Cancer Biology and Health Screening Quiz

Oncology Nursing

• Oncology is a branch of medicine focusing on the study, detection, treatment, and management of cancer and neoplasia.
• Key "root words" include:
  • Neo- new
  • Plasia- growth
  • Plasm- substance
  • Trophy- size
  • +Oma- tumor
  • Statis- location
  • A-none
  • Ana- lack
  • Hyper- excessive
  • Meta- change
  • Dys- bad, deranged

Characteristics of Neoplasia

• Neoplasia involves uncontrolled growth of abnormal cells.
• Benign tumors are characterized by:
  • Well-differentiated cells resembling normal cells
  • Slow growth
  • Encapsulated (well-rounded)
  • Non-invasive (do not spread)
  • Do not metastasize (spread to other locations)
• Malignant tumors are characterized by:
  • Undifferentiated cells
  • Erratic and uncontrolled growth
  • Expansive and invasive (spread into surrounding tissue)
  • Secrete abnormal proteins (tumor markers)
  • Metastasize (spread to other locations)
• Borderline tumors have characteristics between benign and malignant.

Proliferative Patterns

• Anaplasia: cells that lack normal cellular characteristics and differ significantly in shape and organization.
• Dysplasia: cells display bizarre growth, differences in size, shape, or arrangement from normal cells of the same tissue type.
• Metaplasia: conversion of one type of mature cell into another type of cell

Cellular and Tissue Types Affected

• Different cancers affect various tissues and cells.
• Carcinoma—epithelial cells
• Sarcoma—connective tissues (bone, muscle, and blood vessels)
• Lymphomas—lymphatic tissue
• Leukemia—blood-forming cells

Cancer Spread

• Lymphatic spread: tumors travel via lymph vessels to lymph nodes, then potentially to other locations.
• Hematogenous spread: tumors enter blood vessels and travel to distant organs.
• Direct spread: tumors spread by invading adjacent tissues.

Nomenclature of Neoplasia

• Tumors are named based on their:
  • Parenchyma, organ, or cell of origin (e.g., Hepatoma—liver tumor)
  • Pattern or structure (e.g., cyst—fluid-filled; adeno—glandular; papillo—finger-like; polyp—stalked)
  • Embryonic origin (ectoderm, endoderm, mesoderm)
• Benign tumors have the suffix "-oma" (e.g., lipoma, osteoma, myoma).
• Malignant tumors derived from epithelial tissues (e.g., carcinoma) use the suffix "-carcinoma."
• Malignant tumors derived from mesodermal tissues use the suffix "-sarcoma" (e.g. fibrosarcoma)

"PASAWAY" Tumors

• Some tumors with the "-oma" ending are malignant. Examples are hepatomas, lymphomas, gliomas, and melanomas.
• Teratomas are tumors arising from three germ layers.
• Choristomas and hamartomas are non-neoplastic tumors containing tissue not typical for the location.

Cancer Nursing- Normal Cell Cycle

• Cell cycle has three phases:
  • Permanent cells (neurons, cardiac muscle)
  • Stable cells (liver, kidney)
  • Labile cells (epithelial cells, blood cells)

Cancer Nursing- Molecular causes of cancer

• DNA structure alteration.
• Altered DNA function.
• Cellular aberration.
• Cellular death.
• Neoplastic change.
• Proto-oncogene and anti-oncogene genes in DNA

Cancer Nursing- Etiology of cancer

• Physical agents (radiation, irritants, sunlight, altitude, humidity)
• Chemical agents (smoking, dietary ingredients, drugs)
• Genetics and family history (colon cancer, premenopausal breast cancer)
• Dietary habits (low fiber, high fat, processed foods, alcohol)
• Viruses and bacteria (HepaB, herpes, EBV, CMV, papilloma viruses, HIV, HTCLV, H. pylori)
• Hormonal agents (DES, OCPs, especially estrogen)
• Immune disease (AIDS)

Cancer Nursing - Carcinogenesis

• Initiation: Carcinogens alter DNA in cells. Either death or repair may occur. If DNA is altered and not repaired, it leads to apoptosis
• Promotion: repeated exposure to carcinogens causing abnormal genes to express.
• Progression: irreversible change, cells undergo neoplastic transformation leading to malignancy

Cancer Nursing- Spread of cancer

• Lymphatic spread
• Hematogenous spread
• Direct spread

Cancer Nursing - Cancer Diagnosis

• Biopsy (most definitive)
• CT scans
• MRI scans
• Tumor markers

Cancer Nursing- Tumor Markers

• General tumor markers (CEA, LDH)
• Breast cancer markers (CA 15-3, CA 27.29, HER2, estrogen/progesterone receptors)
• Liver and Germ cell tumor markers (AFP)
• GI system markers (CA 19-9, CEA)
• Prostate markers (PSA)
• Ovarian markers (CA 125)

Cancer Nursing- TNM Staging

• T-tumor size
• N-node involvement
• M-metastasis
• Stage progression from 1 to 4

Cancer Nursing - General Medical Management

• Surgery (cure, control, palliation)
• Chemotherapy
• Radiation therapy
• Immunotherapy
• Bone marrow transplant

Cancer Nursing- Surgery

• Types of cancer surgery include:
  • Local excision
  • Wide/Radical excision
  • Salvage surgery
  • Electrosurgery, Cryosurgery, Laser surgery
• Types of surgery include: Prophylactic surgery, Palliative surgery, and Reconstructive surgery

Cancer Nursing- Screening

• Male: Occult blood, chest x-ray, DRE (for prostate and Testicular self-exam)
• Female: SBE, CBE, mammography, Pap Smear
• Combined screening (for males and females)

Cancer Nursing - Nursing Assessment

• Utilize the CAUTION warning signals (change in bowel/bladder habits; a sore that doesn't heal; unusual bleeding; thickening/lump in breast; indigestion; obvious change in warts; nagging cough and hoarseness; unexplained anemia; sudden weight loss.)
• Assess for additional warning signs, including weight loss, frequent infections, skin problems, pain, hair loss, fatigue, and disturbances in body image/depression.

Cancer Nursing - Nursing Interventions

• Maintain tissue integrity: Handle skin gently, do not rub affected areas, apply lotion, clean with soap and water
• Manage stomatitis: use soft-bristled toothbrush, oral rinses with saline gargles or tap water; avoid alcohol-based rinses
• Manage alopecia: recommend wig, scarves, or hats; give information about temporary hair loss
• Promote nutrition: make food appealing, consider patient's preferences, provide small frequent meals, avoid fluids during meals, practice proper oral hygiene before meals. encourage the use of vitamin supplements
• Relieve pain: mild-NSAIDS, moderate – weak opioids, severe-morphine; administer analgesics as needed
• Decrease fatigue: plan activities with rest periods, encourage light exercise, and promote small frequent meals
• Improve body image: use therapeutic communication, encourage self-care and decision making, offer cosmetic material such as makeup and wigs
• Assist in the grieving process: recognize that cancer can cause loss of health, income, sexuality, and body image; answer questions and offer information about cancer and treatment options; provide access to resources and support groups; refer to appropriate support groups for patient
• Manage infection: assess for infection (fever is the most important sign - 38.3 degrees Celsius/100.9 degrees Fahrenheit); monitor patients closely; administer prescribed antibiotics; maintain aseptic technique; and avoid or limit exposure to crowds or other patients with infections
• Identify factors that predispose cancer patients to infection such as impaired skin or mucus membranes, malnutrition, and some medications
• Treat potential complications such as septic shock and bleeding

Cancer of the Central Nervous System (CNS)

• CNS Tissues:
  • Astrocytes – maintain the blood-brain barrier (BBB) and hold neurons in place, also involved in nutrition and waste removal of dead cells in CNS.
  • Oligodendrocytes – produce the myelin sheath within CNS
  • Ependymal – produce and direct Cerebrospinal fluid (CSF) flow, surrounds the choroid plexus
  • Schwann – produce the myelin sheath within the Peripheral nervous system (PNS)
• Meninges: dura mater, arachnoid mater, pia mater (protective coverings around brain and spinal cord)
• Malignant CNS Tumors:
  • Most common primary brain tumors are gliomas, meningiomas, nerve sheath tumors, and pituitary tumors
  • Glioma: (astrocytomas, oligodendrogliomas, mixed gliomas, ependymomas) - highly malignant tumors
  • Meningiomas: derived from protective arachnoid lining of the brain, often benign but can recur
  • Schwannomas and Pituitary tumors: usually benign tumors developing from CN sheath or pituitary tissue, responding to treatment including surgery, radiation or chemotherapy
  • Embryonal/Primitive neuroectodermal tumor (PNET): Medulloblastoma—most common malignant tumor in posterior fossa of the brain, occurs in children and young adults, poor prognosis, associated with CSF metastasis.
• Clinical Features of CNS Cancer:
  • Increased intracranial pressure (ICP): Headaches, nausea, vomiting, papilledema, changes in mental status (confusion, drowsiness), and seizures (especially in 1/3 of patients)
• Diagnosis of CNS Cancer:
  • Imaging techniques like CT scans and MRIs with contrast and angiography are employed to detect and diagnose.
  • MRS (magnetic resonance spectroscopy) assists in evaluating tumor metabolism.
• Treatment Modalities for CNS Cancer:
  • Radiation Therapy (RT) may be used alone or in conjunction with chemotherapy.
  • Common RT techniques include 3DCRT, IMRT, stereotactic radiosurgery and brachytherapy.
  • Chemotherapy with drugs such as Nitrosoureas, Carmustine, Lomustine, Procarbazine, and Biodegradable chemotherapy wafers are some treatments.
  • Radiosensitizers may be used to enhance the effects of RT on tumors.
  • Boron Neutron Capture Therapy is another treatment modality

Colon Cancer

• Risk factors: Increased age, family history, previous colon cancer or polyps, history of inflammatory bowel disease (IBD), high fat, high protein, and low-fiber diet, breast cancer, or genital cancer
• Pathophysiology: Benign neoplastic - DNA alteration —- malignant transformation —- malignant neoplasm- cancer growth and invasion—metastasis (liver)
• Assessment findings: Change in bowel habits (most common), blood in the stool, anemia, anorexia and weight loss, fatigue, rectal lesions (tenesmus), alternating D and C.
• Diagnostic findings: Fecal occult blood, sigmoidoscopy/colonoscopy, biopsy, CEA (carcinoembryonic antigen)
• Complications: Obstruction, hemorrhage, peritonitis, sepsis
• Medical management: Chemotherapy (5-FU), radiation therapy
• Surgical management: Resection, anastomosis, colostomy (temporary or permanent based on tumor location and size)
• Nursing interventions (Pre-operative): Provide protein, calorie, and residue diet, provide information about post-operative care and stoma care, and administer pre-operative medications one day prior to surgery
• Nursing interventions (Post-operative): Monitor for complications (e.g., leakage from the site, prolapse of the stoma, skin irritation, pulmo complications) , assess abdomen for return of peristalsis, assess wound dressings and assist patients with post-operative ambulation, provide nutritional counseling limiting foods that cause gas-formation and odor (cabbage, beans, eggs, fish, peanuts), and use a low-fiber diet for the initial recovery period, splint the incision, and administer pain meds before exercise, and monitor the stoma (pinkish to cherry red, slightly edematous, minimal pinkish drainage).
• Colostomy care: Best time for skin care is after a shower; Apply tape to pouch sides; and maintain the patient in a sitting or standing position when changing the pouch

Breast Cancer

• Risk factors: Genetics (BRCA1/2), Increasing age, Family history, Early menarche/late menopause, Nulliparity, Late age at pregnancy, Obesity, Hormonal replacement therapy, Alcohol use, and Exposure to radiation
• Protective factors: Exercise, Breastfeeding, Pregnancy before age 30
• Pathophysiology: Tumor growth from a single cell, Invade neighboring tissue, Spread through lymph and blood vessels
• Assessment findings: Mass (upper outer quadrant), non-tender, fixed, hard with irregular borders, skin dimpling, nipple retraction, peau d'orange
• Laboratory findings: Biopsy procedures, mammography
• Staging: TNM staging (I - < 2cm, II - 2 to 5 cm, (+) LN, III - > 5 cm, (+) LN, IV - metastasis)
• Medical management: Chemotherapy, Tamoxifen therapy, radiation therapy
• Surgical management: Radical mastectomy, Modified radical mastectomy, Lumpectomy, Quadrantectomy
• Nursing interventions (Pre-operative): Provide breast cancer information and treatment options, reduce fear/anxiety, facilitate decision-making, and offer pre-op routines(consent, NPO, meds, breathing exercises)
• Nursing interventions (Post-operative): Elevate affected extremity, provide pain management, monitor for and manage skin integrity, monitor for drainage and hematoma, encourage and monitor activity; and teach follow-up care (regular checkups, monthly BSE, annual mammography
• Manage lymphedema: Elevate the arm, encourage hand exercises while elevated, refer to physiatrist or physical therapist