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ONCOLOGY
WHAT YOU NEED TO KNOW
Cancer is the second leading cause of death in the Untied Stales. One in three Americans will suffer from
sonic form of cancer. Before we begin the review, test your general knowledge base with the questions on
the next page:
1. The location of cancer with the highest mortality rate is the ___________
2. In males, the two locations with the highest incidence of cancer are:
A. ______________
B.
3. In females, the Iwo locations with the highest incident of cancer are:
A.
B.
4. Three general signs and symptoms of cancer include:
A.
B.
C.
5. A
is a substance that can cause changes in a cell that can lead to cancer.
6. The number one risk factor for developing lung cancer is
7. A diet high in
and low in
places an individual at increased risk of colon cancer.
8. Infection with the human immunodeficiency virus (HIV) increases the risk of developing which two
types of cancer?
A.
B.
9. Three host factors that increase the risk of developing cancer that cannot be controlled include:
A.
B.
C.
10. When a tumor spreads from its primary site, it is called a
11. List the five most common sites of tumor migration:
________________

_______________

_________________

______________

_________________
________________
___________

________________

_________

__________

______________

________________

_______________

_________________
________________

A.

B.
C.

_______________
________________

_______________

D.
E.
Nurses can educate their clients to decrease their risk of developing cancer by instructing them to:
Avoid lung irritants including tirst- and second-hand smoke
Eat low-fat, high-tiber diets
Limit alcohol intake
Avoid direct exposure to sunlight by using sunscreen and protective clothing
Practice safe sex (barrier contraception)
Participate in regular cancer screening programs, based on age and risk groups
CANCER TYPES AND LOCATIONS
It is helpful to recognize types of cancer associated with different tissue types and sites for the NCLEXRN. Try the exercise below to test your understanding of basic anatomy and physiology. Remember: The
base/root word of the cancer usually identifies the tissue type, i.e., osteo = bone.
______________

_________________

12. surface epithelial A. Ostcosarcoma

13. glandular epithclial B. Rhabdomyosarcoma
14. fibrous connective tissue C. Adenosarcoma
15. adipose tissue D. Chondrosarcoma
16. cartilage E. Neurolemic sarcoma
17. bone F. Fibrosarcoma
18. blood vessels G. Leukemia
19. lymph vessels H. Squamous cell sarcoma
20. smooth muscle I. Hemangiosarcoma
21. striated muscle J. Liposarcoma
22. gliul tissue K. Lymphangiosarcoma
23. nerve sheath L. Leiomyosarcoma

24. blood M. Glioma

BASIC CANCER SCREENING GUIDE
For the NCLEX-RN, you should be familiar with the general guidelines for cancer screening

summarized in the table below:

TUMOR STAGING
The TNM system of classification for breast cancer is based on evaluating the spread of disease.
T=tumors size. The range is T0-T4, with TO being no evidence of tumor and t$ being an extensive tumor
that extends into the chest wall or skin. N=Lymph node involvement. The range is from NO-N3. NO
indicates that flO nodes are involved; N3 indicates that there is extensive involvement in the ipsilatcral
internal mammary nodes. M= metastasis; MO = no metastasis; M 1 signifies that metastases are present.
When a tumor is staged by the TNM system as T2 NO MO, it means:

and
TUMOR MARKERS
Tumor markers are monitored for decreases or increases that may correlate closely with responses to
treatment and reoccurrence or spread of disease. u-fetoprotein is a fetal antigen normally not expressed
during adulthood. It can oficu be detected in the blood of clients with liver cancer and germ cell tumors of
the ovary and testes. Carcinoembryonic

Test

Who?

Age

Frequency

Pap smear, Pelvic

examination

Women

Age 18 or when
sexually active and
beyond

Yearly

Breast self exam

Women

Age 20 and beyond

Monthly

Breast clinical exam

Women

Age 20 and beyond

Yearly

Testicular self exam

Men

Age 16 and beyond

Monthly

Sigmoidoscopy

Men and

Age 50 and beyond

Every 3 years

women
Stool occult blood

Men and
women

Age 50 and beyond

Yearly

Digital rectal exam

(prostate check for men)

Men and
women

Age 40 and beyond

Yearly

Age 35 and beyond

Ages 35-40: one baseline

exam Ages 4 1-50: every 2
years
Ages 51 and beyond: yearly

Mammography

Women

antigen (CEA) is an embryonic antigen present in 75 percent of clients with colorectal cancer. It can be
monitored through simple blood wok. A recently popularized tumor marker to follow in men over 40
years old is the prostatic acid phosphatase enzyme. It is usually elevated with prostate enlargement either
from cancer or benign prostatic hypertrophy.
If a 48-year-old male has a routine prostate-special antigen screening test and there is a significant
increase from last years value, what type of cancer would it most likely indicate?
NURSING CARE OF THE CLIENT RECEIVING RADIATION
Approximately 50 percent of client with cancer receive some form of radiation, especially those with
carcinoma, Hodgkins disease, or cancer of the larynx and cervix.
The therapeutic goals of radiation include:
Cure
Tumor reduction for comfort
Maintenance of tumor size during chemotherapy or preparation for surgery
Radiation can immediately kill cells or interrupt cell replication by directly hitting the target cells or by
interacting with critical cell components. Since DNA synthesis is inhibited by radiation, rapidly dividing
cells are affected the most, including cancer cells, gastrointestinal cells, and bone marrow cells. The
vascular changes associated with radiation are dose-dependent. Immediately after radiation, expect the
irradiated area to be reddened and dry. After several treatments, the small vessels in the area may be
damaged or destroyed. With low-dose radiation, the cells can repair themselves between treatments.
TRUE OR FALSE?
The marks indicating the area to be treated with radiation should be washed off immediately after the
treatment to avoid skin breakdown.
The client should wear light, loose clothing.
The client may use moisturizing lotions.
Clients should use sunscreen on treated areas when they are outside
typical side effects Ofl radiation therapy include mucositis, nausea, vomiting, and hair loss.
A client receiving internal radiation may have radioactive excretions.
A client receiving external radiation may have radioactive excretions.
SIDE EFFECTS OF RADIATION
_________________

The adverse effects of radiation therapy vary from client to client. Nutrition must be addressed and an
individualized plan followed for each client. For example. clients receiving radiation to their body
anywhere Form the lung up may experience severe dry mouth at any time during and after the treatment.
This can progress and cause dysphagia. thus compromising nutritional intake. Moist, sofi foods and a lot
of liquid should be encouraged with these clients. Radiation to the lower gastrointestinal tract can cause
constipation or diarrhea.
Nutritional Concerns of Lower Gastrointestinal Radiation Therapy Constipation Encourage fluids
Increase dietary fiber (unless enteritis is present)
_____________________ Increase physical activity as tolerated
Diarrhea Low-fiber diet
_____________________ Protect skin from excoriation
NURSING CARE OF TIlE CLIENT RECEIVING ChEMOThERAPY
Only nurses trained in handling chcmotherapcutic medication should administer them. For the NCLEXRN, you need to know some general principles for the administration f chemotherapy:
34. All drugs must be mixed using the proper protective gear, including:
A.
B.
C.
35. The five rights of drug administration are:
A.
B.
C.
D.
E.
Monitor lab values and know when to hold the medication based on white blood cell count, platelet
count, or creatinine changes.
The normal range for white blood ceLl count is (36.)
The normal range for platelets is (37.)
The normal creatinine range is (38.)
Use a 39 (large / small) bore needle in the most (40. distal / proximal) vein that is accessible and large
enough to tolerate the amount of fluid to be delivered.
_____________

______________
______________

______________

_______________
_______________
______________

________________

________________

__________________

_________________

Prepare IV site aseptically to avoid infection.

Frequently ensure proper line placement to avoid tissue infiltration or necrosis.
41. Signs and symptoms of tissue infiltration include:
A.
B.
C.
D.
E.
Check for signs and symptoms of infection before and after chemotherapy. The risk of infection
increases dramatically when the neutrophils fall to 1 ,000/mL.
Double check that drugs are mixed properly and the correct amount of fluid is given to the client before,
during, and after chemotherapy. Many drugs can be toxic to the kidneys if not diluted enough.
Monitor for signs and symptoms of chemotherapy-induced toxicity, including a discrepancy in input and
output that could signal renal failure, fever, nausea, vomiting, and bone marrow suppression.
in an oncology client a fever that may signal an underlying infection if one that is over 101.3
Fahrenheit (38 Celsius) for 24 hours or more.
______________

_________________
________________
_______________

_________________

SIDE EFFECTS OF CHEMOTHERAPY

The effects of chemotherapy vary from client to client, and range form mild to severe. Nursing support
must be individualized for each client and must include nutritional support. Most of the side efiects of the
common chemotherapy drugs occur because of the medications effects on rapidly dividing cells. Though
there arc many different classes of drugs used in chemotherapy depending on the type and location of the
tumor, the side effects vary only in intensity and duration.
42. Anemia and low white blood cell counts occur because of
43. Alopccia is the result of damage to the rapidly dividing
44. Sterility occurs because of action against the
Other side effects that vary in intensity, duration, and frequency include: stomatositis, dehydration.
malnutrition, diarrhea, and paresihesia.
______________

________________

45. Common causes of nausea and vomiting in oncology clients include:

A.
B.
C.
D.
E.
46. Three way to help manage chemotherapy-induced nausea and vomiting arc:
A.
B.
C.
47. List three types of nausea and vomiting related to chemotherapy:
A.
13.
C.
48. Should antinausca medication be given after the first treatment of chemotherapy, when the client asks
for it. or before the chemotherapy begins?
49. If the chemotherapeutic agent has a long half life, how long should the antinausea medications be
continued?
50. List three common side effects of the serotonin antagonists (Kytril) granisetron and Zofran
(ondansetron):
A.
B.
C.
51. Are Kytril and Zofran used primarily for long term or acute control of emesis?
52. Reglan (metoclopramide) is a benzamide that is used to control nausea and vomiting. List the three
most common side effects:
A.
B.
C.
53. Akathisia is defined as
______________

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_______________
______________

_________________

______________

_______________
______________

______________

_______________

______________

_______________

____________

_____________
_____________

__________________

____________

_____________
_____________

______

54. Es Compazinc (Prochiorperazinc) best used for long-term or short-term control of nausea and
vomiting?
55. Is it best to give medications rectally when a client is complaining of nausea?
______________

To support the client who is experiencing nausea and vomiting, instruct him or her not to lie down after
meals, to eat odorless, nutrient-dense foods, and to limit liquids taken with meals. In addition, the client
should be instructed to avoid greasy, high-fat foods. If the client is constipated, encourage fluids and
increase physical activity and fiber as indicated (assess for damage to the lining of the gastrointestinal
tract; if present. avoid fiber). Mucositis is a common side effect of chemotherapy. and bland, moist, soft
foods should be encouraged. Daily mouth care is imperative in these clients, as mucositis can cause
dysphagia and tremendous discomfort.
NURSING CARE OF THE CLIENT UNDERGOING SURGERY
Surgery is used to help diagnose cancer, stage tumor spread, remove solid tumors, and provide palliative
relief to clients. General preoperative and postoperative care for an oncology client is essentially the same
as it is for other surgical clients. Special attention should be given to the clients psychological condition
if it is an exploratory or diagnostic surgery, since many clients will suffer from anxiety and fear.
The following care plan for the client undergoing mastectomy applies to most forms of cancer and is a
good general guide to nursing interventions for the client undergoing any type of surgery.
Coping related to unknown Assess clients prior surgical Clients who have
events surrounding breast experiences knowledge and
who arc able to
Client can explain Obtain feedback of clients cope with their
surgical procedure and knowledge of this surgery and fears or concerns
preoperative routine perioperative routine vill recover more
rapidly
Provide specific information to
resolve misconceptions
Allow time for questions and
concerns, especially about loss of
her breast

Nursing Diagnosis
interventions Rationale
Expected Outcome
Preoperative

Provide emotional support to

client and partner

Postoperative
high risk for infection in
wound because of removal
of lymph channels and
presence of wound drainage
system
Client will have
decreased wound drainage and

Assess drainage system for

patency; color, odor, amount, and
type of secretions; and proper
suctioning
Instruct client on proper care of
wound drainage system: cleaning
site and catheter insertion site:
emptying infection collection

Clients who arc able to care for

themselves recover more rapidly;

maintaining suction reduces risk

of a scroma; cleaning wound and
catheter insertion sites reduces
risk of infection

removal of drains about 7-10

(lays after surgeri with no
signs of

device; recording amount, color,

and type of drainage; maintaining
suction collection device
Have client demonstrate home
care of wound drainage system
following instruction

Have client report signs of

infection: fever, redness at surgical
site, or purulent drainage
Assess clients ability to inspect

Grieving over body

alteration
client and partner will adjust
nornall to altered breast
appearance

her breast after surgery

Assist client in looking at surgical
site if needed
Listen attentively to clients and
partners concern to provide
emotional support
Request Reach to Recovery visit

Emotional healing to loss of a

breast takes time for most
women

for in the hospital or after discharge

Altered tissue perfusion

related to removal of some
lymph nodes in surgical site
client will verbalize care for
her arm on surgical side to
prevent or control_lmphedeina

Instruct client to avoid heavy

lifting: getting a blood pressure,
intravenous lines. laboratory
studies on affected arm;
infections from burns, sewing,
or gardening hospital or after
discharge

Some clients are prone to

develop lymphedema:
prevention is less difficult and
costly than treating
lymphedema