oncology 1-6,9, 11-13

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kdarnell
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150228
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oncology 1-6,9, 11-13
Updated:
2012-04-26 21:33:23
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oncology 11 13
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oncology 1-6, 9, 11-13
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  1. define neoplasm
    new or abnormal formation of tissue
  2. define benign neoplasm
    disordered cell growth

    does not spread
  3. define malignant neoplasm
    cancer
  4. define tumor
    means swelling

    oma=tumor
  5. define cachexia
    physical wasting and weight loss
  6. define paraneoplastic syndrome
    when a tumor produces hormones or cytokines that circulate and have adverse effects on tissues away from metastasis
  7. when is a patient in remission?
    when lab fails to find evidence of cancer cells
  8. when is a patient cured?
    in remission for 5 years
  9. characteristics of carcinoma:

    arises from __1____ which originate from embryological __2___

    malignant cells form __3____ tumor

    location: __4___, glands _5___, in the epithelium of __6__, __7__,, __8__, __9__

    is it the most common neoplasm? (10)

    metastasizes via __11___ system
    • 1.epithelial cells: skin cells or gland cells
    • 2. ectoderm
    • 3. solid
    • 4. skin
    • 5. adeno
    • 6. breast
    • 7. lung
    • 8. colon
    • 9. stomach
    • 10. yes 80%
    • 11. lymph
  10. characteristics of sarcoma

    arises from __1__, __2__, __3__,__4__, which originate from embryologic __5__

    it is __6__% common

    metastasizes via __7__ system
    • 1. muscle
    • 2.bone
    • 3. cartilage
    • 4. fat
    • 5. mesoderm, mesenchymal cells
    • 6. 10
    • 7. venous
  11. characteristics of lymphoma

    arises from __1___, __2__, __3__

    two types __4__ & __5__

    non-hodgkins is associated with __6__
    • 1. lymph nodes
    • 2. spleen
    • 3. intestinal lining
    • 4. hodgkins
    • 5. non hodgkins
    • 6. AIDS
  12. characteristics of leukemia

    arises from __1___

    types are: ALL, AML, CML, CLL
    1. hematopoietic stem cells
  13. grades of malignancy

    1-
    2-
    3-
    4-
    1- well differentiated

    2-moderately differentiated

    3-poorly differentiated

    4-undifferentiated (bad prognosis)
  14. what does the T mean in the TNM system of staging and what are the levels?

    Tx,
    T1
    T2
    T3
    T4
    T= tumor size

    Tx= tumor cannot be evaluated

    T1= in situ-no penetration <2cm

    T2=beyond membrane >2cm <5cm

    T3= through layers >5cm

    T4=into surrounding structures
  15. what does the N mean in the TNM staging of tumors and what do the levels mean?

    Nx
    No
    N1-N3
    N4
    N= nodes involved

    Nx=nodes cannot be evaluated

    No=no evidence of node involvement

    N1-N3=increasing increments of involvement

    N4=both sides of body involved
  16. what does the M mean in the TNM staging of tumors and what do the levels mean?

    Mx
    Mo
    M1
    M= metastasis

    Mx=metastasis cannot be evaluated

    Mo=no metastasis

    M1=distant metastasis
  17. staging for hodgins/non-hodgkins lymphoma
    1
    2
    3
    4
    1-single lymph

    2-two or more regions-same side of diaphragm

    3-regions on both sides

    4-diffuse with extra lymphatic organs involved
  18. what is the most serious form of skin cancer?
    malignant melanoma
  19. characteristics of malignant melanoma

    does it affect white or black people more? 1

    risk factors: ___2___ and __3___

    the ___4___are the most common place of occurence
    1 affect white people more 10x

    2-UV exposure

    3-multiple moles

    4-soles of the feet
  20. ABCD's of screening melanoma what do the E's mean?
    • A-asymmetry (lopsided)
    • B-border (irregular edges)
    • C-color (black, brown, red, white, blue)
    • D-diameter (larger than pencil eraser)

    E can mean evolving or Elevated
  21. What does C-A-U-T-I-O-N mean?
    • C-change in bowel or bladder
    • A-a sore that does not heal
    • U-unusual bleeding or discharge
    • T-thickening or lump in the breast (or anywhere)
    • I-indigestion or difficulty swallowing
    • O-obvious change in wart/mole
    • N-nagging cough or hoarseness
  22. Clues to screening for cancer:
    older than ? (1)

    previous history of cancer especially in the presence of __2__, __3__, __4__, or __5__

    any woman with pain in the __6__,__7__,__8__,__9__

    anyone with pain in the back, pelvic, groin or hip pain with additional __10__ complaints

    women with prolonged ___11___

    men with sciatica and history of __12__cancer

    when a back injury ___13___
    • 1-older than 50
    • 2-carpal tunnel
    • 3-back pain
    • 4-shoulder pain
    • 5-joint pain
    • 6-chest
    • 7-breast
    • 8-axillary
    • 9-shoulder
    • 10-abdominal
    • 11-menstrual bleeding
    • 12-prostate
    • 13-not improving as anticipated
  23. early warning signs of cancer:

    _1__muscle weakness, changes in ___2___

    recent weight loss of __3_lbs or more in 1 month

    constant/intermittent pain? 4

    pain present at __5__

    signs of ___6___ be screened for cancer as possible cause

    development of __7___deficits

    changes in __8__,__9__,__10__,__11__ of lymph nodes

    hard rubbery nodes lasting more than __12__weeks in 1 or more locations
    • 1-proximal
    • 2-deep tendon reflexes
    • 3-10lbs
    • 4-CONSTANT pain
    • 5-at night
    • 6-nerve root compression
    • 7-neurological deficits
    • 8-size
    • 9-shape
    • 10-tenderness
    • 11-consistency
    • 12-4 weeks
  24. when is nadir given?
    10-14 days after chemo has been completed when myelosupporession peaks
  25. explain the reverse isolation protocol:
    pt protects themselves from public instead of vice versa
  26. what is myelosuppression?
    bone marrow depression

    =decreased production of blood components
  27. LAB VALUES:

    platelets-

    WBC

    RBC

    hemoglobin

    hematocrit
    platelets- 200,000-500,000 mm3

    WBC-5,000-10,000 mm3

    RBC- male 5.0 million/mm3 femal 4.5 million/cubic mm3

    hemoglobin-male 14-18 g/dL female 12-16 g/dL

    hematocrit-male 42-54% female 37-47%
  28. platelet levels and exercises

    between 30,000-50,000 mm3

    below 30,000 mm3

    below 20,000 mm3
    30,000-50,000-resistive ex should be changed to active ex, ambulation can continue

    below 30,000-gentle exercises at bed

    below 20,000-minimal exercise
  29. drugs (2) that can cause cardiac toxicity and what to do
    Adriamycin/ Daunorubin

    check for SOB, diaphoresis, chest pain, increased pulse
  30. drugs (4) that can cause pulmonary fibrosis and what to do
    Bleomycin, other drugs: Methotrexate, Cisplatin, Busulfan

    may cause RLD

    look for cyanosis, confusion, chest pain, dizziness, increased heart rate
  31. drugs (4) that can cause peripheral neuropathy and what to do
    Vincristine, other drugs: Ara-c, Cisplatin, Vinblastine

    loss of strength in hand intrinsics
  32. drugs(2) that cause fibrosis and what to do
    Cisplatin, Adriamycin

    check for redness, pain or swelling at IV site
  33. signs/symptoms of GI toxicity and what to do
    nausesa vomiting diarrhea

    maintain strength and endurance
  34. drugs that cause alopecia (6)
    Adriamycin, Actinomycin D, Methotrexate, Cytoxin IV, 5-FU, Vincristine
  35. principals for pts undergoing chemo (4)
    know chemo regimen

    save all urine

    schedule therapy before any chemo given

    allow pt to set limits
  36. radiation therapy

    targets ___1____: disrupts replication and causes cell death

    methods of administration: __2___ or __3___

    goal: 4

    typical regimen is __x/wk for __weeks

    factors affecting patient reactions: (6)
    • 1-cellular DNA
    • 2-external beam
    • 3-radioactive seed implant
    • 4-target tumor and minimize exposure to healthy tissue
    • 5- 5x/wk for 6 weeks
    • 6-total dose
    • frequency
    • intensity
    • treatment schedule
    • chemo
    • radiation
  37. side effects of radiation:
    1-
    2-
    pulmonary-
    neuromusculoskeletal
    GI-
    pain-
    integumentary- early vs late
    • 1-fatigue, lethargy, mental depression, confusion
    • 2-myelosuppression
    • pulmonary-RLD
    • neuromusculoskeletal-decreased bone density, strength
    • GI-radiation sickness
    • pain-chest wall, breast, axillary
    • integumentary-early-inflammation, hair loss, edema
    • late-radiation fibrosis
  38. early PT intervention following radiation
    • skin and wound care
    • ROM
    • no eccentric strengthening
    • no thermal modalities, no massage
  39. PT intervention following radiation (5)
    • address loss of ROM
    • joint mobs
    • strength training
    • soft tissue mobs
    • education
  40. changes in skin (9)
    • 1-erythema
    • 2-alterations in pigmentation
    • 3-hair loss
    • 4-flaking
    • 5-ulceration
    • 6-loss of perspiration
    • 7-scarring
    • 8-changes in superficial blood vessels
    • 9-edema
  41. measuring fatigue

    subjective or objective?
    subjective

    described by experiences
  42. etiology of fatigue in cancer patients (8)
    • 1-pre existing
    • 2-direct result of disease or cachexia
    • 3-immobility
    • 4-symptoms related to cancer
    • 5-depression
    • 6-medications
    • 7-demands of dealing with cancer
    • 8-treatment related fatigue
  43. what are 2 types of treatment related patterns of fatigue
    chemo-peaks within days, returns to pre tx levels in 3-12 weeks

    radiation-progressive and cumulative peaks 4-6 weeks, 3-12 months duration
  44. medical conditions associated with fatigue (13)
    • 1-cancer
    • 2-autoimmune
    • 3-localized infection
    • 4-chronic bacterial, fungal, parasitic
    • 5-HIV
    • 6-chronic inflammatory disease
    • 7-anemia
    • 8-neurologic disease
    • 9-endocrine disease
    • 10-drug abuse
    • 11-adverse effects of chronic meds
    • 12-toxin
    • 13-chronic pulmonary, cardiac, GI etc
  45. assessment of fatigue (8)
    • 1-location
    • 2-intensity
    • 3-duration
    • 4-better/worse?
    • 5-impact?
    • 6-presence of unrelieve sx
    • 7-physical exam
    • 8-lab

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