MEDSURG FINALS MEDIQUETTE GIRLS

ONCOLOGY
CANCER The pathophysiology of cancer includes the physical and
hormonal changes associated with cancer and
• The term Cancer is generally used to refer to a group
paraneoplastic syndrome. In general, cancer occurs in
of diseases associated with the abnormal growth of
four main stages. The pathological stage of cancer is
cells.
determined through biopsy (removal of small body tissue
• This growth leads to the formation of a swelling, for laboratory examination) where the cancerous cells
commonly known as a tumor. are compared to normal cells.
• The type of tumor associated with cancer is known
as a malignant tumor. PHYSICAL CHANGES ASSOCIATED WITH CANCER
• Normally, the cells of this tumor invade the
LUMPS MALIGNAT BENIGN
neighboring tissues and other parts of the body, TUMOR TUMOR
whereby they establish a secondary growth area.
Referred to Spread and Slow growth
This phenomenon is known as metastasis. as tumors, establish new rate, fixed
PATHOLOGIC STAGE OF CANCER that can tumors in position, less
either be other tissue life
• Cancer begins when body cells in the body begin to malignant or and organs threatening
grow uncontrollably. This may be triggered by agents benign around the
that cause mutation such as radiation or exposure to body
heavy metals such as asbestos. Cancer normally
starts growing in a small area and then eventually
PARANEOPLASTIC SYNDROME
spread to other body parts if not detected early.
• One of the main causes of cancer is mutation. A Local signs and symptoms of cancer normally manifest
mutation is the spontaneous changes that occur in themselves at the primary and metastatic sites
the genetic material (genes). associated with particular cancer. Cancer cell can also
• The TWO TYPES OF GENES associated with cancer produce hormones and other circulating compounds in
development include oncogenes and tumor the body such as peptides (chains of short amino acids).
suppressor genes. The release of such compounds leads to other clinical
manifestations of this disease in sites that are not
directly affected by it. These types of clinical
manifestations are collectively known as
PARANEOPLASTIC SYNDROME.

These manifestations normally occur at distant target

sites that are not directly involved with cancer. For
instance, a CARCINOID TUMOR (a tumor occurring in the
neuroendocrine system) releases some peptides whose
effects cause wheezing, flushing, and diarrhea. In
ONCOGENES addition, lymphoma (cancer of the lymphatic system),
leads to indirect effects such as melanin deposition that
are the mutated versions of the normal genes is manifested as MELANOSIS (skin darkening).
(commonly known as PROTO-ONCOGENES) that
normally code for the growth factors and receptors, thus SIGNS AND SYMPTOMS
ensuring normal cell survival and proliferation (division). • Fatigue
– Therefore, the oncogenes are associated with • Lump or area of thickening under the skin.
abnormal or uncontrolled cell survival and proliferation. • Unintended weight loss or gain.
The activation of oncogenes leads to cancer
• Yellowing, darkening, or redness of skin. Sores
development.
• not healing, and alterations of existing moles.
TUMOR SUPPRESSOR GENES • Changes in bowel/bladder habits.
• Persistent cough and trouble breathing.
are associated with coding proteins which inhibit cell
• Difficulty swallowing.
division (ensure controlled cell division) and promote the
• Hoarseness.
normal death of cells. Mutation of tumor suppressor
• Persistent indigestion
genes robs their ability to control dividing cells.
• Unexplained muscle or joint pain.
Ultimately, this leads to the development of cancer.
• Fevers or night sweats.
PATHOPHYSIOLOGY • Unexpected bleeding or bruising

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STAGING NX: Cancer in nearby lymph nodes cannot be
measured.
Cancer staging typically depends on the test results or N0: There is no cancer in nearby lymph nodes.
the tumor’s size to decide the overall stage N1, N2, N3: Refers to the number and location
of lymph nodes that contain cancer. The
STAGE 0 Carcinoma – means there’s no
cancer. However abnormal cells higher the number after the N, the more
lymph nodes that contain cancer.
that have the potential to
eventually become a cancer are M-DISTANT METASTASIS
present. MX: Metastasis cannot be measured.
STAGE 1 means the cancer is small and is M0: Cancer has not spread to other parts of
present in 1 area. This is typically the body.
called early-stage cancer M1: Cancer has spread to other parts of the
STAGE 2 – Early locally advanced cancer – body
slight larger that the stage 1, but GRADING
they’re still confined to the organ
• Tumor grade is the description of a tumor based
where they started, sometimes
on how abnormal the tumor cells and the tumor
stage tumors have spread to
small amount of nearby lymph tissue look under a microscope.
nodes • It assesses tumor cells under a microscope for
STAGE 3 – Advanced locally advanced size, shape, color arrangement.
cancer – quite large, sometimes
GX grade cannot be assessed;
it has spread to nearby organs
undetermined grade
that were initially not involves
G1 well differentiated; low
with cancer and almost always
grade, tumor cells look like
include some involvement with
normal tissue cells tend to
lymph nodes
spread and grow slowly
STAGE 4 Metastatic cancer – indicates
G2 moderately differentiated;
the cancer has spread to other
intermediate grade,
body parts.
somewhat abnormal
G3 poorly differentiated; high
THE TNM STAGING SYSTEM grade, most of the cells look
abnormal tend to spread and
Tumor-Node-Metastasis grow quickly
The TNM system is the most widely used cancer staging G4 undifferentiated; highest
grade, all are most abnormal
system and uses numbers and letters to describe these
cells
three aspects of a cancer. It categorizes cancer
progression for most solid tumors that spread to other
sites in the body. ASSESSMENT:
• The T refers to the size and extent of the main tumor. • Physical Assessment
• The N refers to the number of nearby lymph nodes o MOLES; asymmetrical, ragged, or
that have cancer. irregular border, uneven color, large,
• The M refers to whether the cancer has changing in size, shape and color.
metastasized. This means that the cancer has spread o LUMPS; large, hard, painless to touch,
from the primary tumor to other parts of the body. and appear spontaneously.
• Family History
T-PRIMARY TUMOR
o Obtain information both maternal and
TX: Main tumor cannot be measured. paternal sides of the family to trace if the
T0: Main tumor cannot be found. disease is genetic.
T1, T2, T3, T4: Refers to the size and/or extent
• Personal History
of
o Obtain past and previous medical history
the main tumor. The higher the number after
the T, for precancerous lesions or previous
the larger the tumor or the more it has grown cancer.
into DIAGNOSTIC TESTS:
nearby tissues.
N-REGIONAL LYMPH NODES
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1. Biopsy-A procedure done in which tissue • MUSCULARIS- smooth muscle layer for mixing
samples are obtained to diagnose malignancy. and moving food.
2. X-ray-Procedures such as Mammogram and • SUBMUCOSA- connective tissue layer with blood
Barium enemas are done for better visualization vessels and nerves.
of the condition. • MUCOSA -innermost layer, secretes gastric
3. Bone Marrow Biopsy-A procedure involved in juices and protects the stomach lining.
obtaining a sample of the bone marrow using a
small needle being inserted in the bone. PARTS
4. Scans-Scans such as Bone Scans, Computed • CARDIA- entrance of stomach near the stomach
Tomography (CT) scan, MUGA scan, and Positron near the esophagus.
Emission Tomography and Computed • FUNDUS- the upper part that expands to store
Tomography (PET-CT) scans are done for
food.
imaging.
• BODY- main central region for mixing and
5. MRI-This procedure gives a more accurate and
digestion
detailed results in imagery compared to normal
• PYLORUS- lower part connected to the small
scans.
intestine
6. Endoscopic Procedures-Procedures such as
Colonoscopy, Sigmoidoscopy, and Upper GASTRIC SECRETION
Endoscopy gives us a clearer image of the colon
to assess for abnormal growths. • combination of mucus, intrinsic factor, pepsinogen,
7. Tumor Marker Test-This procedure is most often and hydrochloric acid (HCI).
used after a cancer diagnosis. This procedure • AMOUNT-Stomach secretes about 2-3 liters of
helps determine whether the cancer has spread gastric juice daily
to the other parts of the body. • PRODUCTION-Gastric acid is secreted by parietal
8. Fecal Occult Blood Tests-A lab test used to check cells in the gastric glands, mainly in the body and
stool samples for hidden (occult) blood. As blood fundus regions.
may be an indication of colon cancer or polyps. FUNCTIONS
9. Pap test-This procedure is a test for cervical • ACID PRODUCTION: Produces an acidic environment
cancer in women, which involves collecting cells (pH 1.5-3.5) that supports pathogen defense and
from the cervix for laboratory testing. enzyme activity.
• PEPSIN ACTIVATION: When gastric acid is present,
STOMACH CANCER the inactive form of pepsinogen (which aids in the
digestion of proteins) is transformed into the active
• Stomach cancer is also known as gastric cancer enzyme pepsin.
• It is a type of disease that occurs when cells in • MUCUS PROTECTION: The stomach lining is shielded
the stomach grow out of control from acid damage by the mucus layer
INCIDENCE in THE PHILIPPINES PATHOPHYSIOLOGY
• Stomach cancer incidence in the Philippines is RISK FACTORS
lower than other Asian countries. According to
WHO, deaths caused by the cancer in2020 • H. Pylori
reached 1, 868 or 0.28% of total deaths. • Diet Rich in Salt, Smoked,
• Pickled, Cured, Processed Foods
ANATOMY AND PHYSIOLOGY
• Smoking and Alcohol
STOMACH
• Family History
• A digestive organ located in the upper left
abdomen CHRONIC INFLAMMMATION
• Situated next to the liver and spleen in the upper
Pre-Cancerous Lesions
left section of the abdomen, under the
Development of Early Tumor
diaphragm Malignant Tumor
• Located between T10 and L3 vertebral segment. METASTITIS
LAYERS SIGNS AND SYMPTOMS

• SEROSA- outermost layer, protective covering. EARLY LATE

MANIFESTATIONS MANIFESTATIONS

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• Loss of • Weight loss MOST COMMON SITES

appetite • Anemia
1. Pyloric Antrum
• Nausea and • Blood usually
vomiting 2. Lesser Curvature
occult in the
• Upper stool 3. Cardia
abdominal • Hemorrhage 4. Fundus
pain • Difficulty of 5. Body
• Heartburn swallowing
• Bloating • Loss of
strength

RISK FACTORS

a) Sex More common in men

b) Age55 years old above
c) Ethnicity Hispanic Americans, African Americans,
Native Americans, Asian Americans, Pacific
Islanders
d) Type A blood DIAGNOSTIC TESTS
e) Obesity
f) Epstein-Barr virus infection 1. Endoscopy
g) Pernicious Anemia 2. Biopsy
h) Family history of stomach cancer and genetic 3. CT Scan
syndromes 4. Laparoscopy
i) Consumption of foods that are cured, smoked, TREATMENT
processed and others that are high in salt
j) Diet low in fruits and vegetables 1. SURGERY- Partial or Total gastrectomy
k) Infection caused by Helicobacter pylori 2. Immunotherapy
l) Gastritis 3. Chemotherapy
m) Smoking 4. Radiation
n) Presence of polyps NURSING MANAGEMENT
TYPES OF STOMACH CANCER PREOPERATIVE

1. ADENOCARCINOMA • Obtain consent

• It is the most common type of stomach • Check medical history (past illness, surgery,
cancer that develops from the gland cells in medications)
the mucosa. • Check for previous use of tobacco and alcohol
2. LYMPHOMA consumption
• It is a cancer that starts in immune system • Do the bowel preparation
cells called lymphocytes. Some lymphomas • Administer preop medications
start in the wall of the stomach. Most • Maintain NPO 12 hours prior surgery
lymphomas that start in the stomach are a • Prepare the patient psychologically and reduce
type of non- Hodgkin's lymphoma. the patient's anxiety
3. CARCINOID TUMORS
POSTOPERATIVE
• They start in the neuroendocrine cells, which
are found in many areas of the body. • Monitor VS
4. GIST Gastrointestinal Stromal Tumors • Maintain airway patency
• They start in the neuroendocrine cells, which • Assess neurologic status
are found in many areas of the body. • Manage pain
• Assess the surgical site
• Assess fluid and electrolyte imbalance
• Check WBC level to monitor for infection
• Monitor for input and output.
• Monitor for return of gag reflex.
• Monitor for dumping syndrome.
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COMPLICATIONS • Diarrhea
TYPES OF CERVICAL CANCER
• Pleural Effusion • SQUAMOUS CELL CARCINOMA
• Нераtomegaly • – this type of cervical cancer begins in thin, flat
• Bowel Obctructions cells, called squamous cells.
• ADENOCARCINOMA
CERVICAL CANCER • – this type of cervical cancer begins in the
column-shaped gland cells that line the cervical
• Cervical cancer is a growth of cells that starts in the canal
cervix. STAGES OF CERVICAL CANCER
• Various strains of the human papillomavirus, also STAGE 1 The cancer is
called HPV, play a role in causing most cervical confined to the cervix
cancers. HPV is a common infection that's passed and has not spread
through sexual contact. beyond it.
• When cervical cancer happens, it's often first treated STAGE 2 The cancer has grown
with surgery to remove the cancer. beyond the
• Other treatments may include medicines to kill the cervix and uterus, but
cancer cells. has not spread
• CERVIX is a muscular, tunnel-like organ. It’s the to the walls of the
lower part of the uterus, and it connects the uterus pelvis or the lower
and vagina. Sometimes called the “neck of the part of the vagina.
uterus. STAGE 3 The cancer has
ANATOMY AND PHYSIOLOGY spread to the lower
part of the vagina or
• Menstruation
the walls of the
• Pregnancy
pelvis. The cancer
• Fertility
may be blocking
• Vaginal delivery the ureters.
• Protecting the Uterus STAGE 4 The cancer has grown
into the
RISK FACTORS bladder or rectum, or
a. Smoking tobacco to other organs
b. Increasing number of sexual partners like the lungs or
c. Early sexual activity bones.
d. Other sexually transmitted infections
e. A weakened immune system
f. Exposure to miscarriage prevention medicine SCREENING
• Pap test - During a Pap test, a member of a
PREVENTION healthcare team scrapes and brushes cells from the
1. HPV vaccine cervix. The cells are then examined in a lab to check
2. Routine Pap tests for cells that look different
3. Practice safe sex • HPV DNA test - The HPV DNA test involves testing
4. Don’t smoke cells from the cervix for infection with any of the
types of HPV that are most likely to lead to cervical
SIGN AND SYMPTOMS cancer.
• Pelvic Pain STAGING
• Unusual vaginal discharge (watery, bloody • Imaging tests - Imaging tests make pictures of the
• vaginal discharge that may be heavy and have a body. They can show the location and size of the
foul odor) cancer. Tests might include X-ray, MRI, CT and
• Lower back pain positron emission tomography (PET) scan.
• Pain during sex • Visual examination of your bladder and rectum – The
• Vaginal bleeding after sex doctor may use special scopes to look for signs of
• Vagina bleeding between periods cancer inside the bladder and rectum.
• Longer or heavier menstrual periods than usual
• Leg pain DIAGNOSTIC TEST
• Edema of the extremities A. PUNCH BIOPSY - which uses a sharp tool to pinch
• Hematuria off small samples of cervical tissue.
• Rectal pain B. ENDOCERVICAL CURETTAGE - which uses a
small, spoon-shaped instrument, called a curet,
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or a thin brush to scrape a tissue sample from the compared to women.
cervix. • Ethnicity/Race – More common in African
C. ELECTRICAL WIRE LOOP - which uses a thin, low- Americans
voltage electrified wire to take a small tissue PRE-EXISTING MEDICAL CONDITION
sample. This test also may be called a loop
• Chronic Pancreatitis
electrosurgical excision procedure, also known
• Diabetes
as LEEP.
D. CONE BIOPSY - also called conization, is a • Liver Conditions
procedure that allows your doctor to take SIGNS AND SYMPTOMS
deeper layers of cervical cells for testing. • Jaundice
MANAGEMENT AND TREATMENT • Dark urine
A. Radiation • Light-colored stool
• Two types of radiation: • Upper abdominal pain
− External beam radiation therapy (EBRT) • Middle back pain
− Brachytherapy • Fatigue
B. Chemotherapy • Itchy skin
C. Surgery • Nausea and vomiting
− Some of the most common kinds of surgery for STAGING
cervical cancer include: STAGE 0 This is also known as carcinoma
• Laser surgery in situ. Cancer cells are found
• Cryosurgery only in the top layers of cells
• Cone biopsy lining the
• Simple hysterectomy pancreatic ducts. It's considered
a pre-cancerous condition
• Radical hysterectomy with pelvic lymph node
dissection
STAGE 1 At this stage, cancer is confined
• Trachelectomy to the pancreas and hasn't
• Pelvic exenteration spread beyond
D. Targeted therapy ◦ Stage IA: Tumor is less than 2
E. Immunotherapy cm in size and limited to the
pancreas.
◦ Stage IB: Tumor is more than 2
PANCREATIC CANCER cm but less than 4 cm and
• The pancreas lies behind the lower part of the
limited to the pancreas.it.
stomach. It makes enzymes that help digest food
and hormones that help manage blood sugar. STAGE 2 Cancer has spread beyond the
• Pancreatic cancer is a type of cancer that begins pancreas to nearby tissues or
as a growth of cells in the pancreas. lymph nodes but hasn't
• Pancreatic cancer rarely is found at its early metastasized to distant organs.
stages when the chance of curing it is greatest.
This is because it often doesn't cause symptoms STAGE 3 Cancer has spread beyond the
until after it has spread to other organs. pancreas, involving major blood
ETIOLOGY vessels and possibly nearby
GENETIC FACTOR lymph nodes, but it hasn't
• Hereditary chronic pancreatitis due to gene metastasized to distant organs
changes (mutations). STAGE 4 Cancer has spread to distant
organs, such as the liver, lungs,
• Hereditary syndromes with changes (mutations)
or peritoneum (the lining of the
in genes, such as BRCA1 or BRCA2
abdominal cavity)
genes.
DIAGNOSTIC LAB
LIFESTYLE FACTOR IMAGING TEST
• Smoking • Used to diagnose pancreatic cancer include
• Obesity ultrasound, CT scans, MRI scans and,
• Alcohol Consumption sometimes, positron emission tomography
DEMOGRAPHIC FACTOR scans, also called PET scans.
• Age – Occurring in individuals over 60 years GENETIC TESTING
old.
• Gender – Men have a slightly higher risk
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• Uses a sample of blood or saliva to look for • Schedule follow-up appointments with the
inherited DNA changes that increase the risk of patient's oncologist, surgeon, and other
cancer. healthcare providers
BLOOD TEST • Provide the patient and family with a detailed
• Blood tests might show proteins called tumor schedule of upcoming appointments, including
markers that pancreatic cancer cells make. dates, times, and locations.
TREATMENT • Explain the importance of regular follow- up
SURGERY visits to monitor treatment response, manage
• Surgery is needed to remove the tumor and any symptoms,
affected tissues, which can potentially cure the and address any concerns.
cancer or significantly prolong survival. HEALTH TEACHING
• Whipple Procedure (Pancreaticoduodenectomy) • Discuss the importance of maintaining a healthy
• Distal Pancreatectomy lifestyle
• Total Pancreatectomy • Provide resources and referrals to
dietitians/nutritionists to help the patient
CHEMOTHERAPY develop appropriate meal plans and address
• Uses drugs to kill cancer cells or stop their nutritional needs.
growth. It can be given before surgery • Offer guidance on managing the side effects of
(neoadjuvant therapy) to shrink the tumor or treatment.
after surgery (adjuvant therapy) to eliminate OUT PATIENT
remaining cancer cells. • Coordinate appointments with the patient's
RADIATION THERAPY healthcare team.
• Uses high-energy rays to target and destroy • Provide the patient with a schedule of upcoming
cancer cells. It can be used in combination with appointments and instructions on how to
chemotherapy or as a standalone treatment. prepare for each visit.
IMMUNOTHERAPY • Collaborate with the primary care physician to
• Immunotherapy helps fight pancreatic cancer ensure continuity of care and regular follow-up.
by enhancing the immune system's ability to • Facilitate communication between the patient
recognize and attack cancer cells. and the healthcare team to address any
TARGETED THERAPY concerns or questions that may arise.
• Uses drugs that specifically target the cancer DIET
cells' genetic mutations. • Diet as tolerated as possible.
PALLIATIVE CARE SPIRITUAL
• Focuses on relieving symptoms and improving • Offer a compassionate & empathetic presence,
quality of life. This may involve pain actively listening to the patient's fears and
management, nutritional support, and anxieties.
procedures to relieve blockages in the bile duct • Validate the patient's emotions and provide
or intestines. reassurance.
DISCHARGE PLANNING • Encourage the patient to express their feelings
• As a nurse involved in the discharge planning for openly, fostering an environment of trust and
pancreatic cancer patients, your role is vital in understanding.
ensuring a smooth transition from the hospital • Encourage the patient and family to seek
to home or another care setting. Here are some emotional and psychological support through
important considerations for pancreatic cancer counseling, support groups, or therapy to help
discharge planning from a nursing perspective: cope with the challenges of pancreatic cancer.
MEDICATION
• Review the patient's medication regimen.
CANCER ONCOLOGY NURSING
• Provide detailed instructions on medication Essential concepts of cancer
administration, including dosage, timing, and • What is cancer?
potential side effects. • What cell growth vs cancer cell growth
• Educate the patient and family about the • Etiology and causative factors
importance of medication adherence and the • Pathophysiology
significance of each medication in managing • Classification of the tumors
TREATMENT • Effects of cancer
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NURSING PROCESS

• Assessment
• Laboratory
• Tumor staging and grading
• Nursing diagnosis and planning
• Implementation and management
• Treatment modalities
• Chemotherapy
• End of life issues
WHAT IS CANCER

• Cancer is a complex of disease which occurs when Type of cell

normal cells mutate into abnormal cells that takes
over normal tissues, eventually harming and
destroying the host.
• A large group of disease characterized by
- Uncontrolled growth and spread of
abnormal cells
- Proliferation (rapid reproduction by the cell
division)
- Metastasis (spread or transfer of cancer cells CELL GROWTH AND METABOLISM
from one organ or part to another not
Cell grows through the functioning of cellular
directly connected)
metabolism. Cell metabolism is the process by which
ONCOLOGY
individual cells process nutrients molecules. Metabolism
• Branch of medicine that deals with the study, has two distinct divisions:
detection, treatment and management of Cancer • Catabolism =which the cell breaks down complex
and neoplasia.
molecules to produce energy and
ROOT WORDS
• Anabolism=which the cells use energy and to
• Neo-new construct molecules and perform other biological
• Plasia- growth functions.
• Plasm- substance Function of cell
• Trophy- size • Cell division
• +oma -tumor • Transport Metabolism
• Statis- location • Transport through cell membrane
• A-none Cell division
• Ana- lack
• Hyper-excessive Is the process by which new cells are formed for growth,
repair, and replacement at the body.
• Meta-changes
• Dys-bad, deranged Types of cell division
THE CELL STRUCTURE & PHYSIOLOGY
Definition of cell • Mitosis: which result in two cell identical to the one
The cell is the fundamental unit of structure parent cell
• Meiosis: daughters' cell with half genetic material
Cell structure I. The Cell Cycle

• All living things must be able to grow and reproduce.

• They grow and reproduce during the cell cycle.
M Phase (M stands for Mitosis)

a. This is mitosis (nuclear division)

b. Mitosis is responsible for tissue repair. It heals the
cut.
There are 4 stages of Mitosis

Prophase
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a. Chromosomes coil up, thicken, and become visible. Chromosomes
b. Nuclear membrane dissolves
• Function: Carries genetic information that control
c. Spindle forms from the centrioles
inherited characteristics such as eye color and blood
Metaphase
type.
a. Chromosomes are pulled to the equator of the cell − DNA is always in the form of chromosomes.
and line up. Eukaryotic Cell Organelles and Function
b. Meta means “middle.”
Anaphase Ribosomes

a. The chromosomes (in pairs) are pulled apart by the • Nickname: “Protein factories”
spindle fibers. • Function: Produce proteins - Proteins are passed to
the interior of the endoplasmic reticulum. From
b. Looks like an “X” that has been pulled apart. there they will be transported to the Golgi bodies.
Telophase − Found in all cells, prokaryotic and eukaryotic
Endoplasmic Reticulum (ER)
a. Opposite of prophase
b. Everything done in prophase is undone in • Nickname: “Passageway”
telophase. • Function: Passageway that carries proteins and
c. daughter cell nuclei form around chromosomes at other materials from one part of the cell to another.
opposite ends of the dividing mother 2 Types:
✓ At the end of telophase, the cell undergoes Rough ER:
cytokinesis (cyto means cell; kinese means to cut). • Rough appearance because it has ribosomes
a. The cell splits. Function: helps make proteins, that’s why it has
b. begins at the end of cytokinesis. ribosomes
c. Plant cells form a cell plate between the two new Smooth ER:
cells which will become the new cell wall between
the cells. • NO ribosomes
d. In animal cells the cell separates when it’s • Function: makes fats or lipids
“pinched” in half by the cytoskeleton. This Golgi Complex
indentation is called the cleavage furrow.
• Nickname: mailroom
REMEMBER PMAT
• Function: receives, packages, and distributes
1. Prophase proteins and other materials to different locations
2. Metaphase inside/outside of the cell
3. Anaphase • Appearance: stack of pancakes
4. Telophase Lysosomes:
Eukaryotic Cell
Nucleus • circular, but bigger than ribosomes
• Nickname: “Clean-up Crews”
Nickname: “The Control Center and Genetics” Function: • Function: to break down large food particles into
• holds the DNA smaller ones. Also, breaks down old cell parts
and release substances to reuse.
• Genes in thread-like chromosomes
Mitochondria
• Control production of all proteins
Parts: • Nickname: “The Powerhouse”
• Function:
Nucleolus: dark spot in the middle of the nucleus that
helps make ribosomes  Produce most of the energy the cell needs to
carry out its functions.
Located Inside the Nucleus  Muscle cells have large numbers of
Chromatin mitochondria.
 Breaks down food to make ATP
• Function: Material in cells that contains DNA and
• ATP: is the major fuel for all cell activities that require
carries genetic information and direct functions of a
energy
cell.
•
− Thin strands inside the nucleus.
When the cell get ready to divide it makes Cell Membrane

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• Nickname: “Gatekeeper” • Does not metastasize

• Function: forms outside boundary of animal cell and MALIGNANT
allows materials to move in and out of the cell
• Undifferentiated
• Selectively permeable – allows some substances to
• Erratic and uncontrolled growth
move through and some cannot.
• Expansive and Invasive
Cancer Epidemiology
• Secretes abnormal proteins
• Cancer affects all ages (more on 65 years old and • METASTASIZES
above
• Higher in men than women and higher in LOSS OF NOMAL GROWTH CONTROL
industrialized sectors
• 1 in 4 deaths from cancer
• Early detection/improvements in technology have
improved prognosis for many
Proliferative patterns

Several patterns of cell growth exist:

1. Hyperplasia-enlargement caused by increased cells:

unusual growth in a part of the body, caused by an
excessive multiplication.
2. Metaplasia-the transformation of one kind of tissue
into another undesirable type.
3. Dysplasia-unusual development or growth of a part
of the body such as an organ, bone, or cell, including
the total absence of such a part.
4. Neoplasia-the formation or existence of tumors
Mechanisms of metastasis

1. Lymphatic spread-the transport of tumor cells

through lymphatic system. Ex. Breast tumors from
axillary, clavicular and thoracic lymph channels.
2. Hematogenous spread-via the blood stream.
3. Angiogenesis-growth of new capillaries from the
host tissue, the formation of new blood vessels.
4. Carcinogenesis- the production of cancerous cells
Malignant transformation
3 step cellular process
• Initiation carcinogens, such as chemicals,
physical factors, biologic agents etc.
• Promotion repeated exposure to promoting
agents (cocarcinogens)
• Progression cells have propensity to invade
adjacent tissues and to metastasize.

CHARACTERISTICS OF NEOPLASIA

• Uncontrolled growth of abnormal cells

 Benign
 Malignant
 Borderline
BENIGN

• Well-differentiated
• Slow growth
• Encapsulated
• Non- invasive
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• Pancreatic adenocarcinoma
• Squamous cell carcinoma
2. Mesodermal connective tissue origin
• Use the suffix SARCOMA
• Fibrosarcoma
• Myosarcoma
• Angiosarcoma
PASAWAY

1. “OMA” but malignant

• Hepatoma, lymphoma, glioma, melanoma
2. Three germ Layer
• TERATOMA
3. Non-neoplastic but “Oma”
• Choristoma
• Hamatoma
ETIOLOGY/CAUSATIVE FACTORS

• Viruses
• Chemical carcinogens
• Physical stressors
• Hormonal factors
• Genetic factors

NOMENCLATURE OF NEOPLASIA

Tumor is named according to:

1. Parenchyma, organ or cell

• Hepatoma-liver
• Osteoma-bone
• Myoma-muscles
2. Patterns and structure either GROSS or
MICROSCOPIC
• Fluid-Filled- Cyst ETIOLOGY OF CANCER
• Glandular-Adeno
1. PHYSICAL AGENTS
• Finger-Like—Palillo
• Radiation
• Stalk- polyp
• Exposure to irritants
3. Embryonic origin
• Exposure to sunlight
• Ectoderm (usually gives rise to epithelium)
• Altitude, humidity
• Endoderm (usually give rise to the glands)
2. CHEMICAL AGENTS
• Mesoderm 9usually give rise to connective
•Smoking
tissues)
•Dietary ingredients
BENIGN TUMORS
•Drugs
• Suffix-OMA is used 3. GENETICS AND FAMILY HISTORY
• Adipose tissue-LipOMA •Colon Cancer
• Bone-OsteOMA •Premenopausal breast cancer
• Blood vessels-angiOMa 4. DIETARY HABITS
• Fibrous tissue-fibrOMa •Low-Fiber
MALIGNANT TUMOR •High-fat
•Processed foods
• Name according to embryonic cell origin •Alcohol
1. Ectoderm, endodermal, glandular, epithelial 5. VIRUSES AND BACTERIA
• Use the suffix CARCINOMA

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• DNA viruses- HepaB, Herpes, EBV, CMV,
Papilloma Virus
• RNA Viruses- HIV, HTCLV • Bacterium- H. pylori
6. Hormonal agents
• DES- diethylstilbestrol (popularly known
teratogen as well)
• OCP especially estrogen
6. IMMUNE DISEASE
• AIDS

EXAMPLES OF CANCER W/VIRUS

EIPSTEIN BARR VIRUS Burkitt’s Lymphoma

HUMAN PAPILOMA Cervical Cancer
VIRUS
HEPATITIS B VIRUS Liver Cancer
HUMAN T- Adult T-cell Leukemia
LYMPHOCYTIC VIRUS
KAPOSI’S SARCOMA - Kapos’is Sarcoma
ASSOCIATED HERPES
VIRUS
BURKITT’S SARCOMA
• a cancer of the lymphatic system

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• Bizarre cell growth differing in size, shape and cell

arrangement

CARCINOMA IN SITU
CLASSIFICATION OF TUMOR ACCORDING TO THE
BEHAVIOR OF TUMOR
• Benign - tumors that cannot spread by invasion
or metastasis; hence, they only grow locally
• Malignant - tumors that are capable of
spreading by invasion and metastasis. By
definition, the term "cancer"
PATTERNS OF CELL PROLIFERATION

Metaplasia

• Conversion of one type of cell in a tissue to another

type not normal for that tissue

Anaplasia

• Change in the DNA cell structure and orientation to

one another, characterized by loss of differentiation
and a return to a more primitive form.

Neoplasia

• uncontrolled cell growth, either benign or malignant

METASTASIS
PATTERNS OF CELL PROLIFERATION
•Hyperplasia • Metastasis: 3 stages
•Dysplasia ➢ Invasion: neoplastic cells from primary tumor
• Metaplasia invade into surrounding tissue with penetration
• Anaplasia of blood or lymph.
• Neoplasia ➢ Spread: tumor cells spread through lymph or
HYPERPLASIA circulation or by direct expansion
• Tissue growth based on an excessive rate of cell ➢ Establishment and growth: tumor cells are
division, leading to a larger than usual number of established and grow in secondary site: lymph
cells; the process of hyperplasia is potentially nodes or in organs from venous circulation
reversible; can be a normal tissue response to an
irritating stimulus. An example is a callus. CANCER NURSING

Spread of Cancer

1. LYMPHATIC
• Most common
2. HEMATOGENOUS
• Blood-borne, commonly to Liver and Lungs
3. DIRECT SPREAD
DYSPLASIA
• Seeding of tumors

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Body Defenses Against TUMOR LYMPHOMAS AND LEUKEMIAS
• hematopoietic system
1. T cell System/ Cellular Immunity NERVOUS TISSUE TUMORS
• Cytotoxic T cells kill tumor cells • ex. nerve cells-neuroblastoma
2. B cell System/ Humoral immunity MYELOMA
• B cells can produce antibody • Develops in the plasma cells of bone marrow
3. Phagocytic cells DIFFERENT KINDS OF CANCER
• Macrophages can engulf cancer cell debris

CANCER TENDS TO INVOLVE MULTIPLE MUTATIONS

NAMING CANCERS

MUTATIONS AND CANCER

Genes Implicated in cancer

Cancer Detection and Diagnosis

Effects of Cancer

• Disruption of Function- can be due to obstruction or

CANCER TENDS TO CORRUPT SURROUNDING
pressure
ENVIRONMENT
• Hematologic Alterations: can impair function of
blood cells
• Hemorrhage: tumor erosion, bleeding, severe
anemia
• Anorexia-Cachexia Syndrome: wasted appearance
of client
• Paraneoplastic Syndromes: ectopic sites with excess
hormone production
− ↑Parathyroid hormone → hypercalcemia
− ↑secretion of insulin→ hypoglycemia
CLASSIFICATIONS OF TUMORS − ↑Antidiuretic hormone (ADH) → fluid retention,
HTN & peripheral edema
CARCINOMAS: EPITHELIAL TISSUE • ↑Adrenocorticotropic hormone (ACTH): cause
• body surfaces, lining of body cavities etc: excessive secretion of cortisone (ie: fluid retention,
(adenocarcinoma） ↑glucose levels)
SARCOMAS: CONNECTIVE TISSUE • Pain: major concern of clients and families
• stiated muscle, bone, etc:(osteosarcoma) associated with cancer
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• Physical Stress: body tries to respond and destroy FACTORS THAT LEAD TO CANCER
neoplasm • Smoking- lung cancer
ASSESSMENT • Sunlight (10am to 2pm) basal/squamous cell
(skin cancer)
• Nursing History • Ionizing Radiation - medical and dental xrays
− Health History - chief complaint and history of • Nutrition and diet (high fats and low fiber diet)
present illness (onset, course, duration, location, • Alcohol - liver, oral and esophagus cancer
precipitating and alleviating factors) • Chewing of tobacco (mouth, larynx and throat)
− Cancer signs: CAUTION US! • Estrogen endometrial cancer (give it with
estrogen)
EARLY DETECTION • Occupational hazards (nickel and asbestos)

• Chest-Xray and sputum cytology (lung cancer)

• Physical exam (every year for over 40 y/o) skin, WARNING SIGNS OF CANCER
lymph nodes, mouth, thyroid, breast, testes,
rectum, prostate CAUTION US!
• Oral Exam - annually
• TSE- monthly following shower Change in bowel or bladder habits
• Digital Rectal Exam- annually for 40y/o and
above A sore that does not heal
• BSE - every month after menstruation
• Breast Clinical Exam- done by physician (every Unusual bleeding or discharge
3 years for 20-40 y/o then yearly for over 40
y/o) Thickenings or lumps
• Mammography- once for 35-40 y/o, then yearly
for over 50 y/o Indigestion or difficulty in swallowing
• Pap smear- age 18 and all sexually active
Obvious change in a wart or mole
women then yearly after 3 negative results
• Pelvic Exam - same with pap smear
Nagging or persistent cough or hoarseness
• Endometrial tissue sampling - menopause
• Sigmoidoscopy- for 50 y/o and above annually
Unexplained anemia
for 2 years then every 3 years if negative
• Fecal Occult Blood- doctor’s recommendation Sudden unexplained weight loss
7 WARNING SIGNALS 7 SAFEGUARDS
Change in bowel and Uterus annual pap smear 1. Change in bowel or bladder habits
bladder habits
A sore that does not heal Breast regular BSE • A person with colon cancer may have diarrhea or
Unusual bleeding or Basic PE yearly for all constipation, or he may notice that the stool has
discharge adults become smaller in diameter
Thickening or lump in Lung control or • A person with bladder or kidney cancer
breast or elsewhere preferably stop smoking
Indigestion or difficulty in annual chest Xray for 2. A sore that does not heal
swallowing high risk
Obvious change in wart Oral annual oral exam by • Small, scaly patches on the skin that bleed or do
or mole the doctor not heal may be a sign of skin
Nagging cough or Colon or Rectum DE, cancer
hoarseness of the voice proctosigmoidoscopy • A sore in the mouth that does not heal can
(40y/o) indicate oral cancer
Unexplained anemia S kin avoid undue
exposure to sunlight (10-
3.Unusual bleeding or discharge
2 PM)
Sudden weight loss
• Blood in the stool is often the first sign of colon
cancer

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• Similarly, blood in the urine is usually the first • CEA (Carcinoembryonic antigen): colon cancer
sign of bladder or kidney cancer • Alkaline Phosphatase: bone metastasis
• Postmenopausal bleeding (bleeding after
– Biopsy
menopause) may be a sign of uterine cancer
DIAGNOSTIC TESTS
4. Thickenings or lumps
Determine location of cancer:
• Enlargement of the lymph nodes or glands (such
as the thyroid gland) can be an early sign of • X-rays
cancer • Computed tomography
• Breast and testicular cancers may also present as • Ultrasounds
a lump • Magnetic resonance imaging
• Nuclear imaging
5.Indigestion or difficulty in swallowing • Angiography

• Cancers of the digestive system, including those Diagnosis of cell type:

of the esophagus, stomach, and pancreas, may • Tissue samples: from biopsies, shedded cells
cause indigestion, heartburn, or difficulty (e.g. Papanicolaou (PAP) smear), & washings
swallowing • Cytologic Examination: tissue examined under
microscope
6.Obvious change in a wart or mole
Direct Visualization:
• Moles or other skin lesions that change in shape,
• Sigmoidoscopy
size, or color should be reported
• Cystoscopy
7. Nagging or persistent cough or hoarseness
• Endoscopy
• Cancers of the respiratory tract, including lung
• Bronchoscopy
cancer and laryngeal cancer, may cause a cough
• Exploratory surgery; lymph node biopsies to
that does not go away or a hoarse (rough) voice
determine metastases
8. Unexplained anemia
9. Sudden unexplained weight loss
PHYSICAL ASSESSMENT

INSPECTION
skin and mucus membranes for lesions, bleeding,
petechiae, and irritation

Assess stools, urine, sputum, vomitus for acute or occult

bleeding

Scalp noting hair texture and hair loss

PALPATION
Abdomen for any masses, bulges or abnormalities

Lymph nodes for enlargement

AUSCULTATION
of lung sounds, heart sounds and bowel sounds

LABORATORY & DIAGNOSTIC TESTS • CANCER

DETECTION EXAMINATION

LABORATORY TESTS
• Complete blood cell count (CBC)
• Tumor markers – identify substance (specific
proteins) in the blood that are made by the
tumor
• PSA (Prostatic-specific antigen): prostate cancer
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• During your follow-up visits after initial

treatment, tumor marker tests may be done to
monitor for recurrence.

MOST COMMON TUMOR MARKERS APPROVED BY THE

FOOD AND DRUG ADMINISTRATION FOR SCREENING,
DIAGNOSIS, OR MONITORING OF CANCER

• Alpha-fetoprotein (AFP): AFP is a glycoprotein

produced by the developing fetus, but levels decline
after birth. Diagnosis and monitoring of patients with
testicular cancer and HEPATIC MASSES.
TUMOR MARKER- DESCRIPTION
• Less than 15 ng/L in men and non-pregnant women.
• Tumor markers are substances that show up in Levels greater than 1,000 ng/L indicate malignant
your blood, urine, or tumor. disease (except in pregnancy).
• These are hormones, proteins, or parts of •
proteins that are made by the tumor or by your • CA125: (cancer antigen 125) This test is FDA
body, in response to the tumor, or particular approved for the diagnosis and monitoring of
benign conditions. women with ovarian cancer.
• An elevated level of a tumor marker can • Benign diseases detected by the test include
indicate cancer; however, there can also be endometriosis, ovarian cysts, fibroids, inflammatory
other causes of the elevation. bowel disease, cirrhosis, peritonitis, and
pancreatitis.
TUMOR MARKER IDENTIFICATION
• Less than 35 U/mL
• Analysis of substances found in blood or
• Carcinoembryonic antigen (CEA): glycoprotein that
other body fluids that are made by the tumor
is part of the normal cell membrane. CEA is shed into
or by the body in response to the tumor
serum and reaches very high levels in colorectal
• Diagnostic Uses: Breast, colon, lung, ovarian,
cancer. Over 50% of persons with breast, colon, lung,
testicular, prostate cancers
gastric, ovarian, pancreatic, and uterine cancer have
USE OF TUMOR MARKER TESTS: elevated levels of CEA.
• To detect, diagnose, and monitor cancer. • Less than 3 ug/L for nonsmokers and less than 5 ug/L
• These test results are used together with other for smokers.
data, such as biopsy results, to get a clear picture
of the stage of your cancer, what type of • Prostate specific antigen (PSA): A small glycoprotein
treatment will be most effective, and to measure with protease activity that is specific for prostate
your progress during treatment. tissue.
• You may have a tumor marker test before • Prostate specific antigen (PSA): Less than 4 ng/L.
starting treatment, to get a baseline level.
• This score will be used to compare with later • Human chorionic gonadotropin (hCG): A
tumor marker tests. glycoprotein produced by cells of the trophoblast
and developing placenta.
USE OF TUMOR MARKER TEST RESULTS:
• About 60% of testicular cancers secrete hCG.
• Your test levels will show how well your
• Less than 20 IU/L for males and non-pregnant
treatment is working.
females. Greater than 100,00 IU/L indicates
• If your tumor marker levels decrease, that is a
trophoblastic tumor.
good sign that the cancer is responding to the
therapy.
• An increased level indicates that the cancer is • Nuclear matrix protein (NMP22) and bladder tumor
resisting the treatment, and a change may be associated analytes (BTA): NMP22 is a structural
required.
nuclear protein that is released into the urine when
• After you have finished treatment, another bladder carcinoma cells die.
tumor marker test may be done to check for any • Urine is tested using an immunochemical method.
return of the cancer.
Approximately 70% of bladder carcinomas are
positive for NMP22.

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NURSING CONSIDERATIONS NURSING CONSIDERATIONS

PRE-PROCEDURE • Patient safety

• MRI is not recommended for pregnant women,
• A nurse or phlebotomist usually collects the blood by pacemaker, cochlear implants, aneurysm clips, and
venipuncture, therefore follow standard precautions other metallic implants
for prevention of exposure to bloodborne • Patients who have been exposed to shrapnel or
pathogens. metal shavings (especially in the eye)
• Urine is collected by the patient using the midstream • Because eye-shadow may contain metallic
void technique. substances, patients undergoing MRI should not
POST-PROCEDURE wear make-up during the examination.
• Routine care of the area around the puncture site • During the MRI examination, all patients, but
• Pressure is applied for a few seconds and the wound particularly those under sedation or anesthesia or in
is covered with a bandage. critical condition, should be monitored using
• If a bruise or swelling develops around the puncture physiologic monitoring equipment, intercom
site, the area is treated with a moist warm compress. systems, and video.
COMPLICATIONS • Some patients may be claustrophobic during the
• Risks of venipuncture include mild dizziness, examination or may experience anxiety.
bruising, swelling, or excessive bleeding from the • To alleviate these discomforts, an MRI compatible
puncture site music system and increased ventilation in the
• Several results over a period of months may be magnet bore can be installed.
needed to evaluate treatment and identify
recurrence. COMPUTERIZED TOMOGRAPHY (CT-SCAN)
• Positive results must be interpreted cautiously
because some tumor markers are increased in • Use of narrow-beam x-ray to scan successive layers
nonmalignant diseases and in a small number of of tissue for a cross-sectional view
apparently healthy persons.
Diagnostic Uses:
• A false positive result occurs when the value is
elevated, but cancer is not present. • Neurologic pelvic, skeletal, abdominal. thoracic
• A false negative result occurs when the value is cancers
normal, but cancer is present. • During a computerized tomography (CT) scan, a thin
MAGNETIC RESONANCE IMAGING X-ray beam rotates around the area of the body,
• Use of magnetic fields and radiofrequency signals to generating a 3-D image of the internal structures
create sectioned images of various body structures
PURPOSE
Diagnostic Uses: Neurologic, pelvic, abdominal, thoracic
cancers Common CT indications include:

PURPOSE • Sinus studies. The CT scan can show details of

sinusitis, and bone fractures. Physicians may
An MRI unit has several diagnostic clinical applications, order CT of the sinuses to provide an accurate
including: map for surgery.
• Brain studies. Brain scans can detect
• diagnosing diseases of the central nervous system, hematomas, tumors, and strokes. The
brain, and spine introduction of CT scanning, especially spiral CT,
• detecting musculoskeletal disorders and injuries has helped reduce the need for more invasive
• identifying infectious diseases such as those procedures such as cerebral angiography.
associated with acquired immunodeficiency • Body scans. CT scans of the body will often be
syndrome (AIDS) used to observe abdominal organs, such as the
• detecting metastatic liver disease liver, kidneys, adrenal glands, spleen, and
• imaging the cardiovascular system lymph nodes, and extremities
• staging prostate, bladder, and uterine cancers • Aorta scans. CT scans can focus on the thoracic
• studying bone marrow diseases or abdominal aorta to locate aneurysms and
• imaging the breast adjunctive to conventional other possible aortic diseases.
mammography
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• Chest scans. CT scans of the chest are useful in • Bronchial, gastrointestinal cancers
distinguishing tumors and in detailing
accumulation of fluid in chest infections. MAMMOGRAPHY
• is the process of using low-dose amplitude-X-rays to
NURSING CONSIDERATION examine the human breast and is used as a
• Pregnant women or those who could possibly be diagnostic as well as a screening tool. The goal of
pregnant should not have a CT scan unless the mammography is the early detection of breast
diagnostic benefits outweigh the risks. cancer, typically through detection of characteristic
• Contrast agents are often used in CT exams and the masses and/or micro-calcifications. Mammography
use of these agents should be discussed with the is believed to reduce mortality from breast cancer
medical professional prior to the procedure.
• Patients should be asked to sign a consent form POSITRON EMISSION TOMOGRAPHY
concerning the administration of contrast media.
• Through the use of a tracer, provides black and white
• One common ingredient in contrast agents, iodine,
or color-coded images of the biologic activity of a
can cause allergic reactions. Patients who are known
particular area, rather than its structure; used in
to be allergic to iodine (or shellfish) should inform
detection of cancer or its response to treatment
the physician prior to the CT scan.

Diagnostic Uses:
FLUOROSCOPY
• Lung, colon, liver, pancreatic, head and neck cancers;
• Use of x-rays that identify contrasts in body tissue
Hodgkin and non-Hodgkin lymphoma and melanoma
densities; may involve the use of contrast agents
PET FUSION
Diagnostic Uses:
• Use of a PET scanner and a CT scanner in one
• Skeletal, lung, gastrointestinal cancers
machine to provide an image combining anatomic
detail, spatial resolution, and functional metabolic
PURPOSE
abnormalities
• Used to detect bone cancer or digestive cancers, and
RADIOIMMUNOCONJUGATES
digestive ulcers
• Monoclonal antibodies are labeled with a
Precaution: Clinical staff are also exposed to radiation,
radioisotope and injected intravenously into the
and portable radiation shields, lead aprons, and radiation
patient; the antibodies that aggregate at the tumor
badges should be worn by all staff present during
site are visualized with scanners
fluoroscopy.

ULTRASONOGRAPHY Diagnostic Uses:

• Colorectal, breast, ovarian, head and neck cancers;
• High-frequency sound waves echoing off body lymphoma and melanoma
tissues are converted electronically into images;
used to assess tissues deep within the body TUMOR STAGING AND GRADING

Diagnostic Uses: • Staging determines size of tumor and existence

of metastasis
• Abdominal and pelvic cancers • Grading classifies tumor cells by type of tissue
• The TNM system is based on the extent of the
ENDOSCOPY tumor (T), the extent of spread to the lymph
nodes (N), and the presence of metastasis (M)
• Direct visualization of a body cavity or passageway
by insertion of an endoscope into a body cavity or PRIMARY TUMOR (T)
opening; allows tissue biopsy, fluid aspiration, and • TX - Primary tumor cannot be evaluated
excision of small tumors; both diagnostic and • T0 - No evidence of primary tumor Tis -
therapeutic Carcinoma in situ (early cancer that has not
spread to neighboring tissue)
Diagnostic Uses: • T1, T2, T3, T4 - Size and/or extent of the primary
tumor

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REGIONAL LYMPH NODES (N)
• NX - Regional lymph nodes cannot be evaluated
• N0 - No regional lymph node involvement (no
cancer found in the lymph nodes)
• N1, N2, N3 - Involvement of regional lymph
nodes (number and/or extent of spread)

DISTANT METASTASIS (M)

• MX - Distant metastasis cannot be evaluated
• M0 - No distant metastasis (cancer has not
spread to other parts of the body)
• M1 - Distant metastasis (cancer has spread to
distant parts of the body)

NURSING DIAGNOSES
• Acute or chronic pain
• Impaired skin integrity
• Impaired oral mucous membrane
• Risk for injury
• Risk for infection
• Fatigue
• Imbalanced nutrition: less than body
requirements
• Risk for imbalanced fluid volume SOME CARCINOGENS IN THE WORKPLACE
• Anxiety
• Disturbed body image
• Deficient knowledge
• Ineffective coping
• Social isolation

OUTCOME IDENTIFICATION
• Pain relief
• Integrity of skin and oral mucosa
• Absence of injury and infection
• Fatigue relief
• Maintenance of nutritional intake and fluid and
electrolyte balance
• Improved body image
• Absence of complications
• Knowledge of prevention and cancer treatment
• Effective coping through recovery and grieving
process
• Optimal social interaction

IMPLEMENTATION/MANAGEMENT
• Prevention and detection TREATMENT MODALITIES
− Primary Prevention • Aimed towards:
• Reducing modifiable risk factors in the external ➢ Cure - free of disease after treatment → normal
and internal environment life
– Secondary Prevention ➢ Control - Goal for chronic cancers
• Recognizing early signs and symptoms and ➢ Palliative Care: Quality of life maintained at
seeking prompt treatment highest level for the longest possible time
• Prompt intervention to halt cancerous process • Surgery- surgical removal of tumors; most
commonly used treatment
• Preventive or prophylactic

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• Diagnostic surgery 2. Promote measures to maintain intact skin

• Curative surgery integrity
• Reconstructive surgery 3. Promote measures that maintain oral
• Palliative surgery mucosa
• Chemotherapy- use of antineoplastic drugs to 4. Promote measures to prevent injury from
promote tumor cell death, by interfering with abnormal bleeding.
cellular functions and reproduction • Monitor platelet count; avoid aspiring
• Radiotherapy – directing high-energy ionizing products, etc.
radiation to destroy malignant tumor cells 5. Promote measures that identify and prevent
without harming surrounding tissues infection.
Types: • Monitor WBC count; encourage
➢ Teletherapy (external): radiation delivered frequent handwashing and overall
in uniform dose to tumor; Teletherapy is cleanliness
external beam irradiation and uses a device 6. Help decrease the client's fatigue and
located at a distance from the patient. It increase his activity level
produces X-rays of varying energies and is 7. Promote measures that ensure adequate
administered by machines a distance from nutritional intake
the body 31A½ to 39 inches (80 to 100 cm). • High protein, high calorie diet
➢ Brachytherapy: delivers high dose to tumor 8. Ensure adequate fluid and electrolyte
and less to other tissues; radiation source is balance
placed in tumor or next to it; In 9. Promote measures to enhance body image.
brachytherapy, the radiation device is placed • Take an honest gentle, caring approach;
within or close to the target tissue. Radiation encourage client to express and
is delivered in a high dose to a small tissue verbalize feelings
volume with less radiation to adjacent 10. Promote measures that address preventing
normal tissue, but requires direct tumor complications of cancer therapy
access. 11. Instruct client and family about the disease
process and treatments; provide necessary
information for self- care.
12. Help client and family cope effectively
13. Promote measures to reduce social
isolation.

CARE OF CLIENTS RECEIVING CHEMOTHERAPY

Classes of Chemotherapy Drugs:

• Immunotherapy - use of chemical or • Alkylating agents:
microbial agents to induce mobilization - Action: create defects in tumor DΝΑ
of immune defenses. - Ex: Nitrogen Mustard, Cisplatin
• Biologic response modifiers (BRMs) - - Toxic Effects: reversible renal tubular necrosis
use of agents that alters immunologic • Antimetabolites:
relationship between tumor and host in - Action: phase specific
a beneficial way - Ex: Methotrexate; 5 fluorouracil
• Bone marrow peripheral stem cell - Toxic Effects: nausea, vomiting, stomatitis,
transplantation - aspirating bone diarrhea, alopecia, leukopenia
marrow cells from compatible donor • Antitumor Antibiotics:
and infusing them into the recipient - Action: non- phase specific; interfere with DNA
• Gene therapy - transfer of genetic - Ex: Actinomycin D, Bleomycin, adriamycin
materials into the client's DNA (doxorubicin)
NURSING MANAGEMENT - Toxic Effect: damage to cardiac muscle
1. Promote measures that relieve pain and • Miotic inhibitors:
discomfort. - Action: Prevent cell division during M phase of
• Pharmacologic and non-pharmacologic cell division
interventions - Ex: Vincristine, Vinblastine

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- Toxic Effects: affects neurotransmission, and vomiting with specific nursing and medical
alopecia, bone marrow depression interventions
• Hormones: • Monitor lab results (drugs withheld if blood
- Action: stage specific G1 counts seriously low); blood and blood product
- Ex: Corticosteroids administration
• Assess for dehydration, oncologic emergencies
• Hormone Antagonist:
• Teach regarding fatigue, immunosuppression
- Action: block hormones on hormone- binding
precautions
tumors ie: breast, prostate, endometrium; cause
• Provide emotional and spiritual support to
tumor regression
clients and families
- Ex: Tamoxifen (breast); Flutamide (prostate)
- Toxic Effects: altered secondary sex COLON CANCER
characteristics 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
EFFECTS OF CHEMOTHERAPHY
PATHOPHYSIOLOGY
• Tissues: (fast growing) frequently affected • Benign neoplasm → DNA alteration malignant
• Examples: mucous membranes, hair cells, bone transformation → malignant neoplasm → cancer
marrow, specific organs with specific agents, growth and invasion → metastasis (liver)
reproductive organs (all are fetal toxic; impair
ASSESSMENT FINDINGS
ability to reproduce)
1. Change in bowel habits- Most common
CHEMOTHERAPHY ADMINISTRATION 2. Blood in the stool
3. Anemia
• Routes of administration: 4.Anorexia and weight loss
- Oral 5.Fatigue
- Body cavity (intraperitoneal or intrapleural) 6.Rectal lesions- tenesmus, alternating D and C
- Intravenous
• Use of vascular access devices because of threat DIAGNOSTIC FINDINGS
of extravasation (leakage into tissues) & long • Fecal occult blood
term therapy • Sigmoidoscopy and colonoscopy
• BIOPSY
• Types of vascular access devices:
• CEA – Carcino-embryonic antigen
- PICC lines: (peripherally inserted central
catheters)
COMPLICATIONS OF COLORECTAL CA
- Tunneled catheters: (Hickman, Groshong)
• Obstruction
- Surgically implanted ports: (accessed with 900 • Hemorrhage
angle needle- Huber needles) • Peritonitis
NURSING CARE OF CLIENTS RECEIVING • Sepsis
CHEMOTHERAPY
Assess and manage: MEDICAL MANAGEMENT
• Toxic effects of drugs (report to physician) • Chemotherapy- 5-FU
• Side effects of drugs: manage nausea and • Radiation therapy
vomiting, inflammation and ulceration of
mucous membranes, hair loss, anorexia, nausea SURGICAL MANAGEMENT
• Surgery is the primary treatment
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• Based on location and tumor size

• Resection, anastomosis, and colostomy
(temporary or permanent)

NURSING INTERVENT: 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
• 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
• Lightly pat dry the area and NEVER rub
BREAST CANCER: ASSESSMENT FINDINGS
• Lightly dust the peri-stomal area with nystatin
• MASS - the most common location is the upper
powder
outer quadrant
• Measure the stomal opening
• Mass is NON-tender. Fixed, hard with irregular
• The pouch opening is about 0.3 cm larger than
borders
the stomal opening
• Skin dimpling
• Apply adhesive surface over the stoma and press
• Nipple retraction
for 30 seconds
• Peau d' orange
• Empty the pouch or change the pouch when
• 1/3 to ¼ full (Brunner)
LABORATORY FINDINGS
½ to 1/3 full (Kozier)
• Biopsy procedures
• Mammography
BREAST CANCER
(PAGE 151-ONWARDS: KEM)
• The most common cancer in FEMALES
• Numerous etiologies implicated BREAST CANCER: LABORATORY FINDINGS

1. Biopsy procedures
BREAST CANCER: RISK FACTORS
2. Mammography
1. Genetics
2. Increasing age ( > 50 yo) BREAST CANCER STAGING
3. Family History of breast cancer
4. Early menarche and late menopause Stage 1 <2cm
5. Nulliparity Stage 2 2-5 cm, (+) LN
6. Late age at pregnancy Stage 3 >5 cm, (+) LN
7. Obesity Stage 4 Metastasis
8. Hormonal replacement
9. Alcohol
MEDICAL MANAGEMENT
10. Exposure to radiation
1. Chemotherapy
PROTECTIVE FACTORS 2. Tamoxifen therapy
• Exercise 3. Radiation therapy
• Breast feeding
SURGICAL MANAGEMENT
• Pregnancy before 30 yo
1. Radical Mastectomy
2. Modified radical mastectomy
3. Lumpectomy
4. Quadrantectomy

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MEDSURG FINALS MEDIQUETTE GIRLS
ONCOLOGY

• Support operative site when moving

• Hand, shoulder exercise done on 2nd day
• Post-op mastectomy exercise 20 minutes TID

REMEMBER: NO BP OR IV PROCEDURE ON OPERATIVE

SIDE

• Heavy lifting is avoided

• Elevate the arm at the level of the heart
• On a pillow for 45 minutes TID to relieve
transient edema.

BREAST CANCER: NURSING INTERVENTION: POST-OP

MANAGE COMPLICATIONS

Lymphedema

• 10-20% of patients
• Elevate arms, elbow above shoulder and hand
above elbow
• Hand exercise while elevated
• Refer to surgeon and physical therapist.

Hematoma

• Notify surgeon
• Apply bandage wrap (Ace wrap_ and ice pack.

NURSING INTERVENTION: PRE-OP Infection

1. Explain breast cancer and treatment options • Monitor temperature, redness, swelling and
2. Reduce fear and anxiety and improve coping foul-odor.
abilities • IV antibiotics.
3. Promote decision making abilities • No procedure on affected extremity.
4. Provide routine pre-op care: consent, NPO, NURSING INTERVENTION: POST-OP
meds, teaching about breathing exercise.
TEACH FOLLOW-UP care
BREAST CANCER: NURSING INTERVENTION: POST-OP
POSITION PATIENT • Regular check-up
• Supine • Monthly BSE on the other breast
• Affected extremity elevated to reduce edema. • Annual mammography

RELIEVE PAIN AND DISCOMFORT

• Moderate elevation of extremity

• IM/IV injection of pain meds
• Warm shower on 2nd day post-op

MAINTAIN SKIN INTEGRITY

• Immediate post-op: snug dressing with drainage

• Maintain patency of drain (JP)
• Monitor for hematoma w/in 12h and apply
bandage and ice, refer to surgeon.
• Drainage is removed when the discharge is less
than 30ml in 24 hours.
• Lotions, creams are applied ONLY when the
incision is healed in 4-6 weeks.

PROMOTE ACTIVITY

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