Male Reproductive Disorder

SN3712 Medical & Surgical Nursing II

Intended learning outcomes

 By the end of this lecture, students should be able to …

 provide nursing care to people with common male reproductive disorder in
psychiatric hospital
 Describe the basic anatomy & function of male reproductive system
 Describe the sign & symptoms of some common male reproductive disorder
 Provide basic nursing assessment, intervention & evaluation to people with
common male reproductive disorder
Anatomy of male reproductive system
Function of different parts of male
reproductive organ
Erectile Dysfunction (ED) （!!!)
 Erectile dysfunction is defined as the persistent inability to attain and
maintain an erection sufficient enough to permit satisfactory sexual
performance
 The term impotent is used mainly when describing men who
experience erectile failure during attempted intercourse more than
75% of the time
 A normal penile erection is caused by one or two main mechanisms:
Reflex erection or psychogenic erection
 Increasing age is the main risk associated with developing ED
Causes of Erectile dysfunction (!!!)
Clinical Manifestation

 Erectile dysfunction symptoms might include persistent:

 Trouble getting an erection
 Trouble keeping an erection
 Reduced sexual desire
 ED Vs mental health
 Themain psychopathological disorders that interfere
directly with the erectile mechanism are
 depressive disorders (18–35%),
 anxiety disorders (37%),
 obsessive–compulsive disorder, psychotic disorders
(46–47%),
 andthe antipsychotic medications used to treat
these disorders.

(Farre & Lasheras, 2004)

Physiology of Penile erectile
Neurophysiology of Penile erectile
 The penile erectile tissue, specifically the cavernous smooth musculature
and the smooth muscles of the arteriolar and arterial walls, plays a key
role in the erectile process. In the flaccid state, these smooth muscles
are tonically contracted, allowing only a small amount of arterial flow for
nutritional purposes.
 Sexual stimulation triggers release of neurotransmitters from the
cavernous nerve terminals. This results in relaxation of these smooth
muscles and the following events:
 Dilatation of the arterioles and arteries by increased blood flow in both
the diastolic and the systolic phases
 Trapping of the incoming blood by the expanding sinusoids
 Compression of the subtunical venular plexuses between the tunica
albuginea and the peripheral sinusoids, reducing the venous outflow
 Increase of intracavernous pressure which raises the penis from the
dependent position to the erect state (the full-erection phase)
 A further pressure increase with contraction of the ischiocavernosus
muscles (rigid-erection phase)
 Assessment

(Miller, 2000)
 International Index of
Erectile Function

International index of erectile

function is a validated tools for
screening ED.

(Rosen, 1997)
 International Index of Erectile Function
 IIEF assessment is limited by the superficial assessment of psychosexual background and the
very limited assessment of partner relationship, both important factors in the presentation
of male sexual dysfunction. Analysis of the questionnaire should, therefore, be viewed as
an adjunct to, rather than a substitute for, a detailed sexual history and examination. The
following guide-lines may be applied:

 1. Patients with low IEEF scores (<14 out of 30) in Domain A (Erectile Function) may be
considered for a trial course of therapy with Sildenafil unless contraindicated. Specialist
referral is indicated if this is unsuccessful.
 2. Patients demonstrating primary orgasmic or ejaculatory dysfunction (Domain B) should
be referred for specialist investigation.
 3. Patients with reduced sexual desire (Domain C) require testing of blood levels of
androgen and prolactin.
 4. Psychosexual counselling should be considered if low scores are recorded in Domains D
(Intercourse satisfaction) and E (Overall satisfaction) but there is only a moderately
lowered score (14 to 25) in Domain A.
Management - Medication
 1st line treatments –
 Phosphodiesterase 5 (PDE5) inhibitors: -
 Sidenafil (Viagra) ~ short half-lives (4-6 hrs)
 Vardenafil (Levitra) ~ short half-lives (4-6 hrs)
 Tadalafil (Cialis) ~ half-lives (16-18 hrs)
 PDE5 inhibitors work only in the presence of sexual stimulation.
 All these medications are effective 30 to 60 minutes after a dose
 2nd line treatment
 Alprostadil (Caverject) is available as both an intracavernous injection and a
transurethral formulation.
 Sidenafil & Vardenafil users may experience changes in color vision
especially seeing objects and surroundings as being blue-green in color

Belavic (2010)
 Management (Medication)
Urethral suppository:
It contains a medication that works like
the injection.

A small suppository is inserted into the

urinary tube using an applicator,
delivering the medication directly into
the blood stream.

The medication in the suppository relaxes

the blood vessels in the penis, allowing
blood to flow into the penis, creating an
erection.

Produces an erection within 10 minutes,

which can last 30 minutes – 1 hour
Penile Implant

 www
Premature Ejaculation (PE)

 A condition in which the occurrence of ejaculation sooner than

desired, either before or shortly after penetration, causing distress to
either one or both partner (AUA, 2004)
 Alternatively, it is a lack of control over ejaculation and on a
frequent basis, has difficulty lasting or withholding their
ejaculation for a desired time.
 WHO defined Premature Ejaculation” as:
 “The inability to delay ejaculation sufficient to enjoy lovemaking,
manifested by either an occurrence of ejaculation before or very
soon after the beginning of intercourse or ejaculation occurring in
the absence of sufficient erection to make intercourse possible.”
Premature Ejaculation (PE)
 A typical sexual intercourse usually last from 12-20 minutes and
on an average women need more than 10 minutes to achieve an
orgasm.
 If a men ejaculate before their partner achieves orgasm then
he is a premature ejaculator.
 This condition varies in between men, some men ejaculates few
minutes into foreplay, some lose control before inserting their
penis into the vagina or some right after their first penetration.
 One of the most common complaint of men or couples,
affecting 20-30% of men (Waldinger, 2007)
Physiology of Ejaculation (PE)
 Ejaculation is a spinal reflex under supraspinal control.
 It is a sequential process composed of emission and expulsion.
 Emission refers to the secretion of seminal fluid from the prostate and the
seminal vesicles, contraction of the smooth muscles of the seminal tract
from the epididymis to the prostate to transport the ejaculate, closure of
the bladder neck and the internal urethral sphincter, and the ejection of
sperms into the posterior urethra.
 Expulsion occurs when the semen is forcefully advanced through the
urethral meatus by rhythmic contractions of the pelvic floor muscles and
the bulbospongiosus muscles.
Assessment of PE
 Assessments of PE include measurements of the Intravaginal ejaculation
latency time (IELT) and the Patient reported outcomes (PROs).
 IELT is an objective prospective measurement at-each-coitus using a
stopwatch handled by the female partner.
 PROs assess the subjective components of PE that include control over
ejaculation, satisfaction with intercourse, interpersonal distress or difficulty,
and the patient's perception.
 PROs address both the observable and non-observable aspects of the
condition included in the definitions.
 PROs are typically evaluated by self-completed questionnaires such as the
Premature Ejaculation Profile (PEP).
 Management
 Psychotherapy & sex therapy
 Behavioral, cognitive, and sex therapy are the first line treatment
for Ejaculatory Dysfunction".
 An integrated approach, including a combination of
psychological/behavioural and pharmacologic treatments, may be
most effective because this combined strategy would address both
the psychological and physiological dimensions of PE
 Medical management
 No medication solely indicated and approved for treating PE.
 Current available drug for PE involve the use of serum serotonin
reuptake inhibitors (SSRIs), phosphodiesterase type 5 inhibitor
(PDE5i) and topical anaesthetics.
(Mak, 2009)
Psychotherapy for PE

 Sensate focusing exercises (Masters and Johnson 1966)

 Non-genital gratification
 Genital gratification
 Non-demanding intercourse
 True intercourse
 Other cognitive techniques
 Cognitive restructuring
Management - Meication
 SSRI
 Dapoxetine
 a new short-acting SSRI in development for the on-demand treatment of
PE.
 It is believed to delay the timing of ejaculation via modulation of the
expulsion reflex at a supraspinal level
 Topical agents
 Desensitise the penile skin have been used for the treatment of PE.
 They include lidocaine spray, lidocarine/prilocaine-based cream or spray.
 Although topical agents are simple to use, their applications are limited by
side effects of penile anaesthesia and even female partner vaginal
numbness if the agent is not confined by a condom.
Further information and training in
management of PE
 香港性教育、研究及治療專業協會
 [Link]
Scrotal Disorders

 Hydrocele
 Varicocete (self-study)
 Testicular torsion
 Testicular cancer
 Epididymitis
 Orchitis
Scrotal Disorders
 Hydrocele
 It is a fluid filled sack along the spermatic cord within the
scrotum.
 Body fluid drains incorrectly through the open tract from the
abdomen into the scrotum where it becomes trapped causing
enlargement of the scrotum
 In older men, inflammation or trauma of the testis or
epididymis can also cause hydrocele

 Signs & symptoms

 a painless, swollen scrotum, on one or both sides, that feels like a
water-filled balloon
Management
 Small hydrocele may go untreated without further problem
 However, it can be very large and makes clothing uncomfortable
and may be cosmetically unacceptable
 No treatment is necessary until it is too large and uncomfortable
 Investigations aims at ruling out other severe medical problem
may be prescribed.
 Surgical management is available:
 Needle aspiration,
 Or surgical excision (Hydrocelectomy)
Management (Post-Hydrocelectomy)
 Teach the man that the drainage may be present for the first
24-48 hours
 Use ice pack in first 24 hours to reduce swelling
 Explain the importance of wearing scrotal support
 Keep the scrotum elevated to avoid edema
 The wound pain may start 2-3 hours after surgery and last for
24 hours
 Pain management
 Health education
 The scrotum may keep swollen for few weeks
 Remind him limit physical activity for a week
 Observe for surgical complication
 Hematoma in loose scrotal tissue
 Scrotal injury / infection
Testicular Torsion
 It occurs when a testicle is mobile and the spermatic cord twists, cutting off
the blood supply.
 An emergency requiring immediate surgical intervention where spermatic
cord is untwisted and the testicle is immobilized by suturing to scrotum (need
emergency operation otherwise infertility)
 Without prompt surgery, the testicle may atrophy or develop abscess, and if it
turns necrotic, and hence removal is needed at this stage

 Clinical Manifestation:
 acute testicular pain, exacerbated by sitting, running and sex
 Acute scrotal swelling and severe pain as blood supply to testicles is interrupted
Testicular Cancer

 Most common and serious solid tumor (cancer) in men

between 15 and 35 years of age
 Family Hx, men with HIV positive or cryptorchism
(undescended testicles) are known risk factors
 Medical management:
 Surgical removal of affected testis – orchiectomy
 Radiation therapy
 Chemotherapy
 Clinical manifestation

 Painless enlargement in the testicle

 Heaviness in scrotum, inguinal area or lower abdomen
 Metastasis to retroperitoneal lymph nodes (lymphatic spread)
include back pain, vague abdomen pain, nausea & vomiting,
bowel and bladder changes, anorexia and weight loss
 Distant metastasis occurs most commonly to the lungs (cough,
dyspnea and hemoptysis are noted)
Medical Management

 Radical orchiectomy
 ice bag and scrotal support upon ambulation
 Radiation therapy of perineum and pelvis
 Chemotherapy
Management
 Health Education
 Monthly testicular exam (self-exam) recommended
 Starting from 13 years old – adulthood
 High risk for testicular cancer:
 15–40 years old
 White
 T: Timing, once a month
S: Shower, warm water relaxes scrotal sac
E: Examine, check for changes, report changes immediately
Epididymitis
 Epididymitis
 An inflammation of the epididymis
 Can be the result of infection or non-infection causes such as
trauma
 Infection
 Bacteria (Most common)
 Staphylococcus and [Link] are the common pathogens
 Source of infection can be come from other structure such as
prostate, bladder, or urethra.
 Can be a complication of STD such as gonorrhea or chlamydia
 The infective agents passes upward via the urethra, ejaculatory
duct, vas deferns and then to epididymis
Clinical manifestation

 Pain along the inguinal canal and along the vas deferens
 Followed by pain and swelling in the scrotum and the groin
 Swollen of epididymis & fever may present
 Management
 Surgical management:
 Rule out testicular tumor especially it does not resolve within 1-2 week
 Chronic pain and recurrent epididymis may require epididymectomy
 Medication
 Antibiotics appropriate to the specific micro-organism may be prescribed
 NSAID such as Naproxen or ibuprofen may be used to to reduce inflammation and promote
comfort.
 Analgesic to relieve pain
 Health Education
 Advise patients to wear scrotal support when moving
 Advise patients to apply cold compresses or ice to the scrotum intermittently and taking sitz baths
 Advise him to avoid lifting, straining and sex until the infection is under control.
Orchitis
Orchitis
 Orchitis refers to the inflammation of the testicle.
 Orchitis can occur due to a variety of causes, some of
which include urinary infection, viral illness elsewhere in
the body, minor physical trauma and reaction to
medication
 Possible pathogens are pneumonia, TB, gonorrhea, syphilis,
or mumps
 Usually both testes and the epididymis are involved
 If infection is bilateral, fertility may be at risk
Clinical Manifestation

 Fever
 Scrotal pain
 Edema
 Report of heavy feeling in the involved testes
 Dysuria
 Pain on ejaculation
 Blood in the semen
 Discharge from penis
Management
 Medication
 Antibiotics appropriate to the specific micro-organism may
be prescribed
 NSAID such as Naproxen or ibuprofen may be used to to
reduce inflammation and promote comfort.
 Health Education
 Advise patients to wear scrotal support when moving
 Advise patients to apply cold compresses or ice to the
scrotum intermittently and taking sitz baths
 Advise him to avoid lifting, straining and sex until the
infection is under control
Phimosis (包皮過長)
Phimosis (包皮過長)
 Phimosis is a condition in which the prepuce cannot be retracted over
the glans (陰莖頭) penis.
 It is normally seen in younger children due to adhesions between
prepuce and glans penis.
 Around 96% of males at birth are noticed to have a non-retractile
foreskin. This is due to naturally occurring adhesions between prepuce
and glans.
 The foreskin gradually becomes retractable over a variable period of
time ranging from birth to 18 years of age or more.
 Thus preputial retractability improves with increasing age.
 2% of normal males continue to have non-retractability throughout life
even though they are otherwise normal
(Shahid, 2012)
Clinical Manifestation

 In pathological primroses signs and symptoms can be:

 Pain, skin irritation,
 Local infections,
 Bleeding, dysuria,
 Hematuria, frequent episodes of urinary tract infections,
 Preputial pain, painful erection and intercourse,
 Weak urinary stream

(Shahid, 2012)
 Management

 Surgical management
 Circumcision: removal of the prepuce by surgery
 Health Education
 Sexual intercourse may be resumed after 1-2 weeks
when pain has subsided
Reference
 Black, J. M., & Hawks, J. H. (2009). Medical‐surgical nursing: clinical
management for positive outcomes (8th ed.). St. Louis, MO: Elsevier Saunders.
Oncology Nursing
SN 3712 Medical & Surgical Nursing
Learning objective
By the end of this lecture, students should
•Understand the basic science of cancer
•Understand the scope of practice of oncology nursing
•Recognize current treatment of cancer
No of cancer cases in 2010 & 2020
No of Death Cases due to Cancer in 2010
& 2020
Cancer and Age
Total no of diagnosed cancer in 2020
◦ Male – 16703 (Decreased 5.6% as compared with 2019)
◦ Female – 17476 (Increased 0.5% as compared with 2019)
For the aged 0 – 19:
◦ Most common cancer – Leukaemia (35.9% for male & 28.2% for female)
For the aged 20 – 44:
◦ Most common cancer – Nasopharyngeal cancer (13.8%) for male & Breast cancer (36.7%) for female
For the aged 45 – 64:
◦ Most common cancer – Colorectal cancer (18.4%) for male & Breast cancer (35.7%) for female
For the aged 65 – 74:
◦ Most common cancer – Lung cancer (20.9%) for male & Breast cancer (25.5%) for female
For the aged 75 or older:
◦ Most common cancer – Lung cancer (21.8%) for male & Colorectal cancer (19.7%) for female
Oncology Nursing
Oncology nursing refers to
“... the provision of high quality of care to patients with cancer, their families and the community
we serve. ”
The scope of oncology nursing
“The practice of oncology nursing involves prevention, detection, treatment, rehabilitation and
palliative care.”

(HA Guidelines for Specialty Nursing Services: Clinical Oncology, 2010)

Source: [Link]
Area of expertise of oncology nursing
❖ Radiotherapy nursing
❖ Chemotherapy & hormonal therapy nursing
❖ Biotherapy nursing
❖ Nutritional support
❖ Cancer pain management
❖ Care of patient with oncological emergencies & complications
❖ Palliative care
❖ Haematology & bone marrow transplant nursing
 Role of oncology Nurses
❖ are patients & families advocates.
❖ collaborate with other disciplines to provide personalized patient care in a holistic approach.
❖ coordinate with community to provide continuity of care & support services.
❖ dedicate the care to relieve distressing symptoms & to promote comfort for patients in their
cancer trajectory.
❖ belief that cancer patients should live with quality & die with dignity.
❖ encourage & support the advancement of oncology nursing practice
❖ pursue to provide quality care through evidence-based practice.
Advanced Oncology Nursing Practice &
New Roles
❖Nurse Clinic
❖Cancer Case Manager
❖Nurse Consultant
Target Client Groups
Client groups under the provision of:
❖ Oncological treatment for cancer patients;
❖ Radiotherapy for indicated benign diseases;
❖ Palliative treatment for cancer patients with advanced diseases;
❖ Screening of cancers for high-risk populations.
Science of Cancer & it’s prevention
Cancer refers to a series of cellular & genetic aberrations that cause abnormal & uncontrolled
cell proliferation.
Cancer cells has the ability to invade surrounding tissue & to metastasize (spread to distant
secondary sites).
Volker (2005)
A cancerous tumor has the capacity to grow rapidly and to metastasize or spread to other
tissues.
Pathophysiology of the malignant process
Pathophysiology of the malignant process
Oncogenes:
• It refers to cancer causing genes.
• They can be normal genes but are found to have inappropriately high
levels in clients with cancers or
• They may be modified or restructured normal genes due to mutation.
• In all of these situations, they cause cancerous changes in the tissues.
Pathophysiology of the malignant
process
Tumor suppressor genes:
They are normally responsible for inhibiting cell division and
avoid survival of cells which possess problematic DNA. For the
clients with cancer problem, these tumor suppressor genes are
often malfunctioned.
 3-stage Theory of Carcinogenesis
❖ Initiation
• DNA damage caused by an initiator
(Carcinogens).

❖ Promotion
• Process by which promoters are subsequently
introduced.
• Tobacco & asbestos are examples of complete
carcinogens (initiator + promoter)

❖ Progression
• Occurrence of tumour invasion, angiogenesis &
metastasis
Source: [Link]
Common examples of carcinogens
Staging of Cancer
Staging refers to the size of the tumor and the existence of metastasis.
TNM system is frequently used
T:________
N:________
M:________
Staging of Cancer
For example, breast cancer classified as T3 N2 M0 means that there is a large tumor which has
spread outside the breast to nearby lymph nodes but not to other parts of the body.
For many cancers, TNM combinations correspond to one of five stages. Criteria for stages differ
for different types of cancer. For example, bladder cancer T3 N0 M0 is stage III, whereas colon
cancer T3 N0 M0 is stage II.

(National Institute of Cancer of U.S. , 2015)

 Grading of Cancer
◆Tumor grade is the description of a tumor based on how abnormal the tumor cells and the tumor tissue look
under a microscope.
◆It is an indicator of how quickly a tumor is likely to grow and spread.
◆ If the cells of the tumor and the organization of the tumor’s tissue are close to those of normal cells and tissue,
the tumor is called “well-differentiated. These tumors tend to grow and spread at slower rate than tumors that
are “undifferentiated” or poorly differentiated”
◆Poorly differentiated & “undifferentiated” tumor cell have abnormal-looking and may lack normal tissue
structures.
◆Base on these difference in appearance, doctor assign a numerical “grade” to most cancer. The factors used to
determine tumor grade vary between different types of cancer.
GX: Grade cannot be assessed (undetermined grade)
G1: Well differentiated (Low Grade)
G2: Moderately differentiated (intermediate grade)
G3: Poorly differentiated (High Grade)
G4: Undifferentiated (High Grade)
Tumor Markers
Prostate-specific Antigen (PSA) – Prostate Cancer
CA 15-3 & CA 27-29 – Recurrent Breast Cancer
Carcinoembryonic Antigen (CEA) – Colorectal (Gold standard), Breast, Lung, Thyroid, Pancreas,
Liver, Stomach, Ovary & Bladder Cancer
CA 125 – Ovarian Cancer
Human Chorionic Gonadotropin (HCG) – Ovarian Tumor & Testicular Cancer
Alpha-fetoprotein (AFP) – Ovarian Tumor, Testicular & Liver Cancer, Chronic Hepititis
Beta-2-Microglobulin (B2M) – Myeloma, Chronic lymphocytic Leukemia & Lymphoma
HER-2/neu – Breast Cancer
Chromogranin A (CgA) – Carcinoid Tumor, Lung Cancer
Management
❖ Surgery
❖ Radiotherapy
❖ Chemotherapy
❖ Targeted therapy
Management
Health Education:
◦ Prevention of cancer
◦ 1/3 of cancers can be prevented by healthy diet, regular exercise & healthy weight.
◦ 1/3 of cancers can be prevented by no smoking.
Recommendations by HK Anti-Cancer Society
Do not smoke or chew tobacco
Be as lean as possible without becoming underweight
Be physically active for at least 30 minutes everyday
Avoid sugary drinks, limit consumptions of energy- dense foods
Eat different vegetables (1.5-2 bowl per day), fruits (2 bowl per day), whole grains & pulses such
as beans
Limit consumption of red meat & avoid processed meats
Limit alcoholic drinks
Limit consumption of salty foods & foods preserved with salt
Don’t use supplements to protect against cancer
Recommendations by HK Anti-Cancer Society
Best for mothers to breastfeed for up to 6 months
Practise safer sex, receive regular Pap smear examination, & consider receiving vaccine that can
prevent cervical cancer
Vaccination against Hepatitis B infection
Protect against excessive exposure to the sun
(HKACS, 2007)
 Management (Surgery)
⚫Surgery plays a key role in diagnosing cancer and finding out how far it may have spread
⚫Biopsy is the procedure done to remove tissue (called a sample) from an area that may be cancer.
⚫A doctor looks at the sample under a microscope to see if there are cancer cells in it.
⚫Some biopsies may need to be done during surgery. But many types of biopsies are done by taking
out small pieces of tumor through a thin needle or through a flexible lighted tube called an
endoscope
Management (Radiotherapy)
Radiotherapy (RT) refers to the use of external ionizing radiation, such as radioactive drug for
medical treatment.
The ionizing radiation, which forms ions in the cells of the tissues it passes through thereby
killing the cells or altering their DNA, comes in two major types: photons and particles (electrons,
protons, neutrons, α particles, and β particles).
Electron and most particle beams are used for tumors close to the body surface because they do
not go deeply into tissues.
On the other hand, proton beams are a newer application that causes little damage to tissues
they pass through but kill cells at the end of their path, possibly resulting in fewer side effects.
(American Cancer Society, 2011)
Radiotherapy
Purpose of RT
To treat local or regional disease.
To destroy cancer cells with minimal injury to normal cells.

Source of RT
RT machines (linear accelerator).
Radionuclides:
• Radioactive sources that emit radiation in the form of & particles or rays.
• Iodine-131, gold-198 etc.
Methods of RT Delivery
Teletherapy
• External beam radiation therapy.
Brachytherapy
• Internal or implant radiation therapy.
Side effect of RT
Early onset:
Happen during or shortly after treatment.
Fatique, Skin reactions, alopecia, xerostomia, mucositis etc.
Late onset:
Usually permanent, develop several months to years after treatment.
Presented as degeneration, loss of function, such as cataracts, pulmonary
fibrosis etc.
Other management
⚫Education
⚫Emotional support
⚫Nutritional counselling
⚫Mouth care
⚫Skin care
⚫Medication management
⚫Pain control
⚫Symptom management
Chemotherapy
Mechanism
Interfere with replication & other normal functions of cancer cells, which cause
cell death or tumor shrinkage.
Normal cells are also affected but have a greater ability to repair.
Tumors which are small, vascular, have high proliferative rate & a large number
of dividing cells more sensitive.
Rapidly dividing normal cells are more affected by the drugs:
• Bone marrow • GI Mucosa
• Hair follicles
Chemotherapy
Usually given by multiple courses because it provides a broader range of
coverage of new resistant cells.
Routes of administration:
• Oral, intravenous, intrathecal, intracavity, intraperitoneal, intraarterial etc.
Potential Side Effects
Targeted Therapy
⚫Targeted therapy drugs, like other drugs used to treat cancer, are technically
considered chemotherapy.
⚫But targeted therapy drugs don’t work the same way as traditional
chemotherapy
⚫These drugs tend to have different (and often less severe) side effects than
standard chemo drugs.
Target therapy Action
Examples of target therapy
Reference
Langhorne, M. E., Fulton, J. S., Otto, S. E. (2007). Oncology Nursing (5th ed.). St. Louis, MO:
Elsevier.