Topic 6: Cancer

Question 1

cancer

Answer 1

Characterized by uncontrolled unregulated growth of cells

Question 2

stage 0

Answer 2

cancer in situ

Question 3

stage I

Answer 3

tumor limited to the tissue of origin; localized tumor growth

Question 4

stage II

Answer 4

limited local spread

Question 5

stage III

Answer 5

extensive local and regional spread

Question 6

stage IV

Answer 6

metastasis

Question 7

TNM

Answer 7

(primary) tumor, (regional lymph) nodes, (distant) metastases

Question 8

T0

Answer 8

No evidence of primary tumor

Question 9

Tis

Answer 9

Carcinoma in situ

Question 10

T1-4

Answer 10

ascending degrees of increase in tumor size and involvement

Question 11

Tx

Answer 11

Tumor cannot be measured or found

Question 12

N0

Answer 12

No evidence of disease in lymph nodes

Question 13

N1-4

Answer 13

ascending degrees of nodal involvement

Question 14

Nx

Answer 14

regional lymph nodes unable to be assessed clinically

Question 15

M0

Answer 15

no evidence of distant metastases

Question 16

M1-4

Answer 16

ascending degrees of metastatic involvement, including distant nodes

Question 17

Mx

Answer 17

cannot be determined

Question 18

Side effects of Radiation Therapy

Answer 18

· Acute and long-term site-specific changes
· Vary according to site
· Local skin changes and hair loss
· Altered taste sensations
· Fatigue
· Bone marrow suppression

Question 19

Prevention and Early Detection of Cancer

Answer 19

· Limit alcohol use
· Get regular physical exercise
· Maintain a normal body weight
· Have regular colorectal screenings
· Avoid smoking and tobacco
· Get regular mammography screening and Pap smears
· Obtain adequate, consistent periods of rest (at least 6-8 hours a night)
· Use sunscreen of 15 or higher
· Eliminate, reduce and cope with stress
· Eat balanced diet that includes vegetables, fruit, whole grain, and adequate amounts of FIBER

Question 20

Heath Promotion and Maintenance

Answer 20

· Avoidance of known or potential carcinogens (use skin protection, don’t use tobacco)
· Modifying associated factors (decrease alcohol, high fiber diet, low fat)
· Removal of “at risk” tissues
· Chemoprevention
· Vaccination
· Cancer Screening Guidelines

Question 21

Problems Caused by Chemo and Radiation Management: hyperuricemia

Answer 21

o Monitor uric acid levels
o Allopurinol may be given prophylactically
o Maintain fluid intake

Question 22

Problems Caused by Chemo and Radiation Management: cardiotoxicity

Answer 22

o Monitor heart with ECG and EF
o Administer antidysrhythmics as ordered

Question 23

Problems Caused by Chemo and Radiation Management: fatigue

Answer 23

o Assess for reversible causes of fatigue
o Reassure client that fatigue is a common side effect
o Encourage patient to rest when fatigued, pace activities according to energy levels

Question 24

Problems Caused by Chemo and Radiation Management: anorexia

Answer 24

o Monitor weight
o Eat small frequent meals of high-protein, high-calorie foods
o Encourage patient to eat

Question 25

Problems Caused by Chemo and Radiation Management: constipation

Answer 25

o Take stool softeners as needed o Eat high fiber foods o Increase fluid intake o Increase activity IF TOLERATED

Question 26

Problems Caused by Chemo and Radiation Management: diarrhea

Answer 26

o Antidiarrheal, low fiber, low residue diet

Question 27

Problems Caused by Chemo and Radiation Management: N/V

Answer 27

o Encourage patient to eat and drink when not nauseated o Prophylactic antiemetics o Diversional activities

Question 28

Problems Caused by Chemo and Radiation Management: stomatitis, mucositis, esophagitis

Answer 28

o Asses oral mucosa daily and teach patient to do this o Encourage nutritional supplements if intake is decreasing o Avoid spicy or acidic, and too hot or too cold foods o Teach patient to choose moist, bland, softer foods o Encourage patient to keep oral cavity clean and moist with oral rinse (saline or salt and soda solution) o Discourage of irritants like alcohol and tobacco

Question 29

Problems Caused by Chemo and Radiation Management: anemia, leukopenia, thrombocytopenia (due to bone marrow suppression)

Answer 29

o Monitor CBC levels o Avoid large crowds and people with infections o Observe for signs of bleeding

Question 30

Problems Caused by Chemo and Radiation Management: Alopecia

Answer 30

o Suggest ways to cope with hair loss (hair pieces, scarves, wigs) o Cut long hair before therapy o Avoid excessive shampooing, brushing, curling, and drying of hair

Question 31

Problems Caused by Chemo and Radiation Management: chemo induces skin changes

Answer 31

o Alert patient to potential skin changes o Encourage to avoid sun exposure o Symptomatic management (lotion, corticosteroid creams)

Question 32

Problems Caused by Chemo and Radiation Management: radiation skin changes (dry to moist desquamation

Answer 32

o Lubricate the dry skin with a nonirritating lotion emollient (such as aloe vera) o Wet reaction must be kept clean and protected from further damage. o Wet desquamation of tissues generally produces pain, drainage, and increased risk of infection.

Question 33

Problems Caused by Chemo and Radiation Management: cognitive changes "chemo brain"

Answer 33

o Teach clients to use a daily planner, get enough rest, exercise brain (puzzles), focus on one thing

Question 34

chemo PPE

Answer 34

· Eye protection · Masks · Double gloves (or "chemo" gloves) · Gown

Question 35

Teach 7 warning signs of cancer: CAUTION

Answer 35

· Change in bowel or bladder habits · A sore that does not heal · Unusual bleeding or discharge from any orifice · Thickening or lump in the breast or elsewhere · Indigestion or difficulty in swallowing · Obvious change in a wart or mole · Nagging cough or hoarseness

Question 36

Radiation skin reaction teaching:

Answer 36

· Cleanse skin with mild soap, rinse thoroughly, pat dry · Apply nonmedicated, nonperfumed lotions/creams to alleviate dry skin · Rinse area with saline solution. Expose the area to air as much as possible · Observe area DAILY for signs of infection · Avoid weaking tight fitting clothes and harsh fabrics · Avoid direct exposure to sun and excessive heat or cold Avoid potential irritants (perfume, lotion, tape, dressings)

Question 37

SE of radiation

Answer 37

o Acute and long-term site-specific changes o Vary according to site o Local skin changes and hair loss o Altered taste sensations o Fatigue o Bone marrow suppression

Question 38

leukemia

Answer 38

cancer of the blood

Question 39

Chronic Myelogenous Leukemia (CML)

Answer 39

excess mature yet hypofuncitonal neutrophils - both mature and immature granulocytes are present in large numbers in the marrow and blood

Question 40

Chronic Lymphocytic Leukemia (CLL)

Answer 40

a form of leukemia characterized by extremely high levels of lymphocytes; most often found in middle-age adults

Question 41

s/s of CML

Answer 41

· No symptoms in early disease · Fatigue and weakness · Fever · Sternal tenderness · Weight loss · Joint & bone pain · Massive splenomegaly · Increase in sweating

Question 42

s/s CLL

Answer 42

· Frequently no symptoms (detection often makes during exam of unrelated condition) · Chronic fatigue · Anorexia · Splenomegaly and lymphadenopathy and hepatomegaly · May progress to fever, night sweats, weight loss, and frequent infection

Question 43

Leukostasis

Answer 43

o A high leukemic white count in the peripheral blood (more than 100,000 cells/µL) can causes blood to thicken and potentially block circulatory pathways, life threatening

Question 44

diagnostic studies for leukemia

Answer 44

· Peripheral blood evaluation and bone marrow examination

Question 45

Diagnostic Findings of CML

Answer 45

· Low RBC count · Low Hgb, Hct · High platelet count early, lower count later · ↑ banded neutrophils and myeloblasts and often basophils, normal number of lymphocytes, and normal or low number of monocytes.

Question 46

Diagnostic Findings of CLL

Answer 46

· Mild anemia and thrombocytopenia with disease progression · Total WBC count >100,000/µL. Increase in peripheral lymphocytes and lymphocytes in bone marrow

Question 47

DIAGNOSTIC HALLMARK of CML

Answer 47

The Philadelphia chromosome

Question 48

Treatment for leukemia

Answer 48

· Chemotherapy is the mainstay of the treatment · Other medications: Corticosteroids · Radiation therapy · Leukostasis treatment > Leukapheresis (proced. to reduce WBC ct) > Hydroxyurea (med to reduce WBC ct, used in emergency leukostasis) > To prevent thrombosis (clot w/in vessel)

Question 49

Hydroxyurea SE

Answer 49

N/V/D, Constipation, Mucositis, flu-like symptoms, hair loss

Question 50

Leukapheresis Procedure

Answer 50

· Step 1 - Blood will flow from the vein into the machine where it's separated into different parts. · Step 2 - A small portion of the immune, platelets, & RBCs will be removed. · Step 3 - The rest of the cells are returned to your body.

Question 51

Stages of Chemotherapy

Answer 51

Induction Postinduction or postremission Maintenance

Question 52

Induction therapy

Answer 52

· attempt to bring about remission o Aggressive, seeks to destroy leukemic cells Patient may become critically ill because bone marrow

Question 53

Postinduction or Postremission therapy

Answer 53

intensification therapy and consolidation therapy

Question 54

Intensification therapy

Answer 54

high-dose therapy given right after induction therapy for several months

Question 55

Consolidation therapy

Answer 55

started after remission is achieved; purpose is to eliminate remaining leukemic cells

Question 56

Maintenance therapy

Answer 56

uses lower doses of the same drugs; goal is to keep the body free of leukemic cells