ONCOLOGY:

NURSING MANAGEMENT
IN CANCER CARE
 ONCOLOGY
It is a branch of medicine that
deals with the study, detection,
treatment and management of
cancer.

Therefore, an oncology nurse is a

nurse who specializes in treating and
caring for people who have cancer.
 CANCER

• abnormal growth that is

characterized by a continuing,
purposeless, unwanted, uncontrolled
and damaging growth of cells that
differ structurally and functionally
from the normal cells from which
they developed.
CANCER is a group of
distinct diseases with
different causes,
manifestations,
treatment and
prognoses.
 Learning Objectives
• Compare the structure and function of the normal cell
and the cancer cell.
• Differentiate between benign and malignant tumors.
• Identify agents and factors that have been found to be
carcinogenic.
• Describe the significance of health education and
preventive care in decreasing the incidence of cancer.
• Differentiate among the purposes of surgical procedures
used in cancer treatment, diagnosis, prophylaxis,
palliation, and reconstruction.
• Describe the roles of surgery, radiation therapy,
chemotherapy, targeted therapy, and other therapies in
treating cancer.
• A large group of diseases
characterized by:
-uncontrolled growth & spread of
abnormal cells,
-proliferation (rapid reproduction by cell
division),
-metastasis (spread or transfer of cancer
cells from one organ or part to
another not directly connected).
Normal
cell division

Cell suicide or Apoptosis

Cancer
cell division
 CHARACTERISTICS OF CHARACTERISTIC OF
NORMAL CELLS CANCER CELLS

• HAVE LIMITED CELL ▪ HAVE RAPID OR

DIVISION. CONTINUOUS CELL DIVISION.
NORMAL CELLS DIVIDE FOR
ONE OF TWO REASONS:
A. to develop normal tissue
B. to replace lost or damaged
normal tissue
• UNDERGO APOPTOSIS. ▪DO NOT RESPOND TO
SIGNALS FOR APOPTOSIS.
NORMAL CELLS HAVE A FINITE
LIFE SPAN.THE PURPOSE OF
APOPTOSIS IS TO ENSURE
THAT EACH ORGAN HAS
ADEQUATE NUMBER OF CELLS
AT THEIR FUNCTIONAL PEAK
 CHARACTERISTICS OF
NORMAL CELLS
• SHOW SPECIFIC MORPHOLOGY.
EACH NORMAL CELL TYPE HAS A
DISTINCT AND RECOGNIZABLE
APPEARANCE, SIZE AND SHAPE
• HAVE A SMALL NUCLEAR-
CYTOPLASMIC RATIO.
NUCLEUS IS SMALL COMPARED
WITH THE SIZE OF THE REST OF
THE CELL, INCLUDING THE
CYTOPLASM
• PERFORM SPECIFIC
DIFFERENTIATED FUNCTIONS
CHARACTERISTIC OF
CANCER CELLS
▪ SHOW ANAPLASTIC
MORPHOLOGY.
CELLS LOSE THE
APPEARANCE OF THEIR
PARENT CELLS
▪HAVE LARGE N:C RATIO
▪ LOSE SOME OR ALL
DIFFERENTIATED FUNCTION.
CANCER CELLS SERVE NO
USEFUL PURPOSE
 CHARACTERISTICS OF CHARACTERISTIC OF
NORMAL CELLS CANCER CELLS

• ADHERE TIGHTLY ▪ ADHERE LOOSELY

TOGETHER TOGETHER
• NON-MIGRATORY ▪ ARE ABLE TO MIGRATE
• GROW IN AN ORDERLY ▪ GROW BY INVASION
AND WELL-REGULATED
MANNER
▪ ARE NOT CONTACT-
• ARE CONTACT INHIBITED INHIBITED
EACH CELL DIVIDES ONLY
WHEN SOME OF ITS SURFACE
IS NOT IN DIRECT CONTACT
WITH ANOTHER CELL

• ARE EUPLOID ▪ARE ANEUPLOID

HUMAN CELLS HAVE 23 PAIRS
OF CHROMOSOMES
 Example of Normal Growth

Dead cells shed

from outer surface

Epidermis

Dividing cells
in basal layer Dermis
 Beginning of the Tumors
Cancerous Growth (Neoplasms)

underlying
tissue
Invasion & Metastasis

1. Cancer cells
invade surrounding
tissues and blood vessels

2. Cancer cells are

transported by the
circulatory system
in distant sites

3. Cancer cells
reinvade and grow
at new location
 PREFIX/SUFFIX
• Neo- new
• Plasia- growth
• Plasm- substance
• Trophy- size
• +Oma- tumor
• Statis- location
• A- none
• Ana- lack
• Hyper- excessive
• Meta- change
• Dys- bad
• HYPERTROPHY- increase in the size of cells
• HYPERPLASIA- increase in the number of cells
(most often associated with periods of rapid
body growth)
• METAPLASIA - conversion of one type of cell
in a tissue to another type not normal for
that tissue
• DYSPLASIA – bizarre cell growth resulting in
cells that differ in size, shape or arrangement
from other cells of the same type of tissue
(pre-cancer)
CARCINOMA-IN-SITU=cancerous in appearance,
but has not penetrated or invaded deeper into the
underlying tissue
• ANAPLASIA

-cells that lack normal

cellular characteristics
and differ in shape and
organization with
respect to their cells of
origin

-anaplastic cells are

usually malignant
(advanced cancer)
• NEOPLASIA- uncontrolled cell growth that
follows no physiologic demand
(tumor growth)
 Types of Neoplasia
BENIGN
• Well-differentiated
• Slow growth
• Encapsulated
• Non-invasive
• Does NOT
metastasize
 Types of Neoplasia
MALIGNANT
• Undifferentiated
• Erratic and
Uncontrolled
Growth
• Expansive and
Invasive
• Secretes
abnormal proteins
• METASTASIZES
BENIGN TUMORS
MALIGNANT TUMORS
 Types of Neoplasia
BORDERLINE/ IN SITU
- “in its place”
- a tumor that grows only in a
specific area (e.g. Bowen’s
disease- is a very early form of skin cancer
that's easily treatable. The main sign is a red, scaly
patch on the skin. It affects the squamous cells,
which are in the outermost layer of skin, and is
sometimes referred to as squamous cell carcinoma in
situ.
AGE IS THE MOST OUTSTANDING
RISK FACTOR FOR CANCER.

Cancer incidence increases

progressively with age.
Approximately 77% of people
diagnosed with cancer are over age
55.
UK: Regions of Highest Incidence
Lung
cancer

JAPAN:
Stomach
cancer
CANADA:
Leukemia

US:
CHINA:
Colon
Liver
cancer
cancer
BRAZIL:
Cervical
cancer
AUSTRALIA:
Skin
cancer
 Etiology or Causes of CANCER

Some viruses or bacteria

Physical
Some
agents like
chemicals
radiation

Heredity
Diet
Hormones
Some Viruses Associated
with Human Cancer
Bacteria and Stomach Cancer

Patient’s H. pylori
tissue sample
 Tobacco Use and Cancer

Some Cancer-Causing Chemicals

in Tobacco Smoke
 High-Strength Radiation

High

Leukemia
Incidence

Low
Least Most

X-ray dose
(atomic radiation)
Heredity Can Affect Many Types of Cancer

Inherited Conditions That

Increase Risk for Cancer
DIETARY FACTORS- fats, alcohol,
salt-cured or smoked meats, nitrites
and nitrate- containing foods, high
calorie diet
HORMONAL AGENTS- oral
contraceptive pills and prolonged
estrogen replacement therapy
increases the risk for liver and breast
cancers;
 ABNORMAL CELL FORMED BY
MUTATION OF DNA

CELL GROWS AND PROLIFERATES

METASTASIS OCCURS WHEN

ABN. CELLS INVADE OTHER TISSUE,
THROUGH LYMPH AND BLOOD
 =process of transforming normal cells into
malignant cells; a 3-step cellular process

1. INITIATION- anything that can

penetrate a cell, get into the nucleus,
and damage the DNA can damage the
genes and become “initiators”.
These initiators are called “ carcinogens”
and may be chemicals, physical agents
or viruses.
Initiation, results from an irreversible genetic alteration, most
likely one or more simple mutations, transversions, transitions,
and/or small deletions in DNA.
 2. PROMOTION- enhancement of the
cellular changes that occurred during
INITIATION
The reversible stage of promotion does not involve changes in the
structure of DNA but rather in the expression of the genome
mediated through promoter-receptor interactions.
• Latency period- time between a cell’s initiation
and the development of an overt tumor; may
range from months to years
• PROMOTER – potentiates the effects of the
initiator; may be hormones, drugs or
chemicals
3. PROGRESSION- changes that a cancer
cell undergoes to make it more
malignant & malignant tumor grows in
size, becomes anaplastic and less
differentiated
The final irreversible stage of progression is characterized by
karyotypic instability and malignant growth.

• Tumor Angiogenesis Factor(TAF)-

triggers capillaries and other blood
vessels in the area to grow new
branches into the tumor for continued
nourishment
=(4.)METASTASIS
Spread of malignant tumor to other
location by penetrating into the
lymph vessels circulating throughout
the body
Considered 2nd cancer
IMMUNE SYSTEM & CANCER
“All cancer is the result of an
immune system that didn’t
destroy mutant cells”
Immune system destroys
“10,000″ mutated (cancer)
cells every day.
When defense ceases cancer
multiplies becomes cancer.
Cause of the distress to the immune
system:

FOOD => ENZYMES destroyed by

COOKING =>
PANCREAS doubles it’s size in trying to
keep up with the demand =>
EXHAUSTION => compromised
immune system => vulnerable
climate to the formation of CANCER
GENETICS & CANCER
AUTOSOMAL
DOMINANT
CONDITION

50% chance of
having a child
(male or female)
who will also have
the condition
GENETICS & CANCER
AUTOSOMAL
RECESSIVE
CONDITION
one gene in the pair
changed, not
expected to have
signs or symptoms
(CARRIER)
25% chances of
having a child with
the condition
X-LINKED RECESSIVE
Female = carrier
Since a male has only
one X chromosome,
he has only one
copy of each gene
on that
chromosome.
Therefore, if one of the
genes on his X
chromosome has a
mutation, he will
have whatever
condition is
associated with that
mistake
• ROLE OF THE NURSE IS TO ASSIST
PATIENTS TO AVOID KNOWN
CARCINOGENS AND TO HELP THEM
ADOPT DIETARY AND LIFESTYLE
CHANGES
• eat more vegetables
• increase fiber intake
• increase intake of vitamin a to reduce risk
for esophageal, laryngeal and lung cancer
• increase intake of foods rich in vitamin c
to protect against stomach and esophageal
cancer
• practice weight control because obesity
is linked to cancers of the uterus, gall
bladder, breast and colon
• reduce fat intake
• avoid nitrate-cured, smoked and salt-
cured foods
• stop smoking
• reduce alcohol intake to reduce the risk
of liver cancer
• avoid overexposure to the sun, wear
protective clothing, and use a sunscreen
• REGULAR SCREENING FOR CANCER
DOES NOT REDUCE CANCER
INCIDENCE BUT CAN GREATLY
REDUCE SOME TYPES OF CANCER
DEATHS
• yearly mammography for women older
than 40 years old
• yearly clinical breast exam for women
older than 40 years
• breast self exam every month for women
20-39 years old
• colonoscopy at age 50 years and then
every 10 years
• yearly fecal occult blood in adults of all
ages
• yearly prostate specific antigen (psa) test
and digital rectal examination for men
over age 50
• yearly pap smear and pelvic exam for
women 18 years and up
• CHANGES IN BOWEL OR BLADDER HABITS
• A SORE THAT DOES NOT HEAL
• UNUSUAL BLEEDING OR DISCHARGE
• THICKENING OR LUMP IN THE BREAST OR
ELSEWHERE
• INDIGESTION OR DIFFICULTY SWALLOWING
• OBVIOUS CHANGE IN A WART OR MOLE
• NAGGING COUGH OR HOARSENESS

• UNEXPLAINED ANEMIA
• SUDDEN UNEXPLAINED WEIGHT LOSS
CLASSIFICATION OF CANCER
According to Behavior of Tumor

•BENIGN - tumors that cannot spread by

invasion or metastasis; hence, they only
grow locally

•MALIGNANT - tumors that are capable of

spreading by invasion and metastasis. By
definition, the term“cancer” applies only
to malignant tumors
• ASK CLIENT FOR SYMPTOMS AND
SIGNS
• LOOK FOR BRUISING, PALPATE FOR
MASSES
• USUALLY PERFORMED TO OBTAIN A
TISSUE SAMPLE FOR ANALYSIS OF
CELLS SUSPECTED TO BE
MALIGNANT

• IN MOST INSTANCES, IT IS TAKEN

FROM THE ACTUAL TUMOR
A. EXCISIONAL BIOPSY

-MOST FREQUENTLY USED FOR

EASILY ACCESSIBLE TUMORS OF THE
SKIN, BREAST, UPPER AND LOWER
GIT AND UPPER RESPIRATORY TRACT.
B. INCISIONAL BIOPSY

-PERFORMED IF THE TUMOR MASS IS

TOO LARGE TO BE REMOVED.

-JUST A WEDGE OF TISSUE FROM THE

TUMOR IS REMOVED FOR ANALYSIS.
Picture of scrotal ulcer showing everted
edges, peno-scrotal warts
C. NEEDLE BIOPSY

- PERFORMED TO SAMPLE
SUSPICIOUS MASSES THAT ARE
EASILY ACCESSIBLE.

-INVOLVES ASPIRATING TISSUE

FRAGMENTS THROUGH A NEEDLE.
• Magnetic Resonance Imaging (MRI)
• Computed Tomography Scan (CT scan)
• Ultrasound
• DIRECT VISUALIZATION OF A BODY
CAVITY OR PASSAGEWAY BY
INSERTION OF AN ENDOSCOPE INTO
A BODY CAVITY OR OPENING;
CANCER MANAGEMENT MAY RANGE FROM:

1. CURE
-COMPLETE ERADICATION OF MALIGNANT
DISEASE
2. CONTROL
-PROLONGED SURVIVAL AND
CONTAINMENT OF CANCER CELL GROWTH
3. PALLIATION
-RELIEF OF SYMPTOMS ASSOC. WITH
CANCER
1. SURGERY AS A PRIMARY
TREATMENT
– THE GOAL IS TO REMOVE THE
ENTIRE TUMOR OR AS MUCH AS IS
FEASIBLE AND ANY INVOLVED
SURROUNDING TISSUE, INCLUDING
REGIONAL LYMPH NODES
• TWO COMMON SURGICAL
APPROACHES:
A. LOCAL EXCISION – WARRANTED
WHEN THE MASS IS SMALL
 Surgical Management Of A
Dermatofibrosarcoma Protuberance Of The Face

Dermatofibrosarcoma protuberans (DFSP) is a

rare variety of mesenchymal tumor arising from
dermis. It is locally aggressive and highly
recurrent malignant neoplasm.
 managed by wide local excision with a single
stage reconstruction using local rotational flaps
post operative result (right eye had to be sacrificed)
B. RADICAL EXCISION

-REMOVAL OF THE PRIMARY TUMOR,

LYMPH NODES, ADJACENT INVOLVED
STRUCTURES AND SURROUNDING
TISSUES THAT MAY BE AT HIGH RISK
FOR TUMOR SPREAD
-MAY RESULT IN DISFIGUREMENT
AND ALTERED FUNCTIONING
2. PROPHYLACTIC SURGERY

-REMOVING NON- VITAL TISSUES OR

ORGANS THAT ARE LIKELY TO
DEVELOP CANCER

-EX. PROPHYLACTIC MASTECTOMY

3. PALLIATIVE SURGERY
-IF THE CANCER HAS SPREAD TOO FAR TO
BE COMPLETELY REMOVED, ANY
SURGERY BEING CONSIDERED WOULD
BE PALLIATIVE (INTENDED TO RELIEVE
OR PREVENT SYMPTOMS)
-EX. CANCER OF THE PANCREAS
(blockage of the bile ducts or the intestine)
❖Surgical biliary bypass: If cancer is blocking the
small intestine and bile is building up in the
gallbladder, a biliary bypass may be done.

=During this operation, the doctor will cut the

gallbladder or bile duct and sew it to the small
intestine to create a new pathway around the
blocked area.
4. RECONSTRUCTIVE SURGERY

-MAY FOLLOW CURATIVE OR RADICAL

SURGERY IN AN ATTEMPT TO IMPROVE
FUNCTION OR OBTAIN A DESIRABLE
COSMETIC EFFECT

-USUALLY FOR BREAST, HEAD, NECK

AND SKIN CANCERS
• USE OF IONIZING RADIATION TO
INTERRUPT CELLULAR GROWTH.

• IT BREAKS THE STRANDS OF THE DNA

HELIX, LEADING TO CELL DEATH.

• MAY BE USED TO CONTROL MALIGNANT

DISEASE WHEN A TUMOR CAN NOT BE
REMOVED SURGICALLY OR WHEN LOCAL
METASTASIS TO THE LYMPH NODES IS
PRESENT
• BODY TISSUES THAT UNDERGO
FREQUENT CELL DIVISION ARE
MOST SENSITIVE TO RADIATION
THERAPY
• TISSUES THAT ARE MOST SENSITIVE TO
RADIATION THERAPY:

-BONE MARROW
-SKIN
-MUCOUS MEMBRANES
-HAIR CELLS
-GONADS
-LYMPHATIC TISSUE
-EPITHELIUM OF THE GIT
A. EXTERNAL RADIATION- USE X RAYS
AND GAMMA RAYS (COBALT)
B. INTERNAL RADIATION (BRACHYTHERAPY)
- INTERNAL RADIATION IMPLANTATION
- DELIVERS A HIGH DOSE OF RADIATION TO A
LOCALIZED AREA.
- CAN BE IMPLANTED BY MEANS OF NEEDLES,
SEEDS, BEADS OR CATHETERS INTO BODY
CAVITIES LIKE VAGINA, ABDOMEN, PLEURA
OR INTERSTITIAL COMPARTMENTS LIKE THE
BREAST.
PRECAUTIONS FOR CLIENTS
UNDERGOING BRACHYTHERAPY:

1. ASSIGN THE CLIENT TO A PRIVATE

ROOM
2. POSTING APPROPRIATE NOTICES
ABOUT RADIATION THERAPY
PRECAUTIONS
3. PREGNANT STAFF MEMBERS ARE
PROHIBITED TO ATTEND TO THESE
CLIENTS
4. PROHIBIT VISITS BY CHILDREN OR
PREGNANT VISITORS
5. LIMIT VISITS FROM OTHERS TO 30
MINUTES DAILY
6. MAKE VISITORS MAINTAIN A 6 –
FOOT DISTANCE FROM THE
RADIATIONS SOURCE
• 2 SYSTEMIC SIDE EFFECTS OF RADIATION
THERAPY:
1. FATIGUE
-RELATED TO THE INCREASED ENERGY
DEMANDS NEEDED TO REPAIR DAMAGED
CELLS
-TEACH TO CONSERVE ENERGY BY
PRIORITIZING ACTIVITIES
2. ALTERED TASTE SENSATIONS
-CAUSED BY METABOLITES RELEASED
FROM DEAD AND DYING CELLS; MOST
CLIENTS WOULD HAVE AVERSION TO THE
TASTE OF RED MEATS
OTHER SIDE EFFECT MAY INCLUDE:

•MILD SKIN PROBLEMS AT THE

RADIATION SITE (REDNESS)

•NAUSEA & VOMITING

Ex. Radiation to the throat and upper
chest can cause difficulty in swallowing
(dysphagia) + burning and tightness in
the chest = esophagitis

Damage to the salivary glands may

also happen and would cause dry mouth
= xerostomia

Stomatitis can be relieved may be

relieved by using ice cold liquids such as
tea or cola to relieve discomfort
• ANTINEOPLASTIC AGENTS ARE USED IN
AN ATTEMPT TO DESTROY TUMOR CELLS
BY INTERFERING WITH CELLULAR
FUNCTIONS AND REPRODUCTION.

• PRIMARILY USED TO TREAT SYSTEMIC

DISEASE RATHER THAN LESIONS THAT
ARE LOCALIZED AND CAN BE REMOVED
BY SURGERY
• EACH TIME A TUMOR IS EXPOSED TO A
CHEMOTHERAPEUTIC AGENT, 20%-99%
OF THE TUMOR CELLS IS DESTROYED.

• NORMAL CELLS MOST AFFECTED BY

CHEMO ARE THOSE THAT DIVIDE
RAPIDLY.

• REPEATED DOSES ARE NECESSARY OVER

A PROLONGED PERIOD TO ACHIEVE
REGRESSION OF THE TUMOR
• MAY BE ADMINISTERED IN THE
HOSPITAL, CLINIC OR HOME
SETTING BY TOPICAL, ORAL, IV, IM,
SC, ARTERIAL or INTRACAVITARY

• BUSULFAN, CISPLATIN,
METHOTREXATE, BLEOMYCIN,
DOXORUBICIN,VINCRISTINE
• SIDE EFFECTS OF CHEMOTHERAPY:
1. ALOPECIA / HAIR LOSS
-Reassure clients that hair loss is
temporary.
-Hair regrowth usually begins
about 1 month after
completion of chemo
-New hair may differ from
the original hair color,
texture and thickness
-Assist clients in selecting a type
of head covering. Clients can
disguise hair loss with wigs,
caps, scarves, and turbans
 2. NAUSEA AND VOMITING
- May persist for up to 24 hours after
administration
- Rx: antiemetics, relaxation
techniques, imagery, altering diet
3. MYELOSUPPRESSION
(DEPRESSION OF BONE MARROW
FUNCTION)
- Reduces the circulating number of:
➢ leukocytes especially neutrophils
(neutropenia) which causes
immunosuppression
➢ erythrocytes (anemia) causes client
to feel fatigued, some tissues are
hypoxic
➢ platelets (thrombocytopenia) causes
risk for excessive bleeding
 4. MUCOSITIS / SORES IN MUCOUS
MEMBRANE
- May involve the entire GI tract
especially in the mouth (stomatitis)
- Rx: good, frequent oral hygiene; use
of soft-bristled toothbrush or
disposable mouth sponges(also have
risk for bleeding); no dental floss &
water pressure gum cleaners ; avoid
mouthwashes that contain alcohol;
rinse mouth with plain water or
saline
 5. KIDNEY DAMAGE
- Rapid tumor cell lysis after chemo
results in increased urinary excretion
of uric acid causing renal damage
6. CARDIOPULMONARY EFFECTS
- Cardiac toxicities and toxic effects on
lung function
7. REPRODUCTIVE SYSTEM EFFECTS
- Early menopause; permanent
sterility
- Rx: sperm banking
8. NEUROLOGIC DAMAGE
- Peripheral neuropathies; loss of DTRs
& paralytic ileus may occur