Table of Contents:

1. Pathophysiology & Warning Signs 4. Chemotherapy

2. Biopsy & Diagnosis 5. Radiation
3. Pain & Psychosocial Support 6. Oncological Emergencies

Cancer

1. Pathophysiology & Warning Signs

TABLE 1. RISK FACTORS & SCREENING FOR MAJOR CANCERS
Cancer = uncontrolled growth of
abnormal cells.
Average Screening Age
y Cancer can develop in any tissue, Cancer Risk Factors
(Varies)
including soft tissues (tumors) or blood
and bone marrow (leukemia), and can
Breast BRCA mutations, Mammograms starting at
spread to other parts of the body.
longer cumulative age 40-50
y Key nursing interventions include
estrogen exposure
screening at-risk clients and teaching
(early menarche, late
clients about risk reduction.
menopause, nulliparity)
General causes and risk factors
y Advancing age Lung Smoking, asbestos CT scan for high-risk
y Genetics (BRCA1/BRCA2 mutations)

Hematologic/Oncologic
exposure individuals (heavy smokers)

Environmental exposures (smoking,
UV light) Colorectal Family history, age Colonoscopy starting at age
y Some medications >50, inflammatory 45; fecal occult blood test
(immunosuppressants) bowel disease, diet high annually starting at age 45-50
y Chronic inflammation (ulcerative colitis) in red meat
y Viruses (HPV for cervical cancer,
Epstein-Barr virus for lymphoma) Prostate Age >65, Black PSA levels, and digital rectal
y Additional risk factors and screening ethnicity, family history exams starting at age 40-50
protocols vary by specific cancer
(TABLE 1). See related CHEAT SHEETS for more information.
Warning signs

Teach clients to report concerning signs of cancer 2. Biopsy & Diagnosis
(CAUTION):
When cancer is suspected, a biopsy (tissue sample) and
y Change in bowel or bladder habits
imaging are performed for diagnosis and staging.
y A sore that does not heal
y CT, MRI, and PET scans are performed for staging
y Unusual bleeding or discharge
and detecting metastases.
y Thickening or lump in breast or elsewhere
y Stages:
y Indigestion or difficulty swallowing
y Stage 0: Carcinoma in situ (in one place)
y Obvious change in a wart or mole
y Stage I-II: Localized or early regional spread
y Nagging cough or hoarseness
y Stage III: Extensive regional spread
y Stage IV: Metastatic cancer (distant spread,
often liver or bone)

 Cancer warning signs: Teach clients to monitor for warning signs of cancer, such as CAUTION, Change
in bowel habits, A sore that does not heal, Unusual bleeding or discharge, Thickening or lump in breast or
elsewhere, Indigestion or dysphagia, Obvious change in wart or mole, Nagging cough or hoarseness.

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3. Pain & Psychosocial Support y Monitor for infection (leukocytosis).
Pain
Clients with low-grade fevers or any signs of
y Cancer can cause extreme chronic pain. infection should immediately notify the HCP.

Manage pain with NSAIDs, opioids, and
Implement neutropenic precautions if
adjuvant medications (corticosteroids) necessary (TABLE 2).
as prescribed. y Monitor for anemia (RBC count).
y Administer analgesics on a regular schedule
Administer erythropoietin as prescribed to
(around the clock) with additional doses for stimulate RBC production.
breakthrough pain (see ANALGESICS y Encourage rest to combat fatigue.
CHEAT SHEET). y Monitor platelet counts for thrombocytopenia.
y Encourage nonpharmacological pain y Avoid invasive procedures (IM injections,
management (meditation, music). enemas) and actions that can irritate or

Clients choosing palliative care can undergo injure tissues and cause bleeding
chemotherapy, radiation, and surgery to help (forceful nose blowing).
symptoms. y Avoid aspirin.

Use a soft bristle toothbrush and
Psychosocial Support
electric razor.
y Refer client to support groups.

Notify HCP of signs of bleeding (petechiae).
y Discuss expectations of treatments.
y Administer antiemetics (ondansetron) to help
y Actively listen to client concerns (chemotherapy side
with GI side effects.
effects, infertility, end-of-life).
y Assist clients with peripheral neuropathy to

Hematologic/Oncologic
prevent falls.
4. Chemotherapy
y Perform oral care after each meal and at bedtime
Chemotherapy is a mainstay of cancer treatment to help with mucositis.
and may also be combined with radiation or y Recommend oral rinses and soft-bristled
surgical therapies. toothbrushes.
y Chemotherapy: Systemic medications that kill y Avoid overly hot, cold, spicy, or rough food
rapidly dividing cancer cells but also affect healthy that can injure tissues.
cells, especially in the bone marrow, GI tract, and y Use appropriate PPE when handling
mucous membranes chemotherapy drugs and the bodily fluids of
y Common adverse effects of chemo: clients receiving treatment.

Bone marrow suppression  Neutropenia, y Chemotherapy can be absorbed through skin
anemia, and thrombocytopenia (WBC, or mucous membranes during preparation.
hemoglobin, andplatelets) y Bodily fluids and excretions may contain
y Gastrointestinal: Nausea, vomiting, diarrhea, chemotherapy residues, requiring
mucositis (inflammation of mucous membranes careful handling.
of the GI tract)
y Hair loss (alopecia) TABLE 2. NEUTROPENIC PRECAUTIONS
y Peripheral neuropathy
y Nursing interventions:
y Place client in a private room.
y Use central lines or implanted ports to
y Do not enter if you are not feeling well.
administer chemotherapy drugs, which are
y Perform hand hygiene before entering the room.
vesicants, to prevent extravasation (vesicant
y Use dedicated equipment (stethoscope).
leaks into surrounding tissues  tissue necrosis).
y Disinfect all equipment.
y Avoid raw foods (fruits, vegetables, eggs,
shellfish).

 Chemotherapy adverse effects: The nurse should monitor the client’s WBC and hemoglobin levels
and temperature to detect infection and bone marrow suppression. Clients with neutropenia should
report low-grade fevers to the HCP.

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5. Radiation Therapy
Radiation therapy: Localized treatment

TABLE 3. INTERNAL RADIATION SAFETY (BRACHYTHERAPY)
destroys cancer cells by damaging
their DNA.
y Types: Time y Cluster care.
y External beam radiation: Targets y Wear a film badge (dosimeter) to monitor exposure
specific body areas (never share badge).
y Brachytherapy: Radioactive y Limit each visitor’s time (e.g., 30 min/day).
seeds are implanted directly into
the tumor (client is considered Distance y Stay at the foot of bed as much as possible.
radioactive). y Visitors should keep as much distance as possible
y Common side effects: (e.g., 6 ft [2 m]).
y Fatigue

Localized skin changes Shielding y Wear lead aprons.
(redness, peeling) y Position a lead shield in front of the implant to
y Local tissue effects (esophagitis in protect caregivers and visitors.
neck/chest radiation) y Keep client’s door closed.
y Nursing interventions:
If implant is dislodged, do not pick up with bare
y Teach clients to avoid irritating or hands (use lead gloves or long forceps).
injuring sensitive skin.

Use mild soaps. 6. Oncological Emergencies

Hematologic/Oncologic

Avoid scented lotions and soaps.
Oncological emergencies are life-threatening

Wear loose clothing.
complications of cancer or cancer treatments.
y Avoid friction (gently pat skin dry, wash with
y Tumor lysis syndrome: Chemotherapy causes rapid
their hands instead of a washcloth).
destruction of tumor cells  Release of cellular

Avoid sun exposure to the irradiated area
contents  Metabolic imbalances
during and after treatment.
y Symptoms:potassium, uric acid, and
y Encourage rest and hydration to help with fatigue.
phosphate; andcalcium

To minimize radiation exposure when caring
y Nursing actions:
for clients receiving brachytherapy, follow the

Administer IV fluids and diuretics to correct
principles of time, distance, and shielding
electrolyte imbalances.
(TABLE 3).

Administer allopurinol touric acid.
y Caregivers who are pregnant should not
y Hypercalcemia of malignancy: Due to bone resorption
care for these clients.
from bone cancers or PTH-secreting tumors
y Do not allow children or pregnant women
y Symptoms: Nausea, muscle weakness, polyuria
to visit.
y Nursing actions:

Administer IV fluids and diuretics to
calcium loss through urination.

Administer bisphosphonates to inhibit
bone resorption.

 Radiation skin care: Teach clients receiving radiation  Tumor lysis syndrome: For clients receiving
to protect irradiated skin by using mild soap, chemotherapy, monitor electrolytes to
avoiding scented lotions, avoiding sun exposure, detect tumor lysis syndrome (hyperkalemia,
and wearing loose clothing. hyperuricemia, hyperphosphatemia, and
hypocalcemia). If tumor lysis syndrome occurs,
 Brachytherapy safety: When caring for clients
correct electrolyte imbalances with IV fluids and
with internal radiation (brachytherapy) follow the
diuretics and administer allopurinol to decrease
principles of time (cluster care), distance (stay
uric acid.
at foot of the bed), and shielding (lead apron) to
minimize exposure.
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6. Oncological Emergencies, Continued
y Superior vena cava (SVC) syndrome: Tumor in the y Syndrome of inappropriate antidiuretic hormone
neck/chest obstructs the SVC (SIADH): Tumors and chemotherapy can cause
y Symptoms: Upper body edema, including facial production of antidiuretic hormone (ADH), leading to
swelling, periorbital edema, distended neck and water retention and dilutional hyponatremia.
chest veins y Symptoms: Weakness, personality changes,
y Nursing actions: Anticipate chemotherapy seizures, and coma
and radiation. y Nursing actions: Implement fluid restriction,
y Spinal cord compression: Tumor in epidural space monitor sodium levels, and administer sodium
or around spinal cord supplementation.
y Symptoms: Severe, persistent back pain; motor
weakness; sensory deficits
y Nursing actions: Prepare client for radiation or
possible surgery.

Hematologic/Oncologic
 Teach clients to report warning signs of cancer  What principles should be followed to minimize
including CAUTION: C_____, A_____, U_____, radiation exposure when caring for clients
T_____, I_____, O_____, N_____. receiving internal radiation (brachytherapy)?

 To detect complications of chemotherapy, such as  Which electrolyte imbalances are present in

infection and bone marrow suppression, the nurse tumor lysis syndrome? To correct electrolyte
should monitor the client’s _____ and _____ levels, imbalances, administer _____ fluids and _____,
and _____ (vital sign?). Clients with neutropenia and decrease uric acid by administering _____.
should report _____ fevers to the HCP.

 Teach clients receiving radiation to protect irradiated

skin by using _____ soap, avoiding _____ lotions,
avoiding _____ exposure, and wearing ____
clothing.
3. mild, scented, sun, loose 4. Time, distance, and shielding 5. Hyperkalemia, hyperuricemia, hyperphosphatemia, and hypocalcemia; IV, diuretics, allopurinol
Indigestion or difficulty swallowing, Obvious change in a wart or mole, Nagging cough or hoarseness 2. WBC, hemoglobin, temperature; low-grade
Answers: 1. Change in bowel or bladder habits, A sore that does not heal, Unusual bleeding or discharge, Thickening or lump in breast or elsewhere,

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