Tumor markers are soluble glycoproteins that are found in the blood, urine, or tissues of patients with certain types of cancer.
They are used to help diagnose cancer, monitor treatment, and check for recurrence.
Where do tumor markers come from ?
They are typically produced by tumor cells, but in some cases they may be produced by the body in response to malignancy or to certain benign conditions.
Not all tumors or cancers give tumor markers but some may. They sometimes may not necessarily be produced due to cancer but by normal condition or tissue as well.
What the common tumor markers and what are they used to diagnose ? List
Here are some common tumor markers and the types of cancer they are associated with:
Prostate-Specific Antigen (PSA) –
Used primarily to diagnose and monitor prostate cancer.
CA 125 (Cancer Antigen 125) –
Used mainly for ovarian cancer diagnosis and monitoring, though it can also be elevated in other conditions.
Carcinoembryonic Antigen (CEA) –
Often used in the management of colorectal cancer, but can also be elevated in cancers of the lung, breast, pancreas, and stomach.
CA 19-9 (Cancer Antigen 19-9) –
Primarily used for pancreatic cancer diagnosis and monitoring, and sometimes for gastrointestinal cancers.
Not all tumors or cancers give tumor markers but some may. They sometimes may not necessarily be produced due to cancer but by normal condition or tissue as well.
Alpha-Fetoprotein (AFP) –
Used to diagnose and monitor liver cancer (hepatocellular carcinoma) and germ cell tumors, such as testicular cancer.
Beta-Human Chorionic Gonadotropin (β-hCG) –
Used to diagnose and monitor germ cell tumors, including testicular and ovarian cancers.
HER2/neu –
Not a traditional marker in blood tests, but a protein overexpressed in some breast cancer cells; it is used to guide treatment decisions for HER2-positive breast cancers.
BRCA1 and BRCA2 –
Genetic mutations rather than traditional markers, these are used to assess risk for breast and ovarian cancers.
Calcitonin –
Elevated levels can indicate medullary thyroid cancer.
S100 –
Used primarily to monitor melanoma.
These markers are most effective when used alongside other diagnostic tools, as they can sometimes be elevated in non-cancerous conditions or not elevated in all cases of cancer.
Some MCQs with solution in Pathophysiology/ Oncology
Some MCQs with solution in Pathophysiology/ Oncology
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Question No 1
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) “Don’t worry. We have some great cancer doctors on staff. I’m sure chemo will help you fight it.”
B) “Maybe if you’re lucky, they have stopped it from metastasizing to your liver.”
C) “A simple intestinal surgery will cure you.”
D) “Most colon polyps are not cancerous. The biopsy results will direct your care.”
Question No 2
A lung biopsy and magnetic resonance imaging have confirmed the presence of a benign lung tumor in a client. Which of the following characteristics is associated with this client’s neoplasm?
A) The tumor will grow by expansion and is likely encapsulated.
B) The cells that constitute the tumor are undifferentiated, with atypical structure.
C) If left untreated, the client’s tumor is likely to metastasize.
D) The tumor is likely to infiltrate the lung tissue that presently surrounds it.
Question No 3
A newly diagnosed lung cancer client asks how his tumor spread (metastasized) so fast without displaying many signs/symptoms. The nurse responds that malignant tumors affect area tissues by:
A) Increasing tissue blood flow
B) Providing essential nutrients
C) Liberating enzymes and toxins
D) Forming fibrous membranes
Question No 4
A client had a positive Pap smear. The surgeon diagnosed “cancer in situ of the cervix.” The client asks, “What does this mean?” From the following statements, which is most appropriate in response to this question? The tumor has:
A) Been walled off within a strong fibrous capsule
B) Developed a distant infiltration
C) Not crossed the basement membrane, so it can be surgically removed with little chance of growing back
D) Grown undifferentiated cells that no longer look like the tissue from which it arose
Question No 5
While studying to become chemo-certified, the nurse reviews some basic concepts about cancer cells. When a client asks about why the tumor grows so fast, the nurse will respond based on which of the following physiological principles? Select all that apply.
A) Cancer cells have shorter cell cycle times than normal cells.
B) Cancer cells do not die when they are programmed to die.
C) Growth factors prevents cancer cells from entering resting (G0) cell cycle phase.
D) Cancer cells will reach a balance between cell birth and cell death rate.
E) Cancer cells never reach a flattened growth rate.
Question No 6
While looking at cancer cells under a microscope, the instructor asks the students to describe the cells. Which of the student answers are accurate? Select all that apply.
A) The cells are in different sizes and shapes.
B) The nucleoli are larger than normal.
C) The cells are contact inhibited.
D) The cells do not resemble the tissue of origin.
E) The cells are attached to an extracellular matrix.
Question No 7
The angiogenesis process, which allows tumors to develop new blood vessels, is triggered and regulated by tumor-secreted:
A) Procoagulants
B) Growth factors
C) Attachment factors
D) Proteolytic enzymes
Question No 8
Which of the following processes characterizes an epigenetic contribution to oncogenesis?
A) A DNA repair mechanism is disrupted.
B) A tumor suppressor gene is present, but it is not expressed.
C) Cells lose their normal contact inhibition.
D) Regulation of apoptosis in impaired, resulting in accumulation of cancer cells.
Question No 9
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) The client’s immune system is trying to kill the cancer cell by sending this protein to engulf it.
B) This is a good result. Normal cells undergo apoptosis if DNA is damaged in any way.
C) This means the cancer cells have found a way to survive and grow even with damaged DNA.
D) The client’s body is trying to limit the blood supply to the cancer cells by producing high levels of this protein.
Question No 10
A farmer’s long-term exposure to pesticides has made the cells in his alveoli and bronchial tree susceptible to malignancy. Which of the following processes has taken place in the farmer’s lungs?
A) Promotion
B) Progression
C) Initiation
D) Differentiation
Question No 11
Genetic screening may be indicated for individuals who have a family history of which of the following neoplasms?
A) Liver cancer
B) Multiple myeloma
C) Leukemia
D) Breast cancer
Question No 12
A public health nurse has cited a reduction in cancer risk among the many benefits of maintaining a healthy body mass index. Which of the following facts underlies the relationship between obesity and cancer?
A) Obesity can cause inflammation and hormonal changes that are associated with cancer.
B) Adipose tissue is more susceptible to malignancy than other types of connective tissue.
C) Increased cardiac workload and tissue hypoxia can interfere with normal cell differentiation.
D) Increased numbers of body cells increase the statistical chances of neoplastic cell changes.
Question No 13
Which of the following dietary guidelines should a nurse provide to a group of older adults to possibly decrease their risks of developing colon cancer?
A) “As much as possible, try to eat organic foods.”
B) “Regular vitamin supplements and a low-carbohydrate diet are beneficial.”
C) “Try to minimize fat and maximize fiber when you’re planning your meals.”
D) “Eat enough fiber in your diet that you have bowel movement at least once daily.”
Question No 14
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) Hepatitis B related to IV drug use as a teenager.”
B) Numerous admissions for COPD exacerbations requiring steroids.”
C) Three miscarriages with no live births.”
D) Your uterus and ovaries removed for endometriosis.”
Question No 15
A male client with a diagnosis of liver cancer has been recently admitted to a palliative care unit following his recent development of bone metastases. His family shares with the nurse that even though he is usually a “big eater,” he just isn’t interested in food. This has resulted in a loss of muscle mass. Which of the following factors may underlie the client’s change in nutritional status?
A) The action of cytokines and persistent inflammation
B) Loss of appetite due to fatigue and pain
C) Changes in peptide hormone levels
D) Production of onconeural antigens by cancerous cells
Question No 16
Although clinical manifestations vary with the type of cancer and organs involved, the oncology nurses have observed that the most frequent side effects clients with cancer experience are: Select all that apply.
A) Copious lymph flow
B) Sleep disturbances
C) Involuntary weight gain
D) Visceral organ expansion
E) Lack of energy
Question No 17
Paraneoplastic syndromes are manifestations of cancer that often result from:
A) Radiation and chemotherapy
B) Compression of area vessels
C) Tumor-related tissue necrosis
D) Inappropriate hormone release
Question No 18
A client with nonspecific signs/symptoms has gone to the primary health care provider. The client’s chief complaints revolve around extreme fatigue, unplanned weight loss, and being so weak in the muscles. The diagnostic workup included a carcinoembryonic antigen (CEA) tumor marker. The CEA result was elevated. The nurse should anticipate the physician will order which of the following diagnostic tests related to the elevated CEA? Select all that apply.
A) Testicular ultrasound
B) Colonoscopy
C) Mammogram
D) Thyroid scan
E) Brain CT
Question No 19
A client is scheduled for a bronchoscopy related to a history of “bronchitis” for the last 3 months that has been unresponsive to antibiotics. The nurse shares with the client that a primary purpose for this bronchoscopy is to help diagnose the problem by:
A) Visualizing airways looking for adhesions
B) Opening airways looking for any aspirated food
C) Flushing out the airway to remove debris and sputum
D) Taking tissue biopsy and looking for abnormal cells
Question No 20
A breast cancer client has just learned that her tumor clinical stage is T3, N2, M0. After the physician leaves, the client asks the nurse to explain this to her again. The nurse will use which of the following statements in his or her answer? Your:
A) Tumor is very small and has zero number of mitoses.
B) Tumor has metastasized to at least three distal sites and you have cancer in your lymph nodes.
C) Tumor is large and at least two lymph nodes are positive for cancer cells.
D) Extent of disease is unknown, but it looks like your cancer has stayed intact and not spread to the bloodstream.
Question No 21
Which of the following subjective/objective findings can be considered an adverse effect to the radiation treatment the client is undergoing to “shrink” a tumor prior to surgery? Select all that apply.
A 51-year-old client has been diagnosed with stage IV breast cancer with lung metastases. The oncologist sits down with the client/family to explain treatment options. The nurse knows that which of the following treatment options will be discussed for her cancers?
A) Radiation therapy
B) Chemotherapy
C) Surgery
D) Hormone therapy
Question No 23
A client’s oncologist has presented the possibility of implementing biotherapy in the treatment of the client’s brain tumor. Which of the following mechanisms of action provide the therapeutic effects of biotherapy? Select all that apply.
A) Stimulating the immune response to tumor cells
B) Inhibiting tumor protein synthesis
C) Reversing angiogenesis
D) Altering the hormonal environment of tumor cells
E) Causing breaks in the DNA of tumor cells
Question No 24
A 2-year-old child has been diagnosed with neuroblastoma. The tumor is extremely large. Parents ask how this cancer could be so extensive, yet the child has not displayed many symptoms until this past week. Nurses explain that early diagnosis of childhood cancers is often difficult because the signs and symptoms are:
A) Already present at birth
B) Absent until the late stage
C) Similar to those of other childhood diseases
D) Seen as developmental delays
Question No 25
A 5-year-old girl’s diagnosis of bone cancer required an aggressive treatment regimen. The client immediately receives doxorubicin chemotherapy. The nurse administering this medication should perform a detailed assessment of which body system that has been greatly affected by this drug?
Postherpetic neuralgia (PHN) Jaipur Block for Postherpetic neuralgia (PHN)
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Varicella zoster
Definition of Postherpetic neuralgia (PHN)
Postherpetic neuralgia (PHN) is a localized dermatomal neuropathic pain experienced 1 month after herpes zoster.
Immunosuppression is the commonest risk factor for PHN.
Varicella-zoster virus (VZV) is the causative agent of varicella, or ” the chickenpox,” and herpes zoster, or “shingles.”
Acute herpes zoster typically presents with a rash that is painful but self-limited. Some patients may continue to experience pain for months to years after the resolution of the rash, a condition known as postherpetic neuralgia (PHN).
Risk factors for post herpetic neuralgia
age more than 60 years
severe pain during acute herpes zoster
severe or more rash with acute herpes zoster
How long does the pain of PHN lasts?
Generally pain of PHN lasts from few months to several. Most of them last for few months.
Is there sensory loss with PHN?
Yes, the same dermatomes involved with herpes and PHN may also have sensory loss like loss of thermal, tactile, inprick or vibration sensations.
Occasionally the sensory deficit may cross dermatome margins but the uninvolved contralateral dermatomes are normal or unimpaired.
herpes zoster
Does PHN cause allodynia?
Allodynia is a condition that causes pain from the stimuli that normally wouldnt cause pain suchas light touch, brushing, combing hair, wearing clothing etc.
And PHN may occasionally cause allodynia as well.
Pain in Postherpetic neuralgia (PHN)
Broadly type of pain in PHN is divided into two broad categories spontaneous and stimulus evoked.
Spontaneous pain can be either continuous (burning, aching, throbbing) or intermittent (stabbing, shooting, electric-shock-like pain). Stimulus-evoked pain can present as allodynia and hyperalgesia. Allodynia is the commonest type of pain reported in PHN.
Diagnosis of PHN
The diagnosis of PHN is made when localized neuropathic pain persists beyond three months in the same distribution as a preceding documented episode of acute herpes zoster.
Testing for varicella-zoster virus (VZV) antibodies in the blood or cerebrospinal fluid is available and may be useful in atypical cases to confirm past exposure to the virus; however, positive tests do not specify PHN as the source of pain
Differential diagnosis of PHN
Trigeminal neuropathy
Other forms of craniofacial pain
Acute radiculopathy
Diabetic amyotrophy and idiopathic lumbosacral radiculoplexus neuropathy
Recurrent acute herpes zoster
Treatment of Postherpetic neuralgia (PHN) with local anesthetics
Local anesthetics act by suppressing sodium channels and decreasing ectopic discharges, thus reducing membrane excitability.
Lignocaine has faster onset of action (2-3 min) of but the duration of action (2 h) in contrast bupivacaine though is slow to act but has a continued activity for longer time (4-8 h).
There is no consensus on the concentration of anesthetics required, though few studies have reported a dose-related effect.
Treatment of Postherpetic neuralgia (PHN)
Intradermal therapy leads to faster onset of action, and the reservoir effect leads to sustained action with less systemic absorption. A higher dose of local anesthetics may cause arrythmias
Steroids and Anesthetics for Postherpetic neuralgia (PHN)
A combination of dexamethasone and local anesthetics gives a good response in stimulus-induced postherpetic neuralgia
Treatment options for PHN
Following medications can be used for treatment of PHN:
Gabapentinoids like gabapentin or pregabalin
Tricyclic antidepressants TCAs like Amitriptyline, Nortriptyline, Desipramine
Capsaicin topical
Lidocaine patches
Antiseizure medications like valproic acid, carbamazepine, oxcarbazepine. lamotrigine
Contralateral homonymous lower quadrantanopia is the type of visual loss seen when the lesion is located ataa which one of the following anatomical locations?
Which of the following correctly describes the primary position of the right eye in right third cranial nerve palsy?
(a) Downwards and outwards.✅ (b) Downwards and inwards (c) Upwards and outwards (d) Upwards and inwards
Which of the following findings are seen in Diabetic Retinopathy on fundus examination?
1. Microaneurysm 2. Dot and blot hemorrhage 3. Retinal thickening 4. Neovascularization Select the correct answer using the code given below: (a) 1, 2 and 3 (b) 1, 2 and 4✅ (c) 1, 3 and 4 (d) 2.3 and 4
Consider the following causes of visual loss:
1. Obstruction of the central retinal artery 2. Vitreous and retinal haeno.tlhage 3. Cataract 4. Retinal detachment Which of the above causes are associated with acute visual loss in a patient? (a) I, 2 and 3 (b) 1, 3 and 4 (c) 1, 2 and 4✅ (d) 2, 3 and 4
5 tips to control yout gout: Does cold compression help in acute gout flare up?
(toc)Table of Contents
acute gout and joint involvement
Introduction of Gout
Gout is a acute inflammatory condition which involces joints and soft tissue.
Use of cold for Gout
Cold compression can be helpful in managing acute gout attacks. During a gout flare-up, applying cold packs to the affected joint can reduce pain and inflammation. The cold helps by numbing the area and reducing blood flow, which in turn decreases swelling and inflammation. It is recommended to apply cold packs for 20 minutes at a time, with a protective barrier such as a towel between the cold pack and the skin, and to repeat as needed with intervals in between applications (Arthritis Society Canada).
When to use cold therapy?
Using cold therapy is most beneficial during an active gout attack, whereas heat should be avoided as it can exacerbate symptoms. After the initial acute phase, applying heat can help with general pain and stiffness but should not be used on inflamed joints (Cleveland Clinic) (Home).
Seek treatment on time if one of your joint is painful and swollen
Reduce your weight if youre obese
Stop smoking
Treat comorbidities
Exercise
Do not connsume other medications that may increase uric acid level in blood
If you want ti knw about diet that good for uric acid please contact us.
Complications of Gout
Gout is acute painful condition which leads to severe pain of one or more joints. But this can last ofr several days if untreated prevennting use of the joint and dysfunction.
Repeated gout flare up and attacks can permanently damage the joint, goint membrane named synivium and the cartilage leading to permanent dysfunction.
High uric acid in blood can also lead to crystallization of it in kidneys leading to kidney stones.
Yes it will help. Get some ice, cover it with a piece of clothe. and keep it in the affected joint for few minutes then keep it off. Do not keep it continuously.
But remember this is not alternative to treatment but add on to it.
Recurrent pain
Joint dysfunction
Permanent damage of joint
Kidney stones
Ongoing pain and multiple joints involvement
Treatment of Gout
Your doctor may use one or many of the following drug for treatment of gout
Yes it will help. Get some ice, cover it with a piece of clothe. and keep it in the affected joint for few minutes then keep it off. Do not keep it continuously.
But remember this is not alternative to treatment but add on to it.
For more comprehensive information on managing gout, including the use of medications and lifestyle adjustments, you can refer to resources from the Arthritis Society Canada and the Cleveland Clinic.
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These groups help manage blood glucose levels through different mechanisms, such as increasing insulin secretion, improving insulin sensitivity, decreasing glucose production in the liver, and enhancing glucose excretion in the urine.
A 50-year-old woman presents with severe epigastric pain that radiates to her back and is relieved by leaning forward. Laboratory tests show elevated serum amylase and lipase. What is the most likely diagnosis?
A 72-year-old man with a history of chronic obstructive pulmonary disease (COPD) presents with worsening shortness of breath and a productive cough. His temperature is 38.5°C (101.3°F). A chest X-ray reveals an infiltrate in the right lower lobe. What is the most appropriate treatment?
A. Inhaled bronchodilators
B. Oral corticosteroids
C. Antibiotics
D. Diuretics
E. Anticoagulants
A 34-year-old woman presents with fatigue, muscle weakness, and craving for salty foods. Her blood pressure is 90/60 mm Hg. Laboratory tests show hyponatremia and hyperkalemia. What is the most likely diagnosis?
