Clinical Manifestations
- Neurologic assessment
6. Localized Symptoms
Description: Sensory, motor or cognitive
disturbances
Specific areas of the brain and S/S:
a. Frontal lobe – hemiparesis, seizures,
changes in emotional state
(apathetic impulsive) and behavior
(speech, gestures)
b. Parietal lobe – decreased sensation,
seizures
c. Temporal lobe – psychological
disorders, seizures
d. Occipital lobe – visual deficits
(hemianopsia, visual hallucinations)
e. Cerebellum – dizziness, muscle
icoordination (gait), cranial nerve
deficits
f. Brainstem – cranial nerve deficits,
motor and sensory impairments
Dx test
1. Computed tomography (CT) scan
2. Magnetic resonance imaging (MRI)
3. Computer-assisted stereotactic (3D)
biopsy
4. Positron emission tomography (PET) scan
5. Electroencephalogram (EEG)
6. Cerebrospinal fluid (CSF) analysis
Medical management
1. Surgical Management
Objectives:
a. Establish diagnosis
b. Remove tumor
c. Relieve symptoms
Example: Craniotomy
Care of Clients who underwent Intracranial
Surgery
Assessment:
- Vital signs
- I&O and electrolyte levels
- Surgical dressing
Care of Clients who has undergone
Intracranial Surgery
Nursing Diagnosis:
1. Risk for ineffective cerebral tissue
perfusion
2. Risk for imbalance body temperature
3. Impaired gas exchange
4. Ineffective coping
5. Impaired communication
6. Impaired physical mobility
Nursing Interventions
1. Maintain cerebral tissue perfusion
a. Maintain adequate oxygenation – oxygen
administration, placement of endotracheal
tube
b. Reduce cerebral edema – medications
(mannitol, dexamethasone)
c. Prevent increase in ICP – intraventricular
drain, proper head position (neutral, lie on
unoperated side), raise head of bed
2. Regulate temperature
a. Maintain or reduce body temperature –
blankets, ice packs, antipyretics
b. Perform rewarming methods
3. Improve gas exchange
a. Increase fluid intake
b. Aspiration precaution
c. Reposition frequently
d. Suction secretions, coughing exercises
(with caution = increase ICP)
Medical Management
2. Radiation Therapy
- Gamma radiation is delivered via an
external beam to the tumor
Brachytherapy (implantation of radiation
source) – may is applicable for some types
Radiosurgery (gamma knife) – allow
treatment of deep, inaccessible tumors
3. Chemotherapy
- Used in conjunction with radiotherapy or
as sole therapy
- Blood-brain barrier may prevent drugs
from getting to the tumor. Temozolomide is
a chemotherapy drug which crosses the
blood-brain barrier
4. Pharmacologic Therapy
Corticosteroids (dexamethasone) – reduce
inflammation and edema
Osmotic diuretics (mannitol) – decrease ICP
Anticonvulsants (diazepam) control
seizures
Nursing Management
- Assess: Vital signs, neurologic function,
headache, characteristics, gag reflex, motor
function, sensory disturbances, speech, eye
movement and pupils, cranial nerve
function
- Maintain or prevent increase in ICP
- Reorient to person, time and place
- Prevent further injuries and complications
a. Aspiration
b. Seizure
c. Fatigue
Thyroid Tumors
Tumors are classified based on:
a. Malignancy
b. Thyrotoxicosis
c. Glandular enlargement
A tumor is referred to as goiter when it
produces visible swelling on the neck
Tyroid Cancer
- Exposure to radiation (head, neck or chest)
in the younger years increases risk of
thyroid cancer
Types:
a. Differential – develops from follicular
cells; almost similar to normal tissue
b. Medullary – develops from parafollicular
cells (C-cells); may spread before diagnosis
c. Anaplastic – develops from an existing
thyroid cancer; undifferentiated; spreads
quickly; difficult to treat; rare
Parathyroid Cancer
- Parathyroid glands are 4 tiny hlands
attached to the thyroid. They help regulate
the body calcium levels
- The cancers causes high blood calcium
levels (weak, dehydration, fracture)
Thyroid Cancer
- Global Cancer Incidence (Both Sexes)
Rank: 9
New cases diagnosed in 2018: 567,233
% of all cases: 3.3
Incidence: ¾ cases = women, 2/3 cases =
below 55 years old
Assessment:
- Palpation: single, hard, fixed location, or
presence of lymphadenopathy malignancy
- Thyroid function test (blood tests to
evaluate thyroid function)
- Needle biopsy, aspiration biopsy
(procedure for diagnosis or staging)
- Imaging: Ultrasound, MRI, CT, Thyroid scan
Medical Management
1. Surgical Management
- Treatment of choice
- Thyroidectomy (with Neck Dissection for
lymph node involvement)
2. Radiation
a. Radioactive Iodine Therapy – Thyroid
gland absorbs radioactive Iodine (RAI, also
called I-131): radiation destroys thyroid cells
(including cancer cells)
- SE: neck soreness, nausea, dry mouth,
tender salivary glands, changes in taste,
pain
b. External Radiation
- SE: Mucostitis, dryness of mouth,
dysphagia, anorexia, fatigue
Care of Clients who underwent Thyroid
Surgery
Nursing Interventions
1. Surgical Site
a. Assess surgical dressing and reinforce as
necessary
b. Observe for bleeding (sides/back of neck,
anterior dressing, V/S, pressure on site)
2. Respiration
a. Assess for edema of glottis, hematoma,
injury to laryngeal nerve
b. Prepare emergency equipment
(tracheostomy, surgical evacuation)
3. Pain
a. Administer analgesics as prescribed
b. Avoid tension on suture (support head,
semi-fowler position)
4. Communication
a. Minimize taling
b. Note any voice changes (possible
laryngeal nerve injury)
5. Nutrition
a. Preoperative: High calorie (Increased
metabolism)
Avoid stimulants: tea,
coffee, cola
b. Postoperative: High calorie (promote
weight gain)
Cold fuilds and ice
Soft diet, easily swallowed
6. Tetany (due to injured or removed
parathyroid)
a. Monitory blood calcium leve
b. Assess: spasms, muscle twitching
c. Antidote: IV calcium gluconate
d. Environment: Minimize noise, drafts,
bright lights, or sudden movement
Goal: serum calcium level = 9 to 10 mg/dL
(2.2 to 2.5 mmol/L)
Lung Cancer
- is the leading cancer killer worldwide
Etiology: Inhaled carcinogens (cigarette
smoke >85%, environmental agents)
Risk Factors:
1. Tobacco Smoke
- Assess: pack-year history (pack/day x years
smoked), age of initiation
- Smokeless nicotine products and passive
smoking also increases risk for cancer
2. Environmental and Occupational
Exposure
- Carcinogens: vehicle emissions, factory
pollutants, radon, industrial carcinogens
3. Genetic Mutations
- Inherited and acquired gene alterations
- Known genetic alterations: TP53 (p 16
tumor suppressor), K-RAS (ALKoncogenes)
Classification according to cell type:
1. Non-small Cell Lung Cancer (NSCLC)
- 85% of lung cancers
- subtypes: adenocarcinoma, squamous cell,
large cell
a. Adenocarcinoma – origin; mucus-
secreting cells; location: peripheral
b. Squamous cell carcinoma – origin: lining - Pneumonectomy (entire lung)
of airway; location: central - Chest wall resection
- linked to history of smoking
2. Radiation Therapy
C. Large cell carcinoma – undifferentiated; 3. Chemotherapy
location: peripheral
- fast growing cancer Nursing Management
1. Airway Clearance
2. Small Cell Lung Cancer (SCLC) a. Encourage: DBE, chest physiotherapy,
- 15% of lung cancers coughing techniques
- rare non-smokers b. Facilitate: Suctioning, positioning,
- grows and spreads faster than NSCLC bronchoscopy
- responds well to chemotherapy and c. Administer: Oxygen, bronchodilator
radiation medications

Lung Cancer 2. Fatigue

Global Cancer Incidence (Both Sexes) a. Energy conservation
Rank: 1 b. Relaxation techniques
New cases diagnosed in 2018: 2,093,876 c. Promote sleep
% of all cancers: 12.3
Laryngeal Cancer
Clinical Manifestations - Malignant tumors of the larynx arise from
1. Cough – chronic, dry to productive (note the surface epithelium
changes in character) - Almost all cancers of the larynx are
2. Dyspnea squamous cell carcinomas which developed
3. Hemoptysis (blood-tinged sputum) from dyspnea
4. Chest or shoulder pain
5. Recurring fever Carcinoma in Situ – Earliest form of cancer
6. Hoarseness of voice seen only on the epithelial lining
7. Dysphagia
8. Head and neck edema Risk Factors
1. Carcinogens – Tobacco, secondhand
Dx tests smoke, paint fumes, dust, tar, chemicals
1. Chest X-ray 2. Other Factors: Nutritional deficiencies,
2. CT scans alcohol abuse, genetic disposition, race,
3. Bronchoscopy weakened immune system
4. Fine-needle aspiration
Laryngeal Cancer
Medical Management Global Cancer Incidence (Both Sexes)
1. Surgical Management Rank: 21
Lung Resection – treatment of choice for New cases diagnosed in 2018: 177,422
localized tumors %of all cancers: 1.0
Types: Incidence: Common among 65 years above,
- Lobectomy (single lobe) and men
Clinical Manifestations Breast Cancer
- Hoarseness (more than 2 weeks) - can start from different parts of the breast
- Persistent cough ducts (ductal), milk glands (lobular)
- Sore, painful throat
- Lump in the neck Risk Factors:
Late S/S: dysphagia, dyspnea, nasal 1. Gender – 99% women
obstruction/discharge, ulceration, foul 2. Age
breath 3. Personal and family history
4. Genes – BRCA1 and BRCA3 mutations
Assessment (tumor suppressor genes)
- PA: Head and neck, thyroid gland and 5. Hormonal Factors: Early menarche, late
lymph node palpation menopause, nulliparity or late age
- Imaging: Laryngoscopy, CT scan, MRI, PET pregnancy hormone therapy
scan, Barium swallow 6. Radiation exposure
- Diagnostic: Fine-needle aspiration biopsy
Types:
Medical Management 1. Ductal Carcinoma in Situ (DCIS)
1. Surgical Management - Proliferation of cancer cells inside the milk
- Vocal Cord Stripping, Laser Surgery, ducts, without invasion or metastasis; stage
Laryngectomy 0
- Can develop into invasive breast cancer
2. Radiation Therapy - Seen on mammogram:
- Complications: mucositis, ulceration, pain, Paget Disease
xerostomia (dry mouth) - DCIS of the nipple
- Scaly, erythematous, pruritic lesion
3. Speech Therapy of the ni
- Alternative mode of communication: - May be invasive
writing, lip speaking and reading, word
boards 2. Invasive Breast Cancer
- Alaryngeal communication: Esophageal a. Infiltrating Ductal Carcinoma
speech, artificial larynx, tracheoesophageal - Most common case (80%)
puncture - Origin: Duct system
- Form: solid, irregular mass
Promoting Alternative Communication
Methods b. Infiltrating Lobular Carcinoma
- Accounts for 10 to 15% of cases
Nursing Interventions - Origin: lobules
1. Place call bell within reach - Form: ill-defined thickening, multicentric,
2. Use handheld communication devices: bilateral
Magic Slate, electronic tablets, notebooks,
phones c. Medullary Carcinoma
3. Picture-word-phrase board - 5% of cases, common in women <50 years
4. Hand Signals old
- origin: duct
- form: encapsulated, may be large
Staging
- Classification of cancer by the extent of
the disease
- Most common system: TNM by the
American Joint Committee on Cancer
- Tumor, Nodes, Metastasis
Prognosis
- Prediction of outcome
- Smaller tumor > Bigger tumor
- Stage I > Stage IV
- Localized > Invasive
Breast Cancer
Global Cancer Incidence (Both Sexes)
Rank: 2
New cases diagnosed in 2018: 2,088,849
% of all cancers: 12.3
Incidence: 2/3 cases among women 55
years above
Clinical Manifestations
- Lumps: usually on upper, outer quadrant,
nontender, fixed, hard with irregular
borders
- Mammographic abnormality
- Advanced S/S: skin dimpling: nipple
retraction, skin ulceration
Surgical Management
1. Mastectomy
- Treat invasive breast cancer
- Removal of breast tissue + nipple-arealoa
(Total), pectoralis muscles (radical)
2. Breast Conservation Treatment
- Exercise the tumor in the breast achieve
acceptable cosmetic result
- Lumpectomy, wide excision, partial
mastectomy
3. Lymph Node Dissection
- Sentinel Lymph Node Dissection (1st nodes
receiving drainage from tumor)
- Axillary Lymph Node Dissection
Care of Clients who underwent Surgery for
Breast Cancer
Nursing Diagnosis
1. Acute Pain, Altered Comfort
2. Disturbed Body Image
3. Risk for Ineffective Coping
4. Self-care Deficit
5. Risk for Sexual Dysfunction
Nursing Interventions
1. Pain and Discomfort
a. Administer analgesics
b. Assess for infection or hematoma
c. Take warm showers
d. Distraction methods
2. Body Image
a. Provide privacy when viewing surgical
site
b. Allow expression and acknowledgement
of feelings
c. Provide temporary breast padding
3. Sexual Function
a. Perform sexual activities when less tired
b. Assume comfortable positions
c. Alternative expressions of affection –
Hugging, kissing, manual stimulation
4.1 Manage Complications: Lymphedema,
Transient edema
a. Prescribed exercises
b. Elevation of arm above heart level
c. Muscle pumping
4.2 Manage Complications: Hematoma,
Seroma Formation
a. Apply compression wrap
b. Warm shower or compress
4.3 Manage Complications: Infection Hormonal Therapy
a. Monitor S/S: redness, warmth, Adjuvant Hormonal Therapy
tenderness, foul-smelling drainage - use of synthetic hormones or medications
b. Antibiotics that compete with hormone receptor sites
of cancer
- Indicated for hormone receptor-positive
Radiation Therapy tumors:
Goal: Eradicate residual cancer cells a. Estrogen receptor positive (ER+)
1. External-beam Radiation (started 6 weeks b. Progesterone receptor positive (PR+)
after surgery)
Phases: Tamoxifen – main hormonal agent used in
a. Simulation hormonal therapy
b. Whole breast radiation (5 to 6
weeks) Nursing Care:
c. Boost radiation 1. Hot Flashes
a. Wear light clothing
2. Brachytherapy b. Avoid caffeine and spicy foods
- Delivers radiation by an internal device c. DBE
placed close to the tumor (given 4 to 5
days) 2. Vaginal Dryness
a. Vaginal moisturizers (Replens, Vit.E
Nursing Care: suppository)
Provide instructions to maintain skin b. Vaginal lubrication during intercourse (KY
integrity: JELLY)
1.Use mild soap, hydrophilic lotions
(Lubriderm), antipruritic soap (Aveeno) 3. Nausea and Vomiting
2. Avoid tight clothes, underwire bras a. Consume bland diet
3. Minimize sun exposure to treated are b. Take medication in the evening
(use sunblocks)

Targeted Therapy
Chemotherapy - HER-2/neu protein regulates cell growth:
Adjuvant Chemotherapy associated to rapid growth of tumors and
- use of anticancer agents to delay or poor prognosis
prevent recurrence of cancer
Indications: Trastuzumab targets and inactivates the
1. Lymph node involvement HER-2/neu protein, slowing tumor growth
2. Tumors > 1cm Adverse effects: fever, chills, nausea,
vomiting, diarrhea, headache
CMF Agents – most widely used
chemotherapy drug combination
- Cyclophosphamide
- Methotrexate
- Fluorouracil