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Oncology

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Sum of knowledge about tumors; it is the branch of medincine concerning the study of tumors

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The leading cancer sites for the male

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Prostate, lung, colong, and rectum

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The leading cancer sites for the female

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Breast, lung, colon, and rectum

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Number one leading cause of death

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Heart disease

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Number two leading cause of death

answer

Cancer

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Cancer in Older Adults

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- The types of cancers seen in older adults are prostate, lung, breast, and colorectal cancer. Cancers of the skin, urinary bladder, vagina, and vulva are seen primarily in older adults. Chronic lymphocytic leukemia and multiple myeloma are seen more frequently in older adults than in younger people. - Many early signs and symptoms of cancer may be misdiagnosed as normal changes of aging. - Because of fear or experience, older adults may adopt a fatalistic frame of mind after hearing the diagnosis of cancer - The type of treatment or cancer should be based on the older person's wishes and overall state of health. Older individuals, their family members, and significant others should be presented with all options so that they can make informed decisions regarding treatment.

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Cancer Cultural considerations

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- Blacks have a higher incidence of cancer than whites - The death rate from the four most common cancer (lung, colorectal, breast, prostate) is higher among minorities (except Asian Americans) than among whites - Asian Americans have the lowest death rate from cancer of any ethnic group. - Black men have almost twice the rate of prostate cancer as white men and are more than twice as likely to die from the disease - Hispanic women have the highest rate of invasive cervical cancer of any group other than Vietnamese, and twice the incidence rate of non-Hispanic white women - Although black women are less likely than white women to develop breast cancer, they are more likely to die from the disease if they develop it. - Native Americans have a lower incidence of cancer than any other group in the US but have the poorest survival rate when they do get cancer.

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Leading cause of cancer related death in both men and women

answer

Lung cancer. Breast and prostate occur more often than lung cancer, but they have better cure and survival rates because of early detection and treatment

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Carcinogenesis

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Process by which normal cells are transformed into cancer cells

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Carcinogens

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Substances known to increase the risk for developing cancer

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Cancer risk factors

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- Smoking: - Dietary habits: obesity is a risk factor for breast, prostate, gallbladder, ovarian, and uterine cancer. Diet also plays a role in the development of colon, rectal, and breast cancer - Ultraviolet (UV) radiations: UV rays is a factor in the development of basal and squamous cell skin cancers and melanoma. - Environmental and chemical carcinogens: Include fumes from rubber and chlorine and dust from cotton, coal, nickel, chromate, asbestos, and vinyl chloride. - Smokeless tobacco: Increase the risk of cancer of the mouth, larynx, pharynx, and esophagus. - Frequent heavy consumption of alcohol: Result in oral cancer and cancer of the larynx, throat, esophagus, and liver.

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About how many percentage are not inherited

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90%

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Genetic Susceptibility

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- The incidence of postmenopausal breast cancer is three time higher and the incidence of premenopausal breast cancer is five times higher in women with a family history of this disease. If a female has genes BRCA1 or BRCA2, she has a 40% to 80% risk of having breast cancer during her life time. Of all women who develop breast cancer, 95% do not carry these genes. Breast cancer is rare in Asian women and common in white women - The incidence of lung cancer is greater in smokers with a family history this disease than in smokers without a family history of the disease - The incidence of leukemia is greater in an identical twin of a person with the disease. - Neuroblastoma occurs with increased frequency among siblings. - Colon cancer is more likely to occur in women who have a history of breast cancer

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Cancer risk assessment

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Cancer risk assessment is the first step toward identifying hereditary cancer predisposition. The assessment begins with a comprehensive family history, included information on first-, second-, and third degree relatives. Next obtain medical records to confirm the cancer diagnoses identified in the family history. The records usually requested include pathology reports, autopsy reports, death certifications, and discharge summaries from hospitalizations

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Genetic Counseling

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Essential component of the genetic evaluation. It is comprehensive and includes obtaining informed consent and proving education, health promotion, and support to individuals and families facing the uncertainty of hereditary cancer and cancer syndromes

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Foods to Reduce Cancer Risk

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- Vegetables from the cabbage family - Broccoli, cauliflower, brussels sprouts - All types of cabbage and kale - Vegetables and fruits high in beta-carotene - Carrots, peaches, apricots, squash, broccoli - Rich source of vitamin C - Grapefruit, orange, cantaloupe, strawberries, red and green peppers, broccoli, tomatoes - Eat lean meat, fish, and skinned poultry - Choose low-fat dairy products, including white cheese rather than yellow - Eat whole grains - Include beans in the diet - Avoid salt-cured, smoked, or nitrite-cured foods - Limit saturated fat and added sugars

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Cancer's Seven Warning Signals

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C - Changes in bowel or bladder habits A - A sore that does not heal U - Unusual bleeding or discharge T - Thickening or lump in breast or elsewhere I - Indigestion or difficulty swallowing O - Obvious change in warts or moles N - Nagging cough or hoarseness

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Cancer-Related checkup

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- Every 3 years between the ages of 20 and 40, and every year thereafter - Screening for colorectal cancer begins at age 50 - Examination for cancer of the ovaries begins at age 20 - Screening for breast cancer begins at age 40. - Examination for testicular cancer begins at puberty - Screening for prostate cancer begins at age 50

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Prevention in Colorectal Cancer

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- Get at least 30 minutes of physical activity on most days - Achieve and maintain a healthy weight - Eat plenty of fruits, vegetables, and whole grain foods, and limit intake of high fat foods - Quit smoking

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Screening Tests for Colorectal Cancer

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- Beginning at age 50, a person should follow one of the four screening options below: - Yearly fecal occult blood test (FOBT) - Stool DNA tests (SDNA) - Flexible sigmoidoscopy every 5 years - Of the options above, the American Cancer Society prefers yearly FOBT combined with flexible sigmoidoscopy every 5 years, or one of the following examination schedules: - Double-contrast barium enema every 5 years - Colonscopy every 10 years - CT colonography every 5 years

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Prevention in Skin Cancer

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- Stay out the sun, especially between 10 am and 4 pm - Wear a broad-brimmed hat, a shirt, and sunglasses when out in the sun - Use sunscreen with an SPF of 15 or higher - American Cancer Society recommeds the "Slip! Slop! Slap! Wrap!": Slip on a shirt, Slop on 15 SPF sunscreen, Slap on a hat, and Wrap on sunglasses before any exposure to the sun - Do not use tanning beds or sunlamps - Protect young children from excessive sun exposure - Check your skin regularly for abnormal or changing areas

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Screening Test for Skin Cancer

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- Skin examination older than 20 years of age every 3 years - Skin examination older than 40 years of age every year - Self examination monthly

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Prevention in Cervical Cancer

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- Abstain from sex or practice safer sex - Quit smoking - Eat a diet rick in fruits and vegetables - Watch for and report signs and symptoms: - Abnormal uterine bleeding or spotting - Abnormal vaginal discharge - Pain during intrcourse

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Screening Tests for Cervical Cancer

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- Have a yearly pelvic examination with Pap test beginning at age 18 or when sexually active - A vaccine is approved for females aged 9 to 19 years to reduce cervical-related neoplasia and cervical cancer resulting from HPV types 16 to 18. Three vaccines are given over 6 months. - Beginning at age 30, after three or more consecutive satisfactory normal yearly examinations, the conventional or liquid-based Pap test may be screened eery 2 or 3 years at the physician's discretion.

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Prevention of Breast Cancer

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- Follow recommended guidelines for early detection of breast cancer - Talk with your physician about the risks and benefits of hormone replacement therapy for your risk of cancer and other diseases - Get at least 30 minutes of physical activity on most days - Achieve and maintain a healthy weight - Eat plenty of fruits, vegetables, and whole-grain foods, and limit intake of high-fat foods - Decrease your alcohol intake

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Screening test for Breast Cancer

answer

Age 20 to 39 - Breast self-examination each month - Clinical breast examination by health care professional every 3 years Ages 50 and over - Mammogram every 2 years - Clinical breast examination by health care professional, near the time of the mammogram - Breast self examination every month - If woman is at increased risk, consult health care provider about benefits and limitations of baseline mammogram before age 50 and additional examinations such as breast ultrasound and MRI

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Prevention for Endometrial Cancer

answer

- Watch for and report an abnormal uterine spotting or bleeding - Use oral contraceptives for many years - Talk with your physician about the risks and benefits of hormone replacement therapy for your risk of cancer and other disease - If taking hormone replacement therapy with your uterus still intact, take estrogen with progesterone

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Screening test for Endometrial Cancer

answer

- Talk with the physician especially at the time of menopause, about the risks and symptoms of endometrial cancer - Report any vaginal bleed or spotting to our physician

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Prevention for Ovarian Cancer

answer

- Use oral contraceptive for several years - Watch for and report signs and symptoms - Abdominal swelling - Vaginal bleeding - Back or leg pain - Chronic stomach pain - Talk with your physician about the risks and benefits of hormone replacement therapy and your risks of cancer and other diseases, like heart disease and osteoporosis - Talk with your physician about having our ovaries removed, if you are at high risk. (This surgery causes sudden menopause.

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Prevention for Prostate Cancer

answer

- Eat a diet low in fat and high in vegetables, fruits, and grains. - Get at least 30 minutes of physical activity on most days - Achieve and maintain a healthy weight.

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Screening test for Prostate Cancer

answer

Men should consider a yearly prostate-specific antigen (PSA) blood test and digital rectal examination starting at age 50 or at age 45 if at high risk. Symptoms include blood in the urine, difficulty starting to urinate, a weak flow of urine, or other urination problems

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Prevention for Testicular Cancer

answer

- Eat a balanced diet which includes fresh fruits and vegetables - Participate in a regular exercise program - Learn and practice testicular self-examination after a warm bath or shower

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Cell

answer

The basic unit of structure and function in all living things.

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Characteristic of normal cells

answer

- Adult human body contains approximately 60,000 billion cells - All cells use oxygen, which combines with fat, protein, or carbohydrates to release the energy needed for cells to function - Cells able to reproduce: when cells are destroyed, the remaining cells of the same type reproduce until the correct number has been replenished. - Our immune system helps us from developing cancer by destroying the abnormal cells.

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Characteristic of cancer cells

answer

- When malignant cells change, they become unlike paent cells - Instead of limiting their growth to meet specific needs of the body, they continue to reproduce in a disorderly and unrestricted manner - Local increase in the number of cells, loss of normal cellular arrangement, variation in cell shape and size, increased nuclear size, increased miotic activity, and abnormal mitosis and chromosomes - Can classified as nonneoplastic growth and neoplastic growth

question

Four common nonneoplastic growth patterns

answer

Hypertrophy (abnormal enlargement of body part or organ) Hyperplasia (abnormal increase in number of cells) Metaplasia (conversion of cells to a form that is not normal) Dysplasia (abnormal development or growth of cells, tissues, or organs)

question

Neoplasm

answer

Uncontrolled or abnormal growth of cells

question

General characteristics of Benign Tumors

answer

- Slow, steady growth - Remains localized - Usually contained within a capsule - Smooth, well defined; movable when palpated - Resembles parent tissue - Crowds normal tissue - Rarely recurs after removal - Rarely fatal

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General characteristics of Malignant Tumors

answer

- Rate of growth varies - usually rapid - Metastasized - Rarely contained within a capsule - Irregular; more immobile when palpated - Little resemblance to parent tissue - Invades normal tissue - May recur after removal - Fatal without treatment

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Malignant

answer

Growing worse and resisting treatment, as in cancerous growths

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Metastasized

answer

Process by which tumor cells spread from the primary site to a secondary site

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Metastasis can occur by

answer

1. Direct spread of tumor cells by diffusion to other body cavities 2. circulation by way of blood and lymphatic channels

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Immunosurveillance

answer

The immune system's recognition and destruction of newly developed abnormal cells

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Importance of T cells

answer

- Responsible for immunosurveillance - If T cell function is suppressed by age, drugs, poor nutrition, alcohol, serious infections, or certain disease process, the risk of cancer increases. - To suppress T cell rejection of a transplanted organ, steroids and other drugs are given.

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Carcinoma

answer

Malignant tumors composed of epithelial cells, which tend to metastasize. Originate from embryonal ectoderm (skin and glands) and endoderm (mucous membrane linings of the respirtory tract, gastrointestinal tract, and genitourinary tract)

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Sarcoma

answer

Malignant tumors of connective tissues; they originat from embryonal mesoderm, such as muscle, bone, or fat, usually manifesting as a painless swelling. May affect bone, bladder, kidneys, liver, lungs, parotids, and spleen.

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Grading of Tumors

answer

G1 - Well-differentiated grade; cell differ slightly from normal cells (mild dysplasia) G2 - Moderately sell-differentiated grade; cells are more abnormal (moderate dysplasia) G3 - Poorly differentiated grade; cells are very abnormal (severe dysplasia) G4 - Undifferentiated; cells are immature and primitive (anaplasia); cells difficult to determine

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Clinical Staging

answer

Based on a description of the extend of the disease rather than on cell appearance: Stage 0 - Cancer in situ Stage 1 - Tumor limited to the tissue of origin; localized tumor growth Stage 2 - Limited local spread Stage 3 - Extensive local and regional spread Stage 4 - Metastasis

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Tumor size (T), lymph nodes (N), metastasis (M)

answer

Represents the standardization of the clinical staging of cancer. Determine to extend of the disease proce3ss of cancer according to three parameters

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T Subclasses: Primary Tumor

answer

Tx - Tumor cannot be adequately assessed TO - No evidence of primary tumor Tis - Carcinoma in situ T1 - T4 - Progressive increase in tumor size and involvement

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N Subclasses: Regional Lymph Nodes

answer

Nx - Regional lymph nodes cannot be assessed NO - No regional lymph node metastasis N1-N4 - Increasing involvement of regional lymph nodes

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M Subclasses: Distant Metastasis

answer

Mx - Not assessed Mo - No (known) distant metastasis M1-M4 - Distant metastasis present, specify site(s)

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Exfoliative cytology

answer

Means of study cells that the body has shed during the normal sequence of growth and replacement of body tissue.

question

Bethesda System

answer

- Negative : Normal (formerly class I) - Probably negative : May indicate infection, atypical squamous cells, or reactive changes (formerly class II) - Suspicious, but not conclusive for malignancy: Low grade squamous intraepithelial lesion (formerly class III) - More suspicious, strongly suggestive of malignancy: High-grade squamous intraepithelial lesion (formerly class IV) - Conclusive for malignancy: Invasive squamous cell carcinoma (formerly class V)

question

Biopsy

answer

The removal of a small piece of living tissue from an organ or other part of the body for microscopic examination: used to confirm or establish a diagnosis, establish prognosis, or follow the course of a disease

question

Three types of biopsy

answer

Incisional, excisional, and needle aspiration

question

Incisional Biopsy

answer

This type of biopsy is a removal of a portion of tissue for examination, such as the bite biopsy performed during endoscopy

question

Excisional Biopsy

answer

This type of biopsy is a removal of the complete lesion, with little or no margin of surrounding normal tissue removed, as in polypectomy. Another example is the dissection of peripheral lymph nodes, such as those of the axilla for staging of breast cancer or those of the peritoneal region for staging of various abdominal cancers.

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Needle aspiration

answer

Type of biopsy is the aspiration of fluid or tissue by means of a needle

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Endoscope

answer

Rigid or flexible tubes containing a magnifying lens and a light.

question

Bone scanning

answer

Before the scan, a radioactive material is injected into a vein in the arm. The patient is encouraged to drink water over the next 1 to 3 hours to aid renal clearance of any radioisotope not picked up by the bone. Areas of concentrated uptake may represent a tumor or an abnormality.

question

Tomography

answer

Special technique of making multiple radiographic films at different depths of a specific area, organ, or structure

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Computed Tomography (CT)

answer

Uses radiographs and a computed scanning system to record images of specific structures at different angles. It is helpful in detecting small lesions that were missed by radiographs or tomography.

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Radioisotope Studies

answer

Require the injection or ingestion of a radioactive substance. A scanning device is used to identify the distribution of the substance in different areas of the body.Concentration in a specific organ, such as the thyroid gland or the brain.

question

Ultrasound Testing

answer

Noninvasive procedure using high frequency sound waves to examine internal structures. The sound waves are converted into electrical impulses, which produce an image on a display screen. Can show the size, consistency, and shape of the structure being studied. It is most helpful in distinguishing between cystic and solid tumors. It is not used to examine bones or airfilled organss

question

Magnetic Resonance Imaging (MRI)

answer

Painless diagnostic procedure that does not involve any exposure to radiation. This test is currently used in the diagnosis of intracranial and spinal lesions and of cardiovascular and soft tissue abnormalities. The procedure also provides information about changes within the cells of soft tissues, arteries, veins, the brain, and the spinal column.

question

Positron Emission Tomography (PET)

answer

- A radioactive chemical is given to the patient just before the scanning. It can demonstrate glucose metabolism, oxygenation, blood flow, and tissue perfusion for any designated area. - Useful to visualize fast-growing tumors and to specify their anatomical location. - Helps note tumor response to therapeutic intervention, identify a recurrence of a tumor after surgical intervention, and assist in differentiating a tumor from other abnormal condition. - Extremely useful in visualizing regional and metastatic extension of a specific tumor. - Use to determine the specific site to perform a biopsy of a suspected tumor.

question

Measurement of Alkaline Phosphatase Blood Levels

answer

Alkaline phosphatase is elevated if there is metastasis to the bone or liver

question

Serum Calcitonin Level

answer

Calcitonin is a hormone secreted by the thyroid gland in response to a rising serum calcium level. The level is increased in the blood of people who have cancer of the thyroid. It may be elevated with breast cancer and oat cell cancer of the lung.

question

Carcinoembryonic Antigen Serum Level

answer

Cannont be used as general indicator of cancer because CEA can be elevated for other reasons, such as smoking cigarettes. CEA is found in increased amounts in the blood of people with colorectal cancer. This test is used less frequently today because research has found it less accurate than was previously thought.

question

Three example of blood studies (markers)

answer

- PSA for prostate cancer - CA-125 for ovarian cancer - CA-19-9 for pancreatic or hepatobiliary cancer

question

PSA

answer

A biologic marker, specific for cellular activity in the prostate gland. Plays an important role in staging prostate cancer and in monitoring for recurrence. ACS recommend its use for screening asymptomatic men. It is done by collecting a sample of the patient's blood before prostate palpation. The normal range for a man over the age of 40 is 0 to 4 ng/L. Although it's used to screen for prostate cancer, it is used most widely to determine the effectiveness of cancer treatment and to assess the recurrence of prostate cancer.

question

CA-125

answer

Cancer antigen detected in the blood and peritoneal ascite. The normal range is 35 unites/mL. May be elevated in gynecologic cancers (including ovarian cancer) and cancer of the pancreas. This test is used mainly to signal a recurrence of ovarian cancer, since other conditions - such as endometriosis, hepatitis, pelvic inflammatory diseases, or pregnancy - may increase the levels in the blood

question

CA-19-9

answer

Used in the diagnosis, monitoring of a patient's response to therapeutic intervention, and surveillance of the patient with pancreatic or hepatobiliary cancer. Is not an effective screening tool for pancreatic or biliary tumors in the general population because of its lack of sensitivity and specificity.

question

Stool Examination for Occult Blood

answer

- Guaiac test, Hematest, Occultest, and Hemoccult test are commonly used to detect occult (hidden) blood in the stools. For accurate test results, it is essential that the person not ingest red meat, turnips, melons, aspirin, or vitamin C for 4 days before the test. The test must be performed on three consecutive bowel movements.

question

The Use of Laser Surgery

answer

Major uses are in ophthalmology, gynecology, urology, neurosurgery, and otolaryngology.

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Radiation Therapy

answer

- Can be used to cure or control cancer that has spread to local lymph nodes or to threat tumors that cannot be removed - May be used preoperatively to reduce the size of a tumor - Postopertive radiation may be indicated to destroy malignant cells not removed by surgery. - May be used to slow the growth of malignant tumor - May be delivered externally or internally

question

External Radiation Therapy

answer

- Specific area on the body is marked to indicated the port at which it will be directed - Instruct the patient to avoid using any ointments, lotions, or powder on the area. - Protect the radiated area from direct sunlight and to avoid applications of heat or cold because these would increase erythema, drying, and pruritus of the skin, which is common over an irradiated area - Encourage a diet high in protein and calories and a fluid intake of 2 or 3L/day. Feeling of lethargy and fatigue are common during treatment, and that frequent rest periods are helpful

question

Internal Radiation Therapy

answer

- Radioactive implant (brachytherapy) is the insertion of sealed radioactive materials temporarily or permanently into hollow cavities, within body tissues, or on the body's surface. - Unsealed internal radiation is administered intravenously or orally, so that is distributed throughout the patient's body - Stand as far away as possible from the site where an internal radiation device is in the patient's body - If direct, prolonged care is needed, wear a lead apron. - Children younger than 18 years of age and pregnant women should not be allowed to visit implant patients. Limit visit to 10 minutes.

question

Chemotherapy

answer

Used to reduce the size or slow the growth of metastatic cancer. It work by interfering with the cells' replication process (ability to multiply or reproduce). These drug damage the cell and cause cellular death. Both malignant and normal cells are affected. Cells that multiply rapidly, such as cells of the hematopoietic system, the hair folllicles, and the GI system, are affect the most.

AHN Ch. 17 – Care of the Patient with Cancer – Flashcards

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