tamoxifen, aromatase inhibitors, androgen deprivation, hormonal therapies, surgical castration).

55

Ca Tx and hot flashes: incidence

  • Occurs in 78% breast Ca patients
  • Chemotherapy can cause premature ovarian failure with temporary or permanent amenorrhea.
  • Occur in 35 – 80% of men treated with androgen deprivation therapy (prostate Ca).

56

Tx for hot flashes

Effexor (SSRI)

  • SSRI’s (selective serotonin reuptake inhibitors) may be effective in elevating hot flashes however drug interactions may exist with tamoxifen (CYP 2D6 interaction -> decreased efficacy of tamoxifen and increased risk of relapse).

57

CAM for hot flashes

  • Acupuncture
  • Black Cohosh – herb. Evidence shows may or may not help.
  • Hypnosis
  • Relaxation therapy
  • Vitamin E (weak study results)
  • Yoga

58

Skin reactions to chemo or biotherapy

  • mild, moderate, severe. Rarely life threatening but affects quality of life.
  • Two Major Types Rash:
    • Acneform 
    • Maculopapular 

59

Acneform 

– diffuse erythema face body progressing to follicular  papules/pustules resembling acne
(clinical manifestation of rash d/t chemo / biotherapy)

A image thumb
60

Maculopapular 

– flat macules and elevated papules associated with pruritus.

(clinical manifestation of rash d/t chemo / biotherapy)

61

Carboplatin and rashes

– allergic reactions (rash, urticaria, erythema, pruritus)

(clinical manifestation of rash d/t chemo / biotherapy)

62

Interleukin-2 and rashes

– erythematous rash, pruritus, dry/peeling skin. (Sarna lotion)

(clinical manifestation of rash d/t chemo / biotherapy)

63

Palmar-Plantar Erythrodysesthesia (Hand foot syndrome)

 

Q image thumb

  • Mild redness at first with discomfort on palms and soles
  •  tingling sensation at fingertips progressing to more intense burning pain/tenderness, swelling, desquamation, crusting, ulceration, epidermal necrosis.
  • (Bag Balm, cooling pads)

 

(clinical manifestation of rash d/t chemo / biotherapy)

64

Xerosis

 

– abnormally dry, flaky, dull skin (moisturizer, emollients)

(clinical manifestation of rash d/t chemo / biotherapy)

A image thumb
65

Paronychia

– painful inflammation of tissue around fingernails/toenails more commonly great toes and thumbs. (Antibiotics)

(clinical manifestation of rash d/t chemo / biotherapy)

A image thumb
66

Photosensitivity

– erythematous response to ultraviolet or visible light.

(Retinoids, topical steroids, topical antiseptics)

(clinical manifestation of rash d/t chemo / biotherapy)

67

Pruritis

  • – intense itching that may lead to scratching.
  • Consider thick non-alcohol moisturizer/emollients; Benadryl, Atarax (antihistamine);  topical steroid cream or Elidel (immune modulator).

 

(clinical manifestation of rash d/t chemo / biotherapy)

68

Prevention of skin reactions d/t chemo / biotherapy

  • Minimize exposure to sunlight/UV light
  • Sunscreen with zinc oxide/titanium dioxide
  • Protect skin: Avoid temperature extremes to skin, avoid long hot showers or baths, washing dishes or cold compresses.
  • Avoid constrictive clothes, shoes, jewelry.
  • Keep skin moisturized with alcohol free products.