ONCOLOGY NURSING

CANCER BACKGROUND
Introduction
o Cancer nursng practce covers a
age groups, and nursng specates
and s carred out n a varety of
heath care settngs, ncudng the
home, communty acute care
nsttutons, and rehabtaton
centers. Nurse need to dentfy
ther own reactons to cancer
because of ts assocaton wth pan
and death and to set reastc goas
to meet the chaenges nherent n
carng for patents wth cancer. In
addton, the cancer nurse must be
prepared to support the patent
and famy through a wde range of
physca, emotona , soca, cutura
and sprtua crses.
Oncology
o Study of Cancer
o Oncoogc Nursng specazes n
the care and treatment of cents
wth cancer.
Incidence and Prevalence
o Maes: 4 most common types of
cancer are prostate; ung and
bronchus; and coorecta
o Femaes: 4 most common types of
cancer are breast; ung and
bronchus; and coorecta
Ri! "actor "or cancer# $ o%e are
controlla&le' o%e are not(
o )irue and Bacteria
Epsten-Barr vrus s hghy
suspected as a cause n
Burktts ymphoma,
nasopharyngea cancer, and
some types of non-Hodgkns
ymphoma and Hodgkns
dsease.
Herpes smpex vrus type II,
cytomegaovrus, and human
papomavrus types 16, 18, 31
and 33 are assocated wth
dyspasa and cancer of the
cervx.
Hepatts B vrus s mpcated n
the cancer of the ver; the
human T-ce ymphotropc vrus
may be a cause of some
ymphocytc eukemas and
ymphomas.
Human mmunodefcency
vrus(HIV) s assocated wth
Kaposs sarcoma. The
bacterum Hecobacter pyorus
has been assocated wth an
ncreased ncdence of gastrc
magnancy, secondary to
nfammaton and n|ury of
gastrc ces.
o P*yical Agent
Exposure to sunght or
radaton, chronc rrtaton or
nfammaton.
Tobacco use
Dagnostc x-ray procedures or
wth radaton therapy used to
treat dsease.
o C*e%ical Agent
Smokng s strongy assocated
wth cancers of the ung, head
and neck, esophagus, pancreas,
cervx, and badder.
Asbestos, uranum, and vruses
acts synergstcay wth tobacco
to promote cancer
deveopment.
Chewng tobacco s assocated
wth cancers of the ora cavty
and prmary occurs n men
younger than 40 years of age.
Aromatc amnes and anne
dyes; pestcdes and
formadehydes; arsenc; soot,
and tars; asbestos; benzene;
bete nut and me; cadmum;
chromum compounds; ncke
and znc ores; wood dust;
beryum compounds; and
poyvny chorde
o Genetic and +a%ilial +actor
o Dietary +actor
Detary substances assocated
wth an ncreased cancer rsk
ncude fats, acoho, sat-cured
or smoked meats, foods
contanng ntrates and ntrtes,
and a hgh caorc detary
ntake.
Obesty s assocated wth
endometra cancer and possbe
postmenopausa breast cancers.
o ,or%onal Agent
Cancers of the reproductve
tract depends on endogenous
hormona eves for growth.
Dethystbestero (DES) has
ong been recognzed as a
cause of vagna carcnomas.
Role o" t*e I%%une Syte%
Patents who are
mmunocompetent have been
shown to have an ncreased
ncdence of cancer.
Organ transpant recpents who
receve mmunosuppressve
therapy to prevent re|ecton of
the transpanted organ have an
ncreased ncdence of
ymphoma. Kaposs sarcoma,
squamous ce cancer of the
skn and cervca and
anogenetca cancers.
Patents wth mmunodefency
dseases, such as AIDS, have an
ncreased ncdence of Kaposs
sarcoma; ymphoma, recta and
head and neck cancers. Some
patents who have receved
akyatng agents to treat
Hogkns dsease have an
ncreased ncdence of
secondary magnances.
Autommune dseases, such as
rheumatod arthrts and
S|ogrens syndrome, are
assocated wth ncreased
cancer deveopment.
o Nuring Role
Incudes heath promoton to
ower the controabe rsks
Increase consumpton of fresh
vegetabes (especay those of
cabbage famy) because
studes ndcate that roughage
and vtamn-rch foods hep to
prevent certan knds of cancer.
Increase fber ntake because
hgh-fber dets may reduce the
rsk for certan cancers ( eg.
Breast, prostate, and coon).
Increase ntake of vtamn A,
whch reduces the rsk of
esophagea, aryngea, and ung
cancers.
Increase ntake of foods rch n
vtamn C, such as ctrus fruts
and brocco, whch are thought
to protect aganst stomach and
esophagea cancers.
Practce weght contro because
obesty s nked to cancers of
the uterus, gabadder, breast
and coon.
Reduce ntake of detary fat
because a hgh-fat det ncrease
the rsk of breast, coon, and
prostate cancers.
Practce moderaton n
consumpton of sat-cured,
smoked, and ntrate-cured
foods; these have been nked
to esophagea and gastrc
cancers.
Stop smokng cgarettes and
cgars, whch are carcnogens.
Reduce acoho ntake because
drnkng arge amounts of
acoho ncreases the rsks of
ver cancer. ( Note: peope who
drnk heavy and smoke are at
greater rsk for cancers of the
mouth, throat, arynx, and
esophagus)
Avod overexposure to the sun,
wear protectve cothng, and
use a sunscreen to prevent skn
damage from utravoet rays
that ncrease the rsk of skn
cancer.
P,YSIOLOGY O+ CANCER
Background
a. Norma ce growth ncudes two
events
- Repcaton of ceuar DNA
- Mtoss (ce dvson)
b. Four phases of Ce Cyce
- G1 phase - RNA and proten
synthess occur
- S phase - DNA synthess
occurs
- G2 phase - premtotc phase;
DNA synthess s compete
mtotc spnde forms
- Mtoss - ce dvson occurs
The G0 phase, the restng or
dormant phase of ces, can
occur after mtoss and durng
the G1 phase. In G0 phase are
those dangerous ces that are
not actvey dvdng but have
the potenta for repcatng. The
admnstraton of certan
chemotherapeutc agent (as
we as admnstraton of some
other forms of therapy) s
coordnated wth the ce cyce.
So%e un-roductive
di""erentiation occur $ een on
&io-y re-ort(
- Anapasa: ces that ack
norma ceuar
characterstcs and dffer n
shape and organzaton wth
respect to ther ces of
orgn; usuay, anapastc
ces are magnant.
- Dyspasa: bzarre ce
growth resutng n ces that
dffer n sze, shape, or
arrangement from other
ces of the same type of
tssue.
- Metapasa: converson of
one type of mature ce nto
another type of ce.
Neopasms: aso caed tumors - mass
of new tssue that grows
ndependenty of surroundng organs.
C,ARAC.ERI
S.ICS
BENIGN /ALIGNAN.
Ce
characterstcs
We-
dfferentat
ed ces
that
resembe
norma
ces of the
Ces are
undfferenta
ted and often
bear tte
resembance
to the norma
ces of the
tssue from
whch the
tumor
orgnated.
tssue from
whch they
arose.
Mode of Acton Tumor
grows by
expanson
and does
not
nftrate
the
surroundn
g tssues;
usuay
encapsuat
ed.
Grows at the
perphery
and sends
out
processes
that nftrate
and destroy
the
surroundng
tssues.
Rate of
Growth
Rate of
growth s
usuay
sow
Rate of
growth s
varabe and
depends on
eve of
dfferentato
n; the more
anapastc
the tumor
faster t
grows
Metastass Does not
spread by
metastass
Gans access
to the bood
and
ymphatc
channes and
metastaszes
to other
areas of the
body.
Genera
Effects
Is usuay a
ocazed
phenomeno
n that does
not cause
generazed
effects
uness ts
ocaton
nterferes
wth vta
functons
Often causes
generazed
effects, such
as anema,
weakness,
and weght
oss.
Tssue
Destructon
Does not
usuay
Often causes
extensve
cause
tssue
damage
uness ts
ocaton
nterferes
wth bood
fow
tssue
damage as
the tumor
outgrows ts
bood suppy
or
encroaches
on bood foe
to the area;
may aso
produce
substances
that cause
ce damage.
Abty to
Cause Death
Does not
usuay
cause
death
uness ts
ocaton
nterferes
wth vta
functons
Usuay
causes death
uness
growth can
be
controed.
E""ect o" Cancer
A. Ditur&ed or lo o"
-*yiologic "unctioning "ro%
-reure or o&truction
- Anoxa and necross of
organs
- Loss of functon: Bowe or
badder obstructon
- Increased ntracrana
pressure
- Interrupted vascuar/venous
bockage
- Asctes
- Dsturbed ver functonng
B. ,e%atologic Alteration#
I%-aired "unction o" &lood
cell
- Leukopena
- Anema
- Cottng dsorders
C. Infectons: fstua deveopment
and tumor may become necrotc;
erode skn surface
D. Hemorrhage: tumor eroson,
beedng, severe anema
E. Anorexa-Cachexa Syndrome:
wastng away of cent
- Unexpaned rapd weght
oss, anorexa wth atered
sme and taste
- Cataboc state: use of
bodys tssue and musce
protens to support cancer
ce growth
F. Paraneopastc Syndromes:
ectopc stes wth excess
hormone producton
- Parathyrod hormone
(Hypercacema)
- Ectopc secreton of nsun
(hypogycema)
- Antduretc hormone (ADH:
fud retenton)
- Adrenocortcotropc hormone
(ACTH)
G. Pan: ma|or concern of cents
and fames assocated wth
cancer.
Source Decri-tio
n
Underlyin
g Cancer
Bone
Metastass
Throbbng,
achng
Breast,
Prostate,
myeoma
Nerve
Compress
on
Burnng,
Sharp,
Tngng
Breast,
Prostate,
Lymphoma
Lymphatc
or Venous
Obstructo
n
Du,
Achng,
Tghtness
Breast,
Kapos,
Lymphoma
Ischema Sharp,
Throbbng
Kapos
Organ
Obstructo
n
Du,
Crampy,
gnawng
Coon,
Gastrc
Organ
Inftraton
Dstenton,
Crampy
Lver,
Pancreas
Skn
nfammat
on,
nfecton,
necross
Burnng,
sharp
Breast,
head, neck
Kapos
H. Physca Stress: body tres to
respond and destroy neopasm
- Fatgue
- Weght oss
- Anema
- Dehydraton
- Eectroyte mbaance
I. Psychoogca Stress
- Cancer equas death
sentence
- Gut from poor heath habts
- Fear of pan, sufferng, and
death
- Stgmatzed
COLLABORA.I)E CARE
Dagnostc Tests:
a. Determne ocaton of cancer
- X-rays
- Computed tomography
- Utrasound
- Magnetc resonance magng
- Nucear magng
- Angography
b. Dagnoss of ceuar type of
cancer - can be done through
tssue sampes from bopses,
shedded ces, ( e.g.
Papancoaou smear) washngs
- Cytoogc examnaton:
tssue examned under
mcroscope
- Identfcaton System of
Tumors: Cassfcaton -
Gradng - Stagng
- Cassfcaton: accordng to
the tssue or ce of orgn,
e.g. sarcoma, from
supportve tssue
- Gradng:
o Evauates degree of
dfferentaton and rate of
growth
o Grade 1 (east
aggressve) to Grade IV
( most aggressve)
- Stagng
o Reatve tumor sze and
extent of dsease
o TNM (Tumor sze, Nodes:
Lymph node nvovement:
metastases)
c. Tumor markers: specfc
protens whch ndcate
magnancy
- PSA ( Prostatc-specfc
antgen): prostate cancer
- CEA ( Carcnoembryonc
antgen): coon cancer
- Akane Phosphatase: bone
metastass
- CA 125: cancer of the breast
and endometrum
d. Drect Vsuazaton
- Sgmodoscopy
- Cystoscopy
- Endoscopy
- Bronchoscopy
- Exporatory surgery: ymph
node bopses to determne
metastases
e. Other non-specfc tests
- CBC, Dfferenta
- Eectroytes
- Bood Chemstres
- Lver enzymes: aanne
amnotransferase
(ALT);aspartate
amnotransferase (AST)
actc dehydrogenase(LDH)
Treatment Goas: dependng on type
and stage of cancer
a. Cure
- Recover from specfc cancer
wth treatment
- Aert for recurrence
- May nvove rehabtaton
wth physca and
occupatona therapy
- Three seasons of survva
o Dagnoss/treatment
o Extended survva:
treatment competed and
watchfu watng
o Permanent survva: rsk
of recurrence s sma
b. Contro: contro of symptoms
and progresson of cancer
- Contnued surveance
- Treatment when ndcated
( e.g some badder cancer,
prostate cancer)
c. Paaton of symptoms: may
nvove termna care f cents
cancer s not respondng to
treatment
.REA./EN. OP.IONS
(depend on type of cancer) aone or
wth combnaton
Drug Cla
and
E0a%-le
/ec*ani
% o"
Action
Co%%on Side
E""ect
Alkylating
Agents
Busulfan,
carboplastin,
chlorambucil,
cisplatin,
cyclophospham
ide,
dacarbazine,
hexamethyl
melamine,
ifosfamide ,
melphalan,
nitrogen
mustard,
thiotepa
Alter DNA
structure by
misreading
DNA code,
initiating
breaks in
the DNA
molecule,
cross-
linking DNA
strands
Bone marrow
suppressions,
nausea,
vomiting,
cystitiscyclopho
sphamide,
ifosfamide!,
stomatitis,
alopecia,
gonadal
suppression,
renal toxicity
cisplatin!
Nitrourea Smar to Deayed and
Carmustne
(BCNU),
omustne
(CCNU),
semustne
(methy
CCNU,
streptozocn
the
akyatng
agents:
cross the
bood -
bran
barrer
cumuatve
myeosupress
on, especay
thrombocutope
na: nausea,
vomtng
.o-oio%er
ae 1
In*i&itor
Irnotecan,
topotecan
Induce
breaks n
the DNA
strands by
bndng to
enzyme
toposome
rase 1,
preventn
g ces
from
dvdng
Bone marrow
suppresson,
darrhea,
nausea,
vomtng,
hepato-toxcty
Anti%eta&ol
ite
5-
azacytadne,
cytarabne,
Interferen
ce wth
the
bosynthe
ss of
Nausea,
vomtng,
darrhea, bone
marrow
suppresson,
edatrexate
fudarabne,
5-fuorouc
(5-FU), FUDR,
genctabne,h
ydroxyurea,
6-
mercaptopur
ne,
methotrexate
, pentostatn,
6-thoguanne
metabote
s or
nucec
acds
necessary
for RNA
and DNA
synthess
proctts,
stomatts,
rena toxcty
( methotrexate
),
hepatotoxcty
Antitu%or
Anti&iotic
Beomycn,
dactnomycn,
daunorubcn,
doxorubcn

(Andramycn)
, darubcn,
mtomycn,
mtoxantrone,
pcamycn
Interfere
wth DNA
synthess
by bndng
DNA;
prevent
RNA
synthess
Bone marrow
suppresson,
nausea,
vomtng,
aopeca,
anorexa,
cardac toxcty
(daunorubcn,
doxorubcn)
/itotic Arrest Bone marrow
S-indle
Poion
Pant
akaods:
etoposde,
tenposde,
vnbastne,
vncrstne
( VCR),
vndesne,
vnorebne
taxanes:
pactaxe,
docetax
metaphas
e by
nhbtng
mtotc
tubuar
formaton
(spnde):
nhbt
DNA and
proten
synthess
Arrest
metaphas
e by
nhbtng
tubun
depoymer
zaton
suppresson
(md wth
VCR),
neuropaths
(VCR),
stomatts
,or%onal
Agent
Androgens
and
antandrogen
s, estrogens
and
Bnd to
hormone
receptor
stes that
ater
ceuar
growth:
Hypercacema
, |aundce,
ncrease
appette,
mascunzato
n,
femnzaton,
antestrogen,
progestns
and
antprogestn
s, aromatase
nhbtors,
utenzng
hormone -
reeasng
hormone
anaogs,
sterod
bock
bndng of
estrogens
to
receptor
stes
( antestro
gens):
nhbt
RNA
synthess;
suppress
aromatase
of
cytochrom
e P450
system,
whch
decrease
estrogen
eve
sodum and
fud retenton,
nausea,
vomtng, hot
fashes,
vagna
dryness
C,E/O.,ERAPY
- Admnstraton of
chemotherapeutc agents
a. Traned and certfed personne,
accordng to estabshed gudenes
b. Preparaton
- Protect personne from toxc
effects
- Extreme care for correct
dosage; doube check wth
physcan orders,
pharmacsts preparaton
c. Proper dsposa of cents excreta
d. Routes
- Ora
- Body cavty ntrapertonea
or ntrapeura
- Intravenous
o Use of vascuar access
devces because of threat
of extravasaton
( eakage nto tssues)
and for ong-term therapy
o Types of vascuar access
devces
- PICC nes (perpheray
nserted centra catheters)
- Tunneed catheters
(Hckman, Groshong)
- Surgcay mpanted ports
( accessed wth 90 degrees
ange neede)
e. Nursng care of cents recevng
chemotherapy
Assess and manage
o Toxc effects of drugs ( report to
physcan)
o Sde effects of drugs: manage
nfammaton and uceraton of
mucous membranes, har oss,
anorexa, nausea and vomtng wth
specfc nursng and medca
nterventons
Montor ab resuts ( drugs wthhed f
bood counts serousy ow); bood and
bood product admnstraton
Assess for dehydraton, oncoogc
emergences
Teach regardng fatgue,
mmunosuppresson precautons
Provde emotona and sprtua
support to cents and fames
SURGERY
a. Dagnoss, stagng, and sometmes
treatment of cancer
b. Invoves remova of body part,
organ, sometmes wth atered
functonng ( e.g. coostomy)
c. Debukng (decrease sze) of
tumors n advances cases
d. Reconstructon and rehabtaton
(e.g breast mpant post
mastectomy)
e. Psychoogca support to dea wth
surgery as we as cancer dagnoss
RADIA.ION .,ERAPY
a. Treatment of choce for some
tumors to k or reduce tumor,
reeve pan or obstructon
b. Devery
- Teetherapy (externa):
radaton devered n
unform dose to tumor
- Brachytherapy: devers hgh
dose to tumor and ess to
other tssues; radaton
source s paced n tumor or
next to t
- Combnaton
c. Goas
- Maxmum tumor contro wth
mnma damage to norma
tssues
- Caregvers must protect
seves by usng sheds,
dstancng and mtng tme
wth the cent, foowng
safety protocos
d. Treatment schedues
- Panned accordng to
radosenstvty of tumor,
toerance of cent
- Montor bood ce counts
e. Sde Effects
- Skn ( externa radaton):
banchng, erythema,
soughng
- Ucerated mucous
membranes: pan, ack of
sava
- Gastrontestna: nausea and
vomtng, darrhea, beedng,
sometmes fstua formaton
- Radaton pneumona
BIO.,ERAPY
a. Modfcaton of boogc processes
that resut n magnances; based on
mmune surveance hypothess
b. Used for hematoogca
magnances, rena and meanoma
c. Monocona antbodes ( nocuate
anma wth tumor antgen and
retreve aganst tumor for human)
P,O.ODYNA/IC .,ERAPY
a. Cent gvng photosenstzng
compound whch concentrates n
magnant tssue
b. Later gven aser treatment to
destroy tumor
BONE /ARRO2 .RANSPLAN.A.ION
AND PERIP,ERAL BLOOD S.E/ CELL
.RANSPALAN.A.ION
a. Stmuaton of nonfunctonng
marrow or repace bone marrow
b. Common treatment for eukema
PAIN CON.ROL
a. Incudes pan drecty from cancer,
treatment or unreated
b. Necessary for contnung functon
or comfort n termnay cent
c. Goa s maxmum reef wth
mnma sde effects
d. Mutpe combnatons of anagescs
(narcotc and non-narcotc) and
ad|uvants such as sterods or
antdepressants; ncudes around the
cock (ATC) schedue wth addtona
medcatons for break-through pan
e. Mutpe routes of medcatons
f. May nvove n|ectons of anesthetcs
nto nerve, surgca severng of
nerves radaton
g. May need to progress to stronger
pan medcatons as pan ncreases
and cent deveops toerance to pan
medcaton
NURSING DIAGNOSES +OR CLIEN.S
2I., CANCER
An0iety
a. Therapeutc nteractons wth cent
and famy; communty resources
such as Amercan Cancer Socety, " I
Can Cope"
b. Avaabty of communty resources
for termnay (Hospce care n-
patent, home care)
Ditur&ed Body I%age
a. Incudes oss of body parts ( e.g.
amputatons): appearance changes
(skn, har); atered functons ( eg
coostomy): cachexc appearance,
oss of energy, abty to be
productve
b. Fear of re|ecton, stgma
Antici-atory Grieving
a. Facng death and makng
preparatons for death; w be
consderaton
b. Offer reastc hope that cancer
treatment may be successfu
Ri! "or In"ection
Ri! "or In3ury
a. Organ obstructon
b. Pathoogca fractures
Altered Nutrition# le t*an &ody
re4uire%ent
a. Consutaton wth detcan, ab
evauaton of nutrtona status
b. Managng probems wth eatng:
anorexa, nausea and vomtng
c. May nvove use of parentera
nutrton
I%-aired .iue Integrity
a. Ora, pharyngea, esophagea
tssues ( due to chemotherapy,
beedng due to ow pateet counts,
funga nfectons such as thrush)
b. Teach nspecton, frequent ora
hygene, specfc non-rrtatng
products, thrush contro
ONCOLOGIC E/ERGENCIES
Pericardial e""uion and
Neo-latic Cardiac .a%-onade
a. Concern: compresson of heart by
fud n the percarda sac,
compromsed cardac output
b. Treatment: percardocentess
Su-erior )ena Cava Syndro%e
a. Concern: obstructon of venous
system wth ncreases venous
pressure and stass; faca and neck
edema wth sow progresson to
respratory dstress
b. Treatment: respratory support:
decrease tumor sze wth radaton or
chemotherapy
Se-i and Se-tic S*oc!
a. Concern: eary recognton of
nfecton
b. Treatment: prompt
S-inal Cord Co%-reion
a. Concern: pressure from expandng
tumor can cause rreversbe
parapega; back pan nta
symptom wth progressve
paresthesas; eg pan weakness
b. Treatment : eary detecton and
radaton or surgca decompresson
O&tructive Uro-at*y
a. Concern: bockage of urne fow;
undagnosed can resut n rea faure
b. Treatment: restore urne fow
,y-ercalce%ia
a. Concern: hgh cacum from ectopc
parathyrod hormone or metastases
b. Behavors: fatgue, musce
weakness, poyura, constpaton
progressng to coma, sezures
c. Treatment: restore fuds wth
ntravenous sane; oop duretcs;
more defntve treatments
,y-erurice%ia
a. Concern: occurs wth rapd necross
of tumor ces as wth chemotherapy;
can resut n rena damage and
faure
b. Preventon and treatment wth
fuds and aopurno (Zyoprm)
SAID, $SYNDRO/E O+
INAPPROPRIA.E AN.IDIURE.IC
,OR/ONE SECRE.ION(
a. Concern: ectopc ADH producton
from tumor eads to excessve
hyponatrema
b. Treatment: restore sodum eve