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:
• 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------------------G1SG2M
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
IPP
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 Pap’s Smear
3. Male- DRE for prostate, Testicular
self-exam
 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 patient’s 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 FEMALES
 1. PROSTATE  1. BREAST
CANCER CANCER
 2. LUNG CANCER  2. LUNG CANCER

 3. COLORECTAL  3. COLORECTAL
CANCER CANCER
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)
 COLON 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
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
 Co lo n cancer
NURSING INTERVENTION
Post-Operative care
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
 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
Colostomy begins to function 3 days
after surgery
The drainage maybe soft/mushy or
semi-solid 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
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 peri-
stomal 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
 1/3to ¼ full (Brunner)
 ½ to 1/3 full (Kozier)
 Breast Cancer
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. PAGET’S disease - NIPPLE
 Breast Cancer
RISK FACTORS
1. Genetics
2. Increasing age ( > 50yo)
3. Family History of breast cancer
4. Early menarche and late menopause
5. Nulliparity
6. Late age at pregnancy
 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
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
LABORATORY FINDINGS
1. Biopsy procedures
Percutaneous needle biopsy
Needle aspiration from mammary duct
Excision biopsy
2. Mammography- American Cancer Society
recommends annual screening at age 40
 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
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
POST MAST ECTOM Y
EXERCI SES

Wall climbing
 POST MAST ECTOM Y
EXERCI SES

Overhead pulleys
POST MAST ECTOM Y
EXERCI SES

Rope turning
POST MAST ECTOM Y
EXERCI SES

Arm swing
 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
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

 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