NUR155: MEDICAL SURGICAL NURSING

LESSON TITLE: CARE OF PATIENTS WITH CANCER

1ST SEMESTER S.Y 2021-2022 MODULE: 36-46

CANCER CANCER CELLS:

 Have uncontrollable growth  sarcoma: arises from
 A disease process that begins when an abnormal cell is the connective tissues.
transformed by the genetic mutation of the cellular DNA.  when we mention carcinoma,  lymphoma and
 This abnormal cell forms a clone and begins to proliferate the tumor usually arises from myeloma starts in the
abnormally, ignoring growth-regulating signals in the environment surface or grandular epithelium cells of the immune
surrounding the cell. system
 The cells acquire invasive characteristics, and changes occur in CELLULAR ORIGIN
CARCINOMA: ADENOCARCINOMA: SARCOMA:
surrounding tissues.
 originates in  originates in the  originates in fat,
 The cells infiltrate these tissues and gain access to lymph and
epithelial glandular tissue muscle blood
blood vessels, which carry the cells to other areas of the body tissue (breast, prostate) vessels, nerves,
bones
BENIGN MALIGNANT METASTASIS
NEOPLASM NEOPLASM  Cells travel
 Slow-growing,  Aggressive form through the
 Localized, and that invades and blood or
encapsulated destroys tissues. lymphatic
with well-  having cells or system and
 defined processes that invade other
borders. are characteristic tissue and
 Not cancerous. of cancer organs to form a
Secondary
tumor.

TUMOR GRADING

 we examine the tumor through biopsy under a microscope.

 abnormality of the cells determines the grade of the cancer.
 increasing abnormality increases the grade, from 1–4.

GRADE 1 Cells slightly abnormal and well differentiated

GRADE 2 Cells more abnormal and moderately differentiated
GRADE 3 Cells very abnormal and poorly differentiated
GRADE 4 Cells immature and undifferentiated

PATHOPHYSIOLOGY
 CANCER STAGING  Persistent, unexplained fevers or
night sweats
 Staging is the classification of the extent of the disease.  Unexplained bleeding or bruising
 The tumor, node, metastases (TNM) system- classifies cancer
by tumor size (T), the degree of regional spread or node
involvement (N), and distat metastasis (M). MEDICAL MANAGEMENT- PHYSICIAN’S ORDER
SPECIAL NOTATION LABORATORY /DIAGNOSTIC
Treatment may be primary (to EXAMINATION
kill cancer cells), adjuvant (to  Computed tomography
kill remaining cancer cells), or (ct) scans,
palliative (to treat signs and  Magnetic resonance
symptoms) imaging (mri)
 Surgery  Positron emission
 Stem cell transplants tomography (pet)
 Radiation therapy  Ultrasound scans.
 Smoking cessation  External-beam radiation
 Balanced nutrition therapy
MEDICATION o Tomotherapy
Chemotherapeutic drugs o Proton
 Alkylating agents therapy
 Topoisomerase  Internal radiation
A NUMERICAL SYSTEM ALSO IS USED TO CLASSIFY THE EXTENT OF inhibitors therapy
DISEASE.  Mitotic inhibitors o Brachy
STAGE 0 Cancer in situ (limited to surface cells)  Antimetabolites therapy
STAGE 1 Cancer limited to the tissue of origin, evidence of tumor  Antibiotics  X ray examination
growth  Enzymes  Mammograhy
STAGE 2 Limited local spread of cancerous cells  Proteasome  Cytology studies
STAGE 3 Extensive local and regional spread inhibitors  Biopsy
STAGE 4 Distant metastasis  Tyrosine kinase o Needle
inhibitors o Incisional
IV FLUID as ORDERED o Excisional
THERE ARE TWO BROAD CATEGORIES OF GENES THAT ARE AFFECTED:

 ONCOGENES NURSING CARE PLANS

these are cancer causing genes. They may be normal genes
which are expressed at inappropriately high levels in patients RISK FOR INFECTION
INTERVENTION
with cancers or they may be altered or changed normal
 Maintain or teach asepsis for dressing changes and wound
genes due to mutation. In both cases these genes lead to
care, peripheral IV and central venous management, and
cancerous changes in the tissues. catheter care and handling.
 TUMOR SUPPRESSOR GENES  Wash hands and teach patient and SO to wash hands
these genes normally inhibit cell division and prevent survival before contact with patients and between procedures
of cells that have damaged DNA. In patients with cancer with the patient. Instances when to wash hands:
these tumor suppressor genes are often disabled. This is o Before putting on gloves and after taking them
off.
caused by cancer- promoting genetic changes. Typically,
o Before and after touching a patient, before
changes in many genes are required to transform a normal
handling an invasive device (Foley catheter, IV
cell into a cancer cell. catheter, and so on) regardless of whether or
not gloves are used.
ASSESSMENT (GENERAL) o After contact with body fluids or excretions,
SUBJECTIVE CUES OBJECTIVE CUES mucous membranes, non-intact skin, or wound
 Fatigue  Lump or area of thickening that dressings.
 Changes in bowel can be felt under the skin o If moving from contaminated body site to
or bladder habits  Weight changes, including another site during the care of the same
 Difficulty unintended loss or gain individual.
swallowing  Skin changes, such as yellowing, o After contact with inanimate surfaces and
 Persistent darkening or redness of the skin, objects in the immediate vicinity of the patient.
indigestion or sores that won't heal, or changes o After removing sterile or nonsterile gloves.
discomfort after to existing mole o Before handling medications or preparing food.
eating  Persistent cough or trouble  Encourage intake of protein-rich and calorie-rich foods.
 Persistent, breathing  Encourage fluid intake of 2,000 to 3,000 mL of water per
unexplained  Hoarseness day, unless contraindicated.
muscle or joint pain EVALUATION
  Patient remains free of infection, as evidenced by
normal vital signs and absence of signs and
symptoms of infection.
 Early recognition of infection to allow for prompt
treatment.
 Patient will demonstrate meticulous hand washing
technique.
ACUTE PAIN
INTERVENTION
 Suggest use of non-pharmacological techniques as
appropriate.
 Encourage increased oral fluid intake (2-3 liters if no
contraindications)
 Encouraged the use of analgesic (e.g., acetaminophen)
or antispasmodics (e.g., phenazopyridine) as prescribed
 Determine timing or precipitants of “breakthrough” pain
when using around-the-clock agents, whether oral, IV, or
patch medications.
 Provide nonpharmacological comfort measures
(massage, repositioning, backrub) and diversional
activities (music, television)
 Encourage use of stress management skills or
complementary therapies (relaxation techniques,
visualization, guided imagery, biofeedback, laughter,
music, aromatherapy, and therapeutic touch).
 Provide cutaneous stimulation (heat or cold, massage).
EVAULUATION
 Client will use pharmacological and nonpharmacological
pain relief strategies.
 Client will report satisfactory pain control at a level less
than 3 to 4 on a scale of 0 to 10.
ALTERED NUTRITION: LESS THAN BODY REQUIREMENTS
INTERVENTION
 Ascertain patient’s dietary program and usual pattern
then compare with recent intake.
 Discuss eating habits and encourage a diabetic diet
(balanced diet) as prescribed by the doctor.
 Consult dietician and/or physician for further assessment
and recommendation regarding food preferences and
nutritional support.
 Provide liquids containing nutrients and electrolytes as
soon as the patient can tolerate oral fluids then progress
to a portion of more solid food as tolerated.
 Observe for signs of hypoglycemia: changes in LOC, cold
and clammy skin, rapid pulse, hunger, irritability, anxiety,
headache, lightheadedness, shakiness.
 Regular exercise
 Refer the patient to an exercise physiologist, physical
therapist, or cardiac rehabilitation nurse for specific
exercise instructions.
EVALUATION
 Ingest appropriate amounts of calories/nutrients.
 Display usual energy level.
 Demonstrate stabilized weight or gain toward
usual/desired range with normal laboratory values.
RISK FOR INEFFECTIVE THERAPEUTIC REGIMEN
MANAGEMENT
INTERVENTION
 Investigate the patient’s prior efforts to manage the HIV
care regimen.
 Evaluate the patient’s self-management skills, including
the ability to maintain medication administration
 Assess for factors that may negatively affect success with
following the regimen.
 Assess the patient’s financial resources for health care.
 Determine and ensure that patient’s knowledge about the
symptoms, causes, treatment, and prevention of
hyperglycemia.
EVALUATION
 Patient demonstrates knowledge of diabetes self-care
measures.
RISK FOR IMPAIRED SKIN INTEGRITY.
INTERVENTION
 Use foot cradle on the bed. Use space boots on ulcerated
heels, elbow protectors, and pressure-relief mattresses.
 Wash feet daily with mild soap and warm water. Check
water temperature before immersing feet in the water.
 Inspect feet daily for erythema or trauma.
 Change socks or stockings daily. Encourage the patient to
wear white cotton socks.
 Use gentle moisturizers on the feet.
 Cut toenails straight across after softening toenails with a
bath.
 The patient should not walk barefoot.
EVALUATION
 Patient’s skin on legs and feet remains intact while the
patient is hospitalized.
 Patient will demonstrate proper foot care.
ANTICIPATORY GRIEVING
INTERVENTION
 Expect initial shock and disbelief following diagnosis of
cancer and traumatizing procedures (disfiguring surgery,
colostomy, amputation).
 Provide open, nonjudgmental environment. Use
therapeutic communication skills of Active-Listening,
acknowledgment, and so on.
 Encourage verbalization of thoughts or concerns and
accept expressions of sadness, anger, rejection.
Acknowledge normality of these feelings.
 Visit frequently and provide physical contact as
appropriate, or provide frequent phone support as
appropriate for setting. Arrange for care provider and
support person to stay with patient as needed.
 Determine way that patient and SO understand and
respond to death such as cultural expectations, learned
behaviors, experience with death (close family members,
friends), beliefs about life after death, faith in Higher
Power (God).
EVALUATION
 Identify and express feelings appropriately.
 Continue normal life activities, looking toward/planning
for the future, one day at a time.
 Verbalize understanding of the dying process and feelings
of being supported in grief work.

CANCER OF THE LUNGS
 LUNG CANCER is the abnormal, uncontrolled cell growth in lung
tissues, resulting in a tumor. A tumor in the lung may be primary
when it develops in lung tissue. It may be secondary when it
spreads (metastasizes) from cancer in other areas of the body,
such as the liver, brain, or kidneys.
 Repetitive exposure to inhaled irritants increases a person’s risk
for lung cancer. Cigarette smoke, occupational exposures, air
pollution containing benzopyrenes, and hydrocarbons have all
been shown to increase risk.
THERE ARE TWO MAJOR CATEGORIES OF LUNG CANCER
SMALL CELL (OAT CELL CARCINOMA)
 FAST- GROWING, EARLY METASTASIS
NON-SMALL CELL:
 Adenocarcinoma—moderate growth rate, early metastasis
 Squamous cell—slow-growing, late metastasis
 Large cell—fast-growing, early metastasis
NURSING CARE PLAN: GENERAL + IMPAIRED GAS EXCHANGE RELATED
ASSESSMENT
SUBJECTIVE OBJECTIVE
 FATIGUE  Coughing due to irritation from mass. Presence
of mucous or exudate may not be until later in
disease.
 Coughing up blood (hemoptysis).
 Weight loss due to the caloric needs of the
tumor, taking away from the needs of the body.
 Anorexia.
 Difficulty breathing (dyspnea) caused by
damaged lung tissue. The patient begins to have
respiratory problems later in the disease.
 Chest pains as mass presses on surrounding
tissue; may not be until late in disease.
 Sputum production.
 Pleural effusion.
 hoarseness
MEDICAL MANAGEMENT-PHYSICIAN’S ORDER
SPECIAL NOTATION
 Surgical removal of affected area of the lung (wedge resection,
segmental resection, lobectomy) or total lung
(pneumonectomy).
 Radiation therapy to decrease tumor size.
 Oxygen therapy to supplement the needs of the body.
 High-protein, high-calorie diet to meet the needs of the body.
LABORATORY /DIAGNOSTIC EXAMINATION
 Mass in lung shown on chest x-ray.
 CT scan shows mass, lymph node involvement.
 Bronchoscopy may show cancer cells on bronchoscopic
washings; may reveal tumor site.
 Cancer cells seen in sputum.
 Biopsy will show cell type:
 Needle biopsy through chest wall for peripheral tumors.
 Tissue biopsy from lung for deeper tumors.
 Bone scan or CT scans shows metastasis of the disease.
MEDICATIONS
 Chemotherapy often with a combination of drugs:
 cyclophosphamide, doxorubicin, vincristine, etoposide,
cisplatin
 may see relapse after treatment
 Administer antiemetics to combat side effects of
chemotherapy:
 ondansetron, prochlorperazine
 Administer analgesics for pain control:
 morphine, fentanyl
IV as ordered
TO VENTILATION- PERFUSION IMBALANCE
IMPAIRED GAS EXCHANGE RELATED TO VENTILATION- PERFUSION
IMBALANCE
INTERVENTION
 Position patient with head of bed elevated, in a semi-Fowler’s
position (head of bed at 45 degrees when supine) as tolerated.
 If patient has unilateral lung disease, position the patient
properly to promote ventilation-perfusion.
 Turn the patient every 2 hours. Monitor mixed venous oxygen
saturation closely after turning. If it drops below 10% or fails to
return to baseline
 promptly, turn the patient back into a supine position and
evaluate oxygen status.
 Maintain an oxygen administration device as ordered,
attempting to maintain oxygen saturation at 90% or greater.
 If the patient is permitted to eat, provide oxygen to the patient
but in a different manner (changing from mask to a nasal
cannula).
 Administer humidified oxygen through appropriate device
(e.g., nasal cannula or face mask per physician’s order); watch
for onset of hypoventilation as evidenced by increased
somnolence after initiating or increasing oxygen therapy.
 Help patient deep breath and perform controlled coughing.
Have patient inhale deeply, hold breath for several seconds,
and cough two to three times with mouth open while
tightening the upper abdominal muscles as tolerated.
 Encourage slow deep breathing using an incentive spirometer
as indicated.
  Pace activities and schedule rest periods to prevent fatigue.  Oxygen therapy to  Needle biopsy
Assist with ADLs. supplement the needs of the through liver tissue
 Administer medications as prescribed. body. for peripheral
EVALUATION  High-protein, high-calorie tumors.
 Patient maintains optimal gas exchange as evidenced by usual diet to meet the needs of  Tissue biopsy from
mental status, unlabored respirations at 12-20 per minute, the body. liver for deeper
oximetry results within normal range, blood gases within MEDICATION tumors.
normal range, and baseline HR for patient.  Chemotherapy often with a  Bone scan or CT scans
 Patient maintains clear lung fields and remains free of signs of combination of drugs: shows metastasis of the
respiratory distress. • cyclophosphamide, disease.
doxorubicin, vincristine,  Ultrasound of the liver
etoposide, cisplatin  Serum AFP, amylase,
CANCER OF THE LIVER (may see relapse after treatment) lipase
 Administer antiemetics to
 LIVER CANCER is cancer that begins in the cells of your liver. combat side effects of
chemotherapy:
Your liver is a football-sized organ that sits in the upper right
• ondansetron,
portion of your abdomen, beneath your diaphragm and above prochlorperazine
your stomach.  Administer analgesics for
 Several types of cancer can form in the liver. The most common pain control:
type of liver cancer is hepatocellular carcinoma, which begins in • morphine, fentanyl
the main type of liver cell (hepatocyte). Other types of liver  Administer Diuretics as
cancer, such as intrahepatic cholangiocarcinoma and needed to combat fluid
retention:
hepatoblastoma, are much less common.
• Aldactone or lasix
 Risk factors include: chronic infection of hepatitis B or C virus;
liver cirrhosis; inherited liver diseases such as hemochromatosis
and Wilson’s disease; diabetes; nonalcoholic fatty liver disease;
exposure to aflatoxins; and excessive alcohol consumption. NURSING CARE PLAN: GENERAL + Excess Fluid Volume related to
o AFLATOXINS- are a family of toxins produced by compromised regulatory mechanism
certain fungi that are found on agricultural crops such
EXCESS FLUID VOLUME RELATED TO COMPROMISED REGULATORY
as maize (corn), peanuts, cottonseed, and tree nuts.
MECHANISM
INTERVENTION
 Measure I&O, weigh daily, and note gain of more than 0.5
PATHOPHYSIOLOGY
kg/day.
 Monitor for cardiac dysrhythmias. Auscultate heart sounds,
Liver cancer happens when liver cells develop changes (mutations) in
noting development of S3/S4 gallop rhythm
their DNA (the material that provides instructions for every chemical
 Measure abdominal girth.
process in your body)
 Encourage bed rest when ascites is present.
↓
 Provide frequent mouth care; occasional ice chips (if NPO).
cells may begin to grow out of control and eventually form a tumor —
a mass of cancerous cells.  Monitor serum albumin and electrolytes (particularly
TAKE NOTE: Sometimes the cause of liver cancer is known, such as with chronic hepatitis potassium and sodium).
infections. But sometimes liver cancer happens in people with no underlying diseases and  Administer mediation as ordered
it's not clear what causes it. EVALUATION
 Demonstrate stabilized fluid volume, with balanced I&O, stable
ASSESSMENT weight, vital signs within patient’s normal range, and absence
SUBJECTIVE CUES OBJECTIVE CUES of edema.
 Fatigue Weight loss due to the caloric
 Loss of appetite needs of the tumor, taking away
 Generalized weakness from the needs of the body. CANCER OF THE THYROID
 Anorexia. Abdominal swelling
 Upper abdominal pain Jaundice  THYROID CANCER occurs in the cells of the thyroid (a butterfly-
White chalky stool shaped gland located at the base of your neck, just below your
Adam's apple). Your thyroid produces hormones that regulate your heart rate,
blood pressure, body temperature and weight.
MEDICAL MANAGEMENT- PHYSICIAN’S ORDER
 Thyroid cancer might not cause any symptoms at first. But as it
SPECIAL NOTATION LABORATORY /DIAGNOSTIC
grows, it can cause pain and swelling in your neck. Several types
 Surgical removal of affected EXAMINATION
area of the liver or liver  CT scan shows mass of thyroid cancer exist. Some grow very slowly and others can be
transplant  Biopsy will show cell very aggressive. Most cases of thyroid cancer can be cured with
 Radiation therapy to type: treatment.
decrease tumor size.  Risk factors include: of the female gender, exposure to high levels
of radiation and certain inherited genetic syndromes.
 TYPES OF THYROID CANCER MEDULLARY THYROID CANCER

PAPILLARY THYROID CANCER  Medullary thyroid cancer begins in thyroid cells called C cells,
which produce the hormone calcitonin.
 The most common form of thyroid cancer  Elevated levels of calcitonin in the blood can indicate
 which produce and store thyroid hormones. medullary thyroid cancer at a very early stage.
 can occur at any age, but most often it affects people ages 30
to 50. Doctors sometimes refer to papillary thyroid cancer
and follicular thyroid cancer together as differentiated
thyroid cancer.

OTHER RARE TYPES

 Other very rare types of cancer that start in the thyroid include
thyroid lymphoma, which begins in the immune system cells of
the thyroid, and thyroid sarcoma, which begins in the connective
tissue cells of the thyroid.

FOLLICULAR THYROID CANCER.

 Follicular thyroid cancer also arises from the follicular cells of

the thyroid.
 It usually affects people older than age 50.
 Hurthle cell cancer is a rare and potentially more aggressive
type of follicular thyroid cancer.

PATHOPHYSIOLOGY

Thyroid cancer occurs when cells in your thyroid undergo genetic

changes (mutations).

↓
The mutations allow the cells to grow and multiply rapidly. The cells
also lose the ability to die, as normal cells would.

↓
The accumulating abnormal thyroid cells form a tumor.

ANAPLASTIC THYROID CANCER ↓

The abnormal cells can invade nearby tissue and can spread
 Anaplastic thyroid cancer is a rare type of thyroid cancer that (metastasize) to other parts of the body.
begins in the follicular cells.
 It grows rapidly and is very difficult to treat.
 Anaplastic thyroid cancer typically occurs in adults age 60
and older. SUBJECTIVE CUES OBJECTIVE CUES
 Fatigue  Weight loss due to the caloric
 Loss of appetite needs of the tumor, taking away
 Generalized from the needs of the body.
weakness  Anorexia.
 Pain in your neck  A lump (nodule) that can be felt
and throat through the skin on your neck
 Difficulty  Changes to your voice, including
swallowing increasing hoarseness
 Swollen lymph nodes
 MEDICAL MANAGEMENT- PHYSICIAN’S ORDER  During the same period, cancer in the area where the top part of
SPECIAL NOTATION LABORATORY the stomach (cardia) meets the lower end of the swallowing tube
 Surgical removal of affected area of /DIAGNOSTIC (esophagus) has become much more common. This area of the
the thyroid, (thyroid lobectomy) EXAMINATION stomach is called the gastroesophageal junction.
 Thyroidectomy  CT scan or MRI
 Lymph node dissection shows mass RISK FACTORS
 Radiation therapy to decrease tumor  Biopsy will show
 A diet high in salty and  Family history of stomach
size. cell type:
smoked foods cancer
 Oxygen therapy to supplement the o Needle
 A diet low in fruits and  Infection with Helicobacter
needs of the body. biopsy
vegetables pylori
 High-protein, high-calorie diet to through
thyroid  Long-term stomach  Smoking
meet the needs of the body.
tissue for inflammation  Stomach polyps
peripheral  Pernicious anemia
tumors.
MEDICATION  Ultrasound of
 Chemotherapy often with a the thyroid
combination of drugs:  Thyroid panel
• cyclophosphamide, doxorubicin, T3,T4 and
vincristine, etoposide, cisplatin calcitonin
(may see relapse after treatment)  TSH
 Administer antiemetics to combat  Radioiodine
side effects of chemotherapy: scan
• ondansetron, prochlorperazine  Positron
 Administer analgesics for pain emission
control: tomography
• morphine, fentanyl (PET) scan At this stage, the tumor is limited to the top layer of
 Administer Diuretics as needed to STAGE I tissue that lines the inside of the esophagus or
combat fluid retention: stomach. Cancer cells also may have spread to a limited
• Aldactone or lasix number of nearby lymph nodes.
The cancer at this stage has spread deeper, growing
STAGE II into a deeper muscle layer of the esophagus or
stomach wall. Cancer may also have spread to more of
RISK FOR INEFFECTIVE AIRWAY CLEARANCE the lymph nodes.
INTERVENTION At this stage, the cancer may have grown through all
 Assess for dyspnea, stridor, “crowing,” and cyanosis. Note STAGE III the layers of the esophagus or stomach and spread to
quality of voice. nearby structures. Or it may be a smaller cancer that
 Monitor respiratory rate, depth, and work of breathing. has spread more extensively to the lymph nodes.
 Caution patient to avoid bending neck; support head with STAGE This stage indicates that the cancer has spread to
pillows. IV distant areas of the body.
 Assist with repositioning, deep breathing exercises, and/or
coughing as indicated.
 Suction mouth and trachea as indicated, noting color and PATHOPHYSIOLOGY
characteristics of sputum.
 Check dressing frequently, especially the posterior portion. cancer begins when an error (mutation) occurs in a cell's DNA. The
 Investigate reports of difficulty swallowing, drooling of oral mutation causes the cell to grow and divide at a rapid rate and to
secretions. continue living when a normal cell would die.
 Keep tracheostomy tray at the bedside.
 Provide steam inhalation; humidify room air. ↓
 Assist with procedures: Tracheostomy, return to surgery. The accumulating cancerous cells form a tumor that can invade nearby
structures. And cancer cells can break off from the tumor to spread
EVALUATION throughout the body.
 Client will maintain a patent airway, with aspiration prevented.
↓
Gastroesophageal junction cancer is associated with having
gastrointestinal reflux disease (GERD) and, less strongly, with obesity
STOMACH CANCER and smoking. GERD is a condition caused by frequent backflow of
stomach acid into the esophagus.
 Stomach cancer usually begins in the mucus-producing cells that
line the stomach. (adenocarcinoma.) There is a strong correlation between a diet high in smoked and salted foods
 For the past several decades, rates of cancer in the main part of and stomach cancer located in the main part of the stomach. As the use of
the stomach (stomach body) have been falling worldwide. refrigeration for preserving foods has increased around the world, the rates of
stomach cancer have declined.
 SUBJECTIVE CUES
 Fatigue
 Loss of appetite
 Generalized weakness
 Feeling bloated after eating
 Feeling full after eating small amounts of food
 Severe, persistent heartburn
 Severe indigestion that is always present
 Unexplained, persistent nausea
 Stomach pain
MEDICAL MANAGEMENT- PHYSICIAN’S ORDER
SPECIAL NOTATION
 Surgical removal of affected
area of the thyroid, (thyroid  CT scan or MRI shows
lobectomy)
 Thyroidectomy
 Lymph node dissection
 Radiation therapy to decrease
tumor size.
 Oxygen therapy to
supplement the needs of the
body.
 High-protein, high-calorie diet  Ultrasound of the
to meet the needs of the
body.
MEDICATION
Targeted therapy uses drugs that
attackspecific abnormalities within  Positron emission
cancer cellsor that direct your
immune system to kill cancer cells
(immunotherapy). Targeted drugs
used to treat stomach cancer
include:
 Trastuzumab
(Herceptin) for stomach
cancer cells that
producetoo much HER2
 Ramucirumab (Cyramza)
for advanced stomach
cancer that hasn't
responded to other
treatments
 Imatinib (Gleevec) for a
rare form of stomach
cancer called
gastrointestinal stromal
tumor
 Sunitinib (Sutent) for
gastrointestinal stromal
tumors
 Regorafenib (Stivarga)
for gastrointestinal
stromal tumors
Administer antiemetics to combat
side effects of chemotherapy:
 ondansetron,
prochlorperazine
 Administer analgesics for
pain control:
 morphine, fentanyl
IV AS ORFERED
OBJECTIVE CUES
 Weight loss due
to the caloric NURSING CARE PLANS: GENERAL + RISK FOR INEFFECTIVE AIRWAY
needs of the CLEARANCE
tumor, taking
away from the
COLORECTAL CANCER (COLON CANCER)
needs of the
body.
 Anorexia.  Colon cancer is a type of cancer that begins in the large
 Vomiting intestine (colon). The colon is the final part of the digestive
tract
 Colon cancer typically affects older adults, though it can
happen at any age. It usually begins as small, noncancerous
LABORATORY /DIAGNOSTIC
(benign) clumps of cells called polyps that form on the inside
EXAMINATION
of the colon. Over time some of these polyps can become
mass colon cancers.
 Biopsy will show cell  ▪ Polyps may be small and produce few, if any, symptoms.
type: For this reason, doctors recommend regular screening tests
o Needle biopsy to help prevent colon cancer by identifying and removing
through thyroid polyps before they turn into cancer.
tissue for
 ▪ If colon cancer develops, many treatments are available to
peripheral
tumors. help control it, including surgery, radiation therapy and drug
treatments, such as chemotherapy, targeted therapy and
thyroid immunotherapy.
 Thyroid panel T3, T4  ▪ Colon cancer is sometimes called colorectal cancer, which is
and calcitonin a term that combines colon cancer and rectal cancer, which
 TSH begins in the rectum.
 Radioiodine scan
 ▪ Adenocarcinoma is the most common type of colon cancer
tomography (PET) scan and may spread by direct extension through the walls of the
intestine or through the lymphatic or circulatory system.
Metastasis is most often to the liver.
RISK FACTORS
 Older age. Colon cancer  Low-fiber, high-fat diet, diet
can be diagnosed at any high in red meat and
age, but a majority of processed meat.
people with colon cancer
are older than 50.  Family history of colon
 Radiation therapy for cancer.
cancer.
 African-American race.  Sedentary lifestyle
 Inflammatory intestinal  Diabetes.
conditions.
 Inherited syndromes that  Obesity.
increase colon cancer
risk.
 Smoking.  Alcohol.
LIFESTYLE CHANGES TO REDUCE THE RISK OF COLORECTAL CANCER:
 EAT A VARIETY OF FRUITS, VEGETABLES AND WHOLE GRAINS-
play a role in cancer prevention.
 DRINK ALCOHOL IN MODERATION, IF AT ALL - limit the amount
of alcohol you drink to no more than one drink a day for women
and two for men.
 STOP SMOKING. Talk to your doctor about ways to quit that may
work for you.
 EXERCISE MOST DAYS OF THE WEEK. Try to get at least 30
minutes of exercise on most days
  MAINTAIN A HEALTHY WEIGHT- maintain your weight by MEDICAL MANAGEMENT- PHYSICIAN’S ORDER
combining a healthy diet with daily exercise. Aim to lose weight SPECIAL NOTATION LABORATORY /DIAGNOSTIC
slowly by increasing the amount of exercise you get and reducing  Surgical removal of the EXAMINATION
the number of calories you eat. polyp (polypectomy) or  Colonoscopy or
laparoscopic route sigmoidoscopy
 endoscopic mucosal  Fecal occult blood test
resection  Double contrast
 partial colectomy with barium enema
ostomy creation  Digital rectal exam
 Lymph node dissection  carcinoembryonic
 Radiation therapy. antigen, or CEA blood
 Radiation therapy to level
decrease tumor size.  Biopsy is confirmative
 Oxygen therapy to for cancer.
supplement the needs of the  Ultrasonography to
body. further delineate the
 High-protein, high-calorie mass.
diet to meet the needs of  CT scan to check for
the body. metastasis
MEDICATION  MRI and Positive
emission tomography
Chemotherapy before surgery to scan
PATHOPHYSIOLOGY shrink some tumors, or after
surgery:
In general, colon cancer begins when healthy cells in the colon develop  cyclophosphamide
changes (mutations) in their DNA.  methotrexate
 fluorouracil
↓  doxorubicin
Healthy cells grow and divide in an orderly way to keep your body  epirubincin
functioning normally. But when a cell's DNA is damaged and becomes  vincristine
 paclitaxel
cancerous, cells continue to divide — even when new cells aren't
 docetaxel
needed. As the cells accumulate, they form a tumor.
Administer analgesics for pain
↓ control:
With time, the cancer cells can grow to invade and destroy normal • morphine, fentanyl
tissue nearby. And cancerous cells can travel to other parts of the body
to form deposits there (metastasis).

BREAST CANCER

ASSESSMENT
SUBJECTIVE CUES
 Fatigue
 Loss of appetite
 Generalized weakness
 Persistent abdominal
discomfort, such as
cramps, gas or pain
 A feeling that your bowel
doesn't empty completely
 Studies show that by age 80, about 1 in 8 women will have
OBJECTIVE CUES breast cancer.
 Anorexia.  Ten percent of all breast cancers are inherited.
 Unexplained weight loss  Two major genes have been identified— BRCA1 and BRCA2.
due to the caloric needs of
 Some studies have implicated a higher-fat diet.
the tumor, taking away
from the needs of the  Some medications, like estrogen, seem to increase the risk of
body. breast cancer.
 Rectal bleeding or blood in  Exposure to radiation also increases the risk.
your stool  Childlessness and delayed childbirth also may be factors.

TYPES OF MALIGNANT BREAST CANCER

A. DUCTAL CARCINOMA IN SITU

 is a non-invasive cancer where abnormal cells have
been found in the lining of the breast milk ducts.
 The atypical cells have not spread outside of the ducts
into the surrounding breast tissue. Ductal carcinoma in
situ is very early cancer that is highly treatable, but if it’s
left untreated or undetected, it may spread into the
surrounding breast tissue.
B. INVASIVE DUCTAL CARCINOMA (INFILTRATIVE DUCTAL  A diagnosis of triple negative breast cancer means that the
CARCINOMA) three most common types of receptors known to fuel most
 The abnormal cancer cells that began forming in the milk breast cancer growth are not present in the cancer tumor.
ducts have spread beyond the ducts into other parts of the o Estrogen
breast tissue. o Progesterone
 Invasive cancer cells can also spread to other parts of the o and the HER-2/neu gene
body.  This means that the breast cancer cells have tested negative
 most common type of breast cancer, making up nearly 70- for hormone epidermal growth factor receptor 2 (HER-2),
80% of all breast cancer diagnoses. estrogen receptors (ER), and progesterone receptors (PR).
 the type of breast cancer that F. METASTATIC BREAST CANCER
 can most commonly affects men.  Metastatic breast cancer is also classified as Stage 4 breast
cancer.
 The cancer has spread to other parts of the body. This usually
Includes:
o lungs
o Liver
o bones
o brain

PATHOPHYSIOLOGY

breast cells begin to grow abnormally. These cells divide more rapidly
than healthy cells do and continue to accumulate, forming a lump or
mass.

 Breast cancer most often begins with cells in the milk-

producing ducts (invasive ductal carcinoma).
 Breast cancer may also begin in the glandular tissue called
C. LOBULAR CARCINOMA IN SITU
lobules (invasive lobular carcinoma) or in other cells or tissue
 a condition where abnormal cells are found in the lobules of
within the breast.
the breast. The atypical cells have not spread outside of the
lobules into the surrounding breast tissue.
↓
 highly treatable and seldom becomes invasive cancer. Cells may spread (metastasize) through your breast to your lymph
However, having LCIS in one breast increases the risk of nodes or to other parts of your body.
developing breast cancer in either breast.
D. INVASIVE LOBULAR BREAST CANCER Researchers have identified hormonal, lifestyle and environmental
 Invasive breast cancer that begins in the lobules (milk glands) factors that may increase your risk of breast cancer. It's likely that
of the breast and spreads to surrounding normal tissue. It breast cancer is caused by a complex interaction of your genetic
can also spread through the blood and lymph systems to makeup and your environment.
other parts of the body.
 the second most common type of breast cancer. Over 10% of RISK FACTORS
invasive breast cancers are invasive lobular carcinomas. Being female. Increasing age. A personal history of
breast conditions.
 Invasive lobular cancer doesn’t always appear clearly on a
A personal history of A family history of Inherited genes that
mammogram, instead an MRI might be needed.
breast cancer. breast cancer. increase cancer risk.
 BRCA1
 BRCA2.
Radiation exposure. Obesity. Beginning your
period at a younger
age.
Beginning Having your first Having never been
menopause at an child at an older pregnant.
older age. age.
Postmenopausal hormone therapy. Drinking alcohol.

E. TRIPLE NEGATIVE BREAST CANCER

 SIGNS AND SYMPTOMS B. SKIN-SPARING MASTECTOMY= most of the skin over the breast
breast lumps or Change in the size, Changes to the skin is left intact. Only the breast tissue, nipple and areola are
thickening that feels shape or over the breast, removed.
different from the appearance of a such as dimpling  it offers the advantage of less scar tissue and a
surrounding tissue breast
reconstructed breast that seems more natural. But it may
not be suitable for larger tumors or those that are close to
A newly inverted Peeling, scaling, Redness or pitting of
nipple crusting or flaking of the skin over your the surface of the skin.
the pigmented area breast, like the skin C. NIPPLE-SPARING MASTECTOMY= a variation of the skin-sparing
of skin surrounding of an orange mastectomy. The breast tissue is removed, but the breast skin
the nipple (areola) and nipple are left in place.
or breast skin  often an option for women who have a small, early-stage
cancer near the outer part of the breast, with no signs of
cancer in the skin or near the nipple.
 Afterward, the nipple may not have a good blood supply,
causing the tissue to shrink or become deformed. Because
the nerves are also cut, there often may be little or no
feeling left in the nipple.
D. MODIFIED RADICAL MASTECTOMY= combines a simple
mastectomy with the removal of the lymph nodes under the arm
(called an axillary lymph node dissection).
E. RADICAL MASTECTOMY = This extensive surgery is rarely done
now. The surgeon removes the entire breast, axillary (underarm)
lymph nodes, and the pectoral (chest wall) muscles under the
breast.
 This operation may still be done for large tumors that are
growing into the pectoral muscles.
F. Double Mastectomy= When both breasts are removed.
 done as a risk- reducing surgery for women at very high risk
for getting breast cancer, such as those with a BRCA gene
mutation.
MEDICAL/SURGICAL MANAGEMENT  This is done after careful consideration and discussion
between the patient and their cancer care team.
SPECIAL NOTATION
NURSING CARE PLAN
 Surgical removal of affected area of the lymph nodes
lumpectomy for small tumors IMPAIRED SKIN INTEGRITY RELATED TO SURGICAL REMOVAL OF
 mastectomy SKIN/TISSUE; ALTERED CIRCULATION, PRESENCE OF EDEMA,
 Lymph node dissection DRAINAGE; CHANGES IN SKIN ELASTICITY, SENSATION; TISSUE
 Radiation therapy. DESTRUCTION - (RADIATION)
 Prophylactic bilateral mastectomy for women with BRCA1 or INTERVENTION GOALS
BRCA2 genes.  Inspect dressings anteriorly  Client will achieve timely
and posteriorly for wound healing, free of
 Radiation therapy to decrease tumor size.
characteristics of drainage. purulent drainage or
 Oxygen therapy to supplement the needs of the body. Monitor amount of edema, erythema.
 High-protein, high-calorie diet to meet the needs of the body. redness, and pain in the  Client will demonstrate
incision. behaviors/techniques to
TYPES OF MASECTOMY promote healing/prevent
 Perform routine complications.
A. SIMPLE OR TOTAL MASTECTOMY= the surgeon removes the assessment of involved
entire breast, including the nipple, areola, and skin. arm. Elevate hand or arm
 Some underarm lymph nodes may be removed depending with shoulder positioned at
appropriate angles (no
on the situation.
more than 65 degrees of
 Most women, if they are hospitalized, can go home the next flexion, 45–65 degrees of
day. abduction, 45–60 degrees
of internal rotation) and
forearm resting on wedge
or pillow, as indicated.
 Maintain in semi-Fowler’s
position on the back or
unaffected side; avoid
letting the affected arm
dangle.

 Refrain from measuring

blood pressure (BP),
injecting medications, or
inserting IVs in the affected
arm.

 Observe graft site (if done)

for color, blister formation;
note drainage from donor PATHOPHYSIOLOGY
site.
 Assess wound drains, In general, cancer begins when a cell develops errors (mutations) in its
periodically noting amount DNA.
and characteristics of
drainage. ↓
The mutations tell the cell to grow and multiply quickly, creating a
 Encourage wearing of mass
loose-fitting or non-
constrictive clothing. ↓
(tumor) of abnormal cells. The abnormal cells continue living when
 Tell patient not to wear a healthy cells would die.
wristwatch or other jewelry
on affected arm. ↓
They can invade nearby tissues and break off from an initial tumor to
 Carry out antibiotics as
spread elsewhere in the body (metastasize).
indicated.

OVARIAN CANCER

 a type of cancer that begins in the ovaries.

o The ovaries — each about the size of an almond —
produce eggs (ova) as well as the hormones estrogen
and progesterone.
 often goes undetected until it has spread within the pelvis and
abdomen. At this late stage, ovarian cancer is more difficult to
treat. Early-stage ovarian cancer, in which the disease is confined
to the ovary, is more likely to be treated successfully.
 Surgery and chemotherapy are generally used to treat ovarian
cancer.

RISK FACTORS
Older age. (ages Inherited gene Other gene
50 to 60 years.) mutations. mutations, including
 breast cancer those associated
gene 1 (BRCA1) with Lynch
 breast cancer syndrome, SIGNS AND SYMPTOMS
gene 2 (BRCA2). SUBJECTIVE OBJECTIVE
Family history of Estrogen hormone Age when  Fatigue  Weight loss due to the caloric
ovarian cancer. replacement therapy, menstruation  Loss of appetite needs of the tumor, taking away
started and ended.  Generalized from the needs of the body.
weakness  Anorexia.
 Discomfort in the  Vomiting
pelvis area  Abdominal bloating or swelling
 Quickly feeling full  Changes in bowel habits, such as
when eating constipation
 • A frequent need to urinate
 MEDICAL TREATMENT/INTERVENTION CERVICAL CANCER
LABORATORY/DIAGNOSTIC SPECIAL NOTATION
EXAMINATIONS  Surgical removal of  a type of cancer that occurs in the cells of the cervix — the
 Pelvic exam affected ovary lower part of the uterus that connects to the vagina.
 Biopsy is confirmative for  Lymph node dissection  Various strains of the human papillomavirus (HPV), a
cancer.  Radiation therapy.
sexually transmitted infection, play a role in causing most
 Ultrasonography to further  Radiation therapy to
delineate the mass. decrease tumor size. cervical cancer.
 CT scan to check for  Oxygen therapy to  When exposed to HPV, the body's immune system typically
metastasis supplement the needs prevents the virus from doing harm. In a small percentage of
 cancer antigen (CA) 125 of the body. people, however, the virus survives for years, contributing to
test.  High-protein, high- the process that causes some cervical cells to become cancer
calorie diet to meet the
cells.
needs of the body.
 You can reduce your risk of developing cervical cancer by
MEDICATIONS having screening tests and receiving a vaccine that protects
CHEMOTHERAPY BEFORE HORMONAL THERAPY: against HPV infection.
SURGERY TO SHRINK SOME • tamoxifen
TUMORS, OR AFTER SURGERY: • anastrozole TYPES OF CERVICAL CANCER
• cyclophosphamide SQUAMOUS CELL CARCINOMA. ADENOCARCINOMA.
• methotrexate ADMINISTER ANALGESICS FOR  This type of cervical cancer begins  This type of cervical
• fluorouracil PAIN CONTROL: in the thin, flat cells (squamous cancer begins in the
• doxorubicin • morphine, fentanyl cells) lining the outer part of the column-shaped
• epirubincin • Progesterone based cervix, which projects into the glandular cells that
• vincristine hormones vagina. line the cervical
• paclitaxel  Most cervical cancers are canal.
• docetaxel squamous cell carcinomas.
Sometimes, both types of cells are involved in cervical cancer. Very
rarely, cancer occurs in other cells in the cervix.
LIPOSOMAL THERAPY

 delivery of chemotherapy in a liposome RISK FACTORS:

 This encapsulated chemotherapy allows increased duration Many sexual Early sexual activity Other sexually transmitted
of action and better targeting. The encapsulation of partners. (younger than 20). infections (STIs).
doxorubicin lessens the incidence of nausea, vomiting, and A weakened Smoking. Exposure to miscarriage
alopecia. The patient must be monitored for bone marrow immune prevention drug.
system.  diethylstilbestrol
suppression.
(DES)
 Gastrointestinal and cardiac effects may also occur. These
medications are administered by oncology nurses as a slow
intravenous infusion over 60 to 90 minutes. PATHOPHYSIOLOGY

NURSING MANAGEMENT
 Nursing care may include administering intravenous therapy
to alleviate fluid and electrolyte imbalances, initiating
parenteral nutrition to provide adequate nutrition, providing
postoperative care after intestinal bypass to alleviate an
obstruction, and providing pain relief and managing drainage
tubes.
 Comfort measures for women with ascites may include
providing small frequent meals, decreasing fluid intake,
administering diuretic agents, and providing rest
 Patients with pleural effusion may experience shortness of
breath, hypoxia, pleuritic chest pain, and cough.
Cervical cancer begins when healthy cells in the cervix develop changes
(mutations) in their DNA.
↓
Healthy cells grow and multiply at a set rate, eventually dying at a set
time. The mutations tell the cells to grow and multiply out of control,
and they don't die.
↓
The accumulating abnormal cells form a mass (tumor). Cancer cells
invade nearby tissues and can break off from a tumor to spread
(metastasize) elsewhere in the body.
It isn't clear what causes cervical cancer, but it's certain that HPV plays a role. HPV is very
common, and most people with the virus never develop cancer. This means other factors —
such as your environment or your lifestyle choices — also determine whether you'll develop
cervical cancer.
 MEDICATIONS
CHEMOTHERAPY BEFORE SURGERY HORMONAL THERAPY:
TO SHRINK SOME TUMORS, OR • tamoxifen
AFTER SURGERY: • anastrozole
• cyclophosphamide
• methotrexate ADMINISTER ANALGESICS
• fluorouracil FOR PAIN CONTROL:
• doxorubicin • morphine, fentanyl
• epirubincin • Progesterone based
• vincristine hormones
• paclitaxel
• docetaxel

SURGICAL PROCEDURES DONE FOR CERVICAL CANCER

a) TOTAL HYSTERECTOMY—removal of the uterus, cervix, and

ovaries
b) RADICAL HYSTERECTOMY—removal of the uterus, ovaries,
fallopian tubes, proximal vagina, and bilateral lymph nodes
through an abdominal incision (Note: “radical” indicates that
an extensive area of the paravaginal, paracervical,
SIGNS AND SYMPTOMS parametrial, and uterosacral tissues is removed with the
SUBJECTIVE OBJECTIVE uterus.)
 Fatigue  Weight loss due to the caloric needs of c) RADICAL VAGINAL HYSTERECTOMY—vaginal removal of the
 Loss of the tumor, taking away from the needs uterus, ovaries, fallopian tubes, and proximal vagina
appetite of the body. d) BILATERAL PELVIC LYMPHADENECTOMY—removal of the
 Generalized  Anorexia. common iliac, external iliac, hypogastric, and obturator
weakness  Vagina bleeding after intercourse,
lymphatic vessels and nodes
 Discomfort in between periods or after menopause
the pelvis  Watery, bloody vaginal discharge that e) PELVIC EXENTERATION—removal of the pelvic organs,
area may be heavy and have a foul odor including the bladder or rectum and pelvic lymph nodes, and
 Pelvic pain or pain during intercourse construction of diversional conduit, colostomy, and vagina
f) RADICAL TRACHELECTOMY—removal of the cervix and
selected nodes to preserve childbearing capacity in a woman
MEDICAL TREATMENT/INTERVENTION of reproductive age with cervical cancer
LABORATORY/DIAGNOSTIC SPECIAL NOTATION
EXAMINATIONS  Surgical removal of UTERINE CANCER
 Pelvic exam the cervix
(trachelectomy)  Cancer of the uterine endometrium (fundus or corpus) has
 Pap smear (all women aged  Hysterectomy
increased in incidence, partly because people are living
between 21 and 65 should get  Lymph node
an annual pap smear) dissection longer and because reporting is more accurate. Most uterine
 Radiation therapy. cancers are endometrioid (that is, originating in the lining of
 HPV DNA test. The HPV DNA  Radiation therapy to the uterus).
test involves testing cells decrease tumor size. • the fourth most common cancer in women and the most
collected from the cervix for  Oxygen therapy to common pelvic neoplasm.
infection with any of the types supplement the needs
• Cumulative exposure to estrogen is considered the major risk
of HPV that are most likely to of the body.
factor.
lead to cervical cancer.  High-protein, high-
calorie diet to meet  This exposure occurs with the use of estrogen
 Biopsy is confirmative for the needs of the body. replacement therapy without the use of
cancer. progestin, early menarche, late menopause,
 Endo-cervical curettage never having children, and anovulation.
 Cone biopsy  Other risk factors include infertility, diabetes,
hypertension, gallbladder disease, and
 Ultrasonography to further
delineate the mass. obesity.
• Tamoxifen may also cause proliferation of the uterine lining,
 CT scan to check for metastasis and women receiving this medication for treatment or
 MRI and Positive emission prevention of breast cancer are monitored by their oncologists.
tomography scan
RISK FACTORS:
 Age: at least 55 Postmenopausal Unopposed estrogen PATHOPHYSIOLOGY
years; median bleeding therapy
age, 61 years leukemia is thought to occur when some blood cells acquire mutations
Obesity that results in increased estrone levels (related to excess in their DNA understood that could contribute to leukemia.
weight) resulting from conversion of androstenedione to estrone in
body fat, which exposes the uterus to unopposed estrogen ↓
Other: nulliparity, truncal obesity, late menopause (after 52 years of Certain abnormalities cause the cell to grow and divide more rapidly
age) and, and to continue living when normal cells would die.
possibly, use of tamoxifen
↓
ASSESSMENT FINDINGS Over time, these abnormal cells can crowd out healthy blood cells in
Endometrial aspiration or Ultrasonography
the bone marrow, leading to
biopsy
↓
fewer healthy white blood cells, red blood cells and platelets, causing
MEDICAL MANAGEMENT
the signs and symptoms of leukemia.
 Treatment of endometrial cancer consists of total hysterectomy
CLASSIFICATION OF LEUKEMIA
(discussed later in this chapter) and bilateral salpingo-
FIRST TYPE OF CLASSIFICATION
oophorectomy and node sampling.
 the abnormal blood cells are immature
o Depending on the stage, the therapeutic approach is ACUTE blood cells (blasts). They can't carry out
individualized and is based on stage, type, LEUKEMIA. their normal functions, and they multiply
differentiation, degree of invasion, and node rapidly, so the disease worsens quickly.
involvement.  Acute leukemia requires aggressive, timely
 Whole PELVIS RADIOTHERAPY is used if there is any spread treatment.
beyond the uterus.  Chronic leukemia involves more mature
blood cells. These blood cells replicate or
o Preoperative and postoperative treatments for stage II
CHRONIC accumulate more slowly and can function
and beyond may include pelvic, abdominal, and vaginal LEUKEMIA. normally for a period of time.
intracavitary radiation.  Some forms of chronic leukemia initially
 Recurrent lesions in the vagina are treated with surgery and produce no early symptoms and can go
radiation. Recurrent lesions beyond the vagina are treated with unnoticed or undiagnosed for years.
hormonal therapy or chemotherapy. Progestin therapy is used SECOND TYPE OF CLASSIFICATION
frequently. Patients should be prepared for such side effects as LYMPHOCYTIC  affects the lymphoid cells (lymphocytes),
LEUKEMIA. which form lymphoid or lymphatic tissue.
nausea, depression, rash, or mild fluid retention with this
 This type of leukemia affects the myeloid
therapy.
MYELOGENOUS cells. Myeloid cells give rise to red blood
Recurrent cancer usually occurs inside the vaginal vault or in the upper vagina, and
LEUKEMIA. cells, white blood cells and platelet-
metastasis usually occurs in lymph nodes or the ovary.
producing cells.
LEUKEMIA

 Leukemia is cancer of the body's blood-forming tissues, including

the bone marrow and the lymphatic system.
 usually involves the white blood cells.
o Your white blood cells are potent infection fighters —
they normally grow and divide in an orderly way, as
your body needs them. But in people with leukemia, the
bone marrow produces abnormal white blood cells,
which don't function properly.

RISK FACTORS FOR LEUKEMIA

Previous Genetic Exposure Smoking Family
cancer disorders to certain history of
treatment chemicals leukemia
 TYPES OF LEUKEMIAS MEDICATIONS
ACUTE  This is the most common type of leukemia CHEMOTHERAPY BEFORE ADMINISTER ANALGESICS
LYMPHOCYTIC in young children. SURGERY TO SHRINK SOME FOR PAIN CONTROL:
LEUKEMIA  ALL can also occur in adults. TUMORS, OR AFTER SURGERY: • morphine, fentanyl
(ALL). • cyclophosphamide • tyrosine kinase
ACUTE  a common type of leukemia. It occurs in • methotrexate inhibitors and anti-
MYELOGENOUS children and adults. • fluorouracil leukemia antibodies.
LEUKEMIA  the most common type of acute leukemia in • doxorubicin
(AML). adults. • epirubincin
CHRONIC  The most common chronic adult leukemia. • vincristine
LYMPHOCYTIC  you may feel well for years without needing • paclitaxel
LEUKEMIA treatment. • docetaxel
(CLL). PATIENT TEACHING FOR PATIENTS WITH LEUKEMIA
CHRONIC  This type of leukemia mainly affects adults. TO PREVENT INFECTION: TO PREVENT BLEEDING:
MYELOGENOUS  A person with CML may have few or no  Avoid eating raw foods  Avoid contact sports
LEUKEMIA symptoms for months or years before  Avoid going to public  Always wear shoes or
(CML). entering a phase in which the leukemia cells places slippers at all times
grow more quickly.  Always wear a mask when  Use an electric shaver
OTHER TYPES.  hairy cell leukemia going out  Cut nails across
 myelodysplastic syndromes  Avoid people with obvious  Avoid handling sharp
 myeloproliferative disorders infection objects

SIGNS AND SYMPTOMS

SUBJECTIVE OBJECTIVE
 Fatigue  Unexplained weight loss due to the
 Loss of caloric needs of the tumor, taking away
appetite from the needs of the body.
 Generalized  Anorexia.
weakness  Fever or chills
 Bone pain or  Frequent or severe infections
tenderness  Swollen lymph nodes, enlarged liver or
spleen
 Easy bleeding or bruising
 Recurrent nosebleeds
 Tiny red spots in your skin (petechiae)
 Excessive sweating, especially at night

MEDICAL TREATMENT/INTERVENTION
LABORATORY/DIAGNOSTIC SPECIAL NOTATION
EXAMINATIONS  Stem cell transplant
 Physical exam, noting  Oxygen therapy as
enlargement of lymph needed
nodes, liver and spleen, pale  High calorie, high fiber
skin from anemia diet
 Complete blood count (CBC)  Low fat, high protein
and WBC differential. diet
 Blood smear. A blood smear,
or peripheral blood smear,
 Bone marrow biopsy is
confirmative for cancer.
 CT scan to check for
metastasis
 Spinal tap (lumbar puncture)
and cerebrospinal fluid
analysis.
 Immunophenotyping or
phenotyping by flow
cytometry and/or
immunohistochemistry
 Cytogenetic tests (FISH and
karyotyping)
 Molecular testing