Cancer Biology Quiz

Oncology Nursing Management in Cancer Care

• Oncology encompasses the nursing management of cancer care.
• Neoplasia is the new growth of tissue.
• A tumor is a swelling characterized by abnormal cell growth exceeding normal levels, lacking defined borders.
• Metastasis is the ability of a tumor to spread.
• Tumors are categorized based on their behavior—benign (non-cancerous) or malignant (cancerous).
• Any malignant tumor is categorized as cancer.
• Tumors comprise two components:
  • Parenchyma: proliferated neoplastic cells.
  • Stroma: supportive tissue encompassing connective tissues, blood vessels, and lymphocytes.
• Tumor enlargement and development depend on stroma and adequate perfusion.
• Benign tumor nomenclature typically ends in "-oma". Examples include fibroma and chondroma.
• Mesenchymal cell tumors adhere to this rule.
• Epithelial tumors, like adenomas (gland-originated), follow this convention.
• Malignant tumor nomenclature often uses "-carcinoma" for epithelial tumors. Examples include adenocarcinoma and squamous cell carcinoma.
• Mesenchymal tumors are called sarcomas. An example is fibrosarcoma.
• A table details benign and malignant epithelial tumors for different tissues (Squamous, Basal cells, Glandular, Neuroectoderm, Urinary Tract, Renal cells, Liver, Placenta, Germ cells).

Differences Between Benign and Malignant Tumors

• Benign tumors resemble normal cells while malignant tumors do not.
• Benign tumors have rare mitosis while malignant tumors have frequent mitosis.
• Benign tumors grow slowly while malignant tumors grow quickly.
• Benign tumors frequently halt growth while malignant tumors rarely halt growth.
• Benign tumors are encapsulated while malignant tumors are not
• Benign tumors do not invade nearby tissues whereas malignant tumors invade and destroy.
• Benign tumors do not metastasize, whereas malignant tumors often metastasize to distant sites.
• Benign tumors usually cause mild compression signs, whereas malignant tumors frequently cause compression signs and other symptoms.

Metastasis

• Metastasis is the spread of cancer from its original site to other parts of the body.
• This graphic shows the colon cancer spreading to the liver.

Cancer

• Cancer is initiated when a normal cell is genetically altered by mutations in cellular DNA causing abnormal growth.
• Abnormal cancer cells have invasive properties, penetrating and invading other tissues. This is metastasis.
• Cancer cells are considered malignant exhibiting uncontrolled growth that does not conform to biological needs.

Malignant Process

• Cell proliferation represents uncontrolled growth with the ability to spread and destroy tissues, causing death.
• Cancer cell characteristics including tumor-specific antigens, altered structure and shape, and metabolism.
• Malignant tumors spread by various mechanisms: lymphatic, hematogenous, and angiogenesis pathways.
• Carcinogenesis is the origin and development of cancer.

Carcinogenic Agents and Risk Factors

• Carcinogenic agents such as viruses, bacteria, physical factors (sunlight, radiation, chronic irritation), chemical agents (tobacco, asbestos), genetic/familial factors, diet, hormones and the immune system can all increase the risk of cancer.

Age

• Cancer incidence increases with age due to somatic mutations and weakened immunity.
• Leukemia is the second leading cause of cancer-related mortality in childhood.

Environmental Factors

• Environmental exposures like workplace toxins (asbestos, vinyl chloride), behaviors (alcohol, smoking, STDs, obesity), nutritional factors, viral illnesses, and alcohol/tobacco use are associated with distinct cancer types (lung, oral cavity, larynx, esophagus, liver, pancreas, bladder).

Early Warning Signs

• Cancer has seven early warning signs ('CAUTION'):
  • Change in bowel or bladder habits
  • A sore that doesn't heal
  • Unusual bleeding or discharge
  • Thickening or lump in the breast or scrotum
  • Indigestion or difficulty swallowing
  • Obvious change in a mole or wart
  • Nagging cough or hoarseness

Primary and Secondary Prevention

• Primary prevention aims to limit the cancer risk in healthy individuals.
• Secondary prevention involves earlier diagnosis and intervention through methods like screening and detection.
• Emphasis is on primary and secondary cancer prevention.
• Methods of preventing cancer include avoiding carcinogens, adopting healthy lifestyle and dietary changes, and educating the public and patients.

Diagnostic Tests

• Diagnostic tests for cancer include tumor staging and grading (TNM classification).

Staging

• Tumor staging defines the size of a tumor and whether metastasis is present.
• TNM classification is employed, with T denoting the primary tumor extent, N indicating lymph node involvement, and M signifying the extent of metastasis.

Grading

• Tumor grading involves categorizing tumor cells based on the type of tissue origin.
• The grading process determines the degree to which tumor cells retain tissue-specific functions.

Specific TNM parameters

• T0-T4: describe tumor size
• N0-N3: describe level of lymphatic spread
• M0-M1: describe presence of distant metastasis

Cancer Management

• Cure: complete eradication of the disease.
• Control: prolonged survival.
• Palliation: relief of symptoms, particularly pain.

Surgical Treatment

• Surgical treatments for cancer include diagnostic surgery (biopsy: excisional, needle, incisional), tumor removal (wide excision, local excision), prophylactic surgery, and reconstructive surgery.
• Local surgery is used for small masses (includes removal and a small margin of healthy tissue).
• Wide or radical excision is performed when the entire tumor can be removed and there is a chance for cure or control. This includes the removal of regional lymph nodes.

Types of Diagnostic Surgery

• Excisional biopsy: used to remove an entire suspicious tumor or a region around it using endoscopic or other methods.
• Incisional biopsy: a sample of tissue from the tumor is removed for analysis via endoscopic or other methods.
• Needle biopsy: for obtaining samples from easily accessible areas such as skin lesions, breast masses, or lung nodules.

Palliative Surgery

• Palliative surgery is performed when a cure is not possible.
• Its aim is to maximize patient comfort and quality of life by managing symptoms (pain, ulceration, bleeding, effusions).
• Examples of palliative surgery include colostomies for bowel obstruction and pleural tube placement for pleural effusions.

Reconstructive Surgery

• Reconstructive surgery is performed after curative or radical surgery. Its purpose is to improve the body's functionality.
• These surgeries are often indicated for cancers of the breast, head, neck, and skin.

Nursing Management in Cancer Surgery

• Pre-operative assessment for factors that impact the patient.
• Patient and family education and support.
• Communication with other health personnel for consistency.
• Post-operative assessment of the patient's response to surgery and monitoring for potential complications (infection, bleeding, thrombophlebitis, fluid/electrolyte imbalances).
• Teaching the patient about wound care, activity, nutrition, and medications.

Radiation Therapy

• Radiation therapy is a curative, control, or palliative treatment.
• Radiation therapy targets the tumor cells, disrupting their growth.
• External radiation uses external X-rays, while internal radiation (brachytherapy) includes implants delivering high-dose radiation to localized areas.
• Radiation therapy includes a lethal tumor dosage that aims to eradicate 95% of the tumor, while preserving healthy tissue.
• This is often delivered over several weeks for tissue repair.

Radiation Therapy Toxicity

• Common side effects of radiation therapy include:
  • Skin changes (alopecia, erythema, stomatitis, xerostomia)
  • Oral mucositis (mouth sores, altered taste)
  • Esophageal irritation, chest pain, dysphagia
  • Anorexia, nausea, vomiting, diarrhea
  • Anemia, leukopenia, thrombocytopenia
  • Fatigue, malaise

Nursing Management in Radiation Therapy

• Patient and family education on procedures and precautions.
• Skin care, oral care, and protection of care providers.

Chemotherapy

• Chemotherapy uses agents that interfere with cell function and replication, destroying tumor cells.
• Chemotherapy targets systemic disease, addressing the entire body rather than a localized tumor.
• It is often administered according to the cell cycle.
• Chemotherapy can be either curative, control, or palliative.

Chemotherapy Agents

• Chemotherapy is categorized based on cell cycle sensitivity (specific and non-specific).
• Chemotherapy agents include alkalizing agents, antimetabolites, and antimetabolites.

Chemotherapy Administration

• Chemotherapy administration has complications such as extravasation (leakage), risk of infection, risk of bleeding, and fluid/electrolyte imbalances.
• Nurse should ensure safety precautions, proper use of equipment, and monitoring are taken when administering chemo agents.

Chemotherapy Adverse Effects

• Common chemotherapy side effects include:
  • Gastrointestinal problems (nausea, vomiting, diarrhea, mucositis)
  • Hematopoietic issues (myelosuppression)
  • Renal complications
  • Cardiac/pulmonary effects
  • Reproductive issues
  • Neurological side effects

Bone Marrow Transplantation (BMT)

• BMT is used for hematologic cancers, and tumors requiring treatments using a dose to destroy the bone marrow.
• Common complications include graft-vs.-host disease, and venous occlusive disease.

Nursing Process for Patients with Cancer

• Assessments often include factors related to infection risk (chemotherapy, malnutrition, age, equipment), WBC monitoring, and signs/symptoms of infection.
• Patients with invasive catheters should be assessed for sepsis, and care givers should be educated about bleeding complications (chemo, radiation, medications like aspirin)
• Patients undergoing chemo should be monitored for various complications from hemorrhage to mental status changes.

Patient Assessment

• Assessment includes addressing skin concerns (lesions, ulcers, and alopecia).
• Nutritional status (weight loss and muscle wasting) is evaluated.
• Dietary history, problems with eating and drinking (anorexia, dysphagia, nausea/vomiting, diarrhea) are considered
• Factors leading to pain should be noted, and patients should be helped to address issues with pain or other symptoms. Mental health factors should be assessed and chronic fatigue.

Common Nursing Diagnoses

• Common diagnoses among cancer patients:
  • Impaired oral mucous membranes
  • Impaired tissue integrity
  • Imbalanced nutrition
  • Chronic pain
  • Fatigue
  • Disturbed body image
  • Grieving

Collaborative Problems

• Potential collaborative problems in cancer care:
  • Infection
  • Bleeding
  • Superior vena cava syndrome
  • Hypercalcemia
  • Spinal cord compression
  • Pericardial effusion
  • Disseminated intravascular coagulation (DIC)

Hospice Care

• Hospice provides multidisciplinary care for patients with terminal illnesses and their families.
• Hospice focuses on improving quality of life and providing palliative care.
• Hospice is focused on symptom management and support for people and their families to cope with the psychosocial implications of terminal illness, and spiritual support.

Oncologic Emergencies

• Oncologic emergencies include:
  • Superior vena cava syndrome
  • Spinal cord compression
  • Pericardial effusion/cardiac tamponade
  • Disseminated intravascular coagulation (DIC)
  • Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
  • Tumor lysis syndrome

Superior Vena Cava Syndrome

• A graphic of superior vena cava syndrome shows tumor compression of the superior vena cava, causing fluid build up.

Test your knowledge on key concepts in cancer biology. This quiz covers topics such as risk factors, prevention strategies, screening methods, and tumor classification. Perfect for students of medical sciences or anyone interested in understanding cancer.