ONCOLOGIC NURSING

• ECTODERMAL
NAMING OF CANCER:
• ENDODERMAL
1. Benign

2. Malignant • GLANDULAR

Naming of Cancer (Benign) • MESODERMAL - connective

tissue/ supporting tissue
1. PARENCHYMA, ORGAN/CELL – origin “sarcoma”
(medical term + “OMA”)
• Example:
• Muscle - MYO (Myoma) fibro+sarcoma;
• Lymph vessel – LYMPHA myo+sarcoma
(Lymphangioma) • Common sites: fat
• Blood vessels – HEMA “liposarcomA” ;
(Hemangioma) BONE
“OSTEOSARCOMA”;
2. PATTERN AND STRUCTURE MUSCLE
(either gross or microscopic) “MYOSARCOMA”

CANCER POINT TO LOCATION:

• Fluid-filled – “CYST”

• Glandular – “ADENO”

• Finger-like – “PAPILLO” PREFIX MEANING

• Stalk – “POLYP”
ADENO GLAND
3. EMBRYONIC ORIGIN:
CHONDRO CARTILAGES
• “ECTODERM” - epithelium
(hair, nails, sense, organs, ERYTHRO RBC
nervous system)

• “ENDODERM” – glands
HEMANGIO BLOOD
(pancreas, liver, thyroid)
VESSELS
HEPATO LIVER
• “MESODERM” – connective
tissue (heart, blood vessels, LIPO FATS
bones, muscles)
LYMPHO LYMPHOCYTE
Examples: blastoma – originates
S
in embryonic tissue of organs MELANO PIGMENT CELL
Naming of Cancer (Malignant) MYELO BONE
1. ACCORDING TO EMBRYONIC
MARROW
CELL ORIGIN:
MYO MUSCLE

• EPITHELIAL (example: OSTEO BONES

epithelial tissue –
“carcinoma” – can be found
in body surfaces, lining of
body cavities
COMPARISON OF
CHARACTERISTICS OF BENIGN VS

CHARACTERISTICS BENIGN MALIGNANT

1. SPREAD OF GROWTH -SLOW -AGGRESSIVE (RAPID

CELL DIVISION/GROWTH)
-GROWS BY EXPANSION
-ESTABLISHES NEW SITE
(MALIGNANT LESION)

2. MODE OF GROWTH -LOCALIZED AND -INVADES SURROUNDING

ENCAPSULATED TISSUES

3. CELL -WELL DIFFERENTIATED -DISORGANIZED

CHARACTERISTICS
-IMMATURE

4. METASTASIS -NEGATIVE -ABILITY TO MIGRATE

-NO TISSUE DAMAGE -CELLS MOVE TO DISTANT

AREAS OF THE BODIES

-DESTROY SURROUNDING
TISSUES

5. PROGNOSIS -VERY GOOD -POOR PROGNOSIS

PROGNOSIS
-CAN LEAD TO DEATH,
-DOES NOT CAUSE UNLESS INTERVENTIONS
DEATH, UNLESS ARE TAKEN
LOCALIZATION
AFFECTS VITAL
FUNCTIONS

6. SHAPE, SIZE -REGULAR -IRREGULAR

-CONSISTENT - PLEOMORPHIC (ABILITY
TO ALTER SHAPE OR SIZE
IN RESPONSE TO
ENVIRONMENTAL
CONDITIONS
7. DIFFERENTIATION -WELL -MODERATELY
DIFFERENTIATED DUE TO
ANAPLASTIC

8. NUCLEUS -SINGLE -MULTIPLE

9. NUCLEUS TO -SMALL -HIGH

CYTOPLASM RATIO

10. CELL GROWTH -ORDERLY -RANDOM

-CONTROLLED -UNCONTROLLED

MALIGNANT NEOPLASM
 • NEOPLASIA- NEW CELL TYPE
GROWTH
CLASSIFICATION OF TUMORS:

• BENIGN THREE STAGES OF METASTASIS

• MALIGNANT • INVASION – INVADE

SURROUNDING TISSUES
• BORDERLINE (low-malignant
potential; heterogenous group of
• SPREAD – DIRECT EXPANSION
lesions defined histological by
atypical epithelial proliferation
• ESTABLISHMENT AND GROWTH
without stromal invasion)
– ESTABLISH AND GROW TO
LYMPH NODES OR IN ORGANS
THREE-WAYS OF SPREAD OF CANCER FROM VENOUS CIRCULATION
CELLS:
CARCINOGENESIS
-PROCESS OF DEVELOPMENT OF
• LYMPHATIC VESSELS– MOST
COMMON CANCER CELLS

• HEMATOGENOUS ( BLOOD)- 3 STAGES

COMMON IN LIVER TO LUNGS
INITITIATION
• SEEDING OF TUMOR- DIRECT
SPREAD – ALTER OR CHANGES DNA OF CELLS

- CELL WILL EITHER DIE (APOPTOSIS)

PATTERN OF CELL PROLIFERATION OR REPAIR

• HYPERTROPHY – INCREASE IN PROMOTION

SIZE
– REPEATEDLY EXPOSURE TO
• ATROPHY – SHRINKAGE ( CARCINOGENS
DECREASE IN SIZE)
- ABNORMAL GENE WILL EXPRESS
GROWTH (NUMBER OF CELLS)
- LATENT OR LONG PERIOD
• HYPERPLASIA – INCREASE
NUMBER OF CELLS PROGRESSION

• DYSPLACIA – DISORGANIZED – IRREVERSIBLE PERIOD

CELLS
- CELL UNDERGO A NEOPLASTIC
• METAPLASIA – CHANGE OF CELL TRANSFORMATION THEN MALIGNANCY
GROWTH

• ANAPLASIA – LACK OR NO CELL

STRUCTURE
 EX: INCREASED PTH RESULTS TO
HYPERCALCEMIA, INCREASED
SECRETION OF INSULIN RESULTS TO
BODY DEFENSES AGAINST TUMOR: HYPOGLYCEMIA, INCEASED ADH

EFFECTS OF CANCER

1. DISRUPTION OF FUNCTION –
RESULTS TO FLUID RETENTION,
DUE TO OBSTRUCTION OF
HYPERTENSION AND PERIPHERAL
PRESSURE
EDEMA
2. HEMATOLOGIC ALTERATION –
6. PAIN – ASSISTED WITH CANCER
IMPAIRED FUNCTION OF BLOOD
CELLS 7. PHYSICAL STRESS – BODY
TRIES TO RESPOND AND
3. HEMORRHAGE – TUMOR
DESTROY NEOPLASM
EROSION AND BLEEDING THAT
CAUSES SEVERE ANEMIA

4. ANOREXIA – CACHEXIA
TUMOR STAGING AND
SYNDROME ( WASTED
APPEARANCE OF CLIENT DUE
GRADING
TO SEVERE WEIGHTLOSS OR
STAGING
MUSCLE WASTING)
• DETERMINE SIZE OF TUMOR IN
5. PARANEOPLASTIC SYNDROME –
EXISTENCE OF METASTSAIS
ECTOPIC SITES WITH EXCESS
HORMONE PRODUCTION

GRADING
 • CLASSIFIES CELL TYPE OF M1 – DISTANT METASTASIS (SPREAD
TISSUE TO OTHER PARTS OF BODY)

TNM( TUMOR, NODES, METASTASIS) CANCER ASSESSMENT:

SYSTEM
• EARLY ARE ASYMPTOMATIC
• EXTENT OF TUMOR, EXTENT OF
SPREAD TO LYMPH NODES , 1. NSG HISTORY: HEALTH
PRESENCE OF METASTASIS HISTORY – CHIEF COMPLAINT;
HISTORY OF PRESENT ILLNESS
(ONSET, COURSE, DURATION,
PRIMARY TUMOR (T) LOCATION, PRECIPITATION, AND
ALLEVIATING FACTORS)
T(X) – CANNOT EVALUATED
 CANCER SIGN (CAUTION
T0 – NO EVIDENCE OF TUMOR
US)

TIS – CARCINOMA IN CITU (NOT

 CHANGE IN
SPREAD TO NEIGHBOR TISSUE
BLADDER AND

T1 – 0-2 CM BOWEL HABITS

(COMMON WITH
T2 – 2-5 CM BLADDER/ KIDNEY

T3– 5-10 CM CA/COLON CA

T4 - >10 CM  A SORE THAT

DOES NOT HEAL
REGIONAL LYMPH NODES (N) (SMALL SCALY
PATCHES – SKIN
N(X) – CANNOT EVALUATED
CA; SORE MOUTH –
N0 – NO EVIDENCE OF REGIONAL ORAL CA)
LYMPH NODES
 UNUSUAL
N1 – 1 LYMPH NODE INVOLVED BLEEDING/DISCHA
RGE (BLOOD IN
N2 – 2 LYMPH NODES INVOLVED
STOOL – COLON CA
N3– 3 OR MORE LYMPH NODES EG:
INVOLVED MELENA(DARK/BLA
CK STOOL) ;
DISTANT METASTASIS (M)
HEMATOCHEZIA ( FRESH BLOOD IN
M(X) – CANNOT EVALUATED
STOOL) ; HEMATURIA -
M0 – NO EVIDENCE OF DISTANT BLADDER/KIDNEY CA; POST
METASTASIS
MENOPAUSAL BLEEDING – UTERINE  INSPECTION
CA/ ENDOMETRIAL CA (SKIN/MUCUS/MEMBRANE
S) – LESIONS, BLEEDING,
 THICKENING /
PETECHIAE AND
LUMPS –
IRRITATION
ENLARGEMENT OF
LYMPHNODES/  ASSESS STOOLS, URINE,
GLANDS (THYROID SPUTUM, VOMITUS FOR
CA); LUMP (BREAST ACUTE AND OCCULT
CA) BLEEDING

 INDIGESTION /  SCALP – HAIR

DIFFICULTY OF TEXTURE/LOSS
SWALLOWING
 PALPITATION (ABDOMEN)
(GASTRIC,
–MASSES, BULGES,
ESOPHAGEAL,
ABNORMALITIES, LYMPH
STOMACH,
NODES ENLARGEMENT
PANCREAS CA)
CAUSES OF  AUSCULTATION (LUNG
INDIGESTION/HEAR SOUNDS, HEART SOUNDS,
TBURN AND BOWEL SOUNDS)

 OBVIOUS CHANGE 3. IMPLEMENT SAFEGUARD

IN WARTS/MOLE – AGAINST CANCER
ASYMETRY,
BORDERS, COLOR, • BASIC ANNUAL PE AND

DIAMETER BLOOD EXAM

(PRECANCEROUS • SKIN – AVOID OVER

LESION) EXPOSURE TO

 NAGGING SUNLIGHT

COUGH/HOARSENE • ORAL - ANNUAL

SS OF VOICE – ORAL EXAM
LARYNGEAL/LUNG
CA • BREAST –
MONTHLY BSE
 UNEXPLAINED FROM 20 Y/O
ANEMIA
• COLON – DRE
 SUDDEN FROM 40 Y/O
UNEXPECTED
WEIGHT LOSS • RECTAL
BIOPSY AND
2. PHYSICAL EXAM: PROSTOSCO
PIC EXAM
 • GUAIAC IMAGING TECHNIQUES
STOOL EXAM
1. DIRECT VISUALIZATION
50 Y/O AND
“SCOPY” – introduction of fiber
ABOVE
optic endoscopy tubes into hollow
• UTERUS – ANNUAL organs to view internal surfaces eg.
PAP’S SMEAR – 40 Bronchoscopy; gastroscopy;
Y/O colonoscopy and sigmoidoscopy

• LUNGS – AVOID 2. INDIRECT VISUALIZATION (USED

CIGARETTE DYE) – includes Radiologic and
SMOKING; ANNUAL imaging test eg. Barium swallow, ct
CXR scan, mri, radioisotope studies and
ultrasound

LABORATORY STUDY
DIAGNOSTIC ASSESSMENT:
• TUMOR MARKERS
• TISSUE SAMPLING
 Biochem substance
• IMAGING TECHNIQUES synthesized and release by
tumor cells
• LAB STUDIES
 ONCOFETAL
• ROUTINE LAB EXAMS
ANTIGEN
TISSUE SAMPLING
 HORMONES
1. EXFOLIATIVE CYTOLOGY – cells
 ISOENZYMES
of body has shed during normal
sequence of body tissue growth and  TISSUE
development
ROUTINE LAB EXAM
2. BIOPSY – surgical removal of piece
• ALT(ALANINE TRANSAMINASE)
of tissue for microscopic exam
• AST (ASPARATE
1. NEEDLE BIOPSY – cells are
TRANSAMINASE)
aspirated through placed in
the tissue • HCG (HUMAN CHORIONIC
GONADOTROPIN)
2. INCISIONAL BIOPSY –
removing or taking small • BILIRUBIN
sample out of tissue mass
• BLEEDING TIME
3. EXCISIONAL BIOPSY –
• CBC
involves removal all of known
tumor