Oncology: Cancer Information PDF

ONCOLOGY Cancer when body cells grow uncontrollably and spread to other parts of the body. Normally human cells grow and multiply (cell division) to form new cells as the body needs the new cell. When old cells die, the new cell automatically...

ONCOLOGY Cancer when body cells grow uncontrollably and spread to other parts of the body. Normally human cells grow and multiply (cell division) to form new cells as the body needs the new cell. When old cells die, the new cell automatically replaces the old ones. Sometimes, this process breaks down and abnormal or damaged cells multiply when they shouldnʼt. These cells may form tumor which are now lumps in the tissues. ONCOLOGY 1  How does cancer develop? Cancer is a genetic disease in which it is caused by changes to the genes, that controls the function of the cell especially how they grow and divide. Genetic changes that causes cancer can happen because of:  errors that occur as cells divide  damage to DNA caused by harmful substances  inherited by the parents The body eliminates this “bad cellsˮ before they turn into cancer cells but as we age, we slowly lose this ability thus there is a higher cancer risk in older adults. Normal Cell  Genetic Mutation (caused by cell division errors, DNA damage from things like radiation or smoking, or inherited faulty genes) → Uncontrolled Cell Growth (the mutated cell starts to divide more than it should because it ignores the normal controls that stop this) → Tumor Forms (a mass of abnormal cells builds up, called a tumor) → Benign Tumor (non-cancerous, doesnʼt spread), Malignant Tumor (cancerous, can invade other tissues) → Angiogenesis (the tumor attracts new blood vessels to get nutrients and grow) → Invasion and Metastasis (cancer cells spread to other parts of the body through the blood or lymphatic system)  Immune Evasion (cancer cells avoid being detected and destroyed by the immune system Cellular origin: Carcinoma - originates from the epithelial tissue (cells that cover the skin or line organs like the lungs or intestines) (Skin cancer, lung cancer) Adenocarcinoma - originates in the glandular tissue (breast, prostate) Glandular tissues (like glands that produce fluids or hormones) Sarcoma  Connective tissues (like muscles, bones, fat, or blood vessels) (Bone cancer, soft tissue cancer.) 7 Warning Signs of Cancer: ONCOLOGY 2  C Change in bowel or bladder A lesion that does not heal U Unusual bleeding or discharge T Thickening or lump formation I  Indigestion or difficulty swallowing O  Obvious changes in wart or mole N Nagging cough or persistent hoarseness U Unexplained anemia S Sudden loss of weigh Other terms: Benign Neoplasm - abnormal but noncancerous collection of cells Malignant Neoplasm - cancerous tumor, an abnormal growth that can grow uncontrolled and spread to other parts of the body Metastasis - cancer spreads to a different body part from where it started Grading: To grade a tumor a biopsy is done. The doctor removes part of the tumor or all of it and sends it to a pathologist, who takes samples of the tumor and assesses the cells of the tumor under a microscope. The cells are graded based on how they look (like their size, shape, color, and are arrangement). In other words, how much does the tumor cellʼs appearance deviate from what the normal cells look like in that particular area. well differentiated - The cancer cells still look and act a lot like normal cells. They grow slowly and are less likely to spread. The cells still resemble the original tissue, like breast tissue or skin cells. moderately or poorly differentiated - their appearance and arrangement doesnʼt mirror what normal healthy cells in that particular area possess, and they look abnormal. These types tend to spread and grow quickly. ONCOLOGY 3  The tumor grades of low to high can be given along with numerical values to reflect that rating: Grade I well differentiated, low grade Grade II moderately differentiated - cancer cells are somewhat different from normal cells. They are starting to look and behave more abnormally but not as aggressively. Grade III poorly differentiated, high grade  The cancer cells look very abnormal. They hardly resemble normal cells, and they tend to grow and spread more quickly. Grade IV undifferentiated, high grade  The cancer cells don't look like normal cells at all. They are completely disorganized and aggressive, growing very quickly. ONCOLOGY 4  TNM (Tumor, Nodal Involvement, Metastasis) Tumor: this category details the location and how much of that tumor is growing into other tissues. The higher the number the more it has grown into other layers or structures. TX tumor canʼt be measured T0 no tumor is found Tis: tumor is in situ In situ means: in original place….the tumor is found in its original place and has not spread from its original location. Not cancerous at this time but in the future it could turn cancerous and spread T1, T2, T3, T4 describes the size/amount the tumor has grown and affected other areas. Higher the number the larger the size/amount it has grown into other areas Node: this category details the spread of the cancer in a nearby lymph node (closest to the primary tumor) (Lymph nodes are small clustered structures that help us fight ONCOLOGY 5  infection. They are found around many important organs) NX: cancer in regional lymph node canʼt be measured N0 no cancer present in regional lymph node N1, N2, N3 the number and location of the lymph nodes that have cancer. N3 means there are more lymph nodes that contain cancer than N1. Metastasis: details if the cancer (primary tumor) has spread to other parts of the body, and if this is the case, how much and the location of it. M0: no cancer found in other parts M1: cancer has spread to organs and tissues Stage: Stage 0: cancer in situ….the cancer is still in its original place and hasnʼt invaded surrounding tissues Stage I: the cancer is localized and not spread into other tissues or lymph nodes Stage II: spread into surrounding tissues and nearby lymph nodes Stage III has spread to even deeper tissues than stage II and further away lymph nodes BUT has not spread to other distant structures in the body like organs Stage IV metastatic cancer. Itʼs cancer that has spread to other parts of the body beyond where the cancer started ONCOLOGY 6  side note: “cˮ “pˮ “yˮ “rˮ example: cT1, pT2, ycT3, rpT3 “cˮ - clinical staging (cancer were staged before treatment) (based on test results from MRI, Labs) “pˮ - pathological staging ( staging done after surgery) “yˮ - post therapy staging either clinical or pathological. Staging after therapy was administered for example, chemotherapy. “rˮ - reoccurrence of cancer Factors Influencing Cancer Development Chemical Carcinogen Smoking Alcohol Asbestos Uranium Pesticides Benzene Tars Physical Carcinogens sunlight radiation (repeated x-ray or with radiation therapy) chronic irritation or inflammation tobacco use radioactive materials ONCOLOGY 7  Viral Carcinogens Epstein-Barr Virus Hepatitis B Virus Human Papillomavirus Helicobacter Pylori Genetics Age Immune Function Dietary Fats Alcohol (should be limited to no more than 2 drinks per day for men and 1 drink per day for women) Salt-cured or smoked meats Nitrate containing foods Red and processed meats Hormonal Agents Oral contraceptives and prolonged estrogen therapy Early onset of menses under age 12 Menopause after age 55 Nulliparity (never giving birth) Delayed childbirth after age 30 Prevention of Cancer Primary Prevention reducing the risk of cancer avoid carcinogens ONCOLOGY 8  make dietary and healthy lifestyle changes Secondary Prevention promote screening and early detection activities breast and testicular self exam mammogram digital rectal examinations PSA blood tests Prostate Specific Antigen Test) Tertiary Prevention the care and rehabilitation of patients after cancer diagnosis and treatment Chemotherapy ONCOLOGY 9  The use of antineoplastic drugs to promote tumor cell destruction. NOTE effect is greatest on rapidly dividing cells, such as bone marrow, GI tract and hair. Chemotherapy given with other treatments: Adjuvant Chemotherapy ONCOLOGY 10  given AFTER surgery to remove the cancer, there may still be cancer cells that are left behind that cannot be seen can also be given after radiation therapy Neoadjuvant chemotherapy given BEFORE the main cancer treatment (such as surgery or radiation) giving chemotherapy first can shrink a large cancerous tumor, making it easier to remove with surgery shrinking may also allow the tumor to be treated more easily with radiation G₀ Phase Resting Phase) Cells in this phase are not actively dividing. They are in a "resting" state. Cancer cells in this phase are often harder to target because they arenʼt actively growing or reproducing. Cells arenʼt actively dividing; cancer cells in this phase are hard to target. G₁ Phase Growth Phase 1 / Pre-synthesis Phase) During this phase, the cell grows and prepares to replicate its DNA. Proteins and enzymes needed for DNA synthesis are produced here. Cells grow and prepare to replicate DNA. S Phase Synthesis Phase) In the S phase, the cell replicates its DNA in preparation for division. This is where the cell makes an exact copy of its DNA. DNA is replicated. G₂ Phase Growth Phase 2 / Pre-mitotic Phase) This is a checkpoint phase where the cell prepares for division. The cell checks for any errors in the DNA that was replicated in the S phase and makes necessary repairs. Cells prepare for division, checking for DNA errors. M Phase Mitosis / Cell Division Phase) ONCOLOGY 11  In the M phase, the cell divides into two daughter cells, each with an identical set of DNA. Mitosis is the actual process of cell division. Cells divide into two identical cells Types of Chemotherapeutic Drugs  Alkylating Agents These drugs damage the DNA of cancer cells directly, preventing them from replicating and growing. The DNA damage stops cancer cells from dividing and eventually causes them to die. These drugs are not phase-specific, meaning they can attack cancer cells at any stage of their growth cycle, including resting cells. causes LONG TERM DAMAGE TO BONE MARROW and can eventually lead to leukemia Medications: Mechlorethamine (nitrogen mustard) Chlorambucil Cyclophosphamide Cytoxan) Busulfan Platinum drugs (cysplatin, carboplatin, and oxalaplatin) are sometimes grouped with alkylating agents because they kill cells in a similar way (less likely cause leukemia) Common Side Effects: Bone Marrow Suppression (less in platinum drugs) Nausea and vomiting Stomatitis Cystitis and Renal toxicity Cysplatin)  Antimetabolites ONCOLOGY 12  DAMAGE CELL DURING THE S PHASE (period of wholesale DNA synthesis during which the cell replicates its genetic content) This blocks the cancer cells from making new DNA, preventing them from growing. commonly used to treat leukemia, breast cancer, ovarian cancer etc) Medications: 5-fluorouracil 5FU 6-mercaptopurine 6MP Capecitabine Clofarabine Cytarabine Floxuridine Hydroxyurea Methotrexate Common Side Effects: Bone marrow suppression nausea and vomiting diarrhea stomatitis renal toxicity hepatotoxicity  Antitumor antibiotics NOT PHASE SPECIFIC breaks or preventing DNA from being copied correctly. This makes it impossible for cancer cells to divide and grow. can permanently damage the heart if given in high doses Medications: ONCOLOGY 13  Daunorubicin Doxorubicin Bleomycin Common side effects: Bone marrow suppression nausea and vomiting anorexia alopecia cardiac toxicity (daunorubicin and doxorubicin)  Antimitotic / Mitotic Spindle Poisons type of drug that blocks cell growth by stopping mitosis. This stops cancer cells from dividing. Plant Alkaloids Vincristine Vindesine Taxanes Paclitaxel Docetaxel  Hormonal Agents These drugs block or lower the hormones that some cancers depend on to grow. For example, estrogen can fuel the growth of some breast cancers, and androgens (like testosterone) can promote prostate cancer growth. Tamoxifen (used for estrogen-positive breast cancer).  Monoclonal Antibodies These drugs are designed to target specific proteins on cancer cells. By attaching to these proteins, monoclonal antibodies mark the cancer cells for ONCOLOGY 14  destruction by the immune system or directly block signals that help cancer cells grow. Medications: Rituximab Transtuzumab Alemtuzumab Gemtuzumab Administration of Chemotherapeutic Agents  Oral PO  taken by mouth (usually as pills) Some chemotherapeutic drugs cant be taken by mouth because the digestive system cant absorb them or because they irritate the digestive system Even when a drug is available in an oral form (such as pill or liquid), this method may not be the best choice  Intravenous IV most common peripheral line - drugs are given through a catheter placed in a vein in the arm central line - drugs are given through a catheter placed into a larger vein on the chest, or neck in order to give several drugs in one time, for long term use, for frequent treatments and continuous infusion chemotherapy NOTE!!!!! extravasation is the leaking of chemo drugs into the surrounding tissues. This can lead to necrosis. If extravasation occurs, STOP THE ADMINISTRATION AND NOTIFY THE PHYSICIAN  Subcutaneous  Intramuscular NOTE!!!!!!!!! IM and SubQ injections are less often used because many drugs can irritate or can even damage the skin, nerve and muscles ONCOLOGY 15  Regional chemotherapy  Intra-arterial - injected into an artery  Intravesical - infused into the bladder  Intrapleural - infused into the chest cavity between the lung and chest wall  Intraperitoneal - infused into the abdomen around the intestines and other organs  Intralesional/intratumoral - injected directly into the tumor  Topical - applied to the skin as a cream or lotion Safety Precautions When Administering Chemo Drugs Chemotherapy drugs can be dangerous to others in these ways: they can cause abnormal changes in DNA Mutagenic) may be able to alter the development of fetus or embryo leading to birth defects (teratogenic) cause another type of cancer (carcinogenic) Best Practices (hospital) nurses wear special gloves, googles and gown when preparing and giving chemotherapy pharmacists or nurses prepare the drugs in areas with special ventilation system to avoid spattering and or inhaling the droplets that can form while mixing use special precaution when handling stool and urine of patient (body waste of patient may contain drugs) use separate containers to dispose sharp items, syringes, IV tubing, and medicine bags. Best Practices (home) flush the toilet twice after use ONCOLOGY 16  patients should sit on the toilet to prevent splashing of urine handwashing use condom during sex (drug can be found in semen and vaginal secretions) avoid deep kissing and sharing food or drink with others clothes or sheets that has body fluids should be washed in a washing machine instead of washing it with hands Common Side Effects of Chemotherapy and their Management  Nausea and vomiting most common side effect may persist for up to 24 hours after its administration antiemetic serotonin blockers (ondansetron, granisetron and dolasetron) dopaminergic (metoclopramide) phenothiazine, sedatives, corticosteroids, and histamines are used in combination with serotonin blockers small frequent meals, bland foods and comfort foods  Stomatitis Preventive Avoid commercial mouthwashes Brush with soft toothbrush, use nonabrasive toothpaste after meals and bedtime. Floss every 24h unless painful or platelet count fails below 40,000 cu/mm Mild Stomatitis (small white patches) use normal saline mouth rinses q 2 hours while awake and q 6 hours at night use soft toothbrush remove dentures except for meals and it should fit well ONCOLOGY 17  apply lip lubricant avoid foods that are spicy or hard to chew and those with extremes of temperature Severe Stomatitis (ulcerations with bleeding and white patches covering 25% of mucosa) obtain tissue sample for culture and sensitivity assess ability to chew, swallow and assess gag reflex use oral rinses as prescribed or place patient on side and irrigate mouth have suction available remove dentures use toothette or gauze soaked with cleansing solution use lip lubricant liquid or pureed diet monitor for dehydration  Myelosuppression (bone marrow suppression) decreases the number of WBC, RBC and PLATELETS Nursing Interventions: check VS q 4hrs monitor WBC and differential each day inspect all sites that may serve as entry ports for pathogens IV site, wounds etc) REPORT FEVER!!!!!!!!!!!!!!!!!!!!!!!! Report altered mental status place client in private room importance of patient avoiding contact with people who have known or recent infection or vaccination all personnel should do hand hygiene ONCOLOGY 18  avoid rectal or vaginal procedures use stool softeners assist patient in meticulous personal hygiene use electric razor encourage the patient to ambulate unless contraindicated avoid fresh fruits, flowers, raw meat, fish and vegetables each day change drinking water, denture cleaning fluid and respiratory equipment containing water Risk for bleeding Assess for bleeding petechiae or ecchymosis decreased in hemoglobin or hematocrit prolonged bleeding from invasive procedures occult blood in any body excretion altered mental status Interventions use soft toothbrush or toothette for mouth care avoid commercial mouthwash use electric razor avoid foods that are difficult to chew draw all blood for lab work with one daily venipuncture avoid taking temperature rectally or administering enemas and suppositories avoid IM injections, use smallest needle apply direct pressure to puncture sites for at least 5 mins lubricate lips with petrolatum avoid bladder catheterizations, use smallest catheter if its necessary ONCOLOGY 19  maintain fluid intake of at least 3L per day unless contraindicated use stool softeners avoid medications that interferes with clotting such as aspirin recommend use of water based lubricant before sex bed rest with padded side rails avoidance of strenuous activities platelet transfusion as prescribed administer diphenhydramine hydrochloride (benadryl) or hydrocortisone sodium succinate to prevent reaction to platelet transfusion supervise activity when out of bed no forceful nose blowing encourage several rest periods increase night time sleep conserve energy encourage patient to ask for assistance encourage reduced job workload encourage adequate protein and calorie intake  Renal System Toxicity Cisplatin, methotrexate and mitomycin are particularly toxic to kidneys Nursing interventions monitor BUN, creatinine tests and serum electrolytes adequate hydration alkalinization of urine to prevent formation of uric acid cystals allopurinol are indicated to prevent these side effects  Alopecia discuss potential hair loss and regrowth to patient and family ONCOLOGY 20  use scalp hypothermia or scalp tourniquets if appropriate cut long hair before treatment use mild shampoo and conditioner, gently pat dry and avoid excessive shampooing avoid electric curlers, curling iron, dryers, clips, hair sprays, hair dyes etc avoid excessive combing of hair or brushing; use wide-toothed comb prevent trauma to scalp lubricate scalp with vitamin A and D ointment to decrease itching use hat when in the sun purchase wig before hair loss begin to wear wig before hair loss encourage patient to wear own clothes and retain social contacts explain that hair growth usually begins again once therapy is completed (hair loss usually begins within 2 to 3 weeks after the initiation of treatment. Regrowth begins within 8 weeks after the last treatment.) Radiation Therapy ONCOLOGY 21  destroys cancer cells with minimal exposure of normal cells to the damaging effects of radiation radiation therapy is effective on tissues directly within the path of the radiation beam SAFETY PRECAUTIONS Distance - at least 6 feet Shielding - lead gown Time  30 mins per shift, film badge, 5mins per nurse patient interaction Patients receiving radiation therapy: wear: ONCOLOGY 22  loose-fitting clothes soft clothing over the treated skin avoid: constricting clothes deodorant strong soaps harsh chemicals wear only skin care products suggested by radiation staff without tattoo marking should not be bathed with soap over the radiation site with tattoo marking wash treated area gently with lukewarm water and mild soap apply hydrating lotions should not contain metals and alcohol perfumes irritating additives (causes skin burning) Patients with radiation implants: private room posting appropriate notices about radiation safety precautions be aware of where the radiation is implanted in the client when prolonged care is required, use a lead shield or wear lead apron wear dosimeter badge and radiation monitor when taking care of the patient do not assign pregnant staff members Safety precautions in caring for patients with radiation implants: children or pregnant visitors are not allowed limit visits for 30mins only ONCOLOGY 23  maintain a 6-foot distance check all linens and materials keep long handled forceps and lead container in the room notify staff for dislodged implants 8 Lʼs long sleeved gown liquid resistant gown lint free gown leak proof bin for soiled linens latex surgical gloves lead apron long handled forceps lead container Lung Cancer ONCOLOGY 24  Lung cancer is a malignant tumor that affects the bronchi (the main passageways of the lungs) or peripheral lung tissue (outer parts of the lungs, away from the center. This area includes the smaller airways (bronchioles) and alveoli. A malignant tumor means the cancer can spread and damage nearby tissues. The lungs are a common site where cancers from other parts of the body can metastasize. This is because the lungs have a rich blood supply, making them a target for cancer cells traveling through the bloodstream. 🥷 Lung cancer begins when normal lung cells mutate and start dividing uncontrollably → formation of a tumor, which can be located in the bronchi (central airways) or peripheral lung tissue (bronchioles and alveoli) → block the bronchi or bronchioles, causing partial or complete obstruction of airflow → tumor can invade and damage the alveoli, reducing the lungs' ability to exchange oxygen and carbon dioxide → cancer can invade nearby structures like the pleura (lining of the lungs), chest wall, or other organs in the chest → chest pain, difficulty breathing → cancer cells can break away from the original tumor and spread through the bloodstream or lymphatic system to other parts of the body, including the brain, liver, bones, and adrenal glands Lung cancer is classified into two main types based on how the cancer cells look under a microscope: Small cell lung cancer SCLC Grows and spreads quickly. ONCOLOGY 25  Non-small cell lung cancer NSCLC Includes subtypes like squamous cell carcinoma, adenocarcinoma, and large cell carcinoma. These are slower- growing cancers but still require treatment. Squamous cell carcinoma Often starts in the cells lining the airways and is linked to smoking. Adenocarcinoma The most common type, usually found in the outer parts of the lungs, and can happen in non-smokers too. Large cell carcinoma A less common type that can occur in any part of the lung and tends to grow quickly. Diagnosis Lung cancer is usually diagnosed through imaging tests such as: ONCOLOGY 26  Chest X-ray, CT scan, PET scan, or MRI, which show a lesion or mass in the lungs. Bronchoscopy (a camera inserted into the lungs) and sputum studies (examining mucus from the lungs) help identify cancer cells. Causes Cigarette smoking Smoking is the leading cause of lung cancer. Even passive smoking (secondhand smoke) can increase the risk. Environmental and occupational pollutants Long-term exposure to harmful chemicals (like asbestos or radon) in the environment or workplace also contributes to lung cancer risk. Signs and Symptoms Cough A persistent cough that doesnʼt go away or changes over time. Wheezing and dyspnea Difficulty breathing and a wheezing sound when breathing. Hoarseness The tumor may press on nerves in the chest, causing a hoarse voice. Hemoptysis Coughing up blood or having blood-tinged mucus (sputum). Sometimes, the sputum is purulent (pus-filled), indicating infection. Chest pain Pain can occur if the tumor presses on nearby tissues or organs. ONCOLOGY 27  Anorexia and weight loss Loss of appetite and unintentional weight loss are common. Weakness Feeling fatigued or weak. Diminished breath sounds When listening to the lungs with a stethoscope, certain areas may have reduced or absent breath sounds due to tumor blockage or lung collapse. Clubbing of the fingernails The fingertips can become swollen and the nails curve around them, a sign of long-term lung problems. Nursing Interventions Monitor vital signs Monitor breathing patterns Watch for changes in how the patient breathes, including breath sounds, and assess for respiratory impairment (e.g., low oxygen levels, hemoptysis). Assess for tracheal deviation This could indicate a collapsed lung or large pleural effusion (fluid buildup), which shifts the position of the trachea. Pain management Administer analgesics (pain-relief medications) as prescribed to keep the patient comfortable. Positioning Place the patient in Fowlerʼs position to make breathing easier. ONCOLOGY 28  Oxygen therapy Administer oxygen as prescribed, and use humidification to keep the airways moist and help loosen mucus. Pleural effusions Monitor for malignant pleural effusions, which can worsen breathing. Respiratory treatments Provide treatments like bronchodilators or inhalers as prescribed to open airways and reduce inflammation. Teach relaxation techniques Help the patient learn relaxation breathing to reduce anxiety and improve breathing. Administer bronchodilators and corticosteroids These medications reduce bronchospasm (tightening of airways), inflammation, and edema (swelling). Diet Provide a high-calorie, high-protein, high-vitamin diet to help the patient maintain strength and health during treatment. Activity and rest Balance periods of activity and rest to help the patient conserve energy. Encourage range-of-motion exercises to maintain physical mobility. Nonsurgical Interventions Radiation therapy Used for localized lung cancer (cancer that hasnʼt spread). It can also help relieve hemoptysis, difficulty swallowing, superior vena cava syndrome, and pain. ONCOLOGY 29  Chemotherapy Used to treat nonresectable tumors (tumors that canʼt be removed surgically) or as an additional therapy to shrink tumors before surgery. Surgical Interventions Laser therapy Used to remove or shrink tumors that are blocking the airways. Thoracentesis, chest tube, pleurodesis Procedures to drain excess fluid from the pleural space (around the lungs) to relieve breathing problems caused by pleural effusions. Thoracotomy with pneumonectomy Surgical removal of an entire lung. Thoracotomy with lobectomy Surgical removal of a lobe of the lung for tumors confined to one lobe. Thoracotomy with segmental resection Surgical removal of a segment of a lung lobe ONCOLOGY 30  Other Therapies Immunotherapy Boosts the bodyʼs immune system to fight cancer. Pembrolizumab Keytruda), which helps boost the immune system to better detect and fight cancer cells Targeted therapy Uses drugs that specifically target cancer cells. Erlotinib Tarceva), which targets mutations in the EGFR Epidermal Growth Factor Receptor) gene that are often present in lung cancer cells, slowing their growth. Photodynamic therapy Uses light to activate drugs that destroy cancer cells. Porfimer sodium Photofrin), a drug that is activated by a specific wavelength of light, causing the release of oxygen that destroys cancer cells in the treated area. Airway stenting and radiofrequency ablation May be used to keep airways open or to destroy tumors. A metal or silicone stent can be placed in the airway to keep it open if a tumor is blocking it. RFA is used to destroy tumors by delivering heat directly to the cancerous cells using high-energy radio waves. Preoperative Interventions Teach the patient about the possible need for a chest tube after surgery, which helps remove air or fluid from the chest cavity. ONCOLOGY 31  Pneumonectomy considerations After the removal of one lung, the empty space in the chest fills with fluid, which helps prevent movement of the heart and other structures. Postoperative Interventions Monitor vital signs Ensure the chest tube drainage system is functioning properly to remove air or blood from the pleural space. Administer oxygen as prescribed to maintain adequate oxygen levels. Avoid complete lateral turning (turning entirely onto one side), as this can cause complications. pressure injuries, decreased oxygenation, or pooling of secretions in the lungs. semi-lateral or 30-degree tilt - reduces pressure on one side place pillows or foam wedges under the patient's back, shoulders, and legs to keep them in a comfortable change the patient's position every 2 hours Encourage activity as tolerated and range-of-motion exercises to prevent complications from immobility. Encourage shoulder exercises on the side of surgery to maintain mobility and prevent stiffness. Priority Nursing Focus The airway is always the primary concern for patients with lung cancer due to the risk of airway obstruction, respiratory compromise, and lung complications. Cervical Cancer ONCOLOGY 32  Pre-invasive cancer At this stage, the cancer is limited to the cervix. This means the cancerous cells are only found in the cervix and haven't spread to other areas. This stage is treatable with less invasive procedures and has a high cure rate. Invasive cancer When cervical cancer becomes invasive, it means the cancer has spread from the cervix to nearby structures in the pelvis, such as the bladder or rectum. Metastasis Cervical cancer tends to spread locally in the pelvis, but it can also spread to distant areas through the lymphatic system. Distant metastasis could involve organs like the lungs, liver, or bones. Premalignant changes These are changes in the cervix cells that occur over time. The progression is from dysplasia (the earliest form of abnormal cells) to carcinoma in situ (the most advanced form of premalignant change). Detecting these ONCOLOGY 33  changes early with regular Pap smears can prevent cancer from developing. Prevention The human papillomavirus HPV vaccine can prevent the types of HPV that are most commonly linked to cervical cancer. For example, the Gardasil vaccine is recommended for young women and men, starting at age 11 or 12. 🔵 cervix is the lower part of the uterus that opens into the vagina cervix produces mucus that helps protect the uterus from infections. The mucus changes in consistency throughout the menstrual cycle to either block or allow sperm to enter. During ovulation, the cervical mucus becomes thinner to allow sperm to pass through and fertilize an egg. During childbirth, the cervix dilates to allow the baby to pass from the uterus into the birth canal cervical cells undergo normal cycles of growth and regeneration, with any abnormal cells being naturally removed by the immune system 🥷 primary cause of cervical cancer is persistent infection with high-risk HPV types  Normally, the immune system clears HPV infections. However, in some cases, especially in immunocompromised individuals, HPV can persist and cause abnormal cellular changes → Cervical cancer often begins with dysplasia, which is a precancerous condition. This occurs when cells on the surface of the cervix start to grow abnormally  If dysplasia is not detected and treated, it can progress to invasive cervical cancer, where cancer cells penetrate deeper layers of the cervix → nvasive cervical cancer can spread (metastasize) to nearby tissues, such as the uterus, vagina, bladder, and rectum, and through the lymphatic system to distant organs like the lungs or liver Risk Factors ONCOLOGY 34  HPV is the most important risk factor for cervical cancer Most sexually active individuals will contract HPV at some point, but the vaccine can prevent the types of HPV that lead to cervical cancer. Family history of cervical cancer Smoking weakens the immune system and increases the risk of developing cervical cancer Early sexual activity (before 17 years old), multiple sex partners, or having a partner with multiple sex partners increases the chance of contracting HPV Individuals with weakened immune systems, such as those with HIV, are at higher risk for developing cervical cancer. Obesity is linked to an increased risk of cervical cancer, Using birth control pills for more than 5 years can slightly increase the risk of cervical cancer Women who have had multiple pregnancies are at a higher risk due to hormonal changes and increased exposure to HPV Early pregnancy increases cervical cancer risk, as the cells in the cervix are more vulnerable during adolescence Signs and Symptoms Early signs of cervical cancer include postmenstrual or postcoital bleeding (bleeding after sex) The cancer can cause a serosanguineous (blood-tinged) or foul-smelling discharge due to infection or tumor breakdown. Pain in the pelvis, lower back, legs, or groin can be caused by the cancer pressing on nearby organs or nerves. Cancer often causes loss of appetite and unintentional weight loss. If the tumor invades surrounding tissues, it can create fistulas (abnormal openings), causing leakage of urine or feces from the vagina. Painful urination can occur if the cancer invades the bladder. ONCOLOGY 35  Blood in the urine can be a sign of bladder involvement. Abnormal changes in the cells of the cervix detected on a Pap smear can indicate early stages of cancer Interventions Laser Therapy used when the cancerous lesion is visible during a colposcopy (a close examination of the cervix) laser beam vaporizes the abnormal tissue, leading to minimal bleeding. patient may have slight vaginal discharge for 612 weeks as the tissue heals. Chemotherapy used in advanced cervical cancer or when surgery is not an option cisplatin and paclitaxel may be used Monitor for neutropenia (low white blood cell count) and teach patients to avoid infections Cryosurgery freezing abnormal tissues, causing necrosis (cell death) No anesthesia is needed, but the patient may feel cramping during the procedure. ONCOLOGY 36  Educate the patient about the heavy watery discharge that will occur for several weeks. Advise them to avoid intercourse and tampons until the discharge stops. Hysterectomy For microinvasive cancer when childbearing is no longer desired, a hysterectomy (removal of the uterus) is performed. Monitor vital signs and watch for bleeding. Encourage coughing and deep-breathing exercises to prevent pneumonia. Early ambulation helps reduce the risk of deep vein thrombosis DVT. Teach patients to avoid strenuous activities like lifting heavy objects and climbing stairs for at least 1 month post-surgery. Teach signs of infection, such as foul-smelling discharge or fever. Pelvic Exenteration radical surgery where all pelvic organs (uterus, bladder, rectum) are removed Monitor for signs of shock or hemorrhage. If an ileal conduit (to drain urine) or a colostomy (to pass feces) is created, teach the patient how to care for these. Ileal Conduit ONCOLOGY 37  Teach the patient to inspect the stoma daily. It should be moist, pink, and free from signs of infection (redness, swelling, discharge). Instruct the patient to clean the skin around the stoma gently with warm water and pat it dry. Emphasize the use of skin barrier products to prevent irritation from urine leakage. Demonstrate how to change the ostomy appliance (pouch) every 3 to 5 days or sooner if there is leakage. Ensure the pouch is cut to fit properly around the stoma to prevent skin breakdown. Teach the patient to empty the pouch when it is one-third to half full to prevent it from becoming too heavy, which could cause leakage or damage to the stoma. Stress the importance of maintaining adequate hydration to prevent urinary tract infections or kidney issues. Advise at least 2 to 3 liters of fluids per day unless contraindicated. Educate the patient on signs of complications, such as changes in stoma appearance, reduced urine output, foul-smelling urine, or signs of infection, and encourage them to report these to their healthcare provider immediately. Colostomy Care ONCOLOGY 38  Stoma Colostomy bag Teach the patient to check the stoma daily. It should appear pink to red and moist. Any color change (like pale or dark blue) should be reported immediately as it could indicate poor blood supply. Instruct the patient to clean the skin around the stoma with mild soap and water. Avoid using alcohol-based products that may irritate the skin, and apply a skin barrier cream to prevent breakdown from fecal leakage. Teach how to change the colostomy bag or appliance regularly (typically every 3 to 7 days) or sooner if leakage occurs. Ensure the wafer or flange fits well around the stoma. Instruct the patient to empty the colostomy bag when it is one-third to half full to avoid it becoming too heavy, which could cause leaks. Provide dietary advice, such as avoiding gas-forming or high-fiber foods that could cause blockages or excessive gas. Gradually reintroduce foods post-surgery and advise the patient to chew food thoroughly. Encourage fluid intake of at least 2 to 3 liters daily to prevent dehydration and constipation, especially if the colostomy is in the ascending or transverse colon, where water absorption is limited. Educate the patient on signs of complications like stoma prolapse, hernia, infection, or obstruction (abdominal pain, swelling, lack of fecal output), and when to seek medical help. Provide sexual counseling as vaginal intercourse will no longer be possible after certain types of exenteration. ONCOLOGY 39  Nonsurgical Interventions Chemotherapy Often used when the tumor cannot be removed surgically or has metastasized. Common drugs include cisplatin, carboplatin, and paclitaxel. These are given to shrink the tumor and slow the progression of the disease Teach patients to recognize the signs of chemotherapy side effects like neutropenia (risk of infection), nausea, and hair loss. Cryosurgery Involves freezing abnormal cells in the cervix, causing them to die. This procedure is used for early-stage, pre-cancerous lesions. After cryosurgery, instruct the patient to avoid tampons and sexual intercourse for several weeks to allow healing. External Radiation Used for advanced stages of cervical cancer or when the cancer has spread. This targets the pelvic area to kill cancer cells. Teach patients about possible side effects like skin irritation and fatigue. Surgical Interventions Loop electrosurgical excision procedure LEEP ONCOLOGY 40  A thin wire loop is used to remove abnormal cervical tissue. It's commonly used for pre-cancerous lesions After LEEP, patients may have mild cramping and discharge. Avoid tampons and intercourse during healing. Conization A cone-shaped portion of the cervix is removed, allowing women to retain reproductive capacity Thereʼs a risk of cervical stenosis or preterm labor in future pregnancies, so follow-up care is crucial. Hysterectomy Removal of the uterus, either vaginally or through an abdominal incision If cancer has spread beyond the cervix, a radical hysterectomy with removal of surrounding tissues and lymph nodes may be performed. ONCOLOGY 41  Pelvic exenteration Removal of all pelvic organs (uterus, bladder, rectum). This is the most radical surgery and is used when cervical cancer recurs and has not spread beyond the pelvis. Post Operative Interventions After surgery, watch for signs of infection (fever, foul-smelling discharge) and excessive bleeding (more than one saturated pad per hour). Encourage early ambulation Use of antiembolism stockings or sequential compression devices helps reduce the risk of DVT. No heavy lifting or strenuous activities for at least 1 month after surgery. Instruct patients to avoid sexual intercourse for 36 weeks after surgery and to monitor for abnormal bleeding. Ovarian Cancer ONCOLOGY 42  Ovarian cancer is a fast-growing and often bilateral (affects both ovaries) cancer. It tends to spread quickly and can affect nearby organs or distant parts of the body through different mechanisms. Metastasis (spread of cancer) can occur in several ways: Direct spread to nearby organs in the pelvis. Lymphatic spread through the lymphatic system to distant parts of the body. Peritoneal seeding, where cancer cells break off and spread throughout the peritoneal cavity (the space surrounding the abdominal organs). Early-stage ovarian cancer is often asymptomatic (shows no symptoms), which makes it hard to detect until it has advanced. Because most cases are diagnosed in later stages, ovarian cancer has a high mortality rate, particularly in white women between the ages of 55 and 65 in North America and Europe. Exploratory laparotomy (surgery to open the abdomen) is used to confirm the diagnosis and stage the tumor A transvaginal ultrasound may be done as a screening tool but is not enough to confirm the diagnosis. It helps detect abnormalities in the ovaries. ONCOLOGY 43  🔵 The ovaries produce and release ova (eggs) during each menstrual cycle, allowing for potential fertilization. This process is regulated by hormonal signals from the pituitary gland FSH and LH  The ovaries secrete important hormones like estrogen and progesterone, which regulate the menstrual cycle, prepare the body for pregnancy, and maintain secondary sexual characteristics  Ovarian follicles mature and release an egg during ovulation, while the remaining structure (the corpus luteum) produces hormones to support a possible pregnancy 🥷 disease begins with mutations in normal ovarian cells, leading to uncontrolled cell division and tumor formation → cancer can start in the epithelial cells (the outer layer of the ovary), germ cells (egg-producing cells), or stromal cells (hormone-producing cells) → tumor grows rapidly and can spread (metastasize)  Ovarian cancer cells can also spread via the bloodstream to distant organs, including the lungs, liver, bones, and other parts of the body Signs and Symptoms Abdominal discomfort or swelling Due to fluid buildup (ascites) or the presence of a tumor. Urinary frequency The tumor may press on the bladder, causing the patient to feel like they need to urinate more often. Weight loss Unexplained weight loss can be a symptom of ovarian cancer. Gastrointestinal disturbances Symptoms like bloating, constipation, or changes in bowel habits can occur because the cancer may press on the intestines. Dysfunctional vaginal bleeding ONCOLOGY 44  Abnormal bleeding, unrelated to the menstrual cycle, may be an early warning sign. Abdominal mass A mass may be felt upon physical examination as the cancer grows. Elevated CA125 levels CA125 is a tumor marker that is often elevated in ovarian cancer. While not definitive, elevated levels may indicate the presence of the disease. Interventions Radiation Therapy External radiation Used if the tumor has spread to other organs. This type of therapy helps shrink the tumor and manage symptoms. Intraperitoneal radioisotopes For early-stage Stage I ovarian cancer, radioisotopes may be inserted into the abdominal cavity to target cancer cells directly. Chemotherapy Chemotherapy is usually administered postoperatively after surgery for most stages of ovarian cancer to kill any remaining cancer cells. Intraperitoneal chemotherapy This involves directly delivering chemotherapy drugs into the abdominal cavity to target cancer cells more effectively in that region. Ensure the patient has emptied their bladder before the procedure to reduce the risk of bladder injury. Position the patient in a semi-Fowlerʼs or sitting position to allow better distribution of the chemotherapy fluid within the abdominal cavity. Encourage the patient to change positions every 1530 minutes after the infusion to promote even distribution of the chemotherapy within the abdominal cavity. Keep track of the patientʼs fluid intake and output, as intraperitoneal chemotherapy can sometimes lead to fluid imbalances or ascites (fluid ONCOLOGY 45  buildup in the abdomen). Watch for signs of dehydration or fluid overload. Monitor the catheter site (if used) for signs of infection, such as redness, warmth, or discharge, and ensure sterile techniques are used during catheter insertion and dressing changes. Surgical Treatment Total abdominal hysterectomy Involves removing the uterus. Bilateral salpingo-oophorectomy Involves the removal of both ovaries and fallopian tubes. This is the mainstay treatment to remove as much of the cancer as possible Debulking surgery In advanced stages, this surgery aims to remove as much of the tumor as possible, followed by chemotherapy. ONCOLOGY 46  Uterine Cancer Endometrial cancer is a slow-growing tumor that develops from the endometrial mucosa (the inner lining of the uterus). This cancer is typically associated with women in their menopausal years. Metastasis (the spread of cancer) occurs through various pathways: Through the lymphatic system, where it can spread to the ovaries and pelvis. Through the bloodstream, allowing it to spread to organs like the lungs, liver, and bones. It can also spread intra-abdominally to the peritoneal cavity (the space within the abdomen that contains the intestines and other organs). ONCOLOGY 47  🔵 endometrium is the inner lining of the uterus that thickens each month in response to hormones (estrogen and progesterone)  If fertilization does not occur, the lining is shed during menstruation → uterus is highly responsive to hormonal signals, especially estrogen and progesterone. Estrogen helps in the thickening of the endometrium, and progesterone stabilizes the lining for potential pregnancy  During pregnancy, the uterus supports the development of the fetus. The endometrium provides nourishment, and the uterine muscles contract during labor to help deliver the baby  Endometrial cells grow and shed cyclically in a controlled manner during menstruation, maintaining the health of the uterine lining. 🥷 Uterine cancer is strongly associated with excess estrogen without the balancing effect of progesterone → prolonged exposure to unopposed estrogen stimulates the endometrial cells to grow excessively, increasing the risk of mutation → disease process often begins with endometrial hyperplasia, an abnormal thickening of the uterine lining. Hyperplasia can progress to atypical hyperplasia, where abnormal cells begin to form → hyperplasia can develop into endometrial cancer as abnormal cells multiply uncontrollably  Once cancer develops, it usually starts in the inner layer of the endometrium and can invade the muscle layer of the uterus (myometrium). This is known as invasive endometrial cancer → As the cancer progresses, it can spread beyond the uterus to the cervix, ovaries, fallopian tubes, and pelvic organs. Risk Factors Estrogen replacement therapy ERT or birth control pills Long-term use of estrogen without progesterone increases the risk of endometrial cancer. Estrogen stimulates the endometrium (the lining of the uterus) to grow and thicken. Without progesterone to counterbalance this effect, the endometrial lining continues to proliferate. Progesterone helps regulate and stabilize the growth of the endometrium by causing it to shed during the menstrual cycle. ONCOLOGY 48  Intrauterine device IUD Use of certain types of IUDs may be associated with an increased risk. Nulliparity Women who have never given birth (nulliparity) have a higher risk because they experience more menstrual cycles over their lifetime. Polycystic ovary disease or endometrial hyperplasia body has a hormonal imbalance where there is too much estrogen and not enough progesterone. Estrogen makes the lining of the uterus (endometrium) grow, but without enough progesterone, the lining doesn't shed properly. endometrium keeps growing and can become too thick Increased age The risk increases with age, particularly after menopause. Early menarche and late menopause Starting periods early (before age 12 or experiencing menopause later (after age 50 increases the number of ovulations a woman has, raising the risk of cancer. Family history A family history of uterine cancer or hereditary nonpolyposis colorectal cancer HNPCC (also called Lynch syndrome) increases the risk. This is a genetic condition that increases the risk of several cancers, including uterine and colorectal cancer. People with Lynch syndrome inherit a mutation in genes that normally help fix DNA mistakes. Without these repairs, cells can grow uncontrollably, increasing the risk of cancer, including uterine cancer. History of breast or ovarian cancer Women with a personal history of these cancers are at greater risk for developing endometrial cancer. Obesity Excess fat tissue produces estrogen, which increases the risk of endometrial cancer. Hypertension and diabetes mellitus Both conditions are linked to increased risk, likely due to underlying hormonal and metabolic imbalances. Hypertension Long-term high blood pressure can affect how blood vessels function and may be linked to hormonal imbalances, which can influence the growth of the endometrial lining. Diabetes mellitus Diabetes involves problems with insulin and blood sugar regulation, leading to metabolic changes. These changes can result in higher ONCOLOGY 49  levels of estrogen, which can stimulate the growth of the uterine lining (endometrium) and increase the risk of cancer. Signs and Symptoms Abnormal vaginal bleeding This is the most common symptom, especially in postmenopausal women. Any bleeding after menopause is a red flag (sheesh) for possible endometrial cancer. Vaginal discharge Unusual discharge, which may be watery or tinged with blood, can be an early sign. Low back pain, pelvic pain, or abdominal pain typically occurs later in the disease process when the cancer has spread or grown significantly. Enlarged uterus In advanced stages, the uterus may become enlarged, which can be detected on physical examination or imaging. Nonsurgical Interventions Radiation Therapy: External radiation Targets the cancer from outside the body and is commonly used to shrink the tumor or manage symptoms. Internal radiation (brachytherapy) Involves placing radioactive material directly inside the uterus. Itʼs used for localized cancer or in combination with surgery. Monitor for radiation side effects like fatigue, skin changes, and bowel or bladder irritation. Educate patients on managing side effects, such as using gentle skincare for areas affected by radiation. Chemotherapy: Chemotherapy is typically reserved for advanced or recurrent endometrial cancer. Drugs like carboplatin and paclitaxel are commonly used. ONCOLOGY 50  Monitor for chemotherapy side effects, including nausea, vomiting, and bone marrow suppression (low blood counts). Teach patients about neutropenia precautions (avoiding infections due to weakened immunity). Progesterone Therapy: Used for estrogen-dependent tumors, progesterone can help slow the growth of cancer by balancing hormonal levels. Educate patients about possible side effects, such as mood changes or weight gain. Antiestrogen Medication: These medications block estrogen, which fuels the growth of some endometrial cancers. An example is tamoxifen, which is also used in breast cancer treatment. Monitor for side effects like hot flashes, fatigue, or the risk of blood clots. Surgical Interventions Total Abdominal Hysterectomy TAH: This is the most common surgery for endometrial cancer. It involves removing the uterus, often along with the cervix. Bilateral Salpingo-Oophorectomy BSO: ONCOLOGY 51  Involves removing both ovaries and fallopian tubes, often performed together with a hysterectomy to remove the source of estrogen production. Postoperative Nursing Interventions: Monitor for infection Check the surgical site for signs of infection, such as redness, swelling, or foul-smelling discharge. Provide adequate pain relief with medications and assess the patientʼs pain levels regularly. Early movement helps prevent complications like deep vein thrombosis DVT. Assess for urinary retention or constipation, which can occur after surgery. Instruct the patient to avoid heavy lifting and strenuous activities for 46 weeks after surgery. Gastric Cancer ONCOLOGY 52  This is a malignant tumor originating from the mucosal cells lining the stomach (secrete mucus, which forms a protective layer over the stomach lining. The mucus protects the stomach from being damaged by the acidic environment needed for digestion). As the disease progresses, the cancer can invade deeper layers, including the muscle of the stomach wall, and eventually spread beyond the stomach to other organs. Risk Factors No single cause of gastric cancer is identified, but several factors are believed to increase the risk: H. pylori infection A bacterial infection that damages the stomach lining and promotes cancerous growths. Dietary factors Eating foods that are smoked, highly salted, processed, or spiced can have carcinogenic effects. Other risks include smoking, alcohol consumption, ingestion of nitrates (preservatives in processed meat), and a history of gastric ulcers. Complications Advanced gastric cancer can lead to serious complications: Hemorrhage Bleeding in the stomach. Obstruction The tumor can block food passage through the digestive system. Metastasis The cancer can spread to other parts of the body. Dumping syndrome: condition that can occur in patients with stomach cancer, particularly after surgery to remove part or all of the stomach (gastrectomy). It happens when food moves too quickly from the stomach to the small intestine After stomach cancer surgery (such as a partial or total gastrectomy), the stomach's capacity to control the slow release of food into the small intestine is reduced or lost. Without a functional pyloric sphincter (the ONCOLOGY 53  valve that normally controls the passage of food), food enters the small intestine too quickly, leading to dumping syndrome. Nausea and vomiting Diarrhea (often watery) Abdominal cramping and pain Bloating and gas Dizziness or lightheadedness Flushing or sweating Hypoglycemia (low blood sugar) Treatment Goal The primary aim of treatment is to remove the tumor and manage the patient's nutritional needs. Signs and Symptoms Early Signs: Indigestion or persistent heartburn. Abdominal discomfort. A full feeling even after eating small amounts. Epigastric pain, which may radiate to the back or behind the breastbone (retrosternal pain). Late Signs: Weakness and fatigue. Anorexia (loss of appetite) and significant weight loss. Nausea and vomiting. A feeling of pressure in the stomach. Dysphagia (difficulty swallowing) and obstructive symptoms. Iron-deficiency anemia due to chronic blood loss (tumor can erode the lining of the stomach, leading to slow, chronic bleeding) ONCOLOGY 54  Ascites (fluid buildup in the abdomen). A palpable epigastric mass and enlarged lymph nodes (late signs of advanced disease). Interventions Monitor vital signs Monitor hemoglobin and hematocrit levels to assess for anemia and bleeding. Administer blood transfusions if needed. Monitor weight regularly to assess for malnutrition and weight loss. Assess nutritional status: Encourage small, bland, and easily digestible meals. Provide vitamin and mineral supplements (e.g., vitamin B12 due to poor absorption after stomach surgeries). Administer pain medications as prescribed to manage discomfort. Prepare the patient for chemotherapy or radiation therapy if prescribed, as these may be part of the treatment plan. Prepare the patient for surgical resection of the tumor. Surgical options may include: ONCOLOGY 55  Partial gastrectomy (removal of part of the stomach). Total gastrectomy (complete removal of the stomach). Postoperative Interventions Monitor vital signs Position the patient in Fowlerʼs position for comfort and to reduce pressure on the abdomen. Administer analgesics and antiemetics as prescribed to manage postoperative pain and nausea. Monitor intake and output Parenteral nutrition may be provided if the patient is unable to eat for a prolonged period. Maintain NPO status for 13 days post-surgery until bowel function returns. This involves listening for the return of bowel sounds before allowing the patient to eat. Monitor nasogastric NG suction: Following a gastrectomy, it is normal for NG tube drainage to be bloody for the first 24 hours, then change to brown-tinged, and eventually become yellow or clear. ONCOLOGY 56  Do not irrigate or remove the nasogastric tube unless instructed by the healthcare provider. Diet progression: After NPO status, start with sips of clear liquids. Gradually advance to six small bland meals per day, as tolerated and prescribed. Monitor for postoperative complications, including: Hemorrhage Watch for signs of internal bleeding (low BP, rapid pulse, dark stools). Dumping syndrome Monitor for symptoms like sweating, diarrhea, and weakness after eating. Diarrhea Common post-surgery, especially if the bowel has been affected. Hypoglycemia Due to rapid digestion, low blood sugar levels may occur after meals.(undigested food (especially carbohydrates) moves too quickly from the stomach into the small intestine. This is known as rapid gastric emptying → When a large amount of carbohydrate-rich food enters the small intestine suddenly, it causes a spike in blood glucose levels → pancreas overproduces insulin, a hormone that helps lower blood sugar by moving glucose from the bloodstream into cells  However, the insulin release is often excessive in response to the sudden surge of glucose, leading to a sharp drop in blood sugar (hypoglycemia) about 13 hours after the meal) Vitamin B12 deficiency Since the stomach is involved in B12 absorption, patients may require lifelong B12 injections or supplements. Colon Cancer ONCOLOGY 57  Malignant (cancerous) lesions that develop in the cells lining the bowel wall or originate as adenomatous polyps in the colon or rectum. These polyps are abnormal growths that can turn into cancer over time. Spread of Tumors Intestinal tumors can spread in several ways: Direct invasion The tumor grows into nearby tissues. Lymphatic spread Cancer cells enter the lymphatic system (a part of the immune system) and spread to other areas. Circulatory spread Cancer cells enter the bloodstream and travel to distant organs (metastasis). Complications: Bowel perforation A hole in the bowel wall, leading to leakage of bowel contents into the abdomen, causing peritonitis (severe infection in the abdominal cavity). Abscess and fistula formation An abscess is a collection of pus, and a fistula is an abnormal connection between organs. Hemorrhage Severe bleeding that can lead to shock (life-threatening drop in blood pressure). Complete intestinal obstruction Blockage of the intestines, preventing normal bowel movements and leading to severe pain and complications. ONCOLOGY 58  Risk Factors Age Risk increases significantly in people over 50 years. Familial Polyposis and Family History Genetic predispositions, especially if a first-degree relative (parent, sibling) has colorectal cancer, increase risk. Previous Polyps or Cancer A personal history of polyps or colorectal cancer heightens risk. Chronic Inflammatory Bowel Disease Conditions like Crohnʼs disease and ulcerative colitis lead to chronic inflammation and increased cancer risk. Other Cancers A history of ovarian, breast, endometrial (uterine) Signs and Symptoms Blood in Stool The most common manifestation, which can be detected through tests like fecal occult blood testing, sigmoidoscopy, or colonoscopy. Anorexia Loss of Appetite), Vomiting, and Weight Loss Anemia Low red blood cell count due to chronic blood loss in the stool. Abnormal Stools Depending on the tumor location: Ascending colon tumor Causes diarrhea The ascending colon is located on the right side of the abdomen and is responsible for absorbing water from ONCOLOGY 59  the stool. A tumor here can disrupt this process, leading to less water being absorbed) Descending colon tumor Can cause constipation or diarrhea and ribbon- like stools due to partial obstruction (blockage can compress the stool, causing it to appear ribbon-like. If the tumor only partially obstructs the colon, alternating patterns of constipation and diarrhea may occur due to periods of blockage and stool buildup, followed by liquid stool passing around the obstruction) Rectal tumor Leads to alternating constipation and diarrhea. (tumor in the rectum can block the exit of stool, causing constipation. When stool finally passes, it may be looser (diarrhea) because it has built up behind the blockage, and the body pushes out liquid stool or smaller stool) Abdominal Distention and Mass Late signs, especially in advanced disease. Cachexia A wasting syndrome with severe weight loss and muscle atrophy In intestinal tumors, malabsorption of nutrients can occur, especially when the tumor blocks parts of the digestive system or interferes with the absorption processes) Imaging Findings Tumors can be identified through diagnostic tests like barium enema, colonoscopy, CT scan, or sigmoidoscopy. Interventions Monitoring for Complications Be alert for signs of bowel perforation, peritonitis, abscess formation, hemorrhage, and intestinal obstruction. Bowel perforation signs Low blood pressure, rapid weak pulse, distended abdomen, and fever. Intestinal obstruction signs Vomiting (can include fecal contents), pain, constipation, abdominal distention, and changes in bowel sounds. Increased peristaltic activity Early sign of intestinal obstruction, indicated by hyperactive bowel sounds. Hypoactive bowel sounds As obstruction worsens, bowel sounds may become diminished As the obstruction worsens, the ability of the intestines ONCOLOGY 60  to move contents through the blockage becomes more difficult. Over time, the intestines become distended and tired from the repeated efforts to push against the obstruction) Radiation Therapy: Preoperative radiation To shrink tumors before surgery. Postoperative radiation To reduce the risk of recurrence or relieve symptoms like pain or bleeding. Nonsurgical Interventions Radiation Therapy: Preoperative radiation Used to control local tumor growth and improve surgical outcomes. Postoperative radiation Administered for palliation (relieving symptoms) in advanced cancer. Chemotherapy After surgery, chemotherapy is often given to control the spread of cancer and manage symptoms. Surgical Interventions Bowel resection Removal of part of the colon along with nearby lymph nodes. Colostomy or Ileostomy Creation of an opening (stoma) in the abdominal wall to allow waste to exit into a bag. A colostomy is from the colon, while an ileostomy is from the small intestine. ONCOLOGY 61  Colostomy and Ileostomy Care Preoperative Care: Consult an enterostomal therapist to determine the best stoma location. Instruct the patient on the preoperative diet and bowel preparation (laxatives/enemas may be prescribed). (low residue diet, clear liquid diet, laxatives and enemas) Use intestinal antiseptics and antibiotics to reduce infection risk. (neomycin and metronidazole)  Reducing the bacterial load in the colon prevents complications like peritonitis (infection in the abdominal cavity) or abscess formation (a collection of pus). Postoperative Colostomy Care: Keep stoma moist with petroleum jelly gauze if no pouch system is in place. Apply a pouch system as soon as possible. Monitor the pouch system for proper fit and leakage, and empty when one- third full. ONCOLOGY 62  Stoma care: Normal stoma color should be red or pink (indicating good blood flow). Pale stoma may indicate low hemoglobin levels (anemia). Assess stool consistency: Liquid stool from the ascending colon colostomy. Loose/semiformed stool from the transverse colon colostomy. Normal stool from the descending colon colostomy. Avoid foods that cause gas or odor (e.g., carbonated drinks). (gas producing foods - beans, broccoli, cauliflower, onions, and legumes) (odor producing foods - eggs, garlic, onions, and certain fish) Postoperative Ileostomy Care: Stoma should be red in color. Initial drainage will be dark green, turning yellow as eating resumes. Risk for dehydration As the ileostomy stool is liquid, there's a risk of dehydration and electrolyte imbalances, so monitoring fluid intake is crucial. Monitor stoma color. A dark blue, purple, or black stoma indicates compromised circulation, requiring notifcation of the surgeon Breast Cancer ONCOLOGY 63  It is classified as invasive when it spreads beyond the mammary ducts into surrounding tissue, growing irregularly. The cancer commonly spreads via the lymphatic system Bone, lungs, brain and liver) Diagnosed through breast biopsy either by needle aspiration or surgical removal of the tumor followed by microscopic examination for malignant cells. Risk Factors Women over 65 years have a higher risk. Genetic predisposition BRCA1/BRCA2 mutations increase risk). BRCA1 Breast Cancer 1 and BRCA2 Breast Cancer 2 are tumor suppressor genes that help repair DNA damage and ensure the stability of a cell's genetic material. Normally, these genes help prevent cancer by correcting DNA errors that can lead to uncontrolled cell growth. In individuals with inherited mutations in BRCA1 or BRCA2, the DNA repair mechanisms are compromised. This allows genetic damage to accumulate over time, which increases the likelihood of developing cancer. Early Menarche and Late Menopause ONCOLOGY 64  Early menarche and late menopause result in a longer reproductive lifespan, meaning the body is exposed to higher levels of estrogen and progesterone over a more extended period. This prolonged exposure to hormones increases the risk of developing hormone receptor-positive breast cancer, which is fueled by estrogen and progesterone. History of cancer in the breast, uterus, or ovaries. Not having children, or having the first child later in life. Abnormal growth of cells in the breast. Oral Contraceptive Use. Recent Hormone Replacement Therapy HRT HRT, especially combined estrogen-progesterone therapy, increases the exposure of breast tissue to estrogen and progesterone. These hormones can stimulate the growth of breast cells, particularly in hormone receptor-positive breast cancers, which rely on estrogen and/or progesterone to grow. Obesity. Radiation Exposure Assessment (Signs and Symptoms) Breast Mass Often detected during Breast Self-Examination BSE in the upper outer quadrant, beneath the nipple, or in the axilla (armpit). Mammography Detects abnormal masses or lesions in the breast. ONCOLOGY 65  Characteristics of Mass: Fixed, irregular, non-encapsulated (grows without a distinct boundary) Typically painless except in late stages. Asymmetry One breast may appear different in size or shape compared to the other. Nipple Changes: Bloody or clear discharge. Retraction or elevation Skin Changes: Dimpling or retraction. ONCOLOGY 66  Peau d'orange appearance (skin looks like an orange peel). Ulceration (google it) Lymph Node Involvement: Axillary lymphadenopathy (swollen lymph nodes under the arm). Lymphedema Swelling of the arm on the affected side due to impaired lymph drainage. Metastasis Symptoms: Bone pain or lung symptoms in late stages (e.g., difficulty breathing). Early Detection: Breast Self-Examination (BSE) ONCOLOGY 67  Performing BSE: Perform 7 to 10 days after menses to minimize tenderness. Postmenopausal women or those whoʼve had a hysterectomy should still perform BSE regularly. Instructions: While in the shower or bath, when the skin is slippery with soap and water, examine your breasts. Use the pads of your second, third, and fourth fingers to press every part of the breast firmly. Use your right hand to examine your left breast, and use your left hand to examine your right breast. Using the pads of the fingers on your left hand, examine the entire right breast using small circular motions in a spiral or up-and-down motion so that the entire breast area is examined. Repeat the procedure using your right hand to examine your left breast. ONCOLOGY 68  Repeat the pattern of palpation under the arm. Check for any lump, hard knot, or thickening of the tissue. Look at your breasts in a mirror. Stand with your arms at your side. Raise your arms overhead and check for any changes in the shape of your breasts, dimpling of the skin, or any changes in the nipple. Next, place your hands on your hips and press down firmly, tightening the pectoral muscles. Observe for asymmetry or changes, keeping in mind that your breasts probably do not match exactly. While lying down, feel your breasts as described in step 1. When examining your right breast, place a folded towel under your right shoulder and put your right hand behind your head. Repeat the procedure while examining your left breast. Mark your calendar that you have completed your breast self-examination; note any changes or unique characteristics you want to check with your primary health care provider. Nonsurgical Interventions Chemotherapy Used to shrink tumors and manage systemic disease. Radiation Therapy Applied post-surgery or in cases where surgery isnʼt an option. Hormonal Therapy: Medications like tamoxifen for estrogen receptor-positive cancers in postmenopausal women. Tamoxifen binds to the estrogen receptors on these cancer cells, preventing estrogen from binding and stimulating cancer growth) Targeted Therapy: Monoclonal antibodies (trastuzumab) for HER2 positive breast cancer. HER2 is a protein that promotes cancer growth, and this therapy blocks its effects. ONCOLOGY 69  HER2 is a protein found on the surface of breast cells that helps regulate cell growth and division. In HER2 positive breast cancer, the cancer cells produce too much of the HER2 protein, which leads to rapid and uncontrolled cell growth. HER2 positive breast cancer is more aggressive than HER2 negative types because the excessive HER2 protein promotes faster tumor growth and spread. Trastuzumab binds to the HER2 protein, trastuzumab blocks the receptors, preventing them from receiving growth signals. This slows down or stops the growth of the cancer cells. Trastuzumab also triggers the immune system to attack and destroy HER2 positive cancer cells. This process is called antibody-dependent cellular cytotoxicity ADCC, where immune cells are recruited to attack the cancer cells tagged by trastuzumab. Surgical Interventions Lumpectomy Removal of the tumor and some surrounding breast tissue. Mastectomy: ONCOLOGY 70  Simple Mastectomy Removal of breast tissue and nipple, bu