NURS 5461 Oncology New Exam With Complete Solutions
100% Verified (A+)
Breast Cancer in Men - ANSWER Rare-Prognosis in stage I is worse in men than in
women Blood born metastases are commonly present when the man appears for initial
therapy
Painless lump; occasionally associated with nipple discharge, retraction, erosion or
ulceration are presenting complaints PE reveals hard, ill-defined, non-tender mass
beneath nipple or areola It is not uncommon for gynecomastia to precede or accompany
breast cancer in men
Breast Cancer in Men 2 - ANSWER Nipple discharge is an uncommon presentation of
breast cancer in males, but if galactorrhea is present, it is associated with the cancer in
75% of cases Staging is the same as for females **Primary site may be from prostate
Biopsy should be performed
Male Breast Cancer: Treatment - ANSWER Modified radical mastectomy in operable
patients Treatment is the same as for women Tamoxifen and castration are main
therapies for advanced cancer in men Bone metastasis is the most common as in
women and castration relieves the pain in most patients
Prognosis of Male Breast Cancer ANSWER Poorer in males compared to females. The
overall survival rate at 5 years is 58% for stage I disease at presentation and at 10 years
is 38% whereas for stage II disease, 5 year survival is 38% and 10 year survival is 10%.
Colon and Rectal Cancer - ANSWER Large bowel cancer is the major cancer in the
elderly, Symptoms masquerade as weakness, anemia or blood in stool Lesions often
seen in right colon - Stool still watery at that location, so obstruction not likely
Left sided lesions usually present with change in bowel habits or bleeding Patients with
adenomatous polyps more likely to develop subsequent cancer
Colon and Rectal Cancer 2 - ANSWER Surgical resection is mainstay XRT used to
decrease local recurrence in rectal area but no evidence that XRT improves survival
,Adjuvant chemo with Fluorouracil and Levamisole improves survival
Lung Cancer - ANSWER Accounts for 32% of cancer deaths among men and 25% of
cancer deaths among women [incidence is growing] Age of incidence is 50-70 years
80-90% are caused by cigarette smoking
Lung Cancer 2 - ANSWER Risk increases 5 times in men who smoke less than ½ PPD; 10
times for ½ to 1 PPD and 20 times for 1-2 PPD
Secondhand smoke - Heavy metals • Nickel; Chromium - Asbestos exposure • Have a
90% greater risk than those not exposed - XRT • Indoor radon; therapeutic XRT - Air
pollution - COPD - Genetic factors
Lung cancer rates - ANSWER decrease with smoking cessation Smoking is associated
with---> - Epidermoid tumors [squamous cell] - Small cell undifferentiated tumors [oat
cell] Relationship to smoking is less certain for---> - Alveolar cell [adenocarcinoma] -
Large cell undifferentiated [anaplastic]
Lung Cancer: Screening - ANSWER Metastases has often occurred by the time the
tumor is detected Usually diagnosed in the last ¼ of the tumor's life 5 year survival rate
for all stages combined with non-small cell is 14% and for small cell is 6% Squamous cell
and adenocarcinoma can take as long as 10-25 years to be large enough to be detected
by CXR Tumor is usually 1 cm for it to be detected on CXR
Lung Cancer: Signs and Symptoms - ANSWER Smoker's cough with increased sputum
production [most common early symptom] Anorexia or weight loss greater than 10%
Dyspnea [obstruction of major bronchus] Hemoptysis Wheezing Fever Hoarseness
[disruption of left recurrent laryngeal nerve] Dysphagia [compression of esophagus or
direct invasion of mediastinum] Chest pain Fatigue Bone pain Neurological deficits
Lung Cancer: Differential Diagnoses - ANSWER Pneumonia Lung abscess Bronchitis
Tuberculosis Granulomas
Lung Cancer: PE - ANSWER may be normal, but: Barrel chest; deviated or fixed trachea
- Hepatomegaly; supraclavicular or cervical lymphadenopathy - Atelectasis from tumor
obstructing bronchus; clubbing or yellow color to nails - Abnormal breathing patterns
, that suggest breathlessness; grayish color to skin; patient appears ill
Small Cell - ANSWER - Virulent - Aggressive - 10% of all lung cancers
Non-small Cell - ANSWER - Squamous cell the most common - Adenocarcinoma - Large
cell
Lung Cancer: Chest X-Ray - ANSWER Hilar mass or enlargement seen with squamous
and small cell - Peripheral masses seen in adenocarcinoma - Cavitation associated with
squamous cell - Infiltrates, atelectasis, pleural effusion, chest wall involvement seen in
centrally located tumors
Lung Cancer: CT Scans - ANSWER Used for lung parenchyma and pleural lesions not
detected with x-ray and calcifications - Dense calcifications not likely to be cancer MRI
can be used for mediastinal staging when CT is not feasible
Lung Cancer: Sputum Cytology - ANSWER Detects 80% of centrally located, but less
than 20% of peripheral tumors Three specimens increases the sensitivity Cytology and
CXR are complementary
Lung Cancer: Bronchoscopy - ANSWER Used for diagnosis and staging of bronchogenic
carcinoma, evaluate vocal cord involvement and for biopsy Can needle aspirate the
nodes Can detect tumors of 2 cm 60-80% of the time, and 20-40% of the time if the tumor
is less than 2 cm
Staging of Lung Cancer - ANSWER TNM international system is used CXR determines
tumor size or spread [chest wall or regional nodes] CT with contrast to assess hilar and
mediastinal size; it can detect metastasis below diaphragm [liver; adrenals] CME
[cervical mediastinal exploration] is used to evaluate mediastinum and hilum to
determine resectability
Small Cell Lung Cancer - ANSWER Formerly called oat cell cancer Typically, it is
centrally located Accounts for ¼ of cases Growth is rapid, with 50-70% being a
metastatic disease beyond the chest wall at the time of clinical presentation and
100% Verified (A+)
Breast Cancer in Men - ANSWER Rare-Prognosis in stage I is worse in men than in
women Blood born metastases are commonly present when the man appears for initial
therapy
Painless lump; occasionally associated with nipple discharge, retraction, erosion or
ulceration are presenting complaints PE reveals hard, ill-defined, non-tender mass
beneath nipple or areola It is not uncommon for gynecomastia to precede or accompany
breast cancer in men
Breast Cancer in Men 2 - ANSWER Nipple discharge is an uncommon presentation of
breast cancer in males, but if galactorrhea is present, it is associated with the cancer in
75% of cases Staging is the same as for females **Primary site may be from prostate
Biopsy should be performed
Male Breast Cancer: Treatment - ANSWER Modified radical mastectomy in operable
patients Treatment is the same as for women Tamoxifen and castration are main
therapies for advanced cancer in men Bone metastasis is the most common as in
women and castration relieves the pain in most patients
Prognosis of Male Breast Cancer ANSWER Poorer in males compared to females. The
overall survival rate at 5 years is 58% for stage I disease at presentation and at 10 years
is 38% whereas for stage II disease, 5 year survival is 38% and 10 year survival is 10%.
Colon and Rectal Cancer - ANSWER Large bowel cancer is the major cancer in the
elderly, Symptoms masquerade as weakness, anemia or blood in stool Lesions often
seen in right colon - Stool still watery at that location, so obstruction not likely
Left sided lesions usually present with change in bowel habits or bleeding Patients with
adenomatous polyps more likely to develop subsequent cancer
Colon and Rectal Cancer 2 - ANSWER Surgical resection is mainstay XRT used to
decrease local recurrence in rectal area but no evidence that XRT improves survival
,Adjuvant chemo with Fluorouracil and Levamisole improves survival
Lung Cancer - ANSWER Accounts for 32% of cancer deaths among men and 25% of
cancer deaths among women [incidence is growing] Age of incidence is 50-70 years
80-90% are caused by cigarette smoking
Lung Cancer 2 - ANSWER Risk increases 5 times in men who smoke less than ½ PPD; 10
times for ½ to 1 PPD and 20 times for 1-2 PPD
Secondhand smoke - Heavy metals • Nickel; Chromium - Asbestos exposure • Have a
90% greater risk than those not exposed - XRT • Indoor radon; therapeutic XRT - Air
pollution - COPD - Genetic factors
Lung cancer rates - ANSWER decrease with smoking cessation Smoking is associated
with---> - Epidermoid tumors [squamous cell] - Small cell undifferentiated tumors [oat
cell] Relationship to smoking is less certain for---> - Alveolar cell [adenocarcinoma] -
Large cell undifferentiated [anaplastic]
Lung Cancer: Screening - ANSWER Metastases has often occurred by the time the
tumor is detected Usually diagnosed in the last ¼ of the tumor's life 5 year survival rate
for all stages combined with non-small cell is 14% and for small cell is 6% Squamous cell
and adenocarcinoma can take as long as 10-25 years to be large enough to be detected
by CXR Tumor is usually 1 cm for it to be detected on CXR
Lung Cancer: Signs and Symptoms - ANSWER Smoker's cough with increased sputum
production [most common early symptom] Anorexia or weight loss greater than 10%
Dyspnea [obstruction of major bronchus] Hemoptysis Wheezing Fever Hoarseness
[disruption of left recurrent laryngeal nerve] Dysphagia [compression of esophagus or
direct invasion of mediastinum] Chest pain Fatigue Bone pain Neurological deficits
Lung Cancer: Differential Diagnoses - ANSWER Pneumonia Lung abscess Bronchitis
Tuberculosis Granulomas
Lung Cancer: PE - ANSWER may be normal, but: Barrel chest; deviated or fixed trachea
- Hepatomegaly; supraclavicular or cervical lymphadenopathy - Atelectasis from tumor
obstructing bronchus; clubbing or yellow color to nails - Abnormal breathing patterns
, that suggest breathlessness; grayish color to skin; patient appears ill
Small Cell - ANSWER - Virulent - Aggressive - 10% of all lung cancers
Non-small Cell - ANSWER - Squamous cell the most common - Adenocarcinoma - Large
cell
Lung Cancer: Chest X-Ray - ANSWER Hilar mass or enlargement seen with squamous
and small cell - Peripheral masses seen in adenocarcinoma - Cavitation associated with
squamous cell - Infiltrates, atelectasis, pleural effusion, chest wall involvement seen in
centrally located tumors
Lung Cancer: CT Scans - ANSWER Used for lung parenchyma and pleural lesions not
detected with x-ray and calcifications - Dense calcifications not likely to be cancer MRI
can be used for mediastinal staging when CT is not feasible
Lung Cancer: Sputum Cytology - ANSWER Detects 80% of centrally located, but less
than 20% of peripheral tumors Three specimens increases the sensitivity Cytology and
CXR are complementary
Lung Cancer: Bronchoscopy - ANSWER Used for diagnosis and staging of bronchogenic
carcinoma, evaluate vocal cord involvement and for biopsy Can needle aspirate the
nodes Can detect tumors of 2 cm 60-80% of the time, and 20-40% of the time if the tumor
is less than 2 cm
Staging of Lung Cancer - ANSWER TNM international system is used CXR determines
tumor size or spread [chest wall or regional nodes] CT with contrast to assess hilar and
mediastinal size; it can detect metastasis below diaphragm [liver; adrenals] CME
[cervical mediastinal exploration] is used to evaluate mediastinum and hilum to
determine resectability
Small Cell Lung Cancer - ANSWER Formerly called oat cell cancer Typically, it is
centrally located Accounts for ¼ of cases Growth is rapid, with 50-70% being a
metastatic disease beyond the chest wall at the time of clinical presentation and
