Oncology Nursing Lecture Week 1-6

NCM 112:
Oncology Nursing
Orientation of the Course
LEARNING OUTCOMES
At the end of the cycle, the students should be able to:
1. Identify the nurse’s roles in the prevention of cancer and in health

education.
2. Discuss the pathophysiology of cancer and its clinical manifestations.
3. Apply the nursing process to identify care of the client in the diagnosis
and treatment phases of cancer.
4. Formulate plan of care for the client with early stage and advanced
cancer.
5. Value the nurse’s role in providing quality, comprehensive,
individualized, ethical and humane care of clients with cancer.
WEEK CONTENT
1ST 1. Basic Concepts of Oncology Nursing

1.1 Terminologies related to Cancer Nursing
1.2 Pathogenesis of Cancer
1.3 Etiologic Factors to Cancer
1.4 Predisposing Factors to Cancer
1.5 Characteristics of Benign and Malignant Neoplasm
2ND 2. Prevention, Screening and Early Detection of Cancer
2.1 Prevention of Cancer
2.2 Dietary Recommendations Against Cancer
2.3 Common Causes of Cancer
2.4 Warning Signs of Cancer
2.5 Staging and Grading of Neoplasia
WEEK CONTENT
3RD 2.6 Cancer Detection Examinations

3. Pathophysiologic Basis of Malignant Neoplasia
4. Treatment Modalities for Cancer
4.1 Surgical Interventions
4.2 Radiation Therapy
4TH 4.3 Chemotherapy
4.3.1 Classification of Chemotherapeutic Agents
4.3.2 Routes of Administration
4.3.3 Nursing Interventions for Side Effects
4.4 Immunotherapy
4.5 Bone Marrow Transplantation
WEEK CONTENT
5TH 5. Oncologic Emergencies

5.1 Infection and Pain
5.2 Hypercalcemia
5.3 Tumor Lysis Syndrome
5.4 SIADH
5.5 Disseminated Intravascular Coagulation (DIC)
5.6 Spinal Cord Compression
6TH 6. Care of Clients with Cancer
6.1 Lung 6.7 Skin
6.2 Breast 6.8 Bladder
6.3 Colon
6.4 Esophageal
6.5 Cervical
6.6 Testicular
Class Performance
QUIZZES – 35%
60% LONG EXAM – 40%

RECITATION – 10%
ASSIGNMENT – 10%
ATTITUDE/ATTENDANCE– 5%
Major Exams
40%
PRELIM EXAM
MIDTERM EXAM
FINAL EXAM
Basic 01
Concepts
Terminologies
CANCER a disease of the cell in which the normal
mechanisms of the control of growth and
proliferation have been altered
MALIGNANT NEOPLASM it is invasive, spreading directly to surrounding
tissues as well as to new sites in the body
BENIGN NEOPLASM a harmless growth that does not spread or invade
other tissues
NEOPLASIA abnormal cellular changes and growth of new
tissues
HYPERPLASIA increase in cell number
HYPERTROPHY increase in cell size

Terminologies
METAPLASIA replacement of one adult cell type by a different
adult cell type
DYSPLASIA changes in cell size, shape, organization
ANAPLASIA reverse cellular development to a more primitive

or embryonic cell type
METASTASES spread of cancer cells to distant parts of the body
to set up new tumors
ONCOLOGY the medical specialty that deals with diagnosis,
treatment, and study of cancer
CARCINOGENS factors associated with cancer causation
Types of Cancer
01 03
Adenocarcinoma Sarcoma
cancer that arises from glandular
tissues (breast, lung, thyroid, colon
02 cancer of supporting or connecting
tissues such as cartilage, bones,
and pancreas CA) muscles or fats
Carcinoma
cancer that is composed of epithelial
cells; develops in tissues covering or
lining organs of the body such as
skin, uterus or breast
Pathogenesis of Cancer
01 02
Cellular Transformation Failure of the Immune
and Derangement Response Theory
Theory
normal cells may be transformed all individuals possess cancer cells,
into cancer cells due to exposure to however, recognized by the immune
some etiologic agents response system
Etiologic Factors
Viruses Hormones
Chemical carcinogens Genetics
Physical agents
VIRUSES and BACTERIA
- oncogenic viruses may be one of the multiple agents acting to
initiate carcinogenesis
- prolonged or frequent viral infections may cause breakdown of

the immune system or overwhelm the immune system
- infections that increase risk of certain forms of cancer are as

follows:
> Human Papilloma Virus (HPV) – cervical cancer
> Epstein-Barr Virus – lymphoma
> Hepatitis B and C – hepatocellular cancer
> Helicobacter Pylori – gastric cancer
CHEMICAL CARCINOGENS
- causing cell mutation or alteration in cell enzymes and proteins
causing altered cell replication
1. INDUSTRIAL COMPOUNDS
• vinyl chloride (used for plastic manufacture, asbestos
factories, construction works)
• polycyclic aromatic hydrocarbons (such as from refuse
burning, auto and truck emissions, oil refineries, air
pollution)
• fertilizers, weed killers
• dyes (aniline dyes used in beauty shops, hair bleach)
2. DRUGS
• tobacco (tar nicotine), 90% of all cases of lung CA are due
to smoking
• alcohol
• cytotoxic drugs
3. HORMONES
• diethylstilbestrol (DES) – non-steroidal estrogen
medication used for pregnancy support, hormone
therapy for menopausal symptoms and estrogen
deficiency
4. FOODS, PRESERVATIVES
• nitrates (bacon, smoked meat)
• talc (polished rice, salami, chewing gum)
• food sweeteners
4. FOODS, PRESERVATIVES
• nitrates (bacon, smoked meat)
• talc (polished rice, salami, chewing gum)
• food sweeteners
• nitrosamines (rubber baby nipples)
• aflatoxins (mold in nuts and grains, milk, cheese, peanut
butter)
5. POLYCYCLIC HYDROCARBON
• charcoal broiling
PHYSICAL AGENTS
1. RADIATION
- from X-rays or radioactive isotopes
- from sunlight/UV rays
2. PHYSICAL IRRITATION/TRAUMA
- from pipe smoking
- multiple deliveries
- jagged tooth
- irritation of the tongue
- overuse of any organ/body part
HORMONES
- estrogen as replacement therapy has been found to increase
incidence of vaginal, cervical and uterine CAs
GENETICS
- when oncogene (hidden or repressed genetic code for cancer that
exists in all individuals) is exposed to carcinogens, changes in cell
structure occurs, malignant tumor develops
- regardless of the cause, several cancers are associated with

familial patterns
Predisposing Factors
AGE - older individuals are more prone to cancer
because they have been exposed to carcinogens
longer
- they have developed alterations in the immune
system
SEX - the most common type of cancer in females is
breast cancer, and prostate cancer in males
URBAN vs RURAL - cancer is more common among urban dwellers
RESIDENCE than among rural residents, probably due to
greater exposure to carcinogens, more stressful
lifestyle and greater consumption of
preservatives
GEOGRAPHIC - most common type of cancer in Japan is gastric
DISTRIBUTION cancer, in USA is breast cancer
- may be due to influence of environmental
factors such diet (raw foods greatly consist
Japanese diet), ethnic customs, types of pollution
OCCUPATION - there is greater risk of exposure to carcinogens
among chemical factory workers, farmers,
radiology department personnel
HEREDITY - positive family history of cancer increases risk to
develop the disease in adults, approximately (34%
of cancers have a familial basis)
STRESS - depression, grief, anger, aggression, despair, or
life stresses decrease immunocompetence
because of affectation of hypothalamus and
pituitary gland
- immunodeficiency may spur the growth and
proliferation of cancer cells
PRECANCEROUS LESIONS - pigmented moles, burn scars, senile keratosis,
leukopenia, benign polyps or adenoma of the
colon or stomach, fibrocystic dse. of the breast,
may undergo transformation into cancerous
lesions and tumors
OBESITY - studies have linked obesity to breast and
colorectal cancer
Characteristics of Benign
and Malignant Neoplasm
BENIGN MALIGNANT
Speed of growth grows slowly grows rapidly
remains localized infiltrates surrounding

Mode of growth
tissues
Capsule encapsulated not encapsulated
well-differentiated mature poorly-differentiated;

Cell characteristics
cells, but cells poorly anaplastic/embryonic type
function of cells
BENIGN MALIGNANT
extremely unusual when commonly following surgery
Recurrence surgically removed because of spread to other
tissues
Metastasis never occur very common
not harmful to host, unless it always harmful to host, may

compresses tissues or result in necrosis,
Effects of neoplasm
obstruct vital organ ulcerations, hemorrhage,
infection
BENIGN MALIGNANT
very good poor prognosis if cells are
Prognosis poorly differentiated and
evidence of metastasis
NCM 112:
Oncology Nursing
Prevention, 02
Screening and
Early Detection
Prevention
PRIMARY PREVENTION
- activities are aimed at prevention before pathologic change has begun
- can help reduce cancer risk through alteration of lifestyle behaviors to
eliminate or reduce exposure to carcinogens
> adapting more healthy diet

> limiting exposure to sun and other sources of UV radiation
> modifying sexual practices
> avoiding cigarettes smoking and alcohol drinking
> decreasing exposure to environmental and occupational carcinogens
SECONARY PREVENTION
- early detection, provides the opportunity to detect precancerous lesions or
early-stage cancers, to treat them promptly
Early Detection
American Cancer Society (ACS) Recommendations for the Early Detection of
Cancer in Asymptomatic People
- cancer-related check-up:
01 AGE FREQUENCY
20 to 40 years every 3 years
40 years and annual

older
AGE BREAST EXAMINATIONS and FREQUENCY
02 20 to 39 years - have clinical breast exam (CBE) every 3 years
- perform breast self-exam (BSE) monthly
40 years and - annual mammogram
older - annual CBE
- perform breast self-exam (BSE) monthly
AGE COLON AND RECTUM EXAMINATIONS and

03 FREQUENCY
50 years and - annual fecal occult blood tests
older - flexible sigmoidoscopy every 5 years
(men/women) - colonoscopy every 10 years
- double-contrast barium enema every 5 -10
years
- digital rectal exam (DRE) done at the same
time as sigmoidoscopy, colonoscopy or double-
contrast barium enema
AGE PROSTATE EXAMINATIONS and FREQUENCY
04 50 years and - annual prostate-specific antigen (PSA) blood
older test
- annual DRE
PROFILE UTERINE EXAMINATIONS and FREQUENCY

05 women who are CERVIX
or have been - annual Pap smear test and pelvic exam
sexually active (after 3 or more consecutive satisfactory exams
with normal findings, may be performed less
or 40 years and frequently)
older - HPV test is recommended
started ENDOMETRIUM
menopause - endometrial biopsy
Dietary Recommendations
American Cancer Society (ACS) Recommendations Against Cancer
1. Avoid obesity
2. Cut down on total fat intake
3. Eat more high fiber foods, like raw fruits and vegetables, whole grain
cereals
4. Include foods rich in vit A and C in daily diet
5. Include cruciferous vegetables in the diet like broccoli, cabbage,
cauliflower, Brussel sprouts
6. Be moderate in the consumption of alcoholic beverages
7. Be moderate in the consumption of salt-cured, smoked-cured and
nitrate-cured foods
Common Causes of Cancer
BREAST CANCER - early menarche
- late menopause
- nulliparous or older than 30 years at the birth of
a first child
LUNG CANCER - tobacco abuse
- asbestos
- radiation exposure
- air pollution
COLORECTAL CANCER - greater incidence in men
- familial polyposis
- ulcerative colitis
- high-fat, low-fiber diet
PROSTATE CANCER - common among males who are 50 years and
older
- African-American have the highest incidence in
the world
- (+) family history
- exposure to cadmium
CERVICAL CANCER - sexual behavior:
> first intercourse at an early age
> multiple sexual partners
> sexual partner who has had multiple sexual
partners
- (+) HPV and AIDS
- low socioeconomic status
- cigarette smoking
HEAD AND NECK CANCER - more common among males
- alcohol and tobacco use
- poor oral hygiene
- long term sun exposure
- occupational
SKIN CANCER - individuals with fair complexion
- (+) family history
- moles (nevi)
- exposure to coal tar, creosote, arsenic, radium
- sun exposure between 11am to 3pm
Warning Signals of Cancer
C change in bowel or bladder habits
A a sore that does not heal
U unusual bleeding or discharge
U unexplained anemia
U unexplained sudden weight loss
T thickening or lump in the breast or elsewhere
I Indigestion or difficulty swallowing
O obvious change in wart or mole
N nagging cough or hoarseness of voice

Staging and Grading of Neoplasia
STAGING
- determining the size of the tumor and existence of metastases
- necessary at the time of diagnosis to determine:
> extent of disease (local vs metastatic);
> prognosis
> proper management
GRADING
- classification of tumor cells
Stage What it means
Stage 0 Abnormal cells are present but have not spread to nearby
tissue. Also called carcinoma in situ, or CIS. CIS is not cancer,
but it may become cancer.
Stage I, Stage II, and Stage III Cancer is present. The higher the number, the larger the
(may also be written as cancer tumor and the more it has spread into nearby
Stage 1, Stage 2, and Stage 3) tissues.
Stage IV (may also be written The cancer has spread to distant parts of the body.
as Stage 4)
NOMENCLATURE OF NEOPLASIA
- tumor is named according to:
1. PARENCHYMA 3. EMBRYONIC ORIGIN

Hepatoma- liver Ectoderm- usually gives
Osteoma- bone rise to epithelium
Myoma- muscle Endoderm- glands
Mesoderm- connective
2. PATTERN AND STRUCTURE, either tissues
gross or microscopic
Fluid-filled- Cyst
Glandular- Adeno
Finger-like- Papillo
Stalk- Polyp
BENIGN TUMOR MALIGNANT TUMOR
- suffix used, -”OMA” 1. Ectodermal, endodermal,
glandular, epithelial
adipose tissue- LipOMA - suffix used, -”CARCINOMA”
bone- osteOMA
muscle- myOMA Pancreatic AdenoCARCINOMA
blood vessels- angiOMA Squamous Cell CARCINOMA
fibrous tissue- fibrOMA
2. Mesodermal, connective tissue
origin
- suffix used, -”SARCOMA”
FibroSARCOMA
MyoSARCOMA
AngioSARCOMA
1. -”OMA” but Malignant
HepatOMA, LymphOMA, GliOMA, MelanOMA
2. THREE-germ layers, -”TERATOMA”
3. Non-neoplastic but -”OMA”

HematOMA
TNM Classification
- a system developed by American Joint Committee of Cancer (AJCC) that
can be applied to all tumor types
T- primary/main tumor size

TX – primary tumor is unable to be assessed
TO – no evidence of primary tumor
TIS – carcinoma in situ (abnormal cells are present but have not
spread to nearby tissue)
T1, T2, T3, T4 – increasing size and/or local extent of primary tumor
N- presence or absence of regional nearby lymph node involvement
NX – regional lymph nodes are unable to be assessed
NO – no regional lymph nodes involvement
N1, N2, N3 – increasing involvement of regional lymph nodes
M- presence or absence of distant metastases
MX – unable to be assessed
MO – absence of distant metastases
M1 – presence of distant metastases
Identifying information
Mercury Mars
It’s the closest planet to Despite being red, Mars
the Sun and the smallest Venus is actually a cold place.
one in the Solar System It’s full of iron oxide dust
Venus has a beautiful
name and is the second
planet from the Sun
Cancer Detection Examinations
CYTOLOGIC EXAMINATION OR PAPANICOLAOU TEST
(PAP’S EXAM, PAP SMEAR)
- cytologic specimen can be obtained from tumors

that tend to shed cells from their surface
> GI tract through endoscopy

> GU tract through colposcopy of the cervix and
vagina
> cystoscopy of the bladder
> laparoscopy of the pelvic and abdominal cavity
CYTOLOGIC EXAMINATION OR PAPANICOLAOU TEST
(PAP’S EXAM, PAP SMEAR)
- interpretation of Papanicolaou Test results are as

follows:
Class I Normal follow-up examination every 1-3 yrs as

recommended by physician
Class II Inflammation may require Pap exam in 3-6 mos as
prescribed
Class III Mild to moderate
dysplasia
Class IV Probably malignant Require biopsy as prescribed
Class V Possibly malignant

BIOPSY
- involves obtaining tissue samples by needle

aspiration, or incision of tumor
1. NEEDLE BIOPSY
- done by aspiration of tumor cells with needle and
syringe
2. EXCISION BIOPSY
- done by removing the entire tumor (small)
3. INCISION OR SUBTOTAL BIOPSY

- done by taking only a part of the tumor (large)
RADIOLOGIC EXAMINATIONS
- ultrasound (UTZ)
- magnetic resonance imaging (MRI)
- radiodiagnostic tests
- computerized axial tomography (CT scan)
- endoscopic examinations
LABORATORY BLOOD TESTS
1. HEMATOLOGIC (CBC)
- hemoglobin (hgb) and hematocrit (hct)
low in anemia, may indicate malignancy
- leukocytes (wbc)
immature WBCs high in leukemia, lymphomas
mature WBCs low in leukemia and metastatic dse
in bone marrow
- platelets
high in chronic myelocytic leukemia (CML),
Hodgkin’s dse
low in acute lymphocytic leukemia (ALL), acute
myelocytic leukemia (AML), multiple
myeloma, bone marrow depression
LABORATORY BLOOD TESTS
2. TUMOR MARKERS
- alpha-feto-protein (AFP)
elevated in lung, testicular, pancreatic, colon,
gastric CAs and choriocarcinoma
- carcinoembryonic antigen (CEA)
elevated in colorectal, breast lung, stomach,
pancreatic and prostate CAs
- human chorionic gonadotropin (HCG)
elevated in choriocarcinoma, germ cell, testicular
CA
- prostatic acid phosphatase
elevated in metastatic prostate CA
- prostatic-specific antigen (PSA)
elevated in prostate CA
NCM 112:
Oncology Nursing
Pathophysiologic
Basis of 03
Malignant
Neoplasia
PREDISPOSING FACTORS/ETIOLOGIC FACTORS
CELLULAR ABBERATIONS
CANCER CELL
PROLIFERATION
- disrupt normal cell growth
and interfere with tissue
function
➢ Pressure
➢ Obstruction
➢ Pain
➢ Effusion
➢ Ulceration
➢ Vascular thrombosis,
thrombophlebitis
Cancer Cell Proliferation
PRESSURE
- due to increase in size of neoplastic growth
OBSTRUCTION
- as tumor continues to grow, hollow organs and vessels become
compressed and obstructed
esophagus, bronchi, ureters, bowel, blood vessels,
lymphatic system
PAIN
- due to: 1. pressure on the nerve endings
2. distention of organs/vessels
3. lack of oxygen to tissues and organs
4. release of pain mediators by the tumor
- a late sign of cancer
Cancer Cell Proliferation
EFFUSION
- when lymphatic flow is obstructed, there may be effusion in serous
cavities
pleural cavity, pleural effusion
abdominal cavity, ascites
ULCERATION AND NECROSIS

- result as the tumor erodes blood vessels and pressure on tissue
causes ischemia ➜ tissue damage and bleeding ➜ infection
VASCULAR THROMBOSIS, EMBOLISM, THROMBOPHLEBITIS

- tumors tend to produce abnormal coagulation factors that cause
increased clotting
pulmonary embolism
CANCER CELL PARANEOPLASTIC

PROLIFERATION SYNDROME
- disrupt normal cell growth - malignant cells produce
and interfere with tissue enzymes, hormones, and
function other substances
➢ Pressure ➢ Anemia
➢ Obstruction ➢ Hypercalcemia
➢ Pain ➢ Edema
➢ Effusion ➢ Disseminated
➢ Ulceration Intravascular Coagulation
➢ Vascular thrombosis, (DIC)
thrombophlebitis
Paraneoplastic Syndrome
ANEMIA
- CA cells produce chemicals that interfere with RBC production
- iron uptake is greater in the tumor than that deposited in the liver
- blood loss that results from bleeding leads to anemia
HYPERCALCEMIA
- tumors of the bone, squamous cell lung CA, breast CA, produce a
parathyroid-like hormone that increases or accelerates bone
breakdown and release of calcium
- also results from metastasis to the bones
- enhanced by immobilization and dehydration
DESSIMINATED INTRAVASCULAR COAGUALTION (DIC)

- more likely to occur in lungs, pancreas, stomach, prostate Cas
- precipitated by the release of tissue thromboplastin or endothelial
injury
CANCER CELL PARANEOPLASTIC Anorexia and Cachexia

PROLIFERATION SYNDROME Syndrome
- disrupt normal cell growth - malignant cells produce - final outcome of
and interfere with tissue enzymes, hormones, and unrestrained cancer cell
function other substances growth
➢ Pressure ➢ Anemia ➢ Tissue wasting
➢ Obstruction ➢ Hypercalcemia ➢ Severe weight loss
➢ Pain ➢ Edema ➢ Severe debilitation
➢ Effusion ➢ Disseminated
➢ Ulceration Intravascular Coagulation
➢ Vascular thrombosis, (DIC)
thrombophlebitis
Anorexia-Cachexia Syndrome
- malignant neoplasms deprive normal cells of nutrition
- tumors produce alteration in enzyme system necessary for
normal metabolism ➜ stored fat is lost, tissues lost nitrogen
(negative nitrogen balance)
- tumors revert to anaerobic metabolism ➜ consume glucose;
deplete glycogen stores in the liver and convert glucose to lactate
- protein depletion, serum albumin levels decrease
- tumors take up sodium; water retention marks malnutrition and is
not immediately reflected as weight loss
- CA cells produce anorexigenic substances that act in the satiety
center of the hypothalamus, causing anorexia
- taste sensation diminishes or becomes altered, and individual may
have aversion to eating particularly meat (tastes bitter)
Treatment 04
Modalities
Surgical Interventions
DIAGNOSTIC SURGERY
- done by cytologic specimen collection and biopsy
PREVENTIVE SURGERY
- involves removal of precancerous lesions or benign tumors
patients with familial polyposis and ulcerative colitis undergo
subtotal colectomies to prevent colon cancer
CURATIVE SURGERY
- involves removal of an entire tumor and surrounding lymph nodes
- cancers are localized to the organ of origin and the regional lymph
nodes are potentially curable by surgery
RECONSTRUCTIVE SURGERY
- done for improvement of the appearance and function of the organ
affected
Surgical Interventions
PALLIATIVE SURGERY
- done for relief of distressing signs and symptoms or for retardation of
metastasis
- attempt to improve client’s quality of life
a. Reduce pain by interrupting nerve pathways or implanting

pain control pumps
b. Relieve airway obstruction
c. Relieve obstruction in the GI and GU tracts
d. Relieve pressure in the brain and spinal cord
e. Prevent hemorrhage
f. Remove infected and ulcerating tumors
g. Drain abscesses
Radiation Therapy
- use of high-energy ionizing radiation that destroys a cell’s ability to
reproduce by damaging its DNA
- may be used as a primary, adjuvant, or a palliative treatment modality:

PRIMARY THERAPY
- the only treatment used and aims to achieve local cure of the cancer
early stage of skin cancer, Hodgkin’s dse., cervical carcinoma
ADJUVANT THERAPY
- can be done preoperatively or postoperatively to aid in destruction of
cancer cells
- also used in conjunction with chemotherapy to enhance destruction of
cancer cells
PALLIATIVE THERAPY
- can be used to relieve pain cause by obstruction, pathologic fractures,
spinal cord compression and metastases
Radiation Therapy
- rapidly diving cells like cancer cells are more vulnerable to radiation;
therefore, radiation kills cancer cells while sparing normal cells from
excessive cell death
-TYPES OF RT:
EXTERNAL RADIATION THERAPY (TELETHERAPY, DXT)
- administered through high-energy X-ray machine
e.g. linear accelerator, cobalt, betatron, or a machine
containing radioisotope
- major advantage is its skin-sparing effect; the maximum effect of
radiation occurs at tumor deep in the body, not on the skin surface
- no need for isolation
Radiation Therapy
INTERNAL RADIATION THERAPY (TELETHERAPY, DXT)
- administered within or near the tumor or into the systemic circulation
Sealed-source (brachytherapy)
- the radioisotope is placed within or near the tumor
- radioactive material is enclosed in a sealed container
- used for both intracavity and interstitial therapy
- intracavity RT is used to uterine and cervical CAs; the radioisotope
is placed in the body cavity, generally for 24-72 hrs (cesium 137 or
radium 226)
- on interstitial therapy, the radioisotope is placed in needles, beads,
seeds, ribbons, or catheters, which are then implanted directly into
the tumor (iridium 192, iodine 125, cesium 137, gold 198, radium 222)
- the radioisotope cannot circulate through the client’s body nor can
contaminate the client’s urine, sweat, blood or vomitus (secretions
are not radioactive)
Radiation Therapy
Unsealed-source
- the radioisotope may be administered intravenously, orally, or by
instillation directly into the body cavity
- the radioisotope circulates through the client’s body; therefore,
client’s urine, sweat, blood or vomitus are radioactive
- e.g. iodine 131, PO for Grave’s dse. and thyroid CA, strontium chloride
89, TIV for relief of painful bony metastases
PRINCIPLES OF RADIATION
PROTECTION – “DTS”
1. DISTANCE
- the greater the distance from radiation source, the less the exposure
dose of ionizing rays
- maintain distance of at least 3 feet when not performing nursing
procedure
2. TIME
- limit contact with the client for 5 minutes each time, a total of 30 mins
per 8-hr shift
3. SHIELDING
- use lead shield during contact with client
PROTECTION
- pregnant staff should not be assigned to clients receiving internal RT
- staff members caring for the client with internal RT should wear
dosimeter badge when in the client’s room
- to prevent feelings of isolation, maintain contact with the client while
keeping distance from radiation exposure; talk with the client from the
doorway of the room
- the client receiving an unsealed source of RT should have a private
room and bath
- foods are served on disposable plates and utensils.
- trash and linens are kept in the client's room and are not removed until
the client is ready for discharge.
- the client is also instructed to rinse the sink with copious amount of
water after tooth brushing and to flush the toilet several times after each
use
PROTECTION
- anyone entering the room wears a new pair of booties each time to
prevent tracking the radioisotope out into the hallway
- caregivers should wear gloves when handling body fluids
- any emesis (vomiting), especially that occurs shortly after ingestion of
oral radioisotope, should be covered with absorbent pads, and the
Radiation Safety Officer should be called immediately
NURSING INTERVENTIONS:
cervical cancer client with isotope implant
PROCEDURE RATIONALE
Client’s back is turned towards To minimize exposure of

the door. healthcare staff to radioisotope
entering the client’s room.
Encourage the client to turn to
sides at regular intervals.
The client should be on complete To prevent dislodgement of the
bed rest. radioisotope.
The client should be given Bowel movement during the
enema before the procedure. procedure may cause
dislodgment of the radioisotope.
PROCEDURE RATIONALE
The client should be given low To prevent dislodgement of the

fiber diet to inhibit defecation radioisotope.
during the procedure until the
device is removed in 2 to 3 days.
The client should have a Foley To prevent bladder distention
catheter in place during the and subsequently prevent
procedure. irradiation of the bladder.
Irradiation of the bladder may
cause fistula formation between
the bladder and the uterus. This
causes urine to come out from
the vagina
PROCEDURE RATIONALE
Have long forceps and lead Use long forceps to pick up

container readily available. dislodged radioisotope and
place it in the lead container.
TEACHING GUIDELINES
REGARDING EXTERNAL RT
1. It is painless.
2. Lie very still on a special table while the intervention is being given and
you may be placed in a special position to maximize tumor
irradiation.
3. Each treatment usually lasts for few minutes, you may hear sounds of
the machine being operated, and the machine may move during the
therapy.
4. As a safety precaution for the therapy personnel, you will remain
alone in the treatment room while the machine is in operation.
5. The technologist will be right outside your room observing you through
a window or by a closed - circuit TV. You may communicate.
6. There is no residual radioactivity after radiation therapy. Safety
precautions are necessary only during the time you are actually
receiving irradiation. You may resume normal activities of daily
living.
CLIENT EDUCATION ON SKIN CARE
IN EXTERNAL RT
Skin care within the treatment area includes the following:
1. Keep your skin dry.
2. Do not wash the treatment area until you are instructed to do so.
When permitted, wash the treated skin gently with mild soap, rinse
well, and pat dry. Use warm water or cool water, not hot water.
3. Do not remove the lines or ink marks placed on your skin.
Avoid using powders, lotions, creams. alcohol and deodorants on
the treated skin.
4. Wear loose - fitting clothing to avoid friction over the treatment
area
5. Do not apply tape to the treatment area if dressings are applied
6. Shave with an electric razor. Do not use pre-shave or after - shave
lotions.
CLIENT EDUCATION ON SKIN CARE
IN EXTERNAL RT
7. Protect your skin from exposure to direct sunlight, chlorinated
swimming pools, and temperature extremes (e.g. hot water
bottles, heating pads, lo packs).
8. Consult your radiation therapist or nurse about specific measures
for individual skin reactions.
side effects of radiation therapy
SIDE EFFECT NURSING INTERVENTIONS
SKIN REACTIONS - observe for early signs of skin

- erythema, dry/ moist reaction and report to the physician
desquamation - keep area dry
- atrophy, telangiectasia, - wash area with water, no soap and
depigmentation, necrotic/ pat dry (do not rub); mild soaps is
ulcerative lesions permitted
- don’t apply ointments, powders or
lotion on the area; cornstarch may be
used
- don’t apply heat; avoid direct
sunshine or cold on the area
- use soft cotton fabrics for clothing to
prevent skin irritation
- don’t erase skin markings
INFECTION - monitor blood counts weekly,

- this is due to bone especially WBC
marrow suppression - good personal hygiene, nutrition,
adequate rest
- teach the client signs of infection to
report to physician
HEMORRHAGE - monitor platelet count
- platelets are vulnerable - avoid physical trauma or use of
to radiation aspirin (ASA)
- teach signs of hemorrhage to report
(e.g. gum bleeding, nose bleeding,
black stools)
- monitor stool and skin for signs of
hemorrhage.
FATIGUE - plenty of rest and good nutrition

- result of high metabolic
demands for tissue repair
and toxic waste removal
WEIGHT LOSS
- anorexia, pain and effect
of cancer.
STOMATITIS & - administer analgesics before meals,
XEROSTOMIA (Dry mouth) as prescribed
- ulceration of oral mucous - bland diet, avoid smoking, alcohol
membrane occurs - good oral hygiene with saline rinses
every 2 hours
- sugarless lemon drops or mint to
increase salivation
Diarrhea, nausea and

vomiting, headache.
alopecia (hair loss) and
cystitis may also occur
Social isolation is also
experienced by the client
due to fear of
contaminating others with
radiation
NCM 112:
Oncology Nursing
Treatment 04
Modalities cont’
Chemotherapy
- the goals may be cure, control, or palliation of manifestations
- a systemic intervention
- recommended when: 1. disease is widespread
2. the risk of undetectable disease is high
3. the tumor cannot be resected and is
resistant to RT
- objective is to destroy all malignant tumor cells without excessive
destruction of normal cells
CHARACTERISTICS OF
CHEMOTHERAPY
1. It affects both normal and cancer cells.
- the rapidly dividing cells, both the normal and cancer cells are
vulnerable by disrupting cell function and division
- mucous membrane, blood cells, hair follicles, skin cells are
rapidly dividing cell
2. It has fraction cell - kill.
- only a certain number of cancer cells are killed with each course
- therefore, must be given in a series
3. It may be cell-cycle specific (CCS), or cell-cycle nonspecific (CCNS)
- CCS chemotherapy may destroy cancer cells at specific stage
of cell division
- CCNS chemotherapy may destroy cancer cells at any stage of
cell division
- combination chemotherapy destroy more malignant cells and
produces fewer side effects because each drug strikes the cancer
cells at different stages in cell cycle
CLASSIFICATION OF
CHEMOTHERAPEUTIC AGENTS
1. Cell Cycle - Specific Groups
a. Antimetabolites
• Cytarabine (Ara-C, Cytosar)
• 5-Fluorouracil (5-FU)
• Mercaptopurine (6-MP, Purinethol)
• Methotrexate (Mexate)
• 6 - Thioguanine (6-TG)
• Fludarabine (Fludara)
• Pentostatin (Nipent)
b. Vinca Alkaloids
• Vinorelbine (Navelbine)
• Vincristine (Oncovin)
• Vinblastine (Velban)
CLASSIFICATION OF
c. Epipodophyllotoxins
• Etoposide (VP-16)
• Teniposide (VM-26, Vumon)
d. Taxanes
• Paclitaxel (Taxol)
e. Miscellaneous
• L-Asparaginase
• Hydroxyurea (Hydrea)
CLASSIFICATION OF
2. Cell Cycle - Nonspecific Groups
a. Alkalyting Agents
• Busulfan (Myleran)
• Carboplatin (Paraplatin)
• Cisplatin (CDDP, Platinol - AQ)
• Cyclophosphamide (Cytoxan)
• Ifosfamide (Ifex)
• Mechlorethamine HCI (Mustargen)
• Thiotepa
CLASSIFICATION OF
b. Antitumor Antibiotics
• Chlorambucil (Leukeran)
• Bleomycin (Blenoxane)
• Dactinomycin (Cosmegen)
• Daunorubicin (Cerubidine)
• Doxorubicin (Adriamycin) b,
• Idarubicin (Idamycin)
• Mitomycin C (Mitomycin)
• Mitoxantrone (Novantrone)
• Plicamycin (Mithracin)
CLASSIFICATION OF
3. Hormonal Therapy
a. Glucocorticoids
• Prednisone (Deltasone)
• Methylprednisolone (Solu-Medrol, Medrol)
• Dexamethasone (Decadron)
b. Estrogens
• Chlorotrianisene (Tace)
• Diethy|stilbestrol (DES)
• Estradiol (Estrace)
c. Antiestrogens
• Tamoxifen (Nolvadex)
CLASSIFICATION OF
d. Progestins
• Depo-Provera
• Megestrol acetate (Megace)
• Leuprolide (Lupron)
e. Nitrosoureas
• Carmustine (BCNU)
• Lomustine (CCNU)
• Streptozocin (Zanosar)
ROUTES OF ADMINSITRATION OF
CHEMOTHERAPY
INTRAVENOUS CHEMOTHERAPY
- extravasation (escape from the vein) of some chemotherapeutic

agents
can cause tissue necrosis in the area
- use of vascular access devices (VAD's) are now preferred as venous
access; provides continuous chemotherapy, multiple access, route for
administration of parenteral fluids, antibiotics, and frequent blood testing.
- VAD's can be implanted (e.g. Port-A-Cath), central lines (e.g. tunneled
and non - tunneled), and peripherally inserted central catheters (PICC
lines)
- the most reported complications of VADs are infection and obstruction
(each institution provides protocol for care of VADs, e.g. change of
dressing, flushing, blood draw, etc.)
CHEMOTHERAPY
REGIONAL CHEMOTHERAPY
- allows high concentrations of drugs to be directed to localized tumors.
- the methods are as follows:
1. Topical - fluorouracil cream may be applied to the skin to treat
actinic
keratoses
2. Intra-arterial - enable major organs or tumor sites to receive
maximal exposure with limited serum levels of medications
3. Intracavity – instills the medication directly into an area such as
the abdomen, bladder, or pleural space
CHEMOTHERAPY
4. Intraperitoneal
– done for cancer in the intraabdominal area (e.g. ovarian
cancer)
- concentration of a chemotherapeutic agent to be delivered
to the actual tumor site with minimal exposure of healthy
tissues
5. Intrathecal
- involves instilling chemotherapeutic agents into the CNS
through a reservoir placed in the ventricle via an Omnaya
reservoir or via a lumbar puncture
- this is done because most medications given systematically
are not effective against CNS tumors because they cannot
cross the blood - brain barrier
side effects of chemotherapy
GASTRO-INTESTINAL - administer antiemetic to relieve

SYSTEM nausea and vomiting
- nausea and vomiting, - replace fluid-electrolyte losses, low-
diarrhea, constipation fiber diet to relieve diarrhea
- increase fluid intake and fibers in diet
to prevent/relieve constipation
INTEGUMENTARY SYSTEM
- pruritus, urticaria and - provide good skin care
systemic signs
- stomatitis (oral - Provide good oral care

mucositis) - avoid hot and spicy food
- alopecia - reassure that it is temporary;

regrowth within 8 weeks of termination
- encourage to wear wigs, hats or head
scarf
- skin pigmentation - inform that it is temporary.
- nail changes - reassure that nails may grow

normally after chemotherapy
HEMATOPOIETIC SYSTEM
- anemia - provide frequent rest periods
- neutropenia - protect from infection

- avoid people with infection
- report fever, chills, diaphoresis, heat,
pain, erythema or exudates on any
body surface
- avoid rectal or vaginal procedures
- avoid fresh fruits, raw meat, fish,
vegetables, fresh flowers, potted plants
- change IV sites every other day
- change all solutions and IV infusion
sets every 48 hrs
- thrombocytopenia - protect from trauma

- avoid ASA
Nadir - the time after

chemotherapy
administration when WBC
or platelet count is at the
lowest point; occurs within
7 to 14 days after drug
administration
GENITO-URINARY SYSTEM
- hemorrhagic cystitis - provide 2-3 liters of fluids
per day
- urine color changes - reassure that it is harmless

REPRODUCTIVE SYSTEM
- premature menopause - reassure that menstruation resumes
or amenorrhea after chemotherapy
Other Treatment for Cancer
1. Biotherapy – use of biologic response modifiers (BRM’s)
2. Hematopoietic Growth Factors
3. Monoclonal antibodies
4. Bone-marrow transplantation
Psychosocial Aspects of Cancer
Care
1. Promote support for the client- your presence, empathy, positive
regard.
2. Provide support of the family.
3. Promote positive self-concept.
4. Promote coping with the cancer experience.
HOSPICE CARE
- now a trend in the care of clients with terminal cancer, or those with
prognosis of having a lifespan of 1 to 6 months
- basic characteristics of a hospice program are:
a. control of manifestations, including pain relief
b. treatment of the client and family as a unit
c. provision of care by an interdisciplinary team
d. 24-hr, 7-day-a-week services
Psychosocial Aspects of Cancer
Care
e. coordinated homecare with back-up inpatient services
f. use of trained volunteers to augment staff services
g. spiritual support
h. bereavement follow-up
i. services given on the basis of need and not on the ability to
pay
j. Structured systems of staff support
NCM 112:
Oncology Nursing
Oncologic 05
Emergencies
Infection and Pain
- infection arises from neutropenia (low neutrophils)
- people with advanced cancer have pain
- severe infection and pain can interfere with the person's ability to enjoy
quality life
- pain management is the priority in care of clients with advanced
cancer
Hypercalcemia
- due to bone resorption (demineralization)
- serum calcium level > 11 mg/dL
- usually occurs in solid tumors like breast, lung, head, neck and renal CAs
- may also occur in hematologic cancer like multiple myeloma, leukemia
- severe hypercalcemia may lead to:
renal failure
coma
cardiac arrest
death
- Calcitonin (Miacalcin) and oral glucocorticoids are given to lower
serum calcium
Tumor Lysis Syndrome
- the destruction of large number of malignant cells may rapidly release
intracellular potassium, phosphorous and nucleic acid into the
circulation
- electrolyte imbalances and acute renal failure may occur
- clients with malignancies that are very responsive to treatment are at
highest risk especially if they have large tumor burden (lymphomas,
leukemias and small cell carcinoma)
MANIFESTATIONS
1. Weakness 6. Muscle cramps or twitching
2. Nausea 7. Oliguria (>80 ml ,<400ml urine output)
3. Diarrhea 8. Hypotension
4. Flaccid paralysis 9. Edema
5. ECG changes 10. Altered mental status
- collaborative management include the following:
1. Intravenous hydration
2. Allopurinol to decrease uric acid concentration
3. Sodium bicarbonate with IV hydration to promote fecal excretion of
excess phosphate
4. Lowering of serum potassium levels with medications, retention
enemas, IV 50% dextrose
Syndrome of Inappropriate
Antidiuretics Hormone
- results from the abnormal production of antidiuretic hormone (ADH)
- may be caused by:
1. small cell lung cancer
2. infection
3. pulmonary disorders
4. emotional stress
5. CNS disorders
6. some drugs, including antineoplastic agents like Cytoxan
(Cyclophosphamide), Oncovin (Vincristine), Velban (Vinblastin),
Platinol - AQ (Cisplatin)
- manifested by water retention and decrease in sodium
SIGNS AND SYMPTOMS

1. Confusion
2. Irritability
3. Headache
4. Muscle weakness
5. Lethargy
6. Decreased urine output
7. Edema
8. Nausea and vomiting
9. Anorexia
- collaborative management are as follows:
1. Fluid excretion (diuretics)
2. IV infusion of hypertonic saline (3% to 5%) if severe, to prevent
pulmonary edema
3. Monitor intake and output
4. Administer medications like Declomycine (Demeclocycline), Lithane
(Lithium), and urea
Disseminated Intravascular
Coagulation (DIC)
- characterized by development of extensive, abnormal clots in the
microcirculation (small blood vessels)
- widespread clotting depletes the general circulation with clotting factors
and platelets leading to excessive bleeding in different sites of the body
- clots that are obstructing the circulation decrease blood flow to major
organs, causing pain, stroke-like manifestations, dyspnea, tachycardia,
oliguna, bowel necrosis
- in cancer, usually caused by gram-negative infection or sepsis, release
of clotting factors from cancer cells, or blood transfusion
- most commonly associated with leukemia and adenocarcinomas of the
lung, pancreas, stomach and prostate
Coagulation (DIC)
- diagnostic findings:
1. prolonged prothrombin time and activated partial thromboplastin
time
2. very low platelet count
3. prolonged clotting times
- medical management are as follows:

1. Correction of the basic problem (e.g., infection).
2. Administer blood products and medication as prescribed
3. IV heparin if with manifestations of thrombosis (although
controversial)
4. Monitor the client for signs and symptoms of bleeding.
Spinal Cord Compression
- caused by direct pressure or compromise of vascular supply to the
spinal cord
- back pain is often the only presenting clinical manifestation in majority
of clients
- may result to irreversible neurologic damage with paralysis and loss of
bowel and bladder control
- treatment is usually with RT; laminectomy may be an alternative
- steroids to reduce inflammation and swelling
Superior Vena Cava Syndrome
- results from external and internal obstruction of the superior vena cava
- obstruction reduces venous return to the heart and decreases cardiac
output
- usually secondary to lung cancer or lymphoma
CLINICAL MANIFESTATIONS
1. Dyspnea
2. Facial swelling
3. Jugular vein distention
4. Sitting up and leaning forward to breathe
5. Swelling of arms, chest pain, dysphagia
- external-beam RT and curative chemotherapy are used for palliation

Cardiac Tamponade
- fluid collects in the pericardial sac (pericardial effusion)
- pericardiocentesis may be performed to draw off the fluid
Care of Clients 06
with Cancer
ASSESSMENT FINDINGS
- hoarseness of voice (most usual)
- mass on anterior neck
- dysphagia, burning sensation with hot/acidic beverages
- halitosis
- hemoptysis
COLLABORATIVE MANAGEMENT
- surgery: laryngectomy
subtotal – retains voice
total – absolute loss of voice
CARE OF CLIENTS WITH CANCER

OF THE LARYNX
LARYNGECTOMY
Preop care
- psychological support
loss of voice
permanent tracheostomy
loss of sense of smell
inability to: blow, blow the nose, sip, whistle, gargle, Valsalva
maneuver
- establish means of communication to be used post-op

OF THE LARYNX
client with tracheostomy
NURSING CARE PROCEDURE
Establish patent airway - suction as necessary

- sterile technique
- semi-fowler’s position
- use NSS to lubricate suction
catheter tip
- apply suction during
withdrawal of suction cath
- apply suction for 5-10 secs
(max of 15 secs)
- insert 3-5 in of the suction cath
- instill 2-5 cc NSS to liquefy
secretions
Prevent infection - cleanse stoma and

tracheostomy at regular basis
- change dressings and ties as
necessary
Establish means of
communication
Psychological support
Assist during speech theraophy

ASSESSMENT FINDINGS
- cough ( hacking, nonproductive initially, then thick, purulent blood-
tinged sputum)
- pleural effusion
- maintain patent airway
- administer oxygen and aerosol therapy
- DBE
- relief of pain
- protection from infection
- adequate nutrition
- chest tube management
CARE OF CLIENTS WITH LUNG

CANCER
- surgery:
PNEUMONECTOMY
- removal of a lung
- position in semi-fowler’s, turned on affected side (to promote lung
expansion, prevent flooding of the remaining lung with blood)
- avoid full side-lying position (to prevent mediastinal shift)
- no chest tube after surgery
LOBECTOMY- removal of a lobe
SEGMENTECTOMY- removal of a segment
WEDGE RESECTION - removal of an entire tumor regardless of the
segment
DECORTICATION – stripping off of fibrinous membrane enclosing the lung
THORACOPLASTY - removal of ribs, usually done after pneumonectomy
(to reduce size of empty thorax, thereby preventing mediastinal shift)

CANCER
STAGES OF BREAST CANCER
Stage I
Tumor size is up to 2cm.
Stage Il
Tumor size is up to 5 cm with axillary lymph node involvement
Stage III
Tumor size is more than 5 cm., with axillary and neck lymph no
involvement
Stage IV
Metastasis to distant organs (liver, lungs, bone and brain)
CARE OF CLIENTS WITH BREAST

CANCER
COLLABORRATIVE MANANAGEMENT
Surgery
1. Lumpectomy/tylectomy - removal of the lump)
2. Simple Mastectomy - removal of the entire breast; pectoralis muscles
and the nipple remain intact
3. Modified Radical Mastectomy (MRM) - removal of the entire breast
and the axillary lymph nodes; pectoralis muscles are conserved
4. Radical Mastectomy (Halstead Surgery) - removal of the entire
breast, pectoralis major and minor muscles and the axillary lymph
nodes; followed by skin grafting. This is rarely done nowadays.
Chemotherapy
Radiation Therapy

CANCER
client undergoing breast surgery
PREOPERATIVE CARE
PROCEDURE RATIONALE
Psychosocial Support. Include the

husband when necessary.
Teach arm exercises to prevent lymph edema
Inform about wound suction

drainage (hemovac, Jackson-
Pratt)
DBCT exercises to prevent postop respiratory
complications
POSTOPERATIVE CARE
PROCEDURE RATIONALE
Place client in semi-Fowler's - position promotes lung

position with arm abducted and expansion
elevated on pillows. - abduction and elevation of am
on the affected side promotes
venous return and prevents
lymphedema
Monitor Hemovac output - normal drainage is
serosanguinous (first 24 hours) -
- composed of plasma and
small amounts of RBC, pinkish or
reddish in appearance but not
viscous
POSTOPERATIVE CARE
PROCEDURE RATIONALE
Check behind patient for Blood flows to the back by

bleeding gravity.
Post signs warning against to prevent obstruction of venous
taking blood pressure, starting and lymphatic flow.
IVs, or drawing blood on affected
side.
Initiate exercise. Give analgesic to prevent stiffness and
before initiating exercises contractures of shoulder girdle
Reinforce special mastectomy to prevent lymphedema
exercises as prescribed
POSTOPERATIVE CARE
PROCEDURE RATIONALE
Provide adequate analgesia to The client cooperates with

promote ambulation and ambulation and exercise if she is
exercise free from pain or discomfort
Encourage regular coughing and to promote lung expansion and
deep breathing exercises prevent atelectasis
Prepare client for size and
appearance of the incision and
provide support when incision is
viewed for first time.
POSTOPERATIVE CARE
PROCEDURE RATIONALE
Provide client with detailed Fitting is not possible for 4 - 6

information concerning breast wks. A temporary prosthesis or
prosthesis. lightly paddled bras may be
worn until healing is complete.
Teach patient to avoid
constrictive clothing and report
persistent edera, redness, or
infection of incision.
Teach patient importance of
continuing monthly breast
examination remaining breast.
ASSESSMENT FINDINGS
- ascending (right) colon: occult blood in stool, anemia, anorexia and
weight loss, abdominal above umbilicus, palpable mass
- distal colon and rectum: hematochezia, alternating constipation and
diarrhea, pencil or ribbon-shaped stool, pain below umbilicus
- surgery:
➢ Hemicolectomy - ascending and transverse colon
➢ Abdominoperineal resection (Mile’s Surgery) – rectosigmoid colon
- involves 2 incisions: lower abdominal (sigmoid removal);
perineal (rectum removal)
- requires permanent colostomy
CARE OF CLIENTS WITH

COLORECTAL CANCER
client undergoing colonic surgery
PREOPERATIVE CARE
Provide psychological support
Promotion of thorough bowel - diet modification:

cleaning > low residue diet 3-5 days preop
(to reduce bulk of feces)
> clear liquid diet 24 hours preop
- mechanical cleansing:
> laxative as ordered
> cleansing enema or intestinal
evacuant as ordered
- neomycin SO4 tablets

PREOPERATIVE CARE
Risk for infection and bleeding - administer vit C and K as

ordered (these are lost in
repeated enema)
POSTOPERATIVE CARE
Managing perineal wound in APR - warm sitz bath to promote

healing and relieve pain
- side lying position during sleep
to prevent pressure and pain
Stoma monitoring - check for signs of ischemia and
necrosis
- check for prolapse stoma
- flatus and fecal drainage begin
in 4-7 days
- colostomy care
Patient independence - health teaching
ASSESSMENT FINDINGS
- most characteristic manifestation is painless hematuria
- surgery: urinary diversions (after removal of bladder)
➢ Ileal conduit – ureters are implanted into a segment of ileum
➢ Koch pouch – pouch created from a segment of ileum, ureters are
implanted into the side of the pouch; client inserts straight catheter q
4-6 hours
➢ Indiana pouch – a continent reservoir created from the ascending
colon and terminal ileum; larger than Koch pouch; straight catheter q
4-6 hours
➢ Ureterostomy – ureters are attached to the surface of abdomen
CARE OF CLIENTS WITH BLADDER

CANCER
➢ Vesicostomy – bladder is sutured to the abdomen, and stoma is
created in the bladder wall
➢ Percutaneous nephrostomy – insertion of a tube into the kidney for
drainage; done if the cancer is inoperable

CANCER
-End-
NCM 112:
Oncology Nursing
Oncologic 05
Emergencies
Infection and Pain
- infection arises from neutropenia (low neutrophils)
- people with advanced cancer have pain
- severe infection and pain can interfere with the person's ability to enjoy
quality life
- pain management is the priority in care of clients with advanced
cancer
Hypercalcemia
- due to bone resorption (demineralization)
- serum calcium level > 11 mg/dL
- usually occurs in solid tumors like breast, lung, head, neck and renal CAs
- may also occur in hematologic cancer like multiple myeloma, leukemia
- severe hypercalcemia may lead to:
renal failure
coma
cardiac arrest
death
- Calcitonin (Miacalcin) and oral glucocorticoids are given to lower
serum calcium
- the destruction of large number of malignant cells may rapidly release
intracellular potassium, phosphorous and nucleic acid into the
circulation
- electrolyte imbalances and acute renal failure may occur
- clients with malignancies that are very responsive to treatment are at
highest risk especially if they have large tumor burden (lymphomas,
leukemias and small cell carcinoma)
MANIFESTATIONS
1. Weakness 6. Muscle cramps or twitching
2. Nausea 7. Oliguria (>80 ml ,<400ml urine output)
3. Diarrhea 8. Hypotension
4. Flaccid paralysis 9. Edema
5. ECG changes 10. Altered mental status
- collaborative management include the following:
1. Intravenous hydration
2. Allopurinol to decrease uric acid concentration
3. Sodium bicarbonate with IV hydration to promote fecal excretion of
excess phosphate
4. Lowering of serum potassium levels with medications, retention
enemas, IV 50% dextrose
- results from the abnormal production of antidiuretic hormone (ADH)
- may be caused by:
1. small cell lung cancer
2. infection
3. pulmonary disorders
4. emotional stress
5. CNS disorders
6. some drugs, including antineoplastic agents like Cytoxan
(Cyclophosphamide), Oncovin (Vincristine), Velban (Vinblastin),
Platinol - AQ (Cisplatin)
- manifested by water retention and decrease in sodium
SIGNS AND SYMPTOMS

1. Confusion
2. Irritability
3. Headache
4. Muscle weakness
5. Lethargy
6. Decreased urine output
7. Edema
8. Nausea and vomiting
9. Anorexia
- collaborative management are as follows:
1. Fluid excretion (diuretics)
2. IV infusion of hypertonic saline (3% to 5%) if severe, to prevent
pulmonary edema
3. Monitor intake and output
4. Administer medications like Declomycine (Demeclocycline), Lithane
(Lithium), and urea
Coagulation (DIC)
- characterized by development of extensive, abnormal clots in the
microcirculation (small blood vessels)
- widespread clotting depletes the general circulation with clotting factors
and platelets leading to excessive bleeding in different sites of the body
- clots that are obstructing the circulation decrease blood flow to major
organs, causing pain, stroke-like manifestations, dyspnea, tachycardia,
oliguna, bowel necrosis
- in cancer, usually caused by gram-negative infection or sepsis, release
of clotting factors from cancer cells, or blood transfusion
- most commonly associated with leukemia and adenocarcinomas of the
lung, pancreas, stomach and prostate
Coagulation (DIC)
- diagnostic findings:
1. prolonged prothrombin time and activated partial thromboplastin
time
2. very low platelet count
3. prolonged clotting times
- medical management are as follows:

1. Correction of the basic problem (e.g., infection).
2. Administer blood products and medication as prescribed
3. IV heparin if with manifestations of thrombosis (although
controversial)
4. Monitor the client for signs and symptoms of bleeding.
Spinal Cord Compression
- caused by direct pressure or compromise of vascular supply to the
spinal cord
- back pain is often the only presenting clinical manifestation in majority
of clients
- may result to irreversible neurologic damage with paralysis and loss of
bowel and bladder control
- treatment is usually with RT; laminectomy may be an alternative
- steroids to reduce inflammation and swelling
Superior Vena Cava Syndrome
- results from external and internal obstruction of the superior vena cava
- obstruction reduces venous return to the heart and decreases cardiac
output
- usually secondary to lung cancer or lymphoma
CLINICAL MANIFESTATIONS
1. Dyspnea
2. Facial swelling
3. Jugular vein distention
4. Sitting up and leaning forward to breathe
5. Swelling of arms, chest pain, dysphagia
- external-beam RT and curative chemotherapy are used for palliation

Cardiac Tamponade
- fluid collects in the pericardial sac (pericardial effusion)
- pericardiocentesis may be performed to draw off the fluid
Care of Clients 06
with Cancer
ASSESSMENT FINDINGS
- hoarseness of voice (most usual)
- mass on anterior neck
- dysphagia, burning sensation with hot/acidic beverages
- halitosis
- hemoptysis
- surgery: laryngectomy
subtotal – retains voice
total – absolute loss of voice

OF THE LARYNX
LARYNGECTOMY
Preop care
- psychological support
loss of voice
permanent tracheostomy
loss of sense of smell
inability to: blow, blow the nose, sip, whistle, gargle, Valsalva
maneuver
- establish means of communication to be used post-op

OF THE LARYNX
Establish patent airway - suction as necessary

- sterile technique
- semi-fowler’s position
- use NSS to lubricate suction
catheter tip
- apply suction during
withdrawal of suction cath
- apply suction for 5-10 secs
(max of 15 secs)
- insert 3-5 in of the suction cath
- instill 2-5 cc NSS to liquefy
secretions
Prevent infection - cleanse stoma and

tracheostomy at regular basis
- change dressings and ties as
necessary
Establish means of
communication
Psychological support
Assist during speech theraophy

ASSESSMENT FINDINGS
- cough ( hacking, nonproductive initially, then thick, purulent blood-
tinged sputum)
- pleural effusion
- maintain patent airway
- administer oxygen and aerosol therapy
- DBE
- relief of pain
- protection from infection
- adequate nutrition
- chest tube management

CANCER
- surgery:
PNEUMONECTOMY
- removal of a lung
- position in semi-fowler’s, turned on affected side (to promote lung
expansion, prevent flooding of the remaining lung with blood)
- avoid full side-lying position (to prevent mediastinal shift)
- no chest tube after surgery
LOBECTOMY- removal of a lobe
SEGMENTECTOMY- removal of a segment
WEDGE RESECTION - removal of an entire tumor regardless of the
segment
DECORTICATION – stripping off of fibrinous membrane enclosing the lung
THORACOPLASTY - removal of ribs, usually done after pneumonectomy
(to reduce size of empty thorax, thereby preventing mediastinal shift)

CANCER
STAGES OF BREAST CANCER
Stage I
Tumor size is up to 2cm.
Stage Il
Tumor size is up to 5 cm with axillary lymph node involvement
Stage III
Tumor size is more than 5 cm., with axillary and neck lymph no
involvement
Stage IV
Metastasis to distant organs (liver, lungs, bone and brain)

CANCER
COLLABORRATIVE MANANAGEMENT
Surgery
1. Lumpectomy/tylectomy - removal of the lump)
2. Simple Mastectomy - removal of the entire breast; pectoralis muscles
and the nipple remain intact
3. Modified Radical Mastectomy (MRM) - removal of the entire breast
and the axillary lymph nodes; pectoralis muscles are conserved
4. Radical Mastectomy (Halstead Surgery) - removal of the entire
breast, pectoralis major and minor muscles and the axillary lymph
nodes; followed by skin grafting. This is rarely done nowadays.
Chemotherapy
Radiation Therapy

CANCER
PREOPERATIVE CARE
PROCEDURE RATIONALE
Psychosocial Support. Include the

husband when necessary.
Teach arm exercises to prevent lymph edema
Inform about wound suction

drainage (hemovac, Jackson-
Pratt)
DBCT exercises to prevent postop respiratory
complications
POSTOPERATIVE CARE
PROCEDURE RATIONALE
Place client in semi-Fowler's - position promotes lung

position with arm abducted and expansion
elevated on pillows. - abduction and elevation of am
on the affected side promotes
venous return and prevents
lymphedema
Monitor Hemovac output - normal drainage is
serosanguinous (first 24 hours) -
- composed of plasma and
small amounts of RBC, pinkish or
reddish in appearance but not
viscous
POSTOPERATIVE CARE
PROCEDURE RATIONALE
Check behind patient for Blood flows to the back by

bleeding gravity.
Post signs warning against to prevent obstruction of venous
taking blood pressure, starting and lymphatic flow.
IVs, or drawing blood on affected
side.
Initiate exercise. Give analgesic to prevent stiffness and
before initiating exercises contractures of shoulder girdle
Reinforce special mastectomy to prevent lymphedema
exercises as prescribed
POSTOPERATIVE CARE
PROCEDURE RATIONALE
Provide adequate analgesia to The client cooperates with

promote ambulation and ambulation and exercise if she is
exercise free from pain or discomfort
Encourage regular coughing and to promote lung expansion and
deep breathing exercises prevent atelectasis
Prepare client for size and
appearance of the incision and
provide support when incision is
viewed for first time.
POSTOPERATIVE CARE
PROCEDURE RATIONALE
Provide client with detailed Fitting is not possible for 4 - 6

information concerning breast wks. A temporary prosthesis or
prosthesis. lightly paddled bras may be
worn until healing is complete.
Teach patient to avoid
constrictive clothing and report
persistent edera, redness, or
infection of incision.
Teach patient importance of
continuing monthly breast
examination remaining breast.
ASSESSMENT FINDINGS
- ascending (right) colon: occult blood in stool, anemia, anorexia and
weight loss, abdominal above umbilicus, palpable mass
- distal colon and rectum: hematochezia, alternating constipation and
diarrhea, pencil or ribbon-shaped stool, pain below umbilicus
- surgery:
➢ Hemicolectomy - ascending and transverse colon
➢ Abdominoperineal resection (Mile’s Surgery) – rectosigmoid colon
- involves 2 incisions: lower abdominal (sigmoid removal);
perineal (rectum removal)
- requires permanent colostomy
CARE OF CLIENTS WITH

COLORECTAL CANCER
PREOPERATIVE CARE
Provide psychological support
Promotion of thorough bowel - diet modification:

cleaning > low residue diet 3-5 days preop
(to reduce bulk of feces)
> clear liquid diet 24 hours preop
- mechanical cleansing:
> laxative as ordered
> cleansing enema or intestinal
evacuant as ordered
- neomycin SO4 tablets

PREOPERATIVE CARE
Risk for infection and bleeding - administer vit C and K as

ordered (these are lost in
repeated enema)
POSTOPERATIVE CARE
Managing perineal wound in APR - warm sitz bath to promote

healing and relieve pain
- side lying position during sleep
to prevent pressure and pain
Stoma monitoring - check for signs of ischemia and
necrosis
- check for prolapse stoma
- flatus and fecal drainage begin
in 4-7 days
- colostomy care
Patient independence - health teaching
ASSESSMENT FINDINGS
- most characteristic manifestation is painless hematuria
- surgery: urinary diversions (after removal of bladder)
➢ Ileal conduit – ureters are implanted into a segment of ileum
➢ Koch pouch – pouch created from a segment of ileum, ureters are
implanted into the side of the pouch; client inserts straight catheter q
4-6 hours
➢ Indiana pouch – a continent reservoir created from the ascending
colon and terminal ileum; larger than Koch pouch; straight catheter q
4-6 hours
➢ Ureterostomy – ureters are attached to the surface of abdomen

CANCER
➢ Vesicostomy – bladder is sutured to the abdomen, and stoma is
created in the bladder wall
➢ Percutaneous nephrostomy – insertion of a tube into the kidney for
drainage; done if the cancer is inoperable

CANCER
-End-

Oncology Nursing Lecture Week 1-6

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Oncology Nursing Lecture Week 1-6

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NCM 112:

1. Identify the nurse’s roles in the prevention of cancer and in health

1ST 1. Basic Concepts of Oncology Nursing

3RD 2.6 Cancer Detection Examinations

5TH 5. Oncologic Emergencies

60% LONG EXAM – 40%

HYPERTROPHY increase in cell size

ANAPLASIA reverse cellular development to a more primitive

Chemical carcinogens Genetics

- prolonged or frequent viral infections may cause breakdown of

- infections that increase risk of certain forms of cancer are as

- regardless of the cause, several cancers are associated with

remains localized infiltrates surrounding

well-differentiated mature poorly-differentiated;

not harmful to host, unless it always harmful to host, may

> adapting more healthy diet

20 to 40 years every 3 years

40 years and annual

AGE COLON AND RECTUM EXAMINATIONS and

PROFILE UTERINE EXAMINATIONS and FREQUENCY

A a sore that does not heal

U unusual bleeding or discharge

U unexplained sudden weight loss

T thickening or lump in the breast or elsewhere

I Indigestion or difficulty swallowing

O obvious change in wart or mole

N nagging cough or hoarseness of voice

1. PARENCHYMA 3. EMBRYONIC ORIGIN

2. THREE-germ layers, -”TERATOMA”

3. Non-neoplastic but -”OMA”

T- primary/main tumor size

- cytologic specimen can be obtained from tumors

> GI tract through endoscopy

- interpretation of Papanicolaou Test results are as

Class I Normal follow-up examination every 1-3 yrs as

Class V Possibly malignant

- involves obtaining tissue samples by needle

3. INCISION OR SUBTOTAL BIOPSY

ULCERATION AND NECROSIS

VASCULAR THROMBOSIS, EMBOLISM, THROMBOPHLEBITIS

CANCER CELL PARANEOPLASTIC

DESSIMINATED INTRAVASCULAR COAGUALTION (DIC)

CANCER CELL PARANEOPLASTIC Anorexia and Cachexia

a. Reduce pain by interrupting nerve pathways or implanting

- may be used as a primary, adjuvant, or a palliative treatment modality:

Client’s back is turned towards To minimize exposure of

The client should be given low To prevent dislodgement of the

Have long forceps and lead Use long forceps to pick up

SKIN REACTIONS - observe for early signs of skin

INFECTION - monitor blood counts weekly,

FATIGUE - plenty of rest and good nutrition

Diarrhea, nausea and

- extravasation (escape from the vein) of some chemotherapeutic

GASTRO-INTESTINAL - administer antiemetic to relieve

- stomatitis (oral - Provide good oral care

- alopecia - reassure that it is temporary;

- skin pigmentation - inform that it is temporary.

- nail changes - reassure that nails may grow

- neutropenia - protect from infection

- thrombocytopenia - protect from trauma

Nadir - the time after

- urine color changes - reassure that it is harmless

SIGNS AND SYMPTOMS

- medical management are as follows: