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COMPREHENSIVE PHASE
HANDOUTS
ONCOLOGY
Prepared By: Ms. Jaidee Rojas, RN
MAY 2024 Philippine Nurse Licensure Examination Review

Cell cycle

Cancer
Cells grow uncontrollably which has a tendency to spread to other parts of the body

Oncology
Branch of science that deals with the study, treatment, diagnosis and prevention of cancer.

Carcinogenesis

Cell Adaptation

Risk factors:
1. Viruses and bacteria
2. Physical agents
3. Chemical agents
4. Genetics
5. Lifestyle factors
6. Hormonal agents

Cancer Prevention
PRIMARY PREVENTION
 Achieve and maintain healthy weight gain
 Adopt a physically active lifestyle
 Consume a healthy diet
 Limit consumption of alcoholic beverages

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SECONDARY PREVENTION
 Screening and early detection

TERTIARY PREVENTION
 Preventing recurrence
 Assessment for development of second malignancies

WARNING SIGNS OF CANCER

C: Change in bowel or bladder habits.

A: A sore that does not heal.
U: Unusual bleeding or discharge.
T: Thickening or lump in the breast or elsewhere.
I: Indigestion or difficulty in swallowing.
O: Obvious change in a wart or mole.
N: Nagging cough or hoarseness.
U: Unexplained anemia.
S: Sudden weight loss.

CANCER DIAGNOSIS
Tumor staging

Tumor grading

Diagnostic Procedures

 Tumor marker identification

Analysis of biochemical mediators found in tumor tissue, blood, or other body fluids

 Nuclear medicine
Uses IV injection or ingestion of imaging radioisotopes followed by imaging of
tissues that have concentrated the radioisotopes.

 Mammography
 Pap smear test
 Colonoscopy
 MRI vs CT scan vs PET scan
 Ultrasound
 Endoscopy
 Fluoroscopy

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  Biopsy

Management of Cancer

SURGERY

 Diagnostic
> Biopsy (Incisional vs excisional)

 As Primary Treatment
> Chemosurgery > Cryosurgery
> Electrosurgery > Laser surgery

 Prophylactic
 Risk reduction surgery
 Reconstructive
 Attempt to improve function or for cosmetic effect
 Palliative
 Relieving symptoms and improve QOL

RADIATION THERAPY
• Neoadjuvant
• Prophylactic
• Palliative

Radiosensitive vs. Radioresistant

External vs Internal

CHEMOTHERAPY

Chemotherapeutic agents

CELL CYCLE SPECIFIC (S PHASE)

• TOPOISOMERASE I INHIBITOR: Irinotecan, Topotecan

• TOPOISOMERASE II INHIBITOR: Etoposide, Teniposide
• ANTIMETABOLITES: Cytarabine, 5-fluorouracil, Hydroxyurea, Methotrexate
•
CELL CYCLE SPECIFIC (M PHASE)

MITOTIC SPINDLE INHIBITORS

• PLANT ALKALOIDS: Vinblastine, Vincristine, Vinorelbine
• TAXANE: Paclitaxel, Docetaxel

CELL CYCLE NON-SPECIFIC

• ALKYLATING AGENT
• Busulfan, Carboplatin, Cisplatin, Cyclophosphamide, Nitrogen mustard, Thiotepa
• NITROSUREAS
• Carmustine, Lomustine
•
• ANTITUMOR ANTIBIOTICS
• Bleomycin, Dactinomycin, Daunorubicin, Doxorubicin, Epirubicin, Idarubicin
•
• HORMONAL AGENTS
• Tamoxifen, Fulvestrant, Goserelin

Side effects:
• Nausea and vomiting
• Stomatitis
• Anemia, leukemia, thrombocytopenia
• Kidney injury
• Cardiac toxicity
• Infertility
• Peripheral neuropathy
• Cognitive impairment
• Fatigue

NURSING CARE FOR PATIENTS WITH CANCER

RISK FOR INFECTION

• Place patient in a private room
• Inform patient to avoid contact with people who have known or recent infection
• Instruct staff in careful hand hygiene before and after entering room
• Avoid rectal or vaginal procedures, IM injections, insertion of urinary catheters
• Encourage patient to ambulate in room unless contraindicated.

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 • Assess IV sites for evidence of infection

RISK FOR IMPAIRED SKIN INTEGRITY

• Avoid the use of soaps, cosmetics, perfumes, lotions, powder in erythematous areas
• Avoid rubbing or scratching skin
• Avoid applying hot water bottles, heating pads
• Avoid exposing the area to sunlight or cold weather
• Avoid tight clothing; Use cotton clothing

IMPAIRED ORAL MUCOUS MEMBRANE INTEGRITY

• Assess oral cavity daily using the same assessment criteria or rating scale.
• Instruct patient to report oral burning, pain, areas of redness, open lesions on oropharyngeal mucosa and lips, pain associated
with swallowing, or decreased tolerance to temperature extremes of food.
• Encourage and assist as needed in oral hygiene.
• Advise patient to avoid irritants such as commercial mouthwashes, alcoholic beverages, and tobacco.
• Avoid irritating foods (acidic, hot, rough, and spicy);
• Use water-based moisturizers to protect lips.

IMPAIRED TISSUE INTEGRITY: ALOPECIA

• Discuss potential hair loss and regrowth with patient and family; advise that hair loss may occur on body parts other than the
head.
• Explore potential impact of hair loss on self- image, interpersonal relationships, and sexuality.
• Explain that hair growth usually begins again once therapy is completed.

Prevent or minimize hair loss through the following:

• Use mild shampoo and conditioner, gently pat dry, and avoid excessive shampooing
• Avoid excessive combing or brushing; use wide-toothed comb.

Suggest ways to assist in coping with hair loss.

• Purchase wig or hairpiece before hair loss.
• Begin to wear wig before hair loss.

IMPAIRED NUTRITIONAL STATUS (ANOREXIA, CACHEXIA, MALABSORPTION)

• Assess and address factors that interfere with oral intake or are associated with increased risk of decreased nutritional status.
• Initiate appropriate referrals for interdisciplinary collaboration to manage factors that interfere with oral intake.
• Suggest smaller, more frequent meals.
• Educate patient to avoid unpleasant sights, odors, and sounds in the environment during mealtime.
• If patient desires, serve alcoholic beverages at mealtime with foods.
• Consider cold foods, if desired.

IMPAIRED NUTRITIONAL STATUS (NAUSEA AND VOMITING)

• Assess the patient’s previous experiences and expectations of nausea and vomiting, including causes and interventions used.
• Adjust diet before and after drug administration according to patient preference and tolerance.
• Prevent unpleasant sights, odors, and sounds in the environment.
• Administer prescribed antiemetics, sedatives, and corticosteroids before chemotherapy and afterward as needed.
• Ensure adequate fluid hydration before, during, and after drug administration; assess intake and output
• Encourage frequent oral hygiene.

FATIGUE
• Encourage balance of rest and exercise; avoiding extended periods of inactivity. At minimum, promote patient’s normal sleep
habits.
• Encourage protein, fat, and calorie intake at least equal to that recommended for the general public.
• Encourage participation in planned exercise programs involving aerobic, resistance, and flexibility training based on individual
limitations and safety measures.
• Encourage the use of relaxation techniques and guided imagery.

CHRONIC PAIN
• Use pain scale to assess pain and discomfort characteristics: location, quality, frequency, duration, etc., at baseline and on an
ongoing basis.
• Assure patient that you know the pain is real and will assist them in reducing it.
• Address myths or misconceptions and lack of knowledge about the use of opioid analgesics.
• Collaborate with patient, primary provider, and other health care team members when changes in pain management are
necessary.
• Explore nonpharmacologic and complementary strategies to relieve pain and discomfort: distraction, imagery, relaxation,
cutaneous stimulation, acupuncture, etc.

GRIEF
• Encourage verbalization of fears, concerns, and questions regarding disease, treatment, and future implications.
• Explore previous successful coping strategies.
• Encourage ventilation of negative feelings, including projected anger and hostility, within acceptable limits.
• Involve spiritual advisor as desired by the patient and family.
• Allow for progression through the grieving process at the individual pace of the patient and family.

DISTURBED BODY IMAGE

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 • Identify threats to patient’s self-esteem (e.g., altered appearance, decreased sexual function, hair loss, decreased energy, role
changes). Validate concerns with patient.
• Encourage continued participation in activities and decision making.
• Encourage patient to verbalize concerns.
• Assist patient in self-care when fatigue, lethargy, nausea, vomiting, and other symptoms prevent independence.
• Assist patient in selecting and using cosmetics, scarves, hair pieces, hats, and clothing that increase their sense of attractiveness.

PROSTATE CANCER

Risk factors:
Unclear cause
Advancing age
Heavy metal exposure
Smoking
History of sexually transmitted infection
It is more common among men of African American descent.

Assessment:
Asymptomatic in early stages
Hard, pea-sized nodule or irregularities palpated on rectal examination
Gross, painless hematuria
Late sx: weight loss, urinary obstruction, and bone pain radiating from the lumbosacral area down the leg
The prostate-specific antigen level is elevated

Surgical interventions:
• Prostatectomy
• Transurethral resection of the prostate (TURP): The procedure involves insertion of a scope into the urethra to excise
prostatic tissue.
• Suprapubic prostatectomy: Removal of the prostate gland by an abdominal incision with a bladder incision.
• Retropubic prostatectomy: Removal of the prostate gland by a low abdominal incision without opening the bladder.
• Perineal prostatectomy: The prostate gland is removed through an incision made between the scrotum and anus.

CONTINOUOS BLADDER IRRIGATION

Decrease bleeding and to keep the bladder free from clots

• 1 lumen is for inflating the balloon (30 mL)
• 1 lumen is for instillation (inflow)
• 1 lumen is for outflow.
• Maintain traction on the catheter, if applied. Instruct the client to keep the leg straight.
• Run the solution at a rate, as prescribed, to keep the urine pink.
• Avoid heavy lifting, stressful exercise, driving, the Valsalva maneuver, and sexual intercourse for 2 to 6 weeks to prevent strain,
and to call the HCP if bleeding occurs

TESTICULAR CANCER
• Most often occurs between 15-40 years old
• Etiology: Genetics, Cryptorchidism
• Early detection: Monthly Testicular Self Exam
• Assessment: Painless testicular swelling; pulling sensation in scrotum
• Metastasis: Lymphadenopathy, Abdominal masses, gynecomastia, back, pone pain and respiratory symptoms.

Interventions:
• Radiation therapy or chemotherapy as needed.
• Unilateral orchiectomy; Radical orchiectomy; Retroperitoneal lymph node dissection.
• Discuss reproduction, sexuality and fertility information and options with the client.
• Post-operative interventions: Monitor for signs of bleeding, infection, IO, pain management.
• Instruct patient to avoid lifting and strenuous activity

CERVICAL CANCER
Risk factors:
Human papillomavirus (HPV) infection, Cigarette smoking, Reproductive behavior

Assessment:
Painless vaginal postmenstrual and postcoital bleeding
Foul-smelling or serosanguineous vaginal discharge
Pelvic, lower back, leg, or groin pain
Anorexia and weight loss
Leakage of urine and feces from the vagina
Dysuria, Hematuria

Interventions:
• Laser therapy: Boundaries of the lesion are visible during colposcopic examination.
• Cryosurgery: Freezing of the tissues
• Conization: Cone-shaped area of the cervix is removed; Allows the woman to retain reproductive capacity.
• Hysterectomy:

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 • Pelvic exenteration: The removal of all pelvic contents, for recurrent cancer if no evidence of tumor outside the pelvis and
no lymph node involvement exist.

TYPES OF PELVIC EXENTERATION

Anterior
Removal of the uterus, ovaries, fallopian tubes, vagina, bladder, urethra, and pelvic lymph nodes
Posterior
Removal of the uterus, ovaries, fallopian tubes, descending colon, rectum, and anal canal
Total
Combination of anterior and posterior

OVARIAN CANCER
Assessment:
Abdominal discomfort or swelling
Gastrointestinal disturbances
Dysfunctional vaginal bleeding
Abdominal mass
Elevated tumor marker (i.e., CA-125)
Interventions:
Radiation, chemotherapy
Total abdominal hysterectomy and bilateral salpingo-oophorectomy

ENDOMETRIAL (UTERINE) CANCER

Risk factors
1. Use of estrogen replacement therapy (ERT)
2. Nulliparity
3. Polycystic ovary disease
4. Increased age
5. Late menopause
6. Family history of uterine cancer 7. Obesity
8. Hypertension
9. Diabetes mellitus

Assessment
Abnormal bleeding, esp post-menopausal women
Vaginal discharge
Low back, pelvic, or abdominal pain
Enlarged uterus

Interventions
Radiation, chemotherapy; Progesterone therapy; Tamoxifen
Total abdominal hysterectomy and bilateral salpingo-oophorectomy

BREAST CANCER

Risk factors:
• Age, family history
• Early menarche and late menopause
• Previous cancer of the breast, uterus, or ovaries
• Nulliparity, late first birth
• Obesity
• High-dose radiation exposure to chest

Interventions:
Radiation therapy, chemotherapy; Hormonal manipulation; Surgery
Post operative interventions:
Monitor vital signs.
Position patient semi-fowler’s, affected arm elevated above the level of the heart
Encourage deep breathing exercises
Assess for infection, color changes, bleeding in surgical site
Maintain FE balance, diuretics and low salt diet for severe lymphedema.

LUNG CANCER

Risk factors: Cigarette smoking; Secondhand smoking; Environmental and occupational pollutants
Assessment:
• Cough, Wheezing, Dyspnea
• Hoarseness
• Hemoptysis, blood-tinged or purulent sputum
• Chest pain
• Anorexia and weight loss, weakness
• Diminished or absent breath sounds, respiratory changes

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Interventions:
• Monitor vital signs, breath sounds, oxygen saturation.
• Position Fowler’s position; Administer oxygen PRN
• High calorie, high protein, high vitamin diet
• Administer bronchodilators, corticosteroids, analgesics as prescribed
• Provide activity and rest periods as tolerated
• Radiation, chemotherapy, surgery (Thoracotomy, Thoracotomy with lobectomy, Thoracotomy with segmental resection);
thoracentesis

PANCREATIC CANCER

Highly malignant, poor prognosis

Increased age, a history of diabetes mellitus, alcohol use, history of previous pancreatitis, smoking, ingestion of a high-fat diet, and
exposure to environmental chemicals.

Assessment:
• Nausea and vomiting; Jaundice
• Abdominal pain; Unexplained weight loss
• Clay-colored stools
• Glucose intolerance

Diagnostics:

• Endoscopic retrograde cholangiopancreatography

Interventions:

• Radiation
• Chemotherapy
• Whipple procedure

GASTRIC CANCER

No single causative agent has been identified

Risk factors:
H. pylori infection
Diet of smoked, highly salted, processed, or spiced foods
Smoking, alcohol and nitrate ingestion
History of gastric ulcers
Complications:
Hemorrhage, obstruction, metastasis, and dumping syndrome

Assessment:
Early:
• Indigestion Abdominal discomfort
• Full feeling Epigastric, back, or retrosternal pain
Late:
• Weakness and fatigue Anorexia and weight loss
• Nausea and vomiting Dysphagia and obstructive symptoms
• Iron deficiency anemia Ascites; Palpable epigastric mass

Interventions:

• Subtotal Gastrectomy
Billroth I
Gastroduodenostomy
Billroth II
Gastrojejunostomy
• Total Gastrectomy
Esophagojejunostomy

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