Oncology Nursing Oncology defined Branch of medicine that deals with the study, detection, treatment and management

of cancer and neoplasia Root words Neo- new Plasia- growth Plasm- substance Trophy- size Oma- tumor Root words A- none Ana- lack Hyper- excessive Meta- change Dys- bad, deranged CELL CHANGES 1. Atrophy 2. Hypertrophy 3. Hyperplasia 4. Metaplasia 5. Dysplasia 6. Anaplasia 7. Neoplasia ETIOLOGY: MULTIFACTORIAL GENETIC FACTORS SMOKING

DIETARY: NITRATES (NITROSAMINES), BENZOPYRENE HORMONAL / CHEMICAL AGENTS BIOLOGIC AGENTS: MOLDS, VIRUSES & BACTERIA OTHERS Characteristics of Neoplasia Uncontrolled growth of Abnormal cells 1. Benign 2. Malignant 3. Borderline Characteristics of Neoplasia BENIGN Well-differentiated Slow growth Encapsulated Non-invasive Does NOT metastasize Characteristics of Neoplasia MALIGNANT Undifferentiated Erratic and Uncontrolled Growth Expansive and Invasive Secretes abnormal proteins METASTASIZES Reasons for Successful Metastasis 1. cancer cells release ENZYMES to escape from the lymphatic and blood vessels

2. secondary site should provide nourishment to cancer cells 3. secondary site should have adequate blood supply Nomenclature of Neoplasia Tumor is named according to: 1. Parenchyma Hepatoma- liver Osteoma- bone Myoma- muscle Nomenclature of Neoplasia Tumor is named according to: 2. Pattern and Structure, either GROSS or MICROSCOPIC Fluid-filled CYST Glandular ADENO Finger-like PAPILLO Stalk POLYP Nomenclature of Neoplasia Tumor is named according to: 3. Embryonic origin Ectoderm ( usually gives rise to epithelium) Endoderm (usually gives rise to glands) Mesoderm (usually gives rise to Connective tissues) BENIGN TUMORS Suffix- OMA is used Adipose tissue- LipOMA Bone- osteOMA

Muscle- myOMA Blood vessels- angiOMA Fibrous tissue- fibrOMA MALIGNANT TUMOR Named according to embryonic cell origin 1. Ectodermal, Endodermal, Glandular, Epithelial Use the suffix- CARCINOMA Pancreatic AdenoCarcinoma Squamous cell Carcinoma MALIGNANT TUMOR Named according to embryonic cell origin 2. Mesodermal, connective tissue origin Use the suffix SARCOMA FibroSarcoma Myosarcoma AngioSarcoma PASAWAY 1. OMA but Malignant HepatOMA, lymphOMA, gliOMA, melanOMA 2. THREE germ layers TERATOMA 3. Non-neoplastic but OMA HEMATOMA CANCER NURSING Review of Normal Cell Cycle 3 types of cells 1. PERMANENT cells- out of the cell cycle

 Neurons, cardiac muscle cell 2. STABLE cells- Dormant/Resting (G0) Liver, kidney 3. LABILE cells- continuously dividing GIT cells, Skin, endometrium , Blood cells CANCER NURSING Cell Cycle G0------------------G1SG2M G0- Dormant or resting G1- normal cell activities S- DNA Synthesis G2- pre-mitotic, synthesis of proteins for cellular division M- Mitotic phase (I-P-M-A-T) CANCER NURSING Proposed Molecular cause of CANCER: Change in the DNA structure altered DNA function Cellular aberration cellular death neoplastic change Genes in the DNA- proto-oncogene And anti-oncogene CANCER NURSING Etiology of cancer 1. PHYSICAL AGENTS Radiation Exposure to irritants

Exposure to sunlight CANCER NURSING Etiology of cancer 2. CHEMICAL AGENTS Smoking Dietary ingredients Drugs CANCER NURSING Etiology of cancer 3. Genetics and Family History Colon Cancer Premenopausal breast cancer CANCER NURSING Etiology of cancer 4. Dietary Habits Low-Fiber High-fat Processed foods alcohol CANCER NURSING Etiology of cancer 5. Viruses and Bacteria DNA viruses- HepaB, Herpes, EBV, CMV, Papilloma Virus RNA Viruses- HIV, HTCLV Bacterium- H. pylori CANCER NURSING Etiology of cancer

6. Hormonal agents DES-diethylstilbestrol OCP especially estrogen CANCER NURSING Etiology of cancer 7. Immune Disease AIDS CANCER NURSING CARCINOGENSIS Malignant transformation IPP Initiation Promotion Progression CANCER NURSING CARCINOGENSIS INITIATION Carcinogens alter the DNA of the cell Cell will either die or mutate CANCER NURSING CARCINOGENSIS PROMOTION Repeated exposure to carcinogens Abnormal gene will express Latent period CANCER NURSING CARCINOGENSIS

PROGRESSION Irreversible period Cells undergo NEOPLASTIC transformation then malignancy CANCER NURSING Spread of Cancer 1. LYMPHATIC Most common 2. HEMATOGENOUS Blood-borne, commonly to Liver and Lungs 3. DIRECT SPREAD Seeding of tumors CANCER NURSING Body Defenses Against TUMOR 1. T cell System/ Cellular Immunity Cytotoxic T cells kill tumor cells 2. B cell System/ Humoral immunity B cells can produce antibody 3. Phagocytic cells Macrophages can engulf cancer cell debris CANCER NURSING Cancer Diagnosis 1. BIOPSY The most definitive 2. CT, MRI 3. Tumor Markers

CANCER NURSING Cancer Grading The degree of DIFFERENTIATION Grade 1- Low grade Grade 4- high grade CANCER NURSING Cancer Staging 1. Uses the T-N-M staging system T- tumor N- Node M- Metastasis 2. Stage 1 to Stage 4 CANCER NURSING GENERAL MEDICAL MANAGEMENT 1. Surgery- cure, control, palliate 2. Chemotherapy 3. Radiation therapy 4. Immunotherapy 5. Bone Marrow Transplant CANCER NURSING GENERAL Promotive and Preventive Nursing Management 1. Lifestyle Modification 2. Nutritional management 3. Screening 4. Early detection SCREENING

1. Male and female- Occult Blood, CXR, and DRE 2. Female- SBE, CBE, Mammography and Paps Smear 3. Male- DRE for prostate, Testicular selfexam Nursing Assessment Utilize the 7 Warning Signals CAUTION C- Change in bowel/bladder habits A- A sore that does not heal U- Unusual bleeding T- Thickening or lump in the breast I- Indigestion O- Obvious change in warts N- Nagging cough and hoarseness Nursing Assessment Weight loss Frequent infection Skin problems Pain Hair Loss Fatigue Disturbance in body image/ depression Nursing Intervention MAINTAIN TISSUE INTEGRITY Handle skin gently Do NOT rub affected area

Lotion may be applied Wash skin only with moisturizing soap and water Nursing Intervention MANAGEMENT OF STOMATITIS Use soft-bristled toothbrush Oral rinses with saline gargles/ tap water Avoid ALCOHOL-based rinses Nursing Intervention MANAGEMENT OF ALOPECIA Alopecia begins within 2 weeks of therapy Regrowth within 8 weeks of termination Encourage to acquire wig before hair loss occurs Encourage use of attractive scarves and hats Provide information that hair loss is temporary BUT anticipate change in texture and color Nursing Intervention PROMOTE NUTRITION Serve food in ways to make it appealing Consider patients preferences Provide small frequent meals Avoid giving fluids while eating Oral hygiene PRIOR to mealtime Vitamin supplements Nursing Intervention RELIEVE PAIN Mild pain- NSAIDS Moderate pain- Weak opioids

Severe pain- Morphine Administer analgesics round the clock with additional dose for breakthrough pain Nursing Intervention DECREASE FATIGUE Plan daily activities to allow alternating rest periods Light exercise is encouraged Small frequent meals Nursing Intervention IMPROVE BODY IMAGE Therapeutic communication is essential Encourage independence in self-care and decision making Offer cosmetic material like make-up and wigs Nursing Intervention ASSIST IN THE GRIEVING PROCESS Some cancers are curable Grieving can be due to loss of health, income, sexuality, and body image Answer and clarify information about cancer and treatment options Identify resource people Refer to support groups Nursing Intervention 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 Nursing Intervention MANAGE COMPLICATION: Septic shock Monitor VS, BP, temp Administer IV antibiotics Administer supplemental O2 Nursing Intervention 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 COLON CANCER 1. PROSTATE CANCER 2. LUNG CANCER 3. COLORECTAL CANCER FEMALES 1. BREAST CANCER 2. LUNG CANCER 3. COLORECTAL CANCER 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 Colon 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 COLON CANCER Sigmoid colon is the most common site Predominantly adenocarcinoma (starts as adenomatous polyps arising in sigmoid and rectum) COLON CANCER PATHOPHYSIOLOGY Benign neoplasm DNA alteration malignant transformation malignant neoplasm cancer growth and invasion metastasis (liver)

6. Rectal lesions/mass 7. Tenesmus FOCUS IS ON EARLY DETECTION & INTERVENTION If early 90% survival 34% diagnosed early 66% late diagnosis Colon cancer Complications 1. Obstruction 2. Hemorrhage 3. Perforation 4. Peritonitis 5. Sepsis 6. direct extension of cancer to adjacent organs Colon cancer 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) Colon cancer MEDICAL MANAGEMENT

1. Chemotherapy- 5-FU 2. Radiation therapy Colon cancer SURGICAL MANAGEMENT Surgery is the primary treatment Based on location and tumor size Resection, anastomosis, and colostomy (temporary or permanent) Colon cancer 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 Colon 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 Colon cancer 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 Colon cancer NURSING INTERVENTION 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 Colon cancer NURSING INTERVENTION Post-Operative care 3. Assess wound dressing for bleeding

NURSING INTERVENTION: COLOSTOMY CARE Colostomy begins to function 3 days after surgery The drainage maybe soft/mushy or semisolid depending on the site Colon cancer NURSING INTERVENTION: COLOSTOMY CARE 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 Colon cancer

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 Colon cancer NURSING INTERVENTION Post-Operative care 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-operative complication Colon cancer NURSING INTERVENTION: COLOSTOMY CARE 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 peristomal area Colon cancer NURSING INTERVENTION: COLOSTOMY CARE Lightly pat dry the area and NEVER rub Lightly dust the peri-stomal area with nystatin powder Colon cancer NURSING INTERVENTION: COLOSTOMY CARE

Measure the stomal opening The pouch opening is about 0.3 cm larger than the stomal opening Apply adhesive surface over the stoma and press for 30 seconds Colon cancer NURSING INTERVENTION: COLOSTOMY CARE Empty the pouch or change the pouch when 1/3 to full (Brunner) to 1/3 full (Kozier) Breast Cancer

RISK FACTORS 7. Obesity 8. Hormonal replacement 9. Alcohol 10. Exposure to radiation Breast Cancer PROTECTIVE FACTORS 1. Exercise 2. Breast feeding 3. Pregnancy before 30 yo Breast Cancer ASSESSMENT FINDINGS

The most common cancer in FEMALES Numerous etiologies implicated Types of Breast Cancer 1. adenocarcinoma : INFILTRATING DUCTAL CARCINOMA - 70% 2. INFLAMMATORY CARCINOMA most malignant 3. PAGETS disease - NIPPLE Breast Cancer LABORATORY FINDINGS RISK FACTORS 1. Biopsy procedures 1. Genetics Percutaneous needle biopsy 2. Increasing age ( > 50yo) Needle aspiration from mammary 3. Family History of breast cancer 4. Early menarche and late menopause 5. Nulliparity 6. Late age at pregnancy Breast Cancer duct Excision biopsy 2. Mammography- American Cancer Society recommends annual screening at age 40 1. MASS- the most common location is the upper outer quadrant 2. Mass is NON-tender. Fixed, hard with irregular borders 3. Skin dimpling(peau d orange) 4. Nipple retraction/discharge 5. axillary adenopathy Breast Cancer

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Breast Cancer Breast cancer Staging TNM staging I - < 2cm II - 2 to 5 cm, (+) LN III - > 5 cm, (+) LN IV- metastasis Breast Cancer MEDICAL MANAGEMENT 1. Chemotherapy 2. Tamoxifen therapy interferes with ESTROGEN ACTIVITY 3. Radiation therapy Breast Cancer NURSING INTERVENTION : PRE-OP 1. Explain breast cancer and treatment options 2. Reduce fear and anxiety and improve coping abilities 3. Promote decision making abilities 4. Provide routine pre-op care: Consent, NPO, Meds, Teaching about breathing exercise Breast Cancer SURGICAL MANAGEMENT 1. simple Mastectomy 2. Radical mastectomy 3. Modified radical mastectomy 4. Lumpectomy OR Segmental Resection

5. Quadrantectomy Breast Cancer NURSING INTERVENTION : Post-OP 1. Position patient: Supine Affected extremity elevated to reduce edema Breast Cancer NURSING INTERVENTION : Post-OP 2. Relieve pain and discomfort Moderate elevation of extremity IM/IV injection of pain meds Warm shower on 2nd day post-op Breast Cancer NURSING INTERVENTION : Post-OP 3. Maintain skin integrity Immediate post-op: snug dressing with drainage Maintain patency of drain (JP) Monitor for hematoma w/in 12H and apply bandage and ice, refer to surgeon Breast Cancer NURSING INTERVENTION : Post-OP 3. Maintain skin integrity Drainage is removed when the discharge is less than 30 ml in 24 H Lotions, Creams are applied ONLY when the incision is healed in 4-6 weeks Breast Cancer

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NURSING INTERVENTION : Post-OP Promote activity Support operative site when moving Hand, shoulder exercise done on 2ndday Post-op mastectomy exercise 20 mins TID (wall climbing, overhead pulleys, rope turning, arm swings) NO BP or IV procedure on operative site POSTMASTECTOMY EXERCISES POSTMASTECTOMY EXERCISES POSTMASTECTOMY EXERCISES POSTMASTECTOMY EXERCISES Breast Cancer NURSING INTERVENTION : Post-OP Promote activity Heavy lifting is avoided Elevate the arm at the level of the heart On a pillow for 45 minutes TID to relieve transient edema Breast Cancer NURSING INTERVENTION : Post-OP MANAGE COMPLICATIONS Lymphedema 10-20% of patients Elevate arms, elbow above shoulder and hand above elbow Hand exercise while elevated Refer to surgeon and physical therapist Breast Cancer

NURSING INTERVENTION : Post-OP MANAGE COMPLICATIONS Hematoma Notify the surgeon Apply bandage wrap (Ace wrap) and ICE pack Breast Cancer NURSING INTERVENTION : Post-OP MANAGE COMPLICATIONS Infection Monitor temperature, redness, swelling and foul-odor IV antibiotics No procedure on affected extremity Breast Cancer NURSING INTERVENTION : Post-OP TEACH FOLLOW-UP care Regular check-up Monthly BSE on the other breast Annual mammography POSTOP RADIATION Therapy (can also be used preop & intraop) Recommendation of ACS Monthly BSE beginning at age 20, 5-7 days AFTER menstruation Clinical breast examination every 3 years age 20-39 years Clinical breast examination and annual mammography at age 40 NURSING DIAGNOSES

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1. Anxiety 2. Decisional Conflict 3. Anticipatory Grieving 4. Risk for Infection 5. Risk for injury 6. Body Image disturbance LUNG CANCER Leading cause of CANCER DEATHS in US for both male and female categories Cancer well-advanced at time of diagnosis Most patients die within one year of initial diagnosis 5-year survival is only 15% LUNG CANCER Etiology: 1. AGE, incidence increases with age 50 2. SMOKING 80% of lung cancer is positively associated with SMOKING 3. IONIZING radiation, INHALED IRRITANTS (ASBESTOS0 LUNG CANCER LUNG LESION: SMALL or OAT CELL Carcinoma 25% *PARANEOPLASTIC SYNDROME NON-SMALL CELL Carcinoma 75% ADENOCARCINOMA

SQUAMOUS CELL CARCINOMA LARGE CELL CARCINOMA LUNG CANCER Signs and Symptoms: CHRONIC COUGH, Hemoptysis, wheezing, shortness of breath, dull aching chest pain, hoarseness, dysphagia SYSTEMIC: weight loss, anorexia, fatigue, bone pain, generalized weakness LUNG CANCER METASTASIS BRAIN mental behavioral changes impaired gait and balance BONE bone pain, pathologic fractures, anemia LIVER jaundice, anorexia, RUQ pain *SUPERIOR VENA CAVA SYNDROME LUNG CANCER DIAGNOSTIC TESTS CHEST X-ray SPUTUM studies BRONCHOSCOPY CT SCAN/MRI BIOPSY CBC, LIVER FUNCTION STUDIES

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LUNG CANCER TREATMENT: SURGERY goal: to remove as much involved tissue as possible while preserving the lung function CHEMOTHERAPY RADIATION goal: to cure or relieve symptom NURSING DIAGNOSES 1. Ineffective Breathing Pattern 2. Activity Intolerance 3. Pain 4. Anticipatory Grieving PROSTATE CANCER CAUSE: UNKNOWN Most primary prostatic CA: ADENOCARCINOMAS Skeletal Metastasis, especially to the VERTEBRAE (COMPRESSION/ FRACTURES OF SPINE) PROSTATE CANCER Manifestations: EARLY: ASYMPTOMATIC URINARY S/SX: SIMILAR TO BPH: urgency, frequency, hesitancy, dysuria, nocturia, hematuria, blood in ejaculate Metastasis: BONE PROSTATIC CANCER DIAGNOSTIC TESTS: DRE (yearly after age 50)

Annual PSA levels, >4ng/ml TRANSRECTAL ULTRASOUND PROSTATIC BIOPSY Needle biopsy Bone scan, MRI, CT scans PROSTATIC CANCER SURGERY: TURP: EARLY DISEASE IN OLD MEN RETROPUBIC PROSTATECTOMY/PERINEAL PROSTATECTOMY RADICAL PROSTATECTOMY REMOVAL OF PROSTATE, PROSTATIC CAPSULE, SEMINAL VESICLES, PORTION OF BLADDER NECK PROSTATIC CANCER HORMONAL MANIPULATION: Orchiectomy Administration of female hormonal agents RADIATION: BRACHYTHERAPY (implanted radioactive seeds to eradicate remaining cancer cells, to reduce metastasis, to relieve spinal cord compression) PROSTATIC CANCER NURSING DIAGNOSES: 1. Urinary incontinence following treatment: stress or urge incontinence or mixed 2. Sexual Dysfunction 3. Acute/Chronic Pain

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