Chapter 16 Oncology

Cancer
Refer to a disease whereby cells mutate into abnormal cells that proliferate
abnormally and do not perform the normal body functions
Anatomic Classification of Tumors and Tumor-Associated Angtigens on Cell Surface
o A tumor is classified by the tissue of origin, anatomic site, and the behavior of
the tumor (benign or malignant).
o Malignant
Aggressive growths that invade and destroy surrounding tissues
o Benign,
Slow growing, encapsulate and can destroy surrounding tissues
Should we be worry about it?
It depends. i.e. if it is benign brain tumor and cause nothing, we
might leave it alone.
Normally brain tumor are secondary to primary tumor
Treat the primary site first then secondary site

Common sites of cancer and their sites of metastasis

o Lungs, bone, brain

What is priority of cancer?

Psycho problem
More important in breast cancer
Pain
Infection
S/e of treatment

A lot of question will be on

Touchy feeling
Screening
What would you do with it. Eg drug
o Zofran- anti-emesis
Do not infuse it to quickly b/c it cause severe headache
o Reglan S/E is severe headache
 Patient with hx of migraine be careful
o Benadryl common questions on broad exam
Helpful with n/v
Helps equalize equilibrium
Helps p.t relax, drowsiness
Watch for paradox effect in elderly and children
Psychotic effect in mental patient
Cancer incidence
o Male = prostate
o Female = breast
o Strongly link to family hx

Cancer site of metastasis

Prioritization with lung cancer
o Breathing
o Complications
COPD, empyema
O2 at lowest as possible
o Assessment
Lungs sounds
Patient skin, appearance, how patient breathing
o Make sure that the cancer is primary or secondary

Pathophysiology Need to know the ending term

o Questions will be like fibrilesarcoma
o What is it? Is it matasize, where it the location, what would you do.
Risk factors
o Family hx
Genetics prediposure
o Viral
HIV, Esin Barr
o Chemical
o Chronic illness
Pancreatic cancer
o Age
Increase risk for people over age of 65
o Hormones
Hormones change
Estrogen
Warning sings
o CAUTION
Change in bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge
Do stool occulting
Thickening or lump in breast or elsewhere
Indigestion or difficulty in swallowing
 Obvious change in wart of mole
Nagging cough or hoarseness
Ask how much they are smoking
Exposure to smoke and chemical

Intervention
o How would you response type of questions are the majority in the first exam

Staging of cancer
o T0 = no evidence of primary tumor
o N0= indicates lymph node involvement
o M= indicate distant metastases
o There are 5 stages
Stage 0: carcinoma in situ
Stage 1: tumor limited to the tissue of origin; localized tumor growth
Stage 2: limited local spread
Stage 3: extensive local and regional spread
Stage 4: distant metastasis
 Diagnostic
o Biopsy is the best test to determine whether patient have cancer of not
o Depends on location
Prostate, PSA
Digital rectal exam
o Mammography
o PAP smear
o Stools for occult blood
o Sigmoidoscopy, colonoscopy
o Breast self-examination
Once a month, 7-10 days after menses
Postmenopausal pt pick same day each month to it

o Testicular self-examination
Once a month, same day
Skin inspection

Treatment
Goal is to cure
If there is no cure best is to control the spreading through;
o 1.Surgical
Know where the surgical site and what would be intervention
Colon cancer
o 2. Chemotherapy
Involves the administration of cytotoxic medications and chemicals
to promote tumor cell death
It is vital for the Cather be in the VEINS or portable cap, because if it
infiltrate it will destroy skin
Types
Oral
o RN: need to have glove on when giving med
o Empty urine
 RN needs to have glove, face mask and
grown
Flush twice
IV
PICC line

o 3. Radiation- Know types we do with Radiation

The goal of this treatment is to cure, control and palliate
External
Teletherapy
o Perform by radiation therapist at the radiation room
Internal
Brachytherapy
o Seed implanted in specific part of body
Prostate/ bladder
RN: monitor I&O, and protect them
self when collecting urine
o Don Mask, Grown, Glove
o ALARA-Know
As low as reasonably achievable
Time
o Cluster care
Distance
o Aim at the site
Shielding
o Shield the part the un-effected part
Chest radiation shield gonad
Assess patients before and after radiation

o 4. Gene Therapy
o Missing or altered genes may lead to cancer.
o Transfer of exogenous genes into cells of patients in an effort to correct defective
gene
5. Bone marrow transplant
o Goal is to restart the blood production for leukemia patient
6. Medication Know for quiz
o Why giving it
o S/E
o Intervention

Noting medical can do then palliative care

o Keep them as comfortable as possible and to keep pt. alive as long as we can

S/E Of Chemotherapy and medication

o Apical
 Priory is self-esteem
Provide wigs, Bandana
o Dirrhea
Give med that bulk up stool
Ducasate
Assess p.t perineum area
Encourage dient low in fiber residue prior to treatment with chemo
o Vomiting
Admit Zofran
Admit as slow as possible to prevent severe headache
o Anorectic
Ask What they want to eat
Sore throat
Give mouth wash to numb the throat
If admit Lidocaine
o Watch out for S/E of the heart
o Neutropenia
No fresh flowers, fruits or veggies in the room
Look at WBC counts
Infection precaution
o Respiratory
Resp distress
Give O2 check O2 sat
Incubate is a last resource
o Done by MD or NP
o Watch for chest to rise and fall
o Watch out for aspiration
o Skin
Skin break down
Rash
o Reproductive
Priority is to be able to reproduce
Harvest the eggs or sperms

Patient and Caregiver Teaching Guide

Coping
o Grief issues
Loss of healthy self
Preparation for death
o Anxiety
o Uncertainties
o Support groups

Complications Resulting From Cancer-Need to know for the test!!

Malnutrition
Altered taste sensation
 Infection
Oncology emergencies
o Superior vena cava syndrome
Obstruction of the SVC by tumor
S&S
Facial edema, periorbital edema , headache, seizure
o Spinal cord compression
Presence of tumor in epidural space
S&S
Bowel and bladder dysfunctions
o Third space syndrome
o Intestinal obstruction

Metabolic emergency
o Syndrome of Inappropriate Antidiuretic hormone (SIADH)
Sustained production of ADH (antidiuretics hormone)
o Hypercalcemia
o Tumor lysis syndrome (TLS)
Metabolize imbalance can lead to renal failure
Phophase, cal Neuro issue
o Seizure
o Septic shock
o Disseminated intravascular coagulation (DIC)
o Cardiac tamponade
o Carotid artery rupture

Nutritional Therapy
o Need to have sufficient nutrition
Hi calories, Hi protein
o Not eating- intervene start from less invasive to most
NG tubePPN (vein)TP
Pain
o Subjective
o Pain assessment-Vital in cancer patient

Breast Cancer
Most important is mental health of patient
 Incidence
o Most common malignancy in American for women (except skin)
o 40 K deaths year in women
o Morbidity and mortality is slowly decreasing
o 5 year survival rate is 98% if there is not axillary node involvement
o Survival rate for advanced breast Ca is only 17%

Cultural Disparities
o AA women have lower survival rates than white women
o White women have higher incidence than non-whites
o Incidence and mortality rates lower among Hispanics and Asian/Pacific Islander
than white/Black women
o Mexican/American have lowest rate of cancer screening of any ethnic group
Etiology
o Genetics
o BRCA-1 and BRCA-2
Mutated genes that can lead to breast cancer
Family hx is increase risk of having it
Risk Factors
o Female
o Increasing age
Age 50 or over
o Family history
o Personal history
o Early menarche & late menopause
o Full-term pregnancy after age 30
o Benign breast disease
o Weight gain and obesity after menopause
Types of Breast Cancer
o Non-invasive breast Ca
Localized in one spot
o Invasive breast Ca
Spread in more than one spot
o Pagets disease
Rare breast malignancy lesion of nipple and areola
S&S
Itching, burning, bloody nipple discharge
o Inflammatory breast Ca
Most malignant form of all breast cancers
S&S
An orange peel appearance

o What is a best way to screen-Test!!

Age 20-30 do
BSE, Once a month, same day, after period
CBE by HP Q3Ys
Age> 40
 o CBE and mammogram Q1Y

Clinical Manifestations
o Lump in upper outer quadrant
RN: If p.t felt a lumpTell patient get it check out
Screening by Ultrasound and mammogram
Determination by biopsy
o Firm, non-mobile, irregularly shaped and non-tender
o Nipple discharge
o Nipple retraction
o Dimpling of skin

Complications
o Recurrence-main complication
Come back after initial treatment
o Metastasis
Spread to other organ

Diagnosis-Test
o History including risk factors
o Physical examination including breast and lymphatics
o Mammography
o Ultrasound
o Biopsy
o MRI if indicated

Surgical Treatment
o Tumor needs to be staged before treatment options are made-Quiz Questions
o Mastectomy
The deeper and the more tissue taken out more complications
Lymphedema
Need to preserve breast tissue and nipple as much as possible for breast
feeding
o Breast conservation surgery (lumpectomy)
Remove just tissue around the tumor

o Modified radical mastectomy

Removal of breast and axillary nodes but preserves pectoralis major
muscle
Taking more than just breast, taking more than just one
procedure
May or may not have breast reconstruction
Surgical follow- up is vital

o Axillary lymph node dissection (ALND)

Dissection of axillary lymph node at the same side often performed
Complication
 Lymphedema-KNOW!!!
o Accumulation of lymph fluid in the tissue after cancer
treatment

Treatment Axillary Node Dissection Question
Lymphatic mapping with sentinel lymph node dissection
o DO: (SLND) is planned for a patient undergoing a modified
Massage, compression radical mastectomy for breast cancer. The nurse
Elevate, avoid trauma understands that:
o Do NOT: A. If one sentinel lymph node is positive for
malignant cells, all of the sentinel lymph nodes
IV, blood pressure will be removed.
Any invasive procedure B. Lymphatic mapping indicates which lymph
nodes are most likely to have metastasis and all
of those nodes are removed.
C. if malignant cells are found in any sentinel
Breast Conservation Therapy nodes, a complete axillary lymph nodes
o Involves removal of entire tumor dissection will be done.
with a margin of normal tissue D. Lymphatic mapping with sentinel lymph node
o Radiation therapy is delivered to entire breast, ending with a boost to tumor bed
o Evidence of systemic disease may warrant chemotherapy before radiation
o Goal of combined surgery and radiation
Maximize benefits of cancer treatment
Maximize cosmetic outcome
Minimizing risks
o Main advantage is that it preserves the breast and nipple
For breast feeding

Post mastectomy Nursing care-Test Questions are from this picture!!!!!

Postoperative Exercises
 Question
During the immediate postoperative period
following a mastectomy, the nurse initially
institutes exercises for the affected arm by:
A. Having the patient brush or comb her hair
with the affected arm.
B. Performing full passive range-of-motion
(ROM)exercises to the affected arm.
C. Asking the patient to flex and extend
the fingers and wrist of the operative
side.
D. Having the patient crawl her fingers up
the wall, raising her arm above her head.
Question
A patient undergoing a modified radical mastectomy for cancer of the
breast is going to use tissue expansion and an implant for breast
reconstruction. The nurse knows that:
A. Weekly injection of water or saline into the expander will
be required.
B. The expander cannot be placed until the healing from the
mastectomy is complete.
C. This method of breast reconstruction uses the patients own
tissue to replace beast tissue.
D. The nipple from the affected breast will be saved to be grafted
Adjuvant therapy
o Chemotherapy
o Radiation
o Brachytherapy
Seeds that contain medication are implanted near the cancer site and will
release medication as schedule
o Hormonal therapy
Estrogen blocker
Steroid can help with inflammation
o Biologic and targeted therapy
Biologic
Targeted
Aim at specific sites
Nursing Process-Look at difference type of nursing dx-TEST!!
o Nursing Assessment
Subjective Question
Past health hx A patient undergoing surgery and
radiation for treatment of breast cancer
Med hx has a nursing diagnosis of disturbed body
Surgery/ other treatment image related to absence of the breast.
Objective An appropriate nursing intervention for
the patient is to:
Palpate by MD A. Provide the patient with
Assessment after surgery information about surgical breast
o Pain, edema, infection reconstruction.
B. Restrict visitors and phone calls
o Post Op care until the patient feels better about
Pain, elevation, self herself.
esteem C. Arrange for a Reach to
o Nursing Diagnosis Recovery visitor or similar
resource available or similar
o Goals or Planning resource available in the
community.
D. Encourage the patient to obtain
 o Nursing Intervention: Acute
o Evaluation

Gerontologic
o Major risk for breast cancer is increased age.
o More than half of all breast cancers are diagnosed in women age 65 or older.
o 48% diagnosed with metastatic disease are 65 years or older.
Because of commodity and other chronic disease
o Older women are less likely to have mammograms.

Leukemia and Lymphoma

Leukemia-too much production of WBC
o A group of malignant disorders affecting the blood and blood-forming tissues of
Bone marrow
Lymph system
Spleen
o Occurs in all age groups
o Results in an accumulation of dysfunctional cells because of a loss of regulation
in cell division
Causing anemia, leukopenia, the production of immature cells,
thrombocytopenia, and a decline in immunity
o Fatal if untreated

Etiology of Leukemia
o Genetic
Down syndrome and adult are more prone to leukemia
o Environmental
Chemical agent
Chemotherapeutic agents
Viruses
Radiation
o Immunologic deficiencies
Have all been associated with the development of leukemia in
susceptible hosts

Types of Leukemia
o Acute or chronic
o Type of leukocyte involved
Myelogenous
Lymphocytic
o Acute lymphocytic leukemia (ALL) Board exam will be on S&S
Most common in pediatric patients
Very immature cells
S&S
Fever, bleeding, fatigue, immunosuppressed
Think of S&S and touchy feeling, what you do as RN ,
assessment, out come o
 o Acute myologenous leukemia (AML)
Effects mostly adults
A combination of younger and mature cells
o Chronic lymphocytic leukemia (CLL)
Mostly granulocytes present in bone morrow
Age onset is in 40s
Phililadephia chromosome markers
o Chronic myologenous leukemia (CML)
Mostly lymphocytes present in bone marrow
Age onset is after 50 years old
Things to know
Treatment
o Blood transfusion as slow as possible within 4 hours, to prevent fluid
overload
o Can tell the blood bank to send out only haft of blood first then another
half
Assessment
o Occult blood in stool and urine
o Low platelets increase risk for bleeding
Soft bristle brush, electric save etc.

Complications of Acute Leukemia

o Petechial (smooth and flash rash) suspects DIC, thrombocytopenia, HIT
o Anemia
o Organ rejection

Clinical Manifestations
o Relate to problems caused by Leukemic cells
infiltrate patients organs:
Splenomegaly
Hepatomegaly
Lymphadenopathy
Bone pain
Meningeal irritation
Massive weight loss with N/V
Oral lesions
Use soft tooth brush, non
alcohol mouth wash,
hydrogen peroxide + H2O,
magic mouth wash
Solid masses (chloromas) can form

Diagnostic Studies
o To diagnose and classify
Peripheral blood evaluation
High WBC, low every thing else
Bone marrow evaluation
 o To identify cell subtype and stage
Morphologic, histochemical, immunologic, and cytogenic methods
o LP and CT scan
o Best is bone marrow biopsy and CBC to determine what is going on

Treatment
Goal
o Goal is to attain remission
Complete remissionno evidence on exam, bone marrow or blood
samples
Partial remissionno symptoms, some evidence in bone marrow
o The patients progress is directly related to the ability to maintain a remission

Treatment with Chemotherapy

o Combination chemotherapy is the first line treatment of Leukemia
Decrease drug resistance
Minimize drug toxicity
Interrupt cell growth at multiple points in the cell cycle

Treatment of Leukemia-Know drugs

o Alkylating agents
o Antitumor antibiotics
o Antitumormetabolites
o Corticosteroids
o Biologic/targeted therapy
o Radiation may be used to prepare a patient for bone marrow transplantation
(BMT)

Bone Marrow/Stem Cell Transplant

o The goal is to totally eliminate leukemic cells from the body using
combinations of chemotherapy with or without total body irradiation
o This therapy eradicates the patients own hematopoietic stem cells
o Replaced with those of an HLA-matched
Sibling, volunteer, identical twin or the patients own stem cell removed
before transplant

BMT Complications
o Graft-versus-host disease
Body rejects graft from other sources, managed with immunosuppressive
agents
S&S

Abdominal pain or cramps and nausea, vomiting, and diarrhea

Dry or irritated eyes

 Jaundice (yellow coloring of the skin or eyes)

Skin rash, itching, redness on areas of the skin

o Relapse of leukemia
o Infection

Outcomes for Patients With Leukemia

o Cope effectively with diagnosis
o Attain and maintain adequate nutrition
o Experience no complications related to the disease or its treatment
What complication they can go through:
TLS, DIC
o Feel comfortable and supported throughout treatment

Question: Induction period of chemotherapy is when chemo destroy both good cells and bad
cells
Chemo drugs preparation: Type of AHII questions are
Pre-hydrationZofran at >4mgIV about 15 best, priority and first
minutes chemo drugsPost-hydration
Radiation preparation
Wrap effected areaSedate themstart procedure

Lymphoma
Malignant neoplasms originating in the bone marrow and lymphatic structures
Result in the proliferation of lymphocytes
Fifth most common type of cancer
There are two types
o Hodgkin's Disease
o Non-Hodgkin's Lymphoma
Worse b/c it can be anywhere

Hodgkins Lymphoma
o Accounts for 12% of all lymphomas
o Occurs most frequently between 15-35 years and after age 50
o Predisposing factors:
Epstein Barr Virus (EBV)
Genetics
Exposure to occupational toxins
o Twice as prevalent in men

Hodgkins Disease
o Malignant condition Characterized by proliferation of abnormal giant,
multinucleated cells
Characterized by the present of Reed-Sternberg cells
o Located in the lymph nodes
 Clinical Manifestations
o Enlargement of cervical, axillary, or inguinal lymph nodes
o Can spread to lungs, spleen and liver
Organ removal might be part of treatment
Spleen removed be aware of infectious situation
o Nodes remain moveable, non-tender
o Painless unless nodes exert pressure on adjacent nerves
o May experience
Weight loss, fatigue, weakness, fever, chills, tachycardia=>100, night
sweats
Diagnostics
o Peripheral blood analysis
Need to know blood drawn procedure
o Lymph node biopsy
o Bone marrow examination
Sedate the patient before hand b/c the blood will be taken form bone
marrow
Look at reed-stern berg cell
o Radiologic evaluation
To look at other organs if they are effected
Stages of Hodgkins Lymphoma-KNOW!!!

Stage one- only one nodes

Stage two two nodes above diaphragm
Stage three- more than three nodes above and lower diaphragm
Stage four all over the body, involve organs

Treatment
o Chemotherapy
Maintenance chemo does not contribute to increased survival rate once
remission is achieved
o Possible radiation

Nursing Care
o Mange problems related to the disease
Pain
Anxiety
Pancytopenia
o Skin care if receiving radiation
 o Psychological support

Non-Hodgkins Disease (NHL)

o Heterogeneous group of malignant neoplasms of B or T cell origin affecting
all ages
o Classified according to
Different cellular characteristics
Lymph node characteristics
o Aging population
o HIV & individuals taking immunosuppressant medications have increased
risk
o Occupational exposure to carcinogens

Clinical Manifestations
o Majority of patients have widely disseminated disease at time of diagnosis
o Painless lymph node enlargement
Primary clinical manifestation
Can wax and wane
o Patients with high grade lymphomas can have B symptoms (fever, night sweats
& weight loss)!!!!
o Airway obstruction, hyperurecemia, G/I complaints or renal failure from tumor
lysis syndrome

Diagnostic studies
o Diagnostic studies similar to Hodgkins disease
o MRI, barium enema or CT
o Lymph node biopsy establishes the cell type and pattern
o Staging guides therapy
o Prognosis for NHL is generally not as good as that for Hodgkins disease

Treatment
o Chemotherapy and sometimes radiation
Chemotherapy usually primary then radiation
Patient with chemo therapy will be very tired, lethargy appearance, as
RN we need to do cluster care**
o More aggressive lymphomas are more responsive to treatment
More likely to be cured
Indolent (low grade) have naturally long course but are difficult to
effectively treat

Multiple Myelomas
Multiple Myelomas
o Neoplastic plasma cells (B cells) invade and kill bone marrow and bone
o Usually effects people over the age of 40
o Exposure to radiation, organic chemicals, herbicides, insecticides and
certain viruses may play a role

Clinical Manifestations
 o Appear late
o Bone pain-big thing for them!!
Pelvis, spine, ribs
o Pathologic fractures (30%)
o Hypercalcemia
o Pancytopenia
Diagnostics
o X-rays
Areas of bone erosion, thinning, collapse
o Blood
Pancytopenia, hypercalcemia,
Monoclonal antibody protein can be found in urine and blood
o Presence of Bence-Jones protein in urine
o Elevated serum (blood) creatinine
At risk for renal failure
Treatment
o Aimed at remission and prolonging life
Ambulation, hydration, pain control
Corticosteroids Drug ending -One Test!!!
o Infection and glucose
o Will increase the glucose level will be on insulin (sliding scale)
o Even they are not diabetes
Chemotherapy
Biologic therapy
Hematopoietic stem cell transplant (HSCT)
Nursing Care
o Aimed at symptom control
Pain
Pathologic fracture prevention
Implement fall precautions
Hydration to combat hypercalcemia
Assess psychosocial needs
o Nursing Diagnosis
ADPINE

Lung, Colon, pancreas and liver cancer

Biggest cause of lung
Lung cancer
cancer = cigarette
o Leading cause of cancer-related deaths
smoking
o Leading cause of death in women
o Survival rates are lower than for most other cancers.
Etiology
o Cause by smoking, chemical
Pathophysiology
o Carcinogens (smoking, chemical) turns good cells to bad cells in the
lungs spread throughout body
Clinical Manifestations
o Hoarseness
 Diagnostic Studies
o Biopsy is the definite
o Scans
o Diagnosis identified by malignant cells
o Sputum specimens obtained for cytologic studies
o Staging- QUIZ
o Screenings
Stop smoking, Tidal volume, peak flow, chest X-ray
Nursing Management
o Nursing Assessment
Priority is breathing, airway Risk factors
Commodity Asbestos exposure
COPD, diabetes, obesity, heart Cigarette smoking
disease, emphysema Exposure to uranium
o Nursing Diagnosis Chronic institial fibrosis =
Base on assessment scar tissue in the lungs and
o Planning or goals will not be able to expand
o Implementation-Acute and homecare

Collaborative Care
o Surgical therapy
Lopectomy
Pneunmoectomy
Hook to chest tube
o Cannot clink the tube, no sings of crepitus (crackles or
pops)
o Radiation therapy RN Important things to improve patient outcome
o Chemotherapy Support, education, what to expect
o Biologic and targeted therapy
o Other therapies Colorectal Cancer
Colon Cancer and Polyps

Gold standard DX of colorectal

cancer = colonoscopy
o Need to sedate first
More common in men
o Clear out stuffs in the colon
Mortality rates are highest among AAs (men and women)
Major risk factors
o After colposcopy= patient
will fart a lot, b/c they need
Increasing age (90% are over 50)
to rid of air in colon before
Family history of colorectal Ca they can go home
Inflammatory or irritable bowel disease for >10
years
Cigarette use
Obesity
 1/3 have a FH of colorectal Ca
Clinical Manifestations
o Hematochezia
Bright red blood in poop lower end of colon
o Melana
Dark blood color in poop upper end of colon
o Abdominal pain/cramping
o Changes in bowel habits
o Constipation diahrrea
Signs and Symptoms by Location

Diagnostics
o History
o Fecal occult blood test (FOBT)
o Double contrast enema
o Sigmoidoscopy
o Colonoscopy
o Who gets screened?
Any body particate

Ostomy
Treatment Need to burp (let gas out
o Surgery of the bag) it to prevent
Polypectomy feces from oozing out
Abdominal-peritoneal resection
Lower anterior resection
o Chemotherapy
For patients who have positive lymph nodes at the time of surgery or
have metastases
o Radiation
Adjunct to surgery and chemo
Palliative measure
Both chemotherapy and ration are often use

Goals of Surgical Treatment of Colon Ca

o Tumor resection with adequate margins of health tissue
o Explore the abdomen to assess whether the cancer has spread
o Remove the lymph nodes that drain the area where cancer is located
 o Restore bowel continuity
o Prevent surgical complications

Chemotherapy for Colon Ca

o Used if patients have positive lymph nodes or metastatic disease**
o Can also be used to shrink tumor before surgery
o Palliative treatment for unresctable tumors

Goals for Patients With Colon Ca

o The patient will have:
Normal bowel elimination patterns
Quality of life appropriate to disease progression
o Pain relief
o Feelings of comfort and well-being

Liver Cancer
Primary Liver Ca
o Fourth most common Ca in world
o 80% have cirrhosis of the liver
o Hepatitis C is responsible for about 50-60% of all liver cancers
o Hepatitis B is responsible for about 20% of liver cancers
o Rare in people under 40 in US
o Metastatic liver cancer is more common than primary liver cancer
Where is my Liver

Before surgery and on aspirin

Check PTT&PT and give
platelets, FFP, (fresh
frozen plasma)

Care before surgery

Education, check labs
Intervention to alleviate anxiety Clinical
Education
Post op what to expect Education for family- post-op care
Pain, might have a bag
Manifestations-KNOW for TEST!!
o Hepatomegaly/splenomegaly
o Jaundice
o Weight loss, Anorexic
o Peripheral edema
o Ascites
Do peracentesis
At risk for infection, hypovolemic shock b/c fluid shift form
vascular to the abdominal space
o Portal HTN
o Dull abdominal pain
 o RUQ pain
o N/V

Diagnostics
o Difficult to diagnose and differentiate between cirrhosis and liver Ca
o Liver scan/ biopsy is a definite
o CT
o MRI
o Endoscopic retrograde cholangiopancreatography (ERCP)
o Liver biopsy
o AFP
Collaborative Care
o Prevention and identification of high risk individuals is key
o Lobectomy
o Liver transplant
o Radiofrequency ablation
Zap the cancerous part off
Complications of liver problem
o Cryoablation Toxicity level of drugs
o Percutaneous ethanol injection (PEI)
Nutrition imbalance
o Chemotherapy

Nursing Care for Patients With Liver Ca

o Keep the patient comfortable
o May have GI bleed or hepatic encephalopathy
o Prognosis is poor

Pancreatic cancer
Pancreatic Ca
o 42,500 are diagnosed and 35,300 die
o Fourth leading cause of death from Ca in US
o Risk increases with age (peaks between 65 and 80 years)
o Half in head of pancreas
o As tumor grows common bile ducts becomes obstructed an jaundice develops
o Usually metastasized at time of diagnosis
o Signs and symptoms similar to pancreatitis
o Prognosis is poor
o Majority of patients die within 5-12 months
o 5 year survival rate is less than 5%

Who Gets Pancreatic Ca?

o Patients with DM and chronic pancreatitis
o Cigarette smoking
o Family history of pancreatic Ca
o High fat diet
o Exposure to benzidine

Signs and Symptoms- KNOW TEST!!

 o Abdominal pain
o Anorexia
o Rapid and progressive weight loss
o Nausea
o Jaundice

Diagnostics for Pancreatic Ca

o Transabdominal ultrasound (u/s)
o CT
o MRI
o Endoscopic Retrograde Cholangiopancreatography (ERCP)
o Endoscopic ultrasound (EUS)
o Tumor markers (CA 19-9)

Treatment for Pancreatic Ca

o Surgery is best option
Whipple procedure
o Only 15-20% are resectable
o Radical pancreaticoduodenectomy or Whipple procedure
o Experimental chemo
o Radiation may be used for pain relief

Collaborative Care
o Pain relief
o Psychological support
o Nutritional support
o Relief from n/v
o Asses for bleeding tendencies
o Support patient and family through the grieving process