ONCOLOGY NURSING

Cancer recognized in ancient times by the skilled observers who gave it the name cancer; an umbrella word used
to describe a group of more than 100 diseases in which cells multiply and spread without restraint.
Causative Factors
Viruses and Bacteria viruses are thought to incorporate themselves in the genetic structure of cells thus altering
future generations of that cell
!ender and "ite for men the most common site of cancers are the prostate colorectal and bladder; for women
the top # cancers are the breast the lung colon and rectum
$ge cancer is a disease of aging; the more advanced the age the highest risk of development of cancer
%ace and &thnicity there are certain cancers specific only to specific races liked blacks 'ewish and $sian
descents
!eographic (actors primary cancers of the liver are common in )ndonesia in parts of $frica and $sia; breast
cancer is common in the *"$ and +estern &urope
Risk Factors
A. Endogenous
1. $ge older people tend to have increased risk for development of cancer due to the longer time of
e,posure to harmful agents
-. !enetic (actors most cancers are not inherited but occur because of random genetic mutations in
people with little or no relevant family history
#. .ormonal (actors hormones such as estrogen do not appear to be primary carcinogens but influences
carcinogenesis
/. 0re1cancerous 2esions includes polyps of the colon and rectum; certain pigmented moles dysplasias
of the cervical epithelium and others
3. )mmunologic (actors persons who have weaker immune system have increased risk for the
development of cancer
B. Exogenous Factors
1. 4rugs and Chemicals many chemicals drugs and products in the environment are known to be
carcinogenic and hundred of others are considered to be associated with the development of cancers
-. %adiation
a. Ionizing Radiation consists of electromagnetic waves or material particles that have sufficient
energy to ionize atoms or molecules
b. Ultraviolet Radiation *V% is produced by the sun by artificial sources such as tanning beds
or those in the industries. 5his type of radiation acts as an initiator a promoter a cocarcinogenic or an
immunosuppressive agent.
c. Radon a colorless odorless radioactive gas that results from the decay of uranium found in
soil and in rocks. 0rolonged breathing at high levels have been linked to an increased incidence of lung cancers.
1
d. Electromagnetic Radiation &6( are e,tremely low fre7uency energy fields and e,posure can
come from household appliances electrical power lines and electricity1generating facilities
#. 2ifestyle 0ractices
a. Smoking and Tobacco use tobacco smoke is the single most lethal cause of cancer in the *"$
and is associated with at least 10 different cancers responsible for up to #08 of all cancer deaths
b. Nutrition the consumption of high fat diet has been researched as a risk factor in many
common cancers including cancers of the colon prostate and breast
/. 9besity considered a risk factor in for colon breast endometrial renal and esophageal cancers.
3. "e,ual and %eproductive (actors se,ual practices play a role in the incidence of certain cancers
because serial "54s have been linked to cancer including .)V
:. Viruses and 9ther 6icroorganisms .BV and .CV can cause chronic infections that are associated
with hepatocellular carcinoma
;. 0sychosocial (actors stress that results from psychosocial trauma loss of a significant other and
personality variables such as helplessness and repression have been suggested as etiologic factors in the
development of cancer
Classification/Site of Origin
1. $denocarcinoma1 originates in glandular tissue
-. Blastoma1 originates in the embryonic tissue of organs
#. Carcinoma1 originates in the epithelial tissue <i.e. tissue that lines organs and tubes=
/. 2eukemia1 originates in tissues that form blood cells
3. 2ymphoma1 originates in lymphatic tissue
:. 6yeloma1 originates in the bone marrow
;. "arcoma1 originates in the connective tissues or supportive tissues <i.e. bone cartilage muscles=
Grading, Staging, Te T!N!"
A. Grading
the cancer is e,amined for its cellular maturity and characteristics. 5he abnormality of the cells
determines he grade of the cancer. $ higher grade means the tissue appears more abnormal and generally is
more aggressive
B. Staging
the classification of the e,tent of the disease
C. The T-N-M Cancer Staging
1. Tumor
5o1 no lymph node involvement
5is1 carcinoma in situ <limited to surface cells only=
511/1 increasing tumor involvement
2. Node
>o1 no lymph node involvement
>11/1 increasing degree if lymph node involvement
>,1 lymph node involvement cannot be assessed
-
3. Metastasis
6o1 no evidence of distant metastasis
611 evident of distant metastasis
the numerical system used to classify the e,tent of the disease
"tage 01 cancer in situ <surface cells=
"tage11 cancer limited to the tissue of origin; evidence of tumor growth
"tage -1 limited local spread of cancerous cells
"tage #1 e,tensive local and regional spread
"tage /1 distant metastasis
Co##on Signs and S$#%to#s of Cancer
Change in bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge
Thickening or lump in breast or elsewhere
Indigestion or difficulty in swallowing
Obvious change in wart or mole
Nagging cough or hoarseness
Anore,ia
Loss of weight <une,plained=
&ato%$siolog$
malignant or cancerous growths represent one form of abnormal growth
an abnormal cell is transformed by the genetic mutation of cellular 4>$
abnormal cells form a clone and proliferates abnormally
cells ac7uire invasive characteristics and infiltrate the surrounding tissues and gain access to lymph and
blood vessels carrying them to the other areas of the body.
Cell &roliferative &atterns
1. .yperplasia1 an increase in the cell number with accompanying increase in size
-. .ypetrophy1 an increase in the cell size but not in its number
#. 6etaplasia1 the conversion of one type of mature cell into another type of cell; a reversible process and
is not related to cancer
/. 4ysplasia1 an alteration in adult cell characterized by changes in their size shape and organization
3. >eoplasia1 abnormal cellular division not necessary for normal cell growth and development; often
leads to the formation of cancer cells
:. $naplasia1 cells that lack normal cellular characteristics and differ in shape and organization with
respect to their cells of origin and are usually malignant.
'enign vs( "alignant Tu#or
Caracteristics 'enign "alignant
Cell
characteristics
+ell1differentiated cells that resemble
normal cells of the tissue from which
the tumor originated
Cells are undifferentiated and often bear little
resemblance to the normal cells of the tissue from
which they arose
6ode of !rowth 5umor grows by e,pansion and does
not infiltrate the surrounding tissues;
usually encapsulated
!rows at the periphery and sends out processes that
infiltrate and destroy surrounding tissues
%ate of !rowth *sually slow %ate of growth is variable and depends on the level of
differentiation
#
6etastasis 4oes not spread by metastasis !ains access to the blood and lymphatic channels and
metastasizes to the other areas of the body
!eneral &ffects )s usually a localized phenomenon that
does not cause generalized effects
unless its location interferes with vital
function
9ften causes generalized effects such as anemia
weakness and weight loss
5issue
4estruction
4oes not usually cause tissue damage
unless its location interferes with blood
flow
9ften causes e,tensive tissue damage as the tumor
outgrows its blood supply or encroaches on blood
flow to the area; may also produce substances that
cause cell damage
$bility to Cause
4eath
4oes not usually cause death unless its
location interferes with vital function
*sually causes death unless growth can be controlled
)iagnostic Tests for S%ecific Cancers
*( Gastrointestinal Cancers
&sophageal
C5 "can
6%)
&sophagoscopy with Biopsy
Barium "wallow
"tomach
!astric "ecretion $nalysis
Carcinogenic $ntigen
!astroscopy with Biopsy
Barium "wallow
Colorectal Cancers
C5 "can
6%)
"tool !uaiac
Colonoscopy and Biopsy
Barium "wallow
Cancer $ntigen
2iver Cancer
2iver Biopsy
2iver &nzyme "tudies
*ltrasound
C5 "can
6%)
$ngiography
+( Genitourinar$ Cancer
0rostate
4igital %ectal &,amination
Bone "can
Biopsy
*rinalysis
0"$ "erum $cid 0hosphatase
/
Bladder
Cytology
Cytoscopy
)V0
*rinalysis
?idney
C5 "can
%enal $ngiogram
?*B "tudies
*rinalysis
)V0
,( G$necologic Cancers
Cervical
Colposcopy
Biopsy
0ap "mear
9vary
0elvic 0hysical &,am
)V0
Barium &nema
*rinalysis
*terine
&ndometrial Biopsy and $spiration
-( Oter Cancers
Breast
Breast 0hysical &,amination
*ltrasound
6ammography
5issue 2ymph >ode Biopsy
&strogen and 0rogesterone %eceptor "tatus
2ung
Chest @1ray
"putum Cytology
(iberoptic Bronchoscopy with Biopsy and Bronchial +ashings
6ediastinography
5horacentesis
"anage#ent of Cancer
Surgical "anage#ent
the oldest and most widely1used option for cancer treatment; may be used for cancer diagnosis and
staging cure adAuvant treatment control of oncologic emergencies or palliation of symptoms
1. 4iagnostic
-. Curative or 0rimary 5reatment
a. ocal e!cision
b. "ide or Radical E!cision
3
c. Endosco#ic Surger$
d. Salvage Surger$
e. Electrosurger$
%. &r$osurger$
g. &'emosurger$
'. aser Surger$
#. 0rophylactic "urgery
/. 0alliative "urgery when cure is not possible; the goal is to make the patient as comfortable as possible
and to promote a satisfying and productive life for as long as possible
3. %econstructive "urgery may follow curative or radical surgery and is carried out in an attempt to
improve function or obtain a desirable cosmetic effect
Radiation Tera%$
ionizing radiation is used to interrupt cellular growth; may be used to cure cancer or to control
malignant disease when a tumor cannot be removed surgically or when a local nodal metastasis is present
1. &,ternal %adiation can be used to destroy cancerous cells at the skin surface or deeper in the body
a. (ilovoltage T'era#$
b. inear )ccelerators*+etatron Mac'ine
c. ,amma Ra$s
-. )nternal %adiation also known as brachytherapy delivers a high dose of radiation to a localized area; can
be implanted by means of needles seeds beads or catheters into the body cavity or interstitial
compartments
a. Intracavitar$ Radioisoto#es
b. Interstitial Im#lants
Ce#otera%$
the use of drugs to kill tumor cells by interfering with cellular function and reproduction
1. $lkylating $gents
-. >itrosureas
#. $ntimetabolites
/. $nti1tumor $ntibitics
3. .ormonal $gents
a. )ndogens
b. &orticosteroids
c. Estrogens
d. -rogestins
e. Estrogen )ntagonists
:. $nti1adrenal
;. Vinca $lkaloids
B. &pipodophylloto,ins
C. 5a,anes
Nursing Care of Cancer &atients
1. 0rotect the skin and oral mucosa
-. 0rotect the cargivers from radiation
#. $ssess for fluid and electrolyte status
/. 6odify risks for infection and bleeding
3. )mplement necessary safeguards
:. $dminister prescribed medications
;. $ssess for the psychological impact of hair loss
B. 6anage nutritional concerns
:
C. 6anage pain
10. 0rovide ade7uate rest
11. 6anage stomatitis
1-. 0rovide emotional support
Oncoog! "uestions #ith $ationae
1. Nina, an oncology nurse educator is speaking to a womens group about breast cancer.. Questions and
comments from the audience reveal a misunderstanding of some aspects of the disease. Various members of the
audience have made all of the following statements. Which one is accurate
a. !ammography is the most reliable method for detecting breast cancer.
b. "reast cancer is the leading killer of women of childbearing age.
c. "reast cancer re#uires a mastectomy.
d. Men can develop breast cancer.
$nswer %. !en can develop breast cancer, although they seldom do. &he most reliable method for detecting
breast cancer is monthly self'e(amination, not mammography. )ung cancer causes more deaths than breast
cancer in women of all ages. $ mastectomy may not be re#uired if the tumor is small, confined, and in an early
stage.
*. Nurse !eredith is instructing a premenopausal woman about breast self'e(amination. &he nurse should tell the
client to do her self'e(amination+
a. at the end of her menstrual cycle.
b. on the same day each month.
c. on the 1st day of the menstrual cycle.
d. immediately after her menstrual period.
$nswer %. ,remenopausal women should do their self'e(amination immediately after the menstrual period,
when the breasts are least tender and least lumpy. -n the 1st and last days of the cycle, the womans
breasts are still very tender. ,ostmenopausal women because their bodies lack fluctuation of hormone
levels, should select one particular day of the month to do breast self'e(amination.
.. Nurse /ent is teaching a male client to perform monthly testicular self'e(aminations. Which of the following
points would be appropriate to make
a. Testicular cancer is a highly curable type of cancer.
b. &esticular cancer is very difficult to diagnose.
c. &esticular cancer is the number one cause of cancer deaths in males.
d. &esticular cancer is more common in older men.
$nswer $. &esticular cancer is highly curable, particularly when its treated in its early stage. 0elf'
e(amination allows early detection and facilitates the early initiation of treatment. &he highest mortality
rates from cancer among men are in men with lung cancer. &esticular cancer is found more commonly in
younger men.
1. 2hea, has malignant lymphoma. $s part of her chemotherapy, the physician prescribes chlorambucil
;
3)eukeran4, 15 mg by mouth daily. When caring for the client, the nurse teaches her about adverse reactions to
chlorambucil, such as alopecia. 6ow soon after the first administration of chlorambucil might this reaction occur
a. 7mmediately
b. 1 week
c. 2 to 3 weeks
d. 1 month
$nswer 8. 8hlorambucil'induced alopecia occurs * to . weeks after therapy begins.
9. $ male client is receiving the cell cycle:nonspecific alkylating agent thiotepa 3&hiople(4, ;5 mg weekly for 1
weeks by bladder instillation as part of a chemotherapeutic regimen to treat bladder cancer. &he client asks the
nurse how the drug works. 6ow does thiotepa e(ert its therapeutic effects
a. 7t interferes with deo(yribonucleic acid 3%N$4 replication only.
b. 7t interferes with ribonucleic acid 32N$4 transcription only.
c. It interferes with DN replication and !N transcription.
d. 7t destroys the cell membrane, causing lysis.
$nswer 8. &hiotepa interferes with %N$ replication and 2N$ transcription. 7t doesnt destroy the cell
membrane.
;. &he nurse is instructing the .9 year old client to perform a testicular self'e(amination. &he nurse tells the
client+
a. &o e(amine the testicles while lying down
b. That the best time for the e"amination is after a shower
c. &o gently feel the testicle with one finger to feel for a growth
d. &hat testicular self'e(amination should be done at least every ; months
$nswer ". &he testicular'self e(amination is recommended monthly after a warm bath or shower when the
scrotal skin is rela(ed. &he client should stand to e(amine the testicles. <sing both hands, with fingers
under the scrotum and thumbs on top, the client should gently roll the testicles, feeling for any lumps.
=. $ female client with cancer is receiving chemotherapy and develops thrombocytopenia. &he nurse identifies
which intervention as the highest priority in the nursingplan of care
a. !onitoring temperature
b. $mbulation three times daily
c. Monitoring the platelet count
d. !onitoring for pathological fractures
$nswer 8. &hrombocytopenia indicates a decrease in the number of platelets in the circulating blood. $
ma>or concern is monitoring for and preventing bleeding. -ption $ elates to monitoring for infection,
particularly if leukopenia is present. -ptions " and %, although important in the plan of care, are not related
directly to thrombocytopenia.
B
?. @ian, a community health nurse is instructing a group of female clients about breast self'e(amination. &he
nurse instructs the client to perform the e(amination+
a. $t the onset of menstruation
b. Avery month during ovulation
c. Weekly at the same time of day
d. # week after menstruation begins
$nswer %. &he breast self'e(amination should be performed monthly = days after the onset of the
menstrual period. ,erforming the e(amination weekly is not recommended. $t the onset of menstruation
and during ovulation, hormonal changes occur that may alter breast tissue.
B. Nurse 8ecilia is caring for a client who has undergone a vaginal hysterectomy. &he nurse avoids which of the
following in the care of this client
a. $levating the knee gatch on the bed
b. $ssisting with range'of'motion leg e(ercises
c. 2emoval of antiembolism stockings twice daily
d. 8hecking placement of pneumatic compression boots
$nswer $. &he client is at risk of deep vein thrombosis or thrombophlebitis after this surgery, as for any ther
ma>or surgery. Cor this reason, the nurse implements measures that will prevent this complication. 2ange'
of'motion e(ercises, antiembolism stockings, and pneumatic compression boots are helpful. &he nurse
should avoid using the knee gatch in the bed, which inhibits venous return, thus placing the client more at
risk for deep vein thrombosis or thrombophlebitis.
15. !ina, who is suspected of an ovarian tumor is scheduled for a pelvic ultrasound. &he nurse provides which
preprocedure instruction to the client
a. Aat a light breakfast only
b. !aintain an N,- status before the procedure
c. Wear comfortable clothing and shoes for the procedure
d. Drink si" to eight glasses of water without voiding before the test.
$nswer %. $ pelvic ultrasound re#uires the ingestion of large volumes of water >ust before the procedure. $
full bladder is necessary so that it will be visualiDed as such and not mistaken for a possible pelvic growth.
$n abdominal ultrasound may re#uire that the client abstain from food or fluid for several hours before the
procedure. -ption 8 is unrelated to this specific procedure.
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