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Oncology 6
Oncology 6
ONCOLOGY
A. General Information:
1. Risk Factors:
a. Alcohol + tobacco = cocarcinogenic
b. TOBACCO is the #1 cause of
preventable cancer.
c. Suspected dietary causes of
cancer:
Low fiber diet Nitrites
(processed sandwich meat)
Increased red meat, Alcohol
Increased animal fat,
Preservative, and additives
d. Increased incidence of
cancer in the
*that is why there is a higher
incidence of cancer > age 60
e. The most important risk
factor for cancer = Aging
f. Diet/exercise habits:
Cruciferous veggies
(broccoli, cauliflower, and
cabbage), Vitamin A foods
(colored veggies), and Vitamin
C could DECREASED risk
Regular physical activity
g. African Americans have a
GREATER incidence than
Caucasians.
h. Primary prevention: ways to
prevent actual occurrence
(sunscreen and no
smoking)
i. Secondary prevention: Using
SCREENING to detect cancer
early when there is
a greater chance for a cure or
control
j. Chronic IRRITATION brings
about uncontrolled growth of
abnormal cells.
2. Prevention:
a. Female:
Monthly self-breast exam over
age 20. ANYTIME AFTER DAY 7-12
YEARLY clinical breast exam
for women >40 years old
Between ages 20-39 needed every
3 years
ANNUAL pelvic exam
Pap smear: every 3 years if
theres been no problem
d. Tx:
Electrosurgical excision
Laser
Cryosurgery
and chemo for
late stages
Conization- remove part of
CERVIX
Hysterectomy
2. Uterine Cancer:
(Endometrial Cancer)
a. Risk Factors:
Greater than 50 years of age
Taking estrogen therapy
without progesterone
Positive family history
menopause LATE
No pregnancy (null parity)
b. S/S:
Major symptoms: post
MENOPAUSAL bleeding
Other S/S: watery/bloody
vaginal discharge, low back/abd
pain, pelvic pain
c. Dx:
CA-125 (blood test) to R/O
OVARIAN involvement
Test to evaluate for
metastasis:
CXR (chest x-ray)
IVP (Intra Venous
Pyelogram)
BE (Barium Enema)
CT
Liver and bone scan
The most definitive
diagnostic test is (dilatation
& curettage) and
endometrial biopsy.
38 Hurst Review Services
d. Tx:
1) Surgery: Hysterectomy
TAH (total abd hysterectomy)
= uterus and cervix only! :
Tubes & ovaries removed?
Bilateral oophorectomy
(ovaries)
Bilateral salpingectomy (tubes)
Radical Hysterectomy:
May remove all of the pelvic
organ
Client may have COLOSTOMY or
ileal conduit
2) Radiation: intra-cavitary
radiation to prevent vaginal
recurrence
3) Chemotherapy: Doxorubicin
(Adriamycin), Cisplatin
(Plantinol-AQ)
4) Estrogen inhibitors:
Medroxyprogesterone (DeproProvera), Tamoxifen
(Nolvadex / Soltamox)
3. Breast Cancer:
a. Risk Factors:
One has a 3 fold risk
increase of developing breast
cancer if a FIRST degree
relative (mother, sister,
daughter) had pre-menopausal
breast cancer.
High dose radiation to thorax
prior to age 20
PERIOD onset prior to age 12
Menopause after age 50
No pregnancy (null parity)
First birth greater than 30
years old
40 Hurst Review Services
b. S/S:
Change in the appearance of
the breast (orange peel
appearance, dimpling,
retraction, discharge from
breast) or lump
Tail of Spence is where 48%
of breast tumors occur: located
in upper outer
quadrant
c. Tx:
1) Surgery:
Post op care:
Bleeding check dressings,
back (POOLING of blood),
hemovac,
Jackson-Pratt drain
Elevate arm on AFFECTED side.
Associated nursing care: Stay
away from arm on affected side
for
lifetime of client:
* No watch, no constriction, no
BPs or injections, wear
gloves when
gardening, watch small cuts, no
nail biting, and no sunburn, no
IV
Is it normal or abnormal to
have respiratory depression
after a
bronchoscopy? ABNORMAL
TOO LOW OR TOO HIGH PROBLEM,
SHOULD BE ALWAYS PERFECT
2) Sputum specimen:
Best time to obtain? In the
morning
Is this sterile? YES
What should the client do
first? RINSE MOUNTH WITH WATER
* Trying to decrease bacterial
count in the mouth
3) Chest x-ray:
4) CT:
5) MRI:
42 Hurst Review Services
d. Tx:
Surgery: The main treatment
for stage I and II
Lobectomy: TAKE OUT PART OF
THE LUNG
Chest tubes and surgical side
up
Pneumonectomy: REMOVAL OF
ENTIRE LUNG
Position on affected side
(surgical side down, good lung
up).
No chest tubes, why? THE LUNG
IS GONE, NO FLUID SPACE.
Avoid severe lateral
positioning mediastinal SHIFT
5. Laryngeal Cancer:
a. Risk Factors:
SMOKING (any form of tobacco
use), alcohol, voice abuse,
chronic
laryngitis, industrial
chemicals
b. S/S:
Hoarseness, lump in neck,
sore throat, cough, problems
breathing,
earache, weight loss, no early
signs
c. Dx:
Laryngeal exam, MRI
d. Tx:
1) Surgery:
Total laryngectomy (removal
of VOCAL cords, epiglottis,
thyroid
cartilage)
d. Tx:
Surgery (all/part of
bladder) urinary diversion
(urostomy)
Ileal conduit (a piece of the
ileum is turned into a BLADDER;
ureters are placed in one end;
the other end is brought to the
abdominal
surface as a stoma)
May be impotent
Hourly OUTPUT
Increase FLUIDS (2,000-3,000
ml of fluid per day).
* flush out conduit
Mucus normal? YES
Intestines always make mucus
(the bladder is made from a
part of
intestine).
Change appliance in THE
MORNING (This is when output
will be at
its lowest).
It is OK to place a little
piece of 4X4 inside stoma
during skin care to absorb
urine... Just dont forget to
remove it
Hurst Review Services 47
8. Prostate Cancer:
a. S/S:
This client comes to the
doctor with S/S of benign
prostatic hyperplasia
(BPH): hesitancy, frequency,
frequent infections (because
the bladder is not
completely emptied), nocturia,
urgency, dribbling. Many
clients are
asymptomatic.
Most common sign is painless
HEMATURIA
Digital rectal exam done and
prostate is hard/nodular; this
usually means
prostate cancer.
b. Dx:
1) Lab work:
PSA will be increased.
Prostate-specific antigen (PSA)
This is a protein that is only
produced by the prostate.
Normal is less than 4 ng/ml.
2) Chemotherapy: Fluorouracil
(5-FU), Doxorubicin
(Adriamycin),
Mutamycin (Mitomycin-C),
Cisplatin (Platinol-AQ)
3) Radiation: