Branch of medicine that deals with the study, detection, treatment and management of cancer and

neoplasia.

Etiologic Factors

Oncogenes – specialized cells triggering CA cells growth. (Genetic factors- stimulated by many factors)
(Medications, food, fluids)
PATHOPHYSIOLOGY

Abnormal cell formed by mutation of DNA

Heredity
Chemicals
Nulliparous (No children) (Nuns are prone to
cancer development; Hormone the triggers
development of cancer cells = ESTROGEN -
develops cancer in Uterus or Ovaries)
Trauma
Cell grows and proliferates
Metastasis occurs when ABN. Cells invade other tissue,
through lymph and blood
Cancer development linked to immune system
failure

Hormonal changes

Childless, nulliparous

1 or 2 children

1st baby born after age 35

Early menarche, late menopause (Exposure to estrogen)

✗ According to behavior of Tumor

✗ Benign - tumors that cannot spread by invasion or metastasis; hence, they grow locally

✗ Malignant - tumors that are capable of spreading by invasion and metastasis. By definition, the term
“cancer” applies only to malignant tumors.
 MALIGNANT - Undifferentiated (Can’t
BENIGN
recognize the parts)
- Erratic and Uncontrolled Growth
Well-differentiated (You can see the parts)
(Not encapsulated)
- Expansive and Invasive
Slow growth
- Secretes abnormal proteins
Encapsulated - METASTASIZES

Non-invasive

Does NOT metastasize

Metaplasia

- conversion of one type of cell in a tissue to another type not normal for that tissue (Ex.

Pseudostratified epithelium > abnormal development of cells > changes into stratified columnar

epithelium)

Anaplasia

- change in the DNA cell structure and orientation to one another, characterized by loss of
differentiation and a return to a more primitive form.

Neoplasia

- uncontrolled cell growth, either benign or malignant

Metastasis: 3 stages

▪ Invasion - neoplastic cells from primary tumor invade into surrounding tissue with penetration of
blood or lymph (Breast CA may cause Lymph Adenopathy)

▪ Spread - tumor cells spread through lymph or circulation or by direct expansion

▪ Establishment and growth - tumor cells are established and grow in secondary site: lymph nodes or
in organs from venous circulation.

Etiology of cancer

1. PHYSICAL AGENTS
4. Dietary Habits Low-Fiber
Radiation
High-fat
Exposure to irritants
Processed foods
Exposure to sunlight (Overexposure)
Alcohol
2. CHEMICAL AGENTS
5. Viruses and Bacteria
Smoking (Thousands of chemicals; only 250 have
been identified; Polyh--) DNA viruses- HepaB, Herpes, EBV, CMV,
Papilloma Virus
Dietary ingredients RNA Viruses- HIV
Bacterium- H. pylori
Drugs
6. Immune Disease
3. Genetics and Family History
AIDS (Decreased immune system
Colon Cancer
response)
Breast cancer
 ▪ BIOPSY- The most definitive Cancer grading (classification of cells)
▪ CT, MRI
▪ Tumor Markers (Suspected with liver CA > Liver ➢ Grade 1 – well-differentiated (benign)
tumor markers) ➢ Grade 2 – moderate well-differentiated
CANCER STAGING (bordeline)

➢ Grade 3 – poorly differentiated (Malig.)

Uses the T-N-M staging system
▪ T- tumor ➢ Grade 4 – very poorly differentiated (Mal)
▪ N- Node (Nodal involvement)
* Grade 3 & 4 - malignant
▪ M- Metastasis
Tx – tumor not adequately assess
T0 – no evidence of primary tumor
T1 – T4 > size of the tumor
 Hair Loss
Fatigue
Disturbance in body image/ depression

MAINTAIN TISSUE INTEGRITY

Handle skin gently

Do NOT rub affected area
Lotion may be applied
Wash skin only with SOAP and Water

MANAGEMENT OF STOMATITIS

Use soft-bristled toothbrush

Oral rinses with saline gargles/ tap water
Avoid ALCOHOL-based rinses

MANAGEMENT OF ALOPECIA (Alopecia begins within 2 weeks of therapy)

 Regrowth within 8 weeks of termination
Encourage to acquire wig before hair loss occurs
Provide information that hair loss is temporary BUT anticipate change in texture and color

RELIEVE PAIN

Mild pain- NSAIDS

Moderate pain- Weak opiods
Severe pain- Morphine
Administer analgesics round the clock with additional dose for breakthrough pain

MANAGE COMPLICATION: INFECTION

Fever is the most important sign (38.3)

Administer prescribed antibiotics X 2weeks
Maintain aseptic technique
Avoid exposure to crowds
Handwashing
Avoid frequent invasive procedures (Immunosuppressed; bone marrow depression > bleeding tendencies)

MANAGE COMPLICATION: Bleeding

Thrombocytopenia (<100,000) is the most common cause

<20, 000→ spontaneous bleeding
Use soft toothbrush
Use electric razor Avoid frequent IM, IV, rectal and catheterization
Soft foods and stool softeners (If with constipation)

Toxic reactions (Stomatitis)

B – bone marrow depression
A – alopecia (hair follicles is affected)
G – GI disturbances (Irritating to GI; N/V)
Mucosa lining affected mostly
Stomatitis ( progress to ulceration of mouth)
n/v
Constipation/diarrhea – anal irritation
Drugs

DES (Diethylstilbestrol)

Cyclophosphamide (CYTOXAN) (Increase OFI, to increase excretion of this drugs)

IOFI
MIO
Observe urine color (reddish – brown -> notify the MD irritation of Uri. Bladder (hemorrhagic cytitis)

Methotrexate
5F
Leukovorin – minimizes methotrexate toxicity

Doxurubicin (ADRIAMYCIN)
 Time

Minimum of 15 mins
Maximum of 30 mins.
Sealed – brachytherapy (long
to prevent overexposure
half-life) (Brachs- near to
Sterility
cancer cells)
Leukemia
Implanted in the body cavity Bone CA
2 – 3 days (after 3 days inform radiologist) Distance

Unsealed – radioisotope with short half life 3 – 5 ft. away from the source

For systemic therapy Given per orem/IV Shielding

Lead apron
Film badge
Dosimeter badge
Pocket ion chambers (latest – 400millirads)

SKIN CARE POST EXTERNAL RT

No need to observe radiation precautions Avoid removing skin crust
Uses x ray machine (No need shielding Avoid chlorinated pool
precautions) Avoid exposure to sunlight
Cobalt therapy (before) Avoid alcohol, talcum powder, ointment, lotion
Betatron (contain heavy metal zinc
Linear accelerator (latest) (Instead,) Use corn-starch, mineral oil
Never rub, just pat it dry
Avoid wearing constrictive clothing
Avoid too hot or cold temperature
Use mild soap & water in the affected area
Do not remove skin mark (remove only after Tx – 4 – 6
weeks after)

Currently the most frequently diagnosed major cancer in the world and the most common cause of cancer mortality
worldwide
Largely due to carcinogenic effects of cigarette smoke
Adenocarcinoma (males 37%, females 47%)¢ Squamous cell carcinoma (males 32%, females 25%)¢ Small cell
carcinoma (males 14%, females 18%) *Cigarette smoke is most common cause for lung CA
Large cell carcinoma (males 18%, females 10%)
In the usual case it is discovered in patients in their 50s whose symptoms are several months duration

Major presenting complaints:

Cough (75%)
Weight loss (40%)
Chest pain (40%)
Dyspnea (20%) (Obstruction causes DOB)

▪ In general, the adenocarcinoma and squamous cell patterns tend to remain localized longer and have a slightly
better prognosis than do the others (Not only lung CA, but Endocrine S/S; problems with ADH) (increased ADH,
more ADH that absorbs fluid)

*Lung CA has ability to produce ADH-like hormone and ACTH-like hormone- inc. of Aldosterone and
Mineralocorticoids, Glucocorticoids= Cushing’s Syndrome

▪ Paraneoplastic syndromes – clinical manifestations produced by lung tumors that secrete hormones like ADH,
ACTH, PTH, calcitonin. DIAGNOSIS

Diagnosis:
NURSING INTERVENTIONS (1)
Chest x-ray
Elevate the head of the bed to ease the work of
CT or combined PET–CT
breathing and to prevent fluid collection in upper
Cytopathology examination of pleural fluid or sputum
body (from superior vena cava syndrome).
Usually, bronchoscopy-guided biopsy and fine- needle
Teach breathing retraining exercises to increase
aspiration Sometimes open lung biopsy
diaphragmatic excursion and reduce work of
Management breathing.
Augment the patient’s ability to cough effectively
Surgery (depending on cell type and stage) by splinting the patient’s chest manually.
Chemotherapy Instruct the patient to inspire fully and cough two
Radiation therapy to three times in one breath.
Nursing care is based on supportive treatment
NURSING INTERVENTIONS (3)
Advise the patient to eat small amounts of
high-calorie and high-protein foods
frequently, rather than three daily meals.
Suggest eating the major meal in the
morning if rapid satiety is the problem.
Change the diet consistency to soft or liquid if patient
has esophagitis from radiation therapy.
Consider alternative pain control methods,
such as biofeedback and relaxation methods,
increase the patient’s sense of control.
Teach the patient to use prescribed
medications as needed for pain without
being overly concerned about addiction.
NURSING INTERVENTIONS (2)
Provide humidifier or vaporizer to provide
moisture to loosen secretions.
Teach relaxation techniques to reduce anxiety
associated with dyspnea.
Allow the severely dyspneic patient to sleep in
reclining chair. Encourage the patient to
conserve energy by decreasing activities.
Ensure adequate protein intake such as milk,
eggs, oral nutritional supplements; and
chicken, and fish if other treatments are not
tolerated – to promote healing and prevent
to edema.
 ▪ 1.5% of all cases in
the US
▪ Female > Male in incidence in those that
the
develop during early and middle adult years
▪ F = M if it develops during childhood and late
adult life
▪ Papillary carcinoma (>85%)
▪ Follicular carcinoma (5% to 15%)
▪ Anaplastic (undifferentiated) carcinoma (<5%0 ▪
Medullary carcinoma (5%) – thyroid cells
that originate from C-cells (specialized cells
from Calcitonin cells)

*T3, T4, Calcitonin= important in cellular metabolic

processes

SYMPTOMS

▪ Neck lump - in the front of the neck near the

Adams apple
▪ Neck nodule
▪ Neck swelling
▪ Hoarseness
▪ Difficulty speaking
▪ Voice changes -compression on trachea; laryngeal nerve
▪ Swollen neck lymph nodes
▪ Swollen lymph nodes
Physical exam - especially a neck exam.
▪ Difficulty swallowing
▪ Difficulty breathing ▪ Thyroid blood tests
▪ Throat pain ▪ TSH blood test – ability of thyroid
▪ Neck pain cancer cells if it produces less or more
of T3 T4
▪ Thyroglobulin blood test
DIAGNOSTIC ▪ Calcium blood test
▪ Ultrasonography
▪ Biopsy Fine-needle aspiration ▪ Radionuclide scanning
▪ Surgical biopsy – determine if benign or malignant
▪ Pathology analysis
▪ Neck ultrasound
▪ Neck MRI ▪ Neck CT
▪ Diagnostic I-131 whole body scan -looks for thyroid cancer cells throughout the body.
MANAGEMENT

▪ Thyroid cancer is most treatable and curable if caught in the earliest stage of the disease.
▪ Treatment is individualized to the type and stage of advancement of the disease, a persons age, medical
history, coexisting diseases and other factors.
▪ Treatment of thyroid cancer may include a combination of surgery, radioactive iodine treatment,
chemotherapy, and radiation therapy.
▪ Surgery generally includes removing most of the thyroid.
▪ Thyroid hormone replacement therapy is prescribed to replace the hormones that were produced by
the thyroid.

NURSING INTERVENTIONS

Provide a comfortable, warm enviroment

Prevent skin breakdown
Avoid using sedatives
Prevent constipation by gradually increasing execrise, administering stool softener, increasing bulk in the diet
and promoting regular bowel habits
Assist the client in adhering to a low calorie diet
Teach the clients the nature of the thyroid hormone deficiency, self care practice, and sign and symptoms to
monitor to asses future health

CLINICAL FEATURES
4th leading cause of cancer in the US
5-year survival rate is dismal, less than 5%
Primarily a disease of the elderly (Prolonged exposure to
carcinogens)
80% of cases occur between the ages of 60 and 80
Strongest influence is cigarette smoking
Other risk factors: fatty diet, chronic pancreatitis, DM,
heredity
Remain silent until they invade adjacent
structures
Obstructive jaundice – specially if carcinoma
of the pancreatic head
Course is typically brief and progressive
Serum levels of CEA and CA19-9 are often
elevated
CT-guided biopsy
Treatment is surgical (Whipple procedure- to
resect tumor and portion of CBD as well as
intestine and stomach), chemotherapy and
radiotherapy, supportive

SYMPTOMS
 Abdominal pain that radiates to your back
Loss of appetite or intended weight loss
Yellowish of your skin and the whites of your eyes (jaundice)
Light-colored stools (No bile in stool)
Dark-colored urine
Itchy skin (Biles that is deposited under the skin; very itchy)
New diagnosis of diabetes or existing diabetes that’s becoming more difficult to control (Pancreas primary
gland that produce insulin; problem with production of insulin)

DIAGNOSIS

Pancreatic ultrasound -Imaging test that create pictures of internal organ

Endoscopic ultrasound - using a scope to create ultrasound pictures of pancreas
Removing a tissue sample for testing(biopsy)
Blood test

TREATMENT

Surgery - Whipple procedure

Radiation

Chemotheraphy
The Whipple procedure (pancreatoduodenectomy) is the most
common operation performed for pancreatic cancer and may
be used to treat other cancers such as small bowel cancer.
Surgeons remove the head of the pancreas, most of the
duodenum (a part of the small intestine), a portion of the bile
duct and sometimes a portion of the stomach.
After the pancreatoduodenectomy, the surgeon reconstructs the
digestive tract.

NURSING MANAGEMENT

Preoperative and Postoperatively, nursing care is directed toward promoting patient comfort, preventing
complications, and assisting the patient to return to and maintain as normal and comfortable a life as possible.
The nurse closely monitors the patient in the intensive care unit after surgery; the patient will have multiple
intravenous and arterial lines in place for fluid and blood replacement as well as for monitoring arterial
pressures, and is on a mechanical ventilator in the immediate postoperative period.
Important to give careful attention to changes in vital signs, arterial blood gases and pressures, pulse oximetry,
laboratory values, and urine outrput.
The nurse must also consider the patients compromised nutritional status and risk for bleeding.
 The uncontrolled replication of the
hematologic progenitor cells involved in the development of
white blood cells, red blood cells, and platelets

*Increased WBC but immature; mature WBC protects from

infections

May originate in any of the blood-forming organs, including

the bone marrow (Myeloid type), lymphatic system, and spleen

Classification depends on which progenitor cell it originated

(lymphoid or myeloid) and is further classified as being acute or chronic on the basis of clinical presentation and
cell maturity
In the acute phase, the malignancy occurs during early cell differentiation, resulting in rapid replication with blasts
In the chronic phase, unregulated replication of differentiated cells occurs

✗ Acute lymphocytic leukemia (ALL) (From lymphatic tissue)

✗ Chronic lymphocytic leukemia (CLL)
✗ Acute myelogenous leukemia (AML) (From bone marrow)
✗ Chronic myelogenous leukemia (CML)

RISK FACTORS
➢ Genetics
➢ Environmental exposures
➢ Viral infections
➢ Immunodeficiency
➢ Children with Trisomy 21 are approximately 20x likelier to develop leukemia than the general population
➢ Children younger than 3 years of age likeliest to develop megakaryoblastic subset of AML
➢ Older children are likeliest to develop ALL
➢ Siblings are to- to fourfold greater risk of AML
➢ High risk among identical twins
Diagnostic and ionizing radiation
➢ Cigarette smoke
➢ Alkylating agents is associated with secondary AML
➢ Viruses – T and B cell lymphoma
➢ Immunodeficiency – high risk for lymphoma
➢ Diagnostic and ionizing radiation
➢ Cigarette smoke
➢ Alkylating agents is associated with secondary AML
➢ Viruses – T and B cell lymphoma
➢ Immunodeficiency – high risk for lymphoma
✗ The patient experiences symptoms within weeks to
months of the beginning of the acute malignant process
✗ The most common symptoms and physical findings at diagnosis
Anemia
Fever
Thrombocytopenia (Prone to bleeding)
Neutropenia (Prone to infections)
Pallor
Fatigue
Anorexia
PetechiaeiBleeding
Infection
Complete PE and history
CBC with platelets and differential count –
peripheral smear (PBS)
Chemistry panel
Bone marrow aspirate
Cytogenetic/molecular features
Genetics
Environmental exposures
Viral infections
Immunodeficiency
Children with Trisomy 21 are approximately
20x likelier to develop leukemia than the
general population
Children younger than 3 years of age
likeliest to develop megakaryoblastic
subset of AML
Older children are likeliest to develop ALL
Siblings are to- to fourfold greater risk of
AML
High risk among identical twins
✗ In addition, the patient may have extramedullary disease and
present with generalized or local lymphadenopathy (From
lymphoid tissue) , bone pain, bone fracture
✗ Extramedullary disease (Not just lymphoid or myeloid)
• CNS involvement – vertigo, nausea, vomiting, papilledema
(Swelling of optic disc- inc ICP) , and blurred vision
• Parotid gland infiltration
• Hepatomegaly
• Splenomegaly
 TREATMENT:

✗ Goal
1. Eradicate the malignant clone
2. Allowing growth of normal hematopoietic cells
✗ ALL – treatment is divided into stages
1. Induction
2. Consolidation
3. Maintenance

✗ Based on the patient’s prognostic factors, the remission induction chemotherapy program generally includes
some if not all of the following drugs:
1. Cyclophosphamide
2. Vincristine
3. Dexamethasone or prednisone
4. L-asparaginase
5. Doxorubicin

✗ Consolidation is several weeks long and includes courses of methotrexate or cytarabine

✗ At the consolidation of treatment, maintenance therapy begins with drugs used in a combination, rotational
schedule

Maintenance therapy may include: The rotational therapy is administered over a 2- to 3-year course
1. Cytarabine Patients also receive intrathecal chemotherapy (Administer
2. Thioguanine medication into the bones) with methotrexate or cytarabine for
3. Methotrexate prophylaxis or treatment of CNS involvement
4. Cyclophosphamide If leukemia cells are positive in the spinal fluid, radiation therapy may
5. Vincristine also be given to the brain
6. Prednisone/dexamethasone Bone marrow/stem cell transplantation may be a treatment option for
7. Doxorubicin patients who have an early relapse, have disease that is
8. L-aspariginase unresponsive to therapy, or have unfavorable cytogenetics
9. Mitoxantrone
10. 6-mercaptopurine

Two phases:
1. Induction – cytarabine and daunorubicin or idarubicin; intensive therapy that lasts for 1
week
2. Postremission or consolidation to maintain remission – options: o Several courses of
high-dose cytarabine chemotherapy o Allogenic (donor) stem cell transplantation o
Autologous stem cell transplantation
 Allogenic bone marrow or stem cell transplantation – the only curative therapy
Interferon alfa and imatinib mesylate (Gleevec) – treatment options for ineligible, unwilling, or waiting to
undergo transplantation
Avoid grapefruit juice when giving Gleevec, because this juice is known to increase the drug’s level

✗ Observation

✗ Chemotherapy
✗ Monoclonal antibiotics, which target the surface antigen ✗ Bone marrow transplantation

✗ The patient and family must balance the treatment regimen and uncertainty of the future, while attempting to
maintain a sense of control and normalcy
✗ Fatigue is a common complaint of patients – feelings of sadness, sleepiness, dizziness, nausea, feeling heavy,
mentally tired, not one’s self, and feeling sorry for one’s self ✗ Patient may not resume their life as it was
before leukemia

ROLE OF THE NURSE

Patient and family education
A supportive presence
Active monitoring and anticipates events

✗ One of the group of malignancies that originate from the

lymphatic system

*Lymphoma originates from nodes

Two groups:

Age-related bimodal incidence distribution

Peaks in mid 20s
Declines until mid 40s
Increases after age 60
Rare before the age of 10
More common in males
One of the most curable malignancies

RISK FACTORS

Etiology is not known

EBV – has been suggested (Epstein Barre Virus- Kissing Disease)
Defects in the immune system function
 Increased incidence among siblings – genetic risk

Clinical manifestations

1. Often asymptomatic
2. Painless lymphadenopathy most commonly found in the supraclavicular, cervical, and mediastinal
(Enlargement of tissue)
3. Spleen, liver, and retroperitoneal lymph nodes may be involved (Splenomegaly & Hepatomegaly)
4. Unexplained weight loss of more than 10% of body weight in 6 months before diagnosis
5. Night sweats; fever with temperatures above 38C
6. Pruritus may be present

Diagnosis and Staging

Thorough history and physical examination
Hematology
Chemistry profile
Histology: Reed-Sternberg cells (Positive HL if presence of RSC)
Chest X-ray to demonstrate mediastinal involvement
Treatment
Radiation therapy – curative in most patients with stage I or II disease
Chemotherapy – used in most patients with stage III and stage IV disease and in some patients with earlier
stage of the disease
Hematopoietic stem cell transplantation

Overall 5 years survival rate with optimum treatment for all patients – approximately 50%-60%

*NHL is more severe than HL; has ability to metastasize to other organs

✗ Malignancy of the B or T lymphocytes

✗ Clones of the malignant cells may infiltrate the lymph nodes, bone marrow, peripheral blood, or other organs ✗
Pattern of spread is less predictable than in HL
✗ Frequently disseminated at the time of diagnosis

Localized or generalized lymphadenopathy

Early involvement of the oropharyngeal lymphoid tissue or infiltration of the bone marrow is common
Abdominal mass may be detected with GIT involvement

Splenomegaly or hepatomegaly – 1/3 of patients

refractory low-grade or follicular CD20-positive B-cell lymphoma

Most common non-skin malignancy in women
Most important risk factor is gender – only 1% of
breast cancer occur in men (worst in men)
Incidence rises throughout the woman’s lifetime,
peaking at age of 75 to 80 years, and then
declining slightly thereafter¢
Women who reach menarche when younger than
11 years of age have 20% increased risk compared
with women who are more than 14 years of age at
menarche (90-95% benign if female)
Late menopause also increases risk
SYMPTOMS:
Presence of lump or mass
Nipple inversion
Breast discharges
Breast or nipple pain
Skin irritation or dimpling
Changes in the skin – “peau d’orange”
Looks like skin of orange
Full term pregnancy at ages younger than 20 years have
half the risk of nulliparous women or women over age
35 at their first birth¢
Other risk factors: first-degree relatives with breast
cancer, atypical hyperplasia, race/ethnicity, estrogen
exposure, breast density, radiation exposure¢
Carcinoma of the contralateral breast or endometrium
Diet – caffeine decreases risk and moderate to heavy
consumption of alcohol increases risk
Obesity
Exercise
Breastfeeding – the longer you breastfeed, the greater
the reduction risk
Environmental toxins
Tobacco
Major risk factors for the development are hormonal
and genetic

DIAGNOSTICS:

Breast exam
Mammography
Breast UTZ
MRI (possibly)
Biopsy

TREATMENT

Surgery- an operation where doctors cut out cancer tissue

Chemotherapy - medicines to shrink or kill the cancer cells
Hormonal therapy- blocks cancer cells from getting the hormones
they need to grow.
Radiotherapy
Lumpectomy
Partial or Segmental Mastectomy or Quadrantectomy¢
Total Mastectomy¢
Modified Radical Mastectomy¢ Radical Mastectomy
 NOTE:
LUMPECTOMY – only remove certain part
✗ After the lumpectomy, a five- to eight-week course
This is also referred to as breast-conserving therapy.
of radiation therapy is often used to treat the
The surgeon removes the cancerous area and a
remaining breast tissue.
surrounding margin of normal tissue.
A second incision may be made in order to remove the ✗ The majority of women who have small, early-stage
lymph nodes. breast cancers are excellent candidates for this
This treatment aims to maintain a normal breast treatment approach.
appearance when the surgery is over.

Women who are not usually eligible for a lumpectomy include:

▪ those who have already had radiation therapy to the

affected breast,
▪ have two or more areas of cancer in the same breast
that are too far apart to be removed through one
incision,
▪ or have cancer that was not completely removed
during the lumpectomy surgery

*Radical Mastectomy- remove entire tissue, nodes, plus chest muscles (Pectoralis muscles) ; in the 70s

NOTE:

During a partial or segmental mastectomy or quadrantectomy, the surgeon removes more breast tissue
than with a lumpectomy. The cancerous area and a surrounding margin of normal tissue are removed, and
radiation therapy is usually given after surgery for six to eight weeks.
With a simple or total mastectomy, the entire breast is removed, but no lymph nodes are removed in this
procedure. Simple mastectomy is most frequently used for further cancer prevention or when the cancer
does not go to the lymph nodes.
The surgeon removes all of the breast tissue along with the nipple in a modified radical mastectomy.
Lymph nodes in the armpit are also removed. The chest muscles are left intact. For many patients,
mastectomy is accompanied by either an immediate or delayed breast reconstruction. This can be done
quite effectively using either breast implants or the patient’s own tissue -- usually from the lower
abdomen.

The surgeon removes all of the breast tissue along with the nipple, lymph nodes in the armpit, and chest
wall muscles under the breast.
This procedure is rarely performed today because modified radical mastectomy has proved to be as effective,
and is less disfiguring.

NURSING INTERVENTIONS
 Monitor for adverse effects of radiation therapy such as fatigue, sore throat, dry cough, nausea, anorexia.
Monitor for adverse effects of chemotherapy; bone marrow suppression, nausea and vomiting, alopecia, weight
gain or loss, fatigue, stomatitis, anxiety, and depression.
Realize that a diagnosis of breast cancer is a devastating emotional shock to the woman.
Provide psychological support to the patient throughout the diagnostic and treatment process.
Involve the patient in planning and treatment.
6. Describe surgical procedures to alleviate fear.
7. Prepare the patient for the effects of chemotherapy, and plan ahead for alopecia, fatigue.
8. Administer antiemetics prophylactically, as directed, for patients receiving chemotherapy.
9. Administer I.V. fluids and hyperalimentation as indicated.
10. Help patient identify and use support persons or family or community.
11. Suggest to the patient the psychological interventions may be necessary for anxiety, depression, or sexual
problems.
12. Teach all women the recommended cancer-screening procedures. (Breast UTZ- Mammography)

▪ Multiple sexual partners

▪ A male partner with multiple previous or current sexual partners
▪ Young age at first intercourse
▪ High parity
▪ Persistent infection with a high oncogenic risk HPV (HPV 16 and 18)
▪ Immunosuppression
▪ Use of OCP (Oral contraceptive pills)
▪ Use of nicotine
▪ Family History

DIAGNOSTIC AND PREVENTION

More than half of invasive cervical cancers are detected in women who did not participate in regular screening
Cervical cancer screening and prevention
▪ Bimanual Pelvic Examination
▪ Pap smear
▪ Cervical biopsy
▪ HPV vaccination (Both male and female can take)
▪ Surgical removal
▪ Adjunctive radiotherapy and chemotherapy
Bleeding that occurs between regular menstrual periods
Bleeding after sexual intercourse
Menstrual periods that last longer and heavier than before
Bleeding after going through menopause
 Increased vaginal discharge
Pelvic pain

TREATMENT

Surgery Management

Early invasive cancers – biopsy

Laser surgery - a narrow beam of intense light destroys cancerous and precancerous cells
LEEP -(loop electrosurgical excision procedure) a wire loop which has an electric current cuts through issue
removing cells from the mouth of the cervix
Highly invasive cancers – hysterectomy with lymph node dissection
Radiation Therapy (Internal radiation therapy- drugs are implanted near cancer area)
Chemotherapy
Prognosis depends on the stage at which the cancer has been detected

Radical Trachelectomy - removal of the cervix, part of the vagina, and the lymph nodes
in the pelvis. Recommended for a small number of women with small tumors who wants
to try to get pregnant later on.

Total Hysterectomy - Removal of the cervix and uterus

Radical Hysterectomy - Removal of the cervix, some tissue around the cervix, the uterus,
and part of the vagina
Fallopiaan Tubes and Ovaries - The surgeon may remove both fallopian tubes and ovaries. This surgery is called a
salpingo-oophorectomy

Lymph Nodes - The surgeon may remove the lymph nodes near the tumor to see if they contain cancer. If cancer cells
have reached the lymph nodes, it means the disease may have spread to the other parts of the body.

✗ Cryosurgery -compressed nitrogen gas flows through a cryo probe making the metal cold enough to freeze and
destroy the abnormal cervical tissue cervix as viewed through speculum with patient in lithotomy position

✗ Palliative treatment-helps to improve peoples quality of life by reducing symptoms of cancer without trying to
cure the disease

✗ DISEASE RELATED: low blood counts, uterine pain due to pyelonephritis, vesicovaginal fistula, menorrhagia

✗ RELATED TO SURGERY: infection and sepsis , hemorrhage, severe pain , shock

✗ RELATED TO RADIATION: anorexia, fatigue, nausea, vomiting, skin changes, which range from redness (like as
sunburn) , Low blood counts
 ✗ RELATED TO CHEMOTHERAPY: immune suppression, mucositis, nausea, vomiting, diarrhea, alopecia, loss of
appetite, increased chance of infection, easy bruising or bleeding, fatigue.

PRE-operative and Post-operative

Assess patients condition

Give careful attention to post op. bleeding
Providing close monitoring and care for first 2-3 days
Early ambulation
Close monitoring the patient undergoing cryosurgery for hemorrhage and hypothermia Instruct
the patient to follow up visit

Pain related to cancer and treatment effect as evidenced by pain scale and facial expression
Imbalanced nutrition less than body requirement related to anorexia, vomiting as evidenced by weight loss
Impaired tissue integrity related to treatment as evidenced by mucocitis
Anxiety related to diagnosis of cancer as evidenced by talking with family member.
Risk for infection related to immune suppression.
Impaired urinary elimination R/T surgical incision.

About 80% of ovarian tumors are benign and mostly occur in young women between the ages of 20 to 45 years
old
Borderline tumors occur in slightly older ages
Malignant tumors are more common in older women
Ovarian cancer accounts for 3% of all cancers in females
SIGNS AND SYMPTOMS

Abdominal bloating, indigestion or nausea

Changes in appetite such as loss of appetite or feeling full sooner
A more frequent or urgent need to urinate and or constipation
Changes in bowel movements Increased abdominal girth.

CAUSES AND RISK FACTORS

Family history
Age -occur after the age of 63 years
Reproductive history (nulliparous)
Breast cancer
Hormone therapy- undergoing hormone replacement therapy( HRT ) after menopause appears to increase
the risk ovarian cancer Obesity and overweight cigarette smoking
DIAGNOSTIC

Transvaginal ultrasound the ovary is well

visualized with a variety of imaging techniques -
four annual

CA-125 and HE-4 - six annual -cancer antigen

125(CA 125) blood test (Tumor markers)

TREATMENT

typical treatment unilateral oophorectomy or

salphingooophorectomy

nodal metastases to pelvic and para-aortic nodes are

common if enlarged, should be resected if possible

malignat germ cell tumors(BEP) chemotherapy -

bleomycin
➢ -etoposide
➢ -cisplatin

NURSING MANAGEMENT

Sexual relations
educate patient about sexual relations
-explain that depression and heightened emotional sensitivity and expected because of upset hormonal
balances
Exhibit interest, concerns and willingness to listen fears
Improving body image assess how patient feels about undergoing a hysterectomy related to the nature
diagnosis significant others religious beliefs, and prognosis
Acknowledge patients concern about ability to have children loss of feminity
 Adenocarcinoma of the prostate is the most common form
of cancer in men
Accounts for 29% of cancer in the US¢ Typically a disease of
men over age 50
Screening is recommended to begin at age 40 (Prostate
UTZ, PSA – if elevated, Prostate CA)
Uncommon in Asia
Compromises urination of patient because of
compression on urethra

RISK FACTORS

genetics, diet and lifestyle (still not clear)

Diet: fatty foods has been implicated, those rich in lycopene are
suspected of preventing or delaying the development
Androgens play an important role in the development (Causes
enlargement of prostate gland)
Most men that underwent TURP have incidental finding of focal
cancer, and do not progress when followed up after 10 years
Older men are typically followed up
Younger men with longer life expectancy may undergo needle
biopsy to look for additional cancer

DIAGNOSTIC

✗ PSA levels Prostatic Specific Antigen (most important test – cutoff point is 4ng/ml), transrectal needle
biopsy, imaging studies (to check for metastatic
osteoblastic carcinoma to the vertebrae)

✗ Elevation, high risk for prostatic CA

Prostatic Specific Antigen

40 to 49 years – 2.5 ng/ml50 to 59 years – 3.5 ng/ml
60 to 69 years – 4.5 ng/ml
70 to 79 years – 6.5 ng/ml

Note:

o numbers 2 to 5 shows the upper age-specific PSA reference ranges o For the test to be valid, there must
be at least three PSA measurements available over a period of 1.5 to
 2 years o A man who has a significant rise, even though the latest serum level may be below the
normal cutoff (<4ng/ml) should undergo additional
work-up

MANAGEMENT

Surgery – radical prostatectomy¢

Antibiotic prophylaxis – quinolones and those that cover
anaerobic bacteria (during biopsy)
Radiation like brachytherapy (Internal radiation therapy)
Cryotherapy
Chemotherapy¢
Hormonal therapy

Post-op effects of surgery:

▪ Risks of anesthesia
▪ Post-op bleeding
▪ Impotence – treat with sildenafil (Viagra) tablets, alprostadil (Caverject) injections into the
penis, devices like penile prosthesis
▪ Incontinence
NURSING MANAGEMENT
✗ Nursing asessment
✗ History collection
✗ Physical examination regarding presenting urinary problems, voiding functions, UTI, urinary retention, Dysuria
✗ Obtain family history
✗ Nutritional assessment and life style