Cancer

OUTLINE
Assessment
Pathophysiology
Medical

and Surgical Management

Nursing management
Behavioral management/ Health
Teaching

Oncology defined
Branch

of medicine that deals with the

study, detection, treatment and
management of cancer and neoplasia

What is Cancer?
CANCER

is a complex of diseases which

occurs when normal cells mutate into
abnormal cells that take over normal
tissue, eventually harming and
destroying the host.

Incidence and Prevalence

2nd

leading cause of death

1 out 3 persons will be affected by
cancer sometime in their lifetime
Cancer of lung leading cause of cancer
deaths in both men and women
Cancer of colon 2nd largest incidence
Breast and prostate highest gender
incidence

Cancer
A large group of diseases characterized
by:
Uncontrolled growth and 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 Versus Malignant cell

Characteristics
NORMAL
Limited

cell division
Undergo apoptosis
Controlled growth
Well differentiated
Adhere tightly
together
Contact inhibited
Euploid

MALIGNANT
Rapidly dividing/
multiplying
Do not undergo apoptosis
Uncontrolled growth
Anaplastic morphology
Adhere loosely together
Able to move/
metastasize
Aneuploid

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

ASSESSMENT
Nursing History
Health History chief complaint and
history of present illness (onset, course,
duration, location, precipitating and
alleviating factors)
Cancer signs: CAUTION US!

Warning Signs of
Cancer
CAUTION US!
Change in bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge
Thickenings or lumps
Indigestion or difficulty in swallowing
Obvious change in a wart or mole
Nagging or persistent cough or hoarseness
Unexplained anemia
Sudden unexplained weight loss

Change in bowel or bladder habits

A person with colon cancer may have
diarrhea or constipation, or he may
notice that the stool has become
smaller in diameter
A person with bladder or kidney cancer

A sore that does not heal

Small, scaly patches on the skin that
bleed or do not heal may be a sign of
skin cancer
A sore in the mouth that does not heal
can indicate oral cancer

 Unusual bleeding or discharge

Blood in the stool is often the first sign
of colon cancer
Similarly, blood in the urine is usually
the first sign of bladder or kidney cancer
Postmenopausal bleeding (bleeding
after menopause) may be a sign of
uterine cancer

 Thickenings or lumps
Enlargement of the lymph nodes or
glands (such as the thyroid gland) can
be an early sign of cancer
Breast and testicular cancers may also
present as a lump

 Indigestion or difficulty in
swallowing
Cancers of the digestive system,
including those of the esophagus,
stomach, and pancreas, may cause
indigestion, heartburn, or difficulty
swallowing

 Obvious change in a wart or mole

Moles or other skin lesions that change
in shape, size, or color should be
reported

 Nagging or persistent cough or

hoarseness
Cancers of the respiratory tract,
including lung cancer and laryngeal
cancer, may cause a cough that does
not go away or a hoarse (rough) voice

 Unexplained anemia
Sudden unexplained weight loss

Physical Assessment
Inspection skin and mucus membranes for
lesions, bleeding, petechiae, and irritation
Assess stools, urine, sputum, vomitus for acute or
occult bleeding
Scalp noting hair texture and hair loss
Palpation
Abdomen for any masses, bulges or abnormalities
Lymph nodes for enlargement
Auscultation of lung sounds, heart sounds
and bowel sounds

Tumor Staging and Grading

Staging determines size of tumor and
existence of metastasis
Grading classifies tumor cells by type of
tissue
The TNM system is based on the extent
of the tumor (T), the extent of spread
to the lymph nodes (N), and the
presence of metastasis (M).

Primary Tumor (T)

TX - Primary tumor cannot be evaluated
T0 - No evidence of primary tumor
Tis - Carcinoma in situ (early cancer that
has not spread to neighboring
tissue)
T1, T2, T3, T4 - Size and/or extent of the
primary tumor

Regional Lymph Nodes (N)

NX - Regional lymph nodes cannot be
evaluated
N0 - No regional lymph node involvement
(no cancer found in the lymph nodes)
N1, N2, N3 - Involvement of regional
lymph nodes (number and/or extent of
spread)

Distant Metastasis (M)

MX - Distant metastasis cannot be
evaluated
M0 - No distant metastasis (cancer has
not spread to other parts of the body)
M1 - Distant metastasis (cancer has
spread to distant parts of the body)

PATHOPHYSI
OLOGY

MEDICAL AND SURGICAL

MANAGEMENT OF
CANCER

Surgery is the
removal of the tumor
and surrounding
tissue during an
operation.
Surgery is the oldest
type of cancer therapy
and remains an
effective treatment for
many types of cancer
today

GOALS OF SURGERY
to remove all or some of the cancerous
tissue after diagnosis
it can also be used to diagnose cancer
find out where the cancer is located
whether it has spread, and whether it is
affecting the functions of other organs in
the body
to restore the body's appearance or
function or to relieve side effects.

TYPES OF CONVENTIONAL
SURGERY
DIAGNOSTIC
biopsy is the only way to make a definitive
diagnosis
2 main types of surgical biopsies
incisional biopsy - removal of a piece of the
suspicious area for examination
excisional biopsy - removal of the entire
suspicious area, such as an unusual mole or a
lump

STAGING
to find out the size of the tumor and if or
where it has spread
this often includes removing some lymph
nodes, which are tiny, bean-shaped organs
that help fight infection, near the cancer to
find out if it has spread there

TUMOR REMOVAL (curative or

primary surgery)
most common type of cancer surgery
may be the only treatment, or it may be
combined with chemotherapy, radiation
therapy, or other treatments, which may
be given before or after surgery

DEBULKING
When the complete removal of a tumor is not
possible or might cause excessive damage to the
body, surgery is used to remove as much of the
tumor as possible
PALLIATION
used to relieve side effects caused by a tumor
may be used to help relieve pain or restore
physical function if a tumor presses on the
affected site
may be used to help stop bleeding
used to insert a feeding tube or tubes that deliver
medications
used to prevent broken bones

RECONSTRUCTION
reconstructive or plastic surgery
may be an option to restore the body's
appearance or function.
PREVENTION
performed to reduce the risk of developing
cancer

TYPES OF MINIMALLY
INVASIVE SURGERY
LAPAROSCOPIC SURGERY.
doctor performs surgery through small incisions
in the skin using a thin, lighted tube with a
camera.
LASER SURGERY
uses a narrow beam of high-intensity light to
remove cancerous tissue.
CRYOSURGERY
uses liquid nitrogen to freeze and kill abnormal
cells.

MOHS MICROGRAPHIC
SURGERY
also called microscopically
controlled surgery
shaves off a skin cancer, one layer
at a time, until all cells in a layer
appear to be normal cells when
viewed under a microscope.
ENDOSCOPY
inserts a thin, flexible tube with a
light and camera on the tip, called
an endoscope, into an opening of
the body (such as the mouth,
rectum, or vagina) to examine the
internal organs.

CHEMOTHERAPY
Chemotherapy is the use of drugs to kill
cancer cells.
Because cancer cells generally grow and
divide faster than normal cells, they are
more susceptible to the action of these
drugs.
damage to healthy cells is unavoidable,
and this damage accounts for the side
effects linked to these drugs.

Uses of traditional
chemotherapy
Chemotherapy is often used as an
adjuvant treatment (treatment given after
surgery or radiation therapy) to kill any
cancer cells that remain.
It may also be used as neoadjuvant
therapy (treatment given before surgery or
radiation therapy to shrink tumors).

Goals of chemotherapy
to eliminate cancer cells and prevent
recurrence.
used to control the cancer by slowing its
growth and/or to reduce symptoms
caused by the cancer (called palliative
therapy).

Many of the traditional chemotherapy drugs

cannot be given every day without causing
serious side effects.
they are usually given intermittently, with
periods of treatment followed by periods of
recovery. This allows healthy (noncancerous)
cells time to heal.
For some cancers, it may be beneficial to use a
dose-dense schedule, meaning there is less
recovery time between treatment cycles.
Although this can improve the effectiveness of
the chemotherapy for some types of cancer, it
also increases the risk of side effects.

Ways of receiving
chemotherapy
Intravenously (IV)
Orally
As an injection
Intra-arterially (IA)
Intraperitoneally
Topically

Other types of drug treatment

for cancer
Hormone therapy
These treatments change the amount of
hormones (natural chemicals that
circulate in the bloodstream and regulate
the activity of certain cells or organs) in
the body, which helps because several
types of cancerincluding some breast
and prostate cancerscan only grow and
spread when certain hormones are
present.

Targeted therapy
These treatments target specific genes,
proteins, or the tissue environment that
contributes to cancer growth and survival.
As a result, this type of treatment blocks
the growth and spread of cancer cells while
limiting damage to normal cells.

Immunotherapy
This type of treatment is designed to boost
the body's natural defenses to fight the
cancer. It uses materials made either by
the body or in a laboratory to bolster,
target, or restore immune system function.

Common side effects of chemotherapy

Fatigue
Pain
Sores in mouth and throat
Diarrhea
Nausea and vomiting
Constipation
Blood disorders
Nervous system effects
Changes in thinking and memory
Sexual and reproductive issues
Appetite loss
Hair loss
Long Term side effects

Radiation as therapy
The goal of this treatment is to destroy
cancer cells without harming nearby
healthy tissue
Radiation therapy may be used as the
main treatment or as an adjuvant therapy
can also be used to shrink tumors and
reduce pressure, pain, and other
symptoms of cancer (called palliative
radiation therapy) when it is not possible
to completely eliminate the disease.

Types of radiation therapy

External-beam radiation therapy
most common type of radiation treatment,
and it involves giving radiation from a
machine located outside the body
Internal radiation therapy
also known as brachytherapy, involves
placing radioactive material into the
cancer itself or into the tissue surrounding
it.

Other treatment options

Intraoperative

radiation therapy

(IORT)
Systemic radiation therapy
Radioimmunotherapy
Radiosensitizers and radioprotectors

Site-specific side effects

Head and neck
Chest
Stomach and abdomen
Pelvis

Nursing management on patients with

cancer


Support adaptation and
independence.

Express feelings freely.

Demonstrate individual involvement in problem-solving process
directed at appropriate solutions for the situation.
Encourage and allow member who is ill to handle situation in
own way.
Display appropriate range of feelings and lessened fear.
Appear relaxed and report anxiety is reduced to a manageable
level.
Begin to develop coping mechanisms to deal effectively with
problems.
Demonstrate adaptation to changes/events that have occurred
as evidenced by setting of realistic goals and active participation
in work/play/personal relationships as appropriate.

Promote comfort.
Report maximal pain
relief/control with minimal
interference with ADLs.
Follow prescribed
pharmacological regimen.
Demonstrate use of relaxation
skills and diversional activities
as indicated for individual
situation.

Maintain optimal physiological functioning.

Report improved sense of energy.
Perform ADLs and participate in desired activities at
level of ability.
Demonstrate stable weight/progressive weight gain
toward goal with normalization of laboratory values
and be free of signs of malnutrition.
Verbalize understanding of individual interferences
to adequate intake.
Participate in specific interventions to stimulate
appetite/increase dietary intake.

Prevent complications.
Display adequate fluid balance as
evidenced by stable vital signs, moist
mucous membranes, good skin turgor,
prompt capillary refill, and individually
adequate urinary output.
Remain afebrile and achieve timely
healing as appropriate.
Identify and participate in interventions
to prevent/reduce risk of infection.
Participate in techniques to prevent
complications/promote healing as
appropriate.

Provide information about disease

process/condition, prognosis, and treatment needs.

Verbalize understanding of body changes,

acceptance of self in situation.
Inform every procedure needed, the disease
itsled, current condition, and the results of every
treatment.
Demonstrate use of effective coping mechanisms
and active participation in treatment regimen.

Behavioral
Management and
Health Teaching

Behavioral Management
Behavioral therapy is a treatment that helps
change potentially self-destructing behaviors.
It is also calledbehavioral
modificationorcognitive behavioral
therapy.
This helps you cope with difficult situations. It
is most often used to treat anxiety.
Therapy is also used on patients with chronic
diseases to help manage pain.
The general benefit is increased quality of life

Benefits include:
better functioning in unfamiliar situations
improved emotional expressions
less outbursts
better pain management
ability to recognize the need for medical help

 The risks for this treatment are

minimal. Some patients consider the
emotional aspects of the sessions risky.
Exploring feelings and anxieties can
cause bursts of crying and anger. The
emotional aftermath of therapy can be
physically exhausting and painful.
A therapist will help to improve coping
mechanisms and to minimize any side
effects from therapy.

 Contingency management
involves the use of rewards (prizes, treats,
and/or special events) to increase the
patient's adherence to the treatment
regimen.
It has been used most frequently on
pediatric cancer patients to encourage their
cooperation.

 Cognitive/Attentional
distraction
This distraction method is used to control
nausea and acute pain/distress.
It involves engaging the patient in highly
interesting (i.e., absorbing) activities during
invasive procedures.
Symptoms are controlled while the patient's
attention is focused on the distraction task,
but they return immediately if the patient's
focus is lost.

 Hypnosis/Distracting
Imagery
Defined as a relatively simple process in
which the patient learns to focus attention
on thoughts or images unrelated to the
source of distress.
While the patient is relaxed through
meditation-like excursions to pleasant
locations/activities, the clinician introduces
suggestions of calm and well-being.
With children, such imaginative
involvement is often gained through
storytelling.

 Systematic Desensitization
This method is used to alter patients'
aversive reactions to stimuli associated with
treatment (e.g., anxiety and nausea upon
seeing a chemotherapy nurse).
It involves gradually introducing feared
stimuli/events in a hierarchical manner,
beginning with the least feared stimuli and
progressing to the most feared.
This exposure is carried out across
individual sessions with the patient calm
and relaxed.

 Exposure to feared stimuli/events can be in

vivo (actual re-exposure to the feared stimuli
while the patient is in a state of relaxation) or
imaginal (exposure to verbal descriptions of
the feared stimuli or situations).
Fears gradually diminish with repeated
exposure in this carefully programmed
manner.

 Relaxation training
The goal of relaxation training is to teach
the patient how to establish a state of deep
relaxation, which has been shown to reduce
pain and anxiety and to facilitate distraction
.
During training with a clinician or via an
audio-tape recording, the patient learns to
focus on soothing images, to tense and
release muscles, and/or to breath deeply

 Cognitive Restructuring
This method involves the patient and
clinician reviewing thoughts, feelings, and
beliefs about medical treatment/procedures
in order to identify those that elicit fear and
distress.
The patient is then encouraged to consider
other ways of viewing the fearful event(s)
that might help reduce feelings of distress
and anxiety.

 Modeling
This method involves the use of in vivo or
videotape demonstrations of successful
coping during invasive diagnostic/treatment
procedures to teach behavioral coping
skills.
It is most commonly used with children.

Health Teaching
Continual reinforcement throughout
the treatment course
Teaching Patients Self-Care
Reiterating side effects of
medications
Technologic advances
Follow-up visits
Referral for home care