Definition

Branch of medicine that

deals with the study,
detection, treatment and
management of cancer
“Root words”
Neo- new
Plasia- growth
Trophy- size
Oma- tumor
Statis- location
“Root words”
Remission – symptoms of cancer are no
longer present
Relapse – the disease reoccurs after a
period of remission
Refractory – the cancer is resistant to
treatment.
 Hyper- excessive
Meta- change
 Cell cycle
Mitosis or M phase
Gap 1 or G1 phase
S phase or synthesis phase
Gap 2 or synthesis phase
G0
The phases describe periods of time for
different cellular process that ultimately
results in a cell’s reproduction or death.
 Cell cycle
Synthesis of RNA & protein occurs in the G1
phase.
S phase, is when DNA is being replicated &
is a relatively short period.
G2 phase occur after DNA synthesis & just
before cell division
Mitosis or cell division ensues during M
phase resulting in two identical daughter
cells.
 Cell cycle
Cells that have left the cycle to
enter the G0 phase are considered to
be in a resting or dormant phase.
These cells can actively synthesize
RNA & proteins & differentiate
Cells in the phase are typically
resistant to the cytotoxic effects of
chemotherapy.
 Cellular differentiation
Cellular differentiation is an orderly
process that progresses from a state
of immaturity to a state of maturity.
Two types of normal genes that can
be affected by mutation are
protooncogenes & tumor suppressor
genes.
 Cellular differentiation
Protooncogenes promote growth,
whereas tumor suppressor genes
suppress growth.
Mutations that alter the
expression of protooncogenes can
activate them to function as
oncogenes (tumor inducing genes).
Characteristic Benign malignant

Encapsulated usually Rarely

Differentiated Normally poorly

Metastasis absent Capable

Recurrence Rare possible

Vascularity slight Moderate to

marked
Mode of growth Expansive Infiltrative
&expansive
Cell characteristics Fairly normal, Abnormal cells,
similar to parent become more unlike
cells parent cells
 Cancer nursing
Etiology of cancer
1. Physical agents
Radiation
Exposure to irritants
Exposure to sunlight
Altitude, humidity
 Cancer nursing
Etiology of cancer
2. Chemical agents
 Smoking
 Dietary ingredients
 Drugs
 Cancer nursing
Etiology of cancer
 Genetics and Family History
 Colon Cancer
 Breast cancer
 Cancer nursing
Etiology of cancer
 Dietary Habits
 Low-Fiber
 High-fat
 Processed foods
 alcohol
 Cancer nursing
Etiology of cancer
Viruses and Bacteria
DNA viruses- HepaB, Herpes, EBV,
CMV, Papilloma Virus
RNA Viruses- HIV,
Bacterium- H. pylori
CANCER NURSING
Etiology of cancer
Hormonal agents
DES
OCP especially estrogen
Immune Disease
AIDS
 Cancer nursing
Body Defenses Against TUMOR
1. T cell System/ Cellular Immunity
Cytotoxic T cells kill tumor cells
2. B cell System/ Humoral immunity
B cells can produce antibody
3. Phagocytic cells
Macrophages can engulf cancer cell
debris
 Development of cancer
Initiation : the first stage, initiation, is a
mutation in the cell’s genetic structure
resulting from an inherited mutation, (an
error that occurs during DNA replication),
or following exposure to a chemical,
radiation, or viral agent.
This altered cell has the potential for
developing in to a clone group of identical
cells) of neoplastic cells.
 Development of cancer
Promotion : it is characterized by the
reversible proliferation of the altered
cells.
An important distinction between
initiation & promotion is that the
activity of promoters is reversible.
This is a key concept in cancer
prevention.
 Development of cancer
Promotion : some carcinogens are
capable of both initiating & promoting
the development of cancer & termed as
complete carcinogens.
A period of time ranging from 1-40
years, elapses between the initial
genetic alteration& the actual clinical
evidence of cancer called latent period.
 Development of cancer
Progression : This stage is
characterized by increased growth
rate of the tumor, increased
invasiveness, & metastasis
As the tumor increases in size,
blood cells within the tumor called
angiogenesis.
How can u lift an elephant with one
hand????
What looks like half apple???
 Classification of cancer
Anatomic site
Histology (grading)
Extent of disease (staging)
 Classification of cancer
Anatomic site
site benign malignant

Epithelial oma Carcinoma

tissue tumors
Surface papiloma Carcinoma
epithelium
Glandular Adenoma adenocarcin
epithelium oma
 Classification of cancer
Anatomic site
site benign malignant
Connective tissue oma sarcoma
tumors
Fibrous tissue fibroma Fibrosarcoma

cartilage chondroma chondrosarcoma

Striated muscle rhabdomyoma Rhabdomyosarc

oma
bone osteoma osteosarcoma
 Classification of cancer
Anatomic site
site benign malignant

Meninges meningioma Meningeal sarcoma

Nerve cells ganglioneuroma neuroblastoma

 Classification of cancer
Anatomic site
Hematopoietic
tissue tumors
Lymphoid tissue Hodgkin’s lymphoma, NHL

Plasma cells Multiple myeloma

Bone marrow Lymphocytic & myelogenous

leukemia
 Classification of cancer
Anatomic site
Hematopoietic
tissue tumors
Lymphoid tissue Hodgkin’s lymphoma, NHL

Plasma cells Multiple myeloma

Bone marrow Lymphocytic & myelogenous

leukemia
 Classification of cancer
Histologic classification
This is based on the degree to which the cells
resemble the tissue of origin.
• Grade I : cells differ slightly from normal
cells (mild dysplasia) & are well
differentiated (low grade)
• Grade II : cells are more abnormal
(moderate dysplasia) & moderately
differentiated (intermediate grade)
 Classification of cancer
Histologic classification
• Grade III : cells are very abnormal
(severe dysplasia) & poorly
differentiated (high grade)
• Grade IV : cells are immature & primitive
(anaplasia) & undifferentiated, cell of
origin difficult to determine (high grade)
• Grade x : grade cannot be assessed
 Classification of cancer
Extent of disease
• Stage 0 : cancer in situ
• Stage I : tumor limited to the tissue of
origin, localized tumor growth
• Stage II : limited local spread
• Stage III : extensive local & regional
spread
• Stage IV : metastasis
 Classification of cancer
TNM classification system
• Primary tumor (T)
• T0 : no evidence of primary tumor
• Tis : carcinoma in situ
• T1-4 : ascending degrees of increase in
tumor size & invovement
• Tx : tumor cannot be measured or found
 Classification of cancer
TNM classification system
• Regional lymphnodes (N)
• N0 : no evidence of disease in lymphnodes
• N1-4 : ascending degrees of nodal
involvement
• Nx : regional lymph nodes unable to be
assessed clinically
 Classification of cancer
TNM classification system
• Distant metastsis (M)
• M0 : no evidence of distant metastasis
• M1-4 : ascending degrees of metastatic
involvement of the host, including
distant nodes
• Mx : cannot be determined
 Warning signs of cancer
Change in bowel & bladder habits
A sore that does not heal
Unusual bleeding or discharge from any body
orifice
Thickening or a lump in the breast or elsewhere
Indigestion or difficulty in swallowing
Obvious change in a wart or mole
Nagging cough or hoarseness
 Diagnostic evaluation
Laboratory analysis
Biochemical analysis of blood, serum,
urine & other body fluids identifies
chemical & hematologic values outside
the normal homeostatic range.
LFT, CBC, RFT, PT, PTT, fibrin levels
 Diagnostic evaluation
Tumor markers
Tumor markers consist of proteins,
antigens, ectopically produced
hormones, enzymes & gene products
that are tumor derived.
It is recognized in serum& body
fluids, & in tissues at the cellular &
genetic levels
 Diagnostic evaluation
Tumor markers
CEA – general carcinogenic antigen
PSA – prostate antigen
CA-125 – ovarian
CA-25,27 – breast
HER 2 NEU – breast
 Diagnostic evaluation
Analytical techniques
• Radioimmuno assay : it determines the
amount of tumor antigen in a serum
sample.
• Immunohistochemistry : it locates
antigens in tissue sections by utilizing
labeled antibodies & observing antigen
antibody interactions (CEA)
 Diagnostic evaluation
Analytical techniques
• Flow cytometry : Rapidly measures
& identifies DNA charateristics &
distribution cell throughout cell
cycle.
• Cytogenetics : it is the analysis of
cell genetic information.
 Diagnostic evaluation
Genetic testing : BRCA 1, BRCA 2
Tumor imaging
• CT
• USG
• MRI
• Nuclear medicine techniques
• Thyroid scans : injection of a radioactive
tracer, iodine, to evaluate the functional ability
of thyroid
 Diagnostic evaluation
Tumor imaging
• Nuclear medicine techniques
• Gallium scans : to visualize
inflammatory lesions of bone, bone
marrow, breast, brain & liver
• PET : biochemical & metabolic
activity of the tissue.
 Diagnostic evaluation
Invasive diagnostic techniques
• Endoscopy
• biopsy
CHEMOTHERAPY
 Chemotherapy
The goal of chemotherapy is to
eliminate or reduce the number of
malignant cells present in the
primary tumor & metastaic tumor
site.
 Chemotherapy
Dose calculation
The dose of drug to be administered
generally based on the individual’s
body surface area
Mosteller equation
BSA = √height (cm) x weight (kg)
3600
 Chemotherapy
Classification
Mitotic inhibitors
Alkylating agents
Topoisomerase
Nitrosureas
inhibitors
Platinum drugs
Corticosteroids
Antimetabolites
Hormone therapy
Antitumor
miscellaneous
antibiotics
 Chemotherapy
Alkylating agents
 cell cycle phase non specific agents
Damage DNA by causing breaks in
the double stranded helix, if repair
doesnot occur, cells will die
immediately (cytocidal),
Cyclophosphamide (cytoxan,neosar),
dacarbazine (DTIC-dome)
 Chemotherapy
Nitrosureas
 cell cycle phase non specific
agents
Break DNA interfere with DNA
replication, cross BB
Carmustine, lomustine
 Chemotherapy
Platinum drugs
 cell cycle phase non specific
agents
Bind DNA to RNA, miscoding
information or inhibiting DNA
replication & cells die.
Carboplatin, cisplatin, oxiplatin
 Chemotherapy
Antimetabolites
 cell cycle phase specific agents
Mimic naturally occurring substances, thus
interfering with enzyme function or DNA
synthesis
Primarily act during S phase
Interfere with purine, pyrimidine & folic acid
metabolism
Mercaptopurine, fluorouracil, methotrexate
 Chemotherapy
Antitumor antibiotics
 cell cycle phase non specific agents
Bind directly to DNA, thus inhibiting
the synthesis of DNA & interfering
with transcription of RNA
Doxorubicin, dactinomycin,
daunorubicin.
 Chemotherapy
Mitotic inhibitors
 cell cycle phase specific agents
Antimicrotubule agents that interfere
with mitosis, act during the late G2
phase & mitosis to stabilize
microtubules, thus inhibiting cell division
Albumin bound particles, paclitaxel
 Chemotherapy
Mitotic inhibitors
 cell cycle phase specific agents
Taxanes : Antimicrotubule agents that interfere
with mitosis, act during the late G2 phase & mitosis
to stabilize microtubules, thus inhibiting cell division
Albumin bound particles, paclitaxel
Vinca alkaloids : act in M phase to inhibit mitosis
(vinblastine, vincristine)
 Chemotherapy
Topoisomerase inhibitors
 cell cycle phase specific agents
Inhibit the normal enzymes
(topoisomerases) that function to make
reversible breaks & repairs in DNA that
allow for flexibility of DNA in replication
Etoposide, teniposide
 Chemotherapy
Corticosteroids
 cell cycle phase non specific agents
Disrupt the cell membrane & inhibit the
synthesis of protein, decrease circulating
lymphocytes, inhibit mitosis, depress
immune system, increase sense of well
being
Cortisone, dexamethasone, hydrocortisone
 Chemotherapy
Hormone therapy
 cell cycle phase non specific agents
Antiestrogens : selectively attach to
estrogen receptors, causing down
regulation of them & inhibiting tumor
growth, also known as selective estrogen
modulators (SERMs)
Tamoxifen, raloxifene
 Chemotherapy
Hormone therapy
Estrogen : interfere with hormone
receptors & proteins (diethylstilbestrol,
DES)
Aromatase inhibitors : inhibit aromatase,
an enzyme that converts adrenal
androgen to estrogen ( exemestane,
letrozole)
 Chemotherapy
Miscellaneous
Inhibits protein synthesis (l-
asparaginase)
Causes changes in DNA in leukemia cells
(arsenic trioxide)
Suppresses mitosis at interphase,
appears to alter performed DNA, RNA, &
protein (procarbazine)
 Chemotherapy
Method of administration
Oral : cytoxan
Intramuscular : bleomycin
IV : doxorubicin, vincristne, cisplatin, 5 –FU,
paclitaxel
Intraperitoneal : alkalyting agents, methotrexate
Intrathecal : methotrexate, cytarabine
Intraarterial : DTIC, 5 FU
Topical : 5 FU cream
 Chemotherapy
Problems caused by chemotherapy
GI system
Stomatitis, mucositis
Nausea & vomiting
Anorexia
Diarrhea
Constipation
hepatotoxicity
 Chemotherapy
Integumentary system
Alopecia
 hyperpigmentation
Hematologic system
Anemia
Leukopenia
thrombocytopenia
 Chemotherapy
Genitourinary system
Hemorrhagic cystitis
Nervous system
Increased ICP
Peripheral neuropathy
 Chemotherapy
Respiratory system
Pneumonitis
CV system
Pericarditis
Myocarditis
Cardiotoxicity
Refer page 282
 Radiation therapy
Radiation is the emission & distribution of
energy through space or a material medium.
It produces ionization of atomic particles &
resultant generation of free radicals act to
break the chemical bonds in DNA.
It leads to lethal (chromosomal disruption)
& sublethal DNA damage (potential for
repair in between radiation doses).
 Radiation therapy
Measurement of radiation are (curie, Ci),
roentegen (R), Rad, Rem, gray (Gy)
Radiation is used to treat a carefully
defined area of the body to achieve local
control of disease.
Radiation may be used independently or in
combination with chemotherapy to treat
primary tumors or for palliative control of
metastatic lesions.
 Radiation therapy
The goals of radiation therapy are
cure, control, or palliation.
Radiation can be delivered externally
called teletherapy or internally called
brachytherapy.
In teletherapy, the patient is exposed
to radiation from a megavoltage
treatment machine.
 Radiation therapy
Brachytherapy consists of the
implantation or insertion of
radioactive materials directly in to
the tumor (interstitial) or in close
proximity adjacent to the tumor
(intracavity or intraluminal)
 Radiation therapy
Definitive /primary therapy : used as an
independent treatment modality with
curative intent. (eg. For ca lung, prostate,
bladder)
Neoadjuvant therapy : given (with or
without chemotherapy) preoperatively to
minimize tumor burden & improve the
likelihood od complete surgical resection.
 Radiation therapy
Adjuvant therapy : administered
following surgery or chemotherapy
to improve local control of disease
recurrence
Prophylaxis : administered to high
risk areas to prevent future cancer
development
 Radiation therapy
Disease control : limiting tumor
growth to extend the symptom free
period as much as possible
Palliation : given to prevent or
relieve distressing symptom such as
pain or SOB, & to preserve
neurologic function.
 Biologic & targeted therapy
Biologic therapy, or biologic response
modifier therapy, consists of agents that
modify the relationship between the host &
the tumor by altering the biologic response
of the host to the tumor cells.
They have direct anti tumor effects
They restore host immune system
Interfere with cancer cell’s ability to
metastasize
 Biologic & targeted therapy
Targeted therapy interferes with cancer
growth by targeting specific cellular receptors
& pathways that are important in tumor growth
α interferon, interleukin 2, levamisole, BCG
vaccine
It include EGFR(EPIDERMALGROWTH
FACTOR RECEPTOR)-tyrosine kinase inhibitors,
CD 20 monoclonal antibodies, proteasome
inhibitors.
 Bone marrow transplantation
BMT & peripheral stem cell
transplantation (PSCT) are effective,
life saving procedures for the
treatment of a number of malignant &
non malignant diseases
It is now referred to as
hematopoietic stem cell
transplantation (HSCT)
 Bone marrow transplantation
Types
Allogenic transplantaion : stem cells are
acquired from a donor, through human
leukocyte antigen (HLA) tissue typing.
Syngeneic transplnatation : is a type of
allogeneic transplantation that involves
obtaining stem cells from one identical
twin.
 Bone marrow transplantation
Types
Autulogous transplantation : patients
receive their own stem cells back
following myeloablative chemotherapy.
It enables patients to receive intensive
chemo or radiation by supporting them
with their previously harvested stem
cells.
 Gene therapy
Gene therapy is an experimental
therapy that involves introducing
genetic material in to a person’s cells
to fight disease.
 Oncologic emergencies
Oncologic emergencies are life
threatening emergencies that can
occur as a result of cancer or cancer
treatment. These emergencies can
be obstructive, metabolic or
infiltrative.
 Oncologic emergencies
Obstructive emergencies
 superior venecava syndrome
SVCS result from obstruction of the SVC by a
tumor or thrombosis
Facial edema, periorbital edema, distension of vein
of head, neck, & chest, head ache & seizures are
manifestations.
Common causes are NHL (NON-HODGKIN’S LYMPHOMA), Ca
lung, breast
 Oncologic emergencies
Obstructive emergencies
 Spinal Cord Injury & compression
SCI compression is a neurologic emergency
caused by the presence of a malignant tumo
in the epidural space of the SCI
Cancer of breast, lung, prostate, GI, & rena
tumors & malenoma produce this problem.
 Oncologic emergencies
Obstructive emergencies
 SCI compression
Back pain that is intense, localized, & persistant
accompanied by vertebral tenderness &
aggravated the Valsalva maneuver, motor
weakness & dysfunction sensory parasthesia &
autonomic dysfunction.
Decompressive laminectomy, radiation in
conjunction with corticosteriods are preferable
 Oncologic emergencies
Obstructive emergencies
Third space syndrome
It involves a shifting of fluid from the
vascular space to the interstitial space
 primarily occurs secondary to
extensive procedures, biologic therapy,
or septic shock
 Oncologic emergencies
Obstructive emergencies
Third space syndrome
Patient shows signs of hypovolemia,
including hypotension, tachycardia, low
CVP, & decreased UOP
Treatment includes fluid, electrolyte &
plasma protein replacement.
 Oncologic emergencies
Metabolic emergencies
Metabolic emergencies are caused by
the production of ectopic hormones
directly from the tumor or are
secondary to metabolic alterations
caused by the presence of tumor or
cancer treatment.
 Oncologic emergencies
Metabolic emergencies
SIADH
It results from abnormal or sustained
production of ADH with resultant water
retention & hyponatremia.
Ca lung, pancreas, duodenum, brain,
esophagus, colon, ovary, prostate, leukemia
etc,
 Oncologic emergencies
Metabolic emergencies
SIADH
Cancer cell in these tumors manufacture,
store & release ADH
Weight gain without edema, weakness,
anorexia, nausea, vomiting, seizures, oliguria
decrease in reflex & coma are the symptoms
 Oncologic emergencies
Metabolic emergencies
SIADH
Chemo drugs vincristine & cytoxan stimulate
the release of ADH from the pituitory or
tumor cells.
Treat the underlying malignancy
Correct the Na, H2O balance, fluid
restriction, IV 3% sodium chloride
 Oncologic emergencies
Metabolic emergencies
Hypercalcemia
It can occur in the presence of cancer that
involves metastsic disease of the bone or
multiple myeloma, or when a parathyroid
hormone like substance is secreted by
cancer cells in the absence of bony
metastasis.
 Oncologic emergencies
Metabolic emergencies
Hypercalcemia
Hypercalcemia resulting from malignancies that
have metastasized occur in patients with Ca lung,
breast, kidney, colon, ovarian or thyroid cancer
Hypercalcemia resulting from secretion of
parathyroid hormone like substance occurs in
SCC of lung, Ca of neck, esophagus, leukemia
 Oncologic emergencies
Metabolic emergencies
Hypercalcemia
Apathy, depression, fatigue, muscle weakness,
ECG changes, polyuria, anorexia, & vomiting
Hydration (3L/day), diuretics, bisphoshonate
(inhibit the action of osteoclasts)
 Oncologic emergencies
Metabolic emergencies
Hypercalcemia
Chronic hypercalcemia result in
nephrocalcinosis & irreversible renal
failure
Correct the calcium level for serum
albumin or check an ionized calcium level.
 Oncologic emergencies
Metabolic emergencies
Tumor lysis syndrome
TLS is a metabolic complication c/by
rapid release of intracellular
components (potassium, phosphate,
DNA & RNA) in response to
chemotherapy
 Oncologic emergencies
Metabolic emergencies
Tumor lysis syndrome
4 hallmark signs are hyperuricemia,
hyperphosphatemia, hyperkalemia, hypocalcemia
Early signs include weakness, muscle cramps,
diarrhea, nausea & vomiting
TLS occur within first 24-48 hours & persist
for 5-7 days
 Oncologic emergencies
Metabolic emergencies
Tumor lysis syndrome
Primary goal is to prevent renal failure &
severe electrolyte abnormalities.
The primary treatment includes increasing
urine production using hydration therapy &
decreasing uric acid concentration using
allopurinol
 Oncologic emergencies
Infiltrative emergencies
It occurs when malignant tumors
infiltrate major organs or secondary to
cancer therapy.
 Oncologic emergencies
Infiltrative emergencies
Cardiac tamponade
It results from fluid accumulation in
the pericardial sac, constriction of the
pericardium by tumor, or pericarditis
secondary to radiation therapy to the
chest
 Oncologic emergencies
Infiltrative emergencies
Manifestations includee a heavy feeling
over the chest, SOB, tachycardia, cough,
dysphagia, hiccups, hoarseness, nausea,
vomiting, excessive perspiration,
decreased LOC, pulsus paradoxus, distant
or mute heart sounds, & extreme anxiety.
 Oncologic emergencies
Infiltrative emergencies
Emergency management is aimed at
reduction of fluid around the heart &
includes surgical establishment of an
indwelling catheter.
Supportive therapy includes admin of O2
therapy, IV hydration, & vasopressor
therapy.
 Oncologic emergencies
Infiltrative emergencies
Carotid artery rupture
 It occurs most frequently in patients
with cancer of the head & neck
secondary to invasion of the arterial
wall by tumor or to erosion following
surgery or radiation therapy.
 Oncologic emergencies
Infiltrative emergencies
Carotid artery rupture
 Bleeding can manifest as minor oozing
or spurting of blood in the case of a
“blowout” of the artery
Apply a pressure to the site with a
finger.
 Oncologic emergencies
Infiltrative emergencies
Carotid artery rupture
IV fluids & blood products are
administered to stabilize the patient for
surgery.
S/mgt involves ligation of the carotid
artery above & below the rupture site &
reduction of local tumor.
CANCER NURSING
GENERAL Promotive and Preventive Nursing
Management
1. Lifestyle Modification
2. Nutritional management
3. Screening
4. Early detection
Nursing Assessment
Weight loss
Frequent infection
Skin problems
Pain
Hair Loss
Fatigue
Disturbance in body image/ depression
Nursing Intervention
MAINTAIN TISSUE INTEGRITY
Handle skin gently
Do NOT rub affected area
Lotion may be applied
Wash skin only with SOAP and Water
Nursing Intervention
MANAGEMENT OF STOMATITIS
Use soft-bristled toothbrush
Oral rinses with saline gargles/ tap water
Avoid ALCOHOL-based rinses
Nursing Intervention
MANAGEMENT OF ALOPECIA
Alopecia begins within 2 weeks of therapy
Regrowth within 8 weeks of termination
Encourage to acquire wig before hair loss
occurs
Encourage use of attractive scarves and hats
Provide information that hair loss is temporary
BUT anticipate change in texture and color
Nursing Intervention
 PROMOTE NUTRITION
 Serve food in ways to make it appealing
 Consider patient’s preferences
 Provide small frequent meals
 Avoids giving fluids while eating
 Oral hygiene PRIOR to mealtime
 Vitamin supplements
Nursing Intervention
 RELIEVE PAIN
 Mild pain- NSAIDS
Moderate pain- Weak opiods
 Severe pain- Morphine
 Administer analgesics round the clock with
additional dose for breakthrough pain
Nursing Intervention
 DECREASE FATIGUE
 Plan daily activities to allow alternating rest
periods
 Light exercise is encouraged
 Small frequent meals
Nursing Intervention
 IMPROVE BODY IMAGE
 Therapeutic communication is essential
 Encourage independence in self-care and decision
making
 Offer cosmetic material like make-up and wigs
Nursing Intervention
 ASSIST IN THE GRIEVING PROCESS
 Some cancers are curable
 Grieving can be due to loss of health, income,
sexuality, and body image
 Answer and clarify information about cancer and
treatment options
 Identify resource people
 Refer to support groups
Nursing Intervention
MANAGE COMPLICATION: INFECTION
Fever is the most important sign (38.3)
Administer prescribed antibiotics X 2weeks
Maintain aseptic technique
Avoid exposure to crowds
Avoid giving fresh fruits and veggie
Handwashing
Avoid frequent invasive procedures
Nursing Intervention
 MANAGE COMPLICATION: Septic shock
 Monitor VS, BP, temp
 Administer IV antibiotics
 Administer supplemental O2
Nursing Intervention
 MANAGE COMPLICATION: Bleeding
 Thrombocytopenia (<100,000) is the most
common cause
 <20, 000 spontaneous bleeding
 Use soft toothbrush
 Use electric razor
 Avoid frequent IM, IV, rectal and catheterization
 Soft foods and stool softeners
COLON CANCER
Risk factors
1. Increasing age
2. Family history
3. Previous colon CA or polyps
4. History of IBD
5. High fat, High protein, LOW fiber
6. Breast Ca and Genital Ca
COLON CANCER
Sigmoid colon is the most common site
Predominantly adenocarcinoma
If early 90% survival
34 % diagnosed early
66% late diagnosis
COLON CANCER
PATHOPHYSIOLOGY
Benign neoplasm DNA alteration malignant
transformation malignant neoplasm  cancer
growth and invasion  metastasis (liver)
COLON CANCER
ASSESSMENT FINDINGS
1. Change in bowel habits- Most common
2. Blood in the stool
3. Anemia
4. Anorexia and weight loss
5. Fatigue
6. Rectal lesions- tenesmus, alternating D and C
Colon cancer
Diagnostic findings
1. Fecal occult blood
2. Sigmoidoscopy and colonoscopy
3. BIOPSY
4. CEA- carcino-embryonic antigen
Colon cancer
Complications of colorectal CA
1. Obstruction
2. Hemorrhage
3. Peritonitis
4. Sepsis
Colon cancer
MEDICAL MANAGEMENT
1. Chemotherapy- 5-FU
2. Radiation therapy
Colon cancer
SURGICAL MANAGEMENT
Surgery is the primary treatment
Based on location and tumor size
Resection, anastomosis, and colostomy (temporary or
permanent)
Colon cancer
NURSING INTERVENTION
Pre-Operative care
1. Provide HIGH protein, HIGH calorie and LOW
residue diet
2.Provide information about post-op care and stoma
care
3. Administer antibiotics 1 day prior
Colon cancer
NURSING INTERVENTION
Pre-Operative care
4. Enema or colonic irrigation the evening and the
morning of surgery
5. NGT is inserted to prevent distention
6. Monitor UO, F and E, Abdomen PE
Colon cancer
NURSING INTERVENTION
Post-Operative care
1. Monitor for complications
Leakage from the site, prolapse of stoma, skin
irritation and pulmo complication
2. Assess the abdomen for return of peristalsis
Colon cancer
NURSING INTERVENTION
Post-Operative care
3. Assess wound dressing for bleeding
4. Assist patient in ambulation after 24H
5.provide nutritional teaching
Limit foods that cause gas-formation and
odor
Cabbage, beans, eggs, fish, peanuts
Low-fiber diet in the early stage of
recovery
Colon cancer
NURSING INTERVENTION
Post-Operative care
6. Instruct to splint the incision and
administer pain meds before exercise
7. The stoma is PINKISH to cherry red,
Slightly edematous with minimal pinkish
drainage
8. Manage post-operative complication
Colon cancer
NURSING INTERVENTION: COLOSTOMY CARE
Colostomy begins to function 3-6 days after surgery
The drainage maybe soft/mushy or semi-solid
depending on the site
Colon cancer
NURSING INTERVENTION: COLOSTOMY CARE
BEST time to do skin care is after shower
Apply tape to the sides of the pouch before shower
Assume a sitting or standing position in changing the
pouch
Colon cancer
NURSING INTERVENTION: COLOSTOMY CARE
Instruct to GENTLY push the skin down and the
pouch pulling UP
Wash the peri-stomal area with soap and water
Cover the stoma while washing the peri-stomal area
Colon cancer
NURSING INTERVENTION: COLOSTOMY CARE
Lightly pat dry the area and NEVER rub
Lightly dust the peri-stomal area with nystatin
powder
Colon cancer
NURSING INTERVENTION: COLOSTOMY CARE
Measure the stomal opening
The pouch opening is about 0.3 cm larger than the
stomal opening
Apply adhesive surface over the stoma and press for
30 seconds
Colon cancer
NURSING INTERVENTION: COLOSTOMY CARE
Empty the pouch or change the pouch when
1/3 to ¼ full
Breast Cancer
RISK FACTORS
1. Genetics- BRCA1 And BRCA 2
2. Increasing age ( > 50yo)
3. Family History of breast cancer
4. Early menarche and late menopause
5. Nulliparity
6. Late age at pregnancy
Breast Cancer
RISK FACTORS
7. Obesity
8. Hormonal replacement
9. Alcohol
10. Exposure to radiation
Breast Cancer
PROTECTIVE FACTORS
1. Exercise
2. Breast feeding
3. Pregnancy before 30 yo
Breast Cancer
ASSESSMENT FINDINGS
1. MASS- the most common location is the upper outer
quadrant
2. Mass is NON-tender. Fixed, hard with irregular
borders
3. Skin dimpling
4. Nipple retraction
5. Peau d’ orange
Breast Cancer
LABORATORY FINDINGS
1. Biopsy procedures
2. Mammography
Breast Cancer
Breast cancer Staging
TNM staging
I - < 2cm
II - 2 to 5 cm, (+) LN
III - > 5 cm, (+) LN
IV- metastasis
Breast Cancer
MEDICAL MANAGEMENT
1. Chemotherapy
2. Tamoxifen therapy
3. Radiation therapy
Breast Cancer
SURGICAL MANAGEMENT
1. Radical mastectomy
2. Modified radical mastectomy
3. Lumpectomy
4. Quadrantectomy
Breast Cancer
NURSING INTERVENTION : PRE-OP
1. Explain breast cancer and treatment
options
2. Reduce fear and anxiety and improve
coping abilities
3. Promote decision making abilities
4. Provide routine pre-op care:
Consent, NPO, Meds, Teaching about
breathing exercise
Breast Cancer
NURSING INTERVENTION : Post-OP
1. Position patient:
Supine
Affected extremity elevated to reduce edema
Breast Cancer
NURSING INTERVENTION : Post-OP
2. Relieve pain and discomfort
Moderate elevation of extremity
IM/IV injection of pain meds
Warm shower on 2nd day post-op
Breast Cancer
NURSING INTERVENTION : Post-OP
3. 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
Breast Cancer
NURSING INTERVENTION : Post-OP
3. Maintain skin integrity
Drainage is removed when the discharge is less
than 30 ml in 24 H
Lotions, Creams are applied ONLY when the
incision is healed in 4-6 weeks
Breast Cancer
NURSING INTERVENTION : Post-OP
Promote activity
Support operative site when moving
Hand, shoulder exercise done on 2 ndday
Post-op mastectomy exercise 20 mins TID
NO BP or IV procedure on operative site
Breast Cancer
NURSING INTERVENTION : Post-OP
Promote activity
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
Breast Cancer
NURSING INTERVENTION : Post-OP
MANAGE COMPLICATIONS
Hematoma
Notify the surgeon
Apply bandage wrap (Ace wrap) and ICE pack
Breast Cancer
NURSING INTERVENTION : Post-OP
MANAGE COMPLICATIONS
Infection
Monitor temperature, redness, swelling and foul-
odor
IV antibiotics
No procedure on affected extremity
Breast Cancer
NURSING INTERVENTION : Post-OP
TEACH FOLLOW-UP care
Regular check-up
Monthly BSE on the other breast
Annual mammography