Oncology (from the Ancient Greek onkos meaning

bulk, mass, or tumor; and suffix logy meaning

study of) is a branch of medicine that deals with
tumors (cancer).
Oncologist - a medical professional who practices
oncology.
Oncology is concerned with:

The diagnosis of any cancer in a person

Therapy (e.g., surgery, chemotherapy,
radiotherapy, and other modalities)
Follow-up of cancer patients after successful
treatment
Palliative care of patients with terminal
malignancies
Ethical questions surrounding cancer care
Screening efforts:
o Of population, or
o Of the relatives of patients (in types of
cancer that are thought to have a
hereditary basis, such as breast
cancer.

Cancer Cells
Small
-

Multiple nuclei
Multiple and

Coarse

A. Characteristics of Normal Cells

The Biology of Normal Cells
1) Have limited cell division
2) Undergo Apoptosis
3) Show specific morphology
4) Perform specific differentiated functions
5) Adhere tightly together
6) Non migratory
7) Grow in the orderly and well regulated
manner
8) Are euploid

B. Evolution of Cancer Cells

1. Cancer Refers to a disease whereby cells
mutate into abnormal cells that proliferate
abnormally.
Neoplasia Refers to an abnormal cell
growth or tumor.
- A mass of new tissue
functioning independently and serving no
useful purpose
2. Invasion Occurs when cancer cells infiltrate
adjacent tissue surrounding the neoplasm
3. Metastasis Occurs when malignant cells
travel through the blood or lymph system and
invade other tissues and
organs to form a secondary tumor.

Normal vs. Cancer cell Structure

Normal Cells

Large cytoplasm
cytoplasm

Single nucleus

Single nucleus
large nuclei

Fine chromatin
chromatin

number of normal cells

D. Metaplasia Refers to the conversion from the
normal pattern of differentiation of one type of cell
into another type of cell not normal for that tissue.
Replacement of other mature cell.
E. Dysplasia Refers to an alteration in the shape,
size, appearance and of cells (reversible)
F. Anaplasia Refers to disorganized, irregular cells
that have nor structure and have loss differentiation;
the result is always malignant (undifferentiated cells)

Normal cell growth(Cell Cycle) consists of 5

intervals or phases
Differentiation - Refers to the process
whereby cells develop specific
structures and functions in order to
specialize in certain tasks.
Apoptosis cell suicide, normal event.
Cellular adaptation
A. Hypertrophy Refers to an increase
in size of normal cells
B. Atrophy Refers to the shrinkage of
cell size
C. Hyperplasia Refers to an increase
in the

C. Characteristics of malignant cells

1. Rapid cell division and growth: regulation of
the mitosis is lost
2. No contact inhibition: Cells do not respect
boundaries of other cells and invade other
tissue areas.
3. Loss of differentiation: Cells lose specialized
characteristics of function for that cell type
and revert back to an earlier, more primitive
cell type.
4. Ability to migrate (metastasize): cells move
to distant areas of the body and establish
new site malignant lesion (tumor).
5. Alteration in cell stracture differences are
evident between normal and malignant cells
with respect to cell membrane, cytoplasm
and overall cell shape.
6. Self survival
a. May develop ectopic sites to produce
hormones needed for growth
b. Can develop a connective tissue stroma
to support growth
c. May develop own blood supply by
secreting agiotensin growth factor to
stimulate local blood vessels to grow
into tumor
D. Epidemiology of Cancer
1. Incidence of cancer
a. Cancer affects every age group though
most cancer and cancer death occur in
people older than 65 years of age
b. Cancer ranks 3rd as the cause of
morbidity in the Philippines
c. Highest incidence of all cancer is
prostrate cancer

d.

Highest cancer incidence in males in

order of frequency: prostate cancer,
lung cancer and colorectal cancer

e.

Highest cancer incidence in females in

order of frequency: breast cancer, lung
cancer and colorectal cancer

Common sites of cancer and their sites of metastasis

Cancer Type
1. Brain cancer
Central Nervous System
2. Breast cancer
Brain
Liver
Lung
Regional lymph nodes
Vertebrae
3. Colon cancer
Brain
Liver
Lung
Lymph nodes
Ovaries
4. Lung cancer
Brain
Liver
Lung
Lymph nodes
Pancreas
Spinal cord
5. Prostate cancer
Bladder
Bone
Liver
Ex. Epstein Barr
Genital herpes
External factors causing CANCER
Papillomavirus
1. Chemical Carcinogens over 1,000 chemicals are
Hepatitis B
known to be carcinogenic
Human cytomegalovirus

Alcoholic beverages (Liver, esophagus,

mouth, breast colon)

Severe as a promoter in cancer of the liver

esophagus

When combined with tobacco, the risk for

4. Dietary Factors
other cancer are even higher
Diets high in fat, low in fiber and those

Anabolic Steroid (Liver)

containing nitrosamines found in preserved

Arsenic (Lung; Skin)

meats and pickled foods promote certain

Asbestos (Lung; Peritoneum)

canncer such as colon, breast, esophageal and

Benzene (Leukemia)
gastric

Diesel exhaust (Lung)

Hair dyes (Bladder)

Personal factors causing CANCER

Pesticides (Lungs)
1. Immune Factions

Sunlight (Skin; Eyes)

2. Age

Tobacco (Lungs; Esophagus;

a. Increased risk for people over age of 65

Mouth; Pharynx; Larynx)

b. Factors attributed to cancer in elderly

Smokeless tobacco (snuff and chewing tobacco)

include hormonal change3s, altered
increases the risk of oral and esophageal
responses and the accumulation of free
cancers
radicals
* Long term exposure to second hand smoke
c. Age has been identified as the single most
increase the risk for lung and bladder cancer
important factor related to the
development of cancer
3. Gender
2. Physical Carcinogens
a. Certain cancers are more commonly seen in
Radiation
specific genders
Chronic Irritation GERD
Ex: Breast cancer most common in
3. Viral Carcinogens
female
Some viral infections tend to increase risk of
Colon cancer more common in
cancer
males

4. Genetic Risk

15% of cancer may be attributed to a

hereditary component
Ex:
Breast, colon, lung, ovarian and
prostate cancer
5. Race can affect any population
- African Americans experience a higher rate
of cancer than any other racial of ethnic group

CARCINOGENESIS: Transformation of Normal Cells

into Cancer Cells
1.

Initiation occurs when carcinogen damages DNA

a. Carcinogenesis cause changes in the
structure and function of the cell at the
genetic or molecular level. This damage
may be reversible or may lead to genetic
mutations if not repaired: however the
mutations may lead immediately to cancer

2.

Promotion occurs with additional assaults to the

cell, resulting in further genetic damage
These genetic events result in a malignant
conversion
Progression the cells are increasingly malignant
in appearance and behaviour and develop into an
invasive cancer with metastases to distant body
parts

3.
4.

Comparison of the Characteristics of Normal and Cancer Cells

Characteristic
Mitotic cell division

Normal Cells
Mitotic division lead to 2
daughter cells

Appearance

1. Cells of same type

homogenous in size, shape, and
growth
2. Cells cohesive, form regular
pattern of expansion
3. Uniform size to nucleus
4. Have characteristic pattern
organization
5. Mixture of stem cells
(precursors) and well
differentiated cells

Growth pattern

1. Do not invade adjacent tissue

2. Proliferate in reponse to
specific stimuli
3. Grow in ideal conditions (ex:
nutrients, oxygens, space,
correct biochemical
environment)
4. Exhibit contact inhibition
5. Cell birth equals or is less
than cell death
6. Stable cell membrane
7. Constant or predictable
growth rate
8. Cannot grow outside specific
environment (Ex: breast cells
grow only in breast)
1. Have specific, designated
purpose

Function

Cancer Cells
Mitosis leads to multiple
daughter cells that may or may
not resemble the parent.
Multiple mitotic spindles
1. Cells larger and grow more
rapidly than normal;
pleomorphic
2. Cells not as cohesive;
irregular patterns of expansion
3. Larger, more prominent
nucleus
4. Lack characteristic pattern of
organization of host cell
5. Anaphylactic, lack of
differentiated cells
characteristics, specific
functions
1. Invade adjacent tissue
2. Proliferation in response to
abnormal stimuli
3. Grow in adverse conditions
such as a lack of nutrients
4. Do not exhibit contact
inhibition
5. Cell birth exceeds cell death
6. Loss of cell control a result of
cell control a result of cell
membrane changes
7. Growth rate erratic
8. Able to break off cells that
migrate through bloodstream or
lymphatics or seed to distant
sites and grow in other sites
1. Severe no useful purpose
2. Do not contribute to the well

2. Contribute to the overall well

being of the host
3. Function in specific,
predetermined manners (ex:
cells in the thyroid secrete
thyroid hormone)

Other

1. Develop specific antigens,

characteristic of the particular
cell formed
2. Chromosomes remain
constant throughout cell division
3. Complex metabolic and
enzyme pattern
4. Cannot invade, erode, or
spread
5. Cannot grow in presence of
necrosis or inflammation

being of the host; parasitic,

actually feed off host without
contributing anything
3. If cells function at all they do
not function normally or they
may actually cause damage (Ex:
Lung cancer cells secrete ACTH
and cause excessive stimulation
of adrenal cortex)
1. Develop antigens completely
different from normal cell
2. Chromosomal aberrations
3. Have more primitive and
simplified metabolic and
enzyme pattern
4. Invade, erode and spread
5. Grow in presence of necrosis
and inflammatory cells such as
lymphocytes and macrophages
6. Exhibit periods of latency that
vary from tumor to tumor
7. Have own blood supply and
supporting stroma

Metastasis
Ability of cancer cell to spread from the original site of tumor to distant organs
Stages
1. Detachment

Tumor cell losses cohensiveness and it has increasing motility

Tumor cell detaches from the primary tumor and create defects in the basement membrane with
resulting stromal invasion and spread into circulation
2. Migration

Cancer cells migrate via the lymph or blood circulation or by direct extension

The lymphatic system provides the most common pathway for the initial spread of malignant, cancer
cell

The blood vessels carry cancer cells from the primary tumor to the capillary beds of the lungs, liver
and bones

Direct tumor extension of tumors to adjacent tissue also occurs

3. Dissemination
Cancer cell are established at the secondary site which may result from entrapment due to the size of
the tumor clump, adherence to cells through specific interaction or by binding to expose basement
membrane
4. Angiogenesis
Is the vascularisation of the tumor
The Immune system and Cancer
Two critical components of the iummune response
1. The ability to recognize a pathogen as foreign
2. The ability to mount a response to eliminate the pathogen
T call lymphocyte, macrophages and antigens recognize cancer cells as non self and destroy them

Immune Surveillance Theory

Purposes that immune responses, particularly cell mediated, provide a defense against cancer cells
by recognizing the antigens on the surface of some neoplastic cells as foreign
They are killed by cytotoxic T-cells trhat have receptors dor specific tumor antigens and by interferon
activated natural killer (NK) lymphocytes and macrophages
Macrophages phagocytise the pathogen and present it as antigen to T and B lymphocytes
Failure of Immune Defenses

The immune system may be unable to recognize cancer cells as foreign or to mount an immune
response due to the following:
a. Its immature, old or weak
b. Malnutrition are chronic ailment
c. Cancer cells escape detection because they resembles normal cells
Others produce substances that shield them from recognition or they may be coated with fibrin
d. Use of immunosuppressive drugs which can suppress immune system

Classification of Neoplasm
1. Benign from latin word Benigonus kind
- benign tumors are generally are self contained and localized and have a well defined perimeter. They
grow slowly expanding outward from a central mass. They are dangerous when they compress surrounding tissue. A
benign tumor near a blood vessel could restrict the flow of blood; in the abdomen it could impair digestion; in the
brain it could cause paralysis
2. Malignant malignant tumors are not self contained, and usually do not compress surrounding tissue. Their growth
is an irregular invation of adjacent cells. Although they may grow slowly, they are also capable of very rapid growth.
They are not localized; in a process called metastasis they shed cells that travel through the blood stream and infect
tissues at other locations. They can even establish malignant growth in the different type of tissue; a breast cancer can
spread to bone tissue, for example.

Characteristic
Speed growth

Mode of growth

Capsule

Cell Characteristic

Recurrence

Metastasis
Effect of neoplasm

Benign Neoplasm
Grows slowly
Usually continues to grow
throughout life unless surgically
removed may have periods of
remission
Grows by enlarging and
expanding
Always remains localized; never
infiltrates surrounding tissue
Almost always contained within
fibrous capsule
Capsule does not prevent
expansion of neoplasm but does
prevent growth by infiltrations
Capsule advantageous because
encapsulated tumor can be
removed surgically
Usually well differentiated
Mitotic figures absent or scanty
Anaplastic cells absent
Cells functions poorly in
comparison with normal cells
from which they arise
If neoplasm arises in glandular
tissue, cells may secrete
hormones
Unusual when surgically
removed
Never occur
Not harmful to host unless
located in area where it
compresses tissue or obstructs
vital organs

Malignant Neoplasm
Usually grows rapidly tend to
grow relentlessly throughout life
rarely, neoplasm may regress
spontaneously
Grows by infiltrating surrounding
tissues may remain localized (in
situ) but usually infiltrates other
tissues
Never contained within a
capsule
Absence of capsule allows
neoplastic cells to invade
surrounding tissues
Surgical removal of tumor
difficult
Usually poorly differentiate large
number of normal and abnormal
mitotic figures present
Cells tend to be anaplastic
Cells too abnormal to perform
any physiologic functions
occasionally a malignant tumor
arising main glandular tissue
secretes hormone
Common following surgery
because tumor cells spread into
surrounding tissues
Very common
Always harmful to host harmful
to host causes death unless
removed surgically or destroyed
by radiation or chemotherapy

Does not produce cachexia

(weight loss, debilitation,
anemia, weakness, wasting)

Prognosis

Very good
Tumor generally removed
surgically

Causes disfigurement, disrupted

organ function, nutritional
imbalances may result in
ulcerations. Sepsis, perforations,
haemorrhages, tissue slough
almost always produces
cachexia, which leaves person
prone to pneumonia, anemia
and other conditions
Depends on cell type and speed
of diagnosis
Poor prognosis if cells are poorly
differentiated and evidence of
metastatic spread exists
Good prognosis indicated if cells
still resemble normal cells and
there is no evidence of
metastasis

Classification of Cancer according to Tissue of Origin

1. Carcinoma refers to the tumor that arises from epithelial tissue: the name of the cancer identifies location
Ex: Basal cell Carcinoma
2. Sarcoma refers to a tumor arising from supportive tissue: the name of the cancer identifies the specific tissue
affected
Ex: Osteosarcoma
3. Adenocarcinoma from glandular tissue
Ex: Lungs, Ovaries
Tissue of Origin
Connective Tissue
Bone
Fibrous tissue
Adipose tissue
Epithelial Tissue
Glandular
Surface
Hematopoietic
Erythrocytes
Granulocytes
Lymphatic Tissue

Benign Neoplasm

Malignant Neoplasm

Osteoma
Fibroma
Lymphoma

Osteosarcoma
Fibrosarcoma
Liposarcoma

Adenoma
Papiloma

Adenocarcinoma
Squamous cell carcinoma

Lymphocytes
Plasma cells
Cancer Prevention and Control
1. Prevention involves measures to avoid or reduce
exposure to cancinogens
- Activities are aimed at interventions
before pathologic change has begun
2. Screening Helps to identify high risk populations
and individuals
3. Early Detection Involves finding a precancerous
lesion or a cancer at its earliest, most treatable stage
- also called secondary prevention
- methods
A. Inspection
B. Palpation
C. Use of test or procedures
Approaches to Cancer Prevention

Erythroleukemia
Leukemia
Hodgkins disease, Malignant
Lymphoma
Lymphocytic Leukaemia
Multiple myeloma
1. Education
2. Regulation prohibit the sale of tobacco and alcohol
to minors, limiting smoking in public places, imposing
excise taxes, regulating the use of manufactured
carcinogens such as asbestos, and prohibiting
carcinogens in foods
3. Host Modification aims to alter the bodys internal
environment to decrease the risk or to reverse a
carcinogenic process
Cancer Prevention
1. Skin: avoid exposure to sunlight
2. Oral: annual oral examination
3. Breast: Monthly BSE from age 20
4. Lungs: Avoid cigarette smoking; annual chest x-ray

5. Colon: DRE for person overage 40. Rectal biopsy,

proctosigmoidoscopic examination, Guiac stool
examination for persons age 50 and above
6. Uterus: annual papsmear from age 40
7. Basic: Annual physical examination and blood
examination
Dietary Recommendation Against Cancer
1. Avoid obesity
2. Cut down on total fat intake
3. Eat more high fiber foods raw fruits and
vegetables, whole grain cereal
4. Include food rich in vitamin A and C in daily diet
5. Include cruciferous vegetables in diet: broccoli,
cabbage, cauliflower, brussels sprouts
6. Be moderate in the consumption of alcoholic
beverages
7. Be moderate in the consumption of salt - cured,
smoke cured and nitrate cured foods
Recommendation of the American Cancer Society
for Early Cancer Detection
1. For detection of breast cancer
A. Beginning at age 20, routinely perform
monthly BSE
B. Women ages 20 39 should have breast
examination by a healthcare provider every 3 years
C. Women age 40 and older should have a
yearly mammogram and BSE by a healthcare provider
2. For detection of Colon and Rectal Cancer
A. All persons age 50 and older should have a
yearly fecal occult blood test
B. Digital rectal examination and flexible
sigmoidoscopy should be done every 5 years
C. Colonoscopy with barium enema should be
done every ten years
3. For detection of Uterine Cancer
A. Yearly papsmear for sexually active females
and any female over age 18
B. A menopause, high risk women should have
an endometrial tissue sample
4. For detection of Prostate Cancer
A. Beginning at age 50, have a yearly digital
rectal examination
B. Beginning age 50, have yearly prostate
specific antiogen (PSA) test

American Cancer Societys Seven 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 breast or else where
I indigestions or difficulty in swallowing
O - obvious change in wart or mole
N nagging cough or hoarseness
U Unexplained anemia
S sudden loss of weight
Diagnostic Tests of Cancer
1. Biopsy or Cytology
A. Histologic and Cytologic Examination of
specimens are performed by the pathologist on tissues
collected by needle aspiration of solid tumors,
exfoliation from epithel;ial surface and aspiration of
fluid from blood or badt cavities
B. Tissues may be obtained by excisional
biopsy, incisional biopsy and needle biopsy
C. By examination of these tissues, the name,
grade, and stage of the tumor can be identified
2. Papsmear
Class I: Normal
Class II: Inflammation
Class III: Mild to moderate dysplasia
Class IV: Probably Malignant
3. Ultrasound
4. MRI
5. X Rays
6. CT Scan
7. Radiographic Techniques
8. Antigen skin Test
9. Laboratory Test
A. Alpha- feto protein
B. HCG
C. Prostatic Acid Phosphase (PSA)
D. Carcinoembryonic Antigens (CEA)
10. Endoscopic Examination
11. Monoclonal Antibodies
Tumor Marklers
1. Tumor markers are protein substances found in the
blood or body fluids
2. Are release either by tumor itself, or by the body as
a defense in response to the tumor ( called Host
response)
3. Tumor markers are derive from the tumor itself
including:
A. Oncofetal Antigens, present normally in fetal
tissue, may indicate an anaplastic process in tumor
cells; carcinoembryonic antigen and alpha-fetoprotein
are examples of oncofetal antigens
B. Hormones are present in large quantities in
the human body; however, high levels of hormones
may indicate a hormone secreting malignancy;
hormones that may be utilized as tumor markers

include ADH, Calcitonin, Catecholamines, HCG and

parathyroid hormone

C. Isoenzymes that are normally present in a particular

tissue may be released in to blood stream if the tissue
is experiencing rapid, excessive growth as the result of
tumor; are examples include neuron specific enolase
(NSE) and prostatic acid phosphatise
D. Tissue specific proteins identify the type of
tissue affected by malignancy; an example is prostatic
specific antigen to identify prostate cancer
4. Host response tumor markers include:
A. C- reactive protein
B. Interleukin-2
C. Lactic dehydrogenase
D. Serum ferritin
E. Tumor necrosis factor
STAGING
1. The TNM tumor system is utilized for classifying
tumors
A. T indicates the tumor size
1. T0 indicates no evidence of tumor
2. T indicates tumors in situ
3. T1, T2, T3, T4, indicate progressive
degrees of tumor size and involvement
B. N indicates lymph node involvement
1. N0 indicates no abnormal lymph
node detected
2. N1a, N2a indicate regional nodes
involved with increasing degree from N1a to n2a, no
metastasis detected
3. N1b, n2b, N3b indicate regional
lymph nodes involvement with increasing degree from
N1b to n3b, metastasis suspected
4. Nx indicates inability to assess
regional nodes
C. M indicates distant metastases
1. M0 indicates no evidence of distant
metastases
2. M1, M2, M3 indicate ascending
degress of distant metastasis and includes distant
lymph nodes
Different Modalities for Cancer
1. Surgical interventions
2. Chemotherapy
3. Radiation therapy
4. Immunotherapy
5. Bone Marrow Transplantation
Surgical Intervention
1. Preventive surgery removal of precancerous
lesions or benign tumors
2. Diagnostic surgery biopsy
3. Curative surgery removal of an entire tumor
4. Reconstructive surgery improvement of structures
and function of an organ

5. Palliative surgery relief of distress in signs and

symptoms; retardations of metastasis

Common Nursing Techniques and Procedures

A. Radiation therapy
1. Is used to kill a tumor, reduce the tumor
size, relieve obstruction, or decrease pain
2. Causes lethal injury to DNA, so it can destroy
rapidly multiplying cancer cells, as well as normal cells
3. Can be classified as internal radiation
therapy (brachytherapy) or external radiation therapy
(teletherapy)
B. The client undergoing Brachytherapy (internal
radiation)
1. Sources
A. Implanted into affected tissue or body cavity
B. Ingested as a solution
C. Injected as a solution into the bloodstream or
body cavity
D. Introduced through a catheter into the tumor
2. Side effects
A. Fatigue
B. Anorexia
C. Immunosuppression
D. Other side effects similar to external radiation
3. Priority nursing diagnoses: Impaired tissue Integrity;
fatigue; anxiety; risk for infection; social isolation;
imbalanced nutrition: less than body requirements
4. Client education
A. Avoid close contact with others until treatment is
completed
b. maintain daily activities unless contraindicated,
allowing for extra rest periods as needed
c. maintain balanced diet; may tolerate food better
if consumes. Small frequent meals.
d. maintain fluid intake. Ensure adequate hydration
(2-3 liters/day)
e. if implant is temporary, maintain bedrest to avoid
dislodging the implant
f. excreted body fluids may be radioactive: doubleflush toilets after use
g. radiation therapy may lead to bone marrow
suppression
5. nursing management
a. exposure to small amounts of radiation is
possible during close contact with persons
receiving internal radiation: understand the
principles of protection from exposure to radiation:
time, distance, and shielding
> 1. Time: minimize time spent in close
proximity to the
radiation source; a common
standard is to limit contact
time to 30 minutes
total per 8-hour shift;minimum distance of 6 feet used
when possible.
> 2. Distance: maintain the maximum
distance possible
from the radiation
source.
> 3. Shielding: Used lead shields and other
precautions to reduce exposure to radiation.
b. Place client in private room.

c. Instruct visitors to maintain atleast a distance of

6 feet from the client and limit visitors to 10-30
minutes
d. Ensure proper handling and disposals of body
fluids, assuring the containers are marked
appropriately.
e. Ensure proper handling of bed linens and
clothing.
F. In the event of a dislodged implant, use longhandled forceps and place the implant to a lead
container; never directly touch the implant.
g. Do not allow pregnant woman to come in to any
contact with radiation.
h. If working routinely near radiation sources, wear a
monitoring device to measure exposure.
i. Educate the client in all safety measures.
6. Evaluation: Client demonstrates measures to
protect others from exposure to radiation, identifies
interventions to reduce risks of infection, remains free
from infection, achieves adequate fluid and nutritional
intake, activities of daily living (ADLs) at levels of
activity.
The client undergoing external radiation therapy
(Teletherapy)
1. The radiation oncologist marks specific locations for
radiation treatment using a semi-permanent type of
ink.
a. Treatment is usually given 15-30 minutes/
day, 5 day/
week, for 2-7 weeks
b. The client does not pose a risk for radiation
exposure to
other people.
2. Side effects of external radiation therapy
a. Tissue damage to target area ( erythema,
sloughing,
hemorrhage)
b. Ulceration of oral mucous membrane.
c. Gastrointestinal effects such as nausea,
vomiting, and diarrhea
d. Radiation pneumonia
e. Fatigue
f. Alopecia
g. Immunosuppression
3. Priority nursing diagnoses: Risk for infection;
Impaired skin integrity; Social isolation; Disturbed body
image; Anxiety; Fatigue
4. Client education exam for external radiation
a. Wash the marked area of the skin with plain
water only
and pat skin dry; do not use soaps,
deodorants, lotions,
perfume,
powders or
medications on the site during the
duration of the
treatment; do not wash off the treatment
side
marks.
b. Avoid rubbing, scratching, or scrubbing the
treatment
site; do not apply extreme temperature

( heat or cold) to
the treatment site; if shaving,
use only an electric razor.
c. Wear soft, loose fitting over the treatment
area.
d. Protect the skin from sun exposure duri9ng
the
treatment and for atleast after the treatment is
completed; when going outdoors, use
sunblocking agents
with sun protector factor (SPF)
of atleast 15.
e. Maintain proper rest, diet and fluid intake as
essential
to promoting health and repair of
normal tissues.
f. Hair loss may occur; choose a wig, hat, or
scarf to cover and protect head ( refer to care of
client with alopecia
later in chapter).

a. Risk for infection

b. Risk for hemmohrage
c. Risk for imbalance nutrition
d. Risk for social isolation
e. Anxiety
7. Nursing management of client undergoing a BMT
a. Monitor for graft- versus host disease
b. Provide private room for the hospitalized
client; client
will be hospitalized for 6-8 weeks
c. Encourage contact with significant others by
using telephone, computer and oher means of
communication
to reduce feelings of isolation.
d. Refer to management for imbalance
nutrition,
immunosuppression and
thromnbocytopenia

5. Nursing management of the client receiving external

radiation
a. Monitor for adverse side effects of radiation
b. Monitor for significant decreases in white
blood cell
counts and platelet counts.
c. Client teaching (refer to later sections for
management of immunosuppression,
thrombocytopenia)

8. Evaluation: Client evaluates understanding of risks

and participates in activities that reduce risk of infect
ion, hemorrhage and malnutrition; client demonstrates
effective coping mechanisms.

6. Evaluation: Client identifies interventions to reduce

risk of infection, remains free from infection, achieves
adequate fluid and nutritional intake, participates in
activities of daily living (ADLs) at level of activity, and
maintains intact skin

THE CLIENT UNDERGOING A BONE MARROW

TRANSPLANT (BMT)
1. BMT used in the treatment of leukemias , usually in
conjunction
with radiation or chemotherapy
a. autologous BMT the client is infused with
own bone
marrow harvested during remission od
disease.
b. allogenic BMT the client is infused with
donor bone
marrow harvested from a healthy
individual
2. The bone marrow is usually harvested from the iliac
crest, then frozen and stored until transfusion.
3. Before receiving the BMT, the client must first
undergo a face off immunosuppressive therapy to
destroy the immune system, infection, bleeding and
death are major complications that can occur during
this conditioning phase,
4. After immunosuppression, the bone marrow is
transfused intravenously through a central line.
5. Side effect of BMT
a. Malnutrition
b. Infection related to immunosuppression
c. Bleeding related to thrombocytopenia
6. Priority nursing diagnoses

THE CLIENT UNDERGOING OTHER THERAPEUTIC

INTERVETIONS
1. Immunotherapy/ Biologic response modifiers (BMR)
a. Enhances the persons own immune responses in
order to modify the biologic processes resulting in
malignant cells
b. Currently considered experimental in use
c. Monoclonal antibodies: antibodies are recovered
from an inoculated animal with a specific tumor
antigen, then given to the person with the particular
cancer type; the goal is destruction of tumor.
d.Cytokines: Normal growth regulating molecules
possessing anti tumor abilities
1. Interleukin 2 (IL 2) increases immune response
effective and destroys abnormal cells
2. Interferons are substances produced by cells to
protect them from viral infection and replication;
interferon- alpha 2b is most commonly used
3. Hematopoietic growth factors such as
granulocytes colony- stimulating factor(G-CSF) and
erythropoietin, balance the suppression of
granulocytes and erythrocytes resulting from
chemotherapy
e. Natural killer cells (NK cells) : exert a spontaneous
cytotoxic effect on specific cancer cell; they also
secrete cytokines and provide resistance to metastasis.
2. Gene therapy
a. Current used in investigational
b. Increases susceptibility of cancer cells to the
destruction to other treatments; insertion of specific

genes enhances ability of clients own immune system

to recognize and destroy cancer cells.
3. Photodynamic theory
a. Used to treat specific superficial tumor such
as those of
the surface of bladder, bronchus, chest
wall, head, neck
and peritoneal cavity
b. photofirin, a photosensitizing compound , is
administered intravenously where it is retained
by
malignant tissue
c. 3 days after injection, the drug is activated
by a laser
treatment which continue for 3 more
days

d. The drug produces a cytotoxic oxygen

molecule( singlet
oxygen)
e. During intravenous administration, monitor
for chills,
nausea, rash, local skin reactions and
temporary
photosensitivity
f. Drug remains in tissues 4-6 weeks after
injection: direct
or indirect exposure to sun
active drugs resulting to
chemical sunburn;
educate client to protect skin from
exposure to
sun.