CANCER  Proliferative

patterns. Cancerous cells are

Epidemiology described as malignant
neoplasms because they
Overall, the incidence of cancer is higher in demonstrate uncontrolled
men than in women and higher in cellular growth that follows
industrialized sectors and nations. no physiologic demand
(neoplasia).
 Characteristics of
 More than 1.4
malignant cells. Cells
million Americans are
are undifferentiated and
diagnosed each year with
often bear little resemblance
cancer, affecting one of
to the normal cells; they grow
various body sites.
at the periphery and sends
 Cancer is second only to
out processes that infiltrate
cardiovascular disease as a
and destroy the surrounding
leading cause of death in the
tissues; the rate of their
United States.
growth is variable and
 Although the number of
depends on level of
cancer deaths has decreased
differentiation; they can gain
slightly, more than 560,
access to
000 Americans were
the blood and lymphatic cha
expected to die from a
nnels and metastasizes to
malignant process in 2008.
other areas of the body; they
 The leading causes of cancer
often cause generalized
deaths in the United States, in
effects such as anemia,
order of frequency, are lung,
weakness, and weight loss;
prostate, and colorectal
they often cause extensive
cancer in men and lung,
tissue damage and causes
breast, and colorectal cancer
death unless growth can be
women.
controlled.
 For all cancer sites combined,
 Invasion and
African American men have
metastasis. Malignant
a 15% higher incidence rate
disease processes have the
and a 38% higher death rate
ability to allow the spread or
than Caucasian men.
transfer of cancerous cells
African-American women
from one organ or body part
have a 9% lower incidence
to another by invasion
rate, but an 18% higher
(growth of the primary tumor
death rate than Caucasian
into the surrounding host
women for all cancer sites
tissues) and metastasis
combined.
(dissemination or spread of
Pathophysiology
malignant cells from the
primary tumor to distant
Cancer is a disease process that begins when sites.
an abnormal cell is transformed by the
genetic mutation of the cellular DNA.
  Carcinogenesis. Carcinogene
sis is a malignant
transformation that
involves initiation (initiators
such as chemicals, physical
factors, and biologic agents,
escape normal enzymatic
mechanisms and alter the
genetic structure of the
cellular
DNA), promotion (repeated
exposure to carcinogens
causes the expression of
abnormal or mutant genetics
information),
and progression (the altered
cells exhibit increased
malignant behavior).
 Role of the immune
system. Some evidence
indicates that the immune
system can detect the
development of malignant
cells and destroy them before
cell growth becomes
uncontrolled, but when the
immune system fails to
identify and stop the growth
of malignant cells, clinical
cancer develops.
Detection and Prevention of Cancer
Nurses and physicians have traditionally
been involved with tertiary prevention, the
care, and rehabilitation of patients after
cancer diagnosis and treatment, but the
American Cancer Society, the National
Cancer Institute, clinicians, and researchers
also place emphasis on primary and
secondary prevention of cancer.
 Primary
prevention. Primary
prevention is concerned with
reducing risks of disease
through health
promotion strategies.
 Secondary
prevention. Secondary
prevention programs promote
screening and early detection
activities such as breast and
testicular self-examination
and Papanicolaou (Pap) tests.
Diagnosis of Cancer
A cancer diagnosis is based on the
assessment of physiologic and functional
changes and results of the
diagnostic evaluation.
 Tumor marker
identification. Analysis of
substances found in body
tissues, blood or other body
fluids that are made by the
tumor or by the body in
response to the tumor.
 Genetic profiling. Analysis
for the presence of mutations
in genes found in tumors or
body tissues.
 Mammography. Mammogra
phy is the use of x-ray images
of the breast.
 Magnetic resonance
imaging (MRI). MRI uses
magnetic fields and radio-
frequency signals to create
sectioned images of various
body structures.
 Computed tomography
(CT). CT scan uses narrow-
beam x-ray to scan
successive layers of tissue for
a cross-sectional view.
 Fluoroscopy. Use of X-rays
that identify contrasts in the
body tissue densities; may
involve the use of contrast
agents.
 Ultrasonography. Ultrasoun
d uses high-frequency sound
waves echoing off body
tissues and is converted
electronically into images;
used to assess deep tissues
within the body.
 Endoscopy. Direct
visualization of a body cavity
or passageway by insertion of
an endoscope into a body
cavity or opening; allows
tissue biopsy, fluid aspiration,
and excision of small tumors.
 Nuclear medicine
imaging. Uses intravenous
injection or ingestion of
radioisotope substances
followed by imaging of
tissues that have concentrated
the radioisotopes.
 Positron emission
tomography
(PET). Through the use of a
tracer, provides black and
white or color-coded images
of the biologic activity of a
particular area, rather than its
structure.
 PET fusion. Use of a PET
scanner and a CT scanner in
one machine to provide an
image combining anatomic
detail, spatial resolution, and
functional metabolic
abnormalities.
 Radioimmunoconjugates. 
Monoclonal antibodies are
labeled with a radioisotope
and injected intravenously
into the patient.
Tumor Staging and Grading
A complete diagnostic evaluation include
identifying the stage and grade of the tumor.
Staging. Staging determines the size of the
tumor and the existence of local invasion
and distant metastasis.
Tumor,
 nodes, and
metastasis (TNM)
system. The TNM system is
frequently used, where T is
the extent of the primary
tumor, N is the absence or
presence and extent of
regional lymph node
metastasis, and M is the
absence or presence of distant
metastasis.
 Grading. Grading refers to
the classification of the tumor
cells, and it seeks to define
the type of tissue from which
the tumor originated and the
degree to which the tumor
cells retain the functional and
histologic characteristics of
the tissue of origin.
 Grade I to IV. Grade
I tumors, also known as well-
differentiated tumors, closely
resemble the tissue of origin
in structure and function
while Grade IV tumors do
not clearly resemble the
tissue of origin in structure
and function.
Management of Cancer
Treatment options offered to cancer patients
should be based on treatment goals for each
specific type of cancer.
Surgery
Surgical removal of entire cancer remains
the ideal and most frequently used treatment
method.
Diagnostic Surgery
Biopsy
 Biopsy. Biopsy is usually
performed to obtain a tissue
sample for analysis of the
cells suspected to be
malignant.
 Types of biopsy. The three
most common biopsy
methods are the excisional,
incisional, and needle
methods.
 Excisional
biopsy. Excisional biopsy is
most frequently used for
easily accessible tumors of
the skin, breast, and upper
and lower gastrointestinal and
upper respiratory tracts.
 Incisional biopsy. Incisional
biopsy is performed if the
tumor mass is too large to be
removed.
 Needle biopsy. Needle
biopsies are performed to
sample suspicious masses
that are easily accessible,
such as growths in the
breasts, thyroid, lung, liver,
and kidney.
Surgery as Primary Treatment
When surgery is the primary approach in
treating cancer, the goal is to remove the
entire tumor or as much as is feasible and
any involved surrounding tissue, including
regional lymph nodes.
 Local excision. Local
excision, often performed on
an outpatient basis, is
warranted when the mass is
small, and it includes removal
of the mass and a small
margin of normal tissue that
is easily accessible.
 Wide or radical
excisions. Wide excisions
include removal of the
primary tumor, lymph nodes,
adjacent involved structures,
and surrounding tissues that
may be at high risk for tumor
spread.
 Video-assisted endoscopic
surgery.  In this minimally
invasive procedure, an
endoscope with intense
lighting and an attached
multichip mini-camera is
inserted into the body
through a small incision.
 Salvage surgery. Salvage
surgery is an additional
treatment option that is an
extensive surgical approach
to treat the local recurrence of
cancer after the use of a less
extensive primary approach.
 Electrosurgery. Uses electric
current to destroy tumor cells.
 Cryosurgery. Uses liquid
nitrogen or a very cold probe
to freeze tissue and cause cell
destruction.
 Chemosurgery. Uses
chemicals
or chemotherapy applied
directly to the tissue to cause
destruction.
 Laser surgery. Uses light
and energy aimed at an exact
tissue location and depth to
vaporize cancer cells.
 Photodynamic
therapy. Intravenous
administration of a light-
sensitizing agent that is taken
up by cancer cells, followed
by exposure to laser within
24-48 hours.
  Radiofrequency
ablation. Uses localized
application of thermal energy
that destroys cancer cells
through heat.
Prophylactic Surgery
Prophylactic surgery involves removing
nonvital tissues or organs that are at
increased risk to develop cancer.
 Examples of prophylactic
surgery. Colectomy,
mastectomy, and
oophorectomy are examples
of prophylactic surgery.
 Qualified
patients. Prophylactic
surgery is offered selectively
to patients and discussed
thoroughly with patients and
families.
Palliative Surgery
When a cure is not possible, the goals of
treatment are to make the patient as
comfortable as possible.
 Palliative surgery. Palliative
surgery is performed in an
attempt to relieve
complications of cancer.
 Communication. Honest and
informative communication
with the patient and family
about the goal of surgery is
essential to avoid false hope
and disappointment.
Reconstructive Surgery
Reconstructive surgery may follow curative
or radical surgery.
 Reconstructive
surgery. Reconstructive
surgery may be performed in
an attempt to improve
function or obtain a more
desirable cosmetic effect.
 Indications. Reconstructive
surgery may be indicated for
breast, head and neck, and
skin cancers.
Radiation Therapy
More than half of patients with cancer
receive a form of radiation therapy at some
point during treatment.
 Uses. Radiation may be used
to cure cancer, as in thyroid
carcinomas, localized cancers
of the head and neck, and
cancers of the uterine cervix;
it may control malignant
disease when a tumor cannot
be removed surgically or
when local nodal metastasis
is present, or it can be used
neoadjuvantly.
 Types. Two types of ionizing
radiation-electromagnetic
radiation (xrays and gamma
rays) and particulate
radiation (electrons, beta
particles, protons, neutrons,
and alpha particles)- can lead
to tissue disruption.
Radiation Dosage
Radiation dosage depends on the sensitivity
of the target tissues to radiation, the size of
the tumor, tissue tolerance of the
surrounding normal tissues, and critical
structures adjacent to the tumor target.
 Lethal tumor dose. The
lethal tumor dose is defined
as that dose that will
eradicate 95% of the tumor
yet preserve normal tissue.
  Fractions. In external beam
radiation, the total radiation
dose is delivered over several
weeks in daily doses called
fractions.
 Fractionated
doses. Repeated radiation
treatments over time also
allow for the periphery of the
tumor to be reoxygenated
repeatedly, because tumors
shrink from the outside
inward.
Administration of Radiation
Radiation therapy can be administered in a
variety of ways depending on the source of
radiation used, the location of the tumor, and
the type of cancer targeted.
 Teletherapy (external beam
radiation). External beam
radiation therapy is the most
commonly used form of
radiation, in which,
depending on the size, shape,
and location of the tumor,
different energy levels are
generated to produce a
carefully shaped beam that
will destroy the targeted
tumor, yet spare the
surrounding healthy tissues
and organs in an effort to
reduce the treatment
toxicities for the patient.
 Brachytherapy (internal
radiation). Internal radiation
implantation, or
brachytherapy, delivers a
high dose of radiation to a
localized area and can be
implanted by means of
needles, seeds, beads, or
catheters into body cavities
(vagina, abdomen, pleura) or
interstitial compartments
(breast, prostate).
Toxicity
 Alopecia. Altered skin
integrity is a common effect
and can include alopecia
or hair loss.
 Stomatitis. Alterations in
oral mucosa secondary to
radiation therapy include
stomatitis or inflammation of
the oral tissues, xerostomia or
dryness of the mouth, change
and loss of taste, and
increased salivation.
 Thrombocytopenia. Bone
marrow cells proliferate
rapidly, and if sites
containing bone marrow are
included in the radiation
field, anemia, leukopenia,
and thrombocytopenia may
result.
Nursing Management in Radiation
Therapy
 Assessment. The nurse asses
ses the
patient’s skin and oropharyn
geal mucosa regularly when
radiation therapy is directed
to these areas, and also the
nutritional status and general
well-being should be
assessed.
 Symptoms. If systemic
symptoms, such as weakness
and fatigue, occur, the nurse
explains that these symptoms
are a result of the treatment
and do not represent
deterioration or progression
of the disease.
 Safety precautions. Safety
precautions used in caring for
 a patient receiving
brachytherapy include  cell-cycle; most affect cells in
assigning the patient to
a private room, posting
appropriate notices about
radiation safety precautions,
having staff members
wear dosimeter badges,
making sure
that pregnant staff members
are not assigned to the
patient’s care, prohibiting
visits by children and
pregnant visitors, limiting
visits from others to 30
minutes daily, and seeing
that visitors maintain a 6 foot
distance from the radiation
source.
Chemotherapy
In chemotherapy, antineoplastic agents are
used in an attempt to destroy tumor cells by
interfering with cellular functions, including
replication.
 Goal. The goal of treatment
is the eradication of enough
tumor so that the remaining
tumor cells can be destroyed
by the body’s immune
system.
 Proliferating cells. Actively
proliferating cells within a
tumor are the most sensitive
to chemotherapeutic agents.
 Nondividing
cells. Nondividing cells
capable of future proliferation
are the least sensitive to
antineoplastic medications
and consequently are
potentially dangerous.
 Cell cycle-specific. Cell
cycle-specific agents destroy
cells that are actively
reproducing by means of the
the S phase by interfering
with DNA and RNA
synthesis.
 Cell cycle-
nonspecific. Chemotherapeut
ic agents that act
independently of the cell
cycle phases are cell cycle
nonspecific, and they usually
have a prolonged effect on
cells, leading to cellular
damage and death.
Antineoplastic Agents
Chemotherapeutic agents are also classified
by chemical group, each with a different
mechanism of action.
 Alkylating agents. Alters
DNA structure by misreading
DNA code, initiating breaks
in the DNA molecule, cross-
linking DNA strands
 Nitrosoureas. Similar to the
alkylating agents, but they
can cross the blood-brain
barrier.
 Topoisomerase I
inhibitors. Induce breaks in
the DNA strand by binding to
enzyme topoisomerase I,
preventing cells from
dividing.
 Antimetabolites. Antimetabo
lites interfere with the
biosynthesis of metabolites or
nucleic acids necessary for
RNA and DNA synthesis.
 Antitumor antibiotics. Interf
ere with DNA synthesis by
binding DNA and prevent
RNA synthesis.
 Mitotic spindle
poisons. Arrest metaphase by
 inhibiting mitotic tubular Protecting
formation and inhibiting caregivers. Nurses must be
DNA and protein synthesis. familiar with their
 Hormonal agents. Hormonal institutional policies
agents bind to hormone regarding personal protective
receptor sites that alter equipment, handling and
cellular growth; blocks disposal of chemotherapeutic
binding of estrogens to agents and supplies, and
receptor sites; inhibit RNA management of accidental
synthesis; suppress aromatase spills or exposures.
of P450 system, which Bone Marrow Transplantation
decreases level.
Nursing Management in Chemotherapy The role of bone marrow transplantation
(BMT) for malignant and some
Nurses play an important role in assessing nonmalignant diseases continues to grow.
and managing many of the problems
experienced by patients undergoing Type of Bone Marrow Transplant
chemotherapy.
Types of BMT based on the source of donor
 Assessing fluid and cells include:
electrolyte
balance. Anorexia, nausea,  Allogeneic. Allogeneic is
vomiting, altered taste, from a related donor other
mucositis, and diarrhea put than the patient; donor may
patients at risk for nutritional be a related donor or a
and fluid electrolyte matched unrelated donor.
disturbances.  Autologous. Autologous
 Modifying risks BMT is from the patient
for infection and bleeding.  himself.
Suppression of the bone  Syngeneic. Syngeneic BMT 
marrow and immune system is from an identical twin.
is expected and frequently Nursing Management in Bone Marrow
serves as a guide in Transplantation
determining appropriate
chemotherapy dosage but
Nursing care of patients undergoing BMT is
increases the risk of anemia,
complex and demands a high level of skill.
infection, and bleeding
disorders.
 Administering  Implementing
chemotherapy. The patient pretransplantation
is observed closely during its care. Nutritional
administration because of the assessments, extensive
risk and consequences of physical examinations, organ
extravasation, particularly of function tests, and
vesicant agent. psychological evaluations are
conducted, with blood work
 that includes assessing past
antigen exposure, and the
patient’s support system,
financial, and insurance
resources are also evaluated.
 Providing care during
treatment. Nursing
management during bone
marrow infusion or stem cell
infusions consists of
monitoring the patient’s vital
signs and blood oxygen
saturation; assessing for
adverse effects such as fever,
chills, shortness of breath,
chest pain, cutaneous
reactions, nausea,
vomiting, hypotension,
or hypertension,
tachycardia, anxiety, and
taste changes; and providing
ongoing support and patient
teaching.
 Providing
posttransplantation
care. Ongoing nursing
assessments such as
psychosocial assessments in
follow-up visits are essential
to detect late effects of
therapy after BMT, which
occur 100 days or more after
the procedure, and donors
also require nursing care
through being assisted in
maintaining realistic
expectations of themselves as
well as of the patient.
Targeted Therapies
Targeted therapies seek to minimize the
negative effects on healthy tissues by
disrupting specific cancer cell functions such
as malignant transformation, cell
communication pathways, processes for
growth and metastasis, and genetic coding.
Biologic Response Modifiers (BRM)
Biologic response modifier therapy involves
the use of naturally occurring or
recombinant agents or treatment methods
that can alter the immunologic relationship
between the tumor and the host to provide a
therapeutic benefit.
 Nonspecific biologic
response modifiers.
Nonspecific agents such as
Calmette-Guérin (BCG)
and Corynebacterium parvu
m, when injected into the
patient, may serve as antigens
that can stimulate an immune
response in the hopes of
eradicating malignant cells.
 Monoclonal
antibodies. Monoclonal
antibodies (MoAbs) have
become available through
technologic advances, and
this type of specificity allows
MoAbs to destroy the cancer
cells and spare normal cells.
 Cytokines. Cytokines,
substances produced by cells
of the immune system to
enhance the production and
functioning of components of
the immune system, are also
the focus of cancer treatment
research.
 Retinoids. Retinoids are
vitamin A derivatives that
play a role in growth,
reproduction, apoptosis,
epithelial cell differentiation,
and immune function,
wherein specific receptors in
the cell nucleus are retinoid-
dependent, thus when
retinoids bind with these
 receptors, cell differentiation
and replication are affected.
 Cancer vaccines. Cancer
vaccines are used to mobilize
the body’s immune response
to recognize and attack
cancer cells, as these cancer
vaccines contain either
portions of cancer cells alone
or portions of cells in
combination with other
substances that can augment
or boost immune responses.
Nursing Management in Biologic
Response Modifier Therapy
It is essential for the nurse to assess the need
for education, support, and guidance for
both the patient and the family and assist in
planning and evaluating patient care.
Monitoring therapeutic and
adverse effects. The nurse
must be familiar with each
agent given and its potential
effects, and also, the nurse
must be aware of the impact
of these side effects on the
patient’s quality of life.
 Promoting home and
community-based care. The
nurse teaches the patient and
family how to administer
BRMs through subcutaneous
injections, provides
instructions about side effects
and helps the patient and
family identify the strategies
to manage many of the
common side effects of BRM
therapy.
Gene Therapy
Gene therapy includes approaches that
correct genetic defects or manipulate genes
to induce tumor cell destruction in the hope
of preventing or combating the disease.
ADVERTISEMENTS
 Challenges. One of the
challenges confronting cancer
gene therapy is the multiple
somatic mutations involved
in the development of cancer,
making it difficult to identify
the most effective gene
therapy approach.
 Viruses. Viruses used as
vectors that transport a gene
into a target cell via the cell
membrane include
retroviruses, adenoviruses,
vaccinia virus, fowlpox,
herpes simplex viruses, and
Epstein-Barr viruses.
Approaches in Gene Therapy
Three general approaches have been used in
the development of gene therapies, with
adenoviruses showing effective promise in
each approach.
 Tumor-directed
therapy. This is the
introduction of a therapeutic
gene (suicide gene) into
tumor cells in an attempt to
destroy them.
 Active
immunotherapy. Active
immunotherapy is the
administration of genes that
will invoke the antitumor
responses of the immune
system.
 Adoptive
immunotherapy. Active
immunotherapy is the
administration of genetically
altered lymphocytes that are
 programmed to cause tumor The most effective way to protect patients
destruction. and families from fraudulent therapies and
Complementary and Alternative questionable cancer cures is to establish a
Medicine trusting relationship, provide supportive
care, and promote hope.
Many patients seek a more holistic or
nontraditional approach, turning to  Communication. Truthful
complementary and alternative therapies responses given in a
while continuing to utilize conventional nonjudgmental manner to
medicine. questions and inquiries about
unproven methods of cancer
 Complementary and treatments may alleviate
Alternative Medicine the fear and guilt on the part
(CAM). CAM was defined as of the patient and the family
diverse medical and health that they are not “doing
care systems, practices, and everything we can” to obtain
products that are not a cure.
presently considered to be  Information. The nurse
part of conventional should inform the patient and
medicine. family should inform the
 Risk. Because of the patient and family of the
possibility of herb-vitamin- characteristics common to
drug interactions, there is fraudulent therapies so that
concern about the use of they will be informed and
biologicals and dietary cautious when evaluating
supplements, which are not other forms of “therapy”.
regulated by the FDA nor  Collaboration. The nurse
subjected to rigorous should encourage the patient
scientific evaluation. to inform their physicians
Unproven and Unconventional Therapies about the use of therapies to
help prevent interactions with
Hopelessness, desperation, unmet needs, medications and other
lack of factual information, and family and therapies that may be
social pressures are major factors that prescribed.
motivate patients to seek unconventional Nursing Care of Patients with Cancer
methods of treatment.
Main Article: 13 Cancer Nursing Care
Definition. Unconventional Plans
treatments are those without
scientific evidence of the The outlook for patients with cancer has
ability to cure or control greatly improved because of scientific and
cancer. technologic advances.
Nursing Management in Unconventional
Therapies Maintaining Tissue Integrity
 Stomatitis. Assessment of surfaces of the
the patient’s subjective gastrointestinal mucosa, all
experience and an objective leading to malabsorption.
assessment of the  Cachexia. Nurses assess
oropharyngeal tissues and patients who are at risk of
teeth are important and for altered nutritional intake so
the treatment of oral that appropriate measures
mucositis, Palifermin may be instituted prior to
(Kepivance), a synthetic nutritional decline.
form of human keratinocyte Relieving Pain
growth factor, could be
administered.  Assessment. The nurse
 Radiation-associated skin assesses the patient for the
impairment. Nursing care source and site of pain as
for patients with impaired well as those factors that
skin reactions includes increase the patient’s
maintaining skin integrity, perception of pain.
cleansing the skin, promoting  Cancer pain
comfort, reducing pain, algorithm. Various opioid
preventing additional trauma, and nonopioid medications
and preventing and managing may be combined with other
infection. medications to control pain as
 Alopecia. Nurses provide adapted from the World
information about hair loss Health Organization three-
and support the patient and step ladder approach.
family in coping with  Education. The nurse
changes in body image. provides education and
 Malignant skin support to correct fears and
lesions. Nursing care misconceptions about opioid
includes cleansing the skin, use.
reducing superficial bacteria, Decreasing Fatigue
controlling bleeding,
reducing odor, protecting the  Assessment. The nurse
skin from further trauma, and assesses physiologic and
relieving pain. psychological stressors that
Promoting Nutrition can contribute to fatigue and
uses several assessment tools
 Anorexia. Anorexia may such as a simple visual
occur because people feel full analog scale to assess levels
after eating only a small of fatigue.
amount of food.  Exercise. The role of
 Malabsorption. Surgical exercise as a helpful
intervention may change intervention has been
peristaltic patterns, later supported by several
gastrointestinal secretions, controlled trials.
and reduce the absorptive
 Pharmacologic
interventions. Occasionally
pharmacologic interventions
are utilized,
including antidepressants for
patients with depression,
anxiolytics for those with
anxiety, hypnotics for
patients
with sleep disturbances, and
psychostimulants for some
patients with advanced cancer
or fatigue that does not
respond to any medication.
Improving Body Image and Self-esteem
 Assessment. The nurse
identifies potential threats to
the patient’s body image
experience, and the nurse
assesses the patient’s ability
to cope with the many
assaults to the body image
experienced throughout the
course of the disease and
treatment.
 Sexuality. Nurses who
identify physiologic,
psychologic or
communication difficulties
related to sexuality or sexual
function are in a key position
to help patients seek further
specialized evaluation and
intervention if necessary.
Assisting in the Grieving Process
 Assessment. The nurse
assesses the patient’s
psychological and mental
status, as well as the mood
and emotional reaction to the
results of diagnostic testing
and prognosis.
 Grieving. Grieving is a care.
normal response to these
fears and to actual or
potential losses.
Monitoring and Managing Potential
Complications
Infection. The
 nurse
monitors laboratory studies to
detect any early changes in
WBC counts.
 Septic shock. Neurologic
assessments are carried out,
fluid and electrolyte status is
monitored, arterial blood
gas values and pulse
oximetry are monitored,
and IV fluids, blood, and
vasopressors are administered
by the nurse.
 Bleeding
and hemorrhage. The nurse
may administer  IL-11, which
has been approved by the
FDA to prevent severe
thrombocytopenia, and
additional medications may
be prescribed to address
bleeding due to disorders of
coagulation.
Promoting Home and Community-Based
Care
Nurses in the outpatient settings often have
the responsibilities for patient teaching and
for coordinating care in the home.
 Teaching patients self-
care. Follow-up visits and
telephone calls from the
nurse assist in identifying
problems and are often
reassuring, increasing the
patient’s and the family’s
comfort in dealing with
complex and new aspects of
  Continuing care. The
responsibilities of the home
care include assessing the
home environment,
suggesting modifications at
home or in care to help the
patient and the family address
the patient’s physical needs.
Practice Quiz: Cancer
Here are some practice questions for this
study guide. Please visit our nursing test
bank page for more NCLEX practice
questions.
1. The nurse teaches a patient
with cancer of the liver about high-
protein, high-calorie diet choices. Which
snack choice by the patient indicates that
the teaching has been effective?
A. Fresh fruit salad.
B. Orange sherbet.
C. Strawberry yogurt.
D. French fries.
1. Answer: C. Strawberry yogurt
 C: Yogurt has high biologic
value because of the protein
and fat content.
 A: Fruit salad does not have
high amounts of protein or
fat.
 B: Orange sherbet is lower in
fat and protein than yogurt.
 D: French fries are high in
calories from fat but low in
protein.
2. After the nurse has explained the
purpose of and schedule for
chemotherapy to a 23-year-old patient
who recently received a diagnosis of
acute leukemia, the patient asks the nurse
to repeat the information. Based on this
assessment, which nursing diagnosis is
most likely for the patient?
A. Acute confusion related to infiltration
of leukemia cells into the central nervous
system.
B. Knowledge deficit: chemotherapy related
to a lack of interest in learning about
treatment.
C. Risk for ineffective health maintenance
related to anxiety about
new leukemia diagnosis.
D. Risk for ineffective adherence to
treatment related to denial of need for
chemotherapy.
2. Answer: C. Risk for ineffective health
maintenance related to anxiety about
new leukemia diagnosis
 C: The patient who has a new
cancer diagnosis is likely to
have high anxiety, which may
impact learning and require
that the nurse repeat and
reinforce information.
 A: The patient’s history of a
recent diagnosis suggests that
infiltration of the leukemia is
not a likely cause of the
confusion.
 B&D: The patient asks for
the information to be
repeated, indicating that lack
of interest in learning and
denial are not etiologic
factors.
3. A hospitalized patient who has received
chemotherapy for leukemia develops
neutropenia. Which observation by the
RN caring for the patient indicates that
the nurse should take action?
A. The patient’s visitors bring in some fresh
peaches from home.
B. The patient ambulates several times a day
in the room.
C. The patient uses soap and shampoo to
shower every other day.
D. The patient cleans with a warm
washcloth after having a stool.
3. Answer: A. The patient’s visitors bring
in some fresh peaches from home.
 A: Fresh, thinned-skin
peaches are not permitted in a
neutropenic diet because of
the risk of bacteria being
present.
 B: The patient should
ambulate in the room rather
than the hospital hallway to
avoid exposure to other
patients or visitors.
 C: Because overuse of soap
can dry the skin and increase
infection risk, showering
every other day is acceptable.
 D: Careful cleaning after
having a bowel movement
will help to prevent perineal
skin breakdown and
infection.
4. While being prepared for a biopsy of a
lump in the right breast, the patient asks
the nurse what the difference is between a
benign tumor and a malignant tumor.
The nurse explains that a benign tumor
differs from a malignant tumor in that
benign tumors
A. Do not cause damage to adjacent tissue.
B. Do not spread to other tissues and organs.
C. Are simply an overgrowth of normal
cells.
D. Frequently recur in the same site.
4. Answer: B. do not spread to other
tissues and organs.
 B: The major difference
between benign and
malignant tumors is that
malignant tumors invade
adjacent tissues and spread to
distant tissues and benign
tumors never metastasize.
 A: Both types of tumors may
cause damage to adjacent
tissues.
 C: The cells differ from
normal in both benign and
malignant tumors.
 D: Benign tumors usually do
not recur.
5. A patient who smokes tells the nurse, “I
want to have a yearly chest x-ray so that
if I get cancer, it will be detected early.”
Which response by the nurse is most
appropriate?
A. “Chest x-rays do not detect cancer until
tumors are already at least a half-inch in
size.”
B. “Annual x-rays will increase your risk
for cancer because of exposure to radiation.”
C. “Insurance companies do not authorize
yearly x-rays just to detect early
lung cancer.”
D. “Frequent x-rays damage the lungs and
make them more susceptible to cancer.”
5. Answer: A. “Chest x-rays do not detect
cancer until tumors are already at least a
half-inch in size.”
 A: A tumor must be at least 1
cm large before it is
detectable by an x-ray and
may already have
metastasized by that time.
 B: Radiographs have low
doses of radiation, and an
annual x-ray alone is not
likely to increase lung cancer
risk.
  C: Insurance companies do
not usually authorize x-rays
for this purpose, but it would
not be appropriate for the
nurse to give this as the
reason for not doing an x-ray.
 D: A yearly x-ray is not a risk
factor for lung cancer
Distinctive tumors were first reported
in scientific journals in 1775, and that
was scrotal cancer directly associated
with chimney sweeps. In 1761, cases
of nasal cancer rose among
individuals who use snuff or
smokeless tobacco. Since then,
cancer has made its identity known
as the disease that plagues the
unsuspecting society.
Cancer can occur anywhere in the
body. When the body’s normal
control mechanisms become
defective, old cells do not die and
new abnormal cells continue to
proliferate. Consequently, these extra
cells form tissue masses which
deprive the normal and healthy cells
of the nutrients necessary for growth
and development.
However, since there is still no cure
for cancer, the healthcare industry
advocates for prevention and early
detection. Screening tests are made
to subject persons suspected to have
cancer but still do not have the
manifestations yet. If the results are
highly suggestive, a biopsy is
conducted to confirm the working
diagnosis.
Mortality Hit
Around the World
World Health Organization
(WHO) reported that in 2012, there
were 14 million new cases of cancer
and 8.2 million cancer-related deaths.
Sixty percent of these new cases are
from Africa, Asia, and some parts of
America. In the United States alone, it
is estimated that for 2016, there will
be 1.6 million new cases of cancer
and cancer-related deaths would
reach half a million.
Nurses as Cancer
Insurgents
When facing cancer, nurses
understand the importance of early
detection and treatment. This
guarantees a relatively higher chance
of surviving the savage disease. The
problem with cancer is that it only
signals its existence when it is
already severe. Unlike other
diseases, it does not scream pain.
Most of the time, before one
becomes aware of its existence,
cancer has made a map out of one’s
body and has lodged itself in every
corner.
Nurses have witnessed parents
become childless and children
become orphaned because of cancer.
Therefore, it is important for nurses
to spread awareness on cancer and
how it can be prevented in the
earliest time possible. Nurses should
learn cancer screening test guidelines
by heart as part of the commitment
to saving lives.
Cancer Screening
Test Guidelines
Here are the screening test
guidelines for different types of
cancer according to American Cancer
Society and U.S. Preventive Task
Force Services:
1. Breast Cancer
Seventy percent of women have no
known predisposing factors to breast
cancer but certain risk factors have
been established. Risk factors include
age 65 and above, two first-degree
relatives diagnosed with breast
cancer at an early age, high breast
tissue density, and factors that affect
circulating hormones like
late menopause, long-term use of
hormonal replacement therapy, and
obesity.
Breast cancer screening
includes mammography, clinical
breast examination (CBE), and breast
self-examination (BSE). It is important
that patients understand what these
examinations are all about, how they
are performed, and their limitations.
Mammogram. Image via: Wikipedia.
Mammography (x-ray of the breast)
is done yearly for women age 40 and
above. However, for women with
increased risk, it may be started at
age 30. CBE is done every 2-3 years
among women 20-39 years of age
and then annually after 40 years of
age. Basically, this is a physical exam
done by a healthcare provider as part
of the regular medical check-up.
Lastly, nurses should teach women 20
years of age and above on how to
perform BSE. This should be done 5-7
days after menstruation when the
breasts are not swollen and tender.
For women with an irregular sexual
cycle, a specific date must be chosen
for monthly BSE.
2. Cervical Cancer
Pap Smear
The screening test for cervical cancer
is Pap Smear. In 2012, the American
College of Obstetricians and
Gynecologists (ACOG) released a new
guideline for this test. First screening
should be at age 21. For women age
21 to 39, screening is done every
three years. Until age 60, screening is
done with cytology if Pap Smear is
positive or if the patient is at high-
risk for HPV test. For women who
have undergone hysterectomy for
benign reasons, routine screening is
discontinued. Lastly, for women age
65 and above, routine screening is
discontinued if three consecutive Pap
smear result is negative.
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3. Ovarian Cancer
Currently, there is no effective
screening test for ovarian cancer
although risk factors would include
history of breast or ovarian cancer in
the family and mutation in BRCA1
and BRCA2 genes.
Pelvic exam
Pelvic exam is done upon check-up
and the doctor would request
ultrasound and magnetic resonance
imaging (MRI) as needed.
4. Testicular Cancer American Cancer Society has no
current recommendations
for liver cancer screening. However,
two most commonly requested test
for liver
cancer includes ultrasound and alph
a-fetoprotein (AFP) blood test.

7. Colorectal Cancer
Screening recommendations for
colorectal cancer include fecal occult
blood test (FOBT), sigmoidoscopy,
and colonoscopy.
Testicular self exam.

Monthly testicular self-examination

(TSE) is recommended for men. A
painless nodule or lump felt is always
advised to be reported to the doctor.
TSE should be done after a
warm shower so the skin is relaxed.

5. Lung Cancer
Low-dose computer tomography
annual screening for lung cancer is
recommended for adults age 55-80
years with smoking history of 30 pack Colonoscopy
years or have quit smoking within 15
years. Screening is discontinued if the Assessment for risk factors (e.g.
person has stopped smoking for at polyps, first-degree relative with
least 15 years. colorectal cancer, personal history of
ulcerative colitis, etc.) should begin at
age 20. However, for those who are
6. Liver Cancer not high risk, routine screening
recommendations should take place
between 50 and 75 years of age.
FOBT is conducted annually. Another
option is to have sigmoidoscopy
every five years and FOBT every
three years. Third option on the list is
to have colonoscopy every 10 years.
8. Prostate Cancer
50 years of age. For men with risk
factors, screening should be started
at age 40.
9. Skin Cancer
As of now, there’s not enough
evidence to recommend a routine
screening that can detect skin
cancers early. However, it is
important to note that fair-skinned
individuals aged 65 and older are at
increased risk for melanoma. Having
atypical moles and/or more than 50
moles increase the risk of the person
for melanoma too.

Prostate cancer is the leading cancer

among men in the U.S. and the
second leading cause of death. Risk
factors include age, history of
prostate cancer in the family and
African American ethnicity. Screening
recommendations include digital
rectal examination (DRE) and
prostate-specific antigen (PSA).
However, these two methods are not
highly accurate. DRE can miss as
much as 25-35% of tumors and its
sensitivity is only 59%. PSA’s
detection rate is only 28-35%. It is
being recommended to combine the
two screening options for men above