Oncology is the branch of medicine that deals with the study, detection, treatment and management of cancer. Cancer develops through a multi-step process called initiation, promotion and progression. Cancer is classified based on its anatomical site, histology, and extent of disease spread. Diagnostic evaluations for cancer include laboratory tests, tumor markers, imaging techniques and invasive procedures like biopsies. Chemotherapy aims to reduce or eliminate cancer cells through use of anti-cancer drugs administered based on individual body surface area calculations.
Oncology is the branch of medicine that deals with the study, detection, treatment and management of cancer. Cancer develops through a multi-step process called initiation, promotion and progression. Cancer is classified based on its anatomical site, histology, and extent of disease spread. Diagnostic evaluations for cancer include laboratory tests, tumor markers, imaging techniques and invasive procedures like biopsies. Chemotherapy aims to reduce or eliminate cancer cells through use of anti-cancer drugs administered based on individual body surface area calculations.
Oncology is the branch of medicine that deals with the study, detection, treatment and management of cancer. Cancer develops through a multi-step process called initiation, promotion and progression. Cancer is classified based on its anatomical site, histology, and extent of disease spread. Diagnostic evaluations for cancer include laboratory tests, tumor markers, imaging techniques and invasive procedures like biopsies. Chemotherapy aims to reduce or eliminate cancer cells through use of anti-cancer drugs administered based on individual body surface area calculations.
Oncology is the branch of medicine that deals with the study, detection, treatment and management of cancer. Cancer develops through a multi-step process called initiation, promotion and progression. Cancer is classified based on its anatomical site, histology, and extent of disease spread. Diagnostic evaluations for cancer include laboratory tests, tumor markers, imaging techniques and invasive procedures like biopsies. Chemotherapy aims to reduce or eliminate cancer cells through use of anti-cancer drugs administered based on individual body surface area calculations.
deals with the study, detection, treatment and management of cancer “Root words” Neo- new Plasia- growth Trophy- size Oma- tumor Statis- location “Root words” Remission – symptoms of cancer are no longer present Relapse – the disease reoccurs after a period of remission Refractory – the cancer is resistant to treatment. Hyper- excessive Meta- change Cell cycle Mitosis or M phase Gap 1 or G1 phase S phase or synthesis phase Gap 2 or synthesis phase G0 The phases describe periods of time for different cellular process that ultimately results in a cell’s reproduction or death. Cell cycle Synthesis of RNA & protein occurs in the G1 phase. S phase, is when DNA is being replicated & is a relatively short period. G2 phase occur after DNA synthesis & just before cell division Mitosis or cell division ensues during M phase resulting in two identical daughter cells. Cell cycle Cells that have left the cycle to enter the G0 phase are considered to be in a resting or dormant phase. These cells can actively synthesize RNA & proteins & differentiate Cells in the phase are typically resistant to the cytotoxic effects of chemotherapy. Cellular differentiation Cellular differentiation is an orderly process that progresses from a state of immaturity to a state of maturity. Two types of normal genes that can be affected by mutation are protooncogenes & tumor suppressor genes. Cellular differentiation Protooncogenes promote growth, whereas tumor suppressor genes suppress growth. Mutations that alter the expression of protooncogenes can activate them to function as oncogenes (tumor inducing genes). Characteristic Benign malignant
Encapsulated usually Rarely
Differentiated Normally poorly
Metastasis absent Capable
Recurrence Rare possible
Vascularity slight Moderate to
marked Mode of growth Expansive Infiltrative &expansive Cell characteristics Fairly normal, Abnormal cells, similar to parent become more unlike cells parent cells Cancer nursing Etiology of cancer 1. Physical agents Radiation Exposure to irritants Exposure to sunlight Altitude, humidity Cancer nursing Etiology of cancer 2. Chemical agents Smoking Dietary ingredients Drugs Cancer nursing Etiology of cancer Genetics and Family History Colon Cancer Breast cancer Cancer nursing Etiology of cancer Dietary Habits Low-Fiber High-fat Processed foods alcohol Cancer nursing Etiology of cancer Viruses and Bacteria DNA viruses- HepaB, Herpes, EBV, CMV, Papilloma Virus RNA Viruses- HIV, Bacterium- H. pylori CANCER NURSING Etiology of cancer Hormonal agents DES OCP especially estrogen Immune Disease AIDS Cancer nursing Body Defenses Against TUMOR 1. T cell System/ Cellular Immunity Cytotoxic T cells kill tumor cells 2. B cell System/ Humoral immunity B cells can produce antibody 3. Phagocytic cells Macrophages can engulf cancer cell debris Development of cancer Initiation : the first stage, initiation, is a mutation in the cell’s genetic structure resulting from an inherited mutation, (an error that occurs during DNA replication), or following exposure to a chemical, radiation, or viral agent. This altered cell has the potential for developing in to a clone group of identical cells) of neoplastic cells. Development of cancer Promotion : it is characterized by the reversible proliferation of the altered cells. An important distinction between initiation & promotion is that the activity of promoters is reversible. This is a key concept in cancer prevention. Development of cancer Promotion : some carcinogens are capable of both initiating & promoting the development of cancer & termed as complete carcinogens. A period of time ranging from 1-40 years, elapses between the initial genetic alteration& the actual clinical evidence of cancer called latent period. Development of cancer Progression : This stage is characterized by increased growth rate of the tumor, increased invasiveness, & metastasis As the tumor increases in size, blood cells within the tumor called angiogenesis. How can u lift an elephant with one hand???? What looks like half apple??? Classification of cancer Anatomic site Histology (grading) Extent of disease (staging) Classification of cancer Anatomic site site benign malignant
Epithelial oma Carcinoma
tissue tumors Surface papiloma Carcinoma epithelium Glandular Adenoma adenocarcin epithelium oma Classification of cancer Anatomic site site benign malignant Connective tissue oma sarcoma tumors Fibrous tissue fibroma Fibrosarcoma
cartilage chondroma chondrosarcoma
Striated muscle rhabdomyoma Rhabdomyosarc
oma bone osteoma osteosarcoma Classification of cancer Anatomic site site benign malignant
Meninges meningioma Meningeal sarcoma
Nerve cells ganglioneuroma neuroblastoma
Classification of cancer Anatomic site Hematopoietic tissue tumors Lymphoid tissue Hodgkin’s lymphoma, NHL
Plasma cells Multiple myeloma
Bone marrow Lymphocytic & myelogenous
leukemia Classification of cancer Anatomic site Hematopoietic tissue tumors Lymphoid tissue Hodgkin’s lymphoma, NHL
Plasma cells Multiple myeloma
Bone marrow Lymphocytic & myelogenous
leukemia Classification of cancer Histologic classification This is based on the degree to which the cells resemble the tissue of origin. • Grade I : cells differ slightly from normal cells (mild dysplasia) & are well differentiated (low grade) • Grade II : cells are more abnormal (moderate dysplasia) & moderately differentiated (intermediate grade) Classification of cancer Histologic classification • Grade III : cells are very abnormal (severe dysplasia) & poorly differentiated (high grade) • Grade IV : cells are immature & primitive (anaplasia) & undifferentiated, cell of origin difficult to determine (high grade) • Grade x : grade cannot be assessed Classification of cancer Extent of disease • Stage 0 : cancer in situ • Stage I : tumor limited to the tissue of origin, localized tumor growth • Stage II : limited local spread • Stage III : extensive local & regional spread • Stage IV : metastasis Classification of cancer TNM classification system • Primary tumor (T) • T0 : no evidence of primary tumor • Tis : carcinoma in situ • T1-4 : ascending degrees of increase in tumor size & invovement • Tx : tumor cannot be measured or found Classification of cancer TNM classification system • Regional lymphnodes (N) • N0 : no evidence of disease in lymphnodes • N1-4 : ascending degrees of nodal involvement • Nx : regional lymph nodes unable to be assessed clinically Classification of cancer TNM classification system • Distant metastsis (M) • M0 : no evidence of distant metastasis • M1-4 : ascending degrees of metastatic involvement of the host, including distant nodes • Mx : cannot be determined Warning signs of cancer Change in bowel & bladder habits A sore that does not heal Unusual bleeding or discharge from any body orifice Thickening or a lump in the breast or elsewhere Indigestion or difficulty in swallowing Obvious change in a wart or mole Nagging cough or hoarseness Diagnostic evaluation Laboratory analysis Biochemical analysis of blood, serum, urine & other body fluids identifies chemical & hematologic values outside the normal homeostatic range. LFT, CBC, RFT, PT, PTT, fibrin levels Diagnostic evaluation Tumor markers Tumor markers consist of proteins, antigens, ectopically produced hormones, enzymes & gene products that are tumor derived. It is recognized in serum& body fluids, & in tissues at the cellular & genetic levels Diagnostic evaluation Tumor markers CEA – general carcinogenic antigen PSA – prostate antigen CA-125 – ovarian CA-25,27 – breast HER 2 NEU – breast Diagnostic evaluation Analytical techniques • Radioimmuno assay : it determines the amount of tumor antigen in a serum sample. • Immunohistochemistry : it locates antigens in tissue sections by utilizing labeled antibodies & observing antigen antibody interactions (CEA) Diagnostic evaluation Analytical techniques • Flow cytometry : Rapidly measures & identifies DNA charateristics & distribution cell throughout cell cycle. • Cytogenetics : it is the analysis of cell genetic information. Diagnostic evaluation Genetic testing : BRCA 1, BRCA 2 Tumor imaging • CT • USG • MRI • Nuclear medicine techniques • Thyroid scans : injection of a radioactive tracer, iodine, to evaluate the functional ability of thyroid Diagnostic evaluation Tumor imaging • Nuclear medicine techniques • Gallium scans : to visualize inflammatory lesions of bone, bone marrow, breast, brain & liver • PET : biochemical & metabolic activity of the tissue. Diagnostic evaluation Invasive diagnostic techniques • Endoscopy • biopsy CHEMOTHERAPY Chemotherapy The goal of chemotherapy is to eliminate or reduce the number of malignant cells present in the primary tumor & metastaic tumor site. Chemotherapy Dose calculation The dose of drug to be administered generally based on the individual’s body surface area Mosteller equation BSA = √height (cm) x weight (kg) 3600 Chemotherapy Classification Mitotic inhibitors Alkylating agents Topoisomerase Nitrosureas inhibitors Platinum drugs Corticosteroids Antimetabolites Hormone therapy Antitumor miscellaneous antibiotics Chemotherapy Alkylating agents cell cycle phase non specific agents Damage DNA by causing breaks in the double stranded helix, if repair doesnot occur, cells will die immediately (cytocidal), Cyclophosphamide (cytoxan,neosar), dacarbazine (DTIC-dome) Chemotherapy Nitrosureas cell cycle phase non specific agents Break DNA interfere with DNA replication, cross BB Carmustine, lomustine Chemotherapy Platinum drugs cell cycle phase non specific agents Bind DNA to RNA, miscoding information or inhibiting DNA replication & cells die. Carboplatin, cisplatin, oxiplatin Chemotherapy Antimetabolites cell cycle phase specific agents Mimic naturally occurring substances, thus interfering with enzyme function or DNA synthesis Primarily act during S phase Interfere with purine, pyrimidine & folic acid metabolism Mercaptopurine, fluorouracil, methotrexate Chemotherapy Antitumor antibiotics cell cycle phase non specific agents Bind directly to DNA, thus inhibiting the synthesis of DNA & interfering with transcription of RNA Doxorubicin, dactinomycin, daunorubicin. Chemotherapy Mitotic inhibitors cell cycle phase specific agents Antimicrotubule agents that interfere with mitosis, act during the late G2 phase & mitosis to stabilize microtubules, thus inhibiting cell division Albumin bound particles, paclitaxel Chemotherapy Mitotic inhibitors cell cycle phase specific agents Taxanes : Antimicrotubule agents that interfere with mitosis, act during the late G2 phase & mitosis to stabilize microtubules, thus inhibiting cell division Albumin bound particles, paclitaxel Vinca alkaloids : act in M phase to inhibit mitosis (vinblastine, vincristine) Chemotherapy Topoisomerase inhibitors cell cycle phase specific agents Inhibit the normal enzymes (topoisomerases) that function to make reversible breaks & repairs in DNA that allow for flexibility of DNA in replication Etoposide, teniposide Chemotherapy Corticosteroids cell cycle phase non specific agents Disrupt the cell membrane & inhibit the synthesis of protein, decrease circulating lymphocytes, inhibit mitosis, depress immune system, increase sense of well being Cortisone, dexamethasone, hydrocortisone Chemotherapy Hormone therapy cell cycle phase non specific agents Antiestrogens : selectively attach to estrogen receptors, causing down regulation of them & inhibiting tumor growth, also known as selective estrogen modulators (SERMs) Tamoxifen, raloxifene Chemotherapy Hormone therapy Estrogen : interfere with hormone receptors & proteins (diethylstilbestrol, DES) Aromatase inhibitors : inhibit aromatase, an enzyme that converts adrenal androgen to estrogen ( exemestane, letrozole) Chemotherapy Miscellaneous Inhibits protein synthesis (l- asparaginase) Causes changes in DNA in leukemia cells (arsenic trioxide) Suppresses mitosis at interphase, appears to alter performed DNA, RNA, & protein (procarbazine) Chemotherapy Method of administration Oral : cytoxan Intramuscular : bleomycin IV : doxorubicin, vincristne, cisplatin, 5 –FU, paclitaxel Intraperitoneal : alkalyting agents, methotrexate Intrathecal : methotrexate, cytarabine Intraarterial : DTIC, 5 FU Topical : 5 FU cream Chemotherapy Problems caused by chemotherapy GI system Stomatitis, mucositis Nausea & vomiting Anorexia Diarrhea Constipation hepatotoxicity Chemotherapy Integumentary system Alopecia hyperpigmentation Hematologic system Anemia Leukopenia thrombocytopenia Chemotherapy Genitourinary system Hemorrhagic cystitis Nervous system Increased ICP Peripheral neuropathy Chemotherapy Respiratory system Pneumonitis CV system Pericarditis Myocarditis Cardiotoxicity Refer page 282 Radiation therapy Radiation is the emission & distribution of energy through space or a material medium. It produces ionization of atomic particles & resultant generation of free radicals act to break the chemical bonds in DNA. It leads to lethal (chromosomal disruption) & sublethal DNA damage (potential for repair in between radiation doses). Radiation therapy Measurement of radiation are (curie, Ci), roentegen (R), Rad, Rem, gray (Gy) Radiation is used to treat a carefully defined area of the body to achieve local control of disease. Radiation may be used independently or in combination with chemotherapy to treat primary tumors or for palliative control of metastatic lesions. Radiation therapy The goals of radiation therapy are cure, control, or palliation. Radiation can be delivered externally called teletherapy or internally called brachytherapy. In teletherapy, the patient is exposed to radiation from a megavoltage treatment machine. Radiation therapy Brachytherapy consists of the implantation or insertion of radioactive materials directly in to the tumor (interstitial) or in close proximity adjacent to the tumor (intracavity or intraluminal) Radiation therapy Definitive /primary therapy : used as an independent treatment modality with curative intent. (eg. For ca lung, prostate, bladder) Neoadjuvant therapy : given (with or without chemotherapy) preoperatively to minimize tumor burden & improve the likelihood od complete surgical resection. Radiation therapy Adjuvant therapy : administered following surgery or chemotherapy to improve local control of disease recurrence Prophylaxis : administered to high risk areas to prevent future cancer development Radiation therapy Disease control : limiting tumor growth to extend the symptom free period as much as possible Palliation : given to prevent or relieve distressing symptom such as pain or SOB, & to preserve neurologic function. Biologic & targeted therapy Biologic therapy, or biologic response modifier therapy, consists of agents that modify the relationship between the host & the tumor by altering the biologic response of the host to the tumor cells. They have direct anti tumor effects They restore host immune system Interfere with cancer cell’s ability to metastasize Biologic & targeted therapy Targeted therapy interferes with cancer growth by targeting specific cellular receptors & pathways that are important in tumor growth α interferon, interleukin 2, levamisole, BCG vaccine It include EGFR(EPIDERMALGROWTH FACTOR RECEPTOR)-tyrosine kinase inhibitors, CD 20 monoclonal antibodies, proteasome inhibitors. Bone marrow transplantation BMT & peripheral stem cell transplantation (PSCT) are effective, life saving procedures for the treatment of a number of malignant & non malignant diseases It is now referred to as hematopoietic stem cell transplantation (HSCT) Bone marrow transplantation Types Allogenic transplantaion : stem cells are acquired from a donor, through human leukocyte antigen (HLA) tissue typing. Syngeneic transplnatation : is a type of allogeneic transplantation that involves obtaining stem cells from one identical twin. Bone marrow transplantation Types Autulogous transplantation : patients receive their own stem cells back following myeloablative chemotherapy. It enables patients to receive intensive chemo or radiation by supporting them with their previously harvested stem cells. Gene therapy Gene therapy is an experimental therapy that involves introducing genetic material in to a person’s cells to fight disease. Oncologic emergencies Oncologic emergencies are life threatening emergencies that can occur as a result of cancer or cancer treatment. These emergencies can be obstructive, metabolic or infiltrative. Oncologic emergencies Obstructive emergencies superior venecava syndrome SVCS result from obstruction of the SVC by a tumor or thrombosis Facial edema, periorbital edema, distension of vein of head, neck, & chest, head ache & seizures are manifestations. Common causes are NHL (NON-HODGKIN’S LYMPHOMA), Ca lung, breast Oncologic emergencies Obstructive emergencies Spinal Cord Injury & compression SCI compression is a neurologic emergency caused by the presence of a malignant tumo in the epidural space of the SCI Cancer of breast, lung, prostate, GI, & rena tumors & malenoma produce this problem. Oncologic emergencies Obstructive emergencies SCI compression Back pain that is intense, localized, & persistant accompanied by vertebral tenderness & aggravated the Valsalva maneuver, motor weakness & dysfunction sensory parasthesia & autonomic dysfunction. Decompressive laminectomy, radiation in conjunction with corticosteriods are preferable Oncologic emergencies Obstructive emergencies Third space syndrome It involves a shifting of fluid from the vascular space to the interstitial space primarily occurs secondary to extensive procedures, biologic therapy, or septic shock Oncologic emergencies Obstructive emergencies Third space syndrome Patient shows signs of hypovolemia, including hypotension, tachycardia, low CVP, & decreased UOP Treatment includes fluid, electrolyte & plasma protein replacement. Oncologic emergencies Metabolic emergencies Metabolic emergencies are caused by the production of ectopic hormones directly from the tumor or are secondary to metabolic alterations caused by the presence of tumor or cancer treatment. Oncologic emergencies Metabolic emergencies SIADH It results from abnormal or sustained production of ADH with resultant water retention & hyponatremia. Ca lung, pancreas, duodenum, brain, esophagus, colon, ovary, prostate, leukemia etc, Oncologic emergencies Metabolic emergencies SIADH Cancer cell in these tumors manufacture, store & release ADH Weight gain without edema, weakness, anorexia, nausea, vomiting, seizures, oliguria decrease in reflex & coma are the symptoms Oncologic emergencies Metabolic emergencies SIADH Chemo drugs vincristine & cytoxan stimulate the release of ADH from the pituitory or tumor cells. Treat the underlying malignancy Correct the Na, H2O balance, fluid restriction, IV 3% sodium chloride Oncologic emergencies Metabolic emergencies Hypercalcemia It can occur in the presence of cancer that involves metastsic disease of the bone or multiple myeloma, or when a parathyroid hormone like substance is secreted by cancer cells in the absence of bony metastasis. Oncologic emergencies Metabolic emergencies Hypercalcemia Hypercalcemia resulting from malignancies that have metastasized occur in patients with Ca lung, breast, kidney, colon, ovarian or thyroid cancer Hypercalcemia resulting from secretion of parathyroid hormone like substance occurs in SCC of lung, Ca of neck, esophagus, leukemia Oncologic emergencies Metabolic emergencies Hypercalcemia Apathy, depression, fatigue, muscle weakness, ECG changes, polyuria, anorexia, & vomiting Hydration (3L/day), diuretics, bisphoshonate (inhibit the action of osteoclasts) Oncologic emergencies Metabolic emergencies Hypercalcemia Chronic hypercalcemia result in nephrocalcinosis & irreversible renal failure Correct the calcium level for serum albumin or check an ionized calcium level. Oncologic emergencies Metabolic emergencies Tumor lysis syndrome TLS is a metabolic complication c/by rapid release of intracellular components (potassium, phosphate, DNA & RNA) in response to chemotherapy Oncologic emergencies Metabolic emergencies Tumor lysis syndrome 4 hallmark signs are hyperuricemia, hyperphosphatemia, hyperkalemia, hypocalcemia Early signs include weakness, muscle cramps, diarrhea, nausea & vomiting TLS occur within first 24-48 hours & persist for 5-7 days Oncologic emergencies Metabolic emergencies Tumor lysis syndrome Primary goal is to prevent renal failure & severe electrolyte abnormalities. The primary treatment includes increasing urine production using hydration therapy & decreasing uric acid concentration using allopurinol Oncologic emergencies Infiltrative emergencies It occurs when malignant tumors infiltrate major organs or secondary to cancer therapy. Oncologic emergencies Infiltrative emergencies Cardiac tamponade It results from fluid accumulation in the pericardial sac, constriction of the pericardium by tumor, or pericarditis secondary to radiation therapy to the chest Oncologic emergencies Infiltrative emergencies Manifestations includee a heavy feeling over the chest, SOB, tachycardia, cough, dysphagia, hiccups, hoarseness, nausea, vomiting, excessive perspiration, decreased LOC, pulsus paradoxus, distant or mute heart sounds, & extreme anxiety. Oncologic emergencies Infiltrative emergencies Emergency management is aimed at reduction of fluid around the heart & includes surgical establishment of an indwelling catheter. Supportive therapy includes admin of O2 therapy, IV hydration, & vasopressor therapy. Oncologic emergencies Infiltrative emergencies Carotid artery rupture It occurs most frequently in patients with cancer of the head & neck secondary to invasion of the arterial wall by tumor or to erosion following surgery or radiation therapy. Oncologic emergencies Infiltrative emergencies Carotid artery rupture Bleeding can manifest as minor oozing or spurting of blood in the case of a “blowout” of the artery Apply a pressure to the site with a finger. Oncologic emergencies Infiltrative emergencies Carotid artery rupture IV fluids & blood products are administered to stabilize the patient for surgery. S/mgt involves ligation of the carotid artery above & below the rupture site & reduction of local tumor. CANCER NURSING GENERAL Promotive and Preventive Nursing Management 1. Lifestyle Modification 2. Nutritional management 3. Screening 4. Early detection Nursing Assessment Weight loss Frequent infection Skin problems Pain Hair Loss Fatigue Disturbance in body image/ depression Nursing Intervention MAINTAIN TISSUE INTEGRITY Handle skin gently Do NOT rub affected area Lotion may be applied Wash skin only with SOAP and Water Nursing Intervention MANAGEMENT OF STOMATITIS Use soft-bristled toothbrush Oral rinses with saline gargles/ tap water Avoid ALCOHOL-based rinses Nursing Intervention MANAGEMENT OF ALOPECIA Alopecia begins within 2 weeks of therapy Regrowth within 8 weeks of termination Encourage to acquire wig before hair loss occurs Encourage use of attractive scarves and hats Provide information that hair loss is temporary BUT anticipate change in texture and color Nursing Intervention PROMOTE NUTRITION Serve food in ways to make it appealing Consider patient’s preferences Provide small frequent meals Avoids giving fluids while eating Oral hygiene PRIOR to mealtime Vitamin supplements Nursing Intervention RELIEVE PAIN Mild pain- NSAIDS Moderate pain- Weak opiods Severe pain- Morphine Administer analgesics round the clock with additional dose for breakthrough pain Nursing Intervention DECREASE FATIGUE Plan daily activities to allow alternating rest periods Light exercise is encouraged Small frequent meals Nursing Intervention IMPROVE BODY IMAGE Therapeutic communication is essential Encourage independence in self-care and decision making Offer cosmetic material like make-up and wigs Nursing Intervention ASSIST IN THE GRIEVING PROCESS Some cancers are curable Grieving can be due to loss of health, income, sexuality, and body image Answer and clarify information about cancer and treatment options Identify resource people Refer to support groups Nursing Intervention MANAGE COMPLICATION: INFECTION Fever is the most important sign (38.3) Administer prescribed antibiotics X 2weeks Maintain aseptic technique Avoid exposure to crowds Avoid giving fresh fruits and veggie Handwashing Avoid frequent invasive procedures Nursing Intervention MANAGE COMPLICATION: Septic shock Monitor VS, BP, temp Administer IV antibiotics Administer supplemental O2 Nursing Intervention MANAGE COMPLICATION: Bleeding Thrombocytopenia (<100,000) is the most common cause <20, 000 spontaneous bleeding Use soft toothbrush Use electric razor Avoid frequent IM, IV, rectal and catheterization Soft foods and stool softeners COLON CANCER Risk factors 1. Increasing age 2. Family history 3. Previous colon CA or polyps 4. History of IBD 5. High fat, High protein, LOW fiber 6. Breast Ca and Genital Ca COLON CANCER Sigmoid colon is the most common site Predominantly adenocarcinoma If early 90% survival 34 % diagnosed early 66% late diagnosis COLON CANCER PATHOPHYSIOLOGY Benign neoplasm DNA alteration malignant transformation malignant neoplasm cancer growth and invasion metastasis (liver) COLON CANCER ASSESSMENT FINDINGS 1. Change in bowel habits- Most common 2. Blood in the stool 3. Anemia 4. Anorexia and weight loss 5. Fatigue 6. Rectal lesions- tenesmus, alternating D and C Colon cancer Diagnostic findings 1. Fecal occult blood 2. Sigmoidoscopy and colonoscopy 3. BIOPSY 4. CEA- carcino-embryonic antigen Colon cancer Complications of colorectal CA 1. Obstruction 2. Hemorrhage 3. Peritonitis 4. Sepsis Colon cancer MEDICAL MANAGEMENT 1. Chemotherapy- 5-FU 2. Radiation therapy Colon cancer SURGICAL MANAGEMENT Surgery is the primary treatment Based on location and tumor size Resection, anastomosis, and colostomy (temporary or permanent) Colon cancer NURSING INTERVENTION Pre-Operative care 1. Provide HIGH protein, HIGH calorie and LOW residue diet 2.Provide information about post-op care and stoma care 3. Administer antibiotics 1 day prior Colon cancer NURSING INTERVENTION Pre-Operative care 4. Enema or colonic irrigation the evening and the morning of surgery 5. NGT is inserted to prevent distention 6. Monitor UO, F and E, Abdomen PE Colon cancer NURSING INTERVENTION Post-Operative care 1. Monitor for complications Leakage from the site, prolapse of stoma, skin irritation and pulmo complication 2. Assess the abdomen for return of peristalsis Colon cancer NURSING INTERVENTION Post-Operative care 3. Assess wound dressing for bleeding 4. Assist patient in ambulation after 24H 5.provide nutritional teaching Limit foods that cause gas-formation and odor Cabbage, beans, eggs, fish, peanuts Low-fiber diet in the early stage of recovery Colon cancer NURSING INTERVENTION Post-Operative care 6. Instruct to splint the incision and administer pain meds before exercise 7. The stoma is PINKISH to cherry red, Slightly edematous with minimal pinkish drainage 8. Manage post-operative complication Colon cancer NURSING INTERVENTION: COLOSTOMY CARE Colostomy begins to function 3-6 days after surgery The drainage maybe soft/mushy or semi-solid depending on the site Colon cancer NURSING INTERVENTION: COLOSTOMY CARE BEST time to do skin care is after shower Apply tape to the sides of the pouch before shower Assume a sitting or standing position in changing the pouch Colon cancer NURSING INTERVENTION: COLOSTOMY CARE Instruct to GENTLY push the skin down and the pouch pulling UP Wash the peri-stomal area with soap and water Cover the stoma while washing the peri-stomal area Colon cancer NURSING INTERVENTION: COLOSTOMY CARE Lightly pat dry the area and NEVER rub Lightly dust the peri-stomal area with nystatin powder Colon cancer NURSING INTERVENTION: COLOSTOMY CARE Measure the stomal opening The pouch opening is about 0.3 cm larger than the stomal opening Apply adhesive surface over the stoma and press for 30 seconds Colon cancer NURSING INTERVENTION: COLOSTOMY CARE Empty the pouch or change the pouch when 1/3 to ¼ full Breast Cancer RISK FACTORS 1. Genetics- BRCA1 And BRCA 2 2. Increasing age ( > 50yo) 3. Family History of breast cancer 4. Early menarche and late menopause 5. Nulliparity 6. Late age at pregnancy Breast Cancer RISK FACTORS 7. Obesity 8. Hormonal replacement 9. Alcohol 10. Exposure to radiation Breast Cancer PROTECTIVE FACTORS 1. Exercise 2. Breast feeding 3. Pregnancy before 30 yo Breast Cancer ASSESSMENT FINDINGS 1. MASS- the most common location is the upper outer quadrant 2. Mass is NON-tender. Fixed, hard with irregular borders 3. Skin dimpling 4. Nipple retraction 5. Peau d’ orange Breast Cancer LABORATORY FINDINGS 1. Biopsy procedures 2. Mammography Breast Cancer Breast cancer Staging TNM staging I - < 2cm II - 2 to 5 cm, (+) LN III - > 5 cm, (+) LN IV- metastasis Breast Cancer MEDICAL MANAGEMENT 1. Chemotherapy 2. Tamoxifen therapy 3. Radiation therapy Breast Cancer SURGICAL MANAGEMENT 1. Radical mastectomy 2. Modified radical mastectomy 3. Lumpectomy 4. Quadrantectomy Breast Cancer NURSING INTERVENTION : PRE-OP 1. Explain breast cancer and treatment options 2. Reduce fear and anxiety and improve coping abilities 3. Promote decision making abilities 4. Provide routine pre-op care: Consent, NPO, Meds, Teaching about breathing exercise Breast Cancer NURSING INTERVENTION : Post-OP 1. Position patient: Supine Affected extremity elevated to reduce edema Breast Cancer NURSING INTERVENTION : Post-OP 2. Relieve pain and discomfort Moderate elevation of extremity IM/IV injection of pain meds Warm shower on 2nd day post-op Breast Cancer NURSING INTERVENTION : Post-OP 3. Maintain skin integrity Immediate post-op: snug dressing with drainage Maintain patency of drain (JP) Monitor for hematoma w/in 12H and apply bandage and ice, refer to surgeon Breast Cancer NURSING INTERVENTION : Post-OP 3. Maintain skin integrity Drainage is removed when the discharge is less than 30 ml in 24 H Lotions, Creams are applied ONLY when the incision is healed in 4-6 weeks Breast Cancer NURSING INTERVENTION : Post-OP Promote activity Support operative site when moving Hand, shoulder exercise done on 2 ndday Post-op mastectomy exercise 20 mins TID NO BP or IV procedure on operative site Breast Cancer NURSING INTERVENTION : Post-OP Promote activity Heavy lifting is avoided Elevate the arm at the level of the heart On a pillow for 45 minutes TID to relieve transient edema Breast Cancer NURSING INTERVENTION : Post-OP MANAGE COMPLICATIONS Lymphedema 10-20% of patients Elevate arms, elbow above shoulder and hand above elbow Hand exercise while elevated Refer to surgeon and physical therapist Breast Cancer NURSING INTERVENTION : Post-OP MANAGE COMPLICATIONS Hematoma Notify the surgeon Apply bandage wrap (Ace wrap) and ICE pack Breast Cancer NURSING INTERVENTION : Post-OP MANAGE COMPLICATIONS Infection Monitor temperature, redness, swelling and foul- odor IV antibiotics No procedure on affected extremity Breast Cancer NURSING INTERVENTION : Post-OP TEACH FOLLOW-UP care Regular check-up Monthly BSE on the other breast Annual mammography