Timby Chapter 18: Intro to Cancer & Dudek Chapter 24: Cancer Nutrition

Comprehensive practice flashcards covering cancer pathophysiology, classifications, staging, oncologic emergencies, treatments, and nutritional management based on Timby Chapter 18 and Dudek Chapter 24.

How is cancer defined pathophysiologically, and how do malignant tumors affect surrounding healthy tissues?

Cancer is characterized by abnormal, unrelated cell proliferation. Cancerous tumors invade healthy tissues and compete with normal cells for oxygen, nutrients, and space.

Based on tissue and cell origin as depicted in the graphic, what are the primary classifications of cancers?

Carcinomas originate from epithelial cells (skin, body cavities, organs); Sarcomas originate from bones and soft tissues/muscles; Myelomas originate from plasma cells (which manufacture antibodies); Leukemias originate from blood-forming cells in bone marrow; Lymphomas originate in the immune system and lymph tissue; and Mixed types derive from multiple cell or tissue types.

What specific tissue of origin defines an adenocarcinoma?

Glandular organs.

What are the key clinical differences between benign and malignant tumors?

Benign tumors are not cancerous, are noninvasive, have a slow growth rate, and do not usually cause death unless impairing a vital organ. Malignant tumors are cancerous, invasive, display uncontrolled growth, and cause alterations in the cell membrane with tumor-specific antigens.

What are the three sequential steps of carcinogenesis (malignant transformation)?

1. Initial process: alters the genetic structure of cellular DNA via carcinogens or genetic mutations; 2. Promotion: mutated cells begin to mutate cell populations in their immediate surroundings; 3. Progression: the tumor invades adjacent tissues and metastasizes.

How do proto-oncogenes differ from tumor suppressor genes, and what occurs when proto-oncogenes mutate?

Proto-oncogenes are normal genes that control cell growth and replication; when mutated or damaged, they become oncogenes that fail to perform their proper regulatory roles. Tumor suppressor genes are normal genes that slow cell growth, repair DNA mistakes, and promote normal cell death.

What are the lifetime incidence rates and mortality ranking for cancer in the United States?

Cancer is the second leading cause of death in the United States, developing in $1\text{ in }2$ men and $1\text{ in }3$ women at some point in their lifetime.

What is the most common cancer overall, and what are the three most common cancers diagnosed in men and women?

Lung cancer is the most common cancer overall. For men, the three most common cancers are prostate, lung, and colon cancer. For women, the three most common are breast, lung, and colon cancer.

Which specific infectious viruses and bacteria are recognized as contributing factors to cancer development?

Kaposi's sarcoma (associated virus), H Pylori, and HPV.

What are the screening recommendations for mammograms, clinical breast examinations, and Pap smears?

Mammograms are recommended annually for females ages $45\text{ to }54$, then every $2\,\text{years}$; clinical breast examinations every $1\text{ to }3\,\text{years}$; and Pap smears every $3\,\text{years}$ starting at age $21$.

What are the cancer screening recommendations for colonoscopy, fecal occult blood testing, and chest CT?

Colonoscopy every $10\,\text{years}$ starting at age $50$; guaiac fecal occult blood testing annually; and low-dose chest CT annually for current or former smokers within the last $15\,\text{years}$.

What clinical warning signs of cancer are represented by the CAUTION UP mnemonic shown in the diagram?

C: Changes in bowel or bladder habits; A: A sore that does not heal; U: Unusual bleeding or discharge; T: Thickening or lump in breast or elsewhere; I: Indigestion or difficulty swallowing; O: Obvious changes in warts or moles; N: Nagging cough or persistent hoarseness; U: Unexplained weight loss; P: Pernicious anemia.

What are the characteristic clinical signs and symptoms of leukemia?

Paleness, fatigue, weight loss, repeated infections, easy bruising, bone and joint pain, and nosebleeds.

What are the classic clinical signs and symptoms of lymphoma?

Enlarged, rubbery lymph nodes, itching, night sweats, unexplained fever, and weight loss.

What signs and symptoms typically manifest in clients with prostate cancer?

Weak and interrupted urine flow, and continuous pain in the lower back, pelvis, or upper thighs.

How do the clinical presentations of laryngeal cancer and lung cancer differ?

Both cancers present with a persistent cough; however, laryngeal cancer presents with a hoarse throat, whereas lung cancer presents with sputum with blood, a heavy chest, and chest pain.

Which tumor markers released by cancer cells are measured during diagnostic laboratory tests?

Prostate-Specific Antigen (PSA), CA 27-29, CA 19-9, and Carcinoembryonic Antigen (CEA).

In the American Joint Committee on Cancer TNM classification system shown, what do T, N, and M designate?

T designates Tumor size ($\text{T-1}$: $0\text{ to }2\,\text{cm}$, $\text{T-2}$: $2\text{ to }5\,\text{cm}$, $\text{T-3}$: $>5\,\text{cm}$, $\text{T-4}$: broken skin or attached to chest wall); N designates Lymph Node Status ($\text{N-0}$: surgeon cannot feel nodes, to $\text{N-3}$: swollen nodes near collarbone); and M designates Metastasis ($\text{M-0}$: tested nodes cancer-free, to $\text{M-1}$: tested nodes show cancer cells or micrometastasis).

How is tumor grading defined from Grade I to Grade IV in terms of cellular differentiation?

Tumors are graded from I to IV based on cellular appearance: differentiated cells closely resemble the tissue of origin, whereas undifferentiated cells exhibit little resemblance to the tissue of origin.

What does each cancer stage from Stage 0 to Stage IV indicate regarding tumor invasiveness and spread?

Stage $0$: cancer in situ (precancerous); Stage I: malignancy present at the primary tumor site; Stage II: tumor with regional lymph node involvement; Stage III: tumor with local metastases; Stage IV: tumor with distant metastases.

What specialized surgical procedure is depicted in the diagram, and how is it performed?

Mohs surgery; it involves shaving off thin layers of skin sequentially and examining each layer microscopically until the final layer removed is free of cancer.

What are the distinct clinical purposes of prophylactic surgery and palliative surgery in oncology?

Prophylactic/preventative surgery removes non-vital tissue based on family history or genetic predisposition to prevent cancer development, whereas palliative surgery is performed to relieve uncomfortable symptoms and enhance quality of life without curative intent.

How does radiation therapy destroy malignant cells at the molecular level?

High-energy beams break the strands of cellular DNA molecules, which prevents malignant cell growth and division.

What local adverse dermatologic effect resulting from radiation therapy is shown in the photograph?

Radiation dermatitis manifesting as severe erythema and desquamation on the treated neck and chest area.

What three core radiation safety principles must nurses follow when caring for patients undergoing internal radiation therapy?

Minimizing length of exposure (placing patients in private rooms), maximizing distance from the radiation source, and using proper shielding with lead-lined gowns or materials.

What is myelosuppression, and what are its two specific hematologic manifestations regarding white blood cells and platelets?

Myelosuppression is the suppression of bone marrow activity, leading to leukopenia (decreased white blood cell count) and thrombocytopenia (decreased platelet count).

What daily fluid intake is recommended for clients on chemotherapy, and what metabolic complication must be closely monitored?

Clients should increase fluid intake to $2500\text{ to }3000\,\text{mL/day}$; nurses must monitor for hyperuricemia, gout, joint pain, and peripheral edema.

What stem cell transplantation procedure is illustrated in the diagram, and how is it conducted?

Autologous peripheral stem cell transplant: patient blood stem cells are mobilized from bone marrow, collected, separated, frozen, and reinfused after high-dose chemotherapy to support bone marrow regrowth without risking graft-versus-host disease (GVHD).

How do allogeneic stem cell transplants differ from syngeneic stem cell transplants?

Allogeneic transplants utilize donor stem cells and carry a risk of graft-versus-host disease (GVHD), requiring immunosuppressant drugs; syngeneic transplants utilize stem cells from an identical twin with an identical tissue type and do not cause GVHD.

What targeted therapy modality is shown in the diagram, and how does it achieve tumor destruction?

Photodynamic therapy (PDT); it utilizes a photosensitizing agent administered to the patient, followed by light exposure to trigger a photosensitive reaction that destroys cancer cells.

What is the pathophysiology and nursing management for the oncologic emergency SIADH?

Excessive levels of antidiuretic hormone cause the body to retain water and develop acute electrolyte imbalances; nursing management includes administering prescribed diuretics and sodium replacement.

What causes Superior Vena Cava (SVC) Syndrome and what emergency intervention is indicated?

Metastasis from lung or breast cancer obstructs venous return at the superior vena cava, causing venous backup and swelling in the face and upper body; treated with emergent radiation therapy.

What electrolyte and metabolic imbalances characterize Tumor Lysis Syndrome, and how is it managed?

Rapid tumor destruction overwhelms bodily excretion, resulting in hyperkalemia, hyperphosphatemia, and hyperuricemia, which lead to cardiac and renal dysfunction; managed with intravenous fluids, electrolyte correction, and hemodialysis.

What profound nutritional condition is pictured in the photograph, and how is it characterized?

Cancer cachexia; characterized by severe muscle wasting and tissue depletion that cannot be fully reversed by conventional nutrition support.

What are the four clinical stages of oral mucositis depicted in the grading chart?

Grade I: Redness, able to eat and drink; Grade II: White patches, able to eat and drink; Grade III: Ulcers that may bleed easily, requiring IV nutrition or tube feeding; Grade IV: Tissue death, significant bleeding, life-threatening, requiring IV nutrition or tube feeding.

A nurse is evaluating risk factors in a client's health history. Which lifestyle substance factor contributes most significantly to the development of oral cancer?

Chewing smokeless tobacco; it causes direct, chronic cellular irritation and chemical exposure to the oral mucosa.

During an integumentary assessment, which mole characteristic should the nurse identify as an immediate indication for healthcare provider referral?

Irregular shape or asymmetric borders; contour changes from previously circular margins warrant urgent biopsy for suspected melanoma.

What priority nursing action is indicated for a client experiencing frequent nausea and vomiting following abdominal radiation therapy?

Monitoring fluid intake and output closely; assessing fluid balance and hydration status prevents severe dehydration and acute electrolyte deficits.

What radioisotope is administered orally or intravenously for systemic internal radiation therapy, and what organ does it selectively target?

Iodine-$131$; it is concentrated primarily in thyroid tissue to destroy hyperactive or malignant thyroid cells.

Which oncologic emergency involves malignant bone destruction or parathyroid-like hormone secretion, and how is it medically managed?

Hypercalcemia; managed pharmacologically with vigorous IV hydration fluids, loop diuretics, and phosphates or bisphosphonates.

What assessment findings indicate spinal cord compression from metastatic tumor invasion, and what immediate interventions are indicated?

New or worsening back pain, motor weakness, sensory loss, and bowel or bladder incontinence; emergency management includes high-dose IV corticosteroids, radiation, and surgical decompression.

Why is an acute fever in a neutropenic cancer client treated as a critical medical emergency, and what is the nurse's priority action?

Neutropenia suppresses classic signs of infection, allowing minor pathogens to rapidly induce septic shock; the nurse must immediately administer prescribed broad-spectrum IV antibiotics STAT.

What diverse administration routes can be utilized to deliver antineoplastic chemotherapy agents?

Intravenous (peripheral, PICC, port), oral, intramuscular (IM), subcutaneous (SQ), topical, intrathecal, and intraperitoneal routes.

What four major pharmacologic classes of conventional chemotherapy agents interfere with cellular DNA and RNA synthesis?

Alkylating agents, nitrosoureas, topoisomerase I inhibitors, and antimetabolites.

Which clinical signs and symptoms should lead the nurse to suspect bladder or kidney malignancy?

Painless gross or microscopic hematuria, dysuria (burning sensation on urination), and increased urinary frequency.

What clinical warning signs are most characteristic of cervical and uterine (endometrial) malignancies?

Abnormal intermenstrual vaginal bleeding, postmenopausal bleeding, unusual foul or watery discharge, dysmenorrhea, and menorrhagia.

Which subjective and objective assessment findings are classic indicators of testicular cancer in a male client?

A painless lump or enlargement in a testicle, scrotal heaviness or sudden fluid collection, dull ache in the lower abdomen or groin, and gynecomastia.

What clinical manifestations are characteristically associated with gastric carcinoma?

Persistent indigestion, epigastric pain occurring after eating, unexplained weight loss, and hematemesis (blood in vomit).

How does a Positron Emission Tomography (PET) scan differ functionally from a standard Computed Tomography (CT) scan in cancer staging?

A CT scan evaluates tumor density, anatomic size, and structural location, whereas a PET scan is a nuclear imaging technique that detects metabolic activity and cellular proliferation rates ('hot spots').

How do cryosurgery and electrosurgery differ in their physical mechanisms of tumor destruction?

Cryosurgery uses liquid nitrogen to freeze and destroy malignant cells, whereas electrosurgery employs high-frequency electric current to ablate tumor tissue.

In targeted cancer therapy, what naming suffix identifies monoclonal antibodies, and how do they function?

They end in the suffix '-mab'; they specifically bind to target antigen receptors on cancer cell surfaces to block proliferative signals or trigger immune destruction.

What is the primary therapeutic mechanism of aromatase inhibitors in treating postmenopausal hormone-receptor-positive breast cancer?

They inhibit the aromatase enzyme from converting peripheral androgens into estrogen, thereby starving estrogen-dependent tumors of growth stimulation.

What safe food-handling instructions regarding thawing and leftover storage should the nurse provide to an immunocompromised oncology client?

Thaw frozen food inside the refrigerator rather than on the counter, refrigerate groceries immediately after purchase, and discard all leftovers after $24\,\text{hours}$.

Which dietary restrictions must an immunocompromised oncology client follow regarding meat cooking, dairy, and food service venues?

Cook all meats to well-done; avoid unpasteurized dairy and raw cheeses; and strictly avoid eating at public buffets or salad bars due to high microbial contamination risks.

What recommended nutritional density should liquid oral nutritional supplements provide to an oncology client per $8\,\text{oz}$ serving?

$230\text{ to }360\,\text{kcal}$ and $10\text{ to }20\,\text{g}$ of protein per $8\,\text{oz}$ serving.

Which dietary strategies should the nurse teach an oncology client experiencing severe cancer-related anorexia?

Eat high-protein, high-calorie foods every $2\,\text{hours}$, plan meal schedules in advance, and select cold or room-temperature foods to minimize strong food odors.

What nonpharmacologic dietary modifications are recommended for managing chemotherapy-related nausea?

Rinse the mouth before and after meals, consume small frequent meals of high-carbohydrate soft foods, and sip ginger ale, ginger tea, or electrolyte drinks.

What fluid and dietary interventions are indicated for an oncology client experiencing treatment-induced diarrhea?

Drink $1\,\text{cup}$ ($240\,\text{mL}$) of hydrating fluid after every loose bowel movement, and avoid caffeine, high-fat foods, dairy products, and sugar-free items containing sorbitol.

What nonpharmacologic nursing measures should be recommended to an oncology client suffering from treatment- or opioid-induced constipation?

Increase dietary fiber intake, maintain a fluid intake of $8\text{ to }10\,\text{cups}$ daily, and participate in regular gentle physical activity (such as walking) to promote peristalsis.

What oral hygiene and dietary comfort measures should the nurse suggest to relieve discomfort from chemotherapy- or radiation-induced stomatitis?

Use a soft-bristle toothbrush, perform frequent saline mouth rinses, avoid hard, acidic, or spicy foods, and consume frozen foods (such as popsicles) to numb inflamed oral tissues.

What localized nutritional impairments commonly develop following radical head and neck cancer surgery or radiation?

Severe dysphagia (swallowing impairment), loss of teeth, xerostomia (dry mouth), altered or absent taste, and difficulty chewing.

What digestive and fluid complications can compromise nutrition following extensive surgical resection of the GI tract for cancer?

Dumping syndrome, early satiety, malabsorption, severe dehydration, constipation, and fluid/electrolyte imbalances.

Which specific macronutrients, vitamins, and minerals must be increased to facilitate tissue repair following oncologic surgery?

Protein, total calories, Vitamin C, B-complex vitamins, and iron.

What priority nursing interventions are emphasized in the palliative care of a terminally ill oncology client?

Proactive pain control, gentle handling during nursing care, keeping skin warm and dry, controlling environmental odors, providing comfort-focused hydration/nutrition, and preserving dignity.

What causes severe xerostomia in clients receiving head and neck radiation, and how does it compromise oral intake?

Radiation damage to salivary glands reduces saliva secretion, resulting in thick secretions, painful swallowing, taste alterations, and increased risk for dental caries and mucosal injury.

What metabolic imbalance should the nurse closely monitor in a client with a malignant pancreatic neoplasm or post-pancreatectomy?

Glucose irregularities (hyperglycemia or hypoglycemia) resulting from impaired endocrine secretion of insulin and glucagon.

How does advanced lung cancer mechanically and physiologically interfere with adequate nutritional intake?

Severe dyspnea and shortness of breath create physical fatigue and respiratory exhaustion during mastication and swallowing.

Why is light, routine physical movement encouraged for clients experiencing cancer-related fatigue?

Low-impact exercise preserves functional lean muscle mass, enhances cardiopulmonary endurance, and counteracts progressive musculoskeletal deconditioning.

In internal radiation therapy nursing care, which items are identified as the most commonly contaminated articles requiring specialized disposal?

Personal protective equipment (PPE) worn by staff members caring for the client, along with linens exposed to excretions.

What is the primary clinical rationale for administering antiemetic medications prior to meals in a client receiving emetogenic therapy?

Prophylactic administration blocks nausea pathways before meal ingestion, preventing anticipatory vomiting and optimizing caloric intake.