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NCM 104 Lecture- Oncology Nursing

Ms. Shandz S. de Rosas, R.N.

ONCOLOGY NURSING
Cancer  recognized in ancient times by the skilled observers who gave it the name cancer; an umbrella word used
to describe a group of more than 100 diseases in which cells multiply and spread without restraint.

Causative Factors
Viruses and Bacteria viruses are thought to incorporate themselves in the genetic structure of cells, thus altering
future generations of that cell

Gender and Site for men, the most common site of cancers are the prostate, colorectal and bladder; for women,
the top 3 cancers are the breast, the lung, colon and rectum

Age cancer is a disease of aging; the more advanced the age, the highest risk of development of cancer

Race and Ethnicity there are certain cancers specific only to specific races liked blacks, Jewish and Asian
descents

Geographic Factors primary cancers of the liver are common in Indonesia, in parts of Africa, and Asia; breast
cancer is common in the USA and Western Europe
Risk Factors

A. Endogenous
1. Age older people tend to have increased risk for development of cancer due to the longer time of
exposure to harmful agents

2. Genetic Factors most cancers are not inherited but occur because of random genetic mutations in
people with little or no relevant family history

3. Hormonal Factors hormones such as estrogen do not appear to be primary carcinogens, but influences
carcinogenesis

4. Pre-cancerous Lesions includes polyps of the colon and rectum; certain pigmented moles, dysplasias
of the cervical epithelium, and others

5. Immunologic Factors persons who have weaker immune system have increased risk for the
development of cancer

B. Exogenous Factors
1. Drugs and Chemicals many chemicals, drugs and products in the environment are known to be
carcinogenic and hundred of others are considered to be associated with the development of cancers

2. Radiation
a. Ionizing Radiation consists of electromagnetic waves or material particles that have sufficient
energy to ionize atoms or molecules

b. Ultraviolet Radiation UVR is produced by the sun, by artificial sources such as tanning beds
or those in the industries. This type of radiation acts as an initiator, a promoter, a cocarcinogenic or an
immunosuppressive agent.

c. Radon a colorless, odorless radioactive gas that results from the decay of uranium found in
soil and in rocks. Prolonged breathing at high levels have been linked to an increased incidence of lung cancers.
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NCM 104 Lecture- Oncology Nursing
Ms. Shandz S. de Rosas, R.N.

d. Electromagnetic Radiation EMF are extremely low frequency energy fields, and exposure can
come from household appliances, electrical power lines, and electricity-generating facilities

3. Lifestyle Practices
a. Smoking and Tobacco use tobacco smoke is the single most lethal cause of cancer in the USA
and is associated with at least 10 different cancers responsible for up to 30% of all cancer deaths

b. Nutrition the consumption of high fat diet has been researched as a risk factor in many
common cancers, including cancers of the colon, prostate and breast

4. Obesity considered a risk factor in for colon, breast, endometrial, renal and esophageal cancers.

5. Sexual and Reproductive Factors sexual practices play a role in the incidence of certain cancers
because serial STDs have been linked to cancer, including HIV

6. Viruses and Other Microorganisms HBV and HCV can cause chronic infections that are associated
with hepatocellular carcinoma

7. Psychosocial Factors stress that results from psychosocial trauma, loss of a significant other, and
personality variables, such as helplessness and repression have been suggested as etiologic factors in the
development of cancer

Classification/Site of Origin
1. Adenocarcinoma- originates in glandular tissue
2. Blastoma- originates in the embryonic tissue of organs
3. Carcinoma- originates in the epithelial tissue (i.e., tissue that lines organs and tubes)
4. Leukemia- originates in tissues that form blood cells
5. Lymphoma- originates in lymphatic tissue
6. Myeloma- originates in the bone marrow
7. Sarcoma- originates in the connective tissues or supportive tissues (i.e., bone, cartilage, muscles)

Grading, Staging, The T-N-M

A. Grading
 the cancer is examined for its cellular maturity and characteristics. The abnormality of the cells
determines he grade of the cancer. A higher grade means the tissue appears more abnormal and generally is
more aggressive

B. Staging
 the classification of the extent of the disease

C. The T-N-M Cancer Staging


1. Tumor
To- no lymph node involvement
Tis- carcinoma in situ (limited to surface cells only)
T1-4- increasing tumor involvement

2. Node
No- no lymph node involvement
N1-4- increasing degree if lymph node involvement
Nx- lymph node involvement cannot be assessed
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NCM 104 Lecture- Oncology Nursing
Ms. Shandz S. de Rosas, R.N.

3. Metastasis
Mo- no evidence of distant metastasis
M1- evident of distant metastasis

 the numerical system used to classify the extent of the disease


Stage 0- cancer in situ (surface cells)
Stage1- cancer limited to the tissue of origin; evidence of tumor growth
Stage 2- limited local spread of cancerous cells
Stage 3- extensive local and regional spread
Stage 4- distant metastasis

Common Signs and Symptoms of Cancer


Change in bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge
Thickening or lump in breast or elsewhere
Indigestion or difficulty in swallowing
Obvious change in wart or mole
Nagging cough or hoarseness
Anorexia
Loss of weight (unexplained)
Pathophysiology

 malignant or cancerous growths represent one form of abnormal growth


 an abnormal cell is transformed by the genetic mutation of cellular DNA
 abnormal cells form a clone and proliferates abnormally
 cells acquire invasive characteristics and infiltrate the surrounding tissues and gain access to lymph and
blood vessels, carrying them to the other areas of the body.

Cell Proliferative Patterns


1. Hyperplasia- an increase in the cell number with accompanying increase in size
2. Hypetrophy- an increase in the cell size, but not in its number
3. Metaplasia- the conversion of one type of mature cell into another type of cell; a reversible process and
is not related to cancer
4. Dysplasia- an alteration in adult cell characterized by changes in their size, shape and organization
5. Neoplasia- abnormal cellular division not necessary for normal cell growth and development; often
leads to the formation of cancer cells
6. Anaplasia- cells that lack normal cellular characteristics and differ in shape and organization with
respect to their cells of origin and are usually malignant.

Benign vs. Malignant Tumor

Characteristics Benign Malignant


Cell Well-differentiated cells that resemble Cells are undifferentiated and often bear little
characteristics normal cells of the tissue from which resemblance to the normal cells of the tissue from
the tumor originated which they arose
Mode of Growth Tumor grows by expansion and does Grows at the periphery and sends out processes that
not infiltrate the surrounding tissues; infiltrate and destroy surrounding tissues
usually encapsulated
Rate of Growth Usually slow Rate of growth is variable and depends on the level of

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NCM 104 Lecture- Oncology Nursing
Ms. Shandz S. de Rosas, R.N.

differentiation
Metastasis Does not spread by metastasis Gains access to the blood and lymphatic channels and
metastasizes to the other areas of the body
General Effects Is usually a localized phenomenon that Often causes generalized effects such as anemia,
does not cause generalized effects weakness and weight loss
unless its location interferes with vital
function
Tissue Does not usually cause tissue damage Often causes extensive tissue damage as the tumor
Destruction unless its location interferes with blood outgrows its blood supply or encroaches on blood
flow flow to the area; may also produce substances that
cause cell damage
Ability to Cause Does not usually cause death unless its Usually causes death unless growth can be controlled
Death location interferes with vital function

Diagnostic Tests for Specific Cancers

1. Gastrointestinal Cancers
Esophageal
CT Scan
MRI
Esophagoscopy with Biopsy
Barium Swallow

Stomach
Gastric Secretion Analysis
Carcinogenic Antigen
Gastroscopy with Biopsy
Barium Swallow

Colorectal Cancers
CT Scan
MRI
Stool Guaiac
Colonoscopy and Biopsy
Barium Swallow
Cancer Antigen

Liver Cancer
Liver Biopsy
Liver Enzyme Studies
Ultrasound
CT Scan
MRI
Angiography

2. Genitourinary Cancer
Prostate
Digital Rectal Examination
Bone Scan
Biopsy
Urinalysis
PSA, Serum Acid Phosphatase

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NCM 104 Lecture- Oncology Nursing
Ms. Shandz S. de Rosas, R.N.

Bladder
Cytology
Cytoscopy
IVP
Urinalysis

Kidney
CT Scan
Renal Angiogram
KUB Studies
Urinalysis
IVP

3. Gynecologic Cancers
Cervical
Colposcopy
Biopsy
Pap Smear
Ovary
Pelvic Physical Exam
IVP
Barium Enema
Urinalysis

Uterine
Endometrial Biopsy and Aspiration

4. Other Cancers
Breast
Breast Physical Examination
Ultrasound
Mammography
Tissue Lymph Node Biopsy
Estrogen and Progesterone Receptor Status

Lung
Chest X-ray
Sputum Cytology
Fiberoptic Bronchoscopy with Biopsy and Bronchial Washings
Mediastinography
Thoracentesis

Management of Cancer

Surgical Management
 the oldest and most widely-used option for cancer treatment; may be used for cancer diagnosis and
staging, cure, adjuvant treatment, control of oncologic emergencies or palliation of symptoms
1. Diagnostic
2. Curative or Primary Treatment
a. Local excision

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NCM 104 Lecture- Oncology Nursing
Ms. Shandz S. de Rosas, R.N.

b. Wide or Radical Excision


c. Endoscopic Surgery
d. Salvage Surgery
e. Electrosurgery
f. Cryosurgery
g. Chemosurgery
h. Laser Surgery
3. Prophylactic Surgery
4. Palliative Surgery when cure is not possible; the goal is to make the patient as comfortable as possible
and to promote a satisfying and productive life for as long as possible
5. Reconstructive Surgery may follow curative or radical surgery and is carried out in an attempt to
improve function or obtain a desirable cosmetic effect

Radiation Therapy
 ionizing radiation is used to interrupt cellular growth; may be used to cure cancer or to control
malignant disease when a tumor cannot be removed surgically or when a local nodal metastasis is present
1. External Radiation can be used to destroy cancerous cells at the skin surface or deeper in the body
a. Kilovoltage Therapy
b. Linear Accelerators/Betatron Machine
c. Gamma Rays
2. Internal Radiation also known as brachytherapy, delivers a high dose of radiation to a localized area; can
be implanted by means of needles, seeds, beads or catheters into the body cavity or interstitial
compartments
a. Intracavitary Radioisotopes
b. Interstitial Implants

Chemotherapy
 the use of drugs to kill tumor cells by interfering with cellular function and reproduction
1. Alkylating Agents
2. Nitrosureas
3. Antimetabolites
4. Anti-tumor Antibitics
5. Hormonal Agents
a. Andogens
b. Corticosteroids
c. Estrogens
d. Progestins
e. Estrogen Antagonists
6. Anti-adrenal
7. Vinca Alkaloids
8. Epipodophyllotoxins
9. Taxanes

Nursing Care of Cancer Patients

1. Protect the skin and oral mucosa


2. Protect the cargivers from radiation
3. Assess for fluid and electrolyte status
4. Modify risks for infection and bleeding
5. Implement necessary safeguards
6. Administer prescribed medications
7. Assess for the psychological impact of hair loss
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NCM 104 Lecture- Oncology Nursing
Ms. Shandz S. de Rosas, R.N.

8. Manage nutritional concerns


9. Manage pain
10. Provide adequate rest
11. Manage stomatitis
12. Provide emotional support