Oncology Nursing Management Chapter 16

Cancer: Definition and Characteristics

• Cancer is a disease process that begins with an abnormal cell transformation due to genetic mutation of cellular DNA.
• Abnormal cells have invasive characteristics, infiltrating other tissues through metastasis.
• Cancer cells are described as malignant, demonstrating uncontrolled growth that does not follow physiologic demand.

Malignant Process

• Cell proliferation: uncontrolled growth with the ability to metastasize and destroy tissue, leading to death.
• Cell characteristics: presence of tumor-specific antigens, altered shape, structure, and metabolism.
• Metastasis occurs through lymphatic spread, hematogenous spread, and angiogenesis.

Carcinogenic Agents and Factors

• Viruses and bacteria
• Physical factors: sunlight, radiation, chronic irritation
• Chemical agents: tobacco, asbestos
• Genetic and familial factors
• Diet
• Hormones
• Immune system dysregulation

Primary and Secondary Prevention

• Primary prevention: reducing cancer risk in healthy people through lifestyle and dietary changes, public and patient education, and avoiding known carcinogens.
• Secondary prevention: early detection and screening to achieve early diagnosis and intervention.

Diagnosis of Cancer

• Diagnostic tests: various types, including tumor staging and grading, TNM classification.

Cancer Management

• Cure
• Control
• Palliation

Surgical Treatment

• Diagnostic surgery
• Biopsy: excisional, needle, incisional
• Tumor removal: wide excision, local excision
• Prophylactic surgery
• Reconstructive surgery

Radiation Therapy

• Curative, control, or palliative
• External radiation
• Internal radiation
• Radiation reactions: effects on GI system, bone marrow, and systemic effects
• Long-term effects and tissue changes

Nursing Care of the Patient Undergoing Radiation Therapy

• Patient and family education
• Skin care
• Oral care
• Protection of care providers

Chemotherapy

• Agents used to destroy tumor cells by interfering with cellular function and replication
• Curative, control, or palliative
• Types of chemotherapeutic agents

Phases of Cell Cycle

Bone Marrow Transplantation (BMT)

• Used for hematologic cancers that affect the marrow or solid tumors treated with ablative chemotherapy
• Types of BMT: allogenic, autologous, and syngeneic
• Graft-vs.-host disease
• Venous occlusive disease

Administration of Chemotherapy

• Routes of administration
• Problem of extravasation
• Risk for fluid and electrolyte imbalances
• Risk for infection
• Risk for bleeding
• Protection of caregivers

Adverse Effects of Chemotherapy

• Toxicity
• GI effects: nausea and vomiting, diarrhea, mucositis, stomatitis
• Hematopoietic effects: myelosuppression
• Renal damage
• Cardiopulmonary system: potential cardiac toxicities
• Reproductive system: potential sterility, potential reproductive cell abnormalities
• Neurologic effects

Common Nursing Diagnoses

• Impaired oral mucosa
• Impaired tissue integrity
• Imbalanced nutrition
• Chronic pain
• Fatigue
• Disturbed body image
• Coping diagnoses and anticipatory grief

Collaborative Problems

• Infection
• Bleeding
• Superior vena cava syndrome
• Hypercalcemia
• Spinal cord compression
• Pericardial effusion
• Disseminated intravascular coagulation (DIC)

Hospice

• Comprehensive, multidisciplinary approach to the care of patients with terminal illness and their families
• Focuses on quality of life, palliation of symptoms, and psychosocial and spiritual care