Review| Oncology

COLLEGE OF NURSING – | BATCH 2022 🔥

important 💗 test taking skill
July 22, 2022 - 111 days until boards

ONCOLOGY Malignant tumor→ harmful → MUST BE REMOVED

Terms ● Rapid growth
• Cancer – number 1 killer ● With metastasis
• Neoplasm – new tissue growth ● Unencapsulated
• Mitosis – cell division ● Invasive
• Metastasis – spread of cancer cells in the body
• Benign – (-oma) CAUTIONS/warning signs
• Malignant – (-carcinoma) ● Change in bowel and bladder habits
• Stable cells – growth in # prn ● A sore that doesn't heal
• Labile cells – growth in # is continuous ● Unusual bleeding
• Differentiation - specialization ● Thickening of lump in breast or elsewhere
• Risk factor – increases the odds ● Indigestion
● Obvious change in warts or mole
Normal cells ● Nagging coughing cough or hoarseness
● Have one nucleus ● Unexplained anemia
● Mitosis (metastasis- cancer cells) ● Sudden weight loss
● Have APOPTOSIS
● Have contact inhibition Staging
● With function ● Numeral
● TNM
● Ann-Arbor (process is asked, specifically for
HODGEKINS)

Numerical
● Stage 1 - limited local
● Stage 2 - limited regional
- Cells→tissues→ organ ● Stage 3 - extensive local and regional
- ● Stage 4 - distant metastasis

TNM
● Tumor (size in cm)
● Nodes (number of lymph nodes)
● Metastasis (with or without)
Tumor
● T0- no tumor
● Tx- tumor cannot be identified
● Tis- in situ (inactive, malignant but acts benign)
Abnormal cells→abnormal tissues→tumor ● T1- <2 cm
Benign tumor→ harmless→ can become malignant ● T2- <5 cm
● Slow growth ● T3- >5 cm
● Without metastasis ● T4- >5 cm (with metastasis)
● Encapsulated (stays in organ)
● noninvasive

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Nodes ● It is all invasive!
● N0- no lymph nodes ● Needs consent
● Nx- cant be identified ● Uses either sedation or anesthesia
● N1- <4
● N2- >4 PAIN
● Cancer is painful! Most painful cancer is
BONE 🔥
● C - compression of nerves
● O - obstruction of organs
● D - destruction of bone
● Use relaxation with guided imagery
● Massage!! Around tumor to promote circulation
but not on the tumor
● Warm/cold compress
● Medication
● Nursing intervention for edema is raising Mild pain Severe pain
extremities (so fluid can flow back to heart)
○ Dont massage it tylenol Codeine

NSAIDS Morphine
Metastasis
● M0 - no metastasis (t0n0m0 is best)
CURE .
● Mx - cannot be identified
Does cancer have a CURE? YES
● M1 - with metastasis
● C - Chemotherapy
● U - upera
Ann-Arbor (cancer of lymph nodes)
● R - radiation
● Stage 1 - 1 Lymph Node
● E - Emotional support
● Stage 2 - 2/more LN, 1 side (either top or
○ Prevent free radicals by consuming
bottom)
antioxidants (like blueberries!)
● Stage 3 - 2/more LN, both sides (both top and
bottom) CHEMO Radiation
● Stage 4 - extralymphatic
Antineoplastics High energy waves
Diagnostics Spreads throughout Localized
● Biopsy- confirmatory!
● CXR (for lung cancer) Internal (more common) Internal (via oral, known
● Mammography (for breast cancer) as BRACHYTHERAPY)
● Pap smear (for cervical cancer)
External (via topical) External (more common)

Biopsy Only 3-6 months Give as ordered

● Aspiration - needle
○ Less invasive Both hazardous!
● Incision - removed tissue samples
● Excision - whole mass removed
○ (can be curative)

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Chemotherapy uric acid excreted in urine. Chemotherapy
● Kills cancer cells attacking normal cells leads to increased uric
● Lacks specificity acid secretion: administer ALLOPURINOL
● More likely to kill cancer cells than normal cells ● Monitor platelet count
● Attracted to rapidly dividing cells ○ Normal: 150k-450k
● Side effects ○ <50k has bleeding tendencies
○ Nausea and vomiting MOST COMMON (bruising)
○ Alopecia ○ <20k bleeds spontaneously (stomach
○ Neutropenia (immunocompromised) acid can create ulcers)
○ Diarrhea
○ Anemia Observation
● Of alopecia: risk of altered body image.
Nursing considerations (CHEMO) Address with a wig, or Inform the patient that
● Caring hair loss is a temporary phenomenon and the
● Handling hair will grow back after chemotherapy (give
● Education wig and makeup BEFORE chemo)
● Monitoring ● Phlebitis (blood vessels– change access of IV
● Observation as intervention)

Caring Radiation therapy

● For nausea and vomiting, administer ● Reduce the size of tumor
antiemetics before chemotherapy (serves as ● Internal - brachytherapy
prophylaxis) ● External - teletherapy
● For diarrhea - administer intravenous fluids to ● Side effects:
replace fluid loss ○ Fatigue, MOST COMMON
○ Alopecia
Handling ○ Skin changes (like getting sunburnt)
● Ppe: googles, mask, gown. gloves ○ Taste alterations (affects taste buds)
● Chemotherapy easily passes through skin:
never be administered by a pregnant nurse Internal radiation
● Never prepare chemotherapy above the ● A source of radiation
shoulders ● Do not go near pregnant– RADIOACTIVE
● Dispose in hazardous containers ● Stay 6 ft away from pt
● Sealed: solid form, cesium/iridium (place
Education source of radiation into the colon)
● Avoid large crowds because the patient is ○ Patient is radioactive but excreta are
immunocompromised not
● Avoid fiber in the diet because risk of enteritis ● Unsealed: liquid form, via IV/oral route
and also not to worsen diarrhea ○ Both patient and excreta (pee/poo) are
radioactive
Monitoring ○ Pt must flush 3 times
● Uric acid levels– chemotherapy lacks
specificity and can attack normal cells.
Damaged cells release purine which turns to

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External radiation ● Interferons slow down tumor growth, similar to
● Not a source of radiation radiation
● Can be visited by a pregnant woman ● Monoclonal antibodies (antibodies that attack
cancer cells)
Nursing Considerations
Internal: ONCOLOGY DISORDERS
● Provide private room 1. Testicular cancer
● Place caution on door 2. Prostate cancer
● Wear a dosimeter film 3. Cervical cancer
● Wear lead shield before entering room 4. Breast cancer
● 1 nurse : 1 patient 5. Lung cancer
● Limit exposure to 30 minutes 6. Laryngeal cancer
● No pregnant nurse 7. Gastric cancer
External: 8. Colon cancer
● Avoid exposure to sunlight 9. Bladder cancer
● Avoid restrictive clothes 10. Multiple myeloma
● Wash area with lukewarm water 11. Leukemia
● Dry with patting, not rubbing motion 12. Hodgkins

Medications Testicular Cancer

● Hormonal meds (hormone sensitive tumors)
● Vinca alkaloids (antimitosis)
● Alkylating agents (DNA replication antagonist)
● Immunomodulator (immune manipulation)

Hormonal medications (TAD)

● Tamoxifen (most common in boards)
● Arimidex ●
Can render cancer patient sterile– decreases
● Diethylstilbestrol testosterone and sperm cells (both produced
by testes)
Vinca Alkaloids (antimitosis) Risk factors
● Velban ● Age 15 to 40 yr/o
● Oncovin (most common) ● Undescended testicles (cryptorchidism)
● Navelbine Manifestation
● Painless testicular mass
Alkylating Agents ● Irregularities in Testicular examination
● Altretamine ○ Perform anytime once every month
● Busulfan (most common as example) after a shower
● Oxaliplatin ○ Why? To avoid “pulling mechanism”
(cold testicles pull closer to body)
Immunomodulators When warm, the testicles move away
● Interleukins (1 and 2) 2 more common from body which is the best time for
○ Modified immune system to destroy TSE
cancer cells, similar to chemo

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 ● Because there is a timor in testes, they will feel ○ Cushngs triad of ICP: hypertension,
a heavy pull bradycardia, bradypnea (risk of shock)
● Late sign: there is back or bone pain
● Gynecomastia (low testosterone thus high
estrogen)
Management
● Pain management
● Chemotherapy
● Radiation
● Surgery: orchiectomy (uni or bilateral) Cervical cancer
○ Avoid lifting heavy objects to avoid ● Tumor in the cervix which can cause pressure
hernia to other organs
Risk factors:
Prostate cancer ● Human papilloma virus: can transfer sexually
Risk factors ● Multiple sex partners (hpv transfers)
● Age more than 50 ● Early intercourse age 16 and below
y/o ● Smoking (universal risk factor for cancer)
● STDs Manifestations
● Heavy metal ● Painless vaginal bleeding
exposure ● Painless vainal discharge
Manifestations ● Fistula– leakage of feces and urine into the
● Irregularities in vaginal canal
digital rectal exam ● Pain in the lumbar, legs, or pelvic
● Painless post coital bleeding Management
● Positive prostate specific antigen: PSA ● Chemotherapy
● + DRE (digital rectal examination)= any lumps, ● Radiation therapy
highly suggestive of prostate cancer ● Surgery: hysterectomy (TAHBSO- total
○ Positive confirmative diagnosis: biopsy abdominal hysterectomy bilateral
● Late sign: pain in the lumbar or legs salphingoophretomy)
Management
● Pain management (mild) Breast cancer
● Chemotherapy Risk factors
● Radiation therapy ● Chest x ray
● Surgery: TURP (transurethral resection of the ● Family history
prostate) ● Nulliparity
TURP ● Early menarche
● Hematuria is normal ● Late menopause
○ If no bleeding→ risk of blood clot Manifestations:
obstructing the urethra ● Painless breast mass
● CBI - continuous bladder irrigation to ensure all ● Irregularities in breast self examination– during
has been removed a shower in front of the mirror raising arm 7-10
● Hyponatremia (due to being diluted) days after menses once a month (any way,
● WOF cerebral edema!! inner to outer or outer to inner)
● WOF: increased ICP ● Higher brest is the affected

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 ● Peau d’orange Management:
● Common sites: Upper outer, Axillae, & Below ● Oxygenation as ordered
nipple ● High fowler's position (to maximize lung
● Common in females but worse in males expansion/lung compliance)
because cancer cells are invasive– aka ● Bronchodilators as ordered–AIRWAY priority
outside the mammary duct ● Chemotherapy
● Surgery:
Management: ○ Lobectomy- 1 lobe
● Position patient in semi fowlers ○ Pneumonectomy- whole lung
● Chemotherapy Post op:
● Radiation therapy
● Administer tamoxifen as ordered
● Surgery:
○ Lumpectomy
○ Mastectomy (lump and breast tissue)
○ MRM– modified radical mastectomy
(Lump + Breast tissue + axillary lymph
nodes + nipple)
● Since there is trauma there could be fluid
shifting (lymph/armedema)--> management is ● WOF mediastinal shift (lung going to opposite
to elevate upper side due to pressure) leading to Tracheal
extremity deviation!! Chest tube thoracostomy (CTT) is
contraindicated because water wants to go
Lung cancer inside
Risk factors ● Positive pressure in the affected chest is the
● Chest x ray desired outcome!!!!!!
● Radon: colorless, ● Let patient lie down on affected side (so fluid
odorless, gaseous wont go there)
chemical that can
be inhaled– is Laryngeal Cancer
found in soil Risk factors
○ Miners are at risk ● Smoking
Manifestations: ● Alcohol
● Wheezes (lower airway obstruction) ● Pollutants
● Dyspnea ● Radiation
● Cough Manifestations
● Hemoptysis ● Feeling of lump in
● Fever throat
● Weakness and fatigue (patient has difficulty in ● Difficulty swallowing
breathing) /pain
● Shortness of breath ● Weight loss (due to pain eating)
● Pulmonary edema (due to semi permeable ● Dyspnea due to airway obstruction
blood vessels ● Cough to compensate for bulk in throat
● Hemoptysis– blood when coughing

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Management Carcinogens
● Aspiration precaution (no, 1 priority is airway!!) ● Overcooked food (burnt) - benzopyrene, a
○ Feeding in upright/high fowler's chemical that can cause cancer
position) ● Preservatives (canned foods like spam,
● High fowlers to optimize lung compliance hotdog, etc) - Nitrosamine, a chemical
● O2 as ordered ● Peanut - aflatoxin
● Total parenteral nutrition as last resort if too Manifestations
painful to swallow ● Difficulty swallowing (food won't go down)
● Tube feeding: ● Fluids are required to pass food
○ NGT ● Heartburn
○ Gastrostomy ● Vomiting
○ Jejunostomy ○ Pyloric sphincter is obstructed and food
● Surgery: laryngectomy cannot go down into the colon– it is
○ Risk for permanent tracheostomy if regurgitated
tumor is deep ● Satiety (feeling of fullness) if there are so many
○ Cordal stripping if superficial tumor– tumors in the stomach taking up space
removing strip of larynx that has cancer ● Melena (hematomesis) - bleeding tumor due to
Post op: HCL dissolving it–blood in stool
● Total laryngectomy– tracheostomy is PAIN
permanent ● initially , generalized abdominal pain
● Assess gag and cough reflexes– laryngeal ● Later on, pain focused in middle of abdomen
nerve intact if present Management
● High fowler's position ● Avoid alcohol
● Mechanical ventilator as ordered ● Avoid carcinogens
● WOF: hemorrhage ● Avoid smoking
● Maintain surgical drains in the incision site ● Small frequent feeding
● Refer to speech therapist ● Administer antacids as ordered
● Blood transfusion as ordered
Gastric Cancer ● Chemotherapy
● Also known as stomach ● Radiation therapy
cancer Surgery:
● During swallowing, lower ● Total gastrectomy
esophageal sphincter (LES) should ● Anastomosis– lower part of esophagus to
be open and the pyloric sphincter jejunum –
should be closed to digest food (in Jejunum
GERD the LES doesn't close) become center
● The stomach takes 2-4 for absorbing
hours for food to become chyme nutrients
Risk factors
● Spicy foods
● Highly seasoned foods
● Smoking
● Alcohol
● Carcinogens

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 ● Billroth I (gastroduodenostomy)
● Billroth II (gastrojejunostomy
● Duodenum must stay because it is connected
to the liver/pancreas etc.
Post op
● NPO 1-3 days depending on peristalsis
(FARTING)
● Advance from NPO to sips of water
○ Then soft diet or liquid diet
● Monitor for electrolyte imbalances (due to
prolonged NPO)
● Administer IVF and electrolytes as ordered
● Administer TPN as ordered
Dumping syndrome
● WOF dumping syndrome– increased gastric
motility, food being dumped rapidly into
alimentary tract
○ Increased peristalsis!
○ Hyperactive bowel sounds
○ Diarrhea
○ Abdominal cramping
○ Palpitations
○ Diaphoresis
● GOAL: delay gastric emptying
○ Give low fiber/low residue diet
○ Don't give fluid with meals/fluid PC
(post cibum/after meal)→ eat solid
foods
○ Lie flat on bed post cibum
○ Antispasmodics to delay gastric
emptying
Colon Cancer
● Purpose of the colon is to absorb water; when
there is a tumor, the colon struggles with
absorbing water. As an effect, the client will be
dehydrated and there will be diarrhea
Risk factors
● More than 50 years old
● Polyps (colon cell growth)
● Family history
● Irritable bowel disease aka IBD (chrons
disease or ulcerative colitis)
Manifestations
● Blood in the stools
● Anemia (due to heavy bleeding)
● Weight loss
● Vomiting - if the tumor obstructs the cecum
100%, you will VOMIT fecal matter since the
fecal matter just can't pass through the colon
(ewwwwww)
● Ascending colon - explosive diarrhea
● Descending colon - ribbonlike stool
Management
● WOF peritonitis (due to perforation)
● WOF perforation
● WOF intestinal obstruction (vomiting fecal
matter)
● Chemotherapy
● Radiation therapy
Surgery: bowel resection with colostomy
● Petroleum jelly gauze to cover stoma
● WOF bleeding → result of procedure
● Note COLOR of stoma, usually pinkish or red
and MOIST!!
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 ● WOF pouch leakage – smelly patient, as Multiple Myeloma
though poop ● Cancer of the plasma, rapid production of
● Ascending Colostomy- liquid stool hematopoietic stem cells (found in bones)
● Transcending colon - semiformed stool ● Hematopoietic stem cells produce rbc, wbc,
● Descending colon - solid fecal matter platelets
○ As a result of cancer, these decrease
Bladder Cancer ● Plasma: produces immunoglobulin
● The bladder holds Risk factors
urine produced by ● Age 60+
kidney ● Radiation exposure
Risk factors ● Chemical exposure
● Smoking Manifestations:
● Chemical exposure ● Decreased RBC, WBC, and platelets
● Radiation ● Bones will release uric acid due to loss
Manifestations
● Urgency
● Frequency
● Dysuria
● Painless hematuria (most common
manifestation– the TUMOR is bleeding)
● Obstruction (clot induced)
Management
● Chemotherapy
● Radiation therapy
Surgery: cystectomy (removal of bladder)
● Bones become brittle because calcium leaves
● Can catheterize AS ORDERED
bone, there will be hypercalcemia in the blood
● conduit – from the ileal or blend with colon
serum
called:
● Bence jones protein also leaves the bone,
○ COLON CONDUIT
leading to kidney stones
○ Poop looks like chicken poo
● Risk for fractures, renal calculi, and renal
failure
Multiple Abnormal plasma Management
myoma Bone marrow to bone- decreased bone density
● Chemotherapy
hodgkins Abnor ● Radiation therapy
mal lymphocytes
Lymph nodes are reed stem berg cells– Leukemia
decreased lymph
POINTS TO
leukemia Abnormal HSC PONDER!
Bone marrow to blood- decreased blood ● Decreased
component
RBC, WBC,
All are blood cancers requiring chemo & radiation therapy platelets (more
than Multiple
myeloma)

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Manifestations Phases
● Decreased RBC leads to: ● Lymphocyte predominant: normal lymph cells,
○ Anemia but a single cancer cell
○ Paleness ● Nodular sclerosis: cancer lymphs multiply
○ Weakness and fatigue ● Mixed cellularity: Cancer lymph and normal
○ Shortness of breath lymph mix with each other
● Decreased WBC (dysfunctional WBCs) ● Lymphocyte depletion: cancer lymphs take
○ Risk for infection over, normal lymphs decrease
● Decreased platelets
○ Bleeding tendencies
○ Bruises
Infection precaution
● Aseptic technique for all procedures
● Isolate patient– reverse isolation
● Limit exposure
● AVOID: fresh fruits, veggies, flowers
● Monitor temperature
● Anticipate oral antibiotics for infections Manifestations
Bleeding Precaution ● Painless lymphadenopathy
● WOF Nadir ● Risk for infection
● AVOID - exposure to sharps ● Cough from mediastinal lymph nodes that can
○ IV fluids obstruct airway
○ IV medications ● B-symptoms– extra lymphatic
○ ASA ○ Warning sign that cancer is now at
NSAIDs stage 4!!
Fatigue ○ Fever
● Rest!! Prolonged ○ Night sweats
● Assist client with ambulation ○ Weight loss
● Schedule activities Hodgkins Non-Hodgkin's
● Packed RBCs as ordered (via IV kahit may
bleeding precautions) With reed stern berg cells Without reed stern berg
cells
Hodgkin's Disease Early detection (can be Late detection (hard to
● Cancer of the treated better) find RSB)
lymph nodes
○ Lymph Better prognosis (due to Poor prognosis
nodes early detection)
produce Bimodal age- Risk HIV burkitt's lymphoma
fluids, are 15-30/50+
part sa
immune system Tx: Chemotherapy & radiation therapy
● Reed stern-berg cells– have no function Management
● Owl’s eyes (the cell shape of cancerous ● Stage 1&2- radiation therapy
lymphocytes) ● Stage 3&4- chemotherapy and radiation

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POST TEST: ONCOLOGY (google.com) (wrong answers) 4. A patient with gastric cancer underwent
gastrojejunostomy(Billroth II). Which of the following
The nurse is instructing a client how to do a testicular
interventions is included in the patient’s post-op care?*
examination. The nurse tells the client:
a. Give patient a high fiber diet
a. To examine testicles while lying down b. Plan for TPN
b. That the best time for examination is after a shower c. Regular NGT irrigation
c. To gently feel the testicle with 1 finger to feel for a d. Instruct client to eat solid foods
growth Risk of dumping syndrome
d. That testicular self-exam is done at least every 6
months 15. The nurse is developing a plan of care for a patient
with multiple myeloma & includes which priority intervention
All of the following are warning signs of cancer except:
in the plan?*
a. Hoarseness of voice
b. Lump in the testicles a. Encouraging fluids
c. Impaired digestion b. Providing frequent oral care
d. Impaired respiratory function c. Coughing & DBE
d. Monitoring RBC count
A patient with cancer was admitted and scheduled for To flush/combat the effects of renal calculi
biopsy of the staging type. It was then confirmed that the
19. In the immediate post-op period the nurse notes a
cancer is in stage III. As a nurse, you understand that this
bloody drainage from the NGT of a patient who underwent
stage is:*
gastrectomy. Which of the following is the appropriate
a. Distant metastasis
nursing intervention?
b. Limited local spread
c. Tumor limited tissue of origin a. Irrigate the NGT
d. Extensive local and regional spread b. Continue monitoring drainage
c. Replace NGT
d. Notify the physician
10. A. patient taking chemotherapy is suffering from What is given is NORMAL so monitor lang (immediate post
op), you shouldn't irrigate it because it is a new suture line
nausea and vomiting. One of the best interventions that the
and flushing will cause pressure and loosen the new suture
nurse could give would be: line
a. Increase sodium in diet
b. Prevent complications of hyperaemia
c. Ingestion of more than the optimal amount of nutrients 24. The nurse is reviewing the history of a client with
d. Watch out for signs and symptoms of hyperkalemia bladder cancer. The nurse expects to note documentation
of which most common symptom of this type of cancer?*
13. A patient with laryngeal cancer is undergoing total
a. Dysuria
laryngectomy. As a nurse, you must plan for a
b. Hematuria
post-operative care. All of the following are included in c. Urgency of urination
post-op intervention except: d. Frequency of urination
a. maintain surgical drains in the chest
b. maintain mechanical ventilator support
c. Increase activity as tolerated
d. assess gag reflex & cough reflex

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