Chapter 16: Oncology Notes
● Cancer is a group of diseases characterized by uncontrolled and unregulated
cell growth
● Chemotherapy is a systematic drug that targets diseased and healthy cells
● Patient education to prevent cancer
○ Smoking, early screenings, environment, excessive UV exposure,
obesity, chemical carcinogens, radiation, viral carcinogens
● Proto-Oncogenes
● Oncogenes
○ Cancer involves the malfunction of genes that control differentiation
and proliferation. Two types of normal genes that can be affected by
mutation are protooncogenes and tumor suppressor genes.
Protooncogenes are normal cell genes that are important regulators of
normal cell processes. Protooncogenes promote growth. Mutations
that change the expression of protooncogenes can cause them to
function as oncogenes (tumor-inducing genes).
● Tumor Suppressor Genes
○ 2 copies from each parent, both copies would need to be damaged to
cause uncontrolled growth
○ Tumor suppressor genes suppress growth. They prevent cells from
going through the cell cycle. Mutations can change tumor suppressor
genes and make them inactive. This results in a loss of their
tumor-suppressing action.
● Comparison of Benign and Malignant Neoplasms
○ Benign
■ Encapsulated, differentiated, no metastasis, Recurrence is rare,
slight vascularity, expansive mode of growth, cell
characteristics- fairly normal, like parent cells
○ Malignant
■ Rarely Encapsulated, Poorly differentiated, Metastasis,
Recurrence is possible, moderate to marked vascularity,
infiltrative and expansive mode of growth, cell characteristicsCells abnormal, become more unlike parent cells
● Angiogenesis
● Anatomic Classification of Tumors- based upon the type of cells and/or
anatomical location
● Metastasis- spread of cancer cells from original location to new locations
● Cancer Staging
○ Stage 0: Cancer in situ. Abnormal cells are present but have not
spread to nearby tissue. Also called, carcinoma in situ, or CIS. CIS is
not cancer, but it may become cancer.
○ Stage I: Tumor limited to the tissue of origin; localized tumor growth
○ Stage II: Limited local spread
○ Stage III: Extensive local and regional spread
○ Stage IV: Metastasis
● Pathology, biopsy: In histologic grading of tumors, the appearance of cells
and degree of differentiation are evaluated pathologically.
● Histological grading
○ Grade I: Cells differ slightly from normal cells (mild dysplasia) and
are well-differentiated (low grade).
○ Grade II: Cells are more abnormal (moderate dysplasia) and
moderately differentiated (intermediate grade).
○ Grade III: Cells are very abnormal (severe dysplasia) and poorly
differentiated (high grade).
○ Grade IV: Cells are immature, primitive (anaplasia), and
undifferentiated. Cell origin is hard to determine (high grade).
○ Grade X: Grade cannot be assessed.
● TNM Classification System
○ We use the TNM classification system (Table 16.5) to determine the
anatomic extent of cancer involvement. There are 3 parameters: tumor
size and invasiveness (T), presence or absence of regional spread to
the lymph nodes (N), and metastasis to distant organ sites (M).
Examples of the TNM classification system are shown in Tables 30.26
and 56.7. We do not use TNM staging with all cancers. For example,
we do not stage leukemias with TNM since they are not solid tumors.
CIS has its own designation in the system (Tis). CIS has all the
histologic characteristics of cancer except invasion, a key feature of
the TNM staging system.
○ T-Primary Tumor (Tumor size and invasiveness), N-Regional Lymph
Nodes, M- Distant Metastases
○ The original description of the extent of the tumor stays part of the
record. If the patient needs more treatment, or if treatment fails,
retreatment staging is done to determine the extent of the disease
before retreatment. “Restaging” classification (rTNM) is distinguished
from the stage at diagnosis since the clinical significance may be
different. Staging cannot decrease, but the stage can increase.
● Prevention and Early Detection of Cancer
○ Limit alcohol use.
○ Get regular physical activity (e.g., 30 min or more of moderate
physical activity 5 times weekly).
○ Maintain a normal weight.
○ Have regular physical examinations.
○ Obtain regular colorectal screenings.
○ Avoid cigarette smoking and other tobacco use.
○ Get regular mammography screening and Pap tests.
○ Be familiar with your own family history and risk factors for cancer.
○ Obtain adequate rest of at least 6–8 hours per night.
○ Use sunscreen with a sun protection factor of 15 or higher. Avoid
tanning beds.
○ Eliminate, reduce, or change the perception of stressors and enhance
the ability to effectively cope with stress (see Chapter 7).
○ Eat a balanced diet that includes vegetables and fresh fruits, whole
grains, and fiber. Reduce dietary fat and preservatives. Limit smoked
and salt-cured meats with high nitrite concentrations.
● Warning Signs of Cancer (Vague Warning Signs)
○ Change in bowel or bladder habits
○ A sore that does not heal
○ Unusual bleeding or discharge from any body orifice
○ Thickening or a lump in the breast or elsewhere
○ Indigestion or difficulty in swallowing
○ Obvious change in a wart or mole
○ Nagging cough or hoarseness
● Diagnostic studies depend on the suspected primary or metastatic site(s) of
the cancer. Examples include:
○ Cytology studies (e.g., Pap test, bronchial washings)
○ Chest x-ray
○ Complete blood count (CBC), chemistry profile
○ Liver function studies (e.g., aspartate aminotransferase [AST])
○ Endoscopic examination: upper GI, sigmoidoscopy, or colonoscopy
(including guaiac test for occult blood)
○ Radiographic studies (e.g., mammography, ultrasound, CT scan, MRI)
○ Radioisotope scans (e.g., bone, lung, liver, brain)
○ PET scan (Fig. 16.7)
○ Tumor markers (e.g., CEA, AFP, PSA, CA-125)
○ Genetic markers (e.g., BRCA1, BRCA2)
○ Molecular receptor status (e.g., estrogen and progesterone receptors)
○ Bone marrow examination
● Sentinel node biopsy- biopsy the nearest draining biopsy to the cancer site
● The goals of cancer treatment are cure, control, and palliation
○ When cure is the goal, we expect treatment to have the greatest chance
of eradicating the cancer. Curative cancer therapy differs by the type
of cancer. It may involve local therapies (e.g., surgery or radiation)
alone or in combination, with or without adjunctive systemic therapy
(e.g., chemotherapy).
○ Control is the goal of treatment for cancers that we cannot completely
eradicate but are responsive to anticancer therapies. As with other
chronic illnesses (e.g., diabetes, heart failure), cancer can be
controlled for long periods with therapy.
○ Palliation is the goal of treatment when the goals are symptom control
or relief and maintaining a satisfactory quality of life. Palliative care
and treatment are not mutually exclusive and can take place
concurrently. An example of treatment in which palliation is the goal
includes using radiation therapy to reduce tumor size and relieve
subsequent symptoms, like the pain of bone metastasis.
● Cancer Treatments
○ Surgery
○ Chemotherapy
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Radiation therapy
Immunotherapy
Targeted therapy
Nursing Management for treatments
Nurses do not give chemotherapy
Table 16.11: Problems Caused by Chemotherapy and Radiation
Therapy
■ Myelosuppression
■ Tissue Vesicant
■ Weakness, hair loss, nausea/vomiting
■ High risk of infection due to immunocompromised status, bone
marrow suppression
■ Diarrhea, mucositis, anemia
■ Skin issues
Different routes of Chemotherapy
■ Oral
■ Intraarterial
■ Intracavitary (pleural, peritoneal)
■ Intramuscular
■ Intrathecal
■ Intravenous
■ Perfusion
■ Subcutaneous
■ Topical
Only persons specifically trained in chemotherapy handling techniques
should be involved with the preparation and administration of cancer
drugs.10 Cancer drugs may pose a hazard to health care persons who do not
follow safe handling guidelines. A person preparing, transporting, or giving
chemotherapy may absorb the drug through inhalation of particles when
reconstituting a powder or through skin contact from exposure to droplets or
powder.
Patients experience systemic symptoms
What will you teach the patient about these?
○ Wigs for hair loss
○ Diet for n/v
○ Small frequent meals
● How will you help the patient manage the side effects?
● Radiation
○ Targeted at specific area
○ External beam-skin care is important
○ Internal radiation (brachytherapy)
■ Insertion of radioactive materials into or near the tumor
○ Principles of ALARA
■ The principles of ALARA (as low as reasonably achievable)
and time, distance, and shielding are vital to our safety when
caring for the person with a source of internal radiation.
Organize care to limit the time spent in direct contact with the
patient. To lessen anxiety and confusion, tell the patient the
reason for time and distance limitations before the treatment.
● Immunotherapy and Targeted Therapy
○ Boost and manipulates environment to inhibit or attack cancer cells
■ Flu like symptoms
■ Orthostatic Hypotension
○ Myelosuppression
■ Nadir-lowest blood counts between 7-10 days after starting
therapy
● What does this mean to you?
● What might be given to stimulate counts?
■ Fatigue
■ GI Issues
■ Skin issues
■ Pneumonitis
● Delayed acute inflammatory reaction that may occur
within 1 to 3 months after completing thoracic radiation.
This reaction is often asymptomatic. An increase in
cough, fever and night sweats may occur. Some patients
may develop pulmonary fibrosis (with or without
pneumonitis), a late effect of therapy.
○ Table 16.19: Oncologic Emergencies
■ Tumor lysis syndrome
■ SIADH
■ Metabolic emergencies
● Hypercalcemia
■ SUperior vena cava syndrome
○ Read Page 284-288