Oncology Nursing

Nurse Licensure
Examination Review
 Oncology defined

Branch of medicine that

deals with the study,
detection, treatment and
management of cancer and
neoplasia
 “Root words”
Neo- new
Plasia- growth
Plasm- substance
Trophy- size
+Oma- tumor
Statis- location
 “Root words”
A- none
Ana- lack
Hyper- excessive
Meta- change
Dys- bad, deranged
 Characteristics of
Neoplasia
Uncontrolled growth of Abnormal cells
1. Benign
2. Malignant
3. Borderline
 Characteristics of
Neoplasia
BENIGN
Well-differentiated
Slow growth
Encapsulated
Non-invasive
Does NOT metastasize
 Characteristics of
Neoplasia
MALIGNANT
Undifferentiated
Erratic and Uncontrolled Growth
Expansive and Invasive
Secretes abnormal proteins
METASTASIZES
 Nomenclature of
Neoplasia
Tumor is named according to:
1. Parenchyma, Organ or Cell
Hepatoma- liver
Osteoma- bone
Myoma- muscle
 Nomenclature of
Neoplasia
Tumor is named according to:
2. Pattern and Structure, either GROSS
or MICROSCOPIC
Fluid-filled CYST
Glandular ADENO
Finger-like PAPILLO
Stalk POLYP
 Nomenclature of
Neoplasia
Tumor is named according to:
3. Embryonic origin
Ectoderm ( usually gives rise to
epithelium)
Endoderm (usually gives rise to glands)
Mesoderm (usually gives rise to
Connective tissues)
 BENIGN TUMORS
Suffix- “OMA” is used
Adipose tissue- LipOMA
Bone- osteOMA
Muscle- myOMA
Blood vessels- angiOMA
Fibrous tissue- fibrOMA
 MALIGNANT TUMOR
Named according to embryonic cell
origin
1. Ectodermal, Endodermal, Glandular,
Epithelial
Use the suffix- “CARCINOMA”
Pancreatic AdenoCarcinoma
Squamos cell Carcinoma
 MALIGNANT TUMOR
Named according to embryonic cell
origin
2. Mesodermal, connective tissue origin
Use the suffix “SARCOMA
FibroSarcoma
Myosarcoma
AngioSarcoma
 “PASAWAY”
1. “OMA” but Malignant
 HepatOMA, lymphOMA, gliOMA,
melanOMA
2. THREE germ layers
 “TERATOMA”

3. Non-neoplastic but “OMA”

 Choristoma

 Hamatoma
 CANCER NURSING
Review of Normal Cell Cycle
3 types of cells
1. PERMANENT cells- out of the cell cycle
 Neurons, cardiac muscle cell
2. STABLE cells- Dormant/Resting (G0)
 Liver, kidney
3. LABILE cells- continuously dividing
 GIT cells, Skin, endometrium , Blood cells
 CANCER NURSING
Cell Cycle
G0------------------G1SG2M
G0- Dormant or resting
G1- normal cell activities
S- DNA Synthesis
G2- pre-mitotic, synthesis of proteins for
cellular division
M- Mitotic phase (I-P-M-A-T)
 CANCER NURSING
Proposed Molecular cause of CANCER:
Change in the DNA structure altered
DNA function Cellular aberration
 cellular death
 neoplastic change
Genes in the DNA- “proto-oncogene”
And “anti-oncogene”
 CANCER NURSING
Etiology of cancer
1. PHYSICAL AGENTS
Radiation
Exposure to irritants
Exposure to sunlight
Altitude, humidity
 CANCER NURSING
Etiology of cancer
2. CHEMICAL AGENTS
Smoking
Dietary ingredients
Drugs
 CANCER NURSING
Etiology of cancer
3. Genetics and Family History
Colon Cancer
Premenopausal breast cancer
 CANCER NURSING
Etiology of cancer
4. Dietary Habits
 Low-Fiber
 High-fat
 Processed foods
 alcohol
 CANCER NURSING
Etiology of cancer
5. Viruses and Bacteria
DNA viruses- HepaB, Herpes, EBV,
CMV, Papilloma Virus
RNA Viruses- HIV, HTCLV
Bacterium- H. pylori
 CANCER NURSING
Etiology of cancer
6. Hormonal agents
DES
OCP especially estrogen
 CANCER NURSING
Etiology of cancer
7. Immune Disease
AIDS
 CANCER NURSING
CARCINOGENSIS
Malignant transformation
IPP
Initiation
Promotion
Progression
 CANCER NURSING
CARCINOGENSIS
INITIATION
Carcinogens alter the DNA of the cell
Cell will either die or repair
 CANCER NURSING
CARCINOGENSIS
PROMOTION
Repeated exposure to carcinogens
Abnormal gene will express
Latent period
 CANCER NURSING
CARCINOGENSIS
PROGRESSION
Irreversible period
Cells undergo NEOPLASTIC
transformation then malignancy
 CANCER NURSING
Spread of Cancer
1. LYMPHATIC
 Most common
2. HEMATOGENOUS
 Blood-borne, commonly to Liver and Lungs
3. DIRECT SPREAD
 Seeding of tumors
 CANCER NURSING
Body Defenses Against TUMOR
1. T cell System/ Cellular Immunity
 Cytotoxic T cells kill tumor cells
2. B cell System/ Humoral immunity
B cells can produce antibody
3. Phagocytic cells
 Macrophages can engulf cancer cell debris
 CANCER NURSING
Cancer Diagnosis
1. BIOPSY
 The most definitive
2. CT, MRI
3. Tumor Markers
 CANCER NURSING
Cancer Grading
The degree of DIFFERENTIATION
Grade 1- Low grade
Grade 4- high grade
 CANCER NURSING
Cancer Staging
1. Uses the T-N-M staging system
T- tumor
N- Node
M- Metastasis
2. Stage 1 to Stage 4
 CANCER NURSING
GENERAL MEDICAL MANAGEMENT
1. Surgery- cure, control, palliate
2. Chemotherapy
3. Radiation therapy
4. Immunotherapy
5. Bone Marrow Transplant
 CANCER NURSING
GENERAL Promotive and Preventive
Nursing Management
1. Lifestyle Modification
2. Nutritional management
3. Screening
4. Early detection
 SCREENING
1. Male and female- Occult Blood, CXR,
and DRE
2. Female- SBE, CBE, Mammography
and Pap’s Smear
3. Male- DRE for prostate, Testicular
self-exam
 Nursing Assessment
Utilize the ACS 7 Warning Signals
CAUTION
C- Change in bowel/bladder habits
A- A sore that does not heal
U- Unusual bleeding
T- Thickening or lump in the breast
I- Indigestion
O- Obvious change in warts
N- Nagging cough and hoarseness
 Nursing Assessment
Weight loss
Frequent infection
Skin problems
Pain
Hair Loss
Fatigue
Disturbance in body image/ depression
 Nursing Intervention
MAINTAIN TISSUE INTEGRITY
Handle skin gently
Do NOT rub affected area
Lotion may be applied
Wash skin only with SOAP and Water
 Nursing Intervention
MANAGEMENT OF STOMATITIS
Use soft-bristled toothbrush
Oral rinses with saline gargles/ tap
water
Avoid ALCOHOL-based rinses
 Nursing Intervention
 MANAGEMENT OF ALOPECIA
Alopecia begins within 2 weeks of therapy
 Regrowth within 8 weeks of termination
 Encourage to acquire wig before hair loss
occurs
 Encourage use of attractive scarves and hats
 Provide information that hair loss is
temporary BUT anticipate change in texture
and color
 Nursing Intervention
 PROMOTE NUTRITION
 Serve food in ways to make it appealing
 Consider patient’s preferences
 Provide small frequent meals
 Avoids giving fluids while eating
 Oral hygiene PRIOR to mealtime
 Vitamin supplements
 Nursing Intervention
 RELIEVE PAIN
 Mild pain- NSAIDS
Moderate pain- Weak opiods
 Severe pain- Morphine
 Administer analgesics round the clock
with additional dose for breakthrough
pain
 Nursing Intervention
 DECREASE FATIGUE
 Plan daily activities to allow alternating
rest periods
 Light exercise is encouraged
 Small frequent meals
 Nursing Intervention
 IMPROVE BODY IMAGE
 Therapeutic communication is essential
 Encourage independence in self-care
and decision making
 Offer cosmetic material like make-up
and wigs
 Nursing Intervention
 ASSIST IN THE GRIEVING PROCESS
 Some cancers are curable
 Grieving can be due to loss of health,
income, sexuality, and body image
 Answer and clarify information about
cancer and treatment options
 Identify resource people
 Refer to support groups
 Nursing Intervention
 MANAGE COMPLICATION: INFECTION
 Fever is the most important sign (38.3)
 Administer prescribed antibiotics X 2weeks
 Maintain aseptic technique
 Avoid exposure to crowds
 Avoid giving fresh fruits and veggie
 Handwashing
 Avoid frequent invasive procedures
 Nursing Intervention
 MANAGE COMPLICATION: Septic
shock
 Monitor VS, BP, temp
 Administer IV antibiotics
 Administer supplemental O2
 Nursing Intervention
MANAGE COMPLICATION: Bleeding
Thrombocytopenia (<100,000) is the
most common cause
<20, 000 spontaneous bleeding
Use soft toothbrush
Use electric razor
Avoid frequent IM, IV, rectal and
catheterization
Soft foods and stool softeners
Colon cancer
 COLON CANCER
Risk factors
1. Increasing age
2. Family history
3. Previous colon CA or polyps
4. History of IBD
5. High fat, High protein, LOW fiber
6. Breast Ca and Genital Ca
 COLON CANCER
Sigmoid colon is the most common site
Predominantly adenocarcinoma
If early 90% survival
34 % diagnosed early
66% late diagnosis
 COLON CANCER
PATHOPHYSIOLOGY
Benign neoplasm DNA alteration
malignant transformation malignant
neoplasm  cancer growth and
invasion  metastasis (liver)
 COLON CANCER
ASSESSMENT FINDINGS
1. Change in bowel habits- Most common
2. Blood in the stool
3. Anemia
4. Anorexia and weight loss
5. Fatigue
6. Rectal lesions- tenesmus, alternating D
and C
 Colon cancer
Diagnostic findings
1. Fecal occult blood
2. Sigmoidoscopy and colonoscopy
3. BIOPSY
4. CEA- carcino-embryonic antigen
 Colon cancer
Complications of colorectal CA
1. Obstruction
2. Hemorrhage
3. Peritonitis
4. Sepsis
 Colon cancer
MEDICAL MANAGEMENT
1. Chemotherapy- 5-FU
2. Radiation therapy
 Colon cancer
SURGICAL MANAGEMENT
Surgery is the primary treatment
Based on location and tumor size
Resection, anastomosis, and colostomy
(temporary or permanent)
 Colon cancer
NURSING INTERVENTION
Pre-Operative care
1. Provide HIGH protein, HIGH calorie
and LOW residue diet
2.Provide information about post-op
care and stoma care
3. Administer antibiotics 1 day prior
 Colon cancer
NURSING INTERVENTION
Pre-Operative care
4. Enema or colonic irrigation the
evening and the morning of surgery
5. NGT is inserted to prevent distention
6. Monitor UO, F and E, Abdomen PE
 Colon cancer
NURSING INTERVENTION
Post-Operative care
1. Monitor for complications
Leakage from the site, prolapse of
stoma, skin irritation and pulmo
complication
2. Assess the abdomen for return of
peristalsis
 Co lo n cancer
NURSING INTERVENTION
Post-Operative care
3. Assess wound dressing for bleeding
4. Assist patient in ambulation after 24H
5.provide nutritional teaching
Limit foods that cause gas-formation and
odor
Cabbage, beans, eggs, fish, peanuts
Low-fiber diet in the early stage of
recovery
 Colon cancer
NURSING INTERVENTION
Post-Operative care
6. Instruct to splint the incision and
administer pain meds before exercise
7. The stoma is PINKISH to cherry red,
Slightly edematous with minimal pinkish
drainage
8. Manage post-operative complication
 Colon cancer
NURSING INTERVENTION:
COLOSTOMY CARE
Colostomy begins to function 3-6 days
after surgery
The drainage maybe soft/mushy or
semi-solid depending on the site
 Colon cancer
NURSING INTERVENTION:
COLOSTOMY CARE
BEST time to do skin care is after
shower
Apply tape to the sides of the pouch
before shower
Assume a sitting or standing position in
changing the pouch
 Colon cancer
NURSING INTERVENTION:
COLOSTOMY CARE
Instruct to GENTLY push the skin down
and the pouch pulling UP
Wash the peri-stomal area with soap
and water
Cover the stoma while washing the peri-
stomal area
 Colon cancer
NURSING INTERVENTION:
COLOSTOMY CARE
Lightly pat dry the area and NEVER rub
Lightly dust the peri-stomal area with
nystatin powder
 Colon cancer
NURSING INTERVENTION:
COLOSTOMY CARE
Measure the stomal opening
The pouch opening is about 0.3 cm
larger than the stomal opening
Apply adhesive surface over the stoma
and press for 30 seconds
 Colon cancer
NURSING INTERVENTION:
COLOSTOMY CARE
Empty the pouch or change the
pouch when
 1/3to ¼ full (Brunner)
 ½ to 1/3 full (Kozier)
 Breast Cancer
The most common cancer in FEMALES
Numerous etiologies implicated
 Breast Cancer
RISK FACTORS
1. Genetics- BRCA1 And BRCA 2
2. Increasing age ( > 50yo)
3. Family History of breast cancer
4. Early menarche and late menopause
5. Nulliparity
6. Late age at pregnancy
 Breast Cancer
RISK FACTORS
7. Obesity
8. Hormonal replacement
9. Alcohol
10. Exposure to radiation
 Breast Cancer
PROTECTIVE FACTORS
1. Exercise
2. Breast feeding
3. Pregnancy before 30 yo
 Breast Cancer
ASSESSMENT FINDINGS
1. MASS- the most common location is
the upper outer quadrant
2. Mass is NON-tender. Fixed, hard with
irregular borders
3. Skin dimpling
4. Nipple retraction
5. Peau d’ orange
 Breast Cancer
LABORATORY FINDINGS
1. Biopsy procedures
2. Mammography
 Breast Cancer
Breast cancer Staging
TNM staging
I - < 2cm
II - 2 to 5 cm, (+) LN
III - > 5 cm, (+) LN
IV- metastasis
 Breast Cancer
MEDICAL MANAGEMENT
1. Chemotherapy
2. Tamoxifen therapy
3. Radiation therapy
 Breast Cancer
SURGICAL MANAGEMENT
1. Radical mastectomy
2. Modified radical mastectomy
3. Lumpectomy
4. Quadrantectomy
 Breast Cancer
NURSING INTERVENTION : PRE-OP
1. Explain breast cancer and treatment
options
2. Reduce fear and anxiety and improve
coping abilities
3. Promote decision making abilities
4. Provide routine pre-op care:
Consent, NPO, Meds, Teaching about
breathing exercise
 Breast Cancer
NURSING INTERVENTION : Post-OP
1. Position patient:
Supine
Affected extremity elevated to reduce
edema
 Breast Cancer
NURSING INTERVENTION : Post-OP
2. Relieve pain and discomfort
Moderate elevation of extremity
IM/IV injection of pain meds
Warm shower on 2nd day post-op
 Breast Cancer
NURSING INTERVENTION : Post-OP
3. Maintain skin integrity
Immediate post-op: snug dressing with
drainage
Maintain patency of drain (JP)
Monitor for hematoma w/in 12H and
apply bandage and ice, refer to surgeon
 Breast Cancer
NURSING INTERVENTION : Post-OP
3. Maintain skin integrity
Drainage is removed when the
discharge is less than 30 ml in 24 H
Lotions, Creams are applied ONLY
when the incision is healed in 4-6
weeks
 Breast Cancer
NURSING INTERVENTION : Post-OP
Promote activity
Support operative site when moving
Hand, shoulder exercise done on
2ndday
Post-op mastectomy exercise 20
mins TID
NO BP or IV procedure on operative
site
 Breast Cancer
NURSING INTERVENTION : Post-OP
Promote activity
Heavy lifting is avoided
Elevate the arm at the level of the
heart
On a pillow for 45 minutes TID to
relieve transient edema
 Breast Cancer
NURSING INTERVENTION : Post-OP
MANAGE COMPLICATIONS
Lymphedema
10-20% of patients
Elevate arms, elbow above shoulder and
hand above elbow
Hand exercise while elevated
Refer to surgeon and physical therapist
 Breast Cancer
NURSING INTERVENTION : Post-OP
MANAGE COMPLICATIONS
Hematoma
Notify the surgeon
Apply bandage wrap (Ace wrap) and
ICE pack
 Breast Cancer
NURSING INTERVENTION : Post-OP
MANAGE COMPLICATIONS
Infection
Monitor temperature, redness,
swelling and foul-odor
IV antibiotics
No procedure on affected extremity
 Breast Cancer
NURSING INTERVENTION : Post-OP
TEACH FOLLOW-UP care
Regular check-up
Monthly BSE on the other breast
Annual mammography