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Oncology Review Questions
Define Cancer
Cancer is an uncontrolled,
unregulated growth of cells
During a blood test, what
protein markers indicate
cancer and why?
CEA - Carcinoemboryonic
antigen
FP- Alpha-fetoprotein
These are fetal cell attributes
that indicate undifferentiated
What determines the rate of
proliferation of cancer cells?
The rate of proliferation is the same as
the rate of the tissue that the cancer
derives from.
Tissues such as; bone marrow, hair
follicles and epithelial lining of GI have
a rapid cell proliferation while other
tissues such as myocardium and
cartilage cell proliferation is slow
Name the stages of cancer
development
1. Initiation
2. Promotion
3.Progression
What is the relationship
between a carcinogen and the
first stage of cancer
development?
Carcinogen’s cause mutation
in a cell’s genetic structure
What happens to a cell when
it’s genetic structures is
mutated by a carcinogen?
1. The cell will die
(apoptosis=cell suicide)
2. The cell will repair itself
3. The cell will survive and
replicate the mutated DNA
in daughter cells
What are some examples of:
Chemical carcinogens?
Radiation carcinogens?
Virus carcinogens?
Chemical carcinogen:
smoking and asbestos
Radiation carcinogen: atomic
bomb and the sun
Viral carcinogen: Mono
What is promotion in terms of
cancer development?
It is the reverse proliferation of
mutated/altered cells by a
presence of promotion agents
What are some promoting
agents that increase the
chances of cancer developing
from altered cells?
Dietary fat, obesity, cigarette
smoking, alcohol consumption
What stage of cancer
development is identified by
tumor growth and invasion
through metastasis?
Progression
What are common sites of
metastasis?
Brain, lungs, bone, liver and
adrenal glands
What is tumor angiogenesis?
The process of formation of
blood vessels within the tumor
itself
What is the process of
metastasis?
1.
Rapid proliferation causes mechanical pressure
leading to penetration of surrounding tissues
2. Metalloproteinase enzymes are produced by
some cancer cells; they destroy the basement
membrane of not only the tumor itself, but also
surrounding lymph, blood vessels, muscles,
nerves and most epithelial boundaries
3. Tumor cells detach and travel to distal organ
sites by blood and lymph
Whats the difference between
hematogenous metastasis
and skip metastasis?
Hematogenous involves spreading
through blood via
metalloproteinase, skip metastasis
happens when the tumor cells
bypass regional lymph nodes to
travel to distant lymph nodes where
it creates a similar enviroment as
the primary cancer site
What are BRAC 1 and BRAC
2, what happens when they
are altered?
BRAC 1&2 are tumor
supressor genes for breast
cancer, when there are
alterations with the BRAC
tumor suppressor genes,
cancer is at a greater risk to
develop
What does the immune
system do?
The immune system has the
potential to distinguish cells of
normal (self) to abnormal
(non-self)
What are TAA?
TAA are tumor-associated
antigens, it is an antigen on
the surface of cancer cells that
are a result of malignant
transformation. This antigen
elicits a response of the
immune system
What is the response to TAA
known as?
Immunologic surveillance
What categories are used to
classify cancer?
Classified according to
1) anatomical site
2) histology/grading
3) and extent of
disease/staging
Where do carcinomas
originate from?
Where do sarcomas originate
from?
Where do lymphomas and
leukemias originate from?
Carcinomas originate from embryonal ectoderm
(skin and glands) and endoderm (mucus
membrane lining of resp. tract, GI tract and GU
tract)
Sarcomas originate from embryonal mesoderm
(connective tissue, muscle, bone and fat)
Leukemia and lymphomias originiate from the
hematopoietic system
What determines the
treatment plan of a type of
cancer?
The staging of the cancer
determines the treatment of
the cancer
What are three types of biopsy
procedure that are used to
examine suspect tissue?
Needle, incisional and
excisional
Goals for treatment are driven
by the presentation of disease
and patient factors, what type
of treatments are determined
by patient factors?
Cure: eradicate cancer
Control: put into remission
Palliation: provides relief from
symptoms and improves
quality of life
What are the treatments for
cancer?
Surgery (used to prevent,
diagnose and treat)
Chemotherapy
Radiation
Biological and targeted
therapy
What is the most common
administration route for
chemotherapy?
Intravenious
What is intrathecal and
intraventricular and why is it
important?
Infusing through the spinal
column, it is important for
administering chemothearpy
to the brain, since it can
bypass the blood/brain barrier
Where does intravesical
chemotherapy deliever to?
Chemotherapy delievered to
the bladder
What are two IV infusion
routes for chemotherapy,
which one is considered to be
the better of the both when it
comes to long term therapy?
PIC line and CVAD
CVADs such as tunneled catheters,
peripherally inserted central catheter
and ports are more beneficial for long
term use because it can be used for
continuous infusion, you are able to
adiminister other products through
the line and there is a decrease in
extravasation injury
What is one negative aspect
to patient safety when it
comes to CVADs such as a
implanted port?
There is an increase for
systemic infection
What are some considerations
when administering
chemotherapy agents?
Be cautious with
chemotherapy agents
because they can be;
1. Vesicants
2. Irritants
3. Extravasation
4. Acute toxicity
What are some symptoms of
acute toxicity with
chemotherapy?
Anaphylactice reaction,
extravasation (caused by
vesicants) and anticipatory
N&V
What is simulation?
Simulation is radiation
treatment and planning
What is the big difference
between teletherapy and
brachytherapy?
Teletherapy is external and is
not radioactive, whereas
brachytherapy is internal and
is radioactive
What type of brachytherapy is
used in radiation treatment for
thyroid cancer?
I-89 (Iodine 89)
Radiation causes bone
marrow suppression, what is
the Nadir
Nadir is the time in which the
patient reaches the lowest
blood cell count, generally 710 days after treatment is
initiated
What does neutropenia
mean?
Low WBC
What does pancytopenia
mean?
All types of blood counts are
low; WBC, RBC and platelets
What medications stimulate
WBC production?
Neupogen/filgrastin and
Neulasta/pegfilgrastin both
stimulate WBC production
What medications stimulate
production of RBC?
Darbepoetin/arnesp and
Epoetin/epogen (Procrit)
stimulates RBC production
Name some antiemetics
Reglan, Zofran and Kytril
What is biologic therapy?
Biologic therapy consists of
agents that modify the
relationship between the host
and the tumor by altering the
biologic response of the thost
to the tumor cells
What are the three ways
biologic therapy affects the
tumor cells?
1. Direct anti-tumor effects
2. Augment host immune
system
3. Interfere with cancer
cell’s ability to metastasize
or differentiate
What is targeted therapy?
Targeted therapy interferes
with cancer growth by
targeting specific cellular
receptors and pathways that
are important in tumor growth
Why is targeted therapy safer
than chemotherapy?
Chemotherapy not only kills
cancer cells but also healthy
normal cells, whereas
targeted therapy has the affect
of killing the cancer cells
without harming normal cells
What is an example of
targeted therapy?
Angiogenesis inhibitors
prevent vascularization of
tumors
If a neutropenic patient has a
temperature of 100.5 or higher
what should be done?
Asses for s/s of fever,
determine the etiology through
UA/cultures, Chest X-ray and
blood test as well as a CBC to
determine the severity of the
neutropenia?
What is a precaution when
treating neutropenic patient
when administering tylenol?
Tylenol can mask s/s of fever,
at times fever can be the only
and first sign of infection. If
infection continues without
attention there is a risk for
septic shock
What are three types of
obstructive emergencies?
Superior vena cava syndrome
Spinal cord compression
Third space syndrome
What is the treatment for
spinal cord compression?
Laminectomy
What is third space syndrome,
what are the symptoms and
what is the treatment?
Third space syndrome is a
shift of fluid volume from
vascular space to interstitial
space, s/s include
hypovolemia, hypotension,
tachycardia and decreased
urine output. Treatment is with
fluids and electrolytes
What infiltrative emergency is
characterized by fluid around
the heart?
Cardiac taponade