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Oncology Nursing Lecture
 

Oncology Nursing Lecture

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    Oncology Nursing Lecture Oncology Nursing Lecture Presentation Transcript

    • JOFRED M. MARTINEZ, RN
    • TRUE OR FALSE1. Today, more than half of all people diagnosed withcancer are cured.2. There are no warning signs with cancer; illnesstends to come on suddenly.3. Most cancers are hereditary.4. Standard treatments for cancer include surgery,radiation, and chemotherapy.5. People undergoing cancer treatment have fewerside effects when they eat a well-balanced diet.
    • TRUE OR FALSE6. HPV, a virus that can cause cancer, iscontagious.7. Men cannot develop breast cancer.8. Chemotherapy is not the only treatment methodfor cancer.9. During chemotherapy, everyone loses their hair.10. A positive attitude can help cure cancer.
    • 1. Compare the structure and function of the normal cell andthe cancer cell.2. Differentiate between benign and malignant tumors.3. Identify agents and factors that have been found to becarcinogenic.4. Describe the significance of health education andpreventive care in decreasing the incidence of cancer.5. Differentiate among the purposes of surgical proceduresused in cancer treatment, diagnosis, prophylaxis, palliation,and reconstruction.
    • 6. Describe the roles of surgery, radiation therapy,chemotherapy, targeted therapy, hematopoietic stem celltransplantation, and other therapies in treating cancer.7. Describe the special nursing needs of patients receivingchemotherapy.8. Describe nursing care related to common nursingdiagnoses associated with cancer: impaired skin integrity,alopecia, nutritional problems, and altered body image.9. Identify potential complications for the patient with cancerand discuss associated nursing care.
    • 10. Describe the concept of hospice in providing care forpatients with advanced cancer.11. Identify assessment parameters and nursing managementof patients with oncologic emergencies.
    • Cancer is a disease process thatbegins when an abnormal cell istransformed by the genetic mutation ofthe cellular DNA.
    • Branch of medicine that deals with thestudy, detection, treatment andmanagement of cancer.
    • Branch of medicine that deals with thestudy, detection, treatment andmanagement of cancer and neoplasia.
    • AtrophyHypertrophyHyperplasiaMetaplasiaDysplasiaAnaplasiaNeoplasia
    • neo+ new+plasia growth+plasm substance+trophy size+oma tumora+ noneana+ lackhyper+ excessivemeta+ changedys+ bad, impaired
    • AtrophyHypertrophyHyperplasiaMetaplasiaDysplasiaAnaplasiaNeoplasia
    • epithelial tissues (carcinoma)glandular tissues (adenocarcinomas)connective, muscle, and bone tissues (sarcomas)brain and spinal cord tissues (gliomas)pigmented cells (melanomas)plasma cells (myelomas)lymphatic tissue (lymphomas)leukocytes (leukemia)erythrocytes (erythroleukemia)
    • • contains TUMOR-SPECIFIC ANTIGENS• contain less FIBRONECTIN• nuclei of cancer cells are large and irregularlyshaped (PLEOMORPHISM)• CHROMOSOMAL ABNORMALITIES and fragilityof chromosomes• mitosis occurs more frequently
    • • mechanical pressure exerted by rapidly proliferatingneoplasms force fingerlike projections of tumor cellsinto surrounding tissue and interstitial spaces• malignant cells are less adherent and break offfrom primary tumor and invade adjacent structures• malignant cells are thought to possess or producespecific destructive enzymes (proteinases), such ascollagenases (specific to collagen), plasminogenactivators (specific to plasma), and lysosomalhydrolyses
    • • Tumor emboli enter the lymph channels by way ofthe interstitial fluid, which communicates withlymphatic fluid.• Malignant cells penetrate lymphatic vessels byinvasion.• Malignant cells either lodge in the lymph nodes orpass between the lymphatic and venouscirculations.
    • • Dissemination of malignant cells via thebloodstream and is directly related to thevascularity of the tumor.• Malignant cells attach to endothelium and attractfibrin, platelets, and clotting factors to sealthemselves from immune system surveillance.• Malignant cells to enter the basement membraneand secrete lysosomal enzymes.
    • T cell System/Cellular ImmunityB cell System/Humoral immunityPhagocytic cells
    • THREE STEPS OF CARCINOGENESIS?INITIATIONPROMOTIONPROGRESSION
    • CAUSES OF CANCER?VIRUSES AND BACTERIAPHYSICAL AGENTSCHEMICAL AGENTSGENETIC FACTORSHEREDITYDIETARY FACTORSHORMONAL FACTORS
    • VIRUSES
    • VIRUSES
    • BACTERIA
    • SUNLIGHT
    • TOBACCO
    • TOBACCO
    • BREAST CANCERFamily HistoryHigh-fat DietObesity after MenopauseEarly Menarche, Late MenopauseAlcohol ConsumptionPostmenopausal Estrogen and ProgestinFirst Child after Age 30
    • CERVICAL CANCERMultiple Sexual PartnerHaving Sex at Early AgeExposure to Human Papilloma VirusSmoking
    • COLORECTAL CANCERFamily HistoryLow Fiber DietHistory of Rectal Polyps
    • ESOPHAGEAL CANCERHeavy Alcohol ConsumptionSmoking
    • LUNG CANCERCigarette SmokingAsbestos, Arsenic, and Radon ExposureSecondhand SmokeTB
    • SKIN CANCERExcessive Exposure to UV Radiation (Sun)Fair ComplexionWork With Coal, Tar, Pitch or CreosoteMultiple or Atypical Nevi (Males)
    • STOMACH CANCERFamily HistoryDiet Heavy in Smoked, Pickled or Salted Foods
    • TESTICULAR CANCERUndescended TesticlesConsumption of Hormones by Mothersduring Pregnancy
    • PROSTATE CANCERIncreasing Of AgeFamily HistoryDiet High in Animal Fat
    • SOLID TUMORSHEMATOLOGICAL CANCERS
    • GradeXGrade cannot be determinedGradeICells differ slightly from normal cells and are welldifferentiated (Mild Dysplasia)GradeIICells are abnormal and are moderately differentiated(Moderate Dysplasia)
    • GradeIIICells are very abnormal and are poorly differentiated(Severe Dysplasia)GradeIVCells are immature (Anaplasia) and undifferentiated,cell of origin is difficult to determine.
    • TThe extent of the primary tumorNThe absence or presence of regionallymph node metastasis.MThe absence or presence ofdistant metastatsis.
    • PRIMARY TUMOR (T)TX: primary tumor cannot be assessed.T0: no evidence of primary tumor.Tis: carcinoma in situT1, T2, T3, T4: increasing size and/ or localextent of the primary tumor.
    • REGIONAL LYMPH NODES (N)NX: regional lymph nodes cannot be assessed.N0: no regional lymph node metastasis.N1, N2, N3: increasing involvement of regionallymph nodes.
    • DISTANT METASTASIS (M)MX: distant metastasis cannot be assessed.M0: no metastasisM1: distant metastasis
    • Prevention is a priority in oncology nursingbecause at least one third of all cancersare preventable.
    • Cancer is also curable if detectedand treated early.
    • The principal role of an oncology nurse asa provider of information and education inthe prevention and early detection ofcancer requires a basic understandingof the etiology and epidemiologyof the disease.
    • PRIMARY PREVENTIONSECONDARY PREVENTION
    • WARNING SIGNS OF CANCERC hange in bowel or bladder habbitsA ny sore that does not healsU nusual bleeding or dischargeT hickening or lump in breast or elsewhereI ndigestionO bvious change in wart or moleN agging cough or hoarsenesU nexplained anemiaS udden and unexplained weight loss
    • WARNING SIGNS OF CANCERC A U T I O N U S
    • 1. Promoting risk factors awareness2. Promoting healthy behaviors3. Limiting alcohol consumption4. Hepa B virus infant vaccination5. Control of STDs6. Changing risk behaviors7. Teaching skills for early detection programs8. Promoting participation in early detection programs
    • Maintain a healthy weight throughout life. Balance caloric intake with physical activity Avoid excessive weight gain throughout the lifecycle Achieve and maintain a healthy weight ifcurrently overweight or obese
    • Adopt a physically active lifestyle. Adults: engage in at least 30 minutes ofmoderate to vigorous physical activity, aboveusual activities, on 5 or more days of the week;45 to 60 minutes of intentional physical activityare preferable Children and adolescents: engage in at least 60minutes per day of moderate to vigorous physicalactivity at least 5 days per week
    • Consume a healthy diet, with an emphasis on plantsources Choose foods and beverages in amounts thathelp achieve and maintain a healthy weight Eat five or more servings of a variety ofvegetables and fruits each day Limit consumption of processed and red meats If you drink alcoholic beverages, limitconsumption.
    • DETECTION OF BREAST CANCER Monthly BSEs Women at age 40 should have a yearlymammogram and breast examination by a healthcare providerDETECTION OF COLON AND RECTAL CANCER All aged 50 and up should have a yearly fecaloccult blood test Digital rectal exam and flexible sigmoidoscopyevery 5 years Colonoscopy with Ba enema every 10 years
    • FOR DETECTION OF UTERINE CANCER Yearly Pap smear for sexually active femalesand any female over age 18 At menopause, high-risk women should have anendometrial tissue sampleFOR DETECTION OF PROSTATE CANCER Beginning age 50, yearly digital rectalexamination and prostate-specific antigen(PSA) test
    • BIOPSYTypes:NeedleIncisionalExcisionalStaging
    • MAMMOGRAPHYPAPANICOLAOU’S (PAP) TESTSTOOLS FOR OCCULT BLOODSIGMOIDOSCOPYCOLONOSPCOPYSKIN INSPECTION
    • ONCOFETAL ANTIGENSCarcinoembryonic Antigen (CEA)Alpha-feto Protein
    • HORMONESADHCalcitoninCatecholaminesHCGPTH
    • ISOENZYMESNeurospecific enolase (NSE)Prostatic acid phosphatase (PAP)
    • TISSUE-SPECIFIC ANTIGENSProstate-specific Antigen (PSA)
    • EXAM
    • 1. A female client has an abnormal result on a Papanicolaoutest. After admitting, she read her chart while the nurse wasout of the room, the client asks what dysplasia means.Which definition should the nurse provide?a. Presence of completely undifferentiated tumor cells thatdon’t resemble cells of the tissues of their originb. Increase in the number of normal cells in a normalarrangement in a tissue or an organc. Replacement of one type of fully differentiated cell byanother in tissues where the second type normally isn’tfoundd. Alteration in the size, shape, and organization ofdifferentiated cells
    • 2. Nurse Merfe is teaching a client who suspects that she hasa lump in her breast. The nurse instructs the client that adiagnosis of breast cancer is confirmed by:a. breast self-examination.b. mammography.c. fine needle aspiration.d. chest X-ray.
    • 3. Nurse Gia is teaching a group of women to perform breastself-examination. The nurse should explain that thepurpose of performing the examination is to discover:a. cancerous lumps.b. areas of thickness or fullness.c. changes from previous self-examinations.d. fibrocystic masses.
    • 4. A client, age 41, visits the gynecologist. After examining her,the physician suspects cervical cancer. Nurse Lyka reviewsthe client’s history for risk factors for this disease. Whichhistory finding is a risk factor for cervical cancer?a. Onset of sporadic sexual activity at age 17b. Spontaneous abortion at age 19c. Pregnancy complicated with eclampsia at age 27d. Human papillomavirus infection at age 32
    • 5. Nurse Sheva is interviewing a male client about his pastmedical history. Which preexisting condition may lead thenurse to suspect that a client has colorectal cancer?a. Duodenal ulcersb. Hemorrhoidsc. Weight gaind. Polyps
    • 6. Nurse Jona is speaking to a group of women about earlydetection of breast cancer. The average age of the womenin the group is 47. Following the American Cancer Societyguidelines, the nurse should recommend that the women:a. perform breast self-examination annually.b. have a mammogram annually.c. have a hormonal receptor assay annually.d. have a physician conduct a clinical examination every 2years.
    • 7. A male client with a nagging cough makes an appointmentto see the physician after reading that this symptom is oneof the seven warning signs of cancer. What is anotherwarning sign of cancer?a. Persistent nauseab. Rashc. Indigestiond. Chronic ache or pain
    • 8. Nurse Patriz is providing breast cancer education at acommunity facility. The American Cancer Societyrecommends that women get mammograms:a. yearly after age 40.b. after the birth of the first child and every 2 yearsthereafter.c. after the first menstrual period and annually thereafter.d. every 3 years between ages 20 and 40 and annuallythereafter.
    • 9. The ABCD method offers one way to assess skin lesions forpossible skin cancer. What does the A stand for?a. Actinicb. Asymmetryc. Amazingd. Assessment
    • 10. What should a male client over age 52 do to help ensureearly identification of prostate cancer?a. Have a digital rectal examination and prostate-specificantigen (PSA) test done yearly.b. Have a transrectal ultrasound every 5 years.c. Perform monthly testicular self-examinations, especiallyafter age 50.d. Have a complete blood count (CBC) and blood ureanitrogen (BUN) and creatinine levels checked yearly.
    • 11. – 19. Warning signs of cancer?20. – 22. Characteristics of benign tumors?23. – 25. Characteristics of malignant tumors?-end-
    • INTERNAL RADIATION THERAPY(BRACHYTHERAPY)EXTERNAL RADIATION THERAPY(TELETHERAPY)
    • SOURCES implanted into the affected tissue or body cavity ingested as a solution injected as a solution into the bloodstream orbody cavity introduced through a catheter into the tumorSIDE EFFECTS fatigue anorexia immunosuppression
    • CLIENT EDUCATION Avoid close contact with others until thetreatment is completed Maintain daily activities unless contraindicated Rest Maintain a balanced diet and fluid intake If implant is temporary, the client should be onbed rest Excreted body fluids may be radioactive; doubleflush toilets after use
    • NURSING MANAGEMENT Minimize time spent in close proximity to theradiation sources Minimum distance should be 6 feet Use lead shields Place the client in a private room Ensure proper handling and disposal of bodyfluids Pregnant women and children are not allowedinside the client’s room
    • SIDE EFFECTS Tissue damage to target area Ulcerations of oral mucous membranes Nausea, vomiting, and diarrhea Radiation pneumonia Fatigue Alopecia Immunosuppression
    • CLIENT EDUCATION Wash marked area of the skin with plain wateronly and pat dry. Do not wash off the treatmentsite marks Avoid rubbing, scratching, or scrubbing thetreatment site. Do not apply extremetemperatures to the treatment site. If shaving isnecessary, use electric razor. Wear soft, loose-fitting clothing over thetreatment area
    • CLIENT EDUCATION Protect skin from sun exposure during thetreatment and for at least 1 year after thetreatment is completed. Maintain proper rest, diet, and fluid intake Hair loss may occur.
    • CLIENT EDUCATION Protect skin from sun exposure during thetreatment and for at least 1 year after thetreatment is completed. Maintain proper rest, diet, and fluid intake Hair loss may occur.
    • ROUTE OF ADMINISTRATION IV Oral Intrathecal Topical Intra-arterial Intracavity Intravesical
    • ALKYLATING AGENTSCyclophosphamide (Cytoxan)Busulfan (Myleran)Mecholorethamine (Mustargen)
    • ANTIMETABOLITES5-fluorouracil (5-FU)Methotrexate
    • CYTOTOXIC ANTIBIOTICSBleomycin (Blenoxane)Doxorubicin (Adriamycin)
    • HORMONES AND HORMONE ANTAGONISTSDiethylstilbestrol (DES)Tamoxifen (Nolvadex)Prednisone
    • State Description Abbreviationquiescent/senescentGap 0 G0A resting phase where the cell has left thecycle and has stopped dividing.InterphaseGap 1 G1Cells increase in size in Gap 1.The G1 checkpoint control mechanism ensuresthat everything is ready for DNA synthesis.Synthesis S DNA replication occurs during this phase.Gap 2 G2During the gap between DNA synthesis andmitosis, the cell will continue to grow.TheG2 checkpoint control mechanism ensuresthat everything is ready to enter the M (mitosis)phase and divide.Cell division Mitosis MCell growth stops at this stage and cellularenergy is focused on the orderly division intotwo daughter cells. A checkpoint in the middleof mitosis (Metaphase Checkpoint) ensuresthat the cell is ready to complete cell division.
    • PLANT ALKALOIDSVinca alkaloidsEtoposide
    •  IV routes may be obtained by subclavian catheters,implanted ports, or peripherally inserted catheters. Extravasation is the major complication of IVchemotherapy. WARNING: NEVER TEST VEIN PATENCY WITHCHEMOTHERAPEUTIC AGENTS. Monitor client closely for anaphylactic reactions orserious side effects. Discontinue infusion accordingto protocol if reaction occur Use caution when preparing, administering, ordisposing chemotherapeutic agents
    • Bone marrow suppression leads to:a. LEUKOPENIA Avoid crowds, people with infections, andsmall children when WBC count is low Avoid undercooked meat and raw fruits andvegetables
    • Bone marrow suppression leads to:b. THROMBOCYTOPENIA Use electric razor when shaving Avoid contact sports If trauma occurs, apply ice and seekmedical assistance Avoid dental work or other invasiveprocedures Avoid aspirin and aspirin-containingproducts
    • GI effects Client educationa. Eat small, frequent, low-fat mealsb. Avoid spicy and fatty foodsc. Avoid extremely hot foods Administer antiemetics prior to chemotherapy Weigh client routinely
    • Stomatitis and mucositosis Client educationa. Use a soft toothbrush. Mouth swabs may beneeded during an acute episodeb. Avoid mouthwashes containing alcohol. Donot use lemon glycerin swabs or dental flossc. Consider using chlorhexidine mouthwash todecrease risk of haemorrhage and protectgums from trauma
    • Stomatitis and mucositosis Client educationd. For xerostomia, apply lubricating andmoisturizing agents to protect the mucousmembranes from trauma and infectione. Consider using “artificial saliva” and hardcandy or mintsf. Avoid smoking and alcoholg. Drink cool liquids, and avoid hot andirritating foods
    • Alopecia (hair loss)a. Encourage the client to choose a wig beforehair loss occursb. Care of hair and scalp includes washing hairtwo to three times a week with mild shampoo.Pat hair dry and avoid the use of blow dryer.
    • Primary treatmentProphylacticPalliativeReconstructive
    •  Testicular Cancer most often occurs between theages of 15 and 40 Metastasis occurs to the lung, liver, bone andadrenal glands. Prevention : Routine Testicular Examination
    •  Painless testicular swelling occurs. Dragging sensation is evident in the scrotum. Palpable lymphadenopathy, abdominal masses,and gynecomastia may indicate metastasis. Late signs include back or bone pain andrespiratory symptoms.
    •  Prepare the client for radiation therapy or unilateralorchiectomy as prescribed . Discuss reproduction, sexuality and fertilityinformation and options with the clientFor Post Op: Monitor for signs of bleeding and wound infection. Monitor Intake and output Notify the physician if chills, fever, increasing painor tenderness at the incision site, or drainage of theincision occurs. Instruct the client to perform a monthly testicularself-examination on the remaining testicle.
    •  Pre-invasive cancer is limited to the cervix Invasive cancer is in the cervix and other pelvicstructures. Metastasis usually is confined to the pelvis, butdistant metastasis occurs through lymphaticspread. Pre malignant changes are described on acontinuum from dysplasia , which is the earliestpremalignant change.
    •  Low socioeconomic groups Early first marriage Early and frequent intercourse Multiple sex partners High parity Poor hygiene
    •  The practice of good perineal needs must beemphasized Avoid sex in an early age, avoid numerouspartners, and practice the use of condom Cancer warning signs: abnormal vaginal bleeding,and spotting after having sex Early detection includes Pap smear for womenover age 18.
    •  Painless vaginal bleeding postmenstrually andpostcoitally Foul-smelling or serosanguinous vaginal discharge Pelvic, lower back, leg or groin pain Anorexia and weight loss Leakage of urine and feces from the vagina Dysuria Hematuria Cytological changes on Papanicolaou’s Test
    • Nonsurgical Chemotherapy Cryosurgery External Radiation Internal Radiation Implants Laser TherapySurgical Hysterectomy Pelvic Exenteration
    •  ESTROGEN replacement immediate post op ifthe ovaries were removed No vaginal entry, douching, or intercourse for 4-6weeks Avoid bending knees
    •  Ovarian cancer grows rapidly , spreads fast and isoften bilateral. Metastasis occurs by direct spread to the organsin the pelvis, by distal spread through lymphaticdrainage or by peritoneal seeding Prognosis is usually poor because the tumorusually is detected late. An exploratory laparotomy is performed todiagnose and stage the tumor.
    •  Abdominal discomfort or swelling Gastrointestinal disturbances Dysfunctional vaginal bleeding Abdominal mass
    •  External radiation is used if the tumor is invadedother organs. Chemotherapy is used postoperatively for allstages of ovarian cancer. Intraperitoneal chemotherapy involves theinstillation of chemotherapy into the abdominalcavity. Immunotherapy alters the immunological responseof the ovary and promotes tumor resistance. Total abdominal hysterectomy and bilateralsalpingo-oophorectomy may be necessary.
    •  Is a slow growing tumor associated with themenopausal years. Metastasis occurs through the lymphatic systemto the ovaries and pelvis; via the blood to thelungs, liver and bone; or intra-abdominally to theperitoneal cavity.
    •  History of uterine polyps Nulliparity Polycystic ovary disease Estrogen stimulation Late menopause Family history
    •  Postmenopausal bleeding Watery, serosanguinous discharge Low back, pelvic, or abdominal pain Enlarged uterus in advanced stages
    • Nonsurgical interventions External radiation or internal radiation is usedalone or in combination with surgery, dependingon the stage of cancer. Chemotherapy is used to treat advanced orrecurrent disease. Progestational therapy with medication such asmedroxyprogesterone (Depo-Provera) ormegestrol acetate (Megace) is used forestrogen dependent tumors. Tamoxifen (Novaldex), an antiestrogen, alsomaybe prescribed.
    • Surgical interventions Total abdominal hysterectomy and bilateralsalpingo-oophorectomy
    •  Breast cancer is classified as invasive when itpenetrates the tissue surrounding the mammaryduct and grows in an irregular pattern. Common sites of metastasis are the bones, lungs;metastasis also occurs to the brain and liver. Diagnosis is made by breast biopsy through aneedle aspiration or by surgical removal of thetumor with microscopic examination for malignantcells. Prevention : MONTHLY BSE
    •  Family history Early menarche and late menopause Previous cancer of the breast, uterus or ovaries Nulliparity Obesity High dose radiation exposure to chest High fat diet
    •  Advice clients to reduce the amount of fat in thediet. Early detection includes: BSE once a month Yearly breast exam by a health care provider Baseline mammogram between the ages 35-39 Yearly mammogram after the age 40
    •  Mass felt during BSE Mass usually felt in the upper outer quadrant orbeneath the nipple. A fixed, irregular noncapsulated mass A painless mass except in late stages Nipple retraction or elevation Asymmetry, with affected breast being higher Bloody or clear nipple discharge Skin dimpling, retraction, or ulceration
    •  Skin edema or peau d’ orange skin Axillary lymphadenopathy Lymphedema of the affected arm Symptoms of bone and lungs metastasis Presence of the lesions on mammography
    •  Chemotherapy Radiation therapy Hormonal manipulation via the use of medicationin postmenopausal women or other medicationssuch as tamoxifen (Novadex) for estrogenreceptor positive tumors
    •  Surgical breast procedures with possible breastreconstruction Oophorectomy for estrogen receptor – positivetumors Ablative therapy with adrenalectomy or chemicalablation, which blocks the production of cortisol,androstenedione, and aldosterone.
    •  Diet high in complex carbohydrates , grains andsalt, and low in fresh, green leafy vegetables andfresh fruit Smoking Alcohol ingestion The use of nitrates History of gastric ulcers
    •  Fatigue Anorexia and weight loss Nausea and vomiting Indigestion and epigastric discomfort A sensation of pressure in the stomach Dysphagia Anemia Ascites Palpable mass
    •  Monitor vital signs. Monitor hemoglobin and hematocrit andadminister blood transfusions as prescribed. Monitor weight. Assess nutritional status; encourage small,bland, easily digestible meals with vitamin andmineral supplements. Administer pain medications as prescribed. Prepare the client for chemotherapy or radiationas prescribed. Prepare the client for surgical resection of thetumor as prescribed.
    • Subtotal GastrectomyBillroth I also called gastroduodenostomy partial gastrectomy, with remaining segmentanastomosed to the duodenumBillroth II also called gastrojejunostomy partial gastrectomy, with remaining segmentanastomosed to the jejunum.
    • Total Gastrectomy also called esophagojejunostomy removal of the stomach with attachment of theesophagus to the jejunum or duodenum.
    •  the most common neoplasm affecting thepancreas. the occurrence of pancreatic cancer has beenlinked to diabetes mellitus, alcohol use, history ofprevious pancreatitis, smoking, ingestion of highfat diet, and exposure to environmentalchemicals. symptoms usually do not occur until the tumor islarge; therefore the prognosis is poor.
    •  nausea and vomiting jaundice unexplained weight loss clay-colored stools glucose intolerance abdominal pain
    •  Radiation Chemotherapy Whipple’s procedure Postoperative care measures are similar to careof a client with pancreatiitis and the clientfollowing gastric surgery.
    •  Intestinal tumors are malignant lesions thatdevelop as polyps in the colon or rectum. Complications include bowel perforation withperitonitis, abscess and fistula formation,hemorrhage and complete intestinal obstruction. Metastasis occurs via the circulatory or lymphaticsystem or by direct extension to other areas in thecolon or other organs.
    •  blood in the stools anorexia, vomiting and weight loss malaise anemia abnormal stools- ascending colon tumor : diarrhea- descending colon tumor : constipation or somediarrhea, or flat ribbonlike stool resulting frompartial obstruction- rectal tumor : alternating constipation anddiarrhea
    •  guarding or abdominal distention abdominal mass (late sign) cachexia (late sign)
    •  Monitor for signs of complications, which includebowel perforation with peritonitis, abscess orfistula formation, hemorrhage and completeintestinal obstruction. Monitor for signs of bowel perforation, whichinclude low blood pressure, rapid and weak pulse,distended abdomen and elevated temperature. Note that an early sign of intestinal obstruction isincreased in peristaltic activity, which produces anincreased in bowel sound; as the obstructionprogresses, hypoactive sounds are heard
    •  Prepare for radiation preoperatively to facilitatesurgical resection, and postoperatively todecrease the risk of recurrence or to reduce pain ,hemorrhage, bowel obstruction, or metastasis. Chemotherapy is used postoperatively to assist inthe control of symptoms and the spread of thedisease.
    •  Colon cancer is cancer of the large intestine(colon), the lower part of your digestive system Most cases of colon cancer begin as small,noncancerous (benign) clumps of cells calledadenomatous polyps. Over time some of thesepolyps become colon cancers.
    •  A change in your bowel habits, including diarrheaor constipation or a change in the consistency ofyour stool for more than a couple of weeks Rectal bleeding or blood in your stool Persistent abdominal discomfort, such ascramps, gas or pain Abdominal pain with a bowel movement A feeling that your bowel doesnt emptycompletely Weakness or fatigue Unexplained weight loss
    •  Age A personal history of colorectal cancer or polyps Inflammatory intestinal conditions Inherited disorders that affect the colon Family history of colon cancer and colon polyps Diet low in fiber and high in fat and calories A sedentary lifestyle Diabetes
    •  Obesity Smoking Alcohol Radiation therapy for cancer
    •  Cancer signs: rectal bleeding, change in stools,pain in the abdomen, and pressure on the rectum Early detection includes an annual digital rectalexam starting at age 40, an annual stool bloodtest starting age 50 and an annual inspection ofthe colon (sigmoidoscopy) at the age 50
    •  Is a malignant tumor of the lung that may beprimary or metastatic. The lungs are the common target of metastasis. Bronchiogenic carcinoma spreads through directextension and lymphatic dissemination. The four major types of lung cancer includesmall cell (oat cell), epidermal (squamous cell),adenocarcinoma, and large cell anaplasticcarcinoma.
    •  Diagnosis is made by a chest x-ray, which willshow a lesion or mass, and bronchoscopy andsputum studies, which will demonstrate apositive cytological study for cancer cells.
    •  Cigarette smoking Exposure to environmental pollutants Exposure to occupational pollutants
    •  dyspnea hemoptysis chronic coughing or change in regular coughingpattern wheezing chest pain or pain in the abdomen cachexia, fatigue and loss of appetite dysphonia clubbing of the fingernails dysphagia
    •  Monitor vital signs. Monitor breathing patterns and breath soundsand for signs of respiratory impairment. Assess for tracheal deviation Administer analgesics as prescribed for painmanagement. Place in Fowler’s position for ease in breathing. Administer oxygen as prescribed andhumidification to moisten and loosen secretions. Monitor pulse oximetry.
    •  Provide respiratory treatments as prescribed. Administer bronchodilators and corticosteroidsas prescribed to decrease bronchospasm,inflammation and edema. Provide a high-calorie, high protein, high vitamindiet. Provide activity as tolerated , rest periods andactive and passive range-of-motion exercises. Monitor for bleeding, infection and electrolyteimbalances.
    •  Laryngeal cancer is a malignant tumor of thelarynx. Laryngeal cancer presents as malignantulcerations with underlying infiltration. Metastasis to the lungs is common. Diagnosis is made by laryngoscopy and biopsyshowing a positive cytological study for cancercells.
    •  Cigarette smoking Exposure to environmental pollutants Exposure to radiation Voice strain
    •  Persistent hoarseness and sore throat Painless neck mass A feeling of a lump in the throat Burning sensation in the throat Dysphasia Change in voice quality Dyspnea Weakness and weight loss Hemoptysis Foul breath odor
    •  Place in Fowler’s position to promote optimal airexchange. Monitor respiratory status. Monitor for signs of aspiration of food and fluids. Administer oxygen as prescribed. Provide respiratory treatments as prescribed. Provide activity as tolerated. Provide a high-calorie, high-protein, high-vitamindiet.
    •  Provide nutritional support via total parenteralnutrition, nasogastric tube feedings, gastrostomyor jejunostomy tube as prescribed. Administer analgesics as prescribed for pain.
    •  This slow-growing cancer of the prostate gland isusually a Androgen dependent type of carcinoma. The risks increases in men with each decadeafter age 50. Prostate cancer can spread via direct invasion ofsurrounding tissuesor by metastasis, through thebloodstream and lymphatics, to the bony pelvisand spine. Bone metastasis is a concern.
    •  Asymptomatic Hard, pea-sized nodule palpated on rectalexamination. Hematuria Late symptoms such as weight loss, urinaryobstruction, and pain radiating form thelumbosacral area down the leg.
    •  Prostatic-specific antigen test is not necessarilyan indicator of malignancy and use is routine tomonitor the client’s response to therapy Spread and mestastasis is indicated by elevatedserum acid and phosphatase.
    •  Age Race or ethnicity Family history High-fat diet High testosterone levels Occupations exposed to harmful chemicals
    •  There are no preventive guidelines Early detection includes an annual digital rectalexam at age 40
    • Non-surgical Prepare the client for hormone manipulationtherapy as prescribed. Prepare the client for radiation therapy, whichmay be prescribed alone or along with surgeryand may be prescribed pre-operatively or post-operatively to reduce the lesion and limitmetastasis. Prepare the client for the administration ofchemotherapy in cases of hormone-resistanttumors.
    • Surgical TURP Suprapubic Prostatectomy Retropubic Prostatectomy Perineal Prostatectomy
    •  Is a malignant lesion of the skin, which may ormay not metastasize. Causes include chronic friction and irritation to askin area and exposure to ultraviolet rays .Diagnosis: Is confirmed by a skin biopsy that is positive forcancer cells.
    •  Basal cell – the most common type of skincancer, basal cell cancer arises from the basalcells contained in the epidermis. Squamous cell – the second most common typeof skin cancer in whites, it is a tumor of theepidermal keratinocytes and can infiltratesurrounding structures, metastasize tolymphnodes, and be subsequently fatal.
    •  Malignant melanoma – cancer of themelanocytes, can metastasize to the brain ,lungs, bone, liver and skin.
    •  Change in color, size, or shape of pre existinglesions Pruritus Local Soreness
    • Appearance of skin cancer lesions: waxy nodule irregular, circular, bordered lesions with hues oftan, black, or blue small, red, nodular lesion oozing, bleeding, crusting lesion
    •  Instruct the client regarding preventive measures. Instruct the client to monitor for lesions that donot heal or that change characteristics. Instruct the client to have moles or lesionsremoved that are subject ot chronic irritation. Instruct the client to avoid contact with chemicalirritants.
    •  Instruct the client to wear layered clothing anduse sun screening lotions with an appropriateskin protection factor when outdoors. Instruct the client to avoid sun exposure between11 am to 3 pm. Assist with surgical excision of the lesion asprescribed.
    •  A malignant exacerbation in the number ofleukocytes, usually at an immature stage, in thebone marrow. May be acute, with a sudden onset and shortduration, or chronic, with a slow onset andpersistent symptoms over a period of years. Leukemia affects the bone marrow causinganemia, leukopenia, the production of immaturecells, thrombocytopenia and a decline inimmunity.
    •  Genetic Viral Immunological Environmental factors Exposure to radiation Medications
    •  Acute Lymphocytic Leukemia – mostlylymphoblasts , age of onset is less than 15years. Acute Myelogenous Leukemia – mostlymyeloblasts present in bone marrow, age ofonset is between 15 and 39 years Chronic Myelogenous Leukemia – mostlygranulocytes present in bone marrow, age ofonset is after 50 years Chronic Lymphocytic Leukemia – mostlylymphocytes present in bone marrow, age ofonset is after 50 years
    •  Anorexia, fatigue, weakness, weight loss Anemia Bleeding (nosebleeds, gum bleeding, rectalbleeding, increased menstrual flow) Petechiae Prolonged bleeding after minor abrasions orlacerations Elevated Temperature Lymphadenopathy and splenomegaly Palpitations, tachycardia, orthostatic hypotension
    •  Pallor, dyspnea on exertion Headache Bone pain and joint swelling Normal, elevated or reduced white blood cellcount Decreased hemoglobin and hematocrit levels Decreased platelet Positive bone marrow biopsy identifyingleukemic blast phase cells
    •  Malignancy of the lymph nodes that originates ina single lymph node or a single chain of nodes. The disease usually involves lymph nodes,tonsils, spleen, and bone marrow and ischaracterized by the presence of the Reed-Sternberg cell in the nodes. Possible causes include viral infections andprevious exposure to alkylating chemicalagents.
    • Stage I Involvement of s single lymph node region or anextra lymphatic organ or siteStage II Involvement of two or more lymph node regionson the same side of the diaphragm or localizedinvolvement of an extralymphatic organ or site
    • Stage III Involvement of lymph node regions on both sideof the diaphragmStage IV Diffuse or disseminated involvement of one ormore extralymphatic organs with or withoutassociated lymph node involvement
    •  Fever Malaise, fatigue, and weakness Night sweats Loss of appetite and significant weight loss Anemia and thrombocytopenia Enlarged lymph nodes, spleen and liver Positive biopsy of lymph nodes, with cervicalnodes most often affected first Presence of Reed-Sternberg cells in nodes Positive computed tomography scan of the liverand spleen
    •  For Stages I and II without mediastinal nodeinvolvement, the treatment of choice isextensive external radiation of the involvedlymph node regions. With more extensive disease, radiation alongwith multi agent chemotherapy is used. Monitor for side effects related to chemotherapyor radiation therapy. Monitor for signs of infection and bleeding.
    •  Maintain infections and bleeding precautions. Discuss the possibility of sterility with the maleclient receiving radiation, and inform the clientof options related to sperm banks.
    •  A malignant proliferation of plasma cells andtumors within the bone. An excessive number of abnormal, plasma cellsinvade the bone marrow, develop into tumors ,and ultimately destroy bone; invasion of thelymph node, spleen, and liver occurs. The abnormal plasma cells produce anabnormal antibody (myeloma protein or BenceJones protein) that is found in the blood andurine.
    •  Bone pain, especially in the pelvis, spine andribs Weakness and fatigue Recurrent infections Anemia Bence-Jones proteinuria and elevated totalserum protein level Osteoporosis Thrombocytopenia and granulocytopenia
    •  Elevated calcium and uric acid levels Renal failure Spinal cord compression and paraplegia
    •  Monitor for signs of bleeding, infection, andskeletal fractures. Encourage fluids up to 3 to 4 L a day to offsetpotential problems associated withhypercalcemia, hyperuricemia and proteinuria. Encourage ambulation to prevent renalproblems and to slow down bone resorption. Provide skeletal support during moving, turningand ambulating to prevent pathological fractures
    •  Provide a hazard –free environment. Instruct the client in home care measures andthe signs and symptoms of infection.