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Flashcards in oncology review Deck (55):
1

cancer is the ___ leading cause of mortality in the US

2nd

2

neoplasia

any new or continued cell growth that occurs which is not necessary for normal development and replacement cells

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characteristics of malignant cells

demonstrate rapid cell division
show anaplastic morphology
have a large nuclear cytoplasmic ratio
lose some or all differentiated functions
adhere loosely together
able to migrate
grow by invasion
are not contact inhibited

4

MALIGNANT vs benign tumors

rapid growth
not encapsulated
irregular shape
poorly differentiated cells
recurrence is common
harmful
variable prognosis

5

malignant vs BENIGN tumors

slow growth
encapsulated
round shape
differentiated cells
recurrence is unusual
less harmful
good prognosis

6

intrinsic risk factors for cancer

immune function (ie HIV)
age (the single most significant risk factor for cancer)
genetic predisposition

7

extrinsic risk factors for cancer

chemical carcinogens
physical carcinogens (radiation exposure-ionizing and UV)
viruses (oncoviruses-HBV & liver)
Dietary factors (excessive animal fats, red meats, nitrates, alcohol)

8

Reducing risk factors

adopt a physically active lifestyle
maintain a healthful weight and diet
avoid tobacco products
wear sunscreen
avoid environmental exposures; asbestos, pesticides, etc

9

7 warning signs of cancer

change in bowel/bladder habits
a sore that does not heal
unusual bleeding/discharge from body or orifice
thickening/lump in breast
ingestion/difficulty swallowing
obvious change in wart/mole
nagging cough/hoarseness

10

normal cell cycle

mitotic phase
gap 1 interphase
s phase
gap 2
gap 0

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mitotic phase

cell divides into 2 identical cells

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gap 1 interphase

from end of mitosis to beginning of DNA synthesis "active state" RNA/Protein synthesis

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S phase

synthesis of DNA

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Gap 2

premitotic phase, end of DNA synthesis

15

Gap 0

quiescent phase or resting phase

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initiation

mutation occurs causing irreversible damage (carcinogen-chemicals, viruses, radiation)

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promotion

promote or enhance; initiates cell growth, repeated exposure (smoking)

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progression

uncontrolled growth of cancer growth, need for TAF (tumor angiogenesis factor)

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metastasis

cancer cells move from their original location and establish remote colonies (cancer still named after primary site of invasion)

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routes for metastatic spread

direct invasion
local seeding
blood borne metastasis
lymphatic spread

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local seeding

distribution of shed cancer cells in local are of primary tumor

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blood borne metastasis

most common route of spread; tumor cells are released into the blood and travel

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lymphatic spread

primary site that has many lymph nodes proximal to tumor, tumor cells are released into the lymphatic system and spread

24

grading

rates tumor cells according to cellular characteristic (G1-G4)

25

Staging

TNM determines cancers location and degree of metastasis at diagnosis for treatment and diagnostic purposes

26

current cancer treatments

surgery
radiation therapy
chemotherapy
hormone therapy
immunotherapy/biotherapy

27

goals of treatment

cure/control
adjuvant
palliative

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cure/control

removal of all cancer from the body - varies for different cancers

29

adjuvant

treatment administered in conjunction with other treatment with the goal of destroying micro-metastasis

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palliative

relieving symptoms

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considerations for treatment

type of tumor
location of tumor
rate of growth
stage, size, metastasis

32

criteria for radiation

-must be rapidly dividing
-tissue of origination must be sensitive
-degree of cell differentiation, rate of mitosis, degree of oxygenation/vascularization are all considered
-used for primary, adjuvant, or palliative therapy

33

types of radiation

internal (brachytherapy, radiopharmaceutical)
external beam

34

brachytherapy

(implants) uses sealed sources to place radioactive material close to tumor for 1-3 days (prostate, cervical, breast cancers)

35

radiopharmaceutical therapy

radioactive material is given by injection or ingestion (thyroid cancers)

36

external beam

initial stimulation (placement of tattoo/dye markings)
session take about 30 minutes
usually given in daily "fractions" based on the phase of cells

37

side effects of radiation

(often dependent on the site of radiation)
fatigue
GI reactions
myelosuppression
alopecia
respiratory complications
sexual problems
skin (limited to tissue directly exposed to radiation)

38

growth fraction
(chemotherapy)

ratio of cells in growth vs resting

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increased percentage of cells in growth phase

high growth fraction
chemo is generally more toxic to tissue that have a high growth fraction

40

solid tumors
(chemotherapy)

generally have a low growth fraction

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disseminated cancer

generally have a high growth fraction

42

tissues with high growth fraction

bone marrow
hair follicles
GI Epithelium
Sperm forming cells

43

effects of chemotherapy on hair follicles

alopecia

44

effects of chemotherapy on GI epithelium

n/v, anorexia, diarrhea, stomatitis (mouth inflammation)

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effects of chemotherapy on sperm forming cells

decreased fertility

46

effects of chemotherapy on bone marrow

myelosuppression (depression of bone marrow which produces red blood cells)

47

meds to treat chemo causing n/v/diarrhea

antiemetics as ordered- zofran (ondansetron), anzemet (dolasetron)
also used: decadron (glucocorticoid), ativan (sedative), marino (marijuana)

48

myelosuppression affects

all cells
erythrocytes (anemia)
thrombocytes (thrombocytopenia)
leukocytes (leukopenia)

49

greatest effects of chemo

7-10 days following treatment (outpatient)
hospitalization for side effects not treatment of chemo

50

interventions for anemia

monitor Hgb, Hct,
transfuse if Hgb

51

Interventions for thrombocytopenia

Monitor thrombocytes 150,000 to 400,000
Transfuse platelets less than 10,000 to 20,000
Monitor for bleeding (gums, epistaxis, hematuria, melena, spontaneous bruising, ecchymosis)
Avoid injections (apply pressure if injection is given)
Avoid rectal temps/trauma

52

Interventions for leukopenia

Monitor wbc's 5000 to 10,000
Determine ANC = absolute neutrophil count
ANC= WBC x %Neutrophils + %Bands/100

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Neutropenic precautions

Initiate precautions for ANC less than 1000
Private room keep door closed
Restrict visitors (no kids less than 12, Persons with cold, URIs etc)
Meticulous hand washing
Monitor temp Q4 hours
Notify Dr. for a temp greater than 101
Avoid rectal temps, exams, or enemas
Teach patients not to floss
Inspect orifices or signs of breakdown or superinfection

54

Management of oral candidiasis (thrush)

Medications include Diflucan (fluconazole), Mycostatin (nystatin), baking soda rinses or saline rinses

55

Biologic therapy

Agents that alters the response of the host to the tumor cells; example into look into stimulates T and B cells and activate NK cells