Characteristics of Neoplasia 2.

secondary site should

ONCOLOGY -Uncontrolled growth of Abnormal

provide nourishment to
cells cancer cells
NURSING 1. Benign 3. secondary site should
2. Malignant have adequate blood
Oncology Nursing
3. Borderline supply
Branch of medicine that Nomenclature of Neoplasia
deals with the study, Characteristics of Neoplasia Tumor is named according to:
detection, BENIGN 1. Parenchyma
treatment and management Well-differentiated Hepatoma- liver
of cancer and neoplasia Slow growth Osteoma- bone
Encapsulated Myoma- muscle
Root Words Non-invasive
Neo- new Does NOT metastasize Tumor is named according to:
Plasia- growth 2. Pattern and Structure, either
Plasm- substance GROSS or MICROSCOPIC
Trophy- size Fluid-filled CYST
Oma- tumor Glandular ADENO
Finger-like PAPILLO
A- none Stalk POLYP
Ana- lack Tumor is named according to:
Hyper- excessive 3. Embryonic origin
Meta- change Ectoderm ( usually gives
Dys- bad, deranged rise to epithelium)
Characteristics of Neoplasia Endoderm (usually gives
MALIGNANT rise to glands)
Undifferentiated Mesoderm (usually gives
Erratic and Uncontrolled rise to Connective tissues)
Growth BENIGN TUMORS
Expansive and Invasive Suffix- OMA is used
Secretes abnormal Adipose tissue- LipOMA
proteins Bone- osteOMA
Muscle- myOMA
METASTASIZES Blood vessels- angiOMA
CELL CHANGES Fibrous tissue- fibrOMA
MALIGNANT TUMOR
1. Atrophy Named according to embryonic
2. Hypertrophy cell origin
3. Hyperplasia 1. Ectodermal, Endodermal,
4. Metaplasia Glandular, Epithelial
5. Dysplasia Use the suffix-
6. Anaplasia CARCINOMA
7. Neoplasia Pancreatic
ETIOLOGY: MULTIFACTORIAL AdenoCarcinoma
GENETIC FACTORS Squamous cell Carcinoma
SMOKING Named according to embryonic
DIETARY: NITRATES cell origin
(NITROSAMINES), 2. Mesodermal, connective tissue
BENZOPYRENE origin
HORMONAL / CHEMICAL Use the suffix SARCOMA
AGENTS FibroSarcoma
Reasons for Successful Metastasis
BIOLOGIC AGENTS: Myosarcoma
1. cancer cells release
MOLDS, VIRUSES & AngioSarcoma
ENZYMES to escape from
BACTERIA PASAWAY
the lymphatic and blood
OTHERS OMA but Malignant
vessels
 HepatOMA, . Genetics and Family History 1. T cell System/ Cellular
lymphOMA, Colon Cancer Immunity
gliOMA, Premenopausal breast Cytotoxic T cells
melanOMA cancer kill tumor cells
2. THREE germ layers . Dietary Habits 2. B cell System/ Humoral
TERATOMA Low-Fiber immunity
3. Non-neoplastic but OMA High-fat B cells can
HEMATOMA Processed foods produce antibody
CANCER NURSING alcohol 3. Phagocytic cells
Review of Normal Cell Cycle . Viruses and Bacteria Macrophages can
3 DNA viruses- HepaB, engulf cancer cell
types of cells Herpes, EBV, CMV, debris
1. PERMANENT cells- out of the Papilloma Virus Cancer Diagnosis
cell cycle RNA Viruses- HIV, HTCLV 1. BIOPSY
Neurons, cardiac Bacterium- H. pylori The most
muscle cell 6. Hormonal agents definitive
2. STABLE cells- Dormant/Resting DES-diethylstilbestrol 2. CT, MRI
(G0) OCP especially estrogen 3. Tumor Markers
Liver, kidney . Immune Disease
3. LABILE cells- continuously AIDS Cancer Grading
dividing CARCINOGENSIS The degree of DIFFERENTIATION
GIT cells, Skin, Malignant transformation Grade 1- Low grade
endometrium , IPP Grade 4- high grade
Blood cells Initiation Cancer Staging
Cell Cycle Promotion 1. Uses the T-N-M staging system
G0------------------G1SG2M Progression T- tumor
G0- Dormant or resting CARCINOGENSIS N- Node
G1- normal cell activities INITIATION M- Metastasis
S- DNA Synthesis Carcinogens alter the DNA 2. Stage 1 to Stage 4
G2- pre-mitotic, synthesis of the cell GENERAL MEDICAL
of proteins for cellular Cell will either die or MANAGEMENT
division mutate 1. Surgery- cure, control,
M- Mitotic phase (I-P-M-A- PROMOTION palliate
T) Repeated exposure to 2. Chemotherapy
Proposed Molecular cause carcinogens 3. Radiation therapy
of CANCER: Abnormal gene will 4. Immunotherapy
Change in the DNA express 5. Bone Marrow
structure altered DNA Latent period Transplant
function Cellular CARCINOGENSIS GENERAL Promotive and
aberration PROGRESSION Preventive Nursing Management
Irreversible period 1. Lifestyle Modification
cellular death Cells undergo NEOPLASTIC 2. Nutritional
transformation then management
neoplastic change malignancy 3. Screening
Genes in the DNA- proto- Spread of Cancer 4. Early detection
oncogene And anti-oncogene 1. LYMPHATIC SCREENING
Etiology of cancer Most 1. Male and female-
1. PHYSICAL AGENTS common Occult Blood, CXR, and
Radiation 2. HEMATOGENOUS DRE
Exposure to irritants Blood-borne, 2. Female- SBE, CBE,
Exposure to sunlight commonly to Liver Mammography and Paps
Etiology of cancer and Lungs Smear
2. CHEMICAL AGENTS 3. DIRECT SPREAD 3. Male- DRE for prostate,
Smoking Seeding of tumors Testicular self-exam
Dietary ingredients Body Defenses Against TUMOR Nursing Assessment
Drugs Utilize the 7 Warning Signals
 Encourage to acquire wig
before hair loss occurs
Encourage use of
attractive scarves and hats
Provide information that
CAUTION hair loss is temporary BUT
C- Change in anticipate change in
bowel/bladder habits texture and color
A- A sore that does not
heal PROMOTE NUTRITION
U- Unusual bleeding Serve food in ways to
T- Thickening or lump in make it appealing
the breast Consider patients
I- Indigestion preferences
O- Obvious change in Provide small frequent
warts meals
N- Nagging cough and Avoid giving fluids while
hoarseness eating
Oral hygiene PRIOR to
Nursing Assessment mealtime
Vitamin supplements
Weight loss
Frequent infection RELIEVE PAIN
Skin problems Mild pain- NSAIDS
Pain Moderate pain- Weak
Hair Loss opioids
Fatigue Severe pain- Morphine
Disturbance in body Administer analgesics
image/ depression round the clock with
additional dose for
Nursing Intervention breakthrough pain
MAINTAIN TISSUE DECREASE FATIGUE
INTEGRITY Plan daily activities to
Handle skin gently allow alternating rest
Do NOT rub affected area periods
Lotion may be applied Light exercise is
Wash skin only with encouraged
moisturizing soap and Small frequent meals
water
IMPROVE BODY IMAGE
MANAGEMENT OF Therapeutic
STOMATITIS communication is
Use soft-bristled essential
toothbrush Encourage independence
Oral rinses with saline in self-care and decision
gargles/ tap water making
Avoid ALCOHOL-based Offer cosmetic material
rinses like make-up and wigs
MANAGEMENT OF ASSIST IN THE GRIEVING
ALOPECIA PROCESS
Alopecia begins within 2 Some cancers are curable
weeks of therapy Grieving can be due to loss
Regrowth within 8 weeks of health, income,
of termination sexuality, and body image
Answer and clarify
information about cancer
and treatment options
Identify resource people
Refer to support groups
MANAGE COMPLICATION:
INFECTION
Fever is the most
important sign
Administer prescribed
antibiotics X 2weeks
Maintain aseptic
technique
Avoid exposure to crowds
Avoid giving fresh fruits
and veggie
Handwashing
Avoid frequent invasive
procedures
MANAGE COMPLICATION:
Septic shock
Monitor VS, BP, temp
Administer IV antibiotics
Administer supplemental
O2
MANAGE COMPLICATION:
Bleeding
Thrombocytopenia
(<100,000) is the most
common cause
<20, 000 spontaneous
bleeding
Use soft toothbrush
Use electric razor
Avoid frequent IM, IV,
rectal and catheterization
Soft foods and stool
softeners
INCIDENCE OF CANCER
MALES
1. PROSTATE
CANCER
2. LUNG CANCER
3. COLORECTAL
CANCER
FEMALES
1. BREAST
CANCER
2. LUNG CANCER
3. COLORECTAL
CANCER

COLON CANCER
Risk factors
1. Increasing age
2. Family history
3. Previous colon CA or
presence of intestinal
polyps
4. History of IBD
(Ulcerative Colitis)
5. High fat, High protein,
LOW fiber
6. Breast Ca and Genital
Ca
Sigmoid colon is the most
common site
Predominantly
adenocarcinoma (starts as
adenomatous polyps
arising in sigmoid and
rectum)
PATHOPHYSIOLOGY
Benign neoplasm DNA
alteration malignant
transformation
malignant neoplasm
cancer growth and
invasion metastasis
(liver)
ASSESSMENT FINDINGS
1. Change in bowel
habits- Most common
(alternating D and C)
2. Blood in the stool
3. Anemia
4. Anorexia and weight
loss
5. Fatigue
6. Rectal lesions/mass
7. Tenesmus
FOCUS IS ON EARLY
DETECTION &
INTERVENTION
If early 90% survival
34% diagnosed early
66% late diagnosis
Complications
1. Obstruction
2. Hemorrhage
3. Perforation
4. Peritonitis
5. Sepsis
6. direct extension of
cancer to adjacent
organs
Diagnostic findings
1. DRE at age 40, annually
1. Fecal occult blood
2. Sigmoidoscopy and
colonoscopy begin at
age 50, every 3-5 years
3. BIOPSY
4. CEA- carcino-embryonic
antigen (to estimate
prognosis, monitor
treatment and recurrence)
MEDICAL MANAGEMENT
1. Chemotherapy- 5-FU
2. Radiation therapy
SURGICAL MANAGEMENT
Surgery is the primary
treatment
Based on location and
tumor size
Resection, anastomosis,
and colostomy (temporary
or permanent)
PREVENTION is primary
issue
CLIENT Teaching:
DIET: high fiber
diet (fruits,
vegetables, whole
grains, legumes)
Screening
recommendations
Seek medical
consult for
bleeding and
warning signs of
cancer
NURSING INTERVENTION
Pre-Operative care
1. Provide HIGH protein,
HIGH calorie and LOW
residue diet
2.Provide information
about post-op care and
stoma care
3. Administer antibiotics 1
day prior
NURSING INTERVENTION
Pre-Operative care
4. Enema or colonic
irrigation the evening and
the morning of surgery
5. NGT is inserted to
prevent distention
6. Monitor UO, F and E,
Abdomen PE
Post-Operative care
1. Monitor for
complications
Leakage from the site,
prolapse of stoma, skin
irritation and pulmonary
complication
2. Assess the abdomen for
return of peristalsis
3. Assess wound dressing
for bleeding
4. Assist patient in
ambulation after 24H
5. provide nutritional
teaching
Limit foods that cause gas-
formation and odor:
Cabbage, beans, eggs, fish,
peanuts
Low-fiber diet in the early
stage of recovery
6. Instruct to splint the
incision and administer
pain meds before exercise
 7. The stoma is PINKISH to
cherry red, Slightly
edematous with minimal
pinkish drainage
8. Manage post-
operativecomplication
NURSING INTERVENTION:
COLOSTOMY CARE
Colostomy begins to Types of Breast Cancer
function 3 days after
surgery
The drainage maybe
soft/mushy or semi-solid
depending on the site
BEST time to do skin care
is after shower
Apply tape to the sides of
the pouch before shower
Assume a sitting or
standing position in
changing the pouch
Instruct to GENTLY push
the skin down and the
pouch pulling UP
Wash the peri-stomal area
with soap and water
Cover the stoma while
washing the peri-stomal
area
Instruct to GENTLY push
the skin down and the
pouch pulling UP
Wash the peri-stomal area
with soap and water
Cover the stoma while
washing the peri-stomal
area
Lightly pat dry the area
and NEVER rub
Lightly dust the peri-
stomal area with nystatin PROTECTIVE FACTORS
powder 1. Exercise
Measure the stomal 2. Breast feeding
opening 3. Pregnancy before 30 yo
The pouch opening is ASSESSMENT FINDINGS
about 0.3 cm larger than 1. MASS- the most
the stomal opening common location is the
Apply adhesive surface upper outer quadrant
over the stoma and press 2. Mass is NON-tender.
for 30 seconds Fixed, hard with irregular
Empty the pouch or borders
change the pouch when 3. Skin dimpling(peau d
1/3 to full orange)
(Brunner) 4. Nipple
to 1/3 full retraction/discharge
(Kozier) 5. axillary adenopathy
Breast Cancer
LABORATORY FINDINGS
The most common cancer 1. Biopsy procedures
in FEMALES Percutaneous
Numerous etiologies needle biopsy
implicated Needle aspiration
from mammary duct
Excision biopsy
1. adenocarcinoma : 2. Mammography-
INFILTRATING DUCTAL American Cancer Society
CARCINOMA - 70% recommends annual
2. INFLAMMATORY screening at age 40
CARCINOMA most
malignant Breast cancer Staging
3. PAGETS disease - TNM staging
NIPPLE I - < 2cm
RISK FACTORS II - 2 to 5 cm, (+) LN
1. Genetics III - > 5 cm, (+) LN
2. Increasing age ( > 50yo) IV- metastasis
3. Family History of breast MEDICAL MANAGEMENT
cancer 1. Chemotherapy
4. Early menarche and late 2. Tamoxifen therapy
menopause interferes with ESTROGEN
5. Nulliparity ACTIVITY
6. Late age at pregnancy 3. Radiation therapy
7. Obesity NURSING INTERVENTION : PRE-OP
8. Hormonal replacement 1. Explain breast cancer
9. Alcohol and treatment options
10. Exposure to radiation 2. Reduce fear and anxiety
and improve coping
abilities
 3. Promote decision pulleys, rope turning, arm Clinical breast examination
making abilities swings) every 3 years age 20-39
4. Provide routine pre-op NO BP or IV procedure on years
care: operative site Clinical breast examination
Consent, NPO, POSTMASTECTOMY EXERCISES and annual mammography
Meds, Teaching Wall climbing at age 40
about breathing Overhead pulleys NURSING DIAGNOSES
exercise Rope turning 1. Anxiety
SURGICAL MANAGEMENT Arm swing 2. Decisional Conflict
1. simple Mastectomy NURSING INTERVENTION : Post-OP 3. Anticipatory Grieving
2. Radical mastectomy Promote activity 4. Risk for Infection
3. Modified radical Heavy lifting is avoided 5. Risk for injury
mastectomy Elevate the arm at the 6. Body Image disturbance
4. Lumpectomy OR level of the heart LUNG CANCER
Segmental Resection On a pillow for 45 minutes
5. Quadrantectomy TID to relieve transient Leading cause of CANCER
NURSING INTERVENTION :Post-OP edema DEATHS in US for both
1. Position patient: NURSING INTERVENTION : Post-OP male and female
Supine MANAGE COMPLICATIONS categories
Affected extremity Lymphedema Cancer well-advanced at
elevated to reduce edema 10-20% of patients time of diagnosis
NURSING INTERVENTION : Post-OP Elevate arms, elbow above Most patients die within
2. Relieve pain and discomfort shoulder and hand above one year of initial
Moderate elevation of elbow diagnosis
extremity Hand exercise while 5-year survival is only
IM/IV injection of pain elevated 15%
meds Refer to surgeon and Etiology:
Warm shower on 2nd day physical therapist 1. AGE, incidence
post-op NURSING INTERVENTION : Post-OP increases with age 50
3. Maintain skin integrity MANAGE COMPLICATIONS 2. SMOKING 80% of lung
Immediate post-op: snug Hematoma cancer is positively associated with
dressing with drainage Notify the surgeon SMOKING
Maintain patency of drain Apply bandage wrap (Ace 3. IONIZING radiation,
(JP) wrap) and ICE pack INHALED IRRITANTS (ASBESTOS0
Monitor for hematoma NURSING INTERVENTION : Post-OP LUNG LESION:
w/in 12H and apply MANAGE COMPLICATIONS SMALL or OAT
bandage and ice, refer to Infection CELL Carcinoma
surgeon Monitor temperature, 25%
NURSING INTERVENTION : Post-OP redness, swelling and foul- *PARANE
3. Maintain skin integrity odor OPLASTIC
Drainage is removed when IV antibiotics SYNDRO
the discharge is less than No procedure on affected ME
30 ml in 24 H extremity NON-SMALL CELL
Lotions, Creams are NURSING INTERVENTION : Post-OP Carcinoma 75%
applied ONLY when the TEACH FOLLOW-UP care ADENOCA
incision is healed in 4-6 Regular check-up RCINOMA
weeks Monthly BSE on the other SQUAMO
NURSING INTERVENTION : Post-OP breast US CELL
Promote activity Annual mammography CARCINO
Support operative site POSTOP RADIATION Therapy (can MA
when moving also be used preop&intraop) LARGE
Hand, shoulder exercise Recommendation of ACS CELL
done on 2ndday Monthly BSE beginning at CARCINO
Post-op mastectomy age 20, 5-7 days AFTER MA
exercise 20 mins TID (wall menstruation Signs and Symptoms:
climbing, overhead
CHRONIC COUGH, Hemoptysis, (COMPRESSION/
wheezing, shortness of breath, FRACTURES OF SPINE)
dull aching chest pain, hoarseness, Manifestations:
dysphagia EARLY:
SYSTEMIC: weight loss, anorexia, ASYMPTOMATIC
fatigue, bone pain, generalized URINARY S/SX:
weakness SIMILAR TO BPH:
urgency,
METASTASIS frequency,
BRAIN mental hesitancy, dysuria,
behavioral changes nocturia,
impaired gait and balance hematuria, blood
BONE bone pain, in ejaculate
pathologic fractures, Metastasis: BONE
anemia DIAGNOSTIC TESTS:
LIVER jaundice,
DRE (yearly after
anorexia, RUQ pain
age 50)
*SUPERIOR VENA CAVA
Annual PSA levels,
SYNDROME
>4ng/ml
TRANSRECTAL
DIAGNOSTIC TESTS
ULTRASOUND
o CHEST X-ray
PROSTATIC BIOPSY
o SPUTUM studies
Needle biopsy
o BRONCHOSCOPY
Bone scan, MRI,
o CT SCAN/MRI
CT scans
o BIOPSY SURGERY:
o CBC, LIVER TURP: EARLY DISEASE IN
FUNCTION OLD MEN
STUDIES RETROPUBIC
TREATMENT: PROSTATECTOMY/PERINEA
o SURGERY goal: to L PROSTATECTOMY
remove as much RADICAL
involved tissue as PROSTATECTOMY-
possible while REMOVAL OF PROSTATE,
preserving the PROSTATIC CAPSULE,
lung function SEMINAL VESICLES,
o CHEMOTHERAPY PORTION OF BLADDER
o RADIATION goal: NECK
to cure or relieve HORMONAL MANIPULATION:
symptom Orchiectomy
Administration of female
NURSING DIAGNOSES hormonal agents
1. Ineffective Breathing RADIATION: BRACHYTHERAPY
Pattern (implanted radioactive seeds
2. Activity Intolerance to eradicate remaining cancer
3. Pain cells, to reduce metastasis, to
4. Anticipatory Grieving relieve spinal cord
compression)
PROSTATE CANCER NURSING DIAGNOSES:
CAUSE: UNKNOWN 1. Urinary incontinence following
Most primary prostatic CA: treatment: stress or urge
ADENOCARCINOMAS incontinence or mixed
Skeletal Metastasis, 2. Sexual Dysfunction
especially to the 3. Acute/Chronic Pain
VERTEBRAE