Collantes, Jose Miguel Abenoja IV-A

MEDICAL – SURGICAL NURSING

ONCOLOGIC NURSING

Definition of Terms
• Dysplasia – Cells differ from other cells of same tissue.
• Anaplasia – Cells are totally different/lack normal cell characteristics, usually
malignant
• Neoplasia – Uncontrolled cell growth, there is cell replication
• Metaplasia – Conversion of one type of mature cell into another type
• Hyperplasia – Increase in the number of cells of a tissue. Associated with periods
of rapid body growth
• Hypertrophy – Increased cellular size

Etiologies
• Chemical Carcinogens
• It is theorized that some cancers are due to the presence of chemicals or
carcinogens because they promote the production of cancer cells.
o Bacon – A fatty cut next to the spare ribs typically cured, smoked, and
thinly sliced. Presence of nitrites can increase cancer cells.
• Vinyl chloride – Plastic manufacture
• Polycyclic aromatic hydrocarbons – Auto emissions
• Dyes
• Talc – Chewing gum, polished rice
• Aflatoxins – Molds in nuts, cheese, peanut butter
• Nitrosamines - Rubber baby nipples
• Smoking – Contains tar, nicotine, and carbon monoxide
• Other harmful contents include:
o Acetone – Nail polish remover
o Acetic acid – Used in making vinegar
o Ammonia – Food and toilet cleaners
o Arsenic – Rat poison
o Butane, Hexamine – Lighter fluid
o Methane – Gasoline
o Cadmium – Rechargeable batteries
o Formaldehyde – Used to preserve dead bodies
o Naphthalene – Moth balls
o Nitrous oxide – Disenfectants
o Vinyl chloride – Used to make PVC pipes
o Ethanol – Alcohol
o Dieldrin/DDT- Insecticides
o Stearic Acid – Candle wax
• Good news to smokers, if you are under 65 years old and you quit now, you
reduce your risk by 50%.
o Stop smoking now and enjoy these good signs:
Collantes, Jose Miguel Abenoja IV-A

▪ Within 20 minutes: V/S being to normalize.

▪ Within 8 hours: CO levels in the body normalizes
▪ Within 24 hours: Chances of heart attack decreases
▪ Within 48 hours: Smell and circulation improves
▪ Within 72 hours: Breathing becomes easier
▪ Within 9 months: O2 levels normalize and energy improves
▪ After 6 years: Risk for CA and CAD greatly decrease
▪ After 10 years: Risk for disease development due to smoking are
kept to a minimum

Theories that attempt to explain cancer occurrence

• Cellular Transformation and Derangement Theory
o Cells become malignant due to exposure to etiologic agents.
• Failure of the Immune Response Theory
o Genetics
o In females, breast cancer are usually genetics
o Everyone has CA cells and people whose immune system are low and
unable to destroy these cancer cells

Seven Warning Signs of Cancer

• C – Change in bowel/bladder habits
• A – A sore that does not heal
• U – Unusual bleeding or discharge
• T – Thickening or lump in the breast or elsewhere
• I – Indigestion or difficulty swallowing
• O – Obvious change in warts or mole
• N – Nagging cough or hoarseness
• U – Unexplained weight loss
• S – Sudden unexplained anemia

Initial Stages of Cancer

1. Precancerous Lesions
a. Polyps
i. Nasal polyps
ii. Vocal cord polyps
b. Senile Keratosis
i. Thickened patches on the skin as a result to exposure to radiation
c. Leukoplakia
i. White patches on mucous membrane

Differentiate Normal vs Cancerous Cells

Normal Cells Cancerous

Well - differentiated Undifferentiated
Collantes, Jose Miguel Abenoja IV-A

Normal growth to replace dead cells Variable rate of growth. Usually rapid,
“parasitic cells”
Organized cellular grouping Disorganized

Differentiate Benign vs Malignant Tumors in Cell Characteristics

Benign Tumors Malignant Tumors

Cell Characteristics: Well Differentiated
Mode of Growth: Expands but does not
infiltrate
Rate of growth: Slow growth
Cell Characteristics: Undifferentiated
Mode of Growth: Infiltrates and destroys
Rate of Growth: Variable rate of growth,
usually rapid

Differentiate Benign vs Malignant Neoplasms in Metastasis

Benign Tumors Malignant Tumors

Metastasis: No metastasis Metastasis: To other body areas
General Effects: Localized effects, usually General Effects: Generalized effects
in the tumor site

Differentiate Benign vs Malignant Neoplasms in Tissue Destruction

Benign Tumors Malignant Tumors

Tissue Destruction: Usually no tissue Tissue Destruction: Extensive tissue
damage unless it interferes with blood damage.
flow.
Ability to cause death: Does not usually Ability to cause death: Usually causes
cause death. death

Metastatic Mechanisms
• Lymphatic spread
o Most common mechanism of metastasis
• Hematogenous spread
o Can survive the arterial circulation and will be distributed through the
arterial circulation
• Angiogenesis
o Spreads through the blood vessels
o New or beginning of the new capillaries and these new capillaries holds the
tissue to feed the cancer cells

Reasons for Successful Metastasis

• Cancer cells release enzymes to escape from the lymphatic and blood vessels.
• Secondary site should provide nourishment to cancer cells.
• Secondary site should have adequate blood supply.
Collantes, Jose Miguel Abenoja IV-A

Nomenclature of Neoplasia
Tumor is named according to:
• Parenchyma
o It is the essential and distinctive tissue of an organ as distinguished from the
connective and supporting tissue.
▪ Hepatoma – liver
▪ Osteoma – bone
▪ Myoma – muscle
• Pattern and Structure, either gross or microscopic
o Fluid – filled – cyst
o Glandular – adeno
o Finger – like – papillo
o Stalk – polyp
• Embryonic Origin
o Ectoderm – usually gives rise to the epithelium
o Endoderm – usually gives rise to glands
o Mesoderm – usually gives rise to connective tissues
• Benign Tumors
o Suffix “-oma” is used
▪ Adipose tissue – lipoma
▪ Bone – osteoma
▪ Muscle – myoma
▪ Blood vessels – angioma
▪ Fibrous tissue – fibroma
• Malignant Tumors
o Suffix “-carcinoma” is used, muscles
▪ Pancreatic adenocarcinoma
▪ Squamous cell carcinoma
o Suffix “-sarcoma” is used, connective tissue origin
▪ Fibrosarcoma
▪ Myosarcoma
▪ Angiosarcoma

Exceptions of the Rule

• “Oma” but malignant
o Hepatoma, lymphoma, glioma, melanoma
• Three germ layers
o Teratoma
• Non – neoplastic but “Oma”
o Hematoma

Three Step Process of Cancer Growth

1. Initiation
• Carcinogens cause DNA mutations
Collantes, Jose Miguel Abenoja IV-A

• (-) CA due to DNA repair mechanism & program apoptosis

2. Promotion
• Repeated exposure to live carcinogens
• (+) CA as mutant genes proliferate
3. Progression
• There is metastasis

Cancer Prevention
1. Breast Self – Examination
• 7 to 10 days after menstruation (same day/month)
• Arms at the side/overhead on waist; leaning forward
• Ideally performed in a shower facing the mirror
• If post – menopausal or irregular menstruation, do BSE same day each month
• Breast clinical exam is done by a trained health professional
o If 20 to 39 years old, every 3 years
o If 40 years old and above, annually
2. Mammography
• Each breast is compressed horizontally then obliquely and an X-Ray is being used
to visualize the breast.
o Non-palpable pin-point calcification by mammogram.
• If 35 to 39 years old, once only for baseline data
• Above 40 years old, annually
• Advise patient not to use deodorants
3. Testicular Self – Examination
• Same day each month
• To start at the age of 15 to 20 years old
• Best time to examine is after a warm bath

Recommended Schedules for Diagnostic Tests

• BSE (Breast Self – Examination)
o Monthly from age 20 years old
• DRE (Digital Rectal Examination)
o Yearly starting 40 years old
• Guaiac Stool Examination
o Yearly from age 50 years old
• Pap Smear
o 18 years old yearly for 3 consecutive years
o Every 3 years until age 40 years old
o After age 40 years old, annually
o If sexually active, every year regardless of age

Biopsy
• Total/excisional – removable mass
• Subtotal/incisional – mass is too large to remove
Collantes, Jose Miguel Abenoja IV-A

• Needle aspiration – Fine and core needle

• Core needle aspiration – Greater tissue sample obtained and it allows more tissue
to be removed from the breast
o For breast
o For parotid gland

Cancer Markers
• Carcino-Embryonic Antigen – should stop after birth
• Alpha Feto Protein – up in lung/cervical CA
• HCG – up in uterine CA, H-mole
• Bence Jones Protein – up in myeloma
• Acid phosphatase – up in prostatic cancer
• Alkaline phosphatase – up in bone/liver CA, rheumatoid arthritis
• Prostate specific antigen (NV: 4-6 ng/dL) – up with BPH (5-6); very high in prostate
CA (8-10)

Difference about Tumor Staging and Tumor Grading

• Tumor staging
o Determine tumor size/existence of metastasis; clinical aspects of cancer
• Tumor grading
o Classify tumor cells, its origin, and degree of differentiation; cellular aspects
of cancer

Tumor Staging
• TNM system
o Tumor, Lymph Node Involvement, Metastasis
o Tumor size
▪ TX: Primary tumor cannot be assessed
▪ TO: No evidence of primary tumor
▪ TIS: Carcinoma in situ
▪ T1 or Stage 1: Localized tumor growth
▪ Treatment: Operable
▪ Survival rate: 70 to 90%
▪ TNM system: T1N0M0
▪ T2 or Stage 2: Limited local spread
▪ Treatment: Still operable
▪ Survival rate: 50% (+/- 5%)
▪ TNM system: T2N1M0
▪ T3 or Stage 3: Extensive local and regional spread
▪ Treatment: Operable but not resectable
▪ Survival rate: 20% (+/- 5%)
▪ TNM System: T3N2M0
▪ T4 or Stage 4: Metastasis
▪ Treatment: Inoperable lesion
Collantes, Jose Miguel Abenoja IV-A

▪ Survival rate: Less than 5%

▪ TNM system: T4N3M1
o Regional Lymph Node Involvement
▪ NX: Regional lymph node cannot be assessed
▪
o Extent of Metastasis
▪ MX: Distant metastasis cannot be assessed
▪ MO: No distant metastasis
▪ M1: Distant metastasis

Cellular Aspects of Cancer

• Grade 1: Well – differentiated tumors/Mild dysplasia
• Grade 2: Moderate dysplasia
• Grade 3: Severe dysplasia
• Grade 4: Poorly differentiated/anaplasia