Oncology .

Nursing management in
cancer patient
Outline:
- Definition of cancer
- Epidemiology of cancer
- Pathophysiology of cancer
- Etiology of cancer
- Differentiate between benign and malignant tumors.
- Warning signs of cancer.
- Methods of cancer treatment
- Nursing care plan for patient with cancer.

Definition of cancer:
- It is a disorder of cell growth characterized by
uncontrolled, uncoordinated and undesirable cell
division.
- Also known as tumor or neoplasm.
Epidemiology:
Lung cancer is the most common cancer in
men.
Breast cancer is the most common cancer in
women.
There are over 100 different forms of cancer.
Pathophysiology of cancer:
-Cancer occurs as a result of mutations , or
abnormal changes, in the genes responsible
for regulating the growth of cells and
keeping them healthy.
-The genes are in each cell’s nucleus, acts as
the “control room”.
- But over time, mutations can “turn on”
certain genes and “turn off” others in a cell.
- The changed cell gains the ability to keep
dividing without control, producing more
cells just like it and forming a tumor.
- A tumor can be benign (not dangerous to
health) or malignant (has the potential to be
dangerous).
The cells acquire invasive characteristics, and
changes occur in surrounding tissues. The cells
infiltrate these tissues and gain access to lymph
and blood vessels, which carry the cells to other
areas of the body.
This phenomenon is called metastasis:
(cancer spread to other parts of the body).

Cancer etiology:
1.Viruses and bacteria:
- Bacteria like H. pylori, which causes stomach ulcers and

has been linked to gastric cancer.
- Viral infections ( hepatitis B and C) .

2.Physical agents:
As exposure to sunlight, radiation, and tobacco use may
lead to cancer (e.g lip cancer among pipe smokers).
3. Chemical agents:
Those who working in the industries, their liver and
kidneys are commonly affected may lead to cancer.
4. Genetic and familial factors:
This may be due to genetics, cultural or lifestyle factors.

5. Dietary factors:
The carcinogenic food that increased cancer risk includes
fats, alcohol, salt and a high caloric diet.
6. Hormonal agents:
- Tumor growth may be caused by disturbances in
hormonal balance or by administration of exogenous
hormones.
- Cancer of the breast and prostate are thought to depend

on endogenous hormonal levels for growth.
-Oral contraceptives are associated with increased

incidence of endometrial cancers.
Classification of cancer:
1-Benign tumors:
-Is a mass of cells that lacks the ability to invade
neighboring tissue or metastasize.
2-Malignant tumors: A tumor that invades
surrounding tissues, is usually capable of
producing metastasis, may recure after attempted
removal, and is likely to cause death unless
adequately treated.
Characteristics of benign and malignant
neoplasm:
Characteristics Benign Malignant
Little resemblance to
• Cell characteristics resemble normal cells
the normal cells
expansion and does not Grows ,infiltrate, and
• Mode of growth
infiltrate. destroy the surrounding tissues
• Rate of growth Slow Usually rapid
Gains access to blood and
• Metastasis Does not spread by lymphatic and
metastasis metastasizes to other areas of the
body
• Recurrence Dose not recurrent when removed Tend to recur when removed
Generalized effect such as anemia
• General effects Usually localized
and weight loss.
Cause extensive tissue damage due
• Tissue destruction Dose not cause tissue damage
to pressure
• Ability to cause Rarely cause death, unless located cause death, unless it growth is
death near vital functions. controlled
The seven warning signs of cancer:
The American Cancer Society uses the word
C-A-U-T-I-O-N
• Change in bowel or bladder habits.
• A sore that does not heal.
• Unusual bleeding or discharge.
• Thickening or lump in the breast, testicles, or
elsewhere
• Indigestion or difficulty swallowing.
• Obvious change in the size, color, shape, or
thickness of a wart, mole, or mouth sore.
• Nagging cough or hoarseness.
The following symptoms may also signal the
presence of some types of cancer:
-Persistent headaches.
-Unexplained loss of weight or loss of appetite.
-Chronic pain in bones or any other areas of the
body.
-Persistent fatigue, nausea, or vomiting.
-Persistent low-grade fever, either constant or
intermittent.
-Repeated infection.
Methods of cancer treatment:
1. Surgery.
2. Radiation therapy.
3. Chemotherapy.
4. Gene Therapy.
5. Laser Therapy.
6. Hormone Therapy.
2.Radiation therapy:
It defined as ionizing radiation. It is used to
interrupt cellular growth.
Side effects of radiotherapy:
- Local side effects:
Alopecia (fall of hair), erythematic (redness),
stomatitis, mouth dryness and decrease
salivation.
- General side effects:
Chest pain, anorexia, nausea, vomiting
(if the stomach and colon are in the irradiated
field), fatigue, malaise and headache.
Chemotherapy
Definition of chemotherapy :
Antineoplastic agents are used in an attempt to
destroy tumor cells by interfering with cellular
functions and reproduction.
Goals of chemotherapy:
- Cure chemotherapy: used to destroyed cancer cell
and will not grow back.
- Control chemotherapy: used to keep cancer cell
from spreading.
- Palliative chemotherapy: used to shrinks tumors
that are causing pain or pressure.
It may be combined with surgery or
radiation therapy, or both, to reduce tumor
size preoperatively, to destroy any
remaining tumor cells postoperatively.
Special problems of chemotherapy
administration:
Extravasation:
- Deposition of intravenous vesicant agents into
the subcutaneous tissue.
- Special care must be taken whenever
intravenous vesicant agents are administered.
- Extravasation cause tissue necrosis and damage
to underlying tendons, nerves, and blood vessels.
Signs& Symptoms of extravasation:
- Absence of blood return from the
intravenous catheter.
- Resistance to flow of intravenous fluid.
- Swelling, pain, or redness at the site.
Management of extravasation:
- If extravasation is suspected, the medication
administration is stopped immediately.
- Ice is applied to the site .
- The physician may aspirate any infiltrated
medication from the tissues and inject a
neutralizing solution into the area to reduce tissue
damage.
- Selection of the neutralizing solution depends on
the extravasated agent.
Side effects of chemotherapy:
1. Gastrointestinal system: Nausea and vomiting are the
most common side effects of chemotherapy and may
persist for up to 24 hours after its administration.
2. Hematopoietic system: Most chemotherapeutic agents
cause myelosuppression (depression of bone marrow
function), resulting in decreased production of blood cells.
, decreases the number of WBCs (leukopenia), red blood
cells (anemia), and platelets (thrombocytopenia) and
increases the risk for infection and bleeding.
3-Renal system: Chemotherapeutic agents can
damage the kidneys because of their direct effects
during excretion and the accumulation of end
products after cell lysis.
4. Reproductive system: Testicular and ovarian
function can be affected by chemotherapeutic
agents, resulting in possible sterility, early
menopause, or permanent sterility may result.
5.Fatigue: Is a distressing side effect for most
patients that greatly affects quality of life.
Fatigue can be debilitating and can last for
months after treatment.
6.Hair loss: Sometimes chemotherapy can affect
all body hair, including eyebrows, lashes, and
pubic hair.
7.Sore mouth: Chemotherapy can affect the
normal rapidly growing cells lining the mouth.
Nursing care plan for patient with cancer:
- Nursing diagnosis:
Risk for infection related to altered immunologic response.
- Goal:
Prevention of infection.
- Nursing intervention:
• Assess patient for evidence of infection: check vital
signs every 4 hours.
• Monitor WBC count.
• Inspect all sites that may serve as entry ports for
pathogens (intravenous sites, wounds, and oral cavity).
• Obtain cultures and sensitivities as indicated before
initiation of antimicrobial treatment (wound exudates,
sputum, urine, stool, blood).
• Importance of patient avoiding contact with people
who have known or recent infection.
• Instruct all personnel in careful hand hygiene before
and after entering room.
• Assist patient in practice of meticulous personal
hygiene.
• Remove fresh flowers and potted plants.
• Avoid insertion of urinary catheters; if catheters are
necessary, use strict aseptic technique.

Oncology .

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Nursing management in

- Methods of cancer treatment

- Nursing care plan for patient with cancer.

This phenomenon is called metastasis:

(cancer spread to other parts of the body).

- Bacteria like H. pylori, which causes stomach ulcers and

- Viral infections ( hepatitis B and C) .

4. Genetic and familial factors:

This may be due to genetics, cultural or lifestyle factors.

- Cancer of the breast and prostate are thought to depend

-Oral contraceptives are associated with increased

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