Patho Exam 2 Cancer (Chp 9) – Flashcards
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Benign vs Malignant tumors
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Benign Malignant -Grow slowly -Grow rapidly -Well-defined capsule -Not encapsulated -Not invasive -Invasive -Well differentiated -Poorly differentiated -Low mitotic index -High mitotic index -Do not metastasize -metastasis (can spread distantly)
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Why are malignant tumors not encapsulated?
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So they can invade other tissues
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Why do benign tumors have capsules?
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So they DO NOT invade other tissues
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How are benign & malignant tumors named?
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-Named by tissues from which they arise
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Suffix for naming benign tumors
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-oma
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Benign fat tumor is called
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lipoma
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Benign uterine tumor is called
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leiomyoma
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Benign cartilage tumor is called
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chondroma
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Malignant epithelial tumors are ___________.
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Carcinomas (Ex. ductal/glandular tumors = adenocarcinoma)
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Malignant connective tissue tumors are _________.
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sarcomas (Ex. rhabdomyosarcomas)
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Lymphatic tissue cancers are ___________.
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Lymphomas
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Cancers of blood-forming cells are ____________.
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Leukemias (Leuk- = WBCs; -emia = blood cells)
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Pervasive epithelial malignant tumors of glandular or epithelial origin that have not broken through the basement membrane or invaded surrounding stroma is called.
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Carcinoma in situ (CIS) (Ex. cervical cancer) (once break through the basement membrane, cancer can metasitize. If catch CIS before breaks through basement membrane it is almost 100% curable)
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__________ are biologic markers that produced by cancer cells or are found on plasma cell membranes, in the blood, CSF, or urine.
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Tumor markers
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2 examples of tumor markers
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1. Hormones 2. Antigens
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3 examples of hormone tumor markers
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1. Inc catecholamines (stress related hormone) = adrenal medullary tumor 2. Inc. ACTH (stress related hormone) = Adrenal tumors or pituitary tumors 3. B-HCG = Germ cell and hepatic cancer
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Example of antigen tumor marker
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Inc Carcinoembryonic antigen = colon, lung, pancreas, or breast cancers
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What are tumor markers used for
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1. Screen and identify individuals at high risk for cancer 2. Indicative of potential types of tumors 3. Observe clinical course of cancer
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Cancer is mainly a disease of ________.
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aging
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As a result of a mutation, a cell acquires characteristics that allow it to have selective advantage over its neighbors, thus cancer-causing mutations have an ________ growth rate or _________ apotptosis
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Increased Decreased
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_________ mutations are required before cancer can develop
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multiple
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List the types of mutated genes
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1. Secretion of growth factors (estrogen, progesterone (Tamoxifen)) 2. Increased growth factor receptors (Her2Neu receptors in breast (Herceptin)) 3. Signal from cell-surface receptor is mutated in the "on" position (normal cells signal "stop" replicating if mutated will stay "on") 4. Mutation in intracellular signaling protein to promote replication
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Mutant genes that in their non mutant state direct protein synthesis and cellular growth
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Oncogenes
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Genes that encode proteins that in their normal state negatively regulate proliferation (slows down)
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Tumor-suppressor genes
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What is another name for tumor-suppressor genes?
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Anti-oncogenes
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Many familial cancers are due to the loss of ________________ gene function.
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Tumor suppressor
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Mutation of tumor-suppressor genes allows....
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unregulated cellular growth
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Growth of new vessels
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angiogenesis
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Advanced cancers can secrete angiogenic factors such as ___________.
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VEGF (Vascular Endothelial Growth Factor)
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Drug that is a VEGF inhibitor
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AVASTAN
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Hallmarks of cancer
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-Self-sufficiency in growth signals -Insensitivity to antigrowth signals -Evading apoptosis -Limitless replicative potential -Sustained angiogenesis -Tissue invasion and metastasis
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Are body cells immortal?
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No, can only divide a limited number of times
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_________ are protective caps on each chromosome and are held in place by ___________.
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Telomeres Telomerase
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___________ becomes smaller and smaller with each cell division
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Telomeres
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Genetic testing for breast cancer looks for what markers
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BRCA1/BRCA2
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Genetic testing for colon cancer looks for
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-Lynch syndrome (hereditary nonpolyposis colorectal cancer): p53 -Familial adneomatous (creates polyps) polyposis gene: APC
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Genetic testing for thyroid cancer looks for the gene...
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RET (an oncogene) (thyroid cancer does not usually metastasize)
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Genetic testing for eye cancer looks for...
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Retinoblastoma: RB1 (tumor suppressor)
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Genetic testing for pancreatic cancer looks for...
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Multiple endocrine neoplasia type 2
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Benefits of gene testing
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-Relief -Fewer checkups -Informed decisions -Intervention
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Limitations of gene testing
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-may be acquired, not inherited -may never lead to disease (finds mutation not disease) -may go undetected
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_________ are genes that encode for proteins that are involved in repairing damaged DNA
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caretaker genes
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chromosome instability is increased in ___________ cells
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malignant
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If the mutation occurs in somatic cells, it is not passed to _____________.
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progeny
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If the mutation occurs in germline cells, it can....
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be passed to future generations
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What are some viruses that can lead to cancer
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1. Hepatitis B & C 2. Epstein - Barr virus (EBV) (like mono) affects B lymphocytes and can lead to B lymphoma 3. Kaposi's sarcoma herpevirus (KSHV) is associated with AIDS and suppresses the immune system 4. Hyman papillomavirus (HPV) can lead to cervical cancer 5. Human T cell leukemia-lymphoma virus (HTLV) an oncogenic virus and retro virus (vertical transmisson can be inherited from mom through birth and horizontal transmission is transmitted through breast feeding, sex, blood transfusions, and dirty needles.)
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Which bacteria can cause cancer?
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Helicobacter pylori (chronic infections are associated with peptic ulcer disease, stomach carcinoma, mucosa-associated lymphoid tissue lymphomas)
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How does chronic inflammation lead to cancer?
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-Cytokine release from inflammatory cells -Free radicals -Mutation promotion -Decreased response to DNA repair
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3 tumor spread mechanisms
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1. Direct invasion of contiguous organs (local spread) 2. Metastases to distant organs (lymphatics and blood) 3. Metastases by way of implantation
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Steps of metastasis
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1. Cancer cells invade surrounding tissues and blood vessels 2. Cancer cells are transported by the circulatory system to distant sites 3. Cancer cells reinvade and grow at new locations
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Spread of cancer from a primary site of origin to a distant site
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metastasis
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Where does metastasis usually occur?
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1st capillary bed encountered by circulating cells
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Preferential growth of cancerous cells in certain organs
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Organ tropism (growth factors, cheekiness, hormones, tissue-selective homing receptors, and chemotactic factors)
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Why do cancer patients experience pain?
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pressure, obstruction, invasion of sensitive structures, stretching of visceral surfaces, tissue destruction, and inflammation.
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What is pain influenced by in cancer patients?
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Fear, anxiety, sleep loss, fatigue and overall physical deterioration (little to no pain during early stages of malignancy)
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What causes fatigue in cancer patients?
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Sleep disturbance, biochemical changes from circulating cytokines, secondary to disease and treatment, psychosocial factors, level of activity, nutritional status, and environmental factors
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Most severe form of malnutrition and is present in 80% of cancer patients at death
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syndrome of cachexia (includes: anorexia, early satiety, weight loss, anemia, asthenia, taste alterations, and altered protein, lipid, and carbohydrate metabolism)
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A decrease of hemoglobin in the blood
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anemia
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Causes of anemia
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chronic bleeding resulting in iron deficiency, severe malnutrition, medical therapies (Chemo), or malignancy in blood-forming organs
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Term for low WBCs in cancer patients
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Leukopenia
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Term for low platelets in cancer patients
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Thromobocytopenia
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Causes for leukopenia and thrombocytopenia
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Direct tumor invasion to the bone marrow chemo drugs are toxic to bone marrow
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Normal female hemoglobin levels
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12-16 g/dL
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Normal male hemoglobin levels
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14-18 g/dL
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Normal WBC levels
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4300-10800 cells/m^3
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normal platelet levels
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150000-450,000 /m^3
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_____________ is a nervous system cancer-fighting agent that is part of the immune system that starts attacking nerve and muscle cells.
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Paraneoplastic syndrome (Brain fog or chemo fog-seen a lot in females with breast cancer. Chemo breaks down tumor in breast (which are hormone related organs) causing tumors to go into circulatory system and causing body to go out of whack. Usually temporary and short term)
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What commonly causes paraneoplastic syndrome?
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Biologic substances released from the tumor or by the immune system (Ex hormones) (Symptom complexes that are triggered by a cancer but are not caused by direct local effects of the tumor mass.)
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In which cancers most often will you see paraneoplastic syndrome?
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Breast Lung Ovarian
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Examples of paraneoplastic syndrome.
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-Difficulty walking or maintaining balance, loss of muscle coordination, and tone, or loss of fine motor skills (s.a. picking up objects) -Difficulty swallowing -Slurred speech -Memory loss -Vision problems, spinning sensations (vertigo), or dizziness, etc.
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Use of nonselective cytotoxic drugs that target vital cellular machinery or metabolic pathways critical to both malignant and normal cell growth replication.
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Chemotherapy
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What is the goal of chemotherapy?
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eliminate enough tumor cells so the body's defense can eradicate any remaining cells
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Obstruction of blood flow through the superior vena cava is what kind of oncologic emergency syndrome?
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Superior Vena Cava Syndrome
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What is and oncologic emergency of the right lung- this tumor could compress the SVC causing superior vena cava syndrome?
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Adenocarcinom
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A common symptom that is observed in 63% of patients with superior vena cava syndrome
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Dyspnea
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What are some other symptoms of an oncologic emergency?
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Cough, chest pain, and head ache
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What is a non-invasive treatment for superior vena cava syndrome?
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Blood thinners
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5 types of chemo treatment
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1. Single-agent chemo 2. Combination chemo 3. Principle of dose intensity 4. Therapeutic index 5. neoadjuvant chemo
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Potent chemo drug given 1 at a time to decrease side effects. Greater dose affinity in hopes of making it more affective.
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Single agent chemo (rarely, if ever, provide a cure)
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2 or more chemo drugs used simultaneously or 1 right after the other (cocktail).
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Combination chemo (less toxic than single chemo)
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__________ is used to define drug dosages that can be delivered per time unit. This is based on body size. (How much drug want to give over a regiment-usually over a few weeks)
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Principle of dose (Dose intensity drops if a patient skips a treatment. Only works when given over time if you get the proper dosage)
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What is principle of dose measured in?
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mg/mm^2
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Ratio between therapeutic and toxic dosage of drug. Measure safety (are we still in a safe zone?)
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Therapeutic index
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______________ is given before localized surgery or radiation treatment for cancer. Done before surgery starts. Could be surgery to remove most tumor and then chemo starts or may try radiation 1st. This is done to make chemo more efficient.
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Neoadjuvant chemo
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___________ is given after surgical excision of a cancer with the goal of eliminating micrometastases.
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Adjuvant chem
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Goals for ionizing radiation
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1. Eradicate cancer without excessive toxicity 2. Avoid damage to normal structures
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What does ionizing radiation damage?
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Cancer cell's DNA
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Which cancer is ionizing radiation better suited for?
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Tumors that are hard to reach like bone cancers (esp in pelvic bone)
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How does one pinpoint where ionizing beam goes on a cancer patient?
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Invisible ink marks spot
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3 different types of cancer surgeries
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1. Biopsy and lymph node sampling 2. Debulking surgery (remove part of tumor to increase effectiveness of chemo) 3. Palliative surgery (remove part of tumor if pressing against something... Ex tumor pressing against ureter preventing urination)
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Another type of cancer therapy where receptors can be activated or blocked. This therapy also interferes with cellular growth and signaling
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Hormone therapy
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Type of cancer therapy where anti tumor responses can selectively eliminate cancer cells while sparing normal cells.
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Immunotherapy (treatment that uses your body's own immune system to help fight cancer)
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Immunotherapy can __________ immune system by ____________.
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Increase Cytokines
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_____________ also called immunotherapy, is a type of treatment that mobilizes the body's immune system to fight cancer. The therapy mainly consists of stimulating the immune system to help it do its job more effectively
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Biologic response modifiers (BMRs)
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___________ is a laboratory-produced molecule that's carefully engineered to attach to specific defects in your cancer cells. They also mimic the antibodies your body naturally produces as part of your immune system's response to germs, vaccines and other invaders
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Monoclonal antibodies
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Example of a monoclonal antibody
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IL-2 alpha interferon
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List the side affects of cancer
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-Gastrointestinal tract (vomiting and diarrhea) -Bone marrow (chemo targets rapidly growing cells) -Hair and skin (lose hair, skin flakey and dry) -Reproductive tract (acne, tearing of skin, reproductive issues)
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What is another term for hair loss
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Alopecia
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A patient asks what causes fatigue related to cancer and cancer therapy. How should the nurse respond? One possible cause is:
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malnutrition Answer Feedback: Suggested causes for fatigue include sleep disturbances, various biochemical changes secondary to disease and treatment, numerous psychosocial factors, level of activity, nutritional status, and other environmental and physical factors.
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A nurse is describing the process of metastasis. Which information should the nurse include? _________________ is necessary for metastasis to occur
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Decreased cell adhesions Answer Feedback: Metastasis requires decreased cell adhesions, increased motility, and presence of lymphatic or blood vessels
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Which statement indicates the nurse needs more instruction regarding cancer pain? Mechanisms that cause cancer pain include:
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cancer cells residing in lymph nodes. Answer Feedback: Cancer cells in lymph nodes are not associated with pain. Direct pressure, obstruction, invasion of a sensitive structure, stretching of visceral surfaces, tissue destruction, infection, and inflammation all can cause pain
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An oncologist is describing the process of gene silencing. Which process will the oncologist discuss?
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DNA methylation Answer Feedback: Cells express different characteristics (for example, a liver cell is different from a brain cell) because a different set of genes is allowed to function in each, and the rest of the genes are silenced because of a process called DNA methylation.
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If a patient experiences cancer-causing mutations of a proto-oncogene, what result does the nurse expect to occur?
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Increased cell division Answer Feedback: Proto-oncogenes normally promote cellular division, and overstimulation of these genes that cause them to function as oncogenes can lead to increased rates of mitosis
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A patients cancer report reads Cervical carcinoma in situ . The nurse interprets this finding as the cervical carcinoma:
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contains cancer cells that have not invaded the surrounding tissue. Answer Feedback: Carcinoma in situ refers to pre-invasive epithelial cancers that have not penetrated the basement membrane.
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A nurse is discussing how cancer cells obtain oxygen and nutrients. Which information should the nurse include? Cancer cells ensure adequate supply of oxygen and nutrients by releasing:
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angiogenic factors. Answer Feedback: Angiogenic factors are secreted by cancer cells to promote the development of new blood vessels to deliver oxygen and nutrients to the growing tumor.
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When a cancer patient has a hemoglobin of 8 mg/dL, what condition will the nurse observe documented on the chart?
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Anemia Answer Feedback: Anemia is commonly associated with malignancy, with 20% of persons diagnosed with cancer having hemoglobin concentrations less than 9 g/dL (normal value = 15 g/dL).
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A nurse is discussing the retinoblastoma gene. What type of gene is the nurse describing?
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A tumor-suppressor gene Answer Feedback: One of the first discovered tumor-suppressor genes, the retinoblastoma (RB) gene, normally strongly inhibits the cell division cycle.
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A patient has a mutation in the APC gene. Which type of cancer will the nurse monitor for in this patient?
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Colon Answer Feedback: Individuals with germline mutations of the APC gene have close to a 100% lifetime risk of colon cancer.
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A patient has a Helicobacter pylori infection. Which type of cancer should the nurse assess for in this patient?
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Gastric cancer Answer Feedback: A Helicobacter pylori infection, which also causes peptic ulcer disease, is considered a primary risk factor for gastric cancer.
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A cancer patient is experiencing pain. The nurse wants the patient to be independent in managing the pain. Which technique should the nurse implement?
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Individual-controlled analgesia Answer Feedback: Individual-controlled analgesia provides many benefits, not the least of which is regaining some control over ones own body.
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A patient is receiving neoadjuvant therapy. What should the nurse teach this patient regarding this type of therapy?
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This will help shrink the tumor before surgery. Answer Feedback: Neoadjuvant therapy can shrink a cancer so that surgery may spare more normal tissue.
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Which of the following factors predisposes a patient who has chronic inflammation to the development of cancer?
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Growth factors are released during the resulting inflammation. Answer Feedback: Inflammatory cells release cytokines and growth and survival factors that stimulate local cell proliferation.
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A nurse is describing the process of when a piece of a chromosome is moved to another chromosome. What term should the nurse use to describe this process?
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Translocation Answer Feedback: When one piece of chromosome is moved to another chromosome, it is known as translocation.
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When cancer extends to distant tissues and organs, what term should the nurse use?
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Metastasis Answer Feedback: Metastasis is the extension of cancer to distant tissues and organs.
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While a nurse is reviewing lab results, the patients BRCA1 is elevated. What type of cancer does the nurse suspect the patient has?
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Breast Answer Feedback: BRCA1 is associated with breast cancer.
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Which statement indicates the patient understood the teaching regarding malignant tumors? Malignant tumors have a tendency to:
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invade surrounding tissues. Answer Feedback: Malignant tumors often invade surrounding tissues; however, they also grow rapidly and have a tendency to metastasize.
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A patient is receiving ondansetron. Which assessment finding will cause the nurse to administer this drug?
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Nausea and vomiting Answer Feedback: Aggressive antinausea (antiemetic) therapy, including the centrally acting serotonin 5-hydroxytryptamine (5-HT3) antagonists (such as ondansetron or dolasetron), has allowed better tolerance of highly emetogenic protocols.
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A patient is experiencing leukopenia from cancer and chemotherapy treatment. Which condition should the nurse assess for in this patient?
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Infection Answer Feedback: Leukopenia, which is manifested by a decreased white blood cell count, increases an individual's risk for infection and sepsis.
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Which of the following alterations in metabolism does the nurse expect to find in people with cancer?
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Increased basic metabolic rate Answer Feedback: The release of cytokines such as TNF, IL-1, IL-6, and interferons results in increased protein, carbohydrate, and lipid metabolism.
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A nurse knows the most common tumor suppressor gene mutation that causes cancer by resisting apoptosis is in:
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p53. Answer Feedback: The most common mutations conferring resistance to apoptosis occur in the p53 tumor-suppressor gene (TP53).
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A cancer patient is complaining of pain. Which pharmacologic therapy for pain management will the nurse implement?
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Narcotics/opioids Answer Feedback: Many modalities are available to treat pain, ranging from combinations of NSAIDs and narcotics.
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Besides monitoring for diminished physical energy, what other assessment findings should the nurse assess for in a patient with cancer-related fatigue?
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Depression Answer Feedback: Fatigue is described by individuals with cancer as tiredness, weakness, lack of energy, exhaustion, lethargy, inability to concentrate, depression, sleepiness, boredom, lack of motivation, and decreased mental status.
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Which symptom will surprise the nurse when assessing a patient with cachexia?
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Heart murmur Answer Feedback: The syndrome of cachexia includes a constellation of symptoms including anorexia, early satiety, weight loss, anemia, asthenia, taste alterations, and altered protein, lipid, and carbohydrate metabolism.
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Which principle should the nurse use to guide nursing care when administering chemotherapeutic agents? Chemotherapeutic agents primarily target:
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all rapidly dividing cells. Answer Feedback: Chemotherapeutic agents target cells at certain stages in the cell cycle and therefore tend to cause injury or death to rapidly dividing cells. Populations affected include cancer cells and any healthy tissue undergoing mitosis, including cells of the bone marrow, hair follicle, and gastrointestinal tract.
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A nurse is discussing the process of triggering new blood vessel formation in a tumor. What is the nurse describing?
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Angiogenesis Answer Feedback: Angiogenesis is the formation of new blood vessels. Angiogenic factors are secreted by cancer cells to promote the development of new blood vessels to support the growing tumor.
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A patient has a sarcoma. The nurse realizes sarcomas are cancers that arise from:
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connective tissues. Answer Feedback: Cancers arising from mesenchymal tissue (including connective tissue, muscle, and bone) usually have the suffix sarcoma.
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A patient is receiving brachytherapy for cervical cancer. How should the nurse explain this type of therapy?
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The radiation source will be inserted internally into the cervix. Answer Feedback: Radiation sources, such as small 125I-labeled capsules (also called seeds), can also be temporarily placed into body cavities, a delivery method termed brachytherapy.
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A patient originally had cancer in the liver and the cancer is now in the lungs. What stage will the nurse observe documented on the chart?
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4 or IV Answer Feedback: Cancer that has spread to distant sites, such as a liver cancer spreading to lung or a prostate cancer spreading to bone, is stage 4.
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An oncologist is presenting information on the mutation of RAS. What response does the nurse expect to occur?
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Unregulated proliferation of cancer cells Answer Feedback: A point mutation in the RAS gene converts it from a regulated proto-oncogene to an unregulated oncogene, an accelerator of cellular proliferation.
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For the function of a tumor suppressor to be lost, which of the following mutational routes is most likely to cause cancer in a patient?
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Mutation of both copies of a tumor suppressor gene Answer Feedback: Both copies of a tumor suppressor gene must be mutated/deleted/inactivated for cancer to occur.
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A nurse remembers neuromuscular dysfunction and the release of inflammatory mediators such as tumor necrosis factor and interleukin-1 are thought to be responsible for which of the following assessment findings of cancer?
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Fatigue Answer Feedback: The hypothesized causes of cancer-related fatigue involve the effects of neuromuscular dysfunction and inflammatory mediators on skeletal muscle function.
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A nurse is asked to define a proto-oncogene. Which is the nurses best response? A proto-oncogene is:
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a normal, nonmutant gene. Answer Feedback: A proto-oncogene normally codes for proteins such as growth factors and growth factor receptors. A normal proto-oncogene does not cause cancer.
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A nurse is preparing to teach about gene p53. Which information should the nurse include? Normally, the tumor suppressor gene p53 induces:
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apoptosis. Answer Feedback: Normally, the p53 gene is a tumor suppressor gene that induces apoptosis of injured or mutated cells. Loss of this gene can contribute to the survival of a cancer cell.
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A patient has a tumor that has distant lymph node involvement but no evidence of distant metastasis to other tissues. How will this be classified on the chart?
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Stage III. Answer Feedback: Stage III tumors have evidence of regional lymph node spread but no distant metastasis.
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A nurse recalls a leading cause of death in developed worlds is:
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cancer Answer Feedback: Cancer is a leading cause of suffering and death in the developed world.
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A patient has metastatic cancer and is receiving chemotherapy and radiation therapy. What is the priority complication the nurse should assess for in this patient?
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Infection Answer Feedback: Infection is the most significant cause of complications and death in persons with malignant disease.
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A patient loses hair from chemotherapy treatment. What term should the nurse use when describing this condition?
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Alopecia Answer Feedback: Alopecia is hair loss from chemotherapy toxicity to the hair follicle.
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Which of the following viruses will the nurse expect to see on the lab report of a patient who has developed cervical cancer?
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Human papilloma virus Answer Feedback: The sexually transmitted human papilloma virus is the primary cause of cervical cancer.
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A nurse is describing an aggregation of cancer cells that accumulates faster than its non-mutant neighbors. Which term is the nurse discussing? Clonal:
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expansion. Answer Feedback: Clonal expansion is the term used to describe the rapid proliferation of a mutated cancer cell and its progeny. Cancer cells gain a selective advantage over their neighboring cells by proliferating and expanding at a faster rate.
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Which statement indicates the nurse needs more instruction regarding anemia and cancer? Anemia in individuals with cancer can be the result of:
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fatigue. Answer Feedback: Fatigue is a symptom of anemia, not a cause. Mechanisms that cause anemia in persons with cancer include chronic bleeding (resulting in iron deficiency), severe malnutrition, cytotoxic chemotherapy, and malignancy in blood-forming organs.
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While assessing a patient with cancer, which of the following is the most commonly reported symptom?
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Fatigue Answer Feedback: Direct pressure, obstruction, invasion of a sensitive structure, stretching of visceral surfaces, tissue destruction, infection, and inflammation all can cause pain.
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An oncologist is discussing the process of metastasis. Which information should the oncologist include? For metastasis to occur, tumor cells must be capable of:
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surviving in the bloodstream. Answer Feedback: Cancers often spread first to regional lymph nodes through the lymphatics and then to distant organs through the bloodstream.
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A patient is preparing to receive adjuvant therapy for cancer. What should the nurse tell the patient to reinforce teaching? This type of therapy:
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is given after cancer surgery. Answer Feedback: Adjuvant chemotherapy is given after surgical excision of a cancer with the goal of eliminating micrometastases.
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A patient is experiencing the wasting syndrome associated with cancer and cancer treatment. What term should the nurse use when documenting this finding?
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Cachexia Answer Feedback: The wasting syndrome associated with cancer and cancer treatment is known as cachexia.
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An oncologist is using the TNM system to stage a cancer tumor. The nurse realizes the N will denote:
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nodes. Answer Feedback: The most commonly used cancer staging scheme is called the TNM system, which stands for tumor, nodes, and metastasis.
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A nurse is discussing cancer and anaplasia. What is the nurse describing when using the term anaplasia?
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Loss of cellular differentiation Answer Feedback: Cancer cells appear undifferentiated, or anaplastic, when compared with normal, mature cells.
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Which of the following statements indicates a patient needs more teaching about cancer pain?
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Most patients with cancer experience pain early in the disease process. Answer Feedback: Pain does not usually occur until late in the disease process after the tumor begins to cause tissue damage and compress nerves. The majority of patients with terminal cancer experience pain
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A nurse is discussing benign tumors. Which information should the nurse include?
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Benign tumors are usually surrounded by a capsule. Answer Feedback: Most benign tumors are surrounded by a capsule that separates the tumor from the surrounding tissue.
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A patient with cancer has poor muscle functioning and fatigue. Which cytokines/inflammatory mediators does the nurse suspect is causing these problems?
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Tumor necrosis factor and interleukin-1 Answer Feedback: Other areas of research for fatigue include muscle function consequences from metabolic products of cancer treatment and associated muscle loss from circulating cytokines (e.g., tumor necrosis factor [TNF] and interleukin-1 [IL-1]).
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A nurse is teaching the staff about the pathophysiology of tissue loss in cancer wasting. Which information should the nurse include? A factor that contributes to the tissue loss in cancer wasting is:
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he release of cytokines. Answer Feedback: Cytokines, including TNF-α, IL-6, and interferon-δ appear to cause the metabolic alterations associated with tissue loss in cancer wasting
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While assessing a patient with pain which individual response to pain should the nurse monitor?
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All of the above (Cultural, psychologic, & physiologic factors) Answer Feedback: Cultural, psychologic, and physiologic factors all play a role in an individual's response to pain.
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A nurse is discussing the genes that maintain gene integrity. Which gene is the nurse describing?
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Caretaker Answer Feedback: These repair mechanisms are directed by caretaker genes, or genes that are responsible for the maintenance of genomic integrity.
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When an oncologist determines the size of the tumor, the degree of node involvement, and the extent of distant metastasis, what is the oncologist doing?
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Staging Answer Feedback: Determining the size of the tumor, the degree of node involvement, and the extent of distant metastasis is called tumor staging.
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A patient is experiencing paraneoplastic syndrome. Which principle should guide nursing care?
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Hormones are probably causing the signs and symptoms. Answer Feedback: Paraneoplastic syndrome is most commonly caused by biologic substances released from the tumor (e.g., hormones) or by an immune response triggered by the tumor.
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A patient has chronic active hepatitis B infection. Which type of cancer should the nurse assess for in this patient?
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Liver Answer Feedback: Chronic active hepatitis B infection can cause increased cell division and mutagenesis in liver cells.
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When a patient asks the nurse how radiation therapy provides an effective means for treating some forms of cancer, how should the nurse respond?
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Ionizing radiation damages the cancer cell's DNA. Answer Feedback: A focused beam of ionizing radiation can cause enough DNA damage to seriously injure or kill tumor cells.
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A nurse is asked about immortality in cancer cells. How should the nurse reply? Immortality in cancer cells is obtained through the production of:
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Telomerase. Answer Feedback: The telomere in normal cells caps the end of each chromosome and prevents unlimited cell division. Cancer cells, like embryonic cells, produce an enzyme called telomerase that helps maintain the telomere and allows the cell to achieve immortality.
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A patient has thrombocytopenia from the cancer and cancer treatments. Which condition should the nurse monitor for in this patient?
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Hemorrhage Answer Feedback: Thrombocytopenia is a major cause of hemorrhage in persons with cancer.
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A patient has colorectal cancer with chronic bleeding and iron deficiency. Which lab tests are most important for the nurse to monitor?
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Red blood cell count and hemoglobin from a complete blood count Answer Feedback: Chronic bleeding and iron deficiency can accompany colorectal or genitourinary malignancy, making the patient prone to anemia. Anemia can be monitored by the red blood cell count and hemoglobin.
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Which of the following treatments to help cancer-related or chemotherapy-related anemia should the nurse discuss with the patient?
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Erythropoietin Answer Feedback: Exogenous erythropoietin can be administered to stimulate bone marrow production of red blood cells.
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The nurse is describing the cell, ras. What type of cell is the nurse discussing?
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Proto-oncogene Answer Feedback: RAS is a proto-oncogene.
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A nurse recalls the normal function of tumor suppressor genes in an individual without cancer is to:
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control production of anti-growth signals. Answer Feedback: Normally, tumor suppressor genes control the production of antigrowth signals, thus preventing tumor growth.
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Which of the following statement indicates the nurse needs more teaching about cancer cells? A typical characteristic of cancer cells is:
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decreased responsiveness to growth signals. Answer Feedback: Cancer cells usually have an increased responsiveness to growth signals.
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Which patient will the nurse monitor most often even though the tumor is benign? The benign tumor is located in the:
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skull/cranium. Answer Feedback: It is important to recognize that benign neoplasms also can be life-threatening if they enlarge in critical locations, like the brain/skull/cranium.
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What screening test can the nurse suggest to a patient who wants to detect cervical cancer early?
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Pap test/smear Answer Feedback: Early detection of cellular atypia in a Pap test alerts healthcare providers to the possibility of cervical carcinoma in situ, which can be effectively treated.
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A patient has a cancer that originated in the blood-forming cells. What diagnosis will the nurse observe documented on the chart?
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Leukemia Answer Feedback: Leukemia always arises from an initial mutation in the blood-forming cells of the bone marrow.
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Which of the following terms should the nurse use to describe a genetic event capable of activating oncogenes?
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Amplification Answer Feedback: Since the growth promoting effect of oncogenes must involve overexpression of the gene, amplification is a genetic event that can activate an oncogene.
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When a nurse is describing malignant tumors, which term should the nurse use?
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Cancer Answer Feedback: The term cancer refers to a malignant tumor and is not used to refer to benign growths such as lipomas or hypertrophy of an organ.
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Which statement indicates the nurse has a good understanding of benign tumors? Benign tumors:
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are usually encapsulated. Answer Feedback: Benign tumors are usually encapsulated
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A nurse reviews a cancer report that states the growth is carcinoma in situ (CIS). How will the nurse interpret this finding?
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The growth is localized to the epithelium. Answer Feedback: CIS growths are localized to the epithelium but have not penetrated the local basement membrane.
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The nurse is describing clonal expansion/proliferation. What process is the nurse discussing?
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When cancer cells proliferate faster than the normal, nonmutant cells. Answer Feedback: Mutant cell may then have a selective advantage over its neighbors; its progeny can accumulate faster than its nonmutant neighbors. This is referred to as clonal proliferation or clonal expansion
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An oncologist is using the TNM system to stage a patients cancer. How does the nurse interpret the M part of the system?
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Metastasis Answer Feedback: One common scheme for standardizing staging is the World Health Organizations TNM system: T indicates tumor spread, N indicates node involvement, and M indicates the presence of distant metastasis.
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A cancer patient is experiencing cachexia. Which typical assessment finding will the nurse observe in this patient?
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Extreme wasting and emaciation Answer Feedback: Cachexia is the most severe form of malnutrition associated with cancer and results in wasting, emaciation, and decreased quality of life.
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A patient has a decreased platelet count from cancer and the chemotherapy. Which complication should the nurse assess for in this patient?
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Bleeding Answer Feedback: Bleeding can result from thrombocytopenia, a decrease in platelets.
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A nurse is discussing autocrine stimulation and cancer. Which information should the nurse include? Autocrine stimulation causes:
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a cancer cell to grow. Answer Feedback: Some cancers acquire the ability to secrete their own growth factors (for example, platelet-derived growth factor [PDGF]) to stimulate their own growth, a process known as autocrine stimulation.
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A nurse is preparing to teach about immortality in cancer cells. Which information should the nurse include?
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Activation of telomerase allows cancer cells to continue dividing. Answer Feedback: Immortality allows cancer cells to somehow activate telomerase to restore and maintain their telomeres, thereby allowing them to continue dividing.
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When a nurse is defining an oncogene, which example should the nurse use?
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Oncogenes stimulate cancer cell growth. Answer Feedback: Oncogenes stimulate cancer cell growth
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Which of the following statements indicates the patient has a good understanding of metastasis? The most common routes of metastasis are through the lymphatic system and:
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blood vessels. Answer Feedback: The most common routes of metastasis are through the lymphatics and blood vessels.
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A patient has chronic infection by the human papilloma virus (HPV). Which cancer does the nurse monitor for in this patient?
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Cervical Answer Feedback: Virtually all cervical cancer is caused by infection with specific subtypes of HPV.
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A cancer patient is having moderate pain. Which treatment will the nurse implement?
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Nonsteroidal anti-inflammatory drugs (NSAIDs) Answer Feedback: Many modalities are available to treat pain, ranging from combinations of NSAIDs and narcotics to palliative surgery and radiation therapy.
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A patient is receiving adjuvant therapy. How should the nurse explain this type of therapy to the patient? This type of therapy:
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is given after surgery. Answer Feedback: Adjuvant chemotherapy is given after surgical excision of a cancer with the goal of eliminating micrometastases.
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A patient has mutations in BRCA1 and BRCA2. What type of cancer should the nurse monitor for in this patient?
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Breast Answer Feedback: Mutations in BRCA1 and BRCA2 make one prone to breast cancer.
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A patient has cancer in the epithelial tissue. Which diagnosis will the nurse observe documented on the chart?
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Carcinoma Answer Feedback: Cancers that arise from epithelial tissues are called carcinomas.
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A patient has cancer of the connective tissue. Which diagnosis will the nurse observe documented on the chart?
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Sarcoma Answer Feedback: Cancers that arise from connective tissues are called sarcomas.
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Which of the following cancers arise from bone marrow stem cells (blood forming cells) and always originate in the bone marrow?
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Leukemia Answer Feedback: Cancers that arise from bone marrow stem cells are called leukemias.
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Which of the following information indicates the nurse has a good understanding of malignant tumors?
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Malignant tumors have a tendency to invade surrounding tissue. Answer Feedback: Malignant tumors often invade healthy tissues.
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A nurse is discussing the p53 gene. What type of gene is the nurse describing?
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Tumor suppressor Answer Feedback: The p53 gene is a tumor suppressor gene.
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A nurse is asked about the function of the p53 gene. What is the nurses best response? p53
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causes apoptosis. Answer Feedback: Apoptosis is the main function of p53.
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A nurse recalls cancer cells stimulate blood vessel growth toward the tumor by releasing:
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angiogenic factors Answer Feedback: Angiogenic factors are secreted by cancer cells to promote the development of new blood vessels to deliver oxygen and nutrients to the growing tumor.
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If a patient experiences a cancer-causing mutations to proto-oncogenes, which response will the nurse expect?
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Increased cell division Answer Feedback: Proto-oncogenes normally promote cellular division, and overstimulation of these genes that cause them to function as oncogenes can lead to increased rates of mitosis.
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When a staff members asks the nurse what mutation is necessary to cause cancer with a tumor suppressor gene, how should the nurse reply?
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Deletion of both copies of a tumor suppressor gene Answer Feedback: Both copies of a tumor suppressor gene must be deleted for cancer to occur.
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A patients ovarian cancer has traveled to the bone. What term should the nurse use to describe this finding?
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Metastasis Answer Feedback: Metastasis occurs when the cancer travels to distant sites.
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A patient has colorectal cancer with chronic bleeding and decreased absorption of iron. Which complication is priority?
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Anemia Answer Feedback: Mechanisms that cause anemia in persons with cancer include chronic bleeding (resulting in iron deficiency), severe malnutrition, cytotoxic chemotherapy, and malignancy in blood-forming organs.
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A patient has a tumor that has regional lymph node involvement. Which stage will the nurse observe documented on the chart?
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Stage II. Answer Feedback: Stage II tumors may have evidence of regional lymph node spread but have not yet spread to distant lymph nodes or other tissues.
