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Questions and Answers
Which type of immune cells are primarily responsible for recognizing tumor-associated antigens?
Which type of immune cells are primarily responsible for recognizing tumor-associated antigens?
What is a consequence of the immune system's inability to recognize malignant cells as foreign?
What is a consequence of the immune system's inability to recognize malignant cells as foreign?
How do Natural Killer (NK) cells contribute to the immune response against tumors?
How do Natural Killer (NK) cells contribute to the immune response against tumors?
What may occur if tumor antigens conceal themselves from the immune system?
What may occur if tumor antigens conceal themselves from the immune system?
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Which immune system component can disrupt cancer cells apart from T-lymphocytes?
Which immune system component can disrupt cancer cells apart from T-lymphocytes?
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What is a primary reason for reporting a fever greater than 38.3°C?
What is a primary reason for reporting a fever greater than 38.3°C?
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Why should cultures and sensitivities be obtained before initiating antimicrobial therapy?
Why should cultures and sensitivities be obtained before initiating antimicrobial therapy?
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How can deep breathing and coughing every two hours help prevent respiratory dysfunction?
How can deep breathing and coughing every two hours help prevent respiratory dysfunction?
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What is the expected outcome of all personnel practicing hand hygiene after each voiding and bowel movement?
What is the expected outcome of all personnel practicing hand hygiene after each voiding and bowel movement?
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What symptom should be monitored in relation to urinary health?
What symptom should be monitored in relation to urinary health?
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What complication may arise from the inappropriate use of antibiotics?
What complication may arise from the inappropriate use of antibiotics?
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Which of the following reflects an altered immunologic response?
Which of the following reflects an altered immunologic response?
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What is an important nursing intervention to minimize infection?
What is an important nursing intervention to minimize infection?
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What role does angiogenesis play in the spread of malignant cells?
What role does angiogenesis play in the spread of malignant cells?
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What is the primary function of the p53 gene in cellular regulation?
What is the primary function of the p53 gene in cellular regulation?
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In the context of metastasis, what happens to malignant cells that survive the turbulent arterial circulation?
In the context of metastasis, what happens to malignant cells that survive the turbulent arterial circulation?
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What occurs during the initiation stage of carcinogenesis?
What occurs during the initiation stage of carcinogenesis?
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Which statement best describes the role of promoting agents in carcinogenesis?
Which statement best describes the role of promoting agents in carcinogenesis?
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How do large tumor emboli contribute to metastasis?
How do large tumor emboli contribute to metastasis?
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What is indicated by a mutation in the p53 gene concerning prognosis and treatment response?
What is indicated by a mutation in the p53 gene concerning prognosis and treatment response?
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Which phase of carcinogenesis involves the development of malignant behavior from previously altered cells?
Which phase of carcinogenesis involves the development of malignant behavior from previously altered cells?
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What is the primary goal of Biologic Response Modifiers (BRM) in cancer treatment?
What is the primary goal of Biologic Response Modifiers (BRM) in cancer treatment?
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Which type of bone marrow transplant is performed using the patient's own stem cells?
Which type of bone marrow transplant is performed using the patient's own stem cells?
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Which of the following is a late complication that can occur after a bone marrow transplant?
Which of the following is a late complication that can occur after a bone marrow transplant?
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What kind of blood work is important prior to bone marrow transplantation?
What kind of blood work is important prior to bone marrow transplantation?
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What is a characteristic of nonspecific Biologic Response Modifiers?
What is a characteristic of nonspecific Biologic Response Modifiers?
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During the administration of BRM therapy, what must nurses closely monitor?
During the administration of BRM therapy, what must nurses closely monitor?
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Which of the following agents are used with Photodynamic Therapy to target malignant tissue?
Which of the following agents are used with Photodynamic Therapy to target malignant tissue?
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What constitutes a significant part of the pretransplantation care for patients undergoing bone marrow transplant?
What constitutes a significant part of the pretransplantation care for patients undergoing bone marrow transplant?
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What is the primary purpose of cytokines in the immune system?
What is the primary purpose of cytokines in the immune system?
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What type of donor is involved in an allogeneic bone marrow transplant?
What type of donor is involved in an allogeneic bone marrow transplant?
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What is the primary goal of surgery as a treatment for cancer?
What is the primary goal of surgery as a treatment for cancer?
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Which of the following best describes a Grade 4 tumor?
Which of the following best describes a Grade 4 tumor?
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What is the function of genetic screening in cancer prevention?
What is the function of genetic screening in cancer prevention?
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Which treatment option is focused on the complete eradication of malignant disease?
Which treatment option is focused on the complete eradication of malignant disease?
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What type of biopsy involves the removal of the entire tumor and surrounding tissues to reduce recurrence?
What type of biopsy involves the removal of the entire tumor and surrounding tissues to reduce recurrence?
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In the TNM staging system, what does 'N' represent?
In the TNM staging system, what does 'N' represent?
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What is one of the foci of primary prevention in cancer?
What is one of the foci of primary prevention in cancer?
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Which of the following treatment options is primarily used for symptom relief rather than cure?
Which of the following treatment options is primarily used for symptom relief rather than cure?
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What type of surgical approach is used when a tumor recurrence occurs after an initial treatment?
What type of surgical approach is used when a tumor recurrence occurs after an initial treatment?
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What is a common psychological response patients may have when undergoing extensive cancer testing?
What is a common psychological response patients may have when undergoing extensive cancer testing?
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What is the purpose of using a needle biopsy?
What is the purpose of using a needle biopsy?
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Which type of cancer management allows for prolonged survival without complete eradication of the disease?
Which type of cancer management allows for prolonged survival without complete eradication of the disease?
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How does tumor grading generally affect prognosis?
How does tumor grading generally affect prognosis?
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Study Notes
Lymphatic and Blood Circulation
- Malignant cells can spread through the lymphatic system or bloodstream.
- Blood circulation is the most common way for malignant cells to spread.
- The vascularity of the tumor influences how easily malignant cells spread through the blood.
- Malignant cells may struggle to survive in the arterial bloodstream due to turbulence, insufficient oxygenation, or destruction by the immune system.
- Most arteries and arterioles are too secure for malignant invasion.
- Malignant cells that survive can attach to endothelium and avoid immune surveillance.
Angiogenesis
- The growth of new capillaries from host tissue is called angiogenesis.
- Angiogenesis helps malignant cells meet their oxygen and nutrient needs.
- Tumor emboli enter the systemic circulation through this new vascular network.
- Large tumor emboli trapped in the microcirculation may metastasize to other locations.
Carcinogenesis: Initiation
- Agents that cause cancer (carcinogens) can alter cellular DNA.
- These include chemicals, physical factors, and biological agents.
- Carcinogens can escape normal enzymatic mechanisms that repair DNA.
- Permanent cell mutations can occur if cells don't repair the DNA damage or undergo apoptosis.
Carcinogenesis: Promotion
- Repeated exposure to promoting agents (co-carcinogens) can activate abnormal genetic information.
- Cellular онсоgеnеs act like "on switches" for cell growth.
- Cancer supressor геnеs act as "off switches" that regulate cell proliferation.
- When suppressor genes are mutated, uncontrolled cell reproduction can occur.
Carcinogenesis: Progression
- Cellular changes from initiation and promotion lead to increased malignant behavior.
- Mutated cells are different from the original cells.
- Tumor cell antigens can stimulate both cellular and humoral immune responses.
- T-lymphocytes identify tumor-associated antigens and release toxic T-lymphocytes to destroy the tumor cells.
Immune System: Normal Immune Response
- Lymphocytes can produce lymphokines to combat malignant cells.
- Macrophages and interferons (IFNs) can disrupt cancer cells.
- B-lymphocytes defend against malignant cells.
- Natural Killer (NK) cells destroy cancer cells directly or produce lymphokines.
Immune System: Failure
- The immune system may not recognize malignant cells as foreign, so it doesn't respond.
- If tumors lack tumor-associated antigens, the immune system remains unalerted.
- Delayed immune responses allow tumors to grow too large for normal immune mechanisms to control.
- Tumor antigens can disguise themselves from the immune system by combining with antibodies.
- Tumor antigen-antibody complexes can suppress antibody production.
- Tumors can change their appearance or produce substances that impair immune responses.
- These substances encourage tumor growth and increase susceptibility to infection.
Cancer Detection and Prevention: Primary Prevention
- Educate the community about cancer risk factors and prevention strategies.
- Help individuals avoid known carcinogens.
- Encourage dietary and lifestyle changes.
Cancer Detection and Prevention: Secondary Prevention
- Screen for genetic predisposition to cancer.
- Evaluate cancer risk.
- Promote public awareness for health-promoting behaviors such as Pap smears, breast exams, testicular self-examinations, and digital rectal exams.
Diagnosis and Nursing Considerations
- Patients undergo testing to determine the presence, extent, and spread of tumors.
- Tests also assess organ system function, obtain tissue samples, and evaluate tumor stage and grade.
- Relieve patient fear and anxiety by explaining procedures, expected sensations, and the patient's role in the tests.
Tumor Staging and Grading
- Staging determines tumor size and metastasis, using the TNM system.
- T: Primary tumor extent
- N: Lymph node involvement
- M: Extent of metastasis
Management of Cancer
- Cure: Complete eradication of malignant disease
- Control: Prolonged survival and containment of cancer cell growth.
- Palliation: Relief of symptoms associated with the disease.
Management of Cancer: Treatment Options
- Surgery
- Radiation therapy
- Chemotherapy
- Bone marrow transplant
- Biologic response modifier therapy
- Photodynamic therapy
- Gene therapy
Surgery: Diagnostic Surgery
-
Biopsy: Obtaining a tissue sample to analyze suspected malignant cells.
- Excisional biopsy: Removes the entire tumor with surrounding tissue.
- Incisional biopsy: Removes a wedge of tissue if the tumor is too large.
- Needle biopsy: Aspirates tissue fragments through a guided needle.
Surgery: Surgery as Primary Treatment
- Local excision: Removes a small mass and a small margin of tissue.
- Radical excision: Removes the primary tumor, lymph nodes, surrounding tissues, and adjacent structures.
- Salvage surgery: Extensive surgery for recurrent cancer after less extensive primary surgery.
Surgery: Other Types of Surgical Interventions
- Electrosurgery: Uses electrical current to destroy tumor cells.
- Cryosurgery: Uses liquid nitrogen to freeze and destroy tissue.
- Chemosurgery: Combines chemotherapy and layer-by-layer surgical removal.
- Laser surgery: Uses light energy to vaporize cancer cells.
- Stereotactic radiosurgery (SRS): A single, precise high-dose radiation therapy administration.
Surgery: Other Types of Surgical Procedures
- Prophylactic surgery: Removing nonvital tissues or organs likely to develop cancer.
- Palliative surgery: Relieves symptoms and improves quality of life.
- Reconstructive surgery: Repairs and restores function and appearance after other treatments.
Bone Marrow Transplant
- Replaces damaged bone marrow with healthy cells to help the body fight cancer and recover.
- Types of BMT (based on donor):
- Allogeneic: From a donor other than the patient (family member or unrelated match).
- Autologous: From the patient (e.g., other parts of their body).
- Syngeneic: From an identical twin.
Bone Marrow Transplantation: Nursing Management: Pretransplantation Care
- Comprehensive evaluations to assess current disease status.
- Nutritional assessments, physical examinations, organ function tests, and psychological evaluations.
- Blood work to assess past antigen exposure.
Bone Marrow Transplantation: Nursing Management: During Treatment
- Monitor vital signs, blood oxygen saturation, and adverse effects such as:
- Fever
- Chills
- Shortness of breath
- Chest pain
- Cutaneous reactions
- Nausea
- Vomiting
- Hypo-/hypertension
- Tachycardia
- Anxiety
- Taste changes
Bone Marrow Transplantation: Nursing Management: Posttransplantation Care
- Late complications can occur after 100 days.
- Infections
- Restrictive pulmonary abnormalities
- Recurrent pneumonia
- Sterility
- Chronic graft-versus-host disease (bone marrow graft rejection)
Biologic Response Modifiers (BRM)
- Uses natural or recombinant agents to alter the immune response to cancer.
- Goal is to destroy or stop malignant growth.
Biologic Response Modifiers (BRM): Nonspecific BRM
-
Bacille Calmette-Guérin (BCG) and Corynebacterium parvum:
- Stimulate the immune system to eradicate malignant cells.
- Monoclonal antibodies: Target specific malignant cells for destruction, sparing normal cells.
Biologic Response Modifiers (BRM): Cytokines
- Interferons (IFN): Antiviral and antitumor properties.
- Interleukins (IL): Signals and coordinates other cells of the immune system.
- Hematopoietic growth factors: Regulate blood cell production (neutrophils, macrophages, monocytes).
- Tumor necrosis factor (TNF): Activates other cells of the immune response.
- Retinoids: Vitamin A derivatives used for treating acute promyelocytic leukemia.
Biologic Response Modifiers (BRM): Nursing Management
- BRM therapies are often investigational.
- Nurses should be familiar with each agent and potential side effects.
- Accurate observations and documentation are crucial for managing toxicities.
Photodynamic Therapy
- Uses photosensitizing agents that accumulate in malignant tissue.
- Agents are activated by a light source (laser) to destroy cancer cells.
Photodynamic Therapy: Nursing Management
- Inspect all entry ports for pathogens (IV sites, wounds, skin folds)
- Report fever, chills, diaphoresis, swelling, heat, pain, redness, exudate. Report changes in respiratory or mental status, urinary frequency or burning, malaise, myalgias, arthralgias, rash, and diarrhea.
- Obtain cultures and sensitivities to identify the organism and guide antimicrobial therapy.
- Practice hand hygiene frequently.
- Minimize infection:
- Discuss infection prevention with the patient.
- Use sterile techniques for invasive procedures.
- Maintain a clean environment for the patient.
- Avoid contact with others who have infections.
Plan of Nursing Care
- Nursing diagnosis: Risk for infection related to altered immunologic response.
- Goal: Prevention of infection.
-
Nursing interventions:
- Obtain cultures and sensitivities before antimicrobial treatment.
- Initiate infection control measures:
- Discuss infection prevention with the patient.
- Practice hand hygiene frequently.
- Maintain a clean environment for the patient.
- Avoid contact with others who have infections.
- Use sterile techniques for invasive procedures.
- Rationale: Identify the organism and the most appropriate antimicrobial therapy. Reduce exposure to infection.
- Expected outcomes: Absence of pathologic bacteria on cultures. No signs and symptoms of infection. Reduced risk of infection transmission.
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Description
This quiz covers the critical aspects of how malignant cells spread through the lymphatic system and bloodstream, highlighting the role of tumor vascularity and angiogenesis. Understand the challenges malignant cells face in circulation and the process of carcinogenesis initiation.
