Cancer Part One

What percentage of new cancer cases in Canada are diagnosed in individuals aged 50 or older?

Approximately 90%.

Which direction across Canada shows increasing cancer incidence and death rates?

From west to east.

Name three modifiable risk factors for cancer that nurses can help address.

Tobacco use, excessive body weight, and lack of physical activity (others include unhealthy diet, alcohol, and excessive sun exposure).

What are the two major cellular dysfunctions that characterize cancer?

Defective cellular proliferation and defective cellular differentiation.

What is the role of proto-oncogenes under normal circumstances?

They regulate normal cellular processes such as promoting growth.

How do proto-oncogenes contribute to cancer development when mutated?

Mutations activate them into oncogenes that drive uncontrolled growth.

What is the function of tumour-suppressor genes?

They inhibit cellular growth and proliferation.

What happens when tumour-suppressor genes are mutated?

They become inactive, resulting in loss of growth suppression.

List two key differences between benign and malignant neoplasms.

Benign tumours are usually well-differentiated and encapsulated, whereas malignant tumours are often undifferentiated and able to metastasize.

What are the three classic phases of cancer development?

Initiation, promotion, and progression.

During which phase of carcinogenesis is DNA mutation considered irreversible?

Initiation.

Why is promotion considered a reversible stage in cancer development?

Because altered cell proliferation can be halted if promoting factors (e.g., obesity, tobacco, alcohol) are removed.

Define ‘latent period’ in cancer development.

The time between initial genetic alteration and clinical evidence of disease, which can span 1–40 years.

What three characteristics define the progression stage of cancer?

Increased tumour growth rate, invasiveness, and metastasis.

Identify four common sites of metastasis listed in the lecture.

Brain/CSF, lung, liver, bone, and adrenals.

What is meant by immunological surveillance?

The continuous monitoring of cell surface antigens by the immune system to detect and destroy abnormal cells.

Give one mechanism by which cancer cells achieve immunological escape.

Suppression of factors that stimulate T-cells or weak surface antigens that evade detection.

Why are cancer classification systems important for healthcare teams?

They standardize communication, guide treatment planning, determine prognosis, and allow statistical comparisons.

From which embryonal layer do carcinomas typically arise?

Ectoderm or endoderm (e.g., skin, glands, mucous membranes of respiratory/GI/GU tracts).

Sarcomas originate from which embryonal layer?

Mesoderm (connective tissue, muscle, bone, and fat).

What is the key prognostic implication of a poorly differentiated tumour on histological grading?

It generally indicates a worse prognosis.

Match Grade I and Grade IV tumours with their differentiation status.

Grade I: Well-differentiated; Grade IV: Anaplastic and undifferentiated.

What does the ‘T’ in the TNM staging system represent?

Tumour size and invasiveness.

Stage the following description: ‘Cancer in situ’.

Stage 0.

State the seven classic warning signs of cancer using the acronym CAUTION.

Change in bowel/bladder habits; A sore that does not heal; Unusual bleeding/discharge; Thickening or lump; Indigestion/difficulty swallowing; Obvious change in wart/mole; Nagging cough/hoarseness.

During cancer diagnosis, why is it important for nurses to provide written information to patients?

To reinforce verbal explanations and reduce anxiety caused by information overload.

What diagnostic procedure involves histological examination of tissue obtained by needle, incisional, or excisional methods?

Biopsy.

List the three primary goals of cancer treatment.

Cure, control, and palliation.

Name the four major cancer treatment modalities.

Surgery, radiation therapy, chemotherapy, and biological/targeted therapy.

Why might surgery be unsuccessful for cancers that have metastasized?

Because the disease is no longer localized and malignant cells are present at distant sites.

Describe brachytherapy in one sentence.

A form of internal radiation where radioactive materials are placed directly inside or near the tumour.

Which principle guides safe nursing care for clients with radioactive implants?

Time, distance, and shielding.

Why are cancer cells more susceptible to cumulative radiation doses than normal cells?

They are less capable of repairing sublethal DNA damage.

Give two common nursing-managed side effects of radiation or chemotherapy.

Fatigue and bone marrow suppression (others: anorexia, skin reactions, GI effects, etc.).

What distinguishes targeted therapy from traditional chemotherapy?

Targeted therapy specifically attacks molecular pathways essential to tumour growth, sparing normal cells.

Identify two nutritional problems frequently observed in cancer patients.

Protein-calorie malnutrition and altered taste sensation.

Why is infection a significant risk for patients undergoing cancer treatment?

Because treatments often suppress the immune system, leading to neutropenia.

Provide one example each of obstructive, metabolic, and infiltrative oncologic emergencies.

Obstructive: Intestinal obstruction; Metabolic: Septic shock; Infiltrative: Cardiac tamponade.

What percentage of patients with advanced cancer experience moderate to severe pain?

About 80%.

Name one pharmacological and one non-pharmacological intervention for cancer pain.

Pharmacological: Opioids; Non-pharmacological: Relaxation therapy or imagery.

List two common emotional responses cancer patients may exhibit that nurses should recognize.

Shock and denial (others include anger, depression, bargaining, acceptance, etc.).

Why can cancer symptoms in older adults be overlooked?

They may be mistakenly attributed to normal aging changes.

Define sepsis as presented in the lecture.

A life-threatening syndrome in which the body's response to infection injures its own tissues and organs.

Which two broad bacterial categories are most often implicated in sepsis?

Gram-negative and Gram-positive bacteria.

List three general variables used to help diagnose sepsis.

Altered mental status, fever >38.3 °C, and tachypnea ≥22 breaths/min (others include HR >90, hyperglycemia, etc.).

Name two organ dysfunction variables indicative of sepsis.

Acute oliguria and arterial hypoxemia (others: elevated creatinine, thrombocytopenia, etc.).

What hemodynamic criterion is used to identify sepsis?

Arterial hypotension (SBP

Define septic shock in one sentence.

A subset of sepsis characterized by persistent hypotension despite adequate fluids and inadequate tissue perfusion requiring vasopressors.

Which three clinical indicators commonly signal septic shock?

Hypotension, elevated lactate levels, and sustained need for vasopressor therapy.

What is the cornerstone of initial therapy for sepsis?

Prompt and aggressive fluid resuscitation.

Why must antibiotics be started as soon as possible in a septic patient?

Early antibiotic therapy reduces mortality by quickly targeting the underlying infection.

What is the nurse’s responsibility if a septic client's condition exceeds the nurse's scope of practice?

Seek prompt consultation and collaboration with appropriate healthcare providers.

Give two laboratory markers that fall under inflammatory variables for sepsis diagnosis.

Elevated C-reactive protein and elevated procalcitonin.

Which platelet count value meets the criterion for thrombocytopenia in sepsis evaluation?

Platelet count <100 × 10⁹/L.

In sepsis assessment, what lactate level is considered hyperlactatemia?

Serum lactate >1 mmol/L.

What mental status change is included as a general diagnostic variable for sepsis?

Altered mental status.

Explain why respiratory failure is common in septic shock.

Because persistent hypotension and tissue hypoxia impair pulmonary perfusion and function.