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NCM 417
Oncology (from the Ancient Greek onkos - meaning bulk, mass, or tumor, and the suffix -logy - meaning "study
of") is a branch of medicine that deals with tumors (cancer). A medical professional who practices oncology is an
oncologist. Oncology is concerned with:
* Cellular adaptation
a. Hypertrophy – refers to an increase in size of normal cells
b. Atrophy – refers to the shrinkage of cell size
c. Hyperplasia – refers to an increase in the number of normal cells
d. Metaplasia – refers to a conversion from the normal pattern of differentiation
of one type of cell into another type of cell not normal for that tissue.
Replacement of other mature cell.
e. Dysplasia – refers to an alteration in the shape, size, appearance and
distribution of cells (reversible)
f. Anaplasia – refers to disorganized, irregular cells that have nor structure and
have loss of differentiation; the result is always malignant (undifferentiated cell)
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NCM 417: Oncology Nursing Lecture Notes
Mae Geraldine E. Dacer, MAN, DM
D. Epidemiology of Cancer
1. Incidence of cancer
a. Cancer affects every age group though most cancer and cancer deaths occur in people older than
65 years of age
b. Cancer ranks 3rd as the cause of morbidity in the Philippines
c. Highest incidence of all cancer is prostate cancer
d. Highest cancer incidence in males in order of frequency: prostate cancer, lung cancer and
colorectal cancer
e. Highest cancer incidence in females in order of frequency: breast cancer, lung cancer and
colorectal cancer
2|Page of 12 Dacer,2020
NCM 417: Oncology Nursing Lecture Notes
Mae Geraldine E. Dacer, MAN, DM
1. Immune Functions
2. Age
a. Increased risk for people over age of 65
b. Factors attributed to cancer in elderly include hormonal changes, altered responses and the accumulation of free
radicals
c. Age has been identified as the single most important factor related to the development of cancer
3. Gender
a. certain cancers are more commonly seen in specific genders
ex: breast cancer –more common in female
colon cancer – more common in males
4. Genetic Risk
- 15% of cancers may be attributed to a hereditary component
Ex: Breast, colon, lung, ovarian and prostate cancers
5. Race – can affect any population
- African-Americans experience a higher rate of cancer than any other racial or ethnic group
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NCM 417: Oncology Nursing Lecture Notes
Mae Geraldine E. Dacer, MAN, DM
Other 1. develop specific antigens, characteristic 1. develop antigens completely different from a
of the particular cell formed normal cell
2. Chromosomes remain constant 2. chromosomal aberrations
throughout cell division 3. have more primitive and simplified
3. Complex metabolic and enzyme pattern metabolic and enzyme pattern
4. Cannot invade, erode, or spread 4. invade, erode and spread
5. cannot grow in present of necrosis or 5. grow in presence of necrosis and
inflammation inflammatory cells such as lymphocytes and
macrophages
6. exhibit periods of latency that vary from
tumor to tumor
7. have own blood supply and supporting
stroma
Metastasis
- ability of cancer cells to spread from the original site of the tumor to distant organs
Stages:
1. Detachment
* tumor cell loses cohesiveness and it has increasing motility
* tumor cell detaches from the primary tumor and create defects in the basemement membranes with
resulting stromal invasion and spread into circulation
2. Migration
* Cancer cells migrate via the lymph or blood circulation or by direct extension
* The lymphatic system provides the most common pathway for the initial spread of malignant cancer cells
* The blood vessels carry cancer cells from the primary tumor to the capillary beds of the lungs, liver and
bones
* Direct tumor extension of tumors to adjacent tissues also occurs
4|Page of 12 Dacer,2020
NCM 417: Oncology Nursing Lecture Notes
Mae Geraldine E. Dacer, MAN, DM
3. Dissemination
*Cancer cells are established at the secondary site which may result from entrapment due to the size of the
tumor clump, adherence to cells at the new through specific interactions, or by binding to exposed
basement membrane
4. Angiogenesis
* Vascularization of the tumor
- they are killed by cytotoxic T cells that have receptors for specific tumor antigens and by interferon-
activated natural killer (NK) lymphocytes and macrophages
- macrophages phagocytize the pathogen and present it as antigen to T and B lymphocytes
Classification of Neoplasms
1. Benign – from latin word “benigunus”- kind
2. Malignant
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NCM 417: Oncology Nursing Lecture Notes
Mae Geraldine E. Dacer, MAN, DM
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NCM 417: Oncology Nursing Lecture Notes
Mae Geraldine E. Dacer, MAN, DM
3. Host modification
- aims to alter the body’s internal environment to decrease the risk of or to reverse a carcinogenic process
Cancer Prevention
1. Skin: Avoid exposure to sunlight
2. Oral: Annual oral examination
3. Breast: Monthly BSE from age 20
4. Lungs: Avoid cigarette smoking; annual chest x-ray
5. Colon: DRE for person over age 40. Rectal biopsy, proctosigmoidoscopic examination, Guiac stool examination for
persons age 50 and above
6. Uterus: annual Pap’s smear from age 40
7. Basic: annual physical examination and blood examination
American Cancer Society’s seven warning signs of cancer (uses acronym CAUTION US):
1. Change in bowel or bladder habits
2. A sore that does not heal
3. Unusual bleeding or discharge
4. Thickening or lump in breast or elsewhere
5. Indigestions or difficulty in swallowing
6. Obvious change in wart or mole
7. Nagging cough or hoarseness
8. Unexplained Anemia
9. Sudden loss of weight
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NCM 417: Oncology Nursing Lecture Notes
Mae Geraldine E. Dacer, MAN, DM
Tumor markers
1. Tumor markers are protein substances found in the blood or blody fluids
2. Are released either by the tumor itself, or by the body as a defense in response to the tumor (called host response)
3. Tumor markers are derived from the tumor itself. And include the ff:
a. Oncofetal antigens, present normally in fetal tissue, may indicate an anaplastic process in tumor
cells; carcinoembyonic antigen (CEA) and alpha-fetoprotein (AFP) are examples of oncofetal
antigens.
b. Hormones are present in large quantities in the human body; however, high levels of hormones
may indicate a hormone-secreting malignancy; hormones that may be utilized as tumor markers
include the antidiuretic hormone (ADH), calcitonin, catecholamines, human chorionic
gonadotropin (HCG), and parathyroid hormone (PTH)
c. Isoenzymes that are normally present in a particular tissue may be released into bloodstream if
the tissue is experiencing rapid, excessive growth as the result of tumor; are examples include
neuron-specific enolase (NSE) and prostatic acid phosphatase (PAP)
d. Tissue-specific proteins identify the type of tissue affected by malignancy; an example of a
tissue-specific protein is the prostatic-specific antigen (PSA) utilized to identify prostate cancer
4. Host-response tumor makers include the following:
a. C-reactive protein
b. Interleukin-2
c. Lactic dehydrogenase
d. Serum Ferritin
e. Tumor necrosis factor
Staging
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NCM 417: Oncology Nursing Lecture Notes
Mae Geraldine E. Dacer, MAN, DM
Surgical Intervention
1. Preventive surgery- removal of precancerous lesions or benign tumors
2. Diagnostic surgery- biopsy
3. Curative surgery- removal of an entire tumor
4. Reconstructive surgery – improvement of structures and function of an organ
5. Palliative surgery – relief of distress in signs and symptoms; retardations of metastasis
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NCM 417: Oncology Nursing Lecture Notes
Mae Geraldine E. Dacer, MAN, DM
h. If working routinely near radiation sources, wear a monitoring device to measure exposure
i. Educate client in all safety measures
6. Evaluation: client demonstrates measures to protect others from exposure to radiation, identifies interventions to
reduce risk of infection, remains free from infection, achieves adequate fluid and nutritional intake
activities of daily living (ADLs) at level of ability
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NCM 417: Oncology Nursing Lecture Notes
Mae Geraldine E. Dacer, MAN, DM
2. Gene therapy
a. Current use in investigational
b. Increases susceptibility of cancer cells to the destruction by other treatments; insertion of specific genes
enhances ability of client’s own immune system to recognize and destroy cancer cells
3. Photodynamic theory
a. Used to treat specific superficial tumors such as those of the surface of bladder, bronchus, chest wall, head,
neck and peritoneal cavity
b. Photofirin, a photosensitizing compound, is administered intravenously where it is retained by malignant
tissue
c. Three days after injection, the drug is activated by a laser treatment which continue for 3 more days
d. The drug produces a cytotoxic oxygen molecule (singlet oxygen)
e. During intravenous administration, monitor for chills, nausea, rash, local skin reactions, and temporary
photosensitivity
f. Drug remains in tissues 4-6 weeks after injection; direct or indirect exposure to sun activates drug, resulting
in chemical sunburn; educate client to protect skin from exposure to sun
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NCM 417: Oncology Nursing Lecture Notes
Mae Geraldine E. Dacer, MAN, DM
4. Cardiac tamponade
a. Pericardial effusion secondary to metastases or esophageal cancer can lead to compression of
heart, restricting heart movement and resulting in cardiac tamponade
b. Signs and symptoms are related to cardiogenic shock or circulatory collapse: anxiety, cyanosis,
dyspnea,hypotension, tachycardia,tachypnea,impaired levels of consciousness, and increased central
venous pressure
c. Pericardiocentesis is performed to remove fluid from pericardial sac
d. Nursing interventions
1) administering oxygen
2) maintaining intravenous line
3) Monitoring vital signs
4) hemodynamic monitoring
5) administration of vasopressor agents
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References
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“Don’t wait for your feelings to change to take the action. Take the action and your feelings will
change.”– Barbara Baron
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