Oncology Nursing Handouts

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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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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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.

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Cell Proliferative Patterns Hyperplasia- an increase in the cell number with accompanying increase in size Hypetrophy- an increase in the cell size, but not in its number Metaplasia- the conversion of one type of mature cell into another type of cell; a reversible process and is not related to cancer Dysplasia- an alteration in adult cell characterized by changes in their size, shape and organization Neoplasia- abnormal cellular division not necessary for normal cell growth and development; often leads to the formation of cancer cells 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 Cell characteristics Mode of Growth Rate of Growth

Benign Well-differentiated cells that resemble normal cells of the tissue from which the tumor originated Tumor grows by expansion and does not infiltrate the surrounding tissues; usually encapsulated Usually slow

Malignant Cells are undifferentiated and often bear little resemblance to the normal cells of the tissue from which they arose Grows at the periphery and sends out processes that infiltrate and destroy surrounding tissues Rate of growth is variable and depends on the level of

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differentiation 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 Metastasis

Does not spread by metastasis

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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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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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. 2. 3. 4. 5. 6. 7.

Protect the skin and oral mucosa Protect the cargivers from radiation Assess for fluid and electrolyte status Modify risks for infection and bleeding Implement necessary safeguards Administer prescribed medications Assess for the psychological impact of hair loss

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8. 9. 10. 11. 12.

Manage nutritional concerns Manage pain Provide adequate rest Manage stomatitis Provide emotional support

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Oncology Nursing Handouts

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