Oncology Nursing

Mohamed Idirss
 Oncology defined

• Branch of medicine that

deals with the study,
detection, treatment and
management of cancer
 “Root words”

• Neo- new
• Plasia- growth
• Plasm- substance
• Trophy- size
• +Oma- tumor
• Statis- location
 “Root words”

• A- none
• Ana- lack
• Hyper- excessive
• Meta- change
• Dys- bad, deranged
 CANCER NURSING

Etiology of cancer
1. PHYSICAL AGENTS
• Radiation
• Exposure to irritants
• Exposure to sunlight
• Altitude, humidity
 CANCER NURSING

Etiology of cancer
2. CHEMICAL AGENTS
• Smoking
• Dietary ingredients
• Drugs
 CANCER NURSING

Etiology of cancer

 Genetics and Family History

• Colon Cancer
• Breast cancer
 CANCER NURSING

Etiology of cancer
 Dietary Habits
 Low-Fiber
 High-fat
 Processed foods
 alcohol
 CANCER NURSING

Etiology of cancer

Viruses and Bacteria

• DNA viruses- HepaB, Herpes, EBV, CMV,
Papilloma Virus
• RNA Viruses- HIV, HTCLV
• Bacterium- H. pylori
 CANCER NURSING

Etiology of cancer

Hormonal agents
• DES
• OCP especially estrogen
 CANCER NURSING

Etiology of cancer

Immune Disease
• AIDS
 CANCER NURSING

Body Defenses Against TUMOR

• 1. T cell System/ Cellular Immunity
• Cytotoxic T cells kill tumor cells
• 2. B cell System/ Humoral immunity
• B cells can produce antibody
• 3. Phagocytic cells
• Macrophages can engulf cancer cell debris
 CANCER NURSING

Cancer Diagnosis
• 1. BIOPSY
• The most definitive
• 2. CT, MRI
• 3. Tumor Markers
 CANCER NURSING

Cancer Staging
The degree of DIFFERENTIATION
• Stage 1- Low grade
• Stage 4- high grade
 CANCER NURSING

GENERAL MEDICAL MANAGEMENT

• 1. Surgery- cure, control, palliate
• 2. Chemotherapy
• 3. Radiation therapy
• 4. Immunotherapy
• 5. Bone Marrow Transplant
 CANCER NURSING

GENERAL Pharmacology
• 1. antimetabolites
• 2. antibiotics
• 3. plant alkaloids
• 4. antiemetics
 CANCER NURSING

GENERAL Promotive and Preventive Nursing

Management
• 1. Lifestyle Modification
• 2. Nutritional management
• 3. Screening
• 4. Early detection
 SCREENING

• 1. Male and female- Occult Blood, CXR, and DRE

• 2. Female- SBE, CBE, Mammography and Pap’s
Smear
• 3. Male- DRE for prostate, Testicular self-exam
 Nursing Assessment

Utilize the ACS 7 Warning Signals

• CAUTION
• C- Change in bowel/bladder habits
• A- A sore that does not heal
• U- Unusual bleeding
• T- Thickening or lump in the breast
• I- Indigestion
• O- Obvious change in warts
• N- Nagging cough and hoarseness
 Nursing Assessment

• Weight loss
• Frequent infection
• Skin problems
• Pain
• Hair Loss
• Fatigue
• Disturbance in body image/ depression
 Nursing Intervention

• MAINTAIN TISSUE INTEGRITY

• Handle skin gently
• Do NOT rub affected area
• Lotion may be applied
• Wash skin only with SOAP and Water
 Nursing Intervention

• MANAGEMENT OF STOMATITIS
• Use soft-bristled toothbrush
• Oral rinses with saline gargles/ tap water
• Avoid ALCOHOL-based rinses
 Nursing Intervention
MANAGEMENT OF ALOPECIA
Alopecia begins within 2 weeks of therapy
Regrowth within 8 weeks of termination
Encourage to acquire wig before hair loss occurs
Encourage use of attractive scarves and hats
Provide information that hair loss is temporary
BUT anticipate change in texture and color
 Nursing Intervention
PROMOTE NUTRITION
Serve food in ways to make it appealing
Consider patient’s preferences
Provide small frequent meals
Avoids giving fluids while eating
Oral hygiene PRIOR to mealtime
Vitamin supplements
 Nursing Intervention
RELIEVE PAIN
Mild pain- NSAIDS
Moderate pain- Weak opiods
Severe pain- Morphine
Administer analgesics round the clock with additional dose
for breakthrough pain
 Nursing Intervention
DECREASE FATIGUE
Plan daily activities to allow alternating rest periods
Light exercise is encouraged
Small frequent meals
 Nursing Intervention
IMPROVE BODY IMAGE
Therapeutic communication is essential
Encourage independence in self-care and decision making
Offer cosmetic material like make-up and wigs
 Nursing Intervention
ASSIST IN THE GRIEVING PROCESS
Some cancers are curable
Grieving can be due to loss of health, income, sexuality,
and body image
Answer and clarify information about cancer and treatment
options
Identify resource people
Refer to support groups
 Nursing Intervention
MANAGE COMPLICATION: INFECTION
Fever is the most important sign (38.3)
Administer prescribed antibiotics X 2weeks
Maintain aseptic technique
Avoid exposure to crowds
Avoid giving fresh fruits and veggie
Handwashing
Avoid frequent invasive procedures
 Nursing Intervention
MANAGE COMPLICATION: Septic shock
Monitor VS, BP, temp
Administer IV antibiotics
Administer supplemental O2
 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
 COLON CANCER

• Risk factors
• 1. Increasing age
• 2. Family history
• 3. Previous colon CA or polyps
• 4. History of IBD
• 5. High fat, High protein, LOW fiber
• 6. Breast Ca and Genital Ca
 COLON CANCER

• Sigmoid colon is the most common site

• Predominantly adenocarcinoma
• If early 90% survival
• 34 % diagnosed early
• 66% late diagnosis
 COLON CANCER

• PATHOPHYSIOLOGY
• Benign neoplasm DNA alteration malignant
transformation malignant neoplasm  cancer
growth and invasion  metastasis (liver)
 COLON CANCER

ASSESSMENT FINDINGS
1. Change in bowel habits- Most common
• 2. Blood in the stool
• 3. Anemia
• 4. Anorexia and weight loss
• 5. Fatigue
• 6. Rectal lesions- tenesmus, alternating D and C
 Colon cancer

• Diagnostic findings
• 1. Fecal occult blood
• 2. Sigmoidoscopy and colonoscopy
• 3. BIOPSY
• 4. CEA- carcino-embryonic antigen
 Colon cancer

• Complications of colorectal CA
• 1. Obstruction
• 2. Hemorrhage
• 3. Peritonitis
• 4. Sepsis
 Colon cancer

• MEDICAL MANAGEMENT
• 1. Chemotherapy- 5-FU
• 2. Radiation therapy
 Colon cancer

• SURGICAL MANAGEMENT
• Surgery is the primary treatment
• Based on location and tumor size
• Resection, anastomosis, and colostomy (temporary
or permanent)
 Colon cancer

NURSING INTERVENTION
Pre-Operative care
• 1. Provide HIGH protein, HIGH calorie and LOW
residue diet
• 2.Provide information about post-op care and
stoma care
• 3. Administer antibiotics 1 day prior
 Colon cancer

NURSING INTERVENTION
Pre-Operative care
• 4. Enema or colonic irrigation the evening and the
morning of surgery
• 5. NGT is inserted to prevent distention
• 6. Monitor UO, F and E, Abdomen PE
 Colon cancer

NURSING INTERVENTION
Post-Operative care
• 1. Monitor for complications
• Leakage from the site, prolapse of stoma, skin
irritation and pulmo complication
• 2. Assess the abdomen for return of peristalsis
 Colon cancer
NURSING INTERVENTION
Post-Operative care
• 3. Assess wound dressing for bleeding
• 4. Assist patient in ambulation after 24H
• 5.provide nutritional teaching
• Limit foods that cause gas-formation and odor
• Cabbage, beans, eggs, fish, peanuts
• Low-fiber diet in the early stage of recovery
 Colon cancer
NURSING INTERVENTION
Post-Operative care
• 6. Instruct to splint the incision and administer
pain meds before exercise
• 7. The stoma is PINKISH to cherry red, Slightly
edematous with minimal pinkish drainage
• 8. Manage post-operative complication
 Colon cancer

• NURSING INTERVENTION: COLOSTOMY

CARE
• Colostomy begins to function 3-6 days after
surgery
• The drainage maybe soft/mushy or semi-solid
depending on the site
 Colon cancer

• NURSING INTERVENTION: COLOSTOMY

CARE
• BEST time to do skin care is after shower
• Apply tape to the sides of the pouch before shower
• Assume a sitting or standing position in changing
the pouch
 Colon cancer

• NURSING INTERVENTION: COLOSTOMY

CARE
• Instruct to GENTLY push the skin down and the
pouch pulling UP
• Wash the peri-stomal area with soap and water
• Cover the stoma while washing the peri-stomal
area
 Colon cancer

• NURSING INTERVENTION: COLOSTOMY

CARE
• Lightly pat dry the area and NEVER rub
• Lightly dust the peri-stomal area with nystatin
powder
 Colon cancer

• NURSING INTERVENTION: COLOSTOMY

CARE
• Measure the stomal opening
• The pouch opening is about 0.3 cm larger than the
stomal opening
• Apply adhesive surface over the stoma and press
for 30 seconds
 Colon cancer

• NURSING INTERVENTION: COLOSTOMY

CARE
• Empty the pouch or change the pouch when
• 1/3 to ¼ full
 Breast Cancer

• The most common cancer in FEMALES

• Numerous etiologies implicated
 Breast Cancer

RISK FACTORS
• 1. Genetics- BRCA1 And BRCA 2
• 2. Increasing age ( > 50yo)
• 3. Family History of breast cancer
• 4. Early menarche and late menopause
• 5. Nulliparity
• 6. Late age at pregnancy
 Breast Cancer

RISK FACTORS
• 7. Obesity
• 8. Hormonal replacement
• 9. Alcohol
• 10. Exposure to radiation
 Breast Cancer

PROTECTIVE FACTORS
• 1. Exercise
• 2. Breast feeding
• 3. Pregnancy before 30 yo
 Discussion of

• Palliative Care
• Oncologic Emergencies
• Lung Cancer
• Male & Female reproductive Cancers
• Brain Tumors
 Case Study 1
R.T. is a 64-year-old man who comes to his primary care provider’s (PCP’s) offi ce for a yearly
examination. He initially reports having no new health problems; however, on further questioning, he
admits to having developed some fatigue, abdominal bloating, and intermittent constipation. His nurse
practitioner completes the examination, which includes a normal rectal exam with a stool positive for
guaiac. Diagnostic studies include a CBC with differential, chem 14, and carcinoembryonic antigen
(CEA). R.T. has not had a recent colonoscopy and is referred to a gastroenterologist for this procedure.
A 5-cm mass found in the sigmoid colon confirms a diagnosis of a polypof the colon. A referral
is made for surgery. The pathology report describes the tumor as stae 11, which means
that the cancer has extended into the mucous layer of the colon. A metastatic work-up is negative.

1. Identify 6 risk factors for colon cancer:

2. Discuss the recommended screening procedures related to colon cancer.
3. What warning sign did R.T. have?
4. What would early signs be for colorectal cancer?
5. What would late signs be?
 Case Study 1
R.T. is a 64-year-old man who comes to his primary care provider’s (PCP’s) offi ce for a yearly examination. He
initially reports having no new health problems; however, on further questioning, he admits to having developed
some fatigue, abdominal bloating, and intermittent constipation. His nurse practitioner completes the
examination, which includes a normal rectal exam with a stool positive for guaiac. Diagnostic studies include a
CBC with differential, chem 14, and carcinoembryonic antigen (CEA). R.T. has not had a recent colonoscopy
and is referred to a gastroenterologist for this procedure.
A 5-cm mass found in the sigmoid colon confirms a diagnosis of a polypof the colon. A referral
is made for surgery. The pathology report describes the tumor as stae 11, which means
that the cancer has extended into the mucous layer of the colon. A metastatic work-up is negative.

6. After bowel prep, R.T. is admitted to the hospital for an exploratory laparotomy, small bowel resection and
sigmoid colectomy. - What are five major complications for him?
7. After surgery, R.T. is admitted to the surgical intensive care unit (SICU) with a large
abdominal dressing. The nurse rolls R.T. side to side to remove the soiled surgical linen,
and the dressing becomes saturated with a large amount of serosanguineous drainage.
Would the drainage be expected after abdominal surgery? Explain.
 Case Study 2
You are a home health nurse who has been seeing P.C., who was diagnosed with lung cancer
approximately 1 year ago. Her provider recently informed her that her cancer is no
longer treatable; the focus of her treatment will change from curative measures to
symptom relief. She is confused and somewhat angry with her provider. She vaguely
remembers the term palliative treatment when discussing her situation with her provider
but doesn’t know what it means.

1. How would you describe palliative treatment?

 Case Study 2
You are a home health nurse who has been seeing P.C., who was diagnosed with lung cancer approximately 1 year
ago. Her provider recently informed her that her cancer is no longer treatable; the focus of her treatment will
change from curative measures to symptom relief. She is confused and somewhat angry with her provider. She
vaguely remembers the term palliative treatment when discussing her situation with her provider but doesn’t
know what it means.

Case progress Note:

P.C. confides that she always felt that she might not survive her illness, but has never formally written
down her wishes concerning what types of treatment she would or would not want. You advise her
to complete an advance directive and/or living will or to complete a medical durable power of attorney
and/or a surrogate decision maker form. In current practice, it is very likely that a part of the home
health intake process will be completion of a Physicians Order on Life Sustaining Treatments (POLST)
Paradigm form.

2. What is the purpose of these documents?

 Case Study 2
3. What health care decisions are considered in these documents?

4. How are advance directives and living wills formalized?

5. P.C. states she is confused and has mixed feelings about her health care wishes right now.
She asks, “If I fill out this form, can I change my mind down the road?” How should you
answer this question?

6. You inform P.C. that you will help with symptomatic control of her illness. What areas
will you focus on, and what question would you ask P.C.?

7. As P.C. becomes more frail and incoherent, what treatment will be given?
 Discussion

• Culturally appropriate treatment

• Share your experiences