ONCOLOGY

• Abnormal cell growth and development.

• It can involve all body organs; clinical presentation depends on the body system affected.

FACTORS

Ø Older age

Ø Genetics

Ø Smoking

Ø High fat diet

Ø Exposure to chemical carcinogens such as chemicals, drugs

Ø Physical carcinogens such as radiations

• INITIATION

Mutation cause abnormal cell division. Oncogenes – divide very fast.

• PROMOTION

Estrogen is promoter, promote division

• PROGRESSION

Additional mutation – causes metastasis

WARNING SIGNS of CANCER

• Unexplained Weight loss

• Fatigue

• Pain

• Infection

• Bleeding

• Any sore that doesn’t heal

BREAST SELF EXAMINATION

• BSE is done, 1 week after the initiation of the cycle.

• If the client, doesn’t get the periods, select particular day of the month and perform BSE same
day each month.

• Best time to do BSE is while taking shower or bath. If the skin is wet with soap and water, its
easy to examine the breasts.

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 • Use 2nd, 3rd and 4th finger of hand and make a pad.

• With finger pad, press every part of the breast firmly.

• Use right hand to check left breast and left hand to check right breast.

• Use small circular motions in a spiral or up-and-down motion so that the entire breast area is
examination.

• Check for any lump, hard knot or thickening of the tissue.

TESTICULAR SELF EXAMINATION

• Best time to perform this examination is right after a shower when your scrotal skin is moist and
relaxed.

• Each side should feel like an egg, firm but not hard. Without lump.

LEUKEMIA

• It’s a group of blood born malignancies that leads to overproduction of leukocytes in bone
marrow.

• These cells are immature in nature.

• Leukemia affects the bone marrow, causing anemia, leukopenia and thrombocytopenia.

• Cells transform from normal to malignant state

CLINICAL PRESENTATION

• Anemia

• Bleeding because of low platelets

• Ecchymosis, petechiae

• Prolonged bleeding after minor lacerations

• Elevated temperatures

• Enlarged spleen, liver or lymph nodes

• Bone pain and joint swelling

Infection and Bleeding are the main concerns

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 Infection is the major cause of death in immunosuppressed client.
Main source is Auto contamination or Cross contamination
ü Initiate protective isolation
ü Ensure frequent hand hygiene
ü Limit visitors
ü Avoid crowds
ü Strict aseptic techniques for all procedures
ü Assign dedicated equipment to the client
ü Limit the number of staff entering in the patient’s room.
ü Eliminate raw fruits and vegetables; eliminate fresh flowers and
live plants from client’s room
ü Change wound dressings daily
ü Neither client nor family members should receive
immunization with live virus.

Bone Marrow gets depressed and platelet count becomes extremely

low
As platelet counts fall below 50,000/mm, risk of bleeding becomes high
ü Examine the signs of bleeding
ü Handle the client gently
ü Taking blood pressure can lead to injury
ü Monitor for signs of internal bleeding such as Pain, Rapid and
weak pulse, increased abdominal girth
ü Avoid injections
ü Pad side rails and sharp corners of bed and furniture
ü Avoid rectal suppositories, enemas and thermometers.
ü If female client is menstruating, count number of pads
ü Soft toothbrush

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 HODGKIN’S DISEASE

• Hodgkin’s disease is a malignancy of the lymph nodes

• It starts with one lymph node and spreads to all nodes. Eventually, it invades non lymphoid
tissue.

• It involves tonsils, spleen and bone marrow

• Presence of Reed-Sternberg cells in the nodes

• First symptom is Enlarged lymph nodes without pain. Treatment is done with Surgery,
Chemotherapy and Radiation therapy.

TESTICULAR CANCER

• It can arise from germinal or non germinal epithelium of testicles.

• Common age is 15 to 40 years of age.

• Cause is unknown but a history of undescended testicle is common.

Clinical Presentation

ü Painless testicular swelling

ü Pulling sensation in the scrotum

ü Back pain may be present

ü Prepare the client for unilateral orchiectomy

CERVICAL CANCER
• It begins with cervix and later on becomes invasive to pelvic structures.

RISK FACTORS ASSESSMENT

HPV Infection PAP Painless vaginal bleeding

SMEAR
Cigarette Smoking Foul smelling discharge
TEST
Pelvic, lower back, leg or
Multiple sex partner
groin pain

Leakage of urine and feces

Early first intercourse from the vagina
NURSING CONCEPTS (canadianrn1@gmail.com) 13

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 PROSTATE CANCER

• It’s a slow growing malignancy of the prostate gland.

• Common in American men

• Risk increases after the age of 50 years

• It originates from epithelial cells of prostate gland and spreads to liver, lungs and kidneys

• Its asymptomatic in early stages and leads to painless hematuria in later stages

MULTIPLE MYELOMA

• MM is malignant proliferation of plasma cells within the bone.

• Excessive abnormal cells invade the bone marrow and destroy the bone. Ultimately it invades
lymph nodes, spleen and liver.

• Abnormal plasma cells produce abnormal antibodies found in blood and urine.

• Myeloma protein are formed

• MM - levels of uric acid and calcium

Bone marrow transplantation and Stem Cell Transplantation

• These are the procedures to replace the stem cells that have been destroyed by high doses of
chemotherapy/radiation therapy.

• The goal of treatment is to get rid of client’s all leukemic or other malignant cells through
treatment with high doses of chemotherapy or irradiation.

• The client remains without any natural immunity until the donor stem cells begin to proliferate.

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 • Infection, Bleeding, Neutropenia and Thrombocytopenia are major concerns until engrafting
occurs

CHEMOTHERAPY - kills or inhibits the reproduction of neoplastic cells and also kills normal
cells.

• The effects of chemotherapy are systemic.

• The normal cells that generally get effected are skin cells, hair and lining of the gastrointestinal
tract, spermatocytes etc.

• The preferred route of chemotherapy is IV

• Chemotherapy is combined with surgery and radiation.

Common Side effects are:

1. Excessive fatigue

2. Alopecia

3. Nausea/Vomiting

4. Myelosuppression leading to Neutropenia, Anemia, Thrombocytopenia

Health Promotion
v If diarrhea is a problem, avoid HOT foods and
high fiber foods.
v Instruct the client to check the oral mucosa for
ulcers.
v Instruct the client to use sodium bicarb for
mouth rinse
v Avoid Crowds

Safe Environment
v Wear gloves, gown, eye protectors and mask
Physiological Integrity when handling IV medications.
v Monitor CBC, White blood cell count and v Pregnant nurses should avoid preparation or
Platelet count. administration of chemotherapy.
v Monitor for spontaneous bleeding, v Discard IV equipment in designated bio
Petechiae, Ecchymosis hazard containers.
v Avoid IM Injections and Venipunctures as v Monitor for extravasation that is leakage of
much as possible medication into surrounding skin and
v Provide high calorie diet with protein subcutaneous tissue – it can cause tissue
supplements necrosis
v Antineoplastic medications stimulate the
vomiting center in brain

• PPE Appropriate ( Special gown / gloves )

• Linens double pack – to prevent leak

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 • Double flush

RADIATION THERAPY

INTERNAL – BRACHYTHERAPY - Radio Opaque substance is placed internally

Ø Door Closed

Ø Limit visitor

Ø 6 Feet Distance

Ø LEAD Apron

Ø Dosimeter film batch

EXTERNAL – TELETHERAPY - Radiations are provided externally

Ø Area marked

Ø Don’t wash off the markings

Ø Gentle with Skin

Ø No lotion/ powder/ ointment unless prescribed

Ø Loose and soft clothes

Ø Protect from Sun

Ø Never Rub the area

COMPLICATIONS

• MALNUTRITION - Provide High Calorie. High Protein and Dense Nutrient rich diet. Due to nausea
and vomiting. Anti-emetics (Ondansetron).

• MUCOSITIS - Inflammation of mucous membranes. No Chips. Provide soft Brush. No Hard food.
Provide Wheat porridge. Rinse mouth with saline water.

• NEUTROPENIA - Decreased Neutrophils / WBC. High risk of infection. No fresh plants and
flowers. No raw vegetables. Careful about body temperatures, report if more than 100F. Isolate.
Avoid crowds. Dedicated equipment. Avoid sick people. Avoid gardening when home. Wash
utensils in hot water.

• ANEMIA - Decreased blood cells. Provide Iron supplements. Increase the intake of Iron and B12
foods. Increase the rest periods (Fatigued).

• THROMBOCYTOPENIA - Avoid unnecessary pricks. Apply prolonged pressure. Use electric razor.
Provide soft toothbrush. Don’t blow the nose vigorously. Avoid NSAIDS – it may increase the
chances of bleeding. Initiate Fall precautions.

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