The top 3 cancers in order by INCIDENCE in men are:

A. 1.lung, 2.prostate, 3.colon/rectum

B. 1.prostate, 2.lung, 3.bladder

C. 1.prostate, 2. lung, 3. colon/rectum

D. 1. lung, 2.prostate, 3.bladder

Top the cancers by INCIDENCE in women in order:

A. 1.breast, 2.lung, 3.colon/rectum

B. 1.breast, 2.lung 3.uterine

C. 1.breast, 2.colon/rectum, 3.lung

D. 1.lung, 2.breast, 3. uterine

Top 3 FATAL cancers among men in order:

A. 1.lung, 2.colon/rectum, 3. prostate

B. 1. prostate, 2.lung, 3.liver

C. 1.lung, 2.prostate, 3.liver

D. 1.lung, 2.prostate, 3.colon/rectum

Top 3 FATAL cancers among women in order:

A. 1.breast, 2.lung, 3.ovary

B. 1.lung, 2.breast, 3.ovary

C. 1.lung, 2.breast, 3.colon/rectum

D. 1.breast, 2.ovary, 3.lung

Which of these is not a stage of cancer development?

A. initiation

B. metastasis

C. promotion

D. progression

B. metastasis;

-the steps in order are initiation, promotion, progression

-metastasis is a part of progression

Initiation is:

A. a mutation in the cell's genetic structure resulting from an inherited mutation

B. characterized by the reversible proliferation of the altered cells

C. cancer-causing agents capable of producing cellular alterations

D. characterized by increased growth rate of a tumor

A. a mutation in the cell's genetic structure resulting from an inherited mutation

-this is the first stage in the development of cancer

-initiation is irreversible, but not all altered cells go on to establish a tumor many undergo apoptosis (programmed cell death)

-An initiated cell is not yet a tumor cell because it hasn't established the ability to self-replicate and grow; the DNA alteration may remain undetected throught the life of the individual as long as no further events stimulate development of a tumor

Promotion is:

 A. a mutation in the cell's genetic structure resulting from an inherited mutation

B. characterized by the reversible proliferation of the altered cells

C. cancer-causing agents capable of producing cellular alterations

D. characterized by increased growth rate of a tumor

B. characterized by the reversible proliferation of the altered cells

-promoting factors include: dietary fat, obesity, cigarette smoking, and alcohol consumption

-changing a person's lifestyle to modify these risk factors can reduce the chance of cancer development

-a period of time ranging from 1-40 years passes from the initail genetic alteration and the actual clinical evidence of cancer; this is called the latent period and is said to consist of initiation and promotion periods

Progression is:

A. a mutation in the cell's genetic structure resulting from an inherited mutation

B. characterized by the reversible proliferation of the altered cells

C. cancer-causing agents capable of producing cellular alterations

D. characterized by increased growth rate of a tumor

D. characterized by increased growth rate of a tumor

-the final stage in the development of cancer

-cancer becomes more invasive and metastasizes

This type of tumor is usually encapsulated:

A. benign

B. malignant

A. benign

-malignant tumors are rarely encapsulated

This type of tumor is poorly differentiated:

A. benign

B. malignant

B. malignant

-benign tumors are well differentiated

This type of tumor is capable of metastasis:

A. benign

B. malignant

B. malignant

-benign tumors do not metastasize

Recurrence of this type of tumor is rare:

A. benign

B. malignant

A. benign

-recurrence of malignant tumors is possible

This type of tumor has moderate to high vascularity:

A. benign

B. malignant

B. malignant

-benign tumors have slight vascularity

This tumors mode of growth is exclusively expansive:

A. benign

B. malignant

A. benign

-malignant tumors are expansive and infiltrative

These cells are fairly normal and similar to the parent cells

A. benign

B. malignant

A. benign

-malignant cells are abnormal and become more unlike the parent cells

Over what age are 77% of all cancer cases diagnosed?

A. 50

B. 55

C. 65

D. 75

B. 55

-as age increases the risk for developing cancer increases

Dietary incluences on cancer

(basically if it's unhealthy it can cause cancer, by means of obesity)

• high red meat and saturated fat, increase risk
• genotoxic foods, coffee; increase risk
• high fat and low fiber; increase risk
• excessive fried or broiled fish and meat; increase risk
• fat to fry foods at high temps; increase risk
• veggies, fruits, fiber, folate, calcium; lower risk

Possible occupational hazards related to cancer exposure:

• think manual labor
• think hospital
• think warehouse/construction

-solar radiation

-ionizing radiation, xrays, radiation therapies

-asbestos

HIV is associated with what cancer?

A. basal cell carcinoma

B. carposi sarcoma

C. liver cancer

D. squamous cell carcinoma

B. carposi sarcoma

-viruses can be carcinogens such as: HIV, Epstein Barr, Hepatitis B & C

Which of the following are considered carcinogens?

Select all that apply

A. tobacco

B. sun rays

C. flourescent lights

D. alcohol

E. unhealthy dietary habits

A,B,D,E

-tobacco: lung cancer

-sun rays: skin cancer

-alcohol: exaserbates tobacco with especially in the mouth, larynx, and esophagus

-unhealthy diet: obesity which contributes to 14-20% of all cancer cases

Stage 0 cancer is:

A. tumor limited to the tissue of origin

B. metastasis

C. limited to local spread

D. cancer in situ

D. cancer in situ

-in situ: : carcinoma in the stage of development when the cancer cells are still within their site of origin, has all the histologic characteristics of cancer except invasion

Stage I cancer is:

A. cancer in situ

B. metastasis

C. limited local spread

D. tumor limited to the tissue of origin, localized tumor growth

Stage II cancer is:

A. limited to local spread

B. cancer in situ

C. tumor limited to the original tissue

D. metastasis

Stage III cancer is:

A. limited local spread

B. metastasis

C. cancer in situ

D. extensive local spread and regional spread

Stage IV cancer is:

A. cancer in situ

B. metastasis

C. extensive regional spread

D. limited local spread

Which of these is not a location that falls under the category of a carcinoma?

A. skin

B. stomach

C. femor

D. trachea

C. femor

-carcinomas originate in the ectoderm (skin and glands) and the endoderm (mucous membrane linings of the respiratory tract, GI tract, and GU tract

What type of cancer does not fall in the category of sarcoma?

A. muscle

B. bone

C. fat

D. skin

D. skin

-sarcomas originate from embryonal mesoderm (connective tissue, muscle, bone, and fat)

Histologic Classification

G1-G4; GX

TNM Classification System

(T) Primary Tumor

(N) Regional Lymph Nodes

(M) Distant Metastasis

Cellular differentiation is:

A. normal genes that are important regulators or normal cell growth

B. an orderly process that progresses from a state of immaturity to a state of maturity

C. the process of a stem cell becoming cancerous

D. the property of a cell to respect its boundary and the territory of other cells

B. an orderly process that progresses from a state of immaturity to a state of maturity

-all body cells have the potential to carry out all bodily functions, differentiation is the process where cells go from this immature state to their mature state where they can carry out only one specific function

__________ are normal cellular genes that are important regulators of normal cellular processes.

A. oncogenes

B. neoplasms

C. nadir

D. protooncogenes

D. protooncogenes

-called the genetic "lock" that keeps the cell in its functioning state

-when the "lock" is exposed to carcinogens it can be "unlocked" allowing genetic alterations and mutations to occur

-these alterations can cause them to act a tumor inducing genes

_______ are tumor inducing genes.

A. neoplasms

B. oncogenes

C. protooncogenes

D. malignancies

B. oncogenes

-oncogenes interfere with normal cell expression under some conditions, causing the cell to become malignant

-this cell regains a fetal appearence and function (poorly differentiated)

BRCA1 and BRCA2 are tumor suppressor genes, alterations in these genes (by carcinogens) increase a person's risk for ______ and ________ cancer.

A. lung, prostate

B. breast, lung

C. breast, ovarian

D. colon, lung

C. breast and ovarian

Alterations to the APC gene (tumor suppresor gene) increase a person's risk for _______ cancer.

A. lung

B. colorectal

C. breast

D. uterine

Mutations in p53 tumor suppressor gene can increase a person's risk for _______ cancer.

A. skin

B. prostate

C. stomach

D. bladder

D. bladder

-mutations in this gene have also been found in breast, colorectal, esophageal, liver, lung, and ovarian cancers

Define Hyperplasia:

A. iincreased density or number of cells

B. dividing cells differentiate into cell types not normally found in that part of the body

C. cells are abnormal in size, shape, appearance, and arrangement because the DNA has lost control of the differentiation process

D. regression of a cell to an immature or undifferentiated cell type.

A. increased density or number of cells

-occurs in response to stress, increased metabolic demands, or elevated levels of hormones

What is Metaplasia?

A. iincreased density or number of cells

B. dividing cells differentiate into cell types not normally found in that part of the body

C. cells are abnormal in size, shape, appearance, and arrangement because the DNA has lost control of the differentiation process

D. regression of a cell to an immature or undifferentiated cell type.

B. dividing cells differentiate into cell types not normally found in that part of the body

-metaplasia is a protective response to chronic stress or injury

What is Dysplasia?

A. iincreased density or number of cells

B. dividing cells differentiate into cell types not normally found in that part of the body

C. cells are abnormal in size, shape, appearance, and arrangement because the DNA has lost control of the differentiation process

D. regression of a cell to an immature or undifferentiated cell type.

What is Anaplasia?

A. iincreased density or number of cells

B. dividing cells differentiate into cell types not normally found in that part of the body

C. cells are abnormal in size, shape, appearance, and arrangement because the DNA has lost control of the differentiation process

D. regression of a cell to an immature or undifferentiated cell type.

D. regression of a cell to an immature or undifferentiated cell type

-usually occurs when a damaging or transforming event takes place inside a dividing, still undifferentiated cell, leading to loss of useful function

Prevention of Cancer:

• think carcinogens
• think what your body needs
• think of other things to avoid
• screening

1. reduce/avoid exposure to known carcinogens
2. eat a balanced diet
3. regular exercise
4. 6-8 hrs of sleep a night
5. regular health exams and screenings
6. reduce stress
7. self-exams (breast, testicular)
8. seek immediate help if you notice a change

Seven warning signs of cancer:

C

A

U

T

I

O

N

Change in bowel/bladder habits

A sore that does not heal

Unusual bleeding or discharge from any body orifice

Thickening of a lump in the breast or elsewhere

Indigestion or difficulty swallowing

Obvious change in a wart or mole

Nagging cough or hoarseness

(also excessive unexplained weightloss)

What is an exaple of surgery as a preventative measure with cancer?

BRCA1, BRCA2

-women with a genetic mutation of the BRCA1 or BRCA2 and family history of breast cancer may benefit from a prophylactic masectomy

-patients with adenomatous familial polyosis may benefit from a total colostomy to prevent colorectal cancer

What is a debulking or cytoreductive procedure related to surgical cancer treatment?

-how are surgery and chemo/radiation used together

-when the goal of surgery is to cure cancer the idea is to remove all or as much of the resectable tumor as possible while sparing normal tissue

-if not all of the tumor can be removed chemo or radiation may be used afterward and be more effective because of the reduced size of the tumor

-or chemo or radiation may be done prior to surgery to reduce the size and increase the chance of successful removal of the entire tumor

When cure or control of cancer is no longer possible, the focus shifts to preservation of quality of life at the highest possible level for as long as possible.

Examples?

-insertion of a feeding tube to maintain nutrition during head and neck cancer treatment

-creation of an ostomy for patients with a rectal abscess or advanced prostate cancer

-placement of a port or PICC to deliver chemo, pain meds, TPN, blood products, and other supplements

-resecting tumors to relieve pain or pressure

-creation of a bladder reservoir at the time of a cystectomy

-breast reconstruction following a masectomy

-spinal or joint rods

-the use of chemicals as a systemic therapy for cancer

-chemotherapy is used to cure, control, and offer palliative relief of cancer

-chemo works to disrupt the cell-cycle of tumor cells

Which of these is NOT one of the 5 things that determines the effectiveness of chemotherapy?

A. mitotic rate of the tissue

B. size of the tumor

C. age of the tumor

D. fat deposits surrounding the tumor

E. location of the tumor

F. presence of resistant tumor cells

D. fat deposits surrounding the tumor

-the more rapid the mitotic rate, the greater the potential for response

-the smaller the tumor the better potential for response

-the younger the tumor the better the potential for response

-location (ex: blood-brain barrier) can make it difficult for chemo to be effective

-mutations inside the tumor can result in cells that are resistant to chemo

How many hours following chemotherapy is there a potential for exposure if the RN comes in contact with the patient's bodily fluids?

A. none

B. 24 hrs

C. 36 hrs

D. 48 hrs

D. 48 hrs

-RN's must be certified in chemotherapy to prepare, handle, or administer

False

-irritants are relatively harmless if they infiltrate

-vesicants can cause severe damage to normal tissue up to necrosis, it is extremely important to monitor for infiltration

The most common route of chemo administration is:

A. PO

B. IM

C. radiation

D. IV

D. IV

-many times this comes in the form of a PICC or PORT as they can be used for long periods of time reducing discomforts, risk of infection, etc

What should the RN's initial action be if infiltration is noticed with a patient undergoing chemotherapy?

A. continue to monitor for adverse effects

B. slow the rate to KVO and call the MD

C. stop the infusion

C. stop the infusion

-protocols for drug-specific extravasation procedures should be followed to minimize further tissue damage

What are the signs of infiltration r/t chemotherapy?

Select all that apply

A. pain

B. swelling

C. cool, pale skin

D. vesicles

A,B,D

-redness is present, not pale skin

What is the main cause of the side effects of chemotherapy?

A. toxicity of the drugs

B. the route in which it is given

C. impaired immune system

D. destruction of normal cells

D. destruction of normal cells

-toxicity of the drugs does cause the side effects however this is only enabled because the chemo doesn't differentiate normal cells from cancer cells.  It destroys them all

-the side effects are exaserbated in cells that rapidly proliferate such as: bone marrow, lining of the GI, and integumentary (hair, skin, nails)

-most often times chemo drugs are used in combination with each other

Define radiation

: the emission and distribution of energy through space or a material medium

-high energy beams (xray, gamma rays, alpha particles, electrons, neutrons, protons) are emitted at the tumor and cause damage to cellular DNA killing the cells.

All cancer cells could be eradicated with radiation. 

True or False?

True

-given at high enough doses radiation could eradicate all cancer cells; however, to avoid serious toxicity and long-term complications of treatment, radiation to surrounding healthy tissue must be limited to the maximal tolerated dose for that specific tissue

____ energy beams of radiation expend energy quickly on impact and penetrate only a short distance.  _____ beams of radiation penetrate deeper not attaining full intensity until they reach a certain depth.

A. low, high

B. high, low

A. low, high

-low energy beams are used to treat superficial cancers (skin)

-high energy beams are used to treat internal targets while sparing the skin

_______ is when radiation is delivered externally. 

_______ is when radiation is delivered internally.

A. teletherapy, bradytherapy

B. bradytherapy, teletherapy

________ is radiation given prior to surgery, _______ is radiation given after surgery.

A. prophylaxis, definitive

B. definitive, adjuvant

C. neoadjuvant, adjuvant

D. prophylaxis, pallitive

Which is the most common type of radiation therapy?

A. teletherapy

B. neoadjuvant therapy

C. brachytherapy

D. low-energy beam therapy

A. teletherapy

-external beam therapy

Brachytherapy includes:

A. low energy beam radiation

B. high energy beam radiation

C. intensity-modulated radiotherapy

D. implantation of radioactive materials

D. implantation of radioactive materials

-implanted in close proximity to the tumor so the dose is directed at the tumor with minimal exposure to surrounding tissue

The RN on the floor is caring for a patient undergoing brachytherapy.  What is important to remember specific to this patient?

A. extreme importance is placed on preventing infiltration

B. limit time by the bed to 30 mins for your shift

C. make sure all measures are taken for pallitive care

D. assess the skin q 30 mins for breakdown

B. limit time by the bed to 30 mins for your shift

-this person is radioactive due to the implant, time by the bed should be limited and shielding should be used if possible

_______ interferes with cancer growth by targeting specific cellular receptors and pathways that are important in tumor growth.

A. radiation therapy

B. targeted therapy

C. bilogic therapy

D. chemotherapy

B. targeted therapy

-these work at sites that are on the cell surface, at the intracellular level, or in the extracellular domain

-these are more selective for specific molecular targets than cytotoxic anticancer drugs, thus they are able to kill cancer cells with less damage to normal cells

________ alters the biological response of the host to the tumor cells.

A. biologic therapy

B. brachytherapy

C. teletherapy

D. chemotherapy

A. biologic therapy

-works in three ways

1. ave direct antitumor effects
2. restore, augment, or modulate host immune system mechanisms
3. have other biologic effects such as: interfering with the cancer cells' ability to metastasize or differentiate

Flu like symptoms are common with biologic therapy for cancer treatment.  What drug is routinely given q 4 hrs and prophylactically to lessen these symptoms?

A. erythropoietin

B. dasatinib

C. pazopanib

D. acetaminophen

D. acetaminophen

-also large amounts of fluids lessen the symptoms

Malnutrition is a possible complication of cancer.  The patient will usually experience ________ and _________ malnutrition characterized by fat and muscle depletion.

A. protein, calorie

B. protein, calcium

C. calorie, carbohydrate

D. calcium, carbohydrate

A. protein, calorie

-Milk, eggs, cheese, meat, poultry, and fish are foods high in protein that should be increased

-mayonnaise, margarine, sour cream, peanut butter, whipped cream, corn oil, jelly, ice cream, and honey are foods high in calories that provide energy and should be increased

-patients may also experience altered taste sensation

What increases the risk for infection in the cancer patient?

Select all that apply

A. ulceration/necrosis caused by the tumor

B. compression of vital organs by the tumor

C. neutropenia caused by the disease or treatment

D. decreased blood volume

Obstructive emergencies are primarily caused by a tumor obstructing an organ or blood vessel.  Which of the following is NOT an example of an obstructive emergency associated with cancer.

A. superior vena cava syndrome

B. spinal cord compression

C. SIADH

D. third space syndrome

E. intestinal obstruction

C. SIADH

-SIADH is a metabolic emergency associated with cancer

Metabolic emergencies result in cancer patients by etopic hormones being produced by the tumor or are secondary to alterations caused by the presence of a tumor or the cancer treatment.  Which of these is NOT a metabolic emergency associated with cancer?

A. SIADH

B. hypocalcemia

C. tumor lysis syndrome

D. septic shock and disseminated intravascular coagulation

B. hypocalcemia

-you may actually see hypercalcemia in cancer that involves metastatic disease of the bone