oncology adults

Oncology Terminology

  • Cancer (CA):
    • Definition: Abnormal cell growth where cells ignore regulation signals.
  • Benign:
    • Definition: Tumor/some kind of mass that is not cancerous.
  • Malignant neoplasms (Cancer cells):
    • Definition: Cancerous cell growth.
  • Tumor:
    • Definition: Abnormal tissue growth.
  • Metastasis:
    • Definition: Spread of cancer from the original site to another site.

Epidemiology

  • Estimated Diagnosis Statistics for 2026:
    • 2.1 million Americans will be diagnosed with cancer.
  • Cancer Mortality Statistics:
    • 2nd leading cause of death, following cardiovascular disease.
    • Leading Causes of Cancer Death in 2025:
    • In men:
      • Lung, Prostate, Colorectal
    • In women:
      • Lung, Breast, Pancreatic
  • Trends:
    • Overall cancer death rates declining since 2016.
    • Leading cause of cancer death under 50: Colorectal cancer has risen, surpassing breast and pancreatic cancers in this age group.
  • Factors Affecting Death Rates:
    • Attitudes / lifestyle choices
    • Cultural beliefs
    • Socioeconomic status / insurance coverage
    • Misconceptions

Etiology of Cancer

  • Understanding Causes:
    • Causes of most cancers are unknown.
    • Carcinogens: Factors associated with cancer causation include exposure leading to alteration of genetic material in cells, which activates oncogenes that produce abnormal cells, eventually becoming cancerous cells.
    • Specific Associations:
    • Lung Cancer: Associated with smoking.
    • Skin Cancer: Associated with UV light rays.
    • Controllable Risk Factors:
    • Can lead to “preventable cancers.”
    • Failure of Immune System: Specific risk factors associated with increased incidence of cancer.

Types of Carcinogens

  • Viruses:
    • Example: HPV, Hepatitis.
  • Physical Agents:
    • Example: Smoking.
  • Chemicals:
    • Examples: Asbestos, Radon.
  • Genetic / Familial Factors:
    • Examples: Chromosomal mutations, BRCA gene.
  • Lifestyle Factors:
    • Examples: High intake of red meats, processed foods, and alcohol.
  • Hormonal Factors:
    • Example: Childbirth, menopause.

Cancer Naming

  • Naming Convention:
    • Based on:
    • The organ or tissue where the cancer first develops (e.g., breast cancer, lung cancer).
    • The specific cell type involved (e.g., -blastoma, -sarcoma).

Immune System's Role in Cancer

  • Surveillance:
    • An intact immune system is essential for cancer surveillance.
    • Conditions leading to immune system invasion can predispose individuals to cancer.

Pathophysiology (Not on Exam)

  • Normal Cell Cycle of Growth and Replication:
    • Five phases of the cell cycle:
    • G0: Resting phase, no proliferation occurring.
    • G1: RNA and protein synthesized.
    • S: Synthesis of DNA and proteins of new chromosomes.
    • G2: Preparation for cell division.
    • M: Actual cell division (mitosis), producing two daughter cells.

Pathophysiology of Cancer Cell Division

  • Characteristics of Cancer Cells:
    • Complete the cell cycle more quickly.
    • Less likely to enter the G0 phase.
    • Exhibit uncontrolled growth patterns and immortality due to lack of the p53 gene.
    • Rapidly growing and reproducing cells are the primary targets of chemotherapy and radiation therapies.

Cancer Prevention

  • Primary Prevention:
    • Definition: Reducing the risks of cancer.
    • Example: HPV immunization and avoiding known carcinogens.
  • Secondary Prevention:
    • Definition: Early detection and screening of cancer.
    • Involves inspection, palpation, and diagnostic tests.
  • Tertiary Prevention:
    • Definition: After diagnosis, focuses on preventing complications.
    • Therapeutic treatments aim to eradicate or arrest disease and/or prevent further complications.

Diagnosis of Cancer

  • Multidisciplinary Approach:
    • Physical exam findings during examination.
  • Diagnosis of Malignancy Techniques:
    • Tissue biopsy
    • Cytology results
    • Laboratory results for hematological malignancies
    • Imaging studies like CT scans, X-rays, and MRIs
    • Note: Must have cells/tissue to confirm diagnosis.

Staging and Grading of Cancer

  • Conducted immediately after diagnosis and prior to treatment:
    • Staging:
    • Determines tumor size, invasion, lymph node involvement, and metastasis.
    • Uses the TNM system (Tumor, Nodes, Metastasized).
    • Grading:
    • Pathologic classification based on the type of tumor cells and their differentiation.
    • Higher stage and grade = poorer prognosis for cure, and higher grades indicate a lesser chance of successful treatment.
    • Stages of Cancer:
      • Stage I: Small tumor, not yet spread.
      • Stage II: Cancer has grown into other tissues, no lymph node involvement.
      • Stage III: Involves lymph nodes.
      • Stage IV: Cancer has spread to other parts of the body.
  • Staging vs. Grading:
    • Staging:
    • Stage 0: In situ cancer / very early lesions.
    • Stage I: Early invasion without metastasis.
    • Stage II: Limited local extension of tumor / minimal node involvement.
    • Stage III: Extensive local and nodal invasion.
    • Stage IV: Distant metastasis / other organs involved.
    • Grading:
    • Evaluation of the extent to which tumor cells differ from normal cells.
      • Grades 1 & 2: Well-differentiated with minimal deviation from normal cells.
      • Grades 3 & 4: Poorly differentiated and highly aberrant compared to normal cells.

Treatment Goals

  • Cure:
    • Eradicate the cancer completely.
  • Palliation:
    • Alleviate symptoms when the disease is beyond treatment.

Cancer Treatment: Surgery

  • Types of Surgery:
    • Primary treatment aimed at removing cancerous tissue.
    • Palliative surgery to make the patient more comfortable.
    • Prophylactic surgery as a preventative measure.
    • Can be used alone or in combination with radiation and chemotherapy.

Cancer Treatment: Radiation

  • Goals:
    • Cure, control (to stop growth and spread), or act as prophylactic (preventative).
  • Effect on Cells:
    • Affects rapidly dividing cells, including:
    • Bone marrow
    • Lymphatic tissue
    • Epithelium of the gastrointestinal (GI) tract
    • Hair follicles
    • Gonads
  • Dosage Considerations:
    • Radiation dosage is weight-based.
    • Need to maintain weight due to the correlation with treated dosage.
    • Body Surface Area (BSA):
    • Specifically calculated for the radiation treatment protocol.

Types of Radiation

  1. External Beam Radiation:
    • Source comes from outside the body, providing direct treatment to the local area.
    • All tissue in the pathway of the beam is affected, and there is a limit to what the body can tolerate.
    • Administered in divided doses over several days or weeks.
  2. Internal Radiation (Brachytherapy):
    • Involves using implants at the treatment site within the tumor.
    • Radioactive implants/seeds are localized at the tumor.
    • Sealed source (the patient is not radioactive), with minimal exposure to nursing staff, and isolation is not needed.
  3. Radioactive Isotopes:
    • Systemic treatment involving injection or ingestion of isotopes.
    • Unsealed source (the patient is radioactive), leading to precautions for staff safety and body fluid precautions, including isolation.

Adverse Effects of Radiation

  • Common Reactions:
    • Skin reactions at the entry and exit site of the beam (for external beam radiation).
    • Bone marrow suppression leading to reduced blood cell counts.
    • Fatigue experienced by patients.
    • Alteration in nutrition due to:
    • Mucositis/Stomatitis, causing sores in the mouth and throat.
    • Some patients may require feeding tubes due mainly to painful sores.
    • Onset of Side Effects:
    • Effects may begin several days or weeks after treatment and can last 2-4 weeks.

Nursing Management of Radiation

  • Skin Care Protocols:
    • Avoid any ointments, powders, soaps, deodorants, or perfumes on the affected area.
    • No shaving with razor blades on affected skin.
    • Protect skin from cold, heat, and sun exposure.
    • Use loose-fitting clothing to minimize irritation.
    • Only use lotions or topical treatments that are approved by Radiology for skin irritations.
    • Do not wash off radiation markings.
  • Monitoring and Managing Symptoms:
    • Monitor complete blood count (CBC) for any adverse effects.
    • Manage symptoms and maintain proper nutrition for the patient during treatment.

Patient Safety & Precautions in Chemotherapy

  • Sample Question A chemotherapy patient has lab values: WBC 2.5, Plts 300,000, and RBC 4.5. Which type of precaution would be appropriate?
    • Answer: Infection precautions due to low WBC, which indicates a high risk for infection.
    • Normal Lab Ranges:
    • WBC: 4.5-11
    • RBC: 4.3-5.5
    • PLTS: 150,000-450,000

Cancer Treatment: Chemotherapy

  • Definition:
    • Use of antineoplastic drugs that are effective against rapidly dividing cells.
  • Principles of Chemotherapy:
    • Disrupts reproduction of malignant cells by altering biochemical processes.
    • Destroys malignant cells while minimizing damage to normal cells.
    • Administered in repeated doses or cycles aimed at catching cancer cells through various phases of the cell cycle.
    • Requires thorough functional and clearance tests before drug administration.
    • Chemotherapy is a systemic treatment that is often invasive and requires careful monitoring.

Cancer Treatment (Chemotherapy): Indications

  • Chemotherapy Use Cases:
    • Indicated for widespread/systemic disease.
    • High risk of undetectable disease.
    • Tumors that cannot be surgically resected or are resistant to radiation therapy.
    • May be used as primary or combination treatment.
  • Goals of Chemotherapy:
    • Achieve cure, control the disease, or provide palliative relief.

Chemotherapy Administration Routes

  • Variety of Routes:
    • Intravenous (IV):
    • Most common and systemic route, careful monitoring for extravasation is required.
    • Topical:
    • Used for treating skin cancer.
    • Intra-arterial:
    • Targets hepatic tumors.
    • Intracavitary:
    • Targets abdominal, bladder, or pleural spaces.
    • Intraperitoneal:
    • Specifically for ovarian cancer.
    • Intrathecal:
    • Routes for treating CNS tumors.
    • IM, SQ, PO:
    • Various methods of administration based on treatment requirements.

Chemotherapy: Adverse Effects

  • Hematopoietic Changes:
    • Leukopenia (low WBC count)
    • Anemia (low RBC count)
    • Thrombocytopenia (low platelet count)
  • Treatment Interruptions:
    • Can interrupt treatment schedules due to adverse effects.
  • Other Side Effects:
    • Nausea and vomiting, though improvements have been seen compared to previous years.
    • Mucositis/Stomatitis can occur at oral, rectal, and vaginal sites, leading to severe diarrhea that may affect the entire GI tract.
    • Skin changes and alopecia (hair loss) are common, but hair may not return to the same state post-treatment.

Major System Toxicities of Chemotherapy

  • Cardiac:
    • e.g., Doxorubicin; can cause toxicity and may involve using a cardiac protectant (Dexrazoxane).
  • Hepatic:
    • e.g., Fluorouracil (5-FU) primarily metabolized by the liver.
  • Renal:
    • e.g., Cisplatin and Cytoxan; pre-hydration and magnesium replacement are necessary to prevent nephrotoxicity.
  • Neurologic:
    • e.g., Cisplatin, plant alkaloids (like Vincristine) can cause neuropathies.
  • Reproductive:
    • Dysfunction can occur, necessitating options for sperm/egg banking and considerations of libido loss.

Nursing Management of Chemotherapy

  • Personal Protective Equipment (PPE):
    • Required for the safe handling and administration of chemotherapy drugs.
  • Special Education:
    • Education on how to handle drugs properly, safe administration procedures, and recognizing side effects or emergencies related to chemotherapy.

Family/Home Management of Chemotherapy

  • Safety Precautions for Family:
    • Actions Required:
    • Keep the family safe from chemotherapy exposure for at least 48 hours post-treatment.
    • Use a separate bathroom.
    • Flush the toilet twice with the lid down.
    • Wear disposable gloves when cleaning up any bodily fluids.
    • Wash clothing or linens contaminated with bodily fluids separately from other laundries.

Biologic Response Modifiers

  • Types of Modifiers:
    • Nonspecific biologic response modifiers stimulate the immune system generally (e.g., BCG).
    • Monoclonal Antibodies:
    • Target specific malignant cells while sparing normal cells (e.g., Trastuzumab).
    • Cytokines:
    • Includes interferons (antiviral, antitumor, immunomodulatory) and colony-stimulating factors (e.g., Erythropoietin for myelosuppression).
    • Vaccines:
    • E.g., HPV4.
    • Gene Therapy:
    • Targeted therapies aimed at specific cancer cells.

Nursing Management for Chemotherapy Patients

  • Patient Assessment:
    • Assess, educate, and evaluate the patient's and family's understanding of the treatment process.
    • Monitor laboratory results and patients’ clinical status regularly.
    • Implement precautions related to neutropenia, anemia, and thrombocytopenia.
    • Determine and assist with self-care needs.
    • Address the nutritional needs of the patient.

Nursing Management for Specific Needs of Oncological Patients

  • Fatigue Management:
    • Acknowledge that fatigue varies among individuals.
    • Teach energy conservation techniques and encourage rest periods between activities.
    • Educate on expected fatigue levels and safety precautions regarding weakness, falls, and driving.
  • Pain Management:
    • Use both pharmacological and non-pharmacological treatments.
    • Monitor pain levels and labs to inform medication choices.
  • Nutritional Needs:
    • Administer anti-emetics proactively (before and/or on a scheduled basis).
    • Encourage small, frequent meals and consider supplemental feedings.
    • Educate on alterations in taste and smell.
    • Maintain thorough oral care to prevent mucositis (using sodium bicarbonate rinses).
    • Provide pain medications as necessary for stomatitis and recommend bland, non-acidic foods.

Bone Marrow Suppression Due to Treatment

Neutropenia:
  • Risks: Increased frequency of infection, but symptoms may not present normally.
    • Cardinal symptom: Fever (>38°C).
    • Importance of meticulous handwashing, staff wearing masks, and placing the patient in a protective environment.
    • Restrictions on fresh flowers, fruits, vegetables, and yogurt with active cultures.
    • May need colony-stimulating factors such as G-CSF (filgrastim).
    • Possible bone pain as a side effect.
Anemia:
  • Symptoms: Fatigue and reduced oxygen-carrying capacity.
    • Consider administration of Erythropoietin (Epoetin alfa) and monitor hemoglobin/hematocrit levels.
    • Blood transfusions may be required if levels are significantly low.
Thrombocytopenia:
  • Monitor for signs of bleeding and bruising, especially GI and oral bleeding.
    • Precautions include:
    • No razors or toothbrushes that could cause cuts.
    • Avoid aspirin products and intramuscular injections.
    • Platelet transfusions may be necessary in severe cases.

Oncology Complications

  • Major Complications:
    • Infection secondary to neutropenia.
    • Septic shock.
    • Severe pain management needs.
    • Bleeding/thrombocytopenia.
    • Hypercalcemia.
    • Tumor lysis syndrome.
    • SIADH (Syndrome of Inappropriate Antidiuretic Hormone secretion).
    • DIC (Disseminated Intravascular Coagulation).
    • Spinal cord compression.

Sample Questions and Rationales

  • Question 3:

    • Family inquiry about gathering for a baby shower post-radiation treatment response:
    • Correct Answer: C. Advise limiting interactions with sick individuals due to increased infection risk despite feeling well.

  • Question 4:

    • If a patient questions late diagnosis of lung cancer spreading, the best response is:
    • Correct Answer: B. Symptoms often do not show until the cancer has spread.