Oncology Review Questions

Define Cancer

Cancer is an uncontrolled, unregulated growth of cells

During a blood test, what protein markers indicate

cancer and why?

CEA - Carcinoemboryonic antigen

FP- Alpha-fetoprotein

These are fetal cell attributes that indicate undifferentiated

What determines the rate of proliferation of cancer cells?

The rate of proliferation is the same as the rate of the tissue that the cancer

derives from.

Tissues such as; bone marrow, hair follicles and epithelial lining of GI have

a rapid cell proliferation while other tissues such as myocardium and cartilage cell proliferation is slow

Name the stages of cancer development

1. Initiation2. Promotion3.Progression

What is the relationship between a carcinogen and the

first stage of cancer development?

Carcinogen’s cause mutation in a cell’s genetic structure

What happens to a cell when it’s genetic structures is

mutated by a carcinogen?

1. The cell will die (apoptosis=cell suicide)

2. The cell will repair itself3. The cell will survive and replicate the mutated DNA

in daughter cells

What are some examples of: Chemical carcinogens? Radiation carcinogens?

Virus carcinogens?

Chemical carcinogen: smoking and asbestos

Radiation carcinogen: atomic bomb and the sun

Viral carcinogen: Mono

What is promotion in terms of cancer development?

It is the reverse proliferation of mutated/altered cells by a

presence of promotion agents

What are some promoting agents that increase the

chances of cancer developing from altered cells?

Dietary fat, obesity, cigarette smoking, alcohol consumption

What stage of cancer development is identified by tumor growth and invasion

through metastasis?

Progression

What are common sites of metastasis?

Brain, lungs, bone, liver and adrenal glands

What is tumor angiogenesis?

The process of formation of blood vessels within the tumor

itself

What is the process of metastasis?

1. Rapid proliferation causes mechanical pressure leading to penetration of surrounding tissues

2. Metalloproteinase enzymes are produced by some cancer cells; they destroy the basement membrane of not only the tumor itself, but also

surrounding lymph, blood vessels, muscles, nerves and most epithelial boundaries

3. Tumor cells detach and travel to distal organ sites by blood and lymph

Whats the difference between hematogenous metastasis

and skip metastasis?

Hematogenous involves spreading through blood via

metalloproteinase, skip metastasis happens when the tumor cells

bypass regional lymph nodes to travel to distant lymph nodes

where it creates a similar enviroment as the primary cancer

site

What are BRAC 1 and BRAC 2, what happens when they

are altered?

BRAC 1&2 are tumor supressor genes for breast

cancer, when there are alterations with the BRAC tumor suppressor genes,

cancer is at a greater risk to develop

What does the immune system do?

The immune system has the potential to distinguish cells of

normal (self) to abnormal (non-self)

What are TAA?

TAA are tumor-associated antigens, it is an antigen on

the surface of cancer cells that are a result of malignant

transformation. This antigen elicits a response of the

immune system

What is the response to TAA known as?

Immunologic surveillance

What categories are used to classify cancer?

Classified according to1) anatomical site

2) histology/grading3) and extent of disease/staging

Where do carcinomas originate from?

Where do sarcomas originate from?

Where do lymphomas and leukemias originate from?

Carcinomas originate from embryonal ectoderm (skin and glands) and endoderm (mucus

membrane lining of resp. tract, GI tract and GU tract)

Sarcomas originate from embryonal mesoderm (connective tissue, muscle, bone and fat)

Leukemia and lymphomias originiate from the hematopoietic system

What determines the treatment plan of a type of

cancer?

The staging of the cancer determines the treatment of

the cancer

What are three types of biopsy procedure that are used to examine suspect tissue?

Needle, incisional and excisional

Goals for treatment are driven by the presentation of disease and patient factors, what type of treatments are determined

by patient factors?

Cure: eradicate cancerControl: put into remission

Palliation: provides relief from symptoms and improves

quality of life

What are the treatments for cancer?

Surgery (used to prevent, diagnose and treat)

ChemotherapyRadiation

Biological and targeted therapy

What is the most common administration route for

chemotherapy?

Intravenious

What is intrathecal and intraventricular and why is it

important?

Infusing through the spinal column, it is important for

administering chemothearpy to the brain, since it can

bypass the blood/brain barrier

Where does intravesical chemotherapy deliever to?

Chemotherapy delievered to the bladder

What are two IV infusion routes for chemotherapy,

which one is considered to be the better of the both when it comes to long term therapy?

PIC line and CVADCVADs such as tunneled catheters, peripherally inserted central catheter and ports are more beneficial for long term use because it can be used for continuous infusion, you are able to adiminister other products through the line and there is a decrease in

extravasation injury

What is one negative aspect to patient safety when it

comes to CVADs such as a implanted port?

There is an increase for systemic infection

What are some considerations when administering

chemotherapy agents?

Be cautious with chemotherapy agents because they can be;

1. Vesicants2. Irritants

3. Extravasation4. Acute toxicity

What are some symptoms of acute toxicity with chemotherapy?

Anaphylactice reaction, extravasation (caused by

vesicants) and anticipatory N&V

What is simulation?

Simulation is radiation treatment and planning

What is the big difference between teletherapy and

brachytherapy?

Teletherapy is external and is not radioactive, whereas

brachytherapy is internal and is radioactive

What type of brachytherapy is used in radiation treatment for

thyroid cancer?

I-89 (Iodine 89)

Radiation causes bone marrow suppression, what is

the Nadir

Nadir is the time in which the patient reaches the lowest

blood cell count, generally 7-10 days after treatment is

initiated

What does neutropenia mean?

Low WBC

What does pancytopenia mean?

All types of blood counts are low; WBC, RBC and platelets

What medications stimulate WBC production?

Neupogen/filgrastin and Neulasta/pegfilgrastin both stimulate WBC production

What medications stimulate production of RBC?

Darbepoetin/arnesp and Epoetin/epogen (Procrit)

stimulates RBC production

Name some antiemetics

Reglan, Zofran and Kytril

What is biologic therapy?

Biologic therapy consists of agents that modify the

relationship between the host and the tumor by altering the biologic response of the thost

to the tumor cells

What are the three ways biologic therapy affects the

tumor cells?

1. Direct anti-tumor effects2. Augment host immune

system3. Interfere with cancer

cell’s ability to metastasize or differentiate

What is targeted therapy?

Targeted therapy interferes with cancer growth by

targeting specific cellular receptors and pathways that are important in tumor growth

Why is targeted therapy safer than chemotherapy?

Chemotherapy not only kills cancer cells but also healthy

normal cells, whereas targeted therapy has the affect

of killing the cancer cells without harming normal cells

What is an example of targeted therapy?

Angiogenesis inhibitors prevent vascularization of

tumors

If a neutropenic patient has a temperature of 100.5 or higher

what should be done?

Asses for s/s of fever, determine the etiology through UA/cultures, Chest X-ray and blood test as well as a CBC to determine the severity of the

neutropenia?

What is a precaution when treating neutropenic patient when administering tylenol?

Tylenol can mask s/s of fever, at times fever can be the only

and first sign of infection. If infection continues without attention there is a risk for

septic shock

What are three types of obstructive emergencies?

Superior vena cava syndromeSpinal cord compressionThird space syndrome

What is the treatment for spinal cord compression?

Laminectomy

What is third space syndrome, what are the symptoms and

what is the treatment?

Third space syndrome is a shift of fluid volume from

vascular space to interstitial space, s/s include

hypovolemia, hypotension, tachycardia and decreased

urine output. Treatment is with fluids and electrolytes

What infiltrative emergency is characterized by fluid around

the heart?

Cardiac taponade