Oncology Study Guide

Oncology Study Guide

Quick Review

Anemia

• A reduction in the mass of circulating red blood cells

• Patients are considered anemic when their hemoglobin levels are more than two standard deviations below the mean level in their hospital's laboratory

• Influenced by variables such as the patient's age, gender, pregnancy, ethnic or racial background

• Not a disease but a symptom of other illnesses

Anemia classification

• on the basis of mean corpuscular volume [microcytic (80), normocytic (80-94), and macrocytic (>94)]

• on the basis of mean corpuscular hemoglobin [hypochromic (27), normochromic (27-32), and hyperchromic (>32)]

• on the basis of etiological factors

Anemia etiology

Anemia may be caused by bleeding, e.g., from the gastrointestinal tract or the uterus; vitamin or mineral deficiencies, esp. vitamin B12, folate, or iron; decreases in red blood cell production, e.g., bone marrow suppression in kidney failure or bone marrow failure in myelodysplastic syndromes; increases in red blood cell destruction as in hemolysis due to sickle cell anemia; or increases in red blood cell sequestration by the spleen (as in portal hypertension), or administration of toxic drugs (as in cancer chemotherapy).

Multiple Choice

Normochromic normocytic anemia is anemia in which the size and hemoglobin content of red blood cells remain normal. The mean corpuscular volume is 80 to 100 fL.

• True

• False

Bone marrow transplant

• Bone marrow = blood forming cells = stem cells

• Procedure may be used to treat a variety of cancers and autoimmune disorders

• Stem cells are destroyed by treatment with radiation or high doses of chemotherapy.

Multiple Choice

Current practice is to mobilize stem cells into the blood stream with growth factors and then to collect and filter the blood by leukapheresis. An ____ bone marrow transplant is a procedure in which a patient’s healthy stem cells are collected from the blood or bone marrow before it is treated, stored, and then given back to the patient after treatment.

• Autologous

• Allogeneic

Open Ended

What does allogenic mean?

Allogenic

Allo means other. The stem cells in allogeneic transplants are from a person other than the patient, either a matched related or unrelated donor.

Veno-occlusive disease

A disruption in the normal flow of venous blood from the sinusoids of the liver and the hepatic venules. It occurs primarily after hematopoietic (stem) cell transplantation and is characterized by enlargement of the liver, right upper quadrant pain, jaundice, and massive fluid retention in the peritoneum (ascites) within the first three weeks after transplantation.

Open Ended

Veno-occlusive disease is also known as what syndrome?

sinusoidal obstruction syndrome

Graft-versus-host disease

Immunological injury suffered by an immunosuppressed recipient of a bone marrow transplant. The donated lymphoid cells (graft) attack the recipient (host), causing damage, esp. to the skin, liver, and gastrointestinal tract. GVH occurs in about 50% of allogeneic bone marrow transplants. It may develop in the first 60 days after transplantation (acute GVH) or many months later (chronic GVH).

TNM system (cancer-staging system)

• Is a system that is used to describe the extent of a cancer's growth in a patient’s body.

• Can be used for most cancers

• Was created and is updated by the American Joint Committee on Cancer (AJCC) and the International Union Against Cancer (UICC)

Cancer and metabolism

Metabolism of carbohydrate, protein, and fat are all altered by tumor growth. Tumors expend a persistent demand for glucose resulting in anaerobic metabolism occurring at a high rate which results in lactate as by-product. The increased lactate pool stimulates gluconeogenesis to take place via Kreb’s cycle. Protein breakdown and lipolysis are occurring at higher rates to try and maintain the high rates of glucose synthesis. Subsequently, glucose intolerance and resistance can develop by excess fatty acid oxidation and decreased uptake and use of glucose by the muscle. Protein metabolism is altered by increased protein breakdown and decreased protein synthesis resulting in loss of skeletal muscle protein.

Multiple Choice

Which of the following is not indicative of cachexia in cancer patients?

• anorexia

• altered BMR

• generalized wasting

• fat gain

Radiation Therapy

• Uses high-energy particles or waves, such as x-rays, gamma rays, electron beams, or protons, to destroy or damage diseased tissues, esp. cancer cells.

• Radiotherapy must be directed only at the diseased tissue.

• Works by making small breaks in the DNA inside cells, which keep cancer cells from growing and dividing, and cause them to die.

Radiation Therapy side effects

The most common side effects of radiation include fatigue, skin problems, hair loss, and low blood count. Other side effects depend on the area being treated and range from nausea, vomiting, hearing loss, dry mouth, change in taste, loss of appetite, tooth decay, hearing loss etc.

 

For example: Mucosal lining of the irradiated area will suffer damaging burns and can develop into obstructions. Radiation to head/neck causes salivary gland, dental and gum destruction with altered taste and smell.

Chemotherapy

Use of chemical agents or medications to systematically treat infections, cancers, and other diseases and conditions. These agents interfere with the steps or phases of the cell-cycle, specifically with the synthesis of DNA and replication of cancer cells.

Multiple Select

There are several general categories of chemotherapy medications. What are they?

• Alkylating Agents

• Antitumor Antibiotics

• Antimetabolites

• Plant Alkaloids

• Miscellaneous

Open Ended

What are the most common (nutrition-related) side effects of chemotherapy?

Common (nutrition related) side effects of chemotherapy:

• myelosuppression, anemia

• xerostomia, mucositis

• anorexia, dysphagia

• nausea/vomiting

• fatigue

• changes in taste/smell

• constipation/diarrhea

Open Ended

List 3 nutritional interventions for mucositis.

Nutritional interventions for mucositis:

• Recommend eating soft, moist foods with extra sauces, dressings, or gravies

• Suggest serving and eating food at cool or room temperature

• Advise avoidance of alcoholic beverages, citrus, caffeine, tomatoes, vinegar and hot peppers, and dry, coarse, or rough foods

• Encourage compliance with medications prescribed to manage oral pain and/or infection

• Recommend good oral hygiene

Nutritional interventions for N/V:

• Recommend eating small, more frequent meals and snacks

• Suggest sipping on cool or room temperature clear liquids in small amounts

• Advise the avoidance of high-fat, greasy, spicy, or overly sweet foods

• Advise the avoidance of foods with strong odors

• Encourage the consumption of bland, soft, easy-to-digest foods on scheduled treatment days

• Encourage compliance with medications that are prescribed to control nausea

Nutritional interventions for dry mouth (xerostomia):

• Suggest sipping on liquids throughout the day to keep oral cavity moist

• Suggest trying tart foods to stimulate salvia, if open sores are not present

• Recommend alternating bites of food with sips of liquids at meals

• Recommend eating soft, moist foods with extra sauces, dressings, or gravies

• Advise avoidance of alcoholic beverages and alcohol-containing mouthwash

Low-microbial Diet

• aka neutropenic diet

• https://youtu.be/nVFNfA8SdRw