Nursing Oncology

Oncology
By:
Ruby Ruth T. Roces, R.N., M.D.
Oncology defined
 It is a branch of medicine that
deals with the study, detection,
treatment and management of
cancer
glossary
 Neoplasia-uncontrolled cell growth that
follows no physiologic demand
 Anaplasia-cells that lack normal cellular
characteristics and differ in shape and

organization
 Metaplasia-conversion of one type of
mature cell into another; reversible

 Dysplasia-bizarre cell growth resulting in
cells that differ in size, shape or
arrangement from other cells of the same
type.
 Hypoplasia-incomplete or
underdevelopment w/ decreased number

of cells
 Hyperplasia-Increase in the number of
cells
 Hypotrophy-decrease in the organ size
/function
 Hypertrophy-increase in the size
“Root words”
 A- none
 Ana- lack
 Hyper- excessive
 Meta- change
 Dys- bad, deranged
Classification of Neoplasia
1. Benign
2. Malignant
3. Borderline/ in situ
WAYS TO DIFFERENTIATE A BENIGN
FROM A MALIGNANT TUMOR
Characteristics Benign Malignant
Rate of growth Slow- growing Varies, but usually fast-growing
Differentiation Well differentiated Poorly differentiated
Local invasion Local invasion, Invasive, expansive,infiltrating,

encapsulated, local destructive, w/ generalized
effects effects
Metastases Non metastatic metastatic

Nomenclature of Neoplasia
Tumor is named according to:
1. Parenchyma, Organ or Cell
 Hepatoma- liver
 Osteoma- bone
 Myoma- muscle
2. Pattern and Structure, either GROSS or
MICROSCOPIC
 Fluid-filled CYST
 Glandular ADENO
 Finger-like PAPILLO
 Stalk POLYP
3. Embryonic origin
 Ectoderm ( usually gives rise to epithelium)
 Endoderm (usually gives rise to glands)
 Mesoderm (usually gives rise to Connective
tissues)
BENIGN TUMORS
 Suffix- “OMA” is used
 Adipose tissue- LipOMA
 Bone- osteOMA
 Muscle- myOMA
 Blood vessels- angiOMA
 Fibrous tissue- fibrOMA
MALIGNANT TUMOR
 Named according to embryonic cell origin
1. Ectodermal, Endodermal, Glandular,
Epithelial
 Use the suffix- “CARCINOMA”
 Pancreatic AdenoCarcinoma
 Squamos cell Carcinoma

MALIGNANT TUMOR
 Named according to embryonic cell origin
2. Mesodermal, connective tissue origin
 Use the suffix “SARCOMA
 FibroSarcoma
 Myosarcoma
 AngioSarcoma
“Exceptionistas”
1. “OMA” but Malignant

 HepatOMA, lymphOMA, gliOMA, melanOMA
2. THREE germ layers
 “TERATOMA”
3. Non-neoplastic but “OMA”
 Choristoma
 Hamatoma
CANCER NURSING
Review of Normal Cell Cycle
3 types of cells
1. PERMANENT cells- out of the cell cycle
 Neurons, cardiac muscle cell
2. STABLE cells- Dormant/Resting (G0)
 Liver, kidney
3. LABILE cells- continuously dividing
 GIT cells, Skin, endometrium , Blood cells
CANCER NURSING
Cell Cycle
G0------------------G1SG2M
 G0- Dormant or resting
 G1- normal cell activities
 S- DNA Synthesis
 G2- pre-mitotic, synthesis of proteins for
cellular division
 M- Mitotic phase (I-P-M-A-T)
CANCER NURSING
Theories to the Pathogenesis of Cancer
 Cellular transformation and derangement
theory
 Immune response failure theory
CANCER NURSING
Etiology of cancer
1. PHYSICAL AGENTS
 Radiation (thyroid CA)
 Exposure to irritants (skin CA)
 Exposure to sunlight (skin CA)

CANCER NURSING
Etiology of cancer
2. CHEMICAL AGENTS
 Smoking (Lung CA)
 Dietary ingredients (gastric CA)
 Drugs
CANCER NURSING
Etiology of cancer
3. Genetics and Family History
 Colon Cancer
 Breast cancer
CANCER NURSING
Etiology of cancer
4. Dietary Habits
 Low-Fiber
 High-fat
 Processed foods
 alcohol
CANCER NURSING
Etiology of cancer
5. Viruses and Bacteria
 DNA viruses- HepaB, Herpes, EBV, CMV,
Papilloma Virus
 RNA Viruses- HIV, HTCLV
 Bacterium- H. pylori
CANCER NURSING
Etiology of cancer
 6. Hormonal agents
 DES
 OCP especially estrogen
CANCER NURSING
Etiology of cancer
 7. Immune Disease
 AIDS
CANCER NURSING
CARCINOGENSIS
 Malignant transformation
 IPP
 Initiation
 Promotion
 Progression
CANCER NURSING
CARCINOGENSIS
 INITIATION
 Carcinogens alter the DNA of the cell
 Cell will either die or repair
CANCER NURSING
CARCINOGENSIS
 PROMOTION
 Repeated exposure to carcinogens
 Abnormal gene will express
 Latent period
CANCER NURSING
CARCINOGENSIS
 PROGRESSION
 Irreversible period
 Cells undergo NEOPLASTIC transformation
then malignancy
CANCER NURSING
Spread of Cancer
 1. LYMPHATIC
 Most common
 2. HEMATOGENOUS
 Blood-borne, commonly to Liver and Lungs
 3. DIRECT INVASION/EXTENSION
 Seeding of tumors
CANCER NURSING
Body Defenses Against TUMOR
 1. T cell System/ Cellular Immunity
 Cytotoxic T cells kill tumor cells
 2. B cell System/ Humoral immunity
 B cells can produce antibody
 3. Phagocytic cells
 Macrophages can engulf cancer cell debris
CANCER NURSING
Cancer Diagnosis
 1. BIOPSY
 The most definitive
 2. CT, MRI- for visualization and staging
 3. Tumor Markers
CANCER NURSING
Cancer Grading
The degree of DIFFERENTIATION
 Grade 1- Low grade
 Grade 4- high grade

CANCER NURSING
Cancer Staging
1. Uses the T-N-M staging system
 T- tumor
 N- Node
 M- Metastasis
2. Stage 1 to Stage 4
CANCER NURSING
GENERAL Promotive and Preventive Nursing
Management
 1. Lifestyle Modification
 2. Nutritional management
 3. Screening
 4. Early detection
Nursing Assessment
Utilize the ACS 7 Warning Signals
 CAUTION
 C- Change in bowel/bladder habits
 A- A sore that does not heal
 U- Unusual bleeding
 T- Thickening or lump in the breast
 I- Indigestion
 O- Obvious change in warts
 N- Nagging cough and hoarseness

SCREENING
 1. Male and female- Occult Blood, CXR, and
DRE
 2. Female- SBE, CBE, Mammography and
Pap’s Smear
 3. Male- DRE for prostate, Testicular self-
exam
CANCER MANAGEMENT
GENERAL MEDICAL MANAGEMENT
- Treatment goals: cure, control and palliation
 1. Surgery
 2. Chemotherapy
 3. Radiation therapy
 4. Immunotherapy
 5. Bone Marrow Transplant

CANCER MANAGEMENT
SURGERY
 Diagnostic- excision, incision, needle
 primary method of treatment- local and wide
excision
 prophylactic
 Palliative- relieve complications of CA
 Reconstructive- improve function or obtain a
more desirable cosmetic effect

CANCER MANAGEMENT
NURSING MANAGEMENT
 Provide education and emotional support
 Assess patient’s responses to the surgery
 Monitor for possible complications such as
infection, bleeding, fluid and electrolyte

imbalance and organ dysfunction
 Plan for discharge, ff-up and home care
CANCER MANAGEMENT
RADIATION THERAPY
 Cure, control, prophylaxis
 Cells are most vulnerable during DNA
synthesis and mitosis

(BM,lymphatic,skin,GIT,gonads)
CANCER MANAGEMENT
MAINTAIN TISSUE INTEGRITY
 Frequently assess for changes
 Handle skin gently
 Do NOT rub affected area
 Lotion may be applied (water-based)
 Wash skin only with SOAP and Water
 During treatment period, avoid soap, creams,
deodorants and powder on treatment areas

CANCER MANAGEMENT
RISK FOR RADIATION INJURY
 Protect caregivers fr exposure to radioactive
implants
 Identify max time that can be spent safely
inpxs room
 Use of shielding equipments
 Explain to px the need for such precautions to
keep px from feeling isolated

CANCER MANAGEMENT
 MANAGEMENT OF STOMATITIS
 Use soft-bristled toothbrush
 Oral rinses with saline gargles/ tap water
 Avoid ALCOHOL-based rinses
CANCER MANAGEMENT
CHEMOTHERAPY
 Destroys tumor cells by interfering w/ cellular
functions and reproduction

 Used primarily to treat systemic disease rather
than localized lesions

CANCER MANAGEMENT
 ADMINISTRATION:
 Topical, Oral, IM, IV, Subcutaneous, arteria,
intracavitary, intrathecal
 Dosage based on TBSA
 Special care needed for vesicants- causes
extravasation (daunorubicin, doxorubicin,
nitrogen mustard, mitomycin, vincristine and
vindesine. If suspected stop immediately and
apply ice except in vonca alkaloid
CANCER MANAGEMENT
Common side effects:
 Nausea and vomiting,stomatitis, anorexia,
diarrhea
 Myelosuppression
 Nephrotoxicity-danorobucin, doxorubucin
 CHF- cisplastin, methroxate, mitomycin
 Pulmonary fibrosis-bleomycin and busulfan

CANCER MANAGEMENT
 Sterility
 Reversible Neurologic damage- taxanes and
plant alkaloids, peripheral neuropathy and
hearing loss- cisplatin
 fatigue
Nursing Intervention
 MANAGEMENT OF ALOPECIA
Alopecia begins within 2 weeks of therapy
 Regrowth within 8 weeks of termination
 Encourage to acquire wig before hair loss
occurs
 Encourage use of attractive scarves and hats
 Provide information that hair loss is
temporary BUT anticipate change in texture
and color
 PROMOTE NUTRITION
 Serve food in ways to make it appealing
 Consider patient’s preferences
 Provide small frequent meals
 Avoids giving fluids while eating
 Oral hygiene PRIOR to mealtime
 Vitamin supplements
 RELIEVE PAIN
 Mild pain- NSAIDS
Moderate pain- Weak opiods
 Severe pain- Morphine
 Administer analgesics round the clock with
additional dose for breakthrough pain
 DECREASE FATIGUE
 Plan daily activities to allow alternating rest
periods
 Light exercise is encouraged
 Small frequent meals
 IMPROVE BODY IMAGE
 Therapeutic communication is essential
 Encourage independence in self-care and
decision making
 Offer cosmetic material like make-up and
wigs
 ASSIST IN THE GRIEVING PROCESS
 Some cancers are curable
 Grieving can be due to loss of health,
income, sexuality, and body image
 Answer and clarify information about
cancer and treatment options
 Identify resource people
 Refer to support groups
 MANAGE COMPLICATION:
INFECTION
 Fever is the most important sign (38.3)
 Administer prescribed antibiotics X 2weeks
 Maintain aseptic technique
 Avoid exposure to crowds
 Avoid giving fresh fruits and veggie
 Handwashing
 Avoid frequent invasive procedures
 MANAGE COMPLICATION: Septic
shock
 Monitor VS, BP, temp
 Administer IV antibiotics
 Administer supplemental O2
 MANAGE COMPLICATION: Bleeding
 Thrombocytopenia (<100,000) is the most
common cause
 <20, 000 spontaneous bleeding
 Use soft toothbrush
 Use electric razor
 Avoid frequent IM, IV, rectal and
catheterization
 Soft foods and stool softeners
1. A chemotherapeutic agent was given to a
patient as an adjunct to surgery .Which of the
following statements about chemotherapy is
true?
 it is a local treatment
 it is affects both normal and cancer cells
 it is effective for all types of cancer
 it has few adverse effects

2. A 30 y.o. client is about to receive chemotherapy.
The nurse is monitoring the patient’s lab results prior
to the initiation of therapy. The nurse knows that the
WBC count of the client is normal if the result
showed
 5,000-10,000 cells/mm3
 3,000- 7,000 cells/mm3
 8,000-12,000 cells/mm3
 1,000-5,000 cells/mm3
3. Testicular self-examination is done as a
preventive screening procedure for testicular
cancer. The right way to do the exam is
 examine the testes after a warm bath or shower
 have the client examine his testes while lying
supine
 to feel for new growth or mass w/ 1 finger
 to have an annual testicular exam done

4. In health teaching done in the OB-gyne ward,
the nurse instructs the clients to perform self-
breast examination
 a week after the onset of menstruation
 monthly during the peak of ovulation
 at the start of menstruation
 1 week before the onset of menstruation.

5. The following are examples of risk factors for
cancer except
 HPV
 low-fat, high-fiber diet
 radiation exposure
 Diethystilbestriol
6. A 54 y.o., G0, has been on conjugated
estrogen for 5 years. Among all the
gynecologic cancers, Which one is she least
likely to acquire or have?
 Vaginal cancer
 Breast cancer
 Ovarian cancer
 Endometrial cancer
7. Colorectal cancers are one of the most
common type of cancers occurring in old age.
Screening for this type of cancer involves the
following except
 digital rectal exam
 occult blood testing
 proctosigmoidoscopy
 CT scan
8. One of the clients in the ward has a family
history of colon cancer. The least appropriate
advise for him would be to
 have low fat, high fiber diet
 to have an annual digital rectal exam
 to test for occult blood
 have a colonoscopy done

9. Pap smear is a procedure done to screen for
cervical cancer. As a preventive measure, this
is ideally done
 At the onset of sexual activity or at age 18
 annually for sexually active women
 every other year for sexually active women
 for women 20 yrs of age and above initially 2
consecutive annual smear.

10. Testicular examination is advised as a screening
procedure to detect testicular cancer. The client still
needs further instructional reinforcements if he
verbalized
 a. “ The testicles are normally egg-shaped”
 b. “ My testicles feel smooth”
 c. “ My testicles normally has a spongy consistency”
 d. “ This test is being done to detect any lumps”

Match the following type of viruses with
the various type of tumor/malignancy
11. Nasopharyngeal cancer a. Epstein-Barr virus
12. Non- hodgkins lymph0ma b. Hepatitis B

13. Hepatocellular cancer c. Human
Papilloma virus
14. Burkitts lymphoma d. HTCLV
15. Hodgkins disease
Mortality and Morbidity Rates
Colon cancer
COLON CANCER
 Risk factors
 1. Increasing age
 2. Family history
 3. Previous colon CA or polyps
 4. History of IBD
 5. High fat, High protein, LOW fiber
 6. Breast Ca and Genital Ca
COLON CANCER
 Sigmoid colon is the most common site
 Predominantly adenocarcinoma
 If early 90% survival
 34 % diagnosed early
 66% late diagnosis
COLON CANCER
 PATHOPHYSIOLOGY
 Benign neoplasm DNA alteration
malignant transformation malignant
neoplasm  cancer growth and invasion 
metastasis (liver)
COLON CANCER
 ASSESSMENT FINDINGS
1. Change in bowel habits- Most common
 2. Blood in the stool
 3. Anemia
 4. Anorexia and weight loss
 5. Fatigue
 6. Rectal lesions- tenesmus, alternating D and C
Colon cancer
 Diagnostic findings
 1. Fecal occult blood
 2. Sigmoidoscopy and colonoscopy
 3. BIOPSY
 4. CEA- carcino-embryonic antigen
Colon cancer
 Complications of colorectal CA
 1. Obstruction
 2. Hemorrhage
 3. Peritonitis
 4. Sepsis
Colon cancer
 MEDICAL MANAGEMENT
 1. Chemotherapy- 5-FU
Colon cancer
 SURGICAL MANAGEMENT
 Surgery is the primary treatment
 Based on location and tumor size
 Resection, anastomosis, and colostomy
(temporary or permanent)
Colon cancer
NURSING INTERVENTION
Pre-Operative care
 1. Provide HIGH protein, HIGH calorie and
LOW residue diet

 2.Provide information about post-op care and
stoma care
 3. Administer antibiotics 1 day prior
Colon cancer
Pre-Operative care
 4. Enema or colonic irrigation the evening and
the morning of surgery

 5. NGT is inserted to prevent distention
 6. Monitor UO, F and E, Abdomen PE

Colon cancer
Post-Operative care
 1. Monitor for complications
 Leakage from the site, prolapse of stoma, skin
irritation and pulmo complication

 2. Assess the abdomen for return of peristalsis
Colon cancer
Post-Operative care
 3. Assess wound dressing for bleeding
 4. Assist patient in ambulation after 24H
 5.provide nutritional teaching
 Limit foods that cause gas-formation and odor
 Cabbage, beans, eggs, fish, peanuts
 Low-fiber diet in the early stage of recovery

Colon cancer
Post-Operative care
 6. Instruct to splint the incision and
administer pain meds before exercise

 7. The stoma is PINKISH to cherry red,
Slightly edematous with minimal pinkish

drainage
 8. Manage post-operative complication
Colon cancer
 NURSING INTERVENTION: COLOSTOMY
CARE
 Colostomy begins to function 3-6 days after
surgery
 The drainage maybe soft/mushy or semi-solid
depending on the site
Colon cancer
CARE
 BEST time to do skin care is after shower
 Apply tape to the sides of the pouch before
shower
 Assume a sitting or standing position in
changing the pouch
Colon cancer
CARE
 Instruct to GENTLY push the skin down and
the pouch pulling UP
 Wash the peri-stomal area with soap and water
 Cover the stoma while washing the peri-stomal
area
Colon cancer
CARE
 Lightly pat dry the area and NEVER rub
 Lightly dust the peri-stomal area with nystatin
powder
Colon cancer
CARE
 Measure the stomal opening
 The pouch opening is about 0.3 cm larger than
the stomal opening
 Apply adhesive surface over the stoma and
press for 30 seconds
Colon cancer
CARE
 Empty the pouch or change the pouch when
 1/3 to ¼ full (Brunner)
 ½ to 1/3 full (Kozier)
1. Colostomy should be drained when it is
 A. full
 Half-full
 100 ml full
 As you wish
 Pouch opening should be
A .3 cm larger than stomal opening
b. .5 cm larger than stomal opening
c. 1 cm larger than stomal opening
d. Same size with the opening
 A client has underwent hemicolectomy and
placement of Right colostomy. You expect the
drainage to be
 A. mushy
 B. solid
 C. purely liquid
 D. purely air
 Most common manifestation of colon Ca is
 A. anemia
 B. tenesmus
 C. alternating diarrhea and constipation
 D. pain
 A client had a colostomy. When do You
expect to note for fecal drainage?
 A. as soon as the colostomy is placed
 B. 1 day after
 C. 3 days after
 D. 1 week after
 All of the following are vesicants except
 A. vincristine
 B. dopamycin
 C. mustard
 D.mitomycin
 In patients receivne chemotherapy suspected
of extravasation, the drug must be stopped and
ice should be applied for all of the following
except
 A. vincristine
 B. doxorobucin
 C. mustard
 D.mitomycin
 A client receiving chemotherapy started to
complain of dyspnea. X-ray showed fibrosis.
Which of the following chemo agent is he
most probably receiving?
 A. vinblastine
 B. taxanes
 C. busulfan
 D. cisplatin
 Cisplatin is known for causing which side
effect
 A. reversible hearing loss
 B. irreversible hearing loss
 C. reversible peripheral neuropathy
 D. irreversible peripheral neuropathy
 A client on chemotherapy started to complain
of dyspnea and orthopnea. Auscultation
showed rales and crackles. Which of the
following drug is he most probably receiving?
 A. chloramphenicol
 B. vinblastine
 C. busulfan
 D. cisplatin
Breast Cancer
 The most common cancer in FEMALES
 Numerous etiologies implicated
Breast Cancer
RISK FACTORS
 1. Genetics- BRCA1 And BRCA 2
 2. Increasing age ( > 50yo)
 3. Family History of breast cancer
 4. Early menarche and late menopause
 5. Nulliparity
 6. Late age at pregnancy

Breast Cancer
RISK FACTORS
 7. Obesity
 8. Hormonal replacement
 9. Alcohol
 10. Exposure to radiation

Breast Cancer
PROTECTIVE FACTORS
 1. Exercise
 2. Breast feeding
 3. Pregnancy before 30 yo
Breast Cancer
ASSESSMENT FINDINGS
 1. MASS- the most common location is the
upper outer quadrant

 2. Mass is NON-tender. Fixed, hard with
irregular borders
 3. Skin dimpling
 4. Nipple retraction
 5. Peau d’ orange
Breast Cancer
 LABORATORY FINDINGS
 1. Biopsy procedures
 2. Mammography
Breast Cancer
 Breast cancer Staging
 TNM staging
 I - < 2cm
 II - 2 to 5 cm, (+) LN
 III - > 5 cm, (+) LN
 IV- metastasis
Breast Cancer
 MEDICAL MANAGEMENT
 1. Chemotherapy
 2. Tamoxifen therapy
Breast Cancer
 SURGICAL MANAGEMENT
1. Radical mastectomy
2. Modified radical mastectomy
3. Lumpectomy
4. Quadrantectomy
Breast Cancer
NURSING INTERVENTION : Post-OP
 Position patient: Supine
 Affected extremity elevated to reduce edema
 Warm shower on 2nd day post-op
 Immediate post-op: snug dressing with drainage
 Maintain patency of drain (JP) ; Drainage is
removed when the discharge is less than 30 ml in
24 H
 Monitor for hematoma w/in 12H and apply
bandage and ice, refer to surgeon
Breast Cancer
 Lotions, Creams are applied ONLY when the
incision is healed in 4-6 weeks

 Hand, shoulder exercise done on 2ndday
 Post-op mastectomy exercise 20 mins TID
 NO BP or IV procedure on operative site
 Heavy lifting is avoided
 Monitor complications ( lymphedema,
hematoma, infecton)
Breast Cancer
TEACH FOLLOW-UP care
 Regular check-up
 Monthly BSE on the other breast
 Annual mammography
Lung cancer
 6th-7th decade
 Number 1 in the morbidity and mortality
survey among all cancers
 Equal incidence for both men and women
 85% caused by inhalation of carcinogenic
materials most commonly cigarette smoking
 Squamous cell carcinoma- more centrally
located, commonly in the segmental and
subsegmental bronchi.
 AdenoCarcinoma- presents more peripherally
as peripheral mass or nodules; most prevalent
lung Ca for both M and F
 Large cell carcinoma-fast growing tumor that
arise peripherally
 Bronchioalveolar cell CA- arises fr the
terminal bronchus and alveoli; usually slow
growing
 Small cell Ca- arises primarily as a proximal
lesion but may arise in any part of the
tracheobronchial tree
Lung Cancer
Etiology
 Tobacco use
 Genetic- > acquired genetic lesion

Lung Cancer
Clinical Manifestations:
 Cough
 Hemoptysis
 Wheeze, stridor
 Dyspnea
 Pneumonitis
 Pain
 Symptoms of lung abscess

Lung Cancer
 Metastatic spread- tracheal obstruction,
dysphagia, hoarseness, Horner’s syndrome,
auperior vena cava syndrome, plural effusion,
respiratory failure.
 Systemic symptoms
 Endocrine syndromes-hypercalcemia
(epidermoid), SIADH (sm cell), gynecomastia
(large cell), clubbing (non-sm. Cell)
Lung Cancer
Stage TNM descriptors 5-yr survival rate
I T1-2,N0,M0 60-80
II T1-2,N1,M0 25-50
IIIA T3,N0-1,M0 25-40

T1-3,N2,M0 10-30
IIIB Any T4 or N3,M0 <5
IV Any M0 <5
Lung Cancer
T1-< 3 cm
T2->3 cm
T3- direct extension into chest wall
T4- invades mediastinum
N0
N1-peribronchial
N2-ipsilateral mediastinal
N3-contralateral mediastinal
Lung Cancer
 TREATMENT
 Surgery (segmentectomy, lobectomy,
pneumonectomy)
 Radiotherapy
 Chemotherapy
Laryngeal cancer
 Risk Factors
 tobacco
 alcohol
 radiation?
 occupation?
CLASSIFICATION ACCORDING TO LOCATION
 1. supraglottic
 - rich in lymphatics
 2. glottic
 - (true vocal cords) most common 55-75%; good
prognosis
 3. subglottic
 - least common 1-5%; metastasizes to the Delphian
node
SYMPTOMS:
 voice change- 2 wks duration
 airway obstruction
 odynophagia
 otalgia
 neck mass
 other constitutional symptoms

DIAGNOSIS:
 LARYNGOSCOPY
 BIOPSY
MANAGEMENT
 local excision/ vocal cord stripping
 LASER vaporization or excision/ cordectomy
 Radiotherapy
(EBRT- external beam radiotherapy or

brachytherapy – radioactive implants)
 Conservation laryngectomy/ Total
laryngectomy
Laryngeal Cancer
NURSING MANAGEMENT: PRE-operative
Provide the patient pre-operative teachings
 Clarify misconceptions
 Tell that the natural voice will be lost
 Teach communication alternatives
Reduce patient ANXIETY

 Provide opportunities for patient and family
members to ask questions

 Referrals to previous patients with laryngeal
cancers and cancer groups

Laryngeal Cancer
NURSING MANAGEMENT: POST-op
Maintain PATENT Airway
 Position patient: Semi or High Fowler’s
 Suction secretions
 Encourage to deep breath, turn and cough
Administer care of the laryngectomy tube

 Suction as needed
 Cleanse the stoma with saline
 Administer humidified oxygen
 Laryngectomy tube is usually removed within 3-6
weeks after surgery

Laryngeal Cancer
Promote alternative communication methods
 Call bell or hand bell, Magic Slate, Hand signals
 Collaborate with speech therapist
Promote adequate Nutrition

 NPO after operation
 No foods or drinks per orem for 10 days
 IVF, TPN are alternative nutrition routes
 Start oral feedings with thick liquids, avoid sweet
foods
Laryngeal Cancer
Monitor for COMPLICATIONS
 Respiratory Distress
 Hemorrhage
 infection
Laryngeal Cancer
NURSING MANAGEMENT: HOME CARE
 Humidification system at home is needed
 AVOID swimming
 Cover the stoma with hands or plastic bib over
the opening
 Advise beauty salons to avoid hair sprays,
powders and loose hair near the opening

 Oral hygiene frequently
Prostate Cancer
Etiology
 Age-related
 Blacks>white
 95 % are adenocarcinomas
Prostate Cancer
Manifestations:
 Rel. to urinary flow obstuction
 Urinary frequency, ec in caliber of stream,
diminished force, hesitancy, dribbling,

nocturia and overflow incontinence
 Dysuria
 Back or hip pain

Prostate Cancer
Diagnostics:
 DRE
 PSA- > 10 ng/ml
 Biopsy- transrectal prostate biopsy under
sonography (TRUS)
Prostate Cancer
Treatment
 Surgery- radical retropubic prostatectomy
 Radiation therapy
*both are associated w/ impotence

 Androgen deprivation- for those w/ metastatic
disease (leuporide, flutamide)

 Chemotherapy- for palliation
quiz
1. All of the following are manifestations of
prostate cancer except
 Hesitancy
 dribbling
 Dysuria
 Painless
 2. The most common manifestation of
laryngeal cancer is
 A. odynophagia
 B. Dysphagia
 C. Voice change
 D. dyspnea
3. Most head and neck cancers are caused by
smoking. Which of the following is not caused
by smoking?
 A. lung cancer
 B. ovarian CA
 C. laryngeal cancer
 D. esophageal cancer
Quiz
4. a 64 y.o patient status post- hemi colectomy
was tachycardic. Examination of the mucus
membrane showed a dry mouth. What is
your assessment to the possible cause of
tachycardia in this patient?
 infection
 3rd spacing
 Dehydration
 sepsis
5. difference between a benign fr malignant
neoplasm include all of the ff except
 well differentiated
 poorly demarcated
 no metastatic potential
 non invasive
6. radiation therapy is effective in actively
dividing cells. All of the ff are ex of those
except
 GIT
 Fatty tissues
 Nerve
 skin
7. screening should be done to detect cancers.
Routine Screening tests involves all of the
following except
 breast exam
 DRE
 Ultrasound
 Occult blood exam
8. A client complained of chronic cough w/
hemoptysis. Assessment showed wasting, dry
skin and s/sxs of cachexia. The client most
probably has
 A. TB
 B. bronchiectasis
 C. lung CA
 D. all of the above

9. Client underwent pneumonectomy. Post-op
the best position to put the client in is
b. Affected side
c. Unaffected side
d. Trendelenburg
e. 10 inch block
 10. Post-mastectomy lotions and cream may be
applied after healing takes place. When does it
usually occur?
 A. 1 month
 B. 2 months
 C. 4 months
 D. 1 year
Cervical Cancer
 peaks: 45-60 y.o.
 Risk factors:
 Early coitus
 Early conception
 Multiple sexual partners
 Cigarette smoking
 High risk partners
 Immunosuppressed
 HPV
 HSV
Cervical cancer
Assessment:
 post coital or irregular bleeding
 Malodorous bloody discharge
 Sciatica
 Leg edema
 Deep pelvic pain

 Treatment:
 Surgery (radical hysterectomy)
 Radiotherapy ( external beam to the pelvis
followed by intracavitary)
Endometrial cancer
 Risk factors:
 50-60
 Obesity
 polycystic ovarian disease
 Early menarche
 Late menopause
 Exogenous unopposed estrogen
 Tamoxifen( antiestrogen in breast but acts like estrogen in
the endometrium)
 Lynch II syndrome(hereditary nonpolyposis colorectal
syndrome)
 Assessment:
 Irregular menses or postmenopausal bleeding
 Diagnosis:
 D and C
Ovarian cancer
 Risk factors:
 Family history
 Low parity and infertility
 Assessment:
 Abdominal distention- most common
 Lower abdominal pain
 Pelvic mass
 Weight loss
 Diagnostics:
 Pelvic ultrasound
 CA-125
 Abdominopelvic CT scan and chest
radiography if suspected of having ovarian CA
 Treatment:
 Surgery
 Chemotherapy:
 Paclitaxel( neuropathy,
alopecia,myelosuppression,hypersensitivity
and bradycardia)
 Carboplatin ( N/V, myelosuppression,
constipation)
Non-Hodgkins Lymphoma
 Heterogenous group of cancers
 Originates from neoplastic growth of lymphoid
tissue
 Mostly involves malignant B lymphocytes;
only 5% are T lymphocytes
Manifestations:
 Symptoms are highly variable
 Symptoms may be absent or very minimal at the
early-stage of the disease

 Typically diagnosed at a latter stage when px is more
symptomatic; lymphadenopathy is noticeable (stages

III or IV)
 1/3 of cases have “B symptoms” (recurrent fever,
drenching night sweats, & unintentional wt. loss of

>10%
Assessment & Diagnostics
 Histopathology
 Immunophenotyping
 Cytogenetic analysis
Staging – based on data obtained from CT

scan, bone marrow biopsies, CSF analysis
Treatment:
 based on actual classification & stage of disease, prior
treatment, & px’s ability to tolerate therapy

 Radiation alone maybe beneficial in localized non-
aggressive forms
 In aggressive types, combination chemotherapy are
given in early stages

 Intermediate forms – chemotherapy + radiotherapy
for st. I & II disease

lymphoma
 Hodgkins disease
 Cause: unknown
 S/sxs: painless lymphadenopathy, *reed
sternberg cell, edema(lymph
obstuction),cough,dypnea(mediastinal node
enlargment)
 Mgt: radio,chemo (MOPP),
supportive,splenectomy
Urinary bladder Cancer
 ETIOLOGY AND RISK FACTORS
 65 Yrs.- median age
 Smoking
 Cyclophosphamide exposure
 Schistoma haematobium
Manifestations:
 Hematuria- mOst common symptom
 Urinary changes may accompany later
 Usually asymptomatic at early stages

 Diagnosis:
 Urinalysis- hematuria
 IVP- decreased bladder filling
 Cystoscopy- diagnostic
 Treatment:
 Based on extent of disease
 Surgical Resection
 Intravesical chemotherapy
Skin cancer
Etiology :
– chronic friction, irritation & exposure to UV
Types:
1. basal cell – most common
2. squamous cell
3. malignant melanoma – most fatal
Squamous cell Carcinoma
Risk factors:
 UV rays
 Radiation
 Actinic keratosis
 Immunosuppression
 Industrial carcinogens
Squamous cell Carcinoma
History and Assessment:
 Slowly evolving
 Assymptomatic
 Occassionaly bleeding and pain
 Exophytic nodules w/ varying degree of
scaling or crusting
Basal Cell Carcinoma
Risk factors:
 UV rays
 May take several forms: nodular, ulcerative,
pigmented ad superficial
Basal Cell Carcinoma
Hx and Assessment:
 Usually asymptomatic unless secondarily
infected in advanced disease

 Pearly-colored PAPULE
 External surface - fine telangiectasia and is
translucent
Melanoma
Risk factors:
 Sun exposure
 Fair skin
 Positive family history
 Presence of dysplastic nevi

Melanoma
Hx and Assessment:
 Usually asymptomatic until late
 Pruritus or mild discomfort
 Recent changed in a previous skin lesion
 A- asymetry
 B- border irregularity
 C- color variation
 D- diameter(large)
Skin Cancer
Interventions:
preventive measures
a. monitoring of any lesion
b. have moles or lesions removed if they are subject
to chronic irritation
c. avoid contact with chemical irritants
d. use of sunscreen
e. avoid too much sun exposure
Hepatocellular CA
 Hepa B
 alcohol
Liver physiology and
Pathophysiology
Normal Function Abnormality in function
1. Stores glycogen = Hypoglycemia
2. Synthesizes proteins = Hypoproteinemia
3. Synthesizes globulins =Decreased Antibody formation
4. Synthesizes Clotting factors = Bleeding tendencies
5. Secreting bile = Jaundice & pruritus
6. Converts ammonia to urea =Hyperammonemia
7. Stores Vit and minerals =Deficiencies of Vit and min
8. Metabolizes estrogen = Gynecomastia, testes atrophy
CONDITION OF THE LIVER
NURSING INTERVENTIONS
 1. Monitor VS, I and O, Abdominal
girth, weight, LOC and Bleeding
 2. Promote rest. Elevated the head
of the bed to minimize dyspnea

 3. Provide Moderate to LOW-protein (1 g/kg/day)
and LOW-sodium diet
 4. Provide supplemental vitamins (especially K)
and minerals
 Administer prescribed
Diuretics= to reduce ascites and edema

Lactulose= to reduce NH4 in the bowel
Antacids and Neomycin= to kill bacterial flora that
cause NH production
6. Avoid hepatotoxic drugs
 Paracetamol
 Anti-tubercular drugs
7. Reduce the risk of injury

 Side rails reorientation
 Assistance in ambulation
 Use of electric razor and soft-bristled

toothbrush
 8. Keep equipments ready including
Sengstaken-Blakemore tube, IV fluids,
Medications to treat hemorrhage
 9. Assist in surgery and chemotherapy
 1. What is the most common manifestation of
urinary bladder cancer?
 A. pelvic pain
 B. Painful hematuria
 C. painless heamturia
 D. pelvic mass
2. In patient w/ liver disorders, they are given
drugs to kill bacterial flora that cause NH
production. Which of the following drugs
serves that purpose?
b. Vancomycin
c. Amoxicillin
d. Neomycin
e. Nitrogen mustard
3. Cervical cancer is fast growing. This is
associated w/ all of the following except
 A. HPV
 B. herpes simplex
 C. genital warts
 D. HTLV
4. Prolonged Exposure to estrogen increases the
risk for acquiring All of the following types of
cancer except
b. Breast CA
c. Ovarian CA
d. Endometrial Ca
e. Ductal CA
5. Malignant melanoma is often seen in fair
skinned individuals. Assessment findings
which will help strenthen the diagnosis
includes
 A- asymetry
 B- border irregularity
 C- color variation
 D- diameter (small)
6. All of the following are correct except
 A. melanoma- assymetrical
 B. squamous CA- ulcerating
 C. basal cell- pearly colored papule
 D. Squamous cell- nodular

7. Lymphoma is a malignancy involving the
lymph tissues. The most common lymph node
involved is
b. Cervical
c. Supraclavicular
d. Mediastinal
e. inguinal
8. Which of the following assessment findings
will aid you in diagnosisng hodgkin’s disease
 A. lymphadenopathy
 B. hematuria
 C. reed sternberg cell
 D. lymphedema
9. Patients w/ cervical cancer often complains of
b. Dysmenorrhea
c. Post coital bleeding
d. Pelvic mass
e. Pelvic pain
10. Patients with liver cancer often presents with
following assessment findings except
b. Esophageal varices
c. Ascites
d. Hyperglycemia
e. Petechiae and echymosis

5. chemotherapy was advised in a patient
diagnosed w/ skin Cancer. Vinblistine was the
agent ordered. You know that vinblistine is a
vesicant type of agent and causes
 extravasation
 intravasation
 nephrotoxicity
 ototoxicity
6. Most frequent cause of fever w/in 24 hrs in a
post-op patient is….
7-9. internal Radiation therapy poses a risk for
both patient and caregiver. Give 3 ways to
avoid unnecessary exposure
10. Most common manifestation of lung cancer
in early stages is…..

Nursing Oncology

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Nursing Oncology

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Oncology

characteristics and differ in shape and

mature cell into another; reversible

underdevelopment w/ decreased number

Rate of growth Slow- growing Varies, but usually fast-growing

Differentiation Well differentiated Poorly differentiated

Local invasion Local invasion, Invasive, expansive,infiltrating,

Metastases Non metastatic metastatic

 Endoderm (usually gives rise to glands)

 Mesoderm (usually gives rise to Connective

 Squamos cell Carcinoma

1. “OMA” but Malignant

 G1- normal cell activities

 G2- pre-mitotic, synthesis of proteins for

 Exposure to irritants (skin CA)

 Exposure to sunlight (skin CA)

 Grade 4- high grade

 C- Change in bowel/bladder habits

 A- A sore that does not heal

 T- Thickening or lump in the breast

 O- Obvious change in warts

 N- Nagging cough and hoarseness

 5. Bone Marrow Transplant

 primary method of treatment- local and wide

 Palliative- relieve complications of CA

 Reconstructive- improve function or obtain a

more desirable cosmetic effect

 Assess patient’s responses to the surgery

 Monitor for possible complications such as

infection, bleeding, fluid and electrolyte

 Cells are most vulnerable during DNA

synthesis and mitosis

 Handle skin gently

 Do NOT rub affected area

 Lotion may be applied (water-based)

 Wash skin only with SOAP and Water

 During treatment period, avoid soap, creams,

deodorants and powder on treatment areas

 Explain to px the need for such precautions to

keep px from feeling isolated

functions and reproduction

than localized lesions

 CHF- cisplastin, methroxate, mitomycin

 Pulmonary fibrosis-bleomycin and busulfan

 it is affects both normal and cancer cells

 it is effective for all types of cancer

 it has few adverse effects

 3,000- 7,000 cells/mm3

 have the client examine his testes while lying

 to have an annual testicular exam done

 monthly during the peak of ovulation

 at the start of menstruation

 1 week before the onset of menstruation.

 low-fat, high-fiber diet

 occult blood testing

 to have an annual digital rectal exam

 to test for occult blood

 have a colonoscopy done

 annually for sexually active women

 every other year for sexually active women

 for women 20 yrs of age and above initially 2

consecutive annual smear.

 b. “ My testicles feel smooth”