WHAT IS CANCER?
Decoding cancer
TUTOR || September 15, 2022
Transcribers: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name
Editors: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name
Outline
Legend:
Remember
Lecturer Book
(Exams)
  
Heading 1
 Heading 2
• The quick brown fox jumps over the lazy dog
 The quick brown fox jumps over the lazy dog
▪ The quick brown fox jumps over the lazy dog
• The quick brown fox jumps over the lazy dog
Subheading
Decoding Cancer
 Steve and Nikki are fraternal twins in high
school. They recently learned that their
mother has been diagnosed with cancer.
They have no idea what this really means for
their mom and for them.
WHAT IS CANCER?
 Mom has a doctor’s appointment so she can’t
make my game. Dad said he would leave
work early to make the game. I’m glad he’s
coming but I wish mom could make it and I
wonder if we should just stay home.
I still don’t know what cancer really is and
Nikki and I don’t want to bug mom and dad.
Can someone just tell me what exactly is
cancer?
Question 1:
 The risk of dying from cancer in the United
States is increasing.
FALSE.
The risk of dying from cancer in the United States
has decreased from 1975 to 2012.
 US Mortality Files, National Center for Health
Statistics, Centers for Disease Control and
Prevention. Rates are per 100,000 and are
age-adjusted to the 2000 US Std Population
(19 age groups - Census P25-1130). Source:
National Cancer Institute. SEER Statistics
Review 1975-2006.
MED-SURG
Explanation:
The risk of dying from breast cancer is not
Previous
increasing in the United States. This graphic
Trans shows that in 1980, 31.7 women and 0.3 men
 per 100,000 people died per year. In 2010, the
number of women who died per 100,000 people
was 21.9. The total decreased from 18.0 to 12.2.
Question 2:
 Cancer can be spread from person to person.
FALSE.
Cancer cannot be
passed from one person
to another. Though cancer
itself isn’t contagious, sometimes viruses, which
are contagious, can lead to the development of
cancer.
Explanation:
The following is further explanation of viruses
that can lead to cancer: Two common cancers
caused by viruses are cervical cancer and liver
cancer. Human papillomavirus (HPV), a sexually
transmitted disease, can cause cervical cancer.
And hepatitis C, a virus transmitted through
sexual intercourse or use of infected intravenous
(IV) needles, can cause liver cancer, though only
a small number of those with the virus will
develop liver cancer.
Question 3:
 What someone does as a young adult has
little effect on their chance of getting cancer
later in life.
FALSE.
Most cases of cancer are the consequence of
many years of exposure to several risk factors.
Explanation:
What you eat, whether you are physically active,
whether you are sunburned, and especially
whether you smoke as a young person have a
substantial influence on whether you develop
cancer later in life.
Page 1 of 6
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
Question 4:
 There is currently a cure for cancer but the
medical industry won’t tell the public about it
because they make too much money treating
cancer patients.
FALSE.
Plenty of doctors and their loved
ones die of cancer each year. Why would
anyone hide such an important discovery?
Think about the speed with which other medical
breakthroughs in vaccines and antibiotics have
been announced and applied.
Explanation:
Remember, cancer is many diseases rather than
a single disease, and cures are already available
for many forms of cancer. Fewer than half of all
people with cancer in the U.S. actually die of the
disease.
Question 5:
 Treating cancer with surgery can cause it to
spread throughout the body.
FALSE.
Specialists in cancer surgery know how to safely
take biopsy samples and to remove tumors
without causing the cancer to spread. In many
cases, surgery is an essential part of the cancer
treatment plan.
Question 6:
 Cancer can be effectively treated.
TRUE.
The five major types of treatment for cancer are
surgery, radiation, chemotherapy, biologic
therapies, and therapies that boost the patient’s
 Effective cancer treatments can include
several types of Cancer Warriors. What do
each of the following professionals do to fight
cancer?
Oncology Physician
 An oncologist is a doctor who treats cancer.
Usually, an oncologist manages a person’s
care and treatment once he or she is
diagnosed with cancer.
 The field of oncology has three major areas:
medical, surgical, and radiation.
Page 2 of 6
 Other types of oncologist are: gynecologic,
pediatric and hematologic oncologist
The role of the oncologist
 An oncologist oversees a patient’s care from
the cancer diagnosis throughout the course of
the disease. The oncologist’s role includes
the following:
 Explaining the cancer diagnosis and stage to
the patient
 Discussing all relevant treatment options and
the oncologist’s recommendations
 Delivering high-quality, compassionate care
 Helping the patient manage cancer-related
pain and other symptoms or treatment side
effects
Cancer Research
 Cancer research is
basic research into cancer to identify causes
and develop strategies for prevention,
diagnosis, treatment, and cure.
 Cancer research ranges from epidemiology,
molecular bioscience to the performance of
clinical trials to evaluate and compare
applications of the various cancer treatments.
Oncology Nurse
 An Oncology Nurse provides care for cancer
patients and those at risk for getting the
disease. They monitor physical conditions,
prescribe medication, and administer
chemotherapy and other treatments.
 Oncology nurses often serve as your first line
of communication, and help coordinate the
many aspects of your care
throughout cancer treatment. ... Safely
administer medications, fluids
and cancer treatments (e.g., chemotherapy)
Oncology Pharmacist
 Oncology pharmacists are actively engaged
in all aspects of cancer care—from
chemotherapy dose preparation and safety
checks, to educating patients about side
effects, to drug development research.
Oncology Social Worker
 Oncology social workers provide information
on resources, medical and insurance
coverage, and how to talk to your family and
the children in your lives about cancer.
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
 They are patient and family advocates.
 They provide assistance in coping with the
diagnosis to patients and families all along
the disease continuum, teach relaxation
techniques to reduce anxiety, lead psycho-
educational support groups, help individuals
transition to survivorship, and conduct
research about all of the above!
 They also provide support to our colleagues
around burnout and compassion fatigue to
help them manage the stressors and loss
associated with working in oncology.
Question 7:
 Cancer is a group of over 100 diseases.
TRUE.
The main categories of cancer include:
Carcinoma
Sarcoma
Leukemia
Lymphoma and myeloma
Central nervous system cancers
Explanation:
Main categories of cancer:
• Carcinoma: cancer that begins in the skin or
in tissues that line or cover internal organs
• Sarcoma: cancer that begins in bone,
cartilage, fat, muscle, blood vessels, or other
connective or supportive tissue
• Leukemia: cancer that starts in blood-
forming tissue, such as the bone marrow,
and causes large numbers of abnormal
blood cells to be produced and enter the
blood
• Lymphoma and myeloma: cancers that
begin in the cells of the immune system
• Central nervous system cancers: cancers
that begin in the tissues of the brain and
spinal cord
Question 8:
 Cancer cells can be distinguished from
normal cells because of their abnormal
growth.
TRUE.
Normally, cells grow and divide to produce more
cells as they are needed to keep the body
healthy. Sometimes, this orderly process goes
wrong. New cells form when the body does not
Page 3 of 6
need them, and old cells do not die when they
should.
Instructor Notes
Question 9:
 Cancer can only occur in specific cells in the
body.
FALSE.
The body is made up of many types of cells, and
all cancer begins in cells. Cancer can develop in
any cell in the body, which is why there are so
many different types.
Question 10:
 Cancer develops because of abnormal gene
function.
TRUE.
Scientists have learned that cancer is caused by
changes in genes that normally control the
growth and death of cells. Certain lifestyle and
environmental factors can change some normal
genes into genes that allow the growth of cancer.
Explanation:
Many gene changes that lead to cancer are the
result of tobacco use, poor diet, exposure to
ultraviolet (UV) radiation from the sun, or
exposure to carcinogens (cancer-causing
substances) in the workplace or in the
environment. Some gene alterations are
inherited (from one or both parents).
However, having an inherited gene alteration
does not always mean that the person will
develop cancer; it only means that their chance
of getting cancer is increased.
Learning about cancer
 Nikki has a lot of questions and Steve is not
sure how to help answer them. What would
you want to know if you were in their shoes?
What’s happening inside?
 I remember learning about the phases of the
cell cycle, but don’t understand the deal with
cancer. I wonder what mom
went through before now!
 I really want to help but I just
keep wondering about what’s
going to happen.
Also, will I get cancer, too?
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
How do healthy and cancerous cells differ?
Discussion.
Differences between normal and cancerous cells,
including:
 Normal cells have a large cytoplasm;
cancerous cells have a small cytoplasm
 Normal cells have a single nucleus;
cancerous cells have multiple nuclei
 Normal cells have a nucleolus; cancerous
cells have multiple and large nucleoli
 Normal cells have fine chromatin; cancerous
cells have coarse chromatin
 Nucleus
Control center of the cell. Contains all genetic
information.
 Mitochondria
Powerhouse of the cell.
Converts sugar to usable energy by cellular
respiration.
 Ribosomes
Site of protein synthesis.
 Golgi Apparatus
Packaging center of the cell. Packages and
secretes proteins.
 Centrioles
Organizes microtubules (spindle fibers) for
mitosis.
 Chromosomes
Made of condensed DNA and proteins.
Codes for genetic traits.
Page 4 of 6
 Endoplasmic Reticulum
Transports intracellular materials.
Phases of Cell Cycle
Gap 0 (G0): Resting
Stage
Gap 1 (G1): Growth
Synthesis (S): DNA
Replication
Gap 2 (G2): Growth
Mitosis (M): Nuclear
Division and
Cytokinesis
Review cell cycle and regulation.
 Gap 0 (G0) Phase is the resting stage, when
a cell leaves the cell cycle, either temporarily
or permanently. Often, they will never reenter
the cell but instead will carry out their function
in the organism until they die.
 GAP 1 (G2) Phase includes growth and prep
of chromosomes for replication.
 Synthesis (S) Phase is where DNA replication
occurs.
 GAP 2 (G2) Phase includes preparation for
mitosis.
 Mitosis (M) Phase is where nuclear and
cytoplasmic division occur. Mitosis is further
divided into 4 phases (prophase, metaphase,
anaphase, telophase)
Refer to video 1 – Cell Cycle and Mitosis
Cell Cycle Quality Control
 The cell has several systems for interrupting
the cell cycle if something goes wrong.
 Checkpoints in G1 and G2 look for DNA
damage and try to repair it.
 Damage that is so severe that it cannot be
repaired will lead a cell to self-destruct by
apoptosis.
 Mitosis checkpoint detects failure of spindle
fibers to attach to kinetochores and will arrest
cell in metaphase until corrected.
 A genetically directed process of cell self-
destruction
 All checkpoints require the function of a
complex of proteins. Mutations in the genes
encoding some of these proteins have been
associated with cancer.
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
 Checkpoint failures due to gene mutations
allow the cell to continue dividing despite
damage to its integrity.
Refer to video 2 (Cell Cycle Checkpoints)
CANCER GROWTH CELL CYCLE QUALITY
CONTROL
Discussion
 there are two types of mutation that can lead
to uncontrolled cell division and cancer:
Tumor Suppressor Gene Mutations and
Proto-oncogene Mutations.
Refer to Video 3 (Animated Introduction to
Cancer Biology)
Tumor Suppressor Gene Mutations
 When a tumor suppressor gene is mutated,
there is loss of function resulting in cell cycle
checkpoint failure and uncontrolled division of
abnormal cells.
Discussion….
 everyone has tumor suppressor genes and
proto-oncogenes. Normally, both work fine
and cells do not grow out of control.
 However, mutations in either or both of these
types of genes change their function, which
may lead to cancer.
 the cells in Tumor Suppressor Gene
Mutation and Proto-Oncogene Mutation
would go through apoptosis; however,
cancer cells avoid apoptosis and keep
growing and dividing, resulting in a tumor.
This is a recessive mutation so both alleles
in the gene need to be mutated to cause the
cancer.
Page 5 of 6
Real-World Comparison
 Tumor suppressor genes are like the brakes
of a car.
 When the brakes lose function, the car moves
out of control.
 Similarly, when tumor suppressor genes lose
function, the cells grow out of control.
When a proto-oncogene is mutated (now called
oncogene), there is gain of function resulting in a
cell cycle checkpoint failure and uncontrolled
division of abnormal cells.
Discussions….
 everyone has tumor suppressor genes and
proto-oncogenes. Normally, both works fine
and cells do not grow out of control.
 that However, mutations in either or both of
these types of genes change their function,
which may lead to cancer.
 the cells in Tumor Suppressor Gene Mutation
and Proto-Oncogene Mutation would go
through apoptosis; however, cancer cells
avoid apoptosis and keep growing and
dividing, resulting in a tumor.
 Proto-oncogenes are a dominant gene
mutation so only one allele needs to be
mutated to cause cancer.
 Proto-oncogenes are like the gas pedal of a
car.
 If the gas pedal gets stuck in the “on”
position, a car keeps moving whether the
pedal is pushed or not.
 Similarly, when a proto-oncogene mutates
into an oncogene, a cell will keep dividing
even when there are no messages to divide
Gene function is activated
 Instructor Notes
 Explain to students that most cancers
have both loss of brakes and the gas
pedal on. Note that this is the same
graphic students saw on Slide 17 – the
repetition of this graphic is meant for
reinforcement of the concept.
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor

Mitotic Division Role Play

 Normal Cell Division

The cell proceeds with normal cell division. At
least one error is detected at one or more cell
cycle checkpoints. Once the errors are
repaired and checkpoints are cleared, the cell
divides normally.
 Tumor Suppressor Gene Mutation
Tumor suppressor gene loses function.
cells will continue to divide.
 Proto-oncogene Mutation
Proto-oncogene mutates into an oncogene.
The cells will continue to divide.

 Instructor Notes
 Tell students they are going to
demonstrate their understanding of the
relationship between the cell cycle and the
development of cancer by acting out the
cell cycles of healthy and cancerous cells.
Remind students that everyone has tumor
suppressor genes and proto-oncogenes.
Normally, both genes work fine and cells
do not grow out of control. However,
mutations in either or both of these types
of genes change their function, which may
lead to cancer. There are three different
scenarios: Normal Cell Division, Tumor
Suppressor Gene Mutation, and Proto-
Oncogene Mutation.

Page 6 of 6
 WHAT IS CANCER?
TUTOR || September 15, 2022 MED-SURG
Transcribers: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name
Editors: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name

Outline affected because either they or their loved

ones or friends are cancer survivors.
Legend:
Remember Previous
 Because cancer is so prevalent, people have
Lecturer Book
(Exams) Trans many questions about its biology, detection,
    diagnosis, possible causes, and strategies for
prevention.
Heading 1
 Heading 2  A large group of diseases characterized by:
• The quick brown fox jumps over the lazy dog  Uncontrolled growth and spread of abnormal
 The quick brown fox jumps over the lazy dog
cells
▪ The quick brown fox jumps over the lazy dog
 Proliferation (rapid reproduction by cell
• The quick brown fox jumps over the lazy dog
division)
Subheading
 Metastasis (spread or transfer of cancer cells
UNDERSTANDING CANCER from one organ or part to another not directly
connected)
• Cancer was recognized in ancient times by
skilled observers who gave it the name
“CANCER” – Loss of Normal Growth Control
• In latin, CANCRI - Which means CRAB

Discussion:
 It afflicts all people of all ages, all socio-
economic and cultural backgrounds and both
sexes. It is a much – dreaded disease.
 CRAB – because it stretches out in many
directions like the legs of a crab
 It poses tremendous physiologic, psycho-
social, cognitive, spiritual and economic
impact to the affected individuals and their
significant others.

What Is Cancer?
 CANCER is a complex of diseases which
occurs when normal cells mutate into
abnormal cells that take over normal tissue,
eventually harming and destroying the host
Discussions:
 Cancer is a renegade system of growth that
originates within a patient’s biosystem, more
commonly known as the human body. There
are many different types of cancers, but all
share one hallmark characteristic: unchecked
growth that progresses toward limitless
expansion.
 It is difficult to imagine anyone who has not
heard of this illness. Most people have been
Discussions:
 Cancer arises from a loss of normal growth
control. In normal tissues, the rates of new
cell growth and old cell death are kept in
balance.
 In cancer, this balance is disrupted. This
disruption can result from uncontrolled cell
growth or loss of a cell’s ability to undergo cell
suicide by a process called “apoptosis.”
 Apoptosis, or “cell suicide,” is the mechanism
by which old or damaged cells normally self-
destruct.

Page 1 of 8
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor

Oncogenes The Beginning of Cancerous Growth

Discussions:
 During the
development of skin
cancer, the normal
balance between cell
division and cell loss
is disrupted. The
basal cells now
divide faster than is needed to replenish the
cells being shed from the surface of the skin.
 Each time one of these basal cells divides,
the two newly formed cells will often retain the
capacity to divide, thereby leading to an
Discussions: increase in the total number of dividing cells.
 One group of genes implicated in the
development of cancer are damaged Tumors (Neoplasms)
genes, called “oncogenes.” Discussions:
 Oncogenes are genes whose PRESENCE  This gradual
in certain forms and/or overactivity can increase in the
stimulate the development of cancer. number of dividing
 When oncogenes arise in normal cells, cells creates a
they can contribute to the development of growing mass of
cancer by instructing cells to make tissue called a
proteins that stimulate excessive cell “tumor” or
growth and division. “neoplasm.”
 If the rate of cell division is relatively rapid,
Example of Normal Growth and no “suicide” signals are in place to trigger
cell death, the tumor will grow quickly in size;
if the cells divide more slowly, tumor growth
will be slower. But regardless of the growth
rate, tumors ultimately increase in size
because new cells are being produced in
greater numbers than needed.
 As more and more of these dividing cells
accumulate, the normal organization of the
Discussions: tissue gradually becomes disrupted.
 To illustrate what is meant by normal growth
control, consider the skin. The thin outermost Invasion and Metastasis
layer of normal skin, called the epidermis, is Discussions:
roughly a dozen cells thick.
 Cancers are
 Cells in the bottom row of this layer, called the capable of
basal layer, divide just fast enough to spreading
replenish cells that are continually being shed throughout
from the surface of the skin. Each time one of the body by
these basal cells divides, it produces two two
cells. mechanisms:
 One remains in the basal layer and retains invasion and
the capacity to divide. The other migrates out metastasis.
of the basal layer and loses the capacity to
divide. The number of dividing cells in the
basal layer, therefore, stays the same.
Page 2 of 8
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
• Invasion refers to the direct migration and
penetration by cancer cells into neighboring
tissues.
• Metastasis refers to the ability of cancer cells
to penetrate into lymphatic and blood vessels,
circulate through the bloodstream, and then
invade normal tissues elsewhere in the body.
STAGES OF CANCER
1. INITIATION
 This is the first step of cancer development in
which a change in the cell’s genetic material
primes the cell to become cancerous.
 The change in the cell’s genetic material
occur spontaneously by an agent that causes
cancer (a carcinogen)
2. PROMOTION
 The second and final step in the development
of cancer.
 Agents that cause promotion, or promoters,
may be substances in the environment or
even some drugs such as sex hormones*
Instead, promoters allow a cell that has
undergone initiation to become cancerous.
Discussion:
➢ Sex hormones – for example testosterone
taken to improve sex drive and energy in
older men
• Unlike carcinogens, promoters do not
cause cancer by themselves instead…
• Promoters has no effect on cells that have
not undergone initiation.
example ionizing radiation ( which is used in x-
rays and is produced in nuclear power plants and
atomic bomb explosions
3. SPREAD/PROGRESSION
 Cancer can grow directly into surrounding
tissue or organs, nearby or distant.
Page 3 of 8
 Cancer can spread through the lymphatic
system. This type of spread is typical of
carcinomas, ex… breast cancer*
 Cancer can also spread via the bloodstream
and this is typical of sarcoma.
 Breast CA usually spread first to the nearby
lymph nodes in the armpit, and only later
spread to distant sites.
• It is also characterized by:
− Uncontrolled growth and spread of
abnormal cells
− Proliferation
− Metastasis
Rapid reproduction by cell division
Spread or transfer of cancer cells
 Proliferation – rapid reproduction by cell
division
 Metastasis – spread or transfer of cancer
cells from one organ or part to another not
directly connected.
ETIOLOGY/CAUSATIVE FACTORS
➢ Viruses and Bacteria
➢ Chemical carcinogens/ Agents
➢ Dietary Factors
➢ Physical stressors
➢ Hormonal factors
➢ Genetic and familial factors
What Causes Cancer?
➢ Some viruses or bacteria
➢ Heredity
➢ Diet
➢ Hormones
➢ Radiation
➢ Some chemicals
Discussions:
 Cancer is often perceived as a disease
that strikes for no apparent reason. While
scientists don’t yet know all the reasons,
many of the causes of cancer have
already been identified.
 Besides intrinsic factors such as heredity,
diet, and hormones, scientific studies point
to key extrinsic factors that contribute to
the cancer’s development: chemicals
(e.g., smoking), radiation, and viruses or
bacteria.
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor

Population-Based Studies with incidence of gastric malignancy related

➢ CANADA: Leukemia to chronic superficial gastritis with resultant
➢ BRAZIL: Cervical cancer metaplastic changes to the gastric mucosa.
➢ U.S.: Colon cancer HUMAN PAPILLOMA VIRUS
➢ AUSTRALIA: Skin cancer
➢ CHINA: Liver cancer
➢ U.K.: Lung cancer
➢ JAPAN: Stomach cancer EPSTEIN BARR VIRUS

Discussions:
 One way of identifying the various causes of
cancer is by studying populations and
behaviors. This approach compares cancer
rates among various groups of people
exposed to different factors or exhibiting
different behaviors.
 A striking finding to emerge from population
studies is that cancers arise with different
frequencies in different areas of the world. For
example, stomach cancer is especially
frequent in Japan, colon cancer is prominent
in the United States, and skin cancer is
common in Australia.
ETIOLOGIC FACTORS TO CANCER: VIRUSES
& BACTERIA
 “Oncogenic viruses” may be one of the
multiple agents acting to initiate
carcinogenesis
 Prolonged or frequent viral infections may
cause breakdown of the immune system or
overwhelm the immune system
Discussions:
 A number of viruses are suspected of causing
cancer in animals, including humans, and are
frequently referred to as oncogenic viruses.
Examples include human papillomaviruses,
the Epstein-Barr virus, and the hepatitis B
virus, all of which have genomes made up of
DNA.
HEPATOCELLULAR
CARCINOMA
Viruses
Discussions:
 In addition to chemicals and radiation, a few
viruses also can trigger the development of
cancer. In general, viruses are small
infectious agents that cannot reproduce on
their own, but instead enter into living cells
and cause the infected cell to produce more
copies of the virus.
 Like cells, viruses store their genetic
instructions in large molecules called nucleic
acids. In the case of cancer viruses, some of
the viral genetic information carried in these
nucleic acids is inserted into the
chromosomes of the infected cell, and this
causes the cell to become malignant.
Examples of Human Cancer Viruses
Some Viruses Associated with Human Cancers

✓ Viral infections that increase risk of certain

forms of cancer are as follows:
1. Human papilloma virus – cervical cancer
2. Epstein – Barr virus – lymphoma and
nasopharyngeal cancer
3. Hepatitis B and C – hepatocellular Discussions:
cancer  Only a few viruses that infect human cells
✓ Helicobacter pylori is one bacterium identified actually cause cancer. Included in this
as a cause of cancer in humans – associated category are viruses implicated in cervical
Page 4 of 8
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
cancer, liver cancer, and certain lymphomas,
leukemias, and sarcomas. Susceptibility to
these cancers can sometimes be spread from
person to person by infectious viruses,
although such events account for only a very
small fraction of human cancers.
 For example, the risk of cervical cancer is
increased in women with multiple sexual
partners and is especially high in women who
marry men whose previous wives had this
disease. Transmission of the human
papillomavirus (HPV) during sexual relations
appears to be involved.
Bacteria and Stomach Cancer
Discussions:
 Viruses are not the only infectious agents that
have been implicated in human cancer. The
bacterium Helicobacter pylori, which can
cause stomach ulcers, has been associated
with the development of cancer, so people
infected with H. pylori are at increased risk for
stomach cancer.
 Research is under way to define the genetic
interactions between this infectious agent and
its host tissues that may explain why cancer
develops.
CHEMICAL AGENTS
 These factors act by causing cell mutation or
alteration in cell enzymes and proteins
causing altered cell replication
➢ Vinyl Chloride (used for plastic
manufacture, asbestos factories,
construction works)
➢ Polycyclic aromatic hydrocarbons (such as
from refuse burning, auto and truck
emissions, oil refineries, air pollution)
➢ Arsenic, soot and tars
➢ Fertilizers, weed killers (pesticides)
➢ formaldehydes
➢ Dyes (aniline dyes used in beauty shops,
hair bleach)
Page 5 of 8
➢ CADMIUM: Battery
➢ CHROMIUM COMPOUNDS: Pigments in
Paint
➢ BERYLLIUM COMPUNDS: Aquamarine,
Emerald, Morganite, Heliodor Goshenite,
Red Heryl
Tobacco Use and Cancer
Discussions:
 Among the various factors that can cause
cancer, tobacco smoking is the greatest
public health hazard. Cigarette smoke
contains more than two dozen different
chemicals capable of causing cancer.
 Cigarette smoking is the main cause of lung
cancer and contributes to many other kinds of
cancer as well, including cancer of the mouth,
larynx, esophagus, stomach, pancreas,
kidney, and bladder.
 Current estimates suggest that smoking
cigarettes is responsible for at least one out
of every three cancer deaths, making it the
largest single cause of death from cancer.
 Other forms of tobacco use also can cause
cancer. For example, cigars, pipe smoke, and
smokeless tobacco can cause cancers of the
mouth.
 Tobacco smoke – single most lethal chemical
carcinogens, accounts 30% of cancer death
in humans.
 Passive smoke (i.e., secondhand smoke) –
has been linked to lung cancer
 Nonsmoker who live with a smoker – have
20%-30% greater risk of developing lung
cancer.
54
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
Genes and Cancer
Discussions:
 Chemicals (e.g., from
smoking), radiation,
viruses, and heredity
all contribute to the
development of
cancer by triggering
changes in a cell’s genes. Chemicals and
radiation act by damaging genes, viruses
introduce their own genes into cells, and
heredity passes on alterations in genes that
make a person more susceptible to cancer.
 Genes are inherited instructions that reside
within a person’s chromosomes. Each gene
instructs a cell how to build a specific product-
-in most cases, a particular kind of protein.
Genes are altered, or “mutated,” in various
ways as part of the mechanism by which
cancer arises.
 When oncogene (hidden or repressed genetic
code for cancer that exists in all individuals) is
exposed to carcinogens, changes in cell
structure occurs, malignant tumor develops
 Regardless of the cause, several cancers are
associated with familial patterns.
Examples of gene related cancer:
Retinoblastoma, pheochromocytoma, Wilm’s
tumor, lung cancer, breast cancer
RETINOBLASTOMA
a rare malignant tumor of the
retina, affecting young children.
PHEOCHROMOCYTOMA
Pheochromocytoma - a small vascular tumor of
the adrenal medulla, causing irregular secretion
of epinephrine and norepinephrine, leading to
attacks of raised blood pressure, palpitations,
and headache.
WILM’S TUMOR
Wilms' tumor or nephroblastoma) is a type of
cancer that starts in the kidneys. It is the most
common type of kidney cancer in children. It is
named after Max Wilms, a German doctor who
Page 6 of 8
wrote one of the first medical articles about the
disease in 1899.
DIET
➢ Fats
➢ Alcohol – should be limited to 2 drinks / day
for men and 1 drink /day for women.
➢ Salt-cured / smoked meats
➢ Nitrates and Nitrites containing foods
➢ Red and processed meats
HARMFUL EFFECTS OF ALCOHOL
➢ Talc (polished rice, salami, chewing gum)
➢ Food sweeteners
➢ Nitrosamines (rubber baby nipples)
➢ Aflatoxins (mold in nuts and grains, milk,
cheese, peanut butter)
AVOID DRUGS, SMOKING, JUNK FOODS
High-Strength Radiation
Discussions:
 Increased rates
of cancer also
have been
detected in
people exposed
to high-strength
forms of radiation
such as X-rays
or radiation emitted from unstable atoms
called radioisotopes. Because these two
types of radiation are stronger than ultraviolet
radiation, they can penetrate through clothing
and skin into the body.
 Therefore, high-strength radiation can cause
cancers of internal body tissues. Examples
include cancer caused by nuclear fallout from
atomic explosions and cancers caused by
excessive exposure to radioactive chemicals.
Discussions:
 Exposure to sunlight or radiation
 Exposure to ionizing radiation can occur with
repeated diagnostic x-ray procedures or with
radiation therapy used to treat disease.
 Background radiation from the natural decay
processes that produce radon has also been
associated with lung cancer.
 Ventilation is advised to homes with high
levels of trapped radon to allow the gas to
disperse into the atmosphere.
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
AIDS and Kaposi’s Sarcoma
Discussions:
 People who
develop AIDS after
being infected with
the human
immunodeficiency
virus (HIV) are at
high risk for
developing a specific type of cancer called
Kaposi’s sarcoma.
 Kaposi’s sarcoma is a malignant tumor of
blood vessels located in the skin. This type of
cancer is not directly caused by HIV infection.
 Instead, HIV causes an immune deficiency
that makes people more susceptible to viral
infection. Infection by a virus called KSHV
(Kaposi’s sarcoma-associated herpesvirus)
then appears to stimulate the development of
Kaposi’s sarcoma.
Heredity and Cancer
Discussions:
 Cancer is not considered an inherited illness
because most cases of cancer, perhaps 80 to
90 percent, occur in people with no family
history of the disease.
 However, a person’s chances of developing
cancer can be influenced by the inheritance
of certain kinds of genetic alterations. These
alterations tend to increase an individual’s
susceptibility to developing cancer in the
future.
 For example, about 5 percent of breast
cancers are thought to be due to inheritance
of particular form(s) of a “breast cancer
susceptibility gene.”
Heredity Can Affect Many Types of Cancer
Inherited Conditions That Increase Risk for
Discussions:
 Inherited
mutations can
influence a
person’s risk
of developing
many types of cancer in addition to breast
cancer.
Page 7 of 8
 For example, certain inherited mutations have
been described that increase a person’s risk
of developing colon, kidney, bone, skin or
other specific forms of cancer. But these
hereditary conditions are thought to be
involved in only 10 percent or fewer of all
cancer cases.
HORMONAL AGENTS
• Tumor growth may be promoted by
disturbances in hormonal balance, either by
the body’s own (endogenous) hormone
production or by administration of exogenous
hormones.
• Cancers of the breast, prostate, and uterus
are thought to depend on endogenous
hormonal levels for growth.
ETIOLOGIC FACTORS TO CANCER:
HORMONAL AGENTS
➢ DIETHYLSTILBESTROL (DES) – cause
vaginal carcinomas
➢ ORAL CONTRACEPTIVES and prolonged
estrogen therapy – associated with an
increased incidence of hepatocellular,
endometrial, and breast cancers but
decrease the risk of ovarian cancer.
Discussions:
 The combination of estrogen and
progesterone appears safer than estrogen
alone in decreasing the risk of endometrial
cancers; however, studies support
discontinuing hormonal therapy containing
both estrogen and progestin because of the
increased risk of breast cancer, coronary
artery disease, stroke and blood clots.
Associated with an increased risk of breast
cancer:
✓ Early onset of menses before age 12
✓ Delayed onset of menopause after age
55,
✓ nulliparity (never giving birth),
✓ delayed childbirth after age 30
• Increased nos. of pregnancies are associated
with a decreased incidence of breast,
endometrial, and ovarian cancers.
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor

Page 8 of 8
 WHAT IS CANCER?
PREDISPOSING FACTORS OF CANCER
TUTOR || September 15, 2022
Transcribers: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name
Editors: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name
Outline
Legend:
Remember
Lecturer Book
(Exams)
  
Heading 1
 Heading 2
• The quick brown fox jumps over the lazy dog
 The quick brown fox jumps over the lazy dog
▪ The quick brown fox jumps over the lazy dog
• The quick brown fox jumps over the lazy dog
Subheading
Predisposing Factors of CANCER
AGE
 older individuals are more prone to cancer
because they have been exposed to
carcinogens longer. In addition, they have
developed alterations in the immune
system
SEX
 The most common type of cancer in
females is breast cancer. Whereas, the
most common type of cancer in males is
prostate cancer
URBAN VS. RURAL RESIDENCE
 Cancer is more common among urban
dwellers than among rural residents. This
is probably due to greater exposure to
carcinogens, more stressful lifestyle and
greater consumption of preservative –
cured foods among urban dwellers.
GEOGRAPHIC DISTRIBUTION
 The most common type of cancer in Japan
is gastric cancer.
 While the most common type of cancer in
the US is breast cancer.
Discussions:
 This may be due to influence of
environmental factors as national diet (raw
foods greatly consist Japanese diet),
ethnic customs, types of pollutions
OCCUPATION
 there is greater risk of exposure to
carcinogens among chemical factory
MED-SURG
workers, farmers, radiology department
personnel
Previous
Trans HEREDITY
  Positive family history of cancer increases
the risk to develop the disease.
Discussions:
 In adults, approximately 34% of cancers
have a familial basis.
 Cancers that may have familial link include
breast, ovarian, colorectal, prostate,
melanoma, uterine, leukemia, sarcomas,
and primary brain tumors.
STRESS
 Depression, grief, anger, aggression,
despair, or life stresses decrease
immunocompetence because of
affectation of hypothalamus and pituitary
gland.
 Immunodeficiency may spur the growth
and proliferation of cancer cells.
PRECANCEROUS LESIONS
 Pigmented moles,
 burn scars,
 senile keratosis,
 leukoplakia,
 benign polyps or adenoma of the colon /
stomach,
 fibrocystic disease of the breast,
Discussions:
 all of the above may undergo
transformation into cancerous lesions and
tumors
OBESITY
 Studies have linked obesity to breast
cancer (in postmenopausal women).
 Also associated with increased risk for
cancers of the pancreas, gallbladder,
thyroid, ovary, and cervix, and for multiple
myeloma
Page 1 of 1
 WHAT IS CANCER?
PATHOPHYSIOLOGY OF CANCER MED-SURG
TUTOR || September 15, 2022
Transcribers: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name
Editors: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name

Outline
Legend:
Remember
Lecturer Book
(Exams)
  
Heading 1
 Heading 2
• The quick brown fox jumps over the lazy dog
 The quick brown fox jumps over the lazy dog
▪ The quick brown fox jumps over the lazy dog
• The quick brown fox jumps over the lazy dog
Subheading
PATHOPHYSIOLOGY OF CANCER
PATHOPHYSIOLOGY
ABNORMAL CELL FORMED BY MUTATION OF
DNA
l Discussions:
CELL GROWS AND PROLIFERATES
l serious health problem than a benign tumor
METASTASIS OCCURS WHEN ABN. CELLS
INVADE OTHER TISSUE,THROUGH LYMPH
AND BLOOD
− Cancer development linked to immune
system failure
− Example of clients susceptible to developing
cancer
Classification of Cancer
 According to Behavior of Tumor
a. Benign - tumors that cannot spread by
invasion or metastasis; hence, they only
grow locally
b. Malignant - tumors that are capable of
spreading by invasion and metastasis. By
definition, the term “cancer” applies only to
malignant tumors
Malignant versus Benign Tumors
 Malignant (cancer) cells invade
neighboring tissues, enter blood vessels,
and metastasize to different sites
 Benign (not cancer) tumor cells grow
only locally and cannot spread by invasion
or metastasis
Discussions:
 Depending on whether or not they can spread
Previous
by invasion and metastasis, tumors are
Trans classified as being either benign or malignant.
  Benign tumors are tumors that cannot
spread by invasion or metastasis; hence, they
only grow locally.
 Malignant tumors are tumors that are
capable of spreading by invasion and
metastasis. By definition, the term “cancer”
applies only to malignant tumors.
Why Cancer Is Potentially Dangerous
 Melanoma cells travel through bloodstream
 Melanoma (initial tumor)
 Brain
 Liver
 A malignant tumor, a “cancer,” is a more
because cancer cells can spread to distant
parts of the body.
 For example, a melanoma (a cancer of
pigmented cells) arising in the skin can have
cells that enter the bloodstream and spread to
distant organs such as the liver or brain.
Cancer cells in the liver would be called
metastatic melanoma, not liver cancer.
 Metastases share the name of the original
(“primary”) tumor. Melanoma cells growing in
the brain or liver can disrupt the functions of
these vital organs and so are potentially life
threatening.
Patterns of cell Proliferation
• Hyperplasia
• Dysplasia
• Metaplasia
• Anaplasia
• Neoplasia
Hyperplasia
 tissue growth based on an excessive rate of
cell division, leading to a larger than usual
number of cells; the process of hyperplasia is
potentially reversible; can be a normal tissue

Page 1 of 5
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
response to an irritating stimulus. An example
is a callus
Discussions:
 Instead of finding a benign or malignant
tumor, microscopic examination of a biopsy
specimen will sometimes detect a condition
called “hyperplasia.”
 Hyperplasia refers to tissue growth based on
an excessive rate of cell division, leading to a
larger than usual number of cells.
Nonetheless, cell structure and the orderly
arrangement of cells within the tissue remain
normal, and the process of hyperplasia is
potentially reversible.
 Hyperplasia can be a normal tissue response
to an irritating stimulus. An example of
hyperplasia is a callus that may form on your
hand when you first learn to swing a tennis
racket or a golf club.
Dysplasia
 Bizarre cell growth differing in size, shape and
cell arrangement
Discussions:
 In addition to hyperplasia, microscopic
examination of a biopsy specimen can detect
another type of noncancerous condition
called “dysplasia.”
 Dysplasia is an abnormal type of excessive
cell proliferation characterized by loss of
normal tissue arrangement and cell structure.
Often such cells revert back to normal
behavior, but occasionally they gradually
become malignant.
 Because of their potential for becoming
malignant, areas of dysplasia should be
closely monitored by a health professional.
Sometimes they need treatment.
Page 2 of 5
Carcinoma in Situ
 The most severe cases of dysplasia are
sometimes referred to as “carcinoma in situ.”
 In Latin, the term “in situ” means “in place,” so
carcinoma in situ refers to an uncontrolled
growth of cells that remains in the original
location.
 However, carcinoma in situ may develop into
an invasive, metastatic malignancy and,
therefore, is usually removed surgically, if
possible.
Patterns of cell Proliferation
➢ Metaplasia
− conversion of one type of cell in a tissue to
another type not normal for that tissue
➢ Anaplasia
− change in the DNA cell structure and
orientation to one another, characterized
by loss of differentiation and a return to a
more primitive form.
➢ Neoplasia
− uncontrolled cell growth, either benign or
malignant
15
Metastasis
• Metastasis: 3 stages
a. Invasion – neoplastic cells from primary
tumor invade into surrounding tissue with
penetration of blood or lymph.
b. Spread – tumor cells spread through
lymph or circulation or by direct expansion
c. Establishment and growth – tumor cells
are established and grow in secondary
site: lymph nodes or in organs from
venous circulation
Cancer Tends to Involve Multiple Mutations
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
Discussions:
 Cancer may begin because of the
accumulation of mutations involving
oncogenes, tumor suppressor genes, and
DNA repair genes. For example, colon cancer
can begin with a defect in a tumor suppressor
gene that allows excessive cell proliferation.
 The proliferating cells then tend to acquire
additional mutations involving DNA repair
genes, other tumor suppressor genes, and
many other growth-related genes.
 Over time, the accumulated damage can yield
a highly malignant, metastatic tumor. In other
words, creating a cancer cell requires that the
brakes on cell growth (tumor suppressor
genes) be released at the same time that the
accelerators for cell growth (oncogenes) are
being activated.
Mutations and Cancer
Genes Implicated in Cancer
Discussions:
 While the prime suspects for cancer-linked
mutations are the oncogenes, tumor
suppressor genes, and DNA repair genes,
cancer conspires even beyond these.
 Mutations also are seen in the genes that
activate and deactivate carcinogens, and in
those that govern the cell cycle, cell
senescence (or “aging”), cell suicide
(apoptosis), cell signaling, and cell
differentiation. And still other mutations
develop that enable cancer to invade and
metastasize to other parts of the body.
Page 3 of 5
Cancer Tends to Corrupt Surrounding
Environment
Discussions:
 In addition to all the molecular changes that
occur within a cancer cell, the environment
around the tumor changes dramatically as
well.
 The cancer cell loses receptors that would
normally respond to neighboring cells that call
for growth to stop. Instead, tumors amplify
their own supply of growth signals. They also
flood their neighbors with other signals called
cytokines and enzymes called proteases.
 This action destroys both the basement
membrane and surrounding matrix, which lies
between the tumor and its path to metastasis-
-a blood vessel or duct of the lymphatic
system.
Classification of Tumors
➢ CARCINOMAS: EPITHELIAL TISSUE
− BODY SURFACES, LINING OF BODY
CAVITIES ETC: (ADENOCARCINOMA)
➢ SARCOMAS: CONNECTIVE TISSUE
− STRIATED MUSCLE, BONE, ETC
(OSTEOSARCOMA)
➢ LYMPHOMAS AND LEUKEMIAS
− HEMATOPOIETIC SYSTEM
➢ NERVOUS TISSUE TUMORS
− EX. NERVE CELLS-NEUROBLASTOMA
➢ MYELOMA
− Develops in the plasma cells of bone
marrow
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor

stand for the location where the cancer began

Different Kinds of Cancer Lung its unchecked growth.
 For example, the prefix “osteo” means bone,
so a cancer arising in bone is called an
osteosarcoma. Similarly, the prefix “adeno”
means gland, so a cancer of gland cells is
called adenocarcinoma--for example, a breast
adenocarcinoma.

COMMON CAUSES OF CANCER

1. BREAST CANCER
− early menarche
Discussions: − late menopause
 Cancer can originate almost anywhere in the − nulliparous or older than 30 years at the
body. birth of a first child.
 Carcinomas, the most common types of 2. LUNG CANCER
cancer, arise from the cells that cover − tobacco abuse
external and internal body surfaces. Lung, − asbestos
breast, and colon are the most frequent − radiation exposure
cancers of this type in the United States. − air pollution
 Sarcomas are cancers arising from cells 3. COLORECTAL CANCER
found in the supporting tissues of the body
− greater incidence in men
such as bone, cartilage, fat, connective
− familial polyposis
tissue, and muscle.
 Lymphomas are cancers that arise in the − ulcerative colitis
lymph nodes and tissues of the body’s − high – fat, low - fiber diet
immune system. − Fmilial polyposis
 Leukemias are cancers of the immature − Ulcerative colitis
blood cells that grow in the bone marrow and 4. PROSTATE CANCER
tend to accumulate in large numbers in the − Common among males who are 50 years
bloodstream. old and older
− African Americans have the highest
Naming Cancers incidence of prostate cancer in the world
− Positive family history
− Exposure to cadmium
5. CERVICAL CANCER
− Sexual Behavior
− First intercourse at an early age
− Multiple sexual partners
− Sexual partner who has had multiple
sexual partner
− Human papilloma virus and AIDS
(acquired immunodeficiency syndrome)
− Low socioeconomic status
− Cigarette smoking
Discussions: 6. HEAD AND NECK CANCER
 Scientists use a variety of technical names to
− More common among males
distinguish the many different types of
− alcohol and tobacco use
carcinomas, sarcomas, lymphomas, and
leukemias. In general, these names are − Poor oral hygiene
created by using different Latin prefixes that − Long term sun exposure

Page 4 of 5
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor

− Occupational exposures – asbestos, tar,

nickel, textile, wood or leather work, and
machine tool experience
7. SKIN CANCER
− individuals with fair complexion
− positive family history
− moles (nevi)
− exposure to coal tar, creosote, arsenic,
radium
− sun exposure between 11 AM to 3 PM

“ Women who smoke like men,

die like men.”

Page 5 of 5
 WHAT IS CANCER?
Effects of Cancer MED-SURG
TUTOR || September 16, 2022
Transcribers: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name
Editors: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name

Outline Cancer signs: CAUTION US!

Legend:
Remember Previous
➢ Change in bowel or bladder habits
(Exams)
Lecturer Book
Trans ➢ A sore that does not heal
    ➢ Unusual bleeding or discharge
➢ Thickenings or lumps
Heading 1 ➢ Indigestion or difficulty in swallowing
 Heading 2 ➢ Obvious change in a wart or mole
• The quick brown fox jumps over the lazy dog ➢ Nagging or persistent cough or hoarseness
 The quick brown fox jumps over the lazy dog
➢ Unexplained anemia
▪ The quick brown fox jumps over the lazy dog
➢ Sudden unexplained weight loss
• The quick brown fox jumps over the lazy dog
Subheading
Warning Signs of Cancer
EFFECTS OF CANCER ▪ C – change in bowel, bladder habits
 Disruption of Function- can be due to - Changes in color; consistency
obstruction or pressure - Size or shape of stools
 Hematologic Alterations: can impair function - Blood present in urine or stool
of blood cells - Alternating constipation and
 Hemorrhage: tumor erosion, bleeding, severe - diarrhea – most characteristic
anemia - manifestation of colon cancer
 Anorexia- Cachexia Syndrome: wasted
appearance of client Discussions:
 A person with colon cancer may have
Effects of Cancer diarrhea or constipation, or he may notice that
 Paraneoplastic Syndromes: ectopic sites with the stool has become smaller in diameter
excess hormone production  A person with bladder or kidney cancer may
- ↑ Parathyroid hormone→ hypercalcemia have urinary frequency and urgency
- ↑ secretion of insulin→ hypoglycemia
- ↑ Antidiuretic hormone (ADH) → fluid ▪ A – a sore that does not heal
retention, HTN & peripheral edema Sores that:
 ↑ Adrenocorticotropic hormone (ACTH): - Don’t seem to be getting better over time
cause excessive secretion of cortisone (ie: - Are getting bigger
fluid retention, ↑ glucose levels) - Getting more painful
 Pain: major concern of clients and families - Are starting to bleed
associated with cancer
 Physical Stress: body tries to respond and Discussions:
destroy neoplasm  Because tumor causes impaired circulation
 Psychological Stress and oxygenation in the area.
 Small, scaly patches on the skin that bleed or
ASSESSMENT do not heal may be a sign of skin cancer
 Nursing History  A sore in the mouth that does not heal can
- Health History – chief complaint and indicate oral cancer
history of present illness (onset, course,
duration, location, precipitating and ▪ U – unusual bleeding or discharge
alleviating factors) - Blood in the urine and stool
- Discharge from any parts of the body*

Page 1 of 4
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
Discussions:
 Blood in the stool is often the first sign of
colon cancer
 Similarly, blood in the urine is usually the first
sign of bladder or kidney cancer
 Postmenopausal bleeding (bleeding after
menopause) may be a sign of uterine cancer
▪ T – thickening or lump in the breast or
elsewhere
- Any lumps found in the breast when doing
BSE
- Any lump in the scrotum when doing self-
exam
- Other lumps found in the body
Discussions:
 Enlargement of the lymph nodes or glands
(such as the thyroid gland) can be an early
sign of cancer
 Breast and testicular cancers may also
present as a lump
▪ I – indigestion or difficulty in swallowing
- Feeling pressure in throat or chest which
makes swallowing uncomfortable
- Feeling full without food or with a small
amount of food
Discussions:
 Cancers of the digestive system, including
those of the esophagus, stomach, and
pancreas, may cause indigestion, heartburn,
or difficulty swallowing
▪ O – obvious change in wart or mole
Use the ABCD Rule:
- A – asymmetry
- B – Border
- C – Color
- D - Diameter
Discussions:
 A - are mole looks the same or different
 B- sharp or ragged
 C-colors seen in the mole
 D-is mole bigger than a pencil eraser
 Moles or other skin lesions that change in
shape, size, or color should be reported
Page 2 of 4
▪ N – nagging cough or hoarseness
- Change in voice or hoarseness
- Cough that does not go away
- Sputum with blood
Discussions:
 Cancers of the respiratory tract, including
lung cancer and laryngeal cancer, may
cause a cough that does not go away or a
hoarse (rough) voice
▪ U – Unexplained anemia
Discussions:
 In EACH CASE, fewer RBC means there
is less hgb to carry O2 throughout the
body
▪ S – Sudden weight loss
 Tumor use your blood and nutrients and
release your waste product inside your
body
 Sometimes tumor release chemicals that
can increase the body’s metabolism which
can lead to unexplained weight loss
Physical Assessment
• Inspection – skin and mucus membranes for
lesions, bleeding, petechiae, and irritation
- Assess stools, urine, sputum, vomitus for
acute or occult bleeding
- Scalp noting hair texture and hair loss
• Palpation
- Abdomen for any masses, bulges or
abnormalities
Lymph nodes for enlargement
• Auscultation – of lung sounds, heart sounds
and bowel sounds
Laboratory & Diagnostic Tests
▪ Cancer detection examination
▪ Laboratory tests
- Complete blood cell count (CBC)
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
- Tumor markers – identify substance
(specific proteins) in the blood that are made
by the tumor
➢ PSA (Prostatic-specific antigen): prostate
cancer
➢ CEA (Carcinoembryonic antigen): colon
cancer
➢ Alkaline Phosphatase: bone metastasis
- Biopsy
Diagnostic Tests
➢ Determine location of cancer:
➢ X-rays
➢ Computed tomography
➢ Ultrasounds
➢ Magnetic resonance imaging
➢ Nuclear imaging
➢ Angiography
Diagnosis of cell type:
- Tissue samples: from biopsies, shedded cells
(e.g. Papanicolaou (PAP) smear), & washings
- Cytologic Examination: tissue examined
under microscope
Direct Visualization:
▪ Sigmoidoscopy
▪ Cystoscopy
▪ Endoscopy
▪ Bronchoscopy
▪ Exploratory surgery; lymph node biopsies to
determine metastases
Cancer Detection and Diagnosis
Discussions:
 Detecting cancer early can affect the outcome
of the disease for some cancers. When
cancer is found, a doctor will determine what
type it is and how fast it is growing.
 He or she will also determine whether cancer
cells have invaded nearby healthy tissue or
spread (metastasized) to other parts of the
body.
 In some cases, finding cancer early may
decrease a person’s risk of dying from the
cancer. For this reason, improving our
methods for early detection is currently a high
priority for cancer researchers.
Page 3 of 4
Early Cancer May Not Have Any Symptoms
Discussions:
 Some people visit the doctor only when they
feel pain or when they notice changes like a
lump in the breast or unusual bleeding or
discharge. But don’t wait until then to be
checked because early cancer may not have
any symptoms.
 That is why screening for some cancers is
important, particularly as you get older.
Screening methods are designed to check
for cancer in people with no symptoms.
Cervical Cancer Screening
Discussions:
 A screening
technique
called the Pap
test (or Pap
smear) allows
early detection
of cancer of the
cervix, the
narrow portion
of the uterus
that extends
down into the
upper part of
the vagina.
 In this
procedure, a doctor uses a small brush or
wooden scraper to remove a sample of cells
from the cervix and upper vagina. The cells
are placed on a slide and sent to a laboratory,
where a microscope is used to check for
abnormalities.
 Since the 1930s, early detection using the
Pap test has helped lower the death rate from
cervical cancer more than 75 percent.
 Should abnormalities be found, an additional
test may be necessary. There are now 13
high-risk types of human papillomaviruses
(HPV) recognized as the major causes of
cervical cancer.
 The U.S. Food and Drug Administration has
approved an HPV test that can identify their
presence in a tissue sample. This test can
detect the viruses even before there are any
conclusive visible changes to the cervical
cells.
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
Breast Cancer Screening
Discussions:
 Breast cancer can sometimes be detected in
its early stages using a mammogram, an X-
ray of the breast.
 Mammography is most beneficial for women
as they age and undergo menopause.
Mammography is a screening tool that can
detect the possible presence of an abnormal
tissue mass.
 By itself, it is not accurate enough to provide
definitive proof of either the presence or the
absence of breast cancer. If a mammogram
indicates the presence of an abnormality,
further tests must be done to determine
whether breast cancer actually is present.
Prostate and Ovarian Cancer Screening
Discussions:
 The U.S. Food and Drug Administration has
approved the PSA test along with a digital
rectal exam to help detect prostate cancer in
men age 50 and older. Doctors often use the
PSA test and DRE as prostate cancer
screening tests; together, these tests can
help doctors detect prostate cancer in men
who have no symptoms of the disease.
 Most men with an elevated PSA test, though,
turn out not to have cancer; only 25 to 30
percent of men who have a biopsy due to
elevated PSA levels actually have prostate
cancer, so researchers are working hard to
find new clues.
 Experts are trying to develop better blood
tests that might alert people to malignancies
while the cancers are still in their early stages.
For example, several new blood tests for
ovarian or prostate cancer are under
development.
Colon Cancer Screening
Discussions:
 A procedure called a fecal occult blood test
(FOBT) detects invisible amounts of blood in
the feces, a possible sign of several
disorders, including colon cancer.
 The test is painless and can be done at home
or in the doctor’s office along with a rectal
exam. With an application stick, a dab of a
stool specimen is smeared on a chemically
treated card, which is tested in a laboratory
for evidence of blood. If blood is confirmed in
the stool, more elaborate tests may be
performed to find the source of the bleeding.
Page 4 of 4
 Some other options include sigmoidoscopy
and colonoscopy. The former exam uses a
lighted instrument called a sigmoidoscope to
find precancerous or cancerous growths in
the rectum and lower colon. The latter exam
uses a lighted instrument called a
colonoscope to find precancerous or
cancerous growths throughout the colon,
including the upper part.
Biopsy
Discussions:
 To diagnose the presence of cancer, a doctor
must look at a sample of the affected tissue
under the microscope. Hence, when
preliminary symptoms, Pap test,
mammogram, PSA test, FOBT, or
colonoscopy indicate the possible existence
of cancer, a doctor must then perform a
biopsy, which is the surgical removal of a
small piece of tissue for microscopic
examination. (For leukemias, a small blood
sample serves the same purpose.)
 This microscopic examination will tell the
doctor whether a tumor is actually present
and, if so, whether it is malignant (i.e., cancer)
or benign.
 In addition, microarrays may be used to
determine which genes are turned on or off in
the sample, or proteomic profiles may be
collected for an analysis of protein activity.
This information will help doctors to make a
more accurate diagnosis and may even help
to inform treatment planning.
Microscopic Appearance of Cancer Cells
Back
Discussions:
 Cancer
tissue has a
distinctive
appearance
under the
microscope.
Among the
traits the
doctor looks
for are a
large number of irregularly shaped dividing
cells, variation in nuclear size and shape,
variation in cell size and shape, loss of
specialized cell features, loss of normal tissue
organization, and a poorly defined tumor
boundary.
 WHAT IS CANCER?
Tumor Staging and Grading
TUTOR || September 17, 2022
Transcribers: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name
Editors: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name
Outline
Legend:
Remember
Lecturer Book
(Exams)
  
Heading 1
 Heading 2
• The quick brown fox jumps over the lazy dog
 The quick brown fox jumps over the lazy dog
▪ The quick brown fox jumps over the lazy dog
• The quick brown fox jumps over the lazy dog
Subheading
TUMOR STAGING AND GRADING
Cancer Staging
 Stage refers to the extent of your cancer,
such as how large the tumor is, and if it has
spread. Knowing the stage of the cancer
helps the doctor:
✓ Understand how serious the cancer is and
the chances of survival
✓ Plan the best treatment for the patient
✓ Identify clinical trials that may be treatment
options for the patient
 A cancer is always referred to by the stage it
was given at diagnosis, even if it gets worse
or spreads. New information about how a
cancer has changed over time gets added on
to the original stage. So, the stage doesn't
change, even though the cancer might.
How Stage Is Determined
Systems that Describe Stage
 There are many staging systems. Some, such
as the TNM staging system, are used for
many types of cancer. Others are specific to a
particular type of cancer. Most staging
systems include information about:
• Where the tumor is located in the body
• The cell type (such as, adenocarcinoma or
squamous cell carcinoma)
• The size of the tumor
• Whether the cancer has spread to nearby
lymph nodes
• Whether the cancer has spread to a
different part of the body
MED-SURG
 Tumor grade, which refers to how abnormal
the cancer cells look and how likely the tumor
Previous
is to grow and spread
Trans
  Doctors use diagnostic tests like biopsies and
imaging exams to determine a cancer's grade
and its stage. While grading and staging help
doctors and patients understand how serious
a cancer is and form a treatment plan, they
measure two different aspects of the disease.
What is a cancer grade?
 A cancer’s grade describes how abnormal the
cancer cells and tissue look under a
microscope when compared to healthy cells.
Cancer cells that look and organize most like
healthy cells and tissue are low grade tumors.
Doctors describe these cancers as being well
differentiated. Lower grade cancers are
typically less aggressive and have a better
prognosis.
 The more abnormal the cells look and
organize themselves, the higher the cancer’s
grade. Cancer cells with a high grade tend to
be more aggressive. They are called poorly
differentiated or undifferentiated.
Some cancers have their own system for
grading tumors. Many others use a standard
1-4 grading scale.
➢ Grade 1: Tumor cells and tissue looks most
like healthy cells and tissue. These are called
well-differentiated tumors and are considered
low grade.
➢ Grade 2: The cells and tissue are somewhat
abnormal and are called moderately
differentiated. These are intermediate grade
tumors.
➢ Grade 3: Cancer cells and tissue look very
abnormal. These cancers are considered
poorly differentiated, since they no longer
have an architectural structure or pattern.
Grade 3 tumors are considered high grade.
➢ Grade 4: These undifferentiated cancers
have the most abnormal looking cells. These
are the highest grade and typically grow and
spread faster than lower grade tumors.
Page 1 of 5
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
What is a cancer stage?
 While a grade describes the appearance of
cancer cells and tissue, a cancer’s stage
explains how large the primary tumor is and
how far the cancer has spread in the patient’s
body.
 There are several different staging systems.
Many of these have been created for specific
kinds of cancers. Others can be used to
describe several types of cancer.
Stage 0 to stage IV
 One common system that many people are
aware of puts cancer on a scale of 0 to IV.
 Stage 0 is for abnormal cells that haven’t
spread and are not considered cancer,
though they could become cancerous in the
future. This stage is also called “in-situ.”
 Stage I through Stage III are for cancers that
haven’t spread beyond the primary tumor site
or have only spread to nearby tissue. The
higher the stage number, the larger the tumor
and the more it has spread.
 Stage IV cancer has spread to distant areas
of the body.
Another staging system that is used for all types
of cancer groups the cancer into one of five main
categories. This staging system is more often
used by cancer registries than by doctors. But
you may still hear your doctor or nurse describe
your cancer in one of the following ways:
➢ In situ—Abnormal cells are present but
have not spread to nearby tissue.
➢ Localized—Cancer is limited to the place
where it started, with no sign that it has
spread.
➢ Regional—Cancer has spread to nearby
lymph nodes, tissues, or organs.
➢ Distant—Cancer has spread to distant
parts of the body.
➢ Unknown—There is not enough
information to figure out the stage.
TNM staging
 Another common staging tool is the TNM
system, which stands for Tumor, Node,
Metastasis. When a patient’s cancer is staged
with TNM, a number will follow each letter.
This number signifies the extent of the
Page 2 of 5
disease in each category. According to the
National Cancer Institute and MD Anderson
experts, the standard TNM system uses the
following rules:
Primary tumor (T)
 TX: Main tumor cannot be measured.
 T0: Main tumor cannot be found.
 T(is), or T in situ: The tumor is still within the
confines of the normal glands and cannot
metastasize.
 T1, T2, T3, T4: Refers to the size and/or
extent of the main tumor. The higher the
number after the T, the larger the tumor or the
more it has grown into nearby tissues. T's
may be further divided to provide more detail,
such as T3a and T3b.
Regional lymph nodes (N)
 Lymphatic fluid transports immune system
cells throughout the body. Lymph nodes are
small bean-shaped structures that help move
this fluid. Cancer often first spreads to and
through nearby lymph nodes.
• NX: Cancer in nearby lymph nodes cannot
be measured.
• N0: There is no cancer in nearby lymph
nodes.
• N1, N2, N3: Refers to the number and
location of lymph nodes that contain
cancer. The higher the number after the N,
the more lymph nodes that contain cancer.
Distant metastasis (M)
 Metastasis is the spread of cancer to other
parts of the body.
• MX: Metastasis cannot be measured.
• M0: Cancer has not spread to other parts
of the body.
• M1: Cancer has spread to other parts of
the body.
Approaches to Control Cancer
 There are four principal approaches to cancer
control:
1. Prevention
2. Early Detection
3. Diagnosis and Treatment
4. Palliative Care
 [SUB] 1.01 TITLE OF LECTURE – Dr. Professor
CANCER DETECTION EXAMINATIONS
1. CYTOLOGIC EXAMINATION or PAPANICOLAU
TEST (PAP’S EXAM, PAP SMEAR)
 Cytologic specimen can be obtained from
tumors that tend to shed cells from their
surface, e.g., G.I. tract through endoscopy,
respiratory tract through laryngoscopy and
bronchoscopy, genito-urinary tract through
colposcopy of the cervix and vagina,
cystoscopy of the bladder, laparoscopy of the
pelvic and abdominal cavity.
INTERPRETATION OF PAPANICOLAU TEST
RESULTS ARE AS FOLLOWS:
CLASS I - Normal
CLASS II - Inflammation
CLASS III - Mild to moderate dysplasia
CLASS IV - Probably Malignant
CLASS V - Possibly Malignant
Discussion:
➢ CLASS I result requires follow – up
examination every 1 to 3 years as
recommended by the physician
➢ CLASS II and III results may require repeat
Pap exam in 3 to 6 months as prescribed
➢ CLASS IV and V results require biopsy as
prescribed
2. BIOPSY – involves obtaining tissue samples by
needle aspiration, or incision of tumor.
• Needle biopsy is done by aspiration of
tumor cells with needle and syringe
• Excisional biopsy is done by removing the
entire tumor. It is done when the tumor is
small.
• Incisional or subtotal biopsy is done by
taking only a part of the tumor. The is
done when the tumor is large.
3. Ultrasound
➢ Magnetic Resonance Imaging (MRI),
➢ Radio diagnostic Test (e.g. X-RAYS,
Mammography)
➢ Computed Tomography (CT Scan),
➢ Endoscopic Examinations
4. LABORATORY BLOOD TESTS FOR CANCER
➢ HEMATOLOGIC (CBC)
Page 3 of 5
➢ Hemoglobin
➢ Hematocrit
➢ Leukocytes
➢ Platelets
LABORATORY BLOOD TESTS FOR CANCER
 TUMOR MARKERS
➢ AFP (Alpha – Feto – Protein)
➢ CEA (Carcinoembryonic Antigen)
➢ HCG (Human Chorionic Gonadotropin)
➢ Prostatic Acid Phosphatase
➢ PSA (Prostatic Specific Antigen)
➢ Hemoglobin and Hematocrit are low in
anemia; may indicate malignancy
Discussion:
 Leukocytes (WBC’s) are high in leukemia
(immature WBC’s), lymphomas;
 low in leukemia (mature WBC’s) and
metastatic disease to bone marrow.
 Platelets are high in CML (Chorionic
Myelocytic Leukemia), Hodgkin’s disease;
 low in ALL (Acute Lymphocytic Leukemia),
AML (Acute Myelocytic Leukemia), Multiple
Myeloma, bone marrow depression.
 AFP is elevated in lung, testicular, pancreatic,
colon, gastric cancers, and choriocarcinoma
Discussion:
 CEA is elevated in colorectal, breast, lung,
stomach, pancreatic, and prostate cancers
 HCG is elevated in choriocarcinoma, germ
cell testicular cancer, ectopic production in
lung, liver, gastric, pancreatic, and colon
cancers.
 Prostatic Acid Phosphatase is elevated in
metastatic prostate cancer. PSA is elevated in
prostate cancer.
NURSING DIAGNOSES
 Acute or chronic pain
 Impaired skin integrity
 Impaired oral mucous membrane
 Risk for injury
 Risk for infection
 Fatigue
 Imbalanced nutrition: less than body
requirements
 Risk for imbalanced fluid volume
 Anxiety
 Disturbed body image
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
 Deficient knowledge
 Ineffective coping
 Social isolation
OUTCOME IDENTIFICATION
1. Pain relief
2. Integrity of skin and oral mucosa
3. Absence of injury and infection
4. Fatigue relief
5. Maintenance of nutritional intake and fluid
and electrolyte balance
6. Improved body image
7. Absence of complications
8. Knowledge of prevention and cancer
treatment
9. Effective coping through recovery and
grieving process
10. Optimal social interaction
IMPLEMENTATION/MANAGEMENT
 Prevention and detection
➢ Primary Prevention
- Reducing modifiable risk factors in the
external and internal environment
➢ Secondary Prevention
- Recognizing early signs and symptoms
and seeking prompt treatment
- Prompt intervention to halt cancerous
process
➢ Tertiary Prevention
- focus on monitoring and preventing
recurrence of the primary cancer as well
as screening for development of second
malignancies in cancer survivors.
✓ Chemotherapy
✓ Radiation therapy
Cancer Prevention
1. Cancer viruses or bacteria
2. Carcinogenic radiation
3. Carcinogenic chemicals
Discussions:
 Since exposure to carcinogens (cancer-
causing agents) is responsible for triggering
most human cancers, people can reduce their
cancer risk by taking steps to avoid such
agents.
 Hence the first step in cancer prevention is to
identify the behaviors or exposures to
particular kinds of carcinogens and viruses
that represent the greatest cancer hazards.
Page 4 of 5
Avoid Tobacco
Discussions:
 As the single largest cause of cancer death,
the use of tobacco products is implicated in
roughly one out of every three cancer
deaths.
 Cigarette smoking is responsible for nearly
all cases of lung cancer, and has also been
implicated in cancer of the mouth, larynx,
esophagus, stomach, pancreas, kidney, and
bladder. Pipe smoke, cigars, and smokeless
tobacco are risky as well.
 Avoiding tobacco is therefore the single
most effective lifestyle decision any person
can make in attempting to prevent cancer.
Protect Yourself from Excessive Sunlight
Discussions:
 While some sunlight is good for health, skin
cancer caused by excessive exposure to
sunlight is not among the sun’s benefits.
Because some types of skin cancer are easy
to cure, the danger posed by too much
sunlight is perhaps not taken seriously
enough.
 It is important to remember that a more
serious form of skin cancer, called melanoma,
is also associated with excessive sun
exposure. Melanomas are potentially lethal
tumors. Risk of melanoma and other forms of
skin cancer can be significantly reduced by
avoiding excessive exposure to the sun,
using sunscreen lotions, and wearing
protective clothing to shield the skin from
ultraviolet radiation.
Limit Alcohol and Tobacco
Discussions:
 Drinking excessive amounts of alcohol is
linked to an increased risk for several kinds of
cancer, especially those of the mouth, throat,
and esophagus. The combination of alcohol
and tobacco appears to be especially
dangerous.
 For example, in heavy smokers or heavy
drinkers, the risk of developing cancer of the
esophagus is roughly 6 times greater than
that for nonsmokers/nondrinkers. But in
people who both smoke and drink, the cancer
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor

risk is more than 40 times greater than that
for nonsmokers/nondrinkers.
 Clearly the combination of alcohol and
tobacco is riskier than would be expected by
just adding the effects of the two together.
can, in turn, increase the chance that mild
cervical abnormalities will progress to more
severe ones or to cervical cancer.
Avoid Carcinogens at Work

Diet: Limit Fats and Calories

Discussions:
 Studies suggest that differences in diet may
also play a role in determining cancer risk.
Unlike clear-cut cancer risk factors such as
tobacco, sunlight, and alcohol, dietary
components that influence cancer risk have
been difficult to determine.
 Limiting fat consumption and calorie intake
appears to be one possible strategy to
decrease risk for some cancers, because
people who consume large amounts of meat, Discussions:
which is rich in fat, and large numbers of  Because people spend so much time at work,
calories exhibit an increased cancer risk, potential carcinogens in the work environment
especially for colon cancer. are studied carefully. Some occupational
carcinogens have been identified because
Diet: Consume Fruits and Vegetables coworkers exposed to the same substances
Discussions: have developed a particular kind of cancer at
 In contrast to factors such as fat and calories, increased frequency.
which appear to increase cancer risk, other  For example, cancer rates in construction
dietary components may decrease cancer workers who handle asbestos have been
risk. found to be 10 times higher than normal.
 The most compelling evidence has been
obtained for fruits and vegetables, whose Industrial Pollution
consumption has been strongly correlated Discussions:
with a reduction in cancer risk.  The fact that several environmental chemicals
 Although the exact chemical components in can cause cancer has fostered the idea that
these foods that are responsible for a industrial pollution is a frequent cause of
protective effect are yet to be identified, cancer. However, the frequency of most
eating five to nine servings of fruits and human cancers (adjusted for age) has
vegetables each day is recommended by remained relatively constant over the past
many groups. half-century, in spite of increasing industrial
pollution.
Avoid Cancer Viruses  So, in spite of evidence that industrial
Discussions: chemicals can cause cancer in people who
 Actions can also be taken to avoid exposure work with them or in people who live nearby,
to the small number of viruses that have been industrial pollution does not appear to be a
implicated in human cancers. A good major cause of most cancers in the population
example is the human papillomavirus (HPV). at large.
 Of the more than 100 types of HPVs, over 30
types can be passed from one person to
another through sexual contact. Among
these, there are 13 high-risk types recognized
as the major cause of cervical cancer.
 Having many sexual partners is a risk factor
for infection with these high-risk HPVs, which
Page 5 of 5
 CHEMOTHERAPY
TUTOR || September 19, 2022 MED-SURG
Transcribers: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name
Editors: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name

Outline CHEMOTHERAPY HAS THE FOLLOWING

CHARACTERISTICS
Legend:
Remember Previous
 It affects both normal and cancer cells.
(Exams)
Lecturer Book
Trans  The rapidly dividing cells, both the normal and
    cancer cells are vulnerable to destruction by
chemotherapy by disrupting cell function and
Heading 1 division.
1. Heading 2  Mucous membrane, blood cells, hair follicles,
• The quick brown fox jumps over the lazy dog skin cells are rapidly dividing cells.
 The quick brown fox jumps over the lazy dog
 Side effects of chemotherapy tend to occur in
▪ The quick brown fox jumps over the lazy dog
these structures.
• The quick brown fox jumps over the lazy dog
 Has fraction cell – kill. Only a certain no. of
Subheading
cancer cells is killed with each course of
CHEMOTHERAPY chemotherapy. Therefore, chemotherapy
 The use of chemicals as a systemic therapy must be given in a series.
for cancer.  May be cell – cycle specific (CCS) or cell –
 Antineoplastic agents are used in an attempt cycle non-specific (CCNS).
to destroy tumor cells by interfering with ➢ CCS chemotherapy may destroy cancer
cellular functions, including replication. cells at specific stage of cell division.
- CCNS chemotherapy may destroy cancer
GOALS: cells at any stage of cell dIvision.
 CURE
 CONTROL  Thus, combination chemotherapy (CCS &
 PALLIATION OF MANIFESTATIONS CCNS) destroys more malignant cells and
produces fewer side effects because each
GOALS OF CANCER TREATMENT drug strikes the cancer cells at different
1. CURE - treatment is offered that is expected stages in the cell cycle.
to have the greatest chance of disease
eradication Chemotherapy Drugs
2. CONTROL – is the goal of the treatment plan  Interfere with cancer cell’s ability to divide and
for many cancers that cannot be completely reproduce.
eradicated but are responsive to anticancer  A single drug or a combination of drugs is
therapies used
3. PALLIATION – relief /control of symptoms & Discussions:
the maintenance of a satisfactory quality of  These can be delivered either directly into the
life rather than cure/control of the disease bloodstream, to attack cancer cells
process throughout the body, or they can be targeted
to specific cancer sites
 CHEMOTHERAPY is a systemic intervention.
It is recommended when: Chemotherapy drugs can:
- disease is widespread
- risk of undetectable disease is high
- Tumor cannot be resected and is resistant
to RT

 The OBJECTIVE of CHEMOTHERAPY

- To destroy all malignant tumor cells
without excessive destruction of normal
cells
Page 1 of 5
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
CLASSIFICATION OF CHEMOTHERAPEUTIC
AGENTS
a. ALKYLATING AGENTS
 Are the oldest and the most commonly used
class of chemotherapy drugs, and work by
directly damaging DNA and preventing cancer
cells from reproducing
 They are cell-cycle phase non-specific,
meaning they kill cancer cells in any phase of
the cell cycle
 Ex: carboplatin, cisplatin, oxaliplatin
b. ANTIMETABOLITES
 Chemotherapy drugs that interfere with DNA
and RNA growth.
 They are cell-cycle specific, meaning they kill
cancer cells in a specific phase of cell
division.
 Ex: capecitabine, gemcitabine, pemetrexed
c. ANTHRACYCLINES
 Are anti-tumor antibiotics that interfere with
enzymes necessary for DNA replication.
 They are cell-cycle non-specific
 Ex: bleomycin, doxorubicin, mitomycin-C
d. PLANT ALKALOIDS
 Are derived from certain types of plants found
in nature, and inhibit or prevent mitosis.
 Cell-cycle specific
 Ex: taxanes, docetaxel, paclitaxel
ROUTES OF ADMINISTRATION OF
CHEMOTHERAPY
1. Oral Chemotherapy Medications (Taken by
Mouth)
 come in a variety of oral forms (pills, tablets,
capsules, liquid)
 Oral chemo medications that are
swallowed are encased in a protective
coating that is broken down by the digestive
juices in the stomach.
 Sub-lingual chemo medications. These
medications are placed under the tongue
where they dissolve and quickly absorb into
the circulation of the body.
Page 2 of 5
2. Subcutaneous Injection of Chemotherapy
Treatments
 are commonly used for some types of biologic
response modifiers and chemotherapy
support drugs.
 If a patient's platelet count is low
subcutaneous injections are less likely to
cause bleeding than intra- muscular
injections.
3. Intra-Muscular Chemotherapy Injections
 Intra-muscular injection is a popular method
for anti- nausea medications because it
bypasses an already irritated stomach.
 Most chemotherapy cannot be given intra-
muscularly because of the harshness of the
chemical.
Discussions:
Absorption of the medication is more rapid then
the oral form but slower then sub lingual,
subcutaneous injection and intravenous
administration
is avoided when possible in patients with low
platelets, as bleeding within the muscle can be a
complication.
4. Intravenous Chemotherapy Treatments
 This is the most common method of
chemotherapy administration, since most
chemo drugs are easily absorbed through the
blood stream.
 IV push chemo is given from a syringe into
your IV. It may take 10 to 15 minutes to get all
of the chemo.
 An infusion of chemo may last from 30
minutes to a few hours.
 A continuous infusion of chemo may last
from 1 to 7 days. This type of infusion is
controlled by an electronic IV pump.
Intravenous medications are given directly
into the blood stream through a variety of
methods.
a. An angiocatheter may be placed in a vein in
the arm or hand and then removed after the
chemo medication is given.
Discussions:
 This is a temporary venous-access device
inserted by a nurse prior to treatment then
removed after treatment has been completed
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
b. PICC line. Can be inserted and used for six
weeks to a few months before it is
discontinued.
c. Non-tunneled catheters. Non-tunneled
catheters are inserted directly through the
skin into the jugular or subclavian vein and
travel through the vessel to the superior vena
cava vessel at entrance of the right atrium of
the heart.
d. Tunneled Catheters, are placed through the
skin in the middle of the chest. They are
tunneled through the subcutaneous tissue
and inserted into the superior vena cava
vessel at entrance of the right atrium of the
heart.
e. Port-a-cath, the port-a-cath is placed under
the skin on the chest.
4. Intraventricular/Intrathecal Chemotherapy
Treatments
 is used when drugs need to reach the
cerebrospinal fluid (CSF), the fluid that is in
the brain and spinal cord.
There are two ways chemotherapy can be given
to the CSF:
1. Lumbar puncture
(Intrathecal). Chemotherapy can be given
through a lumbar puncture (spinal tap).
2. Ommaya reservoir (Intraventricular).
It is placed into the subcutaneous tissue (the
layer of tissue between the skin and the muscle)
on the scalp.
This procedure is used most commonly in acute
leukemias but can be used in other situations as
well.
5. Intraperitoneal Chemotherapy Treatments
 can be given directly into the abdominal
cavity.
 is done for cancer in the intra-abdominal
area, e.g., ovarian cancer.
 The patient is encouraged to change
positions from side to side and lying on the
back to facilitate the movement of the
medication.
Page 3 of 5
6. Intra-Arterial Chemotherapy Treatments
 Intra-arterial infusions enable major organs or
tumor sites to receive maximal exposure with
limited serum levels of medications.
7. Intravesicular Chemotherapy Treatments
 Intravesicular medications are given with the
use of a urinary catheter directly into the
bladder.
8. Intrapleural Chemotherapy Treatments
 Chemotherapy can be given into the pleural.
 Intrapleural chemotherapy is used to control
malignant pleural effusions
 The chemotherapy causes the lung to stick to
the pleural lining, allowing the lung to re-
expand and stay expanded.
Discussions:
 pleural cavity (the space between the lung
and the lining of the lung).
9. Topical Chemotherapy Treatments
 Some chemotherapy creams are applied
directly to the skin in certain cases of skin
cancer.
 The cream is then absorbed through the skin
directly into the cancerous lesion. The use of
topical preparations is very limited in cancer
treatments
CONTRAINDICATIONS TO CHEMOTHERAPY
a. INFECTION
b. RECENT SURGERY\
c. IMPAIRED RENAL/HEPATIC FUNCTION
d. RECENT RADIATION THERAPY
e. PREGNANCY
f. BONE MARROW DEPRESSION
Discussions:
➢ 1 anti-tumor drugs are immunosuppressive
➢ 2 the drugs may retard healing process
➢ 3 the drugs are nephrotoxic and hepatotoxic
➢ 4 also immunosuppressive
➢ 5 the drugs may cause congenital defects
➢ 6 the drugs may aggravate the condition.
WBC levels must be within normal limits
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
SAFE HANDLING OF CHEMOTHERAPEUTIC
AGENTS
1) Wear mask, eye shield, gloves and back –
closing gown.
2) Skin contact with drug must be washed
immediately with soap and water. Eyes must
be flushed immediately with copious amount
of water.
3) Sterile / alcohol – wet cotton pledgets should
be used, wrapped around the neck of the
ampule or vial when breaking and
withdrawing the drug.
4) Expel air bubbles on wet cotton.
5) Vent vials to reduce internal pressure after
mixing.
6) Wipe external surface of syringes and IV
bottles.
7) Avoid self - inoculation by needle stab.
8) Clearly label the hanging IV bottle with
“ANTINEOPLASTIC CHEMOTHERAPY”
9) Contaminated needles and syringes must be
disposed in a clearly marked special
container, “leak – proof”, puncture – proof”
Discussions:
 Vent – opening, outlet, aperture, escape,
exhaust
 Inoculation – immunization, vaccination, jab,
shot, injection, booster
10) Dispose half – empty ampules, vials, IV
bottles by putting into plastic bag, seal and
then into another plastic bag or box, clearly
marked before placing for removal. Label as
“HAZARDOUS WASTE.”
11) Hand washing should be done before and
after removal of gloves.
12) Only trained personnel should be involved in
use of drugs (preferably, chemotherapy
certified nurses).
13) Ideally, preparation of chemotherapeutic
drugs should be in laminar flow conditions
with filtered air to prevent contamination with
microorganisms
NURSING INTERVENTIONS FOR
CHEMOTHERAPY SIDE -EFFECTS
1. G.I. SYSTEM – nausea and vomiting,
diarrhea, constipation
✓ Administer antiemetic to relieve nausea and
vomiting
✓ Replace fluid – electrolyte losses, low – fiber
diet to relieve diarrhea
Page 4 of 5
✓ Increase fluid intake and fibers in diet to
prevent / relieve constipation
2. INTEGUMENTARY SYSTEM
✓ PRURITUS, URTICARIA & SYSTEMIC
SIGNS
- Provide good skin care
✓ STOMATITIS (ORAL MUCOSITIS)
- Provide good oral hygiene
- Avoid hot and spicy food
✓ ALOPECIA
- Reassure that it is temporary
- Encourage to wear wigs, hats or head
scarf
✓ SKIN PIGMENTATION
- Inform that it is temporary
✓ NAIL CHANGES
- Reassure that nails may grow normally
after chemotherapy
3. HEMATOPOIETIC SYSTEM
✓ Anemia
- Provide frequent rest periods
✓ Neutropenia
- Protect from infection
- Avoid people with infection
- Report fever, chills, diaphoresis, heat,
pain, erythema, or exudates on anybody
surface
Discussions:
 Neutropenia – is an abnormally low level of
neutrophils. Neutrophils are a common type
of white blood cell important to fighting off
infections — particularly those caused by
bacteria.
✓ Thrombocytopenia
- Protect from trauma
- Avoid ASA
- Nadir - It is the time after chemotherapy
administration when WBC or platelet count
is at the lowest point. It occurs within 7 to
14 days after drug administration.
Discussions:
 Thrombocytopenia – persistent decrease in
the number of platelets in the blood
4. GENITO – URINARY SYSTEM
✓ Hemorrhagic cystitis
- Provide 2-3 liters of fluids per day
✓ Urine color changes
- Reassure that it is harmless
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor

5. Reproductive system NURSING INTERVENTIONS FOR

✓ Premature menopause or amenorrhea EXTRAVASATION include the following:
- Reassure that menstruation resumes after
chemotherapy

ADVERSE REACTIONS TO CHEMOTHERAPY

ARE AS FOLLOWS:
1. Hypersensitivity reaction
a. Dyspnea
b. Chest tightness or pain
c. Pruritus (itching)
d. Urticaria (wheals)
e. Tachycardia
f. Anxiety
g. Agitation
h. Inability to speak
i. abdominal pain
j. nausea
k. hypotension
l. cloudy mental status
m. flushed appearance
n. cyanosis

• If anaphylactic reaction occurs, the following

nursing interventions are implemented:
a. Stop the drug administration
b. Maintain IV access with 0.9% NS (NaCl)
c. Keep an open airway.
d. Keep client in modified Trendelenburg
position (supine with legs elevated at 20-
30’), unless contraindicated.

2. Extravasation
✓ Vessicant
chemotherapeutic
agents can cause or
form a blister and cause
tissue destruction. Eg., Adriamycin
(Doxurubicin), Oncovin (Vincristine).
✓ Irritant drugs can produce venous pain at the
site and along the vein
✓ Pain, erythema, swelling and lack of blood
return indicate an extravasation.

Page 5 of 5
 RADIOTHERAPY
TUTOR || September 19, 2022 MED-SURG
Transcribers: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name
Editors: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name

Outline ➢ To reduce symptoms:

- Shrink tumors affecting quality of life,
Legend:
Remember Previous
like lung tumor that causes SOB.
Lecturer Book
(Exams) Trans - Alleviate pain by reducing the size of a
    tumor.

Heading 1 Types of Radiation Therapy

1. Heading 2  Externally (Teletherapy, DXT) – external
• The quick brown fox jumps over the lazy dog beam radiation
 The quick brown fox jumps over the lazy dog
- Delivers radiation using a linear
▪ The quick brown fox jumps over the lazy dog
accelerator
• The quick brown fox jumps over the lazy dog
 Internally (Brachytherapy or Seed implants)
Subheading
- Involves placing radioactive sources inside
RADIOTHERAPY the patient.
2. Is a local treatment modality for cancer and it
is the destruction of cancer cells by ionizing EXTERNAL RADIATION THERAPY
radiation  This is administered through a high – energy
3. Purpose: is to destroy malignant cells which X-ray or gamma x-ray machine*
are more sensitive to radiation than are  The major advantage of high-energy radiation
normal cells without permanent damage to is its skin – sparing effect.
adjacent body tissues
Discussions:
Discussions: • (e.g., linear accelerator, cobalt, betatron, or a
 A component of treatment for ½-2/3 of all machine containing radioisotope).
patients with cancer
• The maximum effect of radiation occurs at
 May be used as a Primary, Adjuvant, or a
tumor deep in the body, not on the skin
Palliative treatment modality.
surface.
• There is no need for isolation.

Specialized Types of External Beam Radiation

Therapy
a. Three-dimensional conformal radiation
therapy (3D-CRT)
 Uses CT or MRI scans to create a 3-D picture
of the tumor.
Discussions:
 Beams are precisely directed to avoid
 PRIMARY - (e.g., early stage skin cancer,
radiating normal tissue
Hodgkin’s disease, carcinoma of the cervix.
 ADJUVANT - it can be used in conjunction
b. Intensity Modulated Radiation Therapy
with chemotherapy to enhance destruction of
(IMRT)
cancer cells.
 A specialized form of 3D-CRT
 Radiation is broken into many “beamlets” and
 How is Radio Therapy used?
the intensity of each can be adjusted
 Radiation therapy is used in 2 different ways:
individually
➢ To cure cancer:
- Destroy tumors that have not spread to
other body parts.
- Reduce the risk that cancer will return
after surgery or chemotherapy.
Page 1 of 5
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
c. Proton Beam Therapy
 Uses protons rather than x-rays to treat
certain types of cancer.
 Allows doctors to better focus the dose on the
tumor with the potential to reduce the dose to
nearby healthy tissue
d. Neutron Beam Therapy
 A specialized form of radiation therapy that
can be used to treat certain tumors that are
very difficult to kill using conventional
radiation therapy
e. Stereotactic radiation therapy
 Sometimes called stereotactic radiosurgery
 This technique allows the radiation oncologist
to precisely focus beams of radiation to
destroy certain tumors, sometimes in only one
treatment
f. Stereotactic Radiotherapy
 Stereotactic radiosurgery (SRS) is a non-
surgical radiation therapy used to treat
functional abnormalities and small tumors of
the brain.
 It can deliver precisely-targeted radiation in
fewer high-dose treatments than
traditional therapy, which can help preserve
healthy tissue.
Systems which produce different types of
radiation for external beam therapy include:
A. orthovoltage x-ray machines,
B. Cobalt-60 machines,
C. linear accelerators,
D. proton beam machines, and
E. neutron beam machines.
INTERNAL RADIATION THERAPY
 Places radioactive material into tumor or
surrounding tissue
 Also called Brachytherapy – brachy Greek for
“short distance”
 Radiation sources placed close to the tumor
so large doses can hit the cancer cells
 Allows minimal radiation exposure to normal
tissue
 the radioisotope is placed in needles, beads,
seeds, ribbons, or catheters, which are then
implanted directly into the tumor*
Page 2 of 5
Discussions:
 This can be either permanently or temporarily
placed in the body
THE MAJOR TYPES OF INTERNAL
RADIATION THERAPY
A. SEALED SOURCE – (brachytherapy) the
radioisotope is placed within or near the
tumor. *
- is used for both intracavitary and
interstitial therapy
Discussions:
 The radioactive material is enclosed in a
sealed container.
• INTRACAVITY RT is used to treat cancers of
the uterus and cervix. The radioisotope is
placed in the body cavity, generally for 24 to
72 hrs
• In an INTERSTITIAL THERAPY, the
radioisotope is placed in needles, beads,
seeds, ribbons, or catheters, which are then
implanted directly into the tumor
Discussions:
 In sealed sources of internal radiation, the
radioisotope cannot circulate through the
client’s body nor can it contaminate the
client’s urine, sweat, blood or vomitus. *
 However, radiation exposure can result from
direct contact with the sealed radioisotope,
such as touching the container with bare
hands or from lengthy exposure to the sealed
radioisotope.
 Therefore, the client’s excretions are not
radioactive
B. UNSEALED SOURCE –
 The radioisotopes may be administered
intravenously, orally or by instillation directly
into the body cavity.
- the radioisotope circulates through the
client’s body.
Discussions:
 Therefore, the client’s urine, sweat, blood and
vomitus contain the radioactive isotope.
 [SUB] 1.01 TITLE OF LECTURE – Dr. Professor
PRINCIPLES OF RADIATION PROTECTION -
DTS
i. D – istance
✓ The greater the distance from the radiation
source, the less the exposure dose of ionizing
rays.
✓ Maintain a distance of at least 3 feet when not
performing nursing procedures.
✓ Performed in closed proximity such as
checking placement of the implant &
performing nursing procedures
ii. T – ime
✓ Limit contact with the client for 5 minutes
each time, a total of 30 minutes per 8-hour
shift
✓ Organize care to limit the amount of time
spent in direct contact with the patient
✓ Spend less time with the patient without
sacrificing the quality of care given
iii. S – hielding
 Use lead shield during contact with client
✓ Pregnant staff should not be assigned to
clients receiving internal RT
✓ If available, & no care should be delivered
without wearing a film badge. *
✓ The film badge should not be shared, should
not be worn other than at work, & should be
returned according to the agency’s protocol
Discussions:
 The badge (radiation dosimeter badge) will
indicate cumulative radiation exposure.
 Staff members caring for the client with internal
RT should wear radiation dosimeter badge while
in the client’s room.
Discussions:
 measures the radiation dose that the
individual has received through exposure to
the source
 If the client with cancer of the cervix has
radioisotope implant into the uterus, the
following nursing interventions should be
implemented.
1. Client’s back is turned towards the door.
- To minimize exposure of healthcare staff
to radioisotope entering the client’s room.
Page 3 of 5
2. Encourage the client to turn to sides at
regular intervals
3. The client should be on complete bed rest.
- to prevent dislodgement of the
radioisotope.
4. The client should be given enema before the
procedure.
- Bowel movement during the procedure
may cause dislodgement of the
radioisotope.
5. The client should be given low fiber diet to
inhibit defecation during the procedure until
the device is removed in 2-3 days.
- to prevent dislodgement of the
radioisotope
6. The client should have a Foley catheter in
place during the procedure.
- to prevent bladder distention and
subsequently prevent irradiation of the
bladder.
7. Have long forceps and lead container readily
available. Use long forceps to pick up
dislodged radioisotope and place it in the lead
container.
- The client receiving an unsealed source of
RT: should have a private room and bath.
- All surfaces, including the floor area the
client will be walking on, are covered with
Chux or paper.
✓ Foods are served on disposable plates and
utensils.
✓ Trash and linens are kept in the client’s room
and are not removed until the client is ready
for discharge.
- This is to minimize radiation exposure of
caregivers.
✓ The client is also instructed to rinse the sink
with copious amount of water after tooth
brushing and to flush the toilet several times
after each use.
- To prevent radiation contamination of
other people and the environment.
✓ Anyone entering the room wears a new pair
of booties each time to prevent tracking the
radioisotope out into the hallway.
✓ Caregivers should wear gloves when
handling body fluids
✓ Any emesis (vomiting), especially that occurs
shortly after ingestion of oral radioisotope,
should be covered with absorbent pads, and
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
the radiation safety officer should be called
immediately.
TEACHING GUIDELINES REGARDING
EXTERNAL RADIATION THERAPY
1. It is painless
2. Lie very still on a special table while the
intervention is being given and you may be
placed in a special position to maximize tumor
irradiation.
3. Each treatment usually lasts for few minutes.
You may hear sounds of the machine being
operated, and the machine may move during
the therapy.
4. As a safety precaution for the therapy
personnel, you will remain alone in the
treatment room while the machine is in
operation.
5. The technologist will be right outside your
room observing you through a window or by a
closed – circuit TV. You may communicate.
6. There is no residual radioactivity after
radiation therapy. Safety precautions are
necessary only during the time you are
actually receiving irradiation. You may
resume normal activities of daily living.
CLIENT EDUCATION ON SKIN CARE IN
EXTERNAL RADIATION THERAPY
 Skin Care within The Treatment Area includes
the following:
 Keep your skin dry.
 Do not wash the treatment area until you are
instructed to do so. When permitted, wash the
treated skin gently with mild soap, rinse well,
and pat dry. Use warm water or cool water,
not hot water.
 Do not remove the lines or ink marks
(markings) placed on your skin
 Avoid using powders, lotions, creams, alcohol
and deodorants on the treated skin.
 Wear loose – fitting clothing to avoid friction
over the treatment area.
 Do not apply tape to the treatment area if
dressings are applied.
 Shave with an electric razor. Do not use pre-
shave or after-shave lotions.
 Protect your skin from exposure to direct
sunlight, chlorinated swimming pools, and
temperature extremes*
Page 4 of 5
 Consult your radiation therapist or nurse
about specific measures for individual skin
reactions.
NURSING INTERVENTIONS FOR SIDE
EFFECTS OF RADIATION THERAPY
SKIN REACTIONS
1. SKIN REACTIONS
 erythema, dry/moist desquamation
 atrophy, telangiectasia, depigmentation,
necrotic/ulcerative lesions.
 NURSING INTERVENTIONS:
- Observe for early signs of skin reaction
and report to the physician.
- Keep area dry.
Depigmentation telangiectasia
• Washing area with water, no soap and pat dry
(do not rub). Mild soap is permitted.
• Do not apply ointments, powders or lotion to
the area. Cornstarch may be used.
• Do not apply heat; avoid direct sunshine or
cold on the area.
• Use soft cotton fabrics for clothing. To prevent
skin irritation.
• Do not erase markings on the skin. These
serve as guide for areas of irradiation.
2. INFECTION
 this is due to bone marrow suppression
 NURSING INTERVENTIONS:
- Monitor blood counts weekly, especially
WBC
- Good personal hygiene, nutrition,
adequate rest
- Teach the client signs of infection to report
to physician
3. HEMORRHAGE
 Platelets are vulnerable to radiation.
 NURSING INTERVENTIONS:
- Monitor platelet count
- Avoid physical trauma or use of aspirin
(ASA)
- Teach signs of hemorrhage to report (e.g.,
gum bleeding, nose bleeding, black
stools)
- Monitor stool and skin for signs of
hemorrhage
- Use direct pressure over injection sites
until bleeding stops.
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor

4. FATIGUE
 result of high metabolic demands for tissue
repair and toxic waste removal
 plenty of rest and good nutrition

5. WEIGHT LOSS
 anorexia, pain, and effect of cancer

6. STOMATITIS AND XEROSTOMIA (DRY

MOUTH)
 Ulceration of oral mucous membrane occurs
 NURSING INTERVENTIONS:
- Administers analgesics before meals, as
prescribed
- Bland diet, avoid smoking and alcohol
- Good oral hygiene with saline rinses every
2 hours
- Sugarless lemon drops or mint to increase
salivation

7. Diarrhea, nausea and vomiting, headache,

alopecia (hair loss) and cystitis, may also
occur.

8. Social isolation is also experienced by the

client due to fear of contaminating others
with radiation.

Page 5 of 5
 TREATMENT MODALITIES
TUTOR || September 22, 2022
Transcribers: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name
Editors: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name
Outline
Legend:
Remember
Lecturer Book
(Exams)
  
Heading 1
1. Heading 2
• The quick brown fox jumps over the lazy dog
 The quick brown fox jumps over the lazy dog
▪ The quick brown fox jumps over the lazy dog
• The quick brown fox jumps over the lazy dog
Subheading
TREATMENT MODALITIES
GOALS & MODALITIES
Discussions:
 When caring for the patient & family with
cancer, you should know the goals of the
treatment plan to appropriately communicate
with, educate, & support the patient.
➢ Primary prevention of cancer involves
avoiding exposure to known causes of
cancer.
➢ Secondary prevention of cancer involves
screening for early detection.
➢ Tertiary treatment occurs after a cancer
diagnosis and the purpose is to prolong
survival time or improve quality of life.
➢ Therapies for cancer may be used separately
or, more commonly, in combination to kill
cancer cells.
➢ The types and amount of therapy used
depend on the specific type of cancer,
whether the cancer has spread, and the
health of the patient.
Goals of Cancer Treatment
1- Primary goal
 Cure the patient
 Render him clinically and pathologically free
of disease and return their life expectancy to
that of healthy individuals of the same age
and sex.
2- The best alternative goal
 To prolong survival while maintaining the
patient's functional status and quality of life.
MED-SURG
3- The 3rd goal
 Relive symptoms such as pain for patients in
Previous
whom the likelihood of cure or prolonged
Trans survival is very low

Modalities of cancer treatment
The Major Modalities
➢ Surgery
➢ Radiation
➢ Chemotherapy
➢ Immunotherapy/ Biologic therapy
➢ Molecularly Targeted Therapy
➢ Monoclonal Antibody Therapy
➢ Hormonal Manipulation
➢ Photodynamic Therapy
Discussions:
 The choice of treatment modality depends on
the type of tumor, the extent of the disease,
and the client’s co-morbid condition (e.g.,
cardiac disease), performance status, and
wishes.
The most appropriate type of therapy for each
individual patient is determined by
 Type and extent of tumor involvement
 Treatment goals
 Performance status
 Age
 Client’s co-morbid conditions
Discussions:
• Co-morbid – co-existing disease (cardiac
disease)
• Many patients receive 2 or 3 of these
modalities together
I-Surgery
 is the oldest form of local cancer treatment &
in the early days it was the only effective
method of cancer diagnosis.
 Still provides the best chance of cure for most
patients with solid tumors.
 Involves the removal of diseased tissue and
may be used for prophylaxis, diagnosis, cure,
control, palliation, determination of therapy
effectiveness and reconstruction.
Page 1 of 8
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
Discussions:
 Requires patient be able to tolerate physical
challenges of surgery
Uses
 Treat the primary cancer
 To remove isolated metastatic masses
 To make other methods of treatment possible
➢ e.g. providing access for chemotherapy
delivery (implanted infusion pumps)
 Diagnosis and Staging
 Reconstruct anatomical defects to improve
function, cosmetic appearance, and quality of
life
 Prevention
 Treat complication
➢ Hemorrhage
➢ Perforation
➢ Bowel obstruction
➢ Spinal cord compression
 Debulking
➢ Try to relive pain or other symptoms
➢ Increase effectiveness of radiation or
chemotherapy
 is the reduction of as much of the bulk
(volume) of a tumor as possible. It is usually
achieved by surgical removal. It is also known
as cytoreduction or cytoreductive surgery
(CRS); "cytoreduction" refers to reducing the
number of tumor cells.
 Surgical removal of a source of hormone
➢ A form of hormonal therapy
➢ Used in to treat tumors whose growth
depends on those hormones
➢ Most common type: removal of testes in
prostate cancer and removal of ovaries in
breast cancer.
SURGICAL INTERVENTIONS
1. DIAGNOSTIC SURGERY (Biopsy)
✓ This is done by cytologic specimen collection
and biopsy.
✓ Is the removal of all or part of a suspected
lesion for examination and testing. It provides
proof of the presence of cancer.
2. PROPHYLACTIC/PREVENTIVE SURGERY
✓ This involves removal of precancerous
lesions or benign tumor*
- e.g., patients with familial polyposis and
ulcerative colitis undergo subtotal
colectomies to prevent colon cancer.
3. CURATIVE SURGERY
✓ This involves removal of an entire tumor and
surrounding lymph nodes
✓ Cancers that are localized to the organ of
origin and the regional lymph nodes are
potentially curable by surgery.
4. RECONSTRUCTIVE / REHABILITATIVE
SURGERY
✓ This is done for improvement of the appearance
and function of the organ affected.
✓ This is also an attempt to improve the client’s
quality of life.
5. Cancer control or cytoreductive surgery
✓ Is the removal of part of the tumor and leaving
a known amount of gross tumor. It is also
known as debulking surgery, and it does not
alone result in a cure.
6. Second-look surgery
✓ is used for a rediagnosis after treatment. The
result of this surgery is used to determine
whether a specific therapy should be
continued or discontinued.
7. PALLIATIVE SURGERY
✓ This is done for relief of distressing signs and
symptoms or for retardation of metastasis.
✓ is used to relieve side effects caused by a
tumor.
Discussions:
✓ This is an attempt to improve quality of life
with no hope of cure or intent to lengthen their
lifespan.
EXAMPLES OF PALLIATIVE SURGERY
1. Reduce pain by interrupting nerve pathways
or implanting pain control pumps
2. Relieve airway obstruction
- e.g. tracheostomy
3. Relieve obstructions in the GI and GU tracts
- GI - insertion of feeding tube during head &
neck cancer treatment e.g. colostomy)
- GU - suprapubic cystostomy for the patient
with advanced prostatic cancer)
Page 2 of 8
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
4. Relieve pressure in the brain and the spinal
cord
- ex. draining CSF
5. Prevent hemorrhage
- ex. ligation, placement of venous access
to deliver blood transfusion)
6. Remove infected and ulcerating tumors
- ex. Debridement
7. Drain abscesses
- insertion of drain
PATIENT-CENTERED COLLABORATIVE
CARE
 The nursing care needs of the patient having
surgery for cancer are similar to those related
to surgery for other reasons.
 Surgery usually involves the loss and how
much the loss affects patients depend on the
location and extent of the cancer and surgical
intervention.
 Some cancer surgery results in major scarring
or disfigurement.
• Two additional priority care needs are
psychosocial support and assisting the
patient to achieve or maintain maximum
function.
1. Assess the patient’s and family’s ability to
cope with the uncertainty of cancer and its
treatment and with the changes in body
image and role.
2. Coordinate with the health care team to
provide support for the patient and family.
3. Encourage the patient and family to express
their feelings and concerns.
4. Encourage the patient to look at the surgical
site, touch it, and participate in any dressing
changes or incisional care required.
5. Provide information about support groups,
such as those sponsored by the American
Cancer Society or specialty cancer
organization.
6. Discuss with the patient the idea of having a
person who has coped with the same issues
come for visit.
7. Teach the patient about the importance of
performing and progressing the intensity of
any prescribed exercises to regain as much
function as possible and prevent
complication.
Page 3 of 8
8. Coordinate with the physical therapist,
occupational therapist, and family members to
plan strategies individualized to each patient
to regain or maintain optimal function.
Biological therapy/Immunotherapy for cancer
 is a type of treatment that uses the body's
immune system to kill cancer cells.
 is used in the treatment of many types of
cancer to prevent or slow tumor growth and to
prevent the spread of cancer.
How biological therapy works
 The goal of biological therapy for cancer is
to induce your immune system to recognize
and kill cancer cells.
In general, biological therapies work in one of
two ways:
1. Inducing the immune system to attack
cancer cells.
 example, chemicals that stimulate your
immune system cells could be injected
into your body.
 Or a sample of your immune system cells
could be trained in a lab to attack cancer
cells before being reintroduced to your
body.
2. Making cancer cells easier for your
immune system to recognize.
 Biological therapy can also target the
cancer cells, turning on or off cell signals
that help them elude the immune system
cells.
Two common types:
1. Interleukins (Ils) – which helps different
immune system cells recognize and destroy
abnormal body ells; in particular, IL-1,-2, and
6 appear to “charge up” the immune system
and enhance attacks on cancer cells by
macrophages, natural killer (NK) cells, and
tumor-infiltrating lymphocytes. Side effects of
ILs include generalized inflammatory
reactions that can be severe:
a. Widespread edema from “capillary leak”
b. Chills or rigors (severe shaking with chills);
rigors is managed with meperidine
(Demerol)
c. Fever with flu-like general malaise, often
managed with acetaminophen
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
2. Interferons (IFs) – which can slow tumor cell
division, stimulate the growth and activation of
NK cells (Natural Killer cells), induce cancer
cells to resume a more normal appearance
and function, and inhibit the expression of
oncogenes.
Molecular Targeted Therapy
 Technically biological agents, these drugs
take advantage of one or more differences in
cancer cell growth or metabolism that are not
present or are only slightly present in normal
cells.
 Agents used as targeted therapies disrupt
pathways that lead to excessive cancer cell
division/reproduction by:
1. Targeting and blocking epithelial growth
factor receptors (EGFRs) or the vascular
endothelial growth factor (VEGF) and
receptors (VEGFRs);
• when a cancer cells growth depends on
having the growth factors bind to their specific
receptors, blocking the receptor slows or
eliminates the cancer cell’s growth.
NOTE: For therapies that bind to the EGFR and
VEGFR receptors, normal cells in the skin, GI
tract, and mucous membranes also express
these receptors and may develop open sores,
rashes, and acne-type lesions.
2. Blocking signals for cell division and function.
These drugs include tyrosine kinase inhibitors
(TKIs), multikinase inhibitors (MKIs), and
proteasome inhibitors.
3. Blocking many enzymes essential to cancer
cell and tumor blood vessel growth; these
agents are categorized as multikinase
inhibitors.
4. Blocking the growth of blood vessels so that
nutrients cannot be delivered to tumors
(angiogenesis inhibitors)
5. Inhibiting the formation of proteins in cells, a
drug class called proteasome inhibitors.
 Targeted therapies work only on cancer
cells, that overexpress the actual target
substance. Each person’s cancer cells are
evaluated to determine whether the cells
have enough of a target to be affected by
targeted therapy.
Page 4 of 8
Monoclonal Antibody Therapy
 Monoclonal antibodies bind to specific cell
surface membrane proteins, preventing the
protein from performing its function, typically
promoting cell division. By binding cancer cell
proteins, monoclonal antibodies prevent cell
division.
 The monoclonal antibodies to the EGFR bind
to those specific receptors when the receptors
are on normal tissue. Thus, side effects occur
in those tissues that normally express EGFR,
such as the skin, mucous membranes, and
lining of the GI tract.
Hormonal Manipulation Therapy
 Hormonal manipulation can help control some
types of cancer by decreasing the amount of
hormones reaching hormone-sensitive
tumors.
 Some drugs are hormone antagonists that
compete with natural hormones at the tumor’s
receptor sites, preventing a needed hormone
from binding to the receptor.
 Hormone inhibitors suppress the production
of specific hormones in the normal hormone-
producing organs.
 Androgens and antiestrogen receptor drugs
cause masculinizing effects in women, with
increased chest and facial hair, interruption of
the menstrual period, and shrinkage of breast
tissue.
 Feminine manifestations often appear in men
who take estrogens, progestins, or
antiandrogen receptor drugs, including
thinning facial hair, smoother skin, and
gynecomastia. Testicular and penile atrophy
also occur to some degree.
Photodynamic Therapy
 Photodynamic therapy (PDT) is the selective
destruction of cancer cells through a chemical
reaction triggered by different types of laser
light.
 It is commonly used for non-melanoma skin
cancers, ocular tumors, GI tumors, and lung
cancers located in the airways.
 An agent that sensitizes cells to light is
injected IV along with a dye. These drugs
enter all cells but leave normal cells more
rapidly than cancer cells. Usually within 48 to
72 hours, most of the drug has collected light
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
is focused in the tumor. The light activates a
chemical reaction within those cells, retaining
the sensitizing drug that induces irreversible
cell damage.
Patient-centered Collaborative Care
 The patient has increased sensitivity to
light for up to 12 weeks after the
photosensitizing drug is injected, with the
most sensitivity in the 48 hours
immediately after a treatment.
 The most intense period of light sensitivity
is after injection and before the laser
treatment. During this time, the patient is
at high risk for sunburn and eye pain for 1
to 3 months after therapy.
 Teach the patient to:
1. Reduce exposure to light with protective
clothing, window shades, and UV-protective
sunglass.
2. Refrain from taking any newly prescribed or
over-the-counter (OTC) drugs without
contacting the physician who performed the
PDT. Some drugs make the light sensitivity
even worse; other drugs interact with the
photosensitizing drug.
3. Start re-exposure to sunlight and other bright
lights slowly. Start by exposing only about 1
inch of skin to sunlight at a time. Start with 10
minutes, and increase the time by about 5
minutes each day.
4. Remember that sunscreen cannot prevent
severe sunburn during this time.
Oncologic Emergencies
 Oncologic emergencies are acute
complications associated with cancer and its
treatment that often require immediate
intervention to avoid life-threatening
situations.
 Complications include:
✓ Spinal cord compression
✓ Superior vena cave syndrome
✓ Hypercalcemia
✓ Tumor lysis syndrome
✓ SIADH – Syndrome of Inappropriate
Antidiuretic Hormone
✓ DISSEMINATED INTRAVASCULAR
COAGULATION (DIC)
✓ Infection and Pain
Page 5 of 8
Discussions:
 For prevention and early detection of
oncologic emergencies, physicians must
maintain a high degree of suspicion and must
adequately educate patients about
preventative measures and reporting of
symptoms.
1. Spinal Cord Compression
• Epidural spinal cord compression is
devastating, and it is not an uncommon
complication of malignancy.
• Untreated spinal cord compression will
invariably progress to produce paralysis,
sensory loss, or loss of anal sphincter
control.
• Immediate therapy involves the use of
corticosteroids. Dexamethasone is the
most commonly used steroid,
• Radiotherapy alone is the definitive
treatment for most patients.
2. Superior Vena Cava Syndrome
• It results from external and internal
obstruction of the super vena cava. The
obstruction reduces venous return to the
heart and decreases cardiac output.
• The clinical manifestations of SVC
syndrome are as follows:
1. dyspnea
2. facial swelling
3. jugular vein distention
4. sitting up and leaning forward to
breathe
5. swelling of arms, chest pain, dysphagia
• External beam – RT and curative
chemotherapy are used for palliation.
3. HYPERCALCEMIA
• This is due to bone resorption
(demineralization).
• It usually occurs in solid tumors like
breast, lung, head, neck and renal
cancers. It may also occur in hematologic
cancer like multiple myeloma, leukemia
• Severe hypercalcemia may lead to renal
failure, coma, cardiac arrest and death.
• Calcitonin (Miacalcin) and oral
glucocorticoids are given to lower serum
calcium.
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor

CAUSES OF HYPERCALCEMIA The clinical manifestations of tumor lysis

 Cancers that affect the bone, such as multiple syndrome are as follows:
myeloma or leukemia, and cancer that has 1. weakness
spread to the bone cause the bone to break 2. nausea
down. This releases excess calcium into the 3. diarrhea
blood. 4. flaccid paralysis
 Some tumors produce a protein that acts very 5. ECG changes
similar to parathyroid hormone. This protein 6. Muscle cramps or twitching
causes the bone to release calcium into the 7. Oliguria
blood 8. Hypotension
 Some cancers affect the ability of the kidneys 9. Edema
to remove excess calcium from the blood. 10. Altered Mental Status
 Dehydration caused by nausea and vomiting
makes it difficult for the kidneys to remove • Collaborative Management for Tumor
calcium from the blood properly. Lysis Syndrome include the following:
 Lack of physical activity can cause bone to a. Intravenous hydration
break down, releasing calcium into the blood. b. Allopurinol to decrease uric acid
concentration
4. TUMOR LYSIS SYNDROME c. Sodium bicarbonate with IV hydration to
• Collection of metabolic abnormalities that promote fecal excretion of excess phosphate
occur due to the cell lysis in patients who are d. Lowering of serum potassium levels with
being treated for malignancies. medications, retention enemas, IV 50%
• Tumor lysis syndrome (TLS) is a group of dextrose
metabolic abnormalities that can occur as a
complication during the treatment 5. SIADH - Syndrome of Inappropriate
of cancer, most commonly after the treatment Antidiuretic Hormone
of lymphomas and leukemias.*
• Tumor lysis syndrome is characterized by
high blood potassium (hyperkalemia), high
blood phosphorus (hyperphosphatemia), low
blood calcium (hypocalcemia), high blood uric
acid (hyperuricemia), and higher than normal
levels of blood urea nitrogen (BUN) and other
nitrogen containing compounds.

Discussions:
 In oncology and hematology, this is a
• The signs and symptoms of SIADH are as
potentially fatal complication, and patients
follows:
should be closely monitored before, during,
1. confusion
and after their course of chemotherapy.
2. irritability
3. headache
 The metabolic abnormalities seen in tumor
4. muscle weakness
lysis syndrome can ultimately result in nausea
5. lethargy
and vomiting, but more seriously acute uric
6. decreased urine output
acid nephropathy, acute kidney
7. edema
failure, seizures, cardiac arrhythmias, and
8. nausea and vomiting
death.
9. anorexia
SIADH is manifested by water retention and
decrease in sodium.

Page 6 of 8
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
• THE COLLABORATIVE MANAGEMENT OF
SIADH are as follows:
a. Fluid excretion (diuretics)
b. IV infusion of hypertonic saline (3% to 5%)
if severe, to prevent pulmonary edema
c. Monitor intake and output
d. Administer medications like Declomycine
(Demeclocycline), Lithane (Lithium), and
urea.
• This condition is characterized by
development of extensive, abnormal clots in
the microcirculation (small blood vessels).
The widespread clotting depletes the general
circulation with clotting factors and platelets,
leading to excessive bleeding in different sites
of the body.
6. DISSEMINATED INTRAVASCULAR
COAGULATION (DIC)
• This condition is characterized by
development of extensive, abnormal clots in
the microcirculation (small blood vessels).
The widespread clotting depletes the general
circulation with clotting factors and platelets,
leading to excessive bleeding in different sites
of the body.
• Clot that are obstructing the circulation
decrease blood flow to major organs, causing
pain, stroke – like manifestations, dyspnea,
tachycardia, oliguria, bowel necrosis.
• DIC is most commonly associated with
leukemia and adenocarcinomas of the lung,
pancreas, stomach and prostate.
• Diagnostic findings that support DIC are:
➢ Prolonged prothrombin time and activated
partial thromboplastin time
➢ Very low platelet count
➢ Prolonged clotting times
• The Medical Management for DIC are as
follows:
1. correction of the basic problem (e.g., infection)
2. administer blood products and medication as
prescribed
3. IV heparin if with manifestations of thrombosis
(although, controversial).
4. Monitor the client for signs and symptoms of
bleeding.
Page 7 of 8
7. INFECTION AND PAIN
• Infection arises from neutropenia.
• People with advanced cancer have pain.
• Severe infection and pain can interfere with
the person’s ability to enjoy quality of life.
• Pain management is the priority in care of
clients with advanced cancer.
PSYCHOSOCIAL ASPECTS OF CANCER
CARE
1) Provide support for the client – your
presence, empathy, positive regard
2) Provide support for the family.
3) Promote positive self – concept.
4) Promote coping with the cancer experience.
➢ Hospice care is now a trend in the care of
clients with terminal cancer (for those with
prognosis of having a lifespan of 1 to 6
months)
The basic characteristics of a hospice
program are:
1) Control of manifestations, including pain relief
2) Treatment of the client and family as a unit
3) Provision of care by an interdisciplinary team
4) 24-hour, 7 days a week service
5) coordinated homecare with back – up
inpatient services.
6) use of trained volunteers to augment staff
services.
7) spiritual support
8) bereavement follow-up
9) services given on the basis of need and not
on the ability to pay.
10) Structured systems of support staff
COLLABORATIVE MANAGEMENT FOR THE
CLIENT WITH BREAST CANCER
SURGERY
✓ Lumpectomy / tylectomy –involves
removal of the lump.
✓ Simple Mastectomy – involves removal of
the entire breast. The pectoralis muscles
and the nipple remain intact
✓ Modified Radical Mastectomy (MRM)
involves removal of the entire breast and
the axillary lymph nodes. The pectoralis
muscles are conserved.
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor

✓ Radical Mastectomy (Halstead Surgery)– ✓ Encourage regular coughing and deep

involves removal of the entire breast, breathing exercises. To promote lung
pectoralis major and minor muscles and expansion and prevent atelectasis.
the axillary lymph nodes. It is followed by ✓ Prepare client for size and appearance of
skin grafting. This is rarely done nowadays the incision and provide support when
Chemotherapy incision is viewed for the first time.
Radiation Therapy
• Provide client with detailed information
CARE OF THE CLIENT UNDERGOING concerning breast prosthesis. Fitting is not
BREAST SURGERY possible for 4-6 weeks. A temporary
 PREOPERATIVE CARE prosthesis or lightly padded bras may be
✓ Psychosocial support – include the husband worn until healing is complete.
when necessary
✓ Teach arm exercises to prevent lymph
edema
✓ Inform about wound suction drainage, e.g.,
hemovac, Jackson – Pratt
✓ DBCT exercises to prevent postop
respiratory complications

 POSTOPERATIVE CARE
✓ Place client in semi-fowler’s position with
arm abducted and elevated on pillows.
- Fowler’s position promotes lung
expansion. Abduction and elevation of
arm on the affected side promotes venous
return and prevents lymphedema

✓ Monitor Hemovac output (normal drainage

is serosanguinous for the first 24 hours).
Serosanguinous drainage is composed of
plasma and small amounts of RBC. It is
pinkish or reddish in appearance but not
viscous.
✓ Check behind patient for bleeding. Blood
flows to the back by gravity.
✓ Post signs warning against taking blood
pressure, starting IV’s, or drawing blood on
affected side. To prevent obstruction of
venous and lymphatic flow
✓ Initiate exercise to prevent stiffness and
contractures of shoulder girdle. Give
analgesic before initiating exercises.
✓ Reinforce special mastectomy exercises as
prescribed. To prevent lymphedema.
✓ Provide adequate analgesia to promote
ambulation and exercise. The client
cooperates with ambulation and exercise if
she is free from pain or discomfort.

Page 8 of 8
 NURSING MANAGEMENT OF CANCER
TUTOR || September 21, 2022
Transcribers: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name
Editors: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name
Outline
Legend:
Remember
Lecturer Book
(Exams)
  
Heading 1
1. Heading 2
• The quick brown fox jumps over the lazy dog
 The quick brown fox jumps over the lazy dog
▪ The quick brown fox jumps over the lazy dog
• The quick brown fox jumps over the lazy dog
Subheading
Nursing Management of Cancer
Maintaining Tissue Integrity
 Some of the most frequently encountered
disturbances of tissue integrity include
stomatitis, skin and tissue reactions to
radiation therapy, alopecia, and malignant
skin lesions.
Managing Stomatitis
 Assess oral cavity daily.
 Instruct patient to report oral burning, pain,
areas of redness, open lesions on the lips,
pain associated with swallowing, or
decreased tolerance to temperature extremes
of food.
 Encourage and assist in oral hygiene.
Discussions:
 (brush with soft toothbrush, use nonabrasive
toothpaste after meals and bedtime, floss
every 24 hours unless painful or platelet
count falls below 40,000/mm3); advise patient
to avoid irritants such as commercial
mouthwashes, alcoholic beverages, and
tobacco.
 For mild stomatitis, use normal saline mouth
rinses and a soft toothbrush or toothette,
remove dentures except for meals (make sure
dentures fit properly), apply water-soluble lip
lubricant, and avoid foods that are spicy or
hard to chew and those with extremes of
temperature.
 For severe stomatitis, obtain tissue samples
for culture and sensitivity tests, assess gag
reflex and ability to chew and swallow
MED-SURG
Discussions:
 Instructed to use oral rinses as prescribed or
Previous
position patient on side and irrigate mouth
Trans with suction available, remove dentures, use
 toothette or gauze soaked with solution for
cleansing, use water-soluble lip lubricant,
provide liquid or pureed diet, and monitor for
dehydration.
 Help patient minimize discomfort by using
prescribed topical anesthetic, administering
prescribed systemic analgesics, and
performing appropriate mouth care.
Managing Radiation-Associated Skin
Impairments
 Provide careful skin care by avoiding the use
of soaps, cosmetics, perfumes, powders,
lotions and ointments, and deodorants.
Discussions:
 Use only lukewarm water to bathe the area,
and avoid applying hot-water bottles, heating
pads, ice, and adhesive tape to the area. Do
not shave the area.
 Instruct the patient to avoid rubbing or
scratching the area, exposing the area to
sunlight or cold weather, or wearing tight
clothing over the area.
 If wet desquamation occurs, do not disrupt
any blisters that have formed, report
blistering, and use prescribed ointments
Discussions:
 If the area weeps, apply a non-adhesive
absorbent dressing. If the area is without
drainage, use moisture and vapor permeable
dressings such as hydrocolloids and
hydrogels on noninfected areas.
Addressing Alopecia
 Discuss potential hair loss and regrowth with
patient and family; advise that hair loss may
occur on body parts other than the head.
 Explore potential impact of hair loss on self-
image, interpersonal relationships, and
sexuality.
 Prevent or minimize hair loss
Discussions:
 use scalp hypothermia and scalp tourniquets,
if appropriate, cut long hair before treatment,
avoid excessive shampooing and any hair
Page 1 of 6
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
processing, avoid excessive combing or
brushing
 Suggest ways to assist in coping with hair
loss (eg, purchase wig or hairpiece before
hair loss; wear head coverings).
 Explain that hair growth usually begins again
once therapy is completed.
Managing Malignant Skin Lesions
 Carefully assess and cleanse the skin,
reducing superficial bacteria, controlling
bleeding, reducing odor, protecting skin from
pain and further trauma, and relieving pain.
 Assist and guide the patient and family
regarding care for these skin lesions at home;
refer for home care as indicated.
Promoting Nutrition
Discussions:
 Most patients with cancer experience some
weight loss during their illness. Anorexia,
malabsorption, and cachexia are common
examples of nutritional problems.
 Teach the patient to avoid unpleasant sights,
odors, and sounds in the environment during
mealtime.
 Suggest foods that are preferred and well
tolerated by the patient, preferably high-
calorie and high-protein foods.
Discussions:
 Respect ethnic and cultural food preferences.
 Encourage adequate fluid intake, but limit
fluids at mealtime.
 Suggest smaller, more frequent meals.
 Promote relaxed, quiet environment during
mealtime with increased social interaction as
desired.
 Encourage nutritional supplements and high-
protein foods between meals.
 Encourage frequent oral hygiene and provide
pain relief measures to make meals more
pleasant.
 Provide control of nausea and vomiting.
 Decrease anxiety by encouraging
verbalization of fears and concerns, use of
relaxation techniques, and imagery at
mealtime.
 For collaborative management, provide
enteral tube feedings of commercial liquid
diets, elemental diets, or blenderized foods as
prescribed.
Page 2 of 6
 Administer appetite stimulants as prescribed
by physician.
 Encourage family and friends not to nag or
cajole patient about eating.
Relieving Pain
 Use a multidisciplinary team approach to
determine optimal management of pain for
optimal quality of life.
 Assure patient that you know that pain is real
and will assist him or her in reducing it.
 Help patient and family play an active role in
managing pain.
 Provide education and support to correct
fears and misconceptions about opioid use.
 Encourage strategies of pain relief that
patient has used successfully in previous pain
experience.
 Teach patient new strategies to relieve pain
and discomfort: distraction, imagery,
relaxation, cutaneous stimulation, etc.
 Patients with cancer may have other sources
of pain, such as arthritis or migraine
headaches, that are unrelated to the
underlying cancer or its treatment.
 The nurse assesses the patient for the source
and site of pain as well as those factors that
influence the patient’s perception and
experience of pain, such as fear and
apprehension, fatigue, anger, and social
isolation.
 Pain assessment scales are useful for
assessing the patient’s pain before and after
pain-relieving interventions are instituted to
assess the effectiveness of interventions.
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
Discussions:
 In today’s society, most people expect pain to
disappear or resolve quickly. Although it is
often controllable, advanced cancer pain is
commonly irreversible and not quickly
resolved. For many patients, pain is often
seen as a signal that cancer is advancing and
that death is approaching.
 As patients anticipate pain and anxiety
increases, pain perception heightens,
producing fear and further pain. Thus, chronic
cancer pain can lead to a cycle progressing
from pain to anxiety to fear and back to pain,
especially when the pain is not adequately
managed.
 The nurse assists the patient and family to
take an active role in managing pain.
 The nurse provides education and support to
correct fears and misconceptions about
opioid use. Inadequate pain management
leads to a diminished quality of life
characterized by distress, suffering, anxiety,
fear, immobility, isolation, and depression.
Decreasing Fatigue
 Help patient and family to understand that
fatigue is usually an expected and temporary
side effect of the cancer process and
treatments.
 Help patient to rearrange daily schedule and
organize activities to conserve energy
expenditure
Discussions:
 encourage patient to alternate periods of rest
and activity.
 Encourage patient and family to plan to
reallocate responsibilities, such as childcare,
cleaning, and preparing meals.
Discussions:
 A patient who is employed full time may need
to reduce the number of hours worked each
week.
Page 3 of 6
 Encourage adequate protein and calorie
intake; assess for fluid and electrolyte
disturbances.
 Encourage regular, light exercise, which may
decrease fatigue and facilitate coping.
 Encourage use of relaxation techniques and
mental imagery.
 Address factors that contribute to fatigue and
implement pharmacologic and
nonpharmacologic strategies to manage pain.
 Administer blood products as prescribed.
Improving Body Image and Self-Esteem
Discussions:
 A creative and positive approach is essential
when caring for the patient with altered body
image. It is also important to individualize
care for each patient.
 Assess patient’s feelings about body image
and level of self-esteem. Encourage patient to
verbalize concerns.
 Identify potential threats to patient’s self-
esteem
Discussions:
 eg, altered appearance, decreased sexual
function, hair loss, decreased energy, role
changes). Validate concerns with patient.
 Encourage continued participation in activities
and decision making.
 Assist patient in self-care when fatigue,
lethargy, nausea, vomiting, and other
symptoms prevent independence.
 Assist patient in selecting and using
cosmetics, scarves, hair pieces, and clothing
that increase his or her sense of
attractiveness.
 Encourage patient and partner to share
concerns about altered sexuality and sexual
function and to explore alternatives to their
usual sexual expression.
 Refer patient to collaborating specialists as
needed.
Assisting in Grieving
 Encourage verbalization of fears, concerns,
negative feelings, and questions regarding
disease, treatment, and future implications.
 Encourage active participation of patient or
family in care and treatment decisions.
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor

 Visit family frequently to establish and Managing Septic Shock

maintain relationships and physical  Assess frequently for infection and
closeness. inflammation throughout the course of the
 Involve spiritual advisor as desired by the disease.
patient and family.  Prevent septicemia and septic shock, or
 Allow for progression through the grieving detect and report for prompt treatment.
process at the individual pace of the patient  Monitor for signs and symptoms of septic
and family. shock
 Advise professional counseling as indicated Discussions:
for patient or family to alleviate pathologic  Observe for altered mental status, either
grieving. subnormal or elevated temperature, cool and
 If patient enters the terminal phase of clammy skin, decreased urine output,
disease, assist patient and family to hypotension, tachycardia, other dysrhythmias,
acknowledge and cope with their reactions electrolyte imbalances, tachypnea, and
and feelings. abnormal arterial blood gas [ABG] values
 Maintain contact with the surviving family  Instruct patient and family about signs of
members after death of the patient. septicemia, methods for preventing infection,
and actions to take if infection or septicemia
Monitoring & Managing Potential Complications occurs.
Managing Infection
 Assess patient for evidence of infection Managing Bleeding and Hemorrhage
Discussions:
 Monitor platelet count and assess for
 Check vital signs every 4 hours, monitor white
bleeding
blood cell (WBC) count and differential each
Discussions:
day, and inspect all sites that may serve as
 petechiae or ecchymosis; decrease in
entry ports for pathogens (eg, intravenous [IV]
hemoglobin or hematocrit; prolonged bleeding
sites, wounds, skin folds, bony prominences,
from invasive procedures, venipunctures,
perineum, and oral cavity)
minor cuts, or scratches; frank or occult blood
 Report fever (≥38.3°C [101°F] or ≥38°C
in any body excretion, emesis, or sputum;
[100.4°F] for greater than 1 hour), chills,
bleeding from anybody orifice; altered mental
diaphoresis, swelling, heat, pain, erythema,
status
exudate on anybody surfaces.
 Instruct patient and family about ways to
Discussions:
minimize bleeding
 Also report change in respiratory or mental
Discussions:
status, urinary frequency or burning, malaise,
 use soft toothbrush or toothette for mouth
myalgias, arthralgias, rash, or diarrhea.
care, use electric razor for shaving, avoid
 Discuss with patient and family about placing
foods that are difficult to chew
patient in private room if absolute WBC count
 Initiate measures to minimize bleeding
is less than 1,000/mm3 and the importance of
Discussions:
patient avoiding contact with people who
 draw blood for all laboratory work with one
have known or recent infection or recent
daily venipuncture; avoid taking temperature
vaccination.
rectally or administering suppositories and
 Instruct all personnel in careful hand hygiene
enemas; avoid intramuscular injections, use
before and after entering room.
smallest needle possible if necessary; avoid
 Avoid rectal or vaginal procedures (rectal
bladder catheterizations, use smallest
temperatures, examinations, suppositories,
catheter if necessary; maintain fluid intake of
vaginal tampons) and intramuscular
at least 3 L/24 h unless contraindicated; avoid
injections.
medications that will interfere with clotting
Discussions:
such as, aspirin; recommend use of water-
 Avoid insertion of urinary catheters; if
based lubricant before sexual intercourse.
catheters are necessary, use strict aseptic
technique.
Page 4 of 6
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
 When platelet count is less than 20,000/mm3,
institute bed rest with padded side rails,
avoidance of strenuous activity, and platelet
transfusions as prescribed.
Promoting Home- and Community-Based Care
Teaching Patients Self-Care
 Provide information needed by patient and
family to address the most immediate care
needs likely to be encountered at home.
 Verbally review, and reinforce with written
information, the side effects of treatments and
changes in the patient’s status that should be
reported.
 Discuss strategies to deal with side effects of
treatment with patient and family.
 Identify learning needs on the basis of the
priorities identified by patient and family as
well as on the complexity of home care.
 Instruct patient and family and provide
ongoing support that allows them to feel
comfortable and proficient in managing
treatments at home.
 Refer for home care nursing to provide care
and support for patients receiving advanced
technical care.
 Provide follow-up visits and phone calls to
patient and family, and evaluate patient
progress and ongoing needs.
Continuing Care
 Refer patient for home care
Discussions:
 assessment of the home environment,
suggestions for modifications to assist patient
and
 family in addressing patient’s physical needs
and physical care, and ongoing assessment
of the psychological and emotional effects of
the illness on patient and the family
 Assess changes in the patient’s physical
status and report relevant changes to the
physician.
 Assess adequacy of pain management and
the effectiveness of other strategies to
prevent or manage side effects of treatment.
 Help coordinate patient care by maintaining
close communication with all health care
providers involved in the patient’s care.
 Make referrals and coordinate available
community resources.
Page 5 of 6
Nursing Management Related to Treatment
Cancer Surgery
 Complete a thorough preoperative
assessment for all factors that may affect
patients undergoing surgery.
 Assist patient and family in dealing with the
possible changes and outcomes resulting
from surgery
Discussions:
 provide education and emotional support by
assessing patient and family needs and
exploring with them their fears and coping
mechanisms. Encourage them to take an
active role in decision making when possible.
 Explain and clarify information the physician
has provided about the results of diagnostic
testing and surgical procedures, if asked.
 Communicate frequently with the physician
and other health care team members to
ensure that the information provided is
consistent.
 After surgery, assess patient’s responses to
the surgery and monitor for complications
such as infection, bleeding, thrombophlebitis,
wound dehiscence, fluid and electrolyte
imbalance, and organ dysfunction.
 Provide for patient comfort.
 Provide postoperative teaching that
addresses wound care, activity, nutrition, and
medications.
 Initiate plans for discharge, follow-up care,
and treatment as early as possible to ensure
continuity of care.
 Encourage patient and family to use
community resources such as the American
Cancer Society for support and information.
Bone Marrow Transplantation
 Before BMT, perform nutritional assessments
and extensive physical examinations and
ensure that organ function tests, as well as
psychological evaluations, are completed as
ordered.
 Ensure that patient’s social support systems
and financial and insurance resources are
evaluated.
 Reinforce information for informed consent.
 Provide patient teaching about the procedure
and pre-transplantation and post
transplantation care.
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor

 During the treatment phase, closely monitor

for signs of acute toxicities (eg, nausea,
diarrhea, mucositis, and hemorrhagic cystitis),
and give constant attention to patient.
 During the bone marrow infusions or stem cell
reinfusions, monitor vital signs and blood
oxygen saturation, assess for adverse effects
Discussions:
 fever, chills, shortness of breath, chest pain,
cutaneous reactions, nausea, vomiting,
hypotension or hypertension, tachycardia,
anxiety, and taste changes

 Because of the high risk for dying from sepsis

and bleeding, support patient with blood
products and hemopoietic growth factors and
protect from infection.
 Assess for early graft-versus-host disease
(GVHD) effects on the skin, liver, and GI tract
as well as GI complications
Discussions:
 eg, fluid retention, jaundice, abdominal pain,
ascites, tender and enlarged liver, and
encephalopathy
 Monitor for pulmonary complications, such as
pulmonary edema, and interstitial and other
pneumonias, which often complicate recovery
after BMT.

 Provide ongoing psychosocial patient

assessment, including the stressors affecting
patients at each phase of the transplantation
experience.

Hyperthermia
 Explain to patient and family about the
procedure, its goals, and its effects.
 Assess the patient for adverse effects, and
make efforts to reduce their occurrence and
severity.
 Provide local skin care at the site of the
implanted hyperthermic probes.

Page 6 of 6
 CANCER OF THE BLOOD: LEUKEMIA
TUTOR || September 24, 2022
Transcribers: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name
Editors: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name
Outline
Legend:
Remember
Lecturer Book
(Exams)
  
Heading 1
1. Heading 2
• The quick brown fox jumps over the lazy dog
The quick brown fox jumps over the lazy dog
▪ The quick brown fox jumps over the lazy dog
• The quick brown fox jumps over the lazy dog
Subheading
LEUKEMIA
 The common feature of the leukemias is an
unregulated proliferation or accumulation of
white blood cells (WBCs) in the bone marrow.
 There is also proliferation in the liver and
spleen and invasion of other organs, such as
the meninges, lymph nodes, gums, and skin.
The leukemias are commonly classified
according to the stem cell line involved, either
lymphoid or myeloid.
 Leukemia is also classified as acute (abrupt
onset) or chronic (evolves over months to
years). Its cause is unknown. There is some
evidence that genetic influence and viral
pathogenesis may be involved.
 Bone marrow damage from radiation
exposure or chemicals such as benzene and
alkylating agents can also cause leukemia.
Two major types
➢ Lymphocytic (lymphoblastic) leukemias
have cells from lymphoid pathways.
➢ Myelocytic (myelogenous) leukemias have
abnormal cells originating in myeloid
pathways and have several subtypes classed
by cell characteristics; identifying the
subtypes determines treatment options.
 The basic problem causing leukemia involves
damage to genes controlling cell growth. This
damage then changes cells from a normal to
a malignant (cancer) state. Analysis of the
bone marrow of a patient with acute leukemia
shows abnormal chromosomes about 50% of
the time.
GERIATRIC
1. Environmental, genetic, and immunity factors
influence leukemia development. For
Previous
example, previous treatment for cancer poses
Trans risks for leukemia development from
 exposure to radiation, some chemotherapy
drugs, or ongoing immune deficiencies.
2. The risk for adult-onset leukemia increase
with age.
Clinical Manifestations
Cardinal signs and symptoms include
Weakness and Fatigue, Bleeding Tendencies,
Petechiae and Ecchymoses, Pain, Headache,
Vomiting, Fever, and Infection.
Assessment
 Obtain patient information about:
1. Age
2. Exposure to agents or ionizing radiation that
increase the risk for leukemia
3. Recent history of frequent or severe infections
(e.g influenza, pneumonia, bronchitis) or
unexplained fevers
4. A tendency to bruise or bleed easily or for a
long period; platelet function is often
decreased with leukemic disorders
5. Weakness and fatigue
6. Associated symptoms (headaches, behavior
changes, increased somnolence, decreased
attention span, lethargy, muscle weakness,
loss of appetite, or weight loss)
 Assess for and document:
1. Anemia and anemia-related symptoms
2. Neutropenia
3. Signs of infection, particularly in the
respiratory, skin, and urinary systems
✓ Increased respiratory rate or dyspnea
✓ Abnormal breath sounds with cough
✓ Skin ulcer formation
✓ Urgent, frequent or painful urination
4. Skin changes from reduces perfusion
✓ Pallor and coolness to the touch
✓ Pale conjunctiva and palmar creases
✓ Bruising or petechiae
✓ Mouth sores that do not heal
5. GI changes from bleeding or decreased
✓ perfusion
✓ Nausea and anorexia
✓ Weight loss
Page 1 of 3
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
✓ Rectal fissures
✓ Bloody stools
✓ Reduced bowel sounds, constipation
✓ Enlarged liver or spleen
✓ Abdominal distension or tenderness
6. CNS changes from bleeding or reduced
perfusion
✓ Cranial nerve dysfunction
✓ Papilledema
✓ Seizures or coma
7. Miscellaneous changes
✓ Bone and joint tenderness
✓ Lymph node enlargement
8. Psychosocial issues and concerns, especially
anxiety and fear about the diagnosis,
treatment, and outcome.
9. Abnormal CBC, including:
✓ Decreased hemoglobin and hematocrit
levels
✓ Low platelet count
✓ WBC count (low, normal, or elevated) and
differential
 Diagnosis of leukemia is based on findings
from a bone marrow biopsy. The leukemia
type is diagnosed by cell surface antigens
and chromosomal or gene markers.
Planning and implementation
DRUG THERAPY FRO ACUTE LEUKEMIA
 Induction therapy consists of combination
chemotherapy started at the time of
diagnosis.
1. Neutropenia is a common side effect of
induction therapy. Prolonged hospitalizations
of 2 to 3 weeks are common until recovery of
bone marrow function occurs.
2. Other side effects from drugs used for
induction therapy include nausea, vomiting,
diarrhea, alopecia, stomatitis, kidney toxicity,
liver toxicity, and cardiac toxicity.
 Consolidation therapy consists of another
course of either the same drugs used for
induction at a different dosage or a different
combination of chemotherapy drugs.
- Consolidation therapy may be either a
single course of chemotherapy or
repeated courses.
 Hematopoietic stem cell transplantation
also may be considered, depending on the
disease subtype and the patient’s response to
induction therapy.
Page 2 of 3
 Maintenance therapy may be prescribed for
months to years after successful induction
and consolidation therapies for acute
lymphocytic leukemia (ALL) and acute
promyelocytic leukemia (APL).
- The purpose is to maintain the remission.
Not all types of leukemia respond to
maintenance therapy.
DRUG THERAPY FOR CHRONIC LEUKEMIA
 The decision to initiate therapy is based on
cytogenetic testing, disease stage,
manifestations and disease activity.
 Imatinib mesylate (Gleevec) is used for
chronic myelogenous leukemia (CML) that is
Philadelphia chromosome positive.
 For patients with resistant CML or who are
intolerant to Imatinib, Dasatinib (Sprycel) or
Rituximab (Rituxan) are used.
 Rituximab is often combined with standard
chemotherapy drugs or used as a single
agent for patients with chronic lymphocytic
leukemia (CLL).
 Hematopoietic stem cell transplantation is an
option for patients with CLL.
REDUCING RISK FOR INFECTION
 Potential for infection is related to decreased
immune response and chemotherapy.
 Infection is a major cause of death in the
patient with leukemia because the WBCs are
immature and cannot function or the cells are
depleted from chemotherapy.
 Infection occurs through auto contamination
(normal flora overgrows and penetrates the
internal environment) and cross-
contamination (organisms from another
person or the environment are transmitted to
the patient).
 The three most common sites of infection are
the skin, respiratory tract and intestinal tract.
 Implement infection control and patient
protection measures.
1. Wear a mask when entering the patient’s
room if there is a chance of transmitting an
upper respiratory tract infection.
2. Observe strict aseptic procedures when
performing dressing changes.
3. Place the patient in a private room, if
possible.
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
4. Reduce environmental sources of
contamination.
➢ Do not leave standing collections of water
in vases, denture cups, or humidifiers in
the patient’s room.
➢ Use a minimal bacteria diet (no raw fruits
and vegetables, undercooked meat,
pepper or paprika)
➢ Use high-deficiency particulate air (HEPA)
filtration or laminar airflow syst
5. Monitor for infection.
a. Monitor the daily CBC with differential
WBC count and absolute neutrophil count
(ANC).
b. Inspect the skin and mouth during every
shift for lesions and breakdown.
c. Assess the lungs every 8 hours for
crackles, wheezes, or reduced breath
sounds.
d. Assess all urine for odor and cloudiness
and ask the patient about any urgency,
burning, or pain present with urination.
e. Take vital signs, including temperature, at
least every 4 hours.
f. Provide intervention to maintain skin
integrity.
g. Implement agency neutropenia protocols
when infection is suspected.
h. Drug therapy for infection may include
antibiotic, antiviral or antifungal.
REDUCING RISK FOR INJURY
 Potential for injury is related to bleeding and
adverse drug reactions from chemotherapy.
 Thrombocytopenia increases the risk of
excessive bleeding and occurs from both
leukemia and chemotherapy.
 Institute precautions for patients with
thrombocytopenia
 Administer chemotherapy using best
practices and monitor patient response.
DECREASING FATIGUE
a. Fatigue is related to decreased tissue
oxygenation and increased energy
demands.
b. Production of RBC is limited in leukemia,
causing anemia that contributes to fatigue.
1. Collaborate with nutritionist to provide small,
frequent meals high in protein and
carbohydrates.
Page 3 of 3
2. Administer transfusion therapy (e.g packed
RBC, platelets or clotting factors)
3. Evaluate the patient’s response to drug
therapy with hematopoietic growth factors
such as:
a. Darbepoetin alfa (Aranesp) and epoetin
alfa (Epogen and Procrit) to increase
RBCs.
b. Oprelvekin (Neumega) to increase the
production of platelets.
4. Eliminate or postpone activities that do not
have a direct positive effect on the patient’s
condition.
Community-based care
 Teach the patient and family about:
1. Measures to prevent infection.
2. The importance of continuing therapy and
medical follow-up.
3. The need to report manifestations of infection
or bleeding immediately to the health care
provider.
4. Assessing for petechiae, avoiding trauma and
sharp objects, applying pressure to wounds
for 10 minutes, and reporting blood in the
stool or urine or headache that does not
respond to acetaminophen.
5. Resources for psychological and financial
support and for role and self-esteem
adjustment.
6. Care of the central catheter if in place at
discharge.
7. Assess the patient’s need for a home care
nurse, aide, or equipment.
 CANCER OF THE CERVIX/UTERINE
TUTOR || September 24, 2022
Transcribers: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name
Editors: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name
Outline
Legend:
Remember
Lecturer Book
(Exams)
  
Heading 1
1. Heading 2
• The quick brown fox jumps over the lazy dog
The quick brown fox jumps over the lazy dog
▪ The quick brown fox jumps over the lazy dog
• The quick brown fox jumps over the lazy dog
Subheading
Cancer of the Cervix
 Cancer of the cervix is predominantly
squamous cell cancer and also includes
adenocarcinomas.
 It remains the third most common
reproductive cancer in women and is
estimated to affect more than 11,000 women
in the United States every year.
 Risk factors vary from multiple sex partners to
smoking to chronic cervical infection
(exposure to human papillomavirus [HPV]).
Clinical Manifestations
 Cervical cancer is most often asymptomatic.
When discharge, irregular bleeding, or pain or
bleeding after sexual intercourse occurs, the
disease may be advanced.
 Vaginal discharge gradually increases in
amount, becomes watery, and finally is dark
and foul smelling because of necrosis and
infection of the tumor.
 Bleeding occurs at irregular intervals between
periods or after menopause, may be slight
(enough to spot undergarments), and is
usually noted after mild trauma (intercourse,
douching, or defecation). As disease
continues, bleeding may persist and increase.
 Leg pain, dysuria, rectal bleeding, and edema
of the extremities signal advanced disease.
 Nerve involvement, producing excruciating
pain in the back and legs, occurs as cancer
advances and tissues outside the cervix are
invaded, including the fundus and lymph
glands anterior to the sacrum.
 Extreme emaciation and anemia, often with
fever due to secondary infection and
GERIATRIC
abscesses in the ulcerating mass, and fistula
formation may occur in the final stage.
Previous
Trans Risk Factors
 ➢ Infection with Human Papillomavirus (HPV)
➢ History of STD
➢ Multiple sex partners
➢ Younger than 18 years of age at first
intercourse
➢ Multiparity (multiple pregnancies)
➢ Smoking
➢ Oral contraceptive use
➢ Obesity, poor diet
Discussions: Vaccination with HPV vaccine,
ideally before onset of intercourse, appears to
protect against the high-risk HPV strains that are
responsible for most cervical cancer.
❖ Cervical cancer can be detected at early
stages, when cure is most likely, through a
periodic pelvic examination and Pap Smear
test.
Assessment and Diagnostic Findings
 Pap smear and biopsy results show severe
dysplasia, high grade epithelial lesion
(HGSIL), or carcinoma in situ.
 Other tests may include x-rays, laboratory
tests, special examinations (eg, punch biopsy
and colposcopy), dilation and curettage (D &
C), CT scan, MRI, IV urography, cystography,
PET, and barium x-ray studies.
Medical Management
Discussions: Disease may be staged (usually
TNM system) to estimate the extent of the
disease so that treatment can be planned more
specifically and prognosis.
 Conservative treatments include monitoring,
cryotherapy (freezing with nitrous oxide),
laser therapy, loop electrosurgical excision
procedure (LEEP), or conization (removing a
cone-shaped portion of cervix).
 Simple hysterectomy if preinvasive cervical
cancer (carcinoma in situ) occurs when a
woman has completed childbearing. Radical
trachelectomy is an alternative to
hysterectomy.
Page 1 of 2
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor

 For invasive cancer, surgery, radiation
(external beam or brachytherapy), platinum-
based agents, or a combination of these
approaches may be used.
 For recurrent cancer, pelvic exenteration is
considered.
Assessment
 Ask the patient about vaginal bleeding.
Discussions: Cervical cancer may manifest as
spotting between menstrual periods or after
sexual intercourse or douching. The classic
symptom of invasive cancer is painless vaginal
bleeding. As the cancer grows, bleeding
increases in frequency, duration, and amount,
and it may become continuous.
 Assess for later manifestation:
✓ Watery, blood-tinged vaginal discharge
that becomes dark and foul-smelling
(occurs as the disease progresses)
✓ Leg pain (along the sciatic nerve) or
swelling.
✓ Flank pain indicating hydronephrosis from
tumor blocking a ureter, backing up urine
into the kidney.
 Assess for manifestations of recurrence or
metastatic
✓ Unexplained weight loss
✓ Dysuria (painful urination)
✓ Pelvic pain
✓ Hematuria (bloody urine)
✓ Rectal bleeding
✓ Cheat pain
✓ Coughing
Discussions: Diagnosis is made by cytologic
examination of the Pap smear. Coloscopy
examination may be performed to view the
transformation zone and biopsy many areas of
the cervix.
✓ Report a fever or any heavy vaginal bleeding
or foul-smelling drainage.
Surgical Management: Microinvasive Stage
Discussions: Microinvasive stage depends on
the patient’s health, desire for future child
bearing, tumor size, stage, cancer cell type, and
preferences.
 A conization, in which a cone-shaped area of
cervix is removed surgically, can remove the
affected tissue while preserving fertility.
✓ Potential complications from this
procedure include hemorrhage and
uterine perforation.
✓ Long-term follow-up care is needed,
because new cancers can develop.
 A total hysterectomy, in which the cervix and
body of the uterus are removed but the
fallopian tubes and ovaries are spared, may
be performed if fertility is not an issue.
Non-surgical Management
 Radiation therapy is reserved for invasive
cervical cancer.
 Chemotherapy with radiation therapy may be
also used for invasive cervical cancer.

Interventions
Surgical Management: Early Stage
➢ Surgical management for small, early-stage
cervical cancer includes electrosurgical
excision, laser therapy, and cryosurgery.
➢ Teach patients who have these procedures to
follow restrictions for about 3 weeks:
✓ Refrain from sexual intercourse
✓ Do not use tampons
✓ Do not douche.
✓ Take showers rather than tub baths.
✓ Avoid lifting heavy objects.
Page 2 of 2
 CANCER OF THE LIVER
TUTOR || September 24, 2022
Transcribers: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name
Editors: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name
Outline
Legend:
Remember
Lecturer Book
(Exams)
  
Heading 1
1. Heading 2
• The quick brown fox jumps over the lazy dog
The quick brown fox jumps over the lazy dog
▪ The quick brown fox jumps over the lazy dog
• The quick brown fox jumps over the lazy dog
Subheading
Cancer of the Liver
 Few cancers originate in the liver. Primary
liver tumors usually are associated with
chronic liver disease, hepatitis B and C, and
cirrhosis.
 Hepatocellular carcinoma (HCC), the most
common type of primary liver tumor, usually
cannot be resected because of rapid growth
and metastasis elsewhere.
 Cirrhosis, hepatitis B and C, and exposure to
certain chemical toxins have been implicated
in the etiology of HCC. Cigarette smoking,
especially when combined with alcohol use,
has also been identified as a risk factor.
 Metastases from other primary sites,
particularly the digestive system, breast and
lung, are found in the liver 2.5 times more
frequently than tumors due to primary liver
cancers.
Clinical Manifestations
 Early manifestations include pain (dull ache in
upper right quadrant, epigastrium, or back),
weight loss, loss of strength, anorexia, and
anemia.
 Liver enlargement and irregular surface may
be noted on palpation.
 Jaundice is present only if larger bile ducts
are occluded.
 Ascites develops if such nodules obstruct the
portal veins or if tumor tissue is seeded in the
peritoneal cavity.
Assessment and Diagnostic Findings
 Diagnosis is made on the basis of clinical
signs and symptoms, history and physical
GERIATRIC
examination, and results of laboratory and x-
ray studies, PET scans, liver scans, CT
Previous
scans, ultrasound, MRI, arteriography,
Trans laparoscopy, or biopsy.
  Leukocytosis (increased WBC counts),
erythrocytosis (increased red blood cell
counts), hypercalcemia, hypoglycemia, and
hypocholesterolemia may also be seen on
laboratory assessment. Elevated levels of
serum alpha-fetoprotein (AFP) may be found.
Medical Management
Radiation Therapy
 IV or intra-arterial injection of antibodies
tagged with radioactive isotopes that
specifically attack tumor-associated antigens
 Percutaneous placement of a high-intensity
source for interstitial radiation therapy
Chemotherapy
 Systemic chemotherapy; embolization of
tumor vessels with chemotherapy
 An implantable pump to deliver high-
concentration chemotherapy to the liver
through the hepatic artery
Percutaneous Biliary Drainage
 Percutaneous biliary drainage is used to
bypass biliary ducts obstructed by the liver,
pancreatic, or bile ducts in patients with
inoperable tumors or those who are poor
surgical risks.
 Complications include sepsis, leakage of bile,
hemorrhage, and reobstruction of the biliary
system.
 Observe patient for fever and chills, bile
drainage around the catheter, changes in vital
signs, and evidence of biliary obstruction,
including increased pain or pressure, pruritus,
and recurrence of jaundice.
Other Nonsurgical Treatment Modalities
 Hyperthermia: Heated by laser or
radiofrequency energy is directed to tumors to
cause necrosis of the tumors while sparing
normal tissue.
 Radiofrequency thermal ablation (tumor cell
death from coagulation necrosis).
 Immunotherapy: Lymphocytes with antitumor
reactivity are administered.
Page 1 of 2
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor

 Embolization (ischemia and necrosis of the  Encourage patient to resume activities as

tumor occur).
 For multiple small lesions, ultrasound-guided
injection of alcohol promotes dehydration of
tumor cells and tumor necrosis.
Surgical Management
 Hepatic resection can be performed when the
primary hepatic tumor is localized or when the
primary site can be completely excised and
the metastasis is limited.
 Capitalizing on the regenerative capacity of
the liver cells, surgeons have successfully
removed 90% of the liver. The presence of
cirrhosis limits the ability of the liver to
regenerate.
 In preparation for surgery, the patient’s
nutritional, fluid, and general physical status
are assessed, and efforts are undertaken to
ensure the best physical condition possible.
 Removal of a lobe of the liver is the most
common surgical procedure for excising a
liver tumor.
 In patients who are not candidates for
resection or transplantation, ablation of HCC
may be accomplished by chemicals such as
ethanol or by physical means such as
radiofrequency ablation or microwave
coagulation.
 Removing the liver and replacing it with a
healthy donor organ is another way to treat
liver cancer.
soon as possible, but caution patient to avoid
activities that may damage the pump.
 Provide reassurance and instructions to
patient and family to reduce fear that the
percutaneous biliary drainage catheter will fall
out.
 Provide verbal and written instructions as well
as demonstration of biliary catheter care to
patient and family; instruct in techniques to
keep catheter site clean and dry, to assess
the catheter and its insertion site, and to
irrigate the catheter to prevent debris and
promote patency.
 Refer patient for home care.
 Collaborate with the health care team,
patient, and family to identify and implement
pain management strategies and approaches
to management of other problems: weakness,
pruritus, inadequate dietary intake, jaundice,
and symptoms associated with metastasis.
 Assist patient and family in making decisions
about hospice care, and initiate referrals.
Encourage patient to discuss end-of-life care.

Nursing Management: Postoperative

 Assess for problems related to
cardiopulmonary involvement, vascular
complications, and respiratory and liver
dysfunction.
 Give careful attention to metabolic
abnormalities (glucose, protein, and lipids).
 Provide close monitoring and care for the first
2 or 3 days.
 Instruct patient and family about care of the
biliary catheter and the potential
complications and side effects of hepatic
artery chemotherapy.
 Instruct patient about the importance of
follow-up visits to permit frequent checks on
the response of patient and tumor to
chemotherapy, condition of the implanted
pump site, and any toxic effects.

Page 2 of 2
 CANCER OF THE BREAST
TUTOR || September 24, 2022
Transcribers: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name
Editors: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name
Outline
Legend:
Remember
Lecturer Book
(Exams)
  
Heading 1
1. Heading 2
• The quick brown fox jumps over the lazy dog
The quick brown fox jumps over the lazy dog
▪ The quick brown fox jumps over the lazy dog
• The quick brown fox jumps over the lazy dog
Subheading
BREAST CANCER
OVERVIEW
 Breast cancer is 2nd only to lung cancer as a
cause of cancer death in women.
 Early detection through regular screening like
breast examination and mammography can
improve survival.
Discussions:
 There is no one specific cause of breast
cancer; rather, a combination of genetic,
hormonal, and possibly environmental events
may contribute to its development.
 If lymph nodes are unaffected, the prognosis
is better. The key to improved cure rates is
early diagnosis, before metastasis.
Two Categories
1. Noninvasive cancers remain within the
breast ducts and make up 20% of breast
cancer.
2. Invasive cancers penetrate the tissue
surrounding the ducts and make up 80% of all
breast cancers.
➢ When the breast tumor invades lymphatic
channels, skin drainage is blocked,
causing skin edema, redness, warmth,
and an orange peel appearance of the
skin (“peau d’ orange”).
➢ Invasion of the lymphatic channels carries
cancer cells to the axillary lymph nodes.
Pathologic examination of these nodes
helps determine the stage of the disease.
➢ Invasive breast cancer can spread through
the blood and lymph systems to distant
GERIATRIC
sites, most commonly the bone, lungs,
brain, and liver.
Previous
Trans Risk Factors
  Gender (female) and increasing age.
➢ Previous breast cancer
Discussions: The risk of developing cancer in
the same or opposite breast is significantly
increased.
➢ Family history
Discussions: Having first-degree relative with
breast cancer (mother, sister, daughter)
increases the risk twofold; having two first-degree
relatives increases the risk fivefold.
➢ Genetic mutations (BRCA1 or BRCA2)
account for majority of inherited breast
cancers.
➢ Hormonal factors
Discussions: early menarche (before 12 years
of age), nulliparity, first birth after 30 years of
age, late menopause (after 55 years of age), and
hormone therapy (formerly referred to as
hormone replacement therapy).
➢ Other factors may include exposure to
ionizing radiation during adolescence and
early adulthood obesity, alcohol intake (beer,
wine, or liquor), high-fat diet (controversial,
more research needed).
Protective Factors
 Protective factors may include regular
vigorous exercise (decreased body fat),
pregnancy before age 30 years, and
breastfeeding.
Prevention Strategies
Discussions: Patients at high risk for breast
cancer may consult with specialists regarding
possible or appropriate prevention strategies
such as the following:
➢ Long-term surveillance consisting of twice-
yearly clinical breast examinations starting
at age 25 years, yearly mammography, and
possibly MRI
➢ Chemoprevention to prevent disease before
it starts, using tamoxifen (Nolvadex) and
possibly raloxifene (Evista)
Page 1 of 4
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
➢ Prophylactic mastectomy (“risk-reducing”
mastectomy) for patients with strong family
history of breast cancer
Discussions: a diagnosis of lobular carcinoma in
situ (LCIS) or atypical hyperplasia, a BRCA gene
mutation, an extreme fear of cancer (“cancer
phobia”), or previous cancer in one breast
Clinical Manifestations
➢ Generally, lesions are nontender, fixed, and
hard with irregular borders; most occur in the
upper outer quadrant.
➢ Some women have no symptoms and no
palpable lump but have an abnormal
mammogram.
➢ Advanced signs may include skin dimpling,
nipple retraction, or skin ulceration.
Assessment and Diagnostic Methods
➢ Biopsy (eg, percutaneous, surgical) and
histologic examination of cancer cells.
➢ Tumor staging and analysis of additional
prognostic factors are used to determine the
prognosis and optimal treatment regimen.
➢ Chest x-rays, CT, MRI, PET scan, bone
scans, and blood work
Discussions: complete blood cell count,
comprehensive metabolic panel, tumor markers
[i.e., carcinoembryonic antigen (CEA), CA15-3]
Assessment
 Obtain patient information about:
✓ Age, race, ethnicity
✓ Personal and family history of cancer
✓ Age at menarche and menopause
✓ Number of children and age at first child’s
birth
✓ Health behaviors, including practice of
breast self-exam (BSE), clinical breast
examination, and mammography
✓ How the mass was discovered and how
long ago
✓ Whether other body changes have been
noticed recently, especially bone or joint
pain
✓ Brief nutritional history, including intake of
fat and alcohol
 Assess for:
1. Specific information about the mass:
✓ Location of the mass, described using the
face-of-the-clock method
✓ Shape, size and consistency
Page 2 of 4
✓ Assess benign lumps as mobile and round
or oval; assess possible malignant lumps
as fixed and irregularly shaped, often in
the upper outer breast quadrant.
✓ Skin changes, such as dimpling, orange
peel appearance, redness, and warmth,
nipple retraction, or ulceration.
2. Presence of enlarged axillary or
supraclavicular lymph nodes
3. Pain or soreness in the affected breast
4. Psychosocial adjustments:
Patient’s current knowledge and need for
information
Patient’s self-image, sexuality, and current
intimate relationships
How the patient has successfully handled stress
in the past
Patient’s feelings about the disease and
expectations of treatment
Myths or misconceptions the patient may have
Need for additional resources
5. Pathologic examination of tissue for diagnosis
and prognosis:
✓ Biopsy, which is the definitive test that
proves presence or absence of cancer
✓ Presence of tumor hormone receptors
(cancers that express receptors have a
better treatment response) and protein
expression profiling of tumor cell
✓ Lymph node involvement or other sites of
metastasis
Planning and Implementation
 Teach women ways to minimize surgical area
deformity and enhance body image, such as
the use of a breast prosthesis or the option of
breast reconstruction.
 Address the reactions of family and significant
others to the diagnosis of breast cancer;
provide support and education.
 After breast cancer surgery, assess vital
signs, dressings, drainage tubes, and amount
of drainage.
 Notify the health care team that the arm of the
surgical mastectomy side should not be used
for blood pressures, blood drawing, or
injections.
Discussions: Chronic arm swelling known as
lymphedema can be a side effect from a
mastectomy. If this occurs, it is best not to take
blood pressure on the effected arm to avoid
putting more pressure on the vessels in the arm.
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
 Assess the return of arm and shoulder
mobility after breast surgery and axillary
dissection.
 Teach patient measures to prevent
lymphedema after axillary node dissection or
assist the patient with measures to reduce
lymphedema in the affected arm.
✓ Lymphedema is an abnormal
accumulation of protein fluid in the
subcutaneous tissue of the affected limb
after a mastectomy and is commonly
overlooked topic in health teaching.
✓ Risk factors include injury or infection of
the extremity, obesity, presence of
extensive axillary disease, and radiation
treatment.
✓ A referral to a lymphedema specialist may
be necessary for the patient to be fitted for
a compression sleeve and/or glove, to be
taught exercises and manual lymph
drainage, and to discuss ways to modify
daily activities to avoid worsening the
problem.
Surgical Management
➢ To improve survival and to reduce the risk for
local recurrence, the mass itself should be
removed by one of several types of surgery.
➢ A large tumor may be treated with
chemotherapy to shrink the tumor before it is
surgically removed.
➢ Surgical approaches include:
1. Breast-conserving surgery, in which the bulk
of the tumor is removed (not the entire
breast), is used mostly for stages 1 and 11
breast cancers and is usually followed with
radiation therapy.
2. Modified radical mastectomy, in which the
affected breast, skin and axillary nodes are
completely removed but the underlying
muscles remain intact, is indicated when
tumor is present in different quadrants of the
breast, when the patient may be unable to
have radiation therapy, when the tumor is
large and the breast is small, and when the
patient prefers this approach.
 Provide preoperative care, including
psychological preparation:
a. Review the type of procedure planned.
b. Assess the patient’s current level of
knowledge
Page 3 of 4
c. Teach about perioperative information,
including:
✓ The need for a drainage tube
✓ The location of the incision
✓ Mobility restriction, including avoiding BP
in affected arm
✓ Body image issues
➢ Provide postoperative care:
1. Place a sign over the patient’s bed to
inform the staff to avoid using affected arm
for taking BP measurements, giving
injections or drawing blood.
2. Perform wound care:
✓ Observe the wound for signs of
swelling and infection
✓ Assess drainage tubes for patency,
color of drainage, and the amount.
3. Position the patient for best drainage and
comfort:
✓ Head of the bed up at least 30 degrees
✓ Arm on the same side as the axillary
dissection elevated on a pillow while
he or she is awake.
4. Work with the physical therapist to plan
progressive exercises:
✓ Squeezing the affected hand around a
soft, round object (a ball or rolled
washcloth)
✓ Flexion and extension of the elbow.
➢ Brest reconstruction is common for women
without complications from the cancer surgery
and may be performed during the cancer
surgery or at a later time. It may involve one
or more stages using skin flaps or prostheses.
➢ For patients with breast Ca at a stage for
which surgery is the main treatment, follow-up
with adjuvant radiation therapy,
chemotherapy, hormone therapy, or targeted
therapy may also be prescribed.
➢ The decision to follow the original surgical
procedure with adjuvant therapy for breast CA
is based on:
1. Stage of the disease
2. Patient’s age and menopausal status
3. Patient’s preferences
4. Pathologic examination results
5. Hormone receptor status
6. Presence of a known genetic
predisposition
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
➢ Radiation therapy is administered after
breast-conserving surgery and may be
delivered by any one of several methods.
1. Traditional whole-breast irradiation is
delivered by external beam radiation over
5 to 6 weeks.
2. Interstitial brachytherapy, in which several
catheters loaded with a radioactive source
are inserted at the lumpectomy cavity and
surrounding margin, is given over 4 to 5
days.
3. Balloon brachytherapy, also known as
MammoSite, involves the use of a single
balloon-tipped catheter that is surgically
placed near the tumor bed. The catheter is
loaded with a radiation source and inflated
to conform to the total cavity. A total of 10
treatments are given, with at least 6 hours
between each treatment.
4. Intraoperative radiation therapy uses a
high single dose of radiation delivered
during lumpectomy surgery.
➢ Chemotherapy for breast cancer is delivered
over 3 to 6 months in cycles of 2 to 3 weeks
each month with a combination of agents.
➢ Targeted therapy for breast cancer involves
the use of drugs that target specific features
of cancer cells, such as protein, an enzyme,
or the formation of new blood cells. These
agents are useful only for cancers that
overexpress a certain protein or enzymes.
➢ Hormonal therapy is used to reduce the
estrogen available to breast tumors to stop or
prevent their growth. Agents include:
1. Luteinizing hormone-releasing hormone
(LH-RH) gene agonists that inhibit
estrogen synthesis
✓ Leuprolide (Lupron)
✓ Goserelin (zoladex)
2. Selective estrogen receptors modulators
(SERMs) that block the effect of estrogen
in the breast but not the ovaries of women
who have estrogen receptor (ER)-positive
breast cancer; one example is Tamoxifen
3. Aromatase inhibitors (AIs) to prevent the
conversion of androgen to estrogen in the
adrenal gland.
✓ Anastrozole (Arimidex)
✓ Exemestane (Aromasin)
Page 4 of 4
Community-based Care
 Make the appropriate referrals for care after
discharge:
1. Home health and social services
2. Reach to recovery or other organizations
that provide social support
 Teach the patient and family about:
1. Wound care: drains, dressings, avoidance
of lotions or ointments in the area, keeping
the affected arm elevated if a lymph node
dissection was performed.
2. Initial activity restrictions, especially
stretching or reaching for heavy objects,
while continuing with activity to regain full
range of motion (ROM)
3. Measures to improve body image
4. Information about interpersonal
relationships and roles
5. Essential follow-up, including annual
health care provider visits and
mammography or other imaging
procedures
6. Measures to avoid injury, infection, and
swelling of the affected arm.
 Prepare the patient and partner about
psychosocial issues:
1. Describe the expected postoperative
appearance.
2. Reassure her that scars will fade and
edema will lessen with time.
3. Encourage the woman to look at her
incision before she goes home and offer
to be present when she does so.
4. Involve the partner or family in teaching.
5. Discuss sexual concerns before
discharge. Sexual dysfunction affects up
to 90% of women treated for breast
cancer, although it is an issue seldom
discussed patients and health care
providers.
6. Advise sexually active patients receiving
chemotherapy or radiotherapy to use birth
control during therapy.
 CANCER OF THE PROSTATE
TUTOR || September 24, 2022
GERIATRIC
Transcribers: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name
Editors: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name

Outline Assessment and Diagnostic Methods

➢ Digital rectal examination (DRE; preferably by
Legend:
Remember Previous
the same examiner).
(Exams)
Lecturer Book
Trans ➢ The diagnosis is confirmed by a histologic
    examination of tissue removed surgically by
transurethral resection of the prostate
Heading 1 (TURP), open prostatectomy, ultrasound
1. Heading 2 guided transrectal needle biopsy, or fine-
• The quick brown fox jumps over the lazy dog needle aspiration.
The quick brown fox jumps over the lazy dog
➢ Prostate-specific antigen (PSA) level;
▪ The quick brown fox jumps over the lazy dog
transrectal ultrasound; bone scans, skeletal x-
• The quick brown fox jumps over the lazy dog
rays, and MRI; pelvic CT scans; or
Subheading
monoclonal antibody-based imaging may also
CANCER OF THE PROSTATE be used.
OVERVIEW ➢ Elevated levels of serum acid phosphatase
 Prostate cancer is the second most common ➢ Prostate tissue biopsy
type of cancer in men and most commonly ➢ Lymph node biopsy
affects men over 65 years with black men ➢ CT scan of the pelvis and abdomen
having the greatest risk for this cancer. ➢ MRI
 Most prostate tumors are adenocarcinomas
arising from epithelial cells located in the Assessment
posterior lobe or outer portion of the gland,  Obtain patient information about:
and most are androgen-sensitive (need 1. Age
testosterone to grow). 2. Race and ethnicity
 If found early this slow growing cancer has a 3. Family history of cancer
nearly 100% cure rate. 4. Nutritional habits
 In advanced stages of the disease, metastatic 5. Problems with urination
sites include lymph nodes, bone, lungs, and ✓ Difficulty in starting urination
liver. ✓ Frequent bladder infections
✓ Urinary retention
Clinical Manifestations 6. Pain during intercourse, especially when
 Usually asymptomatic in early stage ejaculating
 Nodule felt within the substance of the gland 7. Any other pain
or extensive hardening in the posterior lobe ➢ Assess for:
Advanced Stage a. Blood in the urine (hematuria)
 Lesion is stony hard and fixed. b. Pain in the pelvis, spine, hips or rib
 Obstructive symptoms occur late in the c. Swollen lymph nodes, especially in the groin
disease: difficulty and frequency of urination, areas
urinary retention, decreased size and force of ➢ Assess for psychosocial issues:
urinary stream. a. anxiety, fear, and/or depression
 Blood in urine or semen; painful ejaculation. b. Determine what support systems the
 Cancer can spread to lymph nodes and bone. patient has, such as family, spiritual
 Symptoms of metastases include backache, leaders or community group support, to
hip pain, perineal and rectal discomfort, help him through diagnosis, treatment and
anemia, weight loss, weakness, nausea, recovery.
oliguria, and spontaneous pathologic c. Refer the patient with concerns related to
fractures; hematuria may result from urethral sexuality and erectile dysfunction (ED) to
or bladder invasion. his surgeon (urologist), sex therapist or
 Sexual dysfunction. intimacy therapist if available.
Page 1 of 3
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
Medical Management
Discussions: Treatment is based on the
patient’s life expectancy, symptoms, risk of
recurrence after definitive treatment, size of the
tumor, Gleason score, PSA level, likelihood of
complications, and patient preference.
Management can range from nonsurgical
methods that involve “watchful waiting” to surgery
(eg, prostatectomy).
Radical Prostatectomy
 Removal of the prostate, seminal vesicles,
tips of the vas deferens, and often the
surrounding fat, nerves, and blood vessels
through suprapubic approach (greater blood
loss), perineal approach (easily contaminated,
incontinence, impotence, and rectal injury
common), or retropubic approach (infection
can readily start).
 This procedure is used with patients whose
tumor is confined to the prostate.
 Sexual impotency and various degrees of
urinary incontinence commonly follow radical
prostatectomy. Nonsurgical
Radiation Therapy
 Teletherapy (external beam radiation therapy
[EBRT]): treatment option for patients with low
risk prostate cancer
 Brachytherapy (internal implants): commonly
used monotherapy
 treatment option for early, clinically organ-
confined prostate cancer
 Side effects: inflammation of the rectum,
bowel, and bladder (proctitis, enteritis, and
cystitis); acute urinary dysfunction; pain with
urination and ejaculation; rectal urgency,
diarrhea, and tenesmus; rectal proctitis,
bleeding, and rectal fistula; painless
hematuria; chronic interstitial cystitis; urethral
stricture erectile dysfunction; and rarely,
secondary cancers of the rectum and bladder
Hormone Therapy
 Androgen deprivation therapy (ADT):
accomplished either by surgical castration
(bilateral orchiectomy, removal of the testes)
or by medical castration with the
administration of medications, such as
luteinizing hormone–releasing hormone
(LHRH) agonists.
 Hypogonadism is responsible for the adverse
effects of ADT, which include vasomotor
flushing, loss of libido, decreased bone
density (resulting in osteoporosis and
Page 2 of 3
fractures), anemia, fatigue, increased fat
mass, lipid alterations, decreased muscle
mass, gynecomastia (increased breast
tissue), and mastodynia (breast/nipple
tenderness).
Other Therapies
➢ Chemotherapy
➢ Cryosurgery for those who cannot
physically tolerate surgery or for
recurrence
➢ Repeated TURPs to keep urethra patent;
suprapubic or transurethral catheter
drainage when repeated TUR is
impractical
➢ Opioid or nonopioid medications to control
pain with metastasis to bone
➢ Blood transfusions to maintain adequate
hemoglobin levels
➢ Various forms of CAM
Nonsurgical Management
 management is usually an adjunct to surgery
but may be done as an alternative
intervention if the cancer is widespread of the
patient’s condition or age prevents surgery.
 External or internal radiation therapy may be
used in the treatment of prostate cancer or for
palliation of late-stage symptoms.
1. External beam radiation therapy (EBRT)
comes from a source outside the body.
Patients are usually treated 5 days each
week for 6 to 9 weeks.
2. Complications of EBRT may include:
a. Acute radiation cystitis
b. Radiation proctitis
3. Internal radiation therapy (brachytherapy) can
be delivered by implanting low-dose radiation
seeds directly into and around the prostate
gland.
4. General management issues for the care of
patients undergoing radiation therapy. (refer
to general nursing management for cancer)
 Hormone therapy is often used for prostate
tumors, because many are hormone
dependent, and these tumors can be
reduced or have their growth slowed through
androgen deprivation. Manipulating the
patient’s hormones may be accomplished in
two ways:
a. The testosterone influence can be
removed by a bilateral orchiectomy
(surgery)
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor

b. Luteinizing hormone-releasing hormone ✓ Teach the patient how to inspect the incision
(LH-RH) agonists or antiandrogens site daily for signs of infection
(drugs) can be given. ✓ Stress the importance of keeping follow-up
 Side effects of hormone therapy may appointments
include:  Refer the patient and partner to agencies or
✓ Hot flashes support groups
✓ Gynecomastia (breast development)  Refer patients with ED or urinary incontinence
 Systemic cytotoxic chemotherapy is an to a urologist or other specialist.
option for patients whose cancer has spread
and for whom other therapies have not
worked.
a. Specific treatment regimens and drug
combinations vary, but the most
commonly used agents for prostate cancer
include docetaxel (Taxotere), cisplatin
(Platinol), and etoposide (VP-16,
VePesid).
b. General management issues for the care
of patients undergoing chemotherapy.
 Cryotherapy (cryoablation) is a minimally
invasive procedure for patients whose
disease is known to be confined to the
prostate gland. Transrectal cryoprobes are
positioned around the prostate gland. Liquid
nitrogen freezes the gland and results in
prostate cell death.

Community-based Care
 Include the patient’s sexual partner in any
teaching and discharge planning.
 Assess and address the patient’s physical
and psychosocial needs before hospital
discharge and ensure his or her continued
management in the community setting.
 Home care management of the patient after a
radical prostatectomy includes:
1. Collaborating with the case manager to
coordinate the efforts of various health care
providers and possibly a home care nurse

2. Health teaching about:

✓ Indwelling urinary catheter care if recovering
from an open procedure, including:
➢ Caring for the catheter and leg bag
➢ Identifying manifestations of urinary
infection and other complications
✓ Restriction for activity or weight lifting
✓ Kegel perineal exercises may reduce the
severity of urinary incontinence after radical
prostatectomy.
✓ Teach the patient to avoid straining at
defecation
Page 3 of 3
 CANCER OF THE STOMACH (STOMACH CANCER)
TUTOR || September 24, 2022
GERIATRIC
Transcribers: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name
Editors: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name

Outline  Advanced gastric cancer may be palpable as

Legend:
Remember
Lecturer Book
(Exams)
  
Heading 1
1. Heading 2
• The quick brown fox jumps over the lazy dog
The quick brown fox jumps over the lazy dog
▪ The quick brown fox jumps over the lazy dog
• The quick brown fox jumps over the lazy dog
Subheading
Cancer of the Stomach
(Gastric Cancer)
 Most gastric cancers are adenocarcinomas;
they can occur anywhere in the stomach. The
tumor infiltrates the surrounding mucosa,
penetrating the wall of the stomach and
adjacent organs and structures.
 It typically occurs in males and people older
than 40 years (occasionally in younger
people). The incidence of gastric cancer is
much greater in Japan.
 Diet appears to be a significant factor (ie, high
in smoked foods and lacking in fruits and
vegetables). Other factors related to the
incidence of stomach cancer include chronic
inflammation of the stomach, Helicobacter
pylori infection, pernicious anemia, smoking,
achlorhydria, gastric ulcers, previous subtotal
gastrectomy (more than 20 years ago), and
genetics.
 Prognosis is poor because most patients
have metastases (liver, pancreas, and
esophagus or duodenum) at the time of
diagnosis.
Clinical Manifestations
 Early stages: Symptoms may be absent or
may resemble those of patients with benign
ulcers (eg, pain relieved with antacids).
 Progressive disease: Symptoms include
dyspepsia (indigestion), early satiety, weight
loss, abdominal pain just above the umbilicus,
loss or decrease in appetite, bloating after
meals, nausea and vomiting, and symptoms
similar to those of peptic ulcer disease.
a mass.
Previous
Trans Assessment and Diagnostic Methods
  EGD for biopsy and cytologic washings is the
diagnostic study of choice.
 Barium x-ray examination of the upper GI
tract, EUS, and CT may be used.
Medical Management
➢ Removal of gastric carcinoma; curative if
tumor can be removed while still localized to
the stomach
➢ Effective palliation (to prevent symptoms such
as obstruction) by resection of the tumor; total
gastrectomy; radical subtotal gastrectomy;
proximal subtotal gastrectomy;
esophagogastrectomy
➢ Chemotherapy for further disease control or
for palliation (5-fluorouracil, cisplatin,
doxorubicin, etoposide, and mitomycin-C)
➢ Radiation for palliation
➢ Tumor marker assessment to determine
treatment effectiveness
Assessment
 Elicit history of dietary intake.
 Identify weight loss, including time frame and
amount; assess appetite and eating habits;
include pain assessment.
 Obtain smoking and alcohol history and family
history (eg, any first- or second-degree
relatives with gastric or other cancer).
 Assess psychosocial support (marital status,
coping skills, emotional and financial
resources).
 Perform complete physical examination
(palpate and percuss abdomen for
tenderness, masses, or ascites).
Nursing Diagnoses
➢ Anxiety related to disease and anticipated
treatment
➢ Imbalanced nutrition, less than body
requirements, related to early satiety or
anorexia
➢ Pain related to tumor mass
➢ Anticipatory grieving related to diagnosis of
cancer
Page 1 of 2
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
➢ Deficient knowledge regarding self-care
activities
Planning and Goals
 The major goals for the patient may include
reduced anxiety, optimal nutrition, relief of
pain, and adjustment to the diagnosis and
anticipated lifestyle changes.
Nursing Interventions
Reducing Anxiety
➢ Provide a relaxed, nonthreatening
atmosphere (helps patient express fears,
concerns, and anger).
➢ Encourage family in efforts to support the
patient, offering assurance and supporting
positive coping measures.
➢ Advise about any procedures and treatments.
Promoting Optimal Nutrition
➢ Encourage small, frequent feedings of
nonirritating foods to decrease gastric
irritation.
➢ Facilitate tissue repair by ensuring food
supplements are high in calories and vitamins
A and C and iron.
➢ Administer parenteral vitamin B12 indefinitely
if a total gastrectomy is performed.
➢ Monitor rate and frequency of IV therapy.
➢ Record intake, output, and daily weights.
➢ Assess signs of dehydration (thirst, dry
mucous membranes, poor skin turgor,
tachycardia, decreased urine output).
➢ Review results of daily laboratory studies to
note any metabolic abnormalities (sodium,
potassium, glucose, BUN).
➢ Administer antiemetic agents as prescribed.
Relieving Pain
➢ Administer analgesic agents as prescribed
(continuous infusion of an opioid).
➢ Assess frequency, intensity, and duration of
pain to determine effectiveness of analgesic
agent.
➢ Work with the patient to help manage pain by
suggesting nonpharmacologic methods for
pain relief, such as position changes,
imagery, distraction, relaxation exercises
(using relaxation audiotapes), back rubs,
massage, and periods of rest and relaxation.
Providing Psychosocial Support
➢ Help patient express fears, concerns, and
grief about diagnosis.
➢ Answer patient’s questions honestly.
Page 2 of 2
➢ Encourage patient to participate in treatment
decisions.
➢ Support patient’s disbelief and time needed to
accept diagnosis.
➢ Offer emotional support, and involve family
members and significant others whenever
possible; reassure that emotional responses
are normal and expected.
➢ Be aware of mood swings and defense
mechanisms (denial, rationalization,
displacement, regression).
➢ Provide professional services as necessary
(eg, clergy, psychiatric clinical nurse
specialists, psychologists, social workers, and
psychiatrists).
➢ Assist with decisions regarding end-of-life
care and make referrals as warranted.
Promoting Home- and Community-Based
Care
TEACHING PATIENTS SELF-CARE
 Teach self-care activities specific to treatment
regimen.
 Include information about diet and nutrition,
treatment regimens, activity and lifestyle
changes, pain management, and
complications.
 Explain that the possibility of dumping
syndrome exists with any enteral feeding, and
teach ways to manage it.
 Explain need for daily rest periods and
frequent visits to physician after discharge.
 Refer for home care; nurse can supervise any
enteral or parenteral feeding and teach
patient and family members how to use
equipment and formulas as well as how to
detect complications.
 Teach patient to record daily intake and
output and weight.
 Teach patient how to cope with pain, nausea,
vomiting, and bloating.
 Teach patient to recognize and report
complications that require medical attention,
such as bleeding (overt or covert
hematemesis, melena), obstruction,
perforation, or any symptoms that become
consistently worse.
 Explain chemotherapy or radiation regimen
and the care needed during and after
treatment.
 CANCER OF THE LUNGS
TUTOR || September 24, 2022
Transcribers: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name
Editors: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name
Outline
Legend:
Remember
(Exams)
Lecturer Book
  
Heading 1
1. Heading 2
• The quick brown fox jumps over the lazy dog
The quick brown fox jumps over the lazy dog
▪ The quick brown fox jumps over the lazy dog
• The quick brown fox jumps over the lazy dog
Subheading
CANCER OF THE LUNGS
OVERVIEW
 Lung cancer is a leading cause of cancer-
related deaths worldwide.
 The overall 5-year survival rate for all patients
with lung cancer is only 16% because most
lung cancers are diagnosed at a late stage,
when metastasis is present.
 Lung cancers arise from a single transformed
epithelial cell in the tracheobronchial airways.
A carcinogen (cigarette smoke, radon gas,
other occupational and environmental agents)
damages the cell, causing abnormal growth
and development into a malignant tumor.
 Most lung cancers are classified into one of
two major categories: small cell lung cancer
(15% to 20% of tumors) and non–small cell
lung cancer (NSCLC; approximately 80% of
tumors).
 NSCLC cell types include squamous cell
carcinoma (20% to 30%), which is usually
more centrally located; large cell carcinoma
(15%), which is fast growing and tends to
arise peripherally; and adenocarcinoma
(40%), which presents as peripheral masses
and often metastasizes and includes
bronchoalveolar carcinoma.
 Metastasis of lung cancer occurs by direct
extension, through the blood, and by invading
lymph glands and vessels.
 Common sites of metastasis for lung cancer
are the bone, liver, brain, and adrenal glands.
 Lung cancers occur as a result of repeated
exposure to inhaled substances that cause
chronic tissue irritation or inflammation.
GERIATRIC
 Cigarette smoking is the major risk factor and
is responsible for 85% of all lung cancer
Previous
deaths.
Trans  Nonsmokers exposed to passive, or
 secondhand, smoke have a greater risk for
lung cancer than nonsmokers.
Risk Factors
 Risk factors include tobacco smoke, second-
hand (passive) smoke, environmental and
occupational exposures, gender, genetics,
and dietary deficits.
 Other factors that have been associated with
lung cancer include genetic predisposition
and underlying respiratory diseases, such as
chronic obstructive pulmonary disease
(COPD) and tuberculosis (TB).
 Lung cancer interferes with oxygenation and
tissue perfusion, including bronchial
obstruction, airway compression,
compression of alveoli, and compression of
blood vessels.
 Common manifestations of lung cancer are
associated with respiratory problems and
include dyspnea, pallor or cyanosis,
tachycardia, bloody sputum and cough.
 Pain is common when lymph nodes are
enlarged and press on nerves.
Assessment
 Obtain patient information about:
1. pack-year history and current smoking
pattern
2. Risk factors, including secondhand smoke
and environmental exposures
3. Cough presence and triggers
4. Sputum
✓ Amount
✓ Color
✓ Character
5. Chest pain, tightness or pressure:
✓ Location
✓ Severity
✓ Duration
✓ Quality
✓ Radiation
6. Dyspnea:
✓ Duration
✓ Triggers and alleviating factors
Page 1 of 4
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
 Assess for pulmonary manifestations:
1. Hoarseness
2. Wheezing
3. Decreased or absent breath sound
4. Breathing pattern abnormalities:
✓ Prolonged exhalation alternating with
periods of shallow breathing
✓ Rapid, shallow breathing
5. Areas of tenderness or masses palpated on
the chest wall
6. Increased fremitus (vibration) in areas of
tumor
7. Decreased or absent fremitus with bronchial
obstruction
8. Tracheal deviation
9. Pleural friction rub
10. Asymmetry of diaphragm movement
11. Use of accessory muscles manifested by
retraction between ribs or at sternal notch
 Assess for non-pulmonary manifestations:
1. Weight loss
2. Muffled heart sound
3. Dysrhythmias
4. Cyanosis of the lips and fingertips
5. Clubbing of the fingers
6. Bone pain
7. Fever/chills related to pneumonitis,
bronchitis, pneumonia
8. Paraneoplastic endocrine syndromes
caused by hormones secreted by tumor
cells, such as syndrome of inappropriate
antidiuretic hormone (SIADH)
 Assess for late manifestations, including
fatigue, weight loss, anorexia, dysphagia,
nausea and vomiting, lethargy, confusion,
and personality changes.
 Assess for psychosocial issues of fear,
anxiety, guilt, or shame:
1. Convey acceptance; interact with patient
in nonjudgmental way.
2. Encourage the patient and family to
express their feelings about possible
diagnosis of lung cancer.
 Diagnosis of lung cancer is made on the
basis of:
1. Chest x-ray
2. CT scan
3. Fiberoptic bronchoscopy
4. Thoracoscopy or thoracentesis to view
and biopsy lung tissue
Page 2 of 4
 Other tests used to determine extent of
metastasis include MRI, PET, or radionuclie
scans of the liver, spleen, brain, and bone.
Non-surgical Management
➢ Chemotherapy is often the treatment of
choice for lung cancers, and it may be used
alone or as adjuvant therapy in combination
with surgery.
➢ The exact combination of drugs used
depends on the response of the tumor and
the overall health of the patient; however,
most include platinum-based agents.
➢ Common side effects that occur with
chemotherapy for lung cancer include:
1. chemotherapy-induced nausea and
vomiting (CIN)
2. Alopecia
3. Mucositis
4. Bone marrow suppression resulting in
immunosuppression, anemia, and
thrombocytopenia
5. Peripheral neuropathy (PN)
➢ Targeted therapy involves the use of drugs
that target specific features of cancer cells,
such as a protein, an enzyme, or the
formation of new blood vessels.
➢ These drugs cause fewer and less severe
side effects for most patients compared with
traditional anti-neoplastic agents. For lung
cancer, targeted therapy drugs include:
1. Erlotinib (Tarceva), an oral drug
2. Bevacizumab (Avastin), given IV
3. Crizotinib (Xalkori), an oral drug
➢ Radiation therapy may be used for locally
advanced lung cancers confined to the chest.
It is typically used in addition tot surgery or
chemotherapy and delivered by external
beam therapy daily over 5 to 6 weeks.
➢ Common side effects of radiation therapy for
lung cancer are:
1. Chest skin irritation and peeling
2. Fatigue
3. Wheezing from inflamed airways
4. Esophagitis and changes in taste
➢ Photodynamic therapy (PDT) may be used to
remove small bronchial tumors when they are
accessible by bronchoscopy.
Discussion: The patient is first injected with
an agent that sensitizes cells to light. This
drug enters all cells but leaves normal cells
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
more rapidly than cancer cells, allowing it to
concentrate in cancer cells.
At about 48 hours, the patient goes to the
operating room and is placed under
anesthesia and intubated. A laser light is
focused on the tumor. The light activates a
chemical reaction within the cells, retaining
the sensitizing drug that induces irreversible
cell damage.
Some cells die and slough immediately;
others continue to slough for several days.
➢ The photosensitizing drug has many effects
that require special patient teaching and care
both before and after the laser treatment.
➢ When PDT is used in the airways, the patient
usually requires a stay in the intensive care
unit (ICU) for airway management.
Surgical Management
➢ Surgery is the main treatment for stage 1 and
stage II NSCLC.
Discussions: Total removal of a non-small cell
primary lung cancer is undertaken in hope of
achieving a cure. If complete resection is not
possible, the surgeon removes the bulk of the
tumor.
➢ The specific surgery depends on the stage of
the cancer and the patient’s overall health
and functional status. Surgeries include:
1. Removal of tumor only
2. Removal of a lung segment
(segmentectomy)
3. Removal of a lobe (lobectomy)
4. Removal of an entire lung
(pneumonectomy)
➢ Procedures can be performed by open
thoracotomy or thoracoscopy with minimally
invasive surgery in selected patients.
➢ Provide routine preoperative care:
1. Teach the patient about the probable
location of the surgical incision or
thoracoscopy openings, shoulder
exercises, and about the chest tube and
drainage system (except after
pneumonectomy)
2. Encourage the patient to express fears
and concerns.
3. Reinforce the surgeon’s explanation of the
surgical procedure.
➢ Provide post0perative care:
1. Respiratory management:
✓ Maintain a patent airway
Page 3 of 4
✓ Assess respiratory status at least 2 hours
for the first 12 to 24 hours.
• Check the alignment of the trachea
• Assess oxygen saturation
• Assess the rate and depth of respiration
• Listen to breath sounds in all remaining
lobes
• Assess the oral mucous membranes for
cyanosis and the nail beds for rate of
capillary refill
✓ Perform oral suctioning as necessary
✓ Provide oxygen therapy or mechanical
ventilation as prescribed
✓ Assist the patient to a semi-fowler’s
position or to sit up in a chair as soon as
possible.
✓ For a patient with spontaneous
respirations, encourage the patient to use
the incentive spirometer every hour while
awake.
✓ If coughing is permitted, help the patient
cough by splinting any incision and
ensuring that the chest tube does not pull
with movement.
2. Pain management.
3. Apply closed chest drainage.
Nursing Management
Managing Symptoms
➢ Instruct patient and family about the side
effects of specific treatments and strategies to
manage them.
➢ Relieving Breathing Problems
➢ Maintain airway patency; remove secretions
through deep breathing exercises, chest
physiotherapy, directed cough, suctioning,
and in some instance’s bronchoscopy.
➢ Administer bronchodilator medications;
supplemental oxygen will probably be
necessary.
➢ Encourage patient to assume positions that
promote lung expansion and to perform
breathing exercises.
➢ Teach energy conservation and airway
clearance techniques.
➢ Refer for pulmonary rehabilitation as
indicated.
Reducing Fatigue
➢ Assess level of fatigue; identify potentially
treatable causes.
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor

➢ Educate patient in energy conservation 2. Pleurodesis is the deliberate development of

techniques and guided exercise as an inflammation in the pleural space to cause
appropriate. the pleura to stick to the chest wall and
➢ Refer to physical or occupational therapist as prevent formation of effusion fluid.
indicated. ➢ Pain management may be needed for chest
Providing Psychological Support pain and pain radiating to the arm. The goal is
➢ Help patient and family deal with poor to keep the patient as comfortable as
prognosis and progression of the disease possible.
(when indicated). ➢ Refer the terminal patient to hospice or other
➢ Assist patient and family with informed palliative care programs.
decision-making regarding treatment options.
➢ Suggest methods to maintain the patient’s
quality of life during the course of this
disease.
➢ Support patient and family in end-of-life
decisions and treatment options.
➢ Help identify potential resources for the
patient and family.

Palliative Interventions
➢ Treatment may focus on symptom
management, rather than cure.
➢ Dyspnea management is a priority.
Discussion: Dyspnea is reduces with
oxygen, drug therapy, radiation, management
of pleural effusion, pain relief, and positioning
for comfort.
For example, the patient with severe dyspnea
may be most comfortable sitting in a lounge
chair or reclining chair.
➢ Oxygen therapy with humidification is
prescribed to treat hypoxemia or to relieve
dyspnea and anxiety
➢ Drug therapy to improve oxygenation and
relieve dyspnea includes:
1. Bronchodilators and corticosteroids for
the patient with bronchospasm
2. Mucolytics to ease removal of thick
mucus and sputum
3. Antibiotics when bacterial infection is
present
➢ Radiation therapy helps relieve hemoptysis,
obstruction of the bronchi and great veins,
dysphagia, and pain resulting from bone
metastasis.
➢ Thoracentesis and pleurodesis relieve
pulmonary symptoms caused by pleural
effusion.
1. Thoracentesis is fluid removal by suction from
the placement of a large needle or catheter
into the intrapleural space.

Page 4 of 4
 CANCER OF THE THYROID
TUTOR || September 24, 2022
Transcribers: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name
Editors: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name
Outline
Legend:
Remember Previous
Lecturer Book
(Exams) Trans
  
Heading 1
1. Heading 2
• The quick brown fox jumps over the lazy dog
The quick brown fox jumps over the lazy dog
▪ The quick brown fox jumps over the lazy dog
• The quick brown fox jumps over the lazy dog
Subheading
CANCER OF THE THYROID
 Cancer of the thyroid is less prevalent than
other forms of cancer.
 The most common type, papillary
adenocarcinoma, accounts for more than half
of thyroid malignancies; it starts in childhood
or early adult life, remains localized, and
eventually metastasizes.
 When papillary adenocarcinoma occurs in an
elderly patient, it is more aggressive.
 Risk factors include female gender and
external irradiation of the head, neck, or chest
in infancy and childhood.
 Other types of thyroid cancer include follicular
adenocarcinoma, medullary, anaplastic, and
thyroid lymphoma.
Clinical Manifestations
 Lesions that are single, hard, and fixed on
palpation or associated with cervical
lymphadenopathy suggest malignancy.
Assessment and Diagnostic Methods
 Needle biopsy or aspiration biopsy of thyroid
gland
 Thyroid function tests
 Ultrasound, MRI, CT scan, thyroid scans,
radioactive iodine uptake studies, and thyroid
suppression tests
Medical Management
 Treatment of choice is surgical removal (total
or near-total thyroidectomy).
 Modified or extensive radical neck dissection
is done if lymph nodes are involved.
 Radioactive iodine is used to eradicate
residual thyroid tissue.
GERIATRIC
 Thyroid hormone is administered in
suppressive doses after surgery to lower the
levels of thyroid-stimulating hormone (TSH) to
a euthyroid state.
  Lifelong thyroxine is required if remaining
thyroid tissue is inadequate to produce
sufficient hormone.
 Radiation therapy is administered by several
routes.
 Chemotherapy is used only occasionally.
Nursing Management
➢ See “Nursing Management” under “Cancer”
for additional information.
➢ Inform the patient about the purpose of any
preoperative tests, and explain what
preoperative preparations to expect; teaching
includes demonstrating to the patient how to
support the neck with the hands after surgery
to prevent stress on the incision.
➢ Provide postoperative care (eg, assess and
reinforce surgical dressings, observe for
bleeding, monitor pulse and blood pressure
for signs of internal bleeding, assess
respiratory status, assess intensity of pain
and administer analgesics as prescribed).
➢ Monitor and observe for potential
complications such as hemorrhage,
hematoma formation, edema of the glottis,
and injury to the recurrent laryngeal nerve.
➢ Teach patient and family about signs and
symptoms of possible complications and
those that should be reported; suggest
strategies for managing postoperative pain at
home and for increasing humidification.
➢ Explains to the patient and family the need for
rest, relaxation, and nutrition; patient can
resume former activities and responsibilities
once recovered from surgery.
➢ Refer for home care, if indicated.
Quality and Safety Nursing Alert
Following thyroid surgery, the patient should be
monitored closely for signs of tetany, including
hyperirritability of the nerves, with spasms of
the hands and feet and muscle twitching.
Laryngospasm, although rare, may occur and
obstruct the airway.
Page 1 of 1
 COLORECTAL CANCER
TUTOR || September 24, 2022
Transcribers: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name
Editors: Last Name, Last Name, Last Name, Last Name, Last Name, Last Name
Outline
Legend:
Remember
Lecturer Book
(Exams)
  
Heading 1
1. Heading 2
• The quick brown fox jumps over the lazy dog
The quick brown fox jumps over the lazy dog
▪ The quick brown fox jumps over the lazy dog
• The quick brown fox jumps over the lazy dog
Subheading
Colorectal cancer
OVERVIEW
 Colorectal cancer (CRC), or cancer of the
colon and rectum, is a common malignancy.
 Colorectal cancer is predominantly (95%)
adenocarcinoma, with colon cancer affecting
more than twice as many people as rectal
cancer.
 It may start as a benign polyp but may
become malignant, invade and destroy
normal tissues, and extend into surrounding
structures.
 Incidence increases with age (the incidence is
highest in people older than 85 years) and is
higher in people with a family history of colon
cancer and those with inflammatory bowel
disease (IBD) or polyps.
 If the disease is detected and treated at an
early stage before the disease spreads, the 5-
year survival rate is 90%; however, only 39%
of colorectal cancers are detected at an early
stage.
 Most CRCs are adenocarcinoma arising from
the glandular epithelial tissue of the colon and
developing as multi-step process.
1. Abnormal proliferation of the colonic
musosa first forms polyps that can
transform into malignant tumor.
2. Tumors can spread by direct invasion and
through the lymphatic and circulatory
systems. The most common sites of
metastasis are the liver, lungs, brain,
bones, and adrenal glands.
 Complications include bowel perforation with
peritonitis, abscess or fistula formation, frank
GERIATRIC
hemorrhage, and complete intestinal
obstruction.
Previous
Trans Risk factors
 ➢ Age older than 50 years
➢ Genetic predisposition
➢ Personal or family history of cancer or
diseases that predispose to cancer
➢ Chron’s disease or ulcerative colitis
Clinical Manifestations
➢ Changes in bowel habits (most common
presenting symptom), passage of blood in or
on the stools (second most common
symptom).
➢ Unexplained anemia, anorexia, weight loss,
and fatigue.
➢ Right-sided lesions are possibly accompanied
by dull abdominal pain and melena (black
tarry stools).
➢ Left-sided lesions are associated with
obstruction (abdominal pain and cramping,
narrowing stools, constipation, and distention)
and bright red blood in stool.
➢ Rectal lesions are associated with tenesmus
(ineffective painful straining at stool), rectal
pain, feeling of incomplete evacuation after a
bowel movement, alternating constipation and
diarrhea, and bloody stool.
➢ Signs of complications: partial or complete
bowel obstruction, tumor extension and
ulceration into the surrounding blood vessels
(perforation, abscess formation, peritonitis,
sepsis, or shock).
➢ In many instances, symptoms do not develop
until colorectal cancer is at an advanced
stage.
Assessment and Diagnostic Methods
➢ Abdominal and rectal examination; fecal
occult blood testing; barium enema;
proctosigmoidoscopy; and colonoscopy,
biopsy, or cytology smears.
➢ CEA studies should return to normal within 48
hours of tumor excision (reliable in predicting
prognosis and recurrence).
Page 1 of 3
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor
Gerontologic Considerations
➢ The incidence of carcinoma of the colon and
rectum increases with age. These cancers
are considered common malignancies in
advanced age.
➢ Colon cancer in the elderly has been closely
associated with dietary carcinogens. Lack of
fiber is a major causative factor because the
passage of feces through the intestinal tract is
prolonged, which extends exposure to
possible carcinogens.
➢ Excess dietary fat, high alcohol consumption,
and smoking all increase the incidence of
colorectal tumors.
➢ Physical activity and dietary folate have
protective effects.
Assessment
 Obtain patient information
✓ Age
✓ History of inflammatory or familial colon
disease
✓ Change in bowel habits with or without
blood in stool
✓ Weight loss, pain, and abdominal fullness
(late signs)
 Assess for:
✓ Rectal bleeding (the most common
manifestation and stool characteristics)
✓ Anemia
✓ Cachexia (late sign)
✓ Abdominal distension or mass (late sign)
 Diagnostic assessment includes:
✓ Fecal occult blood test (FOBT)
✓ Carcinoembryonic antigen (CEA) blood
test
✓ Colonoscopy
✓ CT or MRI of the abdomen with additional
views for evaluation of metastasis (pelvis,
thorax and brain)
Planning and implementation
Discussions: Surgical management with tumor
removal is the PRIMARY APPROACH to
treatment. Nonsurgical management reduces the
potential for cancer recurrence and metastasis
and provides symptoms management and
psychosocial support.
• Radiation therapy:
1. Radiation to reduce tumor size and as
palliative measure to reduce pain,
Page 2 of 3
hemorrhage, bowel obstruction, or
metastasis.
2. General management issues for the care of
patients undergoing radiation therapy.
• Chemotherapy is used after surgery to
interrupt cancer cell division and improve
survival.
• Targeted biotherapy for advanced CRC
• Symptom relief for pain and emesis (opoids
and antiemetics)
• Assisting with grieving and allowing patient to
verbalize feeling about the diagnosis,
treatment, and progression of disease or
recovery.
Surgical management
Discussions: Surgery is the primary treatment
for most colon and rectal cancers; the type of
surgery depends on the location and size of
tumor, and it may be curative or palliative.
➢ Cancers limited to one site can be
removed through a colonoscope.
➢ Laparoscopic colotomy with polypectomy
minimizes the extent of surgery needed in
some cases.
➢ Cancers limited to one site can be
removed through a colonoscope.
➢ Laparoscopic colotomy with polypectomy
minimizes the extent of surgery needed in
some cases.
➢ Neodymium: yttrium-aluminum-garnet
(Nd: YAG) laser is effective with some
lesions.
➢ Bowel resection with anastomosis and
possible temporary or permanent
colostomy or ileostomy (less than one
third of patients) or coloanal reservoir
(colonic J pouch).
Nursing safety priority: action alert
1. Report any of these problems related to the
colostomy to the surgeon:
✓ Signs of ischemia and necrosis (dark red,
purplish, or black color; dry, firm, or
flaccid)
✓ Unusual or excessive bleeding
✓ Mucocutaneous separation (breakdown of
the suture line securing the stoma to the
abdominal wall)
2. Assess the condition of the peristomal skin
(skin around the stoma)
[SUB] 1.01 TITLE OF LECTURE – Dr. Professor

3. Assess for signs of infection, abscess, or

other complications.
4. Consult with the skin care or ostomy
specialist early and often during surgical
recovery.
5. Instruct the patient what to expect about the
appearance and care of the colostomy.
6. When the patient is physically able,
encourage the patient to look at the ostomy (if
performed), and to participate in colostomy
care.

Community-based care
 Provide the patient with these oral and written
instructions:
1. Avoid lifting heavy objects or straining on
defecation to prevent tension on the
anastomosis site.
2. Avoid driving for 4 to 6 weeks.
3. Note the frequency, amount, and
character of the stool.
4. For colon resection, watch for and report
manifestations of bowel obstruction and
perforation (e.g. cramping, abdominal
pain, nausea, vomiting)
5. Look for signs of incisional healing and
infection.
 Teach the patient and family colostomy care,
including:
1. Normal appearance of a stoma.
2. Signs and symptoms of complications
3. How to measure the stoma
4. The choice, use, care and application of
the appropriate appliance to cover the
stoma
5. How to protect the skin adjacent to the
stoma
6. Dietary measures to control gas and odor.
 Provide contacts for community and health
resources as needed, particularly ostomy-
related information, ostomy support groups,
and home health care.

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