ONCOLOGY NURSING

Common Terminologies
Oncogene cancer genes that alter normal genes
Proto oncogenes repressed oncogene that can activated
by etiologic and risk factors
Anaplasia no resemblance to tissues of origin
Metaplasia replacement of the original cell with another
type of cell
Carcinoma cancer cell composed of epithelial cells that
can spread
Neoplasm growth of new tissue
Tumor same with neoplasm
Dysplasia alteration in the size, shape and organization
of differentiated cells
Hyperplasia an increase in the number of normal cells
Cancer Cells
Tumor can be:
BENIGN
Localized
Encapsulated
Hyperplasia,
functional activity
No metastasis
Fatal if it occurs in
restricted area (skull)
Fully differentiated
Slow growth

MALIGNANT
Systemic
Non encapsulated
Anaplasia, metapla
( or function of the
organ involved)
With metastasis
(direct invasion,lymphatic,
embolism, diffusion)
Harmful
Hardly differentiated
Rapid growth

Cancer

Synonymous to death and pain

Chronic disease that has acute exacerbation
Not a single disease with single cause
Common in men
Leading cancer is lung cancer
Male: prostate
Female: breast

Classification of Cancer:
Squamous cell carcinoma surface epithelial
Adenosarcoma glandular epithelial
Fibrosarcoma fibrous connective tissue
Liposarcoma adipose tissue
Chondrosarcoma cartilage
Osteosarcoma bone
Hemangiosarcoma blood vessels
Lymphangiosarcoma lymph vessels
Leiomyosarcoma smooth muscles
Rhabdomyosarcoma striated muscles

Glioma glial cells

Neurolemic sarcoma nerve sheath
Leukemia blood
Classification of Benign:
Glandular tissue adenoma
Bone osteotoma
Nerve cells neuroma
Fibrous tissue - fibroma
Etiology
Exact cause is still unknown
Viruses cancer of the liver, burkitts lymphoma
Chemical Agents tar, asphalt, arsenicals, fuels, oil
Drugs chemo drugs
Physical Agents radiation
Predisposing Factors:
Age (60% of cancer clients are over 65 y/o)
Sex Breast cancer for females and Prostate CA for males
Geographic location cancer of the stomach (Japan)
Occupation factory workers (lung cancer)
Hereditary breast, ovaries and colon
Diet cured and salted foods (stomach)
Stress decreased immune system
Precancerous lesions moles, polyps (colon and stomach)
Early Detection: (SECONDARY)

Chest xray and sputum cytology (lung cancer)

Physical exam (every year for over 40 y/o) skin, lymph

nodes, mouth, thyroid, breast, testes, rectum, prostate

Oral Exam - annually

TSE monthly following shower

Digital Rectal Exam annually for 40y/o and above

Sigmoidoscopy for 50 y/o and above annually for 2

years then every 3 years if negative

Fecal Occult Blood doctors recommendation

BSE every month after menstruation

Breast Clinical Exam done by physician (every 3

years for 20-40 y/o then yearly for over 40 y/o)

Mammography once for 35-40 y/o, then yearly for

over 50 y/o

Pap smear age 18 and all sexually active women

then yearly after 3 negative results

Pelvic Exam same with pap smear

Endometrial tissue sampling menopause

Factors that lead to Cancer

Smoking lung cancer

Sunlight (10am to 2pm) basal/squamous cell

(skin cancer)

Ionizing Radiation medical and dental xrays

Nutrition and diet (high fats and low fiber diet)

Alcohol liver, oral and esophagus cancer
Chewing of tobacco (mouth, larynx and throat)
Estrogen endometrial cancer
Occupational hazards (nickel and asbestos)

7 Warning Signals (CAUTION US)

C
A
U
T
I
O
N
U
S

hange in bowel and bladder habits

sore that does not heal
nusual bleeding or discharge
hickening or lump in breast or elsewhere
ndigestion or difficulty in swallowing
bvious change in wart or mole
agging cough or hoarseness of the voic
nexplained anemia
udden weight loss

7 SAFEGUARDS
B reast regular BSE
U terus annual pap smear
B asic PE yearly for all adults
L ung control or preferably stop smoking,
annual chest xray for high risk
O ral annual oral exam by the doctor
C olon or Rectum DE,
Proctosigmoidoscopy (40y/o)
S kin avoid undue exposure to sunlight (10-2 PM)

Diagnostic Exam
Biopsy
FNAB
Incision
Excision
CT scan
MRI
PET
Direct Visualization

Bronchoscopy

Gastroscopy

Proctosigmoidoscopy
Mammogram
Pap smear
UTZ
Angiogram
Lymphangiogram
Blood Studies
Antigen-skin-testing
Staging and Grading
T Tumor
N Node

T0-T4
N0-N3

Metastasis

M0-M1

Normal
Stage I
Stage II
Stage III
Stage IV

T0, N0, M0
T1, N0, M0
T2, N1, M0
T3, N2, M0
with metastasis

Tis carcinoma in situ (non-infiltrating)

X cant be assessed
Staging System
T Tumor
N Node
M Metastasis

T0-T4
N0-N3
M0-M3

Tis carcinoma in situ (non-infiltrating)

X cant be assessed
Normal
T0, N0, M0
Stage I
T1, N0, M0, < 2cm diameter of the tumor
Stage II
T2, N1, M0, > 2 < 5cm diameter of the
tumor
Stage III
T3, N2, M0, > 5cm diameter of the tumor
Stage IV
any size of the tumor with metastasis
Grading System

Microscopic study of the cell

The poorer the differentiation of the cells the poorer is

the prognosis
Carcinogenesis: Process of cancer formation

Initiation exposure to carcinogen

Promotion exposure to carcinogenic chemicals

will promote the function of proto oncogenes

Transformation conversion to malignant cell

Progression malignant behavior of the cells

Stages of Metastatic Process

Invasion of adjacent tissue

Spread of cancer cells

Establishment and growth at secondary site

Effective Test must be

Specific for the type of Cancer

Reliable

Economical on terms and benefits

Acceptable to the client (most important)

Points to Remember

Most client fear of death upon confirmation of

Cancer

Clients usually ignored cardinal signs of Cancer

Nurse Joseph Bahian Abang

Most often cancer is detected during routine

exam
Questions that need to be answered: Example
(Is the disease curable or not?)

Client Reaction during Diagnoses

Client will use coping strategies to his anxiety level such
as:

Denial
Rational inquiry-seek more information

Affect Reversal-make light of the situation

(laughing etc.)

Mutuality-share concerns and talk with other

persons

Suppression-conscious forgetting

Displacement or redirection-do other things

Client Reaction during Diagnoses

Confrontational

Redefine or revise

Passive acceptance

Disengagement

Externalization or Projection

Moral masochism

Compliance and cooperational

Intervention Phase

Therapeutic communications (silence, non

judgemental, acceptance, active friendliness,
setting limits)

Strategizing how to use effective coping

mechanism (client and SO)

Cancer management will involve surgery,

radiation, chemo and immunotherapy in
combination.
Surgery
Used in diagnosing, staging and treating the client
FNA, I&E biopsy
Cytology specimens

Palliative relieves pain, airway obstruction.

Reconstructive restore maximal function and

appearance

Preventive removal of target organ

Radiation Therapy

Range will be 2,000-5,000 centigrays (cGy)

5,000 cGy will SE

Normal cells and cancer cells are both affected

The goal is to destroy malignant cells without harming

normal cells by:
Fractionation-small frequent dose
Alternating the site
Alpha particle-fast moving helium nucleus (slight
penetration)
Beta particle-fast moving electron (moderate
penetration)
Gamma ray-similar to light ray (high penetration)
Sodium Iodide (131 I)-for thyroid gland
Gold (198 Au)-effective for ascites and pleural effusion
Sodium Phosphate (32 P)-for RBC
Destroys the ability of the cell to reproduce by
damaging the DNA

Radiation Safety

Distance - the greater the distance the lesser

the exposure

Time - the less time spent close to radiation the

less exposure (max of 30 min per shift)

Shielding - use lead aprons and gloves

Standards - kept as low as reasonably

achievable

Monitoring device - film badge (measure the

whole exposure of the nurse)
Types of RADIATION
External Radiation

Administered by high energy xray machine

(radioisotope Cobalt for Prostate and Lung CA)
Internal Radiation

Via injection or orally

Internal Radiation
UNSEALED SOURCE

Radioisotope is administered IV or orally

NaP04 (32 P) IV for polycythemia vera

(131 I) PO for Graves disease

Potential hazard exist because its not encased

Isotope maybe excreted via body fluids

Flush the toilet several times after use

Protect staff and visitors

Marked room and kardex with

RADIATION HAZARD
SEALED SOURCE

radioisotope is placed into needles, beads,

seeds, ribbons or catheter then implanted
directly into the tumor.

Requires a private room and bathroom

Room must be lead-shield proof

Lead container and long forcep on bedside

Check linen and other materials for the presence

of isotope

Chemotherapy

Use of chemicals to destroy cancer cells

Interferes DNA & RNA activities associated with

cell division

Often used in combination with radiation therapy

Cytotoxic - is an agent capable of destroying cells
Cytotoxic drug - alkylating and antimetabolites
Antineoplastic Drugs
Alkylating Agents
Attack the DNA of rapidly dividing cell
Nitrosurea: Carmustine (BCNU)
Nitrogen Mustard: Chlorambucil (Leukeran)
Cyclophosphamide (Cytoxan)
Vinca Alkaloids
Interfere with mitosis (M phase)
Vincristine (Oncovin) Vinblastine (Velban)
Antimetabolites
Inhibits protein synthesis (S phase)
Azathioprine (Imuran)
Fluorouracil (5-FU)
Methotrexate (Mexate) given with leucovorin to protect
normal cells
Antibiotics
Inhibit RNA
Doxorubicin HCl (Adriamycin) Mithramycin (Mithracin)
Antimetabolites
Inhibits protein synthesis (S phase)
Azathioprine (Imuran)
Fluorouracil (5-FU)
Methotrexate (Mexate) given with leucovorin to protect
normal cells
Antibiotics
Inhibit RNA
Doxorubicin HCl (Adriamycin) Mithramycin (Mithracin)
Hormone
Inhibit RNA and protein synthesis in tissues that are
dependent on the opposite sex
Androgens, Estrogens, Progestins, Steroids
(Analogue, Exogenous)
Hormone Antagonist: Mitotane (Lysodren) cortisol
antagonist, Tamoxifen Citrate (Nolvadex) estrogen
antagonist
Immune Agents
Introduction of an agent to stimulate production of
antibodies
Bacillus Calmette-Guerin (BCG)
C&R Goal:

Destroy all malignant cells without excessive

destruction of normal cell

Control growth of tumor when cure is not

possible
Note: all rapid dividing cells (GI mucosa, hair follicles and
bone marrow) are susceptible to the action of chemo and
radiation therapy.
Reasons of Combining Drugs
Synergy - two or more agents works together to enhance
the effect
Adjuvant - an additional treatment
s malignant cell destructions, s the SE
Principle of MDT is instituted to avoid and prevent the SE
C&R SIDE EFFECTS
Common: nausea and vomiting
Stomatitis
Alopecia (2-3 weeks to occur)
Bone marrow depression
Neurologic/Sensory/Perceptual
Meningeal irritation
CN and peripheral neuropathy
Cerebellar toxicity
Ototoxicity
Cardiac
Pericardial Effusion
Arrhythmias
CHF
Pulmonary
Pleural Effusion
Pneumonitis
GIT
Stomatitis
Esophagitis
Pharyngitis
Taste alteration
Anorexia
Nausea and vomiting
Constipation and diarrhea
Weight loss
C&R SIDE EFFECTS
GUT
Nephrotoxicity
Hemorrhagic cystitis
Hyperuricemia
Urine color changes
Reproductive
Loss of libido
Impotence
Amenorrhea
Irregular menses
Menopausal symptoms
Azospermia

Nurse Joseph Bahian Abang

Sterility
Gynecomastia
Hepatic
Hepatotoxicity
Integumentary
Alopecia
Dermatitis and ulcers
Hematopoietic
bone marrow activity
anemia, prone to infection and bleeding tendency
Metabolic
TLS and Hyperkalemia
Perceived Change in Body Image
Obvious reminder of disability
need for prosthesis (breast, leg and eye)

need for hardware (wheel chair, crutches)

need for medication (CR therapy)

extent of disability or limitation

Type of loss

symbols of sexuality

social acceptability (colostomy)

ability to communicate (laryngectomy, aphasia)

anatomic changes (amputation)

Terminally Ill

50% die from the disease

time from diagnosis to death ranges from weeksyears
not all clients become terminally ill
others die during initial treatment; others die from
complications of treatment
Endpoint: no response to treatment and
progressions cannot be controlled

HOSPICE CARE

standard of care for terminally ill cancer clients

symptom control

pain management

providing comfort and dignity

24 hour 7 day coverage

services are given based on clients need not on

its ability to pay
Ethical Issues

caring can be just successful as curing;

when curing is not an option

care is exercised during the final stage of life

Goals of Intervention

to care without functional and structural

impairment

CANCER

Brain Tumor

Cancer of the Larynx

Lung Cancer

Breast Cancer

Cancer of the Stomach

Cancer of the Colon

Cancer of the Liver

Cancer of the Pancreas

Wilms Tumor

Hodgkins and Non Hodgkins

Leukemia

Prostate Cancer
Brain Tumor

if cure is not possible goals must

= prevent further metastasis
= relieve symptoms
= maintain high quality of life

Common: cerebellar astrocytoma, brain stem

glioma, medulloblastoma (brain stem)
s/sx: increased ICP, headache, n&v, projectile
vomiting, decreased LOC, seizures, papilledema
Intervention: symptomatic, surgery, radiation and
chemotherapy (vincristine and
cyclophosphamide)
Follow peri-op craniotomy

Cancer of the Larynx

Cause: smoking

s/sx: hoarseness of the voice, dysphagia,

coughing, bloody sputum

Intervention: laryngectomy and radical neck

dissection

Most preventable type of cancer

Lung Cancer

Cause: smoking

Types: adenocarcinoma (common), small cell

(fatal)

s/sx: chronic cough, wheezing, dyspnea,

repeated unresolved URTI, chest/shoulder pain,
hemoptysis, hoarseness, dysphagia, head and
neck edema

Intervention: chemo and radiation, surgery

(wedge, segment, lobe, entire lung)
Breast Cancer

s/sx: non tender fixed lump (tail of spence),

dimpling, bleeding

Stage I (<2cm) Stage II (>2<5cm + Nodes)

Stage III (>5cm + nodes) Stage IV (metastasis)
Intervention: chemo and radiation, surgery
Lumpectomy, segmental mastectomy (lobe),
simple mastectomy (entire breast), MRM, RM,
URBAN

Follow post-op nursing management

Cancer of the Stomach

Most common GI cancer, cured foods, low in fiber

s/sx: vague fullness, bleeding LATE: ascites, palpable

mass

Intervention: C&R, surgery (billroth I&II)

Follow post-op procedures

Cancer of the Colon

Cause: low fiber high cholesterol diet, POLYPS

s/sx: change in BM, bleeding, obstruction

Adenocarcinoma

Intervention: C&R, surgery

Follow post-op procedures

Colostomy care
Cancer of the Liver

Usually a complication of CIRRHOSIS or from

metastasis

Hepatic failure

s/sx: similar to cirrhosis

Intervention: C&R, (Fluorouracil 5 FU, Cytoxan,

Oncovin), liver transplant

GALL BLADDER CA 1 YEAR SURVIVAL

Cancer of the Pancreas

Mostly adenocarcinomas

Head of the pancreas

s/sx: obstruction of the CBD, anorexia, weight loss,

pain (upper abdomen, left hypochondriac), jaundice

Dx: increased serum lipase and bilirubin

Intervention: C&R, surgery (WHIPPLES,

pancreatoduodenectomy, anastomosis of stomach,
duodenum, CBD and pancreatic duct)
Prostate Cancer

BPH cancer of the prostate

s/sx: asymptomatic

Dx: elevation of CEA, PSA, AP

Intervention: Prostatectomy

Follow post-op procedure of prostatectomy

TESTICULAR CA (curable) CRYPTORCHIDISM

ALL immature proliferation

CLL same, adult
AML reduction of granulocytes
CML myeloid stem cell, blood cells
s/sx: related to blood level
derangement
DX: bone marrow biopsy
Filgrastim (Neupogen) = stimulates
neutophils production

Hodgkins and Non-Hodgkins

Lymphoma

Obstruction of the lymph nodes

s/sx: edema

Hodgkins painless, localized (left

thoracic duct and right lymphatic
duct), lymph node biopsy reveals
REED-STERNBERG cell or GIANT
cell

Non-Hodgkins painful, systemic

CHLORAMBUCIL (LEUKERAN) PO
10 mg OD
Wilms Tumor / Nephroblastoma
Renal parenchyma, left kidney (unilateral)

Stage I kidney, stage II beyond kidney

encapsulated, stage III abdomen,
stage IV metastasis, stage V bilateral

s/sx: during bathing and dressing

mass will be noticed, non-tender, IVP
reveals mass,

NO PALPATION

Intervention: Nephrectomy (good

prognosis)
Cancer of the Skin

Types: basal cell (common), squamous cell (rapid),

malignant (less frequent)

Precancerous: leukoplakia (mouth and lips), nevi

(moles, color change to black, bleeding, irritation),
senile keratosis (brown scalelike spots among elderly)

Cause: UV light, chemicals and irritation

Intervention: protection against sunlight, irritants and

chemicals, lotion (para-amino benzoic acid), report
change in lesion, CHEMOTHERAPY &
IMMUNOTHERAPY

Leukemia

Nurse Joseph Bahian Abang

Nurse Joseph Bahian Abang