Cancer Nursing Notes

CANCER NURSING NOTES

INTRODUCTION TO ONCOLOGY

  • Oncology: The medical specialty concerned with cancer and its treatment.

  • Oncology Nurse: A nursing professional specializing in the care of cancer patients.

  • Radiation Oncologist: A medical doctor specializing in treating cancer with radiation.

  • Care Locations: Oncology care is provided in various healthcare settings including hospitals, outpatient facilities, and specialized clinics.

CANCER DEVELOPMENT

Definition of Cancer

  • Cancer: Characterized by the proliferation of cells that lack the capabilities of normal cellular function. These cells exhibit an abnormal ability to:

    • Divide uncontrollably

    • Proliferate excessively

    • Infiltrate neighboring tissues

    • Destroy existing cells and tissues

  • Cancer can occur at any age and in any tissue. The overall incidence of cancer increases with age and it remains one of the top three causes of death.

Signs and Symptoms

  1. Common Symptoms:

    • Fatigue

    • Unexplained weight loss

    • Fever

    • Pain

    • Sores that do not heal

    • Leukoplakia

    • Persistent cough or hoarseness

    • Dysphagia (difficulty swallowing)

  2. Additional Signs:

    • Changes in skin, such as new or changing moles or spots.

    • Changes in bladder or bowel functions.

    • Unusual bleeding (e.g., in sputum, stool, urine, nipple discharge, or vaginal bleeding).

    • Lump or thickening in breast, testicle, lymph nodes, or other soft tissues.

TUMORS

Tumors Overview

  • Tumors/Neoplasms: Growths that arise from normal tissues.

    • Benign Tumors:

    • Generally not life-threatening, depending on location.

    • Typically slow-growing and well-capsulated.

    • Composed of differentiated cells and lack metastasis.

    • Malignant Tumors:

    • Exhibit rapid growth and uncontrolled replication.

    • Nonencapsulated, infiltrating, and invading other tissues.

    • Composed of anaplastic cells, often metastasizing to distant sites via blood vessels or lymphatic vessels.

TYPES OF CANCER

General Classification

  • Over 100 types of cancer exist.

  • Most Common Cancers:

    • For Men: Prostate, colon, rectum, skin.

    • For Women: Breast, endometrial, colon, rectum.

  • Survival Rates: Have improved due to advancements in medications, surgical techniques, and radiotherapy precision.

Top 10 Cancers and Survival Rates
Male

  1. Prostate: 97.5% survival rate

  2. Urinary Bladder: 78.5% survival rate

  3. Kidney and Renal Pelvis: 74.9% survival rate

  4. Non-Hodgkin Lymphoma: 72% survival rate

  5. Thyroid: 98.9% survival rate

  6. Leukemia: 65.7% survival rate

  7. Colon and Rectum: 64.3% survival rate

  8. Lung and Bronchus: 18.1% survival rate

  9. Pancreas: 10.9% survival rate

Female

  1. Melanoma of the Skin: 91.7% survival rate

  2. Breast: 90.3% survival rate

  3. Corpus Uteri: 82.7% survival rate

  4. Kidney and Renal Pelvis: 76.8% survival rate

  5. Non-Hodgkin Lymphoma: 74.6% survival rate

  6. Colon and Rectum: 65.3% survival rate

  7. Leukemia: 64% survival rate

  8. Lung and Bronchus: 25.4% survival rate

  9. Pancreas: 10.7% survival rate

Cancer Types Classification

  • Carcinomas: Develop from epithelial tissues.

  • Sarcomas: Develop from connective or supportive tissues.

  • Leukemia: Originates in hematopoietic (blood-forming) tissue.

  • Lymphomas and Myelomas: Originate in the immune system.

  • Blastoma: Malignant tumors of immature or embryonic tissue.

CARCINOGENESIS AND CARCINOGENS

Carcinogenesis Definition

  • Carcinogenesis: The process of transformation of a normal cell into a malignant cell.

Carcinogens

  • Definition: Agents that cause damage to cellular DNA leading to cancer development.

  • Types:

    • Chemical Carcinogens: Examples include tobacco smoke, vehicle exhaust, industrial chemicals, asbestos, insecticides, dyes, and hormones.

    • Radiation: Includes sunlight, x-rays, radioactive materials, and UV light radiation.

    • Oncogenic Viruses: Examples include HIV, HTLV, HPV, and Epstein-Barr virus.

Genetic Factors

  • Oncogenetic Causes: DNA may carry oncogenes with defective information that can lead to cancer.

  • Heredity: Transfer of defective DNA can occur through sperm or egg cells.

  • Genetic Screening: Useful for certain cancers like breast and ovarian cancer, retinoblastoma, and Wilms tumor.

CANCER GRADING AND STAGING

Grading Overview

  • Definition: Grading refers to the classification of a tumor based on how closely the tumor cells resemble normal cells.

    • Grade I: Tumors closely resemble normal cells (well-differentiated).

    • Grade II or III: Intermediate phases of differentiation.

    • Grade IV: Very anaplastic (poorly differentiated).

Staging Overview

  • Staging Definition: Describes the extent and spread of cancer in the body.

  • TNM System: Classifies tumors based on size (T), node involvement (N), and metastasis (M).

    • Stages:

    • Stage I: Limited to single node or organ.

    • Stage II: Involves multiple nodes but confined.

    • Stage III: Present above and below diaphragm.

    • Stage IV: Spread to extralymphatic organs.

INCIDENCE AND RISK FACTORS

  • Incidence: Cancer is one of the top three major causes of death in adults in the United States.

  • Risk Factors:

    • Inherited Factors: Passed down from one generation to the next.

    • Acquired Cancers: Due to environmental exposures (tobacco, secondhand smoke, alcohol, radiation, etc.), which are often lifestyle-related and many are preventable.

CANCER PREVENTION AND EARLY DETECTION

Prevention Strategies

  1. Tobacco: Cessation of smoking and use of tobacco products.

  2. Diet: Changes in dietary habits, reducing fats, calories, red meat, alcohol, and increasing fiber, fruits, and vegetables.

  3. Sun Exposure: Reduction of exposure to the sun and avoidance of UV light sources.

  4. Self-Examinations: Performing self-exams for breast and testicular cancer.

  5. Screenings: Regular healthcare examinations for prostate and colorectal cancer.

  6. Exercise: Maintaining an active lifestyle.

  7. Education: Improvement in educational strategies for cancer prevention.

CANCER SCREENING GUIDELINES

  • Screenings recommended for the following cancers:

    • Breast Cancer

    • Colon and Rectal Cancer: Tests for polyps and cancer detection.

    • Cervical Cancer

    • Endometrial (Uterine) Cancer

    • Prostate Cancer: Specific risk factors should be considered.

The Papanicolaou (Pap) Test

  • Used for cervical cancer testing, classified into three categories:

    • Negative for intraepithelial lesion or malignancy.

    • Epithelial cell abnormalities.

    • Other malignant neoplasms.

DIAGNOSTIC TESTS

Types of Diagnostic Tests

  1. Cytology

  2. Laboratory Tests and Blood Studies

    • Includes tumor markers such as enzymes, cancer antigens, oncofetal proteins, hormones, and miscellaneous markers.

  3. Noninvasive Procedures: e.g., Imaging studies.

    • CT Scans

    • Ultrasonography

    • MRI

  4. Invasive Diagnostic Techniques

    • Endoscopy, exploratory surgery, biopsy, and frozen section.

TREATMENT MODALITIES FOR CANCER

Surgery Options

  • Types of surgery include:

    • Incisional, excisional biopsy, cryosurgery, electrocauterization, fulguration, en bloc resection, exenteration.

    • Laser Surgery: Laser-induced interstitial thermotherapy (LITT) and photodynamic therapy (PDT).

    • Prophylactic Surgery: Aimed at preventing cancer.

    • Palliative Surgery: Aimed at relieving symptoms.

    • Hematopoietic Stem Cell Transplant (HSCT): For hematologic cancers.

Chemotherapy

  • Involves various chemotherapeutic agents such as:

    • Alkylating agents, antibiotics, antimetabolites, antimitotics, and hormonal agents.

  • Targeted Drug Therapy: Focuses on specific molecular targets.

  • Clinical Drug Trials: Testing new treatments.

Immunotherapy or Biotherapy

  • Includes:

    • Monoclonal antibodies (MOAB, MoAb)

    • Interferons

    • Hematopoietic growth factors (e.g., colony-stimulating factors)

    • Interleukins (ILs)

    • Retinoids.

Radiation Therapy

  • Types of radiation include:

    • External and internal methods, with brachytherapy being a type of internal radiation.

    • Proton Therapy: Utilizes protons instead of x-rays.

NURSING CONSIDERATIONS

Nursing Process

  • Steps: Data collection, planning and implementation, evaluation.

Specific Considerations

  1. Chemotherapy Administration: Use of personal protective equipment (PPE), knowledge of drug side effects, and modes of administration including oral, IM, topical, IV, etc.

  2. Radiation Therapy Management: Handling side effects like nausea, vomiting, and fatigue.

  3. Nutritional Needs: Diets high in proteins and vitamins, several small meals, and considering cultural beliefs.

  4. Client and Family Education: Teaching about screening, self-examinations, treatment options, and management of side effects.

  5. Follow-Up Care: Importance of routine monitoring for both adults and children for potential late effects post-treatment.

QUESTIONS & ANSWERS

Question 1

  • Statement: During carcinogenesis, disruption occurs with the normal process of DNA replication occurring during cellular mitosis.

  • Answer: True. Disruption results in the development of abnormal, cancerous cells.

Question 2

  • Statement: Every woman who is older than 20 years or who is sexually active needs to take a yearly mammogram.

  • Answer: False. Yearly mammograms are recommended starting at age 40 while clinical breast exams can be performed every 3 years for women in their 20s and 30s.

Question 3

  • Statement: The client with inflammation following chemotherapy is asked to swallow large amounts of the swish-and-swallow solution at a time.

  • Answer: False. Clients should be instructed to swallow small amounts as the solution can anesthetize the throat.

REFERENCES

  • Rosdahl, C.B. (2022). Rosdahl’s Textbook of Basic Nursing (12th ed.). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.