Oncology Nursing Theory I: Lecture 4

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What is a carcinoma?

Cancer that begins in the skin or in tissue that line or cover internal
organs

Cancer that begins in bone, cartilage, ___, muscle, blood vessels or

other connective or __ tissue is called a ___

fat; supportive; sarcoma

What is a lymphoma or myeloma?

cancere that begin in cells of the immune system

Cancers that begin in the tissue of the brain and spinal cord are cal
led ___.

central nervous systems cancers

List the characteristics of benign tumors

-slow growing -growth occurs within a capsule of brous tissue -do

not invade adjacent tissues -do not metastasize -cytology reveal un
iform, well dierentiated cells that resemble tissue of origin

What are the characteristics of a malignant tumor?

-high mitotic rate -rapid growth -not encapsulated -invade surroundi

ng tissue, lymp, and blood and metastasize to distant sites -anaplas
tic, more poorly dierentiated

What is the term used to describe either a new primary cancer or a

metastatic cancer?

secondary

cancer is a ___ diagnosis

microscopic

Oncology Nursing Theory I: Lecture 4

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Tissue or cells are examined ___ to dierentiate malignancy from b

enign problem

histologically

Screening tests should have adequate __ and __ and a high predicti

ve value.

sensitivity and specicity

ToF: screening is denitive.

False

What types of medications would be important to record in a cance

r workup?

-estrogens/progestins -tamoxifen

What is the denition of a symptom?

Any subjective evidence of disease. A symptoms is a phenomenon

that is experienced by an individual. Anxiety, lower back pain, and
fatigue are all symptoms. they are sensations only the patient can
perceive

Dene a sign?

any objective evidence of disease. A sign can be detected by a per

son other an the aected individual. Gross blood in the stool is a sig
n.

Does a change in bladder habits have a connection to cancer?

Yes, it can be a symptom

Prompt recognition of the __ signs and symptoms of cancer allows

____ when cancer is curable

early; diagnosis

Oncology Nursing Theory I: Lecture 4

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what is the metal lm that is collided with a concentrated beam of

electrons to give an xray?

tungsten

Radiation ows easily through __ (black) and soft tissue (___), but n
ot as easily through ___ where there is higher absorption (white)

air; gray; bone

What radiograph is used to see peripheral lung lesions>

chest xray

What are some typical uses for bone xrays?

skeletal survey for multiple myeloma, metastatic boney disease

What are the limitations to GI series?

-fasting required -bowel prep required -may limit other abdominal s

tudies

Ultrasound is a method of using __ waves with high ___. Transducer

sends __ and image made from reections of those waves back fro
m organs/tissue

waves; frequencies; waves

ToF; US can be used for biopsy guidance.

True

Why is US limited?

it is not able to penetrate bone or air

Oncology Nursing Theory I: Lecture 4

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What is the most common diagnostic imaging test in oncology?

CAT scan

What is the test of choice to visual intra-abdominal lesions?

CAT scan

The CAT scan forms a full ___ computer model allowing the clinician
to examine the body one narrow ___ at a time to pinpoint specic a
reas.

3D; slice

ToF: patients are exposed to ionizing radiation during a MRI?

False

what are the components of a MRI to make it work?

-Powerful magnetic eld -radio frequency pulses -computer to produ

ce detailed pictures of organs

What is the preferred imaging for musculoskeletal, brain or CNS tu

mors?

MRI

What is the Nephrotoxic IV contrast used for MRIs?

Gadolinium

Which is more expensive, PET or MRI scans?

PET

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What must be done in order to conduct a bone scan?

Injecting a radiolabeled substance into a vein. This substance is attr

acted to bone, particularly to areas of high bone activity.

What is the gold standard in visualizing solitary pulmonary lesions?

PET scans

What is the radioactive tracer injected during a PET scan>?

ususally F-FDG

96% of pts with lung cancer will have an abnormal ___ ___

PET Scan

Metabolically active areas will take up __ and show up as a ___ spot

on PET scan images

glucose; hot

ToF: all tumors will appear hot on a PET scan.

FALSE: some will not because of limited glucose uptake: slow growi
ng tumors such as bronchoalveolar carcinoma

PET scan can help stage which cancers?

esophageal, colorectal, melanoma and lymphoma, NSCLC, thyroid a

nd breast

What is the typical cost of a PET scan

3-7000

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Diagnosis of cancer requires ___ conrmation by obtaining histologi

c or ___ proof of malignancy

tissue; cytologic

What are the technique methods for biopsy?

-FNA -core needle biopsy -stereostatic biopsy -excisional -incisional

What are the most common diagnostic procedures?

-endoscopy -colonoscopy -laparoscopy -bronchoscopy -thoracoscop

y -mediastinoscopy

What is a histologic examination?

tissue removed during biopsy is sent to a pathology lab, and sliced

into thin sections for viewing under a microscope

Describe cytologic evaluation.

cells examined from uids such as urine, CSF, sputum, peritoneal

uid, pleural uid, cervical/vaginal smears and in uid removed duri
ng biopsy

What are permanent sections in pathology?

-prepared by placing the tissue in xative (usually formalin) to pres

erve the tissue, processing it through additional solutions, and then
placing it in paran wax. After the wax has hardened, the tissue is
cut into very thin slices, which are placed on slides and stained. Th
e process usually takes several days

When are frozen sections done?

when an immediate answer is needed, to determine if the tissue is

cancerous so the surgeon can cut properly

What is the process of frozen sections?

tissue prepared by freezing and slicing the tissue sample. They can
be done in about 15 to 20 mins while the pt is in the OR

Oncology Nursing Theory I: Lecture 4

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What is the grading of a tumor dependent on?

the histopathologic characteristics of tissue

What are the degrees of tumor cells determined by pathologists?

-well dierentiated -moderately well dierentiated -poorly dierenti

ated -undierentiated

What are the tumors that require grading?

-prostate -soft tissue sarcoma -transitional cell carcinoma of the bla

dder -astrocytoma -chondrosarcoma -breast

what are the tumor where grading is not useful?

-Testicular -thyroid -neuroblastoma -osteosarcoma

what is the technique of immunohistochemistry?

IHC uses antibodies for staining protein in tissues on microscopic gl

ass slides and identies specic antigens on the surface of cancer c
ells

Why is IHC important?

helps identify the site of origin of the tumor cells -detects antigens t
hat are used to determine prognostic information such as ER/PR an
d HER2/neu

What does IHC help determine with HER2 cells in particular?

determines total amount of HER2 protein receptors on the surface

of the cell. IHC determined by intensity and % of cells that exhibit a
brown cell surface staining.

What are tumor markers most useful for?

in detecting early relapse and monitoring response to therapy

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What do tumor markers consist of?

protein products, antigens, hormones, enzymes, excreted by cance

r cells or released in response to the presence of cancer

ToF; tumor markers have high enough sensitivity and specicity to

be useful in screening

False

Where are tumor markers measured?

in the serum or tissue of origin

What is the tumor marker associated with neuroblastoma?

VMA

How does ow cytometry work?

the cells are stained with a light-sensitive dye, placed in a uid, and
passed in a stream before a laser or other type of light. the measur
ements are based on how the light sensitive dye reacts to the light.

What does ow cytometry reveal?

the arrangement and amount of DNA in a cell, distinguishes benign

cells from malignant ones, and monitors the eect of anticancer tre
atment

What cancers often use ow cytometry?

lymphoma, bladder cancers and leukemic disorders

what are the 2 techniques used in cytogenetics?

Fluorescence in situ hybridization (FISH) and polymerase chain react

ion (PCR)

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WHat is FISH?

determines the position of particular genes. it can be used to identi

fy chromosomal abnormalities and to map genes.

What is the name of the method of making many copies of particul

ar DNA sequences of relevance to the diagnosis?

PCR

Cytogenetics is known for its use in detecting ___ __

genetic alterations

Why is staging important?

-help the HCP plan appropriate treament -estimate a person's progn

osis -ID a clinical trial opportunity -helps researchers evaluate the r
esults of a clinical trial

What are the elements of the stating system?

-site of the primary tumor -tumor size and number of tumors -lymp
h node involvement -cell type and grade -the presence or absence
of metastasis

Patients are less likely to respond to treatment when __ __ than tho

se athat re asymptomatic and able to maintain ADLs

bed ridden

what is the most widely used staging system for cancer?

TNM system

What is the TNM system based on ?

T: extent of tumor N: extent of spread to lymph nodes M: presence

of distant metastasis

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What are the specics of the TNM classication system?

Tx: tumor cannot be evaluated Tis: carcinoma in situ T0: no signs o

f tumor T1, T2, T3, T4: size and/or extension of the primary tumor
Nx: lymph nodes cannot be evaluated N0: tumor cells absent from
regional lymph nodes N1: regional lymph node metastasis present;
(at some sites: tumor spread to closest or small number of regional
lymph nodes) N2: tumor spread to an extent between N1 and N3 (N
2 is not used at all sites) N3: tumor spread to more distant or nume
rous regional lymph nodes (N3 is not used at all sites) Mx: distant
metastasis cannot be evaluated M0: no distant metastasis M1: meta
stasis to distant organs (beyond regional lymph nodes

What is a 0 score on the eastern cooperative oncology group (ECO

G) performance scale?

fully active; no performance restriction

ToF: the higher the number on the ECOG performance scale, the mo
re functional the person?

false! 0 is most functional, and 4 is completely disabled; no ADLs an

d conned to bed or chair

Which scale is meant for children, the Karnofsky or the Lansky perf
ormance scale?

The Lansky

What is the 0 value for the Karnofsky and Lansky performance scal
es?

K= dead L=unresponsive

ToF: progression of the disease will change the initial stage of the di
sease

FALSE

The ___ is based on information acquired before treatment, supple

mented or modied by information from surgery and the pathologic
exam of a resected specimen including tumor, lymph nodes and dis
tant metastases.

pTNM

What is the cTNM?

based on information obtained from the PE, labs and imaging, endo
scopy and biopsy. Clinical staging uses all information available bef
ore the initiation of denitive treatment.

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What is the denition of a screening mamogram?

performed on women who are asymptomatic for breast cancer. A s

creening mam usually consists of 2 views of each breast. Additional
views may be needed to adequately image all of the breast tissue,
depending on the woman's tissue and other factors

What is a diagnostic mammogram?

Is performed on women or men who present with breast complaints

or have an abnormal clinical exam, and in women who have an abn
ormal screening mamm. Patients with specic breast symptoms, su
ch as palpable lump, nipple discharge, or focal pain require diagnos
tic mammogram

What is the BI-RADS mammographic assessment?

the assessment is placed into categories with corresponding recom

mendations and probabilities of malignancies

Is a low or high number desirable on the BI-RADS?

Low number: 1 is normal and a 6 is a biopsy-proven carcinoma

ToF: the TNM staging for breast cancer goes into depth as where th
e cancer is located and the extent of the growth

True

What is the Ann Arbor Staging system most often used for?

Hodgkins and non-hodgkins lymphoma

What is stage I in the Ann Arbor system?

involvement of 1 single lymph node region or of a single extralymp

hatic organ or site (IE)

What is stage III ann arbor?

involvement of lymph node regions on both sides of the diaphragm

, which may include the spleen IIIS or limited contiguous extralymph
atic organ or site IIIE or both IIIES

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what does in situ mean?

abnormal cells present only in layer of cells in which they develope

d

What is meant by regional staging?

spread beyond primary site to nearby LNs or organ tissue

___ spread is characterized by spread to further organs and LNs

distant

What are the 5 main categories of for grouping cancers according t

o the surveillance, epidemiology and end results program

-in situ -localized -regional -distant -unknown

What are the staging systems for multiple myelomas?>

Durie-Salmon criteria/ISS criteria