52B Exam III - Oncology

• 1. direct growth
• 2. gravity/seeding to another area
• 3. grow to invade lymphatic/blood vessels and get carried to another location (metastasis)

new growth

it will not cause death or interfear with vital function

will cause death if not controlled

• large irregular nuclei
• fast dividing
• not well differentiated (don't look like parent cell)

their growth is restricted by a capsule

• epithelieal (carcinoma)
• connective tissue (sarcoma)

• named for parent tissue type with "oma" suffix added (fibroma, neuroma)
• can also be names for schientists (wilm's-kidney, hodgkin's-lymph nodes)

• 1. Primary Tumor (T)
• - T0 = no tumor present
• - T1-4 = increase in tumor size
• 2. Regional Lymph Nodes (N)
• - N0 = no lymph node involvement
• - N1-3 = increasing involvement
• 3. Distant Metastasis (M)
• - M0 = no metastasis
• - M1 = distant metastasis

• 1. cells well differentiated (look like parent cells)
• 2. cells are moderately different from parent cells
• 3. poorly differentiated (don't look like parent cells)
• 4. no normal characteristics

second leading

• exposure to carcinogens (smoke, asbestos, pollutants)
• age
• radiation exposure (MRI, CT, etc)
• genetic risk factors
• virus (hepatits B, HPV)
• hormonal changes
• health practices (ETOH, nutrition, sexual practices)
• psychological state (stress, depression, lack of support)

• 3/4 of deaths from cancer occur over age 55
• chances increase over age 60 and every 10 years following
• this may be due to decreased immunity or increased exposure to carcinogens

• african americans
• may be due to: environmental or social factors, genetics, deficient knowledge of warning signs, lack of access to medical care

breast cancer

breast (32% of cancer cases) - lump in breast (pt should do self breast exams monthly after period, and have yearly mamogram after 40-50 years of age)

lung - causes caugh, hoarseness, SOB, change in color of mucous membranes. seen on chest x-ray but can go unnoticed until then. 85% of cases could be eliminated if pt quit smoking

colorectal - blood in stool (can be occult or visible). pt over 50 years old should get annual OB on stool, digital exam, and colonoscopy

Uterus (cervix) - abnormal bleeding/discharge. women should get annual PAP smear

prostate (33% of cases) - causes change in urine output and back pain. pt should have annual exams and PSA testing

Prostate Spacific Antigen - increase can show presence of cancer but low amounts are normal

urinary bladder - causes pain on urination, occult blood, frequency, urgency, cloudy urine. pt should have anual exams, UA, and bladder scan

• C-change in elimination habbits
• A-a sore that doesn't heal
• U-unusual bleeding/discharge
• T-thickening or lump in breast/elsewhere
• I-indigestion or difficulty swallowing
• O-obvious change in wart or mole
• N-nagging caugh or hoarseness

• weight loss/muscle wasting
• local effects
• obstuction/pressure
• atrophy
• ulceration
• (best to prevent pt from getting this far)

te worst prognosis because this means they are very late into metastasis

chemo/radiology treatment

the brain due to large amounts of blood circulation to bring cancer cells

• biopsy/cytology- look for cell differentiation
• labs- CBC to look for bleeding/abnormal cells, UA
• body scanning/ imaging (mammogram) to look at soft tissue
• Nuclear Magnetic Resonance (MRI) to look at soft tissue
• computer imaging
• CT- X-ray + computer to look at small sections
• contrast media- barium enema, upper GI series
• nuclear scan- radioisotoped accumulate in fast deviding cells
• ultrasound- shows tissue of different density
• endoscopy

a team of MDs that decide the best reatment for a particular pt

• Curative: removes all cancer cells from body (or enough to allow immune system to take care of the rest)
• Palliative: relieves symptoms

• surgery
• radiation
• chemotherapy
• bioenhancement

to decrease the size of a tumer in surgery if it is too big to be removed completely

it destroys/stops the growth of all rapidly growing cells in that area

• 1. External: rays are applied by machine to a spacific area of the body. no lingering radiation is present.
• 2. Internal: cobolt/gold is sealed into a body cavity. rays can leak so others must use sfety precautions and minimize pt contact.
• 3. Unsealed: PO or placed into body cavity. others must use precausetions with direct contact with pt, discharge, or urine.

distance and length of exposure

• general-itch, tingling, burning of the skin (limit sunexposure) that can cause oozing/sloughing of skin, N/V, anorexia, ,alaise, diarrhea
• late- atrophy/necrosis (can happen years after treatment)

it targets cells in cycle phases

by action (cell cycle spacific vs non-spacific)

• cell cycle spacific- targets cells in one spacific cell cycle
• non-spacific- targets cells in many stages of replication

• PO (best)
• IV (must use PICC, Hickman, Broviac, or Port-a-Cath)
• IM (worst route due to muscle damage)
• local instill (by chest tube or lumbar puncture)

must use PICC, Hickman, Broviac, or Port-a-Cath because a regular IV may infiltrate

heparin must be used to keep it patent

rapid dividing tissues (bone marrow, GI tract, hear etc.)

• GI- diarrhea, stomatitis, N/V, fungal infections
• bone marrow- decreased WBC, Hgb, PLT (prone to infection)
• skin- IV infiltrates cause necrosis, nail changes, photosensitivity
• hair- hair loss initially but it is not permanent

drugs to help reform blood cells. epogen increases RBCs and neupogen increases WBCs

hair loss

• organ toxicity: can effect the heart, liver, lungs, and kidneys so watch labs (liver prteins, BUN, Cr, K) and ensure hydration
• sterility: so pt may want to harvest eggs/sperm before treatment

boosts body's natural cellular immune response in order to fight off cancer cells (can handle 10 million cells at a time but not >100 million)

biological response modifier

• cytokines carry messages for the immunesystem
• the body produces lymphocytes to destroy tumor
• then the immune response creates antibodies against tumor cells

• 1. Interferons: destroy tumor/suppress growth and metastasis
• 2. Interleukins: boost general immune resistance

• guided imagery
• acupressure
• relaxation
• hormone manipulation
• gene therapy
• targeted therapy
• nutritional therapy

no, 60% of pts report mild or no pain

pain

• 1. bone destruction
• 2. obstruction of lumens increases pressure (urinary, GI)
• 3. peripheral nerve involvement
• 4. pressure of growing tumors
• 5. Claudication- inflammation, infection, and necrosis of tissue

pain in lower extremities from lack of 0₂ and circulation

• surgery, nerve blocks, TENS (trans cutanial nerve stimulation- blocks pain signal)
• diversion, imagery
• medication

• mild to moderate = tylenol/ASA
• moderate = codine
• severe/chronic pain = opiates

codine use >6 months results in decreased effectiveness

• start doses high and taper down until the right dose is found
• dose around the clock, not prn

nephroblastoma

the extent of a disease at diagnosis

at birth

primordial malignant cancer of the kidney where cells don't mature and then grow out of control

usually encapsulated, however if ruptured, it can seed down to the abdomen

children under 6 years old, girls, and african americans

• stage 1 - tumor is limited to one kidney, completely curable with removal of effected kidney
• stage 2 - tumor extends beyond kidney, completely curable with removal of effected tissue
• stage 3 - confined to abdomen, requires chemo and does not have as good of a prognosis as stage 1 or 2
• stage 4 - hematogeneous metastasis to lung, liver, bone, or brain
• stage 5 - bilateral kidney involvement (most often due to metastasis) bad prognosis

• #1 = blood in urine
• tight/enlarged abdomen
• non-tender firm/round lump in belly

• tomography
• abdominal ultra sound
• MRI**
• bone scan
• angiogram
• IV pyelogram
• biochemical/hematologic studies (UA for blood/CBC)

do NOT palpate abdomen