The document provides information on various topics related to oncology and cancer treatment. It defines oncology as the branch of medical science dealing with tumors, and cancer as uncontrolled growth of abnormal cells that can spread. The stages of cancer are described using the TNM system which evaluates the size of the primary tumor (T), spread to lymph nodes (N), and metastasis (M). Common cancer treatment modalities are discussed, including chemotherapy, radiation therapy, immunotherapy, hormone therapy, and surgery. Side effects of treatments are also summarized.

1. Prepared By : Spika Khatiwada

2. 
 Oncology: The branch of medical science
dealing with tumors including the origin,
development, diagnosis and treatment of
benign and malignant tumors.
 Oncology is the branch of science that deals
with the study of cancer
Definition

3. 

4. 
 Cancer is a group of neoplastic diseases in which
there is a transformation of normal body cells into
malignant ones.
OR
Uncontrolled and rapid growth of abnormal cells in
human body and its invasion to adjoining parts of the
body which may also spread to other distant organ
from original site is called Metastasis.
Cancer

5. 
 A tumor, also known as neoplasm is an abnormal
mass of tissue which may be solid or fluid- filled that
can be either benign ( non-cancerous) or malignant
(cancerous).
 Benign Tumors aren’t cancerous and can often be
removed. In most of the cases they don’t possess any
health risk and don’t come back.
 Malignant Tumor are cancerous, they can invade
nearby tissues and spread to other parts of the body.
Tumor

6. 
A carcinogen is something that can cause
cancer. Examples includes cancer causing
chemicals, viruses and environmental
exposures.
Physical carcinogens: UV rays and ionizing
radiations
Chemical carcinogens: Asbestos, Tobacco
,Smoke Arsenic
Biological Carcinogens: Infection from
micro-organisms
Carcinogens

7. 
 Ciggerate smoking
 Infections
 Radiation exposures
 Immunosuppressive medicines
 Diet
 Alcohol
 Obesity
 Environmental factors
Risk factors of cancer

8. 

9. 

10. 

11. 

12. 
 The TNM Staging System
 The TNM system is the most widely used
cancer staging system. Most hospitals and medical
centers use the TNM system as their main method
for cancer reporting.
TNM classification of
the cancer

13. 
 In the TNM system:
 The T refers to the size and extent of the main tumor.
The main tumor is usually called the primary tumor
 The N refers to the number of nearby lymph nodes
that have cancer.
 The M refers to whether the cancer has metastasized
This means that the cancer has spread from the
primary tumor to other parts of the body.

14. 
 Primary tumor (T)
 TX: Main tumor cannot be measured.
 T0: Main tumor cannot be found.
 T1, T2, T3, T4: Refers to the size and/or extent of the
main tumor. The higher the number after the T, the
larger the tumor or the more it has grown into
nearby tissues. T's may be further divided to provide
more detail, such as T3a and T3b.

15. 
 Regional lymph nodes (N)
 NX: Cancer in nearby lymph nodes cannot be
measured.
 N0: There is no cancer in nearby lymph nodes.
 N1, N2, N3: Refers to the number and location of
lymph nodes that contain cancer. The higher the
number after the N, the more lymph nodes that
contain cancer.

16. 
 Distant metastasis(M)
 MX: Metastasis cannot be measured.
 M0: Cancer has not spread to other parts of the body.
 M1: Cancer has spread to other parts of the body.

17. 
Differences between Benign
and malignant Tumors

18. 
Seven warning signs and symptoms of cancer according
to WHO
1. Unusual bleeding/ discharge
2. A sore that doesn’t heal
3. Change in bowel and bladder habit
4. Lump in breast or other parts of body
5. Nagging cough
6. Obvious change in color in moles (ABCD)
7. Difficulty swallowing
Warning signs and
symptoms

19. 

20. 

21. 

22. 

23. 
 It is divided according to boarder categories
 Carcinoma: cancer that begins in the skin or in tissues
that line or cover internal organs (epithelial tissues)
(epithelial cells are found in breast, skin, cervix, stomach
prostate)
 Sarcoma: cancer that begins in bone, cartilage, fat, muscle,
blood vessels or other connective tissues.
 Leukemia: cancer that starts in blood forming tissues
such as the bone marrow and causes large numbers of
abnormal blood cells to be produced and enter the blood.
Types Of Cancer

24. 

25. 

26. 
Leukemia

27. 
 Lymphoma: cancers that begins in the cells of
immune systems.
 Central nervous system cancer: cancers that begin in
the tissues of the brain and spinal cord.

28. 

29. 

30. 
 Level of prevention:
 Primary prevention
 Secondary prevention
 Tertiary prevention
Cancer prevention

31. 
 Cancer prevention is a reduction in the risk of
developing clinically evident cancer.
 The primary prevention focuses on minimizing or
eliminating exposure to carcinogenic agents which
can be done by:
a) Dietary modification
b) Prevention and control of infectious agents
c) Control of excessive exposure to radiation
d) Control of the sunlight exposure
e) Control of the chemical/environmental risk factors
f) Personal Hygiene maintenance
g) Prevention and control of occupational hazards

32. 
 Secondary Prevention means early detection and
treatment of cancer. It is best achieved through
effective use of screening.
 Early detection
 Early diagnosis
 Screening

33. 

34. 

35. 
 Tertiary prevention is focused on monitoring for and
preventing the recurrence of the originally
diagnosed cancer and screening for second primary
cancers and long term effects of treatment in cancer
survivors. The focus of this form of prevention is
aimed at detecting complications and second cancers
in long term survivors when treatment is most likely
to be effective and ultimately improve their quality
of life.

36. 
 It may include tumors markers identifications,
imaging studies, mammography, MRI,CT ,USG ,
endoscopy, smear, biopsy, nuclear medicine
imaging.
Different diagnostic
procedures for cancer

37. 
 A cancer may be suspected of various reasons, but
the definitive diagnosis of most malignancies must
be confirmed by histological examination of the
cancerous cells by a pathologist. Tissue can be
obtained from a biopsy or surgery.
 It means removal of small pieces of living tissue from
an organ or a part of body for microscopic
examination for the diagnostic purpose of benign,
malignant other tumor.
Biopsy

38. 
Excisional biopsy
Incisional Biopsy
Tru-cut biopsy
Punch biopsy
Types of biopsy

39. 
Incisional Biopsy

40. 
Excisional Biopsy

41. 

42. 
Tru-cut biopsy

43. 
Punch Biopsy

44. 

45. 
 Before Procedure:
 Explain the procedure
 Collect all preoperative report blood grouping,
complete blood count, bleeding time, clotting time
 consent
 Assess vitals
 Ready the biopsy set and assist if necessary
 Gowning the patient and position maintain.
 Expose the area of biopsy
Patient preparation

46. 
 After procedure:
 Assess the vital sign
 Positioning the patient
 Label the sample correctly
 Explain about the medication, follow-up and report
dressing and suture removal.
 Proper dispatch the sample to the library
 Recording and reporting.

47. 
 It is a specific type of imaging that uses low doses X-
ray system modalities without any effect or hazards.
It is used for the early detection and diagnosis of the
breast disease in the women including both
symptomatic or asymptomatic disease.
 Screening Mammography
 Diagnostic Mammography
Mammogram

48. 

49. 
 Women of 40 or more years of age or after
menopause
 Family hx of breast disease
 Women on hormonal therapy
 Women having palpable lump
 Frequently exposed to chemical or radiation
 Women who have cosmetic surgery and silicone
implants
Criteria for Screening
Mammography

50. 
 Women having obvious lump with family hx
 Women having obvious signs and symptoms of
breast cancer
 Women recommended for mammography by the
physician or the doctors
 Women who has previous breast surgery
 Women who has auxillary and clavicles
lymphadenopathy
Criteria for Diagnostic
Mammography

51. 
 Pap smear test is a test of sample of cells taken form
the woman’s cervix or vagina. The test is done to
look for the changes in the cells of cervix and vagina.
 The purpose of this test is to detect early cancer of
the cervix and to identify the conditions such as
infections and inflammation of cancer.
PAP smear test

52. 

53. 
 Nurse should advise patient to make an
appointment other than during menstruation
(Before appointment )
 Avoid intercourse for 2 days
 Refrain from douching for 1 day
 Cease the use of vaginal medication for at least 48
hours.
Patient preparation

54. 
1. Inform and explain the procedure to patient
2. Advice patient to void.
3. Provide privacy.
4. Assist patient to be in Lithotomy position to her on
examining table
5. Drape patient permit minimal exposure.
Pre-Procedure

55. 
Post procedure
 Observe for any kind of discharge through vagina
 Perineal care as needed
 Comfortable position
 Documentation
 Proper dispatch of the sample

56. 
 VIA is the naked eye inspection of the cervix after
application of 3–5% acetic acid.
 VIA is safe, rapid, reliable and inexpensive.
 Acetic acid acts by coagulating the protein of the
surface epithelium.
 Pre-cancers contain more protein which gets
coagulated and gives an whitish (ace to white)
appearance.
 Wait for at least 1 minute for acetic acid to be
absorbed and white area to appear.
VIA(Visual Inspection
with acetic acid)

57. 
 Distinct white opaque area indicates a positive test.
 VIA negative women should get a repeat test done
after 5 years

58. 

59. 
 Visual inspection with Lugol’s iodine (VILI), also
known as Schiller’s test, uses Lugol’s iodine instead
of acetic acid.
 It involves performing a vaginal speculum exam
during which a health care provider applies Lugol’s
iodine solution to the cervix, viewing the cervix with
the naked eye to identify color changes on the cervix,
Determining whether the test result is positive or
negative for possible precancerous lesions or cancer.
VILI

60. 

61. 
Nuclear Imaging

62. 

63. 
 The major types of treatment are:
 Chemotherapy
 Radiotherapy
 Immunotherapy
 Hormonal Therapy
 Surgery/ Bone marrow transplantation
 Rehabilitation
Cancer treatment
modalities

64. 
Chemotherapy is the treatment of cancer
using specific chemical agents or drugs that
are destructive to malignant cells and tissues.
The term comes from two words that mean
"chemical" and "treatment." Cytotoxic
literally translated means ‘toxic to cells’.
It may be combined with surgery or
radiotherapy or both to reduce tumor size
pre-operatively.
Chemotherapy

65. 
 Primary Chemotherapy
 Adjuvant Chemotherapy
 Neo-adjuvant Chemotherapy
 Concurrent Chemotherapy
Modes of Chemotherapy

66. 
 Cure
 Control
 Palliation
 Prevention
Goals of chemotherapy

67. 

68. 
 Tumor lysis syndrome
 Haematopoietic effect
 GI effects
 Hepatic effect
 Renal Effects
 Integumentary effects
 Reproductive effects
 Neurological effects
Side effects of
chemotherapy

69. 
 Imbalanced nutrition less than body requirement
related to disease process and treatment.
 Impaired tissue integrity related to cancer treatment
 Disturbed body image and situational low self
esteem related to changes in appearance,roles and
function
 Risk for infection related to altered immunological
response
 Risk for injury related to side effects secondary to
chemotherapy
Nursing Management

70. 

71. 
RT uses high energy radiation such as X-ray or
gamma rays to destroy cancer cells and stop
them form growing and multiplying. It is the
method of cure for certain localized cancer.
Radiation is used alone in cases where a tumor is
unsuitable for surgery. More often it is used for
conjunction with surgery and chemotherapy.
Radiation Therapy

72. 
 Radiation destroys a cell’s ability to reproduce by
damaging its DNA, delaying mitosis to repair DNA
or inducing apoptosis.
Mode of action

73. 

74. 
 Teletherapy (External Beam Radiation Therapy)
 Brachytherapy (Internal radiation Therapy)
Types

75. 

76. 

77. 

78. 
 Alpha Rays
 Beta Rays
 Gamma Rays
Types of radioactive
rays

79. 
In general, skin reactions from mild erythema to
moist desuamation and fatigue may occur after
radiation therapy.
Side effects like skin tenderness are generally limited
to the area receiving radiation.
Radiation doesn’t usually cause hair loss and nausea
like chemotherapy
Side effects begin during the 2nd and 3rd week of
treatment and may last for several weeks after final
treatment.
Side effects of RT

80. 
 Side effects also depends on the site of the radiation
such as radiation for head and neck causes dry
mouth, dental problems, mucositis.
 Radiation at pelvic area causes cystis, diarrhoea and
constipation

81. 
Some Common Side effects of radiation therapy are:
 Fatigue
 The skin becomes red,dry,itchy and colour change.
 Alopecia
 Anorexia
 Some patients may experience Nausea and vomiting

82. 
 Answer the queries and allay the fear of patient and
family about the effects of radiation on other parts.
 Explain about procedure of radiation therapy e.g. it
is painless, duration of treatment, importance of
taking nutritious diet including plenty of fluids and
avoid alcohol, tobacco strictly.
 Patient may resume sexual activities if he or she is
comfortable
Nursing care for patients
with radiation therapy

83. 
 Assess patients skin and oropharyngeal mucosa and
maintain personal hygiene and good oral care.
 Assess the nutritional status well
 Protect the treatment area form sunlight
 Advice not to rub, scrub on treated skin area
 Advice to wear soft, cotton clothes
 Don’t apply very hot or cold on the treatment area and
avoid cosmetics
 Advice to take frequent small meals

84. 
 Watch for the side effects and manage each effect
properly
 Check the blood count
 Stop the radiation if he/she has complained
diarrhea, fever or abnormal report.
 Proper recording and reporting.

85. 
 It uses body’s own immune system to destroy cancer
cells. It isn't widely used as it requires many clinical
trails.
 Immunotherapy targets the immune system rather
than the cancer cells.
Immunotherapy

86. 

87. 
 Check-point Inhibitors
 Monoclonal antibodies
 Adoptive cell transfer
 Topoisomerase Inhibitors
 Cancer Vaccines (Sipuleucel-T, laherparepvec (T-
VEC)
 Immunomodulators
Types of
Immunotherapy

88. 
Hormone Therapy

89. 
It is a standard treatment used to treat cancer
of prostate, breast and uterus.
Hormone therapy involves blocking the
production or action of these hormones as a
result, growth of tumor slows down.
In some cases hormone therapy is used in
combination with other treatments such as
chemotherapy and radiotherapy.
Hormone therapy

90. 

91. 
 Hot-flashes
 Loss of bone density
 Loss of libido
 Weight gain
 Mood swings
 Fatigue
 Nausea and Vomiting
Side-Effects

92. 
 This is the process of replacing the bone marrow
with healthy cells especially performed in case of
blood cancer.
Bone Marrow
Transplant

93. 

94. 
 Surgery is the removal of the visible tumor and near
by tissues .It is the most frequently used for cancer
treatment.
 It can be prophylactic, palliative or reconstructive
 It can be used for treatment, prevention and
diagnosis.
 It can be used to remove the entire tumor, debulk a
tumor or to ease cancer symptoms
Surgery

95. 
 Pre-operative management
 Intra-operative management
 Post-operative management
Nursing Care of patient
undergoing surgery

96. 

97. 
 It is a treatment to relieve symptoms rather than cure. It
helps people to live more comfortably.
 Relief from physical, psychosocial and spiritual problem
can be achieved in 90 percentage of advance cancer.
 Palliative care is the approach that improves the quality of
life of patients and their families facing problems with life
threatening illness through the prevention and relief of
suffering by means of early identification, treatment of
pain, other problems, physical, psychological and spiritual.
(WHO 2002)
Palliative care

98. 
 Pain is an unpleasant sensory and emotional
experience associated with actual or potential tissue
damage and described in terms of such damage.
 Causes of pain in cancer:
 Pain form the tumor
 Pain from the cancer treatment
 Pain form other associated symptoms.
Pain Management in
Cancer

99. 
 Acute Pain: pain that comes quickly, may be sever
but lasts for short period of time.
 Incidental pain: pain occurring on particular
movements.
 Chronic pain: pain that may range from mild to
severe and persists over a long period of time.
 Breakthrough pain: chronic pain that occurs in
patients with chronic pain and is controlled by
medications.
Types of pain

100. 
 Assessment of pain
 Management of pain.
 Non-analgesic methods (massage, application of heat and
cold, TENS, relaxation therapy)
 Radiofrequency ablation
 Cryotherapy
 Stimulation induced analgesia
 Spinal cord stimulation
 Accupunture
 Psychological technique
Nursing management in
pain relief

101. 

102. 

103. 

104. 
 The WHO ladder of pain management:
 Step I: Mild Pain (Non-Opioid drug PCM,NSAIDs
+/- adjuvant drugs.
 Step 2: If pain persists weak opioid drug tramadol or
increase +/- non- opioid drug Codeine +/_ adjuvant
drugs.
 Step 3:If pain persists strong opioid drug Morphine
or increases +/- non opioid drug Methadone +/-
adjuvant drugs
Pharmacological Management
(WHO ladder)

105. 

106. 
 Bone/Muscle/pelvic pain = NSAIDS
 Neuropathic pain = Amitryptaline
 Colic Pain = Buscopan
 Nerve compression= Steriod
Adjuvant Drugs

107. 
 Cognitive therapy
 Behavioral therapy
 Heat and cold application
 Massage
 Relaxation therapy
 Diversion
 Cryotherapy
 Accupunture
 Physiotherapy/Radiotherapy/Surgery
Non-Pharmacological
Methods

108. 
 Terminally ill cancer patients are end stage patients
where care is more focused to reduce symptoms. At
terminal phase care received by the patient is the
palliative care or hospice care.
 Care is provided on 4 categories
 To relieve physical symptoms
 To reduce psychological symptoms
 Social needs
 Spiritual needs
Care of Terminally ILL
cancer patients

109. 

110. 
 Acute/chronic pain r/t injury or chronic disability
 Activity intolerance r/t generalized weakness,
immobility, pain
 Anticipatory grieving r/t death
 Ineffective family coping r/t psychological crisis
General nursing
measures

111. 
 Assessment of overall patient condition
 Pain management
 Personal hygiene
 Bowel/bladder care
 Nutritional Management
 Psychological support to patient and family
members
 Hospice care
Nursing interventions

112. 
 The spiritual care can be integrated into the
treatment in variety of ways
 Good IPR and exploration of spiritual believes
 Individual and group prayer
 Counseling and communication services
 Support with end of life issues and decisions
 Making provision for rituals,pray
Spiritual Care

113. 
 Loss
 Grief
 Mourning
 Bereavement
Loss,Grief, Mourning
and Bereavement

114. 

115. 

116. 

117. 

118. 
 According to Kubler Ross (DABDA), it includes
1) Denial
2) Anger
3) Bargaining
4) Depression
5) Acceptance
Stages of Grieving

119. 

120. 
 Hospice isn't a place or just a building, but a concept
of care or a way of caring people in which the end of
life is viewed as a developmental stage.
 Hospice care focuses on caring, not curing and only
life but also death
 All hospice care is palliative but all palliative care
isn’t hospice.
Hospice Care(EOLC)

121. 
 Death must be accepted
 Patients care is best managed by an interdisciplinary
team whose members communicate regularly with
each other
 Pain and other symptoms of terminally illness must
be managed
 Home care of dying is necessary
 Bereavement care must be provided to family
members
 Research and education must be ongoing
Principles

122. 
 Helping people live through their final days and die
with dignity and comfort among family and friends
 Provide care which integrates and nurtures the
mind, body and spirit.
 Facilitate decision making by individual and their
families
Goals of hospice care

123. 
 Doctors
 Nurses
 Home health aids
 Spiritual counselors
 Social workers
 Volunteers
 Bereavement counselors
Hospice Team

124. 
 Patient assessment
 Patient and family education
 Co-ordination of care
 Direct patient care
 Symptoms management and supportive care
Role of oncology nurse

125. 
 Prognosis
 Pain management
 With holding and withdrawing medications
 Resuscitation
 Mechanical Ventilation
 Nutrition and hydration
 Antibiotic treatment
Ethical Issues in EOLC