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Cancer Background
A. Definition
1. Family of complex diseases
2. Affect different organs and organ systems
3. Normal cells mutate into abnormal cells that take
over tissue
4. Eventually harm and destroy host
5. Historically, cancer is a dreaded disease
B. Oncology
1. Study of cancers
2. Oncology nurses specialize in the care, treatment
of clients with cancer
Nursing Care of the Client with Cancer
Physiology of Cancer
A. Background
1. Normal Cell Growth includes two
events
a. Replication of cellular DNA
b. Mitosis (cell division)
Nursing Care of the Client with Cancer
4. Viruses
viruses break the DNA chain and mutates the
normal cells DNA
Epstein-Barr virus
Human papilloma virus
Hepatitis virus
5. Drugs and Hormones
a. Sex hormones often affect cancers of the
reproductive systems (estrogen in some breast
cancers; testosterone in prostate cancer)
b. Glucocorticoids and steroids alter immune
system
6. Chemical Agents
a. Industrial and chemical
b. Can initiate and promote cancer
b. Examples: hydrocarbons in soot ; arsenic in
pesticides; chemicals in tobacco
7. Physical Agents
a. Exposure to radiation
Ionizing radiation found in x-rays, radium, uranium
UV radiation
Sun, tanning beds
8. Immune function
1. Protects the body from cancerous cells
2. Increased rate of cancer in immunocompromised pts
Nursing Care of the Client with Cancer
Effects of Cancer
1. Disturbed or loss of physiologic functioning, from pressure or
obstruction
a. Anoxia and necrosis of organs
b. Loss of function: bowel or bladder obstruction
c. Increased intracranial pressure
d. Interrupted vascular/venous blockage
e. Ascites
f. Disturbed liver functioning
G. Motor and sensory deficits
Cancer invades bone, brain or compresses nerves
h. Respiratory difficulties
a. Airway obstruction
b. Decreased lung capacity
Nursing Care of the Client with Cancer
2. Hematologic Alterations: Impaired function of blood cells
1. Secondary to any cancer that invades the bone marrow (leukemia)
2. May also be caused by the treatment
a. Abnormal wbc’s: impaired immunity
b. Diminished rbc’s and platelets: anemia and clotting
disorders
3. Infections: fistula development and tumors may become
necrotic; erode skin surface
4. Hemorrhage: tumor erosion, bleeding, severe anemia
5. Anorexia-Cachexia Syndrome: wasting away of client
a. Unexplained rapid weight loss, anorexia with altered smell
and taste
b. Catabolic state: use of body’s tissues and muscle proteins
to support cancer cell growth
Nursing Care of the Client with Cancer
6. Paraneoplastic Syndromes: ectopic sites with excess hormone
production
a. Parathyroid hormone (hypercalcemia)
b. Ectopic secretion of insulin (hypoglycemia)
c. Antidiuretic hormone (ADH: fluid retention)
d. Adrenocorticotropic hormone (ACTH)
7. Pain: major concern of clients and families
a. Types of cancer pain
1. Acute: symptom that led to diagnosis
2. Chronic: may be related to treatment or to progression of
disease
b. Causes of pain
1. Direct tumor involvement including metastatic pain
2. Nerve compression
3. Involvement of visceral organs
Nursing Care of the Client with Cancer
Collaborative Care
A.Diagnostic Tests: used to diagnose cancer
1.Determine location of cancer
a. Xrays
b. Computed tomography
c. Ultrasounds
d. Magnetic resonance imaging
e. Nuclear imaging
f. Angiography
2.Diagnosis of cellular type of can be done through tissue
samples from biopsies, shedded cells (e.g. Papanicolaou
smear) washings
a. Cytologic Examination: tissue examined under microscope
b. Identification System of Tumors: Classification – Grading --
Staging
Nursing Care of the Client with Cancer
4. Antimiotic agents
1. Action: Prevent cell division
2. Examples: Vincristine, Vinblastine
3. Toxic Effects: affects neurotransmission,
alopecia, bone marrow depression
5. Hormone agonist
1. Action: large amounts of hormones upset the
balance and alter the uptake of other hormones
necessary for cell division
2. Example: estrogen, progestin, androgen
6. Hormone Antagonist
1. Action: block hormones on hormone-
binding tumors (breast, prostate,
endometrium; cause tumor regression
Decreasing the amount of hormones can decrease
the cancer growth rate
Does not cure, but increases survival rates
2. Examples: Tamoxifen (breast); Flutamide
(prostate)
3. Toxic Effects: altered secondary sex
characteristics
7. Hormone inhibitors
Aromatase inhibitors (Arimidex, Aromasin)
Prevents production of aromatase which is
needed for estrogen production
Used in post menopausal women
Side effects
• Masculinizing effects in women
• Fluid retention
Nursing Care of the Client with Cancer
Effects of Chemotherapy
a. Tissues (fast growing) frequently affected
b. Examples: mucous membranes, hair cells, bone marrow,
specific organs with specific agents, reproductive organs (all
fetal toxic, impair ability to reproduce).
d. Routes
1. Oral
2. Body cavity (intraperitoneal or
intrapleural)
3. Intravenous
a. Use of vascular access devices because of
threat of extravasation (leakage into
tissues) and long-term therapy
a. If the drug is a vessicant it may result in pain,
infection and tissue loss
e.Types of vascular access devices
1. PICC lines (peripherally inserted
central catheters)
2. Tunnelled catheters (Hickman,
Groshong)
3. Surgically implanted ports (accessed
with 90o angle needle
Hickman Catheter
Portacath
PICC Line
Nursing Care of the Client with Cancer
Neutropenic precautions
Private room
Good handwashing
Monitor temp q 4 hours, monitor for chills, UTI, pneumonia
Limit visitors to healthy adults
No flowers or plants
Monitor neutrophil count
Thrombocytopenia
Drop in platlet count (normal 150,000-400,000/mm3)
below 100,000
Test pt for bleeding in stool and urine
Avoid punctures for IV or IM
Handle pt gently
Use electric razor
Avoid placing foley or rectal thermometers
Avoid oral trauma with soft bristle brushes, avoid
flossing, avoid hard candy
Watch for ALOC, pupil changes that might indicate
intracranial bleeds
Stool softeners to avoid straining
C. Mucocitis
Inflammation and ulceration of mucous
membranes and entire GI tract
Rinse mouth with ½ normal saline and ½
peroxide every 12 hours
Topical analgesic medication
Avoid mouthwashes with alcohol
Avoid spicy or hard food
Watch nutritional status
D. Alopecia
Hair loss
2-3 weeks after treatment is started
Affects all the hair, including eyebrows,
eyelashes
Within 4-8 weeks after treatment hair begins
to grow back
Before hair loss, have the pt pick out a wig
that is similar to hair color
E. Peripheral neuropathy
Numbness and tingling to fingers and toes
in a glove and sock pattern
May cause gait and possible fall problems
F. Provide emotional and spiritual
support to patient and families
Nursing Care of the Client with Cancer
Surgery
1. Diagnosis, staging, and sometimes treatment of cancer
2. May be prophylaxis or removal of at risk tissue or organ
prior to development of cancer (breast cancer)
3. Involves removal of body part, organ, sometimes with
altered functioning (e.g. colostomy)
4. Debulking (decrease size of) tumors in advanced cases
5. Reconstruction and rehabilitation (e.g. breast implant post
mastectomy)
6. Palliative surgery to improve the quality of life
Removal of tumor tissue that is causing pain or obstruction
5. Psychological support to deal with surgery as well as
cancer diagnosis
Nursing Care of the Client with Cancer
Radiation Therapy
1. Treatment of choice for some tumors to kill or
reduce tumor, relieve pain or obstruction
Destroy cancer cells with minimal exposure to normal cells
Cells die or are unable to divide
2. Delivery
a. Teletherapy (external): radiation delivered in
uniform dose to tumor
Beam radiation
b. Brachytherapy: delivers high dose to tumor and
less to other tissues; radiation source is placed in
tumor or next to it in the form of seeds
Radiation source within the patient so pt emits radiation for
a period of time and is a hazard to others
c. Combination
3. Goals
a. Maximum tumor control with minimal
damage to normal tissues
b. Caregivers must protect selves by using
shields, distancing and limiting time with
client, following safety protocols
Private room
Caution sign on the door for radioactive material
Dosimeter film badge by staff
No pregnant staff
Limit visitors to ½ hour per day and keep them at
least 6 ft from the source
Nursing Care of the Client with Cancer
4. Treatment Schedules
a. Planned according to radiosensitivity of tumor,
tolerance of client
b. Monitor blood cell counts
5. Side Effects
a. Skin (external radiation): blanching, erythema,
sloughing, breakdown
Use mild soak
Dry skin with a patting motion, not rubbing
Don’t use powders or lotions unless prescribed by
radiologist
Wear soft clothing over the site
Avoid the sun and heat
b. Ulcerated mucous membranes: pain, lack
of saliva (xerostoma)
c. Gastrointestinal: nausea and vomiting,
diarrhea, bleeding, sometimes fistula
formation
d. Radiation pneumonitis
1-3 months after treatment
Cough, SOB, fever
Treated with steroids to decrease inflammation
Nursing Care of the Client with Cancer
Oncologic Emergencies
A. Pericaridal Effusion and Neoplastic
Cardiac Tamponade
1. Concern: compression of heart by fluid
in pericardial sac, compromised cardiac
output
2. Treatment: pericardiocentesis
B. Superior Vena Cava Syndrome
1. obstruction of venous system with
increased venous pressure and stasis; facial
and neck edema with slow progression to
respiration distress
Late signs are cyanosis, decreased cardiac output
and hypotension
2. Treatment: respiratory support; decrease
tumor size with radiation or chemotherapy
Compression of the superior vena cava in SVC
syndrome
C. Sepsis and Septic Shock
1. Early recognition of infection
Patients at risk secondary to low WBC and
impaired immune system
2. Treatment: prompt intervention with
antibiotics and vasopressors
D. DIC disseminated intravascular
coagulation
Triggered by severe illness, usually sepsis
in cancer patients
Abnormal clotting uses up existing clotting
factors and platelets quickly then the pt
hemorrhages
Mortality rate is 70%
Prevention of sepsis is key
Nursing Care of the Client with Cancer