oncology nursing

OncologyOncology

By:By:

Ruby Ruth T. Roces, R.N., M.D.Ruby Ruth T. Roces, R.N., M.D.

Oncology definedOncology defined

It is a branch of medicine that It is a branch of medicine that deals with the study, detection, deals with the study, detection, treatment and management of treatment and management of cancer cancer

glossaryglossary

Neoplasia-uncontrolled cell growth that Neoplasia-uncontrolled cell growth that follows no physiologic demandfollows no physiologic demand

Anaplasia-cells that lack normal cellular Anaplasia-cells that lack normal cellular characteristics and differ in shape and characteristics and differ in shape and organizationorganization

Metaplasia-conversion of one type of Metaplasia-conversion of one type of mature cell into another; reversiblemature cell into another; reversible

Dysplasia-bizarre cell growth resulting in Dysplasia-bizarre cell growth resulting in cells that differ in size, shape or cells that differ in size, shape or arrangement from other cells of the same arrangement from other cells of the same type.type.

Hypoplasia-incomplete or Hypoplasia-incomplete or underdevelopment w/ decreased number underdevelopment w/ decreased number of cellsof cells

Hyperplasia-Increase in the number of Hyperplasia-Increase in the number of cellscells

Hypotrophy-decrease in the organ size Hypotrophy-decrease in the organ size /function /function

Hypertrophy-increase in the sizeHypertrophy-increase in the size

““Root words”Root words”

A- noneA- none Ana- lackAna- lack Hyper- excessiveHyper- excessive Meta- changeMeta- change Dys- bad, derangedDys- bad, deranged

Classification of NeoplasiaClassification of Neoplasia

1. Benign1. Benign

2. Malignant2. Malignant

3. Borderline/ in situ3. Borderline/ in situ

WAYS TO DIFFERENTIATE A BENIGN WAYS TO DIFFERENTIATE A BENIGN FROM A MALIGNANT TUMORFROM A MALIGNANT TUMOR

metastaticNon metastaticMetastases

Invasive, expansive,infiltrating, destructive, w/ generalized effects

Local invasion, encapsulated, local effects

Local invasion

Poorly differentiatedWell differentiatedDifferentiation

Varies, but usually fast-growingSlow- growingRate of growth

MalignantBenignCharacteristics

Nomenclature of NeoplasiaNomenclature of Neoplasia

Tumor is named according to:Tumor is named according to:

1. Parenchyma, Organ or Cell1. Parenchyma, Organ or Cell Hepatoma- liverHepatoma- liver Osteoma- boneOsteoma- bone Myoma- muscleMyoma- muscle



2. Pattern and Structure, either GROSS or 2. Pattern and Structure, either GROSS or MICROSCOPICMICROSCOPIC

Fluid-filledFluid-filled CYST CYST GlandularGlandular ADENO ADENO Finger-likeFinger-like PAPILLO PAPILLO StalkStalk POLYP POLYP



3. Embryonic origin3. Embryonic origin Ectoderm ( usually gives rise to epithelium)Ectoderm ( usually gives rise to epithelium) Endoderm (usually gives rise to glands)Endoderm (usually gives rise to glands) Mesoderm (usually gives rise to Connective Mesoderm (usually gives rise to Connective

tissues)tissues)

BENIGN TUMORSBENIGN TUMORS

Suffix- “OMA” is usedSuffix- “OMA” is used Adipose tissue- LipOMAAdipose tissue- LipOMA Bone- osteOMABone- osteOMA Muscle- myOMAMuscle- myOMA Blood vessels- angiOMABlood vessels- angiOMA Fibrous tissue- fibrOMAFibrous tissue- fibrOMA

MALIGNANT TUMORMALIGNANT TUMOR

Named according to embryonic cell originNamed according to embryonic cell origin

1. Ectodermal, Endodermal, Glandular, 1. Ectodermal, Endodermal, Glandular, EpithelialEpithelial

Use the suffix- “CARCINOMA”Use the suffix- “CARCINOMA” Pancreatic AdenoCarcinomaPancreatic AdenoCarcinoma Squamos cell CarcinomaSquamos cell Carcinoma

MALIGNANT TUMORMALIGNANT TUMOR

Named according to embryonic cell originNamed according to embryonic cell origin

2. Mesodermal, connective tissue origin2. Mesodermal, connective tissue origin Use the suffix “SARCOMAUse the suffix “SARCOMA FibroSarcomaFibroSarcoma MyosarcomaMyosarcoma AngioSarcomaAngioSarcoma

““Exceptionistas”Exceptionistas”

1. “OMA” but Malignant1. “OMA” but Malignant HepatOMA, lymphOMA, gliOMA, melanOMAHepatOMA, lymphOMA, gliOMA, melanOMA

2. THREE germ layers2. THREE germ layers ““TERATOMA”TERATOMA”

3. Non-neoplastic but “OMA”3. Non-neoplastic but “OMA” ChoristomaChoristoma HamatomaHamatoma

CANCER NURSINGCANCER NURSING

Review of Normal Cell CycleReview of Normal Cell Cycle

3 types of cells3 types of cells

1. PERMANENT cells- out of the cell cycle1. PERMANENT cells- out of the cell cycle Neurons, cardiac muscle cellNeurons, cardiac muscle cell

2. STABLE cells- Dormant/Resting (G0)2. STABLE cells- Dormant/Resting (G0) Liver, kidneyLiver, kidney

3. LABILE cells- continuously dividing3. LABILE cells- continuously dividing GIT cells, Skin, endometrium , Blood cellsGIT cells, Skin, endometrium , Blood cells


Cell CycleCell CycleG0------------------G1G0------------------G1SSG2G2MM G0- Dormant or restingG0- Dormant or resting G1- normal cell activitiesG1- normal cell activities S- DNA SynthesisS- DNA Synthesis G2- pre-mitotic, synthesis of proteins for G2- pre-mitotic, synthesis of proteins for

cellular divisioncellular division M- Mitotic phase (I-P-M-A-T)M- Mitotic phase (I-P-M-A-T)


Theories to the Pathogenesis of CancerTheories to the Pathogenesis of Cancer Cellular transformation and derangement Cellular transformation and derangement

theorytheory Immune response failure theoryImmune response failure theory


Etiology of cancerEtiology of cancer

1. PHYSICAL AGENTS1. PHYSICAL AGENTS Radiation (thyroid CA)Radiation (thyroid CA) Exposure to irritants (skin CA)Exposure to irritants (skin CA) Exposure to sunlight (skin CA)Exposure to sunlight (skin CA)



2. CHEMICAL AGENTS2. CHEMICAL AGENTS Smoking (Lung CA)Smoking (Lung CA) Dietary ingredients (gastric CA)Dietary ingredients (gastric CA) DrugsDrugs



3. Genetics and Family History3. Genetics and Family History Colon CancerColon Cancer Breast cancerBreast cancer



4. Dietary Habits4. Dietary Habits Low-FiberLow-Fiber High-fatHigh-fat Processed foodsProcessed foods alcoholalcohol



5. Viruses and Bacteria5. Viruses and Bacteria DNA viruses- HepaB, Herpes, EBV, CMV, DNA viruses- HepaB, Herpes, EBV, CMV,

Papilloma VirusPapilloma Virus RNA Viruses- HIV, HTCLVRNA Viruses- HIV, HTCLV Bacterium- H. pyloriBacterium- H. pylori


Etiology of cancerEtiology of cancer 6. Hormonal agents6. Hormonal agents DESDES OCP especially estrogen OCP especially estrogen


Etiology of cancerEtiology of cancer 7. Immune Disease7. Immune Disease AIDSAIDS


CARCINOGENSISCARCINOGENSIS Malignant transformationMalignant transformation IIPPPP InitiationInitiation PromotionPromotion ProgressionProgression


CARCINOGENSISCARCINOGENSIS INITIATIONINITIATION Carcinogens alter the DNA of the cellCarcinogens alter the DNA of the cell Cell will either die or repairCell will either die or repair


CARCINOGENSISCARCINOGENSIS PROMOTIONPROMOTION Repeated exposure to carcinogensRepeated exposure to carcinogens Abnormal gene will expressAbnormal gene will express Latent periodLatent period


CARCINOGENSISCARCINOGENSIS PROGRESSIONPROGRESSION Irreversible periodIrreversible period Cells undergo NEOPLASTIC transformation Cells undergo NEOPLASTIC transformation

then malignancythen malignancy


Spread of CancerSpread of Cancer 1. LYMPHATIC1. LYMPHATIC

Most commonMost common

2. HEMATOGENOUS2. HEMATOGENOUS Blood-borne, commonly to Liver and LungsBlood-borne, commonly to Liver and Lungs

3. DIRECT INVASION/EXTENSION3. DIRECT INVASION/EXTENSION Seeding of tumorsSeeding of tumors


Body Defenses Against TUMORBody Defenses Against TUMOR 1. T cell System/ Cellular Immunity1. T cell System/ Cellular Immunity

Cytotoxic T cells kill tumor cellsCytotoxic T cells kill tumor cells 2. B cell System/ Humoral immunity2. B cell System/ Humoral immunity

B cells can produce antibodyB cells can produce antibody 3. Phagocytic cells3. Phagocytic cells

Macrophages can engulf cancer cell debrisMacrophages can engulf cancer cell debris


Cancer DiagnosisCancer Diagnosis 1. BIOPSY 1. BIOPSY

The most definitiveThe most definitive 2. CT, MRI- for visualization and staging2. CT, MRI- for visualization and staging 3. Tumor Markers3. Tumor Markers


Cancer Grading Cancer Grading

The degree of DIFFERENTIATIONThe degree of DIFFERENTIATION Grade 1- Low gradeGrade 1- Low grade Grade 4- high gradeGrade 4- high grade


Cancer StagingCancer Staging

1. Uses the T-N-M staging system1. Uses the T-N-M staging system T- tumorT- tumor N- NodeN- Node M- MetastasisM- Metastasis

2. Stage 1 to Stage 42. Stage 1 to Stage 4


GENERAL Promotive and Preventive Nursing GENERAL Promotive and Preventive Nursing ManagementManagement

1. Lifestyle Modification1. Lifestyle Modification 2. Nutritional management2. Nutritional management 3. Screening3. Screening 4. Early detection4. Early detection

Nursing AssessmentNursing Assessment

Utilize the ACS 7 Warning SignalsUtilize the ACS 7 Warning Signals CAUTIONCAUTION C- Change in bowel/bladder habitsC- Change in bowel/bladder habits A- A sore that does not healA- A sore that does not heal U- Unusual bleedingU- Unusual bleeding T- Thickening or lump in the breastT- Thickening or lump in the breast I- IndigestionI- Indigestion O- Obvious change in wartsO- Obvious change in warts N- Nagging cough and hoarsenessN- Nagging cough and hoarseness

SCREENINGSCREENING

1. Male and female- Occult Blood, CXR, and 1. Male and female- Occult Blood, CXR, and DREDRE

2. Female- SBE, CBE, Mammography and 2. Female- SBE, CBE, Mammography and Pap’s SmearPap’s Smear

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

CANCER MANAGEMENTCANCER MANAGEMENT

GENERAL MEDICAL MANAGEMENTGENERAL MEDICAL MANAGEMENT

- Treatment goals: cure, control and palliation- Treatment goals: cure, control and palliation 1. Surgery1. Surgery 2. Chemotherapy2. Chemotherapy 3. Radiation therapy3. Radiation therapy 4. Immunotherapy4. Immunotherapy 5. Bone Marrow Transplant5. Bone Marrow Transplant


SURGERYSURGERY Diagnostic- excision, incision, needleDiagnostic- excision, incision, needle primary method of treatment- local and wide primary method of treatment- local and wide

excisionexcision prophylacticprophylactic Palliative- relieve complications of CAPalliative- relieve complications of CA Reconstructive- improve function or obtain a Reconstructive- improve function or obtain a

more desirable cosmetic effectmore desirable cosmetic effect


NURSING MANAGEMENTNURSING MANAGEMENT Provide education and emotional supportProvide education and emotional support Assess patient’s responses to the surgeryAssess patient’s responses to the surgery Monitor for possible complications such as Monitor for possible complications such as

infection, bleeding, fluid and electrolyte infection, bleeding, fluid and electrolyte imbalance and organ dysfunctionimbalance and organ dysfunction

Plan for discharge, ff-up and home carePlan for discharge, ff-up and home care


RADIATION THERAPYRADIATION THERAPY Cure, control, prophylaxisCure, control, prophylaxis Cells are most vulnerable during DNA Cells are most vulnerable during DNA

synthesis and mitosis synthesis and mitosis (BM,lymphatic,skin,GIT,gonads)(BM,lymphatic,skin,GIT,gonads)


MAINTAIN TISSUE INTEGRITYMAINTAIN TISSUE INTEGRITY Frequently assess for changesFrequently assess for changes Handle skin gentlyHandle skin gently Do NOT rub affected areaDo NOT rub affected area Lotion may be applied (water-based)Lotion may be applied (water-based) Wash skin only with SOAP and WaterWash skin only with SOAP and Water During treatment period, avoid soap, creams, During treatment period, avoid soap, creams,

deodorants and powder on treatment areasdeodorants and powder on treatment areas


RISK FOR RADIATION INJURYRISK FOR RADIATION INJURY Protect caregivers fr exposure to radioactive Protect caregivers fr exposure to radioactive

implantsimplants Identify max time that can be spent safely Identify max time that can be spent safely

inpxs roominpxs room Use of shielding equipmentsUse of shielding equipments Explain to px the need for such precautions to Explain to px the need for such precautions to

keep px from feeling isolatedkeep px from feeling isolated


MANAGEMENT OF STOMATITISMANAGEMENT OF STOMATITIS Use soft-bristled toothbrush Use soft-bristled toothbrush Oral rinses with saline gargles/ tap waterOral rinses with saline gargles/ tap water Avoid ALCOHOL-based rinsesAvoid ALCOHOL-based rinses


CHEMOTHERAPYCHEMOTHERAPY Destroys tumor cells by interfering w/ cellular Destroys tumor cells by interfering w/ cellular

functions and reproductionfunctions and reproduction Used primarily to treat systemic disease rather Used primarily to treat systemic disease rather

than localized lesionsthan localized lesions


ADMINISTRATION:ADMINISTRATION:Topical, Oral, IM, IV, Subcutaneous, arteria, Topical, Oral, IM, IV, Subcutaneous, arteria,

intracavitary, intrathecalintracavitary, intrathecalDosage based on TBSADosage based on TBSASpecial care needed for vesicants- causes Special care needed for vesicants- causes

extravasation (daunorubicin, doxorubicin, extravasation (daunorubicin, doxorubicin, nitrogen mustard, mitomycin, vincristine and nitrogen mustard, mitomycin, vincristine and vindesine. If suspected stop immediately and vindesine. If suspected stop immediately and apply ice except in vonca alkaloidapply ice except in vonca alkaloid


Common side effectsCommon side effects:: Nausea and vomiting,stomatitis, anorexia, Nausea and vomiting,stomatitis, anorexia,

diarrheadiarrhea MyelosuppressionMyelosuppression Nephrotoxicity-danorobucin, doxorubucinNephrotoxicity-danorobucin, doxorubucin CHF- cisplastin, methroxate, mitomycinCHF- cisplastin, methroxate, mitomycin Pulmonary fibrosis-bleomycin and busulfanPulmonary fibrosis-bleomycin and busulfan


SterilitySterility Reversible Neurologic damage- taxanes and Reversible Neurologic damage- taxanes and

plant alkaloids, peripheral neuropathy and plant alkaloids, peripheral neuropathy and hearing loss- cisplatinhearing loss- cisplatin

fatiguefatigue

Nursing InterventionNursing Intervention

MANAGEMENT OF ALOPECIAMANAGEMENT OF ALOPECIAAlopecia begins within 2 weeks of therapyAlopecia begins within 2 weeks of therapy

Regrowth within 8 weeks of terminationRegrowth within 8 weeks of termination Encourage to acquire wig before hair loss Encourage to acquire wig before hair loss

occursoccurs Encourage use of attractive scarves and hatsEncourage use of attractive scarves and hats Provide information that hair loss is Provide information that hair loss is

temporary BUT anticipate change in texture temporary BUT anticipate change in texture and colorand color


PROMOTE NUTRITIONPROMOTE NUTRITION Serve food in ways to make it appealingServe food in ways to make it appealing Consider patient’s preferencesConsider patient’s preferences Provide small frequent mealsProvide small frequent meals Avoids giving fluids while eatingAvoids giving fluids while eating Oral hygiene PRIOR to mealtimeOral hygiene PRIOR to mealtime Vitamin supplementsVitamin supplements


RELIEVE PAINRELIEVE PAIN Mild pain- NSAIDSMild pain- NSAIDS

Moderate pain- Weak opiodsModerate pain- Weak opiods Severe pain- MorphineSevere pain- Morphine Administer analgesics round the clock with Administer analgesics round the clock with

additional dose for breakthrough painadditional dose for breakthrough pain


DECREASE FATIGUEDECREASE FATIGUE Plan daily activities to allow alternating rest Plan daily activities to allow alternating rest

periodsperiods Light exercise is encouragedLight exercise is encouraged Small frequent mealsSmall frequent meals


IMPROVE BODY IMAGEIMPROVE BODY IMAGE Therapeutic communication is essentialTherapeutic communication is essential Encourage independence in self-care and Encourage independence in self-care and

decision makingdecision making Offer cosmetic material like make-up and Offer cosmetic material like make-up and

wigswigs


ASSIST IN THE GRIEVING PROCESSASSIST IN THE GRIEVING PROCESS Some cancers are curableSome cancers are curable Grieving can be due to loss of health, Grieving can be due to loss of health,

income, sexuality, and body imageincome, sexuality, and body image Answer and clarify information about Answer and clarify information about

cancer and treatment optionscancer and treatment options Identify resource peopleIdentify resource people Refer to support groupsRefer to support groups


MANAGE COMPLICATION: MANAGE COMPLICATION: INFECTIONINFECTION

Fever is the most important sign (38.3)Fever is the most important sign (38.3) Administer prescribed antibiotics X 2weeksAdminister prescribed antibiotics X 2weeks Maintain aseptic technique Maintain aseptic technique Avoid exposure to crowds Avoid exposure to crowds Avoid giving fresh fruits and veggieAvoid giving fresh fruits and veggie HandwashingHandwashing Avoid frequent invasive proceduresAvoid frequent invasive procedures


MANAGE COMPLICATION: Septic shockMANAGE COMPLICATION: Septic shock Monitor VS, BP, tempMonitor VS, BP, temp Administer IV antibioticsAdminister IV antibiotics Administer supplemental O2Administer supplemental O2


MANAGE COMPLICATION: BleedingMANAGE COMPLICATION: Bleeding Thrombocytopenia (<100,000) is the most Thrombocytopenia (<100,000) is the most

common cause common cause <20, 000<20, 000 spontaneous bleeding spontaneous bleeding Use soft toothbrushUse soft toothbrush Use electric razorUse electric razor Avoid frequent IM, IV, rectal and Avoid frequent IM, IV, rectal and

catheterizationcatheterization Soft foods and stool softenersSoft foods and stool softeners

1. A chemotherapeutic agent was given to a 1. A chemotherapeutic agent was given to a patient as an adjunct to surgery .Which of the patient as an adjunct to surgery .Which of the following statements about chemotherapy is following statements about chemotherapy is true?true?

it is a local treatmentit is a local treatment it is affects both normal and cancer cellsit is affects both normal and cancer cells it is effective for all types of cancerit is effective for all types of cancer it has few adverse effectsit has few adverse effects

2. A 30 y.o. client is about to receive chemotherapy. 2. A 30 y.o. client is about to receive chemotherapy. The nurse is monitoring the patient’s lab results prior The nurse is monitoring the patient’s lab results prior to the initiation of therapy. The nurse knows that the to the initiation of therapy. The nurse knows that the WBC count of the client is normal if the result WBC count of the client is normal if the result showedshowed

5,000-10,000 cells/mm35,000-10,000 cells/mm3 3,000- 7,000 cells/mm33,000- 7,000 cells/mm3 8,000-12,000 cells/mm38,000-12,000 cells/mm3 1,000-5,000 cells/mm31,000-5,000 cells/mm3

3. Testicular self-examination is done as a 3. Testicular self-examination is done as a preventive screening procedure for testicular preventive screening procedure for testicular cancer. The right way to do the exam iscancer. The right way to do the exam is

examine the testes after a warm bath or showerexamine the testes after a warm bath or shower have the client examine his testes while lying have the client examine his testes while lying

supinesupine to feel for new growth or mass w/ 1 fingerto feel for new growth or mass w/ 1 finger to have an annual testicular exam doneto have an annual testicular exam done

4. In health teaching done in the OB-gyne ward, 4. In health teaching done in the OB-gyne ward, the nurse instructs the clients to perform self-the nurse instructs the clients to perform self-breast examinationbreast examination

a week after the onset of menstruationa week after the onset of menstruation monthly during the peak of ovulationmonthly during the peak of ovulation at the start of menstruationat the start of menstruation 1 week before the onset of menstruation.1 week before the onset of menstruation.

5. The following are examples of risk factors for 5. The following are examples of risk factors for cancer exceptcancer except

HPVHPV low-fat, high-fiber dietlow-fat, high-fiber diet radiation exposureradiation exposure Diethystilbestriol Diethystilbestriol

6. A 54 y.o., G0, has been on conjugated 6. A 54 y.o., G0, has been on conjugated estrogen for 5 years. Among all the estrogen for 5 years. Among all the gynecologic cancers, Which one is she least gynecologic cancers, Which one is she least likely to acquire or have?likely to acquire or have?

Vaginal cancerVaginal cancer Breast cancerBreast cancer Ovarian cancerOvarian cancer Endometrial cancerEndometrial cancer

7. Colorectal cancers are one of the most 7. Colorectal cancers are one of the most common type of cancers occurring in old age. common type of cancers occurring in old age. Screening for this type of cancer involves the Screening for this type of cancer involves the following exceptfollowing except

digital rectal examdigital rectal exam occult blood testing occult blood testing proctosigmoidoscopyproctosigmoidoscopy CT scanCT scan

8. One of the clients in the ward has a family 8. One of the clients in the ward has a family history of colon cancer. The least appropriate history of colon cancer. The least appropriate advise for him would be toadvise for him would be to

have low fat, high fiber diethave low fat, high fiber diet to have an annual digital rectal exam to have an annual digital rectal exam to test for occult blood to test for occult blood have a colonoscopy done have a colonoscopy done

9. Pap smear is a procedure done to screen for 9. Pap smear is a procedure done to screen for cervical cancer. As a preventive measure, this cervical cancer. As a preventive measure, this is ideally doneis ideally done

At the onset of sexual activity or at age 18At the onset of sexual activity or at age 18 annually for sexually active womenannually for sexually active women every other year for sexually active womenevery other year for sexually active women for women 20 yrs of age and above initially 2 for women 20 yrs of age and above initially 2

consecutive annual smear.consecutive annual smear.

10. Testicular examination is advised as a screening 10. Testicular examination is advised as a screening procedure to detect testicular cancer. The client still procedure to detect testicular cancer. The client still needs further instructional reinforcements if he needs further instructional reinforcements if he verbalizedverbalized

a. “ The testicles are normally egg-shaped”a. “ The testicles are normally egg-shaped” b. “ My testicles feel smooth”b. “ My testicles feel smooth” c. “ My testicles normally has a spongy consistency”c. “ My testicles normally has a spongy consistency” d. “ This test is being done to detect any lumps”d. “ This test is being done to detect any lumps”

Match the following type of viruses with Match the following type of viruses with the various type of tumor/malignancythe various type of tumor/malignancy

11. Nasopharyngeal cancer11. Nasopharyngeal cancer a. Epstein-Barr a. Epstein-Barr virusvirus

12. Non- hodgkins lymph0ma12. Non- hodgkins lymph0ma b. Hepatitis B b. Hepatitis B

13. Hepatocellular cancer13. Hepatocellular cancer c. Human c. Human Papilloma virusPapilloma virus

14. Burkitts lymphoma d. HTCLV14. Burkitts lymphoma d. HTCLV

15. Hodgkins disease15. Hodgkins disease

Mortality and Morbidity RatesMortality and Morbidity Rates

Colon cancerColon cancer

COLON CANCERCOLON CANCER

Risk factorsRisk factors 1. Increasing age1. Increasing age 2. Family history2. Family history 3. Previous colon CA or polyps3. Previous colon CA or polyps 4. History of IBD4. History of IBD 5. High fat, High protein, LOW fiber5. High fat, High protein, LOW fiber 6. Breast Ca and Genital Ca6. Breast Ca and Genital Ca


Sigmoid colon is the most common siteSigmoid colon is the most common site Predominantly adenocarcinomaPredominantly adenocarcinoma If earlyIf early 90% survival 90% survival 34 % diagnosed early34 % diagnosed early 66% late diagnosis66% late diagnosis


PATHOPHYSIOLOGYPATHOPHYSIOLOGY Benign neoplasmBenign neoplasm DNA alteration DNA alteration

malignant transformationmalignant transformation malignant malignant neoplasm neoplasm cancer growth and invasion cancer growth and invasion metastasis (liver)metastasis (liver)


ASSESSMENT FINDINGSASSESSMENT FINDINGS1. 1. Change in bowel habits- Most commonChange in bowel habits- Most common

2. Blood in the stool2. Blood in the stool 3. Anemia3. Anemia 4. Anorexia and weight loss4. Anorexia and weight loss 5. Fatigue5. Fatigue 6. Rectal lesions- tenesmus, alternating D and C6. Rectal lesions- tenesmus, alternating D and C


Diagnostic findingsDiagnostic findings 1. Fecal occult blood1. Fecal occult blood 2. Sigmoidoscopy and colonoscopy2. Sigmoidoscopy and colonoscopy 3. BIOPSY3. BIOPSY 4. CEA- carcino-embryonic antigen4. CEA- carcino-embryonic antigen


Complications of colorectal CAComplications of colorectal CA 1. Obstruction1. Obstruction 2. Hemorrhage2. Hemorrhage 3. Peritonitis3. Peritonitis 4. Sepsis 4. Sepsis


MEDICAL MANAGEMENTMEDICAL MANAGEMENT 1. Chemotherapy- 5-FU1. Chemotherapy- 5-FU 2. Radiation therapy2. Radiation therapy


SURGICAL MANAGEMENTSURGICAL MANAGEMENT Surgery is the primary treatmentSurgery is the primary treatment Based on location and tumor sizeBased on location and tumor size Resection, anastomosis, and colostomy Resection, anastomosis, and colostomy

(temporary or permanent)(temporary or permanent)


NURSING INTERVENTIONNURSING INTERVENTION

Pre-Operative carePre-Operative care 1. Provide HIGH protein, HIGH calorie and 1. Provide HIGH protein, HIGH calorie and

LOW residue dietLOW residue diet 2.Provide information about post-op care and 2.Provide information about post-op care and

stoma carestoma care 3. Administer antibiotics 1 day prior3. Administer antibiotics 1 day prior



Pre-Operative carePre-Operative care 4. Enema or colonic irrigation the evening and 4. Enema or colonic irrigation the evening and

the morning of surgerythe morning of surgery 5. NGT is inserted to prevent distention5. NGT is inserted to prevent distention 6. Monitor UO, F and E, Abdomen PE6. Monitor UO, F and E, Abdomen PE



Post-Operative carePost-Operative care 1. Monitor for complications1. Monitor for complications Leakage from the site, prolapse of stoma, skin Leakage from the site, prolapse of stoma, skin

irritation and pulmo complicationirritation and pulmo complication 2. Assess the abdomen for return of peristalsis2. Assess the abdomen for return of peristalsis



Post-Operative carePost-Operative care 3. Assess wound dressing for bleeding3. Assess wound dressing for bleeding 4. Assist patient in ambulation after 24H4. Assist patient in ambulation after 24H 5.provide nutritional teaching5.provide nutritional teaching Limit foods that cause gas-formation and odorLimit foods that cause gas-formation and odor Cabbage, beans, eggs, fish, peanutsCabbage, beans, eggs, fish, peanuts Low-fiber diet in the early stage of recoveryLow-fiber diet in the early stage of recovery


NURSING INTERVENTIONNURSING INTERVENTIONPost-Operative carePost-Operative care 6. Instruct to splint the incision and 6. Instruct to splint the incision and

administer pain meds before exerciseadminister pain meds before exercise 7. The stoma is PINKISH to cherry red, 7. The stoma is PINKISH to cherry red,

Slightly edematous with minimal pinkish Slightly edematous with minimal pinkish drainagedrainage

8. Manage post-operative complication8. Manage post-operative complication


NURSING INTERVENTION: COLOSTOMY NURSING INTERVENTION: COLOSTOMY CARECARE

Colostomy begins to function 3-6 days after Colostomy begins to function 3-6 days after surgerysurgery

The drainage maybe soft/mushy or semi-solid The drainage maybe soft/mushy or semi-solid depending on the sitedepending on the site



BEST time to do skin care is after showerBEST time to do skin care is after shower Apply tape to the sides of the pouch before Apply tape to the sides of the pouch before

showershower Assume a sitting or standing position in Assume a sitting or standing position in

changing the pouchchanging the pouch



Instruct to GENTLY push the skin down and Instruct to GENTLY push the skin down and the pouch pulling UPthe pouch pulling UP

Wash the peri-stomal area with soap and waterWash the peri-stomal area with soap and water Cover the stoma while washing the peri-stomal Cover the stoma while washing the peri-stomal

areaarea



Lightly pat dry the area and NEVER rubLightly pat dry the area and NEVER rub Lightly dust the peri-stomal area with nystatin Lightly dust the peri-stomal area with nystatin

powderpowder



Measure the stomal openingMeasure the stomal opening The pouch opening is about 0.3 cm larger than The pouch opening is about 0.3 cm larger than

the stomal openingthe stomal opening Apply adhesive surface over the stoma and Apply adhesive surface over the stoma and

press for 30 secondspress for 30 seconds



Empty the pouch or change the pouch whenEmpty the pouch or change the pouch when 1/3 to ¼ full (Brunner)1/3 to ¼ full (Brunner) ½ to 1/3 full (Kozier)½ to 1/3 full (Kozier)

1. Colostomy should be drained when it is1. Colostomy should be drained when it is A. fullA. full Half-fullHalf-full 100 ml full100 ml full As you wishAs you wish

Pouch opening should be Pouch opening should be

A .3 cm larger than stomal openingA .3 cm larger than stomal opening

b. .5 cm larger than stomal openingb. .5 cm larger than stomal opening

c. 1 cm larger than stomal openingc. 1 cm larger than stomal opening

d. Same size with the openingd. Same size with the opening

A client has underwent hemicolectomy and A client has underwent hemicolectomy and placement of Right colostomy. You expect the placement of Right colostomy. You expect the drainage to bedrainage to be

A. mushyA. mushy B. solidB. solid C. purely liquidC. purely liquid D. purely airD. purely air

Most common manifestation of colon Ca isMost common manifestation of colon Ca is A. anemiaA. anemia B. tenesmusB. tenesmus C. alternating diarrhea and constipationC. alternating diarrhea and constipation D. painD. pain

A client had a colostomy. When do You A client had a colostomy. When do You expect to note for fecal drainage?expect to note for fecal drainage?

A. as soon as the colostomy is placedA. as soon as the colostomy is placed B. 1 day afterB. 1 day after C. 3 days afterC. 3 days after D. 1 week after D. 1 week after

All of the following are vesicants exceptAll of the following are vesicants except A. vincristineA. vincristine B. dopamycinB. dopamycin C. mustardC. mustard D.mitomycinD.mitomycin

In patients receivne chemotherapy suspected In patients receivne chemotherapy suspected of extravasation, the drug must be stopped and of extravasation, the drug must be stopped and ice should be applied for all of the following ice should be applied for all of the following exceptexcept

A. vincristineA. vincristine B. doxorobucinB. doxorobucin C. mustardC. mustard D.mitomycinD.mitomycin

A client receiving chemotherapy started to A client receiving chemotherapy started to complain of dyspnea. X-ray showed fibrosis. complain of dyspnea. X-ray showed fibrosis. Which of the following chemo agent is he Which of the following chemo agent is he most probably receiving?most probably receiving?

A. vinblastineA. vinblastine B. taxanesB. taxanes C. busulfanC. busulfan D. cisplatinD. cisplatin

Cisplatin is known for causing which side Cisplatin is known for causing which side effecteffect

A. reversible hearing lossA. reversible hearing loss B. irreversible hearing lossB. irreversible hearing loss C. reversible peripheral neuropathyC. reversible peripheral neuropathy D. irreversible peripheral neuropathyD. irreversible peripheral neuropathy

A client on chemotherapy started to complain A client on chemotherapy started to complain of dyspnea and orthopnea. Auscultation of dyspnea and orthopnea. Auscultation showed rales and crackles. Which of the showed rales and crackles. Which of the following drug is he most probably receiving?following drug is he most probably receiving?

A. chloramphenicolA. chloramphenicol B. vinblastineB. vinblastine C. busulfanC. busulfan D. cisplatinD. cisplatin

Breast CancerBreast Cancer

The most common cancer in FEMALESThe most common cancer in FEMALES Numerous etiologies implicatedNumerous etiologies implicated


RISK FACTORSRISK FACTORS 1. Genetics- BRCA1 And BRCA 21. Genetics- BRCA1 And BRCA 2 2. Increasing age ( > 50yo)2. Increasing age ( > 50yo) 3. Family History of breast cancer3. Family History of breast cancer 4. Early menarche and late menopause4. Early menarche and late menopause 5. Nulliparity5. Nulliparity 6. Late age at pregnancy6. Late age at pregnancy


RISK FACTORSRISK FACTORS 7. Obesity7. Obesity 8. Hormonal replacement8. Hormonal replacement 9. Alcohol9. Alcohol 10. Exposure to radiation10. Exposure to radiation


PROTECTIVE FACTORSPROTECTIVE FACTORS 1. Exercise1. Exercise 2. Breast feeding2. Breast feeding 3. Pregnancy before 30 yo3. Pregnancy before 30 yo


ASSESSMENT FINDINGSASSESSMENT FINDINGS 1. MASS- the most common location is the 1. MASS- the most common location is the

upper outer quadrantupper outer quadrant 2. Mass is NON-tender. Fixed, hard with 2. Mass is NON-tender. Fixed, hard with

irregular bordersirregular borders 3. Skin dimpling3. Skin dimpling 4. Nipple retraction4. Nipple retraction 5. Peau d’ orange5. Peau d’ orange


LABORATORY FINDINGSLABORATORY FINDINGS 1. Biopsy procedures1. Biopsy procedures 2. Mammography2. Mammography


Breast cancer StagingBreast cancer Staging TNM stagingTNM staging I - < 2cmI - < 2cm II - 2 to 5 cm, (+) LNII - 2 to 5 cm, (+) LN III - > 5 cm, (+) LNIII - > 5 cm, (+) LN IV- metastasisIV- metastasis


MEDICAL MANAGEMENTMEDICAL MANAGEMENT 1. Chemotherapy1. Chemotherapy 2. Tamoxifen therapy2. Tamoxifen therapy 3. Radiation therapy3. Radiation therapy


SURGICAL MANAGEMENTSURGICAL MANAGEMENT1. Radical mastectomy1. Radical mastectomy

2. Modified radical mastectomy2. Modified radical mastectomy

3. Lumpectomy3. Lumpectomy

4. Quadrantectomy4. Quadrantectomy

Breast CancerBreast CancerNURSING INTERVENTION : NURSING INTERVENTION : Post-OPPost-OP

Position patient: SupinePosition patient: Supine Affected extremity elevated to reduce edemaAffected extremity elevated to reduce edema Warm shower on 2Warm shower on 2ndnd day post-op day post-op Immediate post-op: snug dressing with drainageImmediate post-op: snug dressing with drainage Maintain patency of drain (JP) ; Drainage is Maintain patency of drain (JP) ; Drainage is

removed when the discharge is less than 30 ml in removed when the discharge is less than 30 ml in 24 H24 H

Monitor for hematoma w/in 12H and apply Monitor for hematoma w/in 12H and apply bandage and ice, refer to surgeonbandage and ice, refer to surgeon


NURSING INTERVENTION : Post-OPNURSING INTERVENTION : Post-OP Lotions, Creams are applied ONLY when the Lotions, Creams are applied ONLY when the

incision is healed in 4-6 weeksincision is healed in 4-6 weeks Hand, shoulder exercise done on 2Hand, shoulder exercise done on 2ndnddayday Post-op mastectomy exercise 20 mins TIDPost-op mastectomy exercise 20 mins TID NO BP or IV procedure on operative siteNO BP or IV procedure on operative site Heavy lifting is avoidedHeavy lifting is avoided Monitor complications ( lymphedema, Monitor complications ( lymphedema,

hematoma, infecton)hematoma, infecton)


NURSING INTERVENTION : Post-OPNURSING INTERVENTION : Post-OP

TEACH FOLLOW-UP careTEACH FOLLOW-UP care Regular check-upRegular check-up Monthly BSE on the other breastMonthly BSE on the other breast Annual mammographyAnnual mammography

Lung cancerLung cancer

66thth-7-7thth decade decade Number 1 in the morbidity and mortality Number 1 in the morbidity and mortality

survey among all cancerssurvey among all cancers Equal incidence for both men and womenEqual incidence for both men and women 85% caused by inhalation of carcinogenic 85% caused by inhalation of carcinogenic

materials most commonly cigarette smokingmaterials most commonly cigarette smoking

Squamous cell carcinoma- more centrally Squamous cell carcinoma- more centrally located, commonly in the segmental and located, commonly in the segmental and subsegmental bronchi.subsegmental bronchi.

AdenoCarcinoma- presents more peripherally AdenoCarcinoma- presents more peripherally as peripheral mass or nodules; most prevalent as peripheral mass or nodules; most prevalent lung Ca for both M and Flung Ca for both M and F

Large cell carcinoma-fast growing tumor that Large cell carcinoma-fast growing tumor that arise peripherallyarise peripherally

Bronchioalveolar cell CA- arises fr the Bronchioalveolar cell CA- arises fr the terminal bronchus and alveoli; usually slow terminal bronchus and alveoli; usually slow growinggrowing

Small cell Ca- arises primarily as a proximal Small cell Ca- arises primarily as a proximal lesion but may arise in any part of the lesion but may arise in any part of the tracheobronchial treetracheobronchial tree

Lung CancerLung Cancer

EtiologyEtiology Tobacco useTobacco use Genetic- Genetic- >> acquired genetic lesion acquired genetic lesion


Clinical Manifestations:Clinical Manifestations: CoughCough HemoptysisHemoptysis Wheeze, stridorWheeze, stridor DyspneaDyspnea PneumonitisPneumonitis PainPain Symptoms of lung abscessSymptoms of lung abscess


Metastatic spread- tracheal obstruction, Metastatic spread- tracheal obstruction, dysphagia, hoarseness, Horner’s syndrome, dysphagia, hoarseness, Horner’s syndrome, auperior vena cava syndrome, plural effusion, auperior vena cava syndrome, plural effusion, respiratory failure.respiratory failure.

Systemic symptomsSystemic symptoms Endocrine syndromes-hypercalcemia Endocrine syndromes-hypercalcemia

(epidermoid), SIADH (sm cell), gynecomastia (epidermoid), SIADH (sm cell), gynecomastia (large cell), clubbing (non-sm. Cell)(large cell), clubbing (non-sm. Cell)


<5Any M0IV

<5Any T4 or N3,M0IIIB

25-4010-30

T3,N0-1,M0 T1-3,N2,M0

IIIA

25-50T1-2,N1,M0II

60-80T1-2,N0,M0I

5-yr survival rateTNM descriptorsStage


T1-< 3 cmT1-< 3 cmT2->3 cmT2->3 cmT3- direct extension into chest wallT3- direct extension into chest wallT4- invades mediastinumT4- invades mediastinumN0N0N1-peribronchialN1-peribronchialN2-ipsilateral mediastinalN2-ipsilateral mediastinalN3-contralateral mediastinalN3-contralateral mediastinal


TREATMENTTREATMENT Surgery (segmentectomy, lobectomy, Surgery (segmentectomy, lobectomy,

pneumonectomy)pneumonectomy) RadiotherapyRadiotherapy ChemotherapyChemotherapy

Laryngeal cancerLaryngeal cancer

Risk FactorsRisk Factors tobaccotobacco alcoholalcohol radiation?radiation? occupation?occupation?

CLASSIFICATION ACCORDING TO LOCATIONCLASSIFICATION ACCORDING TO LOCATION 1. supraglottic 1. supraglottic - rich in lymphatics- rich in lymphatics 2. glottic 2. glottic - (true vocal cords) most common 55-75%; good - (true vocal cords) most common 55-75%; good

prognosisprognosis 3. subglottic 3. subglottic - least common 1-5%; metastasizes to the - least common 1-5%; metastasizes to the

Delphian nodeDelphian node

SYMPTOMS: SYMPTOMS: voice change- 2 wks durationvoice change- 2 wks duration airway obstructionairway obstruction odynophagiaodynophagia otalgiaotalgia neck massneck mass other constitutional symptomsother constitutional symptoms

DIAGNOSIS:DIAGNOSIS: LARYNGOSCOPYLARYNGOSCOPY BIOPSYBIOPSY

MANAGEMENTMANAGEMENT local excision/ vocal cord strippinglocal excision/ vocal cord stripping LASER vaporization or excision/ cordectomyLASER vaporization or excision/ cordectomy Radiotherapy Radiotherapy

(EBRT- external beam radiotherapy or (EBRT- external beam radiotherapy or brachytherapy – radioactive implants)brachytherapy – radioactive implants)

Conservation laryngectomy/ Total Conservation laryngectomy/ Total laryngectomylaryngectomy

Laryngeal CancerLaryngeal CancerNURSING MANAGEMENT: PRE-operativeNURSING MANAGEMENT: PRE-operativeProvide the patient pre-operative teachingsProvide the patient pre-operative teachings Clarify misconceptionsClarify misconceptions Tell that the natural voice will be lostTell that the natural voice will be lost Teach communication alternativesTeach communication alternativesReduce patient ANXIETYReduce patient ANXIETY Provide opportunities for patient and family Provide opportunities for patient and family

members to ask questionsmembers to ask questions Referrals to previous patients with laryngeal Referrals to previous patients with laryngeal

cancers and cancer groups cancers and cancer groups

Laryngeal CancerLaryngeal CancerNURSING MANAGEMENT: POST-opNURSING MANAGEMENT: POST-opMaintain PATENT AirwayMaintain PATENT Airway Position patient: Semi or High Fowler’sPosition patient: Semi or High Fowler’s Suction secretionsSuction secretions Encourage to deep breath, turn and coughEncourage to deep breath, turn and coughAdminister care of the laryngectomy tubeAdminister care of the laryngectomy tube Suction as neededSuction as needed Cleanse the stoma with salineCleanse the stoma with saline Administer humidified oxygenAdminister humidified oxygen Laryngectomy tube is usually removed within 3-6 Laryngectomy tube is usually removed within 3-6

weeks after surgeryweeks after surgery

Laryngeal CancerLaryngeal CancerNURSING MANAGEMENT: POST-opNURSING MANAGEMENT: POST-op

Promote alternative communication methodsPromote alternative communication methods Call bell or hand bell, Magic Slate, Hand signalsCall bell or hand bell, Magic Slate, Hand signals Collaborate with speech therapistCollaborate with speech therapist

Promote adequate NutritionPromote adequate Nutrition NPO after operationNPO after operation No foods or drinks per orem for 10 daysNo foods or drinks per orem for 10 days IVF, TPN are alternative nutrition routesIVF, TPN are alternative nutrition routes Start oral feedings with thick liquids, avoid sweet Start oral feedings with thick liquids, avoid sweet

foodsfoods

Laryngeal CancerLaryngeal CancerNURSING MANAGEMENT: POST-opNURSING MANAGEMENT: POST-op

Monitor for COMPLICATIONSMonitor for COMPLICATIONS Respiratory DistressRespiratory Distress HemorrhageHemorrhage infectioninfection

Laryngeal CancerLaryngeal CancerNURSING MANAGEMENT: HOME CARENURSING MANAGEMENT: HOME CARE Humidification system at home is neededHumidification system at home is needed AVOID swimmingAVOID swimming Cover the stoma with hands or plastic bib over Cover the stoma with hands or plastic bib over

the openingthe opening Advise beauty salons to avoid hair sprays, Advise beauty salons to avoid hair sprays,

powders and loose hair near the openingpowders and loose hair near the opening Oral hygiene frequently Oral hygiene frequently

Prostate CancerProstate Cancer

EtiologyEtiology

Age-relatedAge-related

Blacks>whiteBlacks>white

95 % are adenocarcinomas95 % are adenocarcinomas


Manifestations:Manifestations: Rel. to urinary flow obstuctionRel. to urinary flow obstuction Urinary frequency, ec in caliber of stream, Urinary frequency, ec in caliber of stream,

diminished force, hesitancy, dribbling, diminished force, hesitancy, dribbling, nocturia and overflow incontinencenocturia and overflow incontinence

DysuriaDysuria Back or hip painBack or hip pain


DiagnosticsDiagnostics:: DREDRE PSA- PSA- >> 10 ng/ml 10 ng/ml Biopsy- transrectal prostate biopsy under Biopsy- transrectal prostate biopsy under

sonography (TRUS)sonography (TRUS)


TreatmentTreatment Surgery- radical retropubic prostatectomySurgery- radical retropubic prostatectomy Radiation therapyRadiation therapy

*both are associated w/ impotence*both are associated w/ impotence Androgen deprivation- for those w/ metastatic Androgen deprivation- for those w/ metastatic

disease (leuporide, flutamide)disease (leuporide, flutamide) Chemotherapy- for palliationChemotherapy- for palliation

quizquiz

1. All of the following are manifestations of 1. All of the following are manifestations of prostate cancer exceptprostate cancer except

HesitancyHesitancy dribblingdribbling DysuriaDysuria Painless Painless

2. The most common manifestation of 2. The most common manifestation of laryngeal cancer islaryngeal cancer is

A. odynophagiaA. odynophagia B. DysphagiaB. Dysphagia C. Voice changeC. Voice change D. dyspneaD. dyspnea

3. Most head and neck cancers are caused by 3. Most head and neck cancers are caused by smoking. Which of the following is not caused smoking. Which of the following is not caused by smoking?by smoking?

A. lung cancerA. lung cancer B. ovarian CAB. ovarian CA C. laryngeal cancerC. laryngeal cancer D. esophageal cancerD. esophageal cancer

QuizQuiz

4. a 64 y.o patient status post- hemi colectomy 4. a 64 y.o patient status post- hemi colectomy was tachycardic. Examination of the mucus was tachycardic. Examination of the mucus membrane showed a dry mouth. What is membrane showed a dry mouth. What is your assessment to the possible cause of your assessment to the possible cause of tachycardia in this patient?tachycardia in this patient?

infectioninfection 3rd spacing3rd spacing DehydrationDehydration sepsissepsis

5. difference between a benign fr malignant 5. difference between a benign fr malignant neoplasm include all of the ff exceptneoplasm include all of the ff except

well differentiatedwell differentiated poorly demarcatedpoorly demarcated no metastatic potentialno metastatic potential non invasivenon invasive

6. radiation therapy is effective in actively 6. radiation therapy is effective in actively dividing cells. All of the ff are ex of those dividing cells. All of the ff are ex of those exceptexcept

GITGIT Fatty tissuesFatty tissues NerveNerve skinskin

7. screening should be done to detect cancers. 7. screening should be done to detect cancers. Routine Screening tests involves all of the Routine Screening tests involves all of the following exceptfollowing except breast exambreast exam DREDRE UltrasoundUltrasound Occult blood examOccult blood exam

8. A client complained of chronic cough w/ 8. A client complained of chronic cough w/ hemoptysis. Assessment showed wasting, dry hemoptysis. Assessment showed wasting, dry skin and s/sxs of cachexia. The client most skin and s/sxs of cachexia. The client most probably hasprobably has

A. TBA. TB B. bronchiectasisB. bronchiectasis C. lung CAC. lung CA D. all of the aboveD. all of the above

9. Client underwent pneumonectomy. Post-op 9. Client underwent pneumonectomy. Post-op the best position to put the client in isthe best position to put the client in is

a.a. Affected sideAffected side

b.b. Unaffected sideUnaffected side

c.c. TrendelenburgTrendelenburg

d.d. 10 inch block10 inch block

10. Post-mastectomy lotions and cream may 10. Post-mastectomy lotions and cream may be applied after healing takes place. When be applied after healing takes place. When does it usually occur?does it usually occur?

A. 1 monthA. 1 month B. 2 monthsB. 2 months C. 4 monthsC. 4 months D. 1 yearD. 1 year

Cervical CancerCervical Cancer peaks: 45-60 y.o.peaks: 45-60 y.o. Risk factors:Risk factors: Early coitusEarly coitus Early conceptionEarly conception Multiple sexual partnersMultiple sexual partners Cigarette smokingCigarette smoking High risk partnersHigh risk partners ImmunosuppressedImmunosuppressed HPVHPV HSVHSV

Cervical cancerCervical cancer

Assessment:Assessment: post coital or irregular bleedingpost coital or irregular bleeding Malodorous bloody dischargeMalodorous bloody discharge SciaticaSciatica Leg edemaLeg edema Deep pelvic painDeep pelvic pain

Treatment:Treatment: Surgery (radical hysterectomy)Surgery (radical hysterectomy) Radiotherapy ( external beam to the pelvis Radiotherapy ( external beam to the pelvis

followed by intracavitary)followed by intracavitary)

Endometrial cancerEndometrial cancer Risk factors:Risk factors: 50-6050-60 ObesityObesity polycystic ovarian diseasepolycystic ovarian disease Early menarcheEarly menarche Late menopauseLate menopause Exogenous unopposed estrogenExogenous unopposed estrogen Tamoxifen( antiestrogen in breast but acts like estrogen in Tamoxifen( antiestrogen in breast but acts like estrogen in

the endometrium)the endometrium) Lynch II syndrome(hereditary nonpolyposis colorectal Lynch II syndrome(hereditary nonpolyposis colorectal

syndrome)syndrome)

Assessment:Assessment: Irregular menses or postmenopausal bleedingIrregular menses or postmenopausal bleeding

Diagnosis: Diagnosis: D and CD and C

Ovarian cancerOvarian cancer

Risk factors:Risk factors: Family historyFamily history Low parity and infertilityLow parity and infertility

Assessment: Assessment: Abdominal distention- most commonAbdominal distention- most common Lower abdominal painLower abdominal pain Pelvic massPelvic mass Weight lossWeight loss

Diagnostics:Diagnostics: Pelvic ultrasoundPelvic ultrasound CA-125CA-125 Abdominopelvic CT scan and chest Abdominopelvic CT scan and chest

radiography if suspected of having ovarian CAradiography if suspected of having ovarian CA

Treatment:Treatment: SurgerySurgery Chemotherapy:Chemotherapy: Paclitaxel( neuropathy, Paclitaxel( neuropathy,

alopecia,myelosuppression,hypersensitivity alopecia,myelosuppression,hypersensitivity and bradycardia)and bradycardia)

Carboplatin ( N/V, myelosuppression, Carboplatin ( N/V, myelosuppression, constipation)constipation)

Non-Hodgkins LymphomaNon-Hodgkins Lymphoma

Heterogenous group of cancersHeterogenous group of cancers Originates from neoplastic growth of Originates from neoplastic growth of

lymphoid tissuelymphoid tissue Mostly involves malignant B lymphocytes; Mostly involves malignant B lymphocytes;

only 5% only 5% are T lymphocytesare T lymphocytes


Manifestations:Manifestations: Symptoms are highly variableSymptoms are highly variable Symptoms may be absent or very minimal at the Symptoms may be absent or very minimal at the

early-stage of the diseaseearly-stage of the disease Typically diagnosed at a latter stage when px is more Typically diagnosed at a latter stage when px is more

symptomatic; lymphadenopathy is noticeable (stages symptomatic; lymphadenopathy is noticeable (stages III or IV)III or IV)

1/3 of cases have “B symptoms” (recurrent fever, 1/3 of cases have “B symptoms” (recurrent fever, drenching night sweats, & unintentional wt. loss of drenching night sweats, & unintentional wt. loss of >10%>10%


Assessment & DiagnosticsAssessment & Diagnostics HistopathologyHistopathology ImmunophenotypingImmunophenotyping Cytogenetic analysisCytogenetic analysis

Staging – based on data obtained from CT Staging – based on data obtained from CT scan, bone marrow biopsies, CSF analysisscan, bone marrow biopsies, CSF analysis


Treatment:Treatment: based on actual classification & stage of disease, prior based on actual classification & stage of disease, prior

treatment, & px’s ability to tolerate therapytreatment, & px’s ability to tolerate therapy Radiation alone maybe beneficial in localized non-Radiation alone maybe beneficial in localized non-

aggressive formsaggressive forms In aggressive types, combination chemotherapy are In aggressive types, combination chemotherapy are

given in early stagesgiven in early stages Intermediate forms – chemotherapy + radiotherapy Intermediate forms – chemotherapy + radiotherapy

for st. I & II diseasefor st. I & II disease

lymphomalymphoma

Hodgkins diseaseHodgkins disease Cause: unknownCause: unknown S/sxs: painless lymphadenopathy, *reed S/sxs: painless lymphadenopathy, *reed

sternberg cell, edema(lymph sternberg cell, edema(lymph obstuction),cough,dypnea(mediastinal node obstuction),cough,dypnea(mediastinal node enlargment)enlargment)

Mgt: radio,chemo (MOPP), Mgt: radio,chemo (MOPP), supportive,splenectomysupportive,splenectomy

Urinary bladder CancerUrinary bladder Cancer

ETIOLOGY AND RISK FACTORSETIOLOGY AND RISK FACTORS 65 Yrs.- median age65 Yrs.- median age SmokingSmoking Cyclophosphamide exposureCyclophosphamide exposure Schistoma haematobiumSchistoma haematobium


ManifestationsManifestations:: Hematuria- mOst common symptomHematuria- mOst common symptom Urinary changes may accompany laterUrinary changes may accompany later Usually asymptomatic at early stagesUsually asymptomatic at early stages

Diagnosis:Diagnosis: Urinalysis- hematuriaUrinalysis- hematuria IVP- decreased bladder fillingIVP- decreased bladder filling Cystoscopy- diagnosticCystoscopy- diagnostic


Treatment:Treatment: Based on extent of diseaseBased on extent of disease Surgical ResectionSurgical Resection Intravesical chemotherapyIntravesical chemotherapy

Skin cancerSkin cancer

EtiologyEtiology : :– – chronic friction, irritation & exposure to UVchronic friction, irritation & exposure to UV

TypesTypes::1. basal cell – most common1. basal cell – most common2. squamous cell 2. squamous cell 3. malignant melanoma – most fatal3. malignant melanoma – most fatal

Squamous cell CarcinomaSquamous cell Carcinoma

Risk factors:Risk factors: UV raysUV rays RadiationRadiation Actinic keratosisActinic keratosis ImmunosuppressionImmunosuppression Industrial carcinogensIndustrial carcinogens

Squamous cell CarcinomaSquamous cell Carcinoma

History and Assessment:History and Assessment: Slowly evolvingSlowly evolving AssymptomaticAssymptomatic Occassionaly bleeding and painOccassionaly bleeding and pain Exophytic nodules w/ varying degree of Exophytic nodules w/ varying degree of

scaling or crustingscaling or crusting

Basal Cell CarcinomaBasal Cell Carcinoma

Risk factors:Risk factors: UV raysUV rays May take several forms: nodular, ulcerative, May take several forms: nodular, ulcerative,

pigmented ad superficial pigmented ad superficial

Basal Cell CarcinomaBasal Cell Carcinoma

Hx and Assessment:Hx and Assessment: Usually asymptomatic unless secondarily Usually asymptomatic unless secondarily

infected in advanced diseaseinfected in advanced disease Pearly-colored PAPULE Pearly-colored PAPULE External surface - fine telangiectasia and is External surface - fine telangiectasia and is

translucenttranslucent

MelanomaMelanoma

Risk factors:Risk factors: Sun exposureSun exposure Fair skinFair skin Positive family historyPositive family history Presence of dysplastic neviPresence of dysplastic nevi

MelanomaMelanomaHx and Assessment:Hx and Assessment: Usually asymptomatic until lateUsually asymptomatic until late Pruritus or mild discomfortPruritus or mild discomfort Recent changed in a previous skin lesionRecent changed in a previous skin lesion A- asymetryA- asymetry B- border irregularityB- border irregularity C- color variationC- color variation D- diameter(large)D- diameter(large)

Skin CancerSkin Cancer

InterventionsInterventions: :

preventive measurespreventive measuresa.a. monitoring of any lesionmonitoring of any lesion

b.b. have moles or lesions removed if they are subject have moles or lesions removed if they are subject to chronic irritationto chronic irritation

c.c. avoid contact with chemical irritantsavoid contact with chemical irritants

d.d. use of sunscreenuse of sunscreen

e.e. avoid too much sun exposureavoid too much sun exposure

Hepatocellular CAHepatocellular CA

Hepa BHepa B alcoholalcohol

Liver physiology and Liver physiology and PathophysiologyPathophysiology

= Gynecomastia, testes atrophy8. Metabolizes estrogen

=Deficiencies of Vit and min7. Stores Vit and minerals

=Hyperammonemia6. Converts ammonia to urea

= Jaundice & pruritus5. Secreting bile

= Bleeding tendencies4. Synthesizes Clotting factors

=Decreased Antibody formation3. Synthesizes globulins

= Hypoproteinemia2. Synthesizes proteins

= Hypoglycemia1. Stores glycogen

Abnormality in functionNormal Function

CONDITION OF THE LIVERCONDITION OF THE LIVER

NURSING INTERVENTIONSNURSING INTERVENTIONS 1. Monitor VS, I and O, Abdominal 1. Monitor VS, I and O, Abdominal

girth, weight, LOC and Bleedinggirth, weight, LOC and Bleeding 2. Promote rest. Elevated the head 2. Promote rest. Elevated the head

of the bed to minimize dyspneaof the bed to minimize dyspnea


NURSING INTERVENTIONSNURSING INTERVENTIONS 3. Provide Moderate to LOW-protein (1 g/kg/day) 3. Provide Moderate to LOW-protein (1 g/kg/day)

and LOW-sodium dietand LOW-sodium diet 4. Provide supplemental vitamins (especially K) 4. Provide supplemental vitamins (especially K)

and mineralsand minerals Administer prescribedAdminister prescribedDiuretics= to reduce ascites and edemaDiuretics= to reduce ascites and edemaLactulose= to reduce NH4 in the bowelLactulose= to reduce NH4 in the bowelAntacids and Neomycin= to kill bacterial flora that Antacids and Neomycin= to kill bacterial flora that

cause NH productioncause NH production


NURSING INTERVENTIONSNURSING INTERVENTIONS6. Avoid hepatotoxic drugs6. Avoid hepatotoxic drugs

ParacetamolParacetamol Anti-tubercular drugsAnti-tubercular drugs

7. Reduce the risk of injury 7. Reduce the risk of injury Side rails reorientationSide rails reorientation Assistance in ambulationAssistance in ambulation Use of electric razor and soft-bristled Use of electric razor and soft-bristled

toothbrushtoothbrush


NURSING INTERVENTIONSNURSING INTERVENTIONS 8. Keep equipments ready including 8. Keep equipments ready including

Sengstaken-Blakemore tube, IV fluids, Sengstaken-Blakemore tube, IV fluids, Medications to treat hemorrhageMedications to treat hemorrhage

9. Assist in surgery and chemotherapy9. Assist in surgery and chemotherapy

1. What is the most common manifestation of 1. What is the most common manifestation of urinary bladder cancer?urinary bladder cancer?

A. pelvic painA. pelvic pain B. Painful hematuriaB. Painful hematuria C. painless heamturiaC. painless heamturia D. pelvic mass D. pelvic mass

2. In patient w/ liver disorders, they are given 2. In patient w/ liver disorders, they are given drugs drugs to kill bacterial flora that cause NH to kill bacterial flora that cause NH production. Which of the following drugs production. Which of the following drugs serves that purpose?serves that purpose?

a.a. VancomycinVancomycin

b.b. AmoxicillinAmoxicillin

c.c. NeomycinNeomycin

d.d. Nitrogen mustardNitrogen mustard

3. Cervical cancer is fast growing. This is 3. Cervical cancer is fast growing. This is associated w/ all of the following exceptassociated w/ all of the following except

A. HPVA. HPV B. herpes simplexB. herpes simplex C. genital wartsC. genital warts D. HTLVD. HTLV

4. Prolonged Exposure to estrogen increases the 4. Prolonged Exposure to estrogen increases the risk for acquiring All of the following types of risk for acquiring All of the following types of cancer exceptcancer except

a.a. Breast CABreast CA

b.b. Ovarian CAOvarian CA

c.c. Endometrial CaEndometrial Ca

d.d. Ductal CADuctal CA

5. Malignant melanoma is often seen in fair 5. Malignant melanoma is often seen in fair skinned individuals. Assessment findings skinned individuals. Assessment findings which will help strenthen the diagnosis which will help strenthen the diagnosis includesincludes

A- asymetryA- asymetry B- border irregularityB- border irregularity C- color variationC- color variation D- diameter (small)D- diameter (small)

6. All of the following are correct except6. All of the following are correct except A. melanoma- assymetricalA. melanoma- assymetrical B. squamous CA- ulceratingB. squamous CA- ulcerating C. basal cell- pearly colored papuleC. basal cell- pearly colored papule D. Squamous cell- nodularD. Squamous cell- nodular

7. Lymphoma is a malignancy involving the 7. Lymphoma is a malignancy involving the lymph tissues. The most common lymph node lymph tissues. The most common lymph node involved isinvolved is

a.a. CervicalCervical

b.b. SupraclavicularSupraclavicular

c.c. MediastinalMediastinal

d.d. inguinalinguinal

8. Which of the following assessment findings 8. Which of the following assessment findings will aid you in diagnosisng hodgkin’s diseasewill aid you in diagnosisng hodgkin’s disease

A. lymphadenopathyA. lymphadenopathy B. hematuriaB. hematuria C. reed sternberg cellC. reed sternberg cell D. lymphedemaD. lymphedema

9. Patients w/ cervical cancer often complains of9. Patients w/ cervical cancer often complains of

a.a. DysmenorrheaDysmenorrhea

b.b. Post coital bleedingPost coital bleeding

c.c. Pelvic massPelvic mass

d.d. Pelvic painPelvic pain

10. Patients with liver cancer often presents with 10. Patients with liver cancer often presents with following assessment findings exceptfollowing assessment findings except

a.a. Esophageal varicesEsophageal varices

b.b. AscitesAscites

c.c. HyperglycemiaHyperglycemia

d.d. Petechiae and echymosisPetechiae and echymosis

5. chemotherapy was advised in a patient 5. chemotherapy was advised in a patient diagnosed w/ skin Cancer. Vinblistine was the diagnosed w/ skin Cancer. Vinblistine was the agent ordered. You know that vinblistine is a agent ordered. You know that vinblistine is a vesicant type of agent and causes vesicant type of agent and causes extravasationextravasation intravasationintravasation nephrotoxicitynephrotoxicity ototoxicityototoxicity

6. Most frequent cause of fever w/in 24 hrs in a 6. Most frequent cause of fever w/in 24 hrs in a post-op patient is….post-op patient is….

7-9. internal Radiation therapy poses a risk for 7-9. internal Radiation therapy poses a risk for both patient and caregiver. Give 3 ways to both patient and caregiver. Give 3 ways to avoid unnecessary exposureavoid unnecessary exposure

10. Most common manifestation of lung cancer 10. Most common manifestation of lung cancer in early stages is…..in early stages is…..

oncology nursing

Documents

cancer nursingtheories

cancer cell debris

cell cell

cancer nursingcancer

tumor cells b cells

blood cells

types of cells

labile cells