Oncology Part 1 Flashcards by Julie Hodgman

Sarcoma vs Carcinoma vs hematologic malignancy

Sarcoma originate in the connective tissue (bones, muscle, fat, tendon)

Carcinomas originate in the epithelial tissue (organ linings including skin)

HM originate in the blood or lymphatic cells

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What’s the most common type of cancer?

Carcinoma - includes all type of skin cancer

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What are the ways metastasis can occur?

Direct invasion, through blood, through lymphatic system

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Worst co-carcingenic pair

Alcohol and tobacco

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Low fiber is bad why

Fiber causes less motility and causes us to retain the carcinogens for longer (processed foods, preservatives, red meat and animal fat)

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In what age is cancer most prevalent? What race?

> 60 d/t a more poor immune system, the longer you’ve been exposed to toxins such as tobacco, asbestos, diesel, exhaust)
(immunosuppressed also at high risk)

African Americans, then caucasian

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Breast cancer familial gene

BRCA 1

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Does getting chemo for another cancer increase the risk for another type of cancer?

YES

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When is the best time to do a breast exam? What about after menopause?

Day 7-12 after the period is just about over
NEVER do prior because there is swelling then

If post menopausal - Pick a day of every month

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How often should women get a breast exam?

Yearly if >40 years old

Every 3 years if age 20-39

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At what age should women get a yearly mammogram

Starting at age 40

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What do you tell a women prior to getting a mammogram? Why?

No lotion, powder, deodorant because it can be picked up as a Ca deposit, which usually indicates cancer

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How often should women get a pap smear?

Every 3 years starting at age 21 if there are no problems

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When should people get a colonoscopy?

Starting at age 50, and every 10 years if there haven’t been any problems

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When should fecal occult blood be tested?

Start at age 50 and be done yearly, unless there have been problems or a family history of problems

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How often should men have testicular exams? Are testicular tumors dangerous? Why?

Every year

Yes, because they grow very fast

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How often should testicular self exams be done? What is the major age group for testicular CA?

Monthly

Age 15-36 - need to teach TSE early

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When should men get a prostate exam?

> 50, yearly

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CAUTION acronym for cancer

Change in bowel/bladder habits
A sore that doesn't heal
Unusual bleeding/discharge
Thickening/lump
Indigestion or difficulty swallowing
Obvious change in wart/mole
Nagging cough or hoarseness

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Differences between
Anemia
Leukopenia
Thrombocytopenia

Anemia: Low RBC
Leukopenia: Low WBC
Thrombocytopenia: Low Platelets

All because cancer invades the bone marrow

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Differences in risks
Anemia
Leukopenia
Thrombocytopenia

Anemia: Risk for hypoxia
Leukopenia: Risk for infection
Thrombocytopenia: Risk for bleeding (shaving, IM)

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What does cachexia mean?

Extreme wasting and malnutrition, usually indicates close to death

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What is the most common complaint of impending cancer?

FATIGUE especially if the cancer has spread and is d/t either anemia or growth of cancer

Exhaustion that doesn’t go away with sleep

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Fever is a common sign in what kind of cancer?

Leukemia and lymphoma

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Common sites for pain with CA

HA - brain cancer | Back - colon, ovaries, rectum

3 most common blood tests used to diagnose cancer

1. Abnormal CBC & differential (# of different types of WBC - neutrophils are most concerning) 2. Elevated liver enzymes - AST and ALT 3. Tumor markers (biomarkers) - increased, substance or process that is indicative on cancer

Positive diagnostic studies

CXR, CT, MRI PET scan Imaging studies (such as bronchoscopy, endoscopy) Biopsies

What do we need to thinking about with a patient having a bronchoscopy in terms of eating? What are we going to watch for afterwards?

NPO during and until gag reflex returns Watch for RR depression, hoarseness, dysphagia, or SQ emphysema

What is SC emphysema

Crackles when touching skin indicating air trapped and airway perforation and air leaking into the tissue

Is RR depression normal after bronchoscopy?

NO IT IS ABNORMAL Slow RR just means decreased, but DEPRESSION indicates less than 12/min

The respiratory rate should always be ______ for NCLEX?

PERFECT! Or else something is wrong!!

When is the best time to get a sputum sample? Why? Is this a sterile sample?

First thing in the morning because they have been accumulating It is a sterile sample and we are using a sterile technique (aka don't let their mouth tough the collecting device)

What should a patient do first before obtaining a sputum sample? Why?

Rinse mouth out with water This decreases the bacteria count in the mouth because we want the sputum bacteria, not the mouth

Should they just go ahead and to a bronchoscopy to get the sputum?

NO - LEAST INVASIVE FIRST... and it's more expensive that way

Can you get sputum from a trach?

Yes

What does a total laryngectomy remove?

Vocal cords, epiglottis, and thyroid cartilage - permanent stomal breathing forever There are 2 tubes for fluid and air

What happens if a trach falls out?

First of all, never let go of the trach.. BUT if it does and there isn't a sterile one there, put the dirty one back in because infection is better than death

Position of a post-op total laryngectomy

35-45 degree HOB elevated - Mid fowlers NEVER high-fowlers

What kind of feedings will total laryngectomy patients have? Why?

NG to protect the suture line

S/S Carotid artery rupture Innominate artery

Pulsating trach: EMERGENCY because the artery was nicked

When do we hyper oxygenate a sanctioned patient? With what technique? How long?

Before and after Sterile No longer than 10 seconds

When do you stop advancing the suction catheter?

When you *meet resistance* or the patient coughs

What nerve can the suction hit?

Vagus - STOP suction and give 100% oxygen *they are not hypoxic, just have bradycardia

How does a humidified environment help a trach patient?

It warms the air and causes less secretions to develop

What devices to the total laryngectomy patients use

Blom Singer, electrolarynx * They can smoke

How does TNM staging work?

T - size of tumor N - lymph node involvement M - Presence of metastasis T1-4 N0-3 M0-1

Cancer grading

Compares the cancer cells to the parent cancer cell that they evolved from 1-4 (4 is most aggressive)

3 goals of cancer treatment

Cure, Control, Palliation

What is adjuvant therapy?

2 therapies used together (chemo and radiation)

What are neoadjuvant therapies?

Therapies that are time-specific, or one before the next (Ex: surgery THEN chemo)

What 3 things are treatment plans based on?

Recommended plans for the diagnosis Grade of cancer What the client wants

4 reasons for surgery

1. Prevention (benign lesion) 2. Diagnose (staging) 3. Treatment (remove tumor) 4. Reconstruction (Mastectomy - partial or total/radical)

Where is the most common site to use for mastectomy reconstruction?

Abdomen - will have an incision site there as well

What kind of drains will a mastectomy patient have?

Jackson Pratt or Hemovac

What to do you if a lymph node has been removed during a mastectomy?

LIMB ALERT ON THAT SIDE d/t risk of infection! Wear gloves in the garden, no nail biting, no sunburn, caution with small cuts, NO types of constriction

What are good exercises to do when a lymph node is removed? Why?

Brush hair, squeeze a ball, wall climbing, flex and extend elbow All promote new/collateral circulation

Where to check for bleeding after mastectomy?

Front and BACK! Because here may be pooling of blood in the back

Can mastectomy patients use their arm right away?

No.... they need the circulation but need to work up to it

Can surgery be palliative?

Yes to improve QAL

What is the #1 question after cancer surgery?

Did they get it all?

Successful surgery is based on what 3 things?

1. Could it completely be removed? 2. Did it already spread at the time of surgery? 3. Could the surgeon get adequate margins? - amount of normal tissue needed to be removed around the tumor

Why would someone do chemo or radiation before surgery? What kind of therapy is this?

To shrink the size.... this is neoadjuvant therapy

Oncology Part 1 Flashcards

(62 cards)