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Oncology Nursing Review

Oncology defined
Branch

of medicine
that deals with the
study, detection,
treatment and
management of cancer
and neoplasia

Root words
Neo-

new
Plasia- growth
Plasm- substance
Trophy- size
+Oma- tumor
Statis- location

Root words
A-

none
Ana- lack
Hyper- excessive
Meta- change
Dys- bad, deranged

Characteristics of Neoplasia
Uncontrolled
1.

Benign
2. Malignant

growth of Abnormal cells

Characteristics of Neoplasia
BENIGN
Well-differentiated
Slow

growth
Encapsulated
Non-invasive
Does NOT metastasize

Characteristics of Neoplasia
MALIGNANT
Undifferentiated
Erratic

and Uncontrolled Growth


Expansive and Invasive
Secretes abnormal proteins
METASTASIZES

Nomenclature of
Neoplasia
Tumor is named according to:
1. Parenchyma, Organ or Cell
Hepatoma- liver
Osteoma- bone
Myoma- muscle

Nomenclature of
Neoplasia
Tumor is named according to:
2. Pattern and Structure, either GROSS or
MICROSCOPIC
Fluid-filled CYST
Glandular ADENO
Finger-like PAPILLO
Stalk POLYP

Nomenclature of
Neoplasia
Tumor is named according to:
3. Embryonic origin
Ectoderm ( usually gives rise to
epithelium)
Endoderm (usually gives rise to glands)
Mesoderm (usually gives rise to
Connective tissues)

BENIGN TUMORS
Suffix-

OMA is used
Adipose tissue- LipOMA
Bone- osteOMA
Muscle- myOMA
Blood vessels- angiOMA
Fibrous tissue- fibrOMA

MALIGNANT TUMOR
Named

according to embryonic cell

origin
1. Ectodermal, Endodermal, Glandular,
Epithelial
Use the suffix- CARCINOMA
Pancreatic AdenoCarcinoma
Squamos cell Carcinoma

MALIGNANT TUMOR
Named

according to embryonic cell

origin
2. Mesodermal, connective tissue origin
Use the suffix SARCOMA
FibroSarcoma
Myosarcoma
AngioSarcoma

PASAWAY
1. OMA but Malignant

HepatOMA, lymphOMA, gliOMA, melanOMA

2. THREE germ layers

TERATOMA

3. Non-neoplastic but OMA

Choristoma
Hamatoma

CANCER NURSING
Review of Normal Cell Cycle
3 types of cells
1. PERMANENT cells- out of the cell cycle

Neurons, cardiac muscle cell

2. STABLE cells- Dormant/Resting (G0)

Liver, kidney

3. LABILE cells- continuously dividing

GIT cells, Skin, endometrium , Blood cells

CANCER NURSING
Cell Cycle
G0------------------G1SG2M
G0- Dormant or resting
G1- normal cell activities
S- DNA Synthesis
G2- pre-mitotic, synthesis of proteins
for cellular division
M- Mitotic phase (I-P-M-A-T)

CANCER NURSING
Proposed

Molecular cause of CANCER:


Change in the DNA structure altered
DNA function Cellular aberration
cellular death
neoplastic
change
Genes in the DNA- proto-oncogene
And anti-oncogene

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
3. Genetics and Family History

Colon Cancer

Premenopausal breast cancer

CANCER NURSING
Etiology of cancer
4. Dietary Habits

Low-Fiber

High-fat

Processed foods

alcohol

CANCER NURSING
Etiology of cancer
5. Viruses and Bacteria
DNA viruses- HepaB, Herpes, EBV, CMV,
Papilloma Virus
RNA Viruses- HIV, HTCLV
Bacterium- H. pylori

CANCER NURSING
Etiology of cancer
6. Hormonal agents
DES
OCP especially estrogen

CANCER NURSING
Etiology of cancer
7. Immune Disease
AIDS

CANCER NURSING
CARCINOGENSIS
Malignant transformation
IPP
Initiation
Promotion
Progression

CANCER NURSING
CARCINOGENSIS
INITIATION
Carcinogens alter the DNA of the cell
Cell will either die or repair

CANCER NURSING
CARCINOGENSIS
PROMOTION
Repeated exposure to carcinogens
Abnormal gene will express
Latent period

CANCER NURSING
CARCINOGENSIS
PROGRESSION
Irreversible period
Cells undergo NEOPLASTIC
transformation then malignancy

CANCER NURSING
Spread of Cancer
1. LYMPHATIC
Most

2.

3.

common

HEMATOGENOUS
Blood-borne, commonly to Liver and
Lungs

DIRECT SPREAD
Seeding of tumors

CANCER NURSING
Body Defenses Against TUMOR
1. T cell System/ Cellular Immunity

2.

3.

Cytotoxic T cells kill tumor cells

B cell System/ Humoral immunity


B cells can produce antibody

Phagocytic cells
Macrophages can engulf cancer cell
debris

CANCER NURSING
Cancer Diagnosis
1. BIOPSY

2.

The most definitive

CT, MRI
3. Tumor Markers

CANCER NURSING
Cancer Grading
The degree of DIFFERENTIATION
Grade 1- Low grade
Grade 4- high grade

CANCER NURSING
Cancer Staging
1. Uses the T-N-M staging system
T- tumor
N- Node
M- Metastasis
2. Stage 1 to Stage 4

CANCER NURSING
GENERAL MEDICAL MANAGEMENT
1. Surgery- cure, control, palliate
2. Chemotherapy
3. Radiation therapy
4. Immunotherapy
5. Bone Marrow Transplant

CANCER NURSING
GENERAL Promotive and Preventive
Nursing Management
1. Lifestyle Modification
2. Nutritional management
3. Screening
4. Early detection

SCREENING
1.

Male and female- Occult Blood, CXR,


and DRE
2. Female- SBE, CBE, Mammography
and Paps Smear
3. Male- DRE for prostate, Testicular selfexam

Nursing Assessment
Utilize the ACS 7 Warning Signals
CAUTION
C- Change in bowel/bladder habits
A- A sore that does not heal
U- Unusual bleeding
T- Thickening or lump in the breast
I- Indigestion
O- Obvious change in warts
N- Nagging cough and hoarseness

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 patients 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

A quick
overview

RADIATIO
N
THERAPY

RADIATION THERAPY:
MEANING
is theMEDICALuse ofhigh
ionizing radiation.
Also known as
It

Radiotherapy
Radiation

Often
RT
RTx
XRT

oncology

abbreviated as

RADIATION THERAPY:
PURPOSE
Curative
Control

or killmalignantcells

Adjuvanttherapy
Prevent

tumor recurrence
after surgery to remove a
primary malignant tumor

Palliative
Prolong

survival

RADIATION THERAPY:
TYPES
1. External Beam Radiation Therapy
Intensity-modulated radiation

therapy(IMRT)
Aka

HIR

CHART
Stereotactic

Radiation

Therapy
PCI (Prophylactic Cranial
Irradiation)

RADIATION THERAPY:
TYPES
2. INTERNAL RADIATION THERAPY
AKA BRACHYTHERAPY

a. LOW-DOSE-RATE TREATMENT- cancer cells


receive continuous low-dose radiation from
the source over a period of several days.
b. HIGH-DOSE-RATE TREATMENT- a robotic
machine attached to delivery tubes placed
inside the body guides one or more
radioactive sources into or near a tumor, and
then removes the sources at the end of each
treatment session.

RADIATION THERAPY:
TYPES
3. SYSTEMIC RADIATION
THERAPY
-In systemic radiation
therapy, a patient swallows
or receives an injection of a
radioactive substance
Radioactive

iodine

RADIATION
THERAPY:
PRESCRITION

The type of cancer.


The size of the cancer.
The cancers location in the body.
How close the cancer is to normal tissues that
are sensitive to radiation.
How far into the body the radiation needs to
travel.
The patients general health and medical
history.
Whether the patient will have other types of
cancer treatment.
Other factors, such as the patients age and
other medical conditions.

RADIATION THERAPY: SIDE


EFFECTS

Common:

Fatigue
Nausea with or without vomiting
Mouth, throat, stomach sores
Swelling

Late side effects

Fibrosis
Damage to the bowels, causing diarrhea and
bleeding
Memory loss
Infertility
Rarely, asecond cancercaused by radiation
exposure