Oncology: Overview of Cancer Care

Comprehensive vocabulary flashcards covering cancer pathophysiology, staging, prevention, diagnostic evaluations, oncological emergencies, treatment modalities, complications, and hematologic malignancies based on the lecture notes.

Cancer

A condition characterized by abnormal cell growth resulting from genetic mutations, capable of angiogenesis to feed tumors, and spreading to surrounding areas or distant tissues via lymph and blood vessels.

Primary Prevention

Measures aimed at completely preventing the occurrence of cancer before it develops, including immunizations (e.g., HPV vaccine), chemoprevention, avoiding tobacco and alcohol, skin protection, healthy diet and weight management, and reducing environmental carcinogen exposure.

Secondary Prevention

Screening and early detection strategies designed to diagnose cancer at the earliest stage possible; includes mammograms, Pap tests, HPV tests, colonoscopies, monitoring skin changes, and genetic testing.

Tertiary Prevention

Medical and nursing management focused on the proper treatment of established disease to prevent further complications, disability, or recurrence; includes surgery, radiation, chemotherapy, palliative care, and pain relief.

Stage 1 Cancer

Early-stage or localized cancer where a small, invasive mass or tumor has formed (such as a breast tumor $< 2\,cm$) with no spread to lymph nodes or other tissues.

Stage 2 Cancer

Localized cancer where the tumor has grown in size (such as a breast tumor $2\text{--}5\,cm$), started to affect nearby tissue, and spread to regional lymph nodes adjacent to the mass.

Stage 3 Cancer

Regional spread where the tumor affects more surrounding tissue, may exceed $5\,cm$ in size, and has spread to distant lymph nodes away from the primary mass.

Stage 4 Cancer

Advanced or metastatic cancer in which malignant cells have spread beyond the primary region to distant organs or tissues.

Breast Cancer Screening Guidelines

Annual mammography is optional from ages 40 to 44 (recommended if family history exists), required annually from ages 45 to 54, and recommended every 1 to 2 years for women age 55 and older.

Cervical Cancer Screening Guidelines

For women ages 25 to 65, screening consists of a Pap test combined with an HPV test every 5 years, or a Pap test alone every 3 years.

Colon Cancer Screening Guidelines

Routine colonoscopy recommended beginning at age 45 and repeated every 10 years unless family history warrants earlier or more frequent screening.

Prostate-Specific Antigen (PSA)

A tumor marker for prostate cancer with a normal value of $< 4\,ng/mL$; levels $> 10\,ng/mL$ are considered high.

CA 19-9

A tumor marker evaluated for pancreatic cancer, where a normal level is $< 35\,U/mL$ and a high level is $> 100\,U/mL$.

CA 72-4

A tumor marker evaluated for gastric cancer, possessing a normal level of $< 6\,U/mL$ and a high level of $> 30\,U/mL$.

Beta-Human Chorionic Gonadotropin (B-HCG)

A tumor marker associated with testicular cancer, where normal is $< 5\,U/L$ and levels $> 5\,U/L$ indicate elevation.

Beta-2 Microglobulin (B2M)

A tumor marker used in the evaluation of multiple myeloma; normal is $< 2\,mg/L$ and high is $> 2\,mg/L$.

Positron Emission Tomography (PET) Scan

A diagnostic imaging technique involving the injection of a radioactive tracer that accumulates in areas of increased metabolic activity, visualized as 'hot spots' corresponding to areas of malignancy.

Liver Biopsy Priority Nursing Action

Position the patient to lie on their right side post-procedure to apply pressure and prevent the key risk of hemorrhage.

Lung Biopsy Priority Nursing Action

Auscultate breath sounds, monitor oxygen saturation, and report dyspnea immediately due to the key risks of pneumothorax and respiratory distress.

Endoscopy Post-Procedure Nursing Action

Maintain the patient NPO (nothing by mouth) until the gag reflex fully returns to prevent aspiration.

CAUTION Mnemonic

An American Cancer Society tool identifying 7 early warning signs of cancer: Change in bowel or bladder habits; A sore that does not heal; Unusual bleeding or discharge; Thickening or lump in breast or elsewhere; Indigestion or dysphagia; Obvious change in wart or mole; Nagging cough or hoarseness (seek evaluation if persisting $> 2$ weeks).

Bowel Obstruction (Oncological Emergency)

A blockage most common in colon and pancreatic cancers presenting with vomiting, abdominal distention, diminished/absent bowel sounds, and ribbon-like stools; managed with NPO status, nasogastric (NG) tube decompression, IV fluids, and laxatives due to high risk of bowel perforation.

Hypercalcemia (Oncological Emergency)

A metabolic emergency resulting from bone metastasis and bone breakdown; clinical features include confusion, muscle weakness, kidney stones, and bradycardia; managed with vigorous IV rehydration, calcitonin, and bisphosphonates (which take up to 48 hours to work).

Leukostasis

An oncological emergency occurring in acute leukemia when WBC counts exceed $100{,}000/\mu L$, causing microvascular sludging, thrombosis, hemorrhage, respiratory failure, and neurological impairment; treated with emergency chemotherapy to rapidly lower WBC levels.

Pericardial Effusion / Tamponade

Excess fluid accumulation in the pericardial sac, most common in chest cancers (lung, breast, lymphoma), decreasing cardiac output; signs include dyspnea, JVD, hypotension, and muffled heart sounds; treated with urgent pericardiocentesis.

Superior Vena Cava (SVC) Syndrome

Obstruction of venous return from the upper body caused by tumor compression (commonly lung or breast cancer); manifests with facial, neck, and upper chest edema, distended jugular veins, and dyspnea; managed with High Fowler's positioning, corticosteroids, and emergent high-dose radiation.

Tumor Lysis Syndrome (TLS)

A metabolic complication caused by rapid destruction of malignant cells, releasing excessive intracellular contents into the blood; results in hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia, causing acute kidney failure and cardiac dysrhythmias.

Brachytherapy

Internal radiation therapy where radioactive seeds or sources are placed directly inside or near the tumor; requires safety protocols including a private room, lead apron, a 30-minute visitor limit, exclusion of pregnant individuals and children under 16, and having a lead container with tongs in the room.

Chemotherapy Extravasation

Infiltration of vesicant antineoplastic drugs into subcutaneous tissue causing severe pain, blistering, and necrosis; nursing actions require immediately stopping the infusion, leaving the catheter to aspirate residual drug, elevating the extremity, applying cool compresses, and administering specific antidotes.

Nadir

The point of lowest blood cell counts following chemotherapy, typically occurring 7 to 12 days post-infusion, during which the client faces the highest risk of life-threatening infection (lasting 5 to 7 days).

Neutropenic Precautions

Infection control measures for severely immunocompromised patients: private room, wearing a mask during transport, strict hand hygiene, daily temperature checks, avoiding fresh flowers or plants, avoiding crowds, and eliminating invasive procedures like rectal temperatures or injections.

Acute Lymphocytic Leukemia (ALL)

A rapidly progressive leukemia primarily affecting children ('ALL kids') marked by excessive immature blast cells and a high propensity for central nervous system (CNS) involvement.

Acute Myelogenous Leukemia (AML)

A rapid-onset, high-risk acute leukemia occurring primarily in adults, characterized pathologically by the presence of Auer rods and clinically by severe infections and bleeding.

Chronic Lymphocytic Leukemia (CLL)

A slow-progressing leukemia affecting primarily older adults that is often asymptomatic and diagnosed by the presence of mature-appearing 'smudge cells' on a peripheral blood smear.

Chronic Myelogenous Leukemia (CML)

A slow-moving chronic leukemia seen mainly in middle-aged adults, distinguished cytogenetically by the Philadelphia chromosome and clinically by an enlarged spleen (splenomegaly).

Reed-Sternberg Cells

Large, abnormal multinucleated lymphocytes that serve as the definitive microscopic diagnostic hallmark of Hodgkin lymphoma; absent in non-Hodgkin lymphoma.

Hodgkin Lymphoma

A relatively rare lymphoma affecting individuals aged 20 to 40 and 65 and older, characterized by painless lymphadenopathy, the presence of Reed-Sternberg cells, 2 main types with 4 subtypes, and an $88\%$ 5-year survival rate.

Non-Hodgkin Lymphoma

The 8th most common cancer, predominantly affecting individuals aged 65 and older, categorized into 2 main types with over 70 subtypes, lacking Reed-Sternberg cells, and having a $74\%$ 5-year survival rate.

Bone Marrow Biopsy Nursing Management

A needle aspiration procedure usually performed at the hip (iliac crest) to examine cellularity; post-procedure care requires applying direct manual pressure to the site for 5 to 10 minutes, placing a sterile pressure dressing, and monitoring for bleeding and infection.

Phases of Leukemia Chemotherapy

A three-phase protocol consisting of: Induction therapy (initial aggressive chemotherapy to clear leukemia cells from blood and bone marrow), Consolidation therapy (given during remission to eradicate residual hidden cells), and Maintenance therapy (lower-dose treatment to prevent recurrence).