Nursing Oncology

Oncology By: Ruby Ruth T. Roces, R.N., M.D.

Oncology defined 

It is a branch of medicine that deals with the study, detection, treatment and management of cancer

glossary Neoplasia-uncontrolled cell growth that follows no physiologic demand  Anaplasia-cells that lack normal cellular characteristics and differ in shape and organization  Metaplasia-conversion of one type of mature cell into another; reversible 

Dysplasia-bizarre cell growth resulting in cells that differ in size, shape or arrangement from other cells of the same type.  Hypoplasia-incomplete or underdevelopment w/ decreased number of cells 

Hyperplasia-Increase in the number of cells  Hypotrophy-decrease in the organ size /function  Hypertrophy-increase in the size 

“Root words”     

A- none Ana- lack Hyper- excessive Meta- change Dys- bad, deranged

Classification of Neoplasia 1. Benign 2. Malignant 3. Borderline/ in situ

WAYS TO DIFFERENTIATE A BENIGN FROM A MALIGNANT TUMOR Characteristics

Benign

Malignant

Rate of growth

Slow- growing

Varies, but usually fast-growing

Differentiation

Well differentiated

Poorly differentiated

Local invasion

Local invasion, encapsulated, local effects

Invasive, expansive,infiltrating, destructive, w/ generalized effects

Metastases

Non metastatic

metastatic

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 

“Exceptionistas” 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 Theories to the Pathogenesis of Cancer  Cellular transformation and derangement theory  Immune response failure theory

CANCER NURSING Etiology of cancer 1. PHYSICAL AGENTS  Radiation (thyroid CA)  Exposure to irritants (skin CA)  Exposure to sunlight (skin CA)

CANCER NURSING Etiology of cancer 2. CHEMICAL AGENTS  Smoking (Lung CA)  Dietary ingredients (gastric CA)  Drugs

CANCER NURSING Etiology of cancer 3. Genetics and Family History  Colon Cancer  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 

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2. HEMATOGENOUS 

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Most common

Blood-borne, commonly to Liver and Lungs

3. DIRECT INVASION/EXTENSION 

Seeding of tumors

CANCER NURSING 

Body Defenses Against TUMOR 1. T cell System/ Cellular Immunity 

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2. B cell System/ Humoral immunity 

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Cytotoxic T cells kill tumor cells B cells can produce antibody

3. Phagocytic cells 

Macrophages can engulf cancer cell debris

CANCER NURSING 

Cancer Diagnosis 1. BIOPSY 

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The most definitive

2. CT, MRI- for visualization and staging 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 Promotive and Preventive Nursing Management  1. Lifestyle Modification  2. Nutritional management  3. Screening  4. Early detection

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

SCREENING 

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1. Male and female- Occult Blood, CXR, and DRE 2. Female- SBE, CBE, Mammography and Pap’s Smear 3. Male- DRE for prostate, Testicular selfexam

CANCER MANAGEMENT GENERAL MEDICAL MANAGEMENT - Treatment goals: cure, control and palliation  1. Surgery  2. Chemotherapy  3. Radiation therapy  4. Immunotherapy  5. Bone Marrow Transplant

CANCER MANAGEMENT SURGERY  Diagnostic- excision, incision, needle  primary method of treatment- local and wide excision  prophylactic  Palliative- relieve complications of CA  Reconstructive- improve function or obtain a more desirable cosmetic effect

CANCER MANAGEMENT NURSING MANAGEMENT  Provide education and emotional support  Assess patient’s responses to the surgery  Monitor for possible complications such as infection, bleeding, fluid and electrolyte imbalance and organ dysfunction  Plan for discharge, ff-up and home care

CANCER MANAGEMENT RADIATION THERAPY  Cure, control, prophylaxis  Cells are most vulnerable during DNA synthesis and mitosis (BM,lymphatic,skin,GIT,gonads)

CANCER MANAGEMENT MAINTAIN TISSUE INTEGRITY  Frequently assess for changes  Handle skin gently  Do NOT rub affected area  Lotion may be applied (water-based)  Wash skin only with SOAP and Water  During treatment period, avoid soap, creams, deodorants and powder on treatment areas

CANCER MANAGEMENT RISK FOR RADIATION INJURY  Protect caregivers fr exposure to radioactive implants  Identify max time that can be spent safely inpxs room  Use of shielding equipments  Explain to px the need for such precautions to keep px from feeling isolated

CANCER MANAGEMENT    

MANAGEMENT OF STOMATITIS Use soft-bristled toothbrush Oral rinses with saline gargles/ tap water Avoid ALCOHOL-based rinses

CANCER MANAGEMENT CHEMOTHERAPY  Destroys tumor cells by interfering w/ cellular functions and reproduction  Used primarily to treat systemic disease rather than localized lesions

CANCER MANAGEMENT  

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ADMINISTRATION: Topical, Oral, IM, IV, Subcutaneous, arteria, intracavitary, intrathecal Dosage based on TBSA Special care needed for vesicants- causes extravasation (daunorubicin, doxorubicin, nitrogen mustard, mitomycin, vincristine and vindesine. If suspected stop immediately and apply ice except in vonca alkaloid

CANCER MANAGEMENT Common side effects:  Nausea and vomiting,stomatitis, anorexia, diarrhea  Myelosuppression  Nephrotoxicity-danorobucin, doxorubucin  CHF- cisplastin, methroxate, mitomycin  Pulmonary fibrosis-bleomycin and busulfan

CANCER MANAGEMENT  

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Sterility Reversible Neurologic damage- taxanes and plant alkaloids, peripheral neuropathy and hearing loss- cisplatin fatigue

Nursing Intervention 

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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  

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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 breakthrough pain

Nursing Intervention  

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DECREASE FATIGUE Plan daily activities to allow alternating rest periods Light exercise is encouraged Small frequent meals

Nursing Intervention   

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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   

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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

Nursing Intervention 

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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 

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MANAGE COMPLICATION: Septic shock Monitor VS, BP, temp Administer IV antibiotics Administer supplemental O2

Nursing Intervention  

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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

1. A chemotherapeutic agent was given to a patient as an adjunct to surgery .Which of the following statements about chemotherapy is true?  it is a local treatment  it is affects both normal and cancer cells  it is effective for all types of cancer  it has few adverse effects

2. A 30 y.o. client is about to receive chemotherapy. The nurse is monitoring the patient’s lab results prior to the initiation of therapy. The nurse knows that the WBC count of the client is normal if the result showed  5,000-10,000 cells/mm3  3,000- 7,000 cells/mm3  8,000-12,000 cells/mm3  1,000-5,000 cells/mm3

3. Testicular self-examination is done as a preventive screening procedure for testicular cancer. The right way to do the exam is  examine the testes after a warm bath or shower  have the client examine his testes while lying supine  to feel for new growth or mass w/ 1 finger  to have an annual testicular exam done

4. In health teaching done in the OB-gyne ward, the nurse instructs the clients to perform selfbreast examination  a week after the onset of menstruation  monthly during the peak of ovulation  at the start of menstruation  1 week before the onset of menstruation.

5. The following are examples of risk factors for cancer except  HPV  low-fat, high-fiber diet  radiation exposure  Diethystilbestriol

6. A 54 y.o., G0, has been on conjugated estrogen for 5 years. Among all the gynecologic cancers, Which one is she least likely to acquire or have?  Vaginal cancer  Breast cancer  Ovarian cancer  Endometrial cancer

7. Colorectal cancers are one of the most common type of cancers occurring in old age. Screening for this type of cancer involves the following except  digital rectal exam  occult blood testing  proctosigmoidoscopy  CT scan

8. One of the clients in the ward has a family history of colon cancer. The least appropriate advise for him would be to  have low fat, high fiber diet  to have an annual digital rectal exam  to test for occult blood  have a colonoscopy done

9. Pap smear is a procedure done to screen for cervical cancer. As a preventive measure, this is ideally done  At the onset of sexual activity or at age 18  annually for sexually active women  every other year for sexually active women  for women 20 yrs of age and above initially 2 consecutive annual smear.

10. Testicular examination is advised as a screening procedure to detect testicular cancer. The client still needs further instructional reinforcements if he verbalized  a. “ The testicles are normally egg-shaped”  b. “ My testicles feel smooth”  c. “ My testicles normally has a spongy consistency”  d. “ This test is being done to detect any lumps”

Match the following type of viruses with the various type of tumor/malignancy 11. Nasopharyngeal cancer

a. Epstein-Barr virus

12. Non- hodgkins lymph0ma 13. Hepatocellular cancer

b. Hepatitis B c. Human Papilloma virus d. HTCLV

14. Burkitts lymphoma 15. Hodgkins disease

Mortality and Morbidity Rates

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 

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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

Colon 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 

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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 

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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 

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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 

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NURSING INTERVENTION: COLOSTOMY CARE Lightly pat dry the area and NEVER rub Lightly dust the peri-stomal area with nystatin powder

Colon cancer 

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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 

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NURSING INTERVENTION: COLOSTOMY CARE Empty the pouch or change the pouch when  

1/3 to ¼ full (Brunner) ½ to 1/3 full (Kozier)

1. Colostomy should be drained when it is  A. full  Half-full  100 ml full  As you wish

Pouch opening should be A .3 cm larger than stomal opening b. .5 cm larger than stomal opening c. 1 cm larger than stomal opening d. Same size with the opening 

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A client has underwent hemicolectomy and placement of Right colostomy. You expect the drainage to be A. mushy B. solid C. purely liquid D. purely air

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Most common manifestation of colon Ca is A. anemia B. tenesmus C. alternating diarrhea and constipation D. pain

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A client had a colostomy. When do You expect to note for fecal drainage? A. as soon as the colostomy is placed B. 1 day after C. 3 days after D. 1 week after

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All of the following are vesicants except A. vincristine B. dopamycin C. mustard D.mitomycin

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In patients receivne chemotherapy suspected of extravasation, the drug must be stopped and ice should be applied for all of the following except A. vincristine B. doxorobucin C. mustard D.mitomycin

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A client receiving chemotherapy started to complain of dyspnea. X-ray showed fibrosis. Which of the following chemo agent is he most probably receiving? A. vinblastine B. taxanes C. busulfan D. cisplatin

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Cisplatin is known for causing which side effect A. reversible hearing loss B. irreversible hearing loss C. reversible peripheral neuropathy D. irreversible peripheral neuropathy

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A client on chemotherapy started to complain of dyspnea and orthopnea. Auscultation showed rales and crackles. Which of the following drug is he most probably receiving? A. chloramphenicol B. vinblastine C. busulfan D. cisplatin

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 : Post-OP

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Position patient: Supine Affected extremity elevated to reduce edema Warm shower on 2nd day post-op Immediate post-op: snug dressing with drainage Maintain patency of drain (JP) ; Drainage is removed when the discharge is less than 30 ml in 24 H Monitor for hematoma w/in 12H and apply bandage and ice, refer to surgeon

Breast Cancer NURSING INTERVENTION : Post-OP  Lotions, Creams are applied ONLY when the incision is healed in 4-6 weeks  Hand, shoulder exercise done on 2ndday  Post-op mastectomy exercise 20 mins TID  NO BP or IV procedure on operative site  Heavy lifting is avoided  Monitor complications ( lymphedema, hematoma, infecton)

Breast Cancer NURSING INTERVENTION : Post-OP TEACH FOLLOW-UP care  Regular check-up  Monthly BSE on the other breast  Annual mammography

Lung cancer  

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6th-7th decade Number 1 in the morbidity and mortality survey among all cancers Equal incidence for both men and women 85% caused by inhalation of carcinogenic materials most commonly cigarette smoking

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Squamous cell carcinoma- more centrally located, commonly in the segmental and subsegmental bronchi. AdenoCarcinoma- presents more peripherally as peripheral mass or nodules; most prevalent lung Ca for both M and F Large cell carcinoma-fast growing tumor that arise peripherally

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Bronchioalveolar cell CA- arises fr the terminal bronchus and alveoli; usually slow growing Small cell Ca- arises primarily as a proximal lesion but may arise in any part of the tracheobronchial tree

Lung Cancer Etiology  Tobacco use  Genetic- > acquired genetic lesion

Lung Cancer Clinical Manifestations:  Cough  Hemoptysis  Wheeze, stridor  Dyspnea  Pneumonitis  Pain  Symptoms of lung abscess

Lung Cancer 

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Metastatic spread- tracheal obstruction, dysphagia, hoarseness, Horner’s syndrome, auperior vena cava syndrome, plural effusion, respiratory failure. Systemic symptoms Endocrine syndromes-hypercalcemia (epidermoid), SIADH (sm cell), gynecomastia (large cell), clubbing (non-sm. Cell)

Lung Cancer Stage

TNM descriptors

5-yr survival rate

I

T1-2,N0,M0

60-80

II

T1-2,N1,M0

25-50

IIIA

T3,N0-1,M0 T1-3,N2,M0

25-40 10-30

IIIB

Any T4 or N3,M0

<5

IV

Any M0

<5

Lung Cancer T1-< 3 cm T2->3 cm T3- direct extension into chest wall T4- invades mediastinum N0 N1-peribronchial N2-ipsilateral mediastinal N3-contralateral mediastinal

Lung Cancer  

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TREATMENT Surgery (segmentectomy, lobectomy, pneumonectomy) Radiotherapy Chemotherapy

Laryngeal cancer     

Risk Factors tobacco alcohol radiation? occupation?

CLASSIFICATION ACCORDING TO LOCATION  1. supraglottic  - rich in lymphatics  2. glottic  - (true vocal cords) most common 55-75%; good prognosis  3. subglottic  - least common 1-5%; metastasizes to the Delphian node

SYMPTOMS:  voice change- 2 wks duration  airway obstruction  odynophagia  otalgia  neck mass  other constitutional symptoms

DIAGNOSIS:  LARYNGOSCOPY  BIOPSY

MANAGEMENT  local excision/ vocal cord stripping  LASER vaporization or excision/ cordectomy  Radiotherapy (EBRT- external beam radiotherapy or brachytherapy – radioactive implants)  Conservation laryngectomy/ Total laryngectomy

Laryngeal Cancer NURSING MANAGEMENT: PRE-operative Provide the patient pre-operative teachings  Clarify misconceptions  Tell that the natural voice will be lost  Teach communication alternatives Reduce patient ANXIETY  Provide opportunities for patient and family members to ask questions  Referrals to previous patients with laryngeal cancers and cancer groups

Laryngeal Cancer NURSING MANAGEMENT: POST-op Maintain PATENT Airway  Position patient: Semi or High Fowler’s  Suction secretions  Encourage to deep breath, turn and cough Administer care of the laryngectomy tube  Suction as needed  Cleanse the stoma with saline  Administer humidified oxygen  Laryngectomy tube is usually removed within 3-6 weeks after surgery

Laryngeal Cancer NURSING MANAGEMENT: POST-op Promote alternative communication methods  Call bell or hand bell, Magic Slate, Hand signals  Collaborate with speech therapist Promote adequate Nutrition  NPO after operation  No foods or drinks per orem for 10 days  IVF, TPN are alternative nutrition routes  Start oral feedings with thick liquids, avoid sweet foods

Laryngeal Cancer NURSING MANAGEMENT: POST-op Monitor for COMPLICATIONS  Respiratory Distress  Hemorrhage  infection

Laryngeal Cancer NURSING MANAGEMENT: HOME CARE  Humidification system at home is needed  AVOID swimming  Cover the stoma with hands or plastic bib over the opening  Advise beauty salons to avoid hair sprays, powders and loose hair near the opening  Oral hygiene frequently

Prostate Cancer Etiology 

Age-related

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Blacks>white

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95 % are adenocarcinomas

Prostate Cancer Manifestations:  Rel. to urinary flow obstuction  Urinary frequency, ec in caliber of stream, diminished force, hesitancy, dribbling, nocturia and overflow incontinence  Dysuria  Back or hip pain

Prostate Cancer Diagnostics:  DRE  PSA- > 10 ng/ml  Biopsy- transrectal prostate biopsy under sonography (TRUS)

Prostate Cancer Treatment  Surgery- radical retropubic prostatectomy  Radiation therapy *both are associated w/ impotence  Androgen deprivation- for those w/ metastatic disease (leuporide, flutamide)  Chemotherapy- for palliation

quiz 1. All of the following are manifestations of prostate cancer except  Hesitancy  dribbling  Dysuria  Painless

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2. The most common manifestation of laryngeal cancer is A. odynophagia B. Dysphagia C. Voice change D. dyspnea

3. Most head and neck cancers are caused by smoking. Which of the following is not caused by smoking?  A. lung cancer  B. ovarian CA  C. laryngeal cancer  D. esophageal cancer

Quiz 4. a 64 y.o patient status post- hemi colectomy was tachycardic. Examination of the mucus membrane showed a dry mouth. What is your assessment to the possible cause of tachycardia in this patient?  infection  3rd spacing  Dehydration  sepsis

5. difference between a benign fr malignant neoplasm include all of the ff except  well differentiated  poorly demarcated  no metastatic potential  non invasive

6. radiation therapy is effective in actively dividing cells. All of the ff are ex of those except  GIT  Fatty tissues  Nerve  skin

7. screening should be done to detect cancers. Routine Screening tests involves all of the following except    

breast exam DRE Ultrasound Occult blood exam

8. A client complained of chronic cough w/ hemoptysis. Assessment showed wasting, dry skin and s/sxs of cachexia. The client most probably has  A. TB  B. bronchiectasis  C. lung CA  D. all of the above

9. Client underwent pneumonectomy. Post-op the best position to put the client in is b. Affected side c. Unaffected side d. Trendelenburg e. 10 inch block

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10. Post-mastectomy lotions and cream may be applied after healing takes place. When does it usually occur? A. 1 month B. 2 months C. 4 months D. 1 year

Cervical Cancer          

peaks: 45-60 y.o. Risk factors: Early coitus Early conception Multiple sexual partners Cigarette smoking High risk partners Immunosuppressed HPV HSV

Cervical cancer Assessment:  post coital or irregular bleeding  Malodorous bloody discharge  Sciatica  Leg edema  Deep pelvic pain

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Treatment: Surgery (radical hysterectomy) Radiotherapy ( external beam to the pelvis followed by intracavitary)

Endometrial cancer        

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Risk factors: 50-60 Obesity polycystic ovarian disease Early menarche Late menopause Exogenous unopposed estrogen Tamoxifen( antiestrogen in breast but acts like estrogen in the endometrium) Lynch II syndrome(hereditary nonpolyposis colorectal syndrome)

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Assessment: Irregular menses or postmenopausal bleeding Diagnosis: D and C

Ovarian cancer   

Risk factors: Family history Low parity and infertility

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Assessment: Abdominal distention- most common Lower abdominal pain Pelvic mass Weight loss

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Diagnostics: Pelvic ultrasound CA-125 Abdominopelvic CT scan and chest radiography if suspected of having ovarian CA

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Treatment: Surgery Chemotherapy: Paclitaxel( neuropathy, alopecia,myelosuppression,hypersensitivity and bradycardia) Carboplatin ( N/V, myelosuppression, constipation)

Non-Hodgkins Lymphoma  

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Heterogenous group of cancers Originates from neoplastic growth of lymphoid tissue Mostly involves malignant B lymphocytes; only 5% are T lymphocytes

Non-Hodgkins Lymphoma Manifestations:  Symptoms are highly variable  Symptoms may be absent or very minimal at the early-stage of the disease  Typically diagnosed at a latter stage when px is more symptomatic; lymphadenopathy is noticeable (stages III or IV)  1/3 of cases have “B symptoms” (recurrent fever, drenching night sweats, & unintentional wt. loss of >10%

Non-Hodgkins Lymphoma Assessment & Diagnostics  Histopathology  Immunophenotyping  Cytogenetic analysis Staging – based on data obtained from CT scan, bone marrow biopsies, CSF analysis

Non-Hodgkins Lymphoma Treatment:  based on actual classification & stage of disease, prior treatment, & px’s ability to tolerate therapy  Radiation alone maybe beneficial in localized nonaggressive forms  In aggressive types, combination chemotherapy are given in early stages  Intermediate forms – chemotherapy + radiotherapy for st. I & II disease

lymphoma   

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Hodgkins disease Cause: unknown S/sxs: painless lymphadenopathy, *reed sternberg cell, edema(lymph obstuction),cough,dypnea(mediastinal node enlargment) Mgt: radio,chemo (MOPP), supportive,splenectomy

Urinary bladder Cancer     

ETIOLOGY AND RISK FACTORS 65 Yrs.- median age Smoking Cyclophosphamide exposure Schistoma haematobium

Urinary bladder Cancer Manifestations:  Hematuria- mOst common symptom  Urinary changes may accompany later  Usually asymptomatic at early stages

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Diagnosis: Urinalysis- hematuria IVP- decreased bladder filling Cystoscopy- diagnostic

Urinary bladder Cancer    

Treatment: Based on extent of disease Surgical Resection Intravesical chemotherapy

Skin cancer Etiology : – chronic friction, irritation & exposure to UV Types: 1. basal cell – most common 2. squamous cell 3. malignant melanoma – most fatal

Squamous cell Carcinoma Risk factors:  UV rays  Radiation  Actinic keratosis  Immunosuppression  Industrial carcinogens

Squamous cell Carcinoma History and Assessment:  Slowly evolving  Assymptomatic  Occassionaly bleeding and pain  Exophytic nodules w/ varying degree of scaling or crusting

Basal Cell Carcinoma Risk factors:  UV rays  May take several forms: nodular, ulcerative, pigmented ad superficial

Basal Cell Carcinoma Hx and Assessment:  Usually asymptomatic unless secondarily infected in advanced disease  Pearly-colored PAPULE  External surface - fine telangiectasia and is translucent

Melanoma Risk factors:  Sun exposure  Fair skin  Positive family history  Presence of dysplastic nevi

Melanoma Hx and Assessment:  Usually asymptomatic until late  Pruritus or mild discomfort  Recent changed in a previous skin lesion  A- asymetry  B- border irregularity  C- color variation  D- diameter(large)

Skin Cancer Interventions: preventive measures a. b.

c. d. e.

monitoring of any lesion have moles or lesions removed if they are subject to chronic irritation avoid contact with chemical irritants use of sunscreen avoid too much sun exposure

Hepatocellular CA  

Hepa B alcohol

Liver physiology and Pathophysiology Normal Function 1. Stores glycogen

Abnormality in function = Hypoglycemia

2. Synthesizes proteins 3. Synthesizes globulins 5. Secreting bile

= Hypoproteinemia =Decreased Antibody formation = Bleeding tendencies = Jaundice & pruritus

6. Converts ammonia to urea

=Hyperammonemia

7. Stores Vit and minerals

=Deficiencies of Vit and min

8. Metabolizes estrogen

= Gynecomastia, testes atrophy

4. Synthesizes Clotting factors

CONDITION OF THE LIVER NURSING INTERVENTIONS

1. Monitor VS, I and O, Abdominal girth, weight, LOC and Bleeding  2. Promote rest. Elevated the head of the bed to minimize dyspnea 

CONDITION OF THE LIVER NURSING INTERVENTIONS  3. Provide Moderate to LOW-protein (1 g/kg/day) and LOW-sodium diet  4. Provide supplemental vitamins (especially K) and minerals  Administer prescribed Diuretics= to reduce ascites and edema Lactulose= to reduce NH4 in the bowel Antacids and Neomycin= to kill bacterial flora that cause NH production

CONDITION OF THE LIVER NURSING INTERVENTIONS 6. Avoid hepatotoxic drugs  Paracetamol  Anti-tubercular drugs 7. Reduce the risk of injury  Side rails reorientation  Assistance in ambulation  Use of electric razor and soft-bristled toothbrush

CONDITION OF THE LIVER

NURSING INTERVENTIONS 

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8. Keep equipments ready including Sengstaken-Blakemore tube, IV fluids, Medications to treat hemorrhage 9. Assist in surgery and chemotherapy

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1. What is the most common manifestation of urinary bladder cancer? A. pelvic pain B. Painful hematuria C. painless heamturia D. pelvic mass

2. In patient w/ liver disorders, they are given drugs to kill bacterial flora that cause NH production. Which of the following drugs serves that purpose? b. Vancomycin c. Amoxicillin d. Neomycin e. Nitrogen mustard

3. Cervical cancer is fast growing. This is associated w/ all of the following except  A. HPV  B. herpes simplex  C. genital warts  D. HTLV

4. Prolonged Exposure to estrogen increases the risk for acquiring All of the following types of cancer except b. Breast CA c. Ovarian CA d. Endometrial Ca e. Ductal CA

5. Malignant melanoma is often seen in fair skinned individuals. Assessment findings which will help strenthen the diagnosis includes  A- asymetry  B- border irregularity  C- color variation  D- diameter (small)

6. All of the following are correct except  A. melanoma- assymetrical  B. squamous CA- ulcerating  C. basal cell- pearly colored papule  D. Squamous cell- nodular

7. Lymphoma is a malignancy involving the lymph tissues. The most common lymph node involved is b. Cervical c. Supraclavicular d. Mediastinal e. inguinal

8. Which of the following assessment findings will aid you in diagnosisng hodgkin’s disease  A. lymphadenopathy  B. hematuria  C. reed sternberg cell  D. lymphedema

9. Patients w/ cervical cancer often complains of b. Dysmenorrhea c. Post coital bleeding d. Pelvic mass e. Pelvic pain

10. Patients with liver cancer often presents with following assessment findings except b. Esophageal varices c. Ascites d. Hyperglycemia e. Petechiae and echymosis

5. chemotherapy was advised in a patient diagnosed w/ skin Cancer. Vinblistine was the agent ordered. You know that vinblistine is a vesicant type of agent and causes    

extravasation intravasation nephrotoxicity ototoxicity

6. Most frequent cause of fever w/in 24 hrs in a post-op patient is…. 7-9. internal Radiation therapy poses a risk for both patient and caregiver. Give 3 ways to avoid unnecessary exposure 10. Most common manifestation of lung cancer in early stages is…..