ONCOLOGY NURSING -less profuse blood

supply
Oncology- study of tumors - cells resemble the cells -cells cannot be readily
of tissue of origin identified as to tissue of
Neoplasm- uncontrolled or abnormal growth of cells origin
-only destroy normal -invade normal tissue
 General characteristic of cancer: tissue by compression, and compete with
obstruction normal cells for oxygen
-cancer cells can divide and multiply but not in a normal
and nutrients
manner.
-when removed, - when removed
-they continue to reproduce in a disorderly and recurrence is rare recurrence is more
unrestricted manner common
-rarely fatal -fatal if not treated
-cancer cells not subject to the usual restrictions placed on
cell proliferation by the host
The spread of Malignant Neoplasms:
 Cellular features of cancer cells
1. Direct spread of tumor cells by diffusing to other body
-local increase in the number of cells cavities

-lose of normal cellular management -perforation

-variation in cell shape -Fistula- an abnormal passage between related structures

i.e. rectum and vagina
 4 common non-neoplastic growth patterns
2. Circulation by way of blood and lymphatic channels
1. Hyperplasia- increase in the number of cells
Common tumors that spread by blood
-increase in the size of cells after a response to cell
damage or destruction -lung, breast, thyroid, kidneys, prostate

-due to increase hormone stimulation 3. Transplantation or direct transport of tumor cells from
one site to another which may occur accidentally during
2. Dysplasia- disordered growth and may indicate a surgery or other procedures where cancer cells are carried
change in cell shape, growth, differentiation on instruments or gloves.

-can be a result of too many stimuli such as: BREAST CANCER

-infection, trauma, radiation, cytotoxic drugs Risk Factors:

3. Neoplasia- uncontrolled or abnormal growth of cells. 1. Family History

4. Anaplasia- “without form” adult cells regress to more 2. Female gender- due to the hormone ESTROGEN
primitive levels (food of cancer cells)

BENIGN TUMORS MALIGNANT 3. History of a previous breast cancer

TUMORS
4. Age - >50 years old. The older the age, the
-usually slow, steady -usually rapid rate of greater the risk
rate of growth growth
-growth remains -invade to other tissue 5. Menstrual history- early menarche, late
localized and metastasize to other menopause (as early as 45) or both
tissues
6. Reproductive history
-encapsulated -rarely encapsulated
-when palpated, are - when palpated, - Nulliparity
smooth, easily defined irregular border,
movable immobile - First born child after age 30 years.
 7. Ionizing radiation -can metastasize to lungs, liver, and brain.

8. Diet- high fat diet DIAGNOSTIC TESTS:

9. Obesity  Mammogram- best imaging tool for detecting

breast cancer.
10. Benign breast disease
- yearly screening between the ages 40 and 50
11. Oral contraceptives
Best time: 1 week after menstrual period or 1-2 weeks
after the onset of menses (because estrogen level goes
down, no breast tenderness)
CLINICAL MANIFESTATIONS:
 Mammography + MRI

-done for women with a high risk for breast cancer

-single lump, painless, non-tender, and movable/fixed,
firm to hand inconsistency, irregular shape, fixed not
movable
- Mostly found at the Upper Right Quadrant
-dimpling and retraction of the skin and nipple (cooper’s
ligament)
-Peau d’orange skin (tumor is obstructing lymphatic
system; flow of blood is non-continuous leading to
edema.
- Nipple discharge that is unilateral (clear or bloody)
- breast distortion, (is left symmetrical with right?)
- Pain- Late manifestation of any cancer
- Axillary adenopathy
-2 techniques when combined, detected 94% of
tumors.
CLINICAL BREAST EXAM
-yearly done if 40 years old or older
-Every 3 years if 20-39 years old
BREAST SELF EXAMINATION
-monthly for all, beginning at age 20
-done 5-7 days after the onset of menstruation
(because estrogen levels are low)
-done starting at the center of the breast with a
circular motion outer to the axillary.
Stage 1-2- treated with surgery

Patients who undergone breast augmentation- tumor

STAGING OF BREAST CANCER: detected by mammography
Stage 1 – tumor is smaller than 2 cm MRM- done during stage 1 and 2
-nodes in axilla are not yet involved STAGING:
Stage 2- tumor is >2cm but <5cm - A way in which the characteristics of cancer can be
described.
-may or may not involve axillary nodes
-classifying the EXTENT and SPREAD of cancer
Stage 3- lump is <5cm
-allows decisions to be made about the management
-involvement of axillary nodes
of the cancer patient
-peau d’orange /edema
-identifying appropriate treatments
Stage 4- tumor is of any size
- A way of estimating the PROGNOSIS of a case
-axillary nodes involvement
STAGE 0- Cancer in situ
STAGE 1- tumor is limited to the tissue of origin,
localized tumor growth
STAGE 2- limited local spread
STAGE 3- extensive local and regional spread
STAGE 4- metastasis
SURGICAL MANAGEMENT
MRM- nipple, areola, breast tissue, lymph node and
minor pectoralis muscle are removed
- major pectoralis muscle is left
Holstead MRM – all are removed
LUMPECTOMY- tumor 2-3 surrounding tissue
-subject patient for radiation to kill cancer cells that
will metastasize
SIMPLE OR TOTAL MASTECTOMY- nipple,
areola and breast tissue are removed, lymph nodes
are not removed to prevent the complication of
having LYMPHEDEMA.
LUMPECTOMY/TYLECTOMY- followed by
radiation, only tumor is removed. Typically radiation
therapy follows to eradicate residual tumor cells
Biopsy- to check if the tumor is benign or malignant
STAGE 3 AND 4- chemotherapy or hormonal
therapy
POST OPERATIVE CARE
1. Monitoring the vital signs every 15 minutes for
the 1st hour and every 30 minutes after the 1st
hour. For the 1st 24 hours post-operatively-
monitor the patient’s temperature every 4 hours
to monitor for infection.
2. Hemovac/ JP- lasts for about 2-4 days. output
should not be >200 ml in 8 hours. Drain the
output every 8 hours.
3. Elevate the affected arm. Should be at heart’s
level (increases venous return to prevent edema
because of inflammation/injury.
4. Immobilize it for the 1st 24 hours
5. Perform Hand exercises for the 1st 24 hours.
Give patient something to squeeze (ball)
6. Pain management. Administer opioid analgesics
such as Demerol but for only a short period of
time it has an end product (normeperidine) that
can cause seizure if it accumulates in the body.
Let patient to be asleep. Elevation of the arm.
Keep environment quiet. Limit visitors.
7. Save arm precaution (affected side/arm). Blood
pressure should not be taken, no venipuncture,
no extraction of blood and no administration of
IV meds on the affected arm.
8. Let the patient move on her unaffected side- this
lessens the pain and tension on the operative site.
LYMPHEDEMA- (to differentiate with surgical
edema) – preoperatively, measure the circumference
of the patient’s arm (3 inches below and above the
antecubital space). Post-operatively, re-measure it 6
weeks after because surgical edema must have
subsided by this time. If edema is present, this is
lymphedema.
SIGNS AND SYMPTOMS OF LYMPHEDEMA:
-swelling of the fingers or arm
-limb heaviness and skin tightness
-“heat” or burning or “pins and needles” to numbness
-less flexibility in the hands, wrist or ankle
-jewelry feels tight even though they haven’t gained
weight
-feelings of tiredness, aching, weakness
Hand exercises- 24 hours post-op
Arm exercises- 6 weeks post-op
Exercises after breast surgery- page 1473
Lymphedema- obstruction of lymph flow, albumin is
out of IVC
PREVENTING/MINIMIZING LYMPHEDEMA
-wear no constricting clothing or jewelries on affected
arm
-place the arm in a sling when the patient ambulates
initially
-use protective hand and finger covering when washing - decrease alcohol intake (alcohol prevents the absorption
dishes, cooking, sewing. of folic acid)

-use the affected arm frequently and gradually - Exercise regularly

-avoid lifting/ moving heavy objects (6-8 weeks post-op) - have a complete sleep.

-teach the patient to use the affected limb for normal

everyday activities.
LUNG CANCER
PHARMACOLOGICAL MANAGEMENT

TAMOXIFEN- (5-8 yrs) – blocks estrogen receptors on

breast cancer cells, it suppresses growth of residual cancer
cells, also as a treatment of metastatic disease.

Adverse effects-hot flushes, fluid retention, vaginal

discharge, nausea and vomiting.

Endometrial cancer- is the biggest concern in

TAMOXIFEN therapy. Tamoxifen acts as estrogen
agonist at receptors in the uterus leading to endometrial
hyperplasia.

ANASTROZOLE- 1st line oral therapy of post

menopausal women with either early or advanced breast
cancer

Menopausal women- no more estrogen but still has

androgen

-ANASTROZOLE inhibits AROMATASE and thereby

reduces estrogen production.

- Estrogen deprivation can arrest tumor growth-cell death

AROMATASE- an enzyme that will convert androgen to

estrogen

AROMATASE inhibitors- more effective than tamoxifen

and has no endometrial cancer risk

PREVENTING BREAST CANCER

-low caloric diet

-limit fat intake

- Increase intake of ISOFLAVONES (antiestrogen foods)

such as soybeans, soymeat, tofu, cereals, nuts and peas

-eat foods high in PHENOLIC ACIDS (blocks the

aromatase enzyme) such as grapes, strawberries, coffee
beans, pears, oats and potatoes.

-daily folic acid supplements at least 300 mcg. Such as

okra, asparagus, peas, lentils, liver, orange juice and
broccoli