Exam 3 Material

Cellular differentiation

The normal process occurring over many cell cycles that allows cells to specialize in certain tasks.

Hyperplasia

An increase in the number or density of normal cells, which can occur in response to stress, increased metabolic demands, or elevated hormones.

Metaplasia

A change in the normal pattern of cell differentiation where dividing cells differentiate into cells not normally found in that location, such as ciliated columnar cells being replaced with squamous stratified epithelium in smokers' lungs.

Dysplasia

The loss of DNA control over cell differentiation in response to adverse conditions, such as cervical changes resulting from persistent HPV irritation.

Anaplasia

The regression of a cell to an immature or undifferentiated cell type, often associated with malignancies such as Anaplastic large cell lymphoma.

Leukemia

An umbrella term for cancers of the blood and blood-forming tissues caused by DNA mutations, where abnormal or immature white blood cells proliferate, infiltrate organs, and replace normal bone marrow, leading to bone marrow suppression.

Acute leukemia

A classification of leukemia characterized by an abrupt onset of signs and symptoms, in which leukocyte production stops at the blast phase and cells do not mature.

Chronic leukemia

A classification of leukemia in which signs and symptoms evolve over months to years, the majority of leukocytes are mature, and progression is slower.

Acute Myeloid Leukemia (AML)

The most common non-lymphocytic leukemia, caused by a defect in myeloid stem cells, affecting all ages with a peak incidence at 67 years of age.

Remission induction therapy (AML)

The initial treatment phase for acute myeloid leukemia with the goal of killing leukemia cells in the blood and bone marrow to achieve remission.

Post-remission therapy (AML)

The treatment phase for acute myeloid leukemia aimed at eliminating any remaining leukemia cells that may be inactive but could regrow and cause a relapse.

Chronic Myeloid Leukemia (CML)

A leukemia involving a mutation in myeloid stem cells characterized by uncontrolled cell proliferation, the presence of the Philadelphia chromosome, and an average diagnosis age of 64 years.

Tyrosine kinase inhibitors (TKIs)

The initial drugs of choice for chronic myeloid leukemia that block the tyrosine kinase enzyme responsible for causing stem cells to produce excessive white blood cells (blasts).

Acute Lymphocytic Leukemia (ALL)

A cancer caused by uncontrolled proliferation of immature lymphoid stem cells (B-cell or T-cell), most common in young children (boys more than girls) with a peak age of 4 years.

Chronic Lymphocytic Leukemia (CLL)

The most common adult leukemia, originating in bone marrow lymphocytes, primarily affecting older adults with a mean age of 72 years and survival ranging from 2 to 14 years.

Lymphoma

A solid neoplasm of lymphoid origin affecting the lymphatic system, typically originating in lymph nodes but capable of involving the spleen, GI tract, liver, or bone marrow.

Reed-Steinberg cells

The characteristic malignant cells present in Hodgkin lymphoma.

Multiple Myeloma

An incurable malignancy with a median diagnosis age of 70 years, characterized by bone destruction, bone pain reported in 80% of clients (primarily back and ribs), hypercalcemia, and renal impairment.

Induction phase (Chemotherapy)

The chemotherapy phase intended to destroy all cancer cells using chemotherapy drugs and a steroid; evaluated after 4 weeks via bone marrow aspiration to verify remission.

Consolidation phase (Chemotherapy)

A 1- to 2-month phase of combined chemotherapy, steroids, and possibly intrathecal therapy (if cells are in CSF) aimed at eliminating any remaining cancer cells.

Maintenance phase (Chemotherapy)

A 2- to 3-year chemotherapy phase initiated once remission is achieved, using lower doses of induction medications to prevent cancer from returning.

External Beam Radiation (teletherapy)

A radiation therapy method where the radiation oncologist outlines the specific treatment area with semi-permanent ink or a tattoo to deliver localized radiation externally.

Internal Beam Radiation (brachytherapy)

Radiation therapy delivered via sources implanted directly into affected tissue or body cavities, ingested, or infused; unsealed liquid formats cause all body fluids to become contaminated.

Harvesting (HSCT)

The stage of hematopoietic stem cell transplantation that involves collecting stem cells from either the client (autologous) or a donor (allogeneic).

Conditioning (HSCT)

The stage of hematopoietic stem cell transplantation involving aggressive chemotherapy administered to prepare the client's body for the transplant.

Graft-versus-host disease (GVHD)

A complication unique to allogeneic stem cell transplants in which the donor cells recognize the recipient's body tissues as foreign and mount an immune attack.

Tumor lysis syndrome

A potential oncologic emergency characterized by the metabolic disturbances of hyperkalemia, hyperphosphatemia, and hypocalcemia.

Mucositis

An adverse effect of chemotherapy manifesting as red, bleeding ulcers occurring 5 to 15 days following treatment.

Hodgkin lymphoma

A lymphoid malignancy characterized by the presence of Reed-Steinberg cells, a bimodal age distribution (early 20s and after age 50), painless swollen lymph nodes, and high cure rates.

Non-Hodgkin lymphoma

A lymphoid malignancy characterized by an incidence that increases with age (average diagnosis age 66 years), poorer outcomes compared to Hodgkin lymphoma, painless lymphadenopathy, and chemotherapy as the primary treatment.

Four main types of leukemia

1. Acute Myeloid Leukemia (AML): Defect in myeloid stem cells; most common non-lymphocytic leukemia with a peak incidence at age 67. 2. Chronic Myeloid Leukemia (CML): Uncontrolled myeloid proliferation associated with the Philadelphia chromosome; average diagnosis age is 64. 3. Acute Lymphocytic Leukemia (ALL): Proliferation of immature lymphoid stem cells; most common in young children with a peak age of 4. 4. Chronic Lymphocytic Leukemia (CLL): Originates in bone marrow lymphocytes; the most common adult leukemia with a mean age of 72.

AML (Acute Myeloid Leukemia)

A hematologic malignancy presenting with fever, bleeding, bone pain, and gum hyperplasia, having a peak age of $67$.

ALL (Acute Lymphoblastic Leukemia)

A hematologic cancer with a peak age of $4$, presenting with pallor, recurrent infection, and easy bruising, with an $85\%$ 3-year event-free survival rate in children.

Hodgkin Lymphoma

A lymphoma characterized by painless lymph node swelling, severe pruritus, night sweats, and Reed-Sternberg cells on biopsy, typically managed with chemotherapy followed by radiation.

Multiple Myeloma

An incurable but treatable hematologic malignancy presenting with bone pain in $80\%$ of cases, hypercalcemia, renal impairment, and recurrent infection.

Reed-Sternberg Cells

Diagnostic giant cells identified on biopsy that confirm Hodgkin lymphoma.

Gum Hyperplasia

Swelling and overgrowth of the gingival tissues, recognized as a clinical sign associated with acute myeloid leukemia (AML).

Hematology/Oncology Priority Rule

The triage guideline establishing that infection and bleeding come first, and any temperature change or fever is clinically significant.

Hypercalcemia in Multiple Myeloma

A complication of malignant bone breakdown that causes systemic symptoms including constipation, confusion, and elevated serum calcium levels.

Induction Phase Chemotherapy

The first phase of leukemia chemotherapy designed to induce disease remission.

Radiation Skin Markings

Target markings drawn on a patient's skin for external beam radiation alignment that must not be washed off during patient care.

Acute Lymphocytic Leukemia (ALL)

A form of leukemia characterized by the abnormal proliferation of lymphocyte precursors (lymphoblasts), with approximately 80% involving B-cell lineages and 20% involving T-cell lineages.

Acute Myeloid Leukemia (AML)

A malignancy characterized by the rapid accumulation of myeloid precursors (myeloblasts) in the bone marrow and peripheral blood, occurring more commonly than ALL.

What happens to blood cells in leukemia

Immature, nonfunctioning WBCs (blasts) proliferate and enter the bloodstream, overwhelming normal red blood cells and platelets and leading to a marked decrease in RBC production.

Bone Marrow Aspiration and Biopsy

The definitive diagnostic procedure confirming acute leukemia by demonstrating a proliferation of immature WBCs; typically performed at the posterior superior iliac spine if aspirate is dry.

Flow Cytometry (Immunophenotyping)

A diagnostic laboratory test used to determine the specific immunophenotypic cell type of acute leukemia and distinguish AML from ALL.

Non-Hodgkin Lymphoma (NHL)

A heterogeneous group of malignant lymphoid neoplasms characterized by the progressive clonal expansion of B-cells, T-cells, or natural killer cells that lack Reed-Sternberg cells.

Nodular Infiltration Pattern (NHL)

A structural pattern of lymphoid tissue infiltration in non-Hodgkin lymphoma that carries a better prognosis than the diffuse infiltration form.

Lugano Classification Staging System

The standard four-stage staging system utilized to determine disease progression, treatment, and prognosis in patients with non-Hodgkin lymphoma based on nodal and extralymphatic involvement.

Hodgkin Lymphoma

A neoplastic disorder of lymphoid tissue characterized by painless, progressive enlargement of lymph nodes and spleen, distinguished by the histologic presence of Reed-Sternberg cells.

Reed-Sternberg Cells

Giant, abnormal multinucleated histiocytic/lymphocytic cells with large, distinct nucleoli that serve as the pathognomonic diagnostic hallmark of Hodgkin lymphoma.

Nodular Sclerosis

The most common subtype of classic Hodgkin lymphoma, accounting for 60% to 80% of classic cases, and most frequently diagnosed in young adults.

Mixed Cellularity Subtype

A subtype of classic Hodgkin lymphoma that is more commonly diagnosed in late adulthood compared to the nodular sclerosis subtype.

Procarbazine Hydrochloride Dietary Precautions

A dietary requirement during procarbazine therapy mandating the avoidance of vanilla, cheese, and wine to prevent adverse dietary-drug interactions.

Adjuvant Chemotherapy

Chemotherapy administered after primary surgical resection or radiation therapy to eradicate undetectable micrometastases and prevent cancer recurrence.

Induction (Neoadjuvant) Chemotherapy

Chemotherapy administered prior to surgery or radiation therapy to shrink the tumor mass and improve surgical resectability and survival rates.

Folinic Acid (Leucovorin) Rescue

An antidote given following high-dose toxic methotrexate therapy to rescue normal tissue and vital organs from permanent destruction.

Intraperitoneal Chemotherapy

Direct administration of chemotherapeutic agents into the peritoneal cavity via an implanted port and catheter to achieve high local drug concentrations for advanced ovarian cancer and peritoneal carcinomatosis.

Vesicant

A classification of chemotherapeutic drugs (such as DOXOrubicin, vinCRIStine sulfate, and CISplatin at doses $>20\,\text{mL}$ of $0.5\,\text{mg/mL}$) that cause severe tissue damage, ulceration, and necrosis if extravasated.

Extravasation

The unintentional infiltration of a vesicant drug into perivascular and subcutaneous tissue due to a punctured vein or leakage around a venipuncture site.

Emergency Extravasation Protocol

Immediate intervention requiring stopping the infusion, disconnecting the IV tubing without removing the access device/needle, attempting to aspirate residual drug using a $3\,\text{mL}$ syringe, and notifying the practitioner.

Vein Patency Testing in Chemotherapy

A safety requirement specifying that vein patency must never be tested using a chemotherapeutic agent; patency must be confirmed with preservative-free normal saline or $D_5W$.

Chemotherapy PPE Guidelines

Hazardous drug safety protocol requiring two pairs of powder-free chemotherapy gloves (changed every 30 minutes), a polyethylene-coated nonlinting gown, eye protection, and respirators as indicated.

Chemotherapy-Induced Myelosuppression Cutoffs

Clinical thresholds requiring stopping the drug if WBC drops suddenly or is $<2{,}000/\text{mm}^3$, initiating neutropenic precautions if absolute granulocytes are $<1{,}000/\text{mm}^3$, and reporting platelets $<100{,}000/\text{mm}^3$.

Stomatitis Oral Rinse Protocol

Mouth care instruction directing the patient to rinse with $1\,\text{tsp}\ (5\,\text{mL})$ of salt dissolved in $8\,\text{oz}\ (237\,\text{mL})$ of warm water, avoiding lemon-glycerin swabs and commercial mouthwashes.

External Beam Radiation Therapy

The most common form of radiotherapy that delivers high levels of external ionizing radiation (typically photon beams produced by linear accelerators or cobalt/cesium gamma units) to impair DNA/RNA synthesis or decrease mitosis.

Curative Radiation

Radiation therapy delivered with the goal of completely destroying the cancer without expectation of recurrence.

Palliative Radiation

Radiation therapy aimed at symptom relief (such as alleviating bone pain, seizures, bleeding, and headaches caused by cancer) rather than tumor cure.

Fractionation and Rest Breaks in Radiotherapy

A treatment schedule delivering radiation daily for 3 to 5 days a week over 5 to 8 weeks, utilizing weekends without treatment to allow normal cells time to recover.

Radiation Skin Protection Teaching

Patient education directing patients to avoid applying unprescribed lotions, deodorants, or powders to the treated skin, use SPF 30 or higher, and avoid direct sun exposure to the irradiated site for 1 year.

Transurethral Resection of the Prostate (TURP)

A surgical intervention used to treat urinary obstruction caused by benign prostatic hyperplasia (BPH) by passing a resectoscope through the urethra to excise excess tissue, commonly managed postoperatively with continuous bladder irrigation to prevent blood clot formation.

Postoperative TURP Care

Clinical management focused on running continuous bladder irrigation (CBI) through a three-way indwelling catheter to prevent blood clot obstruction and maintain light pink urine, monitoring for transurethral resection (TUR) syndrome (dilutional hyponatremia and fluid overload), managing bladder spasms, and preventing increased intra-abdominal pressure by avoiding straining.

Complications of Transurethral Resection of the Prostate (TURP)

Adverse outcomes including transurethral resection (TUR) syndrome (dilutional hyponatremia and fluid overload from irrigation fluid absorption), hemorrhage and clot retention, retrograde ejaculation, urethral strictures, urinary tract infections, and transient or persistent incontinence.

Absolute Neutrophil Count (ANC)

A laboratory calculation of immune competence and infection risk that quantifies circulating segmented and banded defense cells, where values $<1{,}000/\text{mm}^3$ warrant protective neutropenic precautions and values $<500/\text{mm}^3$ represent severe risk for life-threatening infection.

Neutropenic Precautions

Infection-control and protective isolation measures initiated when the absolute neutrophil count drops below $1{,}000/\text{mm}^3$, consisting of private room placement with positive-pressure HEPA filtration, strict hand hygiene, avoidance of fresh flowers, standing water, and raw or unpeeled produce, exclusion of visitors with infectious symptoms, and avoidance of rectal temperatures, enemas, or suppositories.

Nutritional Support in Oncology

Clinical dietary strategies to prevent cancer cachexia and support healing, characterized by a high-protein, high-calorie intake, small and frequent nutrient-dense meals, soft or room-temperature foods to minimize oral discomfort from mucositis, and avoiding raw or unpasteurized foods during periods of immunosuppression.

Mucositis Clinical Presentation and Management in Oncology

Painful erythematous oral ulcerations appearing $5$ to $15$ days after antineoplastic therapy, managed by inspecting the oral mucosa, rinsing with $1\,\text{tsp}\ (5\,\text{mL})$ salt dissolved in $8\,\text{oz}\ (237\,\text{mL})$ warm water, avoiding lemon-glycerin swabs and commercial mouthwashes, using soft toothbrushes, and consuming soft, bland, room-temperature foods.

Nursing Interventions for Cancer-Related Anorexia

Clinical dietary strategies to stimulate intake, including offering small, frequent, nutrient-dense meals ($5$ to $6$ times daily) high in protein and calories, encouraging the largest meal early in the day when appetite is greatest, avoiding fluids with meals to prevent early satiety, serving foods cold or at room temperature to minimize odor-induced nausea, and adding oral nutritional supplements between meals.