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G0
hibernating cells
Cancer drugs cannot affect this
cycle
Sarcoma
-Cancer of connective tissues
(bones, cartilage, fat)
G1
Lymphoma
-Cancer of lymphocytes
(Hodgkins painless swelling of neck)
G2
Premitotic phase
Gathering in order to reproduce
Myeloma / Leukemia
-Cancer of blood forming cells of
bone marrow (Myeloid)
PATHOGENESIS
Cause: UNKNOWN
RAPID
Theories
GI nausea, vomiting, diarrhea
Skin alopecia
Bone marrow bleeding,
anemia, prone to infection
CARCINOGENESIS
>Initiation exposure to risk factors
(Carcinogens- stimulates CA cell
production)
>Promotion genetic change &
increase in cell number. Still looks the
same
>Transformation genetic change.
Looks ugly & bigger
>Progression genetic change, bigger
& uglier & increase in number
PRE-DISPOSING FACTORS
>Age ( incidence in middle adulthood
and elderly )
>Gender
#1 in Men : Prostate
#1 in Women : Breast
>Viruses & Bacteria
HPV Cervical CA
Hep B, C Liver CA
H. pylori Gastric CA
>Precancerous Lesions
>Diet ( Fiber , Fat )
>Obesity ( Endometrial CA )
ONCOLOGY NURSING
>Occupation / Environmental / Physical
Agents ( Stress can cause CA )
>Genetics
>Hormones ( Estrogen Breast CA )
>Geographic location ( Rural areas are
Smog-free)
>Sexual Practices
>Chemical Agents ( Nitrates, Nicotine,
Alcohol)
>Immunocompromised states
TUMOR STAGING
T
distant metastasis
CANCER STAGING
0
cancer in situ
widespread metastasis
TUMOR
Tx
Cant be assessed
T0
no tumor
Tis
T1-4
NODES
Nx
Cant be assessed
N0
no lymph nodes
N1-4
disease in regional
METASTASIS
Mx
Cant be assessed
M0
No metastasis
M1-4
DIAGNOSTIC EXAMS
>Papanicolau (Pap) Smear
Vaginal spotting is expected
>Self-Breast Exam
1 week after menstruation OR at
the same day every month for
non-menstruating women
>Clinical Breast Exam
>Mammography
>40 yrs old
Check for density
>Breast Ultrasound
Used to detect abnormalities
found in mammogram
More ACCURATE
>Prostate Exam (Digital Rectal Exam +
PSA)
>40 yrs old
>Digital Rectal Exam (for men)
>Testicular Self Exam (for men)
>Fecal Occult Blood Test (Guiac Test)
Upper GI bleeding
No dark meat 3 DAYS before test
>Sigmoidoscopy / Colonoscopy
Every 1 yr or 2 yrs
>50 yrs old
>Biopsy ( MOST RELIABLE )
>Rapid Frozen Section / Cryosection
OTHERS:
>MRI (MOST ACCURATE)
>CT Scan
>Ultrasound
>Endoscopy
ONCOLOGY NURSING
TUMOR MARKERS
Carcino Embryonic Antigen (CEA)
Indicates recurrence
Effectiveness of Chemotherapy
Elevated in Biliary Disease
Used when there is hyperactivity
in the GI
Alpha Feto Protein (AFP)
Hepatocellular carcinoma
Monitor result of Chemo
Human Chorionic Gonadotropin (HcG)
Produced by placenta, by
embryo
Germ cell tumor : Cellular
differentiation (uterus
choriocarcinoma, testicular CA,
H. Mole)
Bence Jones Protein (in urine)
Produced by neoplastic plasma
cells
Malignant bone marrow CA
(multiple myeloma)
NOT DETECTED in Routine
Urinalysis
Acid Phosphatase enzyme in organs
Prostate Acid Phosphatase
prostate CA
Alkaline Phosphatase
Concentrated in liver bile duct,
kidney, bone, placenta
leukocyte alkaline level
chronic myelogenous leukemia
Beta-2 microglobulin
levels - multiple myeloma,
chronic lymphocytic leukemia
levels - kidney disease, hepatitis
Bladder Tumor Antigen
-Bladder CA
-Kidney stones, UTI
ONCOLOGY NURSING
Adjuvant
-Tx given POST primary Tx to increase
cure
Neo-Adjuvant
-Tx given PRIOR to surgery to tumor size
so surgery is not extensive
SURGERY
Diagnostic histopath
Curative
Palliative
Pain Management
Placement of PEG tube
BIOPSY
Incisional
For large tumor
Apply pressure dressing for 6-8 hrs
Excisional
Early access tumors
Skin, UGI, Upper Respi, Breast
Needle Biopsy
Breast, Thyroid, Liver, Lungs
RADIATION
-Beam of high energy waves or streams
of particles
-Localized Tx
-Destroys rapidly dividing cells
Types:
External Teletherapy
Non-radioactive ; Non-threat
Internal Brachytherapy
Radioactive
TELETHERAPY External
Adverse RXN : Burns, Erythema
NRSG CARE
-Do NOT remove the marks!
-No application of cream, lotion,
30 minutes
6 ft away frm Pt
LED Apron
ONCOLOGY NURSING
IF DISLODGEMENT OCCURS:
G2 Antitumor Antibiotics
>Bleomycin
-S/E: Febrile RXN on 1st day
-Pulmonary Fibrosis (scars):
Pulmonary Fnx Test
-Monitor lung status of patient
before each course of therapy
CHEMOTHERAPY
1) Cell-Cycle SPECIFIC
G1 Asparaginase & Prednisone
-for leukemia
-S/E: Pancreatitis, Anaphylaxis
Nrsg Considerations
>Have stand-by :
Epinephrine
Benadryl
Corticosteroids
>Start Allopurinol BEFORE therapy
>Monitor for signs of pancreatitis
S Antimetabolites
>Cytrabine (Cytosar-U)
>5-FU
>Mercaptopurine (Purithenol)
>Methotrexate + Leucovorin
-for Leukoblastic Leukemia
>Hydroxy Urea (Hydrea)
-for Leukemia, Melanoma
-S/E: Megaloblastosis (immature
RBC)
Nrsg Considerations: Antimetabolites
(Folic Acid Antagonists)
>Avoid Folic Acid
-beans, wheat
-will interfere with antimetabolic
function
>Avoid Probenecid
- toxicity of Methotrexate
>Avoid alcohol
>Patient to avoid getting pregnant
during & after therapy
2) Cell-Cycle NON-SPECIFIC
Alkylating Agents
Carboplatin
Chlorambucil
Cisplatin
Cyclophosphamide
Ifosfamide
Mechloritamine
Melphalan (can also cause CA)
ANTIBIOTICS
+ Doxorubicin (RED DRUG)
-A/E: skin & nail
hyperpigmentation
-Monitor for cardiac dysrhythmias
ONCOLOGY NURSING
NURSING CONSIDERATIONS
-Dexrazosane is given 30 minutes prior to
drug
-Stop infusion if cardiac problem occurs
- OFI
-Inform that Urine is RED color for 1-2
days
+ Mitomycin
+Dactinomycin
Cyclophosphamide
Antidote: MESNEX / MESNA
Urotoxic (hemorrhagic cystitis)
Mechlorethamine: Severe vesicant
tissue necrosis
Methotrexate
Antidote: Leucovorin
Folic Acid Antagonist
Cisplatin
Antidote: Amifostine
Ototoxicity
Busulfan
Antidote: Allopurinol
Hyperuricemia
Mechlorethamine
Antidote: Sodium Thiosulfate
Severe Vesicant
Ifosfamide
Antidote: MESNA / MESNEX
Hemorrhagic Cystitis
5-FU
Hyperuricemia Allopurinol
Metabolic Acidosis Na Bicarb
NURSING CONSIDERATION: CHEMO
PRECAUTION
-Stop infusion
-aspirate remaining drug from needle
-Cold compress 20 mins 3x/4x per day
for first 48-72 hrs
-Vasoconstriction diminished
spread extravasate
-Doxurubicin
-Not used in Vinca Alkaloid
-Warm compress
- blood flow to affected areas
-NOT USED IN DOXORUBICIN
-Vinca Alkaloids ( blood flow )
* Allowed attempts for inserting
peripheral line for chemo Tx : 2 ATTEMPTS
ONLY!
Implanted Vascular Access Device
Portacath (Intradermal)
Underneath the skin
-Port-a-cath
-Mediport
Huber needle used for access
CENTRAL IV LINES
Flush with Heparin:
Subclavian Catheter
Intrajugular ( IJ ) catheter
Triple Lumen Catheter
Quad Lumen Catheter
Non-flush with Heparin:
Groshong/Hickman/Dialysis Cath
Peripherally Inserted Central Line
Cath
COMPLICATIONS OF RADIATION &
CHEMO THERAPY
Nausea/Vomiting
-Administer anti-emetic as
ordered
-ice chips
-NPO 4-6 hrs before
-Frequent mouth care
-Monitoring of I/O, Wt &
Electrolyte
-Administer IV therapy as ordered
ONCOLOGY NURSING
-Bland food & Small Frequent
Feeding
Constipation
-fluids & high fiber foods
-stool softener or laxative as
ordered
-AVOID Enema!
Diarrhea
-offer liquids & low fiber diet
-Anti-diarrheal meds as ordered
-Good perineal care
-Stool for occult blood as ordered
-Observe for dehydration
Stomatits
-Good for oral hygiene
-Avoid spicy or hot foods
-Offer topical agents for pain
relief
-Offer popsicle
-Avoid acidic, alcoholic,
tobacco
-Apply KY Jelly
-Apply Nystatin oral suspension as
ordered
Dermatitis
-Wash affected areas with plain
water & pat dry ; Avoid soap
-Use cornstarch, calamine lotion
for itching
-Avoid exposure to heat, wearing
wool & silk
Alopecia
-Plan for wig, scarf, turban or hat
BEFORE hair loss
-Reassure patient that hair will
grow back after therapy
MYELOSUPPRESSION
Thrombocytopenia (platelets: 150,000400,000)
-protect patient from injury
-Avoid use of aspirin products
-Soft bristle toothbrush, electric
razor
-NO IM injections
-Use small gauge needles
ONCOLOGY NURSING
Late signs (malignant)
-irregularly shaped mass
-fixed nodules, adheres to chest
wall
-asymmetry of breasts
-Peau de Orange (orange skin)
Diagnostic Exam
Biopsy (MOST DEFINITE)
Breast Self-Exam (SBE/CBE)
Mammography
Medical Mngt
Administer Anti-Estrogen receptor
(Tamoxifen Citrate / Taxol)
Chemotherapeutic Agents:
-Cyclophosphamide
-Methotrexate with Leucovorin
Surgical Mngt
Lumpectomy/Partial Mastectomy
Simple Mastectomy
-Breast tissue removal
-Breast tissue & lymph node
removal
-Axillary Lymph nodes: Levels II
-Axillary Lymph nodes: Levels III
Modified Radical Mastectomy
-removal of ONLY the lining of the
pectoralis lining
Radical Mastectomy
-Removal of everything (Lymph
nodes, Pectoralis Major & Minor,
Breast)
NURSING MANAGEMENT
Pre-Operative
Assess self-esteem, body image
Emotional support
Breast reconstruction &
prosthetics
Post-Operative
Analgesic RTC as ordered
Perform DBE
ARM PREC (Take the VS on the
legs)
Prevent Complications:
Bleeding
Infection
Atelectasis
Lymph Edema (elevate the arms)
perform hair combing-like
exercise
NURSING MANAGEMENT
-Fowlers position
-promote mobility
-assist with grief & adaptation
-Perform following:
-use lanolin cream
(Sheeps wool) several
times a day
-call MD if signs of
inflammation occur
-Avoid heavy weight lifting,
wearing jewelry, constrictive
clothing and positioning on
OPERATIVE side while sleeping
LARYNGEAL CANCER
Risk Factors
Smoking
Alcohol
Voice Abuse
Chronic Laryngitis
Genetics
Assessment
EARLY:
Hoarseness of voice
Throat lump or pain
LATE:
Coughing
Dysphagia
Dyspnea
Enlarged Cervical Lymph Nodes
Weight Loss
Muffled Voice
Diagnostic Exam
Laryngoscopy visualization of
the Larynx
Bronchoscopy
ONCOLOGY NURSING
Surgical Mngt
(Stages III/IV)
-Total Laryngoscopy
-Radical Neck Dissection/
Modified Neck Dissection
Pre-Operative
-Partial Loss of smell
-Air goes into stoma, not
the nose
-Closed Yawning / Polite
Yawning
-Avoid activity that
intra-thoracic pressure
Post-Operative
-Semi-fowlers position
-Slight neck flexion position
-Support head of patient
-ice collar to patients neck
-NGT, offer clear liquids as
ordered
-Check for signs of bleeding
-Avoid water sports & contact
sports
-Medic ALERT bracelet
-Assist the patient to use trachea
esophageal devices
Electrolarynx
HODGKINS DISEASE
Cause: Unknown
-painless, progressive
enlargement of lymph nodes
*REED-STERNBERG giant cells
-owls eyes
-Large, multi-nucleated cells from
the B lymphocytes
(Ultimately fatal if untreated)
Risk factors
Male (15-40 y.o)
Immunosuppressed individuals
History of mononucleosis or high
titer of EPSTEIN BARR VIRUS
-Human Herpes virus 4
-Cause infectious
mononucleosis (Kissing
Disease)
ONCOLOGY NURSING
Frequent douching
Early age at first coitus (<18 y.o)
Mutiple sexual partners
Tobacco use
Diethylstilbestrol Hormone
EARLY (Asymptomatic)
Postmenopausal bleeding
Bleeding after douching or sex
Irregular vaginal bleeding
Metrorrhagia (inter-menstrual
heavy bleeding)
Leukorrhea (white vaginal
discharge)
Polymenorrhea (menstruation
every 21 days or less)
Signs & Symptoms may include:
-Abnormal Bleeding (between
menses, after menopause, after
sex, after pelvic exam)
-Heavier, long-lasting periods
-Unusual vaginal discharge
-Pelvic pain
Diagnostic Exam
PAP Smear
Colposcopy (visualization of the
cervix)
Biopsy
Surgical Mngt
Cryosurgery
Radiotherapy
Hysterectomy ( TAH / TAHBSO )
NURSING INTERVENTION
-Signs of bleeding post-surgery
-May feel pressure, minor
abdominal cramps, pinch from
forceps
-Pain minimal post pinching
-Expect discharge or spotting for
about a week (Biopsy)
-Avoid douching, use of tampons
nor sex during spotting
-Follow up PAP Smear within 3-4
months post procedure
-Observe radiation precaution
PROSTATE CANCER
Causes: Unknown
Risk Factors
Fat Diet
STD
Hormones
Multiple Sexual Partners
Diagnostic Exam
Biopsy
Prostate Specific Antigen (PSA)
Digital Exam
Assessment
Asymptomatic
Hematuria
Dysuria
Enlargement of Prostate
Low Back Pain
Perineal & rectal discomfort
Medical Mngt
Estrogen Hormones
-Diethylstilbestrol
-Estradiol
-Chlorotrianisine
Synthetic Gonadotropin
Releasing hormone Analog
Leuprolide 3.75 mg q
month
Gseriline Acetate(Zoladex)
Finasteride (Proscar)
Radiation Therapy
Radioactive IODINE & GOLD is
given
Surgical Mngt
Orchiectomy (testes)
TURP
Prostatectomy
NURSING MANAGEMENT
S/P TURP *Urine is bloody for 24-48 hrs
-
ONCOLOGY NURSING
-
NURSING MANAGEMENT
-
Intermittent Irrigation
- with MDs order
- Aseptosyringe
- Saline irrigant
Intra-arterial infusion
Oral ingestion
Care of Stoma
o Assess for possible
tumor
Prevent skin breakdown
o Change appliance
PRN only & when urine
production is slowest
o Place square gauze on
stoma opening when
appliance is off
o Wash skin around
stoma with mild soap &
water
MULTIPLE MYELOMA
Abnormal proliferation of B
lymphocytes in bone marrow
Complications:
Hematopoetic suppression
Hypercalcemia
Proteinuria
Renal Failure
S/Sx
Low Back Pain
Sudden Pathologic fracture
Diffuse osteoporosis
Hypercalcemia
Anemia
Immunosuppression
Risk Factors
Genetics
Familial tendency
Exposure to chemicals
Incidence >40 y.o
Diagnostic Exam
Bone Marrow Biopsy
Blood & Urine Exam
(+) Bence Jones Protein M
CHON in urine
ONCOLOGY NURSING
NURSING MANAGEMENT
-
Combination therapy
Bone Marrow transplant
Reduce calcium level
Encourage activity
OFI
Post-Op: Dorsal
Recumbent or semi
fowlers on affected side
MEDICATION
-
Myocalcin/Calcitonin (nasal
spray)
LUNG CANCER
TYPES
Small Cell
Adenocarcinoma
Epidermal
Large Cell Anaplastic
Risk Factors
Smoking
Environmental & Occupational
exposure
Genetics
Fiber Diet
Assessment
Cough >3 months
Dyspnea
Hoarseness
Hemoptysis
Chest Pain
Anorexia
Weight Loss
Weakness
NURSING MANAGEMENT
-Monitor VS, breathing patterns, breath
sounds & respi impairment
-REVERSE ISOLATION, neutropenic diet
-Assess for tracheal deviation
(pneumothorax)
-Fowlers position
-Oxygen & humidification (to moisten &
loosen secretions)
-Corticosteroid & bronchodilators
- Calorie, CHON, Vitamin diet
Pneumonectomy- removal of
lungs
Malignant neoplasm in
stomach
Adenocarcinoma (Most
Common)
S/Sx
EARLY none
LATE detected
Risk Factors
H.Pylori
Chronic Atrophic Gastritis
Genetics
Barrets esophagus
Billroth II atrophic gastritis
Medical & Surgical Mngt
Surgery
Chemotherapy
Radiation Therapy
COLORECTAL CANCER
Causes
Genetics
Fiber Diet
ONCOLOGY NURSING
Fat intake
Inflammatory Bowel Disease
Diagnostic Exam
Abdominal & Rectal Exam
Occult Blood Exam
Barium Enema
Proctosigmoidocopy
colonoscopy
Carcinoembryonic Antigen
-
Tests effectiveness of
treatment
Identify disease occurrence
NURSING MANAGEMENT
Surgery
Colostomy
Radiation
Chemotherapy
STOMA
-