ONCOLOGY
NURSING
Prof. Rennard Christian De Perio
Clinical Instructor 1- Central Philippine University CON
Nurse Generalist
WHAT IS CANCER?
• Disease process that begins when an abnormal cell TRANSFORMED by the genetic
mutation of the cellular DNA.
• It refers to a process whereby cells mutate
Into abnormal cells, ignoring growth and
The environment .
WHAT IS ONCOLOGY?
• Branch of medicine that deals with the study, detection, treatment and management of cancer.
PROLIFERATIVE PATTERNS
• ATROPHY
• HYPERTROPHY
• HYPERPLASIA
• METAPLASIA
• DYSPLASIA
• ANAPLASIA
• NEOPLASIA
CANCER TERMINOLOGIES
NEO= New
PLASIA= Growth
PLASM= Substance
TROPHY= Size
OMA= Tumor
A= None
ANA= Lack
HYPER= Excessive
META= Change
DYS= Bad, Impaired
CANCER IN THE….
• Epithelial Tissues= CARCINOMA
• Glandular Tissues= ADENOCARCINOMA
• Connective, Muscle, Bones tissues= SARCOMAS
• Brain and Spinal Cord tissues= GLIOMAS
• Pigmented Cells= MELANOMAS
• Plasma Cells= MYELOMAS
• Lymphatic Tissues= LYMPHOMAS
• Leukocytes= LEUKEMIA
• Erythrocytes= ERYTHROLEUKEMIA
BENIGN
Usually occur singly
Rounded, wart like , elliptical
Encapsulated
Slow growth rate
Readily removed
NO METASTASIS
Seldom causes death
MALIGNANT
• Contains TUMOR-SPECIFIC ANTIGENS
• Nuclei of cancer cells are LARGE and IRREGULARLY SHAPED (PLEOMORPHISM)
• Mitosis occurs more frequently.
• Usually multiplies
• Irregular in shape
• Rapid growth
• Toxic to patient
INVASION AND METASTASIS
1. Lymphatic Spread =
• Malignant cells penetrate lymphatic vessels by invasion.
• Malignant cells either lodge in the lymph nodes or pass between the
lymphatic and venous circulations.
HEMATOGENOUS SPREAD
• Malignant cells attach to endothelium and
attract fibrin, platelets and clotting factors to
seal themselves from immune system
surveillance.
• Malignant cells to enter the basement
membrane and secrete lysosomal enzymes.
ANGIOGENESIS
• The formation of new blood vessels. This process involves the migration, growth, and
differentiation of endothelial cells, which line the inside wall of blood vessels. The process of
angiogenesis is controlled by chemical signals in the body.
3 STEPS OF CARCINOGENESIS
• INITIATION = which a change in a cell's genetic
material (a mutation) primes the cell to become
cancerous.
• PROMOTION= the second step in the two-stage model
of cancer development.
• PROGRESSION= the final stage where cancer cells
divides/grows continuously.
CAUSES OF CANCER:
• Viruses and Bacteria = HPV
• Physical Agents = Sunlight exposures
• Chemical Agents= Tobacco , Nicotine
• Genetic Factors = Default in DNA chromosomes
• Heredity / Familial History = Related or bloodline family history and exposures
• Dietary Factors = Unhealthy lifestyle practices
• Hormonal Factors = Imbalances in Male and Female hormones (estrogen, progesterone, testosterone)
ETIOLOGY FOR SPECIFIC TYPE:
BREAST CANCER
• Family History = MOTHER side
• High Fat Diet = High in CHOLESTEROL and SALTS
• Obesity after menopause
• EARLY MENARCHE , LATE MENOPAUSE
• Alcohol Consumption
• Post Menopausal Estrogen and Progestin
• First Child after AGED 30
CERVICAL CANCER
• Multiple Sexual partner
• Having sex at early age
• Exposure to human pappiloma virus
• Smoking
COLORECTAL CANCER
• Family History
• Low Fiber Diet
• History of Rectal Polyps
ESOPHAGEAL CANCER
Heavy alcohol consumption
Smoking
SKIN CANCER
• Excessive exposure to UV Radiation (SUN)
• Fair complexion
• Works with coal, tar, pitch or creosote factories
• Multiple or Atypical Nevi (Males)
STOMACH CANCER
• Family History
• Diet heavy in SMOKED, PICKLED or SALTED
FOODS
TESTICULAR CANCER
• Undescended testicles
• Consumption of Hormones by mothers during
pregnancy
UNDESCENDED TESTICLES
PROSTATE CANCER
• Increasing of age
• Family History
• Diet high in animal fats (Cholesterol)
CANCER GRADING
• The tool we used in grading cancer is TNM SYSTEM.
T= The extent of the primary tumor
N= The absence or presence of regional lymph node metastasis
M= The absence or presence of distant metastasis
IN ONCOLOGY NURSING….
• PREVENTION is the TOP PRIORITY because atleast one third of all cancers are preventable.
THE PRINCIPAL ROLE OF AN ONCOLOGY
NURSE
1. A Provider of information and education in the prevention and early detection of cancer.
2. Counselor
3. Advocate
4. Spiritual Adviser
CANCER PREVENTIONS
• 1. PRIMARY PREVENTION
• 2. SECONDARY PREVENTION
PREVENTION AND DETECTION
WARNING SIGNS OF CANCER
• C = hange in bowel or bladder habits
• A= ny sore that does not heal
• U = nusual bleeding or discharges
• T= hickening or lump in the breast or elsewhere
• I= ndigestion
• O= bvious change in wart or mole
• N= aging cough or hoarseness
• U= nexplained anemia
• S= udden or unexplained weight loss
PREVENTION AND DETECTION
WAYS TO PREVENT
• Promoting risk factors awareness
• Promoting healthy behaviors
• Limiting alcohol consumption
• Hepa B virus vaccination
• Control of STDs
• Changing risk behaviors
• Teaching skills for early detection programs
• Promoting participation in early detection programs
RECOMMENDATIONS
DETECTION OF BREAST CANCER
BREAST SELF-EXAM (BSE)
PREMENOPAUSAL – 2 TO 3 DAYS AFTER every month
MENOPAUSAL- Same day of each month
MAMMOGRAPHY
AGE: 40 years old and above
DONE: Yearly
Aftercare: No deodorants , Powders before the procedure
DETECTION OF COLON AND RECTAL CANCER:
1. All aged 50 and up should have a yearly fecal occult blood test
2. Digital rectal exam and flexible sigmoidoscopy every 5 years
3. Colonoscopy with BA enema every 10 years
RECOMMENDATIONS
FOR DETECTION OF UTERINE CANCER:
1. Yearly Pap-Smear for sexually active females and any female over age 18
2. At menopause, high-risk women should have an endometrial tissue sample.
FOR DETECTION OF PROSTATE CANCER:
Done: 50 years and above
DIGITAL RECTAL EXAM
DONE: 50 years and above (yearly performed)
POSITION: K___ position
PERFORMED: With PSA
Suggestive of prostate cancer: STONY HARD or INDURATED
• FOBT
COLONOSCOPY AND SIGMOIDOSCOPY
SIGMOIDOSCOPY- done every 5 years
COLONOSCOPY- done every 10 years (50 years old and above)
Before:
1. Check consent
2. Sedation
3. Position: LSP
4. NPO (except for ________)
During the procedure:
Monitor: RR and Cardiac rate > it will cause __________.
POST-PROCEDURE:
Watch-out for signs of perforation such as P,F,B
CT SCAN
With radiation
Contraindicated: Pregnant (ask for ______)
If with CONTRAST/DYE: Check for allergic reactions then obtain for CC.
Because it causes nephrotoxic.
MAGNETIC RESONANCE IMAGING
• No radiation
Before MRI: No metals, pacemaker, cards with
magnetic surface.
Ask patient if: CLAUSTROPHOBIC (IF YES ,
HE/SHE MUST BE S____.)
BONE MARROW EXAM (ASPIRATION)
Observe: STERILE TECHNIQUE
Best site:
ADULT- FLAT BONE (Posterior iliac crest)
PEDIA- Long bones (Tibia)
ADULT
PEDIA
Uses: Local Anesthesia
NORMAL: Feeling of slight pressure during
aspiration
WOF: B and I
ONCOFETAL ANTIGEN
Normally found during fetal development but if present in adult, it is
suggestive of cancer.
Nursing alert:
AFP= T and LC
CEA = G and Col
SURGERY
TYPES:
1. Diagnostic = biopsy
2. PROPHYLACTIC = To decrease the risk
3. CONTROL= prevents the spread
4. CURATIVE= remove the tumor
5. PALLIATIVE= relieve signs and symptoms
6. RECONSTRUCTIVE= restore functions/ aesthetics
RADIATION THERAPY
• INTERNAL RADIATION THERAPY
(BRACHYTHERAPY)
• EXTERNAL RADIATION THERAPY (TELETHERAPY)
BRACHYTHERAPY
SOURCES:
Implanted into the affected tissue or body cavity
Ingested as a solution
Injected as a solution into the bloodstream or body cavity
Introduced through a catheter into the tumor
SIDE EFFECTS:
Fatigue
Anorexia
Immunosuppression
CLIENT EDUCATION FOR BRACHYTHERAPY:
1. Avoid close contact with others until the treatment is completed.
2. Maintain daily activities unless contraindicated
3. Rest
4. Maintain a balanced diet and fluid intake
5. Double flush the toilet after use as excreted body fluids may be radioactive
NURSING MANAGEMENT FOR BRACHYTHERAPY:
1. Minimize time spend in close proximity to the radiation sources
2. Minimum distance should be 6 feet from the patient
3. Use lead shields as possible
4. Place the client in a PRIVATE ROOM
5. Ensure proper handling and disposal of body fluids
6. Pregnant women and children are not allowed inside the client’s room
TELETHERAPY
• SIDE EFFECTS:
1. Tissue damage to target area
2. Ulcerations
3. Nausea, Vomiting and diarrhea
4. Radiation Pneumonia
5. Fatigue
6. Alopecia
7. Immunosuppression
• CLIENT EDUCATION FOR TELETHERAPY:
1. Wash marked area of the skin with plain water only and pat dry. Do not wash off the treatment
site marks.
2. Avoid rubbing, scratching, or scrubbing the treatment site. Do not apply extreme temperatures
to the treatment site. If shaving is necessary, USE ELECTRIC RAZOR.
3. Wear soft, loose-fitting clothing over the treatment area
4. Protect skin from sun exposure during the treatment and for atleast 1 Year after the treatment is
completed.
5. Hair Loss may occur.
CHEMOTHERAPY
Route of administration:
1. IV
2. ORAL
3. INTRATHECAL
4. TOPICAL
5. INTRA-ARTERIAL
6. INTRACAVITY
7. INTRAVESICAL
CLASSIFICATIONS OF CHEMOTHERAPY
AGENTS
1. ALKYLATING AGENT (CELL-CYCLE NON-SPECIFIC)
A. CYCLOSPHOSPHAMIDE
Side effects: Bladder toxicity (Hemorrhagic cystitis)
WOF: Painless He_______.
B. Cisplatin (platinol)
Side effects: Alopecia, gonadal suppression, nephrotoxicity
C. Busulfan
Side effects: Pulmonary fibrosis
ANTI-METABOLITES (CELL-CYCLE)
1. Methotrexate (Rheumatrix)
S/E: alopecia, stomatitis, hyperuricemia, hepatoxic
AVOID: FOLIC ACID (it decreases the effect)
ANTIDOTE: FOLINIC ACID (LEUCOVORIN RESCUE)
2. Cytarabine (ARA-C)
S/E: Conjunctivitis with high doses
WOF: Stomatitis
3. Mercaptopurine (6-MP)
S/E: Hyperurecemia/Hepatotoxic
5 FU (FLUORO-URACIL)
WOF: ORAL THRUSH
S/E: Alopecia, stomatitis, diarrhea, photosensitivity
Use: SOFT-BRISTLE TOOTHBRUSH, NYSTATIN WASH (S and S)
HORMONES
1. Tamoxifen (novaldex)
DOC: BREAST/ OVARIAN CA
S/E: edema, hypercalcemia, increase risk of UTERINE CA
2.
WEAR: LONG SLEEVES, GOWN AND MASK
DO NOT: EXPOSE CHEMO DRUGS TO
SUNLIGHT
USED NEEDLES, SYRINGES, TUBINGS AND
PATIENT’S EXCRETA ARE BIOHAZARD
INTRATHECAL CHEMOTHERAPY
NURSING IMPLICATIONS IN
CHEMOTHERAPY
• IV routes may be obtained by subclavian catheters, implanted ports or peripherally inserted
catheters.
• Extravasation is the major complication of IV Chemotherapy.
WARNING: NEVER TEST VEIN PATENCY
WITH CHEMOTHERAPEUTIC AGENTS!
Nursing responsibility:
1. Monitor client closely for anaphylactic reactions or serious side effect.
2. Discontinue infusion according to protocol if reactions occur.
3. Use caution when preparing, administering or disposing chemotherapeutic
agents.
SIDE EFFECTS OF CHEMOTHERAPY
• Bone marrow suppression leads to:
A. LEUKOPENIA
Avoid crowds, people with infections and small children when WBC count is low.
Avoid undercooked meat and raw fruits and vegetables.
SIDE EFFECTS OF CHEMOTHERAPY
B. THROMBOCYTOPENIA=
Use electric razor when shaving.
Avoid contact sports
If trauma occurs, apply ice and seek medical assistance
Avoid dental work or other invasive procedures
Avoid aspirin and aspirin-containing drugs (NSAIDS)
SIDE EFFECTS OF CHEMOTHERAPY
C. GI EFFECTS:
Eat small, frequent, low-fat meals
Avoid spicy and fatty foods
Avoid extremely hot foods
Administer anti-emetics before chemotherapy
Weigh client routinely
SIDE EFFECTS OF CHEMOTHERAPY
D. STOMATITIS AND MUCOSITIS
Use soft toothbrush.
Mouth swabs may be needed during an acute episode.
Avoid mouthwashes containing alcohol. Do not use lemon glycerin swabs or dental floss.
Consider using chlorhexidine mouthwash and protect gums from trauma.
SIDE EFFECTS OF CHEMOTHERAPY
E. ALOPECIA
Encourage the client to choose a WIG before hair loss occurs.
Care of hair and scalp includes washing hair 2 to 3 times a week with a mild
shampoo.
Pat hair dry and avoid the use of a blow dryer.
TESTICULAR CANCER
• ROUTINE TESTICULAR EXAMINATION
DONE: Every month
BEST: Warm shower bath
CONSISTENCY: Hard boil egg
CERVICAL CANCER
PAP SMEAR
AGE: 21-29 Years old and above (3 years)
30-65 years old (every 5 years)
DONE: ANYTIME as long as there
NO MENSTRUATION.
HYSTERECTOMY
OVARIAN CANCER
• TAHBSO is required
• Chemotherapy and external radiation for tumor
ENDOMETRIAL CANCER
• External radiation or internal radiation is used alone.
• Chemotherapy
• Tamoxifen (Novaldax) – an anti-estrogen may also be prescribed.
Surgical Interventions: TAHBSO
BREAST CANCER
• Classified as invasive when it penetrates the tissue surrounding the mammary duct and grows in an
irregular pattern.
• Common sites of metastasis: BONES, LUNGS, BRAIN and LIVER.
• Diagnosis is based on: BIOPSY and needle aspiration or by surgical removal of the tumor with
microscopic exam for malignant cells.
PREVENTION: MONTHLY BREAST SELF-EXAMINATION , BASELINE MAMMOGRAM
BETWEEN AGES 35-39, YEARLY MAMMOGRAM AT THE AGE OF 40.
PEAU DE ORANGE’
Radiation therapy
Chemotherapy
Hormonal Manipulation via the use of medications in postmenopausal women such as
TAMOXIFEN (NOVADEX)
Surgeries:
Mastectomy
GASTRIC CANCER
INTERVENTIONS FOR GASTRIC CANCER
1. SUBTOTAL GASTRECTOMY
A.) BILROTH 1 (ROUX-EN-Y)
Also called gastroduodenostomy
Partial gastrectomy with remaining segment anastomosed to the duodenum
B.) BILROTH II
Also called gastrojejunostomy
> partial gastrectomy with remaining segment anastomosed to the jejunum.
TOTAL GASTRECTOMY
• Also called esophagojejunostomy
> Removal of the stomach with attachment of the esophagus to the jejunum or duodenum.
PANCREATIC CANCER
• Whipple’s procedure
INTESTINAL CANCER
• Blood in the stools
• Anorexia, Vomiting and weight loss
• Body malaise
• Anemia
• Abnormal stools in the following colon sections
