CARE OF THE CLIENTS WITH ONCOLOGICAL DISORDERS
Epidemiology, Etiology, Terms
Disorders that can involve all body
organs with manifestations that vary
METASTASIS
according to the body system affected
and type of tumor cells LOCAL SEEDING –distribution of shed
cancer cells occur in the local area of
Cells lose their normal growth
the primary tumor
controlling mechanisms and the
growth of cells is uncontrolled. BLOOD BORNE –tumor cells enter the
blood, which is the most common
Cancer produces serious health
cause of cancer spread
problems such as impaired immune
and hematopoietic function, altered LYMPHATIC SPREAD –primary sites rich
GIT structure and function, sensory in lymphatics are more susceptible to
deficits and decreased respiratory early metastatic spread
function.
NEOPLASMS
CANCER
Hyperplasia involves an increase in
Cancer is the second most common the number of cell in a tissue; may be
cause of death in the USA a normal or an abnormal cellular
response
Sites in men associated with the
greatest mortality: lung, colon, rectum, a. Metaplasia refers to the conversion
and prostate of one type of cell in a tissue to
another type not normal to that
Sites in women with the greatest
tissue. It results from an outside
mortality: breast, lung, colon, and
stimulus affecting parent stem cells
rectum
and may be reversible or progress
Familiar risk for certain cancers: lung, to dysplasia
stomach, breast, colon, rectum, and
b. Dysplasia refers to a change in
uterus
size, shape, or arrangement of
ETIOLOGY normal cell into bizarre cells; may
precede an irreversible neoplastic
Generally unknown but may be caused change
by interacting factors
c. Anaplasia involves a change in the
Theories include predisposing factors structure of cells and in their
orientation to one another,
a. Constant irritation characterized by a loss of
differentiation and a return to a
b. History of cancers
more primitive form. The resulting
c. Environmental carcinogens poorly differentiated, irregularly
shaped cells are nearly always
d. Radiation malignant
d. Neoplasia refers to the abnormal GRADING – describe the degree of
benign or malignant cell growth malignancy according to the type of
tumor cell
1. Benign neoplasm: usually
harmless, does not infiltrate TREATMENT IN GENERAL
other tissues
Objective: to remove all traces of the
2. Malignant neoplasm: always cancerous tissue
harmful, may spread or
metastasize to tissues far from Treatment plan based on the stage
the original site and grade of tumor
CANCER CLASSIFICATION Surgery: specific to site of malignancy
SOLID TUMORS –associated with MOST COMMON SITES:
organs from which they develop such
as breast cancer or lung cancer To lung from primary site in colon,
rectum, breast, renal system, testes,
HEMATOLOGICAL CANCER –originate and bone
from the blood cell-forming tissue,
such as leukemia, lymphomas, and To liver from primary sites in lung,
multiple myeloma colon, rectum, breast, and renal
system
CANCER TERMINOLOGY
To CNS from primary sites in lung and
Primary site of neoplasm is its site of breast
origin
To bone from pituitary sites in lung,
Secondary sites represent metastasis breast, renal system, and prostate
Types of neoplasms: benign and FACTORS THAT INFLUENCE CANCER
malignant DEVELOPMENT
Four types of malignant neoplasms: Chemical carcinogen –industrial
chemicals, drugs, and tobacco
a. Carcinomas: usually solid tumors
arising from epithelial cells Physical carcinogen –radiation
(diagnostics, sun, ultraviolet)
b. Sarcomas: from muscle, bone, fat,
and other connective tissues Viral –viruses capable of causing
cancer are known as oncoviruses such
c. Lymphomas: originate in the
as Epstein-Barr, heap B, and human
lymphatic system
papillomavirus
d. Leukemias: opriginate in the blood
H. pylori –is associated with increased
system
risk of gastric cancer
STAGING and GRADING –are methods used to
FACTORS THAT INFLUENCE CANCER
describe the tumor
DEVELOPMENT
STAGING –describe and classify extent
Obesity and dietary factors –
of a malignancy when it is diagnosed
preservatives, additives, and nitrates
Genetic predisposition Mammography
Age Pap’s test
Immune function –higher in Stools for occult blood
immunosuppressed persons, such as
AIDS px., organ transplant taking Sigmoidoscopy and colonoscopy
immunosuppressive meds.
BSE
NUTRITIONAL GUIDELINES TO REDUCE THE
TSE
RISK OF MANY TYPES OF CANCER
Avid obesity Skin infection
CAUTION
Decrease total dietary fat intake
Change in the bladder and bowel
Eat more high-fiber foods, such as
habits
whole grain, cereals, fruits, and
vegetables Any sore that does not heal
Include foods rich in vitamins A and C Unusual bleeding or discharge
in the daily diet
Thickening or lump in breast or
Include cruciferous vegetables (e.g. elsewhere
cabbage, broccoli, bruselle’s sprouts,
kohirabi, cauliflower) in the diet Obvious change in wart or mole
Consume alcoholic beverages only in Nagging cough or hoarseness
moderation
PREVENTION
Consume salt-cured, smoked, and
nitrite-cured foods only in moderation AVOIDANCE of known or potential
carcinogens and avoidance or
OTHER ACCEPTED RISK-REDUCTION modification of the factors associated
MEASURES INCLUDE with the development of cancer cells
Avoid tobacco use BREAST SELF EXAMINATION
Avoid excessive sun exposure, PERFORM 7 TO 10 DAYS AFTER
particularly between 10 a.m. and 3 MENSTRUATION
p.m.
Postmenopausal clients should select
Avoid exposure to industrial agents a specific day of the month and
known to increase cancer risk perform BSE monthly on that day
CANCER PAIN MANAGEMENT TESTICULAR SELF EXAMINATION
Although clients with cancer may Performed on the same day of each
experience pain at any time during month
their disease, pain is usually a late
symptom of cancer Best time is right after shower
EARLY DETECTION DIAGNOSTIC TESTS/BIOPSY
Definitive means of diagnostic cancer Collaborate with the other health team
and provides histological proof of to develop a pain management
malignancy program
Involves the surgical incision of a small Mild or moderate pain may be treated
piece of tissue for microscopic with salicylates, acetaminophen,
examination NSAIDS
BIOPSY/TYPES Severe pain is treated with opioids
Needle-aspiration of cells Monitor vital signs and for side effects
of medication
Incisional-removal of suspected tissue
from a larger mass Monitor for effectiveness of
medications
Excisional-complete removal of the
entire lesion Provide non-pharmacological
techniques of pain control, i.e.
OTHER DIAGNOSTIC TESTS
relaxation, biofeedback, massage,
Bone marrow examination heat/cold application
REMINDER
Chest radiograph
“DO NOT UNDER-MEDICATE THE CANCER
Computed tomography
CLIENT WHO IS IN PAIN”
Pap’s smear
Liver function tests SURGERY-indicated to diagnose, stage, and
treat cancer
MRI
Prophylactic-an attempt to remove the
Protoscopic examination
tissue or organ at risk and thus
Mammography prevent the development of cancer
Radioisotope scanning Curative-all gross and microscopic
tumor is removed or destroyed
PAIN CONTROL
Control/debulking-removing a large
Causes of Pain portion of a local tumor such as
ovarian cancer
Bone destruction
Palliative-performed to reduce pain,
Obstruction of an organ relieve airway obstruction, relieve
obstruction in the GI or urinary tract,
Compression of peripheral nerves
relieve pressure in the brain or spinal
Infiltration, distention of tissues Cord
Inflammation, necrosis Palliative-performed to improve quality
of life during the survival time
INTERVENTIONS
Asses the client’s pain
Reconstructive or rehabilative-improve Plant alkaloids: vincristine: bind to
quality of life by restoring maximal substances needed to form mitotic
function and appearance, i.e. breast spindle, thus preventing cell division
reconstruction after mastectomy
Hormone and hormone inhibitors:
SIDE EFFECTS OF SURGERY alters the endocrine environment to
make it less conducive to cell growth;
Loss or loss of function of a specific used in cancers of the breast,
body part prostate, and other reproductive
organs
Reduced function as a result of organ
loss ROUTES OF ADMINISTRATION
Scarring or disfigurement Intravenous (peripheral or central
nervous access)
Grieving about the altered body image
or imposed change of lifestyle • Oral
CHEMOTHERAPY • Intraarterial
Kills or inhibits the reproduction of
• Intraperitoneal
neoplastic cells and kills the normal
cells • Intrapleural
Highly toxic agents that attack all Use
rapidly dividing cells , both normal and
malignant To cure, control or palliate results of
neoplasm
Most agents modify or interfere with
DNA synthesis May be used as an adjunct to surgery
and radiation
ANTINEOPLASTICS (CYTOTOXIC,
ANTIPROLIFERATIVE AGENTS) ADVERSE EFFECTS: RESULTS FROM THE
DAMAGE TO NORMAL CELLS
Alkalyting agents (cytoxan): produce
breaks in DNA molecule and cross- Nausea/vomiting, stomatitis,
linking of strands thus interfering with alterations in taste, anorexia
DNA replication; most effective in
hematologic malignancies Diarrhea, constipation
Antitumor antibiotics (biomycin): bind Alopecia, dermatitis, pruritus,
directly with DNA changing its paresthesia, rash, bruising
configuration and inhibiting replication
Hemorrhagic cystitis
Antimetabolites :5-fluorouracil,
Cardiomyopathy
floxuridine: inhibit DNA synthesis;
most effective against rapidly growing Fatigue, dyspnea, fever, chills
tumors enzymes necessary for cell
function and replication Sterility, amenorrhea
Depression, anxiety
Myelosuppression Use soft-bristle toothbrush
NURSING INTERVENTIONS Avoid use of razors
Monitor lab studies as ordered SPACIAL NURSING CONSIDERATIONS
Monitor IV site for extravasation Exposure to chemotherapeutic agents
can lead to adverse reactions
Maintain strict asepsis
• Contact dermatitis
Administer antiemetic agents as
ordered and prophylactically before • Nausea and vomiting
chemotherapy
• Diarrhea
Give antihistamines as ordered
Exposure during pregnancy can lead
Withhold food and liquids for 4 to 6 to
hours before treatment
• increased risk of fetal abnormalities
Between treatments, give small,
frequent, bland meals • ectopic pregnancies
Give antidiarrheals as ordered • spontaneous abortions
Monitor signs of dehydration and
encourage fluids as tolerated
Provide frequent oral hygiene,
lubricate lips as indicated
For stomatitis, use topical anesthetics
before eating and as indicated
Apply lotion to skin as indicated; avoid
harsh, drying soaps
Provide a restful environment,
emotional support, and anxiolytics as
ordered
TEACH CLIENT
Medications and side effects
Alopecia is temporary
Avoid bruising, aspirin products, and
persons with infection
Conserve energy
Recognize signs of bleeding, anemia,
infection
