ONCOLOGY

MEDICATIONS
RISK FACTOR 1. Alkylating Agents CCN-S
1. Age 65 and above MOST SIGNIFICANT RISK a. Cyclophosphamide (Cytoxan)
FACTOR! A/E: Hemorrhagic Cystitis (Bladder
a. Immune System Bleeding)
b. Hormones b. Cisplatin
2. Gender 2. Anti-metabolites CCS-S
a. Fluorouracil
MALE FEMALE
b. Methotrexate (Folex) Folic Acid Antagonist
1. Prostate Cancer 1 Breast Cancer 3. Anti-tumour Antibiotics CCN-S -mycin
2 Lung Cancer 2. Lung Cancer a. Adriamycin
3 Colorectal Cancer 3. Colorectal Cancer b. Bleomycin
4. Plant (VINCA) Alkaloids CCSM -tine
NO 1. LEADING MORTALITY (DEATH) IS LUNG a. Vincristine (VXR)
CANCER b. Vinblastine (Velban
5. Corticosteroids -sone
3. Geographic Location (Urban) a. Betamethasone
4. Virus (HPV, HSV, EBV, HEPA B, HIV) b. Dexamethasone
5. Radiation
6. Chemical Agents RADIATION THERAPY
7. ASA 1. Kills the tumour
8. Genetics/Hereditary 2. Reduces the size of the tumour
9. Diet 3. Relieves obstruction
a. Low fiber, high fat diet.
Types of Radiation Therapy
NITRATE is the cancerous content found in foods such
like processed foods. Internal Radiation External Radiation
(NO.1 BACON) Also known as Teletherapy, Non-invasive
Brachytherapy, Invasive NOT RADIOACTIVE!
b. Burned/Grilled
RADIOACTIVE!
c. Overused Oil
a. Sealed – Implanted Beam of high energy ray.
MANAGEMENT  Radio-Active  Body fluids are not
1. Chemo-therapy anti-neoplastic medications or  Must be private room radioactive
cytotoxic.  With complete bed rest  Patient is not
Purpose: to promote tumour cell death. & without bathroom radioactive
Resting privileges due to risk of  No need to used rule of
dislodge of the implant STD
 What to do if dislodged?  Out-patient therapy
a. SEEN – pick with  15-30 mins per day, 5
long handled days a week.
RNA & CHON Synthesis forceps then put in
the lead container.
b. UNSEEN - notify
the radiation
department/team.
b. Unsealed – Orally NSG INTERVENTIONS
or IV 1. Do not wash off skin
Radio-Active, Must be markings.
private room, Body fluid are 2. Pat dry with water
radioactive, Instruct pt. to 3. Avoid constrictive
flush toilet 2-3 times after clothing.
used. Ex. Bra & Fitted Jeans
4. Avoid extreme
temperatures.
5. Avoid chemical
 products.  No to spicy foods/hot
S – Shielding  No to smoking/Alcohol
 Lead Apron  Use lip balm or KY jelly
T – Time  Popsicles
Visitor: 10-15 minutes V – Vagina frequent perineal care.
Not allowed to:
P-regnant
I-nfected 1. BREAST CANCER
N-ewly vaccinated
C-hildren Risk factor:
Nurse: 30mins in 1 shift Late menstruation >55 y/o
 5 mins. with 6 visits Obesity High Fats = High Estrogen
D – Distance 6 feet away Nullparity
Genetics
Female/40
SIDE EFFECTS of Chemotherapy Oral contraceptive
& Radiation Therapy Early menarche <12 y/o
PANCYTOPENIA
B – bone marrow
RBC Anemia Fatigue & Rest Prevention: Secondary
WBC Leukopenia  Early detection: Breast self-exam
Immunosuppressed & Isolated
a. 20y/o
PLATELETS Thrombocytopenia b. 5-7 days after menstruation
Bleeding & Safety
c. Start at Upper outer then clockwise
d. Size, shape, symmetry
Asymmetry
O – Ovaries Infertility – Oophorexy
Venous prominent
Testes Sterile
Orange peel skin (peau de orange)
M – Mucosal Lining – Nausea/Vomiting
Nipple dimpling
 Pre – give Anti-emetic
 Post – Small-Frequent-Feeding with bland diet.
S – Skin
1. Radio-dermatitis burned skin due to rad-
therapy. NSG INT: Apply the Teletherapy

A/E: Extravasation – LEAKAGE OF DRUGS, Chemical

Burns
 S-lowing infusion rate
 A-bsent of blood return
 R-edness
 P-ain/Burning sensation
Signs of tumour breast cancer
WHAT IS THE FIRST THING TO DO?
 Non-moveable
 Immediate stop the chemo-therapy
 Irregular mass shaped
 Cold compress
 Nipple discharges or bleeding
 Notify the physician
EXCEPT: VINCA ALKALOIDS DO NOT COLD
MAMMOGRAPHY
COMPRESS
 Discomfort with pain
H – Alopecia due to treatment.  Baseline 35-39y/o
 Yearly 40 & above y/o
 Recommend to use of wigs, hats, cap, and veil  No chemical products (deodorant, etc.)
before alopecia. Based on appreciate age
 Hairless is temporary. BIOPSY confirmatory test
 Percutaneous
O – Oral cavity a. FNA Fine needle aspiration used for
1. Stomatitis – Soreness in mouth smaller lump
2. Xerostomia – Dryness in mouth
 Increase fluid intake
 b. CNA Core needle aspiration used for 2. DRE Digital Rectal Exam
bigger lump  >40 y/o
 Surgical  Not confirmatory test
a. Incisional – removal of a portion of lump  BIOPSY confirmatory test
b. Excisional – removal of the entire lump
Management
Management 1. Chemotherapy
1. Chemo-therapy 2. Radiation Therapy
2. Radiation Therapy 3. Medications
3. Medication a. GNRH/LRH every 1 to 3 months to
a. Tamoxifen Nolvadex anti-estrogen promote negative feedback mechanism.
b. Diethylstilbestrol estrogen to promote 1. Luprol
negative feedback mechanism. 2. Zoladex
4. Surgery b. Diethylstilbestrol anti-estrogen
a. Lumpectomy – removal entire lump 4. Surgery
b. Quadrantectomy – removal quadrant a. Transurethral Resection of the Prostate
c. Simple Mastectomy – removal entire breast surgery to remove parts of the prostate tissue
d. Radical Mastectomy – removal of Breast + through the penis.
Axillary Lymp nodes + Pectoralis  No incision needed
e. MRM – modified radical mastectomy
removal of breast + Axillary lymph node

POST MASTECTOMYCOMPLICATION: LYMPH

EDEMA

NSG RESPONSIBLES:
 Avoid procedure on the affected extremities
 Elevate the affected extremities
 No heavy jewellery on the affected
 Avoid constrictive clothing b. Orchiectomy – removal of testes
 Hand wall climbing
 Rope turning exercise 3. TESTICULAR CANCER
 Combing, shampooing, swimming Risk factors:
Cryptorchidism
2. PROSTATE CANCER Age 15-35 y/o
Risk factors: Trauma
STD History Diethylstilbestrol synthetic estrogen
Testosterone high Orchitis
African American Genetics
Fat
Orchidopexy is a surgical procedure that moves
Forty an undescended testicle into the scrotum.

S/Sx: Prevention: Secondary

1. Asymptomatic 1. Testicular self-exam
2. Enlargement of the prostate  Start at before 15 y/o per month, same day
3. Dysuria (Difficulty of urinating)  After warmth bath
4. Urinary Retention
5. Haematuria S/Sx:
6. Peri-anal and rectal pain 1. Painless Enlargement
7. Low back pain LATE SIGN! 2. Heaviness/ dragging sensation
3. Lump/Mass Pea-size
Prevention: Secondary 4. Low back pain
1. PSA Prostate Specific Antigen Management
 >40 y/o 1. Chemotherapy
 Not confirmatory test 2. Radiation Therapy
 3. Surgery REED STERNBERG CELLS BIOPSY are distinctive,
a. Orchiectomy giant cells found with light microscopy in biopsies from
individuals with Hodgkin lymphoma.

UNILATERAL BILATERAL Mechlorethamine

Impotent No No Oncovin
Sterility No Yes Procarbazine
Prednisone
A
4. HODGKINS’ DISEASE B
Lymph node cancer V
Risk factor D
Hx EBV
Immunosuppress Hodgkins’ Non-Hodgkins
Male 20-40 y/o 20-40 y/o 55 and up y/o
Predictable Unpredictable
S/Sx: Good Prognosis Poor Prognosis
1. Painless Enlargement of the lymph node REED STERNBERG No REED STERNBERG
a. Cervical CELLS CELLS
2. Fatigue
A symptoms B Symptoms 5. CERVICAL CANCER
Night sweat Risk factor
Fever Multiple sex partner caused by HPV
Wt. loss 10% of the body Oral contraceptive
wt. Multiparity >5pregnancy
Smoking
Early age of coitus/pregnancy <16y/o
Note: If B sx are not complete then it is called A sx.
Prevention: Secondary
STAGES
1. Pap smear
I. 1 lymph node
 Start at 21y/o, if before 21y/o sexual active
II. 2 or more lymph node with one side
 Yearly
(Unilateral) CARDIOMEGALY
 But if 3 consecutive are (-), then every 3
III. 2 or more lymph node with both side
years is recommended.
(Bilateral) SPLENOMEGALY +
CARDIOMEGALY
IV. Metastasis CARDIOMEGALY + YEARLY
HEPATOMEGALY + CARDIOMEGALY History of HPV with 3 consecutive (-) result.
Sexually active with 3 consecutive (-) result.
Age 40 and above y/o

Consideration:
 No sex 3 days before pap smear
 No douching
 No menstruation
 Can stop at the age of >70y/o

2. Cervical Biopsy Confirmatory test

MANAGEMENT
STAGES S/Sx:
I. 1 lymph node RADIOTHERAPY 1. Asymptomatic
II. 2 or more lymph node with one side
(Unilateral) RADIOTHERAPY Early PAINLESS Late PAIN
III. 2 or more lymph node with both side Post coital bleeding Dark/excessive bleeding
(Bilateral) COMBINATION CHEMO Metrorrhagia bleeding Foul smelling
IV. Metastasis COMBINATION CHEMO inbetween mens.
Menorrhagia excessive Anemia, Wt. loss
bleeding/prolonged
Malodorous discharges Pelvic/Low back pain
MANAGEMENT 7. LUNG CANCER
1. Chemotherapy Risk factor
2. Radiation Therapy Smoking
3. Surgery Pack Year (No. Packs X No. Years)
a. Conization of the cervix Underlying Respiratory Diseases
b. Cryosurgery used to freeze then necrosis. Radon Gas from soil /rocks
c. Laser therapy used to burn. Genetics rare
d. Hysterectomy and bilateral salpingo- Environmental
oophorectomy
TYPES OF LUNG CA
6. BLADDER CANCER 1. SCLC Small cell lung cancer 15-20%
Risk factor  Major Bronchi
Chronic infection/inflammation: UTI 2. NSCLC Non-small cell lung cancer 80%
a. Aging  Adenocarcinoma most common,
b. Babae located at peripherally , fast-metastasis
c. Catheterization/Sterile S/Sx: EARLY!
d. Dehydration Asymptomatic
e. E.Coli Blood (Haemoptysis)
f. Pregnancy Cough, Non-productive
Age 50y/o & up Dyspnea
Smoking Edema, neck area
Exposure to chemical products Fever, recurrent
S/Sx:
1. Painless Hematuria Diagnostic Test
a. Gross CXR
b. Microscopic MRI/CT Scan
Frequency Cytology
Urgentcy
Dysuria NSG RESPONSIBILITY
Low backpain  Patent airway
 Reduce Fatigue
DIAGNOSTIC TEST  Smoking
1. Routine Urinalysis
2. IVP Intravenous pyelography used for KUB 8. MULTIPLE MYELOMA
(Kidneys, Urether, Bladder) with dye. Abnormal Plasma CELLS there is an
3. Cystoscopy used for direct visualization of the overproduction of Immunoglobulin.
urethral sphincter, prostate, bladder, and
ureteral orifices. Confirmatory test. S/Sx: Bone Pain ribs, spine
Hypercalcemia
NOTE: If walang word na biopsy, choose the word with Fracture
–scopy for confirmatory test. Osteoporosis
BMS Pancytopenia
Management
1. Chemotherapy Diagnostic Test
2. Radiation Therapy  S. Ca Increased
3. Medications  CBC Decreased
a. BCG via catheter, intravesicular  24 urine collection Bence Jones CHON
4. Surgery
a. Cystectomy BONE MARROW BIOSPY confirmatory test,
 Adult, Iliac Crest or sternum
 Pedia, Tibia
Management
 1. Chemotherapy
2. Radiation Therapy
3. Medications
a. Biphosphonate used to strengthen the bones.
1. Pamidronate
2. Zoledronic Acid
b. Thalomide
NSG RESPONSIBILITIES:
1. Safety
a. Isolation
b. Increased Oral fluid intake 2-3L/day
c. Low impact activity
d. Promote ambulation