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Unit 9 Oncology
REQUIRED READINGS:
SMELTZER-Chap. 16,17, & 48
•Do Case Studies from Critical
Thinking Book Before Class!
1st CS on pg:495 Adenocarcinoma
2nd CS on pg:509 Breast Cancer
3rd CS on pg:525 Small Cell Lung CA
PART 1
FHP- multiple
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Cancer
• A disease process that begins when an abnormal cell is
transformed by the genetic mutation of cellular DNA
• The abnormal cells have invasive characteristics and
infiltrate other tissues. This phenomenon is metastasis.
• Cancer cells are described as malignant. These cells
demonstrate uncontrolled growth that does not follow
physiologic demand.
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Malignant Process
• Cell proliferation: uncontrolled growth, with the ability to
metastasize and destroy tissue and cause death
• Cell characteristics: presence of tumor-specific antigens,
altered shape, structure, and metabolism
• Metastasis:
– Lymphatic spread
– Hematogenous spread
– Angiogenesis
• Carcinogenesis
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Carcinogenic Agents and Factors
• Viruses and bacteria
• Physical factors: sunlight, radiation, chronic irritation
• Chemical agents: tobacco, asbestos
• Genetic and familial factors
• Diet
• Hormones
• Role of the immune system
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Primary and Secondary Prevention
• Primary prevention is concerned with reducing cancer
risk in healthy people.
• Secondary prevention involves detection and screening to
achieve early diagnosis and intervention.
• There is now great emphasis on the primary and
secondary prevention of cancer.
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Primary Prevention
• Avoid known carcinogens.
• Lifestyle and dietary changes to reduce cancer risk
• Public and patient education
• See Chart 16-2.
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Secondary Prevention
• Identification of patients at high cancer risk
• Cancer screening
– Self-breast exam
– Self-testicular exam
– Screening colonoscopy
– Pap test
• Public and patient education
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Question
Tell whether the following statement is true or false.
Primary prevention involves detection and screening to
achieve early diagnosis and intervention.
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Diagnosis of Cancer
• Diagnostic Tests
See Table 16-4
• Tumor staging and grading
See Chart 16-3
TNM classification
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Diagnostic Eval
• Tumor markers: identify the extent of a particular type of cancer,
useful in measuring effectiveness of tx
– AFP
– CA – 125
– Calcitonin
– CEA
– Estrogen receptors
– HCG
– Progesterone receptor assay
– Prostatic acid phosphatase
– PSA
– CA -19-9
– CA – 15-3
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Cancer Management
• Cure
• Control
• Palliation
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Surgical Treatment
• Diagnostic surgery
• Biopsy: excisional, needle, incisional
• Tumor removal: wide excision, local excision
• Prophylactic surgery
• Reconstructive surgery
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Radiation Therapy
• Curative, control, or palliative
• External radiation
• Internal radiation
• Radiation reactions
• Effect on the GI system
• Effect on bone marrow
• Systemic effects
• Long-term effects and tissue changes
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Question
The lethal tumor dose of radiation is defined as that which
will eradicate 95% of the tumor yet preserve normal
tissue.
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Nursing Care of the Patient Undergoing
Radiation Therapy
• Patient and family education
• Include restrictions and precautions
• Skin care
• Oral care
• Protection of care providers
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Chemotherapy
• Agents used to destroy tumor cells by interfering with
cellular function and replication
• Curative, control, or palliative
• Types of chemotherapeutic agents
See Table 16-6
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Medical management
• Chemotherapy – goals  cure, control, or palliation of
symptoms;
– CT is used for: disease is widespread; the risk of
undetectable ds is high, the tumor can not be resected &
is resistant to RT
– Adjuvant chemo – after surgery, or RT, chemo drugs are
given to eliminate any submicroscopic cancer cells that
might be present, ex breast ca
– Nonadjuvant chemo – refers to the preop use of chemo
to reduce the bulk & lower the stage of a tumor, easier
for surgical removal
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Phases of Cell Cycle
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Question
What type of antineoplastic agent is 5-fluorouracil (5-FU)
classified as?
a. Nitrosourea
b. Hormonal agent
c. Antimetabolite
d. Antitumor antibiotic
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Bone Marrow Transplantation (BMT)
• Used for hematologic cancers that affect the marrow or
solid tumors, which are treated with a chemotherapy
dosage that ablates the bone marrow
• Types of BMT:
– Allogenic
– Autologous
– (Syngeneic)
• Graft-vs.-host disease
• Venous occlusive disease
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Administration of Chemotherapy
• Routes of administration
• Problem of extravasation
• Increased risk for fluid and electrolyte imbalances
• Risk for infection
• Risk for bleeding
• Protection of caregivers
See Chart 16-7
• See Chart 16-5
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Adverse Effects of Chemotherapy
• Toxicity
• GI effects: nausea and vomiting, diarrhea, mucositis, and
stomatitis
• Hematopoietic effects: myelosuppression
• Renal damage
• Cardiopulmonary system: potential cardiac toxicities
• Reproductive system: potential sterility, potential
reproductive cell abnormalities
• Neurologic effects
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Common Nursing Diagnoses
• Impaired oral mucosa
• Impaired tissue integrity
• Imbalanced nutrition
• Chronic pain
• Fatigue
• Disturbed body image
• Coping diagnoses and anticipatory grief
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Collaborative Problems
• Infection
• Bleeding
• Superior vena cava syndrome
• Hypercalcemia
• Spinal cord compression
• Pericardial effusion
• Disseminated intravascular coagulation (DIC)
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Hospice
• Comprehensive, multidisciplinary approach to the care of
patients with terminal illness and their families
• Focuses upon:
– Quality of life
– Palliation of symptoms
– Psychosocial and spiritual care
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Oncologic Emergencies
• Superior vena cava syndrome
• Spinal cord compression
• Pericardial effusion and cardiac tamponade
• Disseminated intravascular coagulation (DIC)
• Syndrome of inappropriate secretion of antidiuretic
hormone
• Tumor lysis syndrome
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questions
• T or F
•
1.Lymph nodes and blood are the key mechanisms by which cancer cells
spread.
•
2. Approximately 50% of all cancers are thought to be related to the
environment
•
3. Patients receiving internal radiation emit radiation while the implant is in
place
•
4. Nausea and vomiting are the most common side effects of chemotherapy
and may persist for as long as 24-48 hours after administration.
•
5. Prophylactic cancer vaccines have been proven to prevent prostrate, breast
and lung cancers.
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• Important: make sure if your ca pt is in pain he is
getting break through pain meds and is taking his
analgesics around the clock on a regular schedule.
• Many pt need antiemetics 1 hour before the chemo
tx starts.
• Pt exp alopecia to maintain self esteem we
encourage the pt to purchase a wig or turban to
wear.
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