1. ONCOLOGY NURSING
BENIGN MALIGNANT
Differentiation Well-differentiated Undifferentiated
Encapsulation (+) (-)
Metastasis (-) (+)
Prognosis Good Bad
Therapeutic Modality Surgery Surgery
Radiation
Chemotherapy
Metastasis: cancer spread
Common Route: Lymphatics (thru lymph nodes), Hematogeneous (thru blood)
Common Site: Lungs, Liver, Bones, Brain
PREVENTION
Primary Prevention: Healthy Individuals → Health Teaching
● Diet - low fat, high fiber, avoid nitrates (processed/canned foods)
Cruciferous food (cancer-fighting food): Cabbage, Cauliflower, Broccoli
● Exercise - reduce obesity
BMI computation: weight (kg) / height (meter squared)
Normal BMI: 18.5 - 24.9
Underweight < 18.5
Overweight 25.0 - 29.9
Obese > 30.0
● Warning Signs of Cancer : CAUTION US
C - Change in bowel / bladder habit
alternating diarrhea and constipation: Colorectal Cancer
painless, visible hematuria : Bladder Cancer
A - A sore that does not heal
U - Unusual bleeding
T - Thickening or Lump
I - Indigestion / Dysphagia
O - Obvious change in mole
N - Nagging Cough
U - Unexplained Anemia
S - Sudden weight loss
● Stop Smoking, Alcohol consumption
2. Secondary Prevention : High Risk Individuals → Early Detection/Diagnosis (Screening) and
Treatment
a) Breast Self Exam
- 7 days after menstruation (regular cycle)
- Same day each month (irregular cycle, menopausal, post-hysterectomy)
- Inspect for any asymmetry
- Palpate for lump in circular motion
- Squeeze for any abnormal discharges
b) Clinical Breast Exam
- every 3 years for ages <40 y.o. ; annually if > 40y.o.
c) Mammogram
- Compression of breast + X-ray findings
- Annually if >40 y.o.
- Avoid: deodorant, lotion, cream, powder - contain calcium oxalates to prevent
false positive reading
d) Testicular Self-Exam
- After warm shower to ensure relaxed testicles
- Palpate for lump and tenderness
- Monthly
e) Pap Smear
f) Colonoscopy and Sigmoidoscopy
- Baseline: 50 years old ; every 5 years (Sig.) and every 10 years (Col.)
CONFIRMATORY TEST: BIOPSY
- Excisional: Whole tumor
- Incisional: Part of the tumor
Tertiary Prevention: Diagnosed with cancer → Prevent complications
RADIATION THERAPY
- Localized treatment destroy cancer cells
Two types:
a) External Radiation (Teletherapy) - not radioactive
- SE: radiodermatitis : avoid irritants
- Do not erase the markings → guide
b) Internal Radiation (Brachytherapy) - radioactive
- prevent exposure to radiation
S - Shield - lead apron
T - Time - maximum of 30 minutes
D - Distance - 6 feet away
3. Avoid: Pregnant and Children as visitors
Private room, attach door Radiation Sign
Docimeter Badge - measures the amount of exposure to radiation
- Prevent dislodgement of radiation implant
Complete Bed Rest
Foley Catheter, Bedpan
Low fiber diet - to prevent excessive bowel movement
Low Fowlers / Supine
- Dislodgement of implant
If visible/seen:
pick up the implant with long-handled forceps and place it in the lead container
If not visible/seen:
call radiation team
- Resumption of sex: 6 weeks
CHEMOTHERAPY
- Systemic treatment : destroys both the normal and cancer cells
General effects:
Hair : alopecia (temporary)
Skin: dermatitis
Oral Mucosa: stomatitis, dry mouth (xerostomia)
Bone Marrow Suppression: decreased in all blood cells (RBC, WBC, Platelets) = pancytopenia
Gastrointestinal Tract: nausea and vomiting, diarrhea
Vagina: vaginal dryness
Ovaries and Testes: infertility
Management of General effects
1. Bone Marrow Suppression
- Decreased RBC (anemia) - common complaint: fatigue
● Bed rest (balanced activity and rest)
● Give oxygen
● Blood transfusion in severe cases
- Decreased WBC (leukopenia/neutropenia) - high risk for infection
● Reverse isolation (protect the patient from the public) -
immunocompromised
● Hand washing
● Avoid: crowded places, fresh fruits, vegetables and flowers, raw food,
pets and toys with furs/feathers.
4. ● Drug of choice: filgastrim (Neupogen)
- Decreased Platelets (thrombocytopenia) : high risk for bleeding
● Prevent falls/injury: place bed in lowest position, raising side rails
● Avoid anticoagulants, antiplatelet, thrombolytics (-kinase)
● Avoid IM route of medication administration
● Bleeding precautions: soft-bristled toothbrush, electric razor, avoid rectal
procedures, avoid contact sports
2. Nausea and Vomiting
- Drug of choice: ondansetron (Zofran) - 30 minutes - 2 hours prior to chemo
- Ideally, NPO for 4 hours
- Monitor for intake and output ; acid-base imbalance : metabolic alkalosis
3. Diarrhea
- Diet: Low fiber
- Monitor for dehydration → rehydrate as necessary
- Monitor for electrolyte imbalance - hypokalemia → cardiac arrhythmias; Met.
Acidosis
- Intake and output
4. Alopecia
- Usually happens 2 - 3 weeks from the initiation of therapy
- Plan hair loss
- Hair regrowth: finer hair
- Nursing diagnosis: Body Image Disturbance
- Psychological counseling to be able to adapt/cope with condition
5. Stomatitis / Xerostomia
- Avoid irritants : spicy food, hot food, acidic food, alcohol and alcohol-containing
products
- Dry lips: use water-based solutions (KY jelly)
- Offer ice chips and popsicles, cold liquids
Chemotherapeutic Extravasation
- leakage of chemotherapeutic drug (vesicant drug)
- signs and symptoms: redness, burning sensation, pain
- Management: stop infusion
aspirate remaining drug
cold compress except for vinca alkaloids (warm compress)
Chemotherapeutic Drug Classes
a) Alkylating Agents
- cyclophosphamide (Cytoxan)
- cisplatin (Platinol)
Common side effect: Hemorrhagic Cystitis - increase fluid intake
