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Oncology
Seven Warning signs Patient with Cancer:
Cough:
C ----Change in bowel or bladder Pharyngitis Chronic Cough
A----Sore that does not heal Laryngitis Nagging Cough
U----Unusual bleeding or discharge Tonsillitis
T-----Thickening in a lump Common Cold Can be Cancer
I------Indigestion
O-----Obvious change in a wart or mole
N-----Nagging cough or nagging hoarseness Expected

Barking Cough = Croup

Hoarseness: Whooping Cough = Pertussis

Acute: Chronic:
= Low Fever/Night Sweats/ Weight
Common Cold: Cancer Loss/Cough = TB
and end up in
Laryngitis = Expected
Sore Throat:
Common Cold= Expected
If patient Had:
Penicillin Patient in Immunosuppressor/ Antipsychotics/
Dye Clozapine = Agranulocytosis= Notify Doctor
Vaccine
Bee sting
Chronic = Cancer (Oral/Larynx/Lungs)
PRIOTITY = Anaphylaxis Shock

Screening = Early Detection

1- Breast self-examination = Monthly (7 days after menstruation) post menopause woman

in any day
2- Clinical Breast Examination = 20- 39 – every /3 years (more than 40 yearly)
3- Pelvic Exam
4- Physical exam 20- 39 every 3/years
5- Mammography More than 40 yearly

6- Pap Smears: Healthy patient low risk 20 – 39 years = every 3 years more than 40 yearly
(patient high risk = yearly up to 3 pap smears negatives and the can change to every 3
years)
7- W/M = GUIAC more than 50 years old (yearly = fecal blood occult test)
False (+) = red meat/wine/ASA/Fe/Beets/Pepto Bismol
False (-) = Ascorbic Acid = Vit C
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Oncology
8- W/M more than 50 years old
Sigmoidoscopy every 5 years
Colonoscopy every 10 years
(patient with IBD, Crohn, Colitis (inflammatory Vowel Disease) or premalignant lesions =
Yearly

9- Men’s more than 50 years = Prostate

First – PSA (Prostatic Specific Antigen) = normal up to 4
Second – DRE = (abnormal = Hard fixed irregular patterns = Biopsy (is the positive
diagnosis

10- Testes Self-Exam: Most common cancer by sex:

-Monthly / During or after warm shower
-Start 12 years old
-The most common cancer (15-35 years old)
Warning Signs:
~Painless Swelling
~Fluid Accumulation in the scrotum
~Dull Ache in groin area
~Enlargement or tenderness on breast
~Hard Lump
Woman= Breast Cancer
Men = Prostate
The third Cause of cancer M/W= Colon Cancer
The deadliest cancer M/W = Lung Cancer
The most common cancer in the USA = Skin Cancer
(Basal cell carcinoma)

Oral Cancer:

Risk Factor = Smoking

Sign and Symptoms:
1-Lips
2-Oral cavity -A sore that does not heal
-Sore Throat
3-Tongue
-Pain during swallowing
4-Oral Mucosa
-Chronic /Nagging = Hoarseness
5-Pharynx

-Larynx Cancer: Abnormal Malignancy growth at the level vocal cords

Risk Factors: Sign and symptom:

-Smoking -Nagging hoarseness
-Heavy intake alcohol -Sore throat
-Difficulty to swallowing
-Burning sensation when drink hot fluids
-AAA= Anorexia = weight loss/Anemia = fatigue or
SOB/Asthenia = Tired
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Oncology
Treatment = Laryngectomy:

Partial = Remove one vocal Cord = Patient is able to speak

Total = Remove Vocal Cords = Patient is unable to speak (assist to communication) and have a
permanent stoma
(before procedure = establish communication form)
Post-Surgery:

1-Tube feeding = 7-10 days then return to swallowing

2-montitor Sign and symptoms for bleeding
3-Stoma Care

Stoma care: Types of Speech:

1-Avoid = Water/Spray/Aerosol 1-Esophageal speech:
2- wear high collard or turtleneck
3-During shower = cover stoma with a plastic bib By burping air swallowed “Mortimer
4-CPR = stoma Voice”
5-Avoid people with infections
6-wear bracelet ID 2 Mechanical Device
7-Stablish oral hygiene Electrolarynx against neck
8-Before after surgery stablish communication form

Lung Cancer:

Risk Factors:
Sign and Symptoms:
-Smoking
-Second Hand Smoker -Chest Pain
-Age more than 50 years -SOB
-Asbestosis -Anorexia = Weight loss
-Air Pollution -Anemia = Fatigue, SOB
-Genetics -Asthenia = Tired
-Lung Disease = TB -Hemoptysis
-Chronic nagging cough
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Oncology

Surgery: Nursing Intervention Chest Tube:

1-Lung Resection (needs Chest Tube) -Turn Patient to opposite or

unaffected site to help drainage
2-Lobectomy (needs chest Tube) “Good Lung Down”

3-Pneumectomy Nursing intervention chest tube

Lobectomy:

-Turn Patient to unaffected side

Nursing Intervention:

-Turn patient to affected side

(because has no pleura)
Patient 8 years old with SOB malaise, fever, left
-No need of chest tube crackles.

= Left Pneumonia

N/I:

-Turn patient to unaffected side (to help ventilate)

Mom calls and refers children have chest pain = turn

patient the same side (pain management)
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Oncology

Stomach Cancer:
Sign and Symptoms
Risk Factors:
-Indigestion= Dyspepsia
-Heavy intake smoked food -Early satisfied
-Low intake of fruits and vegetable -Belching
-Chronic infection of Helicobacter Pylori -Epigastric pain
-Heavy Smoking -Nausea and vomiting
-Male Patients -Anorexia
-Anemia
-Asthenia

Types of Surgery:

Gastric Resection: (loss of parietal cells Loss of HcL (hydrochloric acid = digestion)

Billroth 1= Gastrostomy

Gastro Jejunostomy

Gastrectomy

Gastric resection
Gastrectomy
Billroth I
Billroth II
Bariatric Surgery

0--------------6 months -------1,2,3, years

-0-6 moth = Dumping Syndrome

-1,2,3,4 years = Pernicious Anemia
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Oncology

Dumping Syndrome: Is a complication that occurs 6 months after the surgery.

-Fast Emptying of the gastric content into the small bowel

Sign and Symptoms: Appear 30 minutes after eating: Nursing Intervention (Dumping Syndrome)
• Fullness sensation • After eating stay at least 30 minutes
• Hypotension or 1 hour lying down
• Tachycardia • Do not drink fluids with meals drink
• Diaphoresis fluids between meals
• Nausea and Vomiting • Diet = Low simplex carbs and
• Borborygmus moderate in fat and proteins
• Abdominal Cramping • Do not use metoclopramide
• Late = Diarrhea because this med enhances the
emptying of stomach

Storage Vitamin B12 = Depletion AFTER years

If surgery 1,2,3 years with a surgery like:

o Billroth 1
o Billroth 2
o Bariatric Surgery
o Stomach surgery
= this means has Pernicious Anemia:
1- Red Beefy Tongue = Glossitis
2- Peripheral Neuritis (risk Injury / Do not bare food)
3- SOB
4- Tired, Fatigue
5- Pale

Positive Diagnose:

-Schelling Test = Urine 24 hours (absorption or not vit b 12)

-Gastric Acid

-Homocysteine Serum Increase = Hemocysteinemia (deficit V B12)

~Risk factor heart disease and brain

Treatment Vitamin B12 (IM) for life

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Oncology
Lymphoma = Malignancies of Lymphoid Tissue
(are related after previous have Epstein Barr Virus)

Hodgkin’s = Good Prognosis

-First Peak = Young people ~ 20- 35 years
~Male with 22 years old, weight loss, low fever, night sweats + Lymphoid Node (neck, Axilla or
groin area) = Hodgkin’s = Notify Dr = Needs Biopsy (positive Diagnosis with Reed Stemberg
Cells)
-Reed Stemberg Cells Present in Biopsy (Direct in Ganglion)
-Stage 1, 2 = Radiation
-Stage 3, 4 = Chemotherapy

Non-Hodgkin’s = bad Prognosis

-Related virus Hepatitis C
-Related autoimmune disorder like (Celiac, Sjoreng’s and Lupus)
-Genetics
-Broad Spectrum of malignancies of lymphoid tissue that is not Hodgkin’s
-Biopsy = NO = Read Sternberg Cells (eyes of an owl cells)

Complication of Both = Oncology Priority = Cava Superior Syndrome

-Can be caused by Hodgkin’s or Non-Hodgkin’s, Mediastinum Tumor and Lung Cancer

S/S
-Swelling neck = “Stokes Sign”
-Jugular Veins distention
-Periorbital Edema = Early Sign
-Puffy Face
-Swelling Hands “and weeding band or ring doesn’t fit”
-SOB
-Cyanosis upper chest

N/I
-Sit the patient
-Notify Doctor
-Diuretics
-Radiation to shrink tumor and improve circulation
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Oncology
Breast Cancer:
High Mortality Cancer M/W = Lung
Cancer
-Early Sign:
~Hard Lump = Upper Outer Quadrant or Tail of Spencer
Sex (cancer)
M= Prostate
1- Lump = hard/Fixed/Irregular and Painless
W= Breast Cancer
2- Abnormal Discharge
3 Colon Cancer
-Late Sign:
1- Orange Skin / Dimple Skin
Most common cancer in USA = Skin
2- Abnormal Unequal Shape
cancer (Basal Carcinoma)
3- Nipple retraction

Diagnosis = 1 Mammography and 2 Positive Diagnosis = Biopsy

Risk Factors:

1-Age more than 50 years old Treatment:

2-BRACA I or BRACA II (genetic mutation)
3-Family History = First Degree 1-Hormonal Therapy
4-Hearly Menarche (before 12 years old) 2-Radiation
5-Late Menopause 3-Chemo
6-Nuliparity 4-Surgery
7-Long Term hormone replacement therapy (estrogen)
8-Obesity -Hormonal Therapy:
9-Alcohol Intake ~Tamoxifen = Selective Strogen Receptor
10-Breast Proliferative Benign Disease Modulator
11-Trauma ~Daily for 5 years
12-Exposure to Ionizing radiation -Side Effects:
*Weight Gain
*Hot Flashes
*High Risk for DVT, Uterine Cancer, Stroke

Raloxifene = treatment for osteoporosis = Selective Strogen

Receptor Modulator
-Decrease Risk Breast Cancer
-Increase Risk for DVT, Uterine Cancer and Stroke
-If patient go to surgery hold before surgery
-If patient with raloxifene need exercise = Walking

Radiations:
Teletherapy or Beam Therapy (Distant)
~Skin Care = Needs take care of skin
Avoid Sunlight
Do not use adhesive tape
Do not remove Marks
Do not apply lotions/ Creams (unless prescribed by
doctor)
Wash only water/ If you need soap use mild soap
and use your hand instead hand towel
Wear cotton clothes
Do not apply heating pad
Brachytherapy (Short) = Close to Tumor:
Unsealed = radiation is not confined to the tumor the
execration is Radioactive (Iodine 131)
Highly teratogenic
Private Room/Private Bathroom
Flush Toilet 2 times
Increase fluids intake
Clean Toilet with solution prescribed by Doctor
Avoid Sexual Contact for at least 1 month
Wash clothes/linen alone to the rest of family
Utensils and Plate and discard
Sealed = The radiation is close to tumor (the excretion is
NOT RADIOACTIVE)
Ex= Seeds, Implants or Needles
Patient Stay at the hospital
Private room with sign saying RADIATION
Do not Pregnant Nurse
Do not allow children less than 16 years old
Nurse Needs to use:
1- Use Dosimeter
2- One nurse to one patient
3- Distant to patient 6”
4- No more than 30 minutes during shift
entering the room
5- Wear Lead Shield
6- Phone # Radiologist and Oncologic Dr
In room Lead Container
Diet low in fiber
Save Linen until finish treatment
Deodorizing in room
Psychosocial Support
Dislodgment of Implant:
1- Tell patient to lie down
2- Handled the implant with a long Forceps
3- Place inside lead container
4- Call Doctor, radiologist….
5- Document
6- (nurse can put the lead vest on top of the
implant to avoid spread of radiation)
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Oncology
Breast Surgery:
1- Lumpectomy (Dr remove malignant tissue,
surrounding tissue and axillary nodes
2- Total Mastectomy (Dr remove breast tissue
only “Carcinoma in situ”
3- Modified Radical Mastectomy (Dr remove
breast tissue, axillary nodes but preserve the
pectorals)
4- Radical Mastectomy (Dr remove breast tissue,
axillary nodes and pectoralis)
Nursing Intervention (post breast surgery)
Relief Pain with analgesic and elevated affected
arm to the level of the heart (opioids at hospital
like morphine = respiratory depression, if
opioids at home like oxycodone = constipation)
Maintain Skin Integrity (Jackson Pratt drainage
most be squeezed not filled= monitor drainage)
Normal decreased of sensibility caused for
disruption of nerves
Allow patient to express feeling (they have
disturbed body image)
Promote Exercise to improve circulation and
avoid contractures and stiffens and improve
venous return
-Exercise = 3 times per day for 6 to 8 weeks for 20
minutes
-Before exercise give analgesic and then take a shower
1- Day after surgery = affected Arm on abduction
above the level of the heart and wrist on
flexion and give ball to squeeze
2- From Second day exercise needs to be
progressive and encourage to brush their own
teeth and comb their hair and avoid heavy
liftings
Complication Post Breast Surgery:
1- Infection
2- Bleeding
3- Lymphedema (risk for Lymphedema = Obesity,
Impaired Skin Integrity, Age)
Teaching (lymphedema) (affected Arm)
Do not blood drown
Take BP
Infection
IV
Use Insect Repellent
Avoid Gardening
Wear Cooking Mitts
Avoid Heavy Lifting
Use Electric razor
Use Thimble when Sewing
Avoid Strong or Harsh Detergents
If a Cut Present:
Wash with soap
Rinse very well
Apply antibiotics Ointment
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Oncology

Cervical Cancer:
Cervical Cancer:
-Young people
-Related with HPV (prevention Vaccine)
Early Sign:
-Related with low socioeconomic status
-Fine, watery discharge
-Multiparity
-Dyspareunia
-Nutritious Deficiency (folates, Carotenes and Vit C)
-Bloody spots after sex
-Multiples sexual partners
-Metrorrhagia = Abnormal uterine bleeding
-First coitus before 20 years old
between irregular menstruations
-HIV infection
-Polymenorrhagia =Frequent menstruation
-Smoking
during a month
-Use of oral Contraceptives
-Chronic Cervical Infection
Late Sign:
-Thick, fool smelling discharge
-Leg swelling
Diagnosis Test:
-Bladder compression
1- Pap smear (abnormal)
2- Colposcopy = Procedure to examine cervix = Sent to lab If abnormal
3- Cone Biopsy if abnormal sent to lab
4- D/C

Treatment:
-Chemo
-Radiation = Brachytherapy “Sealed” = cervical implant (discharge fool smelling)
-Surgery:
Laser = expected slight vaginal discharge for about 6 weeks
-Teaching = No sexual contact / No bubble baths
Cryosurgery = Expected heavy watery discharge
-Teaching = No sexual contact during this time, no swimming, no vaginal douche, no
bubble bath and not hot tube
Conization = Maintain reproductive capacity (risk for cervical incompetency and
increase risk for abortion and preterm labor) (risk for cervical stenosis = Infertility)
(endometrial perforation = risk for bleeding)
Hysterectomy = Loss reproductive capacity
N/I:
o At least one month (climbing stairs, sexual contact, heavy lifting)
o Avoid Bath tub, hot tube, vaginal douche
o Monitor sign and symptoms Bleeding (more than 500ml/24hours = hemorrhage)
-1 menstrual pad saturated in one hour = heavy excessive = Priority
-1 menstrual pad saturated in 15 minutes
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Oncology
Pelvic Exenteration:

o Remove uterus = Hysterectomy

o Remove Ovaries/Fallopian tubes = Bilateral Salpingo-oophorectomy
o Remove Bladder = Ileal Duct
o Remove part of colon = Colostomy
o Remove Vagina
o (sex must be done using other ways)

Bladder Cancer:
Diagnosis = Biopsy
Risk Factors:
This type of cancer has Recurrence
Smoking
Industries workers
Exposure to radiation
Age Treatment:

Sign and Symptoms: Chemo (IV or Vesical Instillation = turn patient

Painless hematuria each 15- 30 minutes, wait 2 hours after 2
Fullness sensation hours patient can void and increase fluids to
Frequency avoid risk for Cystitis Hemorrhage)
Urgency Radiation (complications = Fistulas, Ileitis,
Dysuria Proctitis, Colitis and bladder
Clot = Induce obstruction hemorrhage/ulcers
Repetitive UTI Surgery = Remove Bladder
Koch Bacillus = used in Bladder Cancer by
Metastasis: Intravesical Instillation
Lung
Liver Koch Pouch = The patient is continent
Bones
Urethra
Vagina
Colon
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Oncology

Endometrial Cancer:

o Post Menopause woman

o Abnormal Vaginal Bleeding
Drugs increase risk for uterine
cancer:
Risk Factors:
Tamoxifen (treatment breast
More than 55 years old
cancer)
Family history
Nulliparity
Raloxifene (treatment for
Early menarche before 12 years
Late menopause osteoporosis
Long term use hormone replacement therapy
History of endometriosis

Endometrial Cancer Sign and Symptoms: Treatment:

• Bleeding spot after sex
• Dyspareunia (pain during sex) Hysterectomy
• Abnormal vaginal bleeding (postmenopausal) Hysterectomy with bilateral
• Pink watery discharge Salpingo -oophorectomy = Risk
• S/S compression dysuria for osteoporosis
• Swelling leg
• Anorexia
• Anemia
• Asthenia

Ovarian Cancer: Risk Factor Ovarian Cancer:

-The deadliest cancer in reproductive system • Age

• Brca I and Brca II (genetic mutation)
-Diagnosis cannot be by pelvic exam • Family history first degree
Need transvaginal Ultrasound • Nulliparity
• Early menarche
Ovarian Cancer S/S: • Late menopause
• Abnormal mass lower abdomen • Use hormonal replacement therapy
• Compression of bladder and colon causing • History of breast cancer
constipation
• Leg swelling
• Anorexia
• Anemia
• Asthenia
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Oncology
Treatment Ovarian Cancer:

• Chemo
• Radiation
• Surgery = Hysterectomy with bilateral Salpingo oophorectomy

Prostatic Cancer:
Prostate Screening
Prostatic cancer Prevention:
-Lycopene (tomatoes) • First = PSA (Prostatic Specific Antigen) normal
up to 4
-BPH= Saw Palmetto • Second = DRE = Abnormal Hard, fixed,
irregular, painless = Biopsy (positive
Diagnosis)
Treatment:

• Chemo
• Radiation = Brachytherapy Sealed (seed) = Short Distance close to the tumor (the
excretion is not radioactive
1. Private Room
2. Sign in door
3. Private Bathroom
4. No pregnant nurse
5. NO CHILDRE less than 16 years
6. No nurse pregnant
7. Nurse use lead shield and dosimeter
8. No more than 30 minutes in room (nurse)
9. Lead container
10. Phone number doctor
• Surgery = TURP (trans urethral prostatic resection)
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Oncology