lOMoARcPSD|37321512

Oncology Toprank 2

Nursing (Central Luzon Doctors' Hospital Educational Institution)

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ONCOLOGY NURSING

CANCER

Warning signs: CAUTION US

Changes in bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge
Thickening of lymph node?
Indigestion
Obvious changes in wart/mole
Nagging cough / hoarseness of voice
Unexplained anemia
Sudden Weight Loss
 Etiology
o Unknown
 Risk factors:
o Age – MOST RISK FACTOR
 Older people are at risk.
 The OLDER, the HIGHER the risk due to low immunity.
o Gender
 Top leading cancer based on gender - Cancer Society

MALE FEMALE
Prostate Cancer Breast Cancer
Lung Cancer – leading Lung Cancer – lung is a
cause of mortality common site of metastasis
Colorectal Cancer Colorectal Cancer

o Geographic location
 Urban is MOST at RISK.
o Genetics / Race
 African / Americans
o Radiation Exposure
o Virus / Infections
 HPV, HSV, EPV
o Chemical Agents
 Asbestos
 Smoking
 Alcohol
 BPA (Bisphenol A)
o Diet
 Low fiber & high fat diet = in general, a risk for having cancer.
 Nitrates
 Overcooked food / Grilled foods
 Overused oil
CHEMOTHERAPY
 -Kills rapidly dividing cell
 Disrupts cells cycle.
 Chemo drugs are also known as →Antineoplastic & Cytotoxic Drugs.
2 CLASSIFICATIONS OF CHEMO DRUGS
 Cell Cycle Specific
o May specific phase na tina – target.
o Example: CCSM / Specific in Mitotic Phase
 Cell Cycle Non-Specific
o Disrupts cell cycle.
o Random target

CELL CYCLE\
 G0 – resting phase of the cycle
o Cells and resting, sub cells are dying.
 G1 – RNA and CHON Synthesis
 S – DNA synthesis
 G2 – Pre mitosis
 M – Mitosis (Division)

1. Alkylating Agents

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 CCNS
 Cyclophosphamide (Cytoxan)
o WOF: Haemorrhagic Cystitis
o Patient may manifest haematuria.
o NI: Instruct to increase OFW.
o Mesna– prevents haemorrhagic cystitis / protects the bladder.
 Cisplatin (Platinol)
2. Anti – Metabolites
 CCS – S phase (Prevents the photocopy)
 Fluorouracil (5 – FU)
 Methotrexate (Folex) – interferes with folic acid antagonist.
o WOF: Methotrexate Toxicity
o Antidote: Leucovorin
3. Anti – Tumor Antibiotics
 CCNS
 Adriamycin
 Bleomycin
 Common adverse effect: Cardiotoxocity
 NI: Cardiac monitoring

4. Plant (Vinca) Alkaloids

 CCS – M phase
 Vincristine (VXR)
 Vinblastine (Oncovin)
5. Corticosteroids
 CCNS
 “sone” drugs
Radiation Therapy
 To kill the tumor.
 Shrinks the size of the tumor to relieve obstruction.
Internal Radiation / Brachytherapy
 Sealed Radiation
 Implanted inside the body where the tumor is located.
 Patient is radioactive.
 Patient must be in private room.
 Complication: Implant may be dislodged.
 NI: Patient must be in complete bed rest with no bathroom privileges.
 Patient will be using catheter.
Implant is dislodged. What to do?
 SEEN / Nahulog sa floor
 Pick it up with long forceps and place it in lead container.
 UNSEEN / Nahulog pero di mahanap
 Leave the room / close the door.
 Notify the radiation department.
 Then, inform the physician that the implant was removed.

 Unsealed radiation
 Can be orally or through IV.
 Patient and their body fluid is radioactive.
 Patient must be in private room.
 NI: Instruct patient to flush the toilet 2 – 3 times.

Factors affecting Exposure

o Shielding: Lead apron / gown as this is resistant to radiation.
o Time: Visitors must only stay for 10-15 minutes
 Nurses may stay for 30 minutes per shift / 5 mins for every visits = 6 visits
Bawal ang mga visitors na:
 Pregnant
 Infection
 Newly vaccinated individual: May infect the patient as they may still have virus
 Children
 Dosimeter badge
o Distance: 6ft

External Radiation / Teletherapy

 Beam of high energy rays.
 Patient and its body fluids is NOT RADIOACTIVE.
 No STD criteria.
 Treatment: 15 to 30 min / day; 5 days a week.
 Pwede umuwi ang patient.

Nursing Responsibilities

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1. Do not wash off skin marking.

 Can be wash with water or mild soap.
2. Avoid constrictive clothing at the site of radiation.
3. Avoid extreme temperatures.
4. Avoid chemicals on site of radiation (like powder, lotion)

SIDE EFFECTS OF CHEMOTHERAPY AND RADIATION THERAPY

Bone Marrow Suppression
 Pancytopenia - ↓in RBC, WBC, Platelets.
 Risk for bleeding
 ✓ Priority – Safety
 Brush with soft bristled toothbrush.
Ovaries and Testes
 Only in radiation therapy
 May lead to sterility or infertility – discussed before the start of treatment.
Mucosal Lining
 Very common / normal symptom is nausea & vomiting.
 Give antiemetics before the treatment.
 Minimize N&V by giving anti - emetics and providing SFF (bland diet)
Skin
 In radiotherapy → Radiodermatitis
 In chemotherapy → Extravasation (leakage of chemo drugs)
 Chemical burns
 Extravasation is common in patient with fragile veins.
Signs and Symptoms
o Redness / Erythema above the site
o Pain / Burning Sensation
o Swelling
o Slowing of infusion rate
o No blood return = No backflow

IF THERE IS EXTRAVASATION, IMMEDIATELY STOP THE INFUSION.

STOP, APPLY COLD COMPRESS > NOTIFY THE PHYSICIAN.

Hair
 Alopecia
 Use of wigs, hat, scarf, turban.
 Teach this to patient before treatment.
 “Hair loss is temporary”.

Oral Cavity
 Mucositis / Stomatitis / Xerostomia
 Affects the patient’s appetite.
Nursing Intervention
 Provide frequent oral care.
 Increase OFW
 Instruct to use lip balm.
 Avoid spicy and acidic food.
 Avoid smoking.
 Give popsicles.
Vagina
 Becomes dry.
 Frequent perineal care.
 Use of lubricants during sexual activity.

BREAST CANCER
 Most common cancer in females
 Cause: Unknown
 Breast Cancer Awareness Month - October
Risk Factors:
o Late Menopause
 After 55 years old
o Obesity
 More fats, more estrogen
o Nulliparity
o Genetics
o Female
 Forty and Female
o Oral Contraceptives
o Early Menarche

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 Before 12 years old

Early Detection in Breast Cancer

Breast Self-Examination
o Start at 20 years old every month.
o Examined by yourself
o 7 days after menstruation
o Applicable for those who have regular menstruation.
o To not forget, put a specific memorable date.
Inspection
1. Stand in front of the mirror.
2. Inspect size, shape, and symmetry of breast.
3. Palpate presence of lumps / mumps.
 Common site of lumps / mumps → Upper outer quadrant of breast.

Signs & Symptoms

Asymmetry (Obvious)
Venous prominence
Orange peel skin (peau de orange) > In advance stage
Nipple dimpling

Characteristics of Malignant Lump

Painless
Fixed and non - movable.
Irregular shape / edges

Health Work Breast Examination / Clinical Breast Exam

o Done by health examiner.
o Done during 20 to 39 years old.
o Every 3 years
o 40 years old & above = Every year

Mammography
o Should have baseline mammogram at 35 to 39 years old.
o ✕ No chemicals before mammogram because it can be interpreted as lump.

Biopsy
Types:
o Percutaneous – inject then aspirate only. ✕ hiwa.
 FNA – fine needle aspiration / smaller gauge for small size of lump.
 CAN – core needle aspiration / large gauge for large size of lump.
o Surgical
 Incisional – tinanggal ang part / portion.
 Excisional – entire lump and surrounding tissue is removed.
Management
o Chemotherapy
o Radiation Therapy
o Medications
 Tamoxifen (Nolvadex)
 Hormone antagonist / Anti estrogen
 20 mg/day
 Given for 5 years.
 Prevents occurrence / reoccurrence.
 Diethylstilbesterol (DES)
 Estrogen (produces negative feedback mechanism)
o Surgery
o Common complication post mastectomy: Lymphedema.
 Lumpectomy / Excisional Biopsy
 Simple Mastectomy – whole breast is removed.
 Radical Mastectomy = whole breast, lymph nodes, and pectoralis is removed.
 Modified Radical Mastectomy = whole breast and lymph nodes is removed.

Post – op Interventions:
o Position to semi fowler’s
o Elevate affected arm above heart’s level (2 pillows)
o No procedure on the affected extremity
o No IV insertion
o No blood pressure on affected extremity

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o No heavy jewelleries
o No heavy lifting
o We encourage patient to perform arm exercise.
o Arm exercises for the affected arms (e.g. arm climbing, rope turning).

PROSTATE CANCER
 Most common cancer in men.
Risk Factors
o STD
o Testosterone– Increased amounts
o African - American
o Fat
o Forty

Signs and Symptoms

o Starts as Asymptomatic
o Enlarged prostate
o Dysuria
o Dec. force in urination
o Urinary Retention
o Rectal pain = Rectal compression
o Painful Ejaculation
o Hematuria
o Low Back pain

Diagnostics
o Digital-Rectal Examination
 Should be done yearly: 40y/o above.
o Prostate-specific Antigen
 Done yearly by 40 y/o above.
 Elevated level of PSA when prostate is inflamed
 Normal: 0-4 ng/dL
 Marker for prostate cancer.
 Prevent activities that can stimulate prostate to avoid false positive result.
o Biopsy
 Definitive test for prostate cancer.

Management
o Chemotherapy
o Radiation Therapy
o Use of hormonal medications
 Diethylstilbesterol (DES)
 Anti-testosterone
 Luteinizing hormone releasing hormone – suppresses the production of testosterone.
 Leuprolide
 Goserelin
o Surgery
 Transurethral Resection of the Prostate
 Scrapes the prostate tissue.
 After TRUP, Continuous Bladder Elimination /CBI is initiated.
 CBI prevents clot formation.
 Return: Will be pinkish
 Prostatectomy
 Orchiectomy

TESTICULAR CANCER
Risk factors
o Cryptorchidism
 Undescended testes.
 Orchiopexy will treat this; will place testes in normal place.
o Age (15 to 35 years old)
o Trauma in the testicles

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o Diethylstilbesterol
 Maternal use of DES
o Orchitis – History of this
o Genetics

Testicular Self Examination

 Before 15 years old
 Done same day, every month.
 Inspection at front of the mirror
 Best time to palpate: After a WARM BATH = Testicle is more relaxed.
 Thumb and Forefinger is used = by rolling the balls.
 Sometimes middle finger
Markers for Testicular Cancer
 AFP - ↑
 B – HCG - ↑
Signs and Symptoms
 Painless enlargement of the affected testicle
 Heaviness / Dragging sensation.
 Pea – shape lump or nodule – can be felt when palpated.
 Low back pain, weakness, and weight loss – there is metastasis already & advanced stage.
Management
o Chemotherapy
o Radiation Therapy
Surgery
o Orchiectomy – removal of testicles
May be:
Unilateral Bilateral
Impotence ✕ ✕
(Capable of erection)
Sterility ✕ ✓
(Able to bear child)

HODGKIN’S LYMPHOMA

 A rare cancer of unknown cause that is unicentric in origin and spreads along the lymphatic system.
 Presenting sign → Painless enlargement of the cervical lymph nodes.
 Can also be in supraclavicular and mediastinal.
 Common in patients with AIDS

Risk Factors
 History of EBV
 Also, exposure to Herbicides
 Herbicides → Agent Orange: Agent related to Hodgkin’s.
 Immunosuppression
 Male
 20 to 40 years old

Signs and Symptoms

o Fatigue
A Symptoms B Symptoms
Night Sweats Night Sweats
Fever Fever
Weight loss of at least 10% of
body weight

Late Symptoms:
 Lungs = Pleural Effusion
 Liver = Hepatomegaly / Jaundice
 Renal = Enema
 MSK = Bone Pain
 Spleen = Splenomegaly / Abdominal Pain
Staging of Lymphoma
 Stage 1 = 1 lymph nodes is affected
 Stage 2 = 2 or more lymph nodes are affected but unilateral
 Stage 3 = 2 or more lymph nodes are affected but bilateral
 STAGE 4 = wide stage metastasis

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Diagnostics
Excisional Biopsy
 Prescence of Reed Sternberg Cells / gigantic tumour cells

Management:
 Stage 1 and 2 = Radiation Therapy
 Stage 3 and 4; Presence of B symptoms = Combination chemotherapy

Combinanation Chemotherapy
I.
Mustagen
Oncovin
Procarbazine
Prednisone

II.
Adriamycin
Bleomycin
Vinblastin
Dacarbazine

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