Oncology Nursing Types of Tumor

Risk Factors
v Age
Grading Staging
o Lymphoma
§ Hodgkins (20 - 40 y/o), first sign: Focuses on CANCER CELLS Focuses on TUMOR
Enlargement of lymph nodes
§ Non Hodgkins (60 y/o above)
o Testicular Cancer (15 - 35 y/o) TUMOR STAGING
v Gender Benign Malignant
o Breast Cancer (both gender, but most
common in women) Growth Rate Slow Rapid
§ High Estrogen = Tamoxifen (Nolvadex)
Anti-Estrogen is given Differentiatio Well Poorly/Undifferentiate
o Prostate Cancer (Male) n (Grading) differentiate d
§ High Testosterone = Given synthetic d
estrogen to balance out the high
Capsule Encapsulate
testosterone level
d
v Geographic location
v Genetics Location Localized Metastasis
v Immune Disturbance
o Chronic UTI (Cystitis) → Bladder Cancer, Growth Type Expansive Invasive/ Infiltrative
Pathognomonic sign: Hematuria
(Painless) Recurrence Rare Increased
v Chemical Agents
v Race
o Prostate Cancer common in African
TUMOR → Size (Primary Tumor)
American
• Tx – unidentifiable, unconfirmed
v Tobacco
• T0 – no evidence of tumor
v Alcohol
• T1 S – carcinoma in situ (situ - site of origin)
v Diet
• T1, T2, T3, T4 – ascending degree of tumor
o High fat and low fiber/residue can lead to
size
colorectal cancer
o High fat = high hormones
NODES → Number of lymph node (Regional lymph
node involvement)
Leukemia
• Nx – indicates inability to asses regional
ALL → [Litol (bata)] Lymphocytic; good prognosis
nodes
→ [Matanda] Myelogenous; bad prognosis
• N0 – no lymph node involvement
• N1, N2, N3, N4 – increasing involvement of
TRIAD OF CANCER (ASA) lymph nodes
1. SMOKING (Lung, Bladder, Cervical
Cancer)
METASTASIS → Organ/Tumor
2. ASBESTOS (Lung Cancer)
• M0 – indicates no evidence of distant
3. ALCOHOL (Gastric, Liver Cancer &
metastasis
Cirrhosis)
• M1, M2, M3 - indicate ascending degrees
of distant metastasis and includes distant
Characteristics of Normal Cells lymph nodes
Normal cell growth consists of 5 intervals or phases
a. Resting phase - G0
STAGING
b. Interphase
• 0 – cancer in situ
i.G1 - cellular production of RNA (original
• 1 – tumor limited to disease of origin
copy) & CHON (ink)
• 2 – lymphatic involvement limited spread
ii.S - synthesis of DNA (photocopy)
• 3 – extensive local and regional spread
iii.G2 - pre mitosis
• 4 – wide spread metastasis
c. Actual Cell Division - M (MITOSIS)

Radiation Therapy
Evolution of Cancer Cells
• Kills tumor by reducing tumor size, relieving
1. Cancer - is a disease whereby cells mutate into
obstruction
abnormal cells that proliferate abnormally.
1. Benign Neoplasm
Types of Radiation Therapy
2. Malignant Neoplasm
INTERNAL RADIATION (Brachytherapy)
 • Radioactive source is injected or Cell cycle specific → Vinca Alkaloids/ Plant
implanted into the patient's body cavity. Alkaloids/ Mitotic Inhibitors (M); Anti-metabolites
(S)
SEALED IMPLANT UNSEALED IMPLANT
(“Solid localized”) (“Systematic”)
Cell cycle Nonspecific → can affect all cycles
- Implanted into the - Injected or given orally to
patient’s body the patient. (MEDS)
Side effects of chemo drugs:
N/R: N/R:
1. Nausea & Vomiting → (Antiemetic) 30 mins
• Long handled • Px is ambulatory before chemo: Oral or IV (Stop, Flush,
forceps • Flush toilet 2-3x Introduce)
• Lead • Linens used burned/
container disposed ALKYLATING AGENTS (CCNS)
• Complete bed • For slow growing cancer; solid tumor (i.e.
rest breast, prostate, colorectal, testicular CA)
If problem with radiation occurs, contact
radiation team then notify the physician 1. Cyclophosphamide (Cytoxan) – PO
• Administer PO on an empty stomach
• Increase fluid intake due to residue since it
Factors Affecting Exposure
can cause irritation in the lining of urinary
S – SHIELDING (Lead Apron and Shield, Dosimeter
bladder → Cystitis → Bladder CA → Painless
badge)
Hematuria
T – TIME (30 min/shift → 6 visits, 5 mins each)
D - DISTANCE (3 - 5 feet away from px)
If Cytoxan is not working, then switch to Cisplatin.
Cisplatin is more potent but destroys the kidney
NURSING RESPONSIBILITIES
(nephrotoxic).
ONE NURSE = ONE PATIENT
1. Place the client in a private room with a
private bathroom. Monitor:
2. Organize Nursing Task Urine output - Normal: 30cc/hr
3. Force Fluids Urine Discoloration - If pinkish, go back to Cytoxan
4. Complete bed rest
5. Sex: 2 to 3 weeks after discharge 2. Busulfan (Myleran) – PO
• taken at the same time everyday
EXTERNAL RADIATION THERAPY (Teletherapy) • take drug on an empty stomach
• Beam of high energy rays is directed to the • store drug in a tightly capped and light
patient’s body area. resistant container
• Radiation oncologists mark specific
locations with semi permanent ink (serves 3. Mechlorethamine (Nitrogen mustard,
as guide). Mustargen) – IV
• Potent vesicant (acidic med)
TREATMENT: 15 to 30 min/ session (2 to 7 weeks) • If extravasation occurs, Notify Physician
1. Do not wash the ink
2. Health Teachings Extravasation s/sx:
1. Procedure is painless 1. Pain, redness at site
2. Outpatient → wear loose baggy 2. Blanching (lightness of skin)
clothes, no constrictive clothing 3. Tenderness
3. Avoid using anything with oil → at risk 4. Puffiness of Skin (Edema)
for burns 5. Absence of blood return
4. Avoid extreme temperature 6. Resistance at IV site
(HOT/COLD) to prevent nerve damage
Nursing consideration for Extravasation (Leak):
CHEMOTHERAPY 1. Stop
• Administration of cytotoxic medications 2. Compress (Cold)
and chemicals to promote tumor cell 3. Notify
death.
• Disrupts the cell cycle in various phases,
interfering with cellular metabolism and ANTI – METABOLITES (CCS - S phase)
reproduction • inhibits CHON production, substitutes
erroneous metabolites during DNA
synthesis and inhibits DNA synthesis.
(Replaces “ink” for “pho tocopy”)
 ❖ Dexamethasone (Decadron)
1. Fluorouracil (5-FU, Adrucil) - IV
2. Methotrexate (Folex) – PO,IV,IM,IT 2. ESTROGENS (SYNTHETIC)
• For Autoimmune disorders (RA, MS, GBS, ❖ Diethylstilbestrol (DES)
SLE) • Can be given to prostate/breast CA
• Side effect: early menopausal
Toxicity s/sx: (permanent)
1. Nausea & Vomiting
2. Abdominal Cramping Negative Feedback Mechanism → brain will make
3. Vision Changes the ovaries stop from production of estrogen
4. Stomatitis (Mouth sores)
1. Painful → clean with Hydrogen Peroxide 3. ANTI – ESTROGEN
5. Kidney Failure ❖ Tamoxifen (Nolvadex)
• Commonly given after breast surgery
Antidote: Wellcovorin (Leucovorin) • Side effects: Anorexia, Headache,
Vision changes → Regular eye check-
up
3. Mercaptopurine (Purinethol) - PO
• For Acute Lymphocytic Leukemia (prolong EFFECTS OF CHEMOTHERAPY AND RADIATION
remission) THERAPY
• Bone Marrow
Nursing Responsibilities: • Ovaries & Testes → Sterility → Sperm
1. Give 1 hour after giving a glass of milk banking
(dairy) to lower the gastric acidity • Mucosal lining Irritation → Nausea &
Vomiting, Diarrhea, Constipation
• Skin (CT: Extravasation), (RT: Radiation
ANTI – TUMOR ANTIBIOTICS (CCNS)
Dermatitis)
• inhibits RNA and DNA synthesis
• Hair
• interferes with DNA synthesis
• Oral → Xerostomia (Mouth dryness) → Ice
chips, ice pops, Stomatitis (Mouth sores)
1. Bleomycin (Blenoxane) – IV, IM, SC
• Vaginal dryness
2. Doxorubicin (Adriamycin) – IV
• Severe Vesicants (BONE MARROW
HARMFUL) DISORDERS
Red Bone Marrow → produce blood cells BREAST CANCER
Decreased RBC, WBC and Platelet is called • Abnormal Proliferation of Cancer cells in
PANCYTOPENIA the breast

Pancytopenia might lead to NADIR wherein all RISK FACTORS:

LABS are low (<25,000) → expected to happen on ✔ L – ate Menopause
the 8th day after chemo ✔ O – besity
✔ N – ulliparity
Nursing considerations: ✔ G - enetics
1. Slow IV push, maintain visual on the ✔ F – orty & high fat diet
injection site during administration. ✔ O – ral contraceptive
✔ E – arly Menarche
PLANT ALKALOIDS (CCS - M phase)
1. Etoposide (VP-16, VePesid) BREAST - SELF EXAMINATION
2. Vinblastine (Velban) • Early detection for baseline and
3. Vincristine (Oncovin) comparison
• BONE MARROW FRIENDLY • Done to check changes from the previous
• can cause Neuropathy (nerve damage) BSE
→ give B complex • 20 y/o, monthly [7 days (a week) after
menstruation] for regular
• Same day monthly for irregular
Nursing Responsibilities (Plant Alkaloids)
1. Stop
2. Notify INSPECTION:
• Discoloration
HORMONE ANTAGONIST (CCNS) • Irregularity
1. GLUCOCORTICOID • Maturity
❖ Prednisone (Deltasone) • Lump
• Tenderness
 • Nipple discharge • Encourage arm exercises: circulation
• Nipple retraction →rope turning, hand wall climbing, hair
combing
PALPATION: Outer to inner • Avoid activities and procedures using the
POSITION: Towel placed on the shoulder to affected arm → avoid blood extraction,
expose breast tourniquet
• Wear medic alert bracelet
Breast cancer is more common on the LEFT BREAST • Prevent infection

Most common site: Upper outer quadrant PROSTATE CANCER

Axillary lymph nodes are located in the Tail of • Slow growing
Spence
RISK FACTORS: [STAFF]
Signs and Symptoms [AVON] • STD
• Asymmetrical (Obvious) • Testosterone
• Venous dilated veins • African American
• Orange peel skin (Peau d' orange) • Forty and above
• Nipple discharge/ retraction • Fat diet
All increase testosterone exposure
Diagnostics Procedures:
SIGNS AND SYMPTOMS: [PULHEAD]
1. Mammography
P – Peri-Anal And Rectal Pain
• low dose x-ray of the breast
• Used to detect tumors before they can be U – Urinary Obstruction
felt L – Low Back Pain → Late Sign (Pelvic Bone Is
• Avoid deodorant or perfume Affected)
H – Hematuria
E – Enlargement Of The Prostate
2. Breast biopsy A – Asymptomatic @ Early Age
• 35 - 39 y/o → should atleast have one D – Dysuria
baseline
• 40 y/o above → annually
DIAGNOSTIC PROCEDURES
1. PROSTATE SPECIFIC ANTIGEN
Surgical Management
• First diagnostic procedure (blood
1. Lumpectomy
extraction)
2. Simple/ Total Mastectomy → Removal of
• CHON Produced by the Prostate Gland.
Whole breast
• Normal: 0.2 – 4 nanograms/ml
3. Quadrantectomy
4. Radical Mastectomy (Halstead procedure)
→ Removal of Whole breast, Lymph Node, 2. DIGITAL RECTAL EXAMINATION (DRE)
Pectoralis Major & Minor • Part of Regular Health Check-up
5. Modified Radical Mastectomy → All • All men should have DRE
except Pectoralis Minor (used as pocket • To assess the size, shape, and consistency
for silicon breast) of the Prostate Gland.

Radical → Lymph node removal 3. PROSTATE BIOPSY

• Involves insertion of a scope into the
urethra to cut prostatic tissue
PRE - OP • A movable loop is inserted to cut the tissue
• Assess self-esteem and body image of the prostate
• Support denial • Repeated irrigation of drainage of fluid to
• Educate and breast reconstitution and ensure that the resected tissue and clots
prosthesis are removed from the bladder.

POST OP ORCHIECTOMY
• Prevent Lymphedema (prolonged healing • Removal of the testicles
→ might lead to infection)/ arm edema
(permanent) → tightness/fullness on
arm/armpits/neck POST - OP
• Provide analgesics 1. MONITOR BLEEDING
• Semi - fowlers → facilitate drainage & • Bleeding and Clots (NOTIFY)
reduce swelling 2. CONTROL PAIN – Oral NSAIDS
3. AVOID CONSTIPATION
4. AVOID ENEMA
5. AMBULATION – Encourage Peristalsis • Renal Failure – formation of stones
• Pathological Fractures – fracture in the
TESTICULAR CANCER absence of injury
• Common in Caucasian; rare and curable • Osteoporosis
• Unregulated growth of abnormal cells • PANCYTOPENIA
within the testicles
• Slow growing and usually localized DIAGNOSTIC PROCEDURES
1. BONE MARROW BIOPSY
RISK FACTORS: 2. CBC - PANCYTOPENIA
• Cryptorchidism → undescended testes 3. SERUM CALCIUM – High
(most significant factor) 4. XRAY
• Age: 15 - 35 y/o 5. URINE EXAM – Bence Jones CHON in urine
• Trauma (CA/TUMOR MARKER). Distinguishing factor
• Diethylstilbestrol (DES) from Leukemia
• Orchitis
• Genetics (Caucasian) MANAGEMENT
1. CHEMOTHERAPY
SIGNS AND SYMPTOMS • Cyclophosphamide (Cytoxan)
• PAINLESS ENLARGEMENT – Lump/Hardened • Doxorubicin (Adriamycin)
area (on palpation) • Vincristine (Oncovin)
• Heaviness of the Scrotum – no pain CORTICOSTEROIDS – Dexamethasone (Decadron)
• Back Pain
• Lymphadenopathy 2. RADIATION THERAPY
• Testicular Pain • Decrease the size of plasma cell tumor
but no effect in decreasing the production
TESTICULAR SELF EXAMINATION of malignant plasma cells.
• For familiarity (baseline and comparison)
• Used to assess for changes in testicles that 3. BONE MARROW TRANSPLANT
may indicate testicular cancer. 4. PREVENT INJURY
• Starts at 20 yo 15-35: 1’s a month (Same
day of the month) HODGKIN’S DISEASE
• Best time: after a warm bath (standing • Cause: unknown
position in front of mirror) • Presenting sign: Painless, progressive
• during shower: soapy hands enlargement of lymph nodes (especially
• GRASP & ROLL → use 2 to 3 fingers (thumb, cervical lymph nodes)
index, middle) to check for lumps and pea • REED-STERNBERG giant cells
sized lumps (painless) • Ultimately fatal if untreated

SURGICAL MANAGEMENT Risk factors:

1. ORCHIECTOMY • Male 15-40 y.o. (young adults)
• Primary treatment to diagnose and treat • Immunosuppressed individual
Testicular CA. • History of mononucleosis or high titer of
• Diagnose: to identify the number of EPSTEIN BARR VIRUS
cancer cells involved and assess for
metastasis. Nursing Assessment:

MULTIPLE MYELOMA A symptom B symptom

• Cancer → blood (bone marrow) →
plasma (abnormal) → Ig (abnormal) “Kulang ng isa” Weight loss
Night sweat
Example: Fever
RISK FACTORS Px only experiences night
• F – Fifty and above sweat and fever but not
• A – African Americans weight loss.
• R – Radiation Exposure
Early manifestation:
• E – Exposure to Candles
• Painless swelling of lymph nodes
• Persistent fever
SIGNS AND SYMPTOMS • Night sweats
• BONE PAIN – Increases in activity, • Weight loss
decreases @ rest • Fatigue/Lethargy
• Hypercalcemia – bone destruction • Malaise
• Calculus • Pruritus
 • Appetite loss

Late manifestation:
• Hepatomegaly
• Splenomegaly
• Difficulty of breathing
• Facial edema
• Enlargement of the lower extremities

Diagnostic Examination
• Lymph node biopsy
• CT scan
• X-ray of the abdomen

Interventions:
Combined Chemotherapy:
M - Mustargen
A - Adriamycin
O - Oncovin
B - Bleomycin
P - Procarbazine
V - Vinblastine
P - Prednisone
D - Dacarbazine

Nursing Interventions:
• Health teaching
• Provide comfort measures
• Increase water intake
• Balance activity with rest
• Avoid infection