Lexa oncology/cancer

Q: What are the phases of the cell cycle and what happens in each?

G1 = RNA + protein synthesis; S = DNA synthesis; G2 = DNA synthesis complete + mitotic spindle forms; M = mitosis/cell division; G0 = resting/dormant phase.

Q: How does the cell cycle explain a person's risk of getting cancer?

Cancer risk increases when genetic mutations disrupt normal cell cycle control, causing uncontrolled division instead of normal regulation (including cells escaping G0/resting and ignoring checkpoints).

Q: What are the 3 stages of carcinogenesis and what happens in each?

Initiation = carcinogens (chemical/physical/viral) alter DNA structure; Promotion = repeated exposure to co-carcinogens causes expression of mutant genes after latency; Progression = altered cells gain malignant traits like angiogenesis, invasion, and metastasis.

Q: How does immunity normally prevent cancer?

Immune surveillance recognizes tumor-associated antigens (TAAs) via antigen-presenting cells (APCs), then NK cells and cytotoxic T cells destroy abnormal cells.

Q: How do cancer cells evade the immune system?

Cancer occurs when immune surveillance fails to recognize TAAs or cancer cells mutate further to avoid recognition.

Q: What are hallmark signs of cancer using the CAUTION acronym?

C = Change in bowel/bladder habits; A = A sore that doesn't heal; U = Unusual bleeding/discharge; T = Thickening/lump; I = Indigestion/difficulty swallowing; O = Obvious change in wart/mole; N = Nagging cough/hoarseness.

Q: What are other common systemic signs/symptoms of cancer?

Pain, fatigue, anemia, leukopenia, thrombocytopenia, cachexia (wasting, early satiety, altered metabolism).

Q: How are hallmark signs of cancer assessed by nurses/healthcare providers?

Focused history + physical exam (lumps, skin/mole changes, bleeding, cough/hoarseness), symptom analysis, and diagnostic testing (CBC, imaging, biopsy) based on the CAUTION findings and systemic symptoms.

Q: What is primary prevention nursing care for cancer risk (focus: leukemias, lymphomas, breast cancer)?

Education to avoid carcinogens, smoking cessation, stress management, immunizations (HPV), healthy diet/exercise and lifestyle habits.

Q: What is secondary prevention nursing care for cancer risk (focus: leukemias, lymphomas, breast cancer)?

Screening such as CBC, Pap smears, clinical breast exams, mammograms, and genetic testing (BRCA1/BRCA2).

Q: What is tertiary prevention nursing care for cancer (focus: leukemias, lymphomas, breast cancer)?

Monitor for recurrence, screen for second malignancies, manage side effects and complications of treatments.

Q: How do benign vs malignant neoplasms differ in cell appearance?

Benign = well differentiated, resemble tissue of origin; Malignant = undifferentiated/anaplastic, little resemblance to tissue of origin.

Q: How do benign vs malignant neoplasms differ in rate of growth?

Benign = usually slow; Malignant = variable and faster if more anaplastic.

Q: How do benign vs malignant neoplasms differ in manner of growth?

Benign = expansion, encapsulated, no infiltration; Malignant = overcomes contact inhibition, invades and infiltrates.

Q: How do benign vs malignant neoplasms differ in morbidity/mortality?

Benign = localized, only fatal if interfering with vital functions; Malignant = systemic effects (anemia, weight loss) and causes death unless controlled.

Q: How do benign vs malignant neoplasms differ in metastasis potential?

Benign = does not spread; Malignant = spreads via blood/lymph to distant sites.

Q: What does TNM staging stand for?

T = size/extent of primary Tumor; N = regional lymph Node involvement; M = distant Metastasis.

Q: What does Stage 1 cancer mean?

Confined to organ of origin.

Q: What does Stage 2 cancer mean?

Locally invasive.

Q: What does Stage 3 cancer mean?

Spread to regional structures like lymph nodes.

Q: What does Stage 4 cancer mean?

Spread to distant sites (metastasis) e.g., breast cancer to liver/lungs.

Q: What is the clinical meaning of higher cancer staging?

Higher stages require more aggressive systemic treatment and have worse prognosis.

Q: How does cancer stage affect medical treatment choices?

Lower stages (1-2) focus on local control (surgery/radiation); higher stages (3-4) require systemic therapy (chemotherapy/immunotherapy).

Q: How does cancer stage connect to prevention strategies?

Secondary prevention via screening aims to detect at Stage 1 when outcomes are best.

Q: How does stage affect prognosis?

Prognosis worsens as stage increases because disease burden and systemic spread increase.

Q: What is the difference between blood-borne cancers and solid tumors?

Blood-borne cancers (leukemia/lymphoma) arise from marrow/lymph tissue and spread through blood/lymph early; solid tumors arise from organs and form localized masses that later invade/metastasize.

Q: What is the origin of leukemias/lymphomas vs breast cancer?

Leukemia/lymphoma = bone marrow or lymphoid tissue; Breast cancer = organ tissue (ductal epithelium).

Q: How does growth differ between leukemia/lymphoma and breast cancer?

Leukemia/lymphoma = unregulated leukocyte proliferation; Breast cancer = localized mass that can invade/metastasize.

Q: What are key risk factors for leukemia/lymphoma?

Radiation, benzene/chemicals, genetic risks (Down syndrome, Philadelphia chromosome).

Q: What are key risk factors for breast cancer?

Age, female sex, genetics (BRCA1/2), estrogen exposure, obesity, alcohol.

Q: What are clinical manifestations of leukemia/lymphoma?

Fatigue, fever, petechiae, bruising, lymphadenopathy, bone pain.

Q: What are clinical manifestations of breast cancer?

Firm non-mobile lump, skin dimpling/peau d'orange, nipple inversion.

Q: What labs/diagnostics are most relevant for leukemia/lymphoma?

CBC (abnormal WBCs, anemia, thrombocytopenia) and bone marrow analysis.

Q: What diagnostics are most relevant for breast cancer?

Biopsy (core/needle), mammography, ultrasound, MRI, tumor markers (CEA, AFP).

Q: How do treatments differ between leukemia/lymphoma and breast cancer?

Leukemia/lymphoma = chemotherapy (induction/consolidation) and HSCT; surgery not an option. Breast cancer = surgery (lumpectomy/mastectomy) + radiation + chemo + hormonal therapy (tamoxifen).

Q: Why is hematopoietic support needed during chemotherapy?

Chemo causes myelosuppression (decreased bone marrow function) leading to low WBC/RBC/platelets and infection/bleeding/anemia risks.

Q: What therapies support hematopoietic function during chemotherapy?

CSFs (filgrastim) for WBCs, erythropoietin for RBCs/anemia, interleukin-11 for platelet production (limited by toxicity), blood transfusions for RBCs/platelets.

Q: What are cell cycle-specific (CCS) antineoplastics?

Drugs that work in specific phases (usually S or M), most effective against rapidly growing tumors.

Q: CCS examples?

Antimetabolites (S phase) and plant alkaloids (M phase).

Q: What are cell cycle-nonspecific (CCNS) antineoplastics?

Drugs that act independently of the cycle with prolonged effect; effective against large, slow-growing tumors.

Q: CCNS examples?

Alkylating agents and antitumor antibiotics.

Q: What is combination antineoplastic therapy?

Multiple drugs with different mechanisms to increase cell kill, reduce resistance, and lower toxicity by using lower doses of each.

Q: What is intermittent antineoplastic therapy and why is it used?

Doses spaced out to let normal cells recover (esp bone marrow) and allow dormant tumor cells to re-enter the cycle so they can be killed in the next round.

Q: What common labs must be monitored during chemotherapy and why?

CBC (neutropenia, anemia, thrombocytopenia), LFTs (hepatic toxicity), BUN/Creatinine (renal toxicity), electrolytes especially potassium + calcium (chemo side effects, arrhythmia risk, tumor lysis risk).

Q: What nursing assessment focuses are essential during chemotherapy?

Fluid/electrolyte status (anorexia, N/V, diarrhea risk), cognitive status ("chemo brain"), infection/bleeding assessment (fever >38°C, hemorrhage signs), and extravasation monitoring (no blood return, pain, swelling at IV site).

Q: What patient teaching is priority during chemotherapy?

Strict hand hygiene, avoid crowds/sick contacts, avoid raw fruits/veggies during neutropenia, use soft toothbrush + electric razor to prevent bleeding.

Q: What is hypercalcemia of malignancy?

An oncologic emergency where bone breakdown releases excessive calcium into blood faster than kidneys can excrete.

Q: What is the major effect of hypercalcemia of malignancy on the body?

Neuromuscular + GI + renal + cognitive dysfunction leading to dehydration, kidney injury, dysrhythmias, confusion, and possible coma.

Q: What symptoms are seen in hypercalcemia of malignancy?

"Stones" (kidney stones), "bones" (bone pain), "moans" (N/V, ulcers), "groans" (constipation), "overtones" (confusion, depression).

Q: What is the treatment for hypercalcemia of malignancy?

Aggressive IV hydration, loop diuretics, calcitonin, bisphosphonates.

Q: What patient teaching is associated with hypercalcemia of malignancy?

Maintain mobility, increase hydration, restrict dietary calcium.

Q: What other chemistry value is required to interpret/correct serum calcium?

Phosphate level.

Q: What is radiation therapy in cancer treatment?

Use of ionizing energy to interrupt malignant cell growth by damaging cancer cell DNA.

Q: What are the primary goals of radiation therapy?

Cure, control (prevent spread), prophylaxis, or palliation (relieve metastatic symptoms).

Q: What nursing assessments are priority for patients receiving radiation therapy?

Skin reactions (erythema, desquamation), GI effects (stomatitis, anorexia, diarrhea), and bone marrow suppression.

Q: What are adverse effects of ionizing radiation?

Skin injury/burns, fatigue, GI irritation (stomatitis/anorexia/diarrhea), and myelosuppression.

Q: What nursing care considerations and safety issues apply to external radiation?

Teach need for immobilization during treatment and manage fatigue; patient is NOT radioactive after external therapy.

Q: What nursing care considerations and safety issues apply to internal radiation (brachytherapy)?

Follow time, distance, shielding; private room (often end of hallway); limit staff/visitor exposure time.

Q: What are the pros and cons of lumpectomy?

Pros = breast conservation, less invasive; Cons = risk of local recurrence + usually requires radiation afterward.

Q: What are the pros and cons of total mastectomy?

Pros = removes all breast tissue, reduces risk in that breast; Cons = major body image change and does not include lymph node removal.

Q: What are the pros and cons of modified radical mastectomy?

Pros = removes breast tissue + axillary nodes (better for invasive cancers); Cons = highest risk for lymphedema and nerve damage.

Q: What is the most important complication to monitor for after breast cancer surgery involving lymph nodes?

Lymphedema (arm swelling).

Q: How is lymphedema prevented after breast cancer surgery?

No BP readings/needle sticks/IVs in affected arm and use compression sleeve as prescribed.

Q: How is lymphedema treated if it develops?

Manual lymphatic drainage + prescribed exercises/physio.

Q: What are the core priorities in the nursing plan of care for a patient with cancer?

Risk for infection (neutropenia), risk for injury/bleeding, imbalanced nutrition, coping/grief/psychosocial needs.

Q: What are key discharge teaching priorities for a cancer patient at home?

Infection prevention, bleeding precautions, nutrition/hydration guidance, medication adherence, symptom monitoring (fever/bleeding), when to seek help, and ensuring supports/follow-up.

Q: What psychosocial needs must be addressed in cancer nursing care?

Fear of recurrence, altered body image, family anxiety, grief, coping support, and access to counseling/resources.

Q: What determinants of health (SDoH) should be addressed for cancer care planning?

Income/social status (affording meds/food), social supports, environment/home safety, access to clean water/transportation/healthcare.

Q: What is tertiary prevention in cancer care?

Rehabilitation and prevention of further disability from cancer or treatment effects.

Q: What is quaternary prevention in cancer care?

Protecting patients from unnecessary or overly aggressive interventions that do not improve quality of life.

Q: What are the 3 stages of the carcinogenic process?

Initiation (mutagenic event/initial DNA damage) → Promotion (oncogene activation + tumor suppressor gene failure = uncontrolled growth) → Progression (invasion into surrounding tissue + metastasis + angiogenesis).

Q: What is metastasis?

Spread of cancer cells through the lymphatic system or bloodstream to distant sites.

Q: What is angiogenesis?

Formation of new blood vessels to supply and promote tumor growth.

Q: What is the main difference between blood cancers vs solid tumors?

Blood cancers originate in blood/bone marrow and require systemic/targeted treatment (chemo, stem cell transplant); solid tumors form a mass and removal (surgery) is often priority, followed by targeted/systemic therapy based on staging/grading.

Q: What are key cancer hallmarks?

Increased cell growth signaling + decreased growth suppression, increased mutation rate, angiogenesis, altered metabolism, decreased apoptosis, tumor-promoting inflammation, immune system recruitment/evasion, invasion + metastasis.

Q: What are the main differences between benign vs malignant tumors?

Benign = well-differentiated, encapsulated, slow growth, non-invasive; Malignant = undifferentiated/anaplastic, infiltrates/invades, faster growth, metastasizes via blood/lymph, causes tissue damage.

Q: What are common signs/symptoms of cancer?

Pain, fatigue, unexplained weight loss, night sweats, bruising/bleeding, palpable mass, immunosuppression/infection risk, bowel habit changes, loss of appetite.

Q: What are the 3 levels of prevention/promotion in cancer?

Primary (risk factor education + prevention) → Secondary (screening/early diagnosis) → Tertiary (treatment + managing complications).

Q: What are examples of primary prevention for cancer?

Avoid carcinogens, lifestyle changes (exercise, weight management, smoking cessation), education/resources, immunization like HPV vaccine.

Q: What are examples of secondary prevention for cancer?

Screening (Pap smears, breast/testicular exams, colonoscopy), cancer risk evaluation programs, genetic counseling/testing for high-risk individuals.

Q: What are oncogenes?

"On switch" genes that drive controlled cell growth/proliferation; when mutated/overexpressed they promote cancer.

Q: What are tumor suppressor genes?

"Off switch" genes that stop unnecessary cell division or trigger apoptosis; when inactivated they allow uncontrolled growth.

Q: What are DNA repair genes?

Genes that correct DNA copying/cell division errors; failure leads to mutation accumulation and cancer risk.

Q: What are BRCA1/BRCA2 and why are they important?

Tumor suppressor genes—mutations increase risk of breast, ovarian, pancreatic, and prostate cancers.

Q: What is HER2?

An oncogene—overexpression increases risk of certain cancers (especially breast; also esophageal/stomach).

Q: Why do we ask family history when screening for cancer?

Many cancers can be hereditary (lung, stomach, colorectal, thyroid, renal, prostate, and blood cancers).

Q: What is tumor staging vs grading?

Staging = tumor size/local invasion/metastasis; Grading = tissue of origin + how differentiated the cells are.

Q: What is the TNM system used for?

Cancer staging system describing Tumor size (T), Node involvement (N), and Metastasis (M).

Q: What are common cancer diagnostics?

Bloodwork (esp. blood cancers), biopsy (needle/incisional/excisional), chest radiography (breast/lung), genetic profiling, endoscopy (biopsy/aspiration), MRI/CT (neuro/pelvic/abdominal/skeletal cancers).

Q: What are key nursing considerations for biopsies/surgeries?

Pre-procedure education/meds/expectations; post-procedure vitals/positioning/bedrest; follow-up appointments/wound care/activity restrictions; teach complications + medication routine; assess coping and need for social work/psych/spiritual support.

Q: What are the main goals/types of cancer surgery?

Prophylactic (prevent cancer), palliative (symptom relief when cure not possible), reconstructive (restore function/cosmesis).

Q: What is radiation therapy and how does it kill cancer cells?

Ionizing energy that damages DNA directly (breaks helix strands) and indirectly (free radicals from ionized body fluids → irreversible DNA damage → cell death).

Q: What are 4 main radiation therapy goals?

Cure, prophylaxis (prevent spread), control, palliation.

Q: What are common toxicities of radiation (high yield)?

Rapidly dividing tissues affected: skin (erythema/ulceration, alopecia), GI lining (stomatitis, xerostomia, taste change, N/V), bone marrow suppression (leukopenia, thrombocytopenia).

Q: What are the key safety priorities for internal radiation (brachytherapy)?

Time limits in room, distance, shielding/PPE, dosimeter use, radiation safety officer involvement, what to do if implant dislodges, discharge teaching (separate bathroom, avoid pregnant people/children).

Q: What are the key aspects of chemotherapy?

Systemic cytotoxic therapy affecting cancer + normal cells; can be cell-cycle specific or non-specific; strict schedule allows normal cell recovery; combination therapy improves kill rate and reduces resistance/side effects; routes include PO/IV/SC/intrathecal/intracavitary/portal vein.

Q: What are major adverse effects of chemotherapy?

Cachexia, pleural effusion, hypercalcemia, spinal cord compression, pericardial effusion, neutropenic sepsis, mucositis/stomatitis, SVC syndrome, hypomagnesemia, ascites, N/V, diarrhea.

Q: What vascular access devices can deliver chemotherapy?

IV, PICC, CVC, port-a-cath.

Q: Why is chemo IV administration high risk?

Many chemo drugs are vesicants—extravasation can cause severe tissue necrosis (must monitor IV site closely).

Q: What are mitotic inhibitors (cell cycle specific) and examples?

Block metaphase by inhibiting spindle formation; examples: vincristine, vinblastine, vinorelbine.