Oncology

• Benign tumors

  Cells that are not cancerous
• Malignant tumors

  Cells or processes that are characteristic of cancer
• Metastasis


  Abnormal cells invade surrounding tissue and gain access to lymph and blood vessels carrying them to other areas of the body
• Malignant tumors spread by way of blood and lymph channels to other areas of the body
• Carcinogenic agents and factors

  • Dietary and genetic factors
  • Hormonal and chemical agents
  • Viruses
• Specific agents or factors associated with the etiology of cancer include viruses and bacteria, physical factors, sunlight, radiation, chronic irritation, chemical agents, tobacco, asbestos, genetic and familial factors, diet, and hormones
• Genetic testing

  Helps estimate your chance of developing cancer in your lifetime
• Tumor markers

  Substances that are produced by cancer or by other cells of the body in response to cancer or certain benign (noncancerous) conditions
• Prostate-specific antigen (PSA)


  Cancer type: Prostate cancer, Tissue analyzed: Blood, How used: To help in diagnosis, assess response to treatment, and look for recurrence
• Diagnosis of cancer

  1. Determine presence, extent of tumor

  2. Identify possible disease metastasis

  3. Evaluate functions of involved and uninvolved body systems and organs

  4. Obtain tissue and cells for analysis, including evaluation of tumor stage and grade
• Staging

  Determines the size of the tumor, the existence of local invasion, lymph node involvement, and distant metastasis
• Grading


  Pathologic classification of tumor cells: I–IV
• Cancer management

  • Cure
  • Control
  • Palliation
• Surgical treatment

  1. Diagnostic surgery

  2. Biopsy: excisional, needle, incisional

  3. Tumor removal: wide excision, local excision

  4. Prophylactic surgery

  5. Palliative surgery

  6. Reconstructive surgery
• Prophylactic or risk reduction surgery involves removing nonvital tissues or organs that are at increased risk of developing cancer
• Radiation therapy

  Curative, control, or palliative
• Types of radiation therapy

  • External radiation
  • Internal radiation
• Nursing care of the patient undergoing radiation therapy

  1. Promote healing, patient comfort, quality of life

  2. Assessment: skin, nutritional status, well-being

  3. Protecting caregivers
• Nursing care for impaired skin integrity: erythematous areas

  1. Avoid use of soaps, cosmetics, perfumes, powders, lotions and ointments, deodorants

  2. Use only lukewarm water to bathe area

  3. Avoid rubbing or scratching area

  4. Avoid shaving area with straight-edged razor

  5. Avoid applying hot-water bottles, heating pads, ice, adhesive tape to area

  6. Avoid exposing area to sunlight or cold weather

  7. Avoid tight clothing in area; use cotton clothing

  8. Apply vitamin A and D ointment or zinc to area
• Nursing care for impaired skin integrity: wet desquamation


  1. Do not disrupt any blisters that have formed

  2. Avoid frequent washing of area

  3. Report any blistering

  4. Use prescribed creams or ointments

  5. If area weeps, apply nonadhesive absorbent dressing

  6. If area is without drainage, use moisture-, vapor-permeable dressings such as hydrocolloids, hydro gels on non-infected areas
• Chemotherapy


  Agents used in attempt to destroy cancer cells by interfering with cellular function, replication
• Chemotherapy administration routes

  • Oral
  • Intravenous
  • Intrathecal (into the cerebrospinal fluid via spinal cord)
  • Injections (subcutaneous, intraperitoneal)
  • Bladder (intravesicular instilling)
• Chemotherapy toxicity

  • Gastrointestinal
  • Hematopoietic
  • Renal
  • Cardiopulmonary: Adriamycin (cardio) & Bleomycin (pulmonary)
  • Reproductive: egg harvesting, Sperm banking
  • Neurologic
  • Cognitive
  • Fatigue
• Nursing management in chemotherapy

  1. Assessing fluid, electrolyte status

  2. Assessing cognitive status

  3. Modifying risks for infection, bleeding

  4. Administering chemotherapy

  5. Preventing nausea and vomiting

  6. Managing fatigue

  7. Protecting caregivers
• Patients who are neutropenic and/or who have hematologic malignancies are at greatest risk for septic shock
• Septic shock

  Signs, symptoms include altered mental status, either subnormal or elevated temperature, cool and clammy skin, decreased urine output, hypotension, tachycardia, other dysrhythmias, electrolyte imbalances, tachypnea, abnormal arterial blood gas values
• Bleeding and hemorrhage

  Thrombocytopenia (decrease in circulating platelet count): most common cause of bleeding in patients with cancer, usually defined as platelet count of less than 100,000/mm3 (0.1 × 1012/L)
• Types of hematopoietic stem cell transplantation (HSCT)

  • Allogeneic
  • Autologous
  • Syngeneic
  • Myeloablative
  • Nonmyeloablative
  • Car-T
• Nursing management in HSCT

  1. Implementing pretransplantation care

  2. Providing care during treatment

  3. Providing posttransplantation care

  4. Caring for recipients

  5. Caring for donors
• Graft-versus-host disease (GVHD)


  Major cause of morbidity and mortality in the allogeneic transplant population, occurs when the donor lymphocytes initiate an immune response against the recipient's tissues (skin, gastrointestinal tract, liver) during the beginning of engraftment
• Immunotherapy

  The "treatment of disease by inducing, enhancing, or suppressing an immune response"
• CAR T cell therapy

  A type of cancer immunotherapy that works with your immune system by using your T cells (or fighter cells)
• Targeted therapy

  The use of agents to kill or prevent the spread of cancer cells by targeting a specific part of the cell, with less negative effects on healthy cells than conventional chemotherapy
• Cancer treatment side effects

  • Nutrition
  • Nausea
  • Vomiting
  • Altered body image
  • Pain
  • Fatigue
  • Sexual dysfunction
• Nutritional problems

  • Anorexia
  • Malabsorption
  • Cachexia
• Nursing management for altered nutrition: nausea and vomiting

  1. Assess patient's previous experiences, expectations of nausea and vomiting, including causes, interventions used

  2. Adjust diet before, after drug administration according to patient preference, tolerance

  3. Prevent unpleasant sights, odors, sounds in environment

  4. Use distraction, music therapy, biofeedback, self-hypnosis, relaxation techniques, guided imagery before, during, after chemotherapy

  5. Administer prescribed antiemetic, sedatives, corticosteroids before chemotherapy, afterward as needed

  6. Ensure adequate fluid hydration before, during, after drug administration; assess intake, output

  7. Encourage frequent oral hygiene

  8. Provide pain relief measures if necessary

  9. Consult with dietician as needed

  10. Assess, address other contributing factors to nausea, vomiting
• Nausea medications


  • Ondansetron (Zofran)
  • Granisetron (Kytril)
  • Dexamethasone
  • Lorazepam (Ativan)
  • Prochlorperazine (Compazine)
  • Metoclopramide (Reglan)
  • Cannabinoids
• Nursing management for altered body image


  1. Assess patient's feelings about body image, level of self-esteem

  2. Identify potential threats to patient's self-esteem

  3. Validate concerns with patient

  4. Encourage continued participation in activities, decision making

  5. Encourage patient to verbalize concerns

  6. Individualize care for patient

  7. Assist patient in self-care when fatigue, lethargy, nausea, vomiting, other symptoms prevent independence

  8. Assist patient in selecting and using cosmetics, scarves, hair pieces, clothing that increase his or her sense of attractiveness

  9. Encourage patient, partner to share concerns about altered sexuality and sexual function, to explore alternatives to usual sexual expression

  10. Refer to collaborating specialists as needed
• Nursing management for alopecia


  1. Discuss potential hair loss, regrowth with patient, family

  2. Explore potential impact of hair loss on self-image, interpersonal relationships, sexuality

  3. Prevent or minimize hair loss

  4. Prevent trauma to scalp

  5. Suggest ways to assist in coping with hair loss: Encourage patient to wear own clothes, retain social contacts

  6. Explain that hair growth usually begins again once therapy is completed
• Nursing management for patient self-care

  1. Patient education

  2. Easily understood information

  3. Designed for support across the cancer continuum

  4. Describe what to expect