7096472 Nursing Oncology

8/7/2019 7096472 Nursing Oncology

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OncologyOncology

By:By:

Ruby Ruth T. Roces, R.N., M.D.Ruby Ruth T. Roces, R.N., M.D.


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Oncology definedOncology defined

It is a branch of medicine thatIt is a branch of medicine that

deals with the study, detection,deals with the study, detection,

treatment and management oftreatment and management of

cancercancer


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glossaryglossary

NeoplasiaNeoplasia--uncontrolled cell growth thatuncontrolled cell growth that

follows no physiologic demandfollows no physiologic demand

AnaplasiaAnaplasia--cells that lack normal cellularcells that lack normal cellularcharacteristics and differ in shape andcharacteristics and differ in shape and

organizationorganization

MetaplasiaMetaplasia--conversion of one type ofconversion of one type ofmature cell into another; reversiblemature cell into another; reversible


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DysplasiaDysplasia--bizarre cell growth resulting inbizarre cell growth resulting in

cells that differ in size, shape orcells that differ in size, shape or

arrangement from other cells of the samearrangement from other cells of the sametype.type.

HypoplasiaHypoplasia--incomplete orincomplete or

underdevelopment w/ decreased numberunderdevelopment w/ decreased numberof cellsof cells


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HyperplasiaHyperplasia--Increase in the number ofIncrease in the number of

cellscells

HypotrophyHypotrophy--decrease in the organ sizedecrease in the organ size/function/function

HypertrophyHypertrophy--increase in the sizeincrease in the size


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Classification of NeoplasiaClassification of Neoplasia

1. Benign1. Benign

2. Malignant2. Malignant3. Borderline/ in situ3. Borderline/ in situ


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WAYS TO DIFFERENTIATE A BENIGNWAYS TO DIFFERENTIATE A BENIGN

FROM A MALIGNANT TUMORFROM A MALIGNANT TUMOR

Characteristics Benign Malignant

Rate of growth Slow- growing Varies, but usually fast-growing

Differentiation Well differentiated Poorly differentiated

Local invasion Local invasion,

encapsulated, local

effects

Invasive, expansive,infiltrating,

destructive, w/ generalized

effects

Metastases Non metastatic metastatic


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Nomenclature of NeoplasiaNomenclature of Neoplasia

Tumor is named according to:Tumor is named according to:

1. Parenchyma, Organ or Cell1. Parenchyma, Organ or Cell

HepatomaHepatoma-- liverliver OsteomaOsteoma-- bonebone

MyomaMyoma-- musclemuscle


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2. Pattern and Structure, either GROSS or2. Pattern and Structure, either GROSS or

MICROSCOPICMICROSCOPIC FluidFluid--filledfilled CYSTCYST

GlandularGlandular ADENOADENO

FingerFinger--likelike PAPILLOPAPILLO StalkStalk POLYPPOLYP


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3. Embryonic origin3. Embryonic origin

Ectoderm ( usually gives rise to epithelium)Ectoderm ( usually gives rise to epithelium) Endoderm (usually gives rise to glands)Endoderm (usually gives rise to glands)

Mesoderm (usually gives rise to ConnectiveMesoderm (usually gives rise to Connective

tissues)tissues)


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BENIGN TUMORSBENIGN TUMORS

SuffixSuffix-- OMA is usedOMA is used

Adipose tissueAdipose tissue-- LipOMALipOMA

BoneBone-- osteOMAosteOMA MuscleMuscle-- myOMAmyOMA

Blood vesselsBlood vessels-- angiOMAangiOMA

Fibrous tissueFibrous tissue-- fibrOMAfibrOMA


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MALIGNANT TUMORMALIGNANT TUMOR

Named according to embryonic cell originNamed according to embryonic cell origin

2. Mesodermal, connective tissue origin2. Mesodermal, connective tissue origin

Use the suffix SARCOMAUse the suffix SARCOMA FibroSarcomaFibroSarcoma

MyosarcomaMyosarcoma

AngioSarcomaAngioSarcoma


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ExceptionistasExceptionistas

1. OMA but Malignant1. OMA but Malignant

HepatOMA, lymphOMA, gliOMA,HepatOMA, lymphOMA, gliOMA,

melanOMAmelanOMA

2. THREE germ layers2. THREE germ layers

TERATOMATERATOMA

3. Non3. Non--neoplastic but OMAneoplastic but OMA

ChoristomaChoristoma

HamatomaHamatoma


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CANCERNURSINGCANCERNURSING

Review of Normal Cell CycleReview of Normal Cell Cycle

3 types of cells3 types of cells

1. PERMANENT cells1. PERMANENT cells-- out of the cell cycleout of the cell cycle

Neurons, cardiac muscle cellNeurons, cardiac muscle cell

2. STABLE cells2. STABLE cells-- Dormant/Resting (G0)Dormant/Resting (G0)

Liver, kidneyLiver, kidney

3. LABILE cells3. LABILE cells-- continuously dividingcontinuously dividing GIT cells, Skin, endometrium , Blood cellsGIT cells, Skin, endometrium , Blood cells


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Cell CycleCell Cycle

G0G0------------------------------------G1G1SSG2G2MM

G0G0-- Dormant or restingDormant or resting

G1G1-- normal cell activitiesnormal cell activities

SS-- DNA SynthesisDNA Synthesis

G2G2-- prepre--mitotic, synthesis of proteins for cellularmitotic, synthesis of proteins for cellular

divisiondivision

MM-- Mitotic phase (IMitotic phase (I--PP--MM--AA--T)T)


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Theories to the Pathogenesis of CancerTheories to the Pathogenesis of Cancer

Cellular transformation and derangementCellular transformation and derangement

theorytheory Immune response failure theoryImmune response failure theory


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Etiology of cancerEtiology of cancer

1. PHYSICAL AGENTS1. PHYSICAL AGENTS

Radiation (thyroid CA)Radiation (thyroid CA) Exposure to irritants (skin CA)Exposure to irritants (skin CA)

Exposure to sunlight (skin CA)Exposure to sunlight (skin CA)


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2. CHEMICAL AGENTS2. CHEMICAL AGENTS

Smoking (Lung CA)Smoking (Lung CA) Dietary ingredients (gastric CA)Dietary ingredients (gastric CA)

DrugsDrugs


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3. Genetics and Family History3. Genetics and Family History

Colon CancerColon Cancer Breast cancerBreast cancer


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4. Dietary Habits4. Dietary Habits

LowLow--FiberFiber HighHigh--fatfat

Processed foodsProcessed foods

alcoholalcohol


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6. Hormonal agents6. Hormonal agents

DESDES OCP especially estrogenOCP especially estrogen


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7. Immune Disease7. Immune Disease

AIDSAIDS


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CARCINOGENSISCARCINOGENSIS

Malignant transformationMalignant transformation

IIPPPP InitiationInitiation

PromotionPromotion

ProgressionProgression


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INITIATIONINITIATION

Carcinogens alter the DNA of the cellCarcinogens alter the DNA of the cell Cell will either die or repairCell will either die or repair


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PROMOTIONPROMOTION

Repeated exposure to carcinogensRepeated exposure to carcinogens Abnormal gene will expressAbnormal gene will express

Latent periodLatent period


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PROGRESSIONPROGRESSION

Irreversible periodIrreversible period Cells undergo NEOPLASTIC transformationCells undergo NEOPLASTIC transformation

then malignancythen malignancy


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Spread of CancerSpread of Cancer

1. LYMPHATIC1. LYMPHATIC

Most commonMost common

2. HEMATOGENOUS2. HEMATOGENOUS

BloodBlood--borne, commonly to Liver and Lungsborne, commonly to Liver and Lungs

3. DIRECT INVASION/EXTENSION3. DIRECT INVASION/EXTENSION Seeding of tumorsSeeding of tumors


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Body Defenses Against TUMORBody Defenses Against TUMOR

1. T cell System/ Cellular Immunity1. T cell System/ Cellular Immunity

Cytotoxic T cells kill tumor cellsCytotoxic T cells kill tumor cells 2. B cell System/ Humoral immunity2. B cell System/ Humoral immunity

B cells can produce antibodyB cells can produce antibody

3. Phagocytic cells3. Phagocytic cells Macrophages can engulf cancer cell debrisMacrophages can engulf cancer cell debris


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Cancer DiagnosisCancer Diagnosis

1. BIOPSY1. BIOPSY

The most definitiveThe most definitive 2. CT, MRI2. CT, MRI-- for visualization and stagingfor visualization and staging

3. Tumor Markers3. Tumor Markers


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Cancer GradingCancer Grading

The degree of DIFFERENTIATIONThe degree of DIFFERENTIATION

Grade 1Grade 1-- Low gradeLow grade Grade 4Grade 4-- high gradehigh grade


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Cancer StagingCancer Staging

1. Uses the T1. Uses the T--NN--M staging systemM staging system

TT-- tumortumor NN-- NodeNode

MM-- MetastasisMetastasis

2. Stage 1 to Stage 42. Stage 1 to Stage 4


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GENERAL Promotive and Preventive NursingGENERAL Promotive and Preventive Nursing

ManagementManagement

1. Lifestyle Modification1. Lifestyle Modification

2. Nutritional management2. Nutritional management

3. Screening3. Screening

4. Early detection4. Early detection


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SCREENINGSCREENING

1. Male and female1. Male and female-- Occult Blood, CXR, andOccult Blood, CXR, and

DREDRE

2.F

emale2.F

emale-- SBE, CBE, Mammography andSBE, CBE, Mammography andPaps SmearPaps Smear

3. Male3. Male-- DRE for prostate, Testicular selfDRE for prostate, Testicular self--

examexam


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Nursing AssessmentNursing Assessment

Utilize the ACS 7 Warning SignalsUtilize the ACS 7 Warning Signals

CAUTIONCAUTION

CC-- Change in bowel/bladder habitsChange in bowel/bladder habits

AA-- A sore that does not healA sore that does not heal UU-- Unusual bleedingUnusual bleeding

TT-- Thickening or lump in the breastThickening or lump in the breast

II-- IndigestionIndigestion

OO-- Obvious change in wartsObvious change in warts

NN-- Nagging cough and hoarsenessNagging cough and hoarseness


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Nursing AssessmentNursing Assessment

Weight lossWeight loss

Frequent infectionFrequent infection

Skin problemsSkin problems PainPain

Hair LossHair Loss

FatigueFatigue Disturbance in body image/ depressionDisturbance in body image/ depression


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CANCERMANAGEMENTCANCERMANAGEMENT

GENERAL MEDICAL MANAGEMENTGENERAL MEDICAL MANAGEMENT

-- Treatment goals: cure, control and palliationTreatment goals: cure, control and palliation

1. Surgery1. Surgery 2. Chemotherapy2. Chemotherapy

3. Radiation therapy3. Radiation therapy

4. Immunotherapy4. Immunotherapy 5. Bone Marrow Transplant5. Bone Marrow Transplant


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SURGERYSURGERY

DiagnosticDiagnostic-- excision, incision, needleexcision, incision, needle

primary method of treatmentprimary method of treatment-- local and widelocal and wideexcisionexcision

prophylacticprophylactic

PalliativePalliative-- relieve complications of CArelieve complications of CA ReconstructiveReconstructive-- improve function or obtain aimprove function or obtain a

more desirable cosmetic effectmore desirable cosmetic effect


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RADIATION THERAPYRADIATION THERAPY

Cure, control, prophylaxisCure, control, prophylaxis

Used to disrupt cell growthUsed to disrupt cell growth Cells are most vulnerable during DNACells are most vulnerable during DNA

synthesis and mitosis therfore those bodysynthesis and mitosis therfore those body

tissues which undergo frequent cell divisiontissues which undergo frequent cell division

are most sensitive toare most sensitive to

radiation.(BM,lymphatic,skin,GIT,gonads)radiation.(BM,lymphatic,skin,GIT,gonads)


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MAINTAIN TISSUE INTEGRITYMAINTAIN TISSUE INTEGRITY

Frequently assess for changesFrequently assess for changes

Handle skin gentlyHandle skin gently Do NOT rub affected areaDo NOT rub affected area

Lotion may be applied (waterLotion may be applied (water--based)based)

Wash skin only with SOAP and WaterWash skin only with SOAP and Water


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RISKFOR RADIATION INJURYRISKFOR RADIATION INJURY

Protect caregivers fr exposure to radioactiveProtect caregivers fr exposure to radioactive

implantsimplants Identify max time that can be spent safelyIdentify max time that can be spent safely

inpxs roominpxs room

Use of shielding equipmentsUse of shielding equipments

Explain to px the need for such precautions toExplain to px the need for such precautions to

keep px from feeling isolatedkeep px from feeling isolated


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MANAGEMENT OF STOMATITISMANAGEMENT OF STOMATITIS

Use softUse soft--bristled toothbrushbristled toothbrush

Oral rinses with saline gargles/ tap waterOral rinses with saline gargles/ tap water Avoid ALCOHOLAvoid ALCOHOL--based rinsesbased rinses


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CHEMOTHERAPYCHEMOTHERAPY

Destroys tumor cells by interfering w/ cellularDestroys tumor cells by interfering w/ cellular

functions and reproductionfunctions and reproduction Used primarily to treat systemic disease ratherUsed primarily to treat systemic disease rather

than localized lesionsthan localized lesions


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ADMINISTRATION:ADMINISTRATION:

Topical, Oral, IM, IV, Subcutaneous, arterial,Topical, Oral, IM, IV, Subcutaneous, arterial,intracavitary, intrathecalintracavitary, intrathecal

Dosage based on TBSADosage based on TBSA

Special care needed for vesicantsSpecial care needed for vesicants-- causescausesextravasation (daunorubicin, doxorubicin,extravasation (daunorubicin, doxorubicin,

nitrogen mustard, mitomycin, vincristine andnitrogen mustard, mitomycin, vincristine andvindesine. If suspected stop immediately andvindesine. If suspected stop immediately andapply ice except in vonca alkaloidapply ice except in vonca alkaloid


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Common side effectsCommon side effects::

Nausea and vomiting, stomatitis, anorexia,Nausea and vomiting, stomatitis, anorexia,

diarrheadiarrhea MyelosuppressionMyelosuppression

NephrotoxicityNephrotoxicity--danorobucin, doxorubucindanorobucin, doxorubucin

CHF

CHF

-- cisplastin, methroxate, mitomycincisplastin, methroxate, mitomycin Pulmonary fibrosisPulmonary fibrosis--bleomycin and busulfanbleomycin and busulfan


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SterilitySterility

Reversible Neurologic damageReversible Neurologic damage-- taxanes andtaxanes and

plant alkaloids, peripheral neuropathy andplant alkaloids, peripheral neuropathy andhearing losshearing loss-- cisplatincisplatin

fatiguefatigue


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Nursing InterventionNursing Intervention

MANAGEMENT OF ALOPECIAMANAGEMENT OF ALOPECIAAlopecia begins within 2 weeks of therapyAlopecia begins within 2 weeks of therapy

Regrowth within 8 weeks of terminationRegrowth within 8 weeks of termination

Encourage to acquire wig before hair lossEncourage to acquire wig before hair lossoccursoccurs

Encourage use of attractive scarves and hatsEncourage use of attractive scarves and hats

Provide information that hair loss isProvide information that hair loss istemporary BUT anticipate change in texturetemporary BUT anticipate change in textureand colorand color


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PROMOTE NUTRITIONPROMOTE NUTRITION

Serve food in ways to make it appealingServe food in ways to make it appealing

Consider patients preferencesConsider patients preferences Provide small frequent mealsProvide small frequent meals

Avoids giving fluids while eatingAvoids giving fluids while eating

Oral hygiene PRIOR to mealtimeOral hygiene PRIOR to mealtime Vitamin supplementsVitamin supplements


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RELIEVE PAINRELIEVE PAIN

Mild painMild pain-- NSAIDSNSAIDS

Moderate painModerate pain-- Weak opiodsWeak opiods Severe painSevere pain-- MorphineMorphine

Administer analgesics round the clock withAdminister analgesics round the clock with

additional dose for breakthrough painadditional dose for breakthrough pain


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DECREASE FATIGUEDECREASE FATIGUE

Plan daily activities to allow alternating restPlan daily activities to allow alternating rest

periodsperiods Light exercise is encouragedLight exercise is encouraged

Small frequent mealsSmall frequent meals


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IMPROVE BODY IMAGEIMPROVE BODY IMAGE

Therapeutic communication is essentialTherapeutic communication is essential

Encourage independence in selfEncourage independence in self--care andcare anddecision makingdecision making

Offer cosmetic material like makeOffer cosmetic material like make--up andup and

wigswigs


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ASSIST IN THE GRIEVING PROCESSASSIST IN THE GRIEVING PROCESS

Some cancers are curableSome cancers are curable

Grieving can be due to loss of health,Grieving can be due to loss of health,income, sexuality, and body imageincome, sexuality, and body image

Answer and clarify information aboutAnswer and clarify information about

cancer and treatment optionscancer and treatment options Identify resource peopleIdentify resource people

Refer to support groupsRefer to support groups


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MANAGE COMPLICATION:MANAGE COMPLICATION:INFECTIONINFECTION

Fever is the most important sign (38.3)Fever is the most important sign (38.3)

Administer prescribed antibiotics X 2weeksAdminister prescribed antibiotics X 2weeks

Maintain aseptic techniqueMaintain aseptic technique

Avoid exposure to crowdsAvoid exposure to crowds

Avoid giving fresh fruits and veggieAvoid giving fresh fruits and veggie

HandwashingHandwashing

Avoid frequent invasive proceduresAvoid frequent invasive procedures


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MANAGE COMPLICATION: Septic shockMANAGE COMPLICATION: Septic shock

Monitor VS, BP, tempMonitor VS, BP, temp

Administer IV antibioticsAdminister IV antibiotics Administer supplemental O2Administer supplemental O2


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MANAGE COMPLICATION: BleedingMANAGE COMPLICATION: Bleeding

Thrombocytopenia (


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Mortality and Morbidity RatesMortality and Morbidity Rates


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COLON CANCERCOLON CANCER

Risk factorsRisk factors

1. Increasing age1. Increasing age

2.F

amily history2.F

amily history 3. Previous colon CA or polyps3. Previous colon CA or polyps

4. History of IBD4. History of IBD

5. High fat, High protein, LOW fiber5. High fat, High protein, LOW fiber 6. Breast Ca and Genital Ca6. Breast Ca and Genital Ca


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PATHOPHYSIOLOGYPATHOPHYSIOLOGY

Benign neoplasmBenign neoplasm DNA alterationDNA alteration malignantmalignant

transformationtransformation malignant neoplasmmalignant neoplasm cancercancer

growth and invasiongrowth and invasion metastasis (liver)metastasis (liver)


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ASSESSMENT FINDINGSASSESSMENT FINDINGS

1.1. Change in bowel habitsChange in bowel habits-- Most commonMost common

2. Blood in the stool2. Blood in the stool

3. Anemia3. Anemia

4. Anorexia and weight loss4. Anorexia and weight loss

5. Fatigue5. Fatigue

6. Rectal lesions6. Rectal lesions-- tenesmus, alternating D and Ctenesmus, alternating D and C


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Colon cancerColon cancer

Complications of colorectal CAComplications of colorectal CA

1. Obstruction1. Obstruction

2. Hemorrhage2. Hemorrhage 3. Peritonitis3. Peritonitis

4. Sepsis4. Sepsis


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MEDICAL MANAGEMENTMEDICAL MANAGEMENT

1. Chemotherapy1. Chemotherapy-- 55--FUFU

2. Radiation therapy2. Radiation therapy


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SURGICAL MANAGEMENTSURGICAL MANAGEMENT

Surgery is the primary treatmentSurgery is the primary treatment

Based on location and tumor sizeBased on location and tumor size Resection, anastomosis, and colostomyResection, anastomosis, and colostomy

(temporary or permanent)(temporary or permanent)


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NURSING INTERVENTIONNURSING INTERVENTION

PrePre--Operative careOperative care

1. Provide HIGH protein, HIGH calorie and1. Provide HIGH protein, HIGH calorie andLOW residue dietLOW residue diet

2.Provide information about post2.Provide information about post--op care andop care and

stoma carestoma care

3. Administer antibiotics 1 day prior3. Administer antibiotics 1 day prior


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PrePre--Operative careOperative care

4. Enema or colonic irrigation the evening and4. Enema or colonic irrigation the evening andthe morning of surgerythe morning of surgery

5. NGT is inserted to prevent distention5. NGT is inserted to prevent distention

6. Monitor UO,

Fand E, Abdomen PE

6. Monitor UO,

Fand E, Abdomen PE


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PostPost--Operative careOperative care

1. Monitor for complications1. Monitor for complications

Leakage from the site, prolapse of stoma, skinLeakage from the site, prolapse of stoma, skinirritation and pulmo complicationirritation and pulmo complication

2. Assess the abdomen for return of peristalsis2. Assess the abdomen for return of peristalsis


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3.Assess wound dressing for bleeding3.Assess wound dressing for bleeding

4.Assist patient in ambulation after 24H4.Assist patient in ambulation after 24H

5.provide nutritional teaching5.provide nutritional teaching

Limit foods that cause gasLimit foods that cause gas--formation and odorformation and odor Cabbage, beans, eggs, fish, peanutsCabbage, beans, eggs, fish, peanuts

LowLow--fiber diet in the early stage of recoveryfiber diet in the early stage of recovery


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6. Instruct to splint the incision and6. Instruct to splint the incision andadminister pain meds before exerciseadminister pain meds before exercise

7. The stoma is PINKISH to cherry red,7. The stoma is PINKISH to cherry red,S

lightly edematous with minimal pinkishS

lightly edematous with minimal pinkishdrainagedrainage

8. Manage post8. Manage post--operative complicationoperative complication


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NURSING INTERVENTION: COLOSTOMYNURSING INTERVENTION: COLOSTOMY

CARECARE

Colostomy begins to function 3Colostomy begins to function 3--6 days after6 days after

surgerysurgery

The drainage maybe soft/mushy or semiThe drainage maybe soft/mushy or semi--solidsolid

depending on the sitedepending on the site


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NURSING INTERVENTION: COLOSTOMYNURSING INTERVENTION: COLOSTOMYCARECARE

BEST time to do skin care is after showerBEST time to do skin care is after shower

Apply tape to the sides of the pouch beforeApply tape to the sides of the pouch beforeshowershower

Assume a sitting or standing position inAssume a sitting or standing position in

changing the pouchchanging the pouch


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NURSING INTERVENTION: COLOSTOMYNURSING INTERVENTION: COLOSTOMYCARECARE

Instruct to GENTLY push the skin down andInstruct to GENTLY push the skin down and

the pouch pulling UPthe pouch pulling UP Wash the periWash the peri--stomal area with soap and waterstomal area with soap and water

Cover the stoma while washing the periCover the stoma while washing the peri--stomalstomal

areaarea


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CARECARE

Lightly pat dry the area and NEVER rubLightly pat dry the area and NEVER rub

Lightly dust the periLightly dust the peri--stomal area with nystatinstomal area with nystatin

powderpowder


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CARECARE

Measure the stomal openingMeasure the stomal opening

The pouch opening is about 0.3 cm larger thanThe pouch opening is about 0.3 cm larger than

the stomal openingthe stomal opening

Apply adhesive surface over the stoma andApply adhesive surface over the stoma and

press for 30 secondspress for 30 seconds


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CARECARE

Empty the pouch or change the pouch whenEmpty the pouch or change the pouch when

1/3 to full (Brunner)1/3 to full (Brunner)

to 1/3 full (Kozier) to 1/3 full (Kozier)


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Breast CancerBreast Cancer

The most common cancer in FEMALESThe most common cancer in FEMALES

Numerous etiologies implicatedNumerous etiologies implicated


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RISKFACTORSRISKFACTORS

1. Genetics1. Genetics-- BRCA1 And BRCA 2BRCA1 And BRCA 2

2. Increasing age ( > 50yo)2. Increasing age ( > 50yo) 3. Family History of breast cancer3. Family History of breast cancer

4. Early menarche and late menopause4. Early menarche and late menopause

5. Nulliparity5. Nulliparity 6. Late age at pregnancy6. Late age at pregnancy


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RISKFACTORSRISKFACTORS

7. Obesity7. Obesity

8. Hormonal replacement8. Hormonal replacement 9. Alcohol9. Alcohol

10. Exposure to radiation10. Exposure to radiation


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PROTECTIVEFACTORSPROTECTIVEFACTORS

1. Exercise1. Exercise

2. Breast feeding2. Breast feeding 3. Pregnancy before 30 yo3. Pregnancy before 30 yo


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ASSESSMENT FINDINGSASSESSMENT FINDINGS

1. MASS1. MASS-- the most common location is thethe most common location is theupper outer quadrantupper outer quadrant

2. Mass is NON2. Mass is NON--tender. Fixed, hard withtender. Fixed, hard withirregular bordersirregular borders

3. Skin dimpling3. Skin dimpling

4. Nipple retraction4. Nipple retraction 5. Peau d orange5. Peau d orange


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LABORATORY FINDINGSLABORATORY FINDINGS

1. Biopsy procedures1. Biopsy procedures

2. Mammography2. Mammography


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Breast cancer StagingBreast cancer Staging

TNM stagingTNM staging

II -- < 2cm< 2cm IIII -- 2 to 5 cm, (+) LN2 to 5 cm, (+) LN

IIIIII -- > 5 cm, (+) LN> 5 cm, (+) LN

IVIV-- metastasismetastasis


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MEDICAL MANAGEMENTMEDICAL MANAGEMENT

1. Chemotherapy1. Chemotherapy

2. Tamoxifen therapy2. Tamoxifen therapy 3. Radiation therapy3. Radiation therapy


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SURGICAL MANAGEMENTSURGICAL MANAGEMENT

1. Radical mastectomy1. Radical mastectomy

2. Modified radical mastectomy2. Modified radical mastectomy

3. Lumpectomy3. Lumpectomy

4. Quadrantectomy4. Quadrantectomy


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NURSING INTERVENTION : PostNURSING INTERVENTION : Post--OPOP

2. Relieve pain and discomfort2. Relieve pain and discomfort

Moderate elevation of extremityModerate elevation of extremity IM/IV injection of pain medsIM/IV injection of pain meds

Warm shower on 2Warm shower on 2ndnd day postday post--opop


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3. Maintain skin integrity3. Maintain skin integrity

Immediate postImmediate post--op: snug dressing withop: snug dressing withdrainagedrainage

Maintain patency of drain (JP)Maintain patency of drain (JP)

Monitor for hematoma w/in 12H and applyMonitor for hematoma w/in 12H and apply

bandage and ice, refer to surgeonbandage and ice, refer to surgeon


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3. Maintain skin integrity3. Maintain skin integrity

Drainage is removed when the discharge isDrainage is removed when the discharge isless than 30 ml in 24 Hless than 30 ml in 24 H

Lotions, Creams are applied ONLY whenLotions, Creams are applied ONLY when

the incision is healed in 4the incision is healed in 4--6 weeks6 weeks


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Promote activityPromote activity

Support operative site when movingS

upport operative site when moving Hand, shoulder exercise done on 2Hand, shoulder exercise done on 2ndnddayday

PostPost--op mastectomy exercise 20 mins TIDop mastectomy exercise 20 mins TID

NO BP or IV procedure on operative siteNO BP or IV procedure on operative site


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Promote activityPromote activity

Heavy lifting is avoidedHeavy lifting is avoided

Elevate the arm at the level of the heartElevate the arm at the level of the heart

On a pillow for 45 minutes TID to relieveOn a pillow for 45 minutes TID to relieve

transient edematransient edema


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MANAGE COMPLICATIONSMANAGE COMPLICATIONS

LymphedemaLymphedema 1010--20% of patients20% of patients

Elevate arms, elbow above shoulder andElevate arms, elbow above shoulder and

hand above elbowhand above elbow Hand exercise while elevatedHand exercise while elevated

Refer to surgeon and physical therapistRefer to surgeon and physical therapist


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HematomaHematoma

Notify the surgeonNotify the surgeon

Apply bandage wrap (Ace wrap) andICEApply bandage wrap (Ace wrap) andICE

packpack


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InfectionInfection

Monitor temperature, redness, swelling andMonitor temperature, redness, swelling and

foulfoul--odorodor

IVantibioticsIVantibiotics

No procedure on affected extremityNo procedure on affected extremity


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LL


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Lung cancerLung cancer

66thth--77thth decadedecade

Number1 in the morbidity and mortalityNumber1 in the morbidity and mortality

survey among all cancerssurvey among all cancers

Equal incidence for both men and womenEqual incidence for both men and women

85% caused by inhalation of carcinogenic85% caused by inhalation of carcinogenic

materials most commonly cigarette smokingmaterials most commonly cigarette smoking


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Squamous cell carcinomaSquamous cell carcinoma-- more centrallymore centrally

located, commonly in the segmental andlocated, commonly in the segmental and

subsegmental bronchi.subsegmental bronchi.

AdenoCarcinomaAdenoCarcinoma-- presents more peripherallypresents more peripherally

as peripheral mass or nodules; most prevalentas peripheral mass or nodules; most prevalent

lung Ca for both M and Flung Ca for both M and F

Large cell carcinomaLarge cell carcinoma--fast growing tumor thatfast growing tumor thatarise peripherallyarise peripherally


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Bronchioalveolar cell CABronchioalveolar cell CA-- arises fr thearises fr the

terminal bronchus and alveoli; usually slowterminal bronchus and alveoli; usually slow

growinggrowing

Small cell CaSmall cell Ca-- arises primarily as a proximalarises primarily as a proximal

lesion but may arise in any part of thelesion but may arise in any part of the

tracheobronchial treetracheobronchial tree


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L CL C


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Lung CancerLung Cancer

Clinical Manifestations:Clinical Manifestations:

CoughCough

HemoptysisHemoptysis

Wheeze, stridorWheeze, stridor

DyspneaDyspnea

PneumonitisPneumonitis

PainPain Symptoms of lung abscessSymptoms of lung abscess

L CL C


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Metastatic spreadMetastatic spread-- tracheal obstruction,tracheal obstruction,

dysphagia, hoarseness, Horners syndrome,dysphagia, hoarseness, Horners syndrome,

auperior vena cava syndrome, plural effusion,auperior vena cava syndrome, plural effusion,

respiratory failure.respiratory failure.

Systemic symptomsSystemic symptoms

Endocrine syndromesEndocrine syndromes--hypercalcemiahypercalcemia

(epidermoid), SIADH (sm cell), gynecomastia(epidermoid), SIADH (sm cell), gynecomastia(large cell), clubbing (non(large cell), clubbing (non--sm. Cell)sm. Cell)

L CL C


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Stage TNM descriptors 5-yr survival rate

I T1-2,N0,M0 60-80

II T1-2,N1,M0 25-50

IIIA T3,N0-1,M0

T1-3,N2,M0

25-40

10-30

IIIB Any T4 or N3,M0


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T1T1--< 3 cm< 3 cm

T2T2-->3 cm>3 cm

T3T3-- direct extension into chest walldirect extension into chest wall

T4T4-- invades mediastinuminvades mediastinum

N0N0

N1N1--peribronchialperibronchial

N2N2--ipsilateral mediastinalipsilateral mediastinalN3N3--contralateral mediastinalcontralateral mediastinal

L CL C


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TREATMENTTREATMENT

SurgerySurgery

RadiotherapyRadiotherapy

ChemotherapyChemotherapy

P t t CP t t C


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Prostate CancerProstate Cancer

EtiologyEtiology

AgeAge--relatedrelated

Blacks>whiteBlacks>white

95 % are adenocarcinomas95 % are adenocarcinomas

P t t CP t t C


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Manifestations:Manifestations:

Rel. to urinary flow obstuctionRel. to urinary flow obstuction

Urinary frequency, ec in caliber of stream,Urinary frequency, ec in caliber of stream,

diminished force, hesitancy, dribbling,diminished force, hesitancy, dribbling,

nocturia and overflow incontinencenocturia and overflow incontinence

DysuriaDysuria

Back or hip painBack or hip pain

P t t CP t t C


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DiagnosticsDiagnostics::

DREDRE

PSAPSA-- >> 10 ng/ml10 ng/ml

BiopsyBiopsy-- transrectal prostate biopsy undertransrectal prostate biopsy under

sonography (TRUS)sonography (TRUS)



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TreatmentTreatment

SurgerySurgery-- radical retropubic prostatectomyradical retropubic prostatectomy

Radiation therapyRadiation therapy

*both are associated w/ impotence*both are associated w/ impotence

Androgen deprivationAndrogen deprivation-- for those w/ metastaticfor those w/ metastatic

disease (leuporide, flutamide)disease (leuporide, flutamide)

ChemotherapyChemotherapy-- for palliationfor palliation

NonNon Hodgkins LymphomaHodgkins Lymphoma


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NonNon--Hodgkins LymphomaHodgkins Lymphoma

Heterogenous group of cancersHeterogenous group of cancers

Originates from neoplastic growth of lymphoidOriginates from neoplastic growth of lymphoid

tissuetissue

Mostly involves malignant B lymphocytes;Mostly involves malignant B lymphocytes;

only 5%only 5% are T lymphocytesare T lymphocytes



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Manifestations:Manifestations:

Symptoms are highly variableSymptoms are highly variable

Typically diagnosed at a latter stage when pxTypically diagnosed at a latter stage when px

is more symptomatic; lymphadenopathy isis more symptomatic; lymphadenopathy is

noticeable (stages III or IV)noticeable (stages III or IV)

1/3 of cases have B symptoms (recurrent1/3 of cases have B symptoms (recurrent

fever, drenching night sweats, & unintentionalfever, drenching night sweats, & unintentionalwt. loss of >10%wt. loss of >10%



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Assessment & DiagnosticsAssessment & Diagnostics

HistopathologyHistopathology

ImmunophenotypingImmunophenotyping

Cytogenetic analysisCytogenetic analysis

StagingStaging based on data obtained from CTbased on data obtained from CT

scan, bone marrow biopsies, CSF analysisscan, bone marrow biopsies, CSF analysis



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Treatment:Treatment:

based on actual classification & stage of disease, priorbased on actual classification & stage of disease, prior

treatment, & pxs ability to tolerate therapytreatment, & pxs ability to tolerate therapy

Radiation alone maybe beneficial in localized nonRadiation alone maybe beneficial in localized non--aggressive formsaggressive forms

In aggressive types, combination chemotherapy areIn aggressive types, combination chemotherapy are

given in early stagesgiven in early stages

Intermediate formsIntermediate forms chemotherapy + radiotherapychemotherapy + radiotherapy

for st. I & II diseasefor st. I & II disease


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Diagnosis:Diagnosis:

UrinalysisUrinalysis-- hematuriahematuria

IVPIVP-- decreased bladder fillingdecreased bladder filling

CystoscopyCystoscopy-- diagnosticdiagnostic

Urinary bladder CancerUrinary bladder Cancer


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Urinary bladder CancerUrinary bladder Cancer

Treatment:Treatment:

Based on extent of diseaseBased on extent of disease

Surgical ResectionSurgical Resection

Intravesical chemotherapyIntravesical chemotherapy

QuizQuiz


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QuizQuiz

1 a 64 y.o patient status post1 a 64 y.o patient status post-- hemi colectomyhemi colectomywas tachycardic. Examination of the mucuswas tachycardic. Examination of the mucusmembrane showed a dry mouth. What is yourmembrane showed a dry mouth. What is your

assessment to the possible cause ofassessment to the possible cause oftachycardia in this patient?tachycardia in this patient?

infectioninfection

3rd spacing3rd spacing

DehydrationDehydration

sepsissepsis


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3. radiation therapy is effective in actively3. radiation therapy is effective in actively

dividing cells. All of the ff are ex of thosedividing cells. All of the ff are ex of those

exceptexcept

GITGIT

Fatty tissuesFatty tissues

NerveNerve

skinskin


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4. screening should be done to detect cancers.4. screening should be done to detect cancers.

Routine Screening tests involves all of theRoutine Screening tests involves all of the

following exceptfollowing except

breast exambreast exam

DREDRE

UltrasoundUltrasound

Occult blood examOccult blood exam


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6. Most frequent cause of fever w/in 24 hrs in a6. Most frequent cause of fever w/in 24 hrs in a

postpost--op patient is.op patient is.

77--9. internal Radiation therapy poses a risk for9. internal Radiation therapy poses a risk for

both patient and caregiver. Give 3 ways toboth patient and caregiver. Give 3 ways toavoid unnecessary exposureavoid unnecessary exposure

10. Most common manifestation of lung cancer10. Most common manifestation of lung cancer

in early stages is..in early stages is..

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7096472 Nursing Oncology