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Flashcards in Oncology Deck (54)
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1

Define neoplasm

persistent abnormal dysplastic cell growth

classified by:

  1. cell type
  2. growth pattern
  3. anatomic location
  4. degree of dysplasia
  5. tissue of origin
  6. ability to spread/remain in original location

 

2

List and describe different types of tumors (based on descriptors)

  1. Benign
    • differentiated cells that reproduce at a higher rate than normal
    • often encapsulated, allowing expansion
    • do not spread to other tissues
  2. Malignant
    • undifferentiated cells
    • uncapsulated
    • grow uncontrollably
    • invades normal tissue and causes destruction to surrounding tissues/organs
    • may spread/metastasize to distant sites in body
  3. Primary → orignal tumor in original location
  4. Secondary → metastases that have moved from primary site

 

3

define dysplasia

variability of cell size and shape w/an increased rate of cell division (mitosis)

may be a precancerous change or result from chronic infection

4

define metaplasia

replacement of one mature cell type by a different mature cell type, resulting from certain stimuli such as cigarette smoking

 

5

define hyperplasia

increased # of cells resulting in enlarged tissue mass

may be mechanism to compensate for increased demands, or be pathological when there is a hormonal imbalance

6

define differentiation

extent to which a cell resembles mature morphology and function

(a cell that is well differentiated is physiological and functions as intended)

7

List S/S of cancer

  1. Unusual bleeding or D/C
  2. Unexplained weight loss of >10 lbs
  3. Fever
  4. Fatigue
  5. Pain
  6. Persistent cough or hoarseness w/o a known cause
  7. Skin changes 
    • hyperpigmentation, pruritis, erythema, excessive hair growth

 

8

how is cancer dx?

  1. medical imaging
  2. blood tests for cancer markers
  3. several types of biopsy: definitive test to ID cancer type

 

9

What is cancer staging?

describes location and size of primary site of tumor, the extent of lymph node involvement and the presence or absence of metastasis

TNM system

10

What is the TNM system?

  • T → extent (size/number) of primary tumor
  • N → lymph nodes involvment
  • M → presence/absence of metastasis

 

11

What is cancer grading?

reports the degree of dysplasia, or differentiation from the original cell type

lower grade tumors = highly differentiated cells that more closely resemble original cells (less aggressive tumors)

higher grade tumors = less differentiated cells that are less likely original cells (more aggressive tumors)

12

list and describe the grades for cancer

  • GX → undetermined grade, cannot be assessed
  • G1 → low grade, well-differentiated tumor
  • G2 → Intermediate grade, moderately differentiated tumor
  • G3 → High grade, poorly differentiated tumor
  • G4 → high grade, undifferentiated tumor

 

 

13

Describe the physical characteristics of cancer cells

  1. large number of dividing cells
  2. large, variable shaped nuclei
  3. small cytoplasmic volume relative to nuclei
  4. variation in cell size  and shape
  5. loss of normal specialized cell features
  6. disorganized arrangement of cells
  7. poorly defined tumor boundary

 

14

List and describe cancer treatment goal categories

  1. Cure → chemo, biotherapy, radiation, and/or surgery
    • adjuvent
    • neoadjuvent
  2. Control → enables extension of life when cure not possible
    • attempts to reduce new cancer growth
  3. Palliation → decreased tumor burden, improve QOL, relieve pain
    • cure not possible
    • focus on making pt as comfortable as possible

 

15

List cancer treatment options

  1. Surgical removal of tumor
  2. Radiation therapy
  3. Chemotherapy
  4. Biotherapy
    • immunotherapy
    • hormonal therapy
    • bone marrow transplantation
    • monoclonal antibodies

 

16

List the indications for surgical management of cancer

  1. removal of precancerous lesions/organs at high risk for cancer
  2. establishing a dx by biopsy
  3. assisting in staging by sampling lymph nodes
  4. definitive trx by removing the primary tumor
  5. reconstruction of a limb or organ with or without skin grafting
  6. palliative care such as decompression or bypass procedures

 

 

17

what is the primary goal of radiation?

eradicate tumor cells, either benign or malignant, while minimizing damage to healthy tissue

18

What are the indications for radiation?

  1. definitive trx w/intent to cure
  2. Neoadjuvent trx to improve chances of successful surgical resection
  3. Adjuvent trx to improve local control of cancer growth after chemo or surgery
  4. Prophylactic trx to prevent growth of cancer in asymptomatic, yet high-risk areas for metastasis
  5. Control to limit growth of existing cancer cells
  6. Palliation to relieve pain, prevent fracture, and enhance mobility when cure not possible

 

 

19

List some considerations for radiation therapy

  1. General side effects
    • skin reactions
    • fatigue
    • N/V/D
    • weight loss
    • myelosuppresion (bone marrow suppression)
  2. Site-specific toxicities may occur
  3. Antiemetics often prescribed
  4. use caution w/skin that has become fragile from radiation 

 

20

what is the purpose of chemotherapy? 

inhibit various signaling pathways that control cancer cell proliferation, invasion, metastasis, angiogensis, and cell death

can be primary trx, neoadjuvent, adjuvent therapy

mode of delivery → IV/central line, injection to tumor site

21

What are the typical side effects to chemo?

  1. N/V
  2. cancer pain
  3. loss of hair and other fast growing cells
    • platelets
    • RBCs
    • WBCs

 

22

what is the difference between CCS and CCN agents?

  • CCS → cell-cycle specific agents = work best in a portion of the cell cycle, most likely prophase
  • CCN → cell-cycle-nonspecific agents = work through the entire cell cycle 

 

23

Chemotherapeutic drugs are often given in cycles, what is a typical timeframe?

6-8 cycles

given every 3 weeks (21 days)

24

List some chemotherapy PT considerations

  1. N/V may limit rehab participation
  2. Nutritional status may be impacted due to decreased ability to consume/absorb nutrients
  3. Activities may need modification due to fatigue
  4. Monitor VS
  5. Chemo targets ALL cells that are actively dividing
  6. Common AE
  7. Nadir 
  8. Minitor Lab values
  9. High risk for infection

 

25

what is Nadir?

10-28 days after chemo when WBCs reach lowest values

generally withold therapy 

26

What lab values are important to know for a pt on chemotherapy?

  1. Absoulte Neutrophil count (ANC)
  2. Platelets
    • <10k = hold PT
    • 10k-20k = no resisted exercises
    • >20k = exercise with or w/o resistance
  3. Hemoglobin
    • 8-10 = light aerobic and weight 
    • <8 = light ROM/ISOM, no weights, aerobic ex, progressive ex
  4. Hematocrit
    • 25-35% = light aerobic and weight
    • <25% = light ROM/ISOM, no weights, aerobic ex, progressive ex

27

list specific chemo considerations 

  1. Neutropenia
  2. Lymphedema
  3. Memory problems
  4. Peripheral Neuropathy
  5. Pain

 

28

T/F: research does not support exercising PTs on chemo

FALSE

exercise can lead to increased neutrophil levels, elevated VO2max, improved mood, decreased N/V

29

when should you withhold/stop exercise with a chemo pt?

  1. at rest:
    • HR >100 bpm
    • dyspnea
    • low diastolic BP
  2. during execise:
    • abnormal BP response
    • abnormal fatigue
    • dizziness
    • Nausea
    • Pallor
    • excessive sweating

 

30

what is Biotherapy?

aka immunotherapy, uses the pts native host defense system as mechanism to trx cancer

highly targeted while minimizing toxicity/AE

includes: cytokines, monoclonal antibodies, and vaccines