CARE OF THE CLIENTS WITH ONCOLOGICAL DISORDERS
Epidemiology, Etiology, Terms
 Disorders that can involve all body
organs with manifestations that vary
METASTASIS
according to the body system affected
and type of tumor cells
 Cells lose their normal growth
controlling mechanisms and the
growth of cells is uncontrolled.
 Cancer produces serious health
problems such as impaired immune
and hematopoietic function, altered
GIT structure and function, sensory
deficits and decreased respiratory
function.
NEOPLASMS
CANCER
 Cancer is the second most common
cause of death in the USA
 Sites in men associated with the
greatest mortality: lung, colon, rectum,
and prostate
 Sites in women with the greatest
mortality: breast, lung, colon, and
rectum
 Familiar risk for certain cancers: lung,
stomach, breast, colon, rectum, and
uterus
ETIOLOGY
 Generally unknown but may be caused
by interacting factors
 Theories include predisposing factors
a. Constant irritation
b. History of cancers
c. Environmental carcinogens
d. Radiation
 LOCAL SEEDING –distribution of shed
cancer cells occur in the local area of
the primary tumor
 BLOOD BORNE –tumor cells enter the
blood, which is the most common
cause of cancer spread
 LYMPHATIC SPREAD –primary sites rich
in lymphatics are more susceptible to
early metastatic spread
 Hyperplasia involves an increase in
the number of cell in a tissue; may be
a normal or an abnormal cellular
response
a. Metaplasia refers to the conversion
of one type of cell in a tissue to
another type not normal to that
tissue. It results from an outside
stimulus affecting parent stem cells
and may be reversible or progress
to dysplasia
b. Dysplasia refers to a change in
size, shape, or arrangement of
normal cell into bizarre cells; may
precede an irreversible neoplastic
change
c. Anaplasia involves a change in the
structure of cells and in their
orientation to one another,
characterized by a loss of
differentiation and a return to a
more primitive form. The resulting
poorly differentiated, irregularly
shaped cells are nearly always
malignant
 d. Neoplasia refers to the abnormal
benign or malignant cell growth
1. Benign neoplasm: usually
harmless, does not infiltrate
other tissues
2. Malignant neoplasm: always
harmful, may spread or
metastasize to tissues far from
the original site
CANCER CLASSIFICATION
 SOLID TUMORS –associated with
organs from which they develop such
as breast cancer or lung cancer
 HEMATOLOGICAL CANCER –originate
from the blood cell-forming tissue,
such as leukemia, lymphomas, and
multiple myeloma
CANCER TERMINOLOGY
 Primary site of neoplasm is its site of
origin
 Secondary sites represent metastasis
 Types of neoplasms: benign and
malignant
 Four types of malignant neoplasms:
a. Carcinomas: usually solid tumors
arising from epithelial cells
b. Sarcomas: from muscle, bone, fat,
and other connective tissues
c. Lymphomas: originate in the
lymphatic system
d. Leukemias: opriginate in the blood
system
STAGING and GRADING –are methods used to
describe the tumor
 STAGING –describe and classify extent
of a malignancy when it is diagnosed
 GRADING – describe the degree of
malignancy according to the type of
tumor cell
TREATMENT IN GENERAL
 Objective: to remove all traces of the
cancerous tissue
 Treatment plan based on the stage
and grade of tumor
 Surgery: specific to site of malignancy
MOST COMMON SITES:
 To lung from primary site in colon,
rectum, breast, renal system, testes,
and bone
 To liver from primary sites in lung,
colon, rectum, breast, and renal
system
 To CNS from primary sites in lung and
breast
 To bone from pituitary sites in lung,
breast, renal system, and prostate
FACTORS THAT INFLUENCE CANCER
DEVELOPMENT
 Chemical carcinogen –industrial
chemicals, drugs, and tobacco
 Physical carcinogen –radiation
(diagnostics, sun, ultraviolet)
 Viral –viruses capable of causing
cancer are known as oncoviruses such
as Epstein-Barr, heap B, and human
papillomavirus
 H. pylori –is associated with increased
risk of gastric cancer
FACTORS THAT INFLUENCE CANCER
DEVELOPMENT
 Obesity and dietary factors –
preservatives, additives, and nitrates
  Genetic predisposition  Mammography

 Age  Pap’s test

 Immune function –higher in  Stools for occult blood

immunosuppressed persons, such as
AIDS px., organ transplant taking  Sigmoidoscopy and colonoscopy
immunosuppressive meds.
 BSE
NUTRITIONAL GUIDELINES TO REDUCE THE
 TSE
RISK OF MANY TYPES OF CANCER

 Avid obesity  Skin infection

CAUTION
 Decrease total dietary fat intake
 Change in the bladder and bowel
 Eat more high-fiber foods, such as
habits
whole grain, cereals, fruits, and
vegetables  Any sore that does not heal
 Include foods rich in vitamins A and C  Unusual bleeding or discharge
in the daily diet
 Thickening or lump in breast or
 Include cruciferous vegetables (e.g. elsewhere
cabbage, broccoli, bruselle’s sprouts,
kohirabi, cauliflower) in the diet  Obvious change in wart or mole

 Consume alcoholic beverages only in  Nagging cough or hoarseness

moderation
PREVENTION
 Consume salt-cured, smoked, and
nitrite-cured foods only in moderation  AVOIDANCE of known or potential
carcinogens and avoidance or
OTHER ACCEPTED RISK-REDUCTION modification of the factors associated
MEASURES INCLUDE with the development of cancer cells

 Avoid tobacco use BREAST SELF EXAMINATION

 Avoid excessive sun exposure,  PERFORM 7 TO 10 DAYS AFTER

particularly between 10 a.m. and 3 MENSTRUATION
p.m.
 Postmenopausal clients should select
 Avoid exposure to industrial agents a specific day of the month and
known to increase cancer risk perform BSE monthly on that day

CANCER PAIN MANAGEMENT TESTICULAR SELF EXAMINATION

 Although clients with cancer may  Performed on the same day of each
experience pain at any time during month
their disease, pain is usually a late
symptom of cancer  Best time is right after shower

EARLY DETECTION DIAGNOSTIC TESTS/BIOPSY

  Definitive means of diagnostic cancer  Collaborate with the other health team
and provides histological proof of to develop a pain management
malignancy program

 Involves the surgical incision of a small  Mild or moderate pain may be treated
piece of tissue for microscopic with salicylates, acetaminophen,
examination NSAIDS

BIOPSY/TYPES  Severe pain is treated with opioids

 Needle-aspiration of cells  Monitor vital signs and for side effects

of medication
 Incisional-removal of suspected tissue
from a larger mass  Monitor for effectiveness of
medications
 Excisional-complete removal of the
entire lesion  Provide non-pharmacological
techniques of pain control, i.e.
OTHER DIAGNOSTIC TESTS
relaxation, biofeedback, massage,
 Bone marrow examination heat/cold application

REMINDER
 Chest radiograph
“DO NOT UNDER-MEDICATE THE CANCER
 Computed tomography
CLIENT WHO IS IN PAIN”
 Pap’s smear

 Liver function tests SURGERY-indicated to diagnose, stage, and

treat cancer
 MRI
 Prophylactic-an attempt to remove the
 Protoscopic examination
tissue or organ at risk and thus
 Mammography prevent the development of cancer

 Radioisotope scanning  Curative-all gross and microscopic

tumor is removed or destroyed
PAIN CONTROL
 Control/debulking-removing a large
Causes of Pain portion of a local tumor such as
ovarian cancer
 Bone destruction
 Palliative-performed to reduce pain,
 Obstruction of an organ relieve airway obstruction, relieve
obstruction in the GI or urinary tract,
 Compression of peripheral nerves
relieve pressure in the brain or spinal
 Infiltration, distention of tissues Cord

 Inflammation, necrosis  Palliative-performed to improve quality

of life during the survival time
INTERVENTIONS

 Asses the client’s pain

  Reconstructive or rehabilative-improve
quality of life by restoring maximal
function and appearance, i.e. breast
reconstruction after mastectomy
SIDE EFFECTS OF SURGERY
 Loss or loss of function of a specific
body part
 Reduced function as a result of organ
loss
 Scarring or disfigurement
 Grieving about the altered body image
or imposed change of lifestyle
CHEMOTHERAPY
 Kills or inhibits the reproduction of
neoplastic cells and kills the normal
cells
 Highly toxic agents that attack all
rapidly dividing cells , both normal and
malignant
 Most agents modify or interfere with
DNA synthesis
ANTINEOPLASTICS (CYTOTOXIC,
ANTIPROLIFERATIVE AGENTS)
 Alkalyting agents (cytoxan): produce
breaks in DNA molecule and cross-
linking of strands thus interfering with
DNA replication; most effective in
hematologic malignancies
 Antitumor antibiotics (biomycin): bind
directly with DNA changing its
configuration and inhibiting replication
 Antimetabolites :5-fluorouracil,
floxuridine: inhibit DNA synthesis;
most effective against rapidly growing
tumors enzymes necessary for cell
function and replication
 Plant alkaloids: vincristine: bind to
substances needed to form mitotic
spindle, thus preventing cell division
 Hormone and hormone inhibitors:
alters the endocrine environment to
make it less conducive to cell growth;
used in cancers of the breast,
prostate, and other reproductive
organs
ROUTES OF ADMINISTRATION
 Intravenous (peripheral or central
nervous access)
• Oral
• Intraarterial
• Intraperitoneal
• Intrapleural
Use
 To cure, control or palliate results of
neoplasm
 May be used as an adjunct to surgery
and radiation
ADVERSE EFFECTS: RESULTS FROM THE
DAMAGE TO NORMAL CELLS
 Nausea/vomiting, stomatitis,
alterations in taste, anorexia
 Diarrhea, constipation
 Alopecia, dermatitis, pruritus,
paresthesia, rash, bruising
 Hemorrhagic cystitis
 Cardiomyopathy
 Fatigue, dyspnea, fever, chills
 Sterility, amenorrhea
 Depression, anxiety
  Myelosuppression  Use soft-bristle toothbrush

NURSING INTERVENTIONS  Avoid use of razors

 Monitor lab studies as ordered SPACIAL NURSING CONSIDERATIONS

 Monitor IV site for extravasation  Exposure to chemotherapeutic agents

can lead to adverse reactions
 Maintain strict asepsis
• Contact dermatitis
 Administer antiemetic agents as
ordered and prophylactically before • Nausea and vomiting
chemotherapy
• Diarrhea
 Give antihistamines as ordered
 Exposure during pregnancy can lead
 Withhold food and liquids for 4 to 6 to
hours before treatment
• increased risk of fetal abnormalities
 Between treatments, give small,
frequent, bland meals • ectopic pregnancies

 Give antidiarrheals as ordered • spontaneous abortions

 Monitor signs of dehydration and

encourage fluids as tolerated

 Provide frequent oral hygiene,

lubricate lips as indicated

 For stomatitis, use topical anesthetics

before eating and as indicated

 Apply lotion to skin as indicated; avoid

harsh, drying soaps

 Provide a restful environment,

emotional support, and anxiolytics as
ordered

TEACH CLIENT

 Medications and side effects

 Alopecia is temporary

 Avoid bruising, aspirin products, and

persons with infection

 Conserve energy

 Recognize signs of bleeding, anemia,

infection