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 Statis- location Root words A- none Ana- lack Hyper- excessive Meta- change Dys- bad, deranged Characteristics of Neoplasia Uncontrolled growth of Abnormal cells 1. Benign 2. Malignant 3. Borderline 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 Nomenclature of Neoplasia Tumor is named according to: 1. Parenchyma, Organ or Cell Hepatoma- liver Osteoma- bone

Myoma- muscle Tumor is named according to: 2. Pattern and Structure, either GROSS or MICROSCOPIC Fluid-filled CYST Glandular ADENO Finger-like PAPILLO Stalk POLYP 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 Squamos 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 Choristoma Hamatoma 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 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) Proposed Molecular cause of CANCER: Change in the DNA structure altered DNA function Cellular aberration cellular death neoplastic change Genes in the DNA- protooncogene And anti-oncogene Etiology of cancer 1. PHYSICAL AGENTS Radiation Exposure to irritants Exposure to sunlight Altitude, humidity

CANCER NURSING 2. CHEMICAL AGENTS Smoking Dietary ingredients Drugs CANCER NURSING 3. Genetics and Family History Colon Cancer Premenopausal breast cancer 4. Dietary Habits Low-Fiber High-fat Processed foods alcohol 5. Viruses and Bacteria DNA viruses- HepaB, Herpes, EBV, CMV, Papilloma Virus RNA Viruses- HIV, HTCLV Bacterium- H. pylori CANCER NURSING 6. Hormonal agents DES OCP especially estrogen CANCER NURSING 7. Immune Disease AIDS CARCINOGENSIS Malignant transformation IPP Initiation Promotion Progression INITIATION Carcinogens alter the DNA of the cell Cell will either die or repair CANCER NURSING PROMOTION Repeated exposure to carcinogens Abnormal gene will express

 Latent period PROGRESSION Irreversible period Cells undergo NEOPLASTIC transformation then malignancy Spread of Cancer 1. LYMPHATIC Most common 2. HEMATOGENOUS Blood-borne, commonly to Liver and Lungs 3. DIRECT SPREAD Seeding of tumors 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 Diagnosis 1. BIOPSY The most definitive 2. CT, MRI 3. Tumor Markers Cancer Grading The degree of DIFFERENTIATION Grade 1- Low grade Grade 4- high grade Cancer Staging 1. Uses the T-N-M staging system T- tumor N- Node M- Metastasis 2. Stage 1 to Stage 4 GENERAL MEDICAL MANAGEMENT 1. Surgery- cure, control, palliate 2. Chemotherapy

3. Radiation therapy 4. Immunotherapy 5. Bone Marrow Transplant 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 self-exam Nursing Assessment Utilize the ACS 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 SOAP and Water MANAGEMENT OF STOMATITIS Use soft-bristled toothbrush Oral rinses with saline gargles/ tap water Avoid ALCOHOL-based rinses 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 PROMOTE NUTRITION Serve food in ways to make it appealing Consider patients preferences Provide small frequent meals Avoids giving fluids while eating Oral hygiene PRIOR to mealtime Vitamin supplements RELIEVE PAIN Mild pain- NSAIDS Moderate pain- Weak opiods Severe pain- Morphine Administer analgesics round the clock with additional dose for breakthrough pain DECREASE FATIGUE Plan daily activities to allow alternating rest periods Light exercise is encouraged Small frequent meals IMPROVE BODY IMAGE

Therapeutic communication is essential Encourage independence in selfcare and decision making Offer cosmetic material like make-up and wigs 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 MANAGE COMPLICATION: INFECTION Fever is the most important sign (38.3) Administer prescribed antibiotics X 2weeks Maintain aseptic technique Avoid exposure to crowds Avoid giving fresh fruits and veggie Handwashing Avoid frequent invasive procedures MANAGE COMPLICATION: Septic shock Monitor VS, BP, temp Administer IV antibiotics Administer supplemental O2 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 COLON CANCER Risk factors 1. Increasing age 2. Family history 3. Previous colon CA or polyps 4. History of IBD 5. High fat, High protein, LOW fiber 6. Breast Ca and Genital Ca Sigmoid colon is the most common site Predominantly adenocarcinoma If early 90% survival diagnosed early 66% late diagnosis PATHOPHYSIOLOGY Benign neoplasm DNA alteration malignant transformation malignant neoplasm cancer growth and invasion metastasis (liver) ASSESSMENT FINDINGS 1. Change in bowel habits- Most common 2. Blood in the stool 3. Anemia 4. Anorexia and weight loss 5. Fatigue 6. Rectal lesions- tenesmus, alternating D and C Diagnostic findings 1. Fecal occult blood 2. Sigmoidoscopy and colonoscopy 3. BIOPSY 4. CEA- carcino-embryonic antigen MEDICAL MANAGEMENT 1. Chemotherapy- 5-FU 2. Radiation therapy

SURGICAL MANAGEMENT 1. Surgery is the primary treatment 2. Based on location and tumor size 3. Resection, anastomosis, and colostomy (temporary or permanent) 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 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 Post-Operative care 1. Monitor for complications Leakage from the site, prolapse of stoma, skin irritation and pulmo complication 2. Assess the abdomen for return of peristalsis 3. Assess wound dressing for bleeding 4. Assist patient in ambulation after 24H 5.provide nutritional teachingLimit foods that cause gas-formation and odor Cabbage, beans, eggs, fish, peanuts Low-fiber diet in the early stage of recovery 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 NURSING INTERVENTION: COLOSTOMY CARE Colostomy begins to function 3-6 days after surgery The drainage maybe soft/mushy or semi-solid depending on the site 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 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 Lightly pat dry the area and NEVER rub Lightly dust the peri-stomal area with nystatin powder 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 Empty the pouch or change the pouch when 1/3 to full (Brunner) to 1/3 full (Kozier) Breast Cancer The most common cancer in FEMALES Numerous etiologies implicated Breast Cancer RISK FACTORS 1. Genetics- BRCA1 And BRCA 2

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 7. Obesity 8. Hormonal replacement 9. Alcohol 10. Exposure to radiation 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 4. Nipple retraction 5. Peau d orange LABORATORY FINDINGS 1. Biopsy procedures 2. Mammography Breast cancer Staging TNM staging I - < 2cm II - 2 to 5 cm, (+) LN III - > 5 cm, (+) LN IV- metastasis MEDICAL MANAGEMENT Chemotherapy Tamoxifen therapy Radiation therapy SURGICAL MANAGEMENT Radical mastectomy Modified radical mastectomy Lumpectomy Quadrantectomy 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 NURSING INTERVENTION : Post-OP 1. Position patient: Supine Affected extremity elevated to reduce edema 2. Relieve pain and discomfort Moderate elevation of extremity IM/IV injection of pain meds Warm shower on 2nd day 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 Promote activity Support operative site when moving Hand, shoulder exercise done on 2ndday Post-op mastectomy exercise 20 mins TID NO BP or IV procedure on operative site Heavy lifting is avoided Elevate the arm at the level of the heart On a pillow for 45 minutes TID to relieve transient edema