nursing oncology lecture

8/14/2019 Nursing Oncology Lecture

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Oncology defined

Branch of medicine that

deals with the study,detection, treatment and

management of cancer and

neoplasia


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Root words

Neo- new

Plasia- growth

Plasm- substance

Trophy- size

Oma- tumor


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Root words

A- none

Ana- lack

Hyper- excessive

Meta- change

Dys- bad, deranged


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Characteristics of

NeoplasiaUncontrolled growth of Abnormal cells

1. Benign

2. Malignant

3. Borderline


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Characteristics of

NeoplasiaBENIGN

Well-differentiated

Slow growth

Encapsulated

Non-invasiveDoes NOT metastasize


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Characteristics of

NeoplasiaMALIGNANT

Undifferentiated

Erratic and Uncontrolled Growth

Expansive and Invasive

Secretes abnormal proteinsMETASTASIZES


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Reasons for Successful

Metastasis1. cancer cells release ENZYMES to

escape from the lymphatic and blood

vessels2. secondary site should provide

nourishment to cancer cells

3. secondary site should have adequateblood supply


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Nomenclature of

NeoplasiaTumor is named according to:

1. Parenchyma

Hepatoma- liver

Osteoma- bone

Myoma- muscle


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Nomenclature of


2. Pattern and Structure, either GROSS

or MICROSCOPIC

Fluid-filledCYST

GlandularADENO

Finger-likePAPILLO

StalkPOLYP


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Nomenclature of


3. Embryonic origin

Ectoderm ( usually gives rise to

epithelium)

Endoderm (usually gives rise to glands)

Mesoderm (usually gives rise to

Connective tissues)


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BENIGN TUMORS

Suffix- OMA is used

Adipose tissue- LipOMA

Bone- osteOMA

Muscle- myOMA

Blood vessels- angiOMAFibrous tissue- fibrOMA


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MALIGNANT TUMOR

Named according to embryonic cell origin

1. Ectodermal, Endodermal, Glandular,

Epithelial

Use the suffix- CARCINOMA

Pancreatic AdenoCarcinoma

Squamous cell Carcinoma


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MALIGNANT TUMOR

Named according to embryonic cell origin

2. Mesodermal, connective tissue origin

Use the suffix SARCOMA

FibroSarcoma

MyosarcomaAngioSarcoma


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PASAWAY

1. OMA but Malignant

HepatOMA, lymphOMA, gliOMA,

melanOMA

2. THREE germ layers

TERATOMA

3. Non-neoplastic but OMA HEMATOMA


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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, kidney3. LABILE cells- continuously dividing

GIT cells, Skin, endometrium , Blood cells


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CANCER NURSING

Cell Cycle

G0------------------G1SG2MG0- Dormant or resting

G1- normal cell activities

S- DNA Synthesis

G2- pre-mitotic, synthesis of proteins forcellular division

M- Mitotic phase (I-P-M-A-T)


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CANCER NURSING

Proposed Molecular cause of CANCER:

Change in the DNA structurealtered

DNA functionCellular aberration

cellular death

neoplastic change

Genes in the DNA- proto-oncogene

And anti-oncogene


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CANCER NURSING

Etiology of cancer

1. PHYSICAL AGENTS

Radiation

Exposure to irritants

Exposure to sunlight


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CANCER NURSING

Etiology of cancer

4. Dietary Habits

Low-Fiber

High-fat

Processed foods

alcohol


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CANCER NURSING

Etiology of cancer

5. Viruses and Bacteria

DNA viruses- HepaB, Herpes, EBV,

CMV, Papilloma Virus

RNA Viruses- HIV, HTCLV

Bacterium- H. pylori


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CANCER NURSING

Etiology of cancer

6. Hormonal agents

DES-diethylstilbestrol

OCP especially estrogen


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CANCER NURSING

CARCINOGENSIS

INITIATION

Carcinogens alter the DNA of the cell

Cell will either die or mutate


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CANCER NURSING

CARCINOGENSIS

PROMOTION

Repeated exposure to carcinogens

Abnormal gene will express

Latent period


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CANCER NURSING

CARCINOGENSIS

PROGRESSION

Irreversible period

Cells undergo NEOPLASTIC

transformation then malignancy


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CANCER NURSING

Cancer Diagnosis

1. BIOPSY

The most definitive

2. CT, MRI

3. Tumor Markers


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CANCER NURSING

Cancer Grading

The degree of DIFFERENTIATION

Grade 1- Low grade

Grade 4- high grade


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CANCER NURSING

Cancer Staging

1. Uses the T-N-M staging system

T- tumor

N- Node

M- Metastasis

2. Stage 1 to Stage 4


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SCREENING

1. Male and female- Occult Blood, CXR,

and DRE

2. Female- SBE, CBE, Mammographyand Paps Smear

3. Male- DRE for prostate, Testicular

self-exam


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Nursing Assessment

Weight loss

Frequent infection

Skin problems

Pain

Hair Loss

Fatigue

Disturbance in body image/ depression


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Nursing Intervention

MAINTAIN TISSUE INTEGRITY

Handle skin gently

Do NOT rub affected area

Lotion may be applied

Wash skin only with SOAP and Water


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MANAGEMENT OF STOMATITIS

Use soft-bristled toothbrush

Oral rinses with saline gargles/ tap

water

Avoid ALCOHOL-based rinses


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MANAGEMENT OF ALOPECIA

Alopecia(hair loss) 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


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PROMOTE NUTRITION

Serve food in ways to make it appealing

Consider patients preferences

Provide small frequent meals

Avoids giving fluids while eating

Oral hygiene PRIOR to mealtimeVitamin supplements


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RELIEVE PAIN

Mild pain- NSAIDS

Moderate pain- Weak opiods

Severe pain- Morphine

Administer analgesics round the clock

with additional dose for breakthroughpain


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DECREASE FATIGUE

Plan daily activities to allow alternating

rest periods

Light exercise is encouraged

Small frequent meals


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IMPROVE BODY IMAGE

Therapeutic communication is essential

Encourage independence in self-careand decision making

Offer cosmetic material like make-up

and wigs


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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


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MANAGE COMPLICATION: INFECTION

Fever is the most important sign (38.3)

Administer prescribed antibiotics X2weeks

Maintain aseptic technique

Avoid exposure to crowds

Avoid giving fresh fruits and veggie

Handwashing

Avoid frequent invasive procedures


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MANAGE COMPLICATION: Septic shock

Monitor VS, BP, temp

Administer IV antibioticsAdminister supplemental O2


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MANAGE COMPLICATION: Bleeding

Thrombocytopenia (


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INCIDENCE OF CANCER

MALES

1. PROSTATE

CANCER

2. LUNG CANCER

3. COLORECTAL

CANCER

FEMALES

1. BREAST

CANCER

2. LUNG CANCER

3. COLORECTAL

CANCER


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Colon cancer


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COLON CANCER

Sigmoid colon is the most common site

Predominantly adenocarcinoma

If early90% survival

34 % diagnosed early

66% late diagnosis


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COLON CANCER

ASSESSMENT FINDINGS1. Change in bowel habi ts- Mos t

common (alternat ing D and C)2. Blood in the stool

3. Anemia

4. Anorexia and weight loss5. Fatigue

6. Rectal lesions- tenesmus


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Colon cancer

Diagnostic findings

1. Fecal occult blood

2. Sigmoidoscopy and colonoscopybegin at age 50, every 3-5 years

3. BIOPSY

4. CEA- carcino-embryonic antigen (toestimate prognosis, monitor treatmentand recurrence)


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Colon cancer

Complications

1. Obstruction

2. Hemorrhage3. Peritonitis

4. Sepsis

5. direct extension ofcancer to adjacent

organs


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Colon cancer

MEDICAL

MANAGEMENT

1. Chemotherapy- 5-FU

2. Radiation therapy


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Colon cancer

SURGICAL MANAGEMENT

Surgery is the primary treatment

Based on location and tumor size

Resection, anastomosis, and colostomy

(temporary or permanent)


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Colon cancer

NURSING INTERVENTION

Pre-Operative care

4. Enema or colonic irrigation theevening and the morning of surgery

5. NGT is inserted to prevent distention

6. Monitor UO, F and E, Abdomen PE


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Colon cancer


Post-Operative care

1. Monitor for complicationsLeakage from the site, prolapse ofstoma, skin irritation and pulmonary

complication2. Assess the abdomen for return ofperistalsis


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olon cancerNURSING INTERVENTION

Post-Operative care

3. Assess wound dressing for bleeding4. Assist patient in ambulation after 24H

5. provide nutritional teaching

Limit foods that cause gas-formation and

odorCabbage, beans, eggs, fish, peanuts

Low-fiber diet in the early stage ofrecovery


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Colon cancer


Post-Operative care

6. Instruct to splint the incision andadminister pain meds before exercise

7. The stoma is PINKISH to cherry red,

Slightly edematous with minimal pinkish

drainage

8. Manage post-operative complication


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Colon cancer

NURSING INTERVENTION:

COLOSTOMY CARE

Colostomy begins to function 3-6 daysafter surgery

The drainage maybe soft/mushy or

semi-solid depending on the site


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Colon cancer

NURSING INTERVENTION:COLOSTOMY CARE

Instruct to GENTLY push the skin downand the pouch pulling UP

Wash the peri-stomal area with soapand water

Cover the stoma while washing the peri-stomal area


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Colon cancer


COLOSTOMY CARE

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

nystatin powder


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Colon cancer


COLOSTOMY CARE

Measure the stomal openingThe pouch opening is about 0.3 cm

larger than the stomal opening

Apply adhesive surface over the stomaand press for 30 seconds


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Colon cancer


COLOSTOMY CARE

Empty the pouch o r change thepouch when

1/3 to fu l l (B runner)

to 1/3 fu ll (Kozier )


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Breast Cancer

The most common

cancer in FEMALES

Numerous etiologiesimplicated


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Breast Cancer

RISK FACTORS

1. Genetics

2. Increasing age ( > 50yo)

3. Family History of breast cancer

4. Early menarche and late menopause

5. Nulliparity

6. Late age at pregnancy


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Breast Cancer

PROTECTIVE FACTORS

1. Exerc ise

2. B reas t feed ing

3. Pregnancy befo re 30 yo


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Breast Cancer

ASSESSMENT FINDINGS

1. MASS- the most common location is

the upper outer quadrant2. Mass is NON-tender. Fixed, hard withirregular borders

3. Skin dimpling

4. Nipple retraction

5. Peau d orange


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Breast Cancer

LABORATORY FINDINGS

1. Biopsy procedures

Percutaneous needle biopsy

Excision biopsy

2. Mammography- American Cancer

Society recommends annual screeningat age 40


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Breast Cancer

Breast cancer Staging

TNM staging

I - < 2cm

II - 2 to 5 cm, (+) LN

III - > 5 cm, (+) LN

IV- metastasis


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Breast Cancer

MEDICAL MANAGEMENT

1. Chemotherapy

2. Tamoxifen therapyinterferes withESTROGEN ACTIVITY

3. Radiation therapy


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Breast Cancer

NURSING INTERVENTION : PRE-OP

1. Explain breast cancer and treatmentoptions

2. Reduce fear and anxiety and improvecoping abilities

3. Promote decision making abilities

4. Provide routine pre-op care:Consent, NPO, Meds, Teaching aboutbreathing exercise


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Breast Cancer

SURGICAL MANAGEMENT

1. simple Mastectomy

2. Radical mastectomy3. Modified radical mastectomy

4. Lumpectomy OR Segmental

Resection5. Quadrantectomy


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Breast Cancer

NURSING INTERVENTION : Post-OP

1. Position patient:

Supine

Affected extremity elevated to reduce

edema


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Breast Cancer


2. Relieve pain and discomfort

Moderate elevation of extremity

IM/IV injection of pain meds

Warm shower on 2ndday post-op


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Breast Cancer


3. Maintain skin integrity

Immediate post-op: snug dressing withdrainage

Maintain patency of drain (JP)

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


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Breast Cancer


3. Maintain skin integrity

Drainage is removed when thedischarge is less than 30 ml in 24 H

Lotions, Creams are applied ONLY

when the incision is healed in 4-6weeks


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Breast Cancer


Promote activity

Support operative site when moving

Hand, shoulder exercise done on2ndday

Post-op mastectomy exercise 20

mins TID (wall climbing, overheadpulleys, rope turning, arm swings)

NO BP or IV procedure on operativesite


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Breast Cancer


MANAGE COMPLICATIONS

Lymphedema10-20% of patients

Elevate arms, elbow above shoulder and

hand above elbow

Hand exercise while elevated

Refer to surgeon and physical therapist


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Breast Cancer


MANAGE COMPLICATIONS

Hematoma

Not ify the su rgeon

App ly bandage wrap (Ace wrap) and

ICE pack


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Breast Cancer


TEACH FOLLOW-UP care

Regu lar check-up

Mon thly BSE on the other breast

Annual mammography


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Recommendation of ACS

Monthly BSE beginning at age 20, 5-7

days AFTER menstruation

Clinical breast examination every 3years age 20-39 years

Clinical breast examination and annual

mammography at age 40


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LUNG CANCER

Leading cause of CANCER DEATHS in US

for both male and female categories

Etiology:

1. AGE, incidence increases with age 50

2. SMOKING80% of lung cancer is

positively associated with SMOKING

3. IONIZING radiation, INHALED IRRITANTS

(ASBESTOS)


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LUNG CANCER

LUNG LESION:

SMALL or OAT CELL Carcinoma25%

*PARANEOPLASTIC SYNDROME NON-SMALL CELL Carcinoma75%

ADENOCARCINOMA

SQUAMOUS CELL CARCINOMA

LARGE CELL CARCINOMA


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LUNG CANCER

Signs and Symptoms:

CHRONIC COUGH, Hemoptysis,

wheezing, shortness of breath,hoarseness, dysphagia

SYSTEMIC: weight loss, anorexia, fatigue,

bone pain, generalized weakness


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LUNG CANCER

METASTASIS

BRAIN mental behavioral changes

impaired gait and balance BONE bone pain, pathologic fractures,

anemia

LIVER jaundice, anorexia, RUQ pain

*SUPERIOR VENA CAVA SYNDROME


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LUNG CANCER

DIAGNOSTIC TESTS

CHEST X-ray

SPUTUM studies BRONCHOSCOPY

CT SCAN/MRI

BIOPSY CBC, LIVER FUNCTION STUDIES


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LUNG CANCER

TREATMENT:

SURGERY goal: to remove as much

involved tissue as possible whilepreserving the lung function

CHEMOTHERAPY

RADIATION goal: to cure or relieve

symptom


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PROSTATE CANCER


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PROSTATE CANCER

Manifestations:

EARLY: ASYMPTOMATIC

URINARY S/SX: SIMILAR TO BPH:urgency, frequency, hesitancy, dysuria,

nocturia, hematuria, blood in ejaculate

Metastasis: BONE


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PROSTATIC CANCER

DIAGNOSTIC TESTS:

DRE (yearly after age 50)

Annual PSA levels, >4ng/ml TRANSRECTAL ULTRASOUND

PROSTATIC BIOPSY Needle biopsy

Bone scan, MRI, CT scans


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PROSTATIC CANCER

SURGERY:

TURP: EARLY DISEASE IN OLD MEN

RETROPUBICPROSTATECTOMY/PERINEALPROSTATECTOMY

RADICAL PROSTATECTOMY

REMOVAL OF PROSTATE, PROSTATICCAPSULE, SEMINAL VESICLES, PORTIONOF BLADDER NECK

PROSTATIC CANCER


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PROSTATIC CANCER

HORMONAL MANIPULATION:Orchiectomy

Administration of female hormonal

agents

RADIATION: BRACHYTHERAPY


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PROSTATIC CANCER

NURSING DIAGNOSES:

1. Urinary incontinence following treatment:

stress or urge incontinence Sexual Dysfunction

Acute/Chronic Pain

nursing oncology lecture

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