NCM112N CELLULAR ABERRATION

OUTLINE 1. ONCOLOGY NURSING

1. Oncology Nursing ● A field of specialty
1.1. Cellular Aberration ○ [@] Multidisciplinary approach and
1.2. Incidence and Epidemiology inter-professional
1.3. Cell Cycle ○ [@] Nurses must be equipped with knowledge
1.3.1. Cell Cycle Stages and skills
1.4. Terms ● Provides realistic support to those receiving nursing
2. Etiologic factors (Carcinogens) care and use of standards of practice and nursing
2.1. Viruses and Bacteria process as basis of care.
2.2. Chemical Carcinogens ○ [@] Realistic, sincere in giving support because
2.3. Physical Agents px can sense insincerity.
2.4. Hormonal Agents
2.5. Genetics and Familial Agents 1.1 CELLULAR ABERRATION
3. Theory of Carcinogens ● CANCER
3.1. Carcinogenesis ● “CRAB”
3.1.1. Multistage of Carcinogens ○ [@] means crab in Latin
3.1.2. Flowchart of Molecular Basis of ● BIG C
Cancer ○ [@] It sticks to anyone.
3.1.3. Types of Normal Genes that can ● A group of disorders characterized by abnormal cell
be Affected by Mutation growth and the ability to metastasize with potential in
3.1.4. Benign Growth Pattern killing the host.
3.1.5. Classification (Tumor Types) ○ [@] It is multifactorial (doesn’t only involve a single
3.1.6. Tumor Invasion and Metastasis disease) coming from the different diseases or
4. Health Prevention and Maintenance disorders.
4.1. 10 Steps of Cancer Prevention Protective
Factors 1.2 INCIDENCE AND EPIDEMIOLOGY
4.2. Screening
4.2.1. Breast
4.2.2. Colon and Rectum MALE FEMALE
4.2.3. Prostate MOST CAUSE OF MOST CAUSE OF
4.2.4. Uterus COMMON DEATH COMMON DEATH
4.3. Diagnostic Imaging Methods Prostate Lung Cancer Breast Lung Cancer
4.4. Non-Invasive Diagnostic Procedure Cancer (32%) (31%) Cancer (32%) (27%)
4.4.1. X-Ray
4.4.2. Mammogram Lung Cancer Prostate Lung Cancer Breast Cancer
4.4.3. CT Scan (13%) Cancer (10%) (12%) (18%)
4.4.4. MRI Colorectal Colorectal Colorectal Colorectal
4.4.5. PET Scan Cancer (10%) Cancer (10%) Cancer (11%) Cancer (10%)
4.5. Invasive Diagnostic Procedure Bladder Pancreatic Endometrial Ovarian
4.5.1. Histologic/Cytologic Exam Cancer (7%) Cancer (5%) Cancer (6%) Cancer (6%)
4.5.2. Bronchoscopy
4.5.3. Endoscopy Cutaneous Leukemia Non-Hodgkin’ Pancreatic
4.5.4. Sigmoidoscopy Cancer (5%) (4%) s Lymphoma Cancer
4.5.5. Cystoscopy (4%) (6%)
4.6. Laboratory Studies Table No. 1 “Incidence & Epidemiology”
4.6.1. Tumor Markers
5. Staging of Cancer 1.3 CELL CYCLE
5.1. Stages ● A coordinated sequence of events resulting in
5.2. Grading duplication and division into two daughter cells
5.3. Classification, Grading, & Stage ● [@] Cell is associated to life
LEGEND ● [@] Interphase for cell growth
No logo - From PPT [@] - Prof’s Notes [$] - From Book

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FOUR PHASES ● APOPTOSIS

Interphase - process of programmed death of unwanted cells.
● G1 or Gap 1
○ [@] produce RNA 2. ETIOLOGIC FACTORS (CARCINOGENS)
○ [@]First checkpoint is called restriction ● [@] Carcinogens is something harmful to the body
point ■ Viruses and bacteria
■ [@] commit suicide (apoptosis) or ■ Chemical Carcinogens
will go with process? ■ Physical agents
■ [@] check completeness of the ■ Internal Factors: Hormonal agents
cell before going to S phase ■ Genetics and familial factors
● S phase/ Synthesis ■ Psychological stress
○ [@] Cell replication is regrowing ■ External factors: environment, lifestyle
● G2 or Gap 2
○ [@] Second checkpoint until MITOSIS.
○ [@] Cell grows and prepares itself for 2.1 VIRUSES AND BACTERIA
division’ ● ”Oncogenic viruses”
○ [@] Preparation for Mitosis ■ [@] Everybody has oncogenes to fight these
● M PHASE OR MITOSIS viruses
○ [@] cell division occurs ● Prolonged or frequent viral infections may cause
● G0 or Resting phase breakdown of the immune system or overwhelm the
○ [@] Dormant cells - type of cells that did immune system.
not pass the requirements ○ [@] Ex. HIV, HepB, Epstein Barr Virus
○ [@] Men are usually the carrier of HPV
1.3.1 CELL CYCLE STAGES ○ [@] H. pylori can cause peptic ulcer and
autoimmune disorders

Figure No.1 “Stages of Cell Cycle”

1.4 TERMS
● CELL PROLIFERATION
- Process whereby cells divide and break offspring;
It normally is regulated so that the number of cells
that are actively dividing is equal to the number of
dying or being shed.
○ [@] Applying the theory of homeostasis and
balance.

● DIFFERENTIATION
- the process whereby proliferating cells are
transformed into different and more specialized
cells types as they proliferate.
- determines what a cell looks like, how it functions,
how long it will live. Figure No.2 “Viruses and Bacteria”
○ [@] the more it is differentiated the more
difficult the prognosis is.
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2.2 CHEMICAL CARCINOGENS
● Act by causing cell mutation or alteration in cell
enzymes and proteins.
○ [@] cell mutations means there is an alteration in
the sequence
○ E.g. Industrial compounds - vinyl chloride,
polycyclic aromatic hydrocarbons, fertilizers, weed
killers, dyes, drugs
Figure No.3 “Chemical Carcinogens”
2.3 PHYSICAL AGENTS
● Radiation - x-ray or radioactive isotopes, sunlight/UV
rays, cell towers/sites
● Physical irritation or trauma - pipe smoking, multiple
deliveries, jagged tooth (irritation of mucous
membrane will lead to aberration), irritation of the
tongue, "overuse/underuse of any organ/body part"
Figure No. 4 “Physical Agents”
2.4 HORMONAL AGENTS
● Estrogen as replacement therapy increases incidence
of vaginal and cervical adenocarcinoma
● Estrogen, diethylstilbestrol (DES)
○ [@] These are strong causative agents of cancer
2.5 GENETICS AND FAMILIAL FACTORS
● [@]cancer is inherent to everyone
● Oncogene → when exposed to carcinogens → changes
in cell structure → becomes malignant
3.THEORY OF CARCINOGENS
● Cellular Transformation and Derangement
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○ [@] e.g. Leukemia in Children.
○ [@] In assessing pediatric cancer, always take note
of the maternal history of the mother
● Immune Response Failure
○ [@] As you get older, the more you are more
exposed to environmental insults and disease
(degenerative process)
○ [@] Limited to fight off cancer cells
3.1 CARCINOGENESIS
● The process of transforming a normal cell into a
cancer cell which consists of three stages.
○ Initiation (Carcinogens)
○ Promotion repeated exposure to promote agents
(Carcinogens)
■ [@] Habit of smoking, drinking coffee of
alcohol, and other vices.
○ Progression (increase malignant behavior)
3.1.1 MULTISTAGE OF CARCINOGENS
Figure No. 5
3.1.2 FLOW CHART OF MOLECULAR BASIS OF CANCER
Figure No. 6 “Molecular Basis of Cancer FlowChart”
[@] There is only one pathophysiology of cancer and it
depends on location
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3.1.3 TYPES OF NORMAL GENES THAT CAN BE
AFFECTED BY MUTATION
● Tumor suppressor genes
○ To regulate cell growth
1. BRCA1 and BRCA2
a. [@] Destruction of BRCA1 and BRCA2 will
lead to hormonal cancers. (e.g prostate
cancer)
2. APC gene
a. [@] responsible for colon cancer
3. P53: most common Tumor suppressor.
● Proto-oncogenes
○ Promotes growth, genetic lock protection from
carcinogens (this is healthy)
○ “Unlocked”- exposure to carcinogens
3.1.4 BENIGN GROWTH PATTERN
● Hypertrophy
○ [@] Increase in the size of an organ or cell
○ [@] can be reversible
○ Ex. Benign hypertrophy
● Hyperplasia
○ [@] There is an increase in the number of the cell
due to the physiologic changes then normally it
will go back to its original state
○ [@] can be reversible
○ Ex. increase in breast size during pregnancy,
ovulation
● Metaplasia
○ [@] Abnormal change in an organ tissue
○ [@] Growth of cell in a place where it does not
belong
○ [@] can be reversible
○ [@] Use differentiation.
○ Ex. Increase in breast tissue, change of cervical
tissue during menstruation
● Dysplasia
○ [@] Disorganization of cells; kung saan saan
tumubo
○ [@] can be reversible
○ [@] Not a cancer, but is the presence of
abnormal cells within a tissue organ
● Anaplasia
○ [@] loose cytoplasm, cytoplasm is lost, no
respect to boundary (only one that is not
reversible, already malignant; the rest is
reversible pa) (ANA is considered Malignant)
○ [@] No control, non-reversible
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3.1.5 CLASSIFICATION (TUMOR TYPES)
● Provide a standardized way to:
○ Communicate the status of the cancer to all
members of the health care team and also to the
significant others.
■ [@] DABDA: Denial, Anger, Bargaining,
Depression, Acceptance.
○ Assist in determining the most effective treatment
plan
○ Evaluate the treatment
■ [@] Is it responding or not?
○ Predict prognosis
○ Compare like groups for statistical purposes
● BENIGN
○ Are tumors designated by attaching the suffix -
oma to the cells of origin
○ E.g.
■ Fibroma - benign tumor in the fibrous
tissues
■ Chondroma - cancer of the cartilages
■ Osteoma - cancer of the bone
● MALIGNANT
○ Tumors that are capable of spreading by invasion
and metastasis
○ E.g.
■ Fibrosarcoma
■ Chondrosarcoma
Categories of Malignant Neoplasms:
● Solid Neoplasm
○ Carcinomas - epithelial cell
○ Sarcomas - muscle, bone, fat & connective tissue
● Liquid Neoplasm
○ Lymphomas - lymphoid tissue
○ Leukemias - bone marrow; white blood cells
○ Myelomas - bone marrow; abnormal plasma cells
Characteristics of Malignant cells
○ Accelerated rate of replication, growth continues
uncontrolled fashion.
○ No useful purpose in the body instead they occupy
space and act as parasites by taking blood and
nutrients away from normal tissues
○ Anaplastic and undifferentiated, loss of structural
and functional characteristics of normal cells.
○ Malignant cells invade normal tissues to cause
widespread tissue destruction and eventually
death
3.1.6 TUMOR INVASION AND METASTASIS
● INVASION
○ Occurs when cancer cells infiltrate adjacent
tissues surrounding the neoplasm.
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vital function
● METASTASIS Table No. 2 “Comparison of the Characteristics of Benign
○ Occurs when malignant cells travel through the and Malignant Neoplasm”
blood or lymph and invade other tissues and
organs to form a secondary tumor.
○ Spread of cancer cells from a primary tumor to 4. HEALTH PREVENTION AND MAINTENANCE
distant sites ● Primary prevention
○ Cancer Prevention and Control
○ Breaking away
○ [@] Asses the warning signs of cancer
■ [@] through chemotaxis ● Secondary Prevention
○ Only malignant has the capacity to spread thru: → ○ [@] The importance of screening
Types of metastasis:
■ Lymphatic spread “EASY WAY OUT”
■ Blood
■ Serosal Seeding of body cavities and ● C- Change in bowel or bladder habits
surfaces ○ [@] such as intermittent diarrhea, constipation
■ Hematogenous spread ○ [@]Dribbling urine because of narrowed urethra
● A- A sore that does not heal
○ [@] has a case before; recurrent
● U- Unusual bleeding or discharge
○ [@] Such as menorrhagia, breast discharge
○ [@] Epistaxis
● T- Thickening or lump in the breast or elsewhere
● I- Indigestion or difficulty in swallowing
○ [@] Will only eat a little but is already full
● O- Obvious change in wart or mole
○ [@] discoloration, enlargement
● N- Nagging cough or hoarseness
○ [@] Maybe the tumor is on the vocal cords
Figure No. 7 “Metastasis”

[@] ASSESSMENT:
● Auscultation
CHARACTERISTICS BENIGN MALIGNANT ● Percussion
Speed of growth Slow growth Aggressive growth, ● Palpation
[@] movable Rapid cells division ● Observation & Inspection
and growth ● Pain assessment
[@] non-movable ● Sometimes, 5 senses, and common sense
Growth by expansion Establish new site
malignant lesions 4.1 10 STEPS OF CANCER PREVENTION PROTECTIVE
Mode of growth Localized and Invade surrounding FACTORS
encapsulated tissues [@] If you have family history of cancer- make sure to
Cell Characteristics Well Differentiated With poor cell modify your lifestyle
[@] Similar to parent differentiated 1. Increase consumption of fresh vegetables
cell. 2. Increase fiber intake
○ [@] Like papaya, dragonfruit, pomelo
Metastasis It does not Ability to migrate, cells
○ [@]Too much fiber can cause bloating and
metastasized move to distant areas
of the body constipation
○ [@] It’s best to take it in the morning as
No Tissue damage Destroy surrounding
tissues substitute for caffeine
3. Increase Vitamin A
Prognosis Very good prognosis, Poor Prognosis- can ○ [@] e.g. carrots, squash (for vision
does not cause lead to death unless
enhancement)
death unless interventions are taken
localization affect 4. Increase Vitamin C
5. Practice weight control
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○ [@] Daily exercise. Cancer cells like sedentary
lifestyle because exercises promotes immune 4.2.3 PROSTATE
system ● Digital rectal exam yearly beginning at age 50
○ [@] More exercise will increase circulation ○ Examination to check for
6. Decrease dietary fat amount abnormalities of organs
○ [@] Most colorectal cancer is associated with or other structures in the
high fat content in diet. pelvis and lower
7. Decrease salt abdomen.
○ [@] affects the overall health ○ To check for:
8. Stop cigarette smoking ■ Growths in or
9. Decrease alcohol intake/substance abuse enlargement of the
10. Avoid overexposure to sun prostate gland in
○ [@] Other sources of Vitamin D: eggs and males.
other dairy products ■ Problems in female
reproductive
[@] According to Hippocrates (Father of Medicine): “Our organs (uterus and
food should be our medicine and should be our food”and ovaries)
“Nature itself is the best Physician” ■ Rectal bleeding or tumors in the rectum.
● Prostate - specific antigen (PSA) test yearly beginning
age 50
4.2 SCREENING (PRIMARY) Note:
[@] Under psychosocial assessment ○ [@] soft = normal
[@] Genograms ○ [@] hard and irregular= high risk
● Familial and environmental history
○ [@] genetics ; doing genogram with legend
○ [@] san nakatira yung patient 4.2.4 UTERUS
● Physical examination (IPPA)
● Yearly pelvic examination and Pap smear test for
○ [@] Inspection and observation of px condition
sexually active girls and any women over 18, less often
○ [@] general survey of client, appearance, structure for 3 consecutive negative results
of skin, paleness ● An endometrial sample at menopause for high risk
● Evaluation of lab findings and test findings women.
○ [@] included in your objective data
● Screening methods:
■ [@] guide or basis
○ Breast self-assessment
○ Pap Smear
○ Mammography
○ Self testicular Exam
○ Colon and rectum
○ [@] and prostate screening

4.2.1 BREAST 4.3 DIAGNOSTIC IMAGING METHODS (SECONDARY)

● Monthly BSE - all women ages 20 and above week
after menstruation
● Mammography every year from age 40 years old
○ [@] utz is best because every detail can be seen
4.2.2 COLON AND RECTUM
● Fecal occult blood test every year beginning at age 50
○ [@] Cannot be seen by the naked eye that’s why it’s
done every year.
● Proctosigmoidoscopy every 3-5 years after 50 y/o,
follow-up after 2 negative annual exam
○ [@] to determine the presence of polyposis
○ Polyposis - more than 100 polyps
● Important in the diagnosis and staging of cancer
○ Used to guide the surgeon to the appropriate area
for biopsy
○ Use of this modality is guided by physical exam
■ [@] For the doctor to order an imaging
method.
○ Clinical instruction through collaboration with the
radiology specialist
■ [@] Teamwork
■ [@] Proper explanation to join cooperation
■ [@] Interpersonal and multidisciplinary
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4.4 NON-INVASIVE DIAGNOSTIC PROCEDURE ● Not exposed to radiation

● X-ray [@] Nursing Considerations:
● Mammogram ● Assess if the patient is claustrophobic
● CT Scan ● Fasting is usually prescribed for GIT
● MRI
● PET Scan

4.4.1 X-RAY
● Site specific
● View the dynamic function of an organ
● [@] Nursing responsibilities:
○ [@] Remove metal accessories
○ [@] Explain the procedure to the client
○ [@] Tie up the hair
○ [@] Remove undergarments (ex. bra)
○ [@] Precaution: if pregnant (exposure to radiation)

4.4.2 MAMMOGRAM 4.4.5 PET(Positron Emission Tomography) SCAN

[@] Non-invasive procedure
● Used to screen for malignancies of the breast
● Should be correlated with clinical findings.
○ [@] partnered with UTZ
4.4.3 CT SCAN
● Obtain images from various angles through the body
such as lungs, soft tissue, blood vessels
○ During a CT scan, a thin X-ray beam rotates around
an area of the body, generating a 3D image of the
internal structures
○ [@] If claustrophobic: sedative, talk it out or look
for other non-invasive procedures
● Preferred method for diagnosis liver, kidney, and
pancreatic cancers.
○ [@] Sometimes a contrast is used to assess for
any allergies such as iodine.
● Allows physicians to pinpoint the location of the
cancer within the body and has the ability to monitor a
patient’s response to therapy
● [@] Ability of the patient to respond?
4.5 INVASIVE DIAGNOSTIC PROCEDURE
● Histologic/ Cytologic Exam
● Bronchoscopy
● Endoscopy
● Sigmoidoscopy
● Cystoscopy
4.5.1 HISTOLOGIC/CYTOLOGIC EXAM
● For malignant tissues to be identified by name, grade,
and stage
[@] Confirmatory test: biopsy
● Morphologic features of the cells are examined.
4.5.2 BRONCHOSCOPY
● For malignant tissue

4.4.4 MRI
● Preferred imaging techniques for soft tissue
structures, neurologic imaging, vascular imaging and
avascular necrosis

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4.5.3 ENDOSCOPY ○ [@] A small slender core of tissue is removed

with a biopsy needle
○ [@] Note: Avoid biopsy if px condition is
malignant
3. Needle suction aspiration of solid tumors
● [@] WOF: Bleeding tendencies

Viewing the upper gastrointestinal tract

Direct Visualization
4.5.4 SIGMOIDOSCOPY [@] -scopy - observation
● Bronchoscopy (inspecting the tracheobronchial tree)
○ [@] Monitor RR
○ [@] Make sure that lidocaine/ local anesthesia is
given. Atropine sulfate for dryness
● Sigmoidoscopy (viewing the sigmoid colon by the use
of fiberoptic flexible sigmoidoscope)
● Endoscopy (viewing the upper gastrointestinal tract)
● Cystoscopy (viewing the urethra and bladder)

4.6 LABORATORY STUDIES

● Complete blood count
● Blood chemistry
Viewing the sigmoid colon by use of fiberoptic ○ Serum electrolytes:
flexible sigmoidoscope ○ ALT - alanine aminotransferase (NV: 7-55 units per
liter)
4.5.5 CYSTOSCOPY ○ AST - aspartate aminotransferase (NV: 5 to 40
● After the bladder is filled with water through the units per liter)
cystoscope, the physician is able to examine the ■ [@] Increased of 3x indicates damage to
bladder wall through the scope liver
○ LDH - for liver metastases, chronic disease, and
3 METHODS OF SPECIMEN COLLECTION bacterial infection; enzymes for energy production
1. Exfoliation from an epithelial surface (Pap smear) ■ [@] Lactic Dehydrogenase
or bronchial washing ■ [@] most common site of metastasis is liver
○ [@] Nx responsibility: Informed consent ○ CEA - for colon cancer
2. Aspiration of fluid from body cavities or blood
4.6.1 TUMOR MARKERS
● Biochemical substance synthesized and released by
tumor cell
● Maybe a protein product excreted by cancer cells,
release in response to the presence of cancer cells or
other condition
● Used to aid in the diagnosis of cancer, to detect
recurrence or identify regression of a known
malignancy.
○ [@] to know primary location of tumor

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[@] most difficult part for patient and SO
● Done during the pre-treatment phase
○ [@] Family conferences to decide to what is the
most appropriate treatment
● After surgical resection
○ [@] to see the evolvement of the cancer
○ [@] to have another treatment
● Recurrence after disease free interval

[@] Note: Radiation therapy also affects normal cells.

Figure No.9 “Tumor Markers”

Tumor Tumor Marker

TUMOR TNM STAGING SYSTEM
Esophageal Cancer SCC T0 No evidence of primary tumor

Lung Cancer Tis Carcinoma in situ

[@] located to one area only; can be
Squamous Cell Carcinoma CA-125, CEA, SLX removed surgically
T1, T2, T3, T4 Progressive increase in tumor size
Small Cell Carcinoma CYFRA, SCC, NSE, ProORP and node involvement
[@] liquid tumor= cannot be assessed
Lung Cancer AFP, PIVKA-II Tx Tumor cannot be assessed
Table No. 3 “Staging-Tumor”
Gallbladder Cancer CA19-9, CEA

Prostate Cancer PSA 5.1 STAGES

● Stage I
Germ Cell Tumor NSE ○ The tumor is small, local, and detected early.
○ [@] Goal of treatment is curative.
Thyroid Medullary NSE ● Stage II
Carcinoma ○ The tumor is somewhat larger and has started to
spread to nearby lymph nodes.
Breast Cancer CA-125, CA15-3 CEA ○ [@] Assess supraclavicular area because it may
NCC-ST-439 have already spread to the lungs or vertebra.

Gastric Cancer CEA, STN ● Stage III

○ The tumor has spread to nearby lymph nodes.
Pancreatic Cancer CA-125, CA19-9 ● Stage IV
CEA, Elastase 1 ○ Cancer has spread to other parts of the body.
NCC-ST-439 ■ [@] Goal of treatment is palliative (supportive
SLX,STN management)

Colon Cancer CEA 5.2 GRADING

NCC-ST-439
STN
Gx Grade can not be assessed
Cervix Cancer 𝜷HCG, SCC
STN G1 Well differentiated
[@] Can be treated
Ovarian Cancer 𝜷HCG, SCC
G2 Moderately well differentiated
Ovarian Cancer 𝜷HCG, CA125
STN, SLX
G3 and G4 Poorly to very poorly differentiated
5. STAGING OF CANCER Poor differentiation, poorer prognosis
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5.3 CLASSIFICATION, GRADING, & STAGE

● Stages
○ 0 - benign state
○ I - spread to nearby tissue
○ [@] Start of treatment
○ II - 2-5 cm sometimes involved lymph
○ [@] Mastectomy or radical mastectomy is
done

○ III - more than 5cm spread - advanced spread to

connective tissue
○ [@] Reassess for spread
○ IV - Metastasis
○ [@] Necrotizing Fasciitis - Flesh-eating
bacteria may grow.
● TNM Classifications
○ T - (extent of primary tumor)
○ TX - (cannot be adequately assessed)
■ [@] It could be liquid
■ [@] As a precautionary measure, everyone
is considered to be infected.
○ TO - no evidence of primary tumor
○ TIS - tumor in situ - localized; no spread
■ [@] Early detection, health education
○ T1 - 4 progressive increase in size
■ 1:5 cm < 2:6-9 cm
■ 3:10-15 cm 4:15>
■ [@] Shrink muna bago surgical
intervention

REFERENCES
● APA citation guide. (2016).
http://www.bibme.org/citation-guide/apa/
● Lipson, C. (2011). Cite right: A quick guide to
citation styles – MLA, APA, Chicago, the sciences,
professions, and more (2nd ed). United States of
America: The University of Chicago Press, Ltd.,
London.
● Ferraro, A. (Photographer). (2014). Liberty
enlightening the world [digital image]. Retrieved
from https://www.flickr.com/photos/afer92/
14278571753/in/set-72157644617030616

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 NCM112 CANCER MANAGEMENT AND SUPPORTIVE THERAPIES

obstruction, then given with a colostomy bag for

OUTLINE assistance.
● [@] Comfort measures
1. Cancer Management & Supportive Therapies ● [@] Already malignant
1.1. Subtopic ● NURSING ACTION
1.1.1. Sub-Subtopic ○ To provide supportive care, comfort and better
2. Keep in Mind quality of life
3. Information ○ Provide education and emotional support
3.1. General Format ○ Communicate with physician and other healthcare
3.2. Figure Inserts team
3.3. Lists and Tables ○ Assess patient’s response after surgery and
3.4. Citation monitor for possible complication
3.5. References
LEGEND 2. TREATMENT MODALITIES
No logo - From [@] - Prof’s Notes [$] - From Book 1. Surgical Intervention
PPT 2. Radiation Therapy
3. Hormonal Therapy
1.CANCER MANAGEMENT & SUPPORTIVE THERAPIES 4. BIotherapy
5. Transplantation

1.1 GOALS OF CANCER TREATMENT NOTE:

1. Curative ● Continuous planning with patient and patient’s family
2. Control ● Understand the principles and interrelationship of
3. Palliation treatments
● Collaborations with the entire health care team
1.1.1 CURATIVE
● Complete eradication of the malignant disease 2.1 SURGICAL INTERVENTION
● [@] Meaning there is a complete eradication of the ● Commonly used for:
malignant disease ○ Diagnosis and staging
● [@] Detected early ○ Prophylaxis and tumor removal
● [@]Continuous planning with the patient with the ○ Palliation
patients and patient’s family ○ Reconstruction
● [@] Stage 2 or stage 3 cancer ■ Ex. removing a breast
● [@}Px is responding to the treatment ■ Facial reconstruction
● [@]Understand the principles and interrelationship of ● Choice of surgery depends on:
treatments ○ Extent of the disease
● [@]Collaborations with the entire health care team ■ If still small, can be removed
○ * For them to be able to plan and treat the concert. ■ 90% na ginagawa for tumor
○ Location and structures involved
1.1.2 CONTROL ○ Tumor growth rate and invasiveness
● Prolonged survival and containment of cancer growth ■ *Check the malignancy and sensitivity
● [@] It is a maintenance ■ *May tumor na once ginalaw, more aggressive
● [@] Example: You are diagnosed with Stage II or III ■ *Liquid tumor is not a candidate
cancer, the patient is responding to the treatment ○ Surgical risk to the patient
(radiation therapy, chemotherapy) ○ Quality of life the patient will experience after the
● [@] It is the responsibility of a patient to maintain the surgery
treatment. You have the discipline to follow the protocol. ○ * It depends on the stage and the risk
● [@] Cancer is responding to the treatment applied to the ○ *Take note of the gerontological consideration,
patient and becomes controlled where the risk and modality as well as the risk for
● [@] Px is responsible in controlling, in complying for survival is important to consider when treating an
prolonged survival older adult client*

1.1.3 PALLIATION 2.1.1 DIAGNOSTIC SURGERY

● Relief of symptoms associated with the disease
● [@]Example: you are diagnosed with stage 3 or 4 cancer
and minimal ang response on therapy.
● [@] Use supportive care/treatment like if they remove
part of your large intestine because of partial
● Performed to obtain tissue sample for analysis of cells
suspected to be malignant (Biopsy)
● [@] Biopsy is used as a confirmatory test for any solid
tumor
● *Confirmatory test
2.1.1.1 THREE TYPES OF DIAGNOSTIC SURGERY very conscious to your body if you breast was
removed
1. Excisional - removal of a lump of tissue
○ Surgical interventions are best done at early stages
2. Incisional - removal of a small wedge of the lesion or
of cancer
tumor
■ [@] for main goal of treatment: CURE
3. Needle (fine) - for encapsulated mass
■ [@] Our goal is to identify the route of
● [@] For cyst/fibrocystic
medications …primary and secondary…
● *fine needle to aspirate; indicated for cysts ex.
■ *To meet the goal of treatment which is
Fibrocystic meaning encapsulated; may fluid like
curative
saloob
■ [@] During preoperative, nurses should educate
the patient and family what to expect and what
2.1.2 CURATIVE SURGERY to prepare
● Also referred to as: Debulking ■ [@] During post operative, nurses should
● Right choice for cancer prepare a NCP
● Indicated for cancers that are: ■ *Hierarchy of needs
○ Locally or regionally contained (in situ)
○ Have not metastasized 2.1.3 PROPHYLACTIC SURGERY
○ Have not invaded major organs
○ [@] primary treatment for cancer ● Involves removal of non-vital tissues or organs that are
likely to develop cancer
● Factors to consider in choosing prophylactic surgery:
2.1.2.1 TWO COMMON TECHNIQUES USED IN CURATIVE
○ Family history and genetic predisposition
SURGERY
■ [@] Ex. Angelina Jolie, an actress in America
● Local excision ● She has a history of breast cancer and
○ Indicated for small mass she chose Prophylactic Surgery
○ Includes removal of the mass and a small margin of ○ Presence or absence of symptoms
normal tissue ■ [@] it depends on the result
● Wide excision ○ Potential risks and benefits
○ Also called as: Radical or en bloc dissections ■ [@] Aside from potential risk, it is also
■ Performed if tumor can be removed completely expensive
■ Include removal of the primary tumor, lymph ○ Ability to detect cancer at an early stage
nodes, adjacent involved structures, and ○ Patient’s acceptance of the postoperative outcome
surrounding tissues that may be at risk for ■ [@] Acceptance is important for patient
tumor spread undergoing prophylactic surgery
■ *Mas mataas ang survival ■ [@] There are a lot of “what ifs” that needs to be
● Other surgical approaches answered by the genetic counselor
○ Video assisted endoscopic surgery
■ [@] for thoracic area
2.1.3.1 KEY POINTS TO REMEMBER FOR PROPHYLACTIC
○ Salvage surgery
SURGERY
■ [@] Lumpectomy prior to mastectomy
○ Electrosurgery ● Long-term physiologic and psychological effects are
■ [@] use of heat/ cauterization unknown
■ [@] For wart removal ○ [@] Physiologic - when you develop cancer
■ [@] Uses electric current to destroy anywhere
○ Cryosurgery ○ [@] Psychological - fear, anxiety (may be hormonal
■ [@] use of cold like dry ice related cancer)
■ *nitrogen ○ *Pwedeng hindi lang sa breast mag grow yung
○ Chemosurgery cancer
■ [@] Complete removal of tumor tumor ● Provide preoperative teaching to patient and family
■ *use of cytotoxic agent to remove ○ *Types of assessment
○ Laser surgery ■ Comprehensive
■ [@] Uses light ■ Focus assessment
■ [@] Uses a laser beam to reset a cancer ■ On-going assessment
■ [@] Ex. retinal cancer ● Plan for long-term follow-up care.
○ [@] Usually done post-operative care
○ [@] For any complications, infection, and bleeding
2.1.2.1 KEY POINTS TO REMEMBER FOR CURATIVE
○ [@] Once we exposed ourselves in the environment
SURGERY
(internal and external), be careful
● Plan for the effects of surgery to the patient: Body
image, self-esteem, functional abilities
■ [@] It will affect your body self-image, especially
if you are married. If you’re single, you have fear
and anxiety because in erik-erikson, you are
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2.1.4 PALLIATIVE SURGERY
● [@] For advanced stage of cancer
● Performed in attempt to relieve complications of cancer
○ *Ex. when there are obstructions in the large colon
→ elimination is impaired
○ *Also for the comfort of the client
● Nursing Actions
○ Provide complete peri-operative assessment for all
factors affecting the patient
■ [@] Should execute totality or total assessment
■ *Get all details/information coming from the
client
■ *Needs checklist
○ Provide education and emotional support
■ [@] This is where you develop your empathy to
be able to give your emotional support for the
patient
■ *Be knowledgeable and skillful to execute
health teaching efficiently
■ *Be empathetic with or without experience
■ *Be strong in giving emotional support to
patient
○ Communicate with the physician and other health
care team
■ [@] Because this is a multi-disciplinary
intervention
■ *Example: initiation pa lang namatay na si px
due to allergic reaction to anesthesia
○ Assess patient’s response after surgery and
monitor for possible complications
■ [@] multidisciplinary - referring patient to other
department
■ [@] having harmonious collaboration with other
department
■ *Aseptic technique: wound care etc.
2.2.2 RADIATION TO CONTROL MALIGNANCY
● Used when a tumor cant be removed surgically (most
probably a liquid tumor)
● Local nodal metastasis is present
● In patients with leukemia, radiation prevents infiltration
to the brain or spinal cord
● *Liquid tumors, acute leukemia, chronic leukemia → can
cause blindness once mapunta sa brain → difficult to
manage → advance cancer
2.2.3 RADIATION AS AN ADJUVANT TREATMENT
● Used as adjuvant surgery (administered pre surgically or
postsurgically)
○ *Ex. PRE- because tumor is large enough to
remove via surgical intervention
○ *Ex. POST- If it is found as malignant- additional
therapy
● [@] May be too large/ Shrinks tumor prior to surgery
● Enhances the ability of chemotherapy to cross the blood
brain barrier (e.g. patient with acute lymphocytic
leukemia)
● [@] Most of chemotherapy agent cannot cross the blood
brain barrier
● [@] Wait for the total recovery of the patient before
radiation has been done
● *You need chemotherapy along with radiation therapy
● *Nitrosureas agent - cross blood brain barrier
2.2.4 RADIATION AS A PALLIATIVE TREATMENT
● Effective therapy to reduce symptoms in 50% of patients
with advanced cancer
● Effective in reducing pain and in improving mobility (e.g.
bone metastasis)

2.2 RADIATION THERAPY

● [@]Either or conjunction with other therapies
● [@] Use prior to surgery
● *More than 60 patients _
● Goal:
○ To achieve local-regional control of the cancerous
growth without permanently damaging the
surrounding normal tissue
● Uses of radiation therapy
1. Primary treatment
2. Control malignancy
3. Adjuvant treatment (additional therapy)
4. Palliative treatment

2.2.1 RADIATION AS A PRIMARY TREATMENT Figure 1. Radiation source and Types of Shielding to
● Squamous cell carcinoma of head and neck Radiation
● Primary nervous system malignancies
● Localized lymphoma 2.2.5 IONIZING RADIATION
● Germ cell tumors ● Two types of ionizing radiation
● Cervical pancreatic and prostate cancers ● Direct ionization
i. [@] Uses radiation particles, beta particles,
neutron, alpha, x rays
ii. Beta particles
iii. Electromagnetic rays
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 iv. X-rays
v. Gamma rays ● How cell delay or progress and cause damage to
• Stopped by several feet of nucleus → cell death after replication
concrete or a few inches of ● Cell cycle is specific
lead ● Can repair itself before generally believed to be the
● Forms of shielding: primary damage that leads to damage
● To function until undergo mitosis so it depends

o For alpha particles

▪ Protect yourself by using sheet of
paper
o Beta
▪ Layer of clothing Figure 3. The cell cycle
o Gamma rays
o 6 feet away and shielding ● Cells are most vulnerable to the disruptive effects of
radiation during DNA synthesis and mitosis (early S, G2
and M phases of the cell cycle)
● [@] Precise treatment and planning should target the
tumor
● [@] During mitosis, cancer cells are sensitive to radiation
● *During mitosis, it is sensitive (ang cancer cells)
● *Mitotic cells are more sensitive to tissues containing
dividing and non dividing cells __ bc they are radio
resistant during s phase
● Presence of oxygen because there are principles in
giving radiation therapy → its advantage on
fractalization on how much or to conder the 4 R
● R- repair ability to cancel damage
● Meaning, direct ionization can cause DNA breakage ● R - redistribution - based on the sensitivity of the cell to
→ cell death radiation in different phases of mitotic division?
● Interacts with _ radicals which destroys DNA ● R - repopulation- regeneration of cell after radiation
structure damage
● Reoxygenation - tumor are well oxygenated also appear
● Indirect Ionization to be more sensitive to radiation
o [@] uses of electromagnetic rays (x-rays,
gamma rays most common ionizing 2.2.5.1 KEY POINTS TO REMEMBER
radiation) ● Tumors that are well oxygenated also appear to be more
o Ionizing radiation penetrates tissues and sensitive to radiation
giving up energy and producing fast ● Certain chemicals, including chemotherapy agents, acts
moving electrons. as radiosensitizers (sensitize more hypoxic tumors to
the effects of radiation therapy)
○ [@] Usually in combination with chemotherapy
● Recovery from sublethal doses of radiation occurs in the
interval between the first dose of radiation and
subsequent doses
○ It is given based on the redistribution of such
radiation therapy
● Normal tissue usually is able to recover from radiation
damage more readily than cancerous tissue
○ [@] Let us consider the fractionalization (divide
into equal fraction) - meaning you have different
time of visit to give you adequate radiation therapy
Figure 2. Mechanism of action of Ionizing Radiation
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 ○ *Uses cytotoxic agents which affects the normal
tissues in the cell
○ [@] 4R principles of fractionalization - Repair,
Redistribution, Repopulation , Reoxygenation
○ [@] Repopulation: Regeneration of cell after
damage
○ [@] Reoxygenation: Presence of oxygen that
enhances….
○ [@] Ability of the cancer cell damage
○ [@] Before they divide, it will kill the cancer cell
○ [@] reoxygenation:
○ [@] Ex. cancer in the lung - very sensitive to
radiation
2.2.6 METHODS OF RADIATION ADMINISTRATION/
DELIVERY
1. External Radiation
2. Internal Radiation
2.2.6.1 EXTERNAL RADIATION
● [@] Also known as Telegraphy
● *External - they use a marker for them to know if the
client is responding to radiation
● *NR: Do not wash the marker after bc this is the
gauge of the doctors if the px is responding to the
type of treatment
A. X-ray
● Destroys cancer cells at the skin surface and
underlying tissue
■ [@] Physician will encircle the tumor site
● Kilovoltage therapy devices
○ Delivers maximum radiation dose to superficial
lesions (skin and breast)
● Linear accelerators and Betatrons machines
○ Delivers maximal x-ray and deliver dosage in deeper
structures with less damage to the skin
B. Gamma ray
● Provides radiation beneath the surface of the skin
with less adverse effects
○ Cobalt 60
■ Decay of the particle releases gamma rays
C. Particle-beam radiation therapy
● Accelerates subatomic particles through body
tissues. Damages target cells as well as cells along
its pathway.
2.2.6.2 INTERNAL RADIATION
A. Internal radiation implantation A.K.A brachytherapy
● Involves the insertion of sealed radioactive sources
into:
○ Body cavity (intracavitary)
■ [@] Example: abdominal, peritoneal, pleural etc
■ *Thoracic, abdominal, peritoneal, etc.
naglalagay sila ng implants
○ Directly into body tissues (interstitial)
■ [@] Example: inserted in your prostate area
B. Unsealed Internal Radiation
● Radioisotopes injected intravenously
administered by mouth
■ Iodine-131 - treatment of thyroid cancer
■ Strontium-89 - control bone pain due to
multiple skeletal metastases
● Given palliatively
2.2.6.1 INTRACAVITARY BRACHYTHERAPY
● Radioactive needles, seeds and beads radiation into the
cavity
● Radioisotopes are inserted into specially positioned
applicators
Methods of radiation administration/delivery:
● Placement of applicator is verified by x ray
● Radioisotopes remain in place for a prescribed period
and then are removed
● Patients are maintained on bed rest and log-rolled to
prevent displacement
○ May stay for days depends on the doc’s order
● *Make sure that the client has indwelling catheter prior
to administration, the night before, kelangan linisin,
bigyan ng anti-diarrheal or lomotil For diarrhea para hindi
balik nang balik
● *bowl/bladder elimination must be stopped para hindi
maiba ang position
2.2.6.2 INTERSTITIAL BRACHYTHERAPY
● Radioactive needles, seeds and beads deliver radiation
to the cavity
○ [@] You keep the area sterile to prevent infection
● Radioisotopes are inserted into specially positioned
applicators
● Use 18 g needle to put properly in place the seeding,
radioactive isotopes
● Placement of application is verified
● Maintained in bed rest to prevent displacement
2.2.7 ADVERSE EFFECTS OF RADIATION
● Altered Skin Integrity (alopecia, erythema and
desquamation)
○ [@] Impaired skin integrity
○ *Due to radiation that damages normal cells and
hair follicles
● Altered in oral mucosa (stomatitis, xerostomia, change
in taste, and decreased salivation)
○ [@] Fluid volume deficit
○ *Stomatitis - will cause impaired nutrition
○ *Xerostomia - dryness in the tongue → decrease
salvation
○ Respiratory and reproductive system, meron din
● GIT disturbance (anorexia, nausea, vomiting and
diarrhea)
○ [@] Fluid volume deficit
○ [@] Avoid spicy foods because their mucosal lining
is very sensitive
○ *Because yung mucous linings of GIT is also
affected, it is sensitive
○ *Nurses should be sensitive to their needs after RT
○ *Ex. are you going to buy foods that are already
or peeled, kelangan buo pa and kelangan ikaw or sila
ang mag babalat kasi sensitive
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 ○ *Madali ma-irritate and tiyan kaya nag kaka diarrhea
and sometimes effect of radiation
○ *anticipation/to prevent for those things to happen;
kailangan alagaan diligently for their intake,
appropriate food for them
● Dyspnea, chest pain, dysphagia
○ [@] Dyspnea - possibility of ineffective breathing
pattern but you need supportive assessment pa to
validate
○ [@] Dysphagia - you have to check for cough reflex
for risk of aspiration
○ *Affected and mucous membranes, nahihirapan
huminga, kelangan ng O2
● Bone marrow suppression (acute anemia, leukopenia
and thrombocytopenia)
○ [@] Anemia- check for blood count (ineffective
tissue perfusion) and look for evidences pa to
support your nursing diagnosis
○ [@] Nursing diagnosis: Body image (Alopecia),
Impaired Skin Integrity, Risk for infection, Ineffective
Tissue Perfusion, Risk for Bleeding, Fluid Volume
deficit Nutrition Imbalance, Ineffective Tissue
Perfusion
● [@] It depends on the fraction that is being given to your
client so as a nurse, you have to anticipate for those
things to happen
NURSING DIAGNOSIS
● Risk for bleeding
● Body image bc of alopecia
● Fluid and electrolyte imbalance
● Nutrition imbalance - dysphagia
● Ineffective tissue perfusion - bone marrow
2.2.8 NURSING MANAGEMENT FOR RADIATION
● Patient teaching
○ Provide supplementary teaching about effects of
radiation on the tumor, as well as the normal cells
and tissue
■ [@] For them to be compliant
■ [@] For nurses to get the cooperation
■ *Notify health care provider
○ Provide overview of the radiation administration,
equipments used, and the duration of the procedure
■ [@] It is important for them to know how much
time they have to be in that position
■ [@] That is why Nurses have a very big role in
caring with clients that are diagnosed with
cancer (orient the client on what is expected
during the procedure)
■ [@] The patient is considered as emitting
radiation that is why you have to isolate the
patient. The nurse should also distant herself
from the patient to avoid radiation (At least 6
feet away from the patient when providing care
unless during some circumstances such as bed
bath, wherein maximum time is only 30
minutes)
○ Instruct about possible immobilization during and
after placement of radioisotopes
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○ If implants are to be placed, inform patient and
family about restrictions (visitors and health team)
■ [@] Visitors and health team should also be
aware of the emitting radiation
■ [@] There should be a maximum of 30 minutes
of visitation (or within your shift if nurse)
■ [@] Distance should be 6 feet from the patient
■ *They are considered as radioactive, put sign
2.2.9 RADIATION PRECAUTION
● Time
○ [@] Morning care, IV regulation (30 minutes, every 6
hours, 12 hours)
● Distance
○ [@] 6ft away from the client
● Shielding
○ [@] Types of shielding: paper, plastic, lead, concrete
○ *Use lead and 6 feet away from the client
○ *Radiology unit- wear appropriate shielding d/t
ionization and keep distance
● The radiation source must never be picked up with bare
hands
○ [@] double gloving
● Radiation source must never be placed in the sewage
system via the sink or toilet
○ [@] Radiation should never be picked up by our
hands to avoid radiation and prevent harm to the
nurse (especially on cellular level), emits radiation
● If dislodgement occur, the safety officer or radiation
therapist must be notified immediately
○ [@] because they are the right people to be informed
(they know how to perform the therapy if
dislodgement occur)
○ *More knowledgeable in after care
● If a source of radiation must be picked up with pair of
long handled forceps or tongs, place it in a lead
container
○ [@] To protect other members of healthcare
team/environment
● Patients with radioactive implants
○ Assign patient to a private room with private bath
■ *flush several times toilets to prevent from
exposure, lalo na radioactive material, if isang
beses lang, baka nandoon pa - maapektuhan
ang ordferly ng naglilinis
○ Place a “Caution:” radioactive material sign on the
door of patient’s room
○ Wear dosimeter film badge when providing care for
px- measures radiation exposure
■ *some health care providers esp. Nurses nae-
expose
○ Wear lead apron during patient contact
○ Pregnant women and children younger than 16
years not allowed to visit
■ [@] May cause congenital anomaly, leukemia,
or cellular aberration in the blood
■ *not allowed to visit may cause congenital
anomaly or aberration sa blood
■ Sababy baka magka leukemia after can cause
aberration to blood and baby → Leukemia
 ■ Radiologic therapy is not recommended ● Ovarian cancer
because it is contraindicated ● Pancreatic cancer
○ Limit each visitor to ½ hour per day. Be sure that
they at least 6 feet from source (to protect them) 2.3.1 GOAL OF HORMONAL THERAPY
● Protecting skin and mucosa
● Deprive cancer cell of the hormonal growth signals that
○ Avoid exposure of irradiated area to the sun
stimulates cell division
■ [@] It may aggravate the area,
● * Ex. breast cancer, still in reproductive years, menstrual
irritations of the skin
period → when you have cancer → docs will give you
○ Avoid heat exposure
treatments to force you to have menopause
■ can cause first degree burn
○ Do not apply sunscreen (chemical may irritate the
radiated skin)
■ [@] Advise to use unscented
soaps, lotions, and shampoo . The
more scented the products are,
the more chemicals they contain.
■ *because of d/t chemical contents
of the sunscreen → unscented
soap is recommended instead Figure 4. Goal of hormonal therapy
○ When outdoors, use umbrella and other forms of
shades 1. Tumor dependent on Hormone A
2. Secretion of Hormone A by endocrine system AND
PAHINGA MUNA, ADHARA! administration of large doses of hormone B
3. Administration of large doses anti estrogen
(hormone b)
4. Hormone B competes with Hormone A in tumor
uptake
5. Slowed tumor proliferation
o Forced menopausal - no montlies, cessation of
menstruation ex. At 45 years old
o Even if the patient is not yet 45 years
old
o If single and wanted to have a child →
collect ovum and send it to the bank
(same with male d/t sterility)
o You will not become sterile, but body
will be forced to stop menstruation
o It is a choice bc it is a treatment; to
prevent the spread
2.3. HORMONAL THERAPY o because there is a danger that yung cancer
● Consists of administration of drugs designed to alter the cells mag spread sa ovarian cells para hindi
hormonal envt of cancer cells negatively mag spread to hormonal related cancer
○ [@] In real life, it is difficult to give negative feedback
compared to a positive feedback ● [@] For you to rest, we will give you large doses of
○ *Hormones: estrogen, testosterone Hormone B to counteract / para matalo yung production
○ *Blood loss → hematopoiesis in the bone marrow ng estrogen sa body → it will lead to manifestations like
● Used for cancer that are responsive to or dependent on menopausal (this will help reduce tumor)
hormones for growth ● [@] Slowed down tumor proliferation - meaning di na
○ Breast cancer siya mag-spread to other parts of the body
○ Prostate cancer
■ Testosterone, androgen (hormones that 2.3.1 MECHANISM OF ACTION OF HORMONAL THERAPY
stimulate the prostate) AGENTS
○ Endometrial cancer ● Inhibitors: drugs that inhibit the production of specific
■ [@] For instance, the surgeon will ask you to hormones in the normal-hormone-producing organs
remove your ovary for the purpose of forced ● Hormone antagonist: drugs that inhibit the production of
menopause, so that the cancer cells in the specific hormones in the normal-hormone-producing
ovaries will not metastasize to other organs. organs
● Other cancer reactive to hormonal therapy ○ Walang proliferation
● Karposi’s sarcoma ● Binds to specific hormone receptors on tumor cell -
● Renal cancer limits needed hormone to bind on tumor cell
● Liver cancer
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 ○ Difficulty on achieving and maintaining erection

2.4. BIOTHERAPY
● Involves the use of immunotherapy and biologic
response modifiers (BRM) as a means of changing the
person’s own immune response to cancer
○ [@] This is a treatment of choice for those who are
not qualified in radiation and chemotherapy
○ [@] bio means life, it means bringing back lost
immune system
● Mechanism of action:
○ Modification of host responses
[@] we’re doing this unconsciously
○ Suppression of tumor growth or killing the tumor
Figure 5. Mechanism of Action of Hormone Antagonist cells
○ Modification of tumor cell biology
TYPES OF AGENT EXAMPLE
2.4.1 IMMUNOTHERAPY
HORMONE AGONIST A. Active immunotherapy
● Androgen Fluoxymesterone (Halotestin) ○ They used bacille calmette-guérin (BCG)
Testolactone (Teslac) ■ BCG - Responsible for the protection
during childhood, at birth, protect from
● Estrogen Chlorotrianisene (Tace) primary PTB
Ethinyl estradiol (Estinyl) ■ Ex. bladder cancer → give BCG
components→ to give active immune
HORMONE response of patient to fight of tumor
ANTAGONISTS cells
● Antiandrogen Bicalutamide (Casodex) B. Passive immunotherapy
● Antiestrogen Fulvestrant (Fasodex) ○ Transfer of cultured immune cells into a tumor
bearing host until such time they will recognize
HORMONE INHIBITORS Aminoglutethimide (Elipten) the tumor
Anastrozole (Arimidex) ○ [@] Inject cultured immune cells to recognize
Letrozole (Femara) tumor (vaccines pero wala pa nadedevelop to
Table I. Common Agents Used for Hormonal Manipulation abort cancer)
○ *They will get your immune cells → culture nila
same with cancer cells → until immune system
2.3.3 SIDE EFFECTS OF HORMONAL MANIPULATION
will be able to recognize the tumor inside your
● Androgen and Anti Estrogen body → then they will give it back to you
○ [@] Masculinizing effects of females by forcing your ○ Since there are no yet vaccines for cancer, but we
patient to have menopause have specific vaccine for human papilloma virus
○ Excessive growth of facial and chest hair ○ At the age of 18 years old, ive HPV vaccine
■ bc of androgens specially on females especially on strains 16 or
○ Cessation of menstrual period 18
■ collect egg cells to have a child ○ As of now, vaccines are still under development
■ For people who wants to keep their vanity → to abort cancer
use contraceptive pills C. Adoptive immunotherapy
○ Will have mood swings and Flushes ○ Transfer of sensitized natural killer (NK) cells or T
○ Shrinking of breast tissue lymphocytes, combines with cytokines to the
○ Fluid retention tumor bearing host
■ [@] Avoid eating salty foods. ○ [@] kinukuha mismo sa host at ibabalik din
○ Development of acne sakanila
○ Hypercalcemia ○ Harvest the NK cells from the host
○ Stem cell cultures para makilala tumor cells,
● Estrogen, progestins, and antiandrogens tumor cells tend to escape
○ Loss of facial hair (alopecia) ○ Depends ilang session dahil may evaluation pa
○ Increased smoothness of skin ○ *Its either they will your natural killing cells or
■ [@]Estrogen - to make the skin soft and stem cells to be able to combine with cytokine the
smooth-like tumor bearing host
○ Gynecomastia ○ *Culture the t lymphocytes until such time the
■ [@] Makes breast enlarge tumor cells will be identified and known to the
○ Testicular and penile atrophy body
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 ○ *Since it cancer cells are under surveillance in the
Darbepoetin alfa (Aranesp) Chemotherapy-induced
body
fatigue
2.4.2 BIOLOGIC RESPONSE MODIFIER Oprelvekin (Neumega) Chemotherapy-induced
● Stimulate specific immune system cells to attack and thrombocytopenia
destroy cancer cells;
○ [@] As we are still healthy, you need vitamins or Table II. Common Biologic Modifiers
supplements to bring back the integrity of your
immune system to help fight cancer ● *Commonly use biotherapy due to the effect of
● Blocks cancer cells access to an essential function or chemotherapy
nutrient ○ Sometimes nagkakaroon ng effect ang
○ Interleukin (ILs) chemotherapy, they were able to rec.
■ Helps regulate inflammation and immune Agents to counteract the side/adverse
protection effects brought about the chemotherapy
■ Helps immune system cells to recognize ○ WBC is affects as well as RBC hemoglobin
and destroy abnormal body cells and hematocrit
■ E.G. : IL-1, IL-2, and IL-6 ○ Epogen → stimulate the bone marrow to
[@] these are your lymphokines produce rbc
○ Naturally we have this in our body ○ Darmapoetin alfa - Chemotherapy induced
○ Interferons (INFs) fatigue → d/t damage to normal cells
■ Cells-produced proteins that can protect
non-infected cells from viral infection and 2.4.2.2 SIDE EFFECTS OF BIOLOGIC RESPONSE
replication. MODIFIERS
■ Inhibits the expression of oncogenes ● Generalized and severe inflammatory reaction
depends on the viral load or components in ○ [@] Several days prior to therapy, patients are given
the body, given via IM steroids to decrease the inflammation
■ [@] Hepa profile and viral load to check if ○ [@] Corticosteroids is given to reduce inflammation
pwede sa interferons and suppress immune response
■ [@] Biotherapy for chronic viral infection ● Tissue swelling
(depending on the viral load) ● Fever and chills
■ *example. Hepatitis B and C ● Flu like general malaise
■ *Chronicity of the viral replication will ● Skin rashes, dryness, itching and peeling
directly affect your DNA that causes ● Peripheral neuropathy (SE of interferons therapy)
progression that will develop into ○ [@] Interferons - given through IV.
hepatocellular carcinoma → give
interferons to inhibit the expression of ● *Too risky to have this biotherapy esp. Bringin back
oncogene the tumor suppressor genes bc it will produce
■ *Depends on the viral load → check nila generalized/severe inflammatory reactions
(hepa profile/liver profile) → to inhibit the ● *Corticosteroid is prescribed to prevent
expression of oncogenes inflammatory response and anti-allergenic property
■ [@] have proof fight in viral diseases *For the biotherapy to be successful →
■ 3 Types of Interferons: Alpha, Beta & Decreased immune system → aatakihin
Gamma nila para marecognize sino ang kalaban →
tissue swelling, fever and chills
2.4.2.1 COMMON BIOLOGIC RESPONSE MODIFIERS ○ Needs comprehensive assessment, and
acceptance of the family to undergo such
treatment
AGENT INDICATION ○ Prognosis is very important
■ What are the expectations
Sargramostim (Leukine, Chemotherapy-induced ■ To accept the consequences
Prokine) leukopenia ■ Ask the doctor

Filgrastim (Neupogen) Chemotherapy-induced 2.5. TRANSPLANTATION

neutropenia ● Bone marrow transplant
● *Not used only in cancer
Pegfilgrastim (Neulasta) Chemotherapy-induced ● *Takes risk
neutropenia ○ Used in the treatment of leukemia, usually in
conjunction with radiation or chemotherapy
Epoetin alfa (Epogen, Chemotherapy-induced ○ [@] Route for bone marrow/ hematopoietic
Procrit) anemia transplant: Intravenous Therapy and should be
centralized
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 ○ Indication:
■ Leukemia
■ Severe aplastic anemia
■ [@] These are the immature blood component
meaning they are not useful in your system
■ Lymphomas
■ Multiple myeloma
■ Immune deficiency disorders
■ Solid tumor cancer as breast or ovarian
2.5.1 TYPES OF BONE MARROW TRANSPLANTATION
1. Autologous bone marrow transplant
○ The donor is the patient him/herself (rejection)
○ *Advantage bc of rejection ng cells
2. Allogeneic bone marrow transplant
○ The donor shares the same genetic type as the
px
○ Stem cells are taken either by bone marrow
harvest or apheresis (peripheral blood stem
cells) from a genetically-matched donor,
usually a brother or sister
■ *Apheresis- dumadaan sa
machine to repeat the blood stem
cell that is not the type of the
patient uon crossmatching
■ *Once na wala yung bro/sis mo,
kukuha sa parent
○ Other donors for bone marrow transplants
include the following:
■ A parent: a haploid identical match is
when the donor is a parent and the
genetic match is at least half identical to
the recipient.
■ An identical twin: a syngeneic transplant
is an allogenic transplant from an
identical twin. Identical twins are
considered a complete genetic match for
a marrow transplant
○ Unrelated bone marrow transplants (UBMT or
MUD for matched unrelated donor ( found at
National Bone Marrow Registry)
■ The genetically matched marrow or stem
cells are from an unrelated donor
■ Unrelated donors are found through the
national bone marrow registries (scary in
donors, kasi yung similarity need ng
matching, fear of rejection)
■ [@] There is an increased risk for this
type of transplant
■ *Pinakamaraming donor (unrelated
donors)
■ *Nakakatakot sa rejection
■ *Difficult to trust because it will undergo
the process of cross matching if similar
to be successful and prevent
complications: fear of rejection, severe
complications
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3. Umbilical Cord Blood transplant (Hematopoietic Cell
Transplant)
○ stem cells are taken from an umbilical cord
immediately after delivery of an infant
■ [@] fresh since from immature cells to matured
cells
○ These stem cells reproduce into mature, functioning
blood cells quicker and more effectively than do
stem cells taken from the bone marrow of another
child or adult
■ [@] The danger is series of tests must be done
in matching.
○ The stem cells are tested, typed, counted, and
frozen until they are ready to be transplanted
■ [@] This is quicker to use
2.5.1 SIDE EFFECTS AND COMPLICATIONS OF BONE
MARROW TRANSPLANTATION
● Pain
○ [@] High doses can cause inflammation of the
mouth
○ [@] Because the route of administration is
intravenous that is why it is painful
○ [@] side effect from combination therapy (i.e.
radiation and chemotherapy)
● Fluid overload
[@]Kidneys can't keep up on the large amount of
fluid being given in the form of intravenous
● Respiratory distress
○ [@]Inflammation of the airway due to
chemotherapy, or failure of graft or rejection there is
possibility of death
○ *effect of radiation, chemotherapy, di kinaya ni body
● Organ damage
○ [@] temporary or permanent damage to the liver or
heart can cause infection
● Graft failure
○ [@] Tissue rejection
○ [@] it will result to death, be careful if used for vanity
● Graft-versus -host disease
○ [@] Not appropriate, the body can either can either
adapt or not to foreign materials
○ *may rejection → death
● Most common: PAIN and INFECTION
3. CHEMOTHERAPY
● [@] It is a systemic mode of treatment that uses
cytotoxic that will harm normal cells and cancer cells
● *Cytotoxic agents - harmful to normal cells and it will be
a toxic agent to kill cancer cells
○ Cure for leukemias, lymphomas, and some solid
tumors
○ Decrease Tumor size
○ Adjunctive to surgery/ radiation/bone marrow
transplant
■ [@] make sure that your patient is fully-
recovered before surgery or radiation
○ Prevent or treat suspected metastasis
○ [@] Supportive therapy to palliative cases
31 GOALS OF CHEMOTHERAPY
○ Curative intent:
■ Though cure may be the goal, it doesn't always
workout that way
■ [@] Patient needs maintenance, not 100% to
cure a cancer px
○ Control
■ To shrink any cancerous tumors growing
and/or stop the cancer from growing and
spreading
■ *patient is responding to such treatment like
chemotherapy. Maintenance na lang and follow
up for any manifestations and tests for
possibility of recurrence
○ Palliation
■ At an advanced stage, drugs may be used to
relieve symptoms to improve the quality of life
but not treat the disease itself because it is
already advanced
■ *supportive
● Example:
○ Acute lymphocytic leukemia (ALL)
○ Uses DVPA
■ Daunorubicin given days 1-3
■ Vincristine: day 1,8,15,22
■ Prednisone: day 1 through 28 (mega star meds,
anti inflammatory)
● Corticosteroid - megastar ★
● In cycles
● Ex. on the 4th cycle parang zombie na,
lalaban or mamatay ang pakiramdam
■ Asparaginase: days 17-28
○ [@] DVPA is a protocol. If the patient is not
compliant or is not consistent with this protocol,
then kailangan i-repeat ang treatment like antibiotic
therapy.
○ [@] Must health educate as well.
○ [@]Whole cycle must be completed
● New research: used of chemo based on
○ Circadian Rhythms
■ [@] Aligning when body is mostly awake (it
improves drug effectiveness)
■ [@] Regulates certain pathways to decrease
toxicity
■ [@] Ex. colon cancer - your circadian rhythms
will fight the cancer and given AT NIGHT to
become effective
■ *Better if it is given at night because mas
mataas ang resistensya pag tulog
■ *Sometimes daytime, it depends on the
sensitivity of the cancer cells
■ *Wag magtaka if yung isang agent ibigay nila ng
am at yung iba sa gabi → mas effective
32 POSSIBLE NURSING DIAGNOSIS FOR CHEMOTHERAPY
● Alteration in tissue perfusion
○ [@] d/t decreased hemoglobin, anemia
● Alteration in oral mucous membrane integ
○ * because it will affect all mucus membrane
● Activity intolerance
○ [@] d/t rehabilitation from chemo
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○ [@] ADL’s should be done in a gradual process
○ *rehabilitation; after chemotherapy the patient is
gradually recovering from the effects
○ *Fatigue bago act. int.
● Alteration in comfort: pain/pruritus
○ *di na ina accept because chronic
● Fluid volume deficit
● Potential for infection
○ *put patient on a reverse isolation before and after
chemotherapy because they are
immunocompromised
● Potential for alteration in Nutrition less than Body
requirements
○ [@] There will be a decrease in appetite
○ * because of the oral mucosa → pinapadaan na sa
iv ang nutrition (parenteral total nutrition)
3.3 CHEMOTHERAPY: CELL CYCLE
Figure 6. Chemotherapy cell cycle
● [@] It affects your G1 and your DNA replication
● Neoplastic agent
○ Example on chemotherapy antineoplastic
antineoplastic agent, we have cell specific and non
cell specific
● CELL KILL HYPOTHESIS
○ Each exposure kills 20% - 99% depending on
dosages
○ Repeated exposure targets even those in G0
(dormant phase) and leads to regression
■ Nagkakaroon ng tumor lysis → increased uric
acid in the body → complicated → CKD
○ 100% eradication of tumor cells is impossible
● OBJECTIVES OF CHEMOTHERAPY
○ To destroy all malignant tumor cells without
excessive destruction of normal cells
○ To control tumor growth if cure is no longer possible
○ Used as adjunctive therapy
○ *Surgery biopsy - it is malignant then chemotherapy
is recommended
3.4 CONTRAINDICATIONS OF CHEMOTHERAPY
● Infection
○ [@] It may aggravate immune system; once you
have fully recover from infection, you can
proceed to chemotherapy
○ *because in biotherapy and chemotherapy
induced leukemia, anemia, neutropenia
● Recent surgery
 ○ [@] That is why you have to wait for the full-
recovery of the patient 3.6 PREPARATION OF CHEMOTHERAPY
○ * make sure that patient is fully recovered prior
to chemotherapy because these agents are ● [@] DELEGATED SA PHARMACIST for preparation for
renal toxic and hepatotoxic chemotherapy
● [@] as a nurse, learning should be continuous
● Impaired renal or hepatic function
○ [@] This may aggravate the condition ● [@] It is important to know the specific guidelines since
○ * renal toxic and hepatotoxic; there are several the drugs may cause occupational hazards
procedures to be a candidate ● *Specialization- should be prepared accurately
● Recent radiation therapy ● Drugs may be absorbed by the person administering
● GUIDELINES for handling antineoplastic drugs
○ [@] may aggravate immunosuppression of px
prior to chemotherapy; allow the cells to 1. Avoid contact with solutions for injections
recover [@] Kapag may tira, itapon sa waste…
○ *recovery period before therapy 2. If handling a powder form of drug, wear a mask to
avoid inhaling powder
● Pregnancy
3. Prepare the drugs on disposable trays or towels so
○ [@] When you are pregnant with cancer, this will
delay the treatment that spills can be contained
○ [@] Dilemma: Mother or fetus 4. Dispose of contaminated materials in specific
○ [@] Other option: Delay chemotherapy after chemotherapy containers
a. *Because there are some institutions that
birth or opt for abortion
are preparing the chemotherapeutic agents
○ [@] May cause congenital anomaly
● Bone marrow depression in the nurses station
○ [@] there is already thrombocytopenia so it may
aggravate the condition 3.7 CHEMOTHERAPEUTIC AGENTS
○ *severe ○ Effects:
■ Chemotherapeutic Agent
3.5 ROUTES OF CHEMOTHERAPY ○ Combined medication therapy is used to enhance
● Oral tumor skill
○ [@] Not advised na gamitin kapag nagsstart pa ■ [@] It is given in combination because it is used
to enhance tumor cells' kill. IF NOT, the cancer
lang
○ *Discourage students to start chemotherapy by cells will become resistant and aggressive
○ Synergistic action of drugs will prevent the
mouth; nagkaroon ng underdose; once na
development of drug resistant mechanisms
maunderdose si patient, parang kinikiliti lang
○ *Needs commitment to the therapy
ang cancer cells
○ Combats resistance of cells to chemotherapeutic
○ *Lesser side effects
● Intravenous agents
○ *The reason why it is being in combination because
○ [@] Most commonly route for chemotherapy
it will enhance tumor cell kill
○ [@] Central catheter and sometimes pwede
peripheral depends
○ [@] ex. Leukemia and lymphomas
● Intra-arterial
○ [@] ex. hepatic tumors, head and neck
● Intracavity
○ [@] ex. ovarian cancer
● Intraperitoneal
○ [@] ex. Brain tumor, urinary, bladder cancer
● Intrathecal or intraventricular
● Intravesical
○ [@] ex. bladder tumor
○ [@] As student nurses, you are not allowed to
administer medication if it is indicated as a
starting time kasi hindi pa nakikita kung ilang
tablets yung binigay unless you are closely
supervise ng clinical instructor Figure 7. Target cells of Chemotherapy drugs
■ [@] Ex. na-underdose yung patient → it will
not serve the purpose in giving the 3.7.1 EFFECTS OF CHEMOTHERAPY DRUGS
medication) ● Tissue normally affected are:
○ [@] Remember na you are borrowing the license ○ mucous membrane
of the C.I kaya you have to be very careful as a ■ [@] Mucous membrane is found in the
student nurse mouth up to the rectum
○ [@] Body weight is checked for dosage ○ Hair cells
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 ■ [@] Preparation of the wig for the patient
○ Bone marrow depression
■ [@] It will affect your granulocyte as well as
your organs such as lungs, bladder,
○ Organs
■ [@] Liver and kidney may be affected
3.7.2 CLASSIFICATION OF CHEMOTHERAPEUTIC
AGENTS: Relationship to cell cycles
● [@] Your cell cycle will affect the treatment
(chemotherapy)
● Cycle specific agents
○ Most affect those in the S phase by interfering
with DNA and RNA synthesis
○ M phase (vinca or plant alkaloids) : halt spindle
formation in mitosis phase specifically sa
telophase
○ [@] Mitosis Phases: Prophase, Prometaphase,
Anaphase, Telophase
○ Cytokinesis is needed to split
● Cycle nonspecific agents
○ Act independently of the cell cycle phases
○ Usually have prolonged effects on the cells
leading to cell death and damage
Nursing implications:
●
○ Maintain good hydration
■ [@] 2500-3000 mL
○ Administer antiemetics prior to chemotherapy
■ *anticipate N/V
○ Monitor WBC, uric acid
■ [@] Uric acid is a byproduct of tumour lysis/
damaged tumor
■ *end product of tumor lysis → gouty
arthritis
■ [@] Can cause gouty arthritis and liver
damage
○ Assess for possible infection
○ Discuss concerns for hair loss
■ [@] There is a need to discuss kasi
eventually malalagas ang hair follicles.
Discuss when is the best time to use a
hairpiece or wig. Purchase hairpiece/wig
one month prior to therapy. This is in order
to prepare the client and also for self-
esteem purposes.
■ *1 month prior to chemotherapy
*it doesn't mean na lahat ng manifestations ay
mararamdaman ni patient

3.7.3 CLASSIFICATION OF CHEMOTHERAPEUTIC 3.7.3.2 NITROSOUREAS

AGENTS: Chemical group ● Similar to alkylating agents; across the blood-brain
● Alkylating agents barrier (important for central nervous system
● Nitrosoureas disease)
● Antimetabolites ○ [@] This is the only chemotherapeutic agent
● Antitumor Antibiotics that will cross the blood-brain barrier.
● Plant alkaloids ● Cell cycle non specific
● Hormonal agents
● Miscellaneous agents 3.7.3.3 ANTI-METABOLITES
● Interferes with the biosynthesis of metabolites or
3.7.3.1 ALKYLATING AGENTS nucleic acids
● Contain alkyl groups which binds to DNA and ○ [@] This is needed for RNA and DNA synthesis
prevent replication and mitosis ● Cell-cycle specific
● Cell-cycle nonspecific ○ [@] (best in S phase/DNA specific)
○ [@] Its effect is all throughout the cell cycle ● Use to treat acute leukemia, breast cancer, head and
● *Sterility is the main concern neck cancer, lung cancer, osteosarcoma
● *Ex. sa mga therapy → affect the reproductive ● Nursing Implications
system ○ Monitor CBS, WBC, uric acid
● Common side effects ■ thrombocytopenia, risk for injury, ;uric acid
○ Bone marrow suppression → formation of joint diseases → pain, to __
○ Nausea, vomiting Formation
○ Alopecia ○ Assess oral mucosa
○ Sterility ■ Soft bristled toothbrush for oral care
■ [@] Main Concern ○ Assess for infection, bleeding (d/t
■ [@] Can collect mature egg cells for the thrombocytopenia)
future ○ Provide oral care
○ Cystitis (cyclophosphamide) ■ [@] Dryness of the mucous membrane can
○ Stomatitis make the patient prone to infection.
○ Renal toxicity (Cisplatin) ○ Administer antiemetics pm
■ [@] it is given in combination ○ Evaluate hydration and nutrition status
● Examples: ■ [@] Avoid leftover foods.
○ Busulfan (Busulflex) ■ *Fluid vol. Deficit - force oral fluids 2,500-
○ Cyclophosphamide (Cytoxan) 3,000 mL; facilitate flushing of uric acid
○ Chlorambucil (Leukeran)
○ Cisplatin (Platinol-AQ)

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3.7.3.4 ANTITUMOR ANTIBIOTICS ● Corticosteroids (eg. prednisone): mostly used in CA
therapy); G1 phase/growth of cell
● Inhibit RNA synthesis, and bind DNA causing ● E.g androgen, estrogen, anti-androgen, anti-
fragmentation; interfere with DNA repair estrogens
● Cell-cycle specific ● *Hormone antagonists
● These drugs bind to almost everything they contact
● Side effects:
and kill cells ○ Nausea and vomiting
○ [@]Antidote of methotrexate: leucovorin ○ Hyperglycemia
● Main toxic effect is cardiac muscle toxicity (limits ○ Hypertension
the amount and duration of treatment) ○ Weight gain, gynecomastia
● Side effects are the same with other anticancer
○ Hypertension
drugs ○ Mood changes
○ Eg. Doxorubicin (Adriamycin); Bleomycin ■ *manifestation of menopausal stage
(Blenoxane), Dactinomycin (Cosmegen) ○ Cessation of menstruation
● NURSING IMPLICATION
○ Acne, alopecia
○ Monitor ECG, CBC
■ ECG for toxicity
○ Assess for bleeding 3.7.4 NURSING INTERVENTIONS: SIDE EFFECTS
○ Assess for hydration and nutrition status ● G.I. System - nausea and vomiting, diarrhea,
○ Check for fever 36 hrs after administration constipation
■ Check for vital signs because may delayed ■ *Depends on how the px reacts to such
complication like infection after neoplastic agents
administration ○ Administer antiemetic to relieve nausea and
○ Administer anti emetic PRN vomiting
■ *ice chips to relieve nausea (independent)
3.7.3.5 PLANT ALKALOIDS ○ GI system- nausea and vomiting, diarrhea,
constipation
● Two main groups (from natural products) ○ Replace fluid-electrolyte losses , low-fiber diet
○ [@] Natural products; comes from flowery to relieve constipation/diarrhea
plants na white, pink, and purple ○ Increase fluid intake and fibers in diet to
● Cell-cycle specific
prevent/relieve constipation
○ Vinca alkaloids - Mitosis Phase; inhibit mitotic ■ [@] Take BRAT diet - Banana, Rice, Apple,
tubular formation (spindle) during telophase;
Tea
inhibit DNA and protein synthesis
■ [@] Ensure cleanliness of food to prevent
○ Etoposide (VP-16) or mitotic inhibitors - can be
occurrence of diarrhea
non-specific; all phases; cause breaks in DNA
■ [@] Freshly cooked
and metaphase arrest
■ [@] Magaling ito sa pag-abort ng division
ng cancer cells. Table III. INTEGUMENTARY SYSTEM
○ Eg: 1. vincristine (oncovin), vinblastine(velban),
etoposide (toposar) MANIFESTATIONS NURSING
○ Side effects: INTERVENTIONS
■ hypertension (too rapid IV administration);
■ muscles weakness Pruritus, urticaria and Provide good skin care
■ Areflexia systemic signs Can give unscented lotion
■ Constipation
■ nausea and vomiting
■ Alopecia Stomatitis Provide good oral care (e.g.,
■ *Differs to individual to individual soft bristled toothbrush),
● NURSING IMPLICATIONS avoid hot and spicy food
○ Assess neuromuscular function * How to prepare food for
○ Monitor CBC, gastrointestinal function patients to protect the
○ Manage constipation mucous membrane
■ *Sensitive git
○ Hydration Alopecia Reassure that it is
○ Discuss concern for hair loss temporary, wear wig, hats
*not only the px is being
3.7.3.6 HORMONAL AGENTS affected, but also the entire
social system that you are
● Alters the climate / environment to depress or interacting with
prevent cell proliferation
● Cell-cycle specific Skin pigmentation Inform that it is temporary,

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 may cause anxiety
* will come back after it is
washed out
Nail changes (grow
normally after chemo)
Table IV. HEMATOPOIETIC SYSTEM
MANIFESTATIONS NURSING INTERVENTIONS
Anemia Frequent rest period, eat
foods high in iron
*Fatigue first before activity
intolerance
*Thalassemia with cancer
→ chemotherapy → high in
iron , it will depend because
it will increase RBC/ iron
Neutropenia Protect from infection
Avoid people with infection
Reverse isolation (px
wearing mask, admitted to
private room)
* defense is down; reverse
isolation, limit visitors,
avoid ppl with infection, you
will not be dying to the
cancer itself but to the
opportunistic infections;
social isolation
Thrombocytopenia Protect from trauma
Avoid using aspirin
Table V. GENITO-URINARY SYSTEM
Manifestations Nursing Interventions
Hemorrhagic cystitis Provide 2-3 L of fluid per
day
*be accompanied with s/o
during planning having
such treatment kasi ito ang
side effect to sustain and
maintain your relationship,
you cannot get away with
sexual intercourse, find
other ways
*Bladder problem
*Dryness → bacteria will
multiply
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Urine color changes to Reassure that it is harmless
orange and temporary,
Natural color will come
back after therapy,
Provide hydration
*Root cause of anxiety if it
was not explained to them
clearly that it is harmless
and temporary
*“Bakit orange?”
3. PAIN MANAGEMENT
● *There are culture differences
● As a filipino, tinitiis ang pain
● Pain is purely subjective
● In grieving process is situational crisis it it not only
a preparation in death
● As nurses we are here to guide the client in decision
and offer alternatives but we are not to decide
● Sila pa rin ang pipili kung anong pain meds
● Are you going to reassess after 3o mins? Yes
● Short attention span si patient until magkaroon ng
dependent intervention; if not then ask for an order
● Severe pain → that is the time to give diversional
activities kasi may focus na sa health education si
px. After 30 mins of nursing intervention, __, after 4
hours, nag respond ba si patient; acute pain
3.1 PAIN CARE BILL OF RIGHTS
● Have your report pain taken seriously and be treated
with dignity and respect by doctors, nurses, pharmacist,
and other health care professionals
● Have your pain thoroughly assess and promptly treated
● Be informed by your health care provider about what
they may be causing the pain (pressure), possible
treatment and the benefits, risks and cost of each
● Participate actively in decision about how to manage
your pain
● Have your pain reassessed regularly and your treatment
be adjusted if your pain has not been eased
● Be referred to a pain specialist if your pain persisted
○ *time to order another pain medication ex.
morphine + antidepressant
● Get clear and prompt answers to your questions take
time to make decisions and refuse a particular type of
treatment if you choose
3.2 ANALGESICS
● Are drugs that relieve pain without producing loss of
consciousness or reflex activity
● Indications:
○ Mild Acute Pain - effectively treated with
analgesics such as aspirin, NSAIDS, or
acetaminophen
■ [@] NSAIDS are not given to patients with
thrombocytopenia
 ■ *as the px receives chemotherapy you are
thinking of the side effects. Ex. may
thrombocytopenia → do not give NSAIDS
or aspirin
○ Unrelieved or Moderate Pain - generally treated
with a moderate potency opiate such as
codeine or oxycodone
○ Severe Acute Pain - is treated with opiate
agonist (e.g.) Morphine, hydromorphone
○ Morphine Sulfate - drug of choice for treatment
of severe chronic pain (respiratory depressant)
■ *There are some doctors na takot
magbigay ng morphine bc of the effect na
respiratory depression
○ Meperidine (Demerol) - commonly prescribed
opioid agonist in the pain management of pain
■ [@] Also given to patient-controlled
analgesia
○ Other agents may be used as adjunctive
therapy with analgesics such as
antidepressants or anticonvulsants (brain:
restless di kayo ng morphine), depending on the
pain’s cause
■ *Antidepressants - px tends to become
restless
3.2.1 DRUG CLASS: Opiate Agonist
● Opiate used to refer to drugs derived from opium, such
as heroin & morphine
● Another outdated term is narcotic - induced a stupor or
sleep
● Gradually refer to addictive morphine-like analgesics
3.3 CORTICOSTEROIDS
● Are hormones secreted by the adrenal cortex of the
adrenal glands
○ [@] Mega start in chemotherapy
● Divided into two categories
○ Mineralcorticosteroids
■ (Fludrocortisone, aldosterone)
○ Glucocorticosteroids
■ (Cortisone, hydrocortisone, prednisone)
■ It is given all throughout the chemotherapy
treatment
■ Prolonged use of this will lead to immune
depression
■ *Long term use ng corticosteroid → moon
face (tumataba)
3.3.1 DRUG CLASS: MINERALOCORTICOSTEROIDS
● Actions: it affects fluid and electrolyte balance by acting
on the distal & renal tubules, causing sodium & water
retention and potassium and hydrogen excretion
● Uses: used in combination with glucocorticoids to
replace mineralocorticoid activity in patients who suffer
from adrenocortical insufficiency
○ [@] Specially for cancer in the kidney
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3.3.2 DRUG CLASS: GLUCOCORTICOIDS
● Uses: given because of their anti-inflammatory and
antiallergenic properties
● Relieve the symptoms of tissue inflammation
● Therapeutic Outcomes:
○ Reduced pain & inflammation
○ Minimized shock syndrome and faster
recovery
○ Reduced nausea and vomiting associated
with chemotherapy
3.4 ETHICAL ISSUES
● The rights of children and rights of adult
● Effectiveness of informed consent (DNR)
○ There are reservations on do not resuscitate
waiver.
○ If conscious and awake tapos sasabihin ayaw
na niya → respect the decision
○ Assess if they are able to sustain the financial;
determine if the patient will have surgical
interventions
● Life support in the event of irreversible organ failure
● Allocation of resources
3.5 FUTURE APPLICATION
● Stem Cell Technology (effectiveness of transplant)
● Biologic response Modifiers
● Gene Transfer (alternative for antibiotic; detects
sensitivity for antibiotic)
4. ONCOLOGIC EMERGENCIES
4.1 PATHOPHYSIOLOGIC BASE OF MALIGNANT
NEOPLASIA
“Pathophysiologic Base of Malignant Neoplasia”
*
● Ca cell proliferation
● Disrupt normal cell growth and interfere with tissue
function
○ Pressure
○ Obstruction
○ Apin
○ Effusion
○ Ulceration
○ Vascular thrombosis, embolus,
thrombophlebitis
○ Let us discuss
○ Cancer cell proliferation disrupt
○ Because it will cause pressure, obstruction,
pain effusion, obstruction of the lymphatic
system, effusion and ulceration of the
system
○ Once na mag decrease ang supply ng blood
sa tissues, → ulceration and necrosis
4.2 PROLIFERATION OF CANCER CELLS
● [@] Uncontrolled growth of cancer cells
● Pressure - due to increase in size of neoplastic growth
● Obstruction - as tumor continues to grow, hollow organs
and vessels become compressed and obstructed
○ E.g esophagus, bronchi, ureters, bowel, blood
vessels, lymphatic system
○ [@] continuous production of fluid happens
○ *
○ E.g on hollow organs
○ Supportive therapy on nutrition → opening for
nutrition or PEG → percutaneous endoscopic
gastrostomy for example if there is an
obstruction on the esophagus or
○ Bronchi area obstruction → lobectomy surgical
intervention but seldom done
○ Part of palliative treatment
○ Ex. prostate cancer → enlarged → obstructed
bladder elimination → colostomy
● Pain
○ Due to:
■ Pressure on nerve endings
■ Distention of organs/ vessels
● [@] due to ascites/ build up of fluid
● *Bulging of blood vessels → enlarged
abdomen
■ Lack of O2 to tissues and organs
● [@] May be lactic or anaerobic
● Due to pain, if decreased circulation to
the area → cells die → necrosis →
tumor cell will release pain mediators →
late sign of cancer: PAIN if diagnosed →
malignant or advanced
■ Release of pain mediators by tumor
● Late sign of cancer (e.g., ovarian
cancer)
● Effusion - when lymphatic flow is obstructed, effusion in
serous cavities
○ E.g Pleural cavity, abdominal cavity
○ [@] Sometimes it is dangerous
○ *Most dangerous, needs paresynthesis,
kelangan naka connect sa TCT (test-tube t??)
● Ulceration and Necrosis - result as the tumor erodes
blood vessels and pressure on tissues causes ischemia
- tissue damage and bleeding and infection [@]
serosanguinous
○ *
○ Why? because the first line of defense is
already damaged and injured
○ Use olfactory to assess
○ Terminal stage of death
● Vascular Thrombosis, Embolus, Thrombophlebitis
○ Tumor tend to produce abnormal coagulation
factors that cause increase clotting (pulmonary
emboli - life threatening)
○ * Cause of cellular uncontrolled proliferation/
tumor
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4.3 PARANEOPLASTIC SYNDROME
● Malignant cells produce chemicals, hormones and other
substances (paraneoplastic syndrome)
● Anemia (unexplained)
○ Cancer cells produce chemicals that interfere
with RBC production (emulsion, ulceration)
○ Iron uptake is greater in the tumor than in the
deposited in the liver
■ [@] cancer can be parasitic/ dependent on
the host
○ Blood loss may result from bleeding
■ [@] possibility due to ulcerations
○ * 90% of calcium is in our bones
○ Erosion and ulceration
○ Chemicals na pinoproduce → severe anemia
○ Need to known IV therapy and blood
transfusion
● Hypercalcemia
○ Tumor of the bone, squamous cell lung
carcinoma, cancer of the breast produce a
parathyroid-like hormone that increases or
accelerates bone breakdown and release of
calcium in the blood
○ Also results from metastasis to the bones
○ Enhanced by immobilization and dehydration
○ *Result of bone cancer etc.
○ Ex. immobilization; 99% calcium is needed in
our bone and teeth, once you are immobilized
bc of cancer, yung Ca pupunta sa iba which is
1% lang dapat and EDIT
● Edema
● DIC (Disseminated Intravascular Coagulation)
○ More likely to occur in cancer in the lungs,
pancreas, stomach, prostate
○ Precipitated by the release of tissue
thromboplastin or endothelial injury
■ [@] presence of endothelial injury makes
the patient prone to infection
● Anorexia - Cachexia Syndrome
○ The final outcome of unrestrained cancer cell
growth (chocolates and starches)
○ Malignant neoplasms deprive normal cells of
nutrition
○ Tumor produce alteration in enzyme system
necessary for normal metabolism - stored fat is
lost, tissues lose nitrogen (negative Nitrogen
balance)
■ [@] Results to tissue wasting
○ Tumors revert to an anaerobic metabolism -
consume glucose, deplete glycogen stores in
the liver and convert glucose to lactate
○ Protein depletion, serum albumin levels
decreases
■ [@] nagkakaroon ng edema
■ [@] binibigyan ng egg whites, pinapadaan
sa NGT
○ Tumors take up Na. Water retention (at an early
stage) masks malnutrition and is not
immediately reflected as weight loss
 ○ Cancer cells anorexigenic substances that act
as the satiety center of the hypothalamus
causing anorexia
○ Taste sensation diminishes or becomes altered
and the individual may have aversion to eating
particularly to meat
○ *
○ Tissue washing
○ Severe weight loss
○ Severe debilitation
○ Thrombophlebitis - kapag nagkaroon ng
pulmonary emboli → danger
○ Anorexia
○ As a result of loss of appetite and muscle
wasting → tissue wasting → thin patient and
severe whitlows, severe deb.
○ Loss of appetite
○ Anorexia is a sign of late stage of cancer
○ due to final outcome of unrestrained Ca cell
growth
○ Cachexia syndrome - muscle loss
○ Negative nitrogen balance → muscle wasting
○ sugar, starch - food of cancer cells
○ Edema - d/t protein depletion
○ Fresh egg whites - ngt to increase albumin
levels
○ Before mo makita ang cancer, may weight loss
4.4 ONCOLOGIC EMERGENCIES
● Clinical emergencies in which the condition is secondary
to malignancy or its treatment
● Potentially intermediate catastrophic consequences in
the absence of successful intervention
● *Secondary to malignancy or its treatment
● It could be complications of chemotherapy, biotherapy
etc.
● As nurses during oncologic emergencies → take care of
patient facing death
4.5 TWO DIVISIONS IN ONCOLOGIC EMERGENCIES
(ONCOLOGY NURSING SOCIETY (ONS) CORE
CURRICULUM FOR ONCOLOGY NURSING)
● Structural - [@] paglumalaki sya may possible
obstruction na
○ Cardiac tamponade
○ Increased ICP
■ [@] once it is compressed
○ Spinal cord compression (SCC)
■ [@] From lung cancer and others that are
near to the spinal cord
○ Superior vena cava syndrome
■ [@] Because of possible obstruction
caused by tumor
● Metabolic
○ Disseminated intravascular coagulation
○ Hypercalcemia
○ Hypersensitivity reaction (anaphylaxis)
■ *Hypersensitivity reaction → septic shock
/anaphylactic shock
○ Sepsis
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○ Syndrome of inappropriate antidiuretic
hormone secretion (SIADH)
○ Tumor lysis syndrome (TLS)
4.5.1 REASONS FOR CRITICAL CARE INTERVENTIONS
● New hope for cure or long term remission
○ [@] if the px is responding to the treatment
● Increased ability to treat certain complications
○ *Difficult to treat especially if it is really an
infection
● Consumer demands
○ *Sometimes it is a combination
○ Depends on the stage. They are spending
research for the discovery of cure
4.5.2 CONCEPTS WHEN CARING FOR CANCER
● Identification of patients at risk for developing oncologic
complication
○ [@] Nurses should be knowledgeable enough; ability
of the family to care for the patient
○ *As nurses you were able to assess if the px needs
prevention in progressing to complications
● Involvement of the family and significant others
○ [@] important for the recovery of the patient
○ [@] Nagbiibilin na sila, ayaw na nila ng may gagawin
pa sakanila kaya papapirma ng DNR
○ *They are the ones to decide what is appropriate to
the client, esp. In advanced cancer, it is difficult to
accept
○ Start of grieving process
○ Decision making/advance directives
4.6 STRUCTURAL
4.6.1 CARDIAC TAMPONADE (NEOPLASTIC)
● Compression of cardiac muscle by pathologic fluid
accumulation under pressure within the pericardial sac
(normally we have 50mL of fluid in our pericardial sac to
act as a lubricant)
● *Normally we have fluid as lubricant in the pericardial
sac
● If more fluid → Cardiac tamponade
● SIGNS & SYMPTOMS
○ Cardiogenic shock
○ Tachycardia
○ Tachypnea
○ Cyanosis
○ Anxiety
○ Restlessness
○ Impaired Consciousness
● INTERVENTIONS
○ Start O2 and alert respiratory support as
needed
■ [@] start oxygen via mask as
ordered; patient may have to be
hooked to a mechanical ventilator
■ *d/t decreased oxygenation in the
brain
○ Insert IV cath if one is not already in place
■ *d/t hypovolemic shock
 ○ Monitor vital signs and initiate
hemodynamic monitoring
○ Prepare vasopressor drugs as ordered
○ Bring crash cart to bedside
○ Set up for and assist physician with
pericardial tap
■ [@] for removal of excess fluids
■ *pericardiocentesis
○ Reassure client
■ [@] feeling of impending doom
from the patient/family
● MANAGEMENT
○ Removal of pericardial fluid
(Pericardiocentesis)
○ Corticosteroids (Prednisone) & Diuretics
(Furosemide)
○ Radiation pericarditis
○ Vasoactive drugs
○ Radiation & chemotherapy
■ [@] advised only when the patient
is stable
● *
● Make sure that there is enough medications and
materials needed esp. incase na mag intubate
● Consider the quality of life of the patient after
reviving
● May inflammation → corticosteroid
● Radiation therapy and chemo → the healing process
should set in first esp after resuscitation before any
therapy
4.6.2 INCREASED ICP
● Intracranial hypertension
○ [@] Manifestations: elevated BP and severe
pain (due to compression of nerves) ->
advanced cancer sometimes nagkakaroon ng
hydrocephalus widened pulse pressure and
severe headache (HA)
○ *Increased ICP → hydrocephalus → widened
pulse pressure, severe headache
● MANAGEMENT
○ Corticosteroids - *inflammation
○ Osmotic Diuretics (Mannitol) -*drain/decrease
fluid in brain
○ Anticonvulsants (Phenytoin)
○ Mechanical Hyperventilation
● [@] px is intubated
○ Radiation & Chemotherapy - *once the px
becomes stable
4.6.2 SPINAL CORD COMPRESSION
● Associated with pressure from expanding tumors of the
breast, lung or prostate. Tumor directly enters the spinal
cord or when the vertebrae collapse from tumor
degradation of the bone. PATS disease (extrapulmonary
AED that will grow in the vertebral column) vs. Tumor
(cancer is spinal): comprehensive assessment is very
important kasi they are similar
● *Advance cancer that metastasized sa adjacent area
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● *Potts’s disease → comprehensive assessment is very
important, alamin ang root cause and similar with tumor
of the vertebral column
● *Similar management with spinal cord
● SIGNS & SYMPTOMS
○ Progressive back and leg pain
○ Numbness, paresthesias and coldness
○ Weakness and paralysis (sacral and down to
lumbar -> neurological condition causing lower
extremities to be paralyzed or weak)
○ *Neurodeficit- Is the affected part is your thorax
you have your vertebral column → down below
from your lumbar area to sacral area is being
affected d/t spinal cord compression from
tumor → neuro deficit
● NURSING INTERVENTIONS
○ Neurologic checks every shift with client with
advanced cancers of the breast, lung, prostate or
lymphoma
● [@] check for paresthesia
○ Thorough assessment of all complaints of back
pain or sensory changes
○ Notification of physician if spinal cord
compression is suspected and preparation for
MRI
○ Administration of corticosteroids
(dexamethasone) to reduce edema and protect
function of spinal cord
○ *Check for paresthesia, pallor, (5 P )
● MANAGEMENT(PALLIATIVE)
○ High dose of corticosteroids (to reduce
swelling around the spinal cord & relieve
symptoms
■ *Relieve symptom temporarily bc
cancer cells have unregulated
growth
○ High dose radiation - reduce size of tumor
if the patient is still able to tolerate (maybe
along with chemotherapy)
■ *depends on the quality of life
after surgical intervention
○ Surgery - remove tumor, rearrange bony
tissue (only if tumor is in primary stage)
○ External back or neck braces
○ Radiation & chemotherapy
■ [@] depends on the client’s
response
■ [@] for pain relief or management
as well
○ *Braces - to lessen fatigue
4.6.2 SUPERIOR VENA CAVA SYNDROME
● SVC is compressed by mediastinal tumor or adjacent
thoracic tumors
● Painful & life threatening emergency
● Late stage manifestation of cancer
● SIGNS & SYMPTOMS
○ Facial and arm edema
 ○Pleural effusion Figure No. __ “Disseminated Intravascular Coagulation (DIC)
■ *obstruction in lymphatic system ● Treatment
○ Tracheal edema: respiratory distress ○ Heparin (early phase)
○ Dyspnea and cyanosis ○ Cryoprecipitate clotting factors
○ Altered consciousness and neuro deficit
■ *once not treated immediately → 4.7.2 HYPERCALCEMIA
death ● Excessive ectopic production of parathyroid
● EMERGENCY MEASURES hormone associated with cancers of the Breast,
○ Provide O2 support and prepare for lung etc.
tracheostomy ● Release of calcium into the bloodstream
■ [@] since it is already edematous, ● Normal: 9-11 mg/dL
nasal cannula may not be effective ● SIGNS AND SYMPTOMS
■ *bc of edema ○ Fatigue
■ *Creation of PEG Percutaneous ○ Anorexia
Endoscopic Gastrostomy ○ Nausea
■ *Behavioral tool - pain ○ Polyuria and constipation
assessment ○ Muscle weakness
■ *Refer to heart center ○ Lethargy
○ Monitor vital signs and pain assessment ○ Apathy
(behavioral tool) ○ Diminished reflexes
○ Administer corticosteroids ● MEDICAL MANAGEMENT
(dexamethasone) ○ Oral hydration: decrease calcium level and
○ If the disorder is due to clot, administer anti relieve symptoms (increase fluids orally
fibrinolytic or anticoagulant drugs and intravenously rehydrate the patient and
○ Provide safe environment, including dilute the urine, which prevents super
seizure precautions saturation with calcium ions). Large
■ [@] seizures are due to possible volumes of isotonic saline restore plasma
metastasis to the brain volume and promote urinary calcium
■ [@] Make sure the room is dim; excretion through sodium diuresis.
calm and noise free environment Calcium loss follows sodium loss.
● MANAGEMENT SVCS ○ Medications (oral glucocorticoids,
○ High dose of radiation calcitonin): lower calcium level
○ Stenting in the vena cava ○ If with renal impairment: dialysis
○ Angioplasty (keep stent open for a longer
period)
4.7.3 SEPSIS
○ Surgery (rare) -may induce increase
intrathoracic pressure during closure of ● Organisms enter the bloodstream
chest ● White blood cells are low and immune response is
○ [@] if there is pleural effusion, expect impaired
patient is connected to a chest tube ● [@] 2 phases:
thoracostomy (CTT) ● [@] the higher metabolic rate, the more water is
used up
● [@] 2nd phase (cold shock)
4.7 METABOLIC
○ [@] Cold, clammy skin, cyanosis -
compensatory mechanism
4.7.1 DISSEMINATED INTRAVASCULAR COAGULATION ● Most common entry: GUI
● Problem with clotting process ● Give fluid resuscitation, albumin drip, hook to
● Release of thrombin and thromboplastin from mechanical ventilator
cancer cells or by blood transfusions ● * Hematogenesis spread
● MANAGEMENT:
○ Strict aseptic technique
■ *automatic reverse isolation
○ IV antibiotic therapy
■ [@] end of life na, if di na inaccept ng
px
■ *commonly broad spectrum
■ If not responsive → end of life

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4.7.4 SYNDROME OR INAPPROPRIATE ANTIDIURETIC
HORMONE (SIADH)
● *Fluid that is over diluted → hyponatremia
● Cancer that stimulates the release of ADH
● Usually seen in brain cancers
● MANAGEMENT:
○ Fluid retention, fluid limitation not more
than 1L per day
○ Increase sodium intake
■ [@] need sodium to attract the
fluid
■ *chips
○ Demeclocycline: works in opposition with
ADH
○ Eliminate underlying cause
■ [@] Brain cancer
■ *If underlying cause is brain
cancer → remove the tumor in
brain
4.7.5 TUMOR LYSIS SYNDROME
● Large number of tumor cells are destroyed rapidly
● Intracellular contents of potassium and proteins are
then released into the bloodstream causing
complications.
● *During the treatment phase d/t damaged tumor
● *May lead to Gouty arthritis
● MANAGEMENT:
○ Hydration (3000mL - 5000mL)
■ [@] To flush out fluid inside the
body
■ [@] Urinary elimination
○ Fluids (Sodium bicarbonate) helps
with
○ Uric acid precipitation (lower Uric acid
preventing gout or AKI)
● MEDICAL MANAGEMENT:
○ Antiemetic regimen (nausea, hypovolemic
shock)
○ Diuretics (osmotic)- furosemide
■ *can be furosemide → be careful
because it may cause
hypovolemic shock while patient
is palpatory prior to administration
○ Allopurinol: increase excretion of purines
■ [@] di na masyadong
pineprescribe
■ *di na pineprescribe;
hyperuricemia
○ Sodium polystyrene sulfonate: reduce
serum potassium level - because if it is
increased it will warm your heart
○ Dialysis - treatment choice
■ [@] To decrease potassium level
(kidney failure)
5. PALLIATIVE CARE
● Is one response to the inadequacies in the
prevention and relief of symptoms and distress in
persons approaching death
○ Provides relief from pain and other
distressing symptoms
○ Affirm life regards dying as a normal
process
○ Intends neither to hasten nor to postpone
death
○ Integrates the psychological and spiritual
aspects of patients' care.
○ Offers a support system to help family
cope during the patient’s illness and in their
own bereavement.
○ Uses a team approach to address the
needs of patient and their families,
including bereavement counselling
○ Will enhance quality of life and may also
positively influence the course of illness
○ Knowledge and skill in providing physical
and emotional comfort to dying patients
and their families.
○ [@] Presence: dying px doesn't want to be
alone, the more you are needed
● *Advanced cancer is related to palliation →
psychological effect to the family and patient →
extreme anxiety/ fear like a death sentence → with
several what IF questions
● Actually totoo ito, it is not only the patient undergoing
the grieving process, the family also it is difficult to
them. It differs pag nasa stage ka na ng grieving
process. Di mo alam ang anger mo, bakit aq baket nde
sila
● DABDA
○ Denial
○ Anger
○ Bargaining
○ Depression
○ Acceptance
● Quality of time - tend to have an informal education,
seminars, join social activities
● Emotional comfort - it takes time for us nurses to
develop to give emotional support to the dying patients
○ Hospice care is viewed as part of the
for palliative care continuum - temporary
shelter for cancer patients
■ *Complete package - composed of
team that have expertise for
caring for patient with advanced
cancer but entails demand for
large amount of money
6. HOSPICE CARE
● Vision: Patient centered care provided by an
interdisciplinary team that used the best medical
and nursing science to address physical,
psychosocial, emotional, and spiritual comfort.
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 ● Principles: patient-centered, holistic care provided
by interdisciplinary team
6.1 HOSPICE CARE TEAM
● Nurse care manager
● Physician
● Anesthesiologist/pharmacist
● An infusion therapist
● Social worker
● Physical therapist
● Home health aid and volunteers
6.2 BARRIERS THAT INTERFERE WITH INITIAL AND
TIMELY REFERRALS
● *Prognosis also depends on how we accept positive
reinforcement and support
● Discomfort in discussing end-of-life care issues
● Difficulty in determining Prognosis 6 months or less
● Lack of information or misinformation about
hospice or by patients, family members and health
care providers
● Real or perceived requirement to discontinue life
prolonging therapies in order to receive hospice
services
7. PSYCHOSOCIAL ASPECT OF CARE
7.1 FOCUS OF CARE
● The unique needs of individual at risk for or with
cancer
● The social group affected by that individual based
on their experiences
● Psychosocial variables as a risk factor in
carcinogenesis especially the role of the immune
and endocrine system as mechanism of causation
● [@] Immune system, homeostasis affected = mood
swings (internal and external)
● Ways of maximizing self-actualization and
minimizing psychosocial distress to cancer patient
● *During your diagnosis, you have your anxiety, fear,
emotions
● Deeper assessment
● Home and environment
● Home - family; basic unit of society
○ Environment - ADLs; social life
● If you’re not able to assess deeper, you won’t be able
to X
● *Endocrine
○ Behavior of the patient becomes affected
→ irritation → mood swings
7.2 CANCER AS THREAT
● *Depends if you are in the province, you are single,
breadwinner, lifestyle, holding a position, regular
employee, possible resignation
1. Risk vary with age, geographical location,and
lifestyle
○ The uniqueness of its meaning to the individual
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■ *Is it positive or negative, is it a challenge
na mag struggle or the family’s relationship
becomes closer or it could be cancer is the
cause of the separation
■ There will come a time na mapapagod ang
family member → fatigue
○ Cancer’s chronic nature (where are you located)
○ Cancer’s effect on the individual sense of
identity
○ Cancer's effect on the entire social system of
the person involved to the individual
2. Fear: (acceptance)
○ Dying
○ Changes in body integrity and comfort
○ Changes in self concept and disruption of
future plans
○ Inability to maintain emotional equilibrium
○ Lack of fulfillment of social roles and activities
○ Inability to adapt to new physical and social
environments
○ [@] interpersonal relationships with family
and friends.
Disease and treatment are marked by uncertainty
3. Inability to determine the meaning of illness -
related events
○ It is not inherent in the situation but is a
perception of the individual influenced by:
○ Complexity - different types of treatment
modalities and succeeding follow ups
○ Treatment is complex - clear sa patient and
treatment plan, find solutions by researching
A. Ambiguity concerning the state of illness
■ The complexity of the treatment and the
system of care
■ Information held about the diagnosis and
seriousness
■ Predictability of the course and prognosis
7.3 CANCER IS A CHRONIC ILLNESS
1. Simple crisis resolution model
○ Deals with a continuing series of stressors
rather than a single, time limited crisis
■ [@] Dapat may mutual understanding and
clear instructions to reduce conflicts.
○ Treatment is complex, often extended and may
cause irreparable damage to physical, mental
and social functioning
■ [@] Not only to the patient, include the
significant others of the patient.
■ Clear ang treatment plan
2. Stress management theory
○ Denial maybe adaptive initially may later
interfere with adaptive behavior
3. Vulnerable to psychosocial distress are likely
○ Have been unsuccessful in resolving past
stress situation
○ Are dealing with a number of stressors
simultaneously
○ Perceive minimal support in the situation
7.4. SEARCH FOR PSYCHOLOGICAL RESOURCES
7.4.1 SELF APPRAISAL EXTEND TO SIGNIFICANT OTHERS
AND ULTIMATELY TO HEALTHCARE PROFESSIONALS
● [@] Evaluate the feelings of the patient and the
family
● *Self appraisal - evaluate our self, our needs
● Goal:
○ Fostering individual control
○ Anticipatory socialization
■ [@] Hindi porket may cancer ka na,
limited ka na to socialization.
○ Early discharge and rehabilitative planning
○ *Changes in self concept, the behavior of
the family, if they don't support your
decision
7.4.2 FOSTER THE COPING RESPONSES OF PATIENTS
● Emotion focused
● Active Listening
■ [@] Builds trust
● Play and music therapy or humor
● Providing individual or group testing
and counselling
● *Active listening - interested to know
their concerns
● Play music - uplifts emotion
● Problem - solving focused.
■ [@] Help them solve their problem.
● Giving information
■ [@] Patient needs assurance and
reassurance.
● Anticipatory and group teaching
● Identifying resource information and
personnel
● Referring for more specialized or
intensive therapy
● [@] Counselors, psychiatric
*At an early stage - needs counselling and therapy para yung
coping responses ay in a positive way, marevert kung paano
maaccept
7.5 THE FAMILY
● Family routines, relationships and communication
patterns is threatened
● Family members are challenged to learn new roles,
self care skills and ways of relating to each other
and others outside the family.
● Life becomes more complex as demands on the
family increase
7.5.1 INSTRUMENTS TO EVALUATE THE FAMILY
● Family APGAR (Adaptability, Partnership, Growth,
Affection, and Resolve)
○ Commitment for the members to nurture
each other (participation in the process,
adaptation, and how to resolve problems)
○ It does not assume the structural
institutional, cultural boundaries
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○ *Participation and adaptation to the family
process and how are you going to resolve
the problem
○ Assess adaptability and relationship
● Family Functioning Index (FFI)
○ Questions assess of marital satisfaction,
frequency of disagreement,
communication, problem solving and
feeling of happiness and closeness
○ Validity and reliability estimates appear to
be high
○ [@] Better than APGAR
7.5.2 RESPONSES OF FAMILY TO PHASES OF THE
CANCER EXPERIENCE
● Anxiety, depression, hopelessness and altered
sexual health
○ [@] Concern of cancer patients during their
productivity.
● In General:
○ Shock, uncertainty, accommodation,
immersion and awareness (lovejoy)
○ Compared psychological responses with
cancer and their next kin (Cassileth)
■ Patient and next kin scores on three
outcome measures correlated significantly
■ Scores for both groups indicated a
decrease in psychological status related to
the phase of cancer experience.
7.5.3 NURSING DIAGNOSIS (NANDA)
● Alteration in Family Processes
● Ineffective Family Coping: Compromised
● Family Coping: Potential Growth
7.5.4 FUTURE DIRECTIONS FOR NURSING RESEARCH
● *Sometimes family processes are disrupted
because of cancer and might be the result of
financial problems, support, etc.
● Several issues relating to family responses to a
diagnosis of cancer require further study or
development
○ The effects of the interaction of individual
responses within the context of the family unit.
○ The need for reliable and valid screening
instruments for use with families facing cancer
○ The delineation of critical defining
characteristics that predispose the family to
dysfunctional responses.
● Multiple services and programs designed to meet a
spectrum of family needs are needed, and the
effectiveness of these services and programs must
be evaluated
● [@] Refer to counsellors available in the area; further
health education for screening methods
● [@] As a nurse practitioner we are responsible in
providing awareness
8. ISSUES IN SURVIVORSHIP REFERENCES
● APA citation guide. (2016).
8.1 SURVIVORSHIP http://www.bibme.org/citation-guide/apa/
● Defined as “cured” ● Lipson, C. (2011). Cite right: A quick guide to citation
● Survivorship is more accurately based on control styles – MLA, APA, Chicago, the sciences, professions,
rather than cure due to: and more (2nd ed). United States of America: The
○ Cancer consists of many different diseases University of Chicago Press, Ltd., London.
(how it is started?; different comorbidities) ● Ferraro, A. (Photographer). (2014). Liberty enlightening
○ Some cancers are cured once the cancer is the world [digital image]. Retrieved from
physically removed. https://www.flickr.com/photos/afer92/
● Medically cured until 5 - year mark (absence of 14278571753/in/set-7215764461703061
manifestations)
● *Survivor ADHARA 2023
○ Meet the physiological needs as well This template was inspired and based on UERM College of Medicine
2023B’s Trans-Notes Template and was modified by Trisha Palmaria
8.1.1 CANCER SURVIVOR PARADIGM and the ADHARA Trans-Notes Committee. Please do not remove this to
give credit for their efforts and ideas.
● A cancer Survival Paradigm
○ Basic Survival (food, shelter, medical care)
○ Physical self - concept (attractiveness,
fitness and physical function)
○ Psychologic self-concept (self respect,
integrity and autonomy)
○ Proximal affiliation (intimate relationship)
○ Distal affiliation (social relationship)
○ Avocation (recreation, play)

8.2.1 SURVIVORSHIP AS CONTINUUM

● Continual, ongoing process
● Survival stages
○ Acute survival stage - social support is critical
○ Extended survival stage - altered body image or
vocational changes
○ Permanent survival stage most frequently
associated with “cure” - economic problem
often surface at this stage

9. PSYCHOSOCIAL THEMES
● The major psychosocial themes that can be
anticipated in significant cohorts of adults surviving
cancer are:
○ Interrelationships between psychologic, long-
term effects and psychosocial outcomes
○ Fears of relapse and death
○ Survivor of guilt
○ Uncertain sense of longevity
○ Social adaptation dilemmas
○ Contagious effect the family as survivor

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