Exam 17: Cancer of the Body System
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| The areas that are most susceptible to developing malignant lesions are where? | The lips, oral cavity, tongue, pharynx.
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| Salivary gland tumors in the parotid gland are usually | benign
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| Subm-axillary gland tumors are mor prone to be | Malignant and rapid growing. Usually are painful and impair facial function.
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| Cancer Cell Characterizatrion | Changes in the structure or appearance of anaplatic cells that form a colony of abnormal and dysfunctional calls that invade surrounding tissue.
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| Epithelioma | Cancer associated with the lip.
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| 60% of patients diagnosed with this disorder, cancer has already spread to the neck. | Epithelioma
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| Carcinoma of the oral cavity is more prevalent in whom? | Heavy drinkers, smokers and those with prolonged exposure to wind and sun.
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| Leukoplakia | White, firmly attached patch on the mouth and tongue mucosa.
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| Clinical manifestation of carcinoma of the oral cavity (Lesions) | The lips and buccal mucosa develop Lekoplakia.
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| Carcinoma of the Oral Cavity: Signs and symptoms | Lesion, lump, leukoplakia in mouth or on lip longer than 2 weeks.
Pain, soreness, bleeding from lesion.
Numbness, dysphagia, and loss of feeling.
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| Early stages of malignant lesions of the mouth is characteristically what? | Asymptomatic.
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| An important diagnostic test for examination of soft tissue is an | Indirect laryngoscopy
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| To rule out the presence of cancer of the mandibular structure, what is performed? | Radiographic evaluation is performed of the head and neck.
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| The most accurate method for a definitive diagnosis is what? | An excisional Biopsy
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| Cytological examination includes | The scraping of the lesion as a means of screening intraoral lesions.
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| Early detection of cancer of the oral cavity results in | good prognosis
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| Stage I Malignant Tumor Treatment | Surgery or radiation
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| Stage II & III Tumor Treatment | Surgery AND Radiation
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| Stage IV Tumor Treatment | Treatment is usually palliative.
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| Small tumors in the mouth can result in surgical removal of what? | Tongue to removal of the entire larynx or the portion above the true vocal cords.
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| For patients with advanced disease, treatment is usually what? | Palliative
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| What is used to relieve pain and decrease the size of the tumor? | Radiation or chemotherapy
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| Carcinoma of the esophagus (Malignant epithelial neoplasm) | Usually a tumor with the presence of squamous cell carcinoma or adenocarcinoma that invades the esophagus.
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| Esophageal cancer occurs more commonly in | men
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| 90% of esophageal cancer is squamous cell carcinomas often associated with | alcohol abuse & cigarette smoking
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| other noted causes of esophageal cancer are | Chronic irritation, environmental carcinogens, mucosal damage, and nutritional deficiencies.
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| Esophageal cancer is more prevalent in what age groups in men? | 55-70 years old.
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| Carcinoma of the bronchus, stomach or breast may metastasize to where? | The esophagus.
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| Clinical manifestations of esophageal cancer | difficulty swallowing (dysphagia), sensation of food sticking to throat, leading to weight loss.
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| Diagnostic tests for esophageal cancer | Barium swallow with fluoroscopy and endoscopy.
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| Whats used for the final diagnosis for a high degree of accuracy of esophageal cancer? | A biopsy and cytological procedure.
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| whats considered a palliative treatment for advanced cancer of the esophagus? | Chemotherapy
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| Esophageal dilation is performed to | enlarge the area obstructed by the tumor
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| What is inserted at the site of the tumor to widen the area narrowed by tumor growth? | Prosthesis (stent placement)
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| What therapy is used to destroy some of the tumor? | Endoscopic laser therapy.
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| When located here, the esophagus after resection can be reattached to the stomach. | The lower third of the esophagus.
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| A tumor located here, the esophagus is resected and the esophagus is replaced with a section of jejunum or colon. | The upper two thirds of the esophagus.
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| Types of Surgery for Esophageal cancer | Esophagogastrectomy.
Esophagogastrostomy.
Gastrostomy.
Esophagoenterostomy.
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| Immediate notify physician if what symptoms worsen with treatment? | Continuous weight loss, difficulty swallowing soft foods, and any other new problems.
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| What appears to be contributing factors of stomach cancer? | Heredity and chronic inflammation.
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| What type of cancer is more prevalent in persons between 50 and 70 years old? | Gastric Cancer
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| What groups (racial) have a higher incidence of stomach cancer? | Japanese, African-Americans and Latinos.
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| Why is achlorhydria linked to stomach cancer? | Achlorhydria is the absence of free hydrochloric acid in the stomach which may promote bacterial growth.
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| Clinical manifestations of stomach cancer may include | feeling of fullness, anorexia, weight loss and anemia.
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| Stomach cancer often spreads to where? | Lymph nodes, metastasizes to the spleen, liver, pancreas or colon.
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| What is a late symptom of stomach cancer? | pain
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| Subjective data of a patient with stomach cancer may include... | Complaints of vague epigastric discomfort or indigestion.
Postprandial (after meal) fullness.
Anorexia and weakness.
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| Objective data of a patient with stomach cancer may include... | Weight loss.
Bleeding in stools.
Hematemesis.
Vomiting after taking any intake of food or fluids.
Anemia.
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| Diagnostic tests for stomach cancer | Radiographic studies (barium swallow).
Endoscopic/gastroscopic examination with biopsy.
Stool occult blood tests.
Lab studies to include carcinoembryonic antigens (CEA) levels, CBC, and serem B12 levels.
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| what is the only curative approach/therapeutic management of stomach cancer is what? | A subtotal or total gastrectomy.
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| Problems that can occur during wound healing (post-stomach cancer surgery) may be... | Disrupted by dehiscence (partial or complete separation of wound edges).
Evisceration (viscera protrude through the disrupted wound).
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| patients with this, have a higher percentage of (eventhough rare)cancer of the liver. | Pre-existing cirrhosis.
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| Some cases of cancer of the liver are associated with | Chronic Hepatitis B or C.
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| Who has a higher incidence of liver cancer? | Men
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| With cancer of the liver, why is metastatic lung cancer more common? | The liver has a high rate of blood flow and extensive capillary network; therefore, cancer cells from other parts of the body are often transported to the liver (often metastasize to the lung).
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| Malignant cells causes what happen (physically) to the liver? | The liver becomes enlarged and misshaped.
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| Why is cancer of the liver hard to diagnose? | Its chard to differentiate from cirrhosis.
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| S&S of Cancer of the liver | Hepatomegaly, ascites, portal hypertension.
Weight loss, peripheral edema.
Dull abdominal pain in the epigastric or right upper quadrant.
Jaundice.
Anorexia, nausea, vomiting.
Extreme weakness.
Frequent pulmonary emboli.
Positive AFP.
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| Treatment for cancer of the liver is... | Palliative
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| What is sometime performed when tumor is localized? | Lobectomy
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| Only what percentage of patients have surgically resectable disease | 30-40%
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| Medical management for cancer of the liver is similar to treatment for | cirrhosis
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| Cancer progresses rapidly and death may occur in 4 to 7 months due to what? | hepatic
encephalopathy or massive GI bleeding.
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| Cancer of the gallbladder often occur more often in | women
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| Cancer of the gallbladder is symptomatically similar to | cholecystitis
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| Diagnosis of cancer of the gallbladder is | difficult to detect early.
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| Treatment of cancer of the gallbladder... | surgery might be tried, but because the liver is often invaded as well, prognosis is usually poor.
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| Pancreatic cancer is the __ leading cause of cancer death in mean, and __ in women. | 4th and 6th.
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| Why is there a high death rate attribution with pancreatic cancer? | The difficulty in diagnosing the cancer at a curable stage.
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| Pancreatic cancer is of found in and linked to what? | Cigarette smokers, chemical carcinogens, pts with DM, high meat and fat diet, and coffee consumption.
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| Pancreatic cancer may be or may metastasize from what? | Lung, stomach, duodenum or common bile duct.
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| After diagnosis, many patients live only | 4-8 months.
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| Assessment in pancreatic cancer includes: | Vague symptoms.
Pain present in 85% of cases.
Anorexia, nausea, flatulence, change in stools.
Fatigue.
Pain in the epigastrium or referred to the back; usually worse at night.
Weight loss.
Jaundice, pruritis.
Recent onset of DM.
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| What procedure is often performed with pancreatic cancer? | Whipple procedure.
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| Whipple procedure involves what? | Pancreatoduodenectomy.
Resection of the antrum of the stomach, duodenum and varying sections of the pancreatic ducts & the jejunum.
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| Why is a subtotal pancreatectomy not recommended? | due to complications of postoperative pancreatic fistulas.
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| What produce a better response than single agents in pancreatic cancer? | Combinations of drugs (5-FU and BCNU [carmustine)
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| What is a new chemotherapeutic agent for patients with metastatic adenocarcinoma that has previously been treated with 5-FU. | Gemzar
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| What is believe by some to be the most effective treatment of the almost always fatal pancreatic cancer? | Adjuvant therapy (surgical resection, radiation and chemotherapy)
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| Highest incidence of colon cancer in patients of what age? | 60
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| Predisposing factors of colon cancer include | Dz: Ulcerative Colitis & Diverticulosis ↑ risk.
Polyps may malignantly change & become carcinomas.
Lack of bulk in diet.
High fat intake.
High bacterial counts in colon.
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| Clinical manifestations of Colon cancer | Early stages may be asymptomatic.
S&S vary with location of cancerous growth.
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| Subjective data with colon cancer | Changes in bowel habits, excessive flatus, cramps and rectal bleeding.
Later stages of colon cancer, Pt complain of ABD pain, nausea & cachexia (weakness and emaciation associated with general ill health and malnutrition).
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| Objective data with colon cancer | Vomiting, weight loss, ABD distension or ascites.
Most common clinical manifestations are chronic blood loss and anemia.
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| Diagnostic tests for colon cancer. | DRE cna identify 15% of colorectal cancers.
Proctosigmoidoscopy with biopsy.
Colonoscopy.
Endorectal Ultrasonography.
CT scan of ABD.
Upper GI series, radiological ABD series and barium enema visualization or sigmoidoscopy.
H&H.
CBC.
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| What is significant of a blood test for carcinoembryonic antigen (CEA)? | CEA is a glycoprotein found in malignant and non-malignant growths.
Antibodies to this antigen are measured.
Because the CEA level can be elevated in benign and malignant diseases, it is not considered a specific test for colorectal cancer.
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| Medical management of colorectal cancer includes | Radiation, chemotherapy and surgery.
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| With colorectal cancer radiation therapy is often used prior to surgery... why and for how long? | To reduce the size of the tumor and decrease the rate of lymphatic involvement. Administered over a 4 to 6 week period.
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| With colorectal cancer, chemotherapy is given to whom? | Pts w/ systemic disease that is incurable by Sx and radiation alone.
Pts which undetected metastasis is detected.
Palliative therapy to reduce the tumor size or relieve symptoms of the disease.
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| What does surgery depend on in colorectal cancer? | location of the tumor, presence of obstruction or perforation of the bowel, possible metastasis and the patient's health.
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| If there is no obstruction, a portion of the bowel on either side, what happens? | the tumor is removed and an end-to-end anastomosis is done between the divided ends.
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| When obstruction of the bowel is present, what are the commonly used procedures? | one stage resections with anastomosis or a two stage resection bringing the ends of the bowel to the surface of the abdomen for closure later.
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| Right Hemicolectomy: | Resection of ascending colon and hepatic flexure.
The ileum is anastomosed to the transverse colon.
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| Left Hemicolectomy: | Resection of splenic flexure, descending colon and sigmoid colon.
The transverse colon is anastomosed to the rectum.
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| Anterior Rectosigmoid Resection: | Resection of part of the descending colon, the sigmoid colon, and the upper rectum.
The descending colon is anastomosed to the remaining rectum.
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| In carcinoma of the rectum, every effort is made to preserve what? | The sphincter
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| Complications that can occur with colorectal cancer surgery are what? | delayed wound healing, hemorrhage, persistent perineal sinus tracts, infections, urinary tract and sexual dysfunction.
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| Colon cancer medications: | Antacids.
Cimetidine (Tagamet).
Lomitol.
Kaopectate.
Immodium.
Rantidine (Zantac).
Pepcid.
Prilosec.
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| Antacids: Precaution | Do not give within 2 hours of other medications.
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| Cimetidine (Tagament): action | Inhibits gastric acid.
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| Lomitol: Classification | Antidiarrheal
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| Immodium: classification | Antidiarrheal
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| Kaopectate: Classification | Antidiarrheal
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| Ranitidine: action | Inhibits gastric acid
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| Pepcid: Action | Inhibits gastric acid
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| Prilosec: Action | TOTALLY inhibits gastric acid
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| Metamucil (Psyllium): Use | chronic atonic or spastic constipation with rectal disorders and anorectal
surgery.
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| Skin tumor etiology | an alteration in the genetic structure of the cell (the DNA). This can
be associated with exposure to a carcinogen
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| Risk factors for skin cancer | Hereditary.
Radiation exposure.
Chemicals (Alcohol & tobacco).
Irritants.
Diet.
Hormones.
Immune factors.
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| The most conclusive evidence of cancerous growth is a... | Biopsy
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| Benign tumors: Types | Keloid.
Angioma.
Verruca (wart).
Nevus (Mole).
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| Malignant tumors: Types | Basal Cell Carcinoma.
Squamous cell carcinoma.
Malignant melanoma.
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| ABCD's of Melanoma | A-Asymmetry.
B-Border is irregular.
C-Color is varied from one area to another.
D-Diameter is generally larger than 6mm.
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| Skin cancer preventions | Avoid sun exposure,
Wear hats and clothing to cover skin.
Use sunscreen.
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| Tumors of the bone may be | primary or secondary, benign or malignant.
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| Metastasis from ___, ____, _____,____ and ____ may be one cause of bone cancer. | Lung, breast, prostate, thyroid and kidney.
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| Types of bone cancer | Osteogenic Sarcoma.
Osteochondroma.
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| Osteogenic Sarcoma are primarily malignant bone tumor seen in | Young people.
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| Osteogenic Sarcoma can metastasize throughout the body via | the blood stream.
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| Osteogenic Sarcoma is a fast growing that affects what? | the long bones, particularly the distal femur, proximal tibia, and proximal humerus.
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| Osteogenic Sarcoma affects more of which sex? | Males
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| Osteogenic Sarcoma is seen primarily between what ages? | 10 and 25
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| Osteogenic Sarcoma metastasize and invade other bones and what else? | Lung tissue.
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| Osteochondroma is what type of tumor? | Benign.
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| Osteochondroma usually affect which bones? | humerus, tibia, and femur
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| With bone cancer, why do spontaneous fracture occur? | as the healthy cells are replaced by cancer cells, there is a decrease in the strength of the bone.
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| With bone cancer, why does anemia occur? | due to the invasion of the cancer into the long bone and the disruption of the manufacturing of the red blood cells in the bone marrow.
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| Subjective data with bone cancer | Pain in the affected bone site.
Pain especially with weight bearing.
Tenderness at the affected side.
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| Objective data with bone cancer | Assessment of the affected part that may reveal edema and discoloration of the skin.
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| Diagnostic tests for bone cancer | Radiographic studies.
Bone scan.
Bone biopsy.
CBC, platelets (bone marrow involvement).
Serum protein levels (elevated in multiple myeloma).
Serum alkaline phosphatase (elevation may indicate osteogenic sarcoma).
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| Types of surgery for bone cancer. | Wide excision or resection.
Bone curettage.
Leg or arm amputation.
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| Treatment for bone cancer is aimed at | Removing the malignant lesion
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| Alopecia | the loss of hair from aging, drugs, or disease processes.
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| Hypertrichosis (Hirsutism) | the excessive growth of hair. It can be hereditary or the result of hormone dysfunction and medications.
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| Hypotrichosis | the absence of hair or a decrease in hair growth. Causes include skin disease, endocrine disorders and malnutrition.
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| Paronychia | disorder where the nails get soft or brittle.
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