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100 Cards in this Set
- Front
- Back
What is the time from when a cell enters the cell cycle to when the cell divides into two identical cells?
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Generation time of the cell
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Normal cells respecting the boundaries of cells surrounding them is...
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Contact inhibition
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How fast do cancer cells proliferate?
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Same rate as the cells of the tissue they originated from
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Which type of cancers metastasize?
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Malignant
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Stages of development of cancer
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Initiation - cell mutation
Promotion - reversible cancer. Promoting factors - obesity, cigerrettes, alcohol, dietary fat Progression - metastasis, increased growth of tumor |
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Viruses linked to cancer
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Burkitt's lymphoma from Epstein Barr virus
AIDS - Kaposi's sarcoma Hep B - hepatocellular cancer |
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What is tumor angiogenesis?
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Formation of blood vessels within the tumor itself.
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What kind of proteins do cancer cells secrete?
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The cancer cells don't mature past the fetal stage - alpha fetoprotein and carcinoembryonic antigen
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Suffixes for benign and malignant tumors
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benign - oma
malignant - sarcoma, carcinoma |
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Characteristic of grade IV cancer
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Cells are immature and primitive (anaplasia). Difficult to determine cell of origin.
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What is used to determine the anatomic extent of the cancer?
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TNM system.
T - tumor size/invasiveness N - nodal involvement M metastases T0, M0, N0 = no evidence of tumor in nodes, metastasis T1-4, M1-4, N1-4 = ascending degrees of tumor, metastasis, nodal involvement |
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7 warning signs of cancer
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C - change in bowel/bladder habits
A - a sore that does not heal U - unusual bleeding or discharge T - thickening or lump in breast or elsewhere I - indigestion or difficulty swallowing O - obvious change in wart/mole N - nagging cough or hoarseness |
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When do colonoscopies begin?
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Age 50 and q10years thereafter
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Four ways we treat cancer
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Surgery
Chemo Radiation Biologic targeted therapy |
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Sign of extravasion and what do we do about it
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swelling, redness, vesicles, uceration, necrosis
STOP THE INFUSION IMMEDIATELY |
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What normal tissues are typically affected by chemo?
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Ones that divide quickly - bone marrow (anemia, bleeding), neutrophils (infection), GI tract (N/V, diarrhea, stomatitis, esophagitis), hair (hair falls out), reproductive cells
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Acute effects of chemo
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Hypersensitivity, extravasation
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Delayed effects of chemo
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N/V, alopecia, skin rashes, diarrhea, constipation
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Chronic effects of chemo
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Heart, liver, kidney, lung damage
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Low - energy radiation...
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targets superficial skin lesions (electrons)
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High - energy radiation...
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targets deeper tissues (photons)
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What is the standard fraction of radiation delivery?
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Once a day, M-F for 2-8 weeks
Hypofractionated - less than this Hyperfractionated - more than this Accelerated fractionated - doses twice daily over shortened period of time |
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Simulation is...
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When they figure out exactly where the radiation should be directed and mark it with a tattoo.
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What is it called when radiation is delivered externally?
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Teletherapy
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What is it called when radiation is delivered internally?
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Brachytherapy
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What are the most frequent places cancer metastasizes?
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Lungs, Brain, Bone, Liver, Adrenals
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What precautions should be taken when providing care to a pt with brachytherapy radiation?
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Consolidate tasks so as little time as possible is spent in the room and wear a film badge (only in hospital and don't share it). Film badge measures levels of radiation.
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Hematologic interventions for radiation and chemo pts
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Monitor H and H. Administer iron/erythropoietin, report any temp eleations, pt should avoid lg crowds and people with infections, observe for signs of bleeding
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Management of fatigue in chemo/radiation pts
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Arrange activities after rest periods, walking program, good nutrition/hydration
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How can nurses help with radiation/chemo related N/V?
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Give antiemetics before the tx, light meal 1 hr before tx
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Diet for chemo/radiation pts that are nauseated
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high-protein, high-calorie
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What foods do you avoid when chemo/radiation pts have diarrhea?
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High fiber, fatty, gas producing foods. Avoid milk.
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How does the nurse help with dry mouth/difficulty swallowing in chemo/radiation pts?
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Oral care before and after meals and before bedtime, 1 tsp salt or baking soda in 1L H2O rinses, analgesics, artificial saliva, soft moist bland foods
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How does nurse handle anorexia associated with cancer?
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Pleasant environment for high-calorie, high-protein food and avoid nagging
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What is radiation-recall dermatitis?
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Skin desquamation that occurs months to years after the radiation.
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What is palmar-plantar erythrodyesthesia?
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Hand-foot syndrome. Redness/tingling, moist desquamation, ulceration, blistering, pain of hands and feet r/t chemo.
If severe, hold the chemo for 1-2 weeks. |
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How can the nurse help with the skin reactions to radiation?
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Aloe vera, hydrocortisone, saline rinses, expose area to air, wear light-weight cotton, gentle detergents to launder clothes like Dreft and Ivory Snow, avoid sun exposure, no heat pads/sunlamps, ice bags, no swimming, no shaving in affected area, no deoderents/perfumes to tx field
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When should we expect the pt's hair to grow back?
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3-4wks after chemo/radiation is over
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How does the nurse help the pt with hair loss?
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Suggest wigs/scarves/hair pieces, cut long hair before therapy, avoid excessive shampooing/brushing/combing/hair dryers/curlers, discuss impact of hair loss on body image
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How does the nurse help with the chemo related pneumonitis that occurs 1-3months after radiation?
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Bronchodilators, expectorants, bed rest, O2. NO CORTICOSTEROIDS! Immune system is already depressed.
Cough suppressants at night. |
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How can the nurse help with the sexual effects of chemo/radiation?
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Counsel about erectile dysfunction, lubricants for women, sperm and egg banking
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What can we say to ease the anxiety of remission?
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We will follow and support you ongoing.
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Who is at the highest risk for lung cancer?
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White women and African American men
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Smallest lung cancer lesion detectable on x-ray
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1cm
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What is the most malignant form of lung cancer?
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Small cell carcinoma - chemo is the mainstay of tx
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What is the most common lung cancer?
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Adenocarcinoma - surgical resection attempted b/c doesn't respond well to chemo
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What is paraneoplastic syndrome?
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SIADH, anemia, hypercalcemia, leukocytosis, hypercoagulable disorders, neurologic syndromes due to hormone secretion of cancer cells or the immune response of the body to them.
Associated with small-cell lung carcinoma |
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Symptoms of lung cancer
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Usually silent killer b/c the chronic cough may be attributed to smoking.
Earliest manifestation - persistant pneumonitis b/c of obstructed bronchi (chills, cough, fever) Most common symptom - cough that produces sputum |
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Stages of lung cancer (non-small cell)
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IA - 3A have good prognosis
3B and IV have poor prognosis. Usually inoperable. |
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Small cell lung cancer staging
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Limited or extensive
limited - tumor confined to the chest and regional lymph nodes (usually live about 2 years) extensive - tumor has spread past the chest (usually live 7-10months) |
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Small cell lung cancer tx adjunct
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Prophylactic cranial radiation
Chemo drugs won't cross blood-brain barrier so, radiation to prevent metastases |
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Lung cancer therapies
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Prophylactic cranial radiation, bronchoscopic laser therapy, phtodynamic therapy (Porfimer IV then tumor exposed to light after 48 hours), airway stenting (to support airway against collapse), cryotherapy
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Late symptoms of lung-cancer
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hemoptysis, dysphagia, bone pain, pleural effusions, dysrhythmias, muscle wasting
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Nursing dx for lung cancer
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Ineffective airway clearance
Anxiety Acute pain Imbalanced nutrition:less than body requirements Ineffective self-health management Ineffective breathing pattern |
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What is a hamartoma?
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Benign lung tumor, congenital, composed of fibrous tissue, fat, and blood vessels
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Who is most at risk for colorectal cancer?
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African Americans
Men People with it in their family |
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What is Lynch syndrome?
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Inherited form of heredity colorectal cancer
Autosomal dominant. These people need to be MONITORED. |
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Risk factors for colorectal cancer
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Obesity, smoking, alcohol, large intake of processed and/or red meat
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What can we do to decrease the risk of colorectal cancer?
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Eat whole grains, fruits and vegetables, excercise
NSAIDS and HRT also reduces the risk |
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Most common site of metastasis of colorectal cancer
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Liver (b/c blood leaves through the portal vein)
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Colorectal cancer complications
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Obstruction, bleeding, perforation, peritonitis, fistulas
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Left vs Right sided colon cancer
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Left - Bright red blood in stool, alternating constipation and diarrhea, change in stool caliber (narrow, ribbonlike), sensation of incomplete evacutation
Right - Cramping, colicky discomfort, anemia from occult bleeding, weakness, fatigue |
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Tests for colon cancer
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q5years -
Flexible sigmoidoscopy, double-contrast barium enema, CT colonagraphy q10years - Coloscopy every year - fecal occult blood test, fecal immunochemical test Other - stool DNA test |
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Colonoscopies should begin at age
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50
or 45 for African Americans |
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People with a first degree relative that developed colon cancer before age 60 should have...
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colonoscopy q 5 years beginning at age 40 or 10 years before that family member developed cancer
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Important tests once the colon cancer dx is made
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Liver function, test for anemia, carcinoembryonic antigen test (produced by 90% of all colon cancers)
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The only cure for colon cancer is...
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surgery
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Pre-op colon cancer surgery
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Cleanse the bowel with goLYTELY or Miralax. Oral antibiotics.
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Complications of colorectal surgery
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Persistent perineal sinus tracts, infections, UTI, sexual dysfunctions, hemorrhage, delayed wound healing
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Capecitabine (Xeloda) - chemo used for colon cancer drug alert
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Teach pt not to get immunizations and to report fever >100.5
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Risk factors for breast cancer
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Female, >50 years old, family history, hx of breast/colon/endometrial/ovarian cancer, menarche before 12yo or menopause after 55yo, nulliparity or 1st pregnancy after age 30, obesity after menopause, radiation, >1 alcoholic drink/day, sedentary
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Breast cancer marker
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HER-2
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Clinical manifestations of breast cancer
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usually upper outer quadrant of breast, nonmobile, nontender, irregularly shaped, hard, unilateral nipple discharge, nipple retraction, peau d'orange
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Most important prognostic factor in breast cancer
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Lymph node involvement
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What does estrogen receptor status mean in breast cancer?
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Positive - responsive to hormone therapy, better prognosis
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What does ploidy status mean in breast cancer?
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Diploid - better prognosis
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What is triple negative status in breast cancer?
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Negative for estrogen, progesterone, and HER-2. Poorer prognosis.
Younger women, BRCA-2 mutation, African Americans, and Hispanic |
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Lymphedema is worst with...
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breast cancer.
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Is lymphedema curable?
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No
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Where does lymphedema swell first?
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Thighs. Not feet like cardiac edema.
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How is lymphedema managed?
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Compression stockings if in thighs. Elevate arms if that's wear it is.
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How long does it take radiation SE to take place?
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About 3 weeks.
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What is internal radiaion's purpose?
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Get the cancer cells they didn't get with surgery.
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What do we watch with diarrhea in radiation?
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Look out for orthostatic hypotension due to fluid volume deficit.
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Most common symptom of ovarian, uterine, cervical cancer...
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Abdominal distension is the first time.
Then lots of bleeding. |
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Grade is...
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from the path report. More important then staging.
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What does grade tell you about?
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The tissue
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What does staging tell you about?
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The spread.
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Gene associated with breast/ovarian cancer...
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BRCA gene
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People of what descent are at higher risk of breast cancer?
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Jewish (E. European)
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What cancer is melanoma associated with?
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Pancreatic cancer (which usually looks like gallbladder disease)
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What is usually prescribed with Taxol and why?
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Benedryl, steroids, and Zofran b/c there is usually an allergic reaction due to the ethanol they use to extract the drug from the
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What drug given for neuropathy?
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Gabapentin (Neurontin)
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Drugs most likely to cause neuropathy...
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platin drugs
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IMRT
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type of radiation directed to the area in pulses
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What is taxatear toes?
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Toenails fall off.
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Avastin
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Increases risk for HTN
Stop before surgery Risk for bleeding |
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Herceptin
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Cardiac myopathy
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Palliative care vs Hospice Care
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Palliative care relieves symptoms of pain and suffering.
Hospice care is end-of-life care. Includes palliative care, but does not include curative treatments. |
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To be eligible for hospice care...
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physician must certify pt has <6 months remaining.
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