cancer nursing

Oncology NursingNurse Licensure

Examination 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 growth of Abnormal cells

1. Benign

2. Malignant

3. Borderline

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 MalignantHepatOMA, lymphOMA, gliOMA,

melanOMA

2. THREE germ layers “TERATOMA”

3. Non-neoplastic but “OMA”ChoristomaHamatoma

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. LYMPHATICMost common

2. HEMATOGENOUSBlood-borne, commonly to Liver and Lungs

3. DIRECT SPREADSeeding of tumors

CANCER NURSING

Body Defenses Against TUMOR

1. T cell System/ Cellular ImmunityCytotoxic T cells kill tumor cells

2. B cell System/ Humoral immunityB cells can produce antibody

3. Phagocytic cellsMacrophages can engulf cancer cell debris

CANCER NURSING

Cancer Diagnosis

1. BIOPSY The most definitive

2. 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 Pap’s Smear

3. Male- DRE for prostate, Testicular self-exam

Nursing Assessment

Utilize the ACS 7 Warning SignalsCAUTIONC- Change in bowel/bladder habitsA- A sore that does not healU- Unusual bleedingT- Thickening or lump in the breastI- IndigestionO- Obvious change in wartsN- 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 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

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 FINDINGS1. 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 INTERVENTIONPost-Operative care

1. Monitor for complicationsLeakage from the site, prolapse of stoma, skin irritation and pulmo complication2. Assess the abdomen for return of peristalsis

Colon cancer

NURSING INTERVENTIONPost-Operative care

3. Assess wound dressing for bleeding4. Assist patient in ambulation after 24H5.provide nutritional teachingLimit foods that cause gas-formation and odorCabbage, beans, eggs, fish, peanutsLow-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 CAREBEST time to do skin care is after showerApply tape to the sides of the pouch before showerAssume a sitting or standing position in changing the pouch

Colon cancer

NURSING INTERVENTION: COLOSTOMY CAREInstruct to GENTLY push the skin down and the pouch pulling UPWash the peri-stomal area with soap and waterCover 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 when1/3 to ¼ full (Brunner)½ to 1/3 full (Kozier)

Breast Cancer

The most common cancer in FEMALES

Numerous etiologies implicated

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 FINDINGS1. MASS- the most common location is the upper outer quadrant2. Mass is NON-tender. Fixed, hard with irregular borders3. Skin dimpling4. Nipple retraction5. 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 MANAGEMENT1. Radical mastectomy

2. Modified radical mastectomy

3. Lumpectomy

4. Quadrantectomy

Breast Cancer

NURSING INTERVENTION : PRE-OP1. Explain breast cancer and treatment options2. Reduce fear and anxiety and improve coping abilities3. Promote decision making abilities4. 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 CancerNURSING INTERVENTION : Post-OP

Promote activity

Support operative site when moving

Hand, shoulder exercise done on 2ndday

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