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Oncology Nursing

Oncology Nursing

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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
NeoplasiaNeoplasia-uncontrolled cell growth that follows no physiologic demand  Anaplasia-cells that lack normal cellular Anaplasiacharacteristics and differ in shape and organization  Metaplasia-conversion of one type of Metaplasiamature cell into another; reversible 

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

HyperplasiaHyperplasia-Increase in the number of cells  Hypotrophy-decrease in the organ size Hypotrophy/function  Hypertrophy-increase in the size Hypertrophy .

excessive MetaMeta.bad. deranged .change DysDys.lack HyperHyper.³Root words´      A.none AnaAna.

Classification of Neoplasia 1. Malignant 3. Benign 2. Borderline/ in situ .

WAYS TO DIFFERENTIATE A BENIGN FROM A MALIGNANT TUMOR Characteristics Rate of growth Benign Slow.growing Malignant Varies. w/ generalized effects Metastases Non metastatic metastatic . expansive. local effects Invasive. encapsulated. destructive.infiltrating. but usually fast-growing Differentiation Well differentiated Poorly differentiated Local invasion Local invasion.

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muscle Myoma- .bone Osteoma Myoma.Nomenclature of Neoplasia Tumor is named according to: 1. Organ or Cell  Hepatoma. Parenchyma.liver Hepatoma Osteoma.

either GROSS or MICROSCOPIC  Fluid-filled CYST Fluid Glandular ADENO  Finger-like PAPILLO Finger Stalk POLYP . Pattern and Structure.Nomenclature of Neoplasia Tumor is named according to: 2.

Nomenclature of Neoplasia Tumor is named according to: 3. Embryonic origin  Ectoderm ( usually gives rise to epithelium)  Endoderm (usually gives rise to glands)  Mesoderm (usually gives rise to Connective tissues) .

LipOMA tissueBoneBone.angiOMA vesselsFibrous tissue.myOMA Blood vessels.³OMA´ is used Adipose tissue.osteOMA MuscleMuscle.BENIGN TUMORS       SuffixSuffix.fibrOMA tissue- .

Glandular. Epithelial  Use the suffix. Ectodermal.³CARCINOMA´ suffix Pancreatic AdenoCarcinoma  Squamos cell Carcinoma  . Endodermal.MALIGNANT TUMOR Named according to embryonic cell origin 1.

MALIGNANT TUMOR Named according to embryonic cell origin 2. connective tissue origin  Use the suffix ³SARCOMA  FibroSarcoma  Myosarcoma  AngioSarcoma  . Mesodermal.

³Exceptionistas´ 1. lymphOMA. THREE germ layers  3. gliOMA. Non-neoplastic but ³OMA´ Non  . melanOMA ³TERATOMA´ Choristoma Hamatoma 2. ³OMA´ but Malignant  HepatOMA.

out of the cell cycle cells Neurons. Skin.continuously dividing cells . cardiac muscle cell Liver. PERMANENT cells.Dormant/Resting (G0) cells 3. endometrium . LABILE cells. STABLE cells.CANCER NURSING Review of Normal Cell Cycle 3 types of cells 1. kidney GIT cells. Blood cells 2.

CANCER NURSING Cell Cycle G0------------------G1 G0------------------G1 S G2 M  G0.Dormant or resting G0 G1.Mitotic phase (I-P-M-A-T) (I- .pre-mitotic.normal cell activities G1 S.DNA Synthesis  G2.precellular division  M. synthesis of proteins for G2.

CANCER NURSING Theories to the Pathogenesis of Cancer  Cellular transformation and derangement theory  Immune response failure theory .

PHYSICAL AGENTS  Radiation (thyroid CA)  Exposure to irritants (skin CA)  Exposure to sunlight (skin CA) .CANCER NURSING Etiology of cancer 1.

CANCER NURSING Etiology of cancer 2. CHEMICAL AGENTS  Smoking (Lung CA)  Dietary ingredients (gastric CA)  Drugs .

Genetics and Family History  Colon Cancer  Breast cancer .CANCER NURSING Etiology of cancer 3.

CANCER NURSING Etiology of cancer 4. Dietary Habits LowLow-Fiber HighHigh-fat Processed foods alcohol .

virusesPapilloma Virus  RNA Viruses. EBV.HIV. Herpes.CANCER NURSING Etiology of cancer 5. HTCLV Viruses Bacterium.HepaB.H. Viruses and Bacteria  DNA viruses. pylori Bacterium- . CMV.

Hormonal agents DES OCP especially estrogen .CANCER NURSING    Etiology of cancer 6.

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 .

HEMATOGENOUS  BloodBlood-borne. commonly to Liver and Lungs Seeding of tumors  3.CANCER NURSING  Spread of Cancer 1. DIRECT INVASION/EXTENSION  . LYMPHATIC  Most common  2.

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T cell System/ Cellular Immunity  Cytotoxic T cells kill tumor cells B cells can produce antibody Macrophages can engulf cancer cell debris  2. Phagocytic cells  .CANCER NURSING  Body Defenses Against TUMOR 1. B cell System/ Humoral immunity   3.

for visualization and staging MRI3. MRI. CT. Tumor Markers .CANCER NURSING  Cancer Diagnosis 1. BIOPSY  The most definitive   2.

Low grade 1 Grade 4.CANCER NURSING Cancer Grading The degree of DIFFERENTIATION  Grade 1.high grade 4- .

Metastasis 2.tumor  N. Stage 1 to Stage 4 . Uses the T-N-M staging system T T.CANCER NURSING Cancer Staging 1.Node  M.

Nutritional management  3. Early detection . Screening  4. Lifestyle Modification  2.CANCER NURSING GENERAL Promotive and Preventive Nursing Management  1.

Nursing Assessment Utilize the ACS 7 Warning Signals  CAUTION  C.Indigestion  O.Nagging cough and hoarseness .Obvious change in warts  N.A sore that does not heal  U.Unusual bleeding  T.Thickening or lump in the breast  I.Change in bowel/bladder habits  A.

Occult Blood.SCREENING    1. CXR. Male and female.DRE for prostate.SBE. Female. Testicular selfMaleselfexam . Mammography and FemalePap¶s Smear 3. Male. CBE. and femaleDRE 2.

.

Bone Marrow Transplant . Chemotherapy  3. Radiation therapy  4.CANCER MANAGEMENT GENERAL MEDICAL MANAGEMENT . Surgery  2.Treatment goals: cure. control and palliation  1. Immunotherapy  5.

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

ff-up and home care ff- . fluid and electrolyte imbalance and organ dysfunction  Plan for discharge. bleeding.CANCER MANAGEMENT NURSING MANAGEMENT  Provide education and emotional support  Assess patient¶s responses to the surgery  Monitor for possible complications such as infection.

gonads) .GIT. control.lymphatic.skin. prophylaxis  Cells are most vulnerable during DNA synthesis and mitosis (BM.CANCER MANAGEMENT RADIATION THERAPY  Cure.

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

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 softOral rinses with saline gargles/ tap water Avoid ALCOHOL-based rinses ALCOHOL- .

CANCER MANAGEMENT CHEMOTHERAPY  Destroys tumor cells by interfering w/ cellular functions and reproduction  Used primarily to treat systemic disease rather than localized lesions .

.

intrathecal Dosage based on TBSA Special care needed for vesicants. mitomycin. doxorubicin. intracavitary. IM. Oral. Subcutaneous. IV. nitrogen mustard. arteria.causes vesicantsextravasation (daunorubicin.CANCER MANAGEMENT     ADMINISTRATION: Topical. vincristine and vindesine. If suspected stop immediately and apply ice except in vonca alkaloid .

stomatitis.CANCER MANAGEMENT Common side effects: effects:  Nausea and vomiting. diarrhea  Myelosuppression  Nephrotoxicity-danorobucin. mitomycin CHF Pulmonary fibrosis-bleomycin and busulfan fibrosis- . anorexia.cisplastin. doxorubucin Nephrotoxicity CHF. methroxate.

taxanes and damageplant alkaloids.cisplatin lossfatigue .CANCER MANAGEMENT    Sterility Reversible Neurologic damage. peripheral neuropathy and hearing loss.

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 .

Nursing Intervention        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 .

Nursing Intervention     RELIEVE PAIN Mild pain.Weak opiods painSevere pain.Morphine painAdminister analgesics round the clock with additional dose for breakthrough pain .NSAIDS painModerate pain.

Nursing Intervention     DECREASE FATIGUE Plan daily activities to allow alternating rest periods Light exercise is encouraged Small frequent meals .

Nursing Intervention     IMPROVE BODY IMAGE Therapeutic communication is essential Encourage independence in self-care and selfdecision making Offer cosmetic material like make-up and makewigs .

Nursing Intervention       ASSIST IN THE GRIEVING PROCESS Some cancers are curable Grieving can be due to loss of health. and body image Answer and clarify information about cancer and treatment options Identify resource people Refer to support groups . sexuality. income.

Nursing Intervention         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 .

temp Administer IV antibiotics Administer supplemental O2 . BP.Nursing Intervention     MANAGE COMPLICATION: Septic shock Monitor VS.

000) is the most common cause <20.Nursing Intervention        MANAGE COMPLICATION: Bleeding Thrombocytopenia (<100. rectal and catheterization Soft foods and stool softeners . 000 spontaneous bleeding Use soft toothbrush Use electric razor Avoid frequent IM. IV.

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A chemotherapeutic agent was given to a patient as an adjunct to surgery .1.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 .

000-12. A 30 y. The nurse is monitoring the patient¶s lab results prior to the initiation of therapy.000 3.000-10.000 cells/mm3 1. The nurse knows that the WBC count of the client is normal if the result showed  5. client is about to receive chemotherapy.000 cells/mm3 5.000- .o.7.000 8.000-5.2.000 cells/mm3 8.000 1.000 cells/mm3 3.000.

3. 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 . Testicular self-examination is done as a selfpreventive screening procedure for testicular cancer.

In health teaching done in the OB-gyne ward. .4. OBthe nurse instructs the clients to perform selfselfbreast 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 lowhigh 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. As a preventive measure. Pap smear is a procedure done to screen for cervical cancer. . 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.

Testicular examination is advised as a screening procedure to detect testicular cancer. The client still needs further instructional reinforcements if he verbalized  a. ³ The testicles are normally egg-shaped´ egg b. ³ My testicles normally has a spongy consistency´  d. ³ This test is being done to detect any lumps´ . ³ My testicles feel smooth´  c.10.

hodgkins lymph0ma Non13. Hodgkins disease a. HTCLV . Human Papilloma d. Nasopharyngeal cancer virus 12. Hepatocellular cancer virus 14. Hepatitis B c. Epstein-Barr Epsteinb. Burkitts lymphoma 15.Match the following type of viruses with the various type of tumor/malignancy 11. Non.

Mortality and Morbidity Rates .

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Colon cancer .

History of IBD 5. Previous colon CA or polyps 4. Family history 3. High protein. Increasing age 2. Breast Ca and Genital Ca . LOW fiber 6. High fat.COLON CANCER        Risk factors 1.

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. Rectal lesions. alternating D and C lesions-      . Anemia 4.tenesmus. Anorexia and weight loss 5. Fatigue 6. Blood in the stool 3.Most common habits2.

carcino- . Fecal occult blood 2.Colon cancer      Diagnostic findings 1. Sigmoidoscopy and colonoscopy 3.carcino-embryonic antigen CEA. CEA. BIOPSY 4.

Hemorrhage 3.Colon cancer      Complications of colorectal CA 1. Obstruction 2. Sepsis . Peritonitis 4.

Radiation therapy .5-FU Chemotherapy2. Chemotherapy.Colon cancer    MEDICAL MANAGEMENT 1.

and colostomy (temporary or permanent) .Colon cancer     SURGICAL MANAGEMENT Surgery is the primary treatment Based on location and tumor size Resection. anastomosis.

Provide HIGH protein.Colon cancer NURSING INTERVENTION PrePre-Operative care  1.Provide information about post-op care and poststoma care  3. Administer antibiotics 1 day prior . HIGH calorie and LOW residue diet  2.

Enema or colonic irrigation the evening and the morning of surgery  5. NGT is inserted to prevent distention  6. F and E. Abdomen PE .Colon cancer NURSING INTERVENTION PrePre-Operative care  4. Monitor UO.

Colon cancer NURSING INTERVENTION PostPost-Operative care  1. Assess the abdomen for return of peristalsis . skin irritation and pulmo complication  2. prolapse of stoma. Monitor for complications  Leakage from the site.

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

Slightly edematous with minimal pinkish drainage  8. The stoma is PINKISH to cherry red. Manage post-operative complication post- .Colon cancer NURSING INTERVENTION PostPost-Operative care  6. Instruct to splint the incision and administer pain meds before exercise  7.

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Colon cancer    NURSING INTERVENTION: COLOSTOMY CARE Colostomy begins to function 3-6 days after 3surgery The drainage maybe soft/mushy or semi-solid semidepending on the site .

Colon cancer     NURSING INTERVENTION: COLOSTOMY 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     NURSING INTERVENTION: COLOSTOMY CARE Instruct to GENTLY push the skin down and the pouch pulling UP Wash the peri-stomal area with soap and water periCover the stoma while washing the peri-stomal periarea .

Colon cancer    NURSING INTERVENTION: COLOSTOMY CARE Lightly pat dry the area and NEVER rub Lightly dust the peri-stomal area with nystatin peripowder .

3 cm larger than the stomal opening Apply adhesive surface over the stoma and press for 30 seconds .Colon cancer     NURSING INTERVENTION: COLOSTOMY CARE Measure the stomal opening The pouch opening is about 0.

Colon cancer   NURSING INTERVENTION: COLOSTOMY CARE Empty the pouch or change the pouch when   1/3 to ¼ full (Brunner) ½ to 1/3 full (Kozier) .

full  Half-full Half 100 ml full  As you wish . Colostomy should be drained when it is  A.1.

3 cm larger than stomal opening b.5 cm larger than stomal opening c.Pouch opening should be A . . Same size with the opening  . 1 cm larger than stomal opening d.

purely air .     A client has underwent hemicolectomy and placement of Right colostomy. You expect the drainage to be A. solid C. purely liquid D. mushy B.

anemia B. tenesmus C. pain .     Most common manifestation of colon Ca is A. alternating diarrhea and constipation D.

1 day after C. When do You expect to note for fecal drainage? A. 3 days after D.     A client had a colostomy. 1 week after . as soon as the colostomy is placed B.

mitomycin . dopamycin C. vincristine B.     All of the following are vesicants except A. mustard D.

     In patients receivne chemotherapy suspected of extravasation. the drug must be stopped and ice should be applied for all of the following except A.mitomycin . mustard D. doxorobucin C. vincristine B.

XWhich of the following chemo agent is he most probably receiving? A. taxanes C. cisplatin .     A client receiving chemotherapy started to complain of dyspnea. X-ray showed fibrosis. vinblastine B. busulfan D.

     Cisplatin is known for causing which side effect A. reversible hearing loss B. irreversible peripheral neuropathy . irreversible hearing loss C. reversible peripheral neuropathy D.

chloramphenicol B. cisplatin . Which of the following drug is he most probably receiving? A. busulfan D. Auscultation showed rales and crackles. vinblastine C.     A client on chemotherapy started to complain of dyspnea and orthopnea.

Breast Cancer   The most common cancer in FEMALES Numerous etiologies implicated .

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Nulliparity  6. Family History of breast cancer  4. Early menarche and late menopause  5. Genetics. Late age at pregnancy .Breast Cancer RISK FACTORS  1.BRCA1 And BRCA 2 Genetics 2. Increasing age ( > 50yo)  3.

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

Pregnancy before 30 yo .Breast Cancer PROTECTIVE FACTORS  1. Breast feeding  3. Exercise  2.

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Fixed. Mass is NON-tender. Peau d¶ orange . Nipple retraction  5.Breast Cancer ASSESSMENT FINDINGS  1. hard with NONirregular borders  3. Skin dimpling  4.the most common location is the MASSupper outer quadrant  2. MASS.

Biopsy procedures 2. Mammography .Breast Cancer    LABORATORY FINDINGS 1.

metastasis .> 5 cm.2 to 5 cm. (+) LN III .Breast Cancer       Breast cancer Staging TNM staging I .< 2cm II . (+) LN IVIV.

Breast Cancer 
  

MEDICAL MANAGEMENT 1. Chemotherapy 2. Tamoxifen therapy 3. Radiation therapy

Breast Cancer 

SURGICAL MANAGEMENT 1. Radical mastectomy 2. Modified radical mastectomy 3. Lumpectomy 4. Quadrantectomy

Breast Cancer
NURSING INTERVENTION : Post-OP Post- 

    

Position patient: Supine Affected extremity elevated to reduce edema Warm shower on 2nd day post-op postImmediate post-op: snug dressing with drainage postMaintain 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
NURSING INTERVENTION : Post-OP Post Lotions, Creams are applied ONLY when the incision is healed in 4-6 weeks 4 Hand, shoulder exercise done on 2ndday  Post-op mastectomy exercise 20 mins TID Post NO BP or IV procedure on operative site  Heavy lifting is avoided  Monitor complications ( lymphedema, hematoma, infecton)

Breast Cancer NURSING INTERVENTION : Post-OP PostTEACH FOLLOW-UP care FOLLOW Regular check-up check Monthly BSE on the other breast  Annual mammography .

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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 .

more centrally carcinomalocated. most prevalent lung Ca for both M and F Large cell carcinoma-fast growing tumor that carcinomaarise peripherally .   Squamous cell carcinoma. AdenoCarcinomaAdenoCarcinoma. commonly in the segmental and subsegmental bronchi.presents more peripherally as peripheral mass or nodules.

usually slow growing Small cell Ca.arises primarily as a proximal Calesion but may arise in any part of the tracheobronchial tree .arises fr the CAterminal bronchus and alveoli.  Bronchioalveolar cell CA.

Lung Cancer Etiology  Tobacco use  Genetic.> acquired genetic lesion Genetic- .

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

tracheal obstruction. SIADH (sm cell). Systemic symptoms Endocrine syndromes-hypercalcemia syndromes(epidermoid). clubbing (non-sm. respiratory failure. hoarseness. Cell) (non- . Horner¶s syndrome. spreaddysphagia.Lung Cancer    Metastatic spread. gynecomastia (large cell). auperior vena cava syndrome. plural effusion.

M0 T1-2.M0 Any T4 or N3.N0.M0 5-yr survival rate 60-80 25-50 25-40 10-30 <5 IIIB IV Any M0 <5 .N1.M0 T1-3.M0 T3.N0-1.Lung Cancer Stage I II IIIA TNM descriptors T1-2.N2.

direct extension into chest wall T4T4.Lung Cancer T1T1-< 3 cm T2T2->3 cm T3T3.invades mediastinum N0 N1N1-peribronchial N2N2-ipsilateral mediastinal N3N3-contralateral mediastinal .

lobectomy. pneumonectomy) Radiotherapy Chemotherapy .Lung Cancer     TREATMENT Surgery (segmentectomy.

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Laryngeal cancer      Risk Factors tobacco alcohol radiation? occupation? .

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supraglottic  . good 55prognosis  3. metastasizes to the Delphian 1node .rich in lymphatics  2.(true vocal cords) most common 55-75%.least common 1-5%.CLASSIFICATION ACCORDING TO LOCATION  1. subglottic  . glottic  .

2 wks duration change airway obstruction  odynophagia  otalgia  neck mass  other constitutional symptoms .SYMPTOMS:  voice change.

DIAGNOSIS:  LARYNGOSCOPY  BIOPSY .

MANAGEMENT  local excision/ vocal cord stripping  LASER vaporization or excision/ cordectomy  Radiotherapy (EBRT(EBRT.external beam radiotherapy or brachytherapy ± radioactive implants)  Conservation laryngectomy/ Total laryngectomy .

Laryngeal Cancer NURSING MANAGEMENT: PRE-operative PREProvide the patient pre-operative teachings pre 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 POSTMaintain 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 3weeks after surgery .

Laryngeal Cancer NURSING MANAGEMENT: POST-op POSTPromote 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. avoid sweet foods . TPN are alternative nutrition routes  Start oral feedings with thick liquids.

Laryngeal Cancer NURSING MANAGEMENT: POST-op POSTMonitor for COMPLICATIONS  Respiratory Distress  Hemorrhage  infection .

powders and loose hair near the opening  Oral hygiene frequently .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.

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Prostate Cancer Etiology  AgeAge-related Blacks>white 95 % are adenocarcinomas   .

to urinary flow obstuction  Urinary frequency. diminished force. ec in caliber of stream. hesitancy. dribbling. nocturia and overflow incontinence  Dysuria  Back or hip pain .Prostate Cancer Manifestations:  Rel.

transrectal prostate biopsy under Biopsysonography (TRUS) .> 10 ng/ml PSA Biopsy.Prostate Cancer Diagnostics: Diagnostics:  DRE  PSA.

Prostate Cancer Treatment  Surgery. flutamide)  Chemotherapy.for palliation Chemotherapy- .for those w/ metastatic deprivationdisease (leuporide.radical retropubic prostatectomy Surgery Radiation therapy *both are associated w/ impotence  Androgen deprivation.

quiz 1. All of the following are manifestations of prostate cancer except  Hesitancy  dribbling  Dysuria  Painless .

Dysphagia C. The most common manifestation of laryngeal cancer is A. Voice change D.     2. odynophagia B. dyspnea .

ovarian CA  C.3. esophageal cancer . laryngeal cancer  D. Which of the following is not caused by smoking?  A. lung cancer  B. Most head and neck cancers are caused by smoking.

a 64 y.Quiz 4. What is your assessment to the possible cause of tachycardia in this patient?  infection  3rd spacing  Dehydration  sepsis .hemi colectomy postwas tachycardic.o patient status post. Examination of the mucus membrane showed a dry mouth.

difference between a benign fr malignant neoplasm include all of the ff except  well differentiated  poorly demarcated  no metastatic potential  non invasive .5.

All of the ff are ex of those except  GIT  Fatty tissues  Nerve  skin .6. radiation therapy is effective in actively dividing cells.

7. screening should be done to detect cancers. Routine Screening tests involves all of the following except     breast exam DRE Ultrasound Occult blood exam .

dry skin and s/sxs of cachexia. The client most probably has  A. TB  B. A client complained of chronic cough w/ hemoptysis. bronchiectasis  C.8. Assessment showed wasting. lung CA  D. all of the above .

Unaffected side c. Client underwent pneumonectomy. Trendelenburg d.9. Post-op Postthe best position to put the client in is a. Affected side b. 10 inch block .

4 months D. 2 months C. 1 month B.     10. Post-mastectomy lotions and cream may be Postapplied after healing takes place. When does it usually occur? A. 1 year .

45Risk factors: Early coitus Early conception Multiple sexual partners Cigarette smoking High risk partners Immunosuppressed HPV HSV .Cervical Cancer           peaks: 45-60 y.o.

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: 5050-60 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 distentionLower abdominal pain Pelvic mass Weight loss

   

Diagnostics: Pelvic ultrasound CACA-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)

only 5% are T lymphocytes .NonNon-Hodgkins Lymphoma    Heterogenous group of cancers Originates from neoplastic growth of lymphoid tissue Mostly involves malignant B lymphocytes.

& unintentional wt. lymphadenopathy is noticeable (stages III or IV)  1/3 of cases have ³B symptoms´ (recurrent fever. loss of >10% . drenching night sweats.NonNon-Hodgkins Lymphoma Manifestations:  Symptoms are highly variable  Symptoms may be absent or very minimal at the earlyearly-stage of the disease  Typically diagnosed at a latter stage when px is more symptomatic.

NonNon-Hodgkins Lymphoma Assessment & Diagnostics  Histopathology  Immunophenotyping  Cytogenetic analysis Staging ± based on data obtained from CT scan. CSF analysis . bone marrow biopsies.

& px¶s ability to tolerate therapy  Radiation alone maybe beneficial in localized nonnonaggressive forms  In aggressive types. I & II disease . combination chemotherapy are given in early stages  Intermediate forms ± chemotherapy + radiotherapy for st.NonNon-Hodgkins Lymphoma Treatment:  based on actual classification & stage of disease. prior treatment.

*reed sternberg cell.lymphoma     Hodgkins disease Cause: unknown S/sxs: painless lymphadenopathy. supportive. edema(lymph obstuction).cough.dypnea(mediastinal node enlargment) Mgt: radio.chemo (MOPP).splenectomy .

median age Yrs..Smoking Cyclophosphamide exposure Schistoma haematobium .Urinary bladder Cancer      ETIOLOGY AND RISK FACTORS 65 Yrs.

Urinary bladder Cancer Manifestations: Manifestations:  Hematuria.mOst common symptom Hematuria Urinary changes may accompany later  Usually asymptomatic at early stages .

diagnostic .hematuria IVPIVP.decreased bladder filling CystoscopyCystoscopy.    Diagnosis: UrinalysisUrinalysis.

Urinary bladder Cancer     Treatment: Based on extent of disease Surgical Resection Intravesical chemotherapy .

squamous cell 3. irritation & exposure to UV Types: Types: 1. malignant melanoma ± most fatal . basal cell ± most common 2.Skin cancer Etiology : ± chronic friction.

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 .

.

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pigmented ad superficial . ulcerative.Basal Cell Carcinoma Risk factors:  UV rays  May take several forms: nodular.

fine telangiectasia and is translucent .Basal Cell Carcinoma Hx and Assessment:  Usually asymptomatic unless secondarily infected in advanced disease  Pearly-colored PAPULE Pearly External surface .

.

Melanoma Risk factors:  Sun exposure  Fair skin  Positive family history  Presence of dysplastic nevi .

color variation  D.asymetry  B.Melanoma Hx and Assessment:  Usually asymptomatic until late  Pruritus or mild discomfort  Recent changed in a previous skin lesion  A.border irregularity  C.diameter(large) .

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b.Skin Cancer Interventions: Interventions: preventive measures a. c. monitoring of any lesion have moles or lesions removed if they are subject to chronic irritation avoid contact with chemical irritants use of sunscreen avoid too much sun exposure . e. d.

Hepatocellular CA   Hepa B alcohol .

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Synthesizes Clotting factors Abnormality in function = Hypoglycemia = Hypoproteinemia =Decreased Antibody formation = Bleeding tendencies = Jaundice & pruritus =Hyperammonemia =Deficiencies of Vit and min = Gynecomastia. Converts ammonia to urea 7. Stores glycogen 2. Synthesizes proteins 3. Metabolizes estrogen . testes atrophy 5. Stores Vit and minerals 8. Secreting bile 6. Synthesizes globulins 4.Liver physiology and Pathophysiology Normal Function 1.

LOC and Bleeding  2. Abdominal girth. I and O. weight. Elevated the head of the bed to minimize dyspnea  . Monitor VS. Promote rest.CONDITION OF THE LIVER NURSING INTERVENTIONS 1.

Provide Moderate to LOW-protein (1 g/kg/day) LOWand LOW-sodium diet LOW 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 .CONDITION OF THE LIVER NURSING INTERVENTIONS  3.

Avoid hepatotoxic drugs  Paracetamol  Anti-tubercular drugs Anti7.CONDITION OF THE LIVER NURSING INTERVENTIONS 6. Reduce the risk of injury  Side rails reorientation  Assistance in ambulation  Use of electric razor and soft-bristled softtoothbrush .

CONDITION OF THE LIVER NURSING INTERVENTIONS   8. Assist in surgery and chemotherapy . Medications to treat hemorrhage 9. IV fluids. Keep equipments ready including SengstakenSengstaken-Blakemore tube.

     1. pelvic pain B. painless heamturia D. What is the most common manifestation of urinary bladder cancer? A. Painful hematuria C. pelvic mass .

2. Which of the following drugs serves that purpose? a. Vancomycin b. they are given drugs to kill bacterial flora that cause NH production. In patient w/ liver disorders. Amoxicillin c. Nitrogen mustard . Neomycin d.

genital warts  D. HTLV . HPV  B. This is associated w/ all of the following except  A.3. herpes simplex  C. Cervical cancer is fast growing.

Ductal CA . Prolonged Exposure to estrogen increases the risk for acquiring All of the following types of cancer except a. Breast CA b.4. Ovarian CA c. Endometrial Ca d.

Assessment findings which will help strenthen the diagnosis includes  A.color variation  D.5.asymetry  B. Malignant melanoma is often seen in fair skinned individuals.border irregularity  C.diameter (small) .

ulcerating CA C.pearly colored papule cell D. All of the following are correct except  A.nodular cell- .assymetrical melanoma B. basal cell.6. squamous CA. melanoma. Squamous cell.

Supraclavicular c. inguinal . Cervical b.7. Mediastinal d. Lymphoma is a malignancy involving the lymph tissues. The most common lymph node involved is a.

Which of the following assessment findings will aid you in diagnosisng hodgkin¶s disease  A. lymphadenopathy  B. lymphedema . reed sternberg cell  D.8. hematuria  C.

9. Patients w/ cervical cancer often complains of a. Dysmenorrhea b. Post coital bleeding c. Pelvic mass d. Pelvic pain

10. Patients with liver cancer often presents with following assessment findings except a. Esophageal varices b. Ascites c. Hyperglycemia d. Petechiae and echymosis

chemotherapy was advised in a patient diagnosed w/ skin Cancer. You know that vinblistine is a vesicant type of agent and causes     extravasation intravasation nephrotoxicity ototoxicity .5. Vinblistine was the agent ordered.

7-9. Most common manifestation of lung cancer in early stages is«. Give 3 ways to avoid unnecessary exposure 10.6. internal Radiation therapy poses a risk for both patient and caregiver. Most frequent cause of fever w/in 24 hrs in a postpost-op patient is«. ..

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