ONCOLOGY

Peter Glen L. Reyes, PTRP,RN,MAN

CANCER CELLS
 BREAST CANCER

 CANCER CELL

 LUNG CANCER
Epidemiology, Etiology,
Terms
 Disorders that can involve all body organs with
manifestations that vary according to the body
system affected and type of tumor cells

 Cells lose their normal growth controlling

mechanisms and the growth of cells is uncontrolled.
 Cancer produces serious health problems such as
impaired immune and hematopoietic function,
altered GIT structure and function, sensory deficits
and decreased respiratory function.
 Epidemiology, Etiology, Terms
 Cancer is the second most common cause of death in the
USA
 Sites in men associated with greatest mortality: lung,
colon, rectum and prostate
 Sites in women with greatest mortality: breast, lung, colon,
and rectum
Etiology
 Generally
unknown but may
be caused by
interacting factors

 Theories include
predisposing
factors:
constant irritation
environmental
carcinogens
radiation
METASTASIS

 LOCAL SEEDING –distribution of shed

cancer cells occur in the local area of the
primary tumor
 BLOOD BORNE –tumor cells enter the blood,
which is the most common cause of cancer
spread
 LYMPHATIC SPREAD –primary sites rich in
lymphatics are more susceptible to early
metastatic spread
Hyperplasia involves an increase in
the number of cell in a tissue; may be
a normal or an abnormal cellular
response
 Metaplasia refers to the conversion of one type of
cell in a tissue to another type not normal to that
tissue. It results from an outside stimulus affecting
parent stem cells and may be reversible or progress
to dysplasia
 Dysplasia refers to a change in size, shape, or
arrangement of normal cell into bizarre cells; may
precede an irreversible neoplastic change
 Anaplasia involves a change in the structure of cells
and in their orientation to one another, characterized
by a loss of differentiation and a return to a more
primitive form. The resulting poorly differentiated,
irregularly shaped cells are nearly always malignant
CELL DIVISION

 MUTATION  HYPERPLASIA

 DYSPLASIA
Neoplasia refers to the
abnormal benign or
 malignant
Benign cell
neoplasm: growth
usually harmless, does
not infiltrate other tissues

 Malignant neoplasm: always harmful, may

spread or metastasize to tissues far from
the original site
CANCER CLASSIFICATION
 SOLID TUMORS –
associated with organs from
which they develop such as
breast cancer or lung
cancer

 HEMATOLOGICAL
CANCER –originate from
the blood cell-forming
tissue, such as leukemia,
lymphomas, and multiple
myeloma
Cancer terminology

primary site of
neoplasm is
its site of
origin
 secondary
sites
represent
metastasis
 types of
neoplasms:
benign and
malignant
four types of malignant
neoplasms
carcinomas: usually solid
tumors arising from epithelial
cell
 sarcomas: from muscle, bone,
fat and other connective
tissuesarcomas: from muscle,
bone, fat and other connective
tissue
 lymphomas: originate in the
lymphatic
 system leukemias: originate in
the blood system
TYPES OF CANCER
 SQUAMOUS CELL
CARCINOMA

 LARGE CELL CARCINOMA

 History and physical exam - depends on location
of tumor
 Biopsy: obtaining tissue for histological
examination
 Imaging: CT scan, MRI
 BONE MARROW ASPIRATION
 Usually involves aspiration of the marrow to
diagnose diseases like leukemia, aplastic
anemia
 Usual site is the sternum and iliac crest
 Pre-test: Consent
 Intratest: Needle puncture may be painful
 Post-test: maintain pressure dressing and
watch out for bleeding
DIAGNOSTIC TESTS
MRI
 Uses magnetic waves

 Patients with

pacemakers,
orthopedic metal
prosthesis and
implanted metal
devices cannot
undergo this procedure
 NPO 4-6 hours before

procedure
MRI
 A. Definition
 1. This procedure utilizes magnetism and radio waves to
produce images of cross-sections of the body
 2. The MRI machine registers the existence of odd-number
edatoms in the cross sections of the body, yielding data
about the chemical makeup of the tissues
 3. MRI can produce accurate images of blood vessels,
bone marrow, gray and white brain matter, the spinal cord,
the globe of the eye, the heart, abdominal structures, and
breast tissue, and can monitor blood velocity.
MRI
 Nursing care
 1. Assess ability to withstand confining
surroundings because client must remain in
the tunnel-like machine for up to 90 minutes;
open MRI may be an option for clients who
cannot tolerate closed spaces
 2. Instruct client to toilet prior to test, since
this will be impossible during the procedure
 3. Advise client to remove jewelry, clothing
with metal fasteners, dentures, hearing aids,
and glasses prior to entering scanner.
MRI
 4. Since this procedure is contraindicated for
certain clients, before the test assess for:
 a. Metal prostheses, such as orthopedic
screws, since the magnetic force can
dislodge the devices.
 b. Pacemakers, since the scanner
deactivates pacemaker.
 c. Dysrhythmias, because the magnetic field
can affect the conduction system of the heart
 d. Unstable medical conditions, since
monitoring of the client is limited during the
test.
 5. Evaluate client's response to procedure.
DIAGNOSTIC TESTS
CT scan
 With radiation risk

 If contrast medium
will be used- ensure
consent, assess for
allergies to dyes and
iodine or seafood,
flushing and metallic
taste are expected as
the dye is injected
Computerized
Tomography (CT)
 A. Definition
 1. Cross-sectional visualization of the brain
determined by computer analysis of relative
tissue density as an x-ray beam passes
through; also known as computerized axial
tomography (CAT) scan
 2. Provides valuable information about
location and extent of tumors, infarcted
areas, atrophy, and vascular lesions
 3. May be done with or without intravenous
injection of dye for contrast enhancement
 B. Nursing care
 1. Explain procedure; inform the client that it
will be necessary to lie still and that the
equipment is complex but will cause no pain
or discomfort; infants and cognitively
impaired or anxious clients may need to be
sedated
 2. If the facility is small, arrange
transportation to a larger facility that has the
required equipment
 3. Evaluate for possible allergy to iodine, a
component of the contrast material
 4. Withhold food for approximately 4 hours
prior to testing; dye may cause nausea in
sensitive patients
 5. Remove wigs, clips, and pins prior to the
test
 6. Evaluate client's response to procedure.
Staging and grading
 Staging: describe and classify extent of a
malignancy when it is diagnosed
 Grading: describe the degree of malignancy
according to the type of tumor cell
 Treatment in General
 Objective: to remove all traces of the cancerous
tissue
 Treatment plan based on stage and grade of
tumor
 Surgery: specific to site of malignancy
 Metastatic Disease
 Spread of malignancy beyond
the primary site; means of
metastasis:
 Tumor invades adjacent
tissue

 Tumor sheds cells into body

cavities
 Tumor cells spread via the
lymphatic system or blood
stream
 Major cause of death from cancer
 Most common sites:
 to lung from primary sites in colon,
rectum, breast, renal system, testes and
bone
 to liver from primary sites in lung, colon,
rectum, breast and renal system
 to CNS from primary sites in lung and
breast
 to bone from primary sites in lung, breast,
renal system and prostate
FACTORS THAT INFLUENCE
CANCER DEVELOPMENT
 Chemical carcinogen –
industrial chemicals, drugs,
and tobacco
 Physical carcinogen –
radiation (diagnostics, sun,
ultraviolet)
 Viral –viruses capable of
causing cancer are known
as oncoviruses such as
Epstein-Barr, heap B, and
human papillomavirus
 H. pylori –is associated with
increased risk of gastric
cancer
CAUSES
 SUN EXPOSURE
 PRESERVATIVES
 SMOKED FOODS
 CARCINOGENS
 RADIATION
 TOBACCO
 H.PYLORI
 INDUSTRIAL AGENTS
FACTORS THAT INFLUENCE
CANCER DEVELOPMENT
 Obesity and dietary factors
–preservatives, additives,
and nitrates
 Genetic predisposition
 Age
 Immune function –higher in
immunosuppressed
persons, such as AIDS px.,
organ transplant taking
immunosuppressive meds.
NUTRITIONAL GUIDELINES TO
REDUCE THE RISK OF MANY
TYPES OF CANCER
 Avoid obesity
 Decrease total dietary fat intake
 Eat more high-fiber foods, such
as whole grain, cereals, fruits,
and vegetables
 Include foods rich in vitamins A
and C in the daily diet
 Include cruciferous vegetables
(e.g. cabbage, broccoli,
bruselle’s sprouts, kohirabi,
cauliflower) in the diet
 Consume alcoholic beverages
only in moderation
 Consume salt-cured, smoked,
and nitrite-cured foods only in
moderation
OTHER ACCEPTED RISK-
REDUCTION MEASURES INCLUDE

 Avoid tobacco use

 Avoid excessive sun exposure, particularly
between 10 a.m. and 3 p.m.
 Avoid exposure to industrial agents known to
increase cancer risk
 Cancer Pain Management
 Although clients with cancer may experience pain
at any time during their disease, pain is usually a
late symptom of cancer
EARLY DETECTION

 Mammography
 Pap’s test
 Stools for occult blood
 Sigmoidoscopy and colonoscopy
 BSE
 TSE
 Skin infection
MAMMOGRAPHY
CAUTION

 Change in the bladder and

bowel habits
 Any sore that does not heal
 Unusual bleeding or
discharge
 Thickening or lump in breast
or elsewhere
 I
 Obvious change in wart or
mole
 Nagging cough or
hoarseness
SIGNS OF CANCER
PREVENTION

 AVOIDANCE of known or potential

carcinogens and avoidance or modification of
the factors associated with the development
of cancer cells
BREAST SELF EXAMINATION

 PERFORM 7 TO 10
DAYS AFTER
MENSTRUATION
 Postmenopausal clients
should select a specific
day of the month and
perform BSE monthly
on that day
Breast self examination
TESTICULAR SELF EXAMINATION

 Performed on the same day of each month

 Best time is right after shower
TESTICULAR SELF
EXAMINATION
DIAGNOSTIC TESTS/BIOPSY

 Definitive means of diagnostic cancer and

provides histological proof of malignancy
 Involves the surgical incision of a small piece
of tissue for microscopic examination
BIOPSY/TYPES

 Needle-aspiration of cells
 Incisional-removal of suspected tissue from a
larger mass
 Excisional-complete removal of the entire
lesion
OTHER DIAGNOSTIC TESTS

 Bone marrow examination

 Chest radiograph
 Computed tomography
 Pap’s smear
 Liver function tests
 MRI
 Protoscopic examination
 Mammography
SIGMOIDOSCOPY
PAP TEST
COLONOSCOPY
PAIN CONTROL

 Causes of Pain
 Bone destruction
 Obstruction of an organ
 Compression of peripheral nerves
 Infiltration, distention of tissues
 Inflammation, necrosis
INTERVENTIONS

 Asses the client’s pain

 Collaborate with the other health team to develop a
pain management program
 Mild or moderate pain may be treated with
salicylates, acetaminophen, NSAIDS
 Severe pain is treated with opioids
 Monitor vital signs and for side effects of medication
 Monitor for effectiveness of medications
 Provide non-pharmacological techniques of pain
control, i.e. relaxation, biofeedback, massage,
heat/cold application
REMINDER

 “DO NOT UNDER-MEDICATE THE

CANCER CLIENT WHO IS IN PAIN”
SURGERY-indicated to diagnose,
stage, and treat cancer
 Prophylactic-an attempt to remove the tissue or organ at risk and
thus prevent the development of cancer
 Curative-all gross and microscopic tumor is removed or
destroyed
 Control/debulking-removing a large portion of a local tumor such
as ovarian cancer
 Palliative-performed to reduce pain, relieve airway obstruction,
relieve obstruction in the GI or urinary tract, relieve pressure in
the brain or spinal Cord, performed to improve quality of life
during the survival time
 Reconstructive or rehabilative -improve quality of life by restoring
maximal function and appearance, i.e. breast reconstruction after
mastectomy
SIDE EFFECTS OF SURGERY

 Loss or loss of function of a specific body part

 Reduced function as a result of organ loss
 Scarring or disfigurement
 Grieving about the altered body image or
imposed change of lifestyle
CHEMOTHERAPY

 Kills or inhibits the reproduction of neoplastic

cells and kills the normal cells
 Highly toxic agents that attack all rapidly
dividing cells , both normal and malignant
 Most agents modify or interfere with DNA
synthesis
 ANTINEOPLASTICS (CYTOTOXIC,
ANTIPROLIFERATIVE AGENTS)
Alkalyting agents (cytoxan): produce breaks in DNA molecule
and cross-linking of strands thus interfering with DNA replication;
most effective in hematologic malignancies
Antitumor antibiotics (biomycin): bind directly with DNA changing
its configuration and inhibiting replication
Antimetabolites :5-fluorouracil, floxuridine: inhibit DNA synthesis;
most effective against rapidly growing tumors enzymes
necessary for cell function and replication
Plant alkaloids: vincristine: bind to substances needed to form
mitotic spindle, thus preventing cell division
Hormone and hormone inhibitors: alters the endocrine
environment to make it less conducive to cell growth; used in
cancers of the breast, prostate, and other reproductive organs
Chemotherapy drugs
 Anti neoplastic drugs:
vincristine,etc
ROUTES OF ADMINISTRATION

 Intravenous (peripheral or central nervous

access)
 Oral
 Intraarterial
 Intraperitoneal
 Intrapleural
Use

 To cure, control or palliate results of

neoplasm
 May be used as an adjunct to surgery and
radiation
ADVERSE EFFECTS: RESULTS
FROM THE DAMAGE TO NORMAL
CELLS
 Nausea/vomiting, stomatitis, alterations in taste, anorexia
 Diarrhea, constipation
 Alopecia, dermatitis, pruritus, paresthesia, rash, bruising
 Hemorrhagic cystitis
 Cardiomyopathy
 Fatigue, dyspnea, fever, chills
 Sterility, amenorrhea
 Depression, anxiety
 Myelosuppression
NURSING INTERVENTIONS
 Monitor lab studies as ordered
 Monitor IV site for extravasation
 Maintain strict asepsis
 Administer antiemetic agents as ordered and prophylactically
before chemotherapy
 Give antihistamines as ordered
 Withhold food and liquids for 4 to 6 hours before treatment
 Between treatments, give small, frequent, bland meals
 Give antidiarrheals as ordered
 Monitor signs of dehydration and encourage fluids as tolerated
 Provide frequent oral hygiene, lubricate lips as indicated
 For stomatitis, use topical anesthetics before eating and as
indicated
 Apply lotion to skin as indicated; avoid harsh, drying soaps
 Provide a restful environment, emotional support, and anxiolytics
as ordered
TEACH CLIENT

 Medications and side

effects
 Alopecia is temporary
 Avoid bruising, aspirin
products, and persons with
infection
 Conserve energy
 Recognize signs of
bleeding, anemia, infection
 Use soft-bristle toothbrush
 Avoid use of razors
Anti neoplastic drugs: vincristine,etc
SPeCIAL NURSING
CONSIDERATIONS

 Exposure to chemotherapeutic agents can

lead to adverse reactions
 Contact dermatitis
 Nausea and vomiting
 Diarrhea
Exposure during pregnancy can
lead to

 increased risk of fetal abnormalities

 ectopic pregnancies
 spontaneous abortions
 Salamat po