CHAPTER 23 Gender and Site-Specific

CANCER Cancer
Most Common Sites
Men: Prostate, lung, colon, rectum
Definition
➢ Prostate cancer accounts for 33%
• Cancer comes from the Latin word
of new cases
cancri (crab) because it spreads out
➢ Lung cancer incidence is declining.
like a crab’s legs
Women: Breast, lung, colon, rectum
• A group of over 100 diseases where
➢ Breast cancer accounts for 31% of
cells multiply and spread
new cases
uncontrollably, disrupting normal
➢ Lung cancer is increasing but at a
physiology
slower rate
Impact
• Affects people of all ages, though more
Cancer Death Causes
common with aging
Men: Lung, prostate, colorectal (52% of
• Causes significant anxiety for patients
deaths)
and families
Women: Lung, breast, colorectal (50% of
• Treatments may not always result in a
deaths)
cure but have improved survival rates
• Lung cancer is the leading cause of
and quality of life
death in women since 1987 (25% of all
deaths)
Cancer Nursing
Recognition
• Subspecialty since 1975 under the
Age and Cancer
Risk by Age
Oncology Nursing Society (ONS)
• At age 20: Less than 1%
Roles of Oncology Nurses • By age 50: 7% risk of developing cancer
• Direct care providers, case managers, within 10 years
genetic counselors, researchers, • By age 60: Over 16% for men; over 10%
educators, and consultants for women
• Provide care in hospitals, clinics, Peak Age
hospices, and home settings Women: Breast, lung, and colorectal
cancers peak between ages 55-74
• Educate the public through schools,
Men: Prostate, lung, and colorectal cancers
workplaces, and community
cause most deaths in the same age span
programs
Population Trends
Requirements
• Increasing life expectancy (74.4 years for
• Oncology nursing demands a broad
men, 79.8 for women)
knowledge of pathophysiology and
• By 2030, 20% of the U.S. population will
psychosocial care
be over 65
• Requires complex technical and Challenges in Older Adults
psychomotor skills • Financial limitations, transportation
issues, cultural beliefs, and chronic
Etiology and Epidemiology diseases delay diagnosis and treatment.
Lifetime Risk • Underrepresentation in clinical trials
• Men: 1 in 2; Women: 1 in 3.
limits evidence for treatments
Leading Cause of Death
• Cancer is the leading cause of
death in the U.S. for individuals Race and Ethnicity
younger than 85 years Disparities
• Death rate has decreased but • Defined as differences in cancer
stabilized with a 63% 5-year survival incidence, mortality, and burden
rate among population groups
Trends 1. African-Americans
• Advances in early detection and ➢ Higher incidence and lower
therapy have improved survival for survival rates for many cancers
cancers like breast, colon, and compared to Caucasians
prostate 2. Caucasians
• Over 500,000 Americans die of ➢ Highest incidence among women
cancer annually but lower mortality than African-
American women
3. Hispanic-Americans, Asian-
Americans/Pacific Islanders, Native
Americans
➢ Lower incidence and mortality
rates
➢ Lower awareness of cancer risks and
screening programs
 Contributing Factors Risk Factors for Cancer
Socioeconomic disparities, lack of access to Endogenous (Internal) Factors
healthcare, cultural beliefs, and insurance 1. Age
limitations 60% of cancer diagnoses and 70% of
deaths occur in those aged 65+
Geographic Factors Reasons
Global Distribution • Longer exposure to carcinogens
Liver cancer: Common in Indonesia, Africa, • Reduced ability to repair genetic
and Asia; rare in other regions abnormalities
Breast cancer: More prevalent in the U.S. • Weakened immune system
and Western Europe; less common in Japan
2. Genetic Factors
Migration 5-10% of cancers are inherited (e.g.,
Changes in cancer incidence patterns BRCA1/BRCA2 mutations)
occur after migrating to a new country,
indicating environmental or lifestyle Patterns of Inheritance
influences • Autosomal dominant (one altered gene
causes susceptibility)
Multistep Process of • Autosomal recessive (two altered
Carcinogenesis genes required)
• X-linked recessive (males inherit
Carcinogenesis: A dynamic, multistep altered X chromosome)
process caused by mutations in DNA
regulating cell growth and replication Hereditary Cancer Syndromes
Genes Involved 1. Hereditary breast and ovarian cancer
1. Proto-oncogenes: Regulate normal (BRCA1/BRCA2)
cell growth; mutations turn them into 2. Hereditary nonpolyposis colon cancer
oncogenes → uncontrolled cell growth
2. Tumor suppressor genes: Inhibit cell Familial Cancer: Cancer clusters in
growth and program apoptosis (cell families without clear genetic mutations
death)
3. DNA mismatch/repair genes: Identify 3. Hormonal Factors
and repair mismatched nucleotides in Hormones (e.g., estrogen) influence
DNA; mutations prevent error repair carcinogenesis:
• Make target tissues
Gene Mutations: Overexpression or susceptible
mutations in specific genes are linked to • Permit the carcinogenic
cancers process to progress
Example: HER-2/neu overexpression → • Condition tumors for growth
aggressive breast cancer
p53 tumor suppressor gene mutations → Breast cancer risk linked to endogenous
aggressive tumors and early metastasis estrogen:

Mechanisms of Carcinogenesis •Early menarche

• Genetic abnormalities causing •Late first pregnancy or nulliparity
malignant transformation •Long cumulative exposure to
• Endogenous factors (e.g., hormones) estrogen
• Exogenous carcinogens (e.g., tobacco, Exogenous estrogen therapy:
radiation, chemicals) • Associated with increased risk of
breast and endometrial cancer
Stages of Carcinogenesis • Balancing benefits vs. risks is critical
1. Initiation: Genetic change alters for postmenopausal hormone therapy.
cellular growth/function
2. Promotion: Altered cells undergo 4. Precancerous Lesions
additional malignant changes Benign lesions or tumors that may
3. Progression: Continued growth of become cancerous:
malignant cells 1. Colon/rectal polyps.
• Reversibility: Possible in initiation 2. Pigmented moles.
and promotion stages; irreversible 3. Cervical epithelial dysplasia.
in progression stage 4. Paget's disease of the bone.
5. Senile keratoses.
6. Leukoplakia (oral mucous
membranes)
 Exogenous (External) Factors Carcinogens" listing human
1. Tobacco: The most lethal known carcinogens
carcinogen • The Occupational Safety and
2. Radiation Health Administration (OSHA)
• Ionizing radiation regulates exposure to known
• Ultraviolet radiation carcinogens
3. Nutrition
Carcinogenic Drugs
• Excess energy intake →
Oral contraceptives
obesity → higher cancer risk
• Initially linked to breast cancer risk
4. Inactivity and Obesity: Physical
but also provide protection against
inactivity and obesity increase
ovarian and endometrial cancers
cancer risk
Diethylstilbestrol (DES):
5. Infectious Organisms: Viruses
• Linked to rare vaginal cancers in
(e.g., sexually transmitted diseases)
daughters of mothers who took the
are linked to cancer development
drug during pregnancy
Cancer therapies (alkylating agents):
Immunologic Factors Examples: chlorambucil,
The immune system plays a role in cyclophosphamide, thiotepa
controlling cancer (immune surveillance) • Linked to subsequent acute leukemia
and other cancers
Evidence supporting immune surveillance:
1. Higher incidence of cancer in older
persons with weakened immune
Radiation
Ionizing Radiation
systems
Sources
2. Increased cancer risk in
individuals with • Natural background radiation (e.g.,
immunodeficiency diseases (e.g., uranium in soil)
cellular immunity defects). • Medical radiation (e.g., x-rays, radiation
3. Increased cancer risk (e.g., non- therapy)
Hodgkin's lymphoma) in individuals • Synthetic radiation (e.g., nuclear
receiving immunosuppressive energy, nuclear weapons)
drugs (e.g., cyclosporine,
azathioprine) for organ transplant High levels of radiation exposure are linked
rejection to:
1. Skin cancer (early scientists and radium
Mutated cells with malignant properties workers)
may be recognized as foreign by the 2. Oral and sinus carcinomas,
immune system and destroyed osteosarcomas (radium watch dial
workers)
Reasons tumors evade immune surveillance: 3. Leukemia and other cancers
1. Tumors arise in areas poorly (Hiroshima/Nagasaki survivors)
served by the immune system (e.g., Damage to DNA is permanent and
central nervous system, retrobulbar cumulative with repeated exposure
eye) Health risks
2. Tumors fail to stimulate antibody ➢ Leukopenia, leukemia, bone
formation due to similarity to normal cancer, and sterility
cells ➢ Pregnant women are advised to
3. Overactivity of the immune system avoid radiation exposure during
suppresses its own function early gestation
4. Genetic inability to mount an
effective immune response Ultraviolet Radiation (UVR):
• Tumors can grow unchecked if Sources: sun, tanning beds, industrial
growth exceeds the immune exposure
system’s ability to destroy cells Carcinogenic effects: Skin cancer, lip
cancer, and melanoma of the eye
A tumor must measure 1 cm in diameter Risk factors: sunburns, prolonged
(over 1 billion cells) before it can be exposure to UVR
detected
Radon
• Radioactive gas from uranium
Drugs and Chemicals decay in soil and rocks
Many chemicals, drugs, and environmental
• Linked to increased lung cancer
products are known or suspected
risk with prolonged exposure
carcinogens
• High concentrations occur indoors
• Up to two-thirds of all cancers may
(poorly ventilated buildings or mines)
be linked to environmental factors.
• Mitigation: improved ventilation,
• The National Toxicology Program
home radon monitoring kits
publishes a biennial "Report on
Electromagnetic Radiation (EMR): Misconceptions:
Sources: household appliances, ➢ Filtered cigarettes, pipes, and
electrical power lines, electricity facilities smokeless tobacco still contain
• EMFs can pass through body high levels of carcinogens
tissue, with exposure increasing
near sources (<50 m) Public health interventions:
✓ Ban on cigarette advertising on TV
Health concerns and radio since 1971
1. Minimal increase in leukemia and ✓ Warning labels on cigarette packages
brain tumors among electric utility ✓ Sale of tobacco products to minors
workers prohibited since 1990
2. Possible link to childhood leukemia ✓ Legislation continues to target public
smoking and youth smoking
Cellular phones
• Emit low-frequency radiation 2. Nutrition
• No proven link to brain cancer, but ➢ Diet contributes to 30% of cancers
long-term studies are ongoing as in developed countries
cumulative exposure increases High-fat diets
➢ Associated with colon, prostate,
Lifestyle Practices and breast cancers
1. Smoking and Tobacco Use ➢ Focus on types of fat (e.g., animal
➢ Tobacco smoke is the leading vs vegetable fats) and total energy
cause of cancer intake
➢ Smoking is linked to at least 10 Red meat consumption
types of cancers and responsible for ➢ Linked to colon and prostate cancers
up to 30% of all cancer deaths Fruits and vegetables
➢ Cigarette smoking is the most Lower incidence of cancers
important risk factor for lung ➢ Lung, gastrointestinal, genitourinary,
cancer, the leading cause of cancer and breast cancers
death ➢ Good sources of antioxidants
Linked cancers: (Vitamins C, D, beta-carotene,
➢ Mouth, pharynx, larynx, esophagus selenium)
➢ Pancreas, kidney, bladder, colon, ➢ Antioxidants repair damage
rectum caused by free radicals
Smoking increases risks of: Fiber
• Cardiovascular diseases ➢ Initial belief in its protective role
• Acute and chronic respiratory against colon cancer is not
diseases consistently supported
Alcohol
• Fertility issues, bone mass
➢ Linked to cancers of the mouth,
loss, and dental damage
larynx, esophagus, and liver
➢ Cigarette smoke contains over 60
➢ May increase the risk of breast and
known carcinogens
colorectal cancers
• Both mainstream smoke (direct
➢ Combined effects with smoking
inhalation) and sidestream
and vitamin deficiencies increase
smoke (second-hand smoke) are
cancer risks
harmful
➢ Alcohol-related cancers are more
common in men, older adults,
Risk factors for smokers:
African-Americans, and lower
• Number of cigarettes smoked per day socioeconomic groups
• Duration of smoking Obesity
• Age of starting smoking ➢ Obesity increases risks for
cancers of the:
➢ Smokers have a 20 times greater • Colon, breast, endometrium,
risk of lung cancer than non- kidney, and esophagus
smokers Linked to:
1. Excess energy intake
Benefits of quitting smoking 2. Increased body mass
1. Immediate and long-term health 3. Physical inactivity
improvements 4. Higher levels of insulin and
2. Reduces lung cancer risk by at least insulin-like growth factors
50% ➢ Physical activity may reduce
3. Reduces risk of heart disease and breast cancer risk by affecting
pregnancy complications circulating estrogen
➢ Regular exercise can decrease
cancer risks in overweight
individuals
4. Sexual and Reproductive Factors Normal Cellular Proliferation
• Sexual practices influence cancer 1. Orderly Growth
incidence due to sexually ➢ Growth occurs in response to
transmitted infections trauma, surgery, or inflammation
➢ Growth stops when needs are met
Human papillomavirus (HPV) 2. Contact Inhibition
• Linked to almost all cases of ➢ Normal cells adhere to
cervical cancer neighboring cells, inhibiting overlap
• HPV-16 and HPV-18 are the most and disorganized growth
common high-risk strains 3. Cell Turnover Rates
Other cofactors: older age, oral ➢ Rapid in tissues like bone marrow,
contraceptive use, smoking, and HIV skin, and GI tract
infection ➢ Slower in other tissues
Hepatitis B and C viruses 4. Cell Migration
• Associated with hepatocellular ➢ Normal cells, except certain blood
cancer cells, remain in designated
Epstein-Barr virus locations
• Linked to upper pharynx cancer
and non-Hodgkin’s lymphoma. Cell Cycle Phases
HIV Mitosis: Splitting of one cell into two
• Associated with Kaposi's sarcoma
daughter cells
and lymphoma Cell Cycle Time: Interval from mitosis to
Helicobacter pylori mitosis of daughter cells
• Causes chronic stomach
inflammation and ulcers Phases
• Linked to carcinoma and 1. G0 (quiescent phase): Cells rest but
lymphoma of the stomach remain viable for mitosis
2. G1 (gap phase): RNA and protein
Reproductive factors for breast cancer: synthesis begins
1. Early menarche and late 3. S (synthesis phase): DNA synthesis
menopause increase risk occurs
2. Early childbirth lowers risk; 4. G2: Further RNA, protein synthesis,
delayed childbirth or no children and mitotic spindle development
increases risk 5. Mitosis (M): Cell division occurs
Viruses and Microorganisms Controlled by signals from growth-
1. HPV: Most cases of cervical cancer regulating proteins (proto-oncogenes
2. Hepatitis B and C: Chronic infections and tumor suppressor genes)
linked to liver cancer
3. Epstein-Barr virus: Associated with
pharynx cancer and lymphoma Differentiation
4. HIV: Linked to Kaposi's sarcoma and Stem cells (immature) develop
lymphoma specialized functions as they mature
5. Helicobacter pylori: Linked to stomach
cancer and lymphoma Characteristics:
1. Cells resemble normal forebears (fully
Psychosocial Factors differentiated)
Psychosocial stress may contribute to 2. Differentiation is irreversible once
cancer through its impact on the immune specialized function is achieved
system
• Sustained activation of the Pathophysiology: Alterations in
hypothalamic-pituitary axis may Cell Growth
impair immune response Types of Growth
• Reports linking psychosocial factors 1. Hyperplasia: Increase in cell number
to cancer are mostly anecdotal (e.g., wound healing, callus)
• Psychoneuroimmunology 2. Hypertrophy: Increase in cell size (not
continues to explore these number)
connections 3. Metaplasia: Replacement of one adult
cell type by another (reversible)
Physiology of Cell Kinetics and Example: Respiratory epithelium →
Cancer Development squamous epithelium
Cellular Transformation 4. Dysplasia: Altered cell size, shape,
• Malignant transformation is a and organization
multistep process originating in a 5. Neoplasia: Abnormal, unnecessary
single proliferating cell cellular division
• Transformed cells exhibit altered
abilities to differentiate and proliferate
Benign vs Malignant Neoplasms ➢ Others are named after the organ
Benign of origin (e.g., hepatoma, thymoma)
• Limited growth potential
• Localized with a fibrous capsule 2. Malignant tumors
• Rarely recur after removal Classified based on cell type of origin:
• Regular in shape
• Well-differentiated cells (like parent • Carcinoma: Malignant tumors of
tissue) epithelial cells
• Expansive (non-invasive) growth ➢ From glandular epithelium →
Malignant Prefix adeno- (e.g.,
• May grow rapidly or slowly adenocarcinoma)
• Metastasize throughout the body ➢ From squamous epithelium →
• No enclosing capsule Includes the term squamous
• May recur after treatment • Sarcoma: Malignant tumors of
• Irregular shape with poorly defined connective tissue
borders • Teratoma: Contains all three types
• Poorly differentiated cells (differ from of embryonal tissue
parent tissue) • Blastoma: Tumors originating
• Infiltrative growth during the blastula embryonic
phase
Metastasis
Spread of cancer cells to other body parts Additional terms describe histology (e.g.,
follicular, cystic)
Mechanisms Some tumors have an unknown tissue of
1. Angiogenesis: Formation of new origin, despite investigation
blood vessels to supply tumors
2. Motility: Tumor cells move through Grading of tumors
blood vessels and lymphatics Describes cellular maturity and
3. Altered Cell Adhesion: Tumor cells characteristics
detach from the primary site Tumors graded 1-4
4. Immune Evasion: Tumor cells escape • Higher grade → More abnormal
immune detection appearance → More aggressive
• Undifferentiated/Anaplastic:
Modes of Dissemination Tissue identity completely lost
1. Direct extension into neighboring
tissues Staging of tumors
2. Permeation along lymphatic vessels Describes the extent of the tumor in the
3. Embolism via lymphatic vessels to body
lymph nodes
4. Embolism via blood vessels Three types of staging:
5. Diffusion into body cavities (e.g., 1. Clinical staging: Based on clinical
abdominal or pleural) signs, symptoms, and imaging
2. Surgical staging: Based on surgical
Sites of Metastasis inspection.
3. Pathologic staging: Most definitive;
Depends on venous/lymphatic drainage,
based on microscopic examination
cancer type, and tissue attraction
Common Sites (in order):
TNM system (International Union Against
1. Liver
Cancer and AJCC)
2. Lungs
3. Bone • T: Primary tumor size/extent
4. Brain • N: Regional lymph node involvement
5. Adrenal glands • M: Distant metastasis
Rare Sites: Spleen, muscle, skin
For non-Hodgkin's lymphoma
Ann Arbor staging system: Reflects
Classifying and Naming lymph node groups, organ involvement,
Neoplasms and "B" symptoms (weight loss, fever, night
Tumors are named based on the type of sweats)
tissue involved

1. Benign tumors
➢ Carry the suffix -oma (e.g.,
neuroma, fibroma)
➢ Some are named after scientists
who first described them (e.g.,
Hodgkin's lymphoma, Wilms' tumor)
 Clinical Manifestations of Tumor markers: Proteins associated with
specific cancers
Cancer Examples:
Diverse symptoms depending on:
1. Prostate-specific antigen (PSA) →
• Site and size of the tumor
Prostate cancer
• Tumor’s impact on systems and
2. Carcinoembryonic antigen (CEA) → GI
structures
lesions or disease progression
Local effects
Tumor markers are also used to monitor
1. Obstruction in tubular structures (e.g.,
response to therapy
trachea, ureter, GI tract)
2. Ulceration and infection in epithelial
Newer laboratory techniques:
tissue
1. Radioimmunoassays: Measures
3. Increased pressure in closed
tumor antigens in serum using
structures (e.g., intraspinal or
radiolabeled antigens
intracranial tumors)
2. Flow cytometry: Identifies cellular and
Systemic effects
DNA characteristics (e.g., for leukemia
• Fatigue diagnosis and prognosis)
• Loss of appetite
• Weight loss
Immunologic, hormonal, and
Cytology
Study of sloughed/exfoliated tumor cells
neuromuscular changes may occur due
in body secretions
to malignancy
Common sites for cytologic analysis:
1. Cervical discharges
Early Warning Signs of 2. Sputum
Common Cancers 3. Gastric washings
• Lung cancer: Persistent cough, 4. Pleural fluid
hemoptysis 5. Urinary washings
• Colon cancer: Change in bowel
habits, blood in stool Papanicolaou (Pap) smear
• Breast cancer: Changes in breast ➢ Diagnoses cancer in
tissue, lumps asymptomatic individuals
➢ Identifies precancerous lesions or
Nursing role noninvasive cancer
✓ Encourage early medical attention ➢ Most widely used for cervical
when symptoms suggest cancer cancer screening
✓ Support patients through the
diagnostic process If suspicious cells are found → Biopsy
confirms diagnosis
Collaborative Care
Management: Diagnostic Tests Tumor Imaging
Diagnostic tests provide critical information Radiographs (X-rays): Provide two-
about: dimensional views of organs
• Primary tumor Examples: Chest X-rays, mammograms.
• Extent of the disease
Computed tomography (CT) scans
• Cancer stage
• Provide three-dimensional views
of internal structures
The natural course of the cancer and its
• Detect smaller lesions compared to
pattern of spread are considered
X-rays
Nurses play a vital role in:
Positron emission tomography (PET):
1. Supporting patients and families
• Measures glucose metabolism in
through anxiety and apprehension
caused by tests tissues
• Malignant tissues show high
2. Clearly explaining the rationale for
uptake of radioactive glucose
tests to reduce fear
compounds.
Laboratory Tests Other Radiographic Tests
Used to diagnose organ malfunctions or Barium enema: Uses contrast media to
metabolic aberrations caused by cancer outline structures
Common tests include: Nuclear medicine procedures: Scan
1. Complete blood count (CBC) organs after radiolabeled material
2. Serum chemistry profile administration
3. Examination of body fluids: e.g., Diseased organs → Abnormal uptake of
sputum, urine (for blood) radioisotopes
Invasive Diagnostic Techniques Biotherapy (Immunotherapy)
Focus: Manipulating the immune system
Biopsy to fight cancer
Gold standard for diagnosing cancer Uses: Alone or combined with surgery,
Types of biopsies chemotherapy, and radiotherapy
1. Aspiration (Needle) Biopsy
a. Removes a small plug of tumor Biotherapy Classifications
using a needle 1. Cytokines (e.g., interferons,
b. Pros: Inexpensive, outpatient- interleukins, growth factors)
friendly 2. Monoclonal Antibodies (MABs)
c. Cons: Risk of missing 3. Cellular Therapies (e.g., lymphokine-
malignant focus or "seeding" activated killer cells)
tumor cells 4. Immunomodulators (e.g., vaccine
2. Incisional Biopsy: Surgical removal of therapies)
a section of the tumor 5. Retinoids (Vitamin A derivatives
3. Excisional Biopsy: Removal of the stimulating cell differentiation)
entire tumor (used for small tumors)
Key Biotherapy Agents
Biopsy analysis provides 1. Interferons (IFNs):
1. Histologic diagnosis ➢ Proteins produced in response to
2. Identification of cytologic features viral infections
➢ Types: Alpha, Beta, Gamma
Cytogenetic Abnormalities ➢ Function: Alter cellular
Used for diagnosis and prognosis metabolism, inhibit oncogenes,
Examples and activate natural killer cells
1. Philadelphia chromosome: Chronic ➢ Used for: Hairy cell leukemia, CML,
myelogenous leukemia (CML) Kaposi’s sarcoma, melanoma
2. t(15;17), t(8;21): Acute myelogenous ➢ Side Effects: Flu-like symptoms
leukemia → Good prognosis (fever, chills, malaise)
3. HER-2/neu receptor: Breast cancer
marker 2. Interleukins (ILs):
➢ Stimulate immune cells and
Endoscopy cytokines
Fiberoptic tubes with light sources used ➢ IL-2: Used for renal cell cancer and
to inspect body cavities melanoma
Types of endoscopies ➢ Side Effects: Capillary leak
1. Laparoscopy: Inspects the liver, syndrome (tachycardia, hypotension,
diaphragm, peritoneum, and edema), neurologic, renal, and
abdominal structures hepatic toxicities
2. Other scopes can examine GI,
gynecologic, and genitourinary 3. Hematopoietic Growth Factors (HGFs):
structures ➢ Stimulate blood cell development
Types:
Biopsy specimens or secretions can be 1. G-CSF: Promotes neutrophil growth
obtained during endoscopic procedures 2. GM-CSF: Promotes neutrophils,
eosinophils, macrophages
Medications and Treatments for 3. Erythropoietin (EPO): Treats anemia in
Cancer renal disease and chemotherapy
General Treatment Approaches 4. IL-11: Stimulates platelet production
• Treatment Determinants: Based on but causes fluid imbalance and
patient characteristics, cancer cardiac arrhythmias
specifics, and quality/quantity of
life considerations 4. Monoclonal Antibodies (MABs)
• Treatment Modalities: ➢ Produced using hybridoma
1. Surgery techniques
2. Radiotherapy Examples:
3. Chemotherapy 1. Rituximab: Treats B-cell
4. Biologic Therapy lymphomas by targeting CD20
(Immunotherapy) antigens
5. Multimodality Therapy 2. Trastuzumab (Herceptin): Treats
(combination of treatments) HER-2 positive breast cancer
➢ Side Effects: Fever, chills, infusion-
related reactions, bronchospasm,
and hypotension
 Adverse Effects of Biotherapy Collection Methods:
Common Side Effects ➢ Bone marrow harvesting from iliac
• Flu-like symptoms (fever, chills, crests
headache, malaise) ➢ Peripheral stem cell collection using
• Fatigue (cumulative over time) plasmapheresis
• Neurologic Toxicities: Anxiety, Complications
depression, somnolence, mental status 1. Mucositis, myelosuppression,
changes organ toxicities
• Cardiovascular Toxicities: Arrhythmias, 2. Graft-Versus-Host Disease (GVHD)
hypotension (common with IL-2 therapy) in allogeneic transplants
• Fluid Retention: Peripheral/pulmonary
edema (vascular leak syndrome) Supportive Care: Requires antibiotics,
• Gastrointestinal Issues: Anorexia, blood products, and growth factors
nausea, diarrhea during engraftment

Nursing Management Surgical Management of Cancer

✓ Administer acetaminophen or NSAIDs Surgery as Oldest Cancer Therapy
(avoid aspirin for bleeding risks). ➢ Used for diagnosis, staging, cure,
✓ Manage fatigue with energy palliation, control of emergencies,
conservation strategies and stress- and adjuvant treatment
reducing activities. ➢ Modern trends: minimally invasive
✓ Monitor mental status, fluid balance, approaches, ambulatory procedures,
and administer antiemetic/antidiarrheal multimodality treatment plans
medications
Role in Diagnosis and Staging
Gene Therapy ➢ Surgical biopsy confirms cancer,
Focus: Correcting genetic mutations identifies histology, and checks for
responsible for cancer metastasis
Methods
• Inserting new genes to compensate Curative Surgery
for defective ones ➢ Tumors must be small, localized, and
• Retroviral agents used to integrate fully removable
new genes into the genome. ➢ Wide tissue margins and lymph node
dissections reduce recurrence
Examples ➢ Benefits weighed against prolonged
1. ATRA: Treats Acute Promyelocytic recovery and disfigurement
Leukemia (APL) ➢ Conservative techniques: cryosurgery,
2. Gleevec: Treats CML and laparoscopic approaches, and adjuvant
gastrointestinal stromal tumors by therapies (chemo/radiotherapy)
inhibiting abnormal enzymes
Example: Early Breast Cancer Surgery
Molecular Targeted Therapies ➢ Lumpectomy + radiotherapy replaces
Function: Stop tumor growth by targeting radical mastectomy
specific molecular pathways ➢ Sentinel node biopsy (less invasive)
Examples reduces need for full axillary
• Gefitinib (Iressa): Effective against non- dissections
small cell lung cancer, breast cancer, and
solid tumors Palliative Surgery
• Erlotinib (Tarceva): Used for pancreatic ➢ Reduces tumor bulk, stabilizes
cancer fractures, or relieves symptoms
• Angiogenesis Inhibitors: Block blood ➢ Focus on improving quality of life
vessel development (e.g., Thalidomide Examples
for multiple myeloma) 1. Jejunostomy (nutritional support)
2. Tracheostomy (airway obstruction)
Bone Marrow and Stem Cell 3. Colostomy (bowel obstruction)
4. Laminectomy (spinal cord
Transplantation compression)
Purpose: Replace diseased marrow/stem
cells or protect healthy cells during
intensive therapy Supportive Surgery
Types of Transplants ➢ Placement of vascular access for
1. Syngeneic: Identical twin donor chemo
(perfect HLA match) ➢ Placement of internal radiotherapy
2. Allogeneic: Related/unrelated donor applicators under anesthesia
(HLA matched or unmatched)
3. Autologous: Patient’s own marrow or
stem cells
 Reconstructive Surgery Genetic Counseling
➢ Improves body function and • Assesses hereditary cancer risks.
appearance (e.g., breast and facial • Ethical/legal issues: informed
reconstructions) consent, confidentiality,
insurance/employment discrimination
Pre-Surgical Considerations
• Assess physical and emotional status: Secondary Prevention
age, nutrition, diagnostics, comorbidities • Aimed at early diagnosis and
• Educate patients about postoperative treatment
care and equipment (catheters,
monitors, etc.) Effective Screening Tools
1. Mammograms, Pap smears (breast
Post-Surgical Focus and cervical cancer)
Prevent complications 2. PSA testing and digital rectal exam
➢ Infection risk (immunocompromised (prostate cancer)
patients) 3. Fecal occult blood test and
• Teach infection signs, asepsis, colonoscopy (colorectal cancer)
and restrict visitors with illnesses
➢ Clotting risks: hypercoagulability, Barriers to Screening
thrombosis, and thrombophlebitis. • Cost, lack of transport, cultural
• Address patient/family questions diversity, and health system gaps.
about outcomes (e.g., "Was it
cancer?") Patient Education
➢ Psychosocial Impact Women
✓ Perform monthly breast self-
• Body image issues post-surgery
exams (BSE).
(e.g., mastectomy, colostomy)
✓ Report abnormal vaginal
• Depression: mood changes,
bleeding/discharge
appetite, sleep disturbances,
✓ Routine GI and gynecologic
sexual dysfunction
screenings
• Support groups recommended for Men
emotional support and ✓ Screening for colorectal and
adjustment prostate cancers
✓ Testicular self-exams (ages 15–
Diet and Cancer 40)
Dietary Role in Cancer Older Adults
• Diet affects cancer incidence globally ✓ Address fears, chronic
(protective vs. promoting role). illnesses, and financial
• Focus areas: high-fat diet, obesity, concerns.
alcohol consumption, and low ✓ Encourage participation in
fiber intake screenings tailored to their needs

Diet in Cancer Treatment Radiotherapy

• Maintains nutrition and manages
Definition: Use of radiation to treat
treatment-related side effects diseases, primarily cancer
History
Health Promotion and • X-rays discovered in 1895
Prevention • Radium discovered in 1898
Primary Prevention Uses
• Reduces exposure to known risk • Single, curative modality
factors: • Palliative measure for metastatic
1. Tobacco: Smoking cessation disease
interventions, pharmacotherapy (nicotine • Combined with chemotherapy and
products, bupropion) surgery
2. UV Exposure: Sunscreen SPF 15+,
avoid tanning beds, and limit sun Radiation Physics
exposure Ionizing Radiation: Energy capable of
3. Colon Cancer: Healthy weight, dietary breaking chemical bonds, causing
changes, physical activity, and polyp cellular damage or cell death
removal Types
4. Chemoprevention: Use of agents like Electromagnetic
tamoxifen (breast cancer) and NSAIDs ➢ X-rays (produced by machines) and
(colon cancer) Gamma rays (emitted by radioactive
5. Vaccination: HPV vaccines reduce materials)
cervical cancer risk ➢ Penetrate deep tissues before
releasing energy
• Particulate Radiation Medications:
➢ Includes electrons, neutrons, • Radiosensitizers: Enhance radiation
and alpha particles effects
➢ Releases energy close to the • Radioprotectors: Protect normal
tissue surface tissues
• Measurement Preparation
Units: Grays (Gy) or centigrays (cGy) • Simulation Phase: Target area
➢ Previously measured in rads (port) marked with ink/tattoos
• Immobilization devices used for
Radiation Biology accuracy
Mechanism of Action: • Photographs and treatment
• Damages DNA directly or documentation ensure consistency
interferes with cellular repair and
reproduction 2. Internal Radiation (Brachytherapy):
➢ Radioactive sources placed
Radiosensitivity inside the body
Cells' susceptibility to radiation injury Types
Most Sensitive Cells 1. Sealed Brachytherapy
1. Cells in mitosis (M phase) Radioactive sources (seeds, needles,
2. Rapidly proliferating tissues: bone wires) implanted in the tumor
marrow, skin, gastrointestinal tract Techniques
• Low-Dose Rate (LDR): Radioactive
Hypoxia and Resistance material left in place for hours/days
Hypoxic tumor cells are radioresistant, • High-Dose Rate (HDR): Radiation
requiring 3x the radiation of oxygenated loaded remotely; treatment lasts minutes
cells • HDR is outpatient-friendly; no
hospitalization needed
Fractionization
➢ Dividing total radiation dose into 2. Unsealed Brachytherapy
smaller doses over weeks • Radioactive isotopes administered
➢ Allows normal cells to repair damage orally, intravenously, or instilled
while targeting cancer cells into body cavities
• Example: Iodine-131 for thyroid
Accelerated Fractionization cancer
Two or more treatments per day
Safety Risks
Split Course Therapy ✓ Exposure via body fluids (urine,
Radiation is paused for 1–2 weeks to feces, sputum, wound drainage, etc.).
allow: ✓ Caregivers follow radiation safety
• Repair of normal cells protocols
• Tumor cells to enter a more
radiosensitive phase
Radiation Safety
Sealed Brachytherapy: Radiation safety
Types of Radiotherapy depends on isotope, dose, and exposure
1. External Radiation (Teletherapy): Unsealed Brachytherapy: Caregivers
➢ Radiation directed from an need protection from external and
external source internal exposure
➢ Uses: Alone or combined with
surgery/chemotherapy Common Isotopes:
✓ Curative: Skin, oral cavity, • Iodine-131, Phosphorus-32, and
larynx, cervix, prostate, Gold-198
Hodgkin’s disease
✓ Preoperative: Reduces
tumor size, eradicates
subclinical disease, but
delays wound healing
✓ Postoperative: Targets
residual disease, but requires
wound healing first

Specialized Techniques:
➢ Stereotactic Radiosurgery:
Single high-dose radiation for
small tumors (e.g., gamma knife)
 Treating Tobacco Use and Weight Management
• Maintain a healthy weight
Dependence: A Guide for All throughout life:
Clinicians ➢ Balance food intake with
For Tobacco Users Willing to Quit physical activity
• Implement the "5 As": ➢ Lose weight if overweight
1. Ask about tobacco use
2. Advise all users to quit Limit Alcohol Intake
3. Assess willingness to make a • Drink in moderation, if at all
quit attempt
4. Assist the patient with a quit plan: Protection of Health Care
▪ Set a quit date
▪ Provide practical Professionals from Radiation
counseling Hazards
▪ Identify social supports. Radiation Safety Measures:
▪ Recommend approved ➢ Shield radiation treatment
pharmacotherapy. rooms with concrete and lead
▪ Provide supplemental walls; no entry during treatment
materials. ➢ Internal radiation (gamma rays)
5. Arrange scheduled follow-up requires careful exposure time
appointments management.
Exposure Control:
For Tobacco Users Unwilling to Quit • Time: Minimize time spent with the
• Implement the "5 Rs": patient
1. Relevance: Explain why • Distance: Apply the inverse-
quitting is personally relevant square law:
2. Risks: Highlight the risks of • At 2 m, exposure is 1/4
tobacco use compared to 1 m
3. Rewards: Identify the • At 4 m, exposure is 1/16
rewards of stopping tobacco • Shielding:
use ➢ Lead gloves and aprons are
4. Roadblocks: Identify barriers insufficient for gamma rays
to quitting ➢ Shields act as reminders for
5. Repeat: Address at every safe exposure management
opportunity
Safety Procedures
For Former Smokers ✓ Use lead-lined rooms for implant
• Implement relapse prevention patients
strategies: ✓ Wear dosimetry badges to monitor
➢ Discuss benefits of cessation radiation exposure
➢ Emphasize their success in ✓ Rotate care among nurses; no pregnant
quitting staff are assigned
➢ Address problems or threats ✓ Hospitals must designate a radiation
encountered safety officer for precautions and staff
education
Guidelines on Nutrition and ✓ Post printed radiation precautions on
Physical Activity for Cancer the patient’s door
Prevention
Nutrition Side Effects of Radiotherapy
• Choose plant-based foods: Site-Specific Side Effects:
✓ Eat five or more servings of • Acute toxicities (days to weeks):
fruits and vegetables daily Skin, bone marrow, GI mucosa, and
✓ Choose whole grains over vagina are affected.
processed grains and sugars • Late toxicities (months to years):
✓ Limit intake of red meat and Blood vessel/connective tissue
high-fat meats injuries → cataracts, pulmonary
Physical Activity fibrosis, strictures.
• Adopt a physically active lifestyle:
✓ Be moderately active for 30 Common Reactions
minutes on 5 or more days per Skin Reactions
week • Progression: Erythema → dry
✓ Activities lasting 45+ minutes desquamation → moist
on 5 or more days further reduce desquamation
risks of breast and colon cancers • Skin folds (axilla, groin) are more
prone to damage
Children: Exercise for 60 minutes on 5 or • Alopecia in treatment areas after 3
more days per week weeks
Long-term Effects: Ulceration, fibrosis, Nursing Diagnosis: Risk for Infection
atrophy Nursing Interventions
Fatigue: Cumulative fatigue worsens over ✓ Monitor WBCs, RBCs, and platelets
time, significantly affecting quality of life. regularly
Bone Marrow Suppression: Radiosensitive ✓ Assess for early signs of infection,
marrow → risk for anemia, infection, and anemia, and bleeding
bleeding. ✓ Educate patients on infection
Secondary Malignancies: Rare but include prevention:
leukemia, skin cancer, lymphoma, sarcoma • Meticulous personal
hygiene and frequent
Nursing Management of the handwashing
Patient Receiving Radiotherapy • Avoid contact with
Nursing Diagnosis: Risk for Impaired individuals with active
Skin Integrity infections
Nursing Interventions ✓ Manage infections, anemia, and
✓ Keep skin clean, dry, and protected
bleeding with:
✓ Provide written skin care instructions • Antibiotics, blood
and verify understanding transfusions, and growth
✓ Manage moist desquamation with factor support
prescribed ointments and dressings ✓ Address pelvic radiation side effects:
✓ Support patients experiencing hair • Encourage high fluid intake
loss (scalp care, emotional support) and specific hygiene
practices to manage
Nursing Diagnosis: Fatigue cystitis, urethritis, and
Nursing Interventions: vaginitis
✓ Assess fatigue severity and impact
using tools (e.g., Karnofsky Scale,
ECOG scale).
✓ Address treatable causes (e.g.,
anemia, malnutrition, pain).
✓ Encourage:
• Rest periods and adequate sleep
• Mild daily exercise or activity plans
• Relaxation and distraction
techniques

Nursing Diagnosis: Risk for Imbalanced

Nutrition: Less Than Body Requirements
Nursing Interventions:
✓ Monitor weight weekly and assess for
malnutrition
✓ Encourage a high-calorie, high-
protein, and high-carbohydrate
diet
Manage treatment-related symptoms:
1. Nausea/Diarrhea
• Use antiemetics and antidiarrheal
agents
• Recommend a low-residue diet
• Assess fluid and electrolyte
balance
2. Mucositis
• Use mouth rinses (salt/peroxide)
• Avoid spicy, acidic foods, alcohol,
and tobacco
• Implement pain management (local
anesthetics/systemic analgesics)
3. Xerostomia (dry mouth)
• Recommend artificial saliva and
mouth care strategies
• Use dietary modifications for
swallowing difficulties
• For severe cases, consider enteral
feeding (e.g., feeding tube)
 Chemotherapy Combination Chemotherapy
Role in Cancer Treatment Superior to single-agent therapy for many
➢ Used for cure, long-term control, cancers
or palliation to shrink tumors Benefits
➢ Effective for complete tumor cell 1. Maximal tumor kill by targeting cells in
eradication when the malignant cell multiple ways
population is small and susceptible 2. Reduces the risk of drug resistance
➢ Often used in combination regimens
and as adjuvant therapy to destroy Drugs in combination chemotherapy must:
micrometastases and prevent • Be active when used alone
recurrence • Have different mechanisms of action
• Produce toxicity in different organs
Adjuvant Chemotherapy • Show toxicity at different times after
• Administered alongside surgery or administration
radiotherapy.
• Targets micrometastases that are Dose Intensity
too small to detect • Chemotherapy is most effective when
delivered in sufficient doses within a
Drug Approval Process specified timeframe
• Drugs undergo a rigorous screening • Toxicity can disrupt treatment, leading to
process coordinated by the National dose reductions or delays
Cancer Institute: • Hematopoietic growth factors are used to
• Tests for antitumor activity maintain dose intensity for curative
• Determines pharmacokinetics, regimens
dosing, adverse effects, and
toxicity Tumor Resistance to
Drugs proceed through 4 phases of Chemotherapy
clinical trials Primary Resistance: Genetic resistance
• Phase 1: Identify toxic reactions, present before treatment begins.
optimal dose, and schedule Secondary Resistance: Acquired during
• Phase 2: Determine antineoplastic treatment due to genetic alterations
activity (mutations, deletions, or translocations)
• Phase 3: Compare the new drug to Multiple-Drug Resistance (MDR): Tumors
standard treatments become resistant to multiple agents
• Phase 4: Study effects on advanced during combination therapy
cancer and in combination therapy
Chemotherapeutic Agents
Principles of Chemotherapy Classifications:
Mechanism of Action • Alkylating agents
➢ Interrupts cell growth and • Antimetabolites
replication at various phases of the • Plant (vinca) alkaloids
cell cycle • Antitumor antibiotics
➢ Cell cycle-specific drugs: Act • Steroids
during specific phases
➢ Phase-nonspecific drugs: Act General Effects
throughout the cell cycle • Chemotherapy injures normal cells
(e.g., bone marrow, GI epithelium, hair
Cell Population Growth follicles)
➢ Chemotherapy is most effective when • Side effects: fatigue, organ toxicities,
tumors are small and growing rapidly and unique drug-specific effects
➢ Phase-specific drugs: Effective for
rapidly dividing cells Bone Marrow Effects
➢ Phase-nonspecific drugs: Effective for Myelosuppression: Toxic to bone marrow,
slower-growing tumors leading to:
• Neutropenia (↓ neutrophils):
Cell-Kill Hypothesis risk of infection
• Chemotherapy kills a fixed percentage of • Thrombocytopenia (↓ platelets):
cancer cells with each treatment risk of bleeding
• Repeated cycles aim to reduce cancer • Anemia (↓ RBCs): fatigue,
cells to a level manageable by the immune tachycardia, dizziness, dyspnea
system
• Rationale for multiple treatment courses Nadir
over time • Lowest WBC, RBC, and platelet
levels occur 7–10 days post-
administration
 Infection Risks Sexual Dysfunction
➢ Leading cause of Ovarian Effects:
morbidity/mortality • Germinal epithelium damage;
➢ Sites: oropharynx, lungs, urinary altered fertility
tract, skin • Women <30: likely to regain ovarian
➢ Neutrophil count < 1000/mm³ = function
critical risk for septic shock • Perimenopausal women: may enter
menopause (estrogen depletion)
Stomatitis Testicular Effects:
• Inflammation of oral mucous ➢ Susceptible to damage due
membranes to constant mitosis
• Peak effect: 7–10 days after ➢ Decreased sperm
treatment production and
abnormalities
Bleeding Risk Recovery:
• Platelet count < 50,000/mm³ • Fertility may return depending on
• Can cause bruising, nosebleeds, drug and dose
or severe hemorrhages
Anemia Symptoms: Hypersensitivity Reactions
• Fatigue, headache, tachycardia, Precautions: premedication, frequent
angina, dizziness, dyspnea monitoring, emergency protocols

Gastrointestinal Effects Specific Organ Toxicities

Nausea/Vomiting Heart
• Direct activation of chemoreceptor • Anthracyclines → cardiotoxicity
trigger zone (e.g., ECG changes, heart failure)
• Secretion of serotonin antagonists Lungs
stimulates vomiting center • Bleomycin → pulmonary fibrosis
• Factors: vagus nerve, CNS triggers, • Other drugs: lung toxicities (e.g.,
psychological distress, vestibular cyclophosphamide)
issues Liver
Types • Hepatotoxicity with higher doses.
• Acute (peaks within 12 hours) Kidneys
• Delayed (lasts 2–5 days) • Nephrotoxicity: cisplatin, high-dose
• Anticipatory (conditioned response) methotrexate
Bladder
Other GI Effects • Hemorrhagic cystitis:
1. Constipation and diarrhea cyclophosphamide, ifosfamide
Causes: direct drug effects, altered
diet/activity, opioids, surgeries Prevention (Cryoprotectants)
2. Risk of infection and bleeding in the GI 1. Dexrazoxane (Zinecard):
tract cardioprotective (doxorubicin)
2. Mesna (Mesnex): protects
Alopecia (Hair Loss) bladder (ifosfamide)
Effects 3. Amifostine (Ethyol): protects
• Hair loss begins 2–3 weeks after multiple organs
therapy
• Reversible; regrowth occurs 1–2 Chemotherapy Administration
months post-treatment Nurse Role:
• New hair may differ in • Requires formal chemotherapy
texture/thickness education/certification
Safety:
Fatigue • Risk of carcinogenicity,
Causes teratogenicity, and exposure
• Altered cellular metabolism and (OSHA guidelines).
accumulation of cellular debris Dosing:
• Bone marrow suppression leading to • Based on body surface area (BSA
anemia = height + weight)
• Physical, emotional, and social Routes:
changes from cancer/therapy • Oral, subcutaneous, intramuscular,
Impact intravenous, topical
• Weakness, exhaustion, inability to • Direct instillation: bladder,
perform daily activities peritoneum, CSF (intrathecal), or
• Not relieved by rest tumor site
 Intravenous Drug • Identify and Treat Infections:
✓ Monitor for atypical signs of
Administration infection in neutropenic
Common Route: IV
patients (e.g., fever, mild
tenderness)
Venous Access Devices (VADs)
✓ Consider fever >101°F as a
Types
medical emergency; initiate
• Peripheral IV lines (short-term)
immediate treatment
• Central VADs (long-term):
✓ Perform physical and lab
1. Tunneled and cuffed: long-term use,
exams to identify infection
reduces infection risk
sites
2. Implanted Ports: subcutaneous
✓ Administer antimicrobial
reservoir, accessed via needle
therapy and WBC growth
3. Peripherally Inserted Central
factors (e.g., G-CSF, GM-
Catheters (PICCs):
CSF)
• Inserted into peripheral veins,
• Mucous Membrane Care:
advanced to central veins
✓ Inspect the mouth for
dryness, ulcerations, and
Complications
infections
• Infection (local/systemic)
✓ Start a cleansing, hydrating
• Thrombosis (blood flow
mouth care regimen early
obstruction)
✓ Manage infections (e.g.,
• Occlusion and air embolism
candidiasis, herpes) and
provide analgesics for
Vesicants
mucositis pain
• Drugs causing tissue damage if
✓ Encourage nutritional therapy
extravasation occurs
if oral intake is limited
• Treatment: heat/cold application and
antidotes
Nursing Diagnosis: Risk for Injury
• Monitor Bleeding Risk:
Chemotherapy in the Home ✓ Assess for bleeding signs
Pump Systems: and test for occult blood in
• External pumps: portable for fluids/excretions.
patient mobility ✓ Monitor platelet count;
• Implantable pumps: inserted platelet count <10,000/mm³
similarly to ports, subcutaneous requires prompt
drug injection transfusion
• Prevent Bleeding:
Complications ✓ Implement bleeding
• Seroma formation over the pump precautions (e.g., avoid
pocket (fluid accumulation) invasive procedures, use soft
toothbrushes)
Nursing Management of the ✓ Administer platelet
Patient Receiving transfusions safely and
monitor for transfusion
Chemotherapy reactions
Nursing Diagnosis: Risk for Infection Nursing Diagnosis: Fatigue
• Maximize Patient Defenses: • Manage Energy Levels:
✓ Educate the patient on ✓ Develop energy-conserving
infection risk, signs, and strategies and plan rest
symptoms periods
✓ Teach proper use of a ✓ Encourage balancing
thermometer and when to activity and rest throughout
report fever (>101°F/38.5°C) the day.
✓ Encourage good personal • Promote Independence:
hygiene (skin and mouth care) ✓ Assist with self-care and
• Minimize Infection Sources: encourage participation in
✓ Avoid contact with infected family, work, and social
individuals activities
✓ Hand hygiene for ✓ Engage family in reducing
caregivers before patient patient’s energy demands
contact • Address Anemia:
✓ Follow protocols for VAD, ✓ Monitor for anemia
wound, or tube care symptoms (dyspnea,
tachycardia, headaches
Nursing Diagnosis: Risk for Imbalanced • Neuropathic pain: Nerve fiber or
Nutrition: Less Than Body Requirements CNS involvement (e.g.,
• Address Gastrointestinal Side peripheral neuropathy)
Effects: 2. Therapy-related pain:
✓ Manage nausea, vomiting, • Diagnostic procedures,
diarrhea, or constipation postoperative pain,
with dietary strategies and chemotherapy-induced mucositis
medications. 3. Other conditions unrelated to
✓ Provide antiemetics before, cancer (e.g., arthritis, migraines).
during, and after Goal of Pain Management:
chemotherapy. • Enable patients to maintain normal
• Prevent Malnutrition: daily activities with minimal
✓ Monitor weight, fluid discomfort
balance, and nutritional
status regularly Pain Management Strategies
✓ Encourage high-calorie, Pharmacologic Therapies
high-protein diets with small, • Mild pain: NSAIDs, nonopioids, and
frequent meals adjuvant drugs
✓ Suggest oral care to relieve • Moderate to severe pain: Opioids,
mouth discomfort and rest often combined with nonopioids and
periods before meals adjuvants
• Support Hydration: Principles include:
✓ Encourage increased fluid 1. Use the least invasive route
intake to address fluid losses 2. Maintain around-the-clock
✓ Provide IV rehydration for administration for consistent
severe fluid deficits blood levels
• Advanced Interventions:
✓ Recommend oral Nonpharmacologic Therapies
supplements or enteral • Relaxation, diversion, meditation,
feedings for severely limited hypnosis, imagery
intake. • Heat/cold therapy, cutaneous
✓ Use total parenteral stimulation, and massage
nutrition if gastrointestinal
feeding is not tolerated. Challenges in Pain Management:
• Fear of addiction
Nursing Diagnosis: Disturbed Body
• Lack of understanding of pain
Image
management regimens
• Alopecia Management:
✓ Provide resources for wigs, • Limited financial and
scarves, or caps before hair supportive resources
loss occurs
✓ Reassure patients that hair Nursing Role
• Assess, intervene, and evaluate pain
loss is temporary and will
regrow after treatment management
• Educate patients and families on
opioid safety, addressing tolerance vs.
Cancer Pain dependence concerns
Pain in Cancer Patients
• Pain is one of the most feared
cancer symptoms but often
Complementary and Alternative
appears late in disease Therapies for Cancer
progression Complementary therapies: Used
Pain Prevalence alongside medical treatments to improve
• 30% of patients experience pain well-being
during treatment Examples: Massage, aromatherapy,
• 90% of patients experience pain as relaxation therapy, meditation, yoga
cancer progresses and
metastasizes Alternative therapies: Often outside
Western medicine practices
Sources of Cancer Pain: Examples: Acupuncture, herbal remedies,
1. Tumor-related pain homeopathy
• Somatic pain: Tumors
infiltrating muscles, bones, Nursing Considerations
blood vessels (e.g., bone • Include questions about these
metastases) therapies during patient assessments
• Visceral pain: Organ • Many patients use complementary
involvement (e.g., pancreatic therapies (>50%) alongside prescribed
cancer) treatments.
• Some therapies may be harmful (e.g.,
herbs increasing bleeding risks)
• Provide information in a nonjudgmental
manner to help patients make informed
choices

Oncologic Emergencies
Types of Emergencies
• Obstructive emergencies:
1. Spinal cord compression
2. Superior vena cava syndrome
3. Tracheal or bowel obstruction
4. Increased intracranial
pressure
• Metabolic crises:
1. Hypercalcemia
2. Tumor lysis syndrome
3. Syndrome of Inappropriate
Antidiuretic Hormone (SIADH)
4. Hyperviscosity, disseminated
intravascular coagulation
(DIC)

Nursing Role
• Identify at-risk populations
through early assessments
• Detect early signs of emergencies
and ensure timely treatment
• Support patient transfer to
intensive care if needed for
monitoring and treatment
• Provide emotional support and
ensure continuity of care

Resources for Cancer

Education, Detection, and
Treatment
Role of Technology in Cancer Care:
• Patients are more informed due to
immediate access to information
(e.g., websites, printed materials).
• Nurses must be equally informed to
answer patient questions effectively
Oncology-related Organizations:
• Provide free and up-to-date cancer
information for patients and
healthcare providers