ONCOLOGIC

NURSING
 NEOPLASIA
DIFFERENCE BENIGN MALIGNANT
S (Tumor) (CA)
Differentiatio Well Poor
n
Encapsulatio (+) (-)
n
Metastasis (-) (+)
Prognosis Good Poor
Tx Modalities Surgery Surgery,
Irradiation,
Chemotx, BM
Predisposing Factors:
Carcinogenesis
• G-enetic
• I-mmunosuppression
• V-iral (Human Papilloma, Epstein-Barr, Hepa B)
• E-nv’tal
– Physical
•Radiation, UV rays, nuclear explosion
•Chronic irritation, direct trauma
– Chemical
•Acids, alkalis, hydrocarbons, dye
•Food (↑fat, ↓fiber) & Food additives (Nitrites)
•Drugs (Stillbestrol, urethane)
•Hormones
•Smoking
Predisposing Factors:
Carcinogenesis
•Men: Bronchogenic/Lung CA, liver CA,
prostate CA (middle aged, >40 y/o,
with BPH, hormonal)
•Women: Breast CA (hormonal,
encourage SBE 1 wk after mens),
cervical CA (80%- multiple sex
partners, 20% early pregnancy)
•Ovarian CA
Classification of Cancer
• Based on tissue typing
• Carcinoma- arises from surface
epithelium & glandular tissue
• Sarcoma- arises from connective tissue
• Multiple myeloma- arises from plasma
cells (in BM)
• Lymphoma- arises from lymph glands
• Leukemia- arises from blood cells
Grading of Cancer
• Classifies the cellular aspects of CA
• Grade I: cells differ slightly from N cells,
well-differentiated (mild dysplasia)
• Grade II: cells are more abN, mod.
differentiated (mod. dysplasia)
• Grade III: cells are very abN, poorly
differentiated (severe dysplasia)
• Grade IV: cells are immature
(anaplasia), undifferentiated
Staging of Cancer
• Classifies the clinical aspects of CA
• Stage O: carcinoma in situ
• Stage I: tumor limited to the tissue of
origin, localized tissue growth
• Stage II: limited local spread
• Stage III: extensive local & regional
spread
• Stage IV: metastatis
WARNING/DANGER SIGNS OF
CANCER
• C-hange in bowel/bladder habits
• A- sore that does not heal
• U-nusual bleeding/discharge
• T-hickening of a lump in breast or elsewhere
• I-ndigestion/dysphagia
• O-bvious change in a wart or mole
• N-agging cough/hoarseness
• U-nexplained anemia
• S-udden wt loss
EARLY DETECTION OF
CANCER
•Mammography
•Pap smear
•Stool for occult blood
•Sigmoidoscopy, colonoscopy
•Breast self-examination
•Testicular self-examination
•Skin inspection
Breast Self-Examination
(BSE)
•Done 7-10 days after menses
•Postmenopausal or s/p
hysterectomy: specific day of the
month
•Inspection: In front of the mirror
with arms at sides, arms overhead
& arms at hips (WOF changes in
shape, dimpling of skin or any
changes in nipple)
Breast Self-Examination
(BSE)
• Palpation: While in shower/bath or
lying down with folded towel under
breast being examined
• Use the R hand to examine L breast &
vice versa
• Use the pads of 2nd , 3rd & 4th fingers
• Use small, circular motions in spiral or
in an up-and-down motion to examine
entire breast & under the arm (WOF
lump, hard knot or thickened tissue)
Testicular Self-Examination
(TSE)
• Same day, q month, right after a warm
shower (scrotal skin is moist & relaxed)
• Gently lift each testicle, each one should
feel like an egg, firm but not hard &
smooth without lumps
• Using both hands, place middle fingers
underside of each testicle & thumbs on
top & gently roll the testicles (WOF lumps,
swelling or mass)
CANCER TX MODALITIES:
Chemotherapy
• Kills CA cells & rapidly producing cells
(skin, hair, BM, Reproductive tract,
GIT,)
– Antimetabolites: N2 mustard
– Plant alkaloid: Vincristine &
Vinblastine
– Alkylating: Methotrexate
– Hormones (DES)/ steroids
– Antineoplastic antibiotics
CANCER TX MODALITIES:
Surgery
•Prophylactic
– With premalignant condition or with
strong family hx of CA
•Curative
– Removal of all gross & microscopic
tumor
•Control (cytoreductive)
– “debulking” procedure, ↓ the no. of CA
cells, ↑ the chance of other tx will be
successful
CANCER TX MODALITIES:
Surgery
• Palliative
– Improves quality of life during survival time
– ↓ pain; relieve obstruction (airway, GI or GU),
relieve pressure on brain & spinal cord, prevent
hemorrhage, remove infected or ulcerated
tumors or drain abscesses
• Reconstructive or rehabilitative
– Improves quality of life by restoring maximal
function & appearance (breast reconstruction s/p
mastectomy)
CANCER TX MODALITIES:
Chemotherapy
• Major S/E & Nursing Interventions
• Hair: alopecia
– Encourage pt to wear wigs, cap
– Temporary, hair will regrow in 3-6 mos. after
chemo with new color & texture
• BM: depression
– Anemia: CBR, O2 as ordered
– Leukemia: reverse isolation, strict HW, asepsis
– Thrombocytopenia: Bleeding precautions
CANCER TX MODALITIES:
Chemotherapy
• Major S/E & Nursing Interventions
• GIT: N/V
– Antiemetics 4-6 hrs. pre-chemo & post chemo as
ordered
– NPO temporarily
– Bland diet post chemo
• Stomatitis
– Oral care
– Ice chips/popsicles
• Diarrhea
– Antidiarrheals
– Monitor VS, I/O, WOF dehydration
• WOF paralytic ileus (with Vincristine)
CANCER TX MODALITIES:
Chemotherapy
•Major S/E & Nursing Interventions
•Reproductive tract: sterility
– Encourage sperm banking for M
•Renal damage: ↑ uric acid
– Allopurinol as ordered
•Neuro disturbance: peripheral neuropathy
– Skin, hand & foot care (like in PVD & DM)
CANCER TX MODALITIES:
Radiation
• Use of ionizing radiation that kills CA &
rapidly growing cells & inhibit their growth
• Types of energy
– Alpha rays: don’t penetrate skin tissue
– Beta rays: penetrate skin (e.g. internal
radiation)
– Gamma rays: penetrate deeper,
underlying tissues (e.g. external radiation)
CANCER TX MODALITIES:
Radiation
• Factors Affecting Delivery
– Half-life: time required for the ½ of the
radioisotope to decay
– Time: less time, less exposure
– Distance: the farther the source, the
lesser the exposure
– Shielding: Alpha & Beta rays can be
blocked by gloves, Gamma rays can
be blocked by thick, lead gown &
concrete
CANCER TX MODALITIES:
Radiation
• Methods of Delivery
– Internal: utilizes injection/
implantation of radioactive isotopes
proximal to CA sites for specified
period of time
•Sealed: within a container, don’t
contaminate with body fluids
•Unsealed: e.g. Phosphorus 32
– External: uses electromagnetic waves
e.g. Cobalt
CANCER TX MODALITIES:
Teletherapy/Beam Radiation
• Source: external radiation
• Pt does not emit radiation & does
not pose a hazard to anyone else
• Wash area with water & mild soap,
using the hand than a washcloth,
rinse & pat dry with soft towel
• Don’t remove radiation markings
from the skin
CANCER TX MODALITIES:
Teletherapy/Beam
Radiation
• No powder, ointment, lotion or cream on
area unless ordered
• Wear soft clothing over the area, avoid
constrictive garments
• Avoid sun & heat exposure
• WOF weeping of skin (moist desquamation)
& if noted, cleanse the area with warm
water & pat dry, apply antibiotic or steroid
cream as ordered & expose the site to air
CANCER TX MODALITIES:
Brachytherapy Radiation
•Source: internal radiation
(sealed or unsealed)
•For a pd. of time the pt emits
radiation & pose a hazard to
others
CANCER TX MODALITIES:
Brachytherapy Radiation
•Unsealed Radiation Source
– Administered PO or IV or
instillation into body cavities
– It enters body fluids, eliminated
via various excreta (radioactive
& harmful to others esp. the 1st
48 hrs)
CANCER TX MODALITIES:
Brachytherapy Radiation
•Sealed Radiation Source
– Temporary or permanent solid implant
within tumor target tissues
– The pt emits radiation while the implant is
in place, but the excreta is not radioactive
– Place the pt in a private room with private
bath
– Place a caution sign on the pt’s door
CANCER TX MODALITIES:
Brachytherapy Radiation
•Sealed Radiation Source
– Organize nursing tasks to minimize exposure
to radiation source
– Nursing staff assignments should be rotated,
a nurse should never care for more than 1 pt
with radiation implant at a time, avoid
assigning a pregnant nurse
– Limit time to 30 mins per care provider/shift
CANCER TX MODALITIES:
Brachytherapy Radiation
• Sealed Radiation Source
– Wear a dosimeter film badge to measure
radiation exposure
– Wear a lead shield
– Do not allow children <16 y/o or pregnant
woman to visit the pt
– Limit visitors to 30 min./day, at least 6 ft from
the pt
– Save bed linens & dressings until the source is
removed then dispose
– Other equipments can be removed from the
room at any time
CANCER TX MODALITIES:
Brachytherapy Radiation
•Dislodged Sealed Radiation Source
– Don’t touch it with bare hands, use a
long-handled forceps to place the
source in a lead container kept in the
pt’s room & notify MD
– If unable to locate the radiation
source, bar visitors & notify MD
CANCER TX MODALITIES:
Brachytherapy Radiation
• Sealed Radiation Source Removal
– Pt is no longer radioactive
– Inform the pt that sexual partner cannot “catch” CA
– Pt may resume sexual intercourse after 7-10 days
for cervical or vaginal implant
– Perform povidone-iodine douche as ordered for
cervical implant
– Administer Fleet enema as ordered
– Notify MD if N/V/D, frequent urination, vaginal or
rectal bleeding, hematuria, foul-smelling vaginal
discharge, abdominal pain/distention or fever
occurs
CANCER TX MODALITIES:
Radiation
• Major S/E & Nursing Interventions
– Skin erythema, redness, irritation &
sloughing of tissue
•Assist in bathing the pt
•Force fluids
•Avoid lotion, talcum powder; may use
cornstarch or olive oil
– BM depression (same as in chemo)
– GIT disturbance: Dysgeusia- ↓ taste sensation
esp. with internal implant
•Oral care, avoid hot & cold foods
 LEUKEMIA

•Group of malignant disease

•Rapid ↑ immature WBC,
competes nutrition with
mature WBC and production
of RBC and platelets
•N= 500 RBC: 1 WBC
LEUKEMIA
 CLASSIFICATION OF
LEUKEMIA
• Lympho- affects lymphocytes
• Myelo- affects myeloblasts
• Acute/Blastic- affects immature cells
• Chronic/Cystic- affects mature cells
• Most common in children: Acute
Lymphocytic Leukemia (ALL), peak
onset 2-6 y/o, M>F
• Acute Myelogenous Leukemia (AML):
peak onset 15-39 y/o
 Signs and Symptoms:
LEUKEMIA
• From invasion of BM (“Nadir”)
– Infection: ↑T, poor wound healing, sore
throat, bone weakens→ fracture, bone &
joint pains, lymphadenopathy
– Bleeding: hemorrhage, petechiae,
epistaxis, hematoma, hematuria,
hematemesis, hepatosplenomegaly
– Anemia: pallor, fatigue, anorexia,
constipation
 Signs and Symptoms:
LEUKEMIA
• From invasion of CNS
– ↑ ICP: ↓LOC, severe HA, vomiting,
papilledema, seizures
– CN VII or spinal nerve
involvement
• From invasion of kidneys, testes,
prostate, ovaries, GI and lungs
 LEUKEMIA
• Diagnostic Tests
– PBS- (+) immature WBC
– CBC- ↑ immature WBC, ↓ RBC, ↓
platelets
• Done weekly during maintenance
phase of chemotherapy
– Lumbar Puncture- CNS affectation
• Shrimp/fetal/C-position, avoid neck
flexion may occlude airway of
infants and children
 LEUKEMIA
• Diagnostic Tests
– Bone Marrow Aspiration- (+) blast
cells (immature WBC), common site:
iliac crest
• Post op: apply direct pressure, lie
on affected side to stop bleeding
– Bone Scan- to determine bone
involvement (fractures)
– CT Scan: to determine organ
involvement
 LEUKEMIA

• Triad Management
– Surgery (most
preferred)
– (Cranial) Irradiation
– Chemotherapy
• BM transplant
 Nursing Management:
LEUKEMIA
– Assess for common side
effects: anorexia, nausea
and vomiting (give
antiemetics 30mins prior
to chemo and continue
until 1 day post chemo),
WOF dehydration
 Nursing Management:
LEUKEMIA
– Assure pt that alopecia and
hirsutism are temporary side
effects, hair will regrow in 3-6
mos. With new color & texture
 Nursing Management:
LEUKEMIA
– Assess for stomatitis (oral ulcers)
• Oral care: alcohol-free mouthwash,
pNSS with or without NaHCO3
• Use soft-bristled toothbrush, cotton
plegets
• Apply Xylocaine (topical anesthetic)
on mouth before meals
• Diet: soft and bland according to
child’s preference, small frequent
feedings
 Nursing Management:
LEUKEMIA
– Protect pt from infection
•Strict hand washing
•Reverse isolation
– Protect pt from additional
fatigue
•Bed rest
•Activities balanced with rest
 Nursing Management:
LEUKEMIA
– Protect pt from bleeding
•Minimize parenteral
injections
•Apply pressure on
venipuncture sites
•Use electric razor in
shaving
 Nursing Management:
LEUKEMIA
– Encourage verbalization
of feelings & concerns
– Introduce the family to
other families of children
with CA
– Consult social services &
chaplains as necessary
 HODGKIN’S
DISEASE/LYMPHOMA
• Involves lymph nodes, tonsils, spleen &
BM
• (+) Reed-Sternberg cell in the nodes
• (+) bx of cervical lymph nodes
(affected 1st)
• (+) CT scan of liver & spleen
 MULTIPLE MYELOMA
•Malignant proliferation of plasma
cells and tumors within the bone,
destroying the bone & invading the
lymph nodes, spleen & liver
•abN plasma cells produce an abN Ab
(myeloma protein or Bence Jones
protein) found in blood & urine
∀↓ production of Ig & Ab, ↑uric acid &
Ca→ RF
 S/Sx: MULTIPLE MYELOMA
• Bone pain (pelvis, spine, ribs)
• Osteoporesis (bone loss, pathological fractures)
• Spinal cord compression & paraplegia
• Weakness & fatigue
• Recurrent infections
• Anemia
• Bence Jones proteinuria, ↑ total serum protein, Ca
& uric acid levels
• RF
• Thrombocytopenia, granulocytopenia
 Nursing Interventions:
MULTIPLE MYELOMA
• Administer as ordered
– Chemotherapy
– IVF & diuretics (to eliminate Ca)
– BT for anemia
– Analgesics, antibiotics
• WOF bleeding, infection, fractures, RF
• Force fluids
• Encourage ambulation
• Provide skeletal support during moving, turning &
ambulating
• Maintain hazard-free env’t
 TESTICULAR CANCER
•Occurs between ages 15-40
•Common sites of mets: lymph nodes,
bone, lungs, adrenal glands & liver
•Types
– Germinal tumors (Seminomas,
Nonseminomas)
– Nongerminal tumors (Interstitial cell
tumors, Androblastoma)
 S/Sx: TESTICULAR
CANCER
•Painless testicular swelling
•Dragging sensation in the
scrotum
•S/Sx of mets: palpable
lymphadenopathy, abdominal
masses, gynecomastia
•Late S/Sx: back or bone pain &
respiratory Sx
 Tx: TESTICULAR CANCER
• Chemotherapy
• Radiation
• Surgery
– Unilateral orchiectomy- for dx & primary
surgical mgt.
– Radical retroperitoneal lymph node
dissection- to stage the CA & ↓ tumor vol.
• Reproductive options: sperm storage, donor
insemination & adoption
 Nursing Interventions:
s/p Testicular Surgery
•Suture removal: 7-10 days post-op
•May resume N activities within 1
week except for lifting heavy objects
> 20 lbs or stair climbing
•Perform monthly testicular self-exam
on the remaining testicle
 BREAST CANCER
• Common sites of mets: lymph nodes,
bone, lungs, brain & liver
• Precipitating factors
– Genetics
– Early menarche & late menopause
– Nulliparity
– Obesity
– High-dose radiation exposure to chest
 S/Sx: BREAST CANCER
• Mass felt during BSE (usually in the upper outer
quadrant or beneath the nipple)
• Fixed, irregular, nonencapsulated mass
• Painless (early stage) or painful (late stage)
mass
• Nipple retraction or elevation
• Assymetrical breast (affected breast higher)
• Bloody or clear nipple d/c
 S/Sx: BREAST CANCER
• Skin dimpling, retraction or ulceration
• Skin edema or peau d’orange skin
• Axillary lymphadenopathy
• Lymphedema of affected arm
• Presence of lesion on mammography
• S/Sx of lung/bone mets
 Nonsurgical Tx: BREAST
CANCER
• Chemotx
• Radiation tx
• Hormonal manipulation in post
menopausal women
• Meds: Tamoxifen (Nolvadex) for
estrogen receptor-positive tumors
 Surgical Tx: BREAST
CANCER
• Lumpectomy: removal of tumor with
lymph node dissection
• Simple Mastectomy: removal of breast
tissue & nipple, lymph nodes left intact
• Modified Radical Mastectomy: removal of
breast tissue, nipple & lymph nodes,
muscles left intact
• Halsted Radical Mastectomy: removal of
breast tissue, nipple, lymph nodes &
underlying muscles
 Surgical Tx: BREAST
CANCER
• Oophorectomy: for estrogen
receptor-positive tumors
• Ablative therapy with
adrenalectomy or chemical
ablation which blocks cortisol,
androstenedione & aldosterone
production
 Nursing Interventions:
s/p Breast Surgery
• Semi-Fowlers’ position, turn from back to unaffected
side, with affected arm elevated above the heart level
to promote drainage & prevent lymphedema
• Use a pressure sleeve if edema is severe
• Maintain Jackson-Pratt suction, record the amount &
characteristic of draiange
• No IV, injections, BP, venipunctures in affected arm
• Low Na-diet, diuretics for severe lymphedema
• Refer to MD & PT for appropriate exercise program
 Health Teaching:
s/p Breast Surgery
• Protect & avoid overuse of the hand & arm
during the 1 few months
st

• Keep the affected arm elevated to prevent

lymphedema
• Incision care with lanolin to soften & prevent
wound contractures
• BSE on the remaining breast
• Avoid strong sunlight or heat to the affected
arm
• Don’t carry anything heavy over the affected
arm
 Health Teaching:
s/p Breast Surgery
• Avoid constrictive clothing/jewelry, trauma, cuts, bruises or
burns to the affected arm
• Wear gloves when gardening, washing dishes/clothes
• Use thick oven mitten mitts when cooking
• Use a thimble when sewing
• Apply lanolin hand cream several times daily
• Use cream cuticle remover
• Notify MD if S/ of inflammation occur in the affected arm
• Wear a Medic-Alert bracelet stating lymphedema arm
 CERVICAL CANCER
• Premalignant changes: (Stage I) mild dysplasia to
(Stage II) mod. dysplasia to (Stage III) severe
dysplasia to carcinoma in situ
• Common sites of mets: pelvis & lymphatics
• Precipitating factors
– Low socioeconomic groups
– Early 1st marriage
– Early & frequent intercourse
– Multiple sex partners
– High parity
– Poor hygiene
 S/Sx: CERVICAL CANCER
• Painless vaginal bleeding postmenstrually &
postcoitally
• Foul-smelling or serosanguinous vaginal d/c
• Leakage of urine or feces from the vagina
• Dysuria, hematuria
• Pelvic, lower back, leg or groin pain
• A/, wt loss
• Changes on Pap smear
 Tx: CERVICAL CANCER
• Nonsurgical
– Chemotherapy
– Cryosurgery
– External radiation
– Internal radiation (intracavitary)
– Laser therapy
• Surgical
– Conization
– Hysterectomy
– Pelvic exenteration
 CERVICAL CA: Laser
Therapy
•Energy from the beam is
absorbed by fluid in the tissues,
causing them to vaporize
•Minimal bleeding & slight
vaginal d/c is expected after the
procedure, healing occurs in 6-
12 wks
 CERVICAL CA: Cryosurgery
•Involves freezing of the tissues by a probe
with subsequent necrosis
•No anesthesia required
•Cramping may occur during the procedure
•A heavy, watery d/c is expected several
wks after the procedure, use tampons
•Avoid sexual intercourse
 CERVICAL CA: Conization
•A cone-shaped area of the cervix is
removed
•For women who want further child
bearing
•Long-term follow-up is needed (new
lesions may develop)
•Cx: hemorrhage, uterine perforation,
incompetent cervix, cervical stenosis
& preterm labor
CERVICAL CA: Hysterectomy
•Vaginal approach for microinvasive
CA if childbearing is not desired
•Radical hysterectomy & bilateral
lymph node dissection for CA that
spread beyond the cervix but not
to the pelvic wall
 Nursing Interventions:
s/p Hysterectomy
•Monitor vaginal bleeding (>1 saturated
pad/hr)
•Avoid stair climbing for 1 mo.
•Avoid tub baths & sitting for long
periods
•Avoid strenous activity or lifting >20
lbs
•Avoid sexual intercourse for 3-6 wks
 CERVICAL CA: Pelvic
exenteration
•Radical surgical procedure for
recurrent CA
•When the bladder is removed, an
ileal conduit is created & located at
the R side of the abdomen to divert
urine
•A colostomy is created on the L side
of the abdomen for the passage of
feces
 CERVICAL CA:
Types of Pelvic Exenteration
•Anterior
– Removal of uterus, ovaries, fallopian tubes,
vagina, bladder, urethra & pelvic lymph
nodes
•Posterior
– Removal of uterus, ovaries, fallopian tubes,
descending colon, rectum & anal cnal
•Total
– Combo of anterior & posterior
 Nursing Interventions:
s/p Pelvic exenteration
•Administer perineal irrigation with half-
strength H2O2 & NS
•Avoid strenous activity for 6 mos.
•Perineal opening may drain for several mos.
•Ileal conduit & colostomy care
•Sexual counseling: vaginal intercourse is not
possible s/p anterior & total pelvic exenteration
 OVARIAN CANCER
•Grows rapidly, spreads fast, often
bilateral
•Common sites of mets: pelvis,
lymphatics & peritoneum
•Usually detected late: Poor
prognosis
•Exploratory laparotomy: to dx &
stage the tumor
 S/Sx: OVARIAN CANCER
•Abdominal discomfort or
swelling
•GI disturbance
•Dysfunctional vaginal bleeding
•Abdominal mass
 Tx: OVARIAN CANCER
•External radiation: if with mets
•Chemotherapy: done post-op for
all stages of CA
•Intraperitoneal chemotx:
instillation into abdominal cavity
•Immunotherapy: promotes tumor
resistance
•Surgery: TAHBSO
 ENDOMETRIAL CANCER
• Slow-growing tumor asso. with menopausal years
• Common sites of mets: ovaries, pelvis, peritoneum,
lymphatics & via blood to the lungs, liver & bone
• Precipitating Factors
– Hx of uterine polyps
– Nulliparity
– Polycystic ovary disease
– Estrogen stimulation
– Late menopause
– Family hx
 S/Sx: ENDOMETRIAL
CANCER
•Postmenopausal bleeding
•Watery, serosanguinous
discharge
•Low back, pelvic or
abdominal pain
•Enlarged uterus in advanced
stages
Tx: ENDOMETRIAL CANCER
•External or internal radiation
•Chemotherapy for advanced or
recurrent CA
•Medroxyprogesterone (Depo-Provera)
or Megestrol) Megace for estrogen-
dependent tumors
•Tamoxifen (Nolvadex): antiestrogen
•Surgery: TAHBSO
 GASTRIC CANCER
• Predisposing Factors
– Diet: high in complex CHO, grains & salt, low
in fresh green, leafy vegetables & fruits
– Use of nitrates
– Smoking, alcoholism
– Hx of gastric ulcers
• Cx: hemorrhage, obstruction, mets & dumping
syndrome
• Goal of Tx: remove the tumor & provide
nutritional support
 S/Sx: GASTRIC CANCER
•A/N/V, wt loss
•Fatigue, anemia
•Indigestion, epigastric discomfort
•A sensation of pressure in the
stomach
•Dysphagia
•Ascites
•Palpable mass
 Tx: GASTRIC CANCER
•Chemotx
•Radiation
•Surgery
– Subtotal gastrectomy
•Bilroth I: Gastroduodenostomy
•Bilroth II: Gastrojejunostomy
– Total gastrectomy
•Esophagojejunostomy
 Nursing Interventions:
GASTRIC CANCER
• Fowler’s position for comfort: Pain meds as ordered
• Monitor Hgb, Hct: BT as ordered
• NPO for 1-3 days post-op until peristalsis returns
• Monitor I/O: IVF & e+ as ordered
• Monitor NGT suction, don’t irrigate or remove NGT
• Progressive diet to 6 small bland meals/day
• Monitor wt, nutritional status: Small, bland, easy
digestible meals with vit & mineral supplements
• WOF Cx: hemorrhage, dumping syndrome, diarrhea,
hypoglycemia, Vit B12 deficiency
 PANCREATIC CANCER
•More common in blacks than in
whites, in smokers & in men
•Linked with DM, alcohol use, hx
of pancreatitis, high fat diet,
env’tal chemicals
•With poor prognosis
S/Sx: PANCREATIC CANCER
•N/V
•Jaundice
•Unexplained wt. loss
•Clay-colored stool
•Glucose intolerance
•Abdominal pain
 Tx: PANCREATIC CANCER
•Radiation
•Chemotherapy
•Whipple’s procedure:
pancreaticoduodenectomy with
removal of distal third of the
stomach, pancreaticojejunostomy,
gastrojejunostomy &
choledochojejunostomy
 INTESTINAL TUMORS
•Develop in the cells lining the bowel wall or
develop as polyps in the colon or rectum
•Cx: bowel perforation with peritonitis, abscess
& fistula formation, hemorrhage & complete
gut obstruction
•Common sites of mets: via lymphatics &
blood, colon & other organs
 S/Sx: INTESTINAL TUMORS
• A/V, malaise, wt loss
• Blood in stools, anemia
• AbN stools
– Ascending colon tumor: diarrhea
– Descending colon tumor: constipation with some
diarrhea, ribbon-like stool
– Rectal tumor: alternating constipation & diarrhea
• Guarding or abdominal distention
• Abdominal mass & cachexia (late signs)
 Nursing Interventions:
INTESTINAL TUMORS
• WOF bowel perforation: ↓BP, ↑HR, ↑T, weak
pulse, distended abdomen
• WOF intestinal obstruction: (EARLY S/Sx-
↑peristalsis, ↑ to ↓ bowel sounds) fecal vomiting,
pain, constipation, distended abdomen
• Radiation pre-op
• Chemotherapy post-op
• Surgery: bowel resection & creation of colo or
ileostomy
 COLO/ILEOSTOMY PRE-OP
CARE
•Consult with enterostomal therapist to
identify optimal placement of ostomy
•Low-residue diet for 1-2 days pre-op
•Give intestinal antiseptics & antibiotics,
laxatives & enemas as ordered
COLOSTOMY POST-OP CARE
• Apply petroleum jelly over the stoma to keep it
moist followed by dry sterile gauze if pouch
system is not yet in place
• Monitor the stoma for size, unusual bleeding or
necrotic tissue
• Monitor the stoma for color
– N: pink or red indicating ↓vascularity
– Pale: anemia, Violet/Blue/Black: compromised
circulation
COLOSTOMY POST-OP CARE
• Check pouch system for proper fit & leakage
• Ascending colon colostomy: expect liquid stool
• Transverse colon colostomy: expect loose to semiformed
stool
• Descending colon: expect close to N stool
• Empty pouch when 1/3 full, remove feces from the skin
• Avoid gas/odor-forming foods
COLOSTOMY POST-OP CARE
•WOF perineal wound
infection (if present)
•Administer as ordered
–Analgesics & antibiotics
–Stoma irrigation
 ILEOSTOMY POST-OP CARE
•Post-op drainage: dark green to yellow (as
the pt begins to eat)
•Expect liquid stool
•WOF dehydration & e+ imbalance
•Avoid suppositories through ileostomy
 LUNG CANCER
• Lungs: common target for mets from other organs
• Bronchiogenic carcinoma: direct extension & via
lymphatics
• 4 Major Types
– Small (Oat) Cell
– Epidermal (Squamous Cell)
– Adenocarcinoma
– Large cell anaplastic carcinoma
 LUNG CANCER
•Causes
–Cigarette smoking
–Env’tal & occupational pollutants
•Dx: CXR (lesion or mass),
bronchoscopy & sputum cytological
studies
 S/Sx: LUNG CANCER
•Cough
•Dyspnea
•Hoarseness
•Hemoptysis
•Chest pain
•A/ wt loss
•Weakness
 Nursing Interventions:
LUNG CANCER
• Fowler’s position
• WOF RR distress, tracheal deviation
• Activity as tolerated, rest periods, active/passive
ROM
• Diet: ↑calorie, high CHON, ↑Vit
• Administer as ordered
– O2, bronchodilators, steroids
– Analgesics
– CPT
 Tx: LUNG CANCER
• Radiation
• Chemotherapy
• Immunotherapy
• Surgery
– Laser therapy: to relieve endobronchial obstruction
– Thoracentesis & pleurodesis: to remove pleural fluid
& relieve hypoxia
– Thoracotomy with pneumonectomy or lobectomy or
segmental resection
Pre-op Care: LUNG CANCER
Explain the potential post-op need for chest tubes
•
Closed chest drainage is not used for
•pneumonectomy & the serum fluid that
accumulates in the empty thoracic cavity will
consolidate, preventing mediastinal shift
Post-op Care: LUNG CANCER
•Maintain chest tube drainage
system, WOF SQ emphysema
•Avoid complete lateral turning
•Activity as tolerated, active
ROM of the operative shoulder
•Administer O2 as ordered
4 LEVELS OF
CHEMOTHERAPY
• 1. For Induction
– To achieve complete
remission (disappearance
of leukemic cells)
– Meds: Oral Prednisone
Vincristine and L-
asparaginase IV
4 LEVELS OF
CHEMOTHERAPY
•2. For Sanctuary
– To treat leukemic
cells that invaded
testes and CNS
– Meds: Intrathecal
Methotrexate
4 LEVELS OF
CHEMOTHERAPY
•3. For Maintenance
– To continue remission
– Meds: Oral
Methotrexate, 6-
Mercaptopurine and
Cytarabine
 4 LEVELS OF
CHEMOTHERAPY
• 4. For Reinduction
– To treat leukemic cells after
relapse occurs
*Antigout agents: Allopurinol
(Zyloprim) to treat/prevent
hyperuricemic nephropathy
(force fluids)
 Alkylating Meds
• Cell-cycle nonspecific
• Nitrogen Mustards
– Chlorambucil (Leukeran) &
Mechlorethamine (Mustargen):
hyperuricemia
– Cyclophosphamide (Cytoxan): taken
without food, S/E: alopecia, hemorrhagic
cystitis (hematuria, dysuria)
– Ifosfamide (Ifex)
– Melphalan (Alkeran)
– Uracil mustard
 Alkylating Meds
• Nitrosoureas
– Carmustine (BiCNU)
– Lomustine (CeeNU)
– Streptozocin (Zanosar)
• Alkylating-like Meds
– Altretamine (Hexalen)
– Busulfan (Myleran): hyperuricemia
– Cisplatin (Platinol): ototoxicity & nephrotoxicity
(given amifostine [Ethyol] prior to ↓ risk),
hypoK, hypoCa, hypoMg
– Dacarbazine (DTIC-Dome)
– Thiotepa (Thioplex)
Anti-tumor Antibiotics
• Cell-cycle nonspecific
• Bleomycin SO4 (Blenoxane): pulmonary
toxicity
• Dactinomycin (Actinomycin D, Cosmegan)
• Daunorubicin (Cerubidine, DaunoXome):
causes CHF & dysrhythmias
• Doxorubicin (Adriamycin) & Idarubicin
(Idamycin): cardiotoxicity (given Dexraxozane
[Zinecard] to prevent cardiomyopathy)
Anti-tumor Antibiotics
• Mitomycin (Mutamycin)
• Mitoxantrone (Novantrone)
• Pentostatin (Nipent)
• Plicamycin (Mithracin):
affects bleeding time
• Valrubicin (Valstar)
 Antimetabolites
• Cell-cycle phase-specific (S phase)
• Capecitabine (Xeloda)
• Cladribine (Leustatin)
• Cytarabine (ara-C, Cytosar-U):
alopecia, stomatitis, hyperuricemia,
hepatotoxicity
• Floxuridine (FUDR)
• Fludarabine (Fludara)
 Antimetabolites
• Methotrexate (Folex) & 5-Fluorouracil
(Adrucil): alopecia, stomatitis, hyperuricemia,
photosensitivity, hepatotoxicity, hema, GI &
skin toxicity
– Leucovorin rescue (given leucovorin [folinic
acid or citrovorum factor) to prevent toxicity
r/t Methotrexate
• Hydroxyurea (Hydrea)
• 6-Mercaptopurine (Purinethol): hyperuricemia,
hepatotoxicity
• Procarbazine (Matulane)
• Thioguanide
 Mitotic Inhibitors (Vinca
Alkaloids)
• Cell-cycle phase-specific: M phase
• Docetaxel (Taxotere)
• Etoposide (VePesid)
• Teniposide (Vumon)
• Vinblastine SO4 (Velban)
• Vincristine SO4 (Oncovin): neurotoxicity
(numbness & tingling of fingers & toes),
peripheral neuropathy, ptosis
• Vinorelbine (Navelbine)
Immunomodulator Agents
• Stimulate immune system to
recognize CA cells & destroy
them (Interleukins)
• Slow down tumor cell division,
causes CA cells to differentiate
into non-proliferative forms
(Interferons)
 Immunomodulator Agents
• Aldesleukin (Proleukin, Interleukin-2)
• Interferon alfa-2a
• Interferon alfa-2b
• Interferon alfa-n3 (Alferon N)
Levamisole (Ergamisole)
• Recombinant interferon-α (Intron A,
Roferon A)
• Rituximab (Rituxan)
 Colony-Stimulating Factors
• Induce rapid BM recovery after
chemotherapy
• Granulocyte-Macrophage:
Sargramostim (Leukin, Prokine)
• Granulocyte: Filgrastim (Neupogen)
• Erythropoetin: Epoetin alfa (Epogen)
Side Effects:
Chemotherapy
– Stomatitis/Mucositis
– Alopecia
– A/N/V, Diarrhea
– Anemia, Neutropenia,
Thrombocytopenia
– Infertility
– Extravasation/Phlebitis