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NURS 5461 Oncology Exam Questions With
Verified Answers
Cancer - Answers✔58% of all cases of cancer occur in people over 65 - Women over 65 have
61-78% of lung and colon cancers Between ages 20-60 incidence of cancers is about the same in
both genders; after age 60 aaa cancer rates increase for men-- 70% higher
In patients over 65 years - Answers✔Women get colon, pancreas and gastric cancers most often
- Men get prostate, colon and bladder cancer most often
Second Tumors - Answers✔- XRT for Hodgkin's disease may result in subsequent lung or breast
cancer in the treated field - Patients with colon cancer may have second operable colon cancer
rather than a recurrence
- Strong link between viruses and specific human cancers - Answers✔• Hepatocellular cancer
with Hepatitis B and Hepatitis C • Burkitt's tumor, nasopharynx cancer with EBV • Cervical
cancer with HPV 16 and 18 • Kaposi's sarcoma with HIV
Prevention - Answers✔Avoid carcinogens - Radiation; tobacco - Organic dyes; benzene -
Arsenic; asbestos - Chromium Avoid sunlight - Linked to preventing skin cancers
Screening - Answers✔Breast Cancer - Monthly self breast exams after menses begins - First
screening mammogram at age 35 - Second screening exam at age 40, then yearly mammograms
thereafter
- Women aged 65-74/Women over age 75 - Answers✔• Breast exam yearly; mammogram every
2 years/• If life expectancy and general health goodaa - Breast exam yearly; mammogram every
2 years • If notaaa - Monthly self breast exam
Screening/Prostate Cancer - - Answers✔Men aged 50 and over • DRE • PSA • US of prostate if
indicated • Start earlier in African Americans and men with positive family history
Screening/colon Cancer - Answers✔Colon Cancer - All adults over 50 need flexible
sigmoidoscopy and stools for OB • In patients with polyps ---> colonoscopy needed • After 3
normal flexible sigmoidoscopies at 3 year intervals, can stop surveillance
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Screening Bladder Cancer - Answers✔- Test urine of OB, more than 2-3 RBC per field
otherwise its not microscopic hematirua-unlinkey to be ca
Screening Endometrial Cancer - Answers✔- Evaluate abnormal uterine bleeding in woman on
Tamoxifen or HRT
Aging: Impact on Disease and Therapy - Answers✔Studies have shown that seniors are not
uniformly infirm and they tolerate chemo as well as people under age under 70 Elderly [>70] are
excluded from oncologic clinical trials Studies have shown that response and toxicities of
treatment are not influenced by age
Clinical Assessment - Answers✔?Symptoms of weight loss, fever, night sweats, jaundice,
anorexia and pain should lead to high index of suspicion of cancer Abnormal bleeding or
discharge needs attention Headache, vision change and change in coordination and strength
should be noted
History - Answers✔History should include questions about occupation and exposure to meds -
Occupational exposure to metals, chemicals and asbestos - Medication use such as HRT and
maternal diethylstilbestrol [DES] Ask about smoking and ETOH use Exposure to hepatitis
Physical Exam - Answers✔Targeted PE - Look for jaundice, anemia, petechiae or weight loss -
Assess for skin nodules, ulcers and nevi larger than 5-7 mm • Carefully assess back in men and
posterior calves in women Targeted PE - Examine mouth for ulcers, leukoplakia or lumps -
Carefully palpate lymph nodes • **Nodes more than 1 cm should be biopsied - Inspect/palpate
both breasts
Diagnosis and Staging - Answers✔Staging requires additional tests that specify location or
locations of disease Must separate treatable cancers [lymphoma, breast, ovarian, prostate or
thyroid] from untreatable cancers [pancreas, stomach or lung]
Treatment - Answers✔Surgery - Mainstay of cancer therapy Radiation - XRT plays a major role
in curative therapy and in palliation aaa • Also used to treat prostate cancer and palliation of bone
metastasis Chemotherapy and Hormonal Therapy - Adjuvant chemo or hormone therapy are
effective in a variety of cancers - Leukopenia/anemia • More prevalent in seniors • Use of growth
factors helps to maintain marrow reserves
Breast Cancer - Answers✔Three common masses found in the breast - Fibroadenoma -
Fibrocystic breast changes - Cancer
Fibroadenoma - Answers✔Common benign lesion Occurs in women within 20 years after
puberty, 15-35 year age group Peak age is 20-25 years Multiple tumors in one or both breasts
found in 10-15% of patients Tends to occur at an earlier age in African American women than in
Caucasian women
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Tumor is round, rubbery, discrete, movable, nontender mass 1-5 cm. in diameter, without
associated calcium deposition
Fibroadenoma 2 - Answers✔Does not occur normally after menopause but menopausal woman
can occasionally develop fibroadenoma after administration of hormones FNA confirms the
diagnosis; treatment is by excision under local anesthesia as an OP procedure
Cystosarcoma Phyllodes - Answers✔Fibroadenoma like tumor with cellular stroma that tends to
grow rapidly, rarely malignant
Treatment - Excision of mass with a margin of surrounding breast tissue for malignant
cystosarcoma - Lesions are large and sometimes a simple mastectomy needed to get all of mass -
Lymph node dissection is not necessary, because cystosarcoma metastasizes directly to the lungs
[bypasses the lymph nodes
Fibrocystic Breast Disease - Answers✔Also known as cystic mastitis Most common breast
lesion Common in women 30-50 years, Asymptomatic lump with pain or tenderness; most
pronounced just before menses Fluctuation in size and rapid appearance or disappearance is
common
Fibrocystic Breast Disease PE - Answers✔reveals lumpy, bilateral, diffuse, tender, easily
movable ill-defined masses, usually in UOQ of breasts
Fibrocystic Breast Disease Diagnosis - Answers✔Hard to distinguish from cancer - FNA is often
recommended - Sonogram is useful in differentiating a cystic from a solid mass
Treatment - Avoid trauma by wearing a brassiere that gives good support and protection [24/7] -
iii caffeine - Vitamin E 400 IU daily is thought to help
Breast Cancer - Answers✔After skin cancer, the breast is the most common site of malignancy
in women Second leading cause of cancer death in women [lung cancer is 1st ] Chance of
developing breast cancer increases throughout one's lifetime Mean and median age of women
with breast cancer is 60-61 years
Breast Cancer: Incidence - Answers✔Women whose mums or sisters had breast cancer are 3-4
times more likely to develop the disease than other women Risk is greatest in women whose
mum/sister developed their breast cancer before menopause In spite of the above, most women
[90%] with breast cancer have no family history, most breast CA is still sporadic
Breast Cancer: Incidence - Answers✔Nulliparous women and women whose 1st full term
pregnancy was after age 35 have a 1.5 times higher incidence of breast cancer than multiparous
women Late menarche and artificial menopause are associated with lower incidence of breast
cancer, whereas, early menarche [under age 12] and late natural menopause [after age 50] are
associated with a slight increased risk of breast cancer