ONCOLOGY NURSING

SMITA VERMA
ERA COLLEGE OF NURSING
INTRODUCTION
The word 'oncology' originated
from two Greek word 'onkos' and
‘logos’. The word ‘onkos’ means
mass relating to tumors and
‘logos’ means study or science.
DEFINITION

Oncology is the field of study

and treatment of tumors, may
be benign and malignant.
STRUCTURE OF NORMAL AND
CANER CELLS
 DIFFERENCE BETWEEN NORMAL
CELL AND CANCER CELL NORMAL CELL CANCER CELL
CHARACTE-RISTICS

Growth Normal cells stop growing In contrast, cancer cells don’t stop
(reproducing) when enough cells are growing when there are enough cells
present present.

Cell repair and cell death Normal cells are either repaired or Cancer cells are either not repaired or
die (undergo apoptosis) do not undergo apoptosis.

Stickiness Normal cells secrete substances that Cancer cells fail to make these
make them stick together in a group. substances, and can “float away”.

Ability to Metastasize Normal cells stay in the area of the Cancer cells, travel via the
(Spread) body where they belong. bloodstream and lymphatic system to
other regions of the body

Appearance Under a microscope, normal cells and cancer cells have an abnormal shape,
cancer cells may look quite different. both of the cell, and of the nucleus.
 Cont……..
CHARACTE- NORMAL CELL CANCER CELL
RISTICS

The rate of growth Normal cells reproduce themselves and then Cancer cells reproduce rapidly before
stop when enough cells are present. the cells have had a chance to mature.

Evading the immune When normal cells become damaged, the Cancer cells are able to evade (trick)
system immune system identifies and removes them. the immune system long enough to
grow into a tumor.

Functioning Normal cells perform the function they are Where as cancer cells may not be
meant to perform. functional

Blood supply Normal cells undergo a process called Cancer cells undergo angiogenesis
angiogenesis only as part of normal growth even when growth is not necessary.
and development and when new tissue is
needed to repair damaged tissue.
Evading growth Normal cells are controlled by growth (tumor) Mutations that result in any of these
suppressors suppressors. tumor suppressor genes being
inactivated allow cancer cells to grow
unchecked.
NURSING ASSESSMENT – HISTORY
AND PHYSICAL ASSESSMENT

A review of health history

Past and current diseases, medical conditions and illnesses.
Surgeries have had.
Immunizations have had.
Medicines, vitamins, minerals and herbal remedies are taking.
Current signs and symptoms of diseases such as cancer.
Lifestyle, such as eating and exercise habits, tobacco and
alcohol use and reproductive history.
Family history of cancer and other diseases.
Physical examination
During a physical exam-
Measure height and weight
Examine skin and eyes
Look into nose, mouth, throat and ears
Feel pulses in neck, groin and feet
Check body’s reflexes
Take blood pressure and pulse
Feel lymph nodes in neck, armpits or groin to check if they are
enlarged
Feel abdomen to check for abnormalities or growths on organs
such as the liver, spleen and kidneys
METHODS OF PHYSICAL
EXAMINATION

Inspection
Palpation
Percussion
Auscultation
DIAGNOSTIC TEST
Laboratory tests (blood, urine, etc.)- including complete
blood count(CBC) with differential platelet count and
blood chemistries including liver function test, blood urea
and nitrogen (BUN) and creatinine are done to determine
baseline values.
Further testing depends on cancer diagnosis
Blood markers (carcinoembryonic antigen),
PSA(Prostate specific antigen), CA15- 3,
CA125
Biopsy
Biopsy- The removal of tissue or cells for analysis is called
a biopsy. A biopsy is the only sure way to diagnosis most
cancers. Imaging tests like CT scans and X-rays can help
identify areas of concerns, but they can’t differentiate
between cancerous and noncancerous cells.
Types of biopsies
Bone marrow biopsy
Endoscopic biopsy
Needle biopsy
Skin biopsy
Surgical biopsy
Imaging tests (X-ray, PET/CT, MRI, ultrasound,
etc.)- Imaging tests can be used to look for cancer, find
out how far it has spread, and to help see if cancer
treatment is working.
Nuclear medicine scans (bone scans, etc.)- Nuclear
medicine scans can helps find tumors and see how
much the cancer has spread in the body (called the
cancer's stage).
Endoscopy- An endoscopy is a test that looks inside
the body. The endoscope is a long flexible tube which
has a tiny camera and light on the end of it.
Mammography-A mammography is an x-ray picture
of the breast. It can be used to check for breast cancer
in women who have no signs or symptoms of the
disease.
Breast self-examination (BSE) - It is a screening
method used in an attempt to detect early breast
cancer.
Pap smear test-A procedure in which a small brush
or spatula is used to gently remove cells from the
cervix so they can be checked under a microscope for
cervical cancer or cell changes that may lead to
cervical cancer.
CANCER
INTRODUCTION
The word cancer, often abbreviated Ca, as a term that
frightens most people. Cancer is synonymous with the
term "malignant neoplasm".
The word 'neoplasm' is derived from Greek words
“neo” means “new” and “plasm” means “tissue”.
Thus, neoplasm is defined as an abnormal new growth
or formation of tissue that serves no useful purpose
and may harm. A neoplasm may be either benign or
malignant.
DEFINITION

Cancer is a group of disease

characterized by uncontrolled cellular
growth, local tissue invasion and
systemic metabolic metastasis.
OR,
Cancer is a disease of the cell in
which the normal mechanisms of
control of growth and proliferation
are disturbed.
RISKS FACTORS OF CANCER
DEVELOPMENT
Environmental factors
Occupational factors
Dietary factors
Life style factor
Genetic and familiar factor
Hormonal factor
Medication factor
Age and sex
Socio economic factor
WARNING SIGNS OF CANCER
There are seven warning signs of cancer. They are
represented by “CAUTION”.
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
 STAGING OF CANCER
Stage 0 (carcinoma in situ)-carcinoma in situ is very early cancer.
The abnormal cells are found only in the 1st layer of cells and do not
invade the tissue.
Stage I- Cancer involve the primary site but has not spread to nearby
tissue and hasn’t reached the layer of muscle.
Stage I (A)- Small amount of cancer visible by microscope found
deeper in the tissue. It has not spread to lymph node.
Stage II- Cancer has spread to near area and invade the layer of
muscle. Cancer has spread to lymph node.
Stage II (A)- Cancer has spread to other tissue around the primary
site. It has spread more than one lymph nodes.
Stage III- Cancer has spread throughout the nearly area. It has spread
to distant lymph nodes.
Stage IV- Cancer has spread to other part of the body and other
organs.
TNM CLASSIFICATION OF CANCER

AJCC Classification System of Tumors

T-primary tumor
Tx-primary cannot be evaluated
To-no evidence of primary tumor
Tis-carcinoma in situ
T1, T2, T3, T4-increasing size and/or local
extent of primary tumor
N-presence or absence or regional lymph node
involvement
Nx- regional lymph nodes are unable to be
assessed.
No- no regional lymph node involvement.
N1, N2, N3-increasing involvement of
regional lymph nodes
M-absence or presence of distant
metastasis
Mx-Distant metastatic cannot be
assessed.
Mo- no evidence of distant metastasis.
M1-presence of distant metastasis
(metastasis will be present).
PREVENTION OF CANCER
Primary Prevention
Make appropriate lifestyle changes.
Stop smoking.
Limit alcohol intake.
Eat a healthy diet as outlined above.
Be physically active: maintain a healthy weight and follow
exercise guidelines outlined above.
Avoid sun exposure, especially during the hours of 10 A.M.
and 4 P.M. and cover exposed skin with sunscreen with a skin
protection factor of 15 or higher.
Those at high risk for certain cancers should consider genetic
counseling and testing.
 Vaccinations
Secondary prevention
The goal of screening is early detection to improve
overall outcome and survival. Performing routine
screening tests should be based on whether these tests
are adequate to detect a potentially curable cancer in
an otherwise asymptomatic person and are also cost-
effective.
Screening should be based on an individual's age, sex,
family history of cancer, ethnic group or race,
previous iatrogenic factors (prior radiation therapy or
drugs such as DES), and history of exposure to
environmental carcinogens.
MANAGEMENT OF CANCER

These are the most common treatment of cancer.

The goals of cure, control and palliation are
achieved through the use of treatment modalities
for cancer, which includes;
Chemotherapy
Radiation therapy
Target therapy
Surgery
 CHEMOTHERAPY
DEFINITION
Chemotherapy is the systemic treatment
of cancer with chemicals, i.e. drugs. Here
the use of antineoplastic drugs to promote
tumor cell destructions by interfering with
cellular function and reproduction. It
includes the use of various therapeutic
agents and hormones.
Goals of chemotherapy

The goals of chemotherapy are to destroy as

many tumor cells as possible with minimal
effect on healthy cells. It can be used for cure,
control, and palliation.
 CLASSIFICATION OF
CHEMOTHERAPY
The two major categories of chemotherapeutic drugs
are cell cycle-nonspecific and cell cycle-specific.
Cycle-nonspecific-The cell cycle non- specific have
their effect on the cells that are in the process of
cellular replication and proliferation, as well as on the
cells that are in the resting phase.
Cell cycle-specific-The cell cycle-specific have their
effect on cells that are in the process of cellular
replication or proliferation.
Alkylating agent
Nitrogen mustard (Mechlorethamine)
Chlorambucil (Leukeran)
Busulfan (Myleran)
Antimetabolites
6 Thioguanine (6 TG)
5 Fluorouracil (5 Fu)
Deoxycoformycin (Pentostatin)
Antitumor antibiotics
Bleomycin (Blenoxane)
Mitomycin (Mutamycin)
Plicamycin (Mithracin, mithramycin)
Hormonal agents
(i)Androgens
Testosterone propionate(Drolban)
Testolactone (Teslac)
Methyltestosterone
(ii)Corticosteroids
Cortisone acetate
Prednisone (Meticorten)
Dexamethasone (Decadron)
(iii)Estrogen Vinca alkaloids
Diethylstilbestrol (DES) Vincristine (Oncovin)
Ethinyl estradiol (Estriny) Vinblastine (Velban)
(iv) Progesterones Vindesine sulfate
Megestrol (Megace) Epipodophyllotoxins
Estramustine (Emcyt) Etoposide (VP-16)
(v)Estrogen antagonists
Tamoxifen (Nolvadex)
Leuprolide (Lupron)
(vi) Antiadrenal
Aminoglutethimide
ROUTES OF CHEMOTHERAPY
Chemotherapy can be administered by several routes.
Oral -Ex. cyclophosphomide
Intramuscular -Ex. bleomycin
Intravenous -Ex. doxorubicin, vincristine
Intracavitary -Ex. radioisotopes, alkylating (pleural,
peritoneal) agents
Intrathecal -Ex. methotrexate, cytosine, arbinoside
Intraarterial -Ex. DTIC, 5-Fu, methotrexate, fluxuridine
Perfusion -Ex. alkalinizing, alkylating agents
Continuous infusion -Ex. 5-Fu, methostreate, cytosine, arbinoside
Subcutaneous -Ex. cytosine arabinoside
Topical -Ex. 5-Fu cream
Intraperitoneal -Ex. methotrexate, 5-Fu