Chapter 7 -Neoplasia
A patient who is diagnosed with breast cancer asks the nurse if cancer cells ever die. Which of the following is the nurse's best response? a) "Cancer cell differ from normal cells by being immortal and have an unlimited life span." b) "Knowing this is not that important and you should not worry about that." c) "It really does not matter as it is more important to work on killing them." d) "You need to ask your doctor about this."
a) "Cancer cell differ from normal cells by being immortal and have an unlimited life span." The best response for the nurse to make is to tell the patient the truth and that is cancer cells are immortal and can divide an infinite number of times, hence achieving immorality. The other responses are not therapeutic.
Cancer cells differ from normal cells in many ways. They have lost the ability to accurately communicate with other cells, and they do not have to be anchored to other cells to survive. How else are they different from other cells? (Select all that apply.) a) Cancer cells have an unlimited life span. b) Cancer cells have an increased tendency to stick together. c) Cancer cells are termed genetically unstable d) Cancer cells need increased amounts of growth factor to proliferate. e) Cancer cells have lost contact inhibition.
a) Cancer cells have an unlimited life span. c) Cancer cells are termed genetically unstable e) Cancer cells have lost contact inhibition. Cancer cells differ from normal cells by being immortal with an unlimited life span. Cancer cells often lose cell density-dependent inhibition, which is the cessation of growth after cells reach a particular density. This is sometimes referred to as contact inhibition because cells often stop growing when they come into contact with each other. Another characteristic of cancer cells is the ability to proliferate even in the absence of growth factors. Most cancer cells exhibit a characteristic called genetic instability that is often considered to be a hallmark of cancer.
The cell cycle phase that occurs after mitosis in which DNA synthesis ceases while RNA and protein synthesis and cell growth take place is known as: a) G1 phase b) G2 phase c) S phase d) M phase
a) G1 phase The changes above occur in the G1 phase of the cell cycle. The G2 phase occurs before mitosis.
A client has undergone a screening colonoscopy. The doctor removed several polyps that were sent to pathology and identified as benign. Select the best explanation of a polyp. a) Growth that projects from a mucosal surface b) Benign tumor arising in fibrous tissue c) Benign epithelial neoplasm of glandular tissue d) Benign microscopic or macroscopic fingerlike projections
a) Growth that projects from a mucosal surface A polyp is a growth that projects from a mucosal surface, such as the intestine. Papillomas are benign microscopic or macroscopic fingerlike projections that grow on any surface. A benign epithelial neoplasm of glandular tissue is called an adenoma, and a benign tumor arising in fibrous tissue is called a fibroma.
It is well known that cancer is not a single disease. It follows then that cancer does not have a single cause. It seems more likely that the occurrence of cancer is triggered by the interactions of multiple risk factors. What are some identified risk factors for cancer? a) Hormonal factors, chemicals, and immunologic mechanisms b) Body type, age, and hereditary c) Radiation, cancer-causing viruses, and color of skin d) Immunologic mechanisms, cancer-causing viruses, and color of skin
a) Hormonal factors, chemicals, and immunologic mechanisms Cancer occurs because of interactions among multiple risk factors or repeated exposure to a single carcinogenic (cancer-producing) agent. Among the traditional risk factors that have been linked to cancer are heredity, hormonal factors, immunologic mechanisms, and environmental agents such as chemicals, radiation, and cancer-causing viruses. More recently, there has been interest in obesity and type 2 diabetes mellitus as risk factors for a number of cancers. Body type, age, and color of skin have not been identified as risk factors for cancer.
A nursing student while studying cancer cells identifies which of the following to be the best definition of anaplasia? a) Loss of cell differentiation in cancerous tissue b) Rapid proliferation of cancer cells c) Increased cell differentiation in cancerous tissue d) Decreased proliferation of cancer cells
a) Loss of cell differentiation in cancerous tissue The term "anaplasia" is the loss of cell differentiation in cancerous tissue. Rapid proliferation of cancer cells refers to a rapid increase in number of cells, while decreased proliferation is a decrease in the growth or decrease in the number of cells. An increase in cell differentiation refers to the process by which a less specialized cell becomes a more specialized cell type. This is not what happens during anaplasia.
A patient who is scheduled to have a tissue specimen removed for microscopic study will undergo which of the following tests? a) Tissue biopsy b) X-ray c) Pap test d) Blood sample
a) Tissue biopsy Tissue biopsy involves the removal of a tissue specimen for microscopic study. A pap smear involves taking cells from the outer opening of the cervix of the uterus and the endocervix. A blood sample uses blood from a vein and an X-ray is a form of electromagnetic radiation.
A nursing student says the following to her instructor: " Malignant neoplasms are more well-differentiated than benign tumors." Which of the following is the answer? a) False b) True
a) false Malignant neoplasms are less well-differentiated tumors that have lost the ability to control both cell proliferation and differentiation.
Which is an abnormal mass of tissue in which the growth exceeds and is uncoordinated with that of the normal tissues? a) Neoplasm b) Insertion c) Mutation d) Transformation
a) neoplasm An abnormal mass of tissue in which the growth exceeds and is uncoordinated with that of the normal tissues is called a neoplasm. A transformation occurs when a cell has become cancerous. A mutation is an alteration in the DNA that may or may not result in a transformation. An insertion is a type of mutation.
A nursing student who describes cell characteristics that include regulated growth, genetic stability, limited life span, and growth factor dependence is talking about which of the following types of cells? a) Normal cells b) Both cancer and normal cells c) None of the above d) Cancer cells
a) normal cells Normal cells have regulated growth, high differentiation, genetic stability, growth factor dependence, high density dependence, and cell-to-cell adhesion.
The nursing student studying about cancer says the following: "A neoplasm, benign or malignant, represents a new growth." This statement is considered to be which of the following? a) True b) False
a) true neoplasm, benign or malignant, represents new growth. However, benign and malignant tumors differ in terms of cell characteristics, manner of growth, rate of growth, potential for metastasis, ability to produce generalized effects, tendency to cause tissue destruction, and capacity to cause death.
A nursing instructor who is teaching students about the effects of cancer identifies a need for further instruction when one of the students says which of the following? a) "Cancer disrupts tissue integrity." b) "Many body functions are not affected by cancer." c) "Cancer can cause ulcerations and necrosis." d) "As cancer grows it can erode blood vessels."
b) "Many body functions are not affected by cancer." All of the above statements are true except for one. There probably is no single body function unaffected by the presence of cancer. It can affect other body structures besides its site of origin and many manifestations are compounded by the side effects of the methods used to treat the cancer.
A patient whose mother and grandmother both have had cancer is at a higher risk for also developing the disease. Which of the following tumor suppressor genes are associated with genetic susceptibility to breast cancer? Select all that apply. a) TGF-A b) BRCA1 c) BRCA2 d) TGF-B
b) BRCA1 c) BRCA2 Two tumor suppressor genes called BRCA1 and BRCA2 have been identified in genetic susceptibility to breast and ovarian cancer.
A patent is diagnosed with an adenoma. The nursing student identifies this as being which of the following? a) Benign tumor of bone tissue b) Benign tumor of glandular epithelial tissue c) Malignant tumor of bone tissue d) Malignant tumor of glandular tissue
b) Benign tumor of glandular epithelial tissue An adenoma is a benign tumor of glandular epithelial tissue. An osteoma is a benign tumor of bone tissue.
A nursing student identifies which of the following statements as being true? a) Malignant tumors are usually surrounded by a capsule. b) Benign tumors usually grow by expansion. c) Malignant tumors usually grow by expansion. d) Benign tumors usually spread through the lymph and blood pathways.
b) Benign tumors usually grow by expansion. The only true statement is that benign tumors usually grow by expansion and they also are usually surrounded by a capsule.
The nurse in the oncology unit has just admitted a client with metastatic cancer. The client asks how cancer moves from one place to another in the body. What would the nurse answer? a) Cancer cells are moved from one place in the body to another by transporter cells. b) Cancer cells enter the body's lymph system and thereby spread to other parts of the body. c) The cancer cells are not able to float around the original tumor in body fluids. d) Cancer cells replicate and form a chain that spreads from the original tumor site to the site of the metastatic lesion.
b) Cancer cells enter the body's lymph system and thereby spread to other parts of the body. Metastasis occurs by way of the lymph channels (i.e., lymphatic spread) and the blood vessels (i.e., hematogenic spread). In many types of cancer, the first evidence of disseminated disease is the presence of tumor cells in the lymph nodes that drain the tumor area. When metastasis occurs by way of the lymphatic channels, the tumor cells lodge first in the initial lymph node that receives drainage from the tumor site. Once in this lymph node, the cells may die because of the lack of a proper environment, grow into a discernible mass, or remain dormant for unknown reasons. If they survive and grow, the cancer cells may spread from more distant lymph nodes to the thoracic duct and then gain access to the blood vasculature. Because cancer cells have the ability to shed themselves from the original tumor, they are often found floating in the body fluids around the tumor. Cancer cells are not moved from one place to another by transporter cells. Cancer cells do not form a chain to grow to the new place in the body to form a new tumor.
A patient is diagnosed with leukemia. The student nurse working with this patient correctly identifies this type of cancer to be which of the following? a) Benign cancer b) Hematologic cancer c) Solid tumor d) Not really a cancer
b) Hematologic cancer Hematologic cancers involve cells normally found in the blood and lymph thereby making them disseminated diseases from the beginning.
A patient tells the nurse that he is receiving cancer treatment that involves strengthening the immune system. The nurse documents that the patient is receiving which of the following? a) Antigen therapy b) Immunotherapy c) Promotor therapy d) Procarcinogen therapy
b) Immunotherapy The nurse documents that the patient is receiving immunotherapy, defined as a cancr treatment modality designed to heighten the person's general immune responses in order to increase tumor destruction. (less)
A client has been diagnosed with cancer that was a result of dysfunctional apoptosis. The health care provider explains the process to the multidisciplinary client care team. Select the best explanation. a) It increases the risk for mitochondrial dysfunction. b) It allows for DNA-damaged cells to survive. c) Apoptosis has no impact on malignant development. d) Cells that go through apoptosis are the only ones that become cancerous.
b) It allows for DNA-damaged cells to survive. Apoptosis is considered a normal cellular response to DNA damage; loss of normal apoptotic pathways may contribute to cancer by enabling DNA-damaged cells to survive.
A nursing instructor sees the need for further instruction when one student makes which of the following statements concerning cancer? a) Malignant neoplasms invade and destroy nearby tissue. b) Malignant neoplasms tend to grow slowly. c) Malignant neoplasms tend to grow rapidly. d) Malignant neoplasms have the potential to cause death.
b) Malignant neoplasms tend to grow slowly. Malignant neoplasms, which invade and destroy nearby tissue and spread to other parts of the body, tend to grow rapidly and spread widely and have the potential to cause death.
Following routine colonoscopy screening, a client is told that he had several polyps removed. The client began crying stating, "I just can't deal with cancer. I'm too young." The nurse responds: a) "Maybe if you're lucky, they have stopped it from metastasizing to your liver." b) "A simple intestinal surgery will cure you." c) "Most colon polyps are not cancerous. The biopsy results will direct your care." d) "Don't worry. We have some great cancer doctors on staff. I'm sure chemo will help you fight it."
c) "Most colon polyps are not cancerous. The biopsy results will direct your care." A polyp is a growth that projects from a mucosal surface, such as the intestine. Although the term usually implies a benign neoplasm, some malignant tumors also appear as polyps. Adenomatous polyps are considered precursors to adenocarcinomas of the colon.
A client is exposed to secondhand smoke on a daily basis. The client asks if he is at risk for the development of cancer. The best response would be: a) "Second-hand exposure does not put you at any risk." b) "Second-hand exposure only puts you at any risk if you inhale the end products." c) "Second-hand exposure does put you at any risk." d) "Second-hand exposure will only put you at any risk if youchew tobacco."
c) "second-hand exposure does put you at any risk." Exposure to many carcinogens, such as those contained in cigarette smoke, is associated with a lifestyle risk for development of cancer. It is directly associated with lung and laryngeal cancer and has been linked with cancers of the mouth, nasal cavities, pharynx, esophagus, pancreas, liver, kidney, uterus, cervix, and bladder and myeloid leukemia. Not only is the smoker at risk but others passively exposed to cigarette smoke are at risk. Chewing tobacco increases the risk of cancers of the oral cavity and esophagus.
A 40-year-old female has been diagnosed with hepatocellular carcinoma. When asked what causes this cancer, the physician looks at the history and responds, "I see in your history, you have had: a) Three miscarriages with no live births." b) Numerous admissions for COPD exacerbations requiring steroids." c) Hepatitis B related to IV drug use as a teenager." d) Your uterus and ovaries removed for endometriosis."
c) Hepatitis B related to IV drug use as a teenager." There is strong epidemiologic evidence linking chronic HBV and hepatitis C virus (HCV) infection with hepatocellular carcinoma. It has been estimated that 70% to 85% of hepatocellular cancers worldwide are due to infection with HBV or HCV. COPD, steroidal use, miscarriages, or endometriosis is not associated as a risk factor for hepatocellular carcinoma.
A nurse who is caring for a patient with liposarcoma plans care for a patient with which of the following? a) Benign tumor of fibrous tissues b) Benign tumor of the bone c) Malignant tumor of adipose tissue d) Malignant tumor of smooth muscle
c) Malignant tumor of adipose tissue The nurse should plan care for a patient with a malignant tumor of adipose tissue.
An oncology nurse is caring for a client with newly diagnosed B-cell lymphoma. Extensive blood work has been drawn and sent to the lab. Results reveal an elevated antiapoptotic protein BCL-2 level. The client/family asks, "What does this mean?" The health care provider bases his or her response on the fact that: a) This is a good result. Normal cells undergo apoptosis if DNA is damaged in any way. b) The client's body is trying to limit the blood supply to the cancer cells by producing high levels of this protein. c) This means the cancer cells have found a way to survive and grow even with damaged DNA. d) The client's immune system is trying to kill the cancer cell by sending this protein to engulf it.
c) This means the cancer cells have found a way to survive and grow even with damaged DNA. `
The nursing student studying about cancer growth correctly identifies "cell proliferation" to mean which of the following? a) Increasing cell numbers by DNA replication b) Programmed cell death c) Increasing cell numbers by mitotic cell division d) Apoptosis
c) increasing cell numbers by mitotic cell division Cell proliferation is the process of increasing cell numbers by mitotic cell division. Mitosis cannot start until DNA is properly replicated. Apoptosis is a form of programmed cell death that eliminates senescent and some types of injured cells.
The nurse has provided an educational session with a 56-year-old man newly diagnosed with a benign tumor of the colon. The nurse knows that the client needs further teaching when he makes which remark? a) "Benign tumors still produce normal cells different from other cells around them." b) "Even though benign tumors can't stop growing, they aren't considered cancer." c) "This kind of tumor can't invade other organs or travel to other places in the body to start new tumors." d) "This tumor I have, will I die from it?"
d) "this tumor I have, will I die from it?" Asking if his tumor will make him die shows lack of understanding of educational material he has been given. For unknown reasons, benign tumors have lost the ability to suppress the genetic program for cell proliferation but have retained the program for normal cell differentiation. They do not have the capacity to infiltrate, invade, or metastasize to distant sites.
The family of a 68 year-old man who is in the end stages of small cell lung cancer are distraught at his visible body wasting that has worsened in recent weeks. Which of the following phenomena best accounts for the client's anorexia and cachexia? a) Inadequate cellular metabolism of glucose results from tumor factors. b) Inadequate food intake due to symptoms and treatment results in loss of both muscle and fat. c) High fat losses coupled with preservation of muscle mass exaggerate the appearance of wasting. d) Products of the tumor itself as well as a hypermetabolic state cause cachexia.
d) Products of the tumor itself as well as a hypermetabolic state cause cachexia. The mechanisms of anorexia-cachexia in cancer patients are multifactorial, involving factors that include a hypermetabolic state and the production of specific cytokines and catabolic factors by the tumor. Glucose metabolism itself is not noted to be affected by tumors and muscle mass is lost in large amounts. The phenomenon is not necessarily attributable to the decrease in food intake.
A nurse interpreting a pathology report that indicates a patient has an adenoma determines that the patient's tumor is considered which of the following? a) Apoptotic b) Differentiated c) Malignant d) Benign
d) benign The nurse should interpret the adenoma as a benign tumor that originated in epithelial glandular tissue. Malignant tumors are differentiated. Apoptosis is a form of programmed cellular death.
A nursing student has learned in class that with abdominal cancer the tumor may compress the viscera, which will cause which of the following? a) Polyps b) Hemorrhoids c) Rectal bleeding d) Bowel obstruction
d) bowel obstruction Cancer as it grows can invade and compress adjacent structures. Abdominal cancer may compress the viscera and cause bowel obstruction