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Oncologic nursing

• Test your knowledge addi$onal:

o Stages of cancer in the GI tract
§ A – tumor in mucosal area
§ B1 – tumor at mascularis area
§ B2 – tumor at en5re bowel wall
§ C1 – same as B1 but there is tumor and affected lymph node
§ C2 – same as B2 but there is tumor and affected lymph node
§ D – with metastasis
• N2 – 2 lymph nodes affected
• NX – not able to assess if there is metastasis
• N0 – no lymph nodes affected
• TIS – tumor inside
o Early signs of cancer: CAUTION
§ C- Change in bladder or bowel habits
§ A – sore that does that heal
§ U – unusual discharge
§ T – thickening or lump in breast or elsewhere
§ I – indiges5on
§ O – obvious changes in warts/moles
§ N – nagging cough
§ U – unexplained anemia
§ S – sudden loss of weight
• Cancer
o Cause: unknown
o Risk factors:
§ Age (older) the older the pa+ent the higher the risk for cancer it is because
of the deteriora+ng immune system. MOST SIGNIFICANT RISK FACTOR
• The older you are the more risk on acquiring virus, exposed to
radia+on and chemicals agents.
§ Race usually those who are African-American
§ Gender
• Male – higher risk for prostate, lung, and colorectal cancer
• Female – high risk for breast and lung cancer à because of
metastasis of breast cancer and smoking, colorectal
o The number one mortality is LUNG CANCER.
§ Geographic locaDon – urban area are at risk because of lifestyle especially
the pollu5on compared to the rural area.
§ Exposure to radiaDon – such as technologies.
§ Viruses
• HPV – human papilloma virus
• HSV – heroes simplex virus
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• EBV – Epstein barr virus

• HIV – human immunodeficiency virus.
§ Chemical agents such as asbestos, alcohol, and smoking
• BPA – Bisphenol A
o common in hard plas+cs, should be BPA free yung
kinakainan, avoid na iwan sa maiinit na lugar or lagyan ng
hot water and plas+c.
§ Diet.
• Low fiber
• High fat
• Nitrates in food causes cancer (processed food, bacon à meals has
the highest nitrate contents, instant foods)
• Overcooked/grilled foods
• Over-used oil (all should be used twice only or discard aAer use)
• Treatment in cancer
o Chemotherapy/radiaDon therapy
§ Purpose:
• It kills rapidly dividng cells.
• It disrupts the cell cycle.
o Phases of cell cycles:
§ G0 – res5ng phase
§ G1 – RNA and protein synthesis
§ S – DNA synthesis
§ G2 – pre-mitosis – prepara+on of the copy of RNA
§ M – mitosis cell (cell division) – distribu+on also
prevent leakage.
• 2 classes of drugs.
o CCS (M) – disrupt the mitosis it stops the distribu+on of the
leakage/RNA.
o CCS (S) – disrupts the DNA synthesis it randomly stops the
distribu+on.
§ Chemotherapy drugs
• AlkylaDng agents: CCNS randomly disrupts or yung pag photocopy
o Cyclophosphamide (Cytoxan)
§ Adverse effect:
• Hemorrhaging cys55s (manifest hematuria)
à inc OFI to prevent clot forma+on
§ MESNA – protects bladder lining
o Cispla5n (pla+nol)
§ Adverse effects:
• AnDmetabolites: CCS (S) targets DNA synthesis
o Fluorouracil (S-FLU)
o Methotrexate (folex)
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§ Immunosuppressive agents
§ Folic acid antagonist
§ High risk for toxicity: methotrexate
§ AnDdote: leucovorin
• AnD-tumor anDbioDcs: CCNS randomly distrupts or yung pag
photocopy
o Adriamycin
o Bleomycin
§ Adverse effects for both medica+on: cardiac toxicity
à mgnt: cardiac monitoring
• Plant (vinca) alkaloids: CCS (M) its target is mitosis
o Vinblas5ne (velban)
o Vincris5ne (oncorin)
• CorDcosteroids: CCNS randomly distrupts or yung pag photocopy
o Ends with “sone”
o RadiaDon therapy
§ Purpose:
• It kills the tumor,
• it reduces the size of the tumor (shrinks the tumor)
§ types:
• internal radiaDon/brachytherapy
Sealed Unsealed
How is it put in It is implanted in the It is oral or IV
the paDent? body of the pa+ent. especially when
pa+ent can tolerate
through mouth but
alterna+ve for IV if
not.
Which room? Private room
CBR (complete bed Flush the toilet for 2-
rest) without 3 +mes since the
bathroom privileges pa+ent’s urine an
instead pa+ent are in saliva is radioac+ve.
catheter.

Implant can be
dislodged:
1. seen: if
implant fell
pick it up with
long forceps
and place in a
lead container
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2. unseen: leave
the room
because you
are already
exposed with
the radia+on
as you
prolong your
stay in the
room. à
no+fy the
radia+on
department
à responsible
in looking for
the implant.

• Factors affecDng exposure (STD) it is for internal radia+on only

o S – shielding how does the nurse protects himself/herself
from exposed pa+ent
§ Lead apron à lead is resistant to radia5on
o T – Time of exposure how long should the nurse or any visits
should stay in the exposed pa+ent
§ Visitor: 10 – 15 minutes
§ No PINC: visitors that are not allowed to enter
• Pregnant
• Infec5on pa+ent who has infec+on such as
fever, coughing, or trankaso.
• Newly vaccinated
• Children
§ Time of nurse: 30 minutes/shiA divided to 6 visits x
5 mins
§ Dosimeter: measure radia5on exposure
o D – distance
§ How far: 6 feet
§ External radiaDon/teletherapy
• Beam of high energy rays
• Secre5ons and pa5ent are not radioac5ve thus STD is not needed
already thus, the pa+ent is allowed to go home and can interact
with other people especially family.
• Daily treatment:
o 15 – 30 minutes/day x 5 5mes a day
• Nursing responsibiliDes:
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o Do not wash of skin markings – skin markings are markings

used for treatment in the body (palatandaan ng treatment)
in which semi-permanent ink are used and can be wash by
water using mild soap.
o No extreme temperature for skin
§ No hea+ng/ice packs at the site of radia+on à it
may cause radioderma55s especially for those
burned areas
o No constricDve clothing at the site of radia+on
§ Instruct the pa+ent not to wear bra, or any
constric+ve clothing that may affect the pa+ent aAer
radia+on therapy.
o No chemicals unless ordered by the physician
§ Common side effects of chemo and radiaDon therapy (BOMSHOV)
• B – bone marrow suppression
o Decrease produc5on of RBC, WBC, and Platelets
o Thrombocytopenia – decrease platelets (thrombocytosis –
increase) à bleeding à Mngt: Safety, no contact sports,
electric razor for shaving, soa bristled tooth brush
o Leukopenia – decreased WBC (leukocytosis – increase) à
immunosuppression à Mngt: isola5on, no fresh everything
o Anemia – decreased RBC (Erythrocytosis – increase) –>
fa+gueà Mngt: rest
• O – ovaries and testes
o Especially in radia5on therapy
o Discuss infer5lity and sterility before the start of the
treatment
o RecommendaDon: sperm banking
• M – mucosal lining
o Nausea and vomi5ng especially chemotherapy (cannot be
prevented because it is the normal effect, we can only
minimize)
o Pre-chemotherapy à an5eme5cs
o Post-chemotherapy à can eat but only bland diet and small
frequent feedings.
• S – skin
o Radia5on (teletherapy) à radio derma++s à mngt: skin
care
o Chemotherapy – extravasa5on (leakage of chemo drugs
from the vein and can cause burns)
o s/sx of extravasaDon; leakage of chemodrugs
§ redness/erythema at the site or above the IV site
§ pain/burning sensa5on
§ edema/swelling at the IV site
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§ slowing at the rate of the infusion

§ no blood return
o management of extravasa5on
§ immediately stop the infusion
§ apply cold compress
§ no5fy the physician
o management of vinca alkaloids
§ stop and no5fy the physician
§ DO NOT put cold compress
• Hair/alopecia
o Recommend: wear, wigs, hat, cap, turban, scarf à before
hair loss
o Hair loss is temporary but cannot make sure na babalik sa
da5.
• O – oral cavity
o Xerostomia (dryness of the mouth)
o Mucosi5s or stoma55s
o Will affects pa5ent’s nutri5on
o Mngt for oral cavity
§ Oral care
§ Increase fluid intake
§ Lip balm such as water soluble
§ Ice chips/popsicle
§ Avoid hot and spicy foods
• V – vagina
o Dryness
o Perineal care and lubricants/KY jelly during sexual ac5vity
• Breast cancer
o Cause: idiopathic
o Breast cancer awareness/bra less month – OCTOBER OF THE MONTH
o Risk factors for breast cancer: LONGFOE
§ L – late menopause (aAer 55 years old)
• Longer exposure to estrogen the higher the risk for breast cancer.
§ O – Obesity
• The more fat, the more estrogen thus higher risk for breast cancer
§ N – Nulliparity no children
• Vigorous sucking of the breast prevents cancer. Such as breast
feeding
§ G – GeneDcs
• Hereditary
§ F – forty and above/female
• 99% of female and 1% of male
• Obese male and taking estrigen
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§O – oral contracepDves
§E – early menarche (before 12)
• Philippines is no.1 in asia in breast cancer and no.9 in the world
o PrevenDon of breast cancer
§ BSE (breast self-examina$on)
• Start: 20 years old every month 7 days aaer menstrua5on
• Applicable for those who have regular menstrua5on
o Irregular menstrua5on (not applicable)
o Pre/post-menopausal (not applicable)
o Post hysterectomy (nor applicable)
o BSE: same day every month
• BSE: inspec5on and palpa5on
• InspecDon
o Do in front of the mirror
o Check 3s (size, shape, and symmetry) à AVON
§ A – asymmetry – obvious
§ V – venous – prominence increase
§ O – Orange peel skin (peau de orange) – sign of
advance stage breast cancer
§ N – nipple dimpling
• PalpaDon
o Lump/mass; upper outer
o Discharge/bleeding
o Start at the axillary area (tail of spence)
o Clock face direc5on
o Pinch the nipples.
o Standing on the shower/lying down
o Common site of lump: upper outer quadrant of the breast
• CharacterisDc of malignant lump
o Non-tender
o Fixed/non movable
o Irregular shape
o Painless
§ Health worker breast/exam/clinical breast exam (HWBE/CBE)
• 20-39 years old (every 1-3 years)
• 40 and above yearly)
§ Mammography (X-ray): cannot confirm breast cancer
• Between 35 – 39 years old (baseline)
• 40 and above (yearly)
• There is discomfort but it will depend on the pain tolerance of the
pa+ents. There are +mes it can be painful.
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o Management:
§ Chemotherapy
§ RadiaDon therapy
§ MedicaDons (hormones)
• DOC:
o Tamoxifen (nolvadex) – an5 estrogen
§ 20mg/day for more than 5 years
o DiethylsDlbesterol (DES) – estrogen medica5on (nega+ve
feedback mechanism there is opposite which mean when
there is hormone that increases, the other will decrease.)
§ Suppress the produc+on of estrogen to stop the
produc+on of estrogen.
§ Surgery
• Lumpectomy/excisional biopsy
o Removes the whole lump and surrounding 5ssue

• Simple mastectomy
o Removes the whole breast

• Radical mastectomy
o Removes the whole breast, auxiliary lymph nodes, and
pectoralis.
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• Modified radical mastectomy (MRM)

o Removes whole breast and lymph nodes
o Advantage: pwede maglagay ng prosthe5cs

• Common complicaDon of surgery

o Lymph edema – hindi pantay yung arm due to the edema in
the lymph nodes
§ Mngt:
• PosiDoning: semi fowlers
• Elevate the affected part using the pillows
this is to promote circula+on
• No procedures on the affected extremity
such as BP taking, IV inser+on, blood
extrac+on instead perform on the unaffected
side.
• No heavy jewelries on the affected
extremity
• Recommend arm exercises such as rope
turning, hand wall climbing, swimming, etc.
à to prevent lymph edema.
• Prostate cancer
o Most common cancer among men
o Risk factor: STAFF
§ S – STD (Hx)
§ T – Testosterone (high)
§ A – African Americans
§ F – fi]y and above
§ F – fat/high fat diet (red meat)
o PresenDng signs and symptoms
§ Starts asymptomaDc.
§ Enlargement of the prostate (signs and symptoms are visible)
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• LocaDon: surrounding the urethra à compressed the bladder and

urethra when enlarged if the there is enlarged prostrate that’s the
+me signs and symptoms are visible

• Dysuria (pain and hirap umihi)

• Difficulty to iniDate voiding.
• Decrease force of urine
• Painful ejaculaDon
• Blood/semen in the urine
§ Low back pain à signs of advance stage of prostate cancer
o DiagnosDc procedure
§ Prostate specific aDgen (PSA) MARKER FOR PROSTATE CANCER
• Protein produced by prostate gland whenever it is s5mulated
• Normal: 0-4 ng/dl it elevates when there is problem in the prostate.
• Recommend: age of 50 and above yearly
• High risk: 40 and above yearly
• Cancer marker but not confirmatory
• Also elevated in BPH
§ Digital rectal exam (DRE)
• Recommend: 40 and above yearly

Biopsy
§
• Confirmatory
• Fine needle aspiraDon
o Management
§ Chemotherapy
§ RadiaDon therapy
§ MedicaDon.
• DOC:
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o LHRH (testosterone medica$on) à testosterone

suppression
§ Leuprolide (Lupron) à IM
• Given every month
§ Goserelin (zoladex) à SQ
• Given every 12 weeks
o DiethylsDlbesterol (DES) à estrogen
§ Slows the testosterone.
§ Surgery
• Trans ureteral resecDon of the prostrate (TURP)
o Uses resectoscope.
o Insert at the urethra-> scrapes excess prostate 5ssue
o Expect bleeding aaer
§ Ini5ate CBI (Con+nuous Bladder Irriga+on/Cytolysis)
à to prevent clot formaDon in the urinary
• Radical prostatectomy
o Removal of the prostate gland
• Orchiectomy
o Removal of the tes5cles
• TesDcular cancer
o April – tes5cular cancer awareness
o Cause: idiopathic
o Risk factors: CAT-DOG
§ C – cryptorchidism
• Orchiopexyà surgery to put the tes5cle in place
• S5ll high-risk in tes5cular cancer
§ A – age
• 15 to 35 years old
§ T – Trauma
§ D – Des
• Maternal use of des
• Oral contracep5ves
§ O – orchiDs
• Inflamma5on of tes5cles
§ G – geneDcs
o PrevenDon
§ TesDcular self-examinaDon (TSE)
• Before 15 years old monthly same day each month
• InspecDon (3S) and palpaDon
o Size
o Shape
o Symmetry
o Look, hold, feel
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o Recommend: sperm banking

o Best 5me to palpate a]er a warm bath/shower à relax and
tes5cles.
o What fingers to use:
§ Use thumb and forefinger.
§ Thumb, forefinger including the middle finger.
o Roll the tes5cles.
o Signs and symptoms
§ Painless enlargement of the affected tesDcle
• Normally: asymmetrical
§ Heaviness/dragging sensaDon
§ Pea-sized lump/mass
§ Low back pain, abdominal pain, weight loss à advance stage
• Common site of metastasis: lymph nodes, lungs
o DiagnosDc procedures
§ Alpha-feto protein (AFP)
§ Beta human chorionic gonadotropin (B-HCG)
• if both are elevated it becomes a marker of cancer à BIOPSY
§ lacDc dehydrogenase (LDH)
• elevate: suspect metastasis
o management
§ chemotherapy
§ radia5on therapy
§ surgery
• orchiectomy (unilateral/bilateral)
o most common concern: ano ang mang yayari sa pagkalaki
aaer surgery
Unilateral Bilateral
It the pa5ent is X X as long as the nerve
Impotence (possibility is not damage aAer
of erec+on)? surgery but with low
libido
Will there be Sterility? X /

§ recommend: sperm banking

• Hodgkin’s disease
o September – awareness month
o Lymphoma
o Cause: idiopathic
o Risk factors: HIM
§ H – herbicides (agent orange)
§ I – Immunosuppression/infecDon (EBV)
• EBV – can be acquired through saliva
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• Infec5ous mononucleosis (kissing disease)

§ M – male (20 to 40 years old)
o Signs and symptoms
§ PresenDng sign: painless enlargement of the lymph nodes, fa5gability

§ Common site:
• Cervical/supraclavicular/medias5nal lymph nodes
§ A symptoms
•
§ B symptoms
• Night sweats
• Fever without chills
• Weight loss (at least or more than normal body weight)
o Ex:
§ 200lbs—> dapat 20 or more than 20 lbs and mawala
§ Other s/sx
• Pulmonary effusion
• Jaundice
• Bone pain
• Abdominal pain
o Stages
§ Stage 1- 1 lymph nodes
§ Stage 2- 2 or more lymph nodes on one side of the body (unilateral)
§ Stage 3- 2 or more lymph nodes on both sides of the body (bilateral)
§ Stage 4- wide spread metastasis (almost all organs are affected)
o Confirmatory test
§ Excisional Lymph Nodes Biopsy
• There is the presence of Reed-sternberg cells (giganDc tumor cells
in the lymph nodes)
o Management
§ Stage 1 and 2.
• Radia5on therapy
§ Stage 3, 4, and presence of B symptoms
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• CombinaDon chemotherapy di na kaya ng radia+on therapy; pinag

combine ang chemodrugs. Such as the following:
o MOPP combina+on of the following drugs:
§ M-mustargen
§ O-omcovin
§ P- procarbazine
§ P-prednisone
o ABVD combina+on of the following drugs:
§ A-adriamycin
§ B-bleomycin
§ V-vinblas5ne
§ D-decarbazine
Hodgkin Younger than Microcopin Starts in
40 reed- upper body
sternberg such as chest,
cells neck, and
Staging very predictable
useful
Non-Hodgkin Older than 60 Microscopic Throughout
reed- the body and
sternberg unpredictable
cells