Cancer Nursing

CANCER NURSING
P R E PA R E D B Y : C AT H E R I N T E S N Y G O N Z A G A
CANCER
• A disease caused by an uncontrolled division of abnormal
cells in a part of the body
• It then spreads to other parts of the body through the
blood and lymph systems.
CANCER TERMINOLOGY
• Epithelial tissues (carcinoma)
• Glandular tissues (adenocarcinomas)
• Connective, muscle, and bone tissues (sarcomas)
• Brain and spinal cord tissues (gliomas)
• Pigmented cells (melanomas)
• Plasma cells (myelomas)
• Lymphatic tissue (lymphomas)
• Leukocytes (leukemia)
• Erythrocytes (erythroleukemia)
ETIOLOGY
• Tobacco
• Cancer susceptibility genes
• DNA virus and RNA virus
• Chemicals
• Physical factors
• Dietary factors
• Obesity and lack of physical activity
WARNING SIGNS OF CANCER
(CAUTIONUS)
• C – Change in bladder and bowel habits.
• A – A sore that does not heal.
• U – Unusual bleeding or discharge.
• T – Thickening or lumps in breast or elsewhere.
• I – Indigestion or difficulty of swallowing.
• O – Obvious change in wart or mole.
• N – Nagging cough or hoarseness.
• U – Unexplained anaemia.
• S – Sudden and unexplained weight loss
PATHOPHYSIOLOGY
• Uncontrolled cell proliferation
• Loss of Apoptosis
• Tissue invasion and Metastasis
• Angiogenesis
TUMOUR
• A swelling of a part of the body, generally without

inflammation, caused by an abnormal growth of
tissue, that results when cells divide more than they
should or do not die when they should.
TYPES OF TUMOUR
• Benign tumor :
A benign tumor is a mass of cells (tumor) that lacks the ability to
invade neighbouring tissue or metastasize. The benign tumors are
non-cancerous.
• Premalignant:
In these tumors, the cells are not yet cancerous, but they have the
potential to become malignant
• Malignant tumor:
The cell structure of a “malignant” tumor is significantly different
than that of “normal” cells. The cells can grow and spread to other
parts of the body. Malignant tumors are cancerous.
GRADING OF TUMOUR
• Grade 1 – the cancer cells look very similar to normal cells and
are growing slowly
• Grade 2 – the cells don't look like normal cells and are growing
more quickly than normal
• Grade 3 – the cancer cells look very abnormal and are growing
quickly
• GX means that doctors can't assess the grade. It is also called
undetermined grade.
Some systems have more than 3 grades.
CARCINOGENESIS
BRAIN TUMORS
BRAIN TUMORS
A brain tumor is a localized intracranial lesion that occupies
space within the skull.
• Primary brain tumors originate from cells and structures

within the brain.
• Secondary, or metastatic, brain tumors develop from

structures outside the brain (lung, breast, lower
gastrointestinal tract, pancreas, kidney, and skin)
CAUSES OF BRAIN TUMOR
• Unknown
• Family history
• Immunosuppression
• Being exposed to radiation or certain chemicals at work

Types of Tumors
• Gliomas - most common, cannot be totally removed without causing damage,
because they spread by infiltrating into the surrounding neural tissue.
• Meningiomas - common benign encapsulated tumors of arachnoid cells on the

meninges. Slow growing and occur most often in middle-aged women.
• An acoustic neuroma - a tumor of the eighth cranial nerve (hearing and

balance). It may grow slowly and attain considerable size before it is correctly
diagnosed.
Types of Tumors
• Pituitary adenomas - may cause symptoms as a result of pressure
on adjacent structures or hormonal changes such as hyperfunction or
hypofunction of the pituitary.
• Angiomas - are masses composed largely of abnormal blood vessels

and are found in or on the surface of the brain; they may never cause
symptoms, or they may give rise to symptoms of brain tumor. The walls
of the blood vessels in angiomas are thin, increasing the risk of
hemorrhagic stroke
CLINICAL MANIFESTATIONS
The signs and symptoms of a brain tumor vary greatly and
depend on the brain tumor's size, location and rate of growth.
General signs and symptoms caused by brain tumors may
include:
• New onset or change in pattern of headaches
• Headaches that gradually become more frequent and more
severe
• Unexplained nausea or vomiting
• Papilledema (edema of the optic nerve)
• Vision problems, such as blurred vision, double vision or loss of
peripheral vision
• Gradual loss of sensation or movement in an arm or a leg
• Difficulty with balance (tinnitus and vertigo)
• Speech difficulties
• Confusion in everyday matters
• Personality or behaviour changes
• Seizures, especially in someone who doesn't have a history of
seizures
• Hearing problems
ASSESSMENT
• Neurologic examination indicating areas involved
DIAGNOSTIC METHODS
• CT & MRI
• Positron emission tomography (PET)
• Computer-assisted stereotactic (three-dimensional)

biopsy
• Cerebral angiography
• EEG
• Cytologic studies of the cerebrospinal fluid

MEDICAL MANAGEMENT
• Chemotherapy
• Radiation therapy
• Brachytherapy (the surgical implantation of radiation sources to

deliver high doses at a short distance)
• IV autologous bone marrow transplantation for marrow toxicity

associated with high doses of drugs and radiation
• Gene-transfer therapy (currently being tested)
• External-beam radiation therapy, are used alone or in combination

with surgical resection.
SURGICAL MANAGEMENT
• To remove or destroy the entire tumor without
increasing the neurologic deficit (paralysis, blindness) or
to relieve symptoms by partial removal (decompression).
• A variety of treatment modalities may be used; the

specific approach depends on the type of tumor, its
location, and its accessibility.
NURSING MANAGEMENT
• Perform neurologic checks, monitor vital signs, and maintain a
neurologic flow chart. Space nursing interventions to prevent rapid
increase in ICP.
• Reorient patient when necessary to person, time, and place. Use

orienting devices (personal possessions, photographs, lists, clock).
Supervise and assist with self-care. Monitor and intervene to prevent
injury.
• Monitor patients with seizures.
• Check motor function at intervals; assess sensory disturbances.

NURSING MANAGEMENT
• Evaluate gag reflex and ability to swallow preoperatively.
• Teach patient to direct food and fluids toward the
unaffected side. Assist patient to an upright position to
eat, offer a semisoft diet, and have suction readily
available if gag response is diminished.
• Reassess function postoperatively.

LUNG CANCER
LUNG CANCER
Cancer that forms in tissues of the lung, usually in the cells

lining air passages.
TYPES OF LUNG CANCER
Two main Types of Lung Cancer:
➢Small Cell Lung Cancer (20-25% of all lung cancers)
➢Non Small Cell Lung Cancer (most common ~80%)
Small Cell Lung Cancer
• It usually starts in the bronchi and then effects the whole lung.
• These cancer cells are small and are considered to be quite aggressive in
nature and they have a large growth factors.
• Often metastasize to other parts of the body (brain, liver, and bone marrow)
Non Small Cell Lung Cancer
• NSCLC is any type of epithelial lung cancer other than small cell lung cancer.
• Non-small cell lung Ca usually grows and spreads more slowly than SCLC.
CAUSES AND RISK FACTORS
SIGNS AND SYMPTOMS
There are two types of signs and symptoms of lung cancer:
1) Localized – involving the lung.
2) Generalized – involves other areas throughout the body

if the cancer has spread.
LOCALIZED SIGNS AND SYMPTOMS
• Cough • Chest Pain and tightness
• fatigue • Pleural Effusion
• Breathing Problems, stridor
• blood in phlegm
• Lung infection,
• hemoptysis
• Hoarseness,
• Hiccups
• Weight loss
GENERALIZED SIGNS AND SYMPTOMS
• Bone pain
• Headaches, mental status changes or neurologic findings
• Abdominal pain,
• elevated liver function tests,
• enlarged liver,
• gastrointestinal disturbances (anorexia, cachexia),
• jaundice,
• hepatomegaly
• Weight loss
DIAGNOSTIC TESTS
• CXR • Biopsy-to determine if the tumor is
• CT Scans cancer or not -to determine the type of
cancer -to determine the grade of cancer
• MRI
(slow or fast)
• Sputum cytology
• Bronchoscopy
• Fibreoptic bronchoscopy
• Endoscopy
• Transthoracic fine needle aspiration
• Mediastinoscopy
• Blood Tests *CBC- to check red/white
blood cell & platelets -to check bone
marrow and organ function
• *Blood Chemistry Test- to assess how
organs are functioning such as liver and
kidney
MEDICAL MANAGEMENT
The three main cancer treatments are:
➢surgery (lung resections)
➢Radiation therapy
➢chemotherapy
• drugs involved like- Etoposide , Paclitaxel ,Cyclophosphamide,
Doxorubicin, Vinblastin
Other types of treatment that are used to treat certain cancers are
• hormonal therapy
• biological therapy or stem cell transplant.
SURGICAL MANAGEMENT
• Lobectomy: a single lobe of lung is removed
• Bilobectomy: 2 lobes of the lung are removed (only on R side)
• Sleeve resection: cancerous lobe is removed and segment of the main bronchus is
resected
• Pneumonectomy: removal of entire lung
• Segmentectomy: a segment of the lung is removed
• Wedge resection: removal of a small, pie-shaped area of the segment
• Chest wall resection with removal of cancerous lung tissue: for cancers that have
invaded the chest wall
Radiation treatment : Useful in controlling the neoplasm that can not be surgically
removed.
NURSING DIAGNOSES
1. Ineffective breathing pattern r/t loss of adequate ventilation as evidenced by overexertion of
pt. during respiration.
2. Impaired gas exchange r/t excessive or thick secretions or r/t decreased passage of gases
between alveoli of lungs and vascular system as evidenced by decreased SPo2 level of pt.
3. Chronic pain related to Stage IV NSCLC diagnosis as evidenced by client reporting “pain in
right chest and lower ribs”.
4. Risk of infection related to altered immune system secondary to effects of cytotoxic drugs
as evidenced by side effects of the drug/chemotherapy.
5. Risk for disturbed self concept related to changes in lifestyle.
6. Nausea related to effects of chemotherapy as evidenced by client reporting feeling
nauseated.
7. Risk for deficient fluid volume related to gastrointestinal fluid loss secondary to vomiting.
8. Fatigue related to chemotherapy secondary to stage IV NSCLC as evidenced by client
reporting he “ no longer has the energy to play with his grandchildren or visit his friends”.
Ineffective breathing pattern
• Teach patient about deep breathing exercises
• Encourage alternating activity with rest periods
• Chest physiotherpy
• Suctioning
• Bronchodilator medication
• O2 administration, if required
Impaired gas exchange
• Instruct the patient to stop smoking
• Semi-fowler position
• Administered antibiotics as prescribed
• Adequate hydration
• Deep breathing exercises
• Nebulisation
• Suctioning, as required
Chronic pain
• Relaxation techniques
• Diversional therapy
• Frequant massage
• Encourage energy conservation
• Comfortable position
• Education to avoid concern about pharmacological and non- pharmacological
therapies
• Medication , as prescribed.
Risk of infection
• Monitor the client body temp. routinely
• Encourage the patient to do regular ADL like brushing, bathing, eating, toileting
• Provide a high calorie, high protein diet
• Hand washing before and after taking food
• Antibiotics, as prescribed
Risk of disturbed self concept
• Provide psychological support
• Encourage the family members in caring of the patient
• Encourage the communication with the patient
• Diversional therapy
• Ask the client to identify personal strenght and talent.
Risk of deficit fluid volume
• Encourage the patient to take fluids (2-3 l/day)
• Small and frequent diet
• I/V fluid administration, if prescribed
• Intake- output charting
• Administer skin care, apply hydrating lotion
• Weight recording
BONE CANCER
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CANCER NURSING

• Tissue invasion and Metastasis

• A swelling of a part of the body, generally without

• Primary brain tumors originate from cells and structures

• Secondary, or metastatic, brain tumors develop from

• Being exposed to radiation or certain chemicals at work

• Meningiomas - common benign encapsulated tumors of arachnoid cells on the

• An acoustic neuroma - a tumor of the eighth cranial nerve (hearing and

• Angiomas - are masses composed largely of abnormal blood vessels

• Positron emission tomography (PET)

• Computer-assisted stereotactic (three-dimensional)

• Cytologic studies of the cerebrospinal fluid

• Brachytherapy (the surgical implantation of radiation sources to

• IV autologous bone marrow transplantation for marrow toxicity

• Gene-transfer therapy (currently being tested)

• External-beam radiation therapy, are used alone or in combination

• A variety of treatment modalities may be used; the

• Reorient patient when necessary to person, time, and place. Use

• Monitor patients with seizures.

• Check motor function at intervals; assess sensory disturbances.

• Teach patient to direct food and fluids toward the

unaffected side. Assist patient to an upright position to

eat, offer a semisoft diet, and have suction readily

available if gag response is diminished.

• Reassess function postoperatively.

Cancer that forms in tissues of the lung, usually in the cells

There are two types of signs and symptoms of lung cancer:

1) Localized – involving the lung.

2) Generalized – involves other areas throughout the body

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