According to the book, which cancer has the highest death rate among women?
Which one has the highest incidence rate?
1. Lung ca
2. Breast ca
T or F: Thyroid cancer is more prevalent in women than in men
Describe the first stage of the development of cancer
Initiation: cancer cells arise from normal cells as a result of changes in genes. This first stage involves a mutation in the cell's genetic structure, described by a Mutation (any change in the usual DNA sequence)
What are the two ways gene mutations can occur
1. Inherited from a parent passed from one generation to the next
2. Acquired during a person's lifetime
T or F: Most cancer are inherited genes
False: only 5% of all cancer are inherited
What is a carcinogen and what are the different types
Carcinogen: cancer causing agent capable of producing ell alterations
Describe the second development stage of cancer.
What is the key concept and distinction between the first and second stage?
Promotion: While one cancer cell is not sufficient to result in cancer, the odds are increased with the presence of promoting agents.
Key concept between the two is that promotion activity is reversible (ex: cigarette smoking is a promoting agent in bronchogenic carcinoma)
Describe the final stage of cancer development
Progression: this is characterized by increased growth rate of the tumor, increased invasiveness, and metastasis (spread to other sites)
How do lymphocytes determine which cell is a cancer cell?
Cancer cells may display antigens termed tumor associated antigens (TAAs).
This response to antigens is termed immunologic surveilance.
How can B-cells help with the discovery of tumor cells
they produce specific antibodies that bind to tumor cells, which are often detetable in the patient's serum and saliva
List 6 escape mechanics of cancer cells from the immunologic surveillance
1. suppression of factors that stimulate t cells to react to cancer cells
2. weak surface antigens
3. development of tolerance of the immune system to some tumor antigens
4. suppression of immune response by products secreted by cancer cells
5. induction of suppressor t cells by tumor
6. blocking antibodies that bind TAA
What are CEA and AFP antigens examples of?
CEA: colorectal; rise in levels after chemo or radiation may indicate recurrence or spread of cancer with lung or liver dz and smoking
AFP: produced by malignant liver and fetal liver cells.
List highest cancer rates for men and women, and highest death rates from type of cancer
Rate for men: Prostate
Rate for women: breast
Death rate for men: Lung and bronchus
Death rate for women: Lung and bronchus
What will change the prognosis of a tumor site from situ to invasive?
When the cancer cells have broken through the basement membrane.
How are cancer tumors classified (3)
they are classified according to 1. anatomic site
2. histology (grading)
3. extent of disease
What are the four grades of histologic grading of tumors
Grade I: cells differ slightly from normal cells and are well differentiated (low grade)
Grade II: cells are more abnormal (moderate dysplasia) and moderately differentiated (intermediate grade)
Grade III: Cells are very abnormal (severe dysplasia) and poorly differentiated (high grade)
Grade IV: Cells are immature and primitive (anaplasia) and undifferentiated; cell of origin is difficult to determine (high grade)
Extent of someone's cancer is based on clinical staging. What are these stages (0-4)
Stage 0: cancer in situ
Stage I: tumor limited to the tissue of origin; localized tumor growth
Stage II: limited local spread
Stage III: extensive local ad regional spread
Stage IV: metastasis
What does each letter of the TNM classification system mean. (TNM is a classification system to determine the anatomic extent of the dz involvement according to three parameters)
T: Tumor size and invasiveness
N: presence or absence of regional spread to the lymph nodes
M: metastasis to distant organ sites
This term refers to a neoplasm whose cells are localized and show no tendency to invade or metastasize to other tissues.
Carcinoma in situ (CIS)
List patient teachings for cancer prevention and early detection
1. reduce or avoid eposure to suspected carcinogens (smoking, sun, etc.)
2. Balanced diet
3. Limit alcohol
5. Maintain healthy weight
6. adequate rest and sleep
7. Stress management and coping
8. regular physical examination and knowledge of family hx
9. Learn and follow american cancer's society's recommended cancer screening guidelines
What are the seven warning signs of cancer? (Hint: CAUTION)
C: change in bowel or bladder habits
A: A sore that does not heal
U: Unusual bleeding or discharge
T: Thickening or a lump
I: Indigestion or difficulty in swallowing
O: Obvious change in a wart or mole
N: Nagging cough or hoarseness
What is Neutropenia and which patients are at highest risk for it?
What are nursing considerations
People who have a low number of Neutrophil cells is at risk for a life threatening infection and sepsis. It is more commong with patients receiving chemotherapy than radiation therapy.
Hand hygiene is most important
Monitor temp. regularly
Stomatitis,Mucositis, Esophagitis are from epithelial cells being destroyed by chemo or radiation. It can lead to inflammation and ulceration d/t rapid cell destruction. List nursing interventions to manage patient discomfort
1. Provide analgesics, if swallowing too hard, will be put on PCA pump
2. Avoid spicy or acidic foods: select moist, bland or softer foods
3. Frequent oral rinses with saline
4. With radiation, artificial saliva may help with dryness
With patients who are experiencing anorexia d/t chemo or radiation, what kinds of meals will you want to encourage?
small, frequent meals of high protein and high calorie foods
Following radiation to abdomen and pt. is experiencing diarrhea, list nursing interventions (3)
2. low-fiber, low residue diet
3. encourage fluid intake of at least 3L/day
If a patient will be receiving tx of testes or ova, what will you want to offer or suggest before the tx with patients of childbearing age?
offer opportunity for sperm and ova banking before tx
What is TNF and its purpose?
They are secreted by monocytes and macrophages.
They are Tumor Necrosis Factors and they alert T cells to cancer cells.
Which stage of cancer progression is irreversible? Which one is reversible?
c. Multiple Myeloma
T or F: Grade IV cancer cells differ slightly from normal cells and are well differentiated
False: Grade IV = cells are immature and primitive and undifferentiated. Cell of origin is difficult to determine.
T or F: Grade IV cancer cells origin is difficult to determine
Put these stages of cancer in order from Stage 0 to IV
a. Tumor limited to tissue of origin
c. Limited local spread
d. Extensive local and regional spread
e. cancer in situ
Stage 0 = e
Stage I = a
Stage II = c
Stage III = d
Stave IV = b
If cancer cells, or lumps, are found in just two different areas of the breast, what stage would this be considered?
Stage II: limited local spread
Fill in these values and characteristics of the TNM system
T - 0:
T - 1:
T - 2:
T - 3:
N - 0:
N - 2:
N - 3:
M - 0:
M - 1:
T - 0: No ca
T - 1: <2cm
T - 2: 2-5
T - 3: >5
N - 0: No nodes with cancer
N -1: small, scant
N - 2: medium, moderate
N - 3: Large, many
M - 0: no mets
M - 1: Mets found in distant sites
Match these viruses with the type of cancer that it's correlated with:
2. Epstein-Barr (chronic mono)
3. Hep B
a. Kaposi Sarcoma
c. Hepatocellular carcinoma
d. Cervical ca
*Kaposi Sarcoma: skin patches of cancer
This type of ultraviolet radiation is constant throughout the year and can penetrate glass
T or F: UVB does NOT penetrate glass
This type of radiation is associated with Leukemia, Lymphoma, thyroid ca, bone ca
What are the recommended ages to start each exam and the frequency thereafter
1. Breast self-exam
4. Cervical screening w/ PAP
5. Testicular self-screening
1. Age 20 q1month
2. Age 40 q1year
3. Age 50 q10years
4. Age 21 q1year
Dexamethasone, Lorazepam, and Diphenhydramine are used to treat what in cancer patients?
What are indications of Aprepitant and Fosaprepitant
What is the suffix for Serotonin antagonists (antiemetics)?
Examples: Ondansetron, Granisetron, Palonestron
List the med used for Delayed phase of N/V
D. Rolapitant (varubi) and Aprepitant (Emend)
What is the suffix of Neurokinin-1 antagonists (antiemetics)
Examples: Aprepitant, Fosaprepitant
PCAs are seen used with cancer patients to treat which symptom?
Mucositis: is worst for in-patients who are receiving higher doses of chemotherapy, and receiving BMT.
List oral care for mucositis
Frequent saline rinses
Magic mouthwash (2 parts lidocaine, benadryl, and milk of mag
Uses of soft toothettes
List the kinds of food you want to avoid with cancer patients with mucositis
Spicy and rough textured foods
High acid foods
very hot or cold foods
This is present in 80% of cancer patients at death. It is defined as profound malnutrition and muscle wasting.
Patients with thrombocytopenia are at greatest risk for bleeding when platelet count is < ___a___
What is the formula for calculating ANC
(%polys or segs + bands) x WBC/100
Ex: (40% Segs + 10% Bands) x 2000 WBC / 100
What ANC value has the the highest or severely increased risk for infection? What is the number for no increased risk?
Severe risk: <500
No risk: 1500-2000
A 36-year-old man with lymphoma presents with signs of impending septic shock 9 days after chemotherapy. The nurse could expect which of the following to be present?
Nine days after chemotherapy, one would expect the client to be immunocompromised. The clinical signs of shock reflect changes in cardiac function, vascular resistance, cellular metabolism, and capillary permeability. Low-grade fever, tachycardia, and flushing may be early signs of shock. The client with impending signs of septic shock may not have decreased oxygen saturation levels. Oliguria and hypotension are late signs of shock. Urine output can be initially normal or increased.
Which of the following laboratory values is expected for a client just diagnosed with chronic lymphocytic leukemia?
Chronic lymphocytic leukemia shows a proliferation of small abnormal mature B lymphocytes and decreased antibody response. Thrombocytopenia also is often present. Uncontrolled proliferation of granulocytes occurs in myelogenous leukemia.
A client is diagnosed with multiple myeloma. The client asks the nurse about the diagnosis. The nurse bases the response on which of the following descriptions of this disorder?
Which of the following substances has abnormal values early in the course of multiple myeloma (MM)?
MM is characterized by malignant plasma cells that produce an increased amount of immunoglobulin that isn’t functional. As more malignant plasma cells are produced, there’s less space in the bone marrow for RBC production. In late stages, platelets and WBC’s are reduced as the bone marrow is infiltrated by malignant plasma cells.
Which of the following immunizations should not be given to a 4-month-old sibling of a client with leukemia?
OPV is a live attenuated virus excreted in the stool. The excreted virus can be communicated to the immunosuppressed child, resulting in an overwhelming infection.
A client with leukemia has neutropenia. Which of the following functions must be frequently assessed?
Pneumonia, both viral and fungal, is a common cause of death in clients with neutropenia, so frequent assessment of respiratory rate and breath sounds is required. Although assessing blood pressure, bowel sounds, and heart sounds is important, it won’t help detect pneumonia.
For which of the following conditions is a client with multiple myeloma (MM) monitored?
Calcium is released when the bone is destroyed. This causes an increase in serum calcium levels. MM doesn’t affect potassium, sodium, or magnesium levels.
The nurse is teaching a 17-year old client and the client’s family about what to expect with high-dose chemotherapy and the effects of neutropenia. What should the nurse teach as the most reliable early indicator of infection in a neutropenic client?
A client has been diagnosed with lung cancer and requires a wedge resection. How much of the lung is removed?
The nurse is reviewing the laboratory results of a client diagnosed with multiple myeloma. Which of the following would the nurse expect to note specifically in this disorder?
Findings indicative of multiple myeloma are an increased number of plasma cells in the bone marrow, anemia, and hypercalcemia.
Hypercalcemia is caused by the release of calcium from the deteriorating bone tissue, and an elevated blood urea nitrogen level. An increased white blood cell count may or may not be present and is not related specifically to multiple myeloma.
Which of the following clients is most at risk for developing multiple myeloma?
Giving instructions for breast self-examination is particularly important for clients with which of the following medical problems?
D. Ovarian cancer
Clients with ovarian cancer are at increased risk for breast cancer. Breast self-examination supports early detection and treatment and is very important.
The nurse is developing a plan of care for the client with multiple myeloma. The nurse includes which priority intervention in the plan of care?
Hypercalcemia caused by bone destruction is a priority concern in the client with multiple myeloma. The nurse should administer fluids in adequate amounts to maintain and output of 1.5 to 2 L a day. Clients require about 3 L of fluid pre day. The fluid is needed not only to dilute the calcium overload but also to prevent protein from precipitating in renal tubules. Options 1, 3, and 4 may be components in the plan of care but are not the priority in this client.
Which of the following foods should a client with leukemia avoid?
A low-bacteria diet would be indicated which excludes raw fruits and vegetables.
The client with which of the following types of lung cancer has the best prognosis?
Small cell grows rapidly and quick to mets
Match these tumor markers:
1. Colorectal; GI
4. Pancreatic and gallbladder
1. Colorectal; GI = c
2. Liver = a
3. Ovarian = b
4. Pancreatic and gallbladder = d
Match these tumor markers:
1. pancreatic and gallbladder
3. a & c
If a male patient's Hemoglobin is 11.5, what will be your med intervention? When will you require PRBC?