Oncology Exam

cancer management

-Cure: Complete irradication -Control: Promote survival & control cancer cell growth -Palliation: Relieve symptoms

Ondansetron HCl 6 mg POQ6 hours is prescribed for a client receiving chemotherapy. The nurse knows which time is the most appropriate to administer the medication? One hour after chemo therapy 30 minutes prior to start of chemotherapy Two hours after chemotherapy After the client reports nausea

30 minutes prior to start of chemotherapy. This drug is a potent anti-emetic with a 30 to 40 minute on side of action. Administering the medication 30 minutes prior to chemotherapy will negate nausea and vomiting. Side effects include constipation, diarrhea, fever, lightheadedness, and drowsiness.

treatments prescribed for specific hematologic disorders.

Acute lymphoblastic leukemia: treatment is chemotherapy, bone marrow transplant, stem cell transplant chronic lymphocytic leukemia : treatment is chemotherapy, bone marrow transplant or nothing acute myeloid leukemia: treatment is chemotherapy, stem cell transplant chronic myeloid leukemia: treatment is interferon, chemotherapy with imatinib mesylate, and stem cell transplant.

A nurse understands which risk factor is the most significant for a client to develop cancer? Advancing age Smoking tobacco Drinking alcohol Family history of cancer

Advancing age. Advancing age is the single most significant risk factor. Risk increases significantly after age 50 and 50% of all cancers are current people older than 65 years of age. Tobacco is a carcinogen that contributes to long, pharyngeal, esophageal, cervical, bladder, pancreatic, and kidney cancer

Which of the following would be a risk factor for leukemia radiation smoking gender benzene chemotherapy

All of them

The nurse performs health screenings on a group of clients. The nurse identifies which individual is at greatest risk for developing skin cancer? An adolescent client with dark skin who works as a lifeguard at the local pool. An adult client with light skin who works as a cashier at the local store A middle aged adult client with dark skin who swims daily at the Health Club An older adult client with light skin who worked as a roofer for 40 years

An older adult client with light skin who worked as a roofer for 40 years. The client is over the age of 60, has a lighter natural skin color, and works outdoors on a regular basis. These factors place the client at a high risk for developing skin cancer. The presence of numerous moles in certain types of moles, a family history of skin cancer, skin that burns a ride in easily in the sun, blue or green eyes, and blonde or red hair color are all wrist factors for developing skin cancer.

After two weeks of chemotherapy treatments, a clients white blood cell count is 2,000. The nurse knows this finding is most likely to to which factor? Infection Bone marrow depression Weight loss Polycythemia

Bone marrow depression. Chemotherapy causes bone marrow depression because it affects rapidly growing and dividing cells. I cells produce in the bone marrow are affected, resulting in diminished numbers of white blood cells, red blood cells, and platelets. The client is at risk for infection, anemia, and bleeding. The normal white blood cell count in an adult is 4500 to 11,000.

The nurse knows which finding is the most life-threatening adverse effects of chemotherapy? Alopecia Bone marrow suppression Vomiting Mucositis

Bone marrow suppression. Chemotherapy can cause depression of the bone marrow which results in decreased glucose size, erythrocytes, and platelets. The client is at high risk for bleeding and infection.

A patient with neck cancer is scheduled for a diagnostic test to determine the success of treatment. For what test should the nurse expect to prepare this patient? 1. magnetic resonance imaging (MRI) 2. computed tomography 3. x-ray imaging 4. ultrasonography

Correct Answer: 1 MRI is the diagnostic tool of choice for both screening and follow-up of cranial and head and neck tumors. Computed tomography is used in the screening for renal cell and most gastrointestinal tumors. X-ray imaging is still the method of choice for lung cancer. Ultrasonography is used to detect early prostate cancers and is used to guide needle biopsy. Ultrasound imaging is also used for detecting masses in the denser breast tissue of young women.

Know the seven warning signs of cancer:

CAUTION- C-change in bowel or bladder, A- a sore that does not heal, U- unusual bleeding or discharge, T- thickening or lump, or overgrowth that you can feel in the breast or elsewhere, I- indigestion or difficulty swallowing, O-obvious change in wart or mole, skin changes, N-nagging cough or hoarseness.

After learning that he has a benign tumor in his abdomen, the patient is overheard telling his wife that he has cancer. What should the nurse say to the patient and spouse? 1. "There is a growth in the abdomen but it is encapsulated and after being removed, will not recur." 2. "This type of cancer is easily treated." 3. "This type of cancer will not spread to other tissues." 4. "Even though this growth has invaded other tissues, it can be contained."

Correct Answer: 1 A benign tumor is encapsulated, slow-growing, and once removed, will not recur. The patient does not have cancer but rather a benign tumor. Even though benign tumors will not spread to other tissues, the nurse should not refer to the growth as being cancer. The growth has not invaded other tissues.

A patient diagnosed with acute myeloid leukemia (AML) has an absolute neutrophil count of 200. What action by the nurse would minimize the risk of complications from neutropenia? 1. using strict aseptic technique when performing all procedures 2. spacing frequent meals throughout the day to increase caloric intake 3. restricting fluids and salts to reduce edema 4. regulating the thermostat for a cooler environment

Correct Answer: 1 AML results in neutropenia and thrombocytopenia, which lead to increased risks of bleeding. Actions to minimize these risks include using strict hand hygiene to prevent possible cross-contamination. Weight loss is a symptom of chronic myeloid leukemia (CML), not AML. Therefore, dietary intake is not increased with AML. The patient with AML does not have a problem with fluid shifts or edema that would require fluid and salt restrictions. Fluids are encouraged to remove wastes that occur with chemotherapy treatment and cellular breakdown. Heat intolerance is a symptom of chronic myeloid leukemia (CML), not AML.

The nurse is preparing to provide care to a group of assigned patients. Which patient should the nurse realize is at the highest risk for developing cancer? 1. an African American man 2. a Native American woman 3. an Hispanic man 4. an Hispanic woman

Correct Answer: 1 African Americans have the highest mortality rate for all cancers and major cancers among all ethnic groups. Cancer incidence and mortality are lower in Native American men and women than in any other ethnic or racial group. Hispanics have higher rates of cancers associated with infectious agents, such as uterine, cervix, liver, and stomach cancer.

A patient diagnosed with cancer contacted an attorney about a will and a church to arrange funeral and cemetery arrangements. What do this patient's activities suggest to the nurse? 1. The patient is participating in anticipatory grieving. 2. The patient feels he is going to die within the month. 3. The patient's family will not be willing to make funeral arrangements. 4. The patient wants something to do while waiting for chemotherapy treatments.

Correct Answer: 1 Anticipatory grieving is a response to loss that has not yet occurred. The patient with cancer is often confronted with facing death and making preparations for it. This can be a healthy response that allows the patient and family to work through the dying process and achieve growth in the final stage of life. Participating in the activities of a will and funeral arrangements does not mean that the patient feels he is going to die within the month or that the patient's family will not be willing to make funeral arrangements. The patient is not doing these activities while waiting for chemotherapy treatments.

A male patient is concerned about a recent increase in breast tissue. What should the nurse do to assist this patient? 1. Review the patient's health history. 2. Tell him that it is self-limiting and will go away in time. 3. Suggest that the patient have a mammogram to ensure he does not have breast cancer. 4. Recommend a breast biopsy to find out the reason for the increase in breast tissue.

Correct Answer: 1 Any condition that increases estrogen activity or decreases testosterone production can contribute to gynecomastia. Conditions that increase estrogen activity include obesity, testicular tumors, liver disease, and adrenal carcinoma; conditions that decrease testosterone production include chronic illness such as tuberculosis or Hodgkin' disease, injury, and orchitis. Drugs such as digitalis, opiates, and chemotherapeutic agents are also associated with gynecomastia. Dismissing the patient's concerns is not therapeutic and until further evaluation is completed this could be potentially dangerous. Gynecomastia is usually bilateral. If it is unilateral, biopsy may be necessary to rule out breast cancer.

A female patient is recovering from breast cancer surgery that included axillary node dissection. The nurse realizes that this patient will need education regarding the potential development of which complication? 1. lymphedema 2. metastasis 3. anemia and bleeding 4. altered shoulder movement

Correct Answer: 1 Axillary node dissection is generally performed during surgery for all invasive breast carcinomas to stage the tumor. This surgery can cause lymphedema. Removal of the lymph nodes does not increase risk of metastasis, anemia, or bleeding. Range of motion exercises should be performed on the affected arm to help develop collateral lymph drainage.

A patient diagnosed with cancer and scheduled to begin biotherapy asks the nurse how the therapy will treat the cancer. How should the nurse respond to this patient? 1. "It changes the body processes that caused the cancer by enhancing your own immunity." 2. "It uses radiation implanted into the organ with the cancer." 3. "It uses laser therapy to remove the cancer." 4. "It uses stem cells to treat the cancer."

Correct Answer: 1 Biotherapy modifies the biologic processes that result in malignant cells, primarily through enhancing the person's own immune responses. This is with what the nurse should explain to the patient. Brachytherapy is the implantation of radiation into the organ with the cancer. Photodynamic therapy uses medication that is activated by a laser to treat the cancer. Peripheral blood stem cell transplantation is used to stimulate or replace nonfunctioning bone marrow. It does not treat cancer.

A patient with lung cancer is demonstrating signs of complete tumor response after two courses of chemotherapy. What should the nurse conclude that this response indicates? 1. a long-term survival from the disease 2. an indication that radiation therapy is needed 3. an indication that surgery can be performed 4. a contraindication for further chemotherapy

Correct Answer: 1 Fifty percent of patients with tumors at early stages achieve complete tumor remission with combination chemotherapy. When a complete tumor response is achieved in the first few cycles of chemotherapy, the chances for long-term survival are much greater. This finding does not indicate the need for radiation, surgery, or further chemotherapy.

A patient who was recently diagnosed with prostate cancer comes to the clinic with his wife. She says, "My husband said he has a stage I tumor. Can you explain what this means?" What is the most appropriate response by the nurse? 1. "Stage I means the cancer involves only the prostate, and surgery and radiation treatments are usually needed." 2. "Staging involves a definition of the type of tumor and the treatment plan." 3. "Did your husband tell you he had a stage I tumor?" 4. "Let's wait until the doctor comes, and you can talk with him."

Correct Answer: 1 Grading and staging help determine prognosis and guide treatment decisions. A stage I cancer is confined to the prostate, and treatment will focus on radiation therapy and surgery. The nurse needs to provide factual information and educate the wife. The nurse should not ask the wife about something she already stated. The nurse does not need to wait for the doctor to talk with the patient and spouse. This response could increase the wife's anxiety.

A patient with a history of cancer is surprised to learn that new cancer has been diagnosed in another body part. What should the nurse realize this patient is experiencing? 1. metastasis 2. contact inhibition 3. destructive force from a benign neoplasm 4. a solid mass

Correct Answer: 1 Malignant cells from the primary tumor may travel through the blood or lymph to invade other tissues and organs of the body and form a secondary tumor called a metastasis. Malignant neoplasms can recur after surgical removal of the primary and secondary tumors and after other treatments. Contact inhibition is a characteristic of benign neoplasms. A destructive force from a benign neoplasm is when the benign tumor impinges upon a body part causing damage. Benign tumors are usually solid masses.

A patient will be receiving busulfan (Myleran) as treatment for leukemia. Which intervention should the nurse include in the plan of care for this patient? 1. Assess for infection. 2. Administer anti-emetic prior to chemotherapy. 3. Assess oral mucous membranes. 4. Check stool for occult blood.

Correct Answer: 1 Nursing interventions for a patient receiving busulfan (Myleran) include monitoring white blood cell counts, monitoring blood urea nitrogen level, maintaining adequate fluid intake, assessing for infection, and assessing lungs for coarse rales. Administering an anti-emetic prior to chemotherapy, assessing oral mucous membranes, and checking stool for occult blood are not indicated for busulfan (Myleran).

The patient undergoing brachytherapy for prostate cancer is being given instructions for home care. Which patient statement indicates a need for clarification? 1. "It will be nice to sleep in the same bed as my partner." 2. "Guess I'll have to go buy a box of condoms." 3. "I'll be disappointed about not seeing my grandkids." 4. "I'll make an appointment for my next PSA exam."

Correct Answer: 1 Patients receiving brachytherapy therapy should be instructed to sleep alone and avoid close contact with pregnant women, infants, and children. Patients receiving radiation therapy should be instructed to use condoms during sexual activity. The importance of keeping appointments for yearly PSA examinations should be included.

A patient diagnosed with prostate cancer is demonstrating signs of renal failure. What should this assessment finding suggest to the nurse? 1. obstructive uropathy 2. spinal cord compression 3. urethral strictures from radiation 4. bladder irritation from chemotherapy

Correct Answer: 1 Patients with prostate cancer may experience obstruction of the bladder neck or the ureters. Bladder neck obstruction usually manifests as urinary retention, flank pain, hematuria, or persistent urinary tract infections, but ureteral obstruction is not often evident until the patient is in renal failure. Spinal cord compression does not cause renal failure. Urethral strictures from radiation would not cause renal failure. Bladder irritation from chemotherapy would not cause renal failure.

A patient who is undergoing chemotherapy for lymphoma says, "I thought I was ugly before this all started. Now I know for sure I'm disgusting to look at." What is this patient most at risk for developing related to these comments? 1. changed body image perception 2. reduced sexual response 3. altered taste sensation 4. inability to cope with the diagnosis and treatment

Correct Answer: 1 Radiation and chemotherapy lead to changes in appearance and body function, further altering body image. Reactions to this diagnosis vary and may include refusal to look in a mirror or discuss the effects of the disease or treatment, unwillingness to participate in rehabilitation, inappropriate treatment decisions, increasing dependence on others or refusal to provide self-care, hostility, withdrawal, and signs of grieving. Although altered sexual response may occur, the patient has not identified it as a current problem. The patient has not identified an alteration in taste or indicated lack of coping with the diagnosis or treatment.

The nurse suspects that a patient being treated for cancer is developing septic shock. What did the nurse assess to come to this conclusion? 1. high fever, peripheral edema, hypotension 2. cardiac dysrhythmia, increased urine output, and confusion 3. hypertension, increased urine output, and confusion 4. subnormal temperature, cardiac dysrhythmia, and thirst

Correct Answer: 1 Sepsis occurs when bacteria gain entrance to the blood, grow rapidly, and produce septicemia. Signs and symptoms appear in two phases. The first phase includes vasodilation with hypovolemia, high fever, peripheral edema, hypotension, tachycardia, tachypnea, hot flushed skin with creeping mottling beginning in the lower extremities, and anxiety or restlessness. Without treatment, the shock progresses to the second phase, which includes hypotension; rapid, thready pulse; respiratory distress; cyanosis; subnormal temperature; cold, clammy skin; decreased urinary output; and altered mentation. Cardiac dysrhythmias, increased urine output, hypertension, and thirst are not usual signs of septic shock.

The nurse caring for a patient diagnosed with lung cancer determines that the patient might be experiencing superior vena cava syndrome. What did the nurse assess to make this clinical decision? 1. face and neck swelling 2. hourly urine outputs 250 to 500 mL 3. calcium level of 14.0 mg/dL 4. flat jugular veins

Correct Answer: 1 Superior vena cava (SVC) syndrome is an oncologic emergency and occurs when a lung tumor obstructs the SVC. This results in facial swelling, hands, arms, and neck swelling, distended jugular veins, cyanosis of the upper torso and dyspnea. Hourly urine outputs of 250 to 500 mL/hour are suggestive of the complication known as syndrome of inappropriate ADH (SIADH). A calcium level of 14.0 mg/dL is considered hypercalcemia, which is a metabolic emergency associated with lung cancers.

A patient is scheduled for a nephrectomy for renal cancer. What should the nurse recognize is the goal for this surgery? 1. removal of the kidney 2. removal of the organ 3. bypass an obstruction 4. decrease in tumor size

Correct Answer: 1 The decision to remove or resect an organ for cancer depends upon the organ and if there is some other means to replace the functioning of the lost organ. In the case of a nephrectomy, the patient's remaining kidney can maintain renal functioning. Kidney function cannot be replaced chemically. The removal of a kidney would not be done to bypass an obstruction or to decrease tumor size.

The nurse is reviewing the results of diagnostic testing on a patient suspected of having cancer. Which diagnostic findings should the nurse identify as being consistent with the presence of a malignancy? Standard Text: Select all that apply. 1. high levels of tumor markers 2. positive biopsy results 3. low levels of tumor markers 4. decreased white blood cell count 5. increased hemoglobin and hematocrit

Correct Answer: 1, 2 High levels of tumor markers are indicative of a malignancy. Positive biopsy results are indicative of a malignancy. Leukopenia is not associated with a malignancy. Increased hemoglobin and hematocrit values are not associated with a malignancy.

The nurse is concerned that a patient receiving chemotherapy for cancer is at increased risk for developing an infection. What should the nurse include in this patient's plan of care? 1. Teach the patient to avoid crowds. 2. Encourage socialization with small children. 3. Contact physician with a temperature elevation. 4. Limit intake of protein and vitamin C.

Correct Answer: 1 The nurse should instruct the patient to avoid crowds and children to reduce the risk of developing an infection. Temperature elevation is a normal sign of an infection; however, severely immunocompromised patients may not be able to mount a fever. The absence of a fever does not rule out the presence of an infection. The patient should be instructed to have an adequate daily intake of protein and vitamin C to support the body's immunity.

The nurse is providing instructions to a patient diagnosed with renal cancer regarding when to call for help after discharge. Which statement by the patient indicates that teaching has been successful? 1. "I should call my physician if I experience new bleeding from any site." 2. "I should call my physician if I have an oral temperature higher than 100.5° F." 3. "I should call my physician if I have an episode of diarrhea." 4. "I should call my physician if I experience an occasional headache."

Correct Answer: 1 The nurse should instruct the patient to call the nurse or physician if any of the following signs or symptoms occur: oral temperature higher than 101.5° F; severe headache; significant increase in pain at usual site, especially if the pain is not relieved by the medication regimen, or severe pain at a new site; difficulty breathing; new bleeding from any site; confusion, irritability, or restlessness; verbalizations of deep sadness or a desire to end life; changes in eating patterns; changes in body functioning, such as severe diarrhea or constipation; withdrawal; frequent crying; greatly decreased activity level; and the appearance of edema in the extremities or significant increase in edema already present. The physician or nurse does not need to be contacted if the patient experiences an episode of diarrhea or an occasional headache.

A patient is scheduled to receive a course of external radiation therapy for cancer treatment. What should the nurse instruct the patient about this therapy? 1. Wash the radiation site with plain water and no soap. 2. Shave the treated area with a straight razor. 3. Apply ice packs to the treatment site to help reduce pain. 4. Use a sunscreen for three months after the conclusion of the treatments.

Correct Answer: 1 The nurse should instruct the patient to wash the skin that is marked as the radiation site only with plain water, no soap; do not apply deodorant, lotions, medications, perfume, or talcum powder to the site during the treatment period. If necessary, use only an electric razor to shave the treated area. Apply neither heat nor cold to the treatment site. Protect skin from sun exposure during treatment and for at least one year after radiation therapy is discontinued. Cover skin with protective clothing during treatment; once radiation is discontinued, use sun-blocking agents with a sun protection factor (SPF) of at least 15.

A patient diagnosed with cancer tells the nurse that he does not want to experience anymore pain. What should the nurse do to help this patient? 1. Discuss pain control options. 2. Explain that every patient with cancer has pain. 3. Review ways to reduce pain without the use of medication. 4. Instruct on why pain will continue throughout treatment.

Correct Answer: 1 The pain associated with cancer is usually undertreated because of an inappropriate use of opioids and barriers related to healthcare provider, patient, family, institution, and society. Communication and knowledge deficit are the major barriers to effective pain management. Because of this, the nurse should discuss pain control options with the patient. Not every patient with cancer has pain. Reviewing ways to reduce pain without the use of medication may or may not be appropriate for the patient. The nurse has no way of knowing whether the patient's pain will continue throughout treatment.

A patient tells the nurse that he has a benign tumor that has spread into his lymph glands. How should the nurse respond to this patient? 1. "What did your doctor tell you about the tumor?" 2. "Benign tumors do not spread." 3. "That's a good thing that the tumor is benign." 4. "Since it is benign, are you going to have surgery to remove it?"

Correct Answer: 1 The patient believes that the tumor is benign; however, benign tumors do not spread. These types of tumors are encapsulated and can be easily removed. Since the patient seems to have conflicting information, the nurse should assess the patient by asking what the physician explained about the tumor. The nurse should not tell the patient that benign tumors do not spread. The nurse should not reinforce the patient's belief that the tumor is benign. The patient may or may not know if surgery is indicated to remove the tumor.

A patient with a history of squamous cell lung cancer is admitted to the hospital with arm and periorbital edema. After a few hours, the patient exhibits dyspnea, cyanosis, tachypnea, and an altered level of consciousness. Which action should the nurse take first? 1. Administer oxygen. 2. Call the physician. 3. Monitor vital signs. 4. Initiate seizure precautions.

Correct Answer: 1 The superior vena cava can be compressed by mediastinal tumors or adjacent thoracic tumors. The most common cause is small-cell or squamous-cell lung cancers. Signs and symptoms can develop slowly, and include facial, periorbital, and arm edema as early signs. As the problem progresses, respiratory distress, dyspnea, cyanosis, tachypnea, and altered consciousness and neurologic deficits can occur. Emergency measures include the following: provide respiratory support with oxygen, and prepare for a tracheostomy; monitor vital signs; administer corticosteroids to reduce edema; if the disorder is due to a clot, administer antifibrinolytic or anticoagulant drugs; provide a safe environment, including seizure precautions. The nurse should provide oxygen before contacting the physician or monitoring vital signs. Seizure precautions would not be initiated first.

The nurse is preparing to assess a patient who is newly diagnosed with cancer. What should the nurse include in this assessment? 1. body image concerns 2. increased leukocytes 3. bone pain 4. increased hunger

Correct Answer: 1 There are several physical and psychologic effects that occur in a patient diagnosed with cancer. One of these effects is body image concerns. The patient's leukocytes are usually decreased, not increased. Bone pain will depend upon the type of cancer. A change in appetite can occur, although is it usually a loss of appetite.

A college student is diagnosed with Epstein-Barr virus. The student has a history of smoking and recreational cocaine use and works for a floor refinishing company part-time. Which factors increase this student's risk for developing cancer? Standard Text: Select all that apply. 1. drug use 2. occupation 3. smoking 4. viral infection 5. age

Correct Answer: 1, 2, 3, 4 Some recreational drugs are also implicated as carcinogens. Immunosuppressant promoters include heroin and cocaine. Examples of industrial and environmental carcinogens include polycyclic hydrocarbons, found in soot; benzopyrene, found in cigarette smoke; and arsenic, found in pesticides. Other industrial and environmental chemicals are considered promotional agents. These include wood and leather dust, polymer esters used in plastics and paints, carbon tetrachloride, asbestos, and phenol. Benzopyrene found in cigarette smoke contributes to the development of cancer. Several viruses have been associated with the development of cancer. These viruses include Epstein-Barr. The patient's young age is not a risk factor for the development of cancer.

After prostate surgery a patient is being discharged with an indwelling urinary catheter in place. What teaching should the nurse provide to this patient? Standard Text: Select all that apply. 1. Use the larger urinary drainage bag at night. 2. Keep the larger urinary drainage bag at a level that permits gravity drainage. 3. Do not strap the leg bag too tightly. 4. Place a soft cloth between the leg bag and the skin. 5. Empty the leg bag at least twice a day.

Correct Answer: 1, 2, 3, 4 Teaching for the patient who is going home with an indwelling urinary catheter should include using the larger urinary drainage bag at night and hanging it on the bed frame to permit gravity drainage; avoiding strapping the leg bag too tightly to prevent decreased venous return; placing a soft cloth between the leg bag and the skin to prevent skin irritation; and emptying the leg bag every three to four hours during waking hours to prevent overfilling.

A patient is discharged after transurethral resection of a superficial bladder tumor. What should the nurse include in this patient's discharge instructions? Standard Text: Select all that apply. 1. Avoid constipation and continue to use stool softener. 2. Increase fluid intake. 3. Maintain bed rest. 4. Call the physician if painless hematuria develops. 5. Make a follow-up appointment in 1 year.

Correct Answer: 1, 2, 4 The patient should be instructed to avoid straining with stool, take a stool softener, increase fluids to 2500-3000 mL/day, and monitor for excessive bleeding. Bed rest is not necessary after this surgery. Follow-up appointments will be scheduled more frequently than every year.

At the completion of a dietary history the nurse is concerned that a patient is at risk for developing cancer. Which food habit does the patient have that causes the nurse to have this concern? Standard Text: Select all that apply. 1. eats red meat 5 times a week 2. drinks 6 cups of coffee every day 3. has a salad every evening with dinner 4. prefers fried fish and chicken over baked 5. orders a deli sandwich for lunch every day

Correct Answer: 1, 2, 4, 5 A diet that is high in red meat and saturated fat appears to increase the risk for cancer. Both regular and decaffeinated coffee are believed to increase cancer risk. Repeatedly using fat to fry foods at high temperatures produces high levels of polycyclic hydrocarbons, which increase cancer risk considerably. Some foods are considered genotoxic, such as the nitrosamines and nitrous indoles found in preserved meats and pickled, salted foods. Vegetables, fruits, fiber, folate, and calcium may be protective against cancer.

During a health interview a male patient expresses the desire to avoid developing prostate cancer with aging. What should the nurse recommend to reduce this patient's risk factors for the health problem? Standard Text: Select all that apply. 1. avoiding vasectomy 2. reducing the intake of animal fat 3. increasing the intake of vitamin C 4. restricting exposure to spermicides 5. taking vitamin A supplements

Correct Answer: 1, 2, 5 One risk factor for prostate cancer is having a vasectomy because it is believed to increase the levels of circulating free testosterone. A diet high in animal fat and excessive supplemental vitamin A is also believed to increase the risk for prostate cancer. Vitamin C does not impact the risk for prostate cancer. Spermicides are not identified as increasing the risk for prostate cancer. Excessive supplemental vitamin A is believed to increase the risk for prostate cancer.

A patient is concerned about developing cervical cancer. For which risk factors should the nurse assess this patient? Standard Text: Select all that apply. 1. history of HPV infections 2. first intercourse before the age of 20 3. multiple sex partners 4. long-term use of birth control pills 5. alcohol abuse

Correct Answer: 1, 3, 4 Risk factors that predispose a woman to cervical cancer include HPV infection, first intercourse before 16 years of age, multiple sex partners, and long-term use of birth control pills. Alcohol abuse has not been shown to be a risk factor.

A patient is beginning radiation therapy as part of cancer treatment. What should the nurse teach the patient about the care of the radiation site? Standard Text: Select all that apply. 1. Clean radiation site with soap and water. 2. Apply lotion daily to prevent scaling. 3. Apply ice pack to radiation site if pain or itching occurs. 4. If needed use an electric razor for shaving. 5. Wear tight fighting clothing over the area to protect it.

Correct Answer: 1, 4 Options 2, 3, and 5 are contraindicated for this patient as they will increase the likelihood of tissue trauma at the radiation site.

The nurse is caring for a patient who will be receiving radiation therapy for cervical cancer. Patient education should include which skin care interventions? Standard Text: Select all that apply. 1. wound and skin care 2. applying oil-based lotions to the skin 3. how to remove the markings from the skin 4. monitoring for evidence of fistula formation 5. applying heat to the abdomen with a heating pad

Correct Answer: 1, 4 Wound and skin care is important to prevent or minimize skin breakdown associated with radiation therapy. Fistula formation is a potential complication of radiation to the pelvic or abdominal cavities. Fistulas may develop between the vagina and bladder or rectum. Patients should apply non-oil-based lotions to the skin to relieve itching and maintain skin integrity. Markings are used to localize the radiation beam to the target area and are essential for future radiation treatments. Use of a heating pad to reduce pain is recommended in care for endometrial cancer.

A patient who is being treated for malignant lymphoma is experiencing pruritus. What interventions would be appropriate for this patient? Standard Text: Select all that apply. 1. bathing with cool water 2. vigorously rubbing the skin after bathing 3. applying lavender-scented body lotion 4. keeping the room temperature above normal 5. cleansing bedding and clothing in mild detergent with a second rinse cycle

Correct Answer: 1, 5 The nurse should provide and teach measures to promote comfort and relieve itching. These measures include using cool water and a mild soap to bathe; blotting skin dry; applying plain cornstarch or nonperfumed lotion or powder to the skin unless contraindicated; using lightweight blankets and clothing; maintaining adequate humidity and a cool room temperature; and washing bedding and clothes in mild detergent with a second rinse cycle.

After several doses of chemotherapy, a patient complains of fatigue, pallor, progressive weakness, exertional dyspnea, headache, and tachycardia. Which problem should the nurse identify as a priority for this patient? 1. change in nutritional status 2. difficulty with activity 3. feeling unable to control the disease process 4. psychosocial issues dealing with the disease process

Correct Answer: 2 Fatigue, pallor, weakness, dyspnea with activity, headache and tachycardia would cause difficulty with activity. Nutritional or iron deficiency is not the cause of the symptoms, which are related to tissue hypoxia. These manifestations do not indicate that the patient feels unable to control the disease process. Although the patient might be having coping issues, the physical symptoms are the greatest complaints; therefore, coping is not the top priority in planning care. Physiological needs must be met prior to self-actualization needs.

A patient is suspected of having endometrial cancer. For which diagnostic procedures should the nurse prepare this patient? Standard Text: Select all that apply. 1. abdominal x-ray 2. transvaginal ultrasound 3. dilatation and curettage (D&C) 4. intravenous pyelogram 5. CT scan of abdomen

Correct Answer: 2, 3 Transvaginal ultrasound is used to determine endometrial thickening, which may indicate hypertrophy or malignant changes, and D&C to remove tissue for a definitive diagnosis. Abdominal x-rays, intravenous pyelogram (IVP), or CT scans are used to determine the extent of disease once diagnosed and to check for metastasis.

A patient with cancer is diagnosed with malnutrition. What does the nurse realize are causes of malnutrition in this patient? Standard Text: Select all that apply. 1. decreases in metabolism resulting from increased cancer cell production 2. decreased available nutrients due to the cancers parasitic activity 3. loss of appetite due to side effects of chemotherapy 4. decreased absorption in the gastrointestinal tract 5. parenteral nutrition supplements administered via venous access devices

Correct Answer: 2, 3, 4 The patient with cancer may have a decreased amount of available nutrients. The patient may lose his or her appetite. The patient may not be able to absorb the nutrients well from the gastrointestinal tract. The patient's metabolism will not decrease, it will increase. Parenteral nutrition is not a cause of malnutrition. It can be used to help the patient with cancer.

The student nurse is learning how to care for patients who had thoracic surgery following a diagnosis of lung cancer. The intensive care unit nurse is assessing the student's understanding. Which statements by the student indicate the need for further education? Standard Text: Select all that apply. 1. "I should assess the patient's respiratory system at least every four hours." 2. "I really shouldn't even offer narcotic pain medications to this patient because it will result in severe respiratory depression." 3. "If there are items that the patient needs frequently, I should keep them across the hospital room. This will ensure that the patient will get better faster." 4. "The patient's head of bed should be maintained between 15 and 30 degrees." 5. "The area between the visceral and parietal pleura must be filled with positive pressure to work appropriately, and this can be accomplished with a functioning chest tube."

Correct Answer: 2, 3, 4, 5 Narcotic pain medications should be offered after thoracic surgery to ensure that the patient can perform pulmonary rehabilitation exercises such as coughing, deep breathing, and incentive spirometry. The patient who is using narcotic pain medications to achieve pain control must be monitored for respiratory depression so that it can be treated. This patient should be encouraged to conserve energy. Items that are used frequently should be kept within the patient's reach. The nurse should elevate the head of the bed to 60 degrees, because elevating the head of the bed reduces pressure on the diaphragm and permits optimal lung expansion. The area between the visceral and parietal pleura must be filled with negative pressure to work appropriately. The chest tube is used to achieve negative pressure within this space. The nurse should perform a respiratory assessment at least every four hours.

The family of a patient with terminal metastatic cancer asks the nurse for guidelines regarding when to call for help when the patient is discharged to home. What guidelines should the nurse instruct this family that indicates the patient needs medical intervention? Standard Text: Select all that apply. 1. oral temperature greater than 100° F 2. difficulty breathing 3. onset of bleeding 4. resting comfortably, and reading 5. extreme hunger

Correct Answer: 2,3,5 The nurse should instruct the patient and family to call the physician or nurse for help with any of the following signs or symptoms: an oral temperature greater than 101.5° F (38.6°C); severe headache; significant increase in pain at usual site, especially if the pain is not relieved by the medication regimen; severe pain at a new site; difficulty breathing; new bleeding from any site, such as rectal or vaginal bleeding; confusion, irritability, or restlessness; withdrawal; greatly decreased activity level; frequent crying; verbalizations of deep sadness or a desire to end life; changes in body functioning, such as the inability to void or severe diarrhea or constipation; changes in eating patterns, such as refusal to eat, extreme hunger, or a significant increase in nausea and vomiting; and appearance of edema in the extremities or significant increase in edema already present.

A patient with cancer of the rectum is scheduled for surgery and the placement of a permanent ostomy. Which type of ostomy will this patient most likely have performed during the surgery? 1. ileostomy 2. double-barrel 3. sigmoid 4. transverse loop

Correct Answer: 3 A sigmoid colostomy is the most common permanent colostomy performed, particularly for cancer of the rectum. It is usually created during an abdominoperineal resection. The ileostomy, double-barrel, and transverse loop ostomies are not in the correct area to manage cancer in this location.

A patient who is receiving radiation therapy for lung cancer complains of ongoing fatigue. What should be included in the teaching for this patient? 1. This is a complication of radiation therapy and will continue for years. 2. There is nothing that can help the fatigue. 3. Frequent rest periods and good nutrition can help with the fatigue. 4. Restricting caloric intake often helps with the fatigue.

Correct Answer: 3 Adequate rest and nutrition are important to alleviate the symptoms of radiation fatigue, which is common in patients who are receiving radiation therapy for lung cancer. The fatigue is generally temporary. The fatigue effects due to radiation do not last for years, only during treatment. Restricting calories would only contribute to continued fatigue.

A female patient is concerned that she will develop ovarian cancer because great-grandmother had the disease. Which information from the patient's health history will help reduce the risk for this patient? 1. The patient began her menses at age 10. 2. The patient has never had long-term antibiotic therapy. 3. The patient had her first child at the age of 20. 4. The patient has asymptomatic menstrual cycles.

Correct Answer: 3 Family history is a significant risk factor, with a 50% risk of developing the disease if two or more first- or second-degree relatives have site-specific ovarian cancer. Protective factors include having a child before the age of 25. Early menarche, antibiotic therapy, and asymptomatic menstrual periods are not considered risk factors for ovarian cancer.

A patient who was recently diagnosed with ovarian cancer wants to have children. Which type of treatment should the nurse expect to be prescribed first for this patient? 1. chemotherapy 2. radiation therapy 3. surgery to remove one ovary 4. hormone replacement therapy

Correct Answer: 3 In young women with stage I disease who wish to have children, treatment may be limited to removal of one ovary. Chemotherapy is used after surgery in the treatment of ovarian cancer. Radiation therapy using external-beam or intracavitary implants is performed for palliative purposes only and is directed at shrinking the tumor at selected sites. Hormone therapy is not used to treat ovarian cancer.

A patient diagnosed with leukemia says, "If I have too many white blood cells, and white blood cells fight infections, why do I have to be careful not to be exposed to germs?" What would be an appropriate response for the nurse? 1. "With leukemia, you have the wrong kind of white blood cells." 2. "That's not what leukemia is." 3. "The white blood cells with leukemia aren't effective at fighting infections." 4. "Your bone marrow can become infected."

Correct Answer: 3 The patient has a basic understanding of the diagnosis and simply needs clarification. Leukemic cells are not effective in the normal immune functions of white blood cells (WBCs), and that increases the risk for infection. The cells are not "wrong" but rather not the right type at the right level to fight infection. The risk is not of bone marrow infection but of overall systemic infection.

The nurse is caring for a patient diagnosed with a malignant neoplasm. What does the nurse recognize are characteristics of this neoplasm? Standard Text: Select all that apply. 1. localized encapsulated growths 2. growths demonstrating contact inhibition 3. irregularly shaped growths 4. neoplasms that cause bleeding and inflammation 5. growths that remain stable in size

Correct Answer: 3, 4 Benign neoplasms are localized growths. They form a solid mass, have well-defined borders, and frequently are encapsulated. Benign neoplasms tend to respond to the body's homeostatic controls. Thus, they often stop growing when they reach the boundaries of another tissue (a process called contact inhibition). They grow slowly and often remain stable in size. Because they are usually encapsulated, benign neoplasms often are easily removed and tend not to recur. In contrast to benign neoplasms, malignant neoplasms grow aggressively and do not respond to the body's homeostatic controls. Malignant neoplasms are not cohesive, and present with an irregular shape. Instead of slowly crowding other tissues aside, malignant neoplasms cut through surrounding tissues, causing bleeding, inflammation, and necrosis (tissue death) as they grow.

A mass is found on a mammogram of a 42-year-old female patient and a cyst is confirmed by an ultrasound of the breast. The nurse understands that the next course of action for this patient would be to: 1. adopt the "watch and wait" approach. 2. reduce caffeine intake. 3. apply warm soaks to the cyst. 4. undergo a surgical biopsy.

Correct Answer: 4 A percutaneous needle biopsy is used to define cystic mass or fibrocystic changes and provide specimens for cytologic examination, and a breast biopsy. In aspiration biopsy or fine-needle aspiration biopsy, a needle is used to remove cells or fluid from the breast lesion. Fine needle aspiration biopsies are performed using a stereotactic biopsy device with mammography and a computer to guide the needle. Breast masses are not watched. Reducing caffeine intake is suggested for women with fibrocystic breast disease. Warm soaks are not applicable for this condition.

A patient recently diagnosed with chronic myeloid leukemia (CML) says he does not want to leave his wife alone with all the household finances. Which response should the nurse refrain from making at this time? 1. "I would encourage you to discuss your feelings with your wife so that she can be a part of the decision making process." 2. "I would like to make a referral for you and your wife to a support group that may be helpful with some of the issues you are having." 3. "It must be very difficult for you to think of your wife having to be alone with the household decisions." 4. "You had better get your affairs in order now before it is too late."

Correct Answer: 4 Once the patient has expressed a concern about getting affairs "in order," the nurse can offer additional information or discuss available resources. Anticipatory grieving is identifying emotional losses or potential losses such as function, independence, appearance, friends, self-esteem, and self prior to actual events related to death. Making referrals for support or bereavement groups is appropriate at this time. Leading questions encourage patients to verbalize their feelings.

Risk factors of cancer

viruses, bacteria physical factor: sunlight, radiation, chronic irritation(GERD) chemical agents: tobacco, asbestos genetic, familial factors diet hormones age (>older you get) gender ETOH recreational drugs stress

The nurse recognizes which sign as an indication of cancer of the larynx? Increased drooling Blood streaked sputum Difficulty swallowing Jaundice

Difficulty swallowing Hoarseness, difficulty swallowing, color changes in the mouth or tongue, and oral lesions that do not heal or warning signs of laryngeal cancer

The nurse provides care for a client with stomatitis due to chemotherapy. Which action is most important for the nurse to include in the clients plan of care? Examine the clients mouth for blisters, sores, or drainage Encourage the client to use a commercially prepared mouthwash twice daily Instruct the client to use a soft bristled toothbrush Offer mouth Care morning and night

Examine the clients mouth for blisters, sores, or drainage. The first step of the nursing process is to assess. The nurse should examine the clients mouth thoroughly every four hours in document size, character, and drainage from any blisters or sores.

teletherapy radiation

External Beam RT Most common form of radiation. There is a defined outlined precise target area. They make a mold to shield and protect the surrounding areas.

The nurse does charge teaching for a client after right mask ectomy. The nurse determines the teaching is affective if the client makes which statement? I should eat a full liquid diet for 3 to 4 days I can take a shower as soon as I get home I should empty the drain reservoir twice a day I should eat with my left hand until the stitches are removed

I should empty the drain reservoir twice a day. The client should measure and record the amount of drainage and change the dressing around the drain as needed

The nurse instruct staff members about care of a client diagnosed with cancer of the cervix. The client has internal radiation in place. The nurse intervenes if a staff member makes which statement? I will provide items for a bed bath and make sure the client does not need assistance. I should avoid standing at the foot of the bed. I should place all linens in the special, lead lined hamper I should wear a Dosimeter while I'm in the clients room

I should place all linens in a special, lead lines hamper. The client sheets are not radioactive. The nursing staff will save all dressings and bed linens in the room until after the implant is removed, then dispose in the usual manner. The nurse should not stand in the line of radiation and should organize tasks to limit the amount of time spent into the room.

The nurse provides care for a client diagnosed with cancer receiving chemotherapy. The client shares with the nurse how upsetting losing the hair will be. Which statement by the nurse is best? Wear a wig; I think a wig will look nice on you. I understand, I would not want to lose my hair! It is OK to be upset, let's discuss the different head cover options in the process of hair regrowth after chemotherapy. Wearing attractive hats and scarves won't be that bad.

It's OK to be upset, let's discuss the different head cover options in the process of heavily growth after chemotherapy. The nurses response provides information to the client. The nurse will support the client through empathy and education. The nurse will discuss hair loss and regrowth with the client.

The nurse is leading a smoking cessation class. We construction does the nurse give first? Remove ashtrays and lighters from view Go to places that tempt the client to smoke to test the resolve Make a list of all the reasons you would like to quit smoking Discuss medications that can curb cravings

Make a list of all the reasons you would like to quit smoking. To be successful, the client has to be willing to learn and change behavior. If the client is not motivated to change, instructing the client about how to change will be unsuccessful. Identifying reasons the client would like to quit smoking can serve as a motivator to change behavior and increase the willingness to learn.

The nurse assesses a client with a diagnosis of colorectal cancer. The nurse understands that eating which foods may contribute to the client developing colon cancer? Broccoli and cabbage Red meat and bacon Lettuce salads and spinach Oranges and apples

Red meat and bacon. These foods contribute to the risk of developing colon cancer. Other foods to avoid include processed meats, processed grains, and concentrated sweets

foods that increase cancer risk

Red meat, smoked meats/foods, charred meats, processed, salty, fatty foods, spicy foods for prostate cancer. Artificial sweeteners.

radiosurgery

Surgical tissue management procedure that provides cutting and/or coagulation from *radio waves*. Different *waveforms* are used for *tissue removal* or *coagulation*

The nurse makes a home visit to a client receiving chemotherapy for treatment of cancer. The client white blood cell count is 3500. Which observation, if me by the nurse, requires an intervention? The client cleans The toothbrush daily by washing it in the dishwasher The client eats fruits and vegetables after washing them The client takes and records to oral temperature each day The client pulls weeds in the garden every day

The client pulls weeds in the garden every day. Digging in the garden or working with houseplants is not advised if a client is immunocompromise. Normal white blood cell range is 4500 to 11,000

The nurse provides care for a client diagnosed with immunosuppression due to chemotherapy. The nurse determines care is appropriate if which action is observed? The nurse obtains the clients vital signs every 12 hours while awake The client is placed in a room with a client diagnosed with ulcerative colitis The unlicensed assistive personnel wash his hands prior to changing the clients bed linens The staff brings in blood pressure equipment to obtain the clients blood pressure

The unlicensed assistive personnel wash his hands prior to changing the clients bed linens. All personnel and visitors will wash hands before touching the client or any object is in the clients room. The vital signs should be monitored every four hours to report changes in temperature. The immuno suppressed client should be placed in a private room.

chemotherapy

The use of drugs to treat diseases such as cancer

Normal lab values

WBC- 4,500-10,000 o RBC- women 4.0-5.0 men 4.6-6.0 million/ o Platelets 150,000-400,000/mm3 o Hemoglobin women: 12-15 g/dL men: 13.5-18 g/dL o Hematocrit women: 36-46% men: 40-54% o BUN- 5-25 mg/dL

Lab values you should know

WBC- Chemo causes bone marrow suppression. (below 4500) Platelets- Below 150,000 Hyperphosphatemia - 2.7-4.5 Hyperkalemia - 8.8-10.4 Hyperuricemia - men 3.5-8.0, women 2.8-6.8 Hypocalcemia - 3.5-5.2

A client diagnosed with AML begins menstruating. Which action does the nurse take first? Instruct the client to report any increased dizziness and weakness Contact the health care provider Weighs the clients pads and tampons before and after use Ask the client if there is a past history of heavy periods

Weighs the clients pads and tampons before and after use. The client with AML may bleed excessively due to thrombocytopenia. It is important for the nurse to determine the amount of blood loss and report the healthcare provider

The nurse leads adult woman in a wellness class. The nurse instructed class about risk factors for developing breast cancer. The nurse will intervene if one of the women makes which statement. Women over the age of 40 have a greater chance of developing breast cancer Women with breast implants have a higher risk of developing breast cancer Women who have a mother or sister with breast cancer are at a higher risk of developing breast cancer Women who have never had children have a higher risk of developing breast cancer

Women with breast implants have a higher risk of developing breast cancer. Neither saline nor silicone breast implants have been found to increase a woman's risk of developing breast cancer.

Non-Hodgkin's Lymphoma

a diverse group of lymphoid tissue malignancies that do not contain Reed Sternberg cells. They tend to arise in peripheral lymph nodes and spread early to tissues throughout the body. It is more common than Hodgkin disease. Older adults are more often affected, and it occurs more frequently in men than in women. Bleeding precautions (1185)- bleeding is the second most common cause of leukemia death.

CML

characterized by abnormal proliferation of all bone marrow elements. It affects men more frequently the woman , and onset is typically between ages 30 or 40 and 50 but it can be seen in children and adolescents as well. It is associated with a chromosome abnormality called the Philadelphia chromosome, very large doses of ionizing radiation may also induce CML in some patients. People are often asymptomatic in the early stages. Anemia causes weakness, fatigue, and dyspnea on exertion. The spleen is often enlarged, causing abdominal discomfort. Within three to four years disease progresses to a more aggressive phase. Rapid cell proliferation and hyper metabolism caused fatigue, weight loss, sweating, and heat intolerance. The spleen enlarges leading to a sensation of abdominal fullness and discomfort, and platelet function is affected leading to bleeding and increased bruising. Finally the disease evolves to acute leukemia with blast cell proliferation. This stage is known as the terminal blast crisis phase and as characterized by splenomegaly, and infiltration of leukemic cells into the skin, lymph nodes, bones, and CNS.

AML

characterized by uncontrolled proliferation of myeloblasts (precursors of granulocytes) and hyperplasia of the bone marrow and spleen.The manifestations result from neutropenia and thrombocytopenia. Decreased neutrophils lead to recurrent severe infections such as pneumonia, septicemia, abscesses, and mucous membrane ulceration. Manifestations of thrombocytopenia include petechiae , purpura, ecchymosis (bruising), epistaxis (nosebleeds), hematomas, haematuria, and GI bleeding.

biotherapy

involves the use of immunotherapy and biologic response modifiers as a means of changing the person's own immune response to cancer

CLL

is characterized by proliferation and accumulation of small, abnormal, mature lymphocytes in the bone marrow, peripheral blood, and body tissues. The abnormal cells are usually B lymphocytes it occurs more commonly in older adults (65) CLL has a slow onset and is often diagnosed during a routine physical examination. if symptoms are present, they usually include vague complaints of weakness or malaise. Possible clinical findings include anemia, infection, and enlarged lymph nodes, spleen, and liver

Lymphoma

malignancies of lymphoid tissue. They are characterized by the proliferation of lymphocytes, histiocytes, and their precursors or derivatives. a lymphatic cancer, occurring most often in people between the ages of 15 and 35 or over the age of 50. Somewhat more common in men than women. The exact cause is unknown, but both Epstein Barr virus, and genetic factors play a role in its development. It develops in a single lymph node or chain of nodes, spreading to add joining nodes involved lymph nodes contain Reed Sternberg cells (malignant cells) surrounded by host inflammatory cells. These malignant cells secrete inflammatory mediators substances, attracting inflammatory cells to the tumor site. They may invade almost any tissue in the body.

Which cells would you find in higher than normal values in a leukemia patient? monocytes eosinophil thrombocytes erythrocyte neutrophils

monocytes eosinophils, neutrophils

When to call for help

o Oral temperature greater than 101.5 F o severe headache; significant increase in pain at usual site, especially if the pain is not relieved by the medication regiment. Severe pain at new site o difficulty breathing o new bleeding from any site, such as rectal or vaginal o confusion, irritability, or restlessness o withdrawal, greatly decreased activity level, or frequent crying. o Verbalizations of deep sadness or a desire to end life o changes in body functioning, such as inability to avoid or severe diarrhea or Constipation. o Changes in eating patterns, such as refusal to eat, extreme hunger, or a significant increase in nausea and vomiting. o Appearance of adima in extremities or significant increase in edema already present.

only cure for colorectal cancer

oly cure is complete resection of colon

oncologic emergencies

pericardial effusion superior vena cava syndrome sepsis and shock spinal cord compression hypercalcemia obstrucive uropathy tumor lysis syndrome hyperuricemia

photodynamic therapy

procedure in which cells selectively treated with an agent called a photosensitizer are exposed to light to produce a reaction that destroys the cells

ALL

the most common type of leukemia in children and young adults. It is rarely seen in adults until late middle age, and then its incidence increases with aging. Genetic factors may play a role in its development. Most cases result from malignant transformation of B cells. the malignant cells resemble immature lymphocytes (lymphoblasts) however, they do not mature or function effectively to maintain immunity. These lymphoblasts accumulate in the bone marrow, lymph nodes, and spleen as well as in circulating blood. The onset is usually rapid, lymphoblasts proliferating and bone marrow and peripheral tissues crowd the growth of normal cells. Normal hematopoiesis is suppressed leading to thrombocytopenia, leukopenia, and anemia.

bradytherapy

therapy using radioactive source that are placed inside the body