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ONCOLOGY

Cancer- are mutated stem cells that have undergone structural changes so that they are unable to perform their normal functions
Anatomy and physiology of a cell
- Nucleus – RNA/CHON synthesis= cell metabolism= give antimetabolites- to destroy cell metabolism and RNA/CHON synthesis
- MTX, 6 MP = antidote- 5 FU= antogonistic- dec folic acid= anemia
Chromatin – threadlike material for DNA synthesis= cell replication/multiplication= give alkylating agent= destroy cell
multiplication/replication
- 1. Cytoxan, Cisplatin= hemo cystitis= inc fluid intake, frequent emptying of the bladder
- 2. Plant alkaloid- Vincristine, Vinplastin/ oncovin – nephrotoxicity= constipation and paresthesia=s/e
Classification:
1. Benign- grow slowly, not life threatening/glandular adenoma,bone osteoma,nerve cell neuroma,fibroma
2. Malignant- infiltrate surrounding tissue, invade other tissues and produce secondary lesions/adenocarcinoma,
carcinoma,sarcoma,melanoma

American Cancer Society Warning Signs

Change in bowel, bladder habits

A sore that does not heal

Unusual bleeding or discharge

Thickening or a lump in the breast or elsewhere

Indigestion or difficulty in swallowing

Obvious change in a wart or mole

Nagging cough or hoarseness
Causative Factors
1. Physical- radiation- excessive exposure to sunlight and radiation/ chronic irritation
2. Chemical- food additives- nitrates/ industry- asbestos/pharmaceuticals-stilbesterol/ smoking/alcohol
3. Genetic
4. Viral- Epstein-Barr virus/ Burkitt’s lymphoma
5. Stress
Diagnostic Procedures and Labs.
1. X- rays
2. CAT scan – non invasive, during the patient will lie still- for 1-11/2 H
3. Cytology – cell study, invasive, sterile technique, monitor baseline V/S, after apply pressure
4. Radioisotope scan – introduction of radioisotope tracer into the client’s vein- to determine = organ perfussion determination
5. MRI
6. Mammography- baseline at 35-45 yrs old- no deodorants
7. Lymphangioraphy – introduction of dye into web of foot to det tumor stage and involvement
8. Colposcopic exam of the cervix – invasive, informed consent, ibuprofen b4 procedure to stage tumor= cancer in SITU- confines to
cervical lining only, stage 2 entire cervix, 3 upper 2/3 of vagina, 4 lower 1/3 of vagina, 4 bladder and rectum
9. Bone marrow biopsy –infants = tibia, adult post iliac crest, invasive
10. Hematology
TUMOR marker
1. PSA – 4mg/dl N---8 BPH---10 prostate ca
2. Inc ALP – prostate, bone and liver ca
3. CA 125 / cancer Ag 125= ovarian ca
4. CEA- carcinoembryonic antigen = colon, rectal, breast and lung ca
5. AFP- alpha feto CHON – inc= testicular ca
6. HCG
7. CA 19-9 = GIT ca
8. CA 15-3 = breast ca
9. NSE- neuron specific enolase – neuroblastoma
Stages of Tumor growth
N – stands for lymph node involvement
M – stands for metastasis
2. Satges 0-IV
Early detection:
1.
2.
3.
4.
5.
6.
7.

Seven warning signs
BSE
Rectal exam -40 y/o
Hazards of smoking
Oral self examination-annual mouth and teeth
Hazards of excess sun exposure
Pap smear

alopecia.bloody diarrhea. radium. mucous membrane.bone marrow depression. stomatitis. good mouth care Observe for pulmonary complications.tape. sterility Cyclophosphamide/Cytoxan Alopecia. abdominal bleeding Hematologic abnormalities. hypoglycemia. GI ulceration Diarrhea.bone marrow depression.bone marrow depression Check ECG. avoid alcohol. alopecia. bone marrow depression N/V. cracking Administer antiemetics for nausea.vomiting. Physical exam 30 y/o Q 3 years. stomatitis. loss of reflexes.pulmonary fibrosis.liver damage. Zyloprim given to increase excretion and decrease buildup of urates Check CBC. bone marrow depression. check breath sounds Give antiemetic before administration Nausea. bone pain Good mouth care. Radiotherapy 1. gold Wear cotton clothing Internal radiation ( cesium. good oral hygiene Teach client to report toxic GI sx promptly Check reflexes.changes hormone input into sensitive cells Tamoxifen/Nolvadex Nausea. Leukemia – blood forming. tremors. bone marrow depression. hyperkalemia.interfere with cell division Vincristine/Oncovin Vinblastine/Velban Hormonal Agents. rash Monitor for infection. motor and sensory function. hemorrhagic cystitis.mechanically positioned source of radioactive material placed in body cavity or tumor . confusion. monitor serum calcium.rash. cardiotoxicity. hypercalcemia. stomatitis. give antiemetic before administration. monitor V/S closely. acute bronchospasm can occur if given IV. Lymphoma. amenorrhea Check CBC Extra fluids to flush system Monitor for infection Avoid IM injection when platelet is low Report hematuria. avoid IV infiltration Avoid IV infiltration andextravasation.tissue( WBC’s and platelets) Alkylating agents. give zyloprim. avoid extravasation Red urine. fatigue Liver damage. bottles.8. don’t expose area to cold or sunlight Internal radiation ( cesium.connective tissue c. avoid IV infiltration. blisters. alopecia. radium. force fluids Monitor for infection Give antiemetics Antimetabolites Fluorouracil ( 5-FU ) Methotrexate/MTX Mercaptopurine/6 MP Cytarabine Hydroxyurea/Hydrea Antibiotics-antineoplastics Doxorubirin/Adriamycin Bleomycin/Blenoxane Dactinomycin/ Actinomycin D Vinca Alkaloids. GI sx. bone marrow depression.and hair follicles for side effects No hot water bags.interferes with rapidly reproducing cell DNA Busulfan/Myleran Cisplatin Chlorambucil/Leukeran Side effects Nursing considerations Bone marrow depression. Sealed source. Carcinoma.epithelial tissue b. External radiation( cobalt) Leave markings intact on skin Avoid creams or lotions. over 40 yearly Classification a. bone marrow depression Peripheral neuritis. nonsteroidal antiestrgen Implementation: A. analgesics for pain Observe skin. alopecia. GI sx Transient fall in WBC or platelets. loss of reflexes. weight loss Bone marrow depression. alopecia.edema of hands. GI sx N/V.lymphoid tissue d. alopecia. liver dysfunction. deodorants.nausea. bone marrow depression. infection. stomatitis. perfumes ( vit A and D ointment permitted) Use lukewarm water to cleanse the area Assess skin for redness.monitor hepatic and renal function tests Check liver function tests Force fluids.alopecia Oral and GI ulceration. gold a. N/V.treat fever with acetaminophen. dermatitis. hepatotoxicity N/V.fever. Sarcoma.

in small amount 2.based on ability of drug to kill cancer cells antimetabolites.obtained from the periwinkle plant. high CHON ) Encourage fluids but limit at meal times .affects RNA to make environment less favorable for cancer growth favorable Steroids and sex hormones. loose-fitting C. feces. ulcers. makes the host’s body a less -antitumor antibiotic.administer antidiarrheals .unsealed liquid given orally or instilled in body cavity. analgesics for pain Provide good nutrition B.erythema. Activity level Alternate rest and activity Maintain normal lifestyle H. Chemotherapy Principles. bleeding Oral rinses with saline or soft bristled toothbrush Avoid hot( temperature) or spicy foods Topical antifungals and anesthesia D. Unsealed Source. Nutritional changes anorexia. scarves. Diarrhea. organization Hospice care I.foster cancer cells death by interfering with cellular metabolic process Ankylating agents.TPN as needed .3 step ladder approach For mild pain.weak narcotics ( codeine) and nonnarcotics Severe pain.non narcotic meds used ( Tylenol ) along with antiemetics.Pain relief. Psychosocial Issues Encourage participation in self-care and decision making Provide referral to support groups.Perform oral hygiene and provide relief of pain before meal time . greatest danger from body fluids during the first 24-96 hours Assign patient to private room Place”Caution: Radioactive Material” sign on door Wear dosimeter film badge at all times when interacting with patient( offers no protection but measures amount of exposure) Do not assign pregnant nurse to patient Rotate staff caring for patient Organize tasks limit visitors Encourage patient to do own care Provide shield in room Use antiemetics Provide comfort measures. Hair care Alopecia commonly seen.strong narcotic ( Morphine) Give pain meds on regularly schedule basis ( preventive approavh) additional analgesics G. Mouth care Stomatitis – develops 5-14 days after chemo Symptoms. glucocorticoids For moderate pain. nausea and vomiting Malabsortion and cachexia common Make meals appealing to senses Conform diet to client preferences and nutritional needs Small frequent meals with additional supplements between meals( high calorie. then discard dressings and linens as usual Urine. Skin care Avoid use of soaps. lotions Wear cotton clothing. GI/ nausea and vomiting Antiemetics.Lead container and long-handled forceps in room in event of dislodged source Save all dressings. all fluids are contaminated. antideppressants.act with DNA to hinder cell growth and division Plant alkaloids. hats E. powders. and linens not radioactive Do not stand close or in line with radioactive source Patient on bedrest while implant in place Position of source verified by radiography b.every 4-6 H Withold fluids/foods 4-6 H before chemo Bland diet. bed linens until source is removed.alter the endocrine environment to make it less conducive to growth of cancer cells Major Side effects/ Nursing Care 1. alters body image Assist with wig or hair piece.

highest 2-3 weeks. endocrine abnormalities Care/Pretranplant: 1.client transplant with own harvested narrow 2.alternative treatment for severe aplastic anemia.teaching for oral good hygiene.principal complication . host disease.chronic GVHD.acute GVHD – develops in first 100 days post transplant and affects the skin. assess respirtory infection. includes human leukocytes antigen and mixed leukocyte culture typing Donor bone marrow is aspirated from multiple sites along the iliac crests under general anesthesia Donor marrow is infused IV into the recipient Early evidence of engraftment seen during the second week posttransplant. 5. Recipient immunosuppression attained with total body irritation and chemotherapy to eradicate existing disease and create space in host marrow to allow transplanted cells to grow 2. protect from injury. mucous membranes. patency and observe for signs of infection 6. Renal system Fluids Zyloprim 8. Allogeneic. When working with children introduced new people where they can seen 5.rest periods. Reproductive system Reliable methods of conception 9. wound culture. Client should be in laminar air flow room or in strict reverse isolation surveillance.Maintain good perineal care Give clear liquids as tolerated Monitor K. check platelet count daily. maintain fluid and electrolyte balance and promote nutrition.cultures done 2x a week 3. pneumonia Graft vs. monitor carefully for bleeding. Leukopenia. Neurologic system Peripheral neuropathies. administer oxygen 6. GUT. sloughing off 3.cataracts. marrow and lymphoid tissue . alopecia. Provide chemotherapy and radiation therapy Posttransplant 1. hematologic reconstitution takes 4-6 weeks. Monitor central line frequently.transplant from genetically nonidentical donor. 12. Na and Chloride levels Stomatitis. replace blood products as ordered (all blood products should be irradiated). liver. 10. paralytic ileus BONE MARROW TRANSPLANT.avoiding bumping or bruising skin Protect from injury Avoid aspirin products Avoid giving IM injections Monitor blood count carefully Assess for and teach of increased bleeding tendencies 4. Autologous. change IV sets Q 24 H 2. Maintain protective environment. 4. Syngeneic – transplant between identical twins 3.explain that hair loss is temporary.careful handwashing. 8. Objects must be sterilized 4. Provide skin care: breakdown may result from profuse diarrhea from TBI.sibling -common Donor suitability determined through tissue antigen typing. manifested by multiorgan involvement -recurrent malignancy -late complications. Administer parental narcotics as ordered if necessary to control pain. Provide mouth care. monitor hemoglobin and Hct. loss of deep tendon reflexes. V/S.note bleeding. Provide care every 2 hours or as needed 6. Types: 1. Thrombocytopenia. 11. 9. . Anemia. avoid commercial mouthwash Rinse with viscous lidocaine before meals Perform a cleansing rinse with plain water Advise client to suck on Popsicles to provide moisture 3. check for occult blood in emesis and stools. offer support and encouragement Scalp tourniquet or scalp hypothermia via ice pack may be ordered to minimize hair loss with some agents Wigs 7. 7 . avoid crowds 5. petechiae on skin. observe for easy bruising . etc. Do not use lemon and glycerin swabs. administer antibiotics. immunologic reconstitution takes months Hospitalization of 2-3 months required Prognosis is highly variable Complications: Failure of engraftment Infection.develops 100-400 days post transplant.

activity. consolidation. Cord – bowel/bladder/sensation of the lower extremities frontal lobe. drowsiness.to monitor the child at intervals for evidence of recurrent disease and complications of treatment -method. fever. -impaired g/d. chemotherapy. and slide effects 21. Is complete E. cong immune deficiency Cardinal sx: depends on the site cerebellar area = most common site/ risk 4 injury Pons – respiratory center/ineffective breathing pattern Medulla – cardiac and visceral organs Sp. transplant effect.LEUKOPLAKIA.chemo/radiation -effects – s/e still be evident C. 24.visual disturbances ( occipital lobe). immunotherapy Intracranial Tumors/Brain CA S/S. provide client teaching and discharge planning concerning 20.tx.goal. CNS damage. exposure to sun Cardinal sx: a sore that doesn’t heal.to remove the bulk of tumor method. 15 young.white patches in the buccal mucosa TX: URC THYROID CA 3 F’s female. LEUKOCORIA/ cat’s eye reflex TX: Upera. Late effects of tx. dizziness. monitor hydration status: check skin turgor. measure I&O carefully. protein and caloric intake. urine output. administer fluid replacement as ordered. change in color.to eliminate any remaining malignant cells . black with gray or white ) circular lesion with irregular edges seen on trunk or legs . effects.enucleation wid implant of prosthesis.most lethal. radiation EARS CA acoustic (CN 8) neuronoma.goal. change in LOC Risk Factors: radiation. provide adequate fluid. Induction: goal. 19. communicable diseases and immunizations 22. hearing difficulties.rough thick.altered though process EYE CA Retinoblastoma. Maintenance. freckles Cardinal sx: asymmetry.often the most intensive phase. administer antidiarrheal and agents as needed. observation. hereditary. paresthesia ( cerebellum). balance. daily hygiene and skin care 23. psychologic problem TYPES: Skin cancer-Risk factors: sunlight 10 am-3 pm.method.13.benign motor – vestibules. 17. 16.children. radiation. seizures ( motor cortex).most common . accessory – cochlear.tinnitus. N/V. vomiting. border irregularity.goal. family hx . vertigo. chemo. hereditary – cause Cardinal sx: white pupillary reflex. 20. STAGES OF CANCER TREATMENT A. s/e are potentially life threatening B. Medication regimen: schedule dosages.motor deficits. waxy nodule on sun-exposed area of body. chemicals.to keep child disease free -method. hearing loss TX: UR ORAL CA mouth or buccal mucosa Risk Factors: alcohol. weigh daily.surgery. cigarette. radiation. development of secondary malignancy. check electrolyte daily. red or blonde hair. diameter inc TX: surg resection. ringing of the eras. may ulcerate and crust Squamous cell carcinoma. immunosuppression Basal cell carcinoma. blue eyes.chemo-lasts for several years D.small. scaly tumor seen on arms or face Malignant carcinoma – variegated color ( brown. 18. 15. high risk with fair complexion. 14. moisture of mucous membranes.

pallor. painless LN enlargement. Turgot’s syndrome ( polyps at rectal and GI ). weight loss. or difficulty in swallowing TX: URC Exogenous estrogen use/Premarin CANCER OF THE STOMACH -Cause by excessive intake of highly salted or smoked foods. dysphagia TX: U. frequent smoking and alcohol intake. surgery. hemoptysis TX: URC Risk Factors: Cigarette smoking Chemicals Common in men Cytoxan Cardinal Sx: painless hematuria TX: U. alcohol. anti emetic. pain during swallowing and breathing TX: UR – RAI 131 all body fluids are radioactive.C LARYNX CA Risk Factors:3 F’s father. stool characteristic ( PENCIL LIKE). dyspnea. blood type A.trauma S/S. diet low in vegs and fruits -Cardinal sx: indigestion/dyspepsia -TX: Billroth I and II RENAL CA= Wilms tumor. familial polyposis -S/S – alternating diarrhea. dyspnea. digital rectal exam LUNG CA Risk Factors: cigarette smoking. dyspnea -dx. lower abdominal cramps.laryngectomy R ESOPHAGUS CA Risk Factors: Smoking. clay colored stools. chronic bleeding and anemia -caused by diverticulitis. helicobacter pylori infection. constipation. abnormal glucose tolerance test. jaundice. Alcoholic. Male Cardinal sx: dysphagia. impaired gases-diminished BS. Resected colorectal ca -ADENOCARCINOMA is the most common type of colon cancer .cystectomy= post urinary diversion – Ileal conduit PANCREATIC TUMOR Risk Factors: Pancreatitis. anorexia. NO palpation and biopsy narcotic. antacid. Excessive red meat and fat intake. achlorhydria. exposure to chemicals. weakness. age 50 and above. Renal cell ca Risk Factors: Renal cell ca occurs bet 50-70 years old Exposure to contrast medium and gasoline Nephroblastoma occurs at 2-4 y/0/Wilm’s Asbestos exposure Lalaki common/ male Cardinal sx: RCC= Palpable mass Painless hematuria Pain in the flanks Wilm’s= abdominal enlargement. ELLISON_SOLINGER syndrome ( pancreas secrete Gastrinsecreting tumor). pulmonary irritation and environmental pollution Cardinal sx: nagging cough. atrophic gastritis -RISK Factors: highly colored smoked food/salty food.men and women 50-60 years old . forty.autodigestion of pancreas Alcohol Nutritional def Chemicals Rate of moratality is very high Excessive fats Age above 60 Smoking Cardinal sx: indigestion.Cardinal SX: alteraltion bowel pattern. sigmoidoscopy. straining of voice Cardinal sx: hoarseness of voice.Cardinal sx: palpable mole in the thyroid. dark urine . Test.barium enema.rem of pancreas/ whipples CANCER OF THE COLON/RECTUM -Risk Factors:Family hx of ca. abdominal distension. 2-3x flushing the toilet .weight loss. vague upper or mid-abdominal discomfort. chronic ulcerative colitis. diet low in quantity of vegetable and fruits. Hx of bowel inflam disease/ ulcerative colitis.

treated with radium and hysterectomy CANCER OF THE UTERUS . OR THE WEDGE. red blood cells. and platelets.highly in men LEUKEMIA.symptoms reflect bone marrow failure and associated involvement of other organs Types: . Africans. Do it the same way at each time CANCER OF THE CERVIX.ETIOLOGY: UNKNOWN . blast cells crowd out healthy white blood cells.common site for metastasis Risk factors: Metastasis from other organ. cervical conization. stomatitis Anemias.after period – best time . Place your R arm behind your head .Move around the breast in a set way.S/S. BREAST SELF-EXAMINATION . dyspepsia . leading to bone marrow depression .Acute myeloid leukemias Lymphadenopathy . UP AND DOWN.oliguria CANCER OF THE LIVER. fever.lie down and put a pillow under your R shoulder. nipple discharges.most common cancer in childhood .HOW.removal of head of the pancreas. asymmetry of the breast. CIRCLE.in the bone marrow.now.enlargement of the liver. A firm ridge in the lower curve of each breast is normal .ALL.leading cause of death – 40-44 y/o for women Risk Factors: Advancing maternal age Breast ca hx Cigarette smoking and oral intake of contraceptive pills Diet increase in fats Early menarche and late menopause First child after 35 years old or nulliparity Cardinal sx:– palpation-lump. americans.class V – squamous cell carcinoma. the duodenum and part of the stomach .common site.class I – normal pap smear .000/mm3 less than-2-9 y/o -ANLL.lymphocyte.class II – atypical cells . see your doctor immediately .. metastasis to the lungs . invasive cancer Preinvasive conditions maybe treated by cryosurgery.includes granulocytic and monocytic types S/S. Cirrhosis and Hep B and C.class IV – severe dysplasia.AUER rods Excessive weight loss found only Unusual bleeding/ epistaxis Knee and joint pain Enlarged abdomen Malaise Infection signs. cancer in situ .skin of breast dimpled.first symptom .proliferation of abnormal white blood cells that do not mature beyond the blast phase . sore throat.if you find changes.use the finger pads of your 3 middle fingers on your L HAND TO FEEL FOR LUMPS OR THICKENING. examine your L breast using R finger pads using same procedure . Oral contraceptive pills Cardinal Sx: indigestion.Your finger pads are the top thirds of each finger -Press firmly enough to know your breast feels.lymphoma virus Ionizing radiation Caucasian children Cardinal sx: unusual bleeding or d/c BREAST CANCER.complication = hypoallergenic shock.Alcohol and Aflatoxins ( green bread). WBC 10.ovarian mass during palpation . severe ALL = Genetics Exposure to Benzene or gasoline Nagasaki or HIrushima bomb exposure/ MISO soup Excessive alkylating agents T.abnormal uterine bleeding either pre or post-menopause CANCER OF THE OVARY . acute onset. distal portion of the common bile duct. laser surgery. Asians.cardinal symptom. necrosis are common.class III – moderate dysplasia . 75 % chance of survival.Whipple procedure.upper outer quadrant. or hysterectomy Invasive conditions.detected by Pap smear . hemorrhage.

Abdominal bloating TX: U. sarcomas). flu like sx TX: U -splenectomy= LN dissection/ biopsy 4 Reed-Sternberg cells R – com of alkylating and plant alkaloids= MOPP C . radiation tx. above 50 Race . impaired gases-diminished BS. Nocturnal pain. exposure to chemicals.cystectomy= post urinary diversion – Ileal conduit PROSTATE CA Risk Factors: Family hx Cardinal SX : frequency African American residual urine Men eval of uria flow decrease Age over 65 hesitancy STD’s/ smoking nocturia TX: U = Horse +R+C small urinary stream Hormonal manipulation Orchiectomy. Abd’l enlargement. inc with + hx Alcohol Nulliparity Cardinal Sx: Amenorrhea.intermittent. bilateral. dyspnea. over 70 no tx Radical prostatectomy. (Radium = bone demineralization) Paget’s dis.CI in estrogen producing tumors Extrenal beam/interstitial radiation TESTICULAR CA Risk Factors: 15-39 y/o undescended testicles TSE.inguinal orchiectomy R. secondar cause of cancer Cardinal sx: Bone fx. pain worsens at nite. Ascites. Edema/swelling/lump Tx: URCHIB LUNG CA Risk Factors: cigarette smoking.lymphatics Cisplatin/Platinol HODGKIN CA.Risk Factors: Ovarian dysfunction/ amenorrhea Vague abd’l sx.malignant ca in the lymphatics Risk Factors: cause unknown. young males.. Epstein Barr virus Cardinal SX: supraclavicular node. hemoptysis TX: URC Risk Factors: Cigarette smoking Chemicals Common in men Cytoxan Cardinal Sx: painless hematuria TX: U. Saw Palmetto Berry. nigth sweats.HS Cardinal sx: 4 L’s: Lump. n/v Age. pulmonary irritation and environmental pollution Cardinal sx: nagging cough.TAHBSO Obesity Post menopausal Age 55 above Urban living Sex: F/ sex multiple BONE CA Risk Factors: inherited genes ( osteo. counselling cause impotence SILDENAFIL/ Viagra. pea sized Loaded heavines radiation to scrotum and groin Leg pain Large/obese TX: U. whites Incidence. Occassional fatique. painless.oophorectomy= ERT ENDOMETRIAL CA Risk Factors: Multiple use of Tamoxifen Cardinal sx:bleeding irreg Early menarche Nulliparity tx: u.