NCM 114 Lesson # 7

Topic: Oncology Date: November 7, 2022

CANCER NURSING
ANEMIA
Deficiency or erythrocytes (RBCs) reflected as decreased hematocrit (Hct), hemoglobin
(Hgb), and RBCs.

LEUKEMIA
A. DESCRIPTION
1. Malignant neoplasm of the blood-forming organs
• Anemia results from decreased RBC production and blood loss.
• Immunosuppression occurs because of the large number of IMMATURE
white blood cells or profound neutropenia
• Hemorrhage occurs because of thrombocytopenia.
• Leukemic invasion of other organ systems occurs such as the liver, spleen,
lymph nodes, kidneys, lungs, and brain.
2. PRECIPITATING FACTORS:
• Genetic abnormalities.
• lonizing radiation (therapeutic or atomic).
• Viral infections (human T cells, leukemia virus)
Definition of Terms:
• Neoplasm is a type of abnormal and excessive growth of tissue. The
process that occurs to form or produce a neoplasm is called neoplasia.
• Neutropenia is an abnormally low concentration of neutrophils (a type
of white blood cell) in the blood.
• Thrombocytopenia is a condition characterized by abnormally low levels
of platelets, also known as thrombocytes, in the blood.

B. SIGNS & SYMPTOMS

1. Pallor
2. Fatigue
3. Cool skin, cold intolerance.
4. Blood loss either acute or chronic.
C. TREATMENT
1. Chemotherapy
2. Bone Marrow Transplant

Definition of Terms:
 Hematopoietic stem-cell transplantation (HSCT) is
the transplantation of multipotent hematopoietic stem cells
D. NURSING MANAGEMENT
1. Prevent Infection
2. BT as prescribed.
3. Promote rest
4. DIET TEACHING TO INCLUDE THE FOLLOWING
• Instruct in food selection and preparation to maximize intake: Iron, folic
acid, vitamin By
• Vitamin supplements: Iron, Vit. B12 and folic acid (parenterally if with
pernicious anemia)
ADMINISTRATION OF IRON
DO’s DON’Ts
- Use Z-track method of - Do not use deltoid muscle
administration - Do not massage injection site
- Use air bubble to avoid
withdrawing medication into
subcutaneous tissue

Definition of Terms:
 Pernicious anemia is a type of vitamin B12 deficiency anemia, a disease in
which not enough red blood cells are produced due to
the malabsorption of vitamin B12.

CANCER
A. DESCRIPTION
1. in mitosis, "like produces like"
2. disease process that involves the development reproduction of abnormal cells.
• Tight Junction (zipper) - boundaries involved in Gl system, prevents
digestive juices from seeping into the skin
• Desmosomes (Velcro) - keep cells anchored with each other.
• Gap Junction (Jego)- transfer of impulses to all parts e.g. neurons,
synapse
3. THEORIES OF CANCER
• Cellular Transformation and Derangement Theory
• Failure Of Immune Response Theory
4. CATEGORIES
• CARCINOMA, cancer arising from epithelial tissue (e.g. basal cell
carcinoma)
• SARCOMA, connective tissue, muscle or bone (e.g. osteosarcoma, Kaposis
sarcoma in AIDS)
• LEUKEMIA: blood-forming cells in the bone marrow (e.g. ALL or Acute
Lymphocytic Leukemia)
• LYMPHOMA: lymphoid tissue (e.g. Burkitt's lymphoma)
5. CRADING AND STAGING
• A method used to describe tumor
• GRADING a tumor classifies the cellular aspects of the cancer
• STAGING- clinical aspects
TUMOR NODE METASTASIS
1 – small 0 – no involvement 0 – no metastasis
2-3 – medium 1-3 moderate 1 – metastasis
3 – large 4 - extensive
Definition of Terms:
 Cellular transformation and Derangement theory. In this theory, exposure of
normal cells to some etiologic agent may transform normal cells into cancer cells.
 Failure of the Immune Response Theory. This theory conceptualizes that all
individuals possess cancer cells but these cancer cells are NOT recognized by the
immune system. Thus, cancer cells undergo destruction. Failure of the immune
response system to kill or destroy the cancer cells leads to cancer.

6. CANCER CLASSIFICATION
• SOLID TUMORS-associated with organs from which they develop, such
as breast cancer or lung cancer
 HEMATOLOGIC OR DIFFUSES CANCER-originate from blood-forming
tissues, such as leukemias and lymphomas

7. COMPARISON OF BENIGN AND MALIGNANT NEOPLASMS

CHARACTERISTICS BENIGN METASTASIS
Speed of growth Slow Rapid
Mode of growth Localized Infiltrating
Capsule Encapsulated No capsule
Recurrence Unusual Common
Metastasis None Common
Effect Harmless to host Armful
Prognosis Very good Poor

8. METASTASIS
• Cancer cells move from their original location to other sites
• LOCAL SEEDING: distribution of shed cancer cells in the local area of
the primary tumor
• BLOOD-BORNE: tumor cells enter the blood; most common
• LYMPHATIC: primary sites rich in lymphatics are more susceptible to
early metastatic spread

WARNING SIGNS OF CANCER

C- change in bowel or bladder habits
A- sore that does not heal
U. unusual bleeding/ discharge
T- tumor/ thickening of a lump
I-Indigestion/ Difficulty swallowing
O- obvious change in warts or moles
N- nagging cough or hoarseness of voice
U. unexplained anemia
 S- Sudden weight loss

B. PREVENTION
1. Avoidance of known or potential carcinogens and avoidance or modification
of factors associated with development of cancer
• BLADDER- smoking and environment (like paints, rubber, ink, leather)
• BREAST- history of first-degree relatives, birth of first baby at age 30-
35, menarche before age 12, menopause after age 55, obesity, use of
birth control pills and hormonal replacement, alcohol intake, and high
fat diet
• CERVICAL- history of early sexual activity, early childbearing, multiple
partners, HPV, HIV, pills, smoking
• COLON- family history, polyps, IBS (irritable bowel syndrome), diet
high in protein and fat, low fiber
• ESOPHAGEAL- tobacco and alcohol intake
• LARYNX- tobacco, alcohol intake, chronic laryngitis, nutritional
deficiencies like lack of Riboflavin (Vit B2),
• LIVER- alcohol intake, smoking, hepatitis, cirrhosis
• LUNG- smoking, secondhand smoke, air pollution, Vit. A deficiency,
heredity
• OVARIAN- diet high in fat, alcohol use, (+) history of breast cancer,
endometrium and colon, anovulation, nulliparity, infertility
• PANCREAS- high fat diet, smoking, chemicals, DM, chronic pancreatitis
• PROSTATE- African-Americans, age 55 or older, (+) PSA
• RENAL- Obesity, tobacco, dialysis, chemicals
• SKIN- exposure to sun, chemicals, scarring, ancestry
• STOMACH- H. pylori, diet high in burnt food, gastric ulcers, chronic/
AGE, pernicious anemia
• TESTICULAR- infection, genetic/ endocrine factors, cryptorchidism

C. DIAGNOSTICS
1. BIOPSY
• definitive means of diagnosing cancer and provides histologic proof of
malignancy
• involves surgical incision of a small piece of tissue for microscopic
examination
• TYPES: needle, incisional, excisional, staging
• OBTAIN AN INFORMED CONSENT

D. TREATMENT
1. 3 MAIN APPROACHES TO THE TREATMENT OF CANCER
a. SURGERY- best method for solid tumors that are surgically accessible
 • TYPES:
- Diagnostic
- Prophylactic
- Curative
- Control (cytoreductive)
- Palliative
- Reconstructive or rehabilitative
• Side Effects of Surgery
- Loss or loss of function of a specific body part
- Reduced function as a result of organ loss
- Scarring or disfigurement
- Grieving about altered body image or imposed change in lifestyle
chemotherapy has little selectivity
- kills both good and bad cells
- 2-4 week period between chemotherapy- to allow for
normal cell growth

NADIR- lowest point of bone marrow production

b. RADIATION-kill any cancer cells located in the area

• Types:
1. TELETHERAPY: external radiation
• Client is not radioactive
• Cobalt 60- the higher the energy the deeper the penetration
• NO lotions, powders, creams
• Clothes - Soft cotton
- Marked area- DO NOT WASH
• Avoid sun and heat exposure
• Monitor for erythema and moist desquamation

2. BRACHYTHERAPY: internal radiation

UNSEALED RADIATION SOURCE
- oral or IV route or instillation into body cavities
- excreta are radioactive
- eliminated by 48 hrs
- radioactive isotopes
SEALED RADIATION SOURCE
- solid implant within target tissue
- Client is radioactive while implant is in place, but excreta are not
- Place in PR with caution sign
- nursing assignment rotated
- wear a dosimeter badge to measure radiation exposure
DISTANCE: 6 ft
 TIME: 30mins/shift
SHIELD: lead apron
ALARA "as low as reasonably achievable"

ALARA
It means making every reasonable effort to maintain exposures to ionizing
radiation as far below the dose limits as practical. Be consistent with the
purpose for which the licensed activity is undertaken, taking into account the
state of technology. the economics of improvements in relation to state of
technology, the economics of improvement in relation to benefits of the
public health and safety, and other societal and socioeconomic
considerations. These means are in relation to utilization of nuclear energy

DISLOGED IMPLANT REMOVAL OF IMPLANT

- DO NOT TOUCH WITH BARE
HANDS
- Use long-handled forceps and
place in lead container
- No longer radioactive
- May resume sexual intercourse
after 7-10 days if implant was
cervical or vaginal
- Betadine douche
- Fleet edema as prescribed

C. CHEMOTHERAPY-very little selectivity of action

• Side effects:
- Mucositis
- Alopecia
- Anorexia,
-N&V
-Diarrhea
- Anemia
- Neutropenia
- Thrombocytopenia
- infertility

Chemotherapy- DIFFUSED TUMOR

1. ALKYLATING DRUGS- bind with DNA, inhibit reproduction therefore cell is
unable to replicate
• cisplatin (Platinol) - IV; Testicular and ovarian cancer
• iphosphamide (Ifex)- Testicular cancer
• mechlotheramine (Mustargen)- Hodgkin's disease and lymphoma
*Wear gloves- vesicants can burn/ cause blisters
*prepared by physicians only

2. ANTIMETABOLITES- inhibition/ blocking of cell function or chemical

reaction, no cell growth
3 Subtypes:
a. Folic acid antagonists- interfere with folic acid
• methotrexate (Folex)- important in ALL/ leukemia
• antidote: FOLINIC ACID (leucovorin rescue)
b. Purine antagonists- stops RNA from reproducing
• mercaptoprine (Purinethol)- indicated for all leukemias
c. Pyrimidine antagonists
• 5-FU (fluorouracil)- for all solid tumor
• Cytarabine (Cytosar-U)- treatment of certain leukemias
• Assess cerebellar dysfunction
• Wear sunscreen and to wear protective clothing to prevent
photosensitivity reactions

3. PLANT EXTRACTS
• oncovin (Vincristine)- used for Hodgkin's disease;
• never administer intrathecally
• extremely painful when administered

4. HORMONE ANTAGONISTS
• Tamoxifen (Nolvadex)- estrogen antagonist- breast and ovarian
cancers

5. ANTITUMOR ANTIBIOTICS
• blenoxane (Bleomycin)- important in skin cancer
• Adriamycin (doxorubicin)- solid tumor, Wilm's tumor

NURSING MANAGEMENT
1. MonItor WBC count dally, monitor for signs of infec
2. MONITOR VITAL SIGNS FREQUENTLY
• Note baseline.
• Report fever to physician as requested.
o Parameters for reporting. tend to be lower than those of
postoperative clients.
o Usually report temperature elevations of 100.5°F.
3. ADMINISTER ANTIBIOTICS as prescribed maintaining a strict schedule.
4. NOTIFY PHYSICIAN IF DELAY IN ADMINISTRATION OCCURS.
• Obtain trough and peak blood levels of antibiotics.
o TROUGH: draw blood sample shortly BEFORE administration
of antibiotic.
o PEAK: draw blood sample 30 minutes to 1 hour AFTER
administration of drug.
• Monitor blood levels of antibiotics for therapeutic close range.
5. Teach client and family the importance of infection control.
6. Institute an oral hygiene regime.
• Use soft-bristle toothbrush to avoid bleeding.
• Use salt and soda mouth rinse.
• Lubricate lips with water-soluble gel.
• Avoid lemon-glycerine swabs' they dry oral mucosa.
7. Avoid rectal thermometers and suppositories to prevent further bleeding.
8. Monitor fluid status and balance; febrile clients dehydrate rapidly.
• Monitor I & 0.
• Encourage fluid intake of at least 3 liters/day.
9. Encourage mobility to decrease pulmonary stasis.
10. PROVIDE CARE FOR INVASIVE CATHETERS AND LINES.
• Use strict aseptic technique for all invasive procedures.
• Change dressings 2 to 3 times/week and/or when soiled.
• Use catheter line for piggybacking medication depending on the
purpose of the line and the fluid being infused, i.e., NO medications
can be piggybacked with an infusion of chemotherapeutic agents.
• Lines can often be used for collecting blood samples thereby avoiding
"sticking" the client.
11. PROTECT THE CLIENT FROM BLEEDING AND INJURY.
• Handle the client gently.
• Avoid needle sticks. Use smallest gauge needle possible, and apply
pressure for 10 minutes after needle sticks.
• Encourage use of electric razor only for shaving.
• Instruct client to avoid blowing or picking nose.
• Assess for signs of bleeding.
• Avoid use of salicylates.

CANCER PAIN CONTROL

A. DESCRIPTION
1) care of CA client in pain
2) CAUSES:
1. Bone destruction- most painful pain is bone cancer pain
2. Obstruction of an organ
3. Compression of peripheral nerves
4. Infiltration/ distension of tissue
5. Inflammation/ necrosis
6. Psychological such as fear and anxiety

B. NURSING MANAGEMENT
COLLABORATIVE
1. Administer pain medication at the start of the painful experience
2. Mild: ASA, acetaminophen (Tylenol), NSAIDs
3. Severe: narcotics such as codeine sulfate, meperidine (Demerol), morphine,
hydromorphone HCl (Dilaudid)
4. Subcutaneous injections- continuous IV infusion of narcotics provide superior
pain control
5. Provide nonpharmacologic approaches to pain: relaxation, guided imagery
DO NOT UNDERMEDICATE CANCER CLIENT IN PAIN

BONE MARROW TRANSPLANTATION

A. DESCRIPTION
1. Types:
• Allogeneic- parent or sibling
• Syngeneic- identical twin
• Autologous- most common; self
***marrow is harvested during remission and is stored frozen, and to
be reinfused later
B. PROCEDURE
1. Harvest BONE MARROW
2. Conditioning Areas:
3. Transplantation 1. flat bones- sternum, iliac crest
4. Engraftment 2. long bones- femur- danger of hitting sciatic
nerve
C. COMPLICATIONS
- Use large bore needle
1) Failure to engraft - Prevent bleeding
2) GVHD - Administer via IV like BT
3) Veno-occlusive disease

Definition of Terms:
 Hepatic veno-occlusive disease (VOD) or veno-occlusive disease with
immunodeficiency is a potentially life-threatening condition in which some of the
small veins in the liver are obstructed. It is a complication of high-
dose chemotherapy given before a bone marrow transplant and/or excessive
exposure to hepatotoxic pyrrolizidine alkaloids.
 Graft-versus-host disease (GvHD) is a syndrome, characterized by inflammation in
different organs. GvHD is commonly associated with bone marrow
transplants and stem cell transplants.

SPECIFIC CANCERS
Management and Nursing Care
1. LEUKEMIA- blood cancer
• Increase blood cells but immature
• Pancytopenia
• Bone marrow transplant
• Folex

2. HODGKIN'S-cancer of lymph node

• Reed- Sternberg cells
• Biopsy of lymph node
• Night sweats, painless, swinging pyrexia

3. TESTICULAR- sperm-producing cells of the testicles

• Testicular tortion- painful
 • Enlargement, painless testicular swelling
4. CERVICAL CANCER
• Pap Smear
Class I- no action
Class II- inflammation, comes back in 3 months
Class III- dysplasia, come back in 6 weeks
Class IV/V- cervical cancer
• Manifestations
- Vaginal bleeding, painless, vaginal discharge, foul smelling discharge,
dysuria, hematuria
- Hysterectomy, TAHBSO, pelvic exenteration, cryosurgery

5. OVARIAN CANCER
• Manifestations
- Indigestion-like symptoms
- Increase in abdominal girth
- Diarrhea
- Pelvic pressure
• FNAB- diagnostics

6. BREAST CANCER
• Manifestations
- Usually in upper outer quadrant
- Dimpling; peau d' orange skin
- Nipple retraction
- Discharges
- Lymphadenopathy
• Treatment
- Mastectomy
- Lumpectomy
- Modified Radical Mastectomy
- If estrogen positive cancer, suggest oophorectomy (ovarian-estrogen
positive receptor)
• Post-operative care
- Hands-off the affected side
-Hands- elevate' LIBERTY position
- Prevent lymphedema
- JP drain

7. PROSTATE CANCER
• Dribbling, decrease in projectile/ forced stream of urine, hematuria,
dysuria, back pain
• Radiation therapy. Chemotherapy
• Prostatectomy
• TURP
• Continuous Bladder Irrigation-pink/colorless urine