[5.2] ONCO Part II (Breast Cancer, Lung Cancer, Hodgkin's Lymphoma, Multiple Myeloma, Prostate Cancer, Testicular Cancer, and Cervical Cancer)

From Ma'am Jaidee Rojas' lecture last August 1 and 2, 2025

Breast cancer

Most common cancer worldwide

Terminal duct lobular units (site for milk release)

Where is breast cancer commonly located?

FALSE

• It serves as a protective factor: The more the terminal duct lobular unit is used, the more it matures (cancer cells latches to immature cells)

TRUE or FALSE: Breastfeeding is a risk factor of breast cancer

1. Gender

2. Age

3. Fam history of Cancer

4. Race

What are the non-modifiable risk factors of breast cancer?

• Females: 99%

• Males: 1%

  • BRCA 2 Gene

  • Klinefelter syndrome: XXY (Gynecomastia)

NM Risk factor of Breast Cancer: Risk percentage of females and males. What genes serve as risk factors for males?

55-60 yo (though pabata na nang pabata ngayon)

NM Risk factor of Breast Cancer: Age that are more at risk

Caucasian

NM Risk factor of Breast Cancer: What race is more at risk?

1. Smoking

2. Alcohol drinking

3. Obesity

What are the modifiable risk factors of breast cancer?

For obese females, there is an increase in subcutaneous fats → estrogen conversion

Explain the reason why obesity is a modifiable risk factor of breast cancer.

Progesterone

What is the opposite or counterpart of estrogen?

1. Nulliparity

2. Early Menarche (<12 yo)

3. Late Menopause (>55 yo)

4. Pills

What are the estrogen related modifiable risk factors of breast cancer?

1. Mammography

2. Tumor Marker Test

3. Genetic Testing

4. Imaging Test

What are the diagnostic tests for breast cancer?

Mammography

Diagnostic Test: X-ray of the breast

TRUE

TRUE or FALSE: One should avoid powders, deodorants, and perfumes on the day of the mammography

40 yo

What is the earliest age for mammography?

40-44 yo

Mammography (Age group): Option to start screening

45-54 yo

Mammography (Age group): Required annually

55 yo above

Mammography (Age group): Biennially; every 2 years; every other year

30 yo

Mammography (Age group): If the patient is high risk for breast cancer, what age are they required to be screened annually?

FALSE

• Smaller chested

TRUE or FALSE: Mammography is more painful for larger chested women

1. Yes

2. Yes

3. Yes

4. Yes (Pills)

5. Yes (Gynecomastia)

6. No (No more breast tissue)

Identify if the following groups of people are allowed to have mammography:

1. Smaller chested women

2. With implant

3. Lesbians

4. Transwomen

5. Males

6. Post mastectomy

CA-125

What is the tumor marker for breast cancer?

1. Breast Cancer

2. Ovarian Cancer

What types of cancer share tumor marker CA-125?

1. BRCA 1 Gene

2. BRCA 2 Gene

3. Her 2 Gene

4. Her 2 Proteins

What genes are detected for breast cancer?

1. Breast Cancer

2. Ovarian Cancer

3. Prostate Cancer

What types of cancer share BRCA 2 Gene?

CT Scan

Imaging Test (Breast Cancer): Radiowaves

• 1st; faster results

• Least expensive

MRI

Imaging Test (Breast Cancer): Magnetic Waves

• 2nd; Better detailed structures

Remove metallic objects

1. Remove

2. Retained if they are MRI capable (most of pacemakers nowadays)

   1. Remove of not allowed to undergo MRI if not MRI capable

3. Sedate patient

4. Retained since it is not highly magnetic

   1. If will undergo brain MRI, huwag na ituloy since malabo rin ang images

What should be the nursing intervention before MRI? What should you do if the patient has the following?

1. Jewelries, implants, hearing aids, prostheses

2. Pacemaker

3. Claustrophobia

4. Braces

PET scan

Imaging Test (Breast Cancer): Radioisotopes (special)

PET Scan

Imaging Test (Breast Cancer): Will identify both structural functional abnormalities and metabolic abnormalities

FALSE

• Kikinang ang parts na may high cell metabolism

TRUE or FALSE: In PET scan, kikinang siya kapag may water

PET Scan

Imaging Test (Breast Cancer): Most expensive, more side effects, and slower results

Ultrasound

Imaging Test (Breast Cancer): Sound waves

Drink 6-8 glasses of water without voiding

• Full bladder, para maganda ang bounce ng radiowaves

What should the nursing intervention be if the patient will undergo pelvic and abdominal ultrasound?

FALSE

• Upper outer quadrant

TRUE or FALSE: Breast cancer usually occurs at the left lower quadrant of the breast

FALSE

• Non-tender, firm, fixed, with irregular borders

TRUE or FALSE: Breast cancer presents as tender, firm, movable lumps, with regular borders

Peau D’orange

Breast Cancer: What is the other term for orange peel skin?

FALSE

• Near the areola

TRUE or FALSE: Peau D’orange presents as large pores distant from the areola

TRUE

TRUE of FALSE: Abnormal nipple discharge, inversion, retraction, and ulceration are included in the s/sx of breast cancer

1. Mastectomy

2. Radiation therapy

3. Chemotherapy

4. Progesterone therapy

What are the management for breast cancer?

1. Modified Radical

2. Radical

3. Total

4. Lumpectomy

Breast Cancer: What are the types of Mastectomy?

Modified Radical

Type of Mastectomy:

• Removal of breast tissues + nipple areola complex + Axillary lymph nodes

• Pectoralis major + minor muscles intact

Radical

Type of Mastectomy: Remove everything

Total

Type of Mastectomy:

• Prophylactic and benign

• Removal of breast tissues + Nipple Areola complex

Lumpectomy

Type of Mastectomy:

• Everything is intact; tumor only removed

• Cosmetic effects

1. Lymphedema

2. Hematoma Formation

3. Infection

What are the post-op complications of mastectomy?

1. All about prevention; Semi-fowler’s with affected arm elevated above the level of the heart

2. Avoid BP taking on the affected arm

3. Avoid venipuncture on the affected arm

Mastectomy: What are the interventions for lymphedema as a post-op complication?

1. Jackson-Pratt Drainage (Negative pressure suction) → Please press

Mastectomy: What is/are the intervention/s for hematoma formation as a post-op complication?

1. Antibiotics (7-14 days) [Culture studies first]

Mastectomy: What is/are the intervention/s for infection as a post-op complication?

1. 5-7 days after the menstrual period

2. Same day each month

3. Same day each month

Breast self-examination: Identify what to teach the patient about BSE scheduling?

1. Pre-menopausal

2. Post-menopausal

3. Irregular

Inspection

1. Stand in front of the mirror

2. Place both arms on the side → head → pelvis

BSE: What should you do first? What should your position be?

Palpate

1. Outer to inner palpation from the axilla (circular motion)

2. Press the nipple

3. Lie down

BSE: What should you do second? What should your actions be?

Place folded towel underneath the shoulders

BSE: To spread breast tissues evenly across the chest wall when lying down, what should you do?

Circular motion

1. Up down

2. Radial

BSE: What motion is the best? What are the other methods?

Ronchogenic Carcinoma

What is the other term for lung cancer?

1. Age

2. Gender

3. Fam Hx

4. Cigarettes Smoking

5. Inhalational chemical carcinogens

6. Occupational pollutants

What are the risk factors of lung cancer?

60 yo above

Lung cancer: What age group is the most at risk?

Males

Lung cancer: Who are more at risk, males or females?

80%

Lung cancer: How many percent of lung cancer death cases are caused by cigarette smoking?

TRUE

TRUE or FALSE: Secondhand smoking is a proven risk factor for lung cancer

FALSE

• Not enough evidence

However, the first case of vape-related death was recorded. A 22-year-old male had a cardiac arrest due to the presence of 2 large blood vessels obstructing the heart. The only risk factor found is his vaping for 2 years straight.

TRUE or FALSE: Vape is a proven risk factor for lung cancer

FALSE

• Not enough evidence due to the limited sample size

TRUE or FALSE: Marijuana is a proven risk factor for lung cancer

FALSE

• Safe; however, note the ingredients since some have petroleum, which do not dissolve in the lungs, increasing the risk for pneumonia

TRUE or FALSE: Inhalers are proven to be a risk factor for lung cancer

1. Inhalational chemical carcinogens

2. Occupational pollutants

Which type of risk factor for lung cancer do the following belong to:

1. Rugby, gasoline, paint

2. Silica dust, asbestos, radon gas

1. Tumor marker test

2. Imaging test

3. Bronchoscopic Biopsy

What are the diagnostic tests for lung cancer?

CEA

• Carcinoembryonic Antigen

What is the tumor marker for lung cancer?

1. Lung Cancer

2. Colon Cancer

What types of cancer share the tumor marker CEA?

Low dose CT Scan

What is the initial screening and imaging test for lung cancer?

50-80 years old

1. Annually

2. Smokers (current or previous, 20 smoking pack year Hx)

Lung Cancer: At what age group is low dose CT scan indicated for the screening of lung cancer?

Follow up:

1. How often?

2. Who are required?

1 pack year = 1 pack (20 cigs)/day for a year

Lung Cancer: How is pack years calculated, or what is it’s equivalent?

Both A and B

Lung Cancer: What is the equivalent of 20 smoking pack year history?

a. 1 pack/day 20 years
b. 2 packs/day 10 years

Bronchoscopic Biopsy (Bronchoscopy + Biopsy)

What is the confirmatory test for lung cancer? (Please give the specific procedure)

1. Pre-endoscopy

   1. Suppress gag reflex

   2. Throat lidocaine spray, as ordered

2. Post-endoscopy

   1. Assess for the return of gag reflex (bago supine or pakainin)

Lung Cancer: What are the nursing interventions for the following, in relation to bronchoscopic biopsy?

1. Pre-endoscopy

2. Post-endoscopy

Nagging cough (dry, persistent cough; may lead to hemoptysis but this is a late sign)

→ Dyspnea (d/t decreased O2 capacity)

→ Fatigue

→ Anorexia (leading to inability to do ADLs)

→ Cachexia, N/V, Dysphagia, Hoarseness of the voice

→ Chest pain (late stage)

Lung cancer: Explain the signs and symptoms

1. Thoracotomy (Surgery)

2. Radiation therapy

3. Chemotherapy

Lung Cancer: What are the methods of management for lung cancer?

Thoracotomy

Lung Cancer: Surgical incision into the thoracic cavity

1. Lobectomy

2. Pneumonectomy

3. Wedge Resection

Lung Cancer: What are the types of thoracotomy?

Lobectomy

Lung Cancer (Thoracotomy): Remaining lobes will re-expand

Pneumonectomy

Lung Cancer (Thoracotomy): Removal of the entire lung

Unaffected (to promote max. lung expansion)

• LUPA: Lobectomy → Unaffected; Pneumonectomy → Affected

Lung Cancer (Thoracotomy): What side should the patient who has undergone lobectomy lie on?

Affected side (to promote maximum lung expansion)

• LUPA: Lobectomy → Unaffected; Pneumonectomy → Affected

Lung Cancer (Thoracotomy): What side should the patient who has undergone pneumonectomy lie on?

Wedge Resection

Lung Cancer (Thoracotomy): Same concept as segmental resection; Biopsy

Incentive spirometry

The purposes of this are the following:

1. To prevent atelectasis

2. To strengthen intercostal muscles

10-15 times / Waking hours

How often should incentive spirometry be done?

a. Inhale (INhale = INcentive)
c. Suck

SATA: Incentive Spirometry

a. Inhale
b. Exhale
c. Suck
d. Blow

Tumor

What does “-oma” mean?

Carcinoma

Cancer types: Epithelial tissues (linings, organs, glands)

Carcinoma

Cancer types: 80-90% cases

Sarcoma

Cancer types: Connective Tissues

Osteosarcoma

Cancer types (Sarcoma): Bones

Chondrosarcoma

Cancer types (Sarcoma): Cartilage

Leiomyosarcoma

Cancer types (Sarcoma): Smooth muscles

Sarcoma

Cancer types: Relatively rare; Malignant

Leukemia

Cancer types: Blood

Lymphoma

Cancer types: Lymph tissues, nodes

Myeloma

Cancer types: Plasma cells

Myeloma

Cancer types: WBC; Matured B Cells

Produce antibodies/immunoglobulins

What is the function of Matured B Cells?

Hodgkin’s Lymphoma

What is the type of cancer being described?

• Rare (12,000 Filipinos)

• High cure rate; very good prognosis (kahit stage 4, nagrerecover)