Oncology

Question 1

Oncology Patho

Answer 1

Cancer refers to a class of diseases. Classfied by 
The tissue or blood cell where it starts and the type.

Two types:
Solid tumors and Hematologic malignancies

Question 2

Solid tumors

Answer 2

Arise from specific tissue

Sarcomas
Begin in the connective tissues ( bones, muscles, tendons, cartilage)

Carcinoma
Originate from the epithelial tissues and this is the tissue that lines your organs like lungs, liver, breast, and prostate

Question 3

Hematologic malignancies

Answer 3

Originate from blood and lymphatic cells

Begins with one abnormal cell that starts growing and dividing out of control

Question 4

Metastasis

Answer 4

Travelling or extension of the original cancer to other sites of the body.

Occurs by
direct invasion
Though the blood system
Through the lymphatic system

Question 5

Risk Factors for Cancer

Answer 5

Tobacco is the #1 cause of preventable cancer.
Alcohol and Tobacco = co-carcinogenic

Suspected dietary causes of cancer:
A low fiber diet, Increased red meat, Increased animal fat, Nitrates (process sandwich meats), Alcohol, Preservatives and additives

Obesity, physical inactivity and poor nutrition and aging

Increased incidence in the immunosuppressed

Hereditary, exposure to UV radiation, exposure to carcinogens, Chronic irritation can cause uncontrolled growth of abnormal cells.
Previous history of other types of cancer or chemo.

Question 6

Prevention and Screening : Primary

Answer 6

Ways to help prevent the actual occurrence of cancer.
No smoking
Exercise and Nutrition
Maintain normal body weight
Limit or eliminate alcohol
Vacines for preventable viral exposures such as hep b and HPV
Avoid exposure to known carcinogens

Question 7

Prevention and Screening: Secondary for females

Answer 7

This is when we use screenings to puck up on cancer early, when there is a greater chance for cure or control.

Breast self awareness/ Monthly breast self exams - done anytime on day 7 to 12 of the menstrual cycle.

Post menopausal or woman who have had a hysterectomy should perform the breast self exam on the same day every month

Yearly clinical breast exams for woman greater than 40 years of age. Woman between ages of 20 to 39 need one every three years.

Paps beginning at age 21 and performed every 3 years if there have been no problems

Colonoscopy at age 50 then every 10 years if no problems

Testing stool for fecal occult blood should be done yearly beginning at age 50 unless previous problems or positive family history

Question 8

Mammograms

Answer 8

Mammogram - annually starting at age 40

Do not put lotion, powder or deodorant before exams

Question 9

Prevention and Screening: Secondary for males

Answer 9

Yearly clinical testicular exams
Testicular tumors grow vee fast so monthly self exams are recommended.
Major age group is 15 - 36.
Digital rectal exam and prostate specific antigen may be checked annually for men over the age of 50.
Colonscopy at age 50 then every 10 years and yearly fecal occult blood testing

Question 10

Tertiary Prevention

Answer 10

Focuses on the management of long term care for clients with complex treatments for cancer.

Includes support groups and rehabilitation.

Question 11

Cancer Symptoms : CAUTION

Answer 11

CAUTION

Change in bowel/bladder
A sore that does not heal
Unusual bleeding/discharge
Thickening or lump in breast or elsewhere
Indigestion of difficulty swallowing
Obvious change in wart or mole
Nagging cough or hoarsenes

Question 12

Cancer General Signs and Symptom

Answer 12

Cancer can invade bone marrow which can lead to anemia ( hypoxia), leukopenia (Risk for infection) and thrombocytopenia (Low platelets - bleeding precautions)
Unexplained weight loss
Cachexia
Fever - Leukaemia and Lymphomas (first sign)
Fatigue is the #1 symptoms that clients report with a diagnosis of cancer. ( exhaustion that doesn’t get better with sleep)
Pain (Early sign of bone and brain and testicular cancer), colon, rectumn

Question 13

Cachexia

Answer 13

Extreme wasting and malnutrition

Question 14

Blood tests

Answer 14

Abnormal CBC and Dif
Most concerned about neutrophils
Elevated liver enzymes (AST and ALT) we don’t want liver involved
Tumor Markers

Question 15

Positive diagnostic studies

Answer 15

CXR
CT
MRI
PET scan
Bone Marrow Biopsy
Tissue Biopsy
Imaging Studies

Question 16

Total Laryngectomy

Answer 16

Long term and smaller. Removal of vocal cords, epiglottis and thyroid.
Since the whole larynx ( remember this includes the epiglottis - which stops aspiration into the lungs) is removed the client will have a permanent trach.
All breathing is done through the stoma. Cannot whistle, swim or drink through a straw.

Post op - Keep client at mid fowlers and avoid airway edema
NG feedings to protect the suture line (peristalsis can disrupt the suture line)
Monitor drains and prevent fluid accumulation
Watch for Carotid arter rupture - MASSIVE BLEEDING
Frequent oral care
NPO ppl get pneumonia easily

Question 17

Tracheostomy tube

Answer 17

Needs lots of care. When changing string, don’t move your hand to hold it in place.

If the trach shoots out, re-insert and re-establish airway

This is the new airway. don’t cover it with plastic/ only something breathable.

Bib to cover trach as a filer
Humidified environment helps - decreases the secretions and make them thinner

Question 18

Goals of Cancer Treatment

Answer 18

Cure
Control 
Palliation
Adjuvant therapies
Neoadjuvant Therapies

Treatment plan is based on recommended treatment plans for the diagnosis, grade of cancer and what the client wants.

Question 19

Adjuvant

Answer 19

is when two therapies are used together such as chemo and radiation

Question 20

Neoadjuvant

Answer 20

Time specific therapies or one before the next. Surgery and then chemo.

Question 21

Mastectomy : Post op

Answer 21

Bleeding - check dressings, front and back (pooling of blood can occur in the tissues)

If reconstruction includes using their own tissues, they will also have an abd surgical site from harvesting adipose tissue.

Hemovac or Jackson Pratt drains

If any lymph nodes have been removed, they are unable to fight off infection

Avoid procedures on arm of affected side for lifetime of client. No constriction, no BP, no blouses with elastics, No watch, No IV or injections on affected side.
Wear gloves, watch small cutes, no nail biting and no sunburn

Brush hair, squeeze tennis balls, wall climbing, flex and extend elbow - this promotes new circulation.

Question 22

Radiation Therapy: Internal Radiation (brachytherapy)

Answer 22

Brachytherapy is used to get radiation close to the cancer or target tissue (INSIDE THE BODY)
The client emits radiation for a period of time and is a hazard to others.

Can be sealed or unsealed.
Unsealed: Client and body fluids emit radiation -> given IV or PO, radioactive for 24 to 48 hours

Sealed or solid - Client emits radiation; bodily fluids are NOT radioactive
Can be temporary or a permanent implant that is placed close to or inside the tumor

Question 23

GENERAL RADIATION PRECAUTIONS FOR INTERNAL RADIATION - remember (time, distance and shielding)

Answer 23

Nursing assignments should be rotated daily, so nurse is not continuously exposed

Nurse should only care for one client with a radiation implant in a given shift.
Private Room
Wear a film badge at alltimes
Restrict visitors
Limit each visitor to 30 mins a day and must stay 6 feet away
No one less than 16 years of age and no preg visitors or nurses
Mark the room with instructions for specific isotopes
Wear gloves with risk of exposure to body fluids

Don’t forget that this client is immunosuppresed

Question 24

What do you do if implant gets dislodged?

Answer 24

Put on gloves and put it into lead lined container

Question 25

Preventing dislodgement of implant

Answer 25

How can you help prevent dislodgement of the implant?
Keep the client on Bed rest
Decreases Fiber in the diet as it distends the bowel
Prevent Bladder distention - use an indwelling cath

Question 26

Can the client sleep in the same bed with spouse or children?

Answer 26

NO

They should also not use public transportation, return to work immediately, share utensils or cook for others.

Must flush toilet twice

Question 27

External Radiation

Answer 27

A carefully focused beam is delivered by machine outside of the body.

Client is NOT radioactive.
Side effects are usually limited to exposed tissues:
Erythema
Shedding of skin
Altered Taste
Fatigue
Pancytopenia ( All blood components are decreased)

S&S depends on location and dose.

Don’t wash off or put lotion on markings

Protect the site from sunlight and UV exposure for one year after completion of therapy.

Question 28

Alkylating Agents (Chemotherapy) - Cyclophosphamide
(Cytoxan)

Answer 28

Common uses: 
Breast cancer
Leukemia
Lymphoma
Hodgkin Disease
Multiple myeloma

Contraindications: 
Hypersensitivity
Myelosuppression
Pregnancy
Liver or kidney disease

PO/IV/ 7 days 
Interactions: 
Garlic and ginko
increase antiplatelet
effect. Echinacea
decreases effects of
immunosuppressive drugs.
Ginseng and kava kava
alters bleeding times

MoA: Directly damages DNA (the genetic material in each cell) to keep the cell from reproducing. These drugs work in all phases of the cell cycle.

Advantages: Especially useful for Hodgins’s disease if
resistant to other drug combinations.

Disadvantages: Severe vesicant that can cause tissue
necrosis if it infiltrates into the tissues. Can cause long term damage to thebone marrow

Side Effects: 
Nausea Vomiting
Diarrhea Weight loss
Hematuria Alopecia
Impotence Sterility
Ovarian fibrosis Headache
Dizziness 

Adverse Effects:
Leukemia
Vesicant: Tissue necrosis
Hemorrhagic cystitis
Cardiotoxicity
Hepatotoxicity

Interventions:
Monitor IV site for extravasation: Cold compresses
Assess need for IV hydration. The client should be well hydrated
(2L/day) to prevent hemorrhagic cystitis.
Observe for s/s of hematuria.
Monitor BUN and creatinine
Avoid direct skin, eye, and mucus membrane contact with drug

Education:
Take medication early in the day to prevent accumulation of
drug in the bladder.
Report signs of infection.
Do not visit anyone who has a respiratory infection
Emphasize protective precautions.
Rationale for chemotherapy.
Teach importance of birth control while receiving therapy

Question 29

Anthracyclines (Chemotherapy) - Doxorubicin

Adriamycin

Answer 29

Common Uses:
Breast cancer
Ovarian cancer
Lung cancer
Bladder cancer
Leukemi

Contraindications:
Pregnancy
Severe cardiac
disease

IV/7-10 days
Contraindications:
Calcium channel
blockers increase risk of
cardiotoxicity.
Green tea may enhance
effects.
Garlic, St John’s wart
may decrease effects of
chemo

MoA: These drugs are not like the antibiotics used to treat infections. They work by altering the DNA inside cancer cells to keep them
from growing and multiplying.
anti-tumor antibiotics that interfere with enzymes involved in DNA replication. These drugs work in all phases of the cell cycle.
They are widely used for a variety of cancers.

Disadvantages: Severe cardiotoxic side effects can occur.
Potent vesicant.
Cannot exceed lifetime dose of 550mg/m2

Side Effects: 
Stomatitis Anorexia
Nausea/Vomiting
Diarrhea
Rash
Alopecia

Adverse Effects:
Vesicant
Esophagitis
Thrombocytopenia Anemia
Cardiotoxicity CHF
Anaphylaxis

Interventions:
Give through large bore IV needle.
Monitor IV site for extravasation: Apply ice pack. Notify MD.
Dexrazoxan IV.
Assess cardiac status.

Client Education:
Signs/symptoms of cardiac dysfunction
Drug causes urine to turn pink or red
Report signs of infection or bleeding
Protective precautions
Do not visit anyone with a respiratory infection

Question 30

Anti-Estrogens (Hormone Therapy) - Tamoxifen (Nolvadex)

Answer 30

Common Uses:
Palliative treatment
of advanced breast
cancer positive
lymph nodes in
postmenopausal
women

Contraindications:
Pregnancy
Breastfeeding
Hypersensitivity

PO
Interactions: Increased risk of bleeding with anticoagulants

MoA: This male hormone (androgen) promotes regression of tumors by competing with estradiol at estrogen receptor sites. Decreases
DNA synthesis. Reduces risk of breast cancer in postmenopausal women

Advantages: Prevents tumor recurrence in both
pre-menopausal and postmenopausal
women

Side Effects: 
Masculine secondary sexual characteristics.
Hot flashes
Irregular menses
Fatigue
Headaches
Impotence
Decreased interest in sexual activity

Adverse Effects:
Increases risk of developing uterine
cancer.
Stroke
Pulmonary embolism
Thrombocytopenia

Interventions:
Monitor CBC, platelet count weekly.
Monitor for allergic reactions.

Education:
Avoid use of St. John’s wart, dong qui, black cohosh.
Use nonhormonal contraception during and for 2 months
after discontinuing treatment.
Notify prescriber of signs of stroke.
Increase fluids to 2 liters/day unless contraindicated.
Protect from sun.

Question 31

Antimetabolites (Chemotherapy) - 5-Fluorouracil (5-FU)
(Adrucil), Methotrexate
(Rheumatrex)

Answer 31

Leukemias
Breast cancer
Ovarian cancer
Intestinal tract cancer

Contraindications: Pregnancy and Severe Infection

IV/IM/1 - 9 days
Interactions: Cimetidine increases effect of F-FU
Methotrexate: ASA,
phenytoin increase
toxicity of the drug.

MoA: Interfere with DNA and RNA growth by substituting for the normal building blocks of RNA and DNA. These agents damage cells
during the S phase, when the cell’s chromosomes are being copied.
Methotrexate acts as a substitute for folic acid, which is needed for the synthesis of proteins and DNA.

Disadvantages: Clients receiving methotrexate must
receive leucovorin calcium to “rescue” normal cells from the adverse effects of the drug.

Side Effects: 
Bone marrow suppression Stomatitis
Nausea/Vomiting Anorexia
Alopecia Rash
Photosensitivity Erythema
Hematic and renal dysfunction

Adverse Effects:
Bone marrow suppression
Thrombocytopenia
Hemorrhage
Renal failure
Extravasation

Intervention:
Monitor IV site for extravasation: Apply ice pack. Notify MD.
Avoid direct skin contact with medication.
Administer antiemetic 30-60 minutes before therapy
I&O
Monitor blood counts. Encourage mouth rinses every 2 hours with
normal saline

Client Education:
Report signs of infection
Examine mouth daily/ report signs of stomatitis
Do not visit anyone with a respiratory infection
Use sunscreen when outdoors
Maintain protective precautions
Good oral care with soft toothbrush
Encourage small, frequent meals. Encourage cool, bland foods.

Question 32

Gonadotropin-Releasing Hormone - Leuprolide (Lupron),

Goserelin (Zoladex)

Answer 32

Common uses:
Advanced Breast
cancer
Prostate cancer

Contraindications: Pregnancy
Breastfeeding

IM/SubQ/1-2 weeks
Interactions:
 Increased antineoplastic
action with megestrol.
Black cohosh may interfere
with treatment.

MoA: Suppress the secretion of follicle-stimulating hormone and luteinizing hormone from the pituitary gland. Initially an increase in testosterone
levels is seen. However, with continued use the pituitary gland becomes insensitive to this stimulation, leading to a reduction in the production
of androgens and estrogens..

Side Effects:
Memory impairment Depression
Peripheral edema Alopecia
Anorexia Diarrhea
Hot flashes Impotence
Nausea/vomiting

Adverse Effects:
Seizures
MI
PE
Dysrhythmias
GI bleeding

Interventions:
Assess for increased bone pain.
Monitor for allergic reaction.

Education:
Notify prescriber if menstruation continues – menstruation
should stop.
Bone pain should disappear after 1 week.
Monitor weight. Report weight gain of > 2 lbs (0.9 kg)/day.
How to administer SubQ/IM medication.

Question 33

Plant Alkaloids - Mitotic Inhibitors (Chemotherapy) - Paclitaxel (Taxol)

Answer 33

Common Uses:
Breast cancer
Lung cancer
Myelomas
Lymphomas
Leukemias

IV
Interactions:
Increased bleeding risks with NSAIDS and Anticoagulants

MoA: Mitotic inhibitors are often plant alkaloids and other compounds derived from natural products. They work by stopping mitosis in the M phase of the cell cycle but can damage cells in all phases by keeping enzymes from making proteins needed for cell
reproduction.

Disadvantages: These medications can cause nerve damage

Side Effects: 
Peripheral neuropathy
Bradycardia Hypotension
Nausea/Vomiting Diarrhea
Mucositis/stomatitis
Alopecia
Arthralgia

Adverse Effect:
SVT
Neutropenia Leukopenia
Thrombocytopenia Anemia
Tissue necrosis
Pulmonary edema

Interventions:
ECG monitoring.
Monitor for hypotension
Assess for paresthesias.
Premedicate with antiemetics.
VS during first
Monitor IV site for extravasation: Apply ice pack.

Education:
Report signs of infection: fever, sore throat, flulike
symptoms.
Report signs of anemia: fatigue, headache, faintness, SOB,
irritability.
Report bleeding.
Bleeding precautions.
Avoid vaccinations.

Question 34

Plant Alkaloids - Topoisomerase Inhibitor (Chemotherapy) - Topotecan (Hycamtin), Irinotecan
(Camptosar, CPT-11)

Answer 34

Common Uses: 
Leukemia
Lung cancer
Ovarian cancer
GI cancer

Contraindications: 
Pregnancy
Breastfeeding
Bone marrow
depression

PO/IV
Interactions: Increased bleeding
risk with NSAIDS,
anticoagulants,
platelet inhibitors

MoA: These drugs interfere with enzymes called topoisomerases, which help separate the strands of DNA so they can be copied
during the S phase. (Enzymes are proteins that cause chemical reactions in living cells.)

Side Effects: 
Alopecia Constipation
Diarrhea Nausea
Vomiting
Damage peripheral nerve fibers
Motor instability

Adverse Effects: 
Leukopenia
Hypersensitivity
Neurotoxicity
Loss of DTRs
Bone marrow suppression

Interventions:
Monitor IV site for extravasation: Apply ice pack. Notify MD.
Assess liver and renal function studies.
Increase fluid intake to 2-3 L/day unless contraindicated.

Education:
Rinse mouth 3-4 times/day with water; Brush teeth with soft
toothbrush for stomatitis.
Teach that total alopecia may occur. Hair grows back but is
different in color and texture.
Avoid foods with citric acid or hot and rough texture if
stomatitis is present.
Avoid vaccines, toxoids.
Report signs of anemia: fatigue, headache, faintness, SOB,
irritability.

Question 35

Platinum Drugs (Chemotherapy) - Cisplatin

Answer 35

Common uses:
Advanced bladder cancer
Metastatic testicular cancer
Metastatic ovarian cancer

Contraindications:
Pregnancy
Breastfeeding
Preexisting hearing
impairment
Bone marrow suppression

IV
Interactions: ASA, NSAIDS, Alcohol increase bleeding risk.
Bumetanide, furosemide
increase ototoxicity risk.
Loop diuretics increase
nephrotoxicity risk.

MoA: Alkylates DNA, RNA; Inhibits enzymes that allow for the synthesis of amino acids in proteins; activity not cell-cycle-phase specific.

Advantages: Less likely to cause leukemia later than
alkylating agents.
Disadvantages: Extravasation can occur damaging
tissue

Side EffectS:
Tinnitus Blurred vision
Altered color perception N/V
Diarrhea Weight loss
Impotence Amenorrhea
Alopecia

Adverse Effects: 
Extravasation
Bone marrow depression
Renal toxicity
Bleeding
Ototoxicity Seizures

Nursing interventions:
Monitor IV site for extravasation: Sodium Thiosulfate. Cold
compresses.
Monitor CBC, platelet count weekly. Hold drug for WBC < 4000 or
platelet <100,000.
Monitor BUN, creatinine.
Monitor for signs of anaphylaxis.
Monitor temperature q4h
Monitor for bleeding.
Increase fluid intake to 2-3 L/d to prevent calculi and promote
elimination of medication

Education:
Report s/s of infection.
Report s/s of anemia.
Report bleeding, bruising, petechiae
Bleeding precautions.
Report decreased urine output/flank pain.
Do not receive vaccinations during treatment

Question 36

Progestins - Medroxyprogesterone
acetate (Depo-Provera),
Megestrol acetate (Megace)

Answer 36

Common uses: 
Breast cancer
Endometrial
carcinoma
Renal cancer
Stimulate appetite

PO
MoA: Act by shrinking the cancer tissues - brings about cell death

Advantages: Megace stimulates appetite by unknown action.

Side Effects:
Mood swings Insomnia
Depression Indigestion
Diarrhea Weight gain
Flatus
Nausea/vomiting 

Adverse Effects:
Fluid retention
Thrombotic disorders

Nursing interventions:
Assess PSA levels in men with prostate cancer.
Monitor for thrombophlebitis.

Education:
Report vaginal bleeding
Teach signs of fluid retention.
Monitor glucose if diabetic.

Question 37

Selective Estrogen Receptor Modulators (SERMS) -
Raloxifen (Evista),
Toremifene (Fareston)

Answer 37

Common uses:
Breast cancer prophylaxis in
postmenopausal
women

Contraindications: Pregnancy and breastfeeding

PO
Interaction: Decrease action of anticoagulants

MoA: Act like antiestrogens to slow tumor growth, but have fewer side effects than tamoxifen.

Side Effects: 
Insomnia Depression
Hot flashes Peripheral edema
N/V Diarrhea
Dyspepsia Vaginitis
Weight gain 
Hypocalcemia 

Adverse Effects: 
Stroke
Thromboembolism
Pulmonary embolism
Osteoporosis

Interventions:
Bone density test at baseline and throughout treatment.

Client education:
Take calcium supplements, Vitamin D if intake is inadequate.
Increase exercise with weights.
Report fever, acute migraine, emotional distress.

Question 38

Cervical Cancer: Risks factors, S&S, Diagnosis and Treatment

Answer 38

Risk Factors:
The number one risk factor is Human Papilloma Virus.
Repeated STDs
Multiple sexual partners
Smoking and exposure to second hand smoke
Dietary factors such as certain nutritional deficiencies: folate,
beta-carotene and vitamin C.
Prolonged hormonal therapy
Family history.
Immunosuppression
Sex at a young age and multiple pregnancies

Signs and Symptoms:
Often asymptomatic in pre-invasive cancer
Invasive cancer classic symptoms: painless vaginal bleeding
Other general S/S: watery, blood-tinged vaginal discharge, pelvic pain (and it may occur with intercourse), leg pain along sciatic nerve, and flank/back pain
Excellent cure rate if detected early

Diagnosis: Pap Smear

Treatment:
Electrosurgical excision 
Laser
Cryosurgery
Radiation and chemo for late stages
Conization - remove part of the cervix
Hysterectomy

Question 39

Uterine Cancer ( Endometrial Cancer) Risks factors, S&S, Diagnosis and Treatment

Answer 39

Risk Factors:
Greater than 50 years of age
Taking estrogen therapy without progesterone
Positive Family history 
Late menopause
NO pregnancy 

S/S
Major symptoms: Post menopausal bleeding
Other: watery/bloody vaginal discharge, low back/abd pain, pelvic pain

Diagnosis: CA-125 (blood test) to ovarian involvement. Most definitive is D&C and endometrial biopsy

Treatment:
Radiation, Chemotherapy, Estrogen inhibitors

Hysterectomy
TAH = uterus and cervix only
Bilateral oophrectomy (ovaries)
Bilateral salpingectomy (tubes)

Radical/abdominal hysterectomy - may remove all of the pelvic organs. Client may have colostomy or ileal conduit. 24 hour risk for hemorrhage because of pelvic congestion of blood.

Major complication with vaginal hysterectomy - think infection! will probably have an indwelling cath, if not, make sure in the next 8 hours she voids.

Prevent abdominal distention after surgery because don’t want tension on suture line, it can lead to dehiscence and evisceration.

Avoid high fowler’s because it makes more blood go to the pelvis

May have abdominal and perineal dressing to check,
As this client is at risk for pneumonia, thrombophlebitis and constipation, what is one thing you can do to prevent all these complications - Early ambulation

Avoid sex and driving, girdles and douches, any excercise that increase pelvic congestion should be avoided, Client can hemorrhage 10 - 14 days, Whitish vaginal discharge is normal, shower is best.

Question 40

Breast Cancer : Risks factors, S&S, Diagnosis and Treatment

Answer 40

Risk:
one has a 3 fold risk increase of developing breast cancer if a first degree relative had pre-menopausal breast cancer
high dose radiation to thorax prior to age 20
Period onset prior to age 12
Menopause after age 50
No preg
First birth after 30 years of age

S&S
Change in the appearance of the breast ( orange peel appearance, dimpling, retraction and discharge from the breast or lump)
Tail of Spence is where 48% of breast tumors occur: located in upper
outer quadrant

Treatment:
Surgery
Chemo
Hormonal therapy: Estrogen receptor blocking agents and synthesis inhibitors
Radiation

Question 41

Lung Cancer

Answer 41

Smoking

S/S
Hemoptysis, dyspnea (may be confused with TB, but TB has night sweats), hoarseness, cough, change in endurance, chest pain, pleuritic pain on inspiration, displaced trachea
May metastasize to bone

Diagnosis:
Bronchoscopy
Chest XRAY
CT
MRI

Treatment:
Surgery:
The main treatment for stage I and II lung cancer
Lobectomy: only take out part of the lung
Chest tubes and surgical side up
Pneumonectomy: the entire lung is removed
Position on affected side (surgical side down, good lung up).
No chest tubes, Why? There is not lung!
Avoid severe lateral positioning = mediastinal shift

Question 42

Laryngeal Cancer

Answer 42

Smoking, alcohol, voice abuse, chronic laryngitis, industrial chemicals

Signs and Symptoms
Hoarseness, lump in neck, sore throat, cough, problems breathing, earache, weight loss, no early signs,

Laryngeal exam, MRI

Treatment:
Surgery:
Total laryngectomy
Humidified environment
*Remember, with a total laryngectomy ALL breathing is
done through the stoma.
Radiation
Chemotherapy
Speech Rehabilitation
When should client teaching begin? Preoperatively at
admission
Be a good client advocate:
Refer to International Association of Laryngectomees.
*See if there are local groups such as the Lost Cord Group

Question 43

Colorectal Cancer

Answer 43

Risks:
May start as a polyp
2/3s of colorectal cancer occurs in the rectosigmoid region
Most frequent site of metastasis: the Liver
*Take bleeding precautions
Other problems to watch for: bowel obstruction, perforation, fistula to bladder/vagina
Additional risk factors: inflammatory bowel diseases,
genetic, dietary factors (refined carbs, low fiber, high fat, red meat, fried and broiled foods) if you have a first degree relative with CRC your risk just increased 3X the norm
95% of those who get CRC are greater than 50 years old

Diagnosis:
Fecal occult blood testing should begin at age: 50
The definitive test for colorectal cancer is a colonoscopy.

S&S
Change in bowel habits, constipation, diarrhea, or narrowing of stool
Other S/S: blood in the stool, cramping abdominal pain, weakness, fatigue, anemia, abdominal fullness, unexplained weight loss

May become obstructed (visible peristaltic waves with high pitched tinkling bowel sounds)

Treatment:
Surgery, radiation, and chemo
May have a colostomy post op or may require an abdominoperineal resection
Abdominoperineal resection-removal of the colon, anus,
rectum
*Can you take a rectal temp on this client? No, there is no rectum!
Don’t take rectal temp if thrombocytopenic, abdominoperineal resection, or
immunosuppressed

Question 44

Bladder Cancer

Answer 44

Smoking

Painless, intermittent gross/microscopic hematuria

Cystoscopy
Treatment:
Surgery (remove all or part of bladder) - urinary diversion (urostomy)

Ileal conduit (a piece of the ileum is turned into the bladder; ureters are placed in one end; the other end is brought to the abdominal surface as a stoma)

May be impotent
Hourly outputs
Increase fluids (2,000-3,000 ml of fluid per day).
* Fluids help flush out conduit
Is mucus in the urine normal? Yes
The intestines always make mucus (the bladder is made from a part of intestine).

Change appliance in the morning (This is when output will be at its lowest).

It is OK to place a little piece of 4X4 inside the stoma during skin care to
absorb urine……. Just don’t forget to remove it!

Question 45

Prostate Cancer S/S and Diagnosis

Answer 45

This client comes to the physician with S/S of benign prostatic hyperplasia (BPH): hesitancy, frequency, frequent infections (because the bladder is not completely emptied), nocturia, urgency, dribbling. Many clients are asymptomatic.

Most common sign is painless hematuria
Digital rectal exam is done and if the prostate is hard/nodular; usually means prostate cancer.

Labwork 
PSA increased ( only produced by prostate). normally lass than 4 ng/ml

ALP and acid phosphatase is increased, means bone metastasis

Biopsy must be done to confirm cancer prior to surgery

Question 46

Prostate Cancer Treatment

Answer 46

Treatment:
Watchful waiting: in early stages (for asymptomatic, older
adults with another illness)

Surgery:
Radical Prostatectomy (done when the cancer is localized to
the prostate)

Take out the prostate and the client is cancer free (if there is
no metastasis).

May have erectile dysfunction due to pudendal nerve dam
age.
May have incontinence (Kegel exercises)
Client is sterile.
If there is no lymph node involvement, no increase in acid phosphatase, and no metastasis, the surgeon will try to preserve the pudendal nerve.

Prostatectomy (TURP- transurethral resection of the prostate)
Usually reserved for BPH to help urine flow, NOT a cure for
prostate CA
No incision (go through the urethra)
Most common complication? Bleeding

With other procedures you have to explain the risk of
impotency/infertility, because with other procedures they
have an incision.
Is it normal to see bleeding after this surgery? Yes

Continuous bladder irrigation – maintains patency, flushes out
clots.
3-way catheter
No kinks
Subtract irrigant from output.
Keep up with amount of irrigant instilled

What drug do you give for bladder spasms?
belladonna and opium suppository (B&O suppository®), oxybutynin (Ditropan®)

When the catheter is removed what do you watch for?
Urinary retention
Temporary incontinence is expected (perineal exercises-Kegel)

Avoid sitting, driving, strenuous exercise; do not lift too
much…Why? Can cause them to bleed

Docusate (Colace®); avoid straining. Why? Straining will cause them to bleed.
Increase fluids: to flush out the kidneys.

The TURP is used for symptomatic relief of symptoms… to allow the urine to flow out… This is not a cure for prostate
cancer.

Radiation
Chemotherapy
Hormone therapy
May decrease testosterone levels through bilateral orchiectomy

Question 47

Stomach Cancer

Answer 47

Risk factors:
H-Pylori-associated with stomach cancer
Pernicious anemia and Achlorhydria - There is an increased instance of stomach cancer with people who have pernicious anemia and
achlorhydria.
Related to: pickled foods, salted meats/fish, nitrates,
increased salt
Billroth II (partial gastrectomy with an anastomosis)
Tobacco and Alcohol

Signs/Symptoms:
Most common: Heartburn and abdominal discomfort
Other S/S: loss of appetite, weight loss, bloody stools, coffee-ground vomitus, jaundice (liver metastasis), epigastric and back pain, feeling of fullness, anemia, stool (+) for occult blood, achlorhydria (no HCL in the stomach), obstruction
Signs/Symptoms of an obstruction: abdominal distention, nausea/vomiting, pain.)
Treatment for obstruction: NPO, NG tube to suction for abdominal decompression

Diagnosis:
Upper GI, CT, EGD

Treatment:
Gastrectomy
Fowlers position, decreases stress on the suture line
Will have NG tube for decompression
2 Major complications:
Dumping syndrome andB12 pernicious anemia
No stomach - no intrinsic factor - can’t absorb oral B-12 - can’t make good
RBCs - client is anemic

Question 48

Chemotherapy

Answer 48

The use of chemo is based on several facts
The oncologists will consider
Which pahse of the cell cycle the drug attacks
Time or how often the drug is given
Growth faction ( % of cells dividing at a given time)
Tumor burder
Regional chemo delivers chemo to a specific site
Usually sced every 3 to 4 weeks

Most common body systems affected by side effects:
Blood, GI and Skin + Hair

Question 49

Handling Precautions for Chemo

Answer 49

Exposure can occur by drug contact with the skin or mucous membranes inhalation or accidental injection or ingestion

Full precautions require:
Chemo gown, 2 pairs of chemo gloves, googles/mask

Excretion precautions:
Need to be taught to famiy. When handling body fluids wear two pairs of chemo gloves and a chemo gown. add a face shield.

Question 50

Disposal

Answer 50

Yellow rigid chemo waste container used for sharps and IV containers
Yellow chemo waste bag used for gowns gloves and disposable items

Question 51

Managing chemo Spills

Answer 51

Handle as a hazardous chemical spill

Obtain spill kit and use all protective equipment for clean up

Question 52

Delivery methods of chemo

Answer 52

Most given via IV port
A vesicant in infiltrated, will cause tissue necrosis

S/s of extravasation: Pain, swelling and no blood return

Stay with client receiving vesicant. The most important this is PREVENTION.

Stop the infusion if it happens, apply cold packs.

If drug is oral, wear gloves

Question 53

Transplants

Answer 53

Bone marrow ans stem cells are used as treatments for hematologic cancer.
Occasionally, transplants are necessary when high does of chemo or radidation have destroyed too many blood cells and a transplant is needed as a rescue treatment

Question 54

2 Types of transplants

Answer 54

Stem cell + Bone Marrow

It can come from the client, a matched donor or frmo an identical sibling or twin

They are given into the vein and over time, settle in the bone arrow and produce healthy blood cells

Question 55

Complications of transplants

Answer 55

Infection (Immunosuppressed)
Graft vs HOst Disease
The graft rejects or attacks the host. Treated with anti-rejection drugs and steroids.

Signs of rejection
Abd pain or cramps, N/V, diarrhea
Jaundice or other liver problems
Dark, tea colored urine
SKin rash, itching, redness on areas of the skin

Question 56

Major side Effects of Cancer and Treatment

Answer 56

Body Image - Alopecia, Scar, Weight gain and puffiness from steroid therapy or weight loss.

Fatigue - Plan client care (adequate rest periods)

Infection - private room, wash hands, have their own supplies, limit visitors, change IV tubing and dressings daily, cough and deep breath, no fresh flowers or potted plants, avoid crowds, Do not share toiletries, bathe warm moist areas usually twice daily, wash hands after touching pet, avoid raw fruits and veggies, only fresh water

Question 57

Nursing considerations for side effects

Answer 57

Watch for a slight increase in temp. It may mean sepsis. Since they are immunosuppressed, the temp spikes will not be big and they won’t have the typical s/s of infection

Come to hospital for 38 temp
Monitor absolute neutrophil count

Question 58

Neutropenia

Answer 58

A decreased number of neutrophils in the blood.

Absolute neutrophil count is the best way to assess. Indicates how well the client can handle the infection.

Question 59

Nadir

Answer 59

The lowest point. Neutros are first line defense inside the body to protect us from infections. Don’t wait for cultures - physicians need to treat best guess.
Neutropenia + infection = sepsis, septic shock and DEATH

Question 60

Risk factors for Neutropenia

Answer 60

Age
Advanced Metastatic disease
Malnourishment
B12 and folic acid deficiencies
Impaired tissue integrity 
Presence of other disease( Diabetes, COPD, HF, HIV/AIDS)
Hematologic malignancies 
Leukemias, lymphomas and myelomas
Result of cancer treatments

Question 61

Treatment of Neutropenia

Answer 61

Antibiotics ( Prophylactic)
Implement Neutropenic Precautions
Include all the general ways to prevent infection plus
Vital signs every 4 hours
Private room with door closed and posted sign
Antimicrobial soap for handwashing, not just regular soap
No invasive procedures ( NO IM, rectal exam or meds), NG tube or indwelling cath.
Limit use of tylenol

Question 62

DVT

Answer 62

Second leading cause of death in cancer clients

Prolonged bed rest, Surgerym use of central line, External compression of vessels by tumor, certain chemo drugs

We are worried about PE

Question 63

Thrombocytopenia RIsk factors

Answer 63

Decrease in the number of circulating platelets in the blood - they are responsible for clotting.

Advanced metastatic disease
Hematological Malignancies
Bleeding disorders such as hemophilia, liver disease, idiopathic thrombocytopenia purpura
Bacterial Infections
Anticoagulant meds
Result of cancer treatment

Question 64

Thrombocytopenia Assessment and Treatment

Answer 64

History
Vital signs, SPO2, change in LOC, reports headache and pupil changes, conjunctival hemorrhages, Petechiae, Ecchymosis and purpura, Oozing from puncture site or surgical sites, Bleeding from the rectum, ear, nose or mouth

GIVE THEM PLATELETS

Question 65

Considerations for blood products with oncology patients

Answer 65

RBC transfusions
For clients with symptomatic anemia. Don’t want Hgb/Hct to drop 8 g/dl and 24%.

Platelet Transfusions
TO control or prevent bleeding associated with thrombocytopenia (Don’t infuse cold platelets because the spleen will reject them )

You want cytomegalovirus negative RBC and Platelets.
CMV is a common herpes virus that resembles mononucleosis, usually dormant. To make blood safe, they undergo leukoreduction.

Question 66

Nausea and Vomiting

Answer 66

Most common side effect of chemo and radiation.

Prevention:
Antiemetic before treatment
Behavioural therapies
Acupuncture/acupressire

Ondasetron
Netupitant/paLPNOSTREON
Oral combination antiemetic
Ginger
Aroma therapy - peppermint
Acupuncture/Acupressure
Distraction
Relaxation Techniques

Question 67

Pain

Answer 67

Treat without regard of risk of opioid dependence
Happens due to direct tumor involvement, but can also be the result of the treatment such as with mucositis or peripheral neuropathy

OPioids are considered the gold standard
NO CEILING DOSE

Question 68

TNF inhibitor drugs

Answer 68

TNF inhibitor drugs (eg, etanercept [Enbrel], infliximab [Remicade], adalimumab [Humira]) block the action of TNF, a mediator that triggers a cell-mediated inflammatory response in the body. These drugs reduce the manifestations of rheumatoid arthritis (RA) and slow the progression of joint damage by inhibiting the inflammatory response. The medication causes immunosuppression and increased susceptibility for infection and malignancies.

Clients should have a baseline TST before initiating therapy and yearly skin tests thereafter. Those with latent tuberculosis (TB) must be treated with antitubercular agents before initiating treatment with these drugs. Otherwise, TB reactivation would occur

Major adverse effects of biologic disease-modifying TNF inhibitor drugs (eg, etanercept, infliximab, adalimumab) include severe infections and bone marrow suppression. TB reactivation is a major concern. Therefore, all clients must receive a TST to rule out latent TB.