Oncology Nursing

Objectives
After 2H of active lecture-discussion. The students will be
able to:

1. Define CANCER
2. Present their group audio-visual presentation focusing
on CANCER prevention and awareness
3. Identify the responsibilities of the nurse in CANCER
care
4. Have a preview on the different types of CANCER
5. Include Christian Valuing in the care of clients with
CANCER.
 Cancer
• malignant neoplasm

• is a class of diseases in which a group of

cells display
• uncontrolled growth (division beyond the
normal limits)
• invasion (intrusion on and destruction of
adjacent tissues)
• metastasis (spread to other locations in the
body via lymph or blood).
 Responsibilities of the Nurse
in CANCER care
• Support the idea that cancer is a chronic illness
that has acute exacerbations rather than one
that is synonymous with DEATH and
SUFFERING
• Assess own level of knowledge relative to the
pathophysiology of the disease process
• Make use of current research findings and
practices in the care of the client with cancer and
his or her family
• Identify patients at high risk for cancer
 Responsibilities of the Nurse
in CANCER care
• Participate in PRIMARY and SECONDARY
prevention efforts
• Assess the nursing care needs of the patient
with cancer
• Assess the learning needs, desires, and
capabilities of the patient with cancer
• Identify nursing problems of the patient and the
family
• Assess the social support networks available to
the patient
 Responsibilities of the Nurse
in CANCER care
• Plan appropriate interventions with the patient
and the family
• Assist the patient to identify strengths and
limitations
• Assist the patient to design short-term and long-
term goals for care
• Implement NCPs that interfaces with the medical
regimen and that is consistent with the
established goals
• Collaborate with the members of a
multidisciplinary team to foster continuity of care
Responsibilities of the Nurse
in CANCER care
• Evaluate the goals and resultant outcomes
of care with the patient, family, and
members of the multidisciplinary team
• Reassess and redesign the direction of
care as determined by the evaluation
 PATHOPHYSIOLOGY OF THE
MALIGNANT PROCESS
• Cancer begins when an abnormal cell is transformed
by the genetic mutation of the cellular DNA.
• Abnormal cell forms a clone and begins to proliferate
abnormally, ignoring growth- regulating signals in
the environment surrounding the cell.
• Cells acquire invasive characteristics, and changes
occur in the surrounding tissues.
• Cells infiltrate tissues and gain access to the lymph
and blood vessels, which carry the cells to other
parts of the body (metastasis).
 Cancer is not a single disease with a
single cause; rather it is a group of
distinct diseases with different
causes, manifestations, treatments,
and prognoses.
PROLIFERATIVE PATTERNS
• Cancerous cells:

• malignant neoplasms

• demonstrate uncontrolled cell growth

that follows no physiologic demand.
 Patterns of cell growth:
• Hyperplasia: increase in the number of cells of a tissue;
most often associated with periods of rapid body growth.
• Metaplasia: conversion of one type of mature cell into
another type of cell.
• Dysplasia: bizarre cell growth resulting in cells that differ
in size, shape or arrangement from other cells of the same
tissue.
• Anaplasia: cells that lack normal cellular characteristics
and differ in shape and organization with respect to their
cells of origin; usually, anaplastic cells are malignant.
• Neoplasia: uncontrolled cell growth that follows no
physiologic demand.
 CHARACTERISTICS OF
MALIGNANT CELLS
• Cell membranes are altered, which affects fluid movement in
and out of the cell.
• Contains proteins (tumor- specific antigens), which develop as
they become less differentiated (mature) overtime.
• Contain less fibronectin, a cellular cement; therefore, they are
less cohesive and do not adhere to adjacent cells readily.
• Nuclei are large and irregularly shaped (pleomorphism).
• Nucleoli are larger and more numerous.
• Chromosomal abnormalities (translocations, deletions, additions)
• Mitosis occurs more frequently.
• As the cells grow and divide, more glucose and oxygen are needed.
CHARACTERISTICS OF BENIGN
AND MALIGNANT NEOPLASMS
CHARACTERISTICS BENIGN MALIGNANT
Cell characteristics Well- differentiated cells that Cells are undifferentiated
resemble normal cells of the and often bear little
tissue from which the tumor resemblance to the normal
originated. cells of the tissue from which
they arose.

Mode of growth Tumor grows by expansion Grows at the periphery and

and does not infiltrate the sends out processes that
surrounding tissues; usually infiltrate and destroy the
encapsulated. surrounding tissues.

Rate of growth Rate of growth is usually Rate of growth is variable

slow. and depends on level of
differentiation; the more
anaplastic the tumor, the
faster its growth.

Metastasis Does not spread by Gains access to the blood

metastasis. and lymphatic channels and
metastizes to the other areas
of the body.
General effects Is usually a localized Often causes generalized
phenomenon that does not effects, such as anemia,
cause generalized effects weakness, and weight loss.
unless its location interferes
with vital functions.

Tissue destruction Does not usually cause tissue Often causes extensive tissue
damage unless its location damage as the tumor
interferes with blood flow. outgrows its blood supply or
encroaches on blood flow to
the area; may also produce
substances that causes cell
damage.

Ability to cause death Does not usually cause death Usually causes death unless
unless its location interferes growth can be controlled.
with vital functions.
 INVASION AND METASTASIS
• Invasion: growth of the primary tumor into the surrounding
host tissues.
• Mechanical pressure may force finger-like projections of tumor cells
into surrounding tissues and interstitial spaces.
• Malignant cells are less adherent and may break off from the primary
tumor and invade adjacent structures.
• Malignant cells produce or possesses destructive enzymes
(proteinases) such as collagenenases, plasminogen activators, and
lysosomal hydrolyses that destroys surrounding tissue, including the
structural tissues of the vascular basement membrane, facilitating
invasion of malignant cells.
• Metastasis: dissemination or spread of malignant cells from
the primary tumor to distant sites by direct spread of tumor
cells to by cavities or through lymphatic and blood
circulation.
 METASTATIC MECHANISMS
• Lymphatic spread
• Most common mechanism.
• Tumor emboli enter through interstitial fluid that communicates with
lymphatic fluid or by invasion.
• After entering the lymphatic circulation, may lodge in the lymph nodes
or pass between lymphatic and venous circulation.
• Hematogenous spread
• Malignant cells are disseminated through the blood stream.
• Few malignant cells survive the turbulence of arterial circulation,
insufficient oxygenation, or destruction by the body’s immune system.
• Those that survive are able to attach to endothelium and attract
fibrin, platelets and clotting factors to seal themselves form immune
system vigilance.
• Angiogenesis
• Ability of the malignant cells to induce the growth of new capillaries
from the host tissue to meet their needs for nutrients and oxygen.
 THREE STEPS OF CARCINOGENESIS
(MALIGNANT TRANSFORMATION)
• Initiation
• Initiators (carcinogens) escape normal enzymatic mechanisms
and alter the genetic structure of the cellular DNA where
permanent mutation occurs.
• Promotion
• Repeated exposure to promoting agents (co-carcinogens) causes
the expression of abnormal or mutant genetic mutation even
after long latency periods.
• Progression
• Cellular changes formed during initiation and promotion now
exhibit increased malignant behaviour.
• These cells now show a propensity to invade adjacent tissues
and to metastasize.
ETIOLOGY
• Viruses and Bacteria
• Viruses as a case are hard to determine because they are difficult to isolate.
• Infectious causes are considered when specific cancers appear in cluster.
• Viruses incorporate themselves in the genetic structure of the cells, thus
altering future generations of that cell population- perhaps leading to cancer.
• Examples:
• Epstein- Barr virus: nasopharyngeal cancers, some type of non-
Hodgkin’s lymphoma and Hodgkin’s disease.
• Herpes simplex virus type II, cytomegalovirus, and human
papillomavirus types 16, 18, 31 and 33: dysplasia and cancer of the
cervix.
• Hepatitis B virus: cancer of the liver.
• HIV: Kaposi’s Sarcoma
• H. Pylori: gastric malignancy secondary to inflammation and injury of the
gastric cells.
• Physical agents
• Exposure to sunlight or radiation, chronic irritation or
inflammation, and tobacco use.
• Chemical agents
• 75% are thought to be related to the environment
• Tobacco smoke: single most lethal carcinogen (30% of cancer
deaths)
• Others: aromatic amines and aniline dyes; pesticides and
folmaldehydes; arsenic soot, and tars; asbestos; benzene; betel
nut and lime; cadmium; chromium compounds; nickel and zinc
ores; wood dust; beryllium compounds; and polyvinyl chloride.
• Most chemicals alters DNA structure in body sites distant from
chemical exposure.
• Most often affected: liver, lungs and kidneys
• Genetic and familial factors
• Genetics, shared environments, cultural or
lifestyle factors, or chance alone.
• 5% to 10% of cancers of adulthood and
childhood display a familial predisposition.
• Cancers associated with family inheritance:
retinoblastomas, malignant
neurofibromatosis, and breast, ovarian,
endometrial, colorectal, stomach, prostate,
and lung cancers.
• Dietary factors
• 35% of all environmental cancers
• Dietary substances associated with an increased cancer risk:
• Fats, alcohol, salt- cured or smoked- meats, foods
containing nitrates and nitrites, and high- caloric dietary
intake.
• Foods that lower cancer risks:
• High- fiber foods, cruciferous vegetables (cabbage,
broccoli, cauliflower, Brussel sprouts, kohlbari), carotenoids
(carrots, tomatoes, spinach, apricots, peaches, dark- green
and deep- yellow vegetables)
• Obesity: associated with endometrial cancer, postmenopausal
breast cancer, cancers of the colon, kidney, and gallbladder.
• Hormonal agents
• Disturbances in hormonal balance either by the body’s
own (endogenous) hormone production or by
administration of exogenous hormones.
• Endogenous: cancers of the breast, prostate and uterus
• Oral contraceptives and prolonged estrogen replacement
therapy: hepatocellular, endometrial, and breast cancers.
• Hormonal changes with reproduction are also associated
with cancer incidence.
• Increased numbers of pregnancies are associated with
a decreased incidence of breast, endometrial and
ovarian cancers.
Common Sites of Metastasis for
Different Cancer Types
1. Breast Cancer – bone, lung, liver, brain
2. Lung Cancer – brain, bone, liver, lymph nodes,
adjacent structures
3. Colorectal Cancer – liver, lymph nodes,
adjacent structures
4. Prostate Cancer – Bone(esp. spine and legs),
pelvic nodes
5. Melanoma – GIT, lymph nodes, lung, brain
6. Primary Brain Cancer – CNS
Risk factors for a specific type of
cancer
1. Breast cancer
• family history (immediate female relatives)
• high-fat diet
• obesity after menopause
• early menarche, late menopause
• alcohol consumption
• postmenopausal estrogen and progestin
• first child after age 30
2. Cervical cancer
• multiple sexual partner
• having sex at early age
• exposure to human papilloma virus
• smoking
 Risk factors for a specific
type of cancer
3. Colorectal cancer
• family history (immediate relatives)
• low fiber diet
• history of rectal polyps
4. Esophageal Cancer
• heavy alcohol consumption
• Smoking
5. Lung Cancer
• cigarette smoking
• asbestos, arsenic, and radon exposure
• secondhand smoke
• TB
 Risk factors for a specific
type of cancer
6. Skin Cancer
• excessive exposure to UV radiation (sun)
• fair complexion
• work with coal, tar, pitch or creosote
• multiple or atypical nevi (males)
7. Stomach Cancer
• family history
• diet heavy in smoked, pickled or salted foods
8. Testicular Cancer
• undescended testicles
• consumption of hormones by mothers during pregnancy
9. Prostate Cancer
• increasing of age
• family history
• diet high in animal fat
Cancer Classification
1.Solid Tumors : Associated with the organs
from which they developed, such as breast
or lung cancer

2.Hematological Cancers : Originate from

blood-cell forming tissues, such as the
leukemias and the lymphomas
 Grading and Staging
- Are methods used to describe the
tumor, these methods describe the
extent of the tumor, the extent to
which malignancy has increased in
size, the involvement of regional
nodes, and metastatic development.
 Grading
• Grading: refers to classification of tumor cells.
• Seek to define the type of tissue from which the
tumor originated and the degree to which the
tumor cells retain the functional and histologic
characteristics of the tissue of origin.
• Can be obtained through cytology (examination
of cells from tissue scrapings, body fluids,
secretions or washings), biopsy or surgical
excision.
GRADING
GradeX : Grade cannot be
determined
GradeI : Cells differ slightly
from normal cells and are
well differentiated (Mild
Dysplasia)
GradeII : Cells are abnormal
and are moderately
differentiated ( Moderate
Dysplasia)
GradeIII : Cells are very
abnormal and are poorly
differentiated ( Severe
Dysplasia)
GradeIV : Cells are immature
(anaplasia) and
undifferentiated, cell of
origin is difficult to
determine.
 Staging
• Staging: determines the size of the tumor
and the existence of the metastasis.
• TNM system:
• T: The Extent of the primary tumor
• N: The absence or presence of regional
lymph node metastasis.
• M: The absence or presence of distant
metastatsis.
Primary Tumor (T)
TX: primary tumor cannot be assessed.
T0: No evidence of primary tumor.
Tis: Carcinoma in situ
T1, T2, T3, T4: Increasing size and/ or local extent of the primary
tumor.
Regional Lymph Nodes (N)
NX: regional lymph nodes cannot be assessed.
N0: no regional lymph node metastasis.
N1, N2, N3: increasing involvement of regional lymph nodes.
Distant Metastasis (M)
MX: distant metastasis cannot be assessed.
M0: no metastasis
M1: distant metastasis
 Cancer Prevention, Screening
and detection
• Prevention is a priority in oncology nursing because at
least one third of all cancers are preventable.

• Cancer is also curable if detected and treated early.

• The principal role of an oncology nurse as a provider of

information and education in the prevention and early
detection of cancer requires a basic understanding of the
etiology and epidemiology of the disease.
 The most successful
approach to caner
control is the prevention
of cancer.
Prevention and Detection Measures
1. Promoting cancer awareness
Warning Signs of Cancer
C hange in bowel or bladder habits
A ny sore that does not heals
U nusual bleeding or discharge
T hickening or lump in breast or elsewhere
I ndigestion
O bvious change in wart or mole
N agging cough or hoarseness

U nexplained anemia
S udden and unexplained weight loss
2. Promoting risk factors awareness
3. Promoting healthy behaviors
 Good nutrition and diet
 Tomatoes, spinach, red wine, nuts, broccoli, oats,
salmon, garlic, green tea, blueberries
4. Limiting alcohol consumption
5. Hepa B virus infant vaccination
6. Control of STDs
7. Changing risk behaviors
8. Teaching skills for early detection programs
9. Promoting participation in early detection
programs
 Recommendations of the American
Cancer Society for early cancer detection

1. For detection of breast cancer

• Monthly BSEs
• Women at age 40 should have a yearly
mammogram and breast examination by a
health care provider
2. For detection of colon and rectal cancer
• All aged 50 and up should have a yearly fecal
occult blood test
• Digital rectal exam and flexible sigmoidoscopy
every 5 years
• Colonoscopy with Ba enema every 10 years
3. For detection of uterine cancer
• Yearly Pap smear for sexually active females
and any female over age 18
• At menopause, high-risk women should have
an endometrial tissue sample
4. For detection of prostate cancer
• Beginning age 50, yearly digital rectal
examination and prostate-specific antigen
(PSA) test
 Cancer Screening
-refers to detection of disease through tests,
exams, and other procedures

An ocology nurse should have good hx

taking skills. She should be able to note
down all possible clinical as well as
behavioral clues through PE
DIAGNOSTIC TESTS
Biopsy
- is the definitive means of diagnosing cancer and
provides histological proof of malignancy.
- involves the surgical incision of a small piece of tissue
of microscopic examination

Types:
a. Needle : Aspiration of Cells
b. Incisional : Removal of a wedge of suspected tissue from
a larger mass
c. Excisional : Complete removal of the entire lesion
d. Staging : Multiple needle or incisional biopsies in tissues
where metastasis is suspected or likely.
Other means of Detection
• Mammography
• Papanicolaou’s (Pap) test
• Stools for occult blood
• Sigmoidoscopy
• Colonospcopy
• Skin Inspection
 Tumor Markers
• protein substances found in the
blood or body fluids
• derived from the tumor itself
 Tumor Markers
a. Oncofetal antigens
• Normally present in fetal tissue;may
indicate an anaplastic process in tumor
cells
Ex:
• Carcinoembryonic Antigen (CEA)
• Alpha-feto protein
 Tumor Markers
b. Hormones
• ADH
• Calcitonin
• Catecholamines
• HCG
• PTH
 Tumor Markers
c. Isoenzymes
• increased when a tissue is experiencing
rapid and excessive growth as a result
of a tumor
• Neurospecific enolase (NSE)
• Prostatic acid phosphatase (PAP)
 Tumor Markers

d. Tissue-specific antigens
• identifies the type of tissue affected
by malignancy
• prostatic-specific antigen (PSA)
Management of
Cancer
 Radiation therapy
• Used to kill a tumor, reduce tumor size,
relieve obstruction or decrease pain
• Causes lethal injury to DNA

Classification:
• Internal radiation therapy (brachytherapy)
• External radiation therapy (teletherapy)
 Brachytherapy
a. Sources
• Implanted into the affected tissue or body cavity
• Ingested as a solution
• Injected as a solution into the bloodstream or body
cavity
• Introduced through a catheter into the tumor
b. Side effects:
• Fatigue
• Anorexia
• Immunosuppression
 Brachytherapy
c. Client education
• Avoid close contact with others until the treatment is
completed
• Maintain daily activities unless contraindicated
• Rest
• Maintain a balanced diet
• Maintain fluid intake
• If implant is temporary, the client should be on bed
rest
• Excreted body fluids may be radioactive; double flush
toilets after use
 Brachytherapy
d. Nursing management
• Minimize time spent in close proximity to the radiation
sources
• Limit contact time to 30 mins per 8H shift
• Minimum distance should be 6 ft
• Use lead shields
• Place the client in a private room
• Limit visits to 10-30 minutes
• Ensure proper handling and disposal of body fluids
• Pregnant women and children are not allowed inside
the client’s room
 Teletherapy
• Treatment is usaully given 15-30 minutes per day, 5x per
week, for 2-7 weeks
• Client does not pose a risk of radiation exposure to other
people
• Side effects:
• Tissue damage to target area (erythema, sloughing, and
hemorrhage)
• Ulcerations of oral mucous membranes
• Nausea, vomiting, and diarrhea
• Radiation pneumonia
• Fatigue
• Alopecia
• Immunosuppression
 Teletherapy
• Client education
• Wash marked area of the skin with plain water only and pat dry.
Do not use soaps, deodorants, lotions, perfumes, powders, or
medications on the site during the duration of the treatment. Do
not wash off the treatment site marks
• Avoid rubbing, scratching, or scrubbing the treatment site. Do not
apply extreme temperatures to the treatment site. If shaving is
necessary, use electric razor.
• Wear soft, loose-fitting clothing over the treatment area
• Protect skin from sun exposure during the treatment and for at
least 1 year after the treatment is completed. When going
outdoors, use sun blocking agents with SPF of at least 15.
• Maintain proper rest, diet, and fluid intake
• Hair loss may occur. Choose a wig, hat or scarf to cover and
protect the head.
 Chemotherapy
• Involves the administration of cytotoxic
medications and chemicals to promote death of
tumor cells.
• Route of adminstration:
• IV
• Oral
• Intrathecal
• Topical
• Intra-arterial
• Intracavity
• Intravesical
Classification of Chemotherapeutic agents

a. Alkylating agents
• Non-phase-specific and act by
interfering with DNA replication
 Cyclophosphamide (Cytoxan)
 Busulfan (Myleran)
 Mecholorethamine (Mustargen)
 Classification of Chemotherapeutic agents
b. Antimetabolites
• Interfere with metabolites or nucleic
acids necessary for RNA and DNA
synthesis
• 5-fluorouracil (5-FU)
• Methotrexate
 Classification of Chemotherapeutic agents
c. Cytotoxic antibiotics
• Disrupt or inhibit DNA or RNA
synthesis
• Bleomycin (Blenoxane)
• Doxorubicin (Adriamycin)
 Classification of Chemotherapeutic agents
d. Hormones and hormone
antagonists
• Phase-spcific (G1) and act by
interfering with RNA synthesis
• Diethylstilbestrol (DES)
• Tamoxifen (Nolvadex)
• Prednisone
 Classification of Chemotherapeutic agents
e. Plant alkaloids
• Vinca alkaloids are phase-specific, inhibiting
cell division
• Etoposide acts during all cell-cycle phases,
interfering with DNA and cell division at
metaphase
Nursing implications for the administration of
chemotherapy
• IV routes may be obtained by subclavian catheters,
implanted ports, or peripherally inserted catheters.
• Extravasation is the major complication of IV
chemotherapy. Extreme care must be used when
administering vesicant agents
• WARNING: NEVER TEST VEIN PATENCY WITH
CHEMOTHERAPEUTIC AGENTS.
• Monitor client closely for anaphylactic reactions or
serious side effects. Discontinue infusion according to
protocol if reaction occur
• Use caution when preparing, administering, or disposing
chemotherapeutic agents
Nursing management of the common
side effects of Chemotherapy
a. Bone marrow suppression leads to:
• Leukopenia (immunosuppression)
• Avoid crowds, people with infections, and small children
when WBC count is low
• Avoid undercooked meat and raw fruits and vegetables
• Thrombocytopenia
• Use electric razor when shaving
• Avoid contact sports
• If trauma occurs, apply ice and seek medical assistance
• Avoid dental work or other invasive procedures
• Avoid aspirin and aspirin-containing products
 Nursing management of the common
side effects of Chemotherapy
b. GI effects (anorexia, nausea, vomiting,
and diarrhea)
• Client education
• Eat small, frequent, low-fat meals
• Avoid spicy and fatty foods
• Avoid extremely hot foods
• Administer antiemetics prior to
chemotherapy
• Weigh client routinely
Nursing management of the common
side effects of Chemotherapy
c. Stomatitis and mucositosis
• Client education
• Use a soft toothbrush. Mouth swabs may be needed during
an acute episode
• Avoid mouthwashes containing alcohol. Do not use lemon
glycerin swabs or dental floss
• Consider using chlorhexidine mouthwash to decrease risk of
haemorrhage and protect gums from trauma
• For xerostomia, apply lubricating and moisturizing agents to
protect the mucous membranes from trauma and infection
• Consider using “artificial saliva” and hard candy or mints
• Avoid smoking and alcohol
• Drink cool liquids, and avoid hot and irritating foods
Nursing management of the common
side effects of Chemotherapy
d. Alopecia (hair loss)
• Encourage the client to choose a wig
before hair loss occurs
• Care of hair and scalp includes washing
hair two to three times a week with mild
shampoo. Pat hair dry and avoid the use
of blow dryer.
 Surgery
• Primary treatment
• Prophylactic
• Palliative
• Reconstructive
Types of Cancer
 Testicular Cancer
Arises from germinal epithelium from the sperm-
producing germ cells or from nongerminal
epithelium from other structures in testicles.
Testicular Cancer most often occurs between the
ages of 15 and 40
Metastasis occurs to the lung, liver, bone and
adrenal glands.

Prevention : Routine Testicular Examination

Assessment
• Painless testicular swelling occurs.
• Dragging sensation is evident in the
scrotum.
• Palpable lymphadenopathy, abdominal
masses, and gynecomastia may indicate
metastasis.
• Late signs include back or bone pain and
respiratory symptoms.
Interventions
- Prepare the client for radiation therapy or unlateral
orcheictomy as prescribed .
- Discuss reproduction, sexuality and fertility information
and options with the client
For Post Op:
- Monitor for signs of bleeding and wound infection.
- Monitor Intake and output
- Notify the physician if chills, fever, increasing pain or
tenderness at the incision site, or drainage of the incision
occurs.
- Instruct the client to perform a monthly testicular self-
examination on the remaining testicle.
 Cervical Cancer
Pre-invasive cancer is limited to the cervix
Invasive cancer is in the cervix and other
pelvic structures.
Metastasis usually is confined to the pelvis,
but distant metastasis occurs through
lymphatic spread.
Pre malignant changes are described on a
continuum from dysplasia , which is the
earliest premalignant change.
Precipitating Factors
1. Low socioeconomic groups
2. Early first marriage
3. Early and frequent intercourse
4. Multiple sex partners
5. High parity
6. Poor hygiene
Screening and early detection
a. The practice of good perineal needs
must be emphasized
b. Avoid sex in an early age, avoid
numerous partners, and practice the use
of condom
c. Cancer warning signs: abnormal vaginal
bleeding, and spotting after having sex
d. Early detection includes Pap smear for
women over age 18.
Assessment
• Painless vaginal bleeding postmenstrually and
postcoitally
• Foul-smelling or serosanguineous vaginal
discharge
• Pelvic, lower back, leg or groin pain
• Anorexia and weight loss
• Leakage of urine and feces from the vagina
• Dysuria
• Hematuria
• Cytological changes on Papanicolaou’s Test
Interventions
• Nonsurgical
Chemotherapy
Cryosurgery
External Radiation
Internal Radiation Implants (Intracavitary)
Laser Therapy

• Surgical
Hysterectomy
Pelvic Exenteration
 POST OP CARE
• ESTROGEN replacement immediate post
op if the ovaries were removed
• No vaginal entry, douching, or intercourse
for 4-6 weeks
• Avoid bending knees
 Ovarian Cancer
Ovarian cancer grows rapidly , spreads fast and is
often bilateral.
Metastasis occurs by direct spread to the organs in
the pelvis, by distal spread through lymphatic
drainage or by peritoneal seeding
Prognosis is usually poor because the tumor
usually is detected late.
An exploratory laparotomy is performed to
diagnose and stage the tumor.
Assessment

1. Abdominal discomfort or swelling

2. Gastrointestinal disturbances
3. Dysfunctional vaginal bleeding
4. Abdominal mass
Interventions
1. External radiation is used if the tumor is
invaded other organs.
2. Chemotherapy is used postoperatively for all
stages of ovarian cancer.
3. Intraperitoneal chemotherapy involves the
instillation of chemotherapy into the abdominal
cavity.
4. Immunotherapy alters the immunological
response of the ovary and promotes tumor
resistance.
5. Total abdominal hysterectomy and bilateral
salpingo-oophorectomy may be necessary.
 Endometrial Cancer
Is a slow growing tumor associated with the
menopausal years.

Metastasis occurs through the lymphatic

system to the ovaries and pelvis; via the
blood to the lungs, liver and bone; or
intraabdominally to the peritoneal cavity.
Precipitating Factors
1. History of uterine polyps
2. Nulliparity
3. Polycystic ovary disease
4. Estrogen stimulation
5. Late menopause
6. Family history
Assessment
- Postmenopausal bleeding
- Watery, serosanguineous discharge
- Low back, pelvic, or abdominal pain
- Enlarged uterus in advanced stages
Interventions
Nonsurgical interventions
1. External radiation or internal radiation is used alone or in
combination with surgery, depending on the stage of cancer.
2. Chemotherapy is used to treat advanced or recurrent
disease.
3. Progestational therapy with medication such as
medroxyprogesterone (Depo-Provera) or megestrol acetate
(Megace) is used for estrogen dependent tumors.
4. Tamoxifen (Novaldex), an antiestrogen, also maybe
prescribed.

Surgical interventions
Total abdominal hysterectomy and bilateral salpingo-
oophorectomy
 Breast Cancer
Breast cancer is classified as invasive when it penetrates
the tissue surrounding the mammary duct and grows in
an irregular pattern.
Metastasis occurs via lymph nodes.
Common sites of metastasis are the bones, lungs;
metastasis also occurs to the brain and liver.
Diagnosis is made by breast biopsy through a needle
aspiration or by surgical removal of the tumor with
microscopic examination for malignant cells.

Prevention : Monthly BSE

Precipitating Factors
• Family history
• Early menarche and late menopause
• Previous cancer of the breast, uterus or
ovaries
• Nulliparity
• Obesity
• High dose radiation exposure to chest
• High fat diet
 Guideline prevention, screening and
early detection

Advice clients to reduce the amount of fat in the

diet. Early detection includes:
a. BSE once a month
b. Yearly breast exam by a health care provider
c. Baseline mammogram b/w the ages 35-39
d. Yearly mammogram after the age 40(if with
family hx of breast Ca, mammogram should be
started at age 30)
Assessment
1. Mass felt during BSE
2. Mass usually felt in the upper outer quadrant or
beneath the nipple.
3. A fixed, irregular noncapsulated mass
4. A painless mass except in late stages
5. Nipple retraction or elevation
6. Asymmetry, with affected breast being higher
7. Bloody or clear nipple discharge
8. Skin dimpling, retraction, or ulceration
9. Skin edema or peau d’ orange skin
10. Axillary lymphadenopathy
11. Lymphedema of the affected arm
12. Symptoms of bone and lungs metastasis
13. Presence of the lesions on mammography
Nonsurgical Interventions
1. Chemotherapy
2. Radiation therapy
3. Hormonal manipulation via the use of
medication in postmenopausal women or
other medications such as tamoxifen
(Novadex) for estrogen receptor positive
tumors
Surgical Interventions
1. Surgical breast procedures with possible
breast reconstruction
2. Oophorectomy for estrogen receptor –
positive tumors
3. Ablative therapy with adrenalectomy or
chemical ablation, which blocks the
production of cortisol, androstenedione,
and aldosterone.
 Gastric Cancer
Gastric cancer is a malignant growth in the
stomach.
Risk Factors
• Diet high in complex carbohydrates ,
grains and salt, and low in fresh, green
leafy vegetables and fresh fruit
• Smoking
• Alcohol ingestion
• The use of nitrates
• History of gastric ulcers
Assessment
1. Fatigue
2. Anorexia and weight loss
3. Nausea and vomiting
4. Indigestion and epigastric discomfort
5. A sensation of pressure in the stomach
6. Dysphagia
7. Anemia
8. Ascites
9. Palpable mass
Interventions
1. Monitor vital signs.
2. Monitor hemoglobin and hematocrit and administer
blood transfusions as prescribed.
3. Monitor weight.
4. Assess nutritional status; encourage small, bland,
easily digestible meals with vitamin and mineral
supplements.
5. Administer pain medications as prescribed.
6. Prepare the client for chemotherapy or radiation as
prescribed.
7. Prepare the client for surgical resection of the tumor as
prescribed.
Surgical Interventions
Subtotal Gastrectomy
Billroth I
- also called gastroduodenostomy
- partial gastrectomy, with remaining segment
anastomosed to the duodenum
Billroth II
- also called gastrojejunostomy
- partial gastrectomy, with remaining segment
anastomosed to the jejunum.

Total Gastrectomy
- Also called esophagojejunostomy
- removal of the stomach with attachment of the
esophagus to the jejunum or duodenum.
 Pancreatic Cancer
Is the most common neoplasm affecting the
pancreas.
The occurrence of pancreatic cancer has been
linked to diabetes mellitus, alcohol use, history
of previous pancreatitis, smoking, ingestion of
high fat diet, and exposure to environmental
chemicals.
Symptoms usually do not occur until the tumor is
large; therefore the prognosis is poor.
Assessment
• Nausea and vomiting
• Jaundice
• Unexplained weight loss
• Clay-colored stools
• Glucose intolerance
• Abdominal pain
Interventions
1. Radiation
2. Chemotherapy
3. Whipple’s procedure, which involves a
pancreaticoduodenectomy with removal of the
distal third of the stomach,
pancreaticojejunostomy, gastrojejunostomy
and choledochojejunostomy
4. Postoperative care measures are similar to
care of a client with pancreatiitis and the client
following gastric surgery.
 Intestinal Tumors
Intestinal tumors are malignant lesions that
develop as polyps in the colon or rectum.
Complications include bowel perforation with
peritonitis, abscess and fistula formation,
hemorrhage and complete intestinal
obstruction.
Metastasis occurs via the circulatory or
lymphatic system or by direct extension to
other areas in the colon or other organs.
Assessment
1. Blood in the stools
2. Anorexia, vomiting and weight loss
3. Malaise
4. Anemia
5. Abnormal stools
a. Ascending colon tumor : Diarrhea
b. Descending colon tumor : Constipation or some diarrhea, or
flat ribbonlike stool resulting from partial obstruction
c. Rectal tumor : Alternating constipation and diarrhea
6. Guarding or abdominal distention
7. Abdominal mass (late sign)
8. Cachexia (late sign)
Interventions
1. Monitor for signs of complications, which include bowel
perforation with peritonitis, abscess or fistula
formation, hemorrhage and complete intestinal
obstruction.
2. Monitor for signs of bowel perforation, which include
low blood pressure, rapid and weak pulse, distended
abdomen and elevated temperature.
3. Note that an early sign of intestinal obstruction is
increased in peristaltic activity, which produces an
increased in bowel sound; as the obstruction
progresses, hypoactive sounds are heard
4. Prepare for radiation preoperatively to facilitate
surgical resection, and postoperatively to decrease the
risk of recurrence or to reduce pain , hemorrhage,
bowel obstruction, or metastasis.
5. Chemotherapy is used postoperatively to assist in the
control of symptoms and the spread of the disease.
 Colon Cancer
• Colon cancer is cancer of the large
intestine (colon), the lower part of your
digestive system
• Most cases of colon cancer begin as
small, noncancerous (benign) clumps of
cells called adenomatous polyps. Over
time some of these polyps become colon
cancers.
Assessment:
• A change in your bowel habits, including
diarrhea or constipation or a change in the
consistency of your stool for more than a couple
of weeks
• Rectal bleeding or blood in your stool
• Persistent abdominal discomfort, such as
cramps, gas or pain
• Abdominal pain with a bowel movement
• A feeling that your bowel doesn't empty
completely
• Weakness or fatigue
• Unexplained weight loss
Risk factors:

• Age.
• A personal history of colorectal cancer or polyps.
• Inflammatory intestinal conditions.
• Inherited disorders that affect the colon.
• Family history of colon cancer and colon polyps.
• Diet low in fiber and high in fat and calories.
• A sedentary lifestyle.
• Diabetes.
• Obesity.
• Smoking.
• Alcohol.
• Radiation therapy for cancer.
Screening and early detection
Colorectal Ca
a. Cancer signs: rectal bleeding,
change in stools, pain in the
abdomen, and pressure on the
rectum
b. Early detection includes an
annual digital rectal exam
starting at age 40, an annual
stool blood test starting age 50
and an annual inspection of the
colon (sigmoidoscopy) at the
age 50
 Lung Cancer
Is a malignant tumor of the lung that may be
primary or metastatic.
The lungs are the common target of metastasis.
Bronchiogenic carcinoma spreads through direct
extension and lymphatic dissemination.
The four major types of lung cancer include small
cell (oat cell), epidermal (squamous cell),
adenocarcinoma, and large cell anaplastic
carcinoma.
Diagnosis

Diagnosis is made by a chest x-ray, which

will show a lesion or mass, and
bronhoscopy and sputum studies, which
will demonstrate a positive cytological
study for cancer cells.
Causes
• Cigarette smoking
• Exposure to environmental pollutants
• Exposure to occupational pollutants
Screening and early detection

a. “do not smoke” is an

important msg
b. Guidelines to reduce
exposure to cancer-causing
substances in workplaces
should be followed
Assessment

• dyspnea (shortness of breath)

• hemoptysis (coughing up blood)
• chronic coughing or change in regular coughing
pattern
• wheezing
• chest pain or pain in the abdomen
• cachexia (weight loss), fatigue and loss of
appetite
• dysphonia (hoarse voice)
• clubbing of the fingernails (uncommon)
• dysphagia (difficulty swallowing).
Interventions
1. Monitor vital signs.
2. Monitor breathing patterns and breath sounds and for signs of respiratory
impairment.
3. Assess for tracheal deviation
4. Administer analgesics as prescribed for pain management.
5. Place in Fowler’s position for ease in breathing.
6. Administer oxygen as prescribed and humidification to moisten and
loosen secretions.
7. Monitor pulse oximetry.
8. Provide respiratory treatments as prescribed.
9. Administer bronchodilators and corticosteroids as prescribed to decrease
bronchospasm , inflammation and edema.
10. Provide a high-calorie, high protein, high vitamin diet.
11. Provide activity as tolerated , rest periods and active and passive range-
of-motion exercises.
12. Monitor for bleeding, infection and electrolyte imbalances.
Laryngeal Cancer
Laryngeal cancer is a malignant tumor of the
larynx.
Laryngeal cancer presents as malignant
ulcerations with underlying infiltration.
Metastasis to the lungs is common.
Diagnosis is made by laryngoscopy and
biopsy showing a positive cytological study
for cancer cells.
Causes
• Cigarette smoking
• Exposure to environmental pollutants
• Exposure to radiation
• Voice strain
Assessment
1. Persistent hoarseness and sore throat
2. Painless neck mass
3. A feeling of a lump in the throat
4. Burning sensation in the throat
5. Dysphasia
6. Change in voice quality
7. Dyspnea
8. Weakness and weightloss
9. Hemopytysis
10. Foul breath odor
Interventions
• Place in Fowler’s position to promote optimal air
exchange.
• Monitor respiratory status.
• Monitor for signs of aspiration of food and fluids.
• Administer oxygen as prescribed.
• Provide respiratory treatments as prescribed.
• Provide activity as tolerated.
• Provide a high-calorie, high-protein, high-vitamin diet.
• Provide nutritional support via total parenteral nutrition,
nasogastric tube feedings, gastrostomy or jejunostomy
tube as prescribed.
• Administer analgesics as prescribed for pain.
 Prostate Cancer
This slow-growing cancer of the prostate gland is
usually a Androgen dependent type of
carcinoma.
The risks increases in men with each decade after
age 50.
Prostate cancer can spread via direct invasion of
surrounding tissuesor by metastasis, through the
bloodstream and lymphatics, to the bony pelvis
and spine.
Bone metastasis is a concern.
Assessment
1. Asymptomatic
2. Hard, pea-sized nodule palpated on rectal
examination.
3. Hematuria
4. Late symptoms such as weightloss, urinary
obstruction, and pain radiating form the lumbosacral
area down the leg.
5. Prostatic-specific antigen test is not necessarily an
indicator of malignancy and use is routine to monitor
the client’s response to therapy
6. Spread and mestastasis is indicated by elevated
serum acid and phosphatase.
Risk Factors:
• Age.
• Race or ethnicity.
• Family history.
• High-fat diet
• High testosterone levels.
• Occupations exposed to harmful
chemicals
Screening and early detection
a. There are no preventive guidelines
b. Early detection includes an annual digital
rectal exam at age 40
Interventions
• Non-surgical
1. Prepare the client for hormone manipulation therapy as
prescribed.
2. Prepare the client for radiation therapy, which may be
prescribed alone or along with surgery and may be prescribed pre-
operatively or post-operatively to reduce the lesion and limit
metastasis.
3. Prepare the client for the administration of chemotherapy in
cases of hormone-resistant tumors.

• Surgical
1. TURP
2. Suprapubic Prostatectomy
3. Retropubic Prostatectomy
4. Perineal Prostatectomy
 Skin Cancer
• Is a malignant lesion of the skin, which
may or may not metastasize.
• Causes include chronic friction and
irritation to a skin area and exposure to
ultraviolet rays .

Diagnosis :
Is confirmed by a skin biopsy that is
positive for cancer cells.
Types of Skin Cancer
• Basal cell – the most common type of skin cancer, basal
cell cancer arises from the basal cells contained in the
epidermis.

• Squamous cell – the second most common type of skin

cancer in whites, it is a tumor of the epidermal
keratinocytes and can infiltrate surrounding structures,
metastasize to lymphnodes, and be subsequently fatal.

• Malignant melanoma – cancer of the melanocytes, can

metastasize to the brain , lungs, bone, liver and skin.
 Assessment
a. Change in color, size, or Appearance of Skin Cancer
shape of pre existing Lesions:
lesions
b. Pruritus - A waxy nodule
c. Local Soreness - An irregular, circular,
bordered lesions with
hues of tan, black, or blue
- A small, red, nodular
lesion
- An oozing, bleeding,
crusting lesion
Nursing Interventions
a. Instruct the client regarding preventive measures.
b. Instruct the client to monitor for lesions that do not heal
or that change characteristics.
c. Instruct the client to have moles or lesions removed
that are subject ot chronic irritation.
d. Instruct the client to avoid contact with chemical
irritants.
e. Intsruct the client to wear layered clothing and use sun
screening lotions with an appropriate skin protection
factor when outdoors.
f. Instruct the client to avoid sun exposure between 11
am to 3 pm.
g. Assist with surgical excision of the lesion as
prescribed.
 Leukemia
• A malignant exacerbation in the number of leukocytes,
usually at an immature stage, in the bone marrow.
• May be acute, with a sudden onset and short duration, or
chronic, with a slow onset and persistent symptoms over
a period of years.
• Leukemia affects the bone marrow causing anemia,
leukopenia, the production of immature cells,
thrombocytopenia and a decline in immunity.
• The Cause is unknown and appears to involve gene
damage of cells, leading to the transformation of cells
from a normal state to a malignant state.
Risk Factors :

- Genetic
- Viral
- Immunological
- Environmental factors
- Exposure to radiation
- Medications
Classification of Leukemia
• Acute Lymphocytic Leukemia – mostly
lymphoblasts , age of onset is less than 15
years.
• Acute Myelogenous Leukemia – mostly
myeloblasts present in bone marrow, age of
onset is between 15 and 39 years
• Chronic Myelogenous Leukemia – mostly
granulocytes present in bone marrow, age of
onset is after 50 years
• Chronic Lymphocytic Leukemia – mostly
lymphocytes present in bone marrow, age of
onset is after 50 years
Assessment
1. Anorexia, fatigue, weakness, weight loss
2. Anemia
3. Bleeding (nosebleeds, gum bleeding, rectal bleeding, increased
menstrual flow)
4. Petechiae
5. Prolonged bleeding after minor abrasions or lacerations
6. Elevated Temperature
7. Lymphadenopathy and splenomegaly
8. Palpitations, tachycardia, orthostatic hypotension
9. Pallor, dyspnea on exertion
10. Headache
11. Bone pain and joint swelling
12. Normal, elevated or reduced white blood cell count
13. Decreased hemoglobin and hematocrit levels
14. Decreased platelet
15. Positive bone marrow biopsy identifying leukemic blast phase
cells
 Hodgkin’s
Disease
Is a malignancy of the lymph nodes that originates
in a single lymph node or a single chain of
nodes.
The disease usually involves lymph nodes, tonsils,
spleen, and bone marrow and is characterized
by the presence of the Reed-Sternberg cell in
the nodes.
Possible causes include viral infections and
previous exposure to alkylating chemical agents.
Staging in Hodgkin’s Disease
Stage I
Involvement of s single lymph node region or an extra
lymphatic organ or site
Stage II
Involvement of two or more lymph node regions on the
same side of the diaphragm or localized involvement of
an extralymphatic organ or site
Stage III
Involvement of lymph node regions on both side of the
diaphragm
Stage IV
Diffuse or disseminated involvement of one or more
extralymphatic organs with or without associated lymph
node involvement
Assessment
1. Fever
2. Malaise, fatigue, and weakness
3. Night sweats
4. Loss of appetite and significant weight loss
5. Anemia and thrombocytopenia
6. Enlarged lymph nodes, spleen and liver
7. Positive biopsy of lymph nodes, with cervical nodes
most often affected first
8. Presence of Reed-Sternberg cells in nodes
9. Positive computed tomography scan of the liver and
spleen
Nursing Interventions
1. For Stages I and II without mediastinal node
involvement, the treatment of choice is extensive
external radiation of the involved lymph node regions.
2. With more extensive disease, radiation along with multi
agent chemotherapy is used.
3. Monitor for side effects related to chemotherapy or
radiation therapy.
4. Monitor for signs of infection and bleeding.
5. Maintain infections and bleeding precautions.
6. Discuss the possibility of sterility with the male client
receiving radiation, and inform the client of options
related to sperm banks
 Multiple Myeloma
A malignant proliferation of plasma cells and
tumors within the bone.
An excessive number of abnormal, plasma cells
invade the bone marrow, develop into tumors ,
and ultimately destroy bone; invasion of the
lymph node, spleen, and liver occurs.
The abnormal plasma cells produce an abnormal
antibody (myeloma protein or Bence Jones
protein) that is found in the blood and urine.
Assessment
1. Bone pain, especially in the pelvis, spine and ribs
2. Weakness and fatigue
3. Recurrent infections
4. Anemia
5. Bence Jones proteinuria and elevated total serum
protein level
6. Osteoporosis
7. Thrombocytopenia and Granulocytopenia
8. Elevated calcium and uric acid levels
9. Renal failure
10. Spinal cord compression and paraplegia
Interventions
• Monitor for signs of bleeding, infection, and skeletal
fractures.
• Encourage fluids up to 3 to 4 L a day to offset potential
problems associated with hypercalcemia, hyperuricemia
and proteinuria.
• Encourage ambulation to prevent renal problems and to
slow down bone resorption.
• Provide skeletal support during moving, turning and
ambulating to prevent pathological fractures
• Provide a hazard –free enviroment.
• Instruct the client in home care measures and the signs
and symptoms of infection.