Oncology Nursing

Prepared by
Abdelrady Mohamed elsayed
Mahmoud Reda Mahmoud
Under supervision
Prof.Dr- Zeinab Hussein Ali
Professor and Head of Adult Health
Nursing Department
Code of Conduct
 objectives
At the end of this lecture the learner will
be able to:
1. Compare the function and behavior of
normal and cancer cells.
2. Differentiate between benign and
malignant tumors.
3. Identify agents and factors that have
been found to be carcinogenic.
4. Describe the role of nurses in health
education and prevention in decreasing
the incidence of cancer.
5. Differentiate among the goals of cancer
Cont. Objectives

6-Describe the roles of

surgery, radiation therapy,
chemotherapy,
hematopoietic stem cell
transplantation, and
symptom management in
treating cancer.
7- Use the nursing process
Cont. Objectives

8- Identify potential
complications for the
patient with cancer and
discuss associated nursing
care.

9- Identify assessment
parameters and nursing
 INTRODUCTION
Cancer is a family of complex
diseases with manifestations that vary
according to the body system affected
and the type of tumor cells involved.
This disease can affect people of any
age, gender, ethnicity, or geographic
region. Although the incidence and
mortality rates of cancer have
continued to decline since 1990, it
remains one of the most feared
What Is Cancer?

CANCER is a complex of diseases

which occurs when normal cells
mutate into abnormal cells that take
over normal tissue, eventually
harming and destroying the host.
Metastasis: Metastasis refers to
the spread of cancer from a
primary site to a secondary
site.
Common sites of metastasis are
to the bone and brain (breast
cancer) and to the liver and
brain (lung cancer).
Pathophysiology of the Malignant Process

genetic mutations of the cellular DNA.

abnormal cell behavior

The initial genetically altered cell forms a clony and

begins to proliferate abnormally

evading normal intracellular and extracellular growth-

regulating processes

gain access to the blood and lymph

carry the cells to other areas of the

body.
 Pathophysiology of the Malignant Process
 Cancer is a disease process that begins when an abnormal
cell is transformed by the genetic mutation of the cellular
DNA.

 This abnormal cell begins to proliferate abnormally,

 The cells acquire invasive characteristics, and changes
occur in surrounding tissues. The cells infiltrate these
tissues and gain access to lymph and blood vessels, This
phenomenon is called metastasis (cancer spread to other
11
parts of the body).
 Pathophysiology of the Malignant
Process
 PROLIFERATIVE PATTERNS
During the life span, various body tissues normally
experience periods of rapid or proliferative growth
that must be distinguished from malignant growth
activity. Several patterns of cell growth exist:
hyperplasia, metaplasia, dysplasia, anaplasia, and
neoplasia
 Cancerous cells are described as malignant

neoplasms.
12
 Key Terms
 Plasias" , refer to cancerous or pre-cancerous cells.
 1. Hyperplasia is any abnormal multiplication of cells.
 Hyperplasia refers to an abnormal increase in cellular
quantity (i.e., constantly dividing cells).
 2. Metaplasia is the transformation of one type of tissue
into another.
 Metaplasia ("change in form") refers to the exchanging
of one type of differentiated cell type for another mature
differentiated cell type.
13
 Key Terms
Dysplasia (from the Greek "malformation“. This
generally consists of an expansion of immature cells, with
a corresponding decrease in the number and location of
mature cells.

14
The Four Major Categories of Cancer
• Carcinoma: Cancer arising from epithelial
tissue (for example, basal cell carcinoma)
• Sarcoma: Cancer arising from connective
tissue, muscle, or bone (for example,
osteosarcoma)
• Lymphoma: Cancer arising from lymphoid
tissue (for example, lymphoma)
• Leukemia: Cancer of the blood-forming cells
in the bone marrow (for example,acute
lymphocytic leukemia)
16
Tumor

Benign Tumor
Tumor
Malignant
Tumor
(Cancer)
Classification of Cancer
According to Behavior of Tumor

• Benign - tumors that cannot

spread by invasion or
metastasis; hence, they only grow
locally
• Malignant - tumors that are capable
of spreading by invasion and
metastasis.
Difference between benign and
malignant tumor
Malignant means that the affected cells in the body are
cancerous. The tumors which are malignant can attack
the tissues lying the surrounding region and spread in
the body. On the other hand, benign tumor means that
the tumor is not cancerous. It might grow in size but it
will not spread to other parts of the body.

Therefore we can say that malignant tumors love to grow and

conquer the surrounding area while the benign tumors like to
stay put.
19
 CHARACTERISTICS BENIGN
MALIGNANT NEOPLASM
MALIGNANT BENIGN CHARACTERISTICS

Cells are undifferentiated and often bear little Well-differentiated cells that Cell
resemblance to the normal cells of the tissue resemble normal cells of the
from which they arose tissue from which the tumor characteristics
originated

Grows at the periphery and sends out Tumor grows by expansion Mode of growth
processes that and does not infiltrate
infiltrate and destroy the surrounding tissues the surrounding tissues;
usually encapsulated

Rate of growth is variable and depends on Rate of growth is usually Rate of growth
level of differentiation; the more anaplastic slow
the tumor, the faster its growth

Gains access to the blood and lymphatic Does not spread by Metastasis
channels metastasis
and metastasizes to other areas of the body 20
 Invasion & Metastasis

 Metastasis is the process whereby malignant tumour

cells spread from their site of origin (known as the
PRIMARY SITE or PRIMARY TUMOUR) to some
distant site in the body (known as the SECONDARY
SITE or SECONDARY TUMOUR).
 THE ROUTES OF METASTASIS ARE:-
- BLOOD SPREAD
- LYMPHATIC SPREAD
- DIRECT SPREAD
21
 Etiology of
cancer
1- PHYSICAL AGENTS
• Radiation
• Exposure to irritants
• Exposure to sunlight
• Humidity(poor ventilation)
Etiology of cancer

2. CHEMICAL AGENTS
• Smoking is strongly associated
with cancers of the lung, head and
neck, esophagus, pancreas, cervix,
and bladder.
• Dietary ingredients
• Drugs
 Etiology of cancer

• 3. Genetics and Family History

Abnormal chromosomal patterns and cancer
have been associated with extra
chromosomes, too few chromosomes, or
translocated chromosomes.
• Colon Cancer, lymphoma, skin
cancer
• Premenopausal breast cancer
 Etiology of cancer

4. Dietary Habits
 Low-Fiber
 High-fat
 Processed foods
 alcohol
 Etiology of cancer

5. Viruses and Bacteria

• Viruses as a cause of human cancers are hard
to determine because viruses are difficult to
isolate. Infectious causes are considered or
suspected
• Herpes simplex virus type II, cytomegalovirus,
and human ,papilloma virus types are
associated with cancer of the cervix

•
• The bacterium Helicobacter pylori
has been associated with an
increased incidence of gastric
malignancy,

• The hepatitis B virus is implicated

in cancer of the liver
 Etiology of cancer

• 6. Hormonal agents
disturbances in hormonal balance either
by the body’s own (endogenous)
hormone production or by
administration of exogenous hormones.

• Cancers of the breast, prostate, and

uterus are thought to depend on
endogenous hormonal levels for growth.
Tip

• Oral contraceptives and prolonged

estrogen replacement therapy are
associated with increased
incidence of hepato cellular, and
breast cancers,
• whereas they appear to decrease
the risk for ovarian and
endometrial cancers.
 Etiology of cancer

• 7. Immune Disease
• When the immune system fails to identify and stop
the growth of malignant cells, clinical cancer
develops.

• Organ transplant recipients who receive

immunosuppressive therapy to prevent rejection of
the transplanted organ have an increased
incidence of lymphoma
• AIDS
 Etiology
*Dietary Factors.
- People who take diet low in Vitamin “A” can suffer
from lung cancer.
- Nations who drink are also at risk.
- Black race eat food contaminated, can develop cancer
because of carcinogen substance in their diet.

35
 Etiology

*Hormonal Agents. One of the commonest causes of

breast and uterine endometrial cancer in females is
increased levels of estrogen.

36
37
Risk Factors con.
3- Gender is a risk factor for certain types of cancer, rather
than for acquiring cancer in general (thyroid cancer occurs
more commonly among females, whereas bladder cancer is
seen more often among male patients).

4- Poverty; inadequate access to health care, especially

preventive screening and counseling may be a major factor,
also diet, stress may be involved.

5- Stress; continuous unmanaged stress that keeps hormones

such as epinephrine and cortisol at high levels can result in
systemic fatigue and impaired immune system, resulting in
general wear –and tear and depression of the immune
system.
 Clinical Manifestation
 Cancer symptoms are quite varied and depend
on where the cancer is located, where it has
spread, and how big the tumor is.

39
 Clinical Manifestation
 It is possible to present symptoms such as:

- Fever is very common with cancer, but it more often

happens after cancer has spread from where it started.
Almost all patients with cancer will have fever at some
time, especially if the cancer or its treatment affects the
immune system. Less often, fever may be an early sign of
cancer, such as blood cancers like leukemia or lymphoma
40
 Clinical Manifestation
. - Fatigue is extreme tiredness that does not get better
with rest. It may be an important symptom as cancer
grows. It may happen early, though, in cancers like
leukemia. Some colon or stomach cancers can cause
blood loss. This is another way cancer can cause
fatigue.
41
 Clinical Manifestation
-Unexplained weight loss Most people with cancer
will lose weight at some point. When you lose weight
with no known reason, it's called an unexplained
weight loss. An unexplained weight loss of 10
pounds or more may be the first sign of cancer. This
happens most often with cancers of the pancreas,
stomach, esophagus, or lung. 42
 Clinical Manifestation
- Pain may be an early symptom with some cancers
like bone cancers or testicular cancer. A headache
that does not go away or get better with treatment
may be a symptom of a brain tumor. Back pain can
be a symptom of cancer of the colon, rectum, or
ovary. Most often, pain due to cancer is a symptom
of cancer that has already spread from where it
43

started (metastasized).
 Clinical Manifestation

- Skin changes Along with cancers of the skin, some

other cancers can cause skin symptoms or signs that
can be seen. These signs and symptoms include:
 Darker looking skin (hyperpigmentation)
 Yellowish skin and eyes (jaundice)
 Reddened skin (erythema)
 Itching (pruritis) * Excessive hair growth 44
 Signs and symptoms of certain
cancers
 Change in bowel habits or bladder function(colon cancer)
 Sores that do not heal. (skin cancer)
 Unusual bleeding or discharge. (Cervical, colon,)
 Thickening or lump in the breast or other parts of the
body. (Breast cancer)
 Indigestion or trouble swallowing. (Esophageal cancer)
 Nagging cough or hoarseness. (Lung cancer)
 Clinical Manifestation
• When cancer spreads, or metastasizes, additional
symptoms can present themselves in the newly
affected area.
- Swollen or enlarged lymph nodes .
- If cancer spreads to the brain, patients may

experience vertigo, headaches, or seizures.

- Spreading to the lungs may cause coughing

and shortness of breath.
- In addition, the liver may become enlarged 46
Cancer Diagnosis

• 1. BIOPSY The most definitive

• 2. CT, MRI
• 3. Tumor Markers (carcinogenic embryonic acid
(CEA) and prostate-specific antigen (PSA)
• CBC Particularly important when caring for the
cancer client receiving chemotherapy is the CBC.
• This test monitors for the side effects and bone
marrow depression that can result from
antineoplastic drugs.
Laboratory & Diagnostic Tests
Cancer detection examination
• Laboratory tests
– Complete blood cell count (CBC)
– Tumor markers – identify substance (specific
proteins) in the blood that are made by the
tumor
• PSA (Prostatic-specific antigen): prostate
cancer
• CEA (Carcinoembryonic antigen): colon cancer
• Alkaline Phosphatase: bone metastasis
– Biopsy
Diagnostic Tests
• Determine location of cancer:
– X-rays
– Computed tomography
– Ultrasounds
– Magnetic resonance imaging
– Nuclear imaging
– Angiography
Diagnostic procedures
• - X-rays.

- CT scans / use of narrow beam x-ray to scan successive

layers of tissue for a cross-sectional view (Neurologic,
pelvic, skeletal, abdominal, thoracic cancers)
• Ultrasound Scans , used to assess tissues deep
within the body.

(Abdominal and pelvic cancers)

• MRI scans, Use of magnetic fields and radiofrequency
signals to create sectioned images of various body
structures.

(Neurologic, pelvic, abdominal, thoracic cancers)

• Endoscopy, Direct visualization of a body cavity or
passageway by insertion of an endoscope into a body
cavity or opening; allows tissue biopsy, fluid aspiration and
excision of small tumors; both diagnostic and therapeutic.

(gastrointestinal cancers)
• Direct Visualization:

– Sigmoidoscopy
– Cystoscopy
– Endoscopy
– Bronchoscopy
– Exploratory surgery; lymph
node biopsies to determine
metastases
Mammography
Begin annual mammography at age 40
• For women in their 20s and 30s, it is
recommended that CBE be part of a
periodic health examination, preferably
at least every 3 years.
• Asymptomatic women age 40 years and
over should continue to receive a CBE
as part of a periodic health
examination, preferably annually
Breast self exam
• Remember the alphabet A-B-C-D when assessing
skin lesions.
If the answer is yes to any questions listed here, it
could indicate a possible malignant lesion: .
• A—Is the lesion Asymmetrical in shape? .
• B—Are the Borders of the lesion irregular? .
• C—Are there different Colors within the lesion? .
• D—Is the Diameter of the lesion more than 5mm?
Which is a correct guideline for
performance of self breast exams (SBE) in
a 22year-old female client?

• A. Perform the SBE monthly one week after the

menstrual cycle.
• B. SBE should be done two weeks after the menstrual
cycle.
• C. Perform the SBE on the same day of the month. It
doesn’t matter which day.
• D. The breast exam should be performed when the
breasts are tender and/or swollen.
FOBT
• The nurse is giving instructions to a client who is to
obtain a fecal occult blood test (FOBT). The client should
be instructed to avoid which food for two days prior to
giving the stool specimen?
• A. Peas
• B. Broccoli
• C. Corn
• D. Beets
Staging and grading

Staging:
a number (usually on a scale of 4) established by the
oncologist to describe the degree of invasion of the
body by the tumor.

Grading:
a number (usually on a scale of 3) established by a
pathologist to describe the degree of resemblance of the
tumor to the surrounding benign tissue.
Tumor Staging and Grading
• Staging: determines size of tumor, existence of
metastasis
– TNM
• T: size of primary tumor
• N: lymph node involvement
• M: degree of metastasis

• Grading: classification of tumor cells

 Staging Method of Cancer
 The most common cancer staging method is
called the TNM system.
 T (1-4) indicates the size and direct extent of
the primary tumor.
 N (0-3) indicates the degree to which the
cancer has spread to nearby lymph nodes, and.
 M (0-1) indicates whether the cancer has
metastasized to other organs in the body.
69
 Staging Method of Cancer
 A small tumor that has not spread to lymph
nodes or distant organs may be staged as (T1,
N0, M0), for example.
 TNM descriptions then lead to a simpler
categorization of stages, from 0 to 4, where
lower numbers indicate that the cancer has
spread less. While most Stage 1 tumors are
curable, most Stage 4 tumors are inoperable or
untreatable. 70
 Staging of cancer
• The most common cancer staging
method is called the TNM system.
• T (1-4) indicates the size and direct
extent of the primary tumor.
• N (0-3) indicates the degree to which
the cancer has spread to nearby lymph
nodes, and.
• M (0-1) indicates whether the cancer
has metastasized to other organs in the
body.
Cont.

• A small tumor that has not spread to

lymph nodes or distant organs may be
staged as (T1, N0, M0), for example.
• stage 1 to 4
• lower numbers indicate that the cancer
has spread less.
• While most Stage 1 tumors are curable,
most Stage 4 tumors are untreatable.
 classification system con.
Manifestations Stage
No evidence of primary T0 T (Tumor size, depth of
tumor. T1S invasion and surface
Tumor in situ. spread)
,T2, T3, T4
Ascending degrees of tumor
size and involvement.
No abnormal regional nodes. N0 N ( presence and extend
Regional nodes-no N1a, N2a of lymph node
metastasis. involvement)
, N2b, N3b
Regional lymphnodes-
metastasis suspected.

No evidence of distant M0 M (presence or absence

metastasis. M1, M2, M3 of distant metastasis)
Ascending degrees of
metastatic involvement of
the host including distant nod
Grades of cancer
• Grade1;
• The tumor cells and the organization of the
tumor tissues appear closed to normal,
Well differentiated (low grade)
• Grade2 ;
• These tumors tend to grow and spread
slowly,moderate differentiated.(Intermediate
grade)
• Grade3 ,4;
• Tumors tend to grow rapidly and spread faster
than tumors with a lower
grade,undifferentiated(high grade)
 Treatment Modalities
 1-local therapy:
 -surgery.
 -radiation therapy.
 2-systemic treatment:
 chemotherapy.
 Hormonal therapy.
 Monoclonal antibodies.
 Radioactive material.
 3-supportive care.
 4-non-conventional therapy.
75
 Surgery
 Surgery was the first modality used
successfully in the treatment of cancer.
 It is the only curative therapy for many
common solid tumors.

76
 Chemotherapy
 Systemic chemotherapy is the main treatment
available for disseminated malignant diseases.
 Progress in chemotherapy resulted in cure for
several tumors.
 Chemotherapy usually require multiple
cycles.
 Chemotherapy: Treatment with drugs that kill
cancer cells or make them less active.
77
 Chemotherapy
 The drugs used in cancer treatment vary in
their chemical structure , biological side
effects and toxicities. Some are effective in
treating one specific types of cancer while
others are utilized in the treatment of wide
variety of malignancies. The methods of
administration also vary according to the
chemotherapeutic and new techniques for
safer and more effective administration.
78
 There are different ways of chemotherapy may be
used:

 Adjuvant chemotherapy - Chemotherapy given to destroy cells

that may be present before or after surgery. Adjuvant
chemotherapy is given to prevent a possible cancer recurrence.

 Curative chemotherapy - Chemotherapy given to cure cancer

 Palliative chemotherapy - Palliative is a type of chemotherapy

that is given specifically to address symptom management without
expecting to significantly reduce the cancer

79
 ROLE OF A NURSE
Prior to chemotherapy administration
 Review- The chemotherapy drugs prescription which
should have
-Name of anti-neoplastic agent.
-Dosage -Route of administration.
-Date and time that each agent to be administered.
2. Accurately identify the client
3.Medications to be administered in conjunction with the
80
 ROLE OF A NURSE
Prior to chemotherapy administration

4. Assess the clients condition including

- Most recent report of blood counts including
hemoglobin , hematocrit, white blood cells and
platelets.
-Presence of any complicating condition which
could contraindicate chemotherapeutic agent
administration i.e. infection, severe stomatitis ,
decreased deep tendon reflexes, or bleeding .
-Physical status -Level of anxiety 81

-Psychological status.
 The following guidelines to be kept in mind:

-Inspect the solution, container and tubing for signs

of contamination including particles,
discoloration, cloudiness, and cracks or tears in
bottle or bag.
-Aseptic technique to be followed.
-Prepare medicines according to manufacturer’s
directions.
-Select a suitable vein
-Large veins on the forearm are the preferred site.
82
 The following guidelines to be kept in mind:
Disposal of supplies and unused drugs
a)Do not clip or recap needles or break syringes.
b)Place all supplies used intact in a leak
proof ,puncture proof, appropriate labeled container.
c)Place all unused drugs in containers in a leak
proof, puncture proof, appropriately labeled
container.
d)Dispose of containers filled with
chemotherapeutic supplies and unused drugs in
accordance with regulations of hazardous wastes.
83
Complication of chemotherapy

 Every chemotherapeutic will have some

deleterious side effect on normal tissue .
 E.g. extravasation, nausea & vomiting,
Stomatitis, and alopecia are the most
frequently observed side effects.
84
 Extravasation management
Extravasation is the accidental infiltration of
vesicant or irritant chemotherapeutic drugs
from the vein into the surrounding tissues at
the I/V site.

Injuries that may occur as a result of

extravasation include sloughing of tissue ,
infection, pain ,and loss of mobility of an
extremity. 85
 Nursing responsibilities for the prevention of
extravasation include the following
Central venous access for 24 hrs vesicants infusion
Testing vein patency without using chemotherapeutic agents.

Careful observation of access site and extremity throughout

the procedure
Ensuring blood return from I/V site before, during, and after
vesicant drug infusion.
Educating patients regarding symptoms of drug infiltration ,

e.g. pain, burning, stinging sensation at I/V site.

86
 Fatigue..

 Factors contributing to fatigue

*Surgery/Chemotherapy
*Pain * Malnutrition
*Medications * Anemia *Normal lifestyle
Nursing Care
 Assessing contributing factors, and

encouraging patient to rest and limit daily

activities.
87
 Anorexia..

Factors contributing to anorexia

- Waste products of tissue destruction, anemia,
inactivity, medications, and psychological problems
Nursing Care
* Eat small, frequent meals
* Change diet and environment * Stimulate appetite
*Eat nutritious and high protein snack.
* Avoid fatty or greasy foods.
88

* Take nutritional supplements.

 Mucositis/ Stomatitis.
 Mucositis is….A patchy, white membrane
become confluent and may bleed if disturbed.
Nursing Care
* Avoid irritants—alcohol, tobacco, spicy, acid
foods or hot drinks.
* Eat soft or liquid diet.
* Mouth care with saline or water frequently.

89
 Alopecia..
 Alopecia is descried as the loss of hair that
can occur with the radiation of the brain
Nursing Care
* Gently brush and comb, infrequently shampoo
* Avoid the use of hair coloring and chemical
* Give psychological support for change of body
image
* Give advice for using wig if necessary
90
 Skin Reactions

Skin reactions include erythema, dry and moist desquamation

Nursing Care
* Prevent increasing irritation and avoid scratch
* Not to use any perfumed soap, ointments or deodorant
 Wear loose-cloths and cotton made rather synthetic

materials
* Open to fresh air but not direct to sunlight

91
 Nausea & Vomiting..
Nursing Care
* Eat small, frequent meals
* Eat salty foods, add salt in foods
• Drink clear or cool beverages

Avoid overly sweet, greasy or high fat foods

* Rest with the head elevated after eating
* Mouth care
92

* Take antiemetic medications

 Esophagitis & Dysphagia
 Firstly recognize “difficulty in swallowing
solids” and make swallowing painful resulting
in decrease in intake foods and fluids
Nursing Care
* Eat high-calorie, high-protein diet
* Drink plenty of liquids
* Eat soft and liquid foods
* Blenderlize solid foods
93
 Diarrhea…
 Can occur if the areas of the abdomen and
pelvis are treated
Nursing Care
* Drink plenty of fluids to avoid dehydration
* Avoid milk or dairy products
* Avoid foods high in fiber
* Avoid high fat, spicy, and gas forming foods
* Electrolyte replacement--potassium
94
 Bone Marrow Suppression…
 Can occur if the areas of the abdomen and pelvis
are treated
Nursing Care
* Examine blood counts weekly
* Observe signs and symptoms of bleeding, anemia,
and infection
* Teach patients to look for these signs
* Transfuse blood components as necessary
95

* Give health education on nutritious foods—

 Radiation therapy
 Radiation therapy: is a local modality used in
the treatment of cancer .
 Success depend in the difference in the radio
sensitivity between the tumor and normal tissue.
 It involves the administration of ionizing
radiation in the form of x-ray or gamma rays to
the tumor site.
 Method of delivery: External beam(teletherapy).
Internal beam therapy(Brachytherapy).
96
 Nursing care
PRE-RADIATION

 Preparation of patient (body)

 Laboratory tests—CBC, Blood chemistry

97
How to take care the treated area?

􀂆 Keep the skin dry

 Do not remove the ink marks

 Avoid using powder, lotions, creams, alcohol,

and deodorant
 Wear loose-fitting cloths
 Shave with an electric razor only
 Protect the skin from direct sunlight, and

extreme temperature
98
 Detection and Prevention of
Cancer
Primary and secondary prevention of cancer.
 Primary prevention is concerned with reducing the
risks of cancer in healthy people.
 Secondary prevention involves detection and
screening to achieve early diagnosis and prompt
intervention to halt the cancer process.

99
 PRIMARY PREVENTION
“The American Cancer Society public education program”

1- Increase consumption of fresh vegetables.

2- Increase fiber intake.
3- Increase intake of vitamin A.
4-Increase intake of foods rich in vitamin C.
5-Practice weight control.
6-Reduce intake of dietary fat.
100
 PRIMARY PREVENTION
“The American Cancer Society public education program ”

7- Stop smoking cigarettes and cigars.

8- Reduce (stop) alcohol intake.
9- Avoid over exposure to the sun.

101
 SECONDARY PREVENTION
Detection efforts as suggested by the American Cancer Society

frequency evaluation age gender Site

Every 3 years Clinical breast examination
(CBE)
– 20 F Breast
Every month Breast self-examination (BSE) 39
Every year Clinical breast examination
(CBE) ≤ 40
Every month Breast self-examination (BSE)
Every year Mammogram

Every year Fecal occult blood test

and
≤50 M/F
Every 5 years Flexible sigmoidoscopy /Colon
or rectu
Every 10 years Colonoscopy
or
m
Every 5 years Double-contrast barium enema
102
 NURSING PROCESS:

THE PATIENT WITH CANCER

103
 Assessment:

 BLEEDING.
 SKIN PROBLEMS.
 Alopecia (hair loss).
 NUTRITIONAL CONCERNS.
 PAIN.
 FATIGUE.
 PSYCHOSOCIAL STATUS.
 BODY IMAGE
 INFECTION 104
 NURSING DIAGNOSES
 Impaired oral mucous membrane
 Impaired tissue integrity
 Impaired tissue integrity: alopecia
 Impaired tissue integrity: malignant skin lesions
 Imbalanced nutrition, less than body requirements
 Anorexia, Malabsorption, Cachexia
 Chronic pain
 Fatigue
 Disturbed body image
 Anticipatory grieving
105
 Nursing intervention
” Relieving pain“
 Treat the risk factor or the cause
 Give pain killer
 Adjuvant medications are also administered to manage other
symptoms include : Antiemetic, antidepressants, antiseizure
agents, and corticosteroids.
 Nonpharmacological such as relaxations, massage.
 Be active listener
 Nursing intervention
 IMPROVING BODY IMAGE AND SELF-
ESTEEM:
 Encourage independence and continued
participation in self-care and decision making.
 Any negative feelings that the patient has or
threats to body image should be identified and
discussed.
 The nurse serves as a listener and counselor to
both the patient and the family. 107
 ASSISTING IN THE GRIEVING PROCESS:

 Referral to a support group.

 Grieving is a normal response to these fears
and to the losses anticipated by the patient
 An important role of the nurse is to answer any questions the

patient and family have and

Clarify information provided by the physician.
* Identifying resources and support people (eg, spiritual advisor,
counselor).
 Encourages the patient and family to verbalize

their feelings in an atmosphere of trust and support. 108

End of Chapter

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