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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