1
INTERMEDIATE MED SURG 201 Final Exam Notes - Week 9 (QUESTIONS TO DO)
1. The two major dysfunctions in cancer development. What are they? (page 235)
1. Defective cell proliferation(growth)
• Originates in the stem cells and begins when the stem cell enters the cycle.
It happens twice in the body- when the cell has died (apoptosis) & needs to
be replaced (puberty) or a physical need for more cells such as when there’s
an
infection and there’s an increase in WBC. Growth signal telling the body there is
a need for the cell to divide, then it will divide, follows the stage of mitosis
causes 2 cells- normal cell division.
b. Defective cell differentiation
• Differentiation (maturation)- orderly process that process from a state of
immaturity to a state of maturity that will not change. Process of maturation is
an
orderly process- they went through an order of stages. Cancer does not follow
process of maturation.
2. What is a stem cell?
Undifferentiated cells - stem cells (baby cells) they don’t have functions but thy mature and take
on independent functions and become adult cells
2. What is Contact inhibition?
Contact inhibition occurs when proliferation control in normal cells. Normal cells respect the
boundaries & territories of the cells surrounding them. Cancer cells are characterized by loss of
contact inhibition. They will ultimately build a pyramid effect because they will grow on top of
normal cells and have no regard for boundaries. Cancer cells produce more than 2 cells at a time
which makes them disobedient; cancer cells loves to invade lymphatic & blood supply
2. The three stages in cancer development: P. 236
A. Initiation: everything we have done to out body causes initiation, alcohol, fast food, stress, lack
of activities. There is at least one cell that has mutated. (irreversible phase)
B. Promotion: things to do to slow down- exercise, diet, enough of sleep, manage stress, stop
smoking and alcohol, caffeine. (reversible stage- because we have some control) -benign
tumors are here.
C. Progression: you are not in charge; the cancer cell has invaded (spreading to the local
invasion)- invasion or metastasis happens at this point. Growing rapid
5. What is Latent Period?
Latent Period- includes both the initiation and promotion stages in the natural history of cancer.
makes identification of carcinogens difficult (sleeping cancer) like a toddler when you get close,
they are quiet when they wake up, they flip your house. They can sleep for years anywhere from
1 year to 40 years.
6. What are the main 5 sites for cancer metastasis in general?
Blood, brain, lung, liver, & adrenal glands- because they are rich in oxygen & blood supply.
7. What is TNM
staging?
A. Primary Tumor (T)
• To: No evidence of Tumor
• Tumor in situ
• T1-4: Degrees of increase in tumor site & involvement
• Tx: Tumor cannot be measured
B. Regional Lymph nodes (N)
• No: no evidence
• N1-4: degrees of nodal involvement
• Nx: unable to assess
C. Distant Metastasis (M)
• Mo: No evidence
,2
• M1-4: metastatic involvement, including distant nodes
• Mx: cannot be determined
8. What CEA? → oncofetal antigens; Oncofetal antigens can be used as tumor markers that
clinically are useful to monitor the effect of therapy & may possibly indicate tumor recurrence
but not 100%. CEA is found on the surface of Cancer cells derived from the GI tract from the
fetal gut, liver, & pancreas. CEA disappears in the last 3 months of the fetal life. Elevated CEA
is also found in non-malignant conditions (cirrhosis, ulcerative colitis, & heavy smoking).
8. What is Alfa-fetoprotein? Found on surface cells; produced by malignant liver & fetal liver cells
(testicular carcinoma, viral hepatitis, non-malignant liver disorders); Oncofetal antigens: CEA,
AFP, CA125 (ovarian carcinoma), Ca 19-9 (pancreatic & gallbladder cancer), PSA (prostate
specific antigen, CA 15-3 & CA 27-29 (breast cancer), KRAS (colon), EGFR epidermal growth
factor (Lung cancer).
8. What is the difference between malignant tumor and benign tumor?
• Benign: encapsulated & is well-differentiated rarely spreads
• Malignant: metastasizes and reoccurs
11. What is the purpose of staging?
• Status of cancer, effective tx, evaluate tx plan, prognosis, & compare statistics.
12. What is stage 0,1,2,3,4
§ Stg 0: cancer in situ – cells are localized & show no tendency to invade or metastasize to other
tissues.
§ Stg 1: localized growth
§ Stg 2 starting to spread (limited local spread)- such as stomach cancer moves to other organs.
§ Stg 3: extensive regional growth and local spread
§ Stg 4: metastasize
13. What is PET scan?
Positron emission tomography (PET) is a nuclear medicine procedure that produce three-
dimensional images of the head. Pet scan prior to tx indicated metastasis throughout the body. Pet
scan post tx indicates the effects of therapy. More radioactive material accumulates in the areas
with higher activities.
13. Biopsy and types of biopsy
· Percutaneous- safely removed through the skin
· Endoscope- lung or intraluminal lesions (esophageal, colon, bladder)
· Surgical – laparotomy, thoracotomy, craniotomy
· Fine needle aspiration – for cytologic examination
· Large core biopsy – actual piece of tissue
· Excisional – surgical removal of the entire tissue, lymph node, nodule, or mass AND
tissue surrounding it.
· Incisional – partial excision w/ scalpel or dermal punch.
15. Nursing management of a patient who has is undergoing, and has undergone biopsy
§ obtain consent, prepare for procedures (NPO, withholding/administering medications as
prescribed, monitor lab findings)
§ Provide post-op care as indicated by tumor location & procedure type
§ Prevent general post-op complications (infection, fluid or electrolyte imbalance, hemorrhage,
thromboembolism, inadequate oxygen, shock)
§ Prevent and treat pain using pharm and non-pharmacological procedures
§ Educate the client on care for drains, wounds, & implanted devices.
§ Teach client to monitor for complications after discharge.
16. What are the seven warning signs of cancer? Acronym: CAUTION
Change in bowel/bladder habits
A sore that does not heal
Unusual bleeding or discharge from an orifice
, 3
Thickening or lumps in breast tissue
Indigestion or difficulty swallowing
Obvious change in mole or wart
Nagging cough or hoarseness (laryngeal cancer hoarseness is the earliest manifestation)
17. What are the different types of surgeries of cancer?
• Curative therapy: surgery alone or surgery w/ chemo and surgery
• Prophylactic surgeries: mastectomy – successful in reducing the incidence of some
malignancies. Followed by chemo & radiation
• Debulking: attached to a major blood vessel, portion can be removed to help w/ some of
the symptoms the pt. is experiencing
18. What is debulking and why do we debulk?
• attaches to a major blood vessel, portion can be removed to help w/ some of the symptoms that
the pt. is experiencing. Debulking is used to alleviate for i.e. if there is compression on
breathing, or certain vessels of the heart.
19. Extravasation and chemotherapy
• Extravasation injury due to chemotherapy: if it leaks(infiltrates) it causes local tissue damage
(pressure ulcer stage 3 or above) if it heals it takes many years. *monitor the site for 1 hr during
initiation*
20. Preferred IV sites for chemotherapy & and why?
• Central venous access device (CVAD) is is the safest because it can be used for blood draws,
IV, electrolytes
• Regional administration: delivery of the drug directly into the tumor site. Stomach cancer
you can put chemo into the peritoneal cavity
21. What are the common s/e of chemo and radiation therapy?
• bone marrow suppression aka myelosuppression (anemia, thrombocytopenia, leukopenia)
· WBC are affected w/ in 1-2 weeks, Plt 2-3 weeks, & RBC life span of 120 days.
· Monitor neutrophil, Plt, & rbc count. Typically, lowest blood count is the lowest at 7-10 days.
· Neutropenia is more common in chemo, risk for life threatening infection & sepsis. Precaution
for life threatening infections: wash hands, patients & their contacts. Monitor temp.
· Thrombocytopenia can result in spontaneous bleeding or hemorrhage. Avoid invasive procedures,
avoid activities that place them at risk for injury or bleeding. Serious bleeding happens if plt count
falls below 50,000. Plt transfusions may be administered when it reaches 20,000.
· Colony-stimulating factors: give medications that increase RBCs & WBCs- filgrastim
(neupogen) stimulates WBC. Bone marrow transplant is the best treatment option.
• Malnutrition: N/V, changes in taste(dysgeusia), anorexia, early satiety, thickened saliva.
· Admin antiemetics & antacids, monitor (albumin, ferritin, & transferrin), collaborate w/ dietary
services.
· Anorexia peaks at about 4 weeks of treatment; observe for dehydration, give small frequent meals
of high protein high calorie foods are better tolerated; weight the py twice a week.
· Keep a food diary, encourage brushing teeth before & after meal, asses lab of ferritin, &
limit drinking fluids during meals.
· Soft non-irritating high protein & high calorie foods.
· Avoid extreme temps, tobacco, alcohol, spicy or rough foods.
· Vomiting may occur w/ in 1 hr. of chemo or a few hours after radiation to the chest or abdomen and
present for 24 hrs. admin the pre-chemo med ondansetron (Zofran) & metoclopramide admin 15-30
min prior to chemo. Don’t give PO meds. Asses pt. who are experiencing nausea & vomiting for signs of
dehydration and metabolic alkalosis.
• Anemia
· Common in pt. it has a later onset around 3-4 months after treatment initiation. Erythropoietin
(procrit) it stimulates the RBC. In extreme situations rbc transfusion may be given. But they ultimately
INTERMEDIATE MED SURG 201 Final Exam Notes - Week 9 (QUESTIONS TO DO)
1. The two major dysfunctions in cancer development. What are they? (page 235)
1. Defective cell proliferation(growth)
• Originates in the stem cells and begins when the stem cell enters the cycle.
It happens twice in the body- when the cell has died (apoptosis) & needs to
be replaced (puberty) or a physical need for more cells such as when there’s
an
infection and there’s an increase in WBC. Growth signal telling the body there is
a need for the cell to divide, then it will divide, follows the stage of mitosis
causes 2 cells- normal cell division.
b. Defective cell differentiation
• Differentiation (maturation)- orderly process that process from a state of
immaturity to a state of maturity that will not change. Process of maturation is
an
orderly process- they went through an order of stages. Cancer does not follow
process of maturation.
2. What is a stem cell?
Undifferentiated cells - stem cells (baby cells) they don’t have functions but thy mature and take
on independent functions and become adult cells
2. What is Contact inhibition?
Contact inhibition occurs when proliferation control in normal cells. Normal cells respect the
boundaries & territories of the cells surrounding them. Cancer cells are characterized by loss of
contact inhibition. They will ultimately build a pyramid effect because they will grow on top of
normal cells and have no regard for boundaries. Cancer cells produce more than 2 cells at a time
which makes them disobedient; cancer cells loves to invade lymphatic & blood supply
2. The three stages in cancer development: P. 236
A. Initiation: everything we have done to out body causes initiation, alcohol, fast food, stress, lack
of activities. There is at least one cell that has mutated. (irreversible phase)
B. Promotion: things to do to slow down- exercise, diet, enough of sleep, manage stress, stop
smoking and alcohol, caffeine. (reversible stage- because we have some control) -benign
tumors are here.
C. Progression: you are not in charge; the cancer cell has invaded (spreading to the local
invasion)- invasion or metastasis happens at this point. Growing rapid
5. What is Latent Period?
Latent Period- includes both the initiation and promotion stages in the natural history of cancer.
makes identification of carcinogens difficult (sleeping cancer) like a toddler when you get close,
they are quiet when they wake up, they flip your house. They can sleep for years anywhere from
1 year to 40 years.
6. What are the main 5 sites for cancer metastasis in general?
Blood, brain, lung, liver, & adrenal glands- because they are rich in oxygen & blood supply.
7. What is TNM
staging?
A. Primary Tumor (T)
• To: No evidence of Tumor
• Tumor in situ
• T1-4: Degrees of increase in tumor site & involvement
• Tx: Tumor cannot be measured
B. Regional Lymph nodes (N)
• No: no evidence
• N1-4: degrees of nodal involvement
• Nx: unable to assess
C. Distant Metastasis (M)
• Mo: No evidence
,2
• M1-4: metastatic involvement, including distant nodes
• Mx: cannot be determined
8. What CEA? → oncofetal antigens; Oncofetal antigens can be used as tumor markers that
clinically are useful to monitor the effect of therapy & may possibly indicate tumor recurrence
but not 100%. CEA is found on the surface of Cancer cells derived from the GI tract from the
fetal gut, liver, & pancreas. CEA disappears in the last 3 months of the fetal life. Elevated CEA
is also found in non-malignant conditions (cirrhosis, ulcerative colitis, & heavy smoking).
8. What is Alfa-fetoprotein? Found on surface cells; produced by malignant liver & fetal liver cells
(testicular carcinoma, viral hepatitis, non-malignant liver disorders); Oncofetal antigens: CEA,
AFP, CA125 (ovarian carcinoma), Ca 19-9 (pancreatic & gallbladder cancer), PSA (prostate
specific antigen, CA 15-3 & CA 27-29 (breast cancer), KRAS (colon), EGFR epidermal growth
factor (Lung cancer).
8. What is the difference between malignant tumor and benign tumor?
• Benign: encapsulated & is well-differentiated rarely spreads
• Malignant: metastasizes and reoccurs
11. What is the purpose of staging?
• Status of cancer, effective tx, evaluate tx plan, prognosis, & compare statistics.
12. What is stage 0,1,2,3,4
§ Stg 0: cancer in situ – cells are localized & show no tendency to invade or metastasize to other
tissues.
§ Stg 1: localized growth
§ Stg 2 starting to spread (limited local spread)- such as stomach cancer moves to other organs.
§ Stg 3: extensive regional growth and local spread
§ Stg 4: metastasize
13. What is PET scan?
Positron emission tomography (PET) is a nuclear medicine procedure that produce three-
dimensional images of the head. Pet scan prior to tx indicated metastasis throughout the body. Pet
scan post tx indicates the effects of therapy. More radioactive material accumulates in the areas
with higher activities.
13. Biopsy and types of biopsy
· Percutaneous- safely removed through the skin
· Endoscope- lung or intraluminal lesions (esophageal, colon, bladder)
· Surgical – laparotomy, thoracotomy, craniotomy
· Fine needle aspiration – for cytologic examination
· Large core biopsy – actual piece of tissue
· Excisional – surgical removal of the entire tissue, lymph node, nodule, or mass AND
tissue surrounding it.
· Incisional – partial excision w/ scalpel or dermal punch.
15. Nursing management of a patient who has is undergoing, and has undergone biopsy
§ obtain consent, prepare for procedures (NPO, withholding/administering medications as
prescribed, monitor lab findings)
§ Provide post-op care as indicated by tumor location & procedure type
§ Prevent general post-op complications (infection, fluid or electrolyte imbalance, hemorrhage,
thromboembolism, inadequate oxygen, shock)
§ Prevent and treat pain using pharm and non-pharmacological procedures
§ Educate the client on care for drains, wounds, & implanted devices.
§ Teach client to monitor for complications after discharge.
16. What are the seven warning signs of cancer? Acronym: CAUTION
Change in bowel/bladder habits
A sore that does not heal
Unusual bleeding or discharge from an orifice
, 3
Thickening or lumps in breast tissue
Indigestion or difficulty swallowing
Obvious change in mole or wart
Nagging cough or hoarseness (laryngeal cancer hoarseness is the earliest manifestation)
17. What are the different types of surgeries of cancer?
• Curative therapy: surgery alone or surgery w/ chemo and surgery
• Prophylactic surgeries: mastectomy – successful in reducing the incidence of some
malignancies. Followed by chemo & radiation
• Debulking: attached to a major blood vessel, portion can be removed to help w/ some of
the symptoms the pt. is experiencing
18. What is debulking and why do we debulk?
• attaches to a major blood vessel, portion can be removed to help w/ some of the symptoms that
the pt. is experiencing. Debulking is used to alleviate for i.e. if there is compression on
breathing, or certain vessels of the heart.
19. Extravasation and chemotherapy
• Extravasation injury due to chemotherapy: if it leaks(infiltrates) it causes local tissue damage
(pressure ulcer stage 3 or above) if it heals it takes many years. *monitor the site for 1 hr during
initiation*
20. Preferred IV sites for chemotherapy & and why?
• Central venous access device (CVAD) is is the safest because it can be used for blood draws,
IV, electrolytes
• Regional administration: delivery of the drug directly into the tumor site. Stomach cancer
you can put chemo into the peritoneal cavity
21. What are the common s/e of chemo and radiation therapy?
• bone marrow suppression aka myelosuppression (anemia, thrombocytopenia, leukopenia)
· WBC are affected w/ in 1-2 weeks, Plt 2-3 weeks, & RBC life span of 120 days.
· Monitor neutrophil, Plt, & rbc count. Typically, lowest blood count is the lowest at 7-10 days.
· Neutropenia is more common in chemo, risk for life threatening infection & sepsis. Precaution
for life threatening infections: wash hands, patients & their contacts. Monitor temp.
· Thrombocytopenia can result in spontaneous bleeding or hemorrhage. Avoid invasive procedures,
avoid activities that place them at risk for injury or bleeding. Serious bleeding happens if plt count
falls below 50,000. Plt transfusions may be administered when it reaches 20,000.
· Colony-stimulating factors: give medications that increase RBCs & WBCs- filgrastim
(neupogen) stimulates WBC. Bone marrow transplant is the best treatment option.
• Malnutrition: N/V, changes in taste(dysgeusia), anorexia, early satiety, thickened saliva.
· Admin antiemetics & antacids, monitor (albumin, ferritin, & transferrin), collaborate w/ dietary
services.
· Anorexia peaks at about 4 weeks of treatment; observe for dehydration, give small frequent meals
of high protein high calorie foods are better tolerated; weight the py twice a week.
· Keep a food diary, encourage brushing teeth before & after meal, asses lab of ferritin, &
limit drinking fluids during meals.
· Soft non-irritating high protein & high calorie foods.
· Avoid extreme temps, tobacco, alcohol, spicy or rough foods.
· Vomiting may occur w/ in 1 hr. of chemo or a few hours after radiation to the chest or abdomen and
present for 24 hrs. admin the pre-chemo med ondansetron (Zofran) & metoclopramide admin 15-30
min prior to chemo. Don’t give PO meds. Asses pt. who are experiencing nausea & vomiting for signs of
dehydration and metabolic alkalosis.
• Anemia
· Common in pt. it has a later onset around 3-4 months after treatment initiation. Erythropoietin
(procrit) it stimulates the RBC. In extreme situations rbc transfusion may be given. But they ultimately
