Medical-Surgical Nursing: An Integrated Approach, 2E Chapter 17
Medical-Surgical Nursing: An
Integrated Approach, 2E
NURSING CARE OF
A disease resulting from the uncontrolled
growth of cells, which causes malignant
The second leading cause of death in the
Incidence of Cancer
In the U.S., men have a 1 in 2 lifetime risk
of developing cancer, while women have
a 1 in 3 risk.
Incidence and mortality rates higher for
African Americans than for Anglo
Most cancers are curable if treated early.
Most Common Cancers
In men, most common cancers are
prostate, lung, and colorectal.
In women, they are breast, colorectal,
lung, and uterine.
Cancer and Tobacco
In 2000, approximately 173,000 cancer
deaths were estimated to be caused by
Cancer characterized by neoplasms,
abnormal growth of new tissue.
Neoplasms can be benign (not
progressive, and thus, favorable for
recovery) or malignant (becoming
progressively worse and often resulting in
The rapid multiplication of malignant
neoplasms which spread to distant body
parts through the bloodstream or the
Four Main Classifications of
Lymphomas (cancers occurring in
infection-fighting organs, such as
Leukemias (cancers occurring in blood-
forming organs, such as the spleen, and
in bone marrow).
Sarcomas (cancers occurring in
connective tissue, such as bone).
Carcinomas (cancers occurring in
epithelial tissue, such as the skin).
Chemical substances that initiate or
promote the development of cancer.
These agents are thought to alter the
DNA in the cell nucleus.
Significant Risk Factors for
(tobacco and alcohol
use, diet, sun
Genetic Factors (high
incidence in some
families of certain
types of cancer, e.g.
(possible link to
Common Diagnostic Tests for
Invasive Diagnostic Techniques
Biopsy is the most accurate diagnostic
test for cancer.
Staging and Grading of Tumors
Staging determines the extent of the
spread of cancer.
Grading evaluates tumor cells in
comparison to normal cells.
Detection of Cancer
The earlier cancer is detected, the more
likely it is to be controlled.
Cancer checkup is recommended every 3
years for persons ages 20 to 39 and
annually for those 40 and over.
The oldest form of cancer treatment and
still the most common today.
Surgery is classified as:
Curative (to heal or restore to health).
Palliative (to relieve symptoms in more
Reconstructive (may follow curative or radical
surgery to reestablish function or rebuild for
better cosmetic effect).
Second most common treatment,
radiation therapy, or radiotherapy, uses
high-energy ionizing radiation to kill
May be used to cure, prevent, or relieve
Drugs used in chemotherapy are called
antineoplastics because they inhibit the
growth and reproduction of malignant
Chemotherapy is the treatment of choice
for metastatic cancers. It is also the
treatment most responsible for increasing
cancer cure rates in recent years.
Performed with biologic response
modifiers (BRMs), agents that stimulate
the body’s natural immune system to
control and destroy malignant cells.
Most BRMs are still being evaluated in
Bone Marrow Transplantation
Used for cancers that respond to high
doses of chemotherapy or radiation
Treatment involves aspirating and storing
a fraction of bone marrow, exposing the
client to high-dose drug therapy or total
body irradiation, and then reinfusing the
bone marrow after the treatment is
The oncology nurse must formulate nursing
interventions to manage these problems:
Bone Marrow Dysfunction
Blood counts must be monitored carefully during
and after treatment.
Clients with platelet count below 50,000/mm3
should be monitored for bleeding.
Skin should be inspected daily for bruises or
petechiae. Stool and urine should be monitored
for occult blood. Client should be observed for
bleeding from nose, vagina, rectum, mouth, and
Cachexia, a state of malnutrition and
protein (muscle) wasting occurs in
conjunction with lung, pancreatic,
stomach, bowel, and prostate cancers,
but rarely with breast cancer.
In some cases, untreated cachexia is the
cause of death.
Symptoms of Nutritional
Anorexia (loss of appetite).
Nausea and vomiting.
Altered taste sensation.
Dysphagia (difficulty in swallowing, occurring in
clients with esophageal cancers or in those
Particularly stomatitis, inflammation of the
mucous membrane of the oral cavity.
Approximately 60% to 90% of all
individuals with progressive malignancy
will experience pain.
Pain usually does not occur until
advanced stages of disease.
Most common causes are metastatic
bone disease, venous or lymphatic
obstruction, or nerve compression.
Occurs as a direct result of cancer
treatment or because of anemia, chronic
pain, stress, depression, insufficient rest,
or inadequate nutritional intake.
Frequent rest periods should be provided
for the client.
Defined as the thinning or loss of hair,
which may be induced by chemotherapy
or radiation treatments.
Drug induced alopecia is not permanent.
Hair usually begins to grow back within 8
weeks after completion of treatment.
Color and consistency of hair may
Unpleasant odors emanating from the
cancer client may be a source of
embarrassment. These odors may be
associated with drainage, exudates, or
Meticulous nursing care can eliminate
most offending odors.
One half of all clients with terminal cancer
experience dyspnea, or difficulty in
Cancer clients frequently exhibit changes
in bowel patterns.
Constipation, diarrhea, and subsequent
perineal skin breakdown and bowel
obstructions are common elimination
These are a major problem in cancers
that metastasize to bone.
The cancers weaken the bone to the point
that normal activities can cause painful
Abdominal cancers may cause ascites, or
fluid accumulation in the abdomen.
Many chemotherapy drugs can interfere
with sexual functioning and reproduction.
Premenopausal women may become
Men may experience impotence,
decreased libido, interrupted sperm
production, and ejaculation problems.
Medical Emergencies Associated with
Advanced Stage Cancers
Hypercalcemia. (occurs when serum calcium
level rises higher than 10.5mg./dL. Often
signals final stages of cancer).
Spinal Cord Compression (can result in
Superior Vena Cava Syndrome (collection of
symptoms caused by obstruction of the superior
Cardiac Tamponade (caused by the formation
of pericardial fluid, which reduces cardiac output
by compressing the heart).
Clients may see themselves as burdens to their
Family caregivers may be angry that their own
needs must go unmet.
Family caregivers may feel inadequate with
regard to caring for the client.
Medical equipment (e.g. hospital bed, commode
chair, or wheelchair) may need to be brought
into the home. These may have an impact on
family member state of mind and disposition
with regard to family member with cancer.
A Cancer Client’s Goal
Quality of life, not quantity of life, is the
ultimate goal for clients living with cancer.