Nursing Oncology

Oncology Nursing
Oncology defined
• Branch of medicine that
deals with the study,
detection, treatment and
management of cancer and
neoplasia
“Root words”
• Neo- new
• Plasia- growth
• Plasm- substance
• Trophy- size
• Oma- tumor
“Root words”
• A- none
• Ana- lack
• Hyper- excessive
• Meta- change
• Dys- bad, deranged
CELL CHANGES
• 1. Atrophy
• 2. Hypertrophy
• 3. Hyperplasia
• 4. Metaplasia
• 5. Dysplasia
• 6. Anaplasia
• 7. Neoplasia
ETIOLOGY: MULTIFACTORIAL
• GENETIC FACTORS
• SMOKING
• DIETARY: NITRATES (NITROSAMINES),
BENZOPYRENE
• HORMONAL / CHEMICAL AGENTS
• BIOLOGIC AGENTS: MOLDS, VIRUSES
& BACTERIA
• OTHERS
Characteristics of Neoplasia
Uncontrolled growth of Abnormal cells
• 1. Benign
• 2. Malignant
• 3. Borderline
BENIGN
• Well-differentiated
• Slow growth
• Encapsulated
• Non-invasive
• Does NOT metastasize
MALIGNANT
• Undifferentiated
• Erratic and Uncontrolled Growth
• Expansive and Invasive
• Secretes abnormal proteins
• METASTASIZES
Reasons for Successful
Metastasis
• 1. cancer cells release ENZYMES to
escape from the lymphatic and blood
vessels
• 2. secondary site should provide
nourishment to cancer cells
• 3. secondary site should have adequate
blood supply
Nomenclature of Neoplasia
Tumor is named according to:
1. Parenchyma
• 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
• Squamous cell Carcinoma
MALIGNANT TUMOR
Named according to embryonic cell origin
2. Mesodermal, connective tissue origin
Use the suffix “SARCOMA
• FibroSarcoma
• Myosarcoma
• AngioSarcoma
“PASAWAY”
1. “OMA” but Malignant

– HepatOMA, lymphOMA, gliOMA,
melanOMA
2. THREE germ layers
– “TERATOMA”
3. Non-neoplastic but “OMA”
– HEMATOMA
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
• Proposed Molecular cause of CANCER:
• Change in the DNA structure altered
DNA function Cellular aberration
 cellular death
 neoplastic change
• Genes in the DNA- “proto-oncogene” And
“anti-oncogene”
CANCER NURSING
Etiology of cancer
1. PHYSICAL AGENTS
• Radiation
• Exposure to irritants
• Exposure to sunlight
CANCER NURSING
Etiology of cancer
2. CHEMICAL AGENTS
• Smoking
• Dietary ingredients
• Drugs
CANCER NURSING
Etiology of cancer
3. Genetics and Family History
• Colon Cancer
• Premenopausal 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-diethylstilbestrol
• 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 mutate
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 SPREAD
– 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
• 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 MEDICAL MANAGEMENT
• 1. Surgery- cure, control, palliate
• 2. Chemotherapy
• 3. Radiation therapy
• 4. Immunotherapy
• 5. Bone Marrow Transplant
CANCER NURSING
GENERAL Promotive and Preventive
Nursing Management
• 1. Lifestyle Modification
• 2. Nutritional management
• 3. Screening
• 4. Early detection
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
Nursing Assessment
Utilize the 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
Nursing Assessment
• Weight loss
• Frequent infection
• Skin problems
• Pain
• Hair Loss
• Fatigue
• Disturbance in body image/ depression
Nursing Intervention
MAINTAIN TISSUE INTEGRITY
• Handle skin gently
• Do NOT rub affected area
• Lotion may be applied
• Wash skin only with moisturizing soap and
water
MANAGEMENT OF STOMATITIS
• Use soft-bristled toothbrush
• Oral rinses with saline gargles/ tap water
• Avoid ALCOHOL-based rinses
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
 Avoid giving fluids while eating
 Oral hygiene PRIOR to mealtime
 Vitamin supplements
RELIEVE PAIN
 Mild pain- NSAIDS
Moderate pain- Weak opioids
 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
 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
INCIDENCE OF CANCER
• MALES • FEMALES
– 1. PROSTATE – 1. BREAST CANCER
CANCER – 2. LUNG CANCER
– 2. LUNG CANCER – 3. COLORECTAL
– 3. COLORECTAL CANCER
CANCER
Colon cancer
COLON CANCER
Risk factors
• 1. Increasing age
• 2. Family history
• 3. Previous colon CA or presence of intestinal
polyps
• 4. History of IBD (Ulcerative Colitis)
• 5. High fat, High protein, LOW fiber
• 6. Breast Ca and Genital Ca
COLON CANCER
• Sigmoid colon is the most common site
• Predominantly adenocarcinoma (starts as
adenomatous polyps arising in sigmoid
and rectum)
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
(alternating D and C)
• 2. Blood in the stool
• 3. Anemia
• 4. Anorexia and weight loss
• 5. Fatigue
• 6. Rectal lesions/mass
• 7. Tenesmus
• FOCUS IS ON EARLY
DETECTION &
INTERVENTION
• If early 90% survival
• 34% diagnosed early
• 66% late diagnosis
Colon cancer
Complications
• 1. Obstruction
• 2. Hemorrhage
• 3. Perforation
• 4. Peritonitis
• 5. Sepsis
• 6. direct extension of
cancer to adjacent
organs
Colon cancer
Diagnostic findings
• 1. DRE at age 40, annually
• 1. Fecal occult blood
• 2. Sigmoidoscopy and colonoscopy – begin at
age 50, every 3-5 years
• 3. BIOPSY
• 4. CEA- carcino-embryonic antigen (to estimate
prognosis, monitor treatment and recurrence)
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
• PREVENTION is primary issue
• CLIENT Teaching:
– DIET: high fiber diet (fruits, vegetables, whole
grains, legumes)
– Screening recommendations
– Seek medical consult for bleeding and
warning signs of cancer
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 pulmonary 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 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)
Breast Cancer
• The most common
cancer in FEMALES
• Numerous etiologies
implicated
Types of Breast Cancer
• 1. adenocarcinoma : INFILTRATING
DUCTAL CARCINOMA - 70%
• 2. INFLAMMATORY CARCINOMA –
most malignant
• 3. PAGET’S disease - NIPPLE
Breast Cancer
RISK FACTORS
• 1. Genetics
• 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(peau d’ orange)
• 4. Nipple retraction/discharge
• 5. axillary adenopathy
Breast Cancer
• LABORATORY FINDINGS
• 1. Biopsy procedures
Percutaneous needle biopsy
Needle aspiration from mammary duct
Excision biopsy
• 2. Mammography- American Cancer Society
recommends annual screening at age 40
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 – interferes with
ESTROGEN ACTIVITY
Breast Cancer
NURSING INTERVENTION : PRE-OP
• 1. Explain breast cancer and treatment
options
• 2. Reduce fear and anxiety and improve
coping abilities
• 3. Promote decision making abilities
• 4. Provide routine pre-op care:
– Consent, NPO, Meds, Teaching about breathing
exercise
Breast Cancer
• SURGICAL MANAGEMENT
1. simple Mastectomy
2. Radical mastectomy
3. Modified radical mastectomy
4. Lumpectomy OR Segmental Resection
5. Quadrantectomy
Breast Cancer
NURSING INTERVENTION : Post-OP
1. Position patient:
• Supine
• Affected extremity elevated to reduce
edema
Breast Cancer
2. Relieve pain and discomfort
• Moderate elevation of extremity
• IM/IV injection of pain meds
• Warm shower on 2nd day post-op
Breast Cancer
3. Maintain skin integrity
• Immediate post-op: snug dressing with
drainage
• Maintain patency of drain (JP)
• Monitor for hematoma w/in 12H and apply
bandage and ice, refer to surgeon
Breast Cancer
3. Maintain skin integrity
• Drainage is removed when the
discharge is less than 30 ml in 24 H
• Lotions, Creams are applied ONLY
when the incision is healed in 4-6
weeks
Breast Cancer
Promote activity
• Support operative site when moving
• Hand, shoulder exercise done on
2ndday
• Post-op mastectomy exercise 20
mins TID (wall climbing, overhead
pulleys, rope turning, arm swings)
• NO BP or IV procedure on operative
site
POSTMASTECTOMY EXERCISES
Wall climbing
Overhead pulleys
Rope turning
Arm swing
Breast Cancer

Promote activity
• Heavy lifting is avoided
• Elevate the arm at the level of the
heart
• On a pillow for 45 minutes TID to
relieve transient edema
Breast Cancer

MANAGE COMPLICATIONS
Lymphedema
• 10-20% of patients
• Elevate arms, elbow above shoulder and
hand above elbow
• Hand exercise while elevated
• Refer to surgeon and physical therapist
Breast Cancer

Hematoma
• Notify the surgeon
• Apply bandage wrap (Ace wrap) and
ICE pack
Breast Cancer
Infection
• Monitor temperature, redness, swelling
and foul-odor
• IV antibiotics
• No procedure on affected extremity
Breast Cancer
TEACH FOLLOW-UP care
• Regular check-up
• Monthly BSE on the other breast
• Annual mammography
POSTOP RADIATION Therapy (can also
be used preop & intraop)
Recommendation of ACS
• Monthly BSE beginning at age 20, 5-7
days AFTER menstruation
• Clinical breast examination every 3 years
age 20-39 years
• Clinical breast examination and annual
mammography at age 40
NURSING DIAGNOSES
• 1. Anxiety
• 2. Decisional Conflict
• 3. Anticipatory Grieving
• 4. Risk for Infection
• 5. Risk for injury
• 6. Body Image disturbance
LUNG CANCER
• Leading cause of CANCER DEATHS in
US for both male and female categories
• Cancer well-advanced at time of diagnosis
• Most patients die within one year of initial
diagnosis
• 5-year survival is only 15%
LUNG CANCER
• Etiology:
1. AGE, incidence increases with age 50
2. SMOKING – 80% of lung cancer is
positively associated with SMOKING
3. IONIZING radiation, INHALED
IRRITANTS (ASBESTOS0
LUNG CANCER
• LUNG LESION:
– SMALL or OAT CELL Carcinoma – 25%
• *PARANEOPLASTIC SYNDROME
– NON-SMALL CELL Carcinoma – 75%
• ADENOCARCINOMA
• SQUAMOUS CELL CARCINOMA
• LARGE CELL CARCINOMA
LUNG CANCER
• Signs and Symptoms:
– CHRONIC COUGH, Hemoptysis, wheezing,
shortness of breath, dull aching chest pain,
hoarseness, dysphagia
– SYSTEMIC: weight loss, anorexia, fatigue,
bone pain, generalized weakness
LUNG CANCER
• METASTASIS
– BRAIN – mental behavioral changes
impaired gait and balance
– BONE – bone pain, pathologic fractures,
anemia
– LIVER – jaundice, anorexia, RUQ pain
*SUPERIOR VENA CAVA SYNDROME

LUNG CANCER
• DIAGNOSTIC TESTS
– CHEST X-ray
– SPUTUM studies
– BRONCHOSCOPY
– CT SCAN/MRI
– BIOPSY
– CBC, LIVER FUNCTION STUDIES
LUNG CANCER
• TREATMENT:
– SURGERY goal: to remove as much involved
tissue as possible while preserving the lung
function
– CHEMOTHERAPY
– RADIATION goal: to cure or relieve symptom
NURSING DIAGNOSES
• 1. Ineffective Breathing Pattern
• 2. Activity Intolerance
• 3. Pain
• 4. Anticipatory Grieving
PROSTATE CANCER
• CAUSE: UNKNOWN
• Most primary prostatic CA:
ADENOCARCINOMAS
• Skeletal Metastasis, especially to the
VERTEBRAE (COMPRESSION/
FRACTURES OF SPINE)
PROSTATE CANCER
• Manifestations:
– EARLY: ASYMPTOMATIC
– URINARY S/SX: SIMILAR TO BPH: urgency,
frequency, hesitancy, dysuria, nocturia,
hematuria, blood in ejaculate
– Metastasis: BONE
PROSTATIC CANCER
• DIAGNOSTIC TESTS:
– DRE (yearly after age 50)
– Annual PSA levels, >4ng/ml
– TRANSRECTAL ULTRASOUND
– PROSTATIC BIOPSY Needle biopsy
– Bone scan, MRI, CT scans
PROSTATIC CANCER
• SURGERY:
– TURP: EARLY DISEASE IN OLD MEN
– RETROPUBIC
PROSTATECTOMY/PERINEAL
PROSTATECTOMY
– RADICAL PROSTATECTOMY
• REMOVAL OF PROSTATE, PROSTATIC
CAPSULE, SEMINAL VESICLES, PORTION OF
BLADDER NECK
PROSTATIC CANCER
• HORMONAL MANIPULATION:
Orchiectomy
• Administration of female hormonal
agents
• RADIATION: BRACHYTHERAPY
(implanted radioactive seeds to
eradicate remaining cancer cells, to
reduce metastasis, to relieve spinal cord
compression)
PROSTATIC CANCER
• NURSING DIAGNOSES:
– 1. Urinary incontinence following treatment:
stress or urge incontinence or mixed
– 2. Sexual Dysfunction
– 3. Acute/Chronic Pain

Nursing Oncology

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Nursing Oncology

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Oncology Nursing

1. “OMA” but Malignant

NURSING INTERVENTION : Post-OP

NURSING INTERVENTION : Post-OP

NURSING INTERVENTION : Post-OP

*SUPERIOR VENA CAVA SYNDROME

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