Cancer Nursing

Cancer
A complex of diseases which occurs when
normal cells mutate into abnormal cells
that take over normal tissue, eventually
harming and destroying the host

Patterns of Cell Proliferation
Neoplasia-uncontrolled cell growth
that follows no physiologic demand
Anaplasia-cells that lack normal
cellular characteristics and differ in
shape and organization
Metaplasia-conversion of one type of
mature cell into another; reversible


Dysplasia-bizarre cell growth resulting in
cells that differ in size, shape or
arrangement from other cells of the same
type.
Hypoplasia-incomplete or
underdevelopment w/ decreased number
of cells
Hyperplasia-Increase in the number of
cells


Epidemiology
Can strike at any age
Men Prostate, Lung and Colon and
rectum
Women Breast, Lung and Colon and
rectum
Etiology
Tobacco
Alcohol
Diet
Reproductive and sexual behavior
Physical and chemical agents
Genetics
Infectious agents
Hormonal agents
BENIGN TUMORS
Suffix- OMA is used
Adipose tissue- LipOMA
Bone- osteOMA
Muscle- myOMA
Blood vessels- angiOMA
Fibrous tissue- fibrOMA
MALIGNANT TUMOR
Named according to embryonic cell origin
1. Ectodermal, Endodermal, Glandular,
Epithelial
Use the suffix- CARCINOMA
Pancreatic AdenoCarcinoma
Squamous cell Carcinoma

MALIGNANT TUMOR
Named according to embryonic cell origin
2. Mesodermal, connective tissue origin
Use the suffix SARCOMA
FibroSarcoma
Myosarcoma
AngioSarcoma
Stages in Carcinogenesis
Initiation
Carcinogens
Promotion
CoCarcinogens
ProCarcinogens
Progression
3 Stages of Metastasis

1. Invasion neoplastic cells from primary tumor
invade into surrounding tissue with penetration
of blood or lymph.

2. Spread tumor cells spread through lymph or
circulation or by direct expansion

3. Establishment and growth tumor cells are
established and grow in secondary site: lymph
nodes or in organs from venous circulation
Comparison of Benign and
Malignant Neoplasms
Benign
Similar to cell of origin
Encapsulated
Compresses
Slow growth rate
Seldom recur after removal
Necrosis and ulceration unusual
Unusual systemic effects
Malignant
Dissimilar from cell of origin
Irregular edges
Invades
Rapid growth rate
Moderate to marked vascularity
Frequently recur after removal
Necrosis and ulceration
Systemic effects
CANCER NURSING
Body Defenses Against TUMOR
1. Cellular Immunity

2. Humoral immunity

3. Natural killer cells

Warning Signs of Cancer
C hange in bowel or bladder habits
A sore that doesnt heal
U nusual bleeding or discharge
T hickening or lump
I ndigestion or dysphagia
O bvious change in a wart or mole
N agging cough or hoarseness
Early Detection
Site:
1. Breast
Gender: Female
Evaluation: 20 39 yrs
CBE every 3 years
SBE every month
Evaluation: >40 yrs
CBE every year
SBE every month

Early Detection
2. Colon
Gender: Male or Female
Evaluation: >50 yrs
FOBT and
Flexible Sigmoidoscopy or every 5 yrs
Colonscopy or every 10 yrs
Barium enema every 5 yrs
3. Prostate
Gender: Male
Evaluation: >50 yrs (40 45 yrs if high risk)
PSE or Digital rectal exam every year
Early Detection
4. Cervix
Gender: Female
Evaluation: >21 years or within 3 years after starting to have intercourse
Pap Test every year if regular pap smear; every 2 years if
liquid pap test
Pelvic Exam every year
5. Cancer related checkups
Gender: Male or Female
Evaluation: >20 39 years
Exams for thyroid, testicles, ovaries, lymph nodes, oral cavity
and skin; counseling health precautions and risk factors every
3 years
Evaluation: >40 years
Same every year
Early Detection
Mammography radiologic study of the
soft tissue of the breast used to evaluate
differences in the density of tissue
especially small or poorly defined masses
or nodules; capable of detecting breast
cancers that are too small to be palpated
on physical examination.
Early Detection
Papanicolau Smear microscopic
examination of the cells collected from
the vaginal pool, exocervix and
endocervix
Digital Rectal Exam done annually on
clients over forty years old
Tumor Markers made by the tumor or
the body in response to the tumor

Tumor Markers
Alpha-fetoprotein (AFP) - liver cancer
(hepatocellular carcinoma), testicular cancers

Bladder tumor antigen (BTA) - bladder cancer

CA 15-3 , CA 27.29- breast cancer

CA 125 - epithelial ovarian cancer
Tumor Markers
Carcinoembryonic antigen (CEA)-colorectal
and liver cancer
Estrogen receptors/progesterone receptors-
breast cancer
Human chorionic gonadotropin (HCG)-
choriocarcinoma,testicular and ovarian
cancers (germ cell tumors)
Prostate-specific antigen (PSA)-prostate
cancer
Early Detection
Nuclear med. Imaging oral/IV
radioisotope followed by imaging
PET scan use of a tracer; B/W or color
coded images
PET fusion PET scan and CT scan in 1
machine to provide an image combining
anatomic detail and functional metabolic
abnormalities
Early Detection
Biopsy Diagnostic surgery; obtain tissue
sample
Incisional Biopsy only part of neoplasm is removed
and examined under microscope
Excisional or Total Biopsy entire tumor is removed
and examined under microscope
Fine Needle Aspiration Biopsy aspiration of
secretions from suspicious nodule and examination
under microscope

*Sentinel Lymph Node Biopsy(SLNB)
Early Detection
Bone Marrow Biopsy done by means of
bone marrow aspiration; uses trocar or bone
marrow needle
Sites of Aspiration:
Sternum
Iliac Crest most common
Tibia
Cancer Classification
Grading

G1 well differentiated
G2 moderately well differentiated
G3 poorly differentiated
G4 very poorly differentiated with high degree
of malignancy

Cancer Classification
Staging

Stage 0 in situ
Stage I limited to tissue of origin; localized
Stage II limited local spread
Stage III extensive local and regional spread
Stage IV metastasis
Staging
TNM Staging provides categorization of
primary lesion and extent of involvement
in the clinical assessment of cancer
T primary tumor extent
N lymph node involvement
M metastasis
Prevention and detection

Primary Prevention
Reducing modifiable risk factors in the
external and internal environment
Secondary Prevention
Recognizing early signs and symptoms and
seeking prompt treatment
Prompt intervention to halt cancerous
process
TREATMENT MODALITIES

Aimed towards:
CURE - free of disease after treatment
normal life
Control - Goal for chronic cancers
Palliative Care: Quality of life maintained
at highest level for the longest possible
time
Cancer Management
1. Surgery
A. Diagnostic biopsy
B. Curative
- Debulking

- Local and Wide Excision

- Video assisted endoscopic surgery

- Electrosurgery

- Cryosurgery

Cancer Management
C. Prophylactic remove pre-cancerous lesion
while it is still harmless and non-malignant

D. Palliative retard growth of tumor; relieve
signs and symptoms of tumor; prevent
complication

E. Reconstructive - indicated of breast, head,
neck and skin cancers

Cancer Management
Radiotherapy to destroy the malignant
tumors using ionizing radiation without
unduly harming surrounding tissues
Interrupts cell growth
Used as a cure to CA of thyroid, hodgkins,
testicular, head, neck, uterine and cervix
As a control if not surgically resectable
Means of Administration
External Radiotherapy skin mark, tattoo,
ports (X marks) to localize the area to be
exposed to external radiation

The higher the energy the deeper the
penetration
External Radiotherapy
X-ray machine
Kilovoltage therapy
Max radiation dose given; for skin and
breast CA
Linear accelerators and Betatron
machines
Deep seated cancer with less harm to skin
External Radiotherapy
Radioisotopes/Gamma Rays
cobalt 60 or cesium 137; Beneath skin
surface

Particle beam radiotherapy or High linear
energy transfer radiation
Accelerates subatomic particles, damages
target cells


Client teaching
1. Wash irradiated area gently with warm
water or mild soap and water
2. Do not remove markings
3. Do not rub area
4. No powders, ointments, lotions, creams
on skin unless prescribed
5. Avoid exposure to sun
Means of Administration
Internal Radiotherapy placement of
especially separated isotopes into the
tumor or systematic circulation
Internal Radiotherapy
Interstitial Therapy
Placed in beads, seeds, needles, catheter and ribbons
implanted in tumor
Eg. Cobalt 60, Iodine 125, Tantalium 182

Intracavity Isotope Therapy
To treat gynecological CAs

Oral
Isotope iodine 131 for thyroid CAs
Effects of Radiation
Lethal tumor dose
A dose that will eradicate 95% of tumor yet
preserve normal tissue
Fractionated doses for tissues that proliferate
rapidly
Care of client with sealed radiation
No children or pregnant
Staff wear dosimeter badges; no pregnant staff
Signs/notice at door
At least 6 feet from the source
30 mins per shift

For intracavitary radiation
- bed rest and logrolled
- indwelling catheter
- antidiarrheal drugs and low residue diets
Toxic Effects of Radiation
Bone marrow depression
Deficiency of essential blood component
leading to anemia, leukopenia,
thrombocytopenia
Bone Marrow Depression
Nursing Assessment:
Weakness, pallor, easy fatigability
Susceptibility to infection
Bleeding
Bone Marrow Depression
Nursing Interventions:
Vital signs especially temperature
CBC monitoring
Observe signs and symptoms of infection
Good oral hygiene-prevent gum bleeding;
use soft-bristle toothbrush or non-sting
mouthwash
Basic Factors in Radiation
Protection
Distance
Greater distance from source, less exposure
At least 6 feet
Time
Less time spent close to pt, less exposure
Shielding
Use appropriate materials to halt and absorb
rays of radiant energy
Lead shield x-ray and gamma rays

Cancer Management
Chemotherapy
Use of combination chemotherapeutic agents
to cure or palliate cancer or as an adjuvant
therapy to surgery or radiotherapy
Primarily to treat systemic disease

The Cell Cycle
1. G1 phase
2. S phase
3. G2 phase
4. Mitosis
G0 phase
Classification of
Chemotherapeutic Drugs
Alkylating agents alter DNA structure by
preventing DNA replication and
transcription of RNA

Eg. Cytoxan, Myeleran, Leukeran, Mustargen,
Platinol




Busulfan ( Myleran) may cause
hyperuricemia

Chlorambucil (Leukeran) may cause gonadal
suppression and hyperuricemia

Cisplatin (Platinol) may cause ototoxicity,
tinnitus hypokalemia, hypocalcemia,
hypomagnesemia and nephrotoxicity
(AMIFOSTINE)

Cyclophosphamide ( Cytoxan) may cause
hemorrhagic cystitis and hematuria

Classification of
Chemotherapeutic Drugs
Antimetabolites foster CA cell death by
interfering cell metabolism, interfere with
the biosynthesis of nucleic acids necessary
for RNA and DNA synthesis
Eg. Methotrexate (MTX), 5 FU Fluoracil,
Thioguan, Purinethol, Cytosan-U, Floxuriding
(FUDR)
Cytarabine causes alopecia, stomatitis,
hyperuricemia and hepatotoxicity

5FU- phototoxicity reactions and cerebellar
dysfunction

Methotrexate- alopecia, stomatitis, diarrhea,
hematological, gastrointestinal and skin toxicity

(LEUCOVORIN)

Classification of
Chemotherapeutic Drugs
Mitotic spindle poisons
A. Plant alkaloids make body less favorable
for growth of Ca cells
Eg. Vincristin (Oncovin), Vinblastine (Velban)

B. Taxanes arrest M phase by tubulin
depolymerization
- Eg. Paclitaxel, docetaxel
Classification of
Chemotherapeutic Drugs
Steroids and sex hormones alter the
endocrine environment to make it less
conducive to growth of cancer cells
Eg. Diethylstilbesterol, Androgen, Estrogen,
Antiestrogen, Progestin, Anticortical
Compounds, Antiadrenal
Classification of
Chemotherapeutic Drugs
Antitumor antibiotics affect RNA to make
environment less favorable for Ca growth
E. Adriamycin, Blenoxane, Cosmegen,
Cerubidine, Mithramycin, Mutamycin,
Novantrone
Mithramycin- known to cause problems in
bleeding time
Bleomycin- Pulmonary toxicity
Daunorobicin- May cause congestive heart
failure

Classification of
Chemotherapeutic Drugs
Nitrosureas similar to alkylating agents;
can cross blood-brain barrier (used in
brain affectations)
Eg. Semustine, Lomustine, Carmustine
Topoisomerase I inhibitors DNA binds to
enzyme topoisomerase preventing cell
from dividing
Eg. Irinotecan, topotecan
Methods of Administration
Oral pill or liquid
Subcutaneous injection
through automatic syringe or subcutaneous
injection pump
Intravenous
Vesicants cause soft tissue necrosis
Eg. Nitrogen mustard, Vinblastine, Vincristine
Methods of Administration
Intra-arterial perfusion implantable or portable
infusion pump

Intrathecal administration
Ommaya reservoir mushroom shaped self sealing
silicone dome with catheter attached to lateral
ventricles reservoir-burrhole on scalp flap
Methods of Administration
Vascular access devices
Use of dacron graft into the vein

Intraperitoneal
Tenchoff catherter into abdominal cavity
Eg. Cancer of liver, ovary, colon and rectum
Side Effects and Nursing
Interventions
GI system
Nausea and vomiting
Antiemetics 30-60 mins before and 12-24 hours
after (Metocholopramide, Plasil or Tigan)
Bland foods in small amounts after treatment
Diarrhea
Antidiarrheal drugs
Clearliquid if tolerated
Good perineal care
Monitor K, Na and Cl levels

Side Effects and Nursing
Interventions
Stomatitis
Good oral hygiene avoid commercial mouth wash
NaHCO3 mouthwash for mouth sores
Gargling rinse with water and diluted hydrogen
peroxide after meals
KY jelly to cracked lips
Suck popsicles
Side Effects and Nursing
Interventions
Hematologic system
Thrombocytopenia epistasis, petechiae,
ecchymosis
Avoid bumps or bruise of skin
Protect from physical injury
Avoid aspirin and aspirin products
Avoid IM injection
Monitor platelet count

(EXTRAVASATON)
Side Effects and Nursing
Interventions
Leukopenia
Hand washing, reverse isolation
Note signs and symptoms of respiratory infection
Avoid crowd or persons with infection
Anemia
Adequate rest period
H and H monitoring
O
2
PRN
Side Effects and Nursing
Interventions
Integumentary
Alopecia temporary
Wig during treatment
Hair grows back several months after treatment
Renal

-Check renal function test

-Control proper diet

-Have the correct pH of the urine

Administer correct medication

Bone Marrow Transplantation
Process of obtaining donor cells
traditionally harvested for bone marrow
tissue under general anesthesia

PBSCT
Uses apheresis of the donor to collect
peripheral blood stem cells for reinfusion
Bone Marrow Transplantation
Types:
Allogeneic
Autologous
Syngeneic
Bone Marrow Transplantation
Nursing Management
Pretransplantation care
During treatment:
Monitor VS
O2 sat
Assess for adverse/transfusion reactions, bleeding,
infections, renal and pulmonary complications,
GVHD
Post transplantation care

Hyperthermia (Thermal therapy)
Generation of temperature greater than
41.5C to destroy tumors
Stimulates immune system
Produced by radiowaves, ultrasound,
microwaves, magnetic waves, hot water
baths
Targeted therapies
BRM uses naturally or recombinant
agents that alter immunologic relationship
between the tumor and the cancer patient
Nonspecific BRM BCG

Targeted therapies
MoAbs
Tumor cells injected to mice act as antigens
Antibodies respond and are found at the
spleen
Spleen cells + Cancer cells = Hybridomas
Placed in a culture medium to grow then
harvested, purified and prepared for
diagnostic or treatment purposes
Targeted therapies
Cytokines
Substances produced by cells of the immune
system to enhance production and functioning
of the immune system
Interferons
Interleukins
Hematopoietic Growth factors
Targeted therapies
Retinoids

Cancer vaccines
Autologous
Allogeneic
Prophylactic
Therapeutic
Targeted therapies
Gene Therapy
Manipulate genes to induce tumor cell
destruction
Tumor directed therapy
Active immunotherapy
Adoptive immunotherapy
Growth factors
Inhibits growth factor and promotes apoptosis
Bortezomib, Gefitinib

Phototherapy
Selective cytotoxicity with minimal
destruction to normal tissues
Porfimer (Photofrin)
Major SE happens after 4 6 weeks of
treatment

PARTICULAR
CANCERS
Leukemia
Group of hematological malignancies
Overproduction of leukocytes, usually at
early stages
Classifications:
Acute and Chronic Lymphocytic Leukemia
Acute and Chronic Myelogenous Leukemia
Leukemia
Assessment
Anemia
Bleeding
Elevated temperature
Enlarged lymph nodes, spleen and liver
Pallor
Palpitations
Bone pain and joint swelling
Normal, elevated to reduced WBC count
Positive bone marrow biopsy identifying leukemic
blast phase cells
AML
Defect in the Myeloid cells
Affects all age groups
Fever, Infection, Weakness, Fatigue, and
Bleeding
Diagnosis: CBC and Bone marrow analysis

Management
Induction therapy
Cytarabine and Daunorubicin or Mitoxantrone or
Idarubicin, sometimes Etoposide
Consolidation therapy
Blood products
GCSF or GMCSF
BMT or PBSCT

CML
Pathologic increase in the production of
forms of blasts cells
BCR-ABL gene
Uncommon in people younger than 20
years
3 stages: chronic, transformation and
accelerated
Management
Tyrosine kinase inhibitor
Imatinib mesylate (Gleevec)
Interferon alfa (Roferon A) and Cytosine
Oral Chemo
Hydroxyurea or Busulfan
Leukapheresis
Anthracycline chemo
Daunomycin


ALL
Uncontrolled proliferation of lymphoblasts
B Lymphocytes 75%, T Lymphocytes
25%
Most common in young children
BCR ABL gene in 20% of cases
CNS involvement
Management
Induction therapy
Corticosteroids and Vinca Alkaloids
Intrathecal Methotrexate
Imatinib
Alemtuzumab (Campath)


CLL
Common malignancy of older adults
Malignant clone of B Lymphocyte
Prevalent antigen CD52
B symptoms

Management
Chemo with Fludarabine or Corticosteroids
and Chlorambucil
Rituximab and Alemtuzumab
Leukemia
Management
Infection
Bleeding
Fatigue and Nutrition
Chemotherapy
Induction
Consolidation
Maintenance
Management of infection
1. Protective/Reverse isolation precaution
2. Hand hygiene
3. Limit visitors/ Staff entering the room
4. Strict aseptic technique for all procedures
5. Give private room with door closed
6. Avoid fresh fruits, flowers and standing water
in room
7. Avoid receiving immunization with live virus
Management for bleeding
1. < 50,000/mm3 increase risk for bleed <
20,000/mm3 spontaneous bleed occurs
2. Platelet transfusions
3. Avoid injections
4. Pad side rails
5. Avoid rectal temp and exams
6. Use soft bristled toothbrush and avoid flossing
7. Use electric razor
8. Avoid NSAIDS
9. Avoid blowing nose


Hodgkins Disease
Abnormal proliferation of lymphocytes
Characterized by presence of Reed
Sternberg cells in the nodes
Associated with viral infections
Hodgkins Disease
Assessment
B Symptoms
Malaise, fatigue and weakness
Anemia and thrombocytopenia
Enlarged lymph nodes, spleen and liver
Hodgkins Disease
Staging
Stage 1 Involvement of a single LN
region/extralymphatic organ or site
Stage 2 Involvement of 2 or more LN regions on
same side of the diaphragm or localized
extralymphatic organ or site
Stage 3 Involvement of LN regions on both sides of
the diaphragm
Stage 4 Disseminated involvement of 1 or more
extralymphatic organs with or w/o associated LN
involvement
Hodgkins Disease
Management
External radiation stage 1 and 2
Monitor for signs of infection and bleeding
Multiple Myeloma
Abnormal proliferation of plasma cells with
the bone
Unknown cause
The abnormal plasma cells produce
abnormal antibody
Multiple Myeloma
Assessment
Bone pain in the ribs, spine and pelvis
Osteoporosis
Anemia, thrombocytopenia and leukopenia
Elevated calcium and uric acid levels
Spinal cord compression
Renal failure



Diagnostic Exams:
1. Bence Jones Urine Test detects abnormal
globulin in the urine
2. Xray or Bone scan establishes the degree
of bone involvement
3. Bone marrow aspiration detects number of
plasma cell in the bone marrow
Multiple Myeloma
Management
Chemotherapy
Infection and bleeding precautions
2 3 L fluids per day
Encourage ambulation
Skeletal support
Analgesics
IV fluids and diuretics
Administer Pamidronate disodium(aredia) and
Zoledronic acid(Zometa)
Testicular Cancer
Often occurs between 15 40 yrs
Unknown cause; associated with history
of undescended testicle and thru
genetics
Types:
A. Germinal tumors
B. Nongerminal tumors

Testicular Cancer
Assessment
Painless testicular swelling
Dragging or pulling sensation
Palpable lymphadenopathy
Late: Back or bone pain
Testicular Cancer
Management:
Chemo and radiation
Reproductive options
Surgery:
Unilateral of radical Ochiectomy

Cervical Cancer
Preinvasive cancers
Stage 1 Mild dysplasia
Stage 2 Moderate dysplasia
Stage 3 Severe dysplasia to carcinoma in situ

Cervical Cancer
Risk factors
HPV infection
Smoking
Early first intercourse, multiple sex partners or
male partners with multiple sex partners

Cervical Cancer
Assessment
Painless vaginal postmenstrual and postcoital
bleeding
Foul smelling or serosanguinous vaginal
discharge
Pelvic, lower back, leg or groin pain
Anorexia and weight loss
Dysuria and hematuria

Cervical Cancer
Management
Nonsurgical
Chemotherapy
Cryosurgery
External radiation
Internal radiation implants (intracavitary)
Laser therapy
Surgical
Conization
Hysterectomy
Pelvic exenteration
OVARIAN CANCER
OVARIAN CANCER
Diagnostic exams
Pelvic Exam
Ultrasound
CA-125 assay
Lower GI series or Barium enema
CT Scan
Biopsy
OVARIAN CANCER
Assessment
GI disturbances
Pelvic pressure
Leg pain and pelvic pain
Slight anorexia
Dysfunctional vaginal bleeding
Management
Total hysterectomy
Bilateral salpingo-oophorectomy
Radiation therapy
Chemotherapy
Cyclophosphamide
Doxurubicin
Cisplastin
Carboplastin

Nursing Intervention
Administer intravenous therapy to alleviate fluid
and electrolyte imbalances
Provide adequate nutrition
Provide pain relief and managing drainage tubes
Provide small frequent meals
Provide quite environment

UTERINE CANCER

UTERINE CANCER
Risk factors:
Family history of uterine or colon CA
Age : at least 55 years; median age 65
years
Postmenopausal bleeding/Late menopause
Obesity
Unopposed estrogen therapy(ERT)
Polycystic ovary disease
Nulliparity

UTERINE CANCER
Assessment
Abnormal uterine/vaginal bleeding or
discharge
Low back or abdominal pain
Enlarged uterus


Managements
Total hysterectomy
Bilateral salpingo-oophorectomy
Radiation therapy
Chemotherapy
Progestational therapy
Tamoxifen
Bilateral Salpingo-Oophorectomy
Nursing Interventions
Institute routine pre and post-op care
Assess for hemorrhage, infection or other
post surgical complications
Support woman and family through
procedure encourage expression of
feelings and reactions to procedure
Allow woman to verbalize concerns about
sexuality post surgery
Maintain the patient on low residue diet
to prevent bowel movements which
might dislodge apparatus

BREAST CANCER

Breast Cancer
Types:
A. Ductal Carcinoma In Situ
B. Invasive
1. Infiltrating Ductal
2. Infiltrating Lobular
3. Medullary
4. Mucinous
5. Tubular ductal
6. Inflammatory
7. Pagets disease
ETIOLOGY
- Unknown, but areas under investigation
includes:
Smoking
Age
Family history
Early menarche
Late menopause
Nulliparous or first child after age 34
High fat
Use of oral contraceptive
Breast Cancer
Assessment
Mass the most common location is the upper outer
quadrant (UOQ)
Mass is NON-tender. Fixed, hard with irregular
borders
Skin dimpling
Nipple retraction
Peau d orange
Lymphedema
Asymmetry
Nipple discharges
Breast Cancer
Diagnostic exam
Biopsy procedure
Mammography
Breast Cancer
Management
Tamoxifen therapy blocks estrogen
receptor sites
Radiation therapy
Breast Cancer
Surgical Management
Radical Mastectomy removal of tumor, pect.
Major, pect. Minor + LN
Modified Radical Mastectomy pect. Minor
remains, removal of tumor, pect. major + LN
(most commonly done)
Lumpectomy
Quadrantectomy
Radical Mastectomy
LUMPECTOMY
QUADRANTECTOMY
NURSING INTERVENTION
POST-OP
Position patient
Supine
Affected extremity elevated to reduce edema
Relieve pain and discomfort
Moderate elevation of extremity
IM/IV injection meds
Warm shower on 2nd post-op
Maintain skin integrity
Immediate post-op, snug dressing with drainage
Maintain patency of drain
Monitor for hematoma with in 12 hour and apply bandage and
ice refer to surgeon
Drainage is removed when the discharge is less than 30 ml in
24 hour, inform the doctor to remove JP
Lotions, creams are applied only when the incision is healed in
4-6 weeks
NURSING INTERVENTION
Promote activity
Support operative site when moving
Hand, shoulder exercise done on 2nd day
Post-op mastectomy exercise 20 minutes TID
No BP or Iv procedure on the operative side
Heavy lifting is avoided
Elevate the arm at the level of the heart
On a pillow for 45 minutes TID to relieve transient edema
Gardening is prohibited
Arm > elbow
Elbow > shoulder

LUNG CANCER
Rapid growth of abnormal cells in the
lungs
Caused by smoking, second smoke,
exposure to harmful substance such
as arsenic, asbestos, radioactive
dust, or radon
LUNG CANCER

LUNG CANCER

Lung Cancer
Types:
a. Small cell lung cancer
- less common but they grow more quickly and are more
likely to metastasize

b. Non-small cell lung cancer
1. Adenocarcinoma
- most common type of lung cancer
2. Squamous cell carcinoma
- second most common type of lung cancer
3. Large cell anaplastic
ASSESSMENT FINDINGS
1.Persistent cough (productive) with hemoptysis
2.Chest pain
3.Dyspnea
4.Unilateral wheezing
5.Friction rub
6.Possible paralysis of the diaphragm
7.Fatigue
8.Anorexia
9.Nausea and vomiting
10.Pallor

Diagnostic tests

1. Chest X-ray may show presence of tumor
or evidence of metastasis to surrounding
structures
2. Sputum or cytology reveals malignant cell
3. Bronchoscopy: biopsy reveals malignancy
4. Thoracentesis: pleural fluid contains
malignant cells

MEDICAL MANAGEMENT
Radiation therapy
Chemotherapy
Laser therapy
Surgery
Thoracotomy with
Pneumonectomy
Lobectomy
Segmental resection
Surgical Procedures

Surgical Procedures

NURSING INTERVENTIONS
Provide support and guidance to the client as needed
Provide relief/control pain
Administer medications as ordered and monitor
effects/side effects
Control nausea: administer medications as ordered,
provide oral hygiene, provide small and more
frequent feedings
Provide nursing care for a client with thoracotomy
Provide client teaching and discharge planning
concerning
Disease process, diagnostic and therapeutic
interventions
Side effects of radiation and chemotherapy
Realistic information about prognosis
Laryngeal Cancer
Is a malignant tumor in the larynx (voice
box ), potentially curable if detected early

Less than 1% of all cancers, common in
men than in women ages 50-70 years of
age.

Occurs in : glottic area, supraglottic area,
subglottic area

Laryngeal Cancer

Laryngeal Cancer
Risk factors:
Carcinogens:
- tobacco together with alcohol
- asbestos
- paint fumes
- wood dust
- chemicals
Exposure to radiation
Straining the voice
Chronic laryngitis


Laryngeal Cancer
Assessment
Persistent hoarseness
Change quality of voice
Cough or sore throat
A lump felt on the neck
Dysphagia, dyspnea
Pain radiating to the ear
Weight loss
Hemoptysis
Foul breath odor
Laryngeal Cancer
Diagnostic test
History, Physical Assessment
Laryngoscopy
Biopsy
CT
MRI
PET

Indirect Laryngoscopy
Management
Surgery
Cordal Stripping
Cordectomy
Partial Laryngectomy
Total Laryngectomy
Radiation therapy
Chemotherapy
Speech therapy
Esophageal speech
Mechanical devices
Tracheoesophageal fistula

Surgical Management
Laryngectomy- surgical removal of
part of all of the larynx and
surrounding structures
Partial laryngectomy
Total laryngectomy

Surgical Procedure
Nursing Interventions

Reducing anxiety and depression
Maintaining a patent airway
Promoting alternative communication methods
Adequate nutrition
Promoting positive body image and self-esteem
High fowlers position
Perform tracheostomy care
Monitor signs of aspiration
Assess gag reflex
Assess for hemorrhage and edema in neck


COLORECTAL CANCER
Etiology
Family history of polyposis and Ovarian
and Breast CA
Age above 50 years
Chronic inflammatory bowel disease
Polyps
Low fiber diet

Clinical Manifestation
Change in bowel habits
Passage of blood in stools
Unexplained anemia
Anorexia,
Weight loss
Fatigue
Diarrhea or Constipation

Diagnosis

Fecal occult blood test
Fiber optic sigmoidoscopy
Biopsy
Colonoscopy
Barium enema
Colonoscopy
Colorectal Cancer
Staging: Dukes Classification Modified
Class A: limited to muscular mucosa and submucosa
Class B1: extends into mucosa
Class B2: extends through entire bowel wall into
serosa or pericolic fat, no nodal involvement
Class C1: (+)nodes, limited to bowel wall
Class C2: (+)nodes, extends through entire bowel
wall
Class D: Advanced and with metastasis
Management
Chemotherapy
Adjuvant Therapy
Radiation therapy
Segmental resection with anastomosis
Abdomino perineal traction with sigmoid
colostomy
Ileostomy
SURGICAL MANAGEMENT
Surgery is the primary treatment
Based on location and tumor size
Resection, anastomosis, and colostomy
(temporary or permanent)

NURSING INTERVENTION: COLOSTOMY
Colostomy begins to function 3-6 days
after surgery
The drainage maybe soft/mushy or semi-
solid depending on the site
Gastric Cancer
Most often develops the distal third and may
spread thru the walls of the stomach into
adjacent tissues, lymphatics and abdominal
organs

Men have higher incidence of gastric cancer
than women
Gastric Cancer
Clinical Manifestations
Early
Indigestion or burning sensation
Epigastric, back or retrosternal pain
Full feeling

Late
Nausea and vomiting
Weight loss and Anorexia
Weakness and fatigue
Dysphagia
Iron deficiency anemia
Palpable epigastric mass

Management
Chemotherapy
Radiation therapy
Pharmacologic drugs
Cisplastin
Irinotecan
Doxorubicin
Xeloda
Management
Surgery
Subtotal Gastrectomy
Billroth I
Billroth II

Total Gastrectomy

Nursing Intervention
Encourage the family to support the patient
Offer reassurance and support coping
measures
NPO until peristalsis
Do not remove or irrigate NGT w/o orders
Monitor IV therapy
Record intake and output
Monitor daily weights
Assess for signs of dehydration

LIVER CANCER
Hepatic tumors may be malignant or benign.
Benign liver tumors were uncommon until the
wide spread use of oral contraceptives. Primary
liver tumors are associated with chronic liver
diseases Hepatitis B and C infection and
Cirrhosis.
LIVER CANCER
Clinical Manifestation
Weakness
Anemia
Weight loss
Anorexia
Nausea and vomiting
Right upper quadrant discomfort
Blood tinged ascites
Friction rub over liver
Jaundice
Diagnostic Exams
Increase serum levels of bilirubin
Alkaline phosphatase
Lactic dehydrogenase
AST
GGT
AFP
CEA
Management
Chemotherapy
Percutaneous biliary drainage
Lobectomy
Radiation therapy
WILMS TUMOR
Is a malignant tumor that rises from the
metanephric mesoderm cell of the upper role of
the kidney.
Also known as Nephroblastoma
Wilms tumor
Assessment
Nephroblastoma is usually discovered
early in life (6 mos to 5 yr; peak at 3 to 4yr)
Although it apparently arises from an
embryonic structure present in child before
birth. Nephroblastoma may manifest w/
hematuria and low grade fever occurs
between of renin production
Assessment
Mass is firm, non tender, confined to 1
side and deep within the flank
Abdominal pain
Urinary retention
Anemia
Pallor
Anorexia
HPN
Management
Surgery
Total Nephrectomy
Partial Nephrectomy
Chemotherapy with or without Radiation
Nephrectomy
STAGING NEPHROBLASTOMA
I - tumor confined to the kidney and
completely removes surgically.
II - tumor extending beyond the kidney but
completely removes surgically.
III - Regional spread of the diseases beyond
the kidney w/ residual abdominal dse.
Post operative.
IV - metastases to lung, liver, bone distance
lymph nodes or other distance sites
V - Bilateral diseases.
Nursing Intervention
Monitor BP
Avoid palpation of the abdomen
Place sign at door: Do not palpate
abdomen
PROSTATE CANCER
The most common cancer in the men other than
non melanoma skin cancer
Second most common cause of cancer death in
American men older than 55 y/o
It is estimated that 189,000 new cases of
prostate cancer and 30,200 death occurs
annually
Increase risk prostate cancer only 47 % of the
men in sample who were 40 y/o or Older had
prostate cancer screening as part of annual
physical examination.



PROSTATE CANCER
PROSTATE CANCER
PROSTATE CANCER
Risk Factors
Increasing age rapidly with the age of 50
years.
Familial predisposition
Diet high in red meat and fat increase
Heavy metal exposure
Smoking
History of STDs

Clinical Manifestations
Difficulty and frequency of urination
Decrease size and force of urinary
stream
Painful ejaculation
Hematuria
Hard pea sized nodule
Late signs:
Weight loss, urinary obstruction, bone pain
radiating to lumbosacral area to legs

Management
1. Hormone manipulation therapy
A. Luteinizing hormone
B. Estrogen

2. For advance stages:
a. Pain meds
b. Radiation therapy
c. Corticosteriods

Management
3. Surgery:
A. Orchiectomy(Palliative)
B. Radical Prostatectomy removal of PG
1. Suprapubic
2. Retropubic
3. Perineal
NURSING INTERVENTION
Reducing anxiety
Relieving discomfort
Providing instruction
Preparing patient
Maintaining fluid balance
Relieving pain
Monitoring for hemorrhage and infection