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Terms
• Cancer – number 1 killer
• Neoplasm – new tissue growth
Oncology •
•
Mitosis – cell division
Metastasis – spread of cancer cells in the body
• Benign – (-oma)
• Malignant – (-carcinoma)
• Stable cells – growth in # prn
• Labile cells – growth in # is continuous

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• Differentiation - specialization
Normal cells
• Risk factor – increases the odds
• Have 1 nucleus
• Mitosis
• Have APOPTOSIS
• Have CONTACT INHIBITION
• With function

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TUMOR
Cells Abnormal cells
Benign Malignant

Tissues Abnormal tissues Harmless Harmful

Slow growth Rapid growth
Without With
Organ Tumor metastasis metastasis
Encapsulated Unencapsulated
Non-invasive Invasive

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C Change in bowel and bladder function

Staging:
A A sore that doesn’t heal
WARNING
U Unusual bleeding SIGNS!!! • Numerical
CAUTIONUS!!!
T Thickening or lump in breast or elsewhere • TNM
• Ann-Arber
I Indigestion
O Obvious change in warts or mole
N Nagging cough or hoarseness
U Unexplained anemia
S Sudden weight loss
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Numerical: TNM
• Stage 1 - Limited local • T - Tumor (size)
• Stage 2 - Limited regional • N - Nodes(number of lymph nodes)
• Stage 3 - Extensive local and regional • M - Metastasis(with or without)
• Stage 4 - Distant metastasis
• Stage 5

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Tumor Nodes

• T0 - No tumor • N0 - No lymph nodes

• Tx - Tumor cannot be ID • Nx - LN cannot be ID
• Tis - In situ • N1 - < 4
• T1 - < 2 cm • N2 - > 4
• T2 - < 5 cm
• T3 - > 5 cm
• T4 - > 5 cm (with metastasis)

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Metastasis
(cervical)

(supra-clavicular) • M0 - No metastasis
(axillary) • Mx - Metastasis cannot be ID
(inguinal) • M1 - With metastasis

(mediastinal)

(aortic)

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Ann-Arber
•
•
Stage 1 - 1 LN
Stage 2 - 2/more LN, 1 side
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2
EXTRALYMPHATIC???
•
•
Stage 3 - 2/more LN, both sides
Stage 4 - extralymphatic 1

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Diagnostics: Biopsy:
• Biopsy - Confirmatory • Invasive
Aspiration - Needle
• CXR - Lung cancer • Consent
Incision - Tissue samples removed
• Mammography - Breast cancer • Anesthesia
Excision - Whole mass removed
• Pap smear - Cervical cancer • Sedation

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PAIN!!! Mild pain Severe pain

• C - Compression Tylenol Codeine
• O - Obstruction NSAIDs Morphine
• D - Destruction
• Relaxation w/ guided imagery
• Massage
• Warm/Cold compress
• Medication

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Does cancer have a cure???

YES!!!

C - Chemotherapy C - Chemotherapy
U - Upera U - Upera
R - Radiation R - Radiation
E - Emotional support E - Emotional support

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CHEMO RADIATION Chemotherapy:

Anti-neoplastics High energy waves • Kills cancer cells
Spreads throughout Localized • Lacks specificity
Internal Internal • More likely to kill cancer cells than normal
External External • Attracted to rapidly dividing cells
Topical Brachytherapy • Side effects: N - Nausea and vomiting
Hazardous Hazardous A - Alopecia
3 – 6 mos. As ordered N - Neutropenia
D - Diarrhea
A - Anemia
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C - CARING Caring:

H - HANDLING • N&V – administer anti-emetics

• Diarrhea – administer IVF
E - EDUCATION Handling:
M - MONITORING • Never by a pregnant nurse
O - OBSERVATION • Goggles, mask, gown, gloves
• Dispose in hazardous containers

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Education: Observation:
• Avoid large crowds • Alopecia
• Avoid fiber in the diet • Phlebitis

Monitoring:
• Monitor uric acid levels
• Monitor platelet count

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Radiation Therapy: Radiation

• Reduce the size of tumor
Internal (source) External (not a source)
• Internal - Brachytherapy Sealed -solid form, cesium/iridium
-pt. is radioactive, but excreta
• External - Teletherapy
are not
• Side effects: F - Fatigue
A - Alopecia Unsealed -liquid form, IV/oral route
-both patient and excreta are
S - Skin changes radioactive
T - Taste alterations -flush 3x

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Nursing considerations: • No pregnant nurse

• No visitors below 16 y/o
Internal External
• Private room
• Avoid exposure to sunlight
• Place caution on the door
• Avoid restrictive clothings
• Wear a dosimeter film
• Wash area with lukewarm water
• Wear lead shield before entering room
• Rinse with hand, not washcloth
• 1 nurse : 1 patient
• Dry with patting, not rubbing motion
• Limit exposure to 30mins.

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Medications Hormonal Medications

• Hormonal meds (Hormone sensitive tumors)
• Vinca Alkaloids (Anti-mitosis)
T Tamoxifen
• Alkylating agents (DNA replication antagonist)
A Arimidex
• Immunomodulator (Immune manipulation)
D Diethylstilbestrol

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Vinca Alkaloids Alkylating Agents

V Velban A Altretamine
O Oncovin B Busulfan
N Navelbine O Oxaliplatin

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Immunomodulators Testicular Cancer

shaft
Interleukins (destroy cancer cells) Risk
Manifestations
factors:
• Age
Irregularities
– 15-40 y/o
in TSE
head
Interferons (slow down tumor growth) testicles
• Painless
Undescended
testicular
testicles
mass
Sperm Germinal
Monoclonal antibodies (antibodies cells epithelium • “Heavy pull”
that attack Testosterone • Late: Pain - B Bone
cancer cells) Back
Gynecomastia

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Management: Prostate Cancer

• Pain management Risk Factors:
Manifestations:
• Chemotherapy • Irregularities - DRE
• Age – more than 50 y/o
• Radiation • Painless post-coital
Semen
• STDs
bleeding
• Surgery:Orchiectomy(uni/bilateral)
• (+) PSAmetal exposure
Heavy
- Avoid lifting
heavy objects • Late: Pain - L Lumbar
Legs

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Management:
• Pain management
• Chemotherapy
• Radiation therapy
• Surgery:TURP

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TURP Cervical Cancer

Manifestations:
• Hematuria is normal Risk Factors:
• Painless vaginal
• CBI • bleeding
HPV
• Hyponatremia •• Painless
Multiplevaginal
sex
discharge
partners
• WOF: Cerebral edema
• Fistula –
• Early
• WOF: increased ICP leakage of
intercourse
feces and urine
• Smoking
• Pain in LLP

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Management: Breast Cancer

• Chemotherapy Axillary lymph
nodes
Risk Factors:
Manifestations:
• Radiation therapy Mammary • Commonbreast
CXR
Painless sites:
ducts
• Surgery: Hysterectomy • mass
Family
-Upper
history
outer
Nipple
•• Irregularities
-axillae in
Nulliparity
BSE
Lobules • Early
-below
menarche
nipple
• Higher breast is
• Late menopause
the affected
• Peau d’orange

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Management:
• Position patient in semi fowler’s
• Chamotherapy
Invasive
• Radiation therapy
• Administer Tamoxifen as ordered
• Surgery:Lumpectomy(Lump)
Mastectomy (Lump + BT)
Non-invasive MRM (Lump + BT + ALN + Nipple)
- Elevate affected upper ext.

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Lung Cancer Management:

CO2
O2 Manifestations:
Risk Factors: • O2 as ordered
• Shortness
Wheezes of • High fowler’s position
• CXR
• breath
Dyspnea • Bronchodilators as ordered
Radon
•• Pulmonary
Cough • Chemotherapy
•• edema
Smoking
Hemoptysis • Radiation therapy
• Fever • Surgery:Lobectomy
O2 CO2 • Weakness and Pneumonectomy
fatigue

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Post op: Laryngeal Cancer

• CTT is CI
Manifestations:
Risk Factors:
• (+) pressure in
(+)
(-)pressure
pressure affected chest is • Feeling
Smokingof a
the desired Epiglottis
• lump in throat
Alcohol
outcome! •• Difficulty
Pollutants
Vocal cords swallowing
• Affected side! • Radiation
• Wt. loss
Larynx
• Dyspnea
TRACHEAL DEVIATION • Cough
Trachea
• Hemoptysis

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Management: Post-op:
• Aspiration precaution • Total laryngectomy: tracheostomy is
permanent
• High Fowler’s position
• Assess gag and cough reflexes
• O2 as ordered
• High Fowler’s position
• TPN
• Mech vent as ordered
• Tube feeding- NGT
- Gastrostomy • WOF: hemorrhage
- Jejunostomy • Maintain surgical drains
• Surgery:Laryngectomy • Refer to speech therapist
Cordal stripping

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Gastric Cancer Carcinogens:

Esophagus Risk Factors: • Overcooked food - Benzopyrene
LES • Spicy foods
• Preservatives - Nitrosamine
• Highly
Stomach seasoned • Peanut - Afflatoxin
food
• Smoking
Pyloric
sphincter • Alcohol
• Carcinogens

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Manifestations: PAIN!!!
• Difficulty swallowing • Initially,
• Fluids to pass food generalized
abdominal pain
• Heart burn
• Later on,
• Vomiting focused in the
• Satiety middle
• Hematemesis
• Melena
Area Postrema

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Management: Surgery:
• Avoid carcinogens • Total gastrectomy
• Avoid alcohol • Billroth I
• Avoid smoking Anastomosis (gastroduodenostomy)
• Small frequent feeding • Billroth II
(gastrojejunostomy)
• Administer antacids as ordered
• BT as ordered
• Chemotherapy
• Radiation therapy

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Post-op: Dumping’s Syndrome

• NPO 1-3 days depending on peristalsis (delay gastric
(Increased gastric
emptying)
motility)
• Advance from NPO to sips of water • Low
Increased
residue
peristalsis
diet
• Monitor for electrolyte imbalances • Fluids
Hyperactive
PC bowel sounds
• Administer IVF and electrolytes as ordered • Lie
Diarrhea
flat on bed PC
• Administer TPN as ordered • Antispasmodics
Abdominal cramping to delay
• gastric emptying
Palpitations
• Diaphoresis

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Transverse Colon Cancer Metastasis:

Ascending colon
colon
Risk Factors:
Manifestations:
• Blood than
More in the50y/o
stools
Descending • Polyps
Anemia
colon
• Family history
Weight loss
Cecum Sigmoid
• IBD
Vomiting Lymphatic spread
Rectum
Appendix • AC - Diarrhea Circulatory
• DC - Ribbonlike

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Management: Surgery: Bowel resection with

colostomy
• WOF peritonitis
• Petroleum jelly gauze to cover stoma
• WOF perforation
• WOF bleeding
• WOF intestinal obstruction
• Note color of stoma
• Chemotherapy
• WOF pouch leakage
• Radiation therapy
• AC stool - liquid
• TC stool - Semiformed
• DC stool - solid

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Bladder Cancer Management:

Risk Factors:
Manifestations: • Chemotherapy
• Urgency
Smoking • Radiation therapy
• Chemical exposure
Frequency • Surgery:Cystectomy
• Radiation
Dysuria
• Painless hematuria
• Obstruction (clot induced)

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Multiple Myeloma
Bladder removal Manifestations:
Risk Factors:
• Risk
Age –for
Decreased
60+
fractures
RBC
• Renal
Radiation
Decreased
calculi
exposure
WBC
• Renal
Chemical
Decreased
failure
exposure
Platelets
Colon Conduit • Hyperuricemia
Uric acid
Calcium
• Hypercalcemia
Bence Jones • Brittle bones
Protein • U/A - BJP

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Management: Leukemia
• Chemotherapy POINTS
Risk factors:
TO PONDER!
• Radiation therapy • Decreased
Smoking RBC
• Bone marrow transplant • Decreased
Chemical exposure
WBC
• Decreased
Family history
Platelets

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Manifestations: Infection precaution:

• Decreased RBC - Anemia
- Paleness
- Weakness and fatigue
- Shortness of breath
• Decreased WBC - Risk for infection
• Decreased Platelets - Bleeding tendencies
- Bruises
• Aseptic technique for all procedures
• Isolate patient
• Limit exposure
• AVOID - Fresh fruits
- Fresh vegetables
- Fresh flowers
• Monitor temperature
• Anticipate oral antibiotics for infection

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Bleeding precaution: Fatigue:

• WOF: Nadir • Rest!!!
• AVOID - Exposure to sharps • Assist client with ambulation
- IV fluids • Schedule activities
- IV medications • Packed RBC as ordered
- ASA
- NSAIDs

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Hodgkin’s Disease Phases:

Immune
function • Cancer of the
lymph nodes
• Reed stern-
Lymphocytes
berg cells Lymphocyte predominant Nodular sclerosis

Canal system • Owl’s eyes

for fluids

Fluids Lymph nodes JV

Mixed cellularity Lymphocyte depletion

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Manifestations: Hodgkin’s Non-hodgkin’s

• Painless lymphadenopathy With RSB Without RSB
• Risk for infection Early detection Late detection
• Cough Better prognosis Poor prognosis
• B-symptoms- Fever Bimodal age HIV
- Night sweats (15-30/more than 50) Burkitt’s lymphoma
- Weight loss
Chemotherapy Chemotherapy
Radiation therapy Radiation therapy

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Management:

13
4
2 • Stage 1 and 2 – radiation therapy
• Stage 3 and 4 – chemotherapy
EXTRALYMPHATIC???

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Multiple Hodgkin’s Leukemia

Abnormal Abnormal Abnormal

plasma Lymphocytes HSC
Bone marrow Lymph nodes Bone marrow
to bone to blood
Blood cancer Blood cancer Blood cancer
Chemotherapy Chemotherapy Chemotherapy
Radiation Radiation Radiation
therapy therapy therapy

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