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
MALIGNANT
Localized
Systemic
Encapsulated
Non encapsulated
Hyperplasia,
Anaplasia, metaplasia
functional activity
( or function of the
organ involved)
No metastasis
With metastasis
(direct invasion,
lymphatic,
embolism, diffusion)
Fatal if it occurs in
Harmful
restricted area (skull)
Fully differentiated
Hardly differentiated
Slow growth
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
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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 chemodrugs
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 voice
nexplained anemia
udden weight loss

7 SAFEGUARDS
U
B
B
L
O
C
S

terus annual pap smear

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

Diagnostic Exam
Biopsy
FNA
Incision
Excision
CT scan
MRI
PET
Direct Visualization
Bronchoscopy
Gastroscopy
Proctosigmoidoscopy
Mammogram
Pap smear
UTZ
Angiogram
Lymphangiogram
Blood Studies
Antigen-skin-testing
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Staging and Grading

T Tumor
T0-T4
N Node
N0-N3
M 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
Stage I

T0, N0, M0
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 carcinogens
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
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

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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:

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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
Azoospermia
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
if cure is not possible goals must
= prevent further metastasis
= relieve symptoms
= maintain high quality of life
CANCER
Brain Tumor
Cancer of the Larynx
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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
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
Leukemia
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 REEDSTERNBERG cell or GIANT cell
Non-Hodgkins painful, systemic
CHLORAMBUCIL (LEUKERAN) PO
10 mg OD
Wilms Tumor
Nephroblastoma
Renal parenchyma, left kidney (unilateral)
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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

Set A
CANCER POST TEST
1. Which of the following would be considered an
iatrogenic cause of cancer?
A. ionizing radiation from radon
b. ionizing radiation from uranium ore
c. xrays to treat tumor
d. ultraviolet radiation from the sun
2. A nurse is providing health education in a
community setting about measures to avoid excessive
sun exposure. Which of the following statement is
true:
a. reapply sun screen only when you go to the water
b. avoid peak exposure hours from 10 AM to 2 PM
c. wear loosely woven clothing for added ventilation
d. apply sunscreen after exposure
3. A nurse is palpating a female clients breast. The
area of the breast in which tumors are commonly
found in the?
A. upper inner quadrant
b. lower inner quadrant
c. lower outer quadrant
d. upper outer quadrant
4. Which of the following statements would be correct
about pap smear?
A. it is recommended every other year
b. repeat every 3 years after 4 consecutive negative
results
c. it should be done at age 18 or earlier if sexually
active
d. colposcopy is needed after 4 negative results
5. What is the single most important risk factor for
cancer?
A. family history
b. lifestyle
c. age
d. menopause or hormonal events
6. Which of the following is an environmental factor of
cancer?
A. gender
b. air pollution
c. immunologic status
d. age
7. Kris is on the terminal stage of breast cancer. Her
doctor decided to perform an operation to lessen her
intractable pain. This operation is considered as:
a. reconstructive
b. curative
c. palliative
d. rehabilitative
8. Which of the following nursing interventions would
be most helpful in making the respiratory effort of a
client with metastatic lung cancer more efficient?
a. teaching the diaphragmatic breathing techniques
b. administering cough suppressants as ordered

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c. teaching and encouraging pursed lip breathing

d. placing the client in a low semi fowlers position
9. To manage possible nausea and vomiting, the nurse
should discuss,
a. eating frequent, small meals through out the day
b. eating three normal meals a day
c. eating only cool foods with no odor
d. limiting the amount of food intake
10. What are the common side effects of chemo and
radiation therapy?
A. stomatitis, nausea and vomiting, depression
B. stomatitis, loss of hair and anemia
C. fatigue, alopecia and bone marrow depression
D. dysphagia, anemia and fatigue
11. Common site of metastatic activity?
A. bone
B. brain
C. lungs
D. liver
12. What is the early sign of Cancer of the Larynx?
A. hoarseness of the voice
B. dysphagia
C. coughing
D. bloody sputum
13. Common type of lung cancer?
A. Small oat cell
B. Squamous
C. Large cell
D. adenocarcinoma
14. All of the following are considered early sign of
breast cancer EXCEPT?
A. bloody discharge
B. dimpling or peau d orange
C. tender lump
D. fixed lump
15. What is the early sign of Stomach Cancer?
A. Melena
B. Hematochezia
C. Vague fullness of the stomach
D. Ascites
16.
T1N2M1 means?
A. normal
B. stage I
C. stage III
D. stage IV
CANCER POST TEST
Matching Type
I. CA liver
a. mole
II. CA pancreas
b. painful adenopathy
III. Wilms
c. bone marrow
biopsy
IV. Hodgkins
d. kernicterus
V. Non Hodgkins e. painless adenopathy
VI. CA skin
f. increased ICP
VII. Leukemia
g. whipples procedure
h. no palpation
Set A Key Answers
CANCER POST TEST
Matching Type

I. CA liver
II. CA pancreas
III. Wilms
IV. Hodgkins
V. Non Hodgkins
VI. CA skin
VII. Leukemia

a. mole
b. painful adenopathy
c. bone marrow biopsy
d. kernicterus
e. painless adenopathy
f. increased ICP
g. whipples procedure
h. no palpation

Set A Key Answers

Set B
CANCER POST TEST
1. A client with nagging cough makes an appointment to
see the physician, after reading that this is one of 7
warning signals of cancer. What is another warning sign of
cancer?
A. rashes
B. nausea and vomiting
C. alopecia
D. dysphagia
CANCER POST TEST
2. Which type of cancer causes the most death in women?
A. breast
B. ovarian
C. lung
D. all of the above
3. To elicit more information regarding hoarseness of the
voice the nurse should ask which question?
A. do you eat high fats low fibers
B. do you strain your voice
C. do you smoke cigarettes
D. do you eat spicy foods
4. What is the most common adverse effect of
chemotherapy?
A. alopecia
B. stomatitis
C. nausea and vomiting
D. anemia
5. A client is receiving an internal radioactive implant and
discovers the implant in the bed linen, what should a
nurse do?
A. report to the physician at once
B. pick up with a long-handled forceps and put it in a lead
container
C. put the implant back in place using long handled
forceps
D. leave the room immediately and notify the radiation
department
6. Which of the following is likely to decrease pain of
stomatitis secondary to CHEMO?
A. recommend to discontinue therapy
B. provide a solution of hydrogen peroxide and water for
use as mouth rinse
C. monitor platelet count
D. check regularly for s/sx of stomatitis
7. The nurse instructs the client the diagnosis of breast
cancer is confirmed by?
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A. BSE breast self examination

B. mammography
C. FNAB fine needle aspiration biopsy
D. chest xray
8. For client newly diagnosed with radiation induced
thrombocytopenia, the nurse should include which specific
intervention?
A. bedrest must be encouraged
B. reverse isolation upon admission
C. check petechia every shift
D. all of the above
9. Risk for impaired skin integrity from external radiation
had been made, what will be your nursing intervention?
A. apply talcum powder on the site
B. remove tumor skin marking after radiation
C. wear protective gears when giving direct care
D. avoid use of soap on the irradiated areas
10. Which of the following organs is an occasional site of
metastasis activity?
A. liver
B. colon
C. lungs
D. brain
E. bones
Set B Key Answers
1. D
2. C
3. C
4. C
5. B
6. B
7. C
8. C
9. D
10. B