Ch.16 Cancer Study Guide Qs – Flashcards

a. Lung cancer is the leading cause of cancer deaths in the United States for both women and men and smoking cessation is one of the most important cancer prevention behaviors. Approximately one half of cancer-related deaths in the U.S. are related to tobacco use, unhealthy diet, physical inactivity, and obesity. Cancers of the reproductive organs are the second leading cause of cancer deaths.

d. Malignant cells proliferate indiscriminately and continuously and also lose the characteristic of contact inhibition, growing on top of and in between normal cells. Cancer cells usually do not proliferate at a faster rate than normal cells, nor can cell cycles be skipped in proliferation. However, malignant proliferation is continuous, unlike normal cells.

a. Cancer cells become more fetal and embryonic (undifferentiated) in appearance and function and some produce new proteins, such as carcinoembryonic antigen (CEA) and α-fetoprotein (AFP), on cell membranes that reflect a return to more immature functioning. The other options are unrelated to CEA and AFP.

d. The major difference between malignant and benign cells is the ability of malignant tumor cells to invade and metastasize. Benign tumors can cause death by expansion into normal tissues and organs. Benign tumors are more often encapsulated and often grow at the same rate as malignant tumors.

d. Alkylating agents are used to treat Hodgkin's lymphoma and are carcinogens associated with initiation of acute myelogenous leukemia. Working with radiation would lead to a higher incidence of bone cancer. Epstein-Barr virus is seen in vitro with Burkitt's lymphoma. Intense tanning or exposure to ultraviolet radiation is associated with skin cancers.

a. Mutations in the p53 tumor suppressor gene have been found in many cancers, including bladder, breast, colorectal, esophageal, liver, lung, and ovarian cancers. APC gene mutations increase a person's risk for familiar adenomatous polyposis, which is a precursor for colorectal cancer. BRCA1 and BRCA2 mutations increase the risk for breast and ovarian cancer.

a, c, d. Promoting factors such as obesity and tobacco smoke promote cancer in the promotion stage of cancer development. Eliminating risk factors can reduce the chance of cancer development as the activity of promoters is reversible in this stage. Increased growth, invasion, and metastasis are seen in the progressive stage.

b. Carcinoma in situ has the histologic features except invasion. Evasion of the immune system by cancer cells by various methods is immunologic escape. Oncogenic factors are capable of causing cellular alterations associated with cancer. Tumor cell surface antigens that stimulate an immune response are tumor-associated antigens.

a. Oncogenes are the mutation of protooncogenes, which then induce tumors. Oncogenic viruses cause genetic alterations and mutations that allow the cell to express the abilities and properties it had in fetal development and may lead to cancer. Oncofetal antigens are antigens that are found on the surface and inside the cancer cells. They are an expression of the cells usually associated with embryonic or fetal periods of life and may be used as tumor markers to monitor treatment. Tumor angiogenesis factor is the substance within tumors that promotes blood vessel development.

d. Meningeal sarcoma is from the embryonal mesoderm, is located in the meninges, and is malignant. A meningioma has the same tissue of origin and anatomic site but it is benign. Meningitis is inflammation or infection of the meninges. Meningocele is a hernia cyst filled with cerebrospinal fluid.

c. The breast cancer origination gives it the anatomic classification of a carcinoma. Grade II has moderate abnormal cells with moderate differentiation. T1N1M0 represents a small tumor with only minimal regional spread to the lymph nodes and no metastasis. Sarcomas originate from embryonal mesoderm or connective tissue, muscle, bone, and fat. Leukemias and lymphomas originate from the hematopoietic system. The other histologic grading and TNM classifications do not represent this patient's tumor.

b. Healthy men and women should have a colonoscopy every 10 years, an annual fecal occult blood test, or a barium enema every 5 years. These frequencies may change depending on the results. Annual PSA and digital rectal exams screen for prostate problems, although the decision to test is made by the patient with his health care provider.

b. Although other tests may be used in diagnosing the presence and extent of cancer, biopsy is the only method by which cells can be definitely determined to be malignant.

a. A simple mastectomy can be done to prevent breast cancer in women with high risk and can be used to control, cure, or provide palliative care for breasts with cancerous tumors. A mastectomy would not be used for biopsy or otherwise to establish a diagnosis of cancer.

a.4;b.1;c.3;d.2;e.3;f.2;g.1;h.2.Mammoplastyis done for rehabilitation post mastectomy. A bowel resection and debulking procedure to enhance radiation therapy are done to cure or control cancer. Cordotomy for pain control and colostomy to bypass bowel obstruction are done for palliation. Supportive care includes insertion of a feeding tube, placement of a central venous catheter, and surgical fixation of bones at risk for pathologic fracture.

b. Neuroblastomas are cured with chemotherapy. A positive response of cancer cells to chemotherapy is most likely in solid or hematopoietic tumors that arise from tissue that has a rapid rate of cellular proliferation and new tumors with cells that are rapidly dividing. A state of optimum health and a positive attitude of the patient will also promote the success of chemotherapy.

a. Nitrosureas are cell cycle phase-nonspecific, break the DNA helix, and cross the blood-brain barrier. Antimetabolites are cell cycle phase-specific drugs that mimic essential cellular metabolites to interfere with DNA synthesis. Mitotic inhibitors are cell cycle phase-specific drugs that arrest mitosis. Antitumor antibiotics bind with DNA to block RNA production.

b. One of the major concerns with the IV administration of vesicant chemotherapeutic agents is infiltration or extravasation of drugs into tissue surrounding the infusion site. When infiltrated into the skin, vesicants cause pain, severe local breakdown, and necrosis. Specific measures to ensure adequate dilution, patency, and early detection of extravasation and treatment are important.

a. Intravesical regional chemotherapy is administered into the bladder via a urinary catheter. Leukemia is treated with IV chemotherapy. Osteogenic sarcoma is treated with intraarterial chemotherapy via vessels supplying the tumor. Metastasis to the brain is treated with intraventricular or intrathecal chemotherapy via an Ommaya reservoir or lumbar punctures.

d. Intraperitoneal regional chemotherapeutic administration is used to treat metastasis from a primary colorectal cancer. Intrathecal administration is used with the spinal cord or the brain. Intraarterial administration is used to deliver chemotherapy to tumors via specific vessels. IV administration is used for systemic administration.

b. Patients should always be taught what to expect during a course of chemotherapy, including side effects and expected outcome. Side effects of chemotherapy are serious but it is important that patients be informed about what measures can be taken to help them to cope with the side effects of therapy. Hair loss related to chemotherapy is usually reversible and wigs, scarves, or turbans can be used during and following chemotherapy until the hair grows back.

c. Tissue that is actively proliferating, such as GI mucosa, esophageal and oropharyngeal mucosa, and bone marrow, exhibits early acute responses to radiation therapy. Radiation ionization breaks chemical bonds in DNA, which renders cells incapable of surviving mitosis. This loss of proliferative capacity yields cellular death at the time of division for both normal cells and cancer cells but cancer cells are more likely to be dividing because of the loss of control of cellular division. Cartilage, bone, kidney, and nervous tissues that proliferate slowly manifest subacute or late responses.

d. Avoiding sources of excessive heat and cold will prevent damage to the skin. Only nonmedicated, nonperfumed lotions or creams (e.g., calendula ointment, aloe gel, Aquaphor) are recommended for dry skin. The area should be exposed to air if possible. Gentle cleansing, thorough rinsing, and patting the treatment area dry are recommended.

b. Brachytherapy is the implantation or insertion of radioactive materials directly into the tumor or in proximity to the tumor and may be curative. The patient is a source of radiation and in addition to implementing the principles of time, distance, and shielding, film badges should be worn by caregivers to monitor the amount of radiation exposure. Computerized dosimetry and simulation are used in external radiation therapy.

a. Walking programs scheduled during the time of day when the patient feels better are a way for patients to keep active without overtaxing themselves and help to combat the depression caused by inactivity. Ignoring the fatigue or overstressing the body can make symptoms worse and the patient should rest before activity and as necessary.

b. Alkylating chemotherapeutic agents and high-dose radiation are most likely to cause secondary malignancies as a late effect of treatment. The other conditions are not known to be late effects of radiation or chemotherapy.

c. Biologic therapies are normal components of the immune system and are used therapeutically to restore, augment, or modulate host immune system mechanisms. They have direct antitumor effects or other biologic effects to assist in immune activity against cancer cells. Virtually all biologic therapies may cause a flu-like syndrome. The other options are not correct.

c. The nadir is the point of the lowest blood counts after chemotherapy is started and it is the time when the patient is most at risk for infection. Because infection is the most common cause of morbidity and death in cancer patients, identification of risk and interventions to protect the patient are of the highest priority. The other problems will be treated but they are not the priority.

c. An allogenic hematopoietic stem cell or bone marrow transplant is one in which peripheral stems cells or bone marrow from an HLA-matched donor is infused into a patient who has received high doses of chemotherapy, with or without radiation, to eradicate cancerous cells. In an autologous bone marrow transplant, the patient's own bone marrow is removed before therapy to destroy the bone marrow. The marrow is treated to remove cancer cells and may be infused shortly after conditioning treatment or frozen and stored for later use. With either source, the new bone marrow will take several weeks to produce new blood cells and protective isolation is necessary during this time.

a. Hyperkalemia and hyperuricemia are characteristic of tumor lysis syndrome, which is the result of rapid destruction of large numbers of tumor cells. Signs include hyperuricemia that causes acute kidney injury, hyperkalemia, hyperphosphatemia, and hypocalcemia. To prevent renal failure and other problems, the primary treatment includes increasing urine production using hydration therapy and decreasing uric acid concentrations using allopurinol (Zyloprim).

d. The priority in pain management is to obtain a comprehensive history of the patient's pain. This will determine the medications most useful for this patient's pain to enable giving the dose that relieves the pain with the fewest side effects. Teaching the patient about the lack of tolerance and addiction associated with effective cancer pain management will also be important for this patient's pain management.

a, b, d. Feeling in control, having a strong support system, and the potential of cure or control of the cancer will have a positive effect on coping with the diagnosis. The other options will make coping more difficult for the patient. (See Table 16-19.)