This document provides information on oncology nursing objectives and cancer pathophysiology. It defines key terms like neoplasia, tumors, and cancer. It describes the biological process of oncogenesis and carcinogenesis. It discusses cancer cell proliferation patterns and etiology factors like viruses, chemicals, genetics, diet, and hormones. It also covers cancer detection, diagnosis, staging, grading, and primary treatment methods including surgery, radiation therapy, and chemotherapy.

1. Oncology nursing

2. learning objectives
• Difine neoplasia and tumor
• Biology of oncogenesis/pathophysiology
• Types, nomenclature, and features neoplasm
• Identify pharmacologic interventions for patients with
oncology disorders

3. DEFINITION:
• Oncology: A branch of medicine that specializes in the
diagnosis and treatment of cancer.
• Literally ( Neoplasia-‘new growth’)
• "an abnormal mass of tissue the growth of which
exceeds and is uncoordinated with that of the normal
tissues and persists in the same excessive manner after
the cessation of the stimuli which evoked the change."

4. • Excessive and persistent growth and
proliferation of tissue after cessation of the
stimulus, evoking the transformation.
• So the growth is irreversible
• Autonomous (independent of the physiologic
hormonal stimulation)

7. Pathophysiology of the Malignant
Process
• abnormal cell is transformed by the genetic
mutation of the cellular DNA
• forms a clone and begins to proliferate
abnormally
• The cells acquire invasive characteristics
• metastasis (cancer spread to other parts of
the body)

8. PROLIFERATIVE PATTERNS
• hyperplasia
• metaplasia
• dysplasia
– bizarre cell growth resulting in cells that differ in
size, shape, or arrangement from other cells of the
same type of tissue

9. • Anaplasia
– cells that lack normal cellular characteristics and
differ in shape and organization with respect to their
cells of origin; usually, anaplastic cells are malignant.
• Neo-plasia: uncontrolled cell growth that
follows no physiologic demand
• Cancer = malignant neoplasm

11. Carcinogenesis
• three-step cellular process: initiation,
promotion, and progression.
• Initiation is an exposure of cellurar DNA to
carcinogen that leads to an alteration in
cellular DNA.
– Protective mechanism: repair or
Apoptosis(suicide)

12. • If the altered cell escape both mechanism
promotion stage begin;
• repeated exposure to promoting agents (co-
carcinogens) causes the expression of abnormal
or mutant genetic information
• Progression: increased malignant behavior

13. ETIOLOGY
• viruses and bacteria,
• physical agents,
• Chemical agents
• genetic or familial factors,
• dietary factors, and
• Hormonal agents.

14. Viruses and Bacteria
• Epstein-Barr virus :
– Burkitt’s lymphoma, nasopharyn-geal cancers, and some types of non-Hodgkin’s
lymphoma and Hodgkin’s disease.
• HSV type II, CMV, and HPV types 16, 18, 31, and 33
– dys-plasia and cancer of the cervix.
• HBV : cancer of the liver;
• human T-cell lymphotropic :lymphocytic leukemias and lym-phomas;
• HIV is as-sociated with Kaposi’s sarcoma.
• Helicobacter pylori gastric malignancy,

16. Physical Agents
• Exposure to sunlight
• radiation,
• chronic irritation or inflammation,
• tobacco use.

17. Chemical Agents
• About 75% of all cancers are thought to be
related to the envi-ronment.
• Tobacco smoke, thought to be the single most
lethal chemical carcinogen,
– cancers of the lung, head and neck, esophagus,
pancreas, cervix, and bladder.
• Chewing tobacco is associated with cancers of
the oral cavity

18. • aromatic amines and aniline dyes;
• pesticides and formaldehydes;
• arsenic, soot, and tars;
• asbestos; benzene; betel nut and lime;
cadmium;
• chromium compounds; nickel and zinc ores;
wood dust; beryl-lium compounds; and
polyvinyl chloride.

19. Genetic and Familial Factors
• Almost every cancer type has been shown to
run in families
• This may be due to genetics, shared
environments, cultural or lifestyle factors, or
chance alone.

20. Dietary Factors
• Dietary substances can be proactive
(protective), carcinogenic, or co-carcinogenic.
• The risk for cancer increases with long-term
ingestion of car-cinogens or co-carcinogens or
chronic absence of proactive sub-stances in
the diet.

21. • increased cancer risk include
– fats, alcohol, salt-cured or smoked meats, foods contain-ing
nitrates and nitrites, and a high caloric dietary intake
• reduce cancer risk include
– high-fiber foods, cruciferous vegetables (cabbage, broccoli,
cauliflower, Brussels sprouts, kohlrabi), carotenoids (carrots,
tomatoes, spinach, apricots, peaches, dark-green and deep-
yellow vegetables), and pos-sibly vitamins E and C, zinc, and
selenium.

22. • Obesity is associated with endometrial cancer
and possibly postmenopausal breast cancers.
• Obesity may also increase the risk for cancers
of the colon, kidney, and gallbladder.

23. Hormonal Agents
• Disturbances in hormone may lead to cancer
development
• Diethylstilbestrol (DES): Vaginal carcinoma
• Endogenous hormone: prostate, uterine and
brest Cancer
• OCP: hepatocellular, endome-trial, and breast
cancers and decrease ovarian ca

24. ROLE OF THE IMMUNE SYSTEM
• immune sys-tem can detect the development
of malignant cells and destroy them before
cell growth becomes uncontrolled.
• Immunosuppression is linked to cancer
– lymphoma, Kaposi’s sarcoma, squamous cell
cancer of the skin, and cervical and anogenital
cancers.

25. Detection and Prevention of
Cancer
• PRIMARY PREVENTION
• Education
– avoid known carcinogens
– adopting dietary and various lifestyle changes
– Prophylaxis with medicine: tamoxifen: breast ca

26. • SECONDARY PREVENTION
• promote breast and testicular self-
examination and Papanicolaou (Pap) tests.
• Mammogram
• Screening of high risk individuals

27. Diagnosis of Cancer and Related
Nursing Considerations
• Patients with suspected cancer undergo extensive
testing to
(1) determine the presence of tumor and its extent,
(2) identify possible spread (metastasis) of disease or
invasion of other body tissues,
(3) evalu-ate the function of involved and uninvolved body
systems and organs, and
(4) obtain tissue and cells for analysis, including
evaluation of tumor stage and grade.

28. TUMOR STAGING AND GRADING
• A complete diagnostic evaluation includes
identifying the stage and grade of the tumor.
• Staging determines the size of the tumor and the
existence of metastasis.
• The TNM system is frequently used.
• T -extent of the primary tumor,
• N -lymph node involvement, and
• M -extent of metastasis

29. • Grading refers to the classification of the
tumor cells
• Grade I
– well-differentiated tumors, closely resemble the
tissue
• Grade IV
– poorly differentiated or undifferentiated tumor

30. Management of Cancer
• The range of possible treatment goals may
include
– Eradication of malignant disease (cure)
– prolonged survival and containment of cancer cell
growth (control)
– relief of symptoms associated with the disease
(palliation)
• Multiple treatment options

31. Surgery
• Surgical removal of the entire cancer remains
the ideal and most frequently used treatment
method.
• Diagnostic surgery
• Surgery may be
– the primary method of treatment, or
– it may be prophylactic,
– palliative, or
– reconstructive.

32. Diagnostic Surgery
• most common biopsy methods are
• the excisional
• incisional
• needle methods

36. Surgery as Primary Treatment
• the goal is to remove
– the entire tumor or as much as is feasible (a
procedure sometimes called debulking) and
– any involved surrounding tissue, including regional
lymph nodes.
• Two common surgical approaches
• local and wide excisions

37. • Local excision is warranted when the mass is
small.
– It includes removal of the mass and a small margin of
normal tissue that is easily accessible
• Wide or radical
– excisions (en bloc dissections) include removal of the
primary tumor, lymph nodes, adjacent involved
structures, and surrounding tissues that may be at
high risk for tumor spread.

38. Prophylactic Surgery
• Prophylactic surgery involves removing nonvital
tissues or organs that are likely to develop
cancer.
– Family history and genetic predisposition
– Presence or absence of symptoms
– Potential risks and benefits
– Ability to detect cancer at an early stage
– Patient’s acceptance of the postoperative outcome
• Colectomy, mastectomy, and oophorectomy are
examples

39. Palliative Surgery
• Palliative surgery is performed in an attempt
to relieve complications of cancer, such as
ulcerations, obstructions, hemorrhage, pain,
and malignant effusions

40. Reconstructive Surgery
• Reconstructive surgery may follow curative or
radical surgery and is carried out in an attempt to
improve function or obtain a more desirable
cosmetic effect.

41. RADIATION THERAPY
• In radiation therapy, ionizing radiation is used
to interrupt cellular growth.
• To cure
• To reduce size when surgery is difficult
• prophylactically to prevent leukemic infiltration
to the brain or spinal cord.
• delivered to tumor sites by external or internal
means.

42. • External: radiation is directed to the tissue
from external machine
• Types of rays
– X-rays
– Gamma rays: cobalt 60
– particle-beam radiation therapy(neutrons, pions,
heavy ions)
– intraoperative radiation therapy (IORT)

44. • Internal Radiation
• Internal radiation implantation, or
brachytherapy, delivers a high dose of
radiation to a localized area.

46. CHEMOTHERAPY
• Chemotherapy is used primarily to treat
systemic disease rather than lesions that are
localized and amenable to surgery or radiation

47. • Alkylating Agents
– busulfan, carboplatin, chlorambucil, cisplatin,
cyclophosphamide, dacarbazine, hexamethyl
melamine, ifosfamide, melphalan, nitrogen mustard,
thiotep
• MOA:
– Alter DNA structure by misreading DNA code,
initiating breaks in the DNA molecule, cross-linking
DNA strands

48. • Nitrosureas
– carmustine (BCNU), lomustine (CCNU), semustine
(methyl CCNU), streptozocin
– Cross BBB
• MOA: Similar Alkylating Agents

49. • Antimetabolites
– 5-azacytadine, cytarabine, edatrexate fludarabine,
5-fluorouracil (5-FU), gemcitabine, hydroxyurea,
leustatin, 6-mercaptopurine, methotrexate,
pentostatin, 6-thioguanine
• MOA: Interfere with the biosynthesis of
metabolites or nucleic acids necessary for RNA
and DNA synthesis

50. • Antitumor Antibiotics
– bleomycin, dactinomycin,daunorubicin,
doxorubicin (Adriamycin), idarubicin, mitomycin,
mitoxantrone, plicamycin
– MOA: Interfere with DNA synthesis by binding
DNA; prevent RNA synthesis

51. • Mitotic Spindle Poisons
– Plant alkaloids: etoposide, teniposide, vinblastine,
vincristine (VCR), vindesine, vinorelbine
– Taxanes: paclitaxel, docetaxel
• MOA:
– Arrest metaphase by inhibiting mitotic tubular
formation (spindle); inhibit DNA and protein
synthesis

52. Administration of
Chemotherapeutic Agents
• Chemotherapeutic agents may be administered
in the hospital, clinic, or home setting by topical,
oral, intravenous, intramuscular, subcutaneous,
arterial, intracavitary, and intrathecal route

53. Thanks