Chapter 12 Oncology guided reading /lecture worksheet
Define :
Benign
Malignant
Metastasis
Identify risk factors
Etiology- when reading this section, think about what puts the patient at risk to develop
cancer, can it be avoided?
Viruses and Bacteria ( HPV, HBV, )
**Physical Agents- examples sunlight, radiation, tobacco etc..
**Chemical Agents- SMOKING - chew- pesticides etc…
Genetics and Familial Factors
BRCA1 and BRCA2 could lead to ___________ cancers
Lifestyle Factors- diet , obesity, etc….
Hormonal Agents- women who take estrogen after menopause – increased risk
_____________.
Detection and Prevention of Cancer
What is Primary Prevention?
What is an example?
What is Secondary Prevention?
Examples:
What is Tertiary Prevention?
Examples :
Chart 12-2 Health promotion
American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention
Diagnosis of Cancer
Table 12-3 American Cancer Society Screening Guidelines for the Early Detection of Cancer
Cancer site
Population
Test or procedure
Recommendation
Breast
Cervix
Colorectal
Endometrial
Lung
Prostate
Cancer
checkup
related
Table 12-4 discusses select diagnostic tests used to detect cancer
Chart 12-3 TNM Classification System – this is the way that they classifies tumors and it helps
guide treatment
Management of Cancer
Depending on grading and type of cancer, management will focus on:
cure -
controlpalliationSurgery
Surgical removal of the entire cancer remains the ideal and most frequently used treatment
method. Diagnostic surgery is the definitive method for obtaining tissue to identify the cellular
characteristics that influence all treatment decisions.
Describe surgery used as:
ProphylacticPalliativeTable 12-6 Types of Palliative Surgery and Interventions
Procedure
Indications
ReconstructiveBiopsy methods include excisional, incisional, and needle biopsy
Table 12-5 Select Techniques Used for Localized Destruction of Tumor Tissue
Type of procedure
Description
Examples of use
Think about the Nursing Management- what would that involve?
It is just a review of post operative care already covered. Just review 
Radiation Therapy
External radiation – most common –
Usual treatment time-
Internal Radiation
Brachytherapy
Define it :
Toxicity
Most often localized
When do they usually begin?
Effect on skin- are there areas more susceptible to issues?
Alteration in oral mucosa
Systemic effects
Late effects
Look for side effects of treatment
Nursing Management/ interventions ( how can the nurse help the patient ?)
How do we Protect Caregivers?
Chemotherapy
What are the goals of chemotherapy ?
Administration of Chemotherapeutic Agents
Extravasation
What is it?
When can it Cause damage?
TABLE 12
Drug class and
examples
Mechanism of action
Cell cycle specificity
Common side effects
Select Antineoplastic Agents- look @ the last column. There will be no specific questions about
chemo agents. The questions will focus on how the nurse intervenes based on the side effect.
Hypersensitivity Reactions
Certain agents pose a high risk .
Potential symptoms :
When a reaction is suspected , what is the first action taken
______________________________.
If client needs to be retreated – what steps can be taken to prevent reaction :
Toxicity
Acute vs. Chronic
Gastrointestinal System
nausea and vomiting
Stomatitis
Hematopoietic System
myelosuppression (depression of bone marrow function)
decreased WBCs (leukopenia), granulocytes (neutropenia),
red blood cells (RBCs) (anemia),
platelets (thrombocytopenia) and increased risk of infection and bleeding.
Labs need to be monitored
Renal System
Damage to the kidneys – what can happen ?
Labs need to be monitored
Cardiopulmonary System
Who is at higher risk?
Reproductive System
What could happen ?
What should be discussed ?
Do they need to be on birth control ?
Neurologic System
What can happen ?
What are the symptoms ?
Cognitive Impairment
Fatigue
Quality and Safety Nursing Alert
Patients receiving oxaliplatin must be instructed to avoid drinking cold fluids or going outside
with hands and feet exposed to cold temperatures to avoid exacerbation of these symptoms for 3
to 4 days after therapy (Olsen et al., 2019). Cisplatin may cause peripheral neuropathies and
hearing loss due to damage to the acoustic nerve.
**Nursing Management
Assessing Fluid and Electrolyte Status
Problems :
Important nursing interventions :
Assessing Cognitive Status
Assess when ….
Modifying Risks for Infection and Bleeding
Chemo increases risk of _____________, ____________, and ______ ________.
Administering Chemotherapy
Be aware of what the patient is receivingEducation
Look for signs of extravasation : what should be done if this happens?
Chart 12-5 Safety in Handling Chemotherapy for Health Care Providers
Preventing Nausea and Vomiting
Managing Cognitive Changes
Managing Fatigue
Chart 12-4
Potential Long-Term Complications of Cancer Chemotherapy
Page 325
Protecting Caregivers
Steps that need to be taken:
Types of Hematopoietic Stem Cell Transplantation
Stem Cell transplant
What is a major cause of morbidity and mortality ?
Focus on nursing management:
Implementing Care Before Treatment
Nutritional assessments, extensive physical examinations, organ function tests, and psychological
evaluations are conducted.
Blood work:
Assess patient’s social support systems and financial and insurance resources
Informed consent and patient education about the procedure and care before and after HSCT
are vital.
Providing Care During Treatment
Skilled nursing care is required during the treatment phase of HSCT when high-dose
chemotherapy (conditioning regimen) and total-body irradiation are given. The acute toxicities
of nausea, diarrhea, mucositis, and hemorrhagic cystitis require close monitoring and symptom
management by the nurse.
Nursing management during stem cell infusion:
monitoring vital signs and blood oxygen saturation;
assessing for adverse effects,
providing strategies for symptom control, ongoing support, and patient education.
During stem cell infusion, patients may experience adverse reactions to the cryoprotectant
dimethylsulfoxide (DMSO) used to preserve the harvested stem cells. What are the symptoms?
Providing Care After Treatment
Caring for Recipients
Caring for the donor
Immunotherapy and Targeted Therapy- just general information – nothing specific .
Targeted Therapies. just general information – nothing specific
Nursing Management
Key points of education :
Most of exam will be from this area :
Nursing Care of the Patient with Cancer
chart 12-6 plan of care – the patient with cancer – great reference
Maintaining Tissue Integrity
Stomatitis
Radiation-Associated Impairment of Skin Integrity
Alopecia
Malignant Skin Lesions
Promoting Nutrition
Nutritional Impairment
Chart 12-7 Potential Consequences of Impaired Nutrition in Patients with Cancer
Anorexia
Malabsorption
General Nutrition Considerations
Relieving Pain
Table 12-9 examples of sources of cancer pain
Source
Descriptions
Decreasing Fatigue
Chart 12-8 Sources of Fatigue in Patients with Cancer
Improving Body Image and Self-Esteem
Addressing Sexuality
Underlying cancer
Assisting in the Grieving Process
Monitoring and Managing Potential Complications
Infection
Table 12-10 Assessment of Neutropenic Fever in Patients with Cancer
Septic Shock
Bleeding and Thrombocytopenia
Quality and Safety Nursing Alert
Although laboratory test results confirm the diagnosis of thrombocytopenia, the patient who is
developing thrombocytopenia may display early signs and symptoms. Thus, nurses need to
observe keenly for petechiae and ecchymoses, which are early indicators of decreasing platelet
levels. Early detection promotes early intervention.
Cancer Survivorship
Table 12-12 Components of Survivorship Care
Components of Survivorship Care
Table 12-13 Oncologic Emergencies: Manifestations and Management
Oncologic emergency
Clinical manifestation and
Medical and nursing
diagnostic findings
management
Superior Vena Cava
Syndrome (SVCS)
Spinal Cord
Compression
Hypercalcemia
Tumor Lysis Syndrome
(TLS)
Hospice