4-Oncology-I-11-16-17

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CRITICAL THINKING AND APPLICATION | STUDENT MANUAL 31
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IV. ONCOLOGY I
A. Overview:
1. Pathophysiology:
• Cancer refers to a class of diseases.
There are several different kinds of cancer. Cancer can be 
classified by:
• The tissue or blood cells where it starts
• The type
What are the two types of cancer?
___________________________ and Hematologic malignancies 
a.	 Solid	tumors	arise	from	specific	tissue.	
• Types of solid tumors:
1) Sarcomas 
 Begin in the connective tissues, the tissues that the body 
 uses to connect or support other tissue. 
2) Carcinomas 
 Originate from the _________________ tissues, and this is 
 the tissue that lines your organs. 
These are the cancers that originate in the ______________ 
of organs like the lungs and liver, the breast, colon, or 
prostate. 
b. Hematologic malignancies
Originate from blood or lymphatic cells. 
• Cancer begins with one abnormal cell that starts growing and 
dividing out of control.
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2. Metastasis
• The "traveling" or extension of the _____________________ cancer 
 to other sites of the body.
• Metastasis occurs by:
a. Direct invasion,
b. Through the blood system, or
c. Through the _________________ system
Cancer prevention is about modifying the risk factors.
There are things we can control in our lifestyle that will help 
prevent the development of cancer. 
B. Risk factors:
• ____________________ is the #1 cause of preventable cancer.
• Alcohol + tobacco = co-carcinogenic
• Suspected dietary causes of cancer:
1. A low-fiber diet
2. Increased red meat
3. Increased animal fat
4. Nitrites (processed sandwich meats)
5. Alcohol
6. Preservatives and additives
• _________________, physical inactivity, and poor nutrition
• Increased incidence of cancer in the __________________________.
• The most important risk factor of cancer is ___________________.
• That is why there is a higher incidence of cancer > age 60.
• African Americans have the ________________ incidence of cancer 
 followed by Caucasians.
• Heredity
• Exposure to ultra-violet radiation
• Exposure to carcinogens
• Stress
• Chronic _____________ can cause uncontrolled growth 
 of abnormal cells.
• Previous history of other types of cancer or chemotherapy.
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C. Prevention and Screening:
1. Primary prevention:
 These are ways to help _______________ the actual occurrence 
 of cancer.
 Primary prevention includes things like:
• No __________________
• Exercise and good nutrition
• Maintain normal body weight
• Limit or eliminate alcohol intake
• Vaccines for preventable viral exposures
 such as Hepatitis B and ____________
• Avoid exposure to known carcinogens 
2. Secondary prevention:
 This is when we use _________________ to pick-up on cancer early, 
 when there is a greater chance for cure or control. 
a. Secondary prevention for the female:
• Breast self-awareness is recommended as secondary 
 prevention.
• Beginning in their 20s, women should be told about the 
 ___________ and _______________ of monthly breast self-exam 
 (BSE).
What days of the menstrual cycle are best for doing the 
breast self-exam? Anytime from day _____ through day twelve.
Post-menopausal or women who have had a hysterectomy 
should perform the breast self-exam on the same day every 
month.
• ____________ clinical breast exams for women greater than 
 40 years of age. Women between the ages of 20-39 need 
 one every three years.
• Mammogram-annually starting at age _______, with two views 
 of each breast.
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• Before a mammogram, what should you teach your 
 client to not apply on their body? No lotion, no powder, 
 no ____________________
• Pap smears beginning at age 21 and performed every 
 __________ years if there have been no problems.
• Colonoscopy at age ________, then every 10 years if there 
 have been no problems.
• Testing the stool for fecal occult blood should be done 
 __________ beginning at age 50, unless previous problems 
 or a positive family history. 
b. Secondary prevention for the male:
• Provide information on breast self-awareness and have 
 _____________ clinical testicular exams.
• Testicular tumors grow _________ ___________, so many 
 clinicians recommend monthly testicular self-exams (TSE).
The major age group that gets testicular cancer is young 
males, between ages 15 and 36. Teach TSE early.
• Digital rectal exam and prostate specific antigen (PSA) may be 
 checked annually for men over the age of 50.
• Colonoscopy at age 50 and then every 10 years, and yearly 
 fecal occult ___________ testing. 
3. Tertiary Prevention:
• Focuses on the management of long term care for clients with 
 complex treatments for cancer. 
• Examples of tertiary care are support groups and rehabilitation 
 programs.
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D. Diagnosis:
1. General Signs/Symptoms:
• CAUTION: Change in bowel/bladder habits
A sore that does not heal
Unusual bleeding/discharge
Thickening or lump in breast or elsewhere
Indigestion or difficulty swallowing
Obvious change in wart or mole
Nagging cough or hoarseness
• Cancer can invade the bone marrow which can lead to 
 _______________, leukopenia, and thrombocytopenia.
• Unexplained weight ___________.
Cachexia is another term that we hear used when we are 
studying cancer that means extreme _______________ 
and malnutrition.
• Fever
• Fatigue is the ____________________ that clients report 
 with a diagnosis of cancer.
• Pain 
2. Blood Tests:
• Abnormal CBC & diff
• Most concerned about the _________________.
• Elevated liver enzymes
• AST and ALT
• Tumor markers
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3. Positive Diagnostic Studies:
a. Chest x-ray
b. CT Scan
c. _______
d. PET Scan
e. Bone marrow biopsy
f. Tissue biopsy
g. Imaging studies
Total laryngectomy (removal of __________ cords, epiglottis and thyroid 
cartilage.)
• Since the whole larynx (remember this includes the epiglottis) 
 is removed, this client will have a permanent tracheostomy or 
 _______________________________.
• Position post-op? ____________________________________
• NG feedings to protect the suture line. 
 (Peristalsis can disrupt the ___________________________.)
• Monitor drains 
• Watch for ____________________ artery rupture
• Rupture of the innominate artery.
• Frequent ______________ care to decrease bacterial count in the mouth.
• NPO people tend to get ___________________.
• When the client leaves the hospital, a bib will be used to cover the trach 
 because it acts like a filter.
• A humidified environment helps.
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• With a total laryngectomy, all __________________ is done through the 
 ________________.
So how does a client with a total laryngectomy talk?
They can use an electrolarynx, but the Blom-Singer device is the most common 
device that they use to talk.
• Can the client with a total laryngectomy:
• Whistle? _________
• Drink through a straw? _________
• Smoke? _______
• Swim? _______ 
E. Treatment:
1. Goals of Treatment:
a. Cure
b. ________
c. Palliation
• Adjuvant is when two therapies are used _______________.
• Neoadjuvant are _____________________ therapies, or one before 
 the next.
• The treatment plan will be based on the:
Recommended treatment plans for the diagnosis
Grade of cancer
What the client wants
2. Types of Cancer Treatments:
a. Surgery:
1) Prevention
2) ________________
3)Treatment
4) Reconstruction
• Reconstruction is commonly used with breast cancer
• A mastectomy may be partial or total (radical).
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• Reconstruction can be done with the initial surgery 
 or a later surgery.
 Post op care following a mastectomy
 Bleeding  check dressings, front and back 
 ( ___________ of blood can occur).
• If reconstruction includes using their own tissue, 
 they will also have an abdominal surgical site.
Can harvest adipose tissue from other sites for 
reconstruction, but abdomen is the most common.
• Hemovac or Jackson-Pratt drains
• Associated nursing care, if any lymph nodes were 
 removed with the mastectomy:
Avoid procedures on arm of the affected side for 
lifetime of client:
*No constriction: no BPs, no blouses with elastic, no 
watch, and no IV or injections on the affected side. 
Wear gloves when gardening, watch small cuts, no nail 
biting, and no sunburn.
• Brush hair, squeeze tennis balls, wall climbing, 
 flex and extend elbow
• Why? Promotes _________________ circulation
Successful surgery for cancer is dependent on 3 things:
• Could the cancer be completely removed?
• Had the cancer already spread at the time of surgery?
• Was the surgeon able to get adequate _________________? 
b. Radiation Therapy:
1) Internal Radiation (brachytherapy)
Brachytherapy is used to get the radiation __________ to the 
cancer or target tissue.
It is internal radiation so, it is _____________ the body. 
Brachytherapy is very close to the target tissue because the 
radiation is inside the body.
With all types of brachytherapy, the client emits _____________ 
for a period of time and is a hazard to others.
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Brachytherapy is either unsealed or sealed.
• Unsealed: Client and body fluids emit radiation.
• This is like a radioisotope that is given 
 ___________________ or _____________________.
 Radioactive for 24 to 48 hours.
• Sealed or solid: Client emits radiation; body fluids 
 are not radioactive.
 Can be temporary or a permanent _____________ that is 
 placed close to or inside the tumor.
General radiation precautions for internal radiation. 
Remember: time, distance, and shielding.
Precautions with Internal Radiation:
• Nursing assignments should be rotated ____________, so 
 that the nurse is not continuously exposed.
• The nurse should only care for ________ client with a 
 radiation implant in a given shift.
• Private room
• Wear a film badge at all times
• Restrict visitors
• Limit each visitor to 30 minutes per day
• Visitors must stay at least 6 feet from source
• No visitors less than 16 years of age
• No pregnant visitors/nurses
• Mark the room with instructions for specific isotope
• Wear gloves with risk of exposure to body fluids
How can you help prevent dislodgment of the implant?
Keep the client on ______________.
Decrease _________________ in the diet.
Prevent bladder ________________.
• What do you do if the implant becomes dislodged 
 and you see it?_______________________________________
*Don’t forget this client is immunosuppressed 
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• After radiation can the client sleep in the same bed with 
 their spouse or children? ____________
• Should they use public transportation? __________
• Can they return to work immediately? ___________
• Can they share utensils or cook for others? __________
• Will one flush of the toilet after use be adequate? ________
2) External radiation (teletherapy, external beam radiation):
• A carefully focused beam of high energy rays is delivered 
 by a machine outside of the body.
• The client is _____________ radioactive.
• Side effects are usually limited to exposed tissues.
Erythema
Shedding of skin
Altered taste
Fatigue (side effect of radiation)
Pancytopenia (all blood components are decreased)
• Signs and symptoms are _______________ and 
 ______________ related.
• Is it okay to wash off the markings? __________
• Is it okay to use lotion on the markings? ________
• Protect the site from sunlight and UV exposure for 1 year 
 after completion of therapy. 
 
Oncology II lecture can be found in the Specialty Topic 
videos in your online resources.