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NCLEX Review Oncology Nursing

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									                                       NCLEX Review Oncology Nursing
                                           NP07L016 / Version 1.1
                                                01 Jan 2004

1.        Learning Step / Activity 1. Check your mastery of Oncology Nursing

          1. Read the comprehensive nursing content review

          2. Answer review questions on Oncology Nursing

          3. Review answers and rationales for each test questions

               (1) The rationales for correct answers reinforces learning

             (2) The rationales for incorrect answers corrects knowledge deficits and identifies
          areas of focus for     further study

          4. Key terms related to cancer

            a. Cancer: a group of diseases characterized by the uncontrolled growth and spread
          of abnormal cells that can result in death if not detected and controlled

             b. Carcinoma: a malignant growth composed of epithelial (covering layer of the
          internal and external surfaces of the body) cells that tend to spread to other areas of the

               c. Carcinogen: any cancer-producing substance

            d. Carcinogenesis: The process by which normal cells are transformed into cancer

               e. Benign: not malignant, not recurrent, not spreading, favorable for recovery

             f. Malignant: tending to become progressively worse, resistant to treatment, tending
          to spread and result in death

            g. Metastasis: the process by which tumor cells are spread to distant parts of the
          body, from a primary site to a secondary site

               h. Alopecia: loss of hair due to the destruction of hair follicles

            i. Autologous: something having its origin within an individual, especially a factor
          present in tissues or fluids

             j. Biopsy: removal of a small piece of tissue from and organ or other part of the body
          for microscopic examination., used to confirm or establish a diagnosis, establish a
          prognosis, or follow the course of a disease

               k. Differentiated: most like the parent tissue

            l. Immunosurveillance: the immune system’s recognition and destruction of newly
          developed abnormal cells

  m. Leukopenia: reduction in the number of circulating white blood cells due to
depression of the bone marrow

     n. Neoplasm: uncontrolled or abnormal growth of cells

     o. Oncology: the sum of knowledge regarding tumors, the study of cancer

  p. Palliation: therapy designed to relieve or reduce intensity of uncomfortable
symptoms: does not produce a cure

   q. Papanicolaou (“Pap”) smear: A means of studying cells that the body has shed
during the normal sequence of growth and replacement of body tissue, if cancer is
present cancer cells also shed; commonly used in pelvic examinations to detect cancer
in women

  r. Sarcoma: malignant tumors of connective tissues, such as muscle or bone,
presents as painless swelling

  s. Stomatitis: mouth inflammation caused by destruction of normal cells in the oral

  t. Thrombocytopenia: reduction in the number of circulating platelets due to the
suppression of the bone marrow

        u. Tumor lysis syndrome: an oncologic emergency that occurs with rapid lysis
of malignant cells

5. Frequent sites of malignant neoplasms in men and women.

a.    Lung cancer is the leading cause of cancer-related death in both men and women.

Other types of cancer occur more frequently, but are more curable than lung cancer

      (1) 86 percent die within 5 years of diagnosis

      (2) Incidence peaks between 55 and 65 years of age

      (3) Smoking is the primary cause

 b. Breast cancer is the most common cancer in women (excluding skin cancer). It

can rarely

       occur in men also

 c. Skin cancer is the most common cancer in both men and women

      (1) Melanoma is the most serious type, killing over 7,300 people in the US yearly

      (2) Non-melanoma skin cancer is most common and much less dangerous

      (3) Sunlight exposure is the primary cause

      (4) People of fair complexion that sunburn easily are at higher risk

 d. Prostate cancer is the most common cancer in men (excluding skin cancer)

    (1) Over 317,000 cases are diagnosed annually in the US

 e. Gastrointestinal cancer is the third most common cancer affecting both men and


    (1) Colorectal cancer is the third leading cause of cancer death in the US, leading

to approximately 55,000 deaths annually

 f. Ovarian and testicular cancers are also common malignancies

6. Guidelines for cancer related check ups

 a. The American Cancer Society recommends that all men and women get a

cancer-related checkup every three years from age 20 to 40 and then yearly thereafter.

This checkup may include examinations for cancer of the skin, thyroid, mouth, lymph

nodes, prostate, testes, cervix and ovaries

 b. Table 17-1and 17-2 in Chapter 17 of your text outlines preventive behaviors and

screening tests as recommended by the American Cancer Society

 c. Beginning at age 50, both men and women should undergo the following

screening tests:

    (1) Yearly fecal occult (hidden) blood test combined with flexible sigmoidoscopy

every 5 years

    (2) Double contrast barium enema every 5 years

    (3) Colonoscopy every 10 years

    (4) Skin examination yearly over age 40

 d. Females should undergo the following screening exams:

    (1) Yearly pelvic examination with Pap smear beginning at age 18

    (2) Monthly breast self-examinations

    (3) A yearly mammogram is recommended by many physicians to screen for

breast cancer after the age of 40

 e. Males should undergo the following screening exams:

    (1) Monthly self-examination of the testes after age 18

    (2) Prostate specific antigen (PSA) blood test and digital rectal exam starting at

age 50, or at age 45 if at high risk

  f. People with higher risk, such as a family history of cancer, should undergo earlier

and more frequent screening tests

  g. Exposure to carcinogens in the workplace, home or recreation may indicate early

or specialized cancer screening

7. Grade and stage of tumors.

a. Tumors are named for the parent tissue, location of the growth, its cellular makeup,
or the person by whom it was identified. For example, sarcoma refers to malignant
tumors of connective tissues such as muscle and bone.

b. Tumors are classified grade 1 to 4 by the degree of malignancy with 4 being a
neoplasm most unlike the parent tissue and therefore most malignant.

c. Tumor, Nodes, Metastasis system (TNM), tumors are staged by size, extent of
spread to lymph nodes and extent of metastasis to other organs.

8. Diagnostic testing for cancer.

a. Persons who show signs and symptoms of cancer should undergo diagnostic tests
to confirm or rule out that they have cancer.

b. The only sure way to know if one has a malignancy is with a tissue biopsy, a sample
of tissue for pathological examination.

  (1) Incisional biopsy is the removal of a portion of tissue for examination, such as
when a polyp is removed during endoscopy.

  (2) Excisional biopsy is the removal of a complete lesion, such as a suspicious

   (3) Needle aspiration biopsy is the process of aspirating fluid or cells from
suspicious tissue by use of a needle.

c. An endoscope is used to directly visualize an internal structure through a body
cavity, orifice or through a small incision. Examples are upper gastrointestinal (UGI)
endoscopy and colonoscopy to look for suspicious polyps and growths in the GI tract.

d. Bone scans involve radioactive material injected into a vein in the arm that is
absorbed by malignant cells in the bone. These "hot" malignant cells then "light up" on
imaging. Bone scans are used to determine if cancer has spread to the bone.

e. Computerized Tomography (CT) and magnetic resonance imaging (MRI) use
sophisticated imaging to examine suspicious tissues, especially very small, deep

f. Radioisotope or nuclear medicine studies (similar to bone scans) use radioactive
materials that are known to be absorbed by certain growths such as thyroid and brain
tumors which "light up" on imaging.

g. Ultrasound uses painless high-frequency sound waves to visualize internal organs
to look for tumors.

h. Laboratory tests are used to find "markers" in blood and body fluids that may
indicate the presence of cancer.

   (1) Elevated prostate-specific antigen (PSA) blood levels may indicate the
presence of prostate cancer, but not always. Further tests are ordered by the
evaluating doctor if the PSA is suspiciously high.

   (2) Elevated blood levels of alkaline phosphatase, serum calcitonin and
carcinoembryonic antigen (CEA) may also indicate cancer is present.

i. Stool examination for blood (guaiac testing) is commonly used to detect occult
(hidden) blood in the stool that may be the result of bleeding from pre-cancerous polyps
or cancerous tissue.

j. Nursing interventions for patients undergoing diagnostic testing center on proper
patient education and pretest preparation.

  (1) Consider that any patient undergoing tests to rule out cancer is anxious and may
need reassurance.

   (2) Nurses should reinforce education about preparation for the procedure such as
careful hydration prior to radioisotope and dye studies to assure these substances are
optimally cleared by the kidneys.

   (3) Patients must be informed about how tests are conducted to minimize anxiety.
This is especially true of MRI and CT tests where the patient is immobilized in a small

   (4) MRI tests use a huge magnet. Patients must not have any ferrous metal on or in
their body as a safety measure.


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