ONCOLOGY NURSING

Cancer recognized in ancient times by the skilled observers who gave it the name cancer; an umbrella word used to describe a group of more than 100 diseases in which cells multiply and spread without restraint. Causative Factors Viruses and Bacteria viruses are thought to incorporate themselves in the genetic structure of cells thus altering future generations of that cell !ender and "ite for men the most common site of cancers are the prostate colorectal and bladder; for women the top # cancers are the breast the lung colon and rectum $ge cancer is a disease of aging; the more advanced the age the highest risk of development of cancer %ace and &thnicity there are certain cancers specific only to specific races liked blacks 'ewish and $sian descents !eographic (actors primary cancers of the liver are common in )ndonesia in parts of $frica and $sia; breast cancer is common in the *"$ and +estern &urope Risk Factors A. Endogenous 1. $ge older people tend to have increased risk for development of cancer due to the longer time of e,posure to harmful agents -. !enetic (actors most cancers are not inherited but occur because of random genetic mutations in people with little or no relevant family history #. .ormonal (actors hormones such as estrogen do not appear to be primary carcinogens but influences carcinogenesis /. 0re1cancerous 2esions includes polyps of the colon and rectum; certain pigmented moles dysplasias of the cervical epithelium and others 3. )mmunologic (actors persons who have weaker immune system have increased risk for the development of cancer B. Exogenous Factors 1. 4rugs and Chemicals many chemicals drugs and products in the environment are known to be carcinogenic and hundred of others are considered to be associated with the development of cancers -. %adiation a. Ionizing Radiation consists of electromagnetic waves or material particles that have sufficient energy to ionize atoms or molecules b. Ultraviolet Radiation *V% is produced by the sun by artificial sources such as tanning beds or those in the industries. 5his type of radiation acts as an initiator a promoter a cocarcinogenic or an immunosuppressive agent. c. Radon a colorless odorless radioactive gas that results from the decay of uranium found in soil and in rocks. 0rolonged breathing at high levels have been linked to an increased incidence of lung cancers.

d. Electromagnetic Radiation &6( are e,tremely low fre7uency energy fields and e,posure can come from household appliances electrical power lines and electricity1generating facilities #. 2ifestyle 0ractices a. Smoking and Tobacco use tobacco smoke is the single most lethal cause of cancer in the *"$ and is associated with at least 10 different cancers responsible for up to #08 of all cancer deaths b. Nutrition the consumption of high fat diet has been researched as a risk factor in many common cancers including cancers of the colon prostate and breast /. 9besity considered a risk factor in for colon breast endometrial renal and esophageal cancers. 3. "e,ual and %eproductive (actors se,ual practices play a role in the incidence of certain cancers because serial "54s have been linked to cancer including .)V :. Viruses and 9ther 6icroorganisms .BV and .CV can cause chronic infections that are associated with hepatocellular carcinoma ;. 0sychosocial (actors stress that results from psychosocial trauma loss of a significant other and personality variables such as helplessness and repression have been suggested as etiologic factors in the development of cancer 1. -. #. /. 3. :. ;. Classification/Site of Origin $denocarcinoma1 originates in glandular tissue Blastoma1 originates in the embryonic tissue of organs Carcinoma1 originates in the epithelial tissue <i.e. tissue that lines organs and tubes= 2eukemia1 originates in tissues that form blood cells 2ymphoma1 originates in lymphatic tissue 6yeloma1 originates in the bone marrow "arcoma1 originates in the connective tissues or supportive tissues <i.e. bone cartilage muscles= Grading, Staging, T e T!N!" A. Grading the cancer is e,amined for its cellular maturity and characteristics. 5he abnormality of the cells determines he grade of the cancer. $ higher grade means the tissue appears more abnormal and generally is more aggressive B. Staging the classification of the e,tent of the disease C. The T-N-M Cancer Staging 1. Tumor 5o1 no lymph node involvement 5is1 carcinoma in situ <limited to surface cells only= 511/1 increasing tumor involvement 2. Node >o1 no lymph node involvement >11/1 increasing degree if lymph node involvement >,1 lymph node involvement cannot be assessed

3. Metastasis 6o1 no evidence of distant metastasis 611 evident of distant metastasis the numerical system used to classify the e,tent of the disease "tage 01 cancer in situ <surface cells= "tage11 cancer limited to the tissue of origin; evidence of tumor growth "tage -1 limited local spread of cancerous cells "tage #1 e,tensive local and regional spread "tage /1 distant metastasis Co##on Signs and S$#%to#s of Cancer Change in bowel or bladder habits A sore that does not heal Unusual bleeding or discharge Thickening or lump in breast or elsewhere Indigestion or difficulty in swallowing Obvious change in wart or mole Nagging cough or hoarseness Anore,ia Loss of weight <une,plained= &at o% $siolog$ malignant or cancerous growths represent one form of abnormal growth an abnormal cell is transformed by the genetic mutation of cellular 4>$ abnormal cells form a clone and proliferates abnormally cells ac7uire invasive characteristics and infiltrate the surrounding tissues and gain access to lymph and blood vessels carrying them to the other areas of the body. Cell &roliferative &atterns 1. .yperplasia1 an increase in the cell number with accompanying increase in size -. .ypetrophy1 an increase in the cell size but not in its number #. 6etaplasia1 the conversion of one type of mature cell into another type of cell; a reversible process and is not related to cancer /. 4ysplasia1 an alteration in adult cell characterized by changes in their size shape and organization 3. >eoplasia1 abnormal cellular division not necessary for normal cell growth and development; often leads to the formation of cancer cells :. $naplasia1 cells that lack normal cellular characteristics and differ in shape and organization with respect to their cells of origin and are usually malignant. 'enign vs( "alignant Tu#or C aracteristics Cell characteristics 6ode of !rowth %ate of !rowth 'enign +ell1differentiated cells that resemble normal cells of the tissue from which the tumor originated 5umor grows by e,pansion and does not infiltrate the surrounding tissues; usually encapsulated *sually slow "alignant Cells are undifferentiated and often bear little resemblance to the normal cells of the tissue from which they arose !rows at the periphery and sends out processes that infiltrate and destroy surrounding tissues %ate of growth is variable and depends on the level of differentiation

6etastasis !eneral &ffects

4oes not spread by metastasis )s usually a localized phenomenon that does not cause generalized effects unless its location interferes with vital function 4oes not usually cause tissue damage unless its location interferes with blood flow

!ains access to the blood and lymphatic channels and metastasizes to the other areas of the body 9ften causes generalized effects such as anemia weakness and weight loss 9ften causes e,tensive tissue damage as the tumor outgrows its blood supply or encroaches on blood flow to the area; may also produce substances that cause cell damage *sually causes death unless growth can be controlled

5issue 4estruction

$bility to Cause 4oes not usually cause death unless its 4eath location interferes with vital function

)iagnostic Tests for S%ecific Cancers *( Gastrointestinal Cancers &sophageal C5 "can 6%) &sophagoscopy with Biopsy Barium "wallow "tomach !astric "ecretion $nalysis Carcinogenic $ntigen !astroscopy with Biopsy Barium "wallow Colorectal Cancers C5 "can 6%) "tool !uaiac Colonoscopy and Biopsy Barium "wallow Cancer $ntigen 2iver Cancer 2iver Biopsy 2iver &nzyme "tudies *ltrasound C5 "can 6%) $ngiography +( Genitourinar$ Cancer 0rostate 4igital %ectal &,amination Bone "can Biopsy *rinalysis 0"$ "erum $cid 0hosphatase

Bladder Cytology Cytoscopy )V0 *rinalysis ?idney C5 "can %enal $ngiogram ?*B "tudies *rinalysis )V0 ,( G$necologic Cancers Cervical Colposcopy Biopsy 0ap "mear 9vary 0elvic 0hysical &,am )V0 Barium &nema *rinalysis *terine &ndometrial Biopsy and $spiration -( Ot er Cancers Breast Breast 0hysical &,amination *ltrasound 6ammography 5issue 2ymph >ode Biopsy &strogen and 0rogesterone %eceptor "tatus 2ung Chest @1ray "putum Cytology (iberoptic Bronchoscopy with Biopsy and Bronchial +ashings 6ediastinography 5horacentesis "anage#ent of Cancer Surgical "anage#ent the oldest and most widely1used option for cancer treatment; may be used for cancer diagnosis and staging cure adAuvant treatment control of oncologic emergencies or palliation of symptoms 1. 4iagnostic -. Curative or 0rimary 5reatment a. ocal e!cision b. "ide or Radical E!cision

c. Endosco#ic Surger$ d. Salvage Surger$ e. Electrosurger$ %. &r$osurger$ g. &'emosurger$ '. aser Surger$ #. 0rophylactic "urgery /. 0alliative "urgery when cure is not possible; the goal is to make the patient as comfortable as possible and to promote a satisfying and productive life for as long as possible 3. %econstructive "urgery may follow curative or radical surgery and is carried out in an attempt to improve function or obtain a desirable cosmetic effect Radiation T era%$ ionizing radiation is used to interrupt cellular growth; may be used to cure cancer or to control malignant disease when a tumor cannot be removed surgically or when a local nodal metastasis is present 1. &,ternal %adiation can be used to destroy cancerous cells at the skin surface or deeper in the body a. (ilovoltage T'era#$ b. inear )ccelerators*+etatron Mac'ine c. ,amma Ra$s -. )nternal %adiation also known as brachytherapy delivers a high dose of radiation to a localized area; can be implanted by means of needles seeds beads or catheters into the body cavity or interstitial compartments a. Intracavitar$ Radioisoto#es b. Interstitial Im#lants C e#ot era%$ the use of drugs to kill tumor cells by interfering with cellular function and reproduction 1. $lkylating $gents -. >itrosureas #. $ntimetabolites /. $nti1tumor $ntibitics 3. .ormonal $gents a. )ndogens b. &orticosteroids c. Estrogens d. -rogestins e. Estrogen )ntagonists :. $nti1adrenal ;. Vinca $lkaloids B. &pipodophylloto,ins C. 5a,anes Nursing Care of Cancer &atients 1. -. #. /. 3. :. ;. B. 0rotect the skin and oral mucosa 0rotect the cargivers from radiation $ssess for fluid and electrolyte status 6odify risks for infection and bleeding )mplement necessary safeguards $dminister prescribed medications $ssess for the psychological impact of hair loss 6anage nutritional concerns

C. 10. 11. 1-.

6anage pain 0rovide ade7uate rest 6anage stomatitis 0rovide emotional support Onco og! "uestions #ith $ationa e

1. Nina, an oncology nurse educator is speaking to a womens group about breast cancer.. Questions and comments from the audience reveal a misunderstanding of some aspects of the disease. Various members of the audience have made all of the following statements. Which one is accurate a. !ammography is the most reliable method for detecting breast cancer. b. "reast cancer is the leading killer of women of childbearing age. c. "reast cancer re#uires a mastectomy. d. Men can develop breast cancer. $nswer %. !en can develop breast cancer, although they seldom do. &he most reliable method for detecting breast cancer is monthly self'e(amination, not mammography. )ung cancer causes more deaths than breast cancer in women of all ages. $ mastectomy may not be re#uired if the tumor is small, confined, and in an early stage. *. Nurse !eredith is instructing a premenopausal woman about breast self'e(amination. &he nurse should tell the client to do her self'e(amination+ a. at the end of her menstrual cycle. b. on the same day each month. c. on the 1st day of the menstrual cycle. d. immediately after her menstrual period. $nswer %. ,remenopausal women should do their self'e(amination immediately after the menstrual period, when the breasts are least tender and least lumpy. -n the 1st and last days of the cycle, the womans breasts are still very tender. ,ostmenopausal women because their bodies lack fluctuation of hormone levels, should select one particular day of the month to do breast self'e(amination. .. Nurse /ent is teaching a male client to perform monthly testicular self'e(aminations. Which of the following points would be appropriate to make a. Testicular cancer is a highly curable type of cancer. b. &esticular cancer is very difficult to diagnose. c. &esticular cancer is the number one cause of cancer deaths in males. d. &esticular cancer is more common in older men. $nswer $. &esticular cancer is highly curable, particularly when its treated in its early stage. 0elf' e(amination allows early detection and facilitates the early initiation of treatment. &he highest mortality rates from cancer among men are in men with lung cancer. &esticular cancer is found more commonly in younger men. 1. 2hea, has malignant lymphoma. $s part of her chemotherapy, the physician prescribes chlorambucil

3)eukeran4, 15 mg by mouth daily. When caring for the client, the nurse teaches her about adverse reactions to chlorambucil, such as alopecia. 6ow soon after the first administration of chlorambucil might this reaction occur a. 7mmediately b. 1 week c. 2 to 3 weeks d. 1 month $nswer 8. 8hlorambucil'induced alopecia occurs * to . weeks after therapy begins. 9. $ male client is receiving the cell cycle:nonspecific alkylating agent thiotepa 3&hiople(4, ;5 mg weekly for 1 weeks by bladder instillation as part of a chemotherapeutic regimen to treat bladder cancer. &he client asks the nurse how the drug works. 6ow does thiotepa e(ert its therapeutic effects a. 7t interferes with deo(yribonucleic acid 3%N$4 replication only. b. 7t interferes with ribonucleic acid 32N$4 transcription only. c. It interferes with DN replication and !N transcription. d. 7t destroys the cell membrane, causing lysis. $nswer 8. &hiotepa interferes with %N$ replication and 2N$ transcription. 7t doesnt destroy the cell membrane. ;. &he nurse is instructing the .9 year old client to perform a testicular self'e(amination. &he nurse tells the client+ a. &o e(amine the testicles while lying down b. That the best time for the e"amination is after a shower c. &o gently feel the testicle with one finger to feel for a growth d. &hat testicular self'e(amination should be done at least every ; months $nswer ". &he testicular'self e(amination is recommended monthly after a warm bath or shower when the scrotal skin is rela(ed. &he client should stand to e(amine the testicles. <sing both hands, with fingers under the scrotum and thumbs on top, the client should gently roll the testicles, feeling for any lumps. =. $ female client with cancer is receiving chemotherapy and develops thrombocytopenia. &he nurse identifies which intervention as the highest priority in the nursingplan of care a. !onitoring temperature b. $mbulation three times daily c. Monitoring the platelet count d. !onitoring for pathological fractures $nswer 8. &hrombocytopenia indicates a decrease in the number of platelets in the circulating blood. $ ma>or concern is monitoring for and preventing bleeding. -ption $ elates to monitoring for infection, particularly if leukopenia is present. -ptions " and %, although important in the plan of care, are not related directly to thrombocytopenia.

?. @ian, a community health nurse is instructing a group of female clients about breast self'e(amination. &he nurse instructs the client to perform the e(amination+ a. $t the onset of menstruation b. Avery month during ovulation c. Weekly at the same time of day d. # week after menstruation begins $nswer %. &he breast self'e(amination should be performed monthly = days after the onset of the menstrual period. ,erforming the e(amination weekly is not recommended. $t the onset of menstruation and during ovulation, hormonal changes occur that may alter breast tissue. B. Nurse 8ecilia is caring for a client who has undergone a vaginal hysterectomy. &he nurse avoids which of the following in the care of this client a. $levating the knee gatch on the bed b. $ssisting with range'of'motion leg e(ercises c. 2emoval of antiembolism stockings twice daily d. 8hecking placement of pneumatic compression boots $nswer $. &he client is at risk of deep vein thrombosis or thrombophlebitis after this surgery, as for any ther ma>or surgery. Cor this reason, the nurse implements measures that will prevent this complication. 2ange' of'motion e(ercises, antiembolism stockings, and pneumatic compression boots are helpful. &he nurse should avoid using the knee gatch in the bed, which inhibits venous return, thus placing the client more at risk for deep vein thrombosis or thrombophlebitis. 15. !ina, who is suspected of an ovarian tumor is scheduled for a pelvic ultrasound. &he nurse provides which preprocedure instruction to the client a. Aat a light breakfast only b. !aintain an N,- status before the procedure c. Wear comfortable clothing and shoes for the procedure d. Drink si" to eight glasses of water without voiding before the test. $nswer %. $ pelvic ultrasound re#uires the ingestion of large volumes of water >ust before the procedure. $ full bladder is necessary so that it will be visualiDed as such and not mistaken for a possible pelvic growth. $n abdominal ultrasound may re#uire that the client abstain from food or fluid for several hours before the procedure. -ption 8 is unrelated to this specific procedure.

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