Oncology

Basics of Oncology

  • Content Presentation: The material presented is derived exclusively from lecture slides, with no chapter-related reading or Elsevier content on oncology.
  • Scope of Study:
    • Focus on a basic understanding of fundamental concepts in cancer.
    • The exam questions primarily stem from the evidence presented in these slides and lectures.
    • Throughout the nursing program at TCC, various cancers will be studied as part of disease processes in other related courses, including OBGYN and NP2, which will cover relevant women's health cancers and various cancers, respectively.

Understanding Cancer

  • Definition of Cancer:
    • A malignant neoplastic disorder characterized by the loss of normal growth-controlling mechanisms, leading to uncontrolled cell growth.
    • It can involve organs or collections of cells and is marked by errors in cell division, wherein cells cannot control their own growth.
  • Metastasis:
    • The term describes the movement of cancer cells from their original site to another area of the body.
  • Staging of Cancer:
    • Refers to how far the cancer has spread, specifically applicable to malignant tumors. Staging includes:
    • Size of the tumor
    • Invasion into surrounding tissues
    • Involvement of lymph nodes
    • Spread to other parts of the body
  • Grading of Cancer:
    • Assessment of how abnormal the cancer cells are based on microscopic evaluations of cell division.

Grading and Staging

Grading

  • Purpose: Measures the growth and spread rates of cancer cells, indicating the aggressiveness of the tumor.
  • Grades:
    • Grade I: Slight differentiation from normal cells; well-differentiated.
    • Grade II: Moderate differentiation; moderately abnormal cells.
    • Grade III: Poorly differentiated with very abnormal cells.
    • Grade IV: Undifferentiated immature cells; cannot determine cell origin.

Staging

  • Purpose: Evaluates the extent of cancer spread.
  • Stages:
    • Stage 0: Carcinoma in situ; cancer confined to the place of origin.
    • Stage I: Tumor localized to the original area.
    • Stage II: Limited local spread.
    • Stage III: Extensive local and regional spread.
    • Stage IV: Distant metastasis, where cancer spreads to distant parts of the body.

Causes of Cancer

  • Carcinogens:
    • Include tobacco, radiation, UV rays, drugs, industrial chemicals, and pesticides affecting cancer risk.
  • Viral Agents:
    • Epstein-Barr virus (mono), Hepatitis B and C, and Human Papillomavirus (HPV).
  • Other Factors:
    • Helicobacter pylori infection, obesity, poor diet, and excessive alcohol consumption.
  • Genetic Predisposition:
    • Involves family history and inherited factors contributing to cancer risk.
  • Age:
    • Accumulation of DNA damage over time increases risk.
  • Weakened Immune System:
    • Difficulty in controlling cancerous cells may arise.
  • Note: Not all cancers stem from the same causes; many factors contribute variably to the development of different cancers.

Cancer Prevention Strategies

  • Avoid Carcinogens:
    • Important for reducing cancer risk, along with lifestyle changes and consideration of modifiable risk factors.
  • Modifiable Risk Factors:
    • Factors that can be changed through lifestyle adjustments, such as diet and exercise.
  • Unmodifiable Risk Factors:
    • Genetic predispositions and age; factors outside of personal control.
  • Screening Guidelines for Cancer:
    • Mammography: Recommended starting at age 40, or earlier with a family history.
    • Pap Smears: Initiate at age 21 or upon becoming sexually active.
    • Rectal Exams and Colonoscopy: Begin at age 50.
    • Breast Self-Exam: Should be performed 3-5 days after the menstrual cycle.
    • Testicular Self-Exam: Regular self-assessment encouraged by patients.
    • Skin Inspection: Recommended annually, preferably done by a dermatologist.

Diagnostic Testing in Cancer

  • Biopsy: Essential for diagnosing cancer by examining a small tissue sample under a microscope.
    • Types of Biopsies:
    • Needle Biopsy: Small sample removed for examination.
    • Core Biopsy: Preferable as it retrieves a larger sample for more accurate diagnosis.
    • Incisional Biopsy: Removal of a wedge from the cervix for evaluation.
    • Excisional Biopsy: Whole lesion removal for diagnostic pathology.
  • Imaging and Testing Technologies:
    • CT Scans, MRI, Tumor Markers, and Bone Marrow Testing: Used to suspect cancer, though not definitive for diagnosing.

Recognizing & Assessing Skin Cancer

  • Mnemonic: ABCDE to Assess Skin Carcinomas:
    • A - Asymmetry: Check for uneven shapes in moles.
    • B - Border Irregularity: Look for edges that are blurred, notched, or ragged.
    • C - Color: Examine for uneven pigmentation (blue, pink, gray, and red can signal abnormality).
    • D - Diameter: Identify areas larger than 6 mm; abnormal (e.g., size of a pencil eraser).
    • E - Evolution: Monitor changes in appearance over time.

Neutropenic Precautions

  • Purpose: To protect neutropenic patients (those with low white blood cell counts) from infections.
  • Precautions:
    • No fresh fruits or vegetables allowed in the patient’s room; ensure all food is fully cooked.
    • Avoid standing water or live plants to minimize infection risk.
    • Employ soft toothbrushes to reduce gum bleeding risk.
    • Use electric razors to prevent skin breaks.
    • Avoid rectal temperatures due to bleeding risk in that area.
    • Maintain skin hygiene: keep skin barriers intact with soft treatment methods.
    • Ensure food is adequately cooked.
    • Limit animal exposure to reduce germ transmission.
    • Keep the environment clean to prevent infection hazards.

Radiation Therapy

  • Definition: Treatment involving exposure to external beams of radiation aimed at cancer cells, minimizing surrounding cell damage.
  • Types of Radiation:
    • External Beam Radiation: Directly targets cancer cells using external sources.
    • Brachytherapy: Internal radiation, such as placement of radioactive devices in the tumor area (used for cancers like cervical and prostate).
  • Skin Care Procedures During Radiation:
    • Do not remove radiation treatment markers.
    • Use warm water and mild soap; avoid washcloths for cleaning.
    • Do not apply unsanctioned lotions or powders to the treated skin.
    • Wear soft clothing to safeguard the treated area against abrasions.
    • Steer clear of sun exposure and excessive heat on the skin.
  • Radiation Safety Guidelines:
    • Maintain distance, timeframe, and shielding from radiation sources (e.g., stay 6 feet away, limit exposure to 30 minutes).
    • Handle radioactive excreta with caution (lasts for at least 48 hours post-treatment).
    • Action Plan If Radiation Device Dislodges:
    • Instruct the patient to remain still.
    • Use long-handled forceps to retrieve the radioactive source.
    • Place the device in a lead container.
    • Notify the radiation oncologist.
    • Prevent entry of others into the treatment room until the situation is secured.
    • Document the occurrence following protocol.