WESLEYAN UNIVERSITY – PHILIPPINES
Mabini Extension, Cabanatuan City
JAN RAINIER C. BALARIA, RN, RM, MAN
ONCOLOGY
 Branch of medicine that deals
with the study, detection,
treatment and management of
cancer and neoplasia
 In the Philippines, cancer ranks
third in leading causes of
morbidity and mortality after
communicable diseases and
cardiovascular diseases
 In the Philippines, 75% of all
cancers occur after age 50
years, and only about 3% occur
at age 14 years and below
 If the current low cancer
prevention consciousness
persists, it is estimated that for
every 1800 Filipinos, one will
develop cancer annually
 most Filipino cancer patients
seek medical advice only when
symptomatic or at advanced
stages: for every two new
cancer cases diagnosed
annually, one will die within the
year
 The top cancer sites in the
Philippines include those
cancers whose major causes are
known (where action can
therefore be taken for primary
prevention), such as cancers of
the lung/larynx (anti-smoking
campaign), liver (vaccination
against hepatitis B virus), cervix
(safe sex) and
colon/rectum/stomach (healthy
diet). Except for the liver, the
top Philippine cancer sites are
also the top cancers worldwide
Terms to Define
a. Hyperplasia – increase in the
number of cells
b. Metaplasia – conversion of
one cell to another cell
c. Dysplasia – bizarre cell
growth resulting in difference
in size, shape and
arrangement
d. Anaplasia – cells that lack
normal cellular characteristic
e. Neoplasia – uncontrolled cell
growth
Predisposing Factors
a. Age
Older individuals are more prone
to Ca
b. Sex
Women – breast, uterus, cervix
cancer
Men – prostate, lung Ca
c. Urban Vs Rural
d. Geographic Distribution
e. Occupation
f. Hereditary
g. Stress
h. Precancerous lesions
Pigmented moles, burn scars,
benign polyps, adenoma,
fibrocystic disease of the
breast
i. Obesity
- Breast and colorectal Ca
CANCER INCIDENCE
Carcinogenesis
a. Initiation
- first step, chemicals, physical
factors and biologic agents, escape
the normal enzymatic mechanisms
and alter the genetic structure of
the cellular DNA
- normally these alterations are
reversed by DNA repair mechanism
or programmed cellular suicide
(apoptosis)
2. Promotion
- Repeated exposure
Causes expression of abnormal or
mutant genetic information
-Proto-oncogenes, “on switch”
Ca suppressor genes, “turn off”
P53 gene, a tumor suppressor gene
regulates whether cells repair or
die after DNA is damaged
3. Progression
 WESLEYAN UNIVERSITY – PHILIPPINES
Mabini Extension, Cabanatuan City
JAN RAINIER C. BALARIA, RN, RM, MAN
-Third step of cellular
carcinogenesis
The cellular changes formed during
initiation and promotion now
exhibit increased malignant
behavior
Etiologic Factors
1. Viruses
Oncogenic viruses
a. Epstein Bar virus, Burkitt’s
Lymphoma, nasopharyngeal Ca,
non-Hodgkin and Hodgkin’s
lymphoma
b. Herpes simplex Type II,
Cytomegalovirus and HPV type
16,18,31,33, Cervix Ca
c. HIV, Kaposi Sarcoma
d. H. Pylori, Gastric Ca
2. Physical Agents
- Ultraviolent rays, especially in fair
skinned blue or green eyed people,
skin Ca
- Radiation from x-ray or nuclear,
leukemia, multiple myeloma, Ca of
lung, bone, breast and thyroid
3. Hormones
- Oral contraception or HRT, Inc.
incidence of hepatocellular,
endometrial and breast Ca
4. Chemical Agents
- 75% related to environment
Tobacco smoking, single most
lethal carcinogen, 30% of Ca
deaths, lung, head and neck
esophagus, bladder panceas,
cervix ca
chewing tobacco, ca of the oral
cavity in men younger than 40
years old
5. Industrial compounds
- Vinyl chloride (plastics, asbestos)
Polycyclic aromatic hydrocarbons
(burning, auto and truck emission)
Fertilizers and weed killers
Dyes, (analine dyes, hair dyes)
6. Dietary Factors
Carcinogenic
- fats, alcohol, salt cured or
smoked meats, high caloric content
Proactive
- high fiber, Cruciferous
vegetables ( cabbage, broccoli,
cauliflower, brussels, sprouts)
Carotenoids (carrots, tomatoes,
spinach, apricots, peaches, dark
green and yellow vegetables), vit
E, C, zinc and selenium
7. Genetics
- Oncogenes (hidden/repressed
genetic code for Ca that exists in
all individual
8. Age: Advancing age is significant
risk factors
9. Immunologic Factors
a. Immunosuppressed individuals
more susceptible to cancer
CHARACTERISTICS OF CA
a. Metastasis
1. Lymphatics
- the most common mechanism
breast tumors, axillary, clavicular,
and thoracic LN
2. Hematogenous
- disseminated through the blood
stream
related to the vascularity of the
tumor
Angiogenesis – ability to induce
the growth of new capillaries from
the host tissue to meet the
nutrients and oxygen
Classification and Staging
Tissue of Origin
Carcinoma:
a. Squamous cell Ca – surface
epithelium
b. Adenocarcinoma – glandular or
parenchymal
c. Sarcoma – connective tissue
d. Leukemia, Lymphoma
B. Staging – determines the size of
the tumor and the existence of
metastasis
 WESLEYAN UNIVERSITY – PHILIPPINES
Mabini Extension, Cabanatuan City

JAN RAINIER C. BALARIA, RN, RM, MAN

Osteoma- bone
TNM Classification Myoma- muscle
T – extent of primary tumor Nomenclature of Neoplasia
N – absence or presence and Tumor is named according to:
extent of regional lymph node
metastasis 2. Pattern and Structure, either
M – absence or presence of GROSS or MICROSCOPIC
distance metastasis Fluid-filled CYST
Glandular ADENO
Primary Tumor (T) Finger-like PAPILLO
TX – primary tumor cannot be Stalk POLYP
assessed
TO – no evidence of primary tumor Nomenclature of Neoplasia
Tis – carcinoma in situ Tumor is named according to:
T1,2,3,4 – increasing size or local 3. Embryonic origin
extent of primary tumor Ectoderm ( usually gives rise to
epithelium)
Regional lymph nodes (N) Endoderm (usually gives rise to
NX – regional LN cannot be glands)
assessed Mesoderm (usually gives rise to
NO – no regional LN metastasis Connective tissues)
N1,2,3 – increasing involvement of
LN BENIGN TUMORS
Suffix- “OMA” is used
Distant Metastasis Adipose tissue- LipOMA
MX – Distance metastasis cannot Bone- osteOMA
be assessed Muscle- myOMA
MO – No distant metastasis Blood vessels- angiOMA
M1 – distant metastasis Fibrous tissue- fibrOMA
Grading MALIGNANT TUMOR
Classification of tumor cells Named according to embryonic cell
Grade I – IV, define the type of origin
tissue which the tumor originated 1. Ectodermal, Endodermal,
Normal T0, N0, M0 Glandular, Epithelial
Stage I T1, N0, M0 Use the suffix- “CARCINOMA”
Stage II T2, N1, M0 Pancreatic AdenoCarcinoma
Stage III T3, N2, M0 Squamos cell Carcinoma
Stage IV with metastasis
Named according to embryonic cell
2. Histologic origin
Grade 1 - well differentiated 2. Mesodermal, connective tissue
Grade 2 - Moderately origin
differentiated more abnormal Use the suffix “SARCOMA
Grade 3 - Poorly differentiated, FibroSarcoma
Very abnormal Myosarcoma
Grade 4 - Very immature, AngioSarcoma
anaplastic hard to even determine
the tissue of origin 1. “OMA” but Malignant
HepatOMA, lymphOMA, gliOMA,
melanOMA
Nomenclature of Neoplasia 2. THREE germ layers
Tumor is named according to: “TERATOMA”
1. Parenchyma, Organ or Cell 3. Non-neoplastic but “OMA”
Hepatoma- liver Choristoma
 WESLEYAN UNIVERSITY – PHILIPPINES
Mabini Extension, Cabanatuan City

JAN RAINIER C. BALARIA, RN, RM, MAN

Hamatoma d. Punch

WARNING SIGNS OF CANCER Preprocedure

C – change in bowel or bladder a. Depends on the location and
habits type of biopsy
A – sore that does not heal b. May need to be NPO if
U – unusual bleeding or sedation or contrast is used
discharge c. Inform the client about the
U – unexplain sudden weight procedure
loss
U – unexplained anemia Postprocedure
T – thickening or lump a. Control bleeding
I – indigestion or difficulty in b. Monitor for infection
swallowing c. Manage pain
O – obvious change in wart or d. Inform the client how to
mole obtain the results
N – nagging cough or
hoarseness of voice B. Imaging
- X-ray, ultrasound, MRI, Ct
scan
SCREENING - Methods of obtaining
a. Early detection and information about the
treatment are the presence, location and
cornerstones of cancer extend of tumor
survival Method chosen is based on
b. Educating the public about a 1. ability to visualize tumor
healthy lifestyle and early 2. Risk
detection 3. Client comfort
c. Health education 4. Cost
d. Reduce and avoid exposure
to known carcinogens Preprocedure
e. Eat a balanced diet of a. Assess for allergy if contrast is
vegetables, fruits and whole to be used
grains, reducing fat and red b. NPO depending on the area
smoked and cured meat. being imaged, use of sedation
f. Limit alcohol beverages or contrast
g. Exercise regularly c. Prepare patient for length of
h. Reduce stress and imaging, possible noise of
encourage adequate rest and machinery, need to remain
relaxation still.
i. Follow screening d. Monitor the client for flushing,
recommendations itching or nausea, indicating
j. Know the seven warning allergy to contrast.
signs
k. Seek medical attention
Points to Remember
DIAGNOSTIC test a. Most client fear of death
1. Biopsy upon confirmation of
- removal of tissue for histologic Cancer
examination b. Clients usually ignored
- essential for choosing treatment cardinal signs of Cancer
Types c. Most often cancer is
a. FNAB detected during routine
b. Incision exam
c. Excision
 WESLEYAN UNIVERSITY – PHILIPPINES
Mabini Extension, Cabanatuan City
JAN RAINIER C. BALARIA, RN, RM, MAN
d. Questions that need to be
answered: Example (Is the
disease curable or not?)
Nursing Diagnosis
a. Ineffective coping
b. Anticipatory grieving
c. Disturbed body image
d. Fatigue
e. Impaired elimination
f. Hopelessness
g. Impaired oral mucous
membrane
Common Cancer complaint
a. Nausea
 Impaired nutrition less than
body requirements
 acute pain
 Impaired skin integrity
 Signs and symptoms of
malignant neoplasia
 Proliferation of Ca cells
 Pressure
 Obstruction
2. Pain ( late sign of Ca )
 Pressure on nerve endings
 Distention of organs/vessels
 Lack of O2 to tissue and
organ
 Release of pain mediators
 Pleural effusion and ascites
3. Ulceration and necrosis
 As tumor erodes BV and
pressure on tissue causes
ischemia, tissue damage,
bleeding and infection
 Vascular throbosis, Embolus,
Thrombophlebitis
 Tumors tends to produce
abnormal coagulation factors
Paraneoplastic Syndrome
1. Anemia
 Ca cells produces chemicals
that interfere with RBC
production
 Iron uptake is greater in the
tumor than that deposited in
the liver
 Blood loss from bleeding
2. Hypercalcemia
 Increases and accelerates
bone breakdown and release
of Calcium
3. Anorexia – Cachexia Syndrome
 Final outcome of
unrestrained Ca growth
 Ca deprived normal cells
nutrition
 Protein depletion, serum
albumin decreases
 Tumors take up Na
 Act in the satiety center
causing anorexia
 Taste sensation diminishes
Pain: Cancer and End of Life
a. 30% of clients experience
pain at the time of diagnosis.
b. 30% to 50% experience pain
while undergoing therapy.
c. 70% to 90% experience pain
as cancer advances and
overcomes their defenses
d. Cancer pain is complex,
interactive, and ever-
changing. It comes from two
general sources: the cancer
itself, and its various
treatments
e. Cancer pain is more than a
physical symptom. It is a
reminder of ones mortality
and a harbinger of death.
f. It interferes with normal
routines, degrades the
quality of life, and robs one
of rest, creativity, joy, and
peace.
g. Cancer pain adds stress and
worry to its sufferers and
friends and family. For this
reason, healthcare
professionals
h. Take pain seriously,
recognizing that only the
person in pain knows how it
feels.
i. Provide information and
resources for pain control.
j. Communicate with
genuineness, accurate
 WESLEYAN UNIVERSITY – PHILIPPINES
Mabini Extension, Cabanatuan City

JAN RAINIER C. BALARIA, RN, RM, MAN

empathy, and nonpossessive

warmth. Diagnostic Surgery
k. Encourage sufferers to share Biopsy
their feelings and network Excisional biopsy
with other survivors. - most frequently used for easily
l. Respect culture norms and accessible tumors of the skin,
wishes of sufferers, breast, ULGIT,URTI
maximizing their control - provides the pathologist the cells
m. Encourage release of energy and the entire tissue
through joy-producing - decreases the chance of seeding
activities. the tumor
n. Monitor pain medications, Incisional Biopsy
effectiveness, and adverse - used if the tumor mass is too
effects large to be removed
- a wedge of tissue from the tumor
Management of Cancer is taken
1. Cure Needle Biopsy
 eradication of malignant - done on suspicious masses that
diseases are easily accessible
2. Control - fast, inexpensive and easily
 prolonged survival and performed
containment of cancer cell
growth Surgery as primary treatment
3, Palliation - Remove the entire tumor or
 relief of symptoms as much as is feasible
associated with the disease
1. Local excision
Therapeutic Modalities for Cancer - if the mass is small
a. Surgery 2. Wide or Radical Excision
b. Chemotherapy - removal of the primary tumor,
c. Radiation therapy LN, adjacent and surrounding
d. Immunotherapy tissue
e. Bone Marrow Transplantation - results in disfigurement and
altered function
Surgery 3. Salvage surgery
 The ideal and most
frequently used Prophylactic Surgery
- Removal of non-vital structures
Goals that is likely to develop Ca
a. Primary
b. Prophylactic Palliative Surgery
c. Palliative - when cure is not possible, the
d. reconstructive goal of treatment is to make the
patient as comfortable as possible
and to promote a satisfying and
 Removal of tissue for
productive life for as long as
diagnosis, staging, palliation
possible
or treatment of cancer.
 Most frequently used cancer
Radiation Therapy
therapy
 Used to control malignant
 Most successful single
disease when a tumor cannot
therapy if cancer has not
be removed surgically
spread
 To relieve the symptoms of
 Very often performed on an
metastatic disease,
OPD or brief stay basis
 WESLEYAN UNIVERSITY – PHILIPPINES
Mabini Extension, Cabanatuan City
JAN RAINIER C. BALARIA, RN, RM, MAN
especially when the Ca
spread to the brain, bone.
 A radiosensitive tumor is one
that can be destroyed by a
dose of radiation that still
allows for cell regeneration in
the normal tissue
Radiation Therapy
 Uses ionizing radiation to kill
or limit the growth of cancer
cells. May be internal or
external
 Effect cannot be limited to
cancer cells only
 is a cancer treatment that
uses high doses of radiation
to kill cancer cells and stop
them from spreading. At low
doses, radiation is used as an
x-ray to see inside your body
and take pictures, such as x-
rays of your teeth or broken
bones.
 Radiation use in cancer
treatment works in much the
same way, except that it is
given at higher doses.
Radiation therapy is used to:
a. Treat cancer. Radiation can be
used to cure, stop, or slow the
growth of cancer.
b. Reduce symptoms. When a
cure is not possible, radiation may
be used to shrink cancer tumors in
order to reduce pressure.
 Radiation therapy used in
this way can treat problems
such as pain, or it can
prevent problems such as
blindness or loss of bowel
and bladder control.
 Cells are most vulnerable to
radiation during DNA
synthesis and mitosis
 Most sensitive are those body
tissue that undergo frequent
cell division. (BM, Lymphatic,
GIT, gonads)
 Tumors that are well
oxygenated are more
sensitive to radiation
 Cells most sensitive during M
and G2 phase
Radiosensitivity
Highly sensitive
- ovaries, testes, bone marrow,
blood, intestines
Low sensitivity
- muscle, brain, spinal cord
Types
Teletherapy (External Beam)
a. x-rays are used to destroy
cancerous cells at the skin
surface or deeper
b. b. Used more commonly
c. Client is not radioactive
during treatment
d. Simulation – X-ray or Ct
planning session to identify
the field which delivers
maximum radiation to the
tumor and minimal to normal
tissue. Involves skin
markings
e. Administered in fractions of
the full dose, 5 days a week
for 4-6 weeks
b. Brachytherapy (Internal)
a. used primarily in the head
and neck, gynecologic,
prostate cancer
b. delivers a high dose of
radiation in a local area
using implants
c. Client is radioactive only
when implaint is in placed
d. plan cares efficiently to
minimize nurses, exposure to
implant, use shielding, wear
a film badge and maintain
safe distance.
e. Pregnant nurses should not
care for clients with
implanted radiation
f. Pickup dislodge implants with
long forceps placed in a
special container.
g. Body fluids of clients treated
with systemic radioactive
iodine are radioactive; fluids
of client with implants are
not
 WESLEYAN UNIVERSITY – PHILIPPINES
Mabini Extension, Cabanatuan City
JAN RAINIER C. BALARIA, RN, RM, MAN
Radiation Dosage
 The lethal tumor dose is
defined as the dose that will
eradicate 95% of the tumor
yet preserve normal tissue
Adverse Reaction
a. Seen only in the organs in
the radiation field, except for
systemic effects of nausea,
anorexia and fatigue
b. Skin reactions are common
and expected with external
beam
c. Toxicity
d. Localized to the area being
irradiated
e. Alteration in oral mucosa,
stomatitis, xerostomia,
change and loss of taste,
decreased salivation
f. Altered skin integrity,
alopecia, erythema,
shedding, desquamation
g. Thrombocytopenia
h. Anemia
Radiation Safety
 Distance - the greater the
distance the lesser the
exposure
 Time - the less time spent
close to radiation the less
exposure (max of 30 min
per shift)
 Shielding - use lead
aprons and gloves
 Standards - kept as low as
reasonably achievable
 Monitoring device - film
badge (measure the
whole exposure of the
nurse)
Side Effects
a. Skin: Itching, redness, burning,
sloughing
 Keep skin free of foreign
substance
 Avoid use of medicated
solutions
 Avoid pressure, trauma,
infection
 Avoid exposure to heat, cold
or sunlight
b. Anorexia, vomitting, nausea
 Provide small, attractive
feedings
 Avoid extremes of
temperatures
 Administer antiemetics
before meals
c. Diarrhea
 Encourage low residue,
bland, high protein foods
 Provide good perineal hygine
 Monitor electrolytes, Na,K,Cl
d. Anemia. Leukopenia,
thrombocytopenia
 Isolate patient
 provide frequent rest period
 Encourage high protein diet
 Assess for bleeding
 Monitor lab results CBC,
WBC, Plt
CHEMOTHERAPY
Systemic treatment with chemicals
which destroy rapidly proliferating
cells
Used for cure in testicular, Hodgkin
disease, ALL, neuroblastoma,
Wilms and Burkitt’s lymphoma
Used to control breast, nod-
Hodgkin, small cell lung and
ovarian cancer
Used palliative for relief of pain,
obstruction and to improve comfort
What does chemotherapy do?
Cure cancer - when
chemotherapy destroys cancer
cells to the point that your doctor
can no longer detect them in your
body and they will not grow back.
Control cancer - when
chemotherapy keeps cancer from
spreading, slows its growth, or
destroys cancer cells that have
spread to other parts of your body.
 WESLEYAN UNIVERSITY – PHILIPPINES
Mabini Extension, Cabanatuan City
JAN RAINIER C. BALARIA, RN, RM, MAN
Ease cancer symptoms (also
called Palliative Care) - when
chemotherapy shrinks tumors that
are causing pain or pressure.
Chemotherapy
a. Chemotherapy works by
stopping or slowing the
growth of cancer cells, which
grow and divide quickly. But
it can also harm healthy cells
that divide quickly, such as
those that line your mouth
and intestines or cause your
hair to grow. Damage to
healthy cells may cause side
effects. Often, side effects
get better or go away after
chemotherapy is over.
b. Sometimes, chemotherapy is
used as the only cancer
treatment. But more often,
you will get chemotherapy
along with surgery, radiation
therapy, or biological
therapy. Chemotherapy can:
c. Make a tumor smaller before
surgery or radiation therapy.
This is called neo-adjuvant
chemotherapy.
Destroy cancer cells that may
remain after surgery or radiation
therapy. This is called adjuvant
chemotherapy.
Help radiation therapy and
biological therapy work better.
Destroy cancer cells that have
come back (recurrent cancer) or
spread to other parts of your body
(metastatic cancer).
Cell Cycle
Time required for one tissue cell to
divide and reproduce two identical
daughter cells
Go – resting phase
G1 – RNA and protein synthesis
occurs
S – DNA synthesis occurs
G2 – Premitotic phase
M – cell division occurs
Chemotherapy may be given in
many ways:
Injection. The chemotherapy is
given by a shot in a muscle in your
arm, thigh, or hip or right under the
skin in the fatty part of your arm,
leg, or belly.
Intra-arterial (IA). The
chemotherapy goes directly into
the artery that is feeding the
cancer.
Intraperitoneal (IP). The
chemotherapy goes directly into
the peritoneal cavity (the area that
contains organs such as your
intestines, stomach, liver, and
ovaries).
Intravenous (IV). The
chemotherapy goes directly into a
vein.
Topically. The chemotherapy
comes in a cream that you rub onto
your skin.
Orally. The chemotherapy comes
in pills, capsules, or liquids that you
swallow.
ANTINEOLPLASTIC AGENT
Cell Cycle non-specific
1. Alkylating agents
- acts with DNA to hinder cell
growth and division
- cisplatin, cyclophosphamide
2. Steroids and sex hormones
- alter the endocrine environment
to make it less conducive to growth
of cancer cells.
3. Antitumor antibiotics
- interfere with DNA synthesis by
binding DNA. Prevent RNA
synthesis
- Bleomycin, dactinomycin,
doxorubicin, mitomycin
- cardiac toxicity (daunorubicin,
doxorubicin)
Cell Cycle Specific (S phase)
1. Antimetabolites
- foster cancer cell death by
interfering with cellular metabolic
process
 WESLEYAN UNIVERSITY – PHILIPPINES
Mabini Extension, Cabanatuan City
JAN RAINIER C. BALARIA, RN, RM, MAN
-5-flouroracil, methotrexate,
cytarabine
- renal toxicity (methotrexate)
Cell cycle specific (M phase)
1. Plant alkaloids
- makes the host body a less
favorable environment for the
growth of cancer cells
- arrest metaphase by inhibiting
mitotic tubular formation. Inhibit
DNA and RNA synthesis
-vincristine, vinblastine
- Taxanes: Paclitaxel (bradycardia)
Chemotherapy
a. Used to treat systemic
diseases rather than
localized lesions that are
amenable to surgery and
radiation
b. Used in an attempt to
destroy tumor cells by
interfering with cellular
function and reproduction
c. Use of chemicals to destroy
cancer cells
d. Interferes DNA & RNA
activities associated with cell
division
e. Often used in combination
with radiation therapy
f. Cytotoxic - is an agent
capable of destroying cells
g. Cytotoxic drug - alkylating
and antimetabolites
h. Can be combined with
surgery or radiation therapy
i. Used to reduce the tumor
size preoperatively and to
destroy the remaining tumor
cells preoperatively
j. Eradication of 100% of tumor
is nearly impossible
k. Goal is to eradicate enough
of the tumor so that the
remaining tumor cells can be
destroyed by the immune
system
Contraindication
a. Infection
b. Recent surgery
c. Impaired renal or hepatic
function
d. Recent radiation therapy
e. Pregnancy
f. Bone marrow depression
Extravasation – cause tissue
necrosis and damage to tendons,
nerves and blood vessels
Major side effects
GI System
1. Nausea and vomitting
- administer anti-emetics
- NPO 4-6 hrs before
chemotherapy
- bland diet foods in small
amounts after treatment
2. Diarrhea
3. Stomatitis
- Good oral hygiene
- rinse with viscous lidocaine
before meals
- rinse with plain water or
hydrogen peroxide after meals
- apply water soluble lubricants
- Suck popsicle to provide
moisture
Hematologic (Myelosuppression)
1. Thrombocytopenia
- Avoid bumps or bruishing
- protect client from physical
injury
- Avoid aspirin
- Avoid IM injections
- Assess for bleeding tendencies
b. Leukopenia
- use careful handwashing
- reverse isolation if WBC <1000
- assess for signs of respiratory
infection
- Avoid crowds
c. Anemia
- Provide adequate rest periods
- monitor CBC
- Administer o2 PRM
Integumentary System – Alopecia
- Explain hair loss is not
permanent
- Support and encouragement
- Scalp tournique or scalp
hypothermia to minimize hairloss
- Advise client to obtain wig
Renal system
 WESLEYAN UNIVERSITY – PHILIPPINES
Mabini Extension, Cabanatuan City

JAN RAINIER C. BALARIA, RN, RM, MAN

- may cause direct damage to Hepatotoxicity

kidneys by excreting metabolites. Integumentary
- encourage fluids and frequent Alopecia
voiding Dermatitis and ulcers
- increased excretion of uric acid Hematopoietic
may damage kidneys ↓ bone marrow activity
- Administer allopurinol, Inc. OFI anemia, prone to infection
and bleeding tendency
Reproductive System Metabolic
1. Infertility and mutagenic TLS and Hyperkalemia
damage to chromosomes
2. Banking sperm Perceived Change in Body Image
3. Use contraception a. Obvious reminder of
disability
Side Effects from Radiation and b. need for prosthesis
Chemo Therapy (breast, leg and eye)
a. Neurologic/Sensory/Perceptu c. need for hardware (wheel
al chair, crutches)
a. Meningeal irritation d. need for medication (CR
b. CN and peripheral therapy)
neuropathy e. extent of disability or
c. Cerebellar toxicity limitation
d. Ototoxicity
b. Cardiac Type of loss
a. Pericardial Effusion a. symbols of sexuality
b. Arrhythmias b. social acceptability
c. CHF (colostomy)
c. Pulmonary c. ability to communicate
a. Pleural Effusion (laryngectomy, aphasia)
b. Pneumonitis d. anatomic changes
d. GIT (amputation)
a. Stomatitis
b. Esophagitis Terminally Ill
c. Pharyngitis • 50% die from the disease
d. Taste alteration • time from diagnosis to death
e. Anorexia ranges from weeks- years
f. Nausea and vomiting • not all clients become
g. Constipation and diarrhea terminally ill
h. Weight loss • others die during initial
GUT treatment; others die from
Nephrotoxicity complications of treatment
Hemorrhagic cystitis
• Endpoint: no response to
Hyperuricemia
treatment and progressions
Urine color changes
cannot be controlled
Reproductive
• Loss of libido HOSPICE CARE
• Impotence • standard of care for
• Amenorrhea terminally ill cancer clients
• Irregular menses • symptom control
• Menopausal symptoms • pain management
• Azoospermia • providing comfort and dignity
• Sterility • 24 hour – 7 day coverage
• Gynecomastia
Hepatic
 WESLEYAN UNIVERSITY – PHILIPPINES
Mabini Extension, Cabanatuan City
JAN RAINIER C. BALARIA, RN, RM, MAN
• services given are based on
client’s need not on its ability
to pay
• One can suffer without
physical pain and one can
have physical pain and not
necessarily suffer.
• The founder of the modern
hospice movement described
suffering as “total pain,” an
experience of changing self-
perception, fear of physical
distress and dying, concerns
about relationships, changing
self-perception, and memory
of other person’s suffering (
ETHICAL ISSUES
• caring can be just
successful as curing;
when curing is not an
option
• care is exercised during
the final stage of life
• Goals of Intervention
• to care without functional
and structural impairment
• if cure is not possible
goals must
= prevent further
metastasis
= relieve symptoms
= maintain high
quality of life
Bone Marrow Transplant
• Used in the treatment of
leukemia for clients who
have closely matched donors
• and experiencing temporary
remission with chemotherapy
• Severe aplastic anemia,
breast Ca, brain Ca
Types
Autologous
- own bone marrow, most common
type
Allogenic
- transplant from a genetically
non-identical donor
- sibbling most common type
procedure
1. Harvest – through multiple
aspiration from the iliac crest to
retrieve sufficient bone marrow for
the transplant
- 500ml- 1000ml
2. Conditioning
- immunosuppressant therapy is
given to eradicate all malignant
cells
3. Transplantation
a. administered through central
line like BT
b. infused 30 min
4. Engraftment
a. transfused BM move to marrow
forming sites
b. occurs when WBC, erythrocytes,
plt ct begin to rise
c. takes 2-5 weeks
Complications:
a. Failure of engraftment.
b. Infection: higher risk 3-4
weeks
c. Pneumonia: principal cause
of death during first three
months
d. Graft vs host disease –
principal complication
a. Acute – 1st 100 days post
transplant
b. Chronic – 100-400 days
Nursing Care: Pretransplant
1. Provide protected environment
- strict reverse isolation
2. Monitor central lines frequency
3. Provide care receiving
chemotherapy
Post transplant
• Prevent infection
• Maintain protective
environment
• Administer antibiotics
• Check IV set ups q12hrs
2. Provide mouth care for
stomatitis and mucositis
3. Monitor carefully for bleeding
a. check for occult blood in
emesis, stools
b. observe for easy bruising
 WESLEYAN UNIVERSITY – PHILIPPINES
Mabini Extension, Cabanatuan City

JAN RAINIER C. BALARIA, RN, RM, MAN

c. Check platelet ct daily

d. replaced blood component Myelosuppression
4. Maintain fluid and electrolyte - reduced numbers of white and
balance red blood cells and platelets
5. Provide client health teaching associated with cancer or
treatment
Nursing Assessment - Neutropenia <1000
a. Weight loss - Thrombocytopenia < 100,000
b. Frequent infection - results in infection and bleeding
c. Skin problems - the oral cavity is the primary site
d. Pain of infection
e. Hair Loss
f. Fatigue Assessment
g. Disturbance in body image/ Monitor for clinical manifestations
depression of infection
h. Managing effects of Cancer • Erythema, warmth, swelling
and treatment at incision site
• Fever
• Shaking chills
PAIN • Pain
• Foul smelling duscharge
1. Description
• White oral plaque
a. Whatever the client says it is,
whenever the client says it exists. • Change in sensorium
b. may be caused by treatment, • Monitor for clinical
cancer destruction of tissue or manifestation of bleeding
pressure or pressure on nearby • Bruising and petechiae
structures and cancer progression • Blood in the urine, stool and
c. Bone metastasis is very common vomitus
cause • Changes in mentation
• Pain
Nursing Interventions • Weak, rapid pulse, low blood
a. Assess all clients for pain even if pressure, pale cool skin
they do not appear to be Nursing intervention
experiencing it. a. Instruct practice of careful
b. Educate clients and families washing
about narcotic use b. Perform oral and perineum
1. Correct use of narcotics results care
in addiction in <1% of client c. Place client in protective
2. Narcotic dose may be isolation
increased with increasing dose not d. Administer antibiotics and
have be reserved for last resort antipyretics
use. e. Avoid unnecessary invasive
c. Instruct clients on procedures to prevent
nonpharmacologic methods of pain bleeding or infection
management. f. Avoid shaving
d. Administer pain medication as g. Administer iced gastric
ordered, utilizing a combination of lavage
non-narcotic and narcotic
analgesics MAINTAIN TISSUE INTEGRITY
e. Oral route is preferred if possible a. Handle skin gently
f. Meperidine (demerol) is seldom b. Do NOT rub affected area
used to treat cancer pain because c. Lotion may be applied
it metabolizes and accumulates d. Wash skin only with SOAP
during extended use. and Water
 WESLEYAN UNIVERSITY – PHILIPPINES
Mabini Extension, Cabanatuan City
JAN RAINIER C. BALARIA, RN, RM, MAN
MANAGEMENT OF STOMATITIS
a. Use soft-bristled toothbrush
b. Oral rinses with saline
gargles/ tap water
c. Avoid ALCOHOL-based rinses
MANAGEMENT OF ALOPECIA
Alopecia begins within 2 weeks of
therapy
a. Regrowth within 8 weeks of
termination
b. Encourage to acquire wig
before hair loss occurs
c. Encourage use of attractive
scarves and hats
d. Provide information that hair
loss is temporary BUT
anticipate change in texture
and color
PROMOTE NUTRITION
a. Serve food in ways to make it
appealing
b. Consider patient’s
preferences
c. Provide small frequent meals
d. Avoids giving fluids while
eating
e. Oral hygiene PRIOR to
mealtime
f. Vitamin supplements
RELIEVE PAIN
a. Mild pain- NSAIDS
Moderate pain- Weak opiods
b. Severe pain- Morphine
c. Administer analgesics round
the clock with additional dose
for breakthrough pain
DECREASE FATIGUE
a. Plan daily activities to allow
alternating rest periods
b. Light exercise is encouraged
c. Small frequent meals
IMPROVE BODY IMAGE
a. Therapeutic communication
is essential
b. Encourage independence in
self-care and decision making
c. Offer cosmetic material like
make-up and wigs
ASSIST IN THE GRIEVING PROCESS
a. Some cancers are curable
b. Grieving can be due to loss of
health, income, sexuality,
and body image
c. Answer and clarify
information about cancer and
treatment options
d. Identify resource people
e. Refer to support groups
MANAGE COMPLICATION:
INFECTION
a. Fever is the most important
sign (38.3)
b. Administer prescribed
antibiotics X 2weeks
c. Maintain aseptic technique
d. Avoid exposure to crowds
e. Avoid giving fresh fruits and
veggie
f. Handwashing
g. Avoid frequent invasive
procedures
MANAGE COMPLICATION: Septic
shock
a. Monitor VS, BP, temp
b. Administer IV antibiotics
c. Administer supplemental O2
d. Nursing Intervention
MANAGE COMPLICATION: Bleeding
• Thrombocytopenia
(<100,000) is the most
common cause
• <20, 000 spontaneous
bleeding
• Use soft toothbrush
• Use electric razor
• Avoid frequent IM, IV, rectal
and catheterization
• Soft foods and stool softeners
COLON CANCER
• Adenocarcinoma is the most
common type
• Metastasis is common to the
liver
 WESLEYAN UNIVERSITY – PHILIPPINES
Mabini Extension, Cabanatuan City

JAN RAINIER C. BALARIA, RN, RM, MAN

• 2nd most common site for 6. Rectal lesions- tenesmus,

cancer in men and women alternating D and C
• Ages >50-60
• May be caused by Right sided lesions
diverticulitis, chronic - dull abdominal pain, melena
ulcerative colitis, familial Left sided lesions
polyposis - signs of obstruction and bright
red stool
Cancer sites Rectal lesion
a. Sigmoid colon – 33% - tenesmus, rectal pain.
b. Rectum – 27% Incomplete BM., bloody stool,
c. Ascending Colon – 22% constipation
d. Transverse colon – 11%
e. Descending colon 6% Colon cancer
Diagnostic findings
Metastatic sites 1. Fecal occult blood
Liver the most common site 2. Sigmoidoscopy and colonoscopy
Peritoneal surface 3. BIOPSY
Spread via lymphatics to lung, 4. CEA- carcino-embryonic antigen
bone and brain Colon cancer
Complications of colorectal CA
COLON CANCER 1. Obstruction
Risk factors 2. Hemorrhage
1. Increasing age 3. Peritonitis
2. Family history 4. Sepsis
3. Previous colon CA or polyps
4. History of IBD Colon cancer
5. High fat, High protein, LOW fiber MEDICAL MANAGEMENT
6. Breast Ca and Genital Ca 1. Chemotherapy- 5-FU
2. Radiation therapy
COLON CANCER
Sigmoid colon is the most common Colon cancer
site a. SURGICAL MANAGEMENT
Predominantly adenocarcinoma Surgery is the primary treatment
If early 90% survival Based on location and tumor size
34 % diagnosed early Resection, anastomosis, and
66% late diagnosis colostomy (temporary or
permanent)
COLON CANCER Right hemicolectomy – primary
PATHOPHYSIOLOGY surgery for cancer of the ascending
Benign neoplasm DNA colon
- removal of the terminal ileum,
alteration malignant
cecum, right transverse colon
transformation malignant
Left hemicolectomy – primary
neoplasm  cancer growth and surgery for cancer of descending
invasion  metastasis (liver) and sigmoid colon
- removal of the distal transverse,
COLON CANCER descending and sigmoid colon
ASSESSMENT FINDINGS
1. Change in bowel habits-
Most common
2. Blood in the stool Colostomy
3. Anemia
4. Anorexia and weight loss
5. Fatigue
 WESLEYAN UNIVERSITY – PHILIPPINES
Mabini Extension, Cabanatuan City

JAN RAINIER C. BALARIA, RN, RM, MAN

Single barrel – proximal colon is - change pouch

brought to the surface forming one - empty bag frequently and
stoma’ provide ventilation, use deodorizer
Double barrel – two stomas, - Avoid gas producing foods
proximal excretes stool, distal Promote adequate stomal drainage
secretes mucus - assess stoma for color and
Stool formation depends on intactness
1. Ascending – loose, liquid - mucoid/serosanguinous drainage
2. Transverse – semisolid 1st 24hrs
3. descending – soft, formed stool - assess for flatus
Irrigate colostomy as needed
Sexual dysfunction affects 15 – - position client on toilet or high
1005 depending on the client age, fowlers
surgical technique - fill irrigation bag with water (500-
1000ml)
Colon cancer - Remove old pouch and clean skin
NURSING INTERVENTION - lubricate catheter and insert to
Pre-Operative care stoma
1. Provide HIGH protein, HIGH - allow fecal contents to drain
calorie and LOW residue diet Provide adequate nutrition
2.Provide information about post- 2500ml liquids/day
op care and stoma care
3. Administer antibiotics 3-5 day Health teaching when discharge
prior a. change in odor, consistency and
Colon cancer color of stool
NURSING INTERVENTION b. bleeding from stoma
Pre-Operative care c. persistent constipation and
4. Enema or colonic irrigation the diarrhea
evening and the morning of d. persistent leakage around the
surgery stoma
5. NGT is inserted to prevent e. skin irritation
distention
6. Monitor UO, F and E, Abdomen Colon cancer
PE NURSING INTERVENTION:
Colon cancer COLOSTOMY CARE
Colostomy begins to function 3-6
NURSING INTERVENTION days after surgery
Post-Operative care The drainage maybe soft/mushy or
1. Monitor for complications semi-solid depending on the site
a. Leakage from the site Colon cancer
b. prolapse of stoma
c. Infection NURSING INTERVENTION:
d. Bowel obstruction COLOSTOMY CARE
2. Assess the abdomen for return • BEST time to do skin care is
of peristalsis after shower
• Apply tape to the sides of the
Colostomy Care pouch before shower
Prevent skin breakdown • Assume a sitting or standing
- cleans skin around stoma with position in changing the
mild soap, water and padding pouch
motion NURSING INTERVENTION:
- assess skin regularly for irritation COLOSTOMY CARE
- avoid use of adhesive on irritated • Instruct to GENTLY push the
skin skin down and the pouch
Control odor pulling UP
 WESLEYAN UNIVERSITY – PHILIPPINES
Mabini Extension, Cabanatuan City

JAN RAINIER C. BALARIA, RN, RM, MAN

• Wash the peri-stomal area 2. Mass is NON-tender. Fixed, hard

with soap and water with irregular borders
• Cover the stoma while 3. Skin dimpling
washing the peri-stomal area 4. Nipple retraction
• Lightly pat dry the area and 5. Peau d’ orange
NEVER rub Breast Cancer
• Lightly dust the peri-stomal LABORATORY FINDINGS
area with nystatin powder 1. Biopsy procedures
2. Mammography
• Colon cancer
3. Tumor marker CA 2729
NURSING INTERVENTION:
Breast Cancer
COLOSTOMY CARE
Breast cancer Staging
Empty the pouch or change the
TNM staging
pouch when
I - < 2cm
1/3 to ¼ full (Brunner)
II - 2 to 5 cm, (+) LN
½ to 1/3 full (Kozier)
III - > 5 cm, (+) LN
IV- metastasis
BREAST CANCER
Metastatic sites
a. Bone
The most common cancer in
b. Liver
FEMALES
c. Lung
Numerous etiologies implicated
d. Brain
RISK FACTORS
Treatment
1. Genetics- BRCA1 And BRCA 2
Surgical management is the
2. Increasing age ( > 50yo)
primary treatment for breast
3. Family History of breast cancer
cancer
4. Early menarche and late
Breast conservation (lumpectomy,
menopause
segmental resection)
5. Nulliparity
- removal of the cancer with
6. Late age at pregnancy
margin of healthy tissue
Breast Cancer
- If followed by radiation therapy
7. Obesity
has equivalent 5 year survival to
8. Hormonal replacement
mastectomy
9. Alcohol
10. Exposure to radiation
Simple – removal of all breast,
nipple and skin
PROTECTIVE FACTORS
Modified radical – axillary
1. Exercise
lymphnodes are removed
2. Breast feeding
Radical mastectomy – pectoral
3. Pregnancy before 30 yo
muscles are removed
Stages I and 2 are 70-90% curable
Medical therapy
Invasive or infiltrating, capable of
External beam radiation therapy 3
metastasis
weeks after surgery. Most
a. Ductal – 70%
commonly used
b. Lobular – 10 % higher incidence
Chemotherapy
of contralateral breast cancer
Tamoxifen therapy
Breast Cancer
Breast Cancer
ASSESSMENT FINDINGS
1. MASS- the most common
NURSING INTERVENTIONS: PRE-OP
location is the upper outer
quadrant
 WESLEYAN UNIVERSITY – PHILIPPINES
Mabini Extension, Cabanatuan City
JAN RAINIER C. BALARIA, RN, RM, MAN
1. Explain breast cancer and
treatment options
2. Reduce fear and anxiety and
improve coping abilities
3. Promote decision making
abilities
4. Provide routine pre-op care:
Consent, NPO, Meds, Teaching
about breathing exercise
Breast Cancer
NURSING INTERVENTIONS: Post-OP
1. Position patient:
Supine
Affected extremity elevated to
reduce edema
Breast Cancer
2. Relieve pain and discomfort
Moderate elevation of extremity
IM/IV injection of pain meds
Warm shower on 2nd day post-op
Breast Cancer
3. Maintain skin integrity
Immediate post-op: snug dressing
with drainage
Maintain patency of drain (JP)
Monitor for hematoma w/in 12H
and apply bandage and ice, refer to
surgeon
3. Maintain skin integrity
Drainage is removed when the
discharge is less than 30 ml in 24 H
Lotions, Creams are applied ONLY
when the incision is healed in 4-6
weeks
Promote activity
Support operative site when
moving
Hand, shoulder exercise done on
2ndday
Post-op mastectomy exercise 20
mins TID
NO BP or IV procedure on operative
site
Promote activity
Heavy lifting is avoided
Elevate the arm at the level of the
heart
On a pillow for 45 minutes TID to
relieve transient edema
NURSING INTERVENTIONS: Post-OP
MANAGE COMPLICATIONS
Breast Cancer
Lymphedema
10-20% of patients
Elevate arms, elbow above
shoulder and hand above elbow
Hand exercise while elevated
Refer to surgeon and physical
therapist
Breast Cancer
NURSING INTERVENTIONS: Post-OP
MANAGE COMPLICATIONS
Hematoma
Notify the surgeon
Apply bandage wrap (Ace wrap)
and ICE pack
Breast Cancer
NURSING INTERVENTIONS: Post-OP
TEACH FOLLOW-UP care
Regular check-up
Monthly BSE on the other breast
Annual mammography
Lung Ca
The number 1 cancer killer in men
and women
• 6th to 7th decade of life
• 70% involvement of
lymphnodes
• 85% caused by inhalation of
carcinogenic chemicals
Pathophysiology
Arise from a single transformed
epithelial cell in the
tracheobronchial airways.
Adenocarcinoma - most prevalent
carcinoma of the lung for men and
women, peripherally located and
often metastasized
Squamous cell Ca – centrally
located and arises in the segmental
and subsegmental bronchi
Large cell Ca – fast growing tumor
that arise peripherally
Bronchioalveolar – slower growing
and arises at the alveoli
Classification and staging
Non small cell Ca – 70-75%
a. Adenocarcinoma
- most common (40%)
- slowest growing,
metastasize early
 WESLEYAN UNIVERSITY – PHILIPPINES
Mabini Extension, Cabanatuan City
JAN RAINIER C. BALARIA, RN, RM, MAN
b. Squamous cell – 30%
c. Large cell – rarest
- has the worst prognosis
Small cell (25%)
a. Oat cell (90%)
- very aggressive and
metastasize at diagnosis.
5 year survival rate is 48% if
detected early and localize (rare)
Overall 5 year survival rate is 15%
Risk factors
Tobacco smoking
- single most important
preventable cause of death
- 10x more common than in non-
smoker
- passive smoke exposure
increases the risk to 35%
Environmental and occupational
exposure
- arsenic, asbestos, mustard gas,
oil, radiation
.genetics
Diet
Clinical manifestation
Develops insidiously and is
assymptomatic until late in the
course
s/sx depends on the location and
size of the tumor, degree of
obstruction and metastasis
Cough or chronic cough
- dry, persistent without sputum
production
Wheezing
Hemoptysis or blood tinged sputum
Chest and shoulder pain
Common sites of metastasis
• LN
• Bone
• Brain
• Contralateral lung
• Adrenal glands
• liver
Screening test: No screening
program currently exists.
Assessment:
• Clients are very rarely
symptomatic at the time of
diagnosis.
• Persistent cough and
dyspnea
• Recurrent bronchitis and
pneumonia
• Blood streaked sputum
• Chest pain
Diagnostics
a. Chest xray (solitary
peripheral nodule, coin
lesion)
b. Ct scan of the chest
c. Fiberoptic bronchoscopy
d. Fine needle biopsy under ct
scan
Surgical Management
Dependent on whether the tumor is
resectable
May be cure for non small cell if no
metastasis occurred and lung
function is sufficient on removal of
all or part of the lungs (50%)
Lobectomy – removal of lobe
(common)
Pneumonectomy – removal of the
lung
Segmentectomy – partial removal
of the lung lobe
Adjuvant therapy
a. Chemotherapy is the primary
treatment for small cell
b. Radiation is standard post op for
advanced non-small cell
Radiation therapy – for localized
intrathoracic lung ca and palliation
for hemprtysis, obstruction
dysphagia and pain
Nursing Intervention
Assess for signs of superior vena
cava syndrome
Postlobectomy, manage chest tube
Assess respiration and for presence
of pneumothorax or atelectasis
Position properly post-op
1. Lobectomy – avoid prolonged
lying on the operative site
2. Pneumonectomy – position on
the back or operative side only
 WESLEYAN UNIVERSITY – PHILIPPINES
Mabini Extension, Cabanatuan City
JAN RAINIER C. BALARIA, RN, RM, MAN
Instruct the client on deep
breathing, coughing and
ambulation
Pain management to promote deep
breathing
Refer client to smoking cessation
Prostate Cancer
• a slow growing malignancy of
the prostate gland
• Usually an adenocarcinoma
• This usually spread via blood
stream to the vertebrae
• 2nd most common cause of
cancer deaths
• 190000 new cases each year
and 30,000 deaths annually
• Over 80% are diagnosed in
early stages. Allowing an
almost 100% 5 year survival
rate.
• Overall for all stages survival
is 96%
Prostate Cancer
• Predisposing factor
• Age
• Strong family history
• High fat diet may play a role
• Having a vasectomy may
play a role
Prostate Cancer
Assessment Findings
• DRE: hard, pea-sized nodules
on the anterior rectum
• Hematuria
• Urinary obstruction
• Pain on the perineum
radiating to the leg
Prostate Cancer
Diagnostic tests
1. DRE
2. Prostatic specific antigen (PSA)
3. Elevated SERUM ACID
PHOSPHATASE indicates SPREAD or
Metastasis
Surgical Management
Radical prostatectomy – removal of
prostate, capsule, ejaculatory
ducts, seminal vesicles plus
lymphnodes
Watchful waiting without
intervention may be appropriate in
men over 70 years of age with
small, early stage cancers
Prostate Cancer
Medical and surgical management
Prostatectomy
TURP
Chemotherapy: hormonal therapy
to slow the rate of tumor growth
Nursing Interventions
Prepare patient for chemotherapy
Prepare for surgery
Nursing Interventions: Post-
prostatectomy
1. Maintain continuous bladder
irrigation. Note that drainage
is pink tinged w/in 24 hours
2. Monitor urine for the
presence of blood clots and
hemorrhage
3. Ambulate the patient as soon
as urine begins to clear in
color
4. Provide for bladder retraining
after foley-catheter removal
a. Perineal exercises
b. restrict caffeine
c. limit fluid intake at night
5. Education
a. Avoid lifting, straining, and
prolonged travel
b. possible impotence
Bladder Cancer
Transitional cell carcinoma – most
common (90-95%)
Approximately 54300 new cases
and 12400 deaths
No screening for early detection
Risk factors
• Smoking
• Occupational exposures
• Caucasian males >50 years
old
Asessment
• Gross, painless hematuria
• Dysuria
• Urinary frequency
• Urgency
 WESLEYAN UNIVERSITY – PHILIPPINES
Mabini Extension, Cabanatuan City
JAN RAINIER C. BALARIA, RN, RM, MAN
• Urinary hesitancy
• Suprapubic, rectum, back
pain
Diagnostic
1. Urinary cytology – late
morning or early afternoon
2. Bladder washing more
reliable
3. Flow cytometry – exdamine
DNA content of urine cells
4. IVP – evaluate upper urinary
tracts
5. Cystoscopy – tumor
visualization and biopsy
6. CT scan, transurethral
ultrasound, MRI
7. Tumor marker – p53 and
epidermal growth factor in
late stage
Surgical management
1. Transurethral resection and
fulguration (Destruction of
surrounding tissue with
electricity) most common for
low grade Ca
2. Radical cystectomy (bladder,
prostate, seminal vesicles,
urethra, overy, FT are
removed) for high grade
tumors
3. Adjuvant therapy
4. Radiation therapy – used in
invasive cancer
5. Chemotherapy – cisplatin,
methotrexate, vincristine
Nursing interventions
• Instruct on preop low residue
and clear liquid diet
• Assess for urinary stoma and
teach maintainance of ileal
conduit and appliance
• Assess urinary output (should
produce urine immediately)
for infection and signs of
peritonitis
• Discuss possible sexual
dysfunction
SKIN CANCER
Malignant lesion of the skin, which
may or may not metastasized
Types
a. Basal cell – most common type
arising from the basal cells
contained in the epidermis
b. Squamous Cell – 2nd most
common type in whites.tumor of
the keratinocytes Metastasized to
the LN and fatal
c. Malignant melanoma – can
metastasized to the brain, lung,
bone, skin. Fatal
SKIN CANCER
Causes: UV light exposure, chronic
irritation and friction
Dx: skin biopsy
S/sx: change in color, size, shape of
lesion
• Monitor lesions that do not
heal
• Removed moles or lesions
that are subject to chronic
irritations
• Avoid contact with chemical
irritants
• Use sun screen lotions and
clothing
• Avoid sun exposure between
11am-3pm
• Contact Dermatitis
• Inflammatory response after
contact with a specific
antigen
• Assessment:
• Pruritus and burning
• Edema
• Erythema at the point of
contact
Signs of infection
Vesicles with drainage
GASTRIC CANCER
Approximately 22000 cancers and
13,000 deaths per year
African americans, japanese,
chinese and US have higher
incidence
95% are adenocarcinomas
Prognosis is poor, 5 year survival
rate is 5-15 %
 WESLEYAN UNIVERSITY – PHILIPPINES
Mabini Extension, Cabanatuan City

JAN RAINIER C. BALARIA, RN, RM, MAN

a. Billroth I
Risk factors b. Billroth II
• Male > 40 years of age b. Proximal subtotal gastrectomy
• Low socioeconomic status
• Poor nutritional health habits Paliation of symptoms
and vitamin A deficiency Adjuvant therapy
• Family history External beam radiation for control
of unresectable tumors, palliation
• Previous gastric resection
and increased survival.
• Pernicious anemia
Chemotherapy has little impact – 5
• H. pylori infection FU, doxorubicin, mitomycin
• Gastric atrophy and chronic
gastritis Nursing Intervention
• Rubber workers and coal • Goal is control of clinical
miners manifestation and supporting
optimal functioning
Metastatic sites • Assess the nutritional status
Direct extension to the pancreas, - small frequent feeding low
liver, esophagus. carbohydrate, high fat, high
Intraperitoneal dissemination to protein.
ovary - restrict fluids 30 minutes
Nodal spread to the neck after meals reducing risk of
Bloodstream metastasis to the dumping syndrome
lung, adrenal, liver, bone and
peritoneal cavity Postoperative
- Respiratory status: reflux
Screening aspiration
Among high risk person’s only - Infection
Barrium x-ray or endoscopy - Pain – potential anastomotic
leak obstruction
Assessment - Bezoar (food clumping)
Early manifestations are non- formation causing gastric
specific outlet obstruction
Upper epigastrium, retrosternal - Bleeding
pain - Dumping syndrome
Uneasy sense of fullness after - anemia
meals
Loss of appetite CERVICAL CANCER
Nausea and vomiting
Weakness 13,000 new cancers and 4000
Fatigue deaths
anemia Very treatable and curable
80-90% are squamous carcinoma
Diagnostic procedure
EGD Risk factors
Biopsy Sexual intercourse before age 17,
Endoscopic ultrasound multiple partners
Double contrast upper GI series Sexual partner who has multiple
CT scan partners
Cigarette smoking
Surgical management Human papilloma virus
Only treatment that is potentially Lower socioeconomic status
curative
a. Total gastrectomy Metastatic sites
Radical subtotal gastrectomy Abdomen and pelvis
 WESLEYAN UNIVERSITY – PHILIPPINES
Mabini Extension, Cabanatuan City
JAN RAINIER C. BALARIA, RN, RM, MAN
Lung
Liver
Bone
Screening
Pap’s smear beginning at age 18 or
sexually active
assessment
- Assymptomatic in the early
stage
- Watery vaginal discharge
- Late manifestation,
postcoital, heavy or
intermenstrual bleeding.
diagnostics
Colposcopy – application of acetic
acid followed by magnified
examination of the pelvis
Biopsy
Endocervical curettage
Cone biopsy
Management
Total abdominal hysterectomy and
lymphadenectomy
Depends on the stage and desire
for child bearing
Radiation therapy
Chemotherapy for advanced
disease
Laser therapy
- used when all boundaries of the
lesion are visible during
colposcopic examination.
- minimal bleeding is associated
with the procedure.
- slight vaginal discharge is
expected following the procedure
and healing occurs in 6 to 12
weeks.
Conization
- a cone shaped area of the cervix
is removed
- performed in women who desire
further childbearing.
- long term follow up care is
needed, as new lesions can
develop
- the risk of procedure includes
hemorrhage, uterine perforation,
incompetent cervix and preterm
labor in future pregnancies.
Hysterectomy
For microinvasive cancer if
childbearing is not desired.
A vaginal approach is most
commonly performed.
A radical hysterectomy and
bilateral lymphnode dissection may
be performed for cancer that has
spread beyond the cervix but not
to the pelvic wall.
Nursing intervention
Assess for changes in bowel and
bladder pattern
Bladder training
If laser surgery for early diseases is
used, instruct to avoid douching,
tampoons and sexual activity for 2-
4 weeks
Assess for sexual dysfunction,
surgical shortening of vagina,
vaginal dryness
 Leukemia
 “white blood” neoplastic
proliferation of one particular
cell type.
 Unregulated proliferation of
WBCs in the bone marrow
 Classified into lymphoid or
myeloid, acute and chronic
 Acute Myeloid leukemia
 Defect in hematopoetic stem
cells that differentiate into all
myeloid cells.
 All age group are affected
and incidence increases with
age with peak at age 60
 With treatment patients
survive an average of 1 year
with death usually due to
infection or hemorrhage.
 Clinical manifestation
 Most of signs and symptoms
evolve from insufficient
production of normal blood
cells.
 Fever, infection, weakness,
fatigue, bleeding tendencies.
 Pain from enlarged liver and
spleen
 Hyperplasia of gums
 Diagnostics
 CBC, decrease erythrocytes
and platelets
 WESLEYAN UNIVERSITY – PHILIPPINES
Mabini Extension, Cabanatuan City
JAN RAINIER C. BALARIA, RN, RM, MAN
 Bone marrow aspiration,
excess of immature blast
cells (>30%)
 Medical management
 The objective is to achieve
complete remission by
aggressive chemotherapy
called induction therapy.
 High doses of cytarabine and
daunorubicin
 The aim is eradication of
leukemic cells but it is often
accompanied by eradication
of normal type of myeloid
cells.
 Consolidation therapy
(postremission therapy)
eliminate any residual
leukemia cells that are not
clinically detectable,
diminishing the chance of
remission.
 70% experience relapse
 Consolidation therapy
(postremission therapy)
eliminate any residual
leukemia cells that are not
clinically detectable,
diminishing the chance of
remission.
 70% experience relapse
 Chronic Myeloid Leukemia
 Arises from mutation in the
myeloid stem cell. Normal
myeloid cells continue to
produced, but there is
preference for immature
(blast) forms.
 Uncontrolled proliferation
results in marrow expansion
of long bones, liver and
spleen resulting in pain.
 Chromosome 22
(philadelphia chromosome)
and chromosome 9 (BCR-ABL
gene) producing an abnormal
protein (tyrosine kinase)
causing WBC to divide
rapidly.
 Common in 40 – 50 years old
 Median life expectancy of 3
to 5 years
 Patient is usually
assymptomatic
 WBC exceeds to
100000/mm3.
 Shortness of breath or
confused due to decrease
capillary perfusion of brain
and lungs from leukostasis.
 Treatment
 Imatinib mesylate (Gleevec)
tyrosine kinase inhibitor –
blocking BCR-ABL protein
preventing cells to divide.
 Avoid antacid, grape juice
and acetaminophen
 Treatment
 Imatinib mesylate (Gleevec)
tyrosine kinase inhibitor –
blocking BCR-ABL protein
preventing cells to divide.
 Avoid antacid, grape juice
and acetaminophen
 Correction of chromosome
abnormality
 Interferon alfa and cytosine
administered subcutaneously
daily.
 Many patient cannot tolerate
profound fatigue, depression,
anorexia, mucositis and
inability to concentrate.
 Leukopheresis – blood of
patient is removed and
seperated, leukocytes
removed and remaining
blood returned. Causing
temporary decrease in WBC.
 Acute Lymphocytic Leukemia
 Uncontrolled proliferation of
immature cells (lymphoblast)
 Common in young children,
with boys affected more than
girls
 >80% of children survive at
least 5 years
 Clinical manifestation
 Immature lymphocytes
proliferate in bone marrow
 Decrease WBC, RBC and
platelets
 Leukemic cell infiltration
causing pain from enlarged
liver, spleen, bone pain,
headache and vomiting
 Treatment
 WESLEYAN UNIVERSITY – PHILIPPINES
Mabini Extension, Cabanatuan City
JAN RAINIER C. BALARIA, RN, RM, MAN
 Very sensitive to
corticosteroids and vinca
alkaloids
 Prophylaxis of intrathecal
chemotherapy
(methotrexate)
 Chronic Lymphocytic
Leukemia
 Common malignancy in older
adults >60 years old.
 Average survival time ranges
from 14 years to 2.5 years
 Most of cells are fully mature
 Clinical Manifestation
 Enlargement of lymphnodes,
painful
 Splenomegally
 “B” symptoms – constellation
of symptoms including fever,
drenching sweating, and
unintentional weight loss.
 Absent reaction to skin test
(Anergy)
 Treatment
 Chemotherapy with
corticosteroid and
chlorambucil (leukeran)
 Fludarabine (fludara)
frontline therapy – major side
effect is prolonged bone
marrow supression
 Treatment
 Chemotherapy with
corticosteroid and
chlorambucil (leukeran)
 Fludarabine (fludara)
frontline therapy – major side
effect is prolonged bone
marrow supression
 Lymphomas
 Neoplasms of cells of
lymphoid origin
 Usually starts in lymph
nodes
 Hodgkin’s Lymphoma
 Rare malignancy that has
impressive cure rate.
 Common in men than women
peaks at early 20’s and after
50 years
 Malignant is Reed-Sternberg
cells (hallmark of the
disease)
 Clinical Manifestation
 Painless enlargement of one
or more lymphnodes on one
side of the neck. (cervical,
supraclavicular and
mediatinal)
 Mediatinal mass on chest x-
ray
 Pain after drinking alcohol
 “B” symptoms
 Diagnosis
 Excisional lymphnode biopsy
finding Reed-Sternberg cells
 Elevated ESR and serum
copper level assess disease
activity.
 Treatment
 The intent in treating is cure
regardless of the stage of the
tumor.
 Shortcourse chemotherapy
followed by radiation therapy
 ABVD standard of treatment,
Adriamycin, Bleomycin,
Vinblastine, Decarbazine
 Non Hodgkin’s Lymphoma
 Involved malignant B
lymphocytes
 Incidence increases with age
at diagnosis of 50 to 60 years
old.
 Common in
immunodeficiencies or
autoimmune disorders
 Clinical manifestation
 At early stage symptoms are
virtually absent until late in
the course
 Lymphadenopathy in the
later stage and B symptoms
 management
 Radiation alone in early non
aggressive tumor.
 Oncologic Emergencies
 Superior Vena Cava
Syndrome (SVCS
 Compression or invasion of
the superior vena cava by
tumor, enlarged lymph
nodes, intraluminal thrombus
that obstructs venous
circulation, or drainage of the
 WESLEYAN UNIVERSITY – PHILIPPINES
Mabini Extension, Cabanatuan City
JAN RAINIER C. BALARIA, RN, RM, MAN
head, neck, arms, and
thorax.
 Typically associated with
lung cancer,SVCS can also
occur with lymphoma and
metastases.
 If untreated, SVCS may lead
to cerebral anoxia (because
not enough oxygen reaches
the brain),laryngeal edema,
bronchial obstruction,and
death.
 Gradually or suddenly
impaired venous drainage
giving rise to
• Progressive shortness of breath
(dyspnea),cough, and facial
swelling
• Edema of the neck, arms, hands,
and thorax and reported sensation
of skin tightness and difficulty
swallowing
• Possibly engorged and distended
jugular,temporal, and arm veins
• Dilated thoracic vessels causing
prominent venous patterns on the
chest wall
• Increased intracranial pressure,
associated visual disturbances,
headache, and altered
mental status
Diagnostic
 Diagnosis is confirmed by
• Clinical findings
• Chest x-ray
• Thoracic CT scan
• MRI
. cautiously to minimize edema
 Treatment
• Radiation therapy to shrink tumor
size and relieve symptoms
• Chemotherapy for radiation-
resistant tumor (eg, lymphoma or
small cell lung cancer) or when the
mediastinum has been irradiated to
maximum tolerance
• Anticoagulant or thrombolytic
therapy for intraluminal
thrombosis
• Surgery (less common), eg, vena
cava bypass graft (synthetic or
autologous) to redirect blood flow
around the obstruction
• Supportive measures such as
oxygen therapy,corticosteroids,
and diuretics
 Treatment
• Radiation therapy to shrink tumor
size and relieve symptoms
• Chemotherapy for radiation-
resistant tumor (eg, lymphoma or
small cell lung cancer) or when the
mediastinum has been irradiated to
maximum tolerance
• Anticoagulant or thrombolytic
therapy for intraluminal
thrombosis
• Surgery (less common), eg, vena
cava bypass graft (synthetic or
autologous) to redirect blood flow
around the obstruction
• Supportive measures such as
oxygen therapy,corticosteroids,
and diuretics
 Nursing Intervention
• Monitor and report clinical
manifestations of SVCS.
• Monitor cardiopulmonary and
neurologic status.
• Facilitate breathing by
positioning the patient properly.
This helps to promote comfort and
reduce anxiety produced by
difficulty breathing resulting from
progressive edema.
• Promote energy conservation to
minimize shortness of breath.
• Monitor the patient’s fluid volume
status and administer fluids
 Spinal Cord Compression
 Potentially leading to
permanent neurologic
impairment and associated
morbidity and mortality,
compression of the cord and
its nerve roots may result
from tumor, lymphomas, or
intervertebral collapse.
 The prognosis depends on
the severity and rapidity of
onset.
 About 70% of compressions
occur at the thoracic level,
20% in the lumbosacral level,
 WESLEYAN UNIVERSITY – PHILIPPINES
Mabini Extension, Cabanatuan City
JAN RAINIER C. BALARIA, RN, RM, MAN
and 10% in the cervical
region.
 Metastatic cancers (breast,
lung, kidney, prostate,
myeloma, lymphoma) and
related bone erosion are
associated with spinal cord
compression.
 Clinical manifestation
 Local inflammation, edema,
venous stasis,and impaired
blood supply to nervous
tissues
 Local or radicular pain along
the dermatomal areas
innervated by the affected
nerve root
 Pain exacerbated by
movement, coughing,
sneezing, or the Valsalva
maneuver
 Neurologic dysfunction, and
related motor and sensory
deficits (numbness, tingling,
feelings of coldness in the
affected area, inability to
detect vibration,loss of
positional sense)
 Motor loss ranging from
subtle weakness to flaccid
paralysis
 Treatment
 Radiation therapy to reduce
tumor size to halt
progression and
corticosteroid therapy to
decrease
inflammation and swelling at
the compression site
 Surgery only if symptoms
progress despite radiation
therapy or if vertebral
fracture leads to additional
nerve damage
 Chemotherapy as adjuvant
to radiation therapy
for patients with lymphoma
or small cell lung cancer
 Nursing Intervention
 Perform ongoing assessment
of neurologic function to
identify existing and
progressing dysfunction.
 Control pain with
pharmacologic and
nonpharmacologic measures.
 Prevent complications of
immobility resulting from
pain and decreased function
 Maintain muscle tone by
assisting with range-ofmotion
exercises in collaboration
with physical and
occupational therapists.
 Institute intermittent urinary
catheterization and bowel
training programs for
patients with bladder or
bowel dysfunction.
 Nursing Intervention
 Perform ongoing assessment
of neurologic function to
identify existing and
progressing dysfunction.
 Control pain with
pharmacologic and
nonpharmacologic
measures.
 Prevent complications of
immobility resulting from
pain and decreased function
 Maintain muscle tone by
assisting with range-of-
motion
Exercises in collaboration
with physical and
occupational therapists.
 Institute intermittent urinary
catheterization and bowel
training programs for
patients with bladder or
bowel dysfunction.
 Hypercalcemia
 In patients with cancer,
hypercalcemia is
a potentially life-threatening
metabolic abnormality
resulting when the calcium
released from the bones is
more than the kidneys can
excrete or the bones can
reabsorb.
 Clinical manifestation
 Fatigue, weakness,
confusion,
 Decreased level of
responsiveness, hyporeflexia,
 WESLEYAN UNIVERSITY – PHILIPPINES
Mabini Extension, Cabanatuan City
JAN RAINIER C. BALARIA, RN, RM, MAN
 nausea, vomiting,
constipation, polyuria
 (excessive urination),
polydipsia (excessiv
 Nursing Intervention
 Identify patients at risk for
hypercalcemia and assess for
signs and symptoms of
hypercalcemia.
 Teach at-risk patients to
recognize and report signs
and symptoms of
hypercalcemia.
 Encourage patients to
consume 2 to 3 L of fluid
daily unless contraindicated
by existing renal or cardiac
disease.
 Explain the use of dietary
and pharmacologic
interventions such as stool
softeners and laxatives for
constipation.
 Nursing Intervention
 Identify patients at risk for
hypercalcemia and assess for
signs and symptoms of
hypercalcemia.
 Teach at-risk patients to
recognize and report signs
and symptoms of
hypercalcemia.
 Encourage patients to
consume 2 to 3 L of fluid
daily unless contraindicated
by existing renal or cardiac
disease.
 Explain the use of dietary
and pharmacologic
interventions such as stool
softeners and laxatives for
constipation.
 Cardiac Tamponade
 Cardiac Tamponade is an
accumulation
of fluid in the pericardial
space.
 The accumulation
compresses the heart and
thereby impedes expansion
of the ventricles and cardiac
filling during diastole.
 As ventricular volume and
cardiac output fall, the heart
pump fails, and circulatory
collapse develops.
 CARDIAC TAMPONADE
ASSESSMENT FINDINGS
 1. BECK’s Triad- Jugular
vein distention,
hypotension and
distant/muffled heart
sound
 2. Pulsus paradoxus
 3. Increased CVP
 4. decreased cardiac
output
 Treatment
 Pericardiocentesis (the
aspiration or withdrawal
 of the pericardial fluid by a
large-bore needle inserted
 into the pericardial space).
CARDIAC TAMPONADE
NURSING INTERVENTIONS
 1. Assist in
PERICARDIOCENTESIS
 2. Administer IVF
 3. Monitor ECG, urine
output and BP
 4. Monitor for recurrence
of tamponade
 Pericardiocentesis
 Patient is monitored by
ECG
 Maintain emergency
equipments
 Elevate head of bed 45-60
degrees
 Monitor for complications-
coronary artery rupture,
dysrhythmias, pleural
laceration and myocardial
trauma