Oncology

By:
Ruby Ruth T. Roces, R.N., M.D.
 Oncology defined
 It is a branch of medicine that
deals with the study, detection,
treatment and management of
cancer
 glossary
 Neoplasia-uncontrolled cell growth that
follows no physiologic demand
 Anaplasia-cells that lack normal cellular

characteristics and differ in shape and

organization
 Metaplasia-conversion of one type of

mature cell into another; reversible

 Dysplasia-bizarre cell growth resulting in
cells that differ in size, shape or
arrangement from other cells of the same
type.
 Hypoplasia-incomplete or

underdevelopment w/ decreased number

of cells
 Hyperplasia-Increase in the number of
cells
 Hypotrophy-decrease in the organ size

/function
 Hypertrophy-increase in the size
 “Root words”
 A- none
 Ana- lack
 Hyper- excessive
 Meta- change
 Dys- bad, deranged
 Classification of Neoplasia

1. Benign
2. Malignant
3. Borderline/ in situ
 WAYS TO DIFFERENTIATE A BENIGN
FROM A MALIGNANT TUMOR
Characteristics Benign Malignant

Rate of growth Slow- growing Varies, but usually fast-growing

Differentiation Well differentiated Poorly differentiated

Local invasion Local invasion, Invasive, expansive,infiltrating,

encapsulated, local destructive, w/ generalized
effects effects

Metastases Non metastatic metastatic

 Nomenclature of Neoplasia
Tumor is named according to:
1. Parenchyma, Organ or Cell
 Hepatoma- liver

 Osteoma- bone

 Myoma- muscle
 Nomenclature of Neoplasia
Tumor is named according to:
2. Pattern and Structure, either GROSS or
MICROSCOPIC
 Fluid-filled CYST

 Glandular ADENO

 Finger-like PAPILLO

 Stalk POLYP
 Nomenclature of Neoplasia
Tumor is named according to:
3. Embryonic origin
 Ectoderm ( usually gives rise to epithelium)

 Endoderm (usually gives rise to glands)

 Mesoderm (usually gives rise to Connective

tissues)
 BENIGN TUMORS
 Suffix- “OMA” is used
 Adipose tissue- LipOMA
 Bone- osteOMA
 Muscle- myOMA
 Blood vessels- angiOMA
 Fibrous tissue- fibrOMA
 MALIGNANT TUMOR
 Named according to embryonic cell origin
1. Ectodermal, Endodermal, Glandular,
Epithelial
 Use the suffix- “CARCINOMA”

 Pancreatic AdenoCarcinoma

 Squamos cell Carcinoma

 MALIGNANT TUMOR
 Named according to embryonic cell origin
2. Mesodermal, connective tissue origin
 Use the suffix “SARCOMA

 FibroSarcoma

 Myosarcoma

 AngioSarcoma
 “Exceptionistas”

1. “OMA” but Malignant

 HepatOMA, lymphOMA, gliOMA, melanOMA
2. THREE germ layers
 “TERATOMA”
3. Non-neoplastic but “OMA”
 Choristoma
 Hamatoma
 CANCER NURSING
Review of Normal Cell Cycle
3 types of cells
1. PERMANENT cells- out of the cell cycle
 Neurons, cardiac muscle cell
2. STABLE cells- Dormant/Resting (G0)
 Liver, kidney
3. LABILE cells- continuously dividing
 GIT cells, Skin, endometrium , Blood cells
 CANCER NURSING
Cell Cycle
G0------------------G1SG2M
 G0- Dormant or resting

 G1- normal cell activities

 S- DNA Synthesis

 G2- pre-mitotic, synthesis of proteins for cellular

division
 M- Mitotic phase (I-P-M-A-T)
 CANCER NURSING
Theories to the Pathogenesis of Cancer
 Cellular transformation and derangement

theory
 Immune response failure theory
 CANCER NURSING
Etiology of cancer
1. PHYSICAL AGENTS
 Radiation (thyroid CA)

 Exposure to irritants (skin CA)

 Exposure to sunlight (skin CA)

 CANCER NURSING
Etiology of cancer
2. CHEMICAL AGENTS
 Smoking (Lung CA)
 Dietary ingredients (gastric CA)
 Drugs
 CANCER NURSING
Etiology of cancer
3. Genetics and Family History
 Colon Cancer
 Breast cancer
 CANCER NURSING
Etiology of cancer
4. Dietary Habits
 Low-Fiber
 High-fat
 Processed foods
 alcohol
 CANCER NURSING
Etiology of cancer
5. Viruses and Bacteria
 DNA viruses- HepaB, Herpes, EBV, CMV,

Papilloma Virus
 RNA Viruses- HIV, HTCLV

 Bacterium- H. pylori
 CANCER NURSING
Etiology of cancer
 6. Hormonal agents
 DES
 OCP especially estrogen
 CANCER NURSING
Etiology of cancer
 7. Immune Disease
 AIDS
 CANCER NURSING
CARCINOGENSIS
 Malignant transformation
 IPP
 Initiation
 Promotion
 Progression
 CANCER NURSING
CARCINOGENSIS
 INITIATION
 Carcinogens alter the DNA of the cell
 Cell will either die or repair
 CANCER NURSING
CARCINOGENSIS
 PROMOTION
 Repeated exposure to carcinogens
 Abnormal gene will express
 Latent period
 CANCER NURSING
CARCINOGENSIS
 PROGRESSION
 Irreversible period
 Cells undergo NEOPLASTIC transformation
then malignancy
 CANCER NURSING
Spread of Cancer
 1. LYMPHATIC
 Most common
 2. HEMATOGENOUS
 Blood-borne, commonly to Liver and Lungs
 3. DIRECT INVASION/EXTENSION
 Seeding of tumors
 CANCER NURSING
Body Defenses Against TUMOR
 1. T cell System/ Cellular Immunity
 Cytotoxic T cells kill tumor cells
 2. B cell System/ Humoral immunity
 B cells can produce antibody
 3. Phagocytic cells
 Macrophages can engulf cancer cell debris
 CANCER NURSING
Cancer Diagnosis
 1. BIOPSY
 The most definitive
 2. CT, MRI- for visualization and staging
 3. Tumor Markers
 CANCER NURSING
Cancer Grading
The degree of DIFFERENTIATION
 Grade 1- Low grade

 Grade 4- high grade

 CANCER NURSING
Cancer Staging
1. Uses the T-N-M staging system
 T- tumor

 N- Node

 M- Metastasis

2. Stage 1 to Stage 4
 CANCER NURSING
GENERAL Promotive and Preventive Nursing
Management
 1. Lifestyle Modification

 2. Nutritional management

 3. Screening

 4. Early detection
 SCREENING
 1. Male and female- Occult Blood, CXR, and
DRE
 2. Female- SBE, CBE, Mammography and
Pap’s Smear
 3. Male- DRE for prostate, Testicular self-
exam
 Nursing Assessment
Utilize the ACS 7 Warning Signals
 CAUTION

 C- Change in bowel/bladder habits

 A- A sore that does not heal

 U- Unusual bleeding

 T- Thickening or lump in the breast

 I- Indigestion

 O- Obvious change in warts

 N- Nagging cough and hoarseness

 Nursing Assessment
 Weight loss
 Frequent infection
 Skin problems
 Pain
 Hair Loss
 Fatigue
 Disturbance in body image/ depression
 CANCER MANAGEMENT
GENERAL MEDICAL MANAGEMENT
- Treatment goals: cure, control and palliation
 1. Surgery

 2. Chemotherapy

 3. Radiation therapy

 4. Immunotherapy

 5. Bone Marrow Transplant

 CANCER MANAGEMENT
SURGERY
 Diagnostic- excision, incision, needle

 primary method of treatment- local and wide

excision
 prophylactic

 Palliative- relieve complications of CA

 Reconstructive- improve function or obtain a

more desirable cosmetic effect

 CANCER MANAGEMENT
NURSING MANAGEMENT
 Provide education and emotional support

 Assess patient’s responses to the surgery

 Monitor for possible complications such as

infection, bleeding fluid and electrolyte

imbalance and organ dysfunction
 Plan for discharge, ff-up and home care
 CANCER MANAGEMENT
RADIATION THERAPY
 Cure, control, prophylaxis

 Used to disrupt cell growth

 Cells are most vulnerable during DNA

synthesis and mitosis therfore those body

tissues which undergo frequent cell division
are most sensitive to
radiation.(BM,lymphatic,skin,GIT,gonads)
 CANCER MANAGEMENT
MAINTAIN TISSUE INTEGRITY
 Frequently assess for changes

 Handle skin gently

 Do NOT rub affected area

 Lotion may be applied (water-based)

 Wash skin only with SOAP and Water

 CANCER MANAGEMENT
RISK FOR RADIATION INJURY
 Protect caregivers fr exposure to radioactive

implants
 Identify max time that can be spent safely

inpxs room
 Use of shielding equipments

 Explain to px the need for such precautions to

keep px from feeling isolated

 CANCER MANAGEMENT
 MANAGEMENT OF STOMATITIS
 Use soft-bristled toothbrush
 Oral rinses with saline gargles/ tap water
 Avoid ALCOHOL-based rinses
 CANCER MANAGEMENT
CHEMOTHERAPY
 Destroys tumor cells by interfering w/ cellular

functions and reproduction

 Used primarily to treat systemic disease rather

than localized lesions

 CANCER MANAGEMENT
 ADMINISTRATION:
 Topical, Oral, IM, IV, Subcutaneous, arterial,
intracavitary, intrathecal
 Dosage based on TBSA
 Special care needed for vesicants- causes
extravasation (daunorubicin, doxorubicin,
nitrogen mustard, mitomycin, vincristine and
vindesine. If suspected stop immediately and
apply ice except in vonca alkaloid
 CANCER MANAGEMENT
Common side effects:
 Nausea and vomiting, stomatitis, anorexia,

diarrhea
 Myelosuppression

 Nephrotoxicity-danorobucin, doxorubucin

 CHF- cisplastin, methroxate, mitomycin

 Pulmonary fibrosis-bleomycin and busulfan

 CANCER MANAGEMENT
 Sterility
 Reversible Neurologic damage- taxanes and
plant alkaloids, peripheral neuropathy and
hearing loss- cisplatin
 fatigue
 Nursing Intervention
 MANAGEMENT OF ALOPECIA
Alopecia begins within 2 weeks of therapy
 Regrowth within 8 weeks of termination
 Encourage to acquire wig before hair loss
occurs
 Encourage use of attractive scarves and hats
 Provide information that hair loss is
temporary BUT anticipate change in texture
and color
 Nursing Intervention
 PROMOTE NUTRITION
 Serve food in ways to make it appealing
 Consider patient’s preferences
 Provide small frequent meals
 Avoids giving fluids while eating
 Oral hygiene PRIOR to mealtime
 Vitamin supplements
 Nursing Intervention
 RELIEVE PAIN
 Mild pain- NSAIDS
Moderate pain- Weak opiods
 Severe pain- Morphine
 Administer analgesics round the clock with
additional dose for breakthrough pain
 Nursing Intervention
 DECREASE FATIGUE
 Plan daily activities to allow alternating rest
periods
 Light exercise is encouraged
 Small frequent meals
 Nursing Intervention
 IMPROVE BODY IMAGE
 Therapeutic communication is essential
 Encourage independence in self-care and
decision making
 Offer cosmetic material like make-up and
wigs
 Nursing Intervention
 ASSIST IN THE GRIEVING PROCESS
 Some cancers are curable
 Grieving can be due to loss of health,
income, sexuality, and body image
 Answer and clarify information about
cancer and treatment options
 Identify resource people
 Refer to support groups
 Nursing Intervention
 MANAGE COMPLICATION:
INFECTION
 Fever is the most important sign (38.3)
 Administer prescribed antibiotics X 2weeks
 Maintain aseptic technique
 Avoid exposure to crowds
 Avoid giving fresh fruits and veggie
 Handwashing
 Avoid frequent invasive procedures
 Nursing Intervention
 MANAGE COMPLICATION: Septic
shock
 Monitor VS, BP, temp
 Administer IV antibiotics
 Administer supplemental O2
 Nursing Intervention
 MANAGE COMPLICATION: Bleeding
 Thrombocytopenia (<100,000) is the most
common cause
 <20, 000 spontaneous bleeding
 Use soft toothbrush
 Use electric razor
 Avoid frequent IM, IV, rectal and
catheterization
 Soft foods and stool softeners
Mortality and Morbidity Rates
Colon cancer
 COLON CANCER
 Risk factors
 1. Increasing age
 2. Family history
 3. Previous colon CA or polyps
 4. History of IBD
 5. High fat, High protein, LOW fiber
 6. Breast Ca and Genital Ca
 COLON CANCER
 Sigmoid colon is the most common site
 Predominantly adenocarcinoma
 If early 90% survival
 34 % diagnosed early
 66% late diagnosis
 COLON CANCER
 PATHOPHYSIOLOGY
 Benign neoplasm DNA alteration
malignant transformation malignant
neoplasm  cancer growth and invasion 
metastasis (liver)
 COLON CANCER
 ASSESSMENT FINDINGS
1. Change in bowel habits- Most common
 2. Blood in the stool
 3. Anemia
 4. Anorexia and weight loss
 5. Fatigue
 6. Rectal lesions- tenesmus, alternating D and C
 Colon cancer
 Diagnostic findings
 1. Fecal occult blood
 2. Sigmoidoscopy and colonoscopy
 3. BIOPSY
 4. CEA- carcino-embryonic antigen
 Colon cancer
 Complications of colorectal CA
 1. Obstruction
 2. Hemorrhage
 3. Peritonitis
 4. Sepsis
 Colon cancer
 MEDICAL MANAGEMENT
 1. Chemotherapy- 5-FU
 2. Radiation therapy
 Colon cancer
 SURGICAL MANAGEMENT
 Surgery is the primary treatment
 Based on location and tumor size
 Resection, anastomosis, and colostomy
(temporary or permanent)
 Colon cancer
NURSING INTERVENTION
Pre-Operative care
 1. Provide HIGH protein, HIGH calorie and

LOW residue diet

 2.Provide information about post-op care and

stoma care
 3. Administer antibiotics 1 day prior
 Colon cancer
NURSING INTERVENTION
Pre-Operative care
 4. Enema or colonic irrigation the evening and

the morning of surgery

 5. NGT is inserted to prevent distention

 6. Monitor UO, F and E, Abdomen PE

 Colon cancer
NURSING INTERVENTION
Post-Operative care
 1. Monitor for complications

 Leakage from the site, prolapse of stoma, skin

irritation and pulmo complication

 2. Assess the abdomen for return of peristalsis
 Colon cancer

NURSING INTERVENTION
Post-Operative care
 3. Assess wound dressing for bleeding

 4. Assist patient in ambulation after 24H

 5.provide nutritional teaching

 Limit foods that cause gas-formation and odor

 Cabbage, beans, eggs, fish, peanuts

 Low-fiber diet in the early stage of recovery

 Colon cancer

NURSING INTERVENTION
Post-Operative care
 6. Instruct to splint the incision and

administer pain meds before exercise

 7. The stoma is PINKISH to cherry red,

Slightly edematous with minimal pinkish

drainage
 8. Manage post-operative complication
 Colon cancer
 NURSING INTERVENTION: COLOSTOMY
CARE
 Colostomy begins to function 3-6 days after
surgery
 The drainage maybe soft/mushy or semi-solid
depending on the site
 Colon cancer
 NURSING INTERVENTION: COLOSTOMY
CARE
 BEST time to do skin care is after shower
 Apply tape to the sides of the pouch before
shower
 Assume a sitting or standing position in
changing the pouch
 Colon cancer
 NURSING INTERVENTION: COLOSTOMY
CARE
 Instruct to GENTLY push the skin down and
the pouch pulling UP
 Wash the peri-stomal area with soap and water
 Cover the stoma while washing the peri-stomal
area
 Colon cancer
 NURSING INTERVENTION: COLOSTOMY
CARE
 Lightly pat dry the area and NEVER rub
 Lightly dust the peri-stomal area with nystatin
powder
 Colon cancer
 NURSING INTERVENTION: COLOSTOMY
CARE
 Measure the stomal opening
 The pouch opening is about 0.3 cm larger than
the stomal opening
 Apply adhesive surface over the stoma and
press for 30 seconds
 Colon cancer
 NURSING INTERVENTION: COLOSTOMY
CARE
 Empty the pouch or change the pouch when
 1/3 to ¼ full (Brunner)
 ½ to 1/3 full (Kozier)
 Breast Cancer
 The most common cancer in FEMALES
 Numerous etiologies implicated
 Breast Cancer
RISK FACTORS
 1. Genetics- BRCA1 And BRCA 2

 2. Increasing age ( > 50yo)

 3. Family History of breast cancer

 4. Early menarche and late menopause

 5. Nulliparity

 6. Late age at pregnancy

 Breast Cancer
RISK FACTORS
 7. Obesity

 8. Hormonal replacement

 9. Alcohol

 10. Exposure to radiation

 Breast Cancer
PROTECTIVE FACTORS
 1. Exercise

 2. Breast feeding

 3. Pregnancy before 30 yo
 Breast Cancer
ASSESSMENT FINDINGS
 1. MASS- the most common location is the

upper outer quadrant

 2. Mass is NON-tender. Fixed, hard with

irregular borders
 3. Skin dimpling

 4. Nipple retraction

 5. Peau d’ orange
 Breast Cancer
 LABORATORY FINDINGS
 1. Biopsy procedures
 2. Mammography
 Breast Cancer
 Breast cancer Staging
 TNM staging
 I - < 2cm
 II - 2 to 5 cm, (+) LN
 III - > 5 cm, (+) LN
 IV- metastasis
 Breast Cancer
 MEDICAL MANAGEMENT
 1. Chemotherapy
 2. Tamoxifen therapy
 3. Radiation therapy
 Breast Cancer
 SURGICAL MANAGEMENT
1. Radical mastectomy
2. Modified radical mastectomy
3. Lumpectomy
4. Quadrantectomy
 Breast Cancer
NURSING INTERVENTION : PRE-OP
 1. Explain breast cancer and treatment options

 2. Reduce fear and anxiety and improve coping

abilities
 3. Promote decision making abilities

 4. Provide routine pre-op care:

 Consent, NPO, Meds, Teaching about breathing

exercise
 Breast Cancer
NURSING INTERVENTION : Post-OP
1. Position patient:
 Supine

 Affected extremity elevated to reduce

edema
 Breast Cancer
NURSING INTERVENTION : Post-OP
2. Relieve pain and discomfort
 Moderate elevation of extremity

 IM/IV injection of pain meds

 Warm shower on 2nd day post-op

 Breast Cancer
NURSING INTERVENTION : Post-OP
3. Maintain skin integrity
 Immediate post-op: snug dressing with

drainage
 Maintain patency of drain (JP)

 Monitor for hematoma w/in 12H and apply

bandage and ice, refer to surgeon

 Breast Cancer
NURSING INTERVENTION : Post-OP
3. Maintain skin integrity
 Drainage is removed when the discharge is

less than 30 ml in 24 H
 Lotions, Creams are applied ONLY when

the incision is healed in 4-6 weeks

 Breast Cancer
NURSING INTERVENTION : Post-OP
Promote activity
 Support operative site when moving

 Hand, shoulder exercise done on 2ndday

 Post-op mastectomy exercise 20 mins

TID
 NO BP or IV procedure on operative site
 Breast Cancer

NURSING INTERVENTION : Post-OP

Promote activity
 Heavy lifting is avoided

 Elevate the arm at the level of the heart

 On a pillow for 45 minutes TID to

relieve transient edema

 Breast Cancer

NURSING INTERVENTION : Post-OP

MANAGE COMPLICATIONS
 Lymphedema

 10-20% of patients

 Elevate arms, elbow above shoulder and

hand above elbow

 Hand exercise while elevated

 Refer to surgeon and physical therapist

 Breast Cancer

NURSING INTERVENTION : Post-OP

MANAGE COMPLICATIONS
 Hematoma

 Notify the surgeon

 Apply bandage wrap (Ace wrap) and ICE

pack
 Breast Cancer
NURSING INTERVENTION : Post-OP
MANAGE COMPLICATIONS
Infection
 Monitor temperature, redness, swelling and

foul-odor
 IV antibiotics

 No procedure on affected extremity

 Breast Cancer
NURSING INTERVENTION : Post-OP
TEACH FOLLOW-UP care
 Regular check-up

 Monthly BSE on the other breast

 Annual mammography
 Lung cancer
 6th-7th decade
 Number 1 in the morbidity and mortality
survey among all cancers
 Equal incidence for both men and women
 85% caused by inhalation of carcinogenic
materials most commonly cigarette smoking
 Squamous cell carcinoma- more centrally
located, commonly in the segmental and
subsegmental bronchi.
 AdenoCarcinoma- presents more peripherally
as peripheral mass or nodules; most prevalent
lung Ca for both M and F
 Large cell carcinoma-fast growing tumor that
arise peripherally
 Bronchioalveolar cell CA- arises fr the
terminal bronchus and alveoli; usually slow
growing
 Small cell Ca- arises primarily as a proximal
lesion but may arise in any part of the
tracheobronchial tree
 Lung Cancer
Etiology
 Tobacco use

 Genetic- > acquired genetic lesion

 Lung Cancer
Clinical Manifestations:
 Cough

 Hemoptysis

 Wheeze, stridor

 Dyspnea

 Pneumonitis

 Pain

 Symptoms of lung abscess

 Lung Cancer
 Metastatic spread- tracheal obstruction,
dysphagia, hoarseness, Horner’s syndrome,
auperior vena cava syndrome, plural effusion,
respiratory failure.
 Systemic symptoms
 Endocrine syndromes-hypercalcemia
(epidermoid), SIADH (sm cell), gynecomastia
(large cell), clubbing (non-sm. Cell)
 Lung Cancer
Stage TNM descriptors 5-yr survival rate

I T1-2,N0,M0 60-80

II T1-2,N1,M0 25-50

IIIA T3,N0-1,M0 25-40

T1-3,N2,M0 10-30

IIIB Any T4 or N3,M0 <5

IV Any M0 <5
 Lung Cancer
T1-< 3 cm
T2->3 cm
T3- direct extension into chest wall
T4- invades mediastinum
N0
N1-peribronchial
N2-ipsilateral mediastinal
N3-contralateral mediastinal
 Lung Cancer
 TREATMENT
 Surgery
 Radiotherapy
 Chemotherapy
 Prostate Cancer
Etiology

 Age-related

 Blacks>white

 95 % are adenocarcinomas
 Prostate Cancer
Manifestations:
 Rel. to urinary flow obstuction

 Urinary frequency, ec in caliber of stream,

diminished force, hesitancy, dribbling,

nocturia and overflow incontinence
 Dysuria

 Back or hip pain

 Prostate Cancer
Diagnostics:
 DRE

 PSA- > 10 ng/ml

 Biopsy- transrectal prostate biopsy under

sonography (TRUS)
 Prostate Cancer
Treatment
 Surgery- radical retropubic prostatectomy

 Radiation therapy

*both are associated w/ impotence

 Androgen deprivation- for those w/ metastatic

disease (leuporide, flutamide)

 Chemotherapy- for palliation
 Non-Hodgkins Lymphoma
 Heterogenous group of cancers
 Originates from neoplastic growth of lymphoid
tissue
 Mostly involves malignant B lymphocytes;
only 5% are T lymphocytes
 Non-Hodgkins Lymphoma
Manifestations:
 Symptoms are highly variable

 Typically diagnosed at a latter stage when px

is more symptomatic; lymphadenopathy is

noticeable (stages III or IV)
 1/3 of cases have “B symptoms” (recurrent

fever, drenching night sweats, & unintentional

wt. loss of >10%
 Non-Hodgkins Lymphoma
Assessment & Diagnostics
 Histopathology

 Immunophenotyping

 Cytogenetic analysis

Staging – based on data obtained from CT

scan, bone marrow biopsies, CSF analysis
 Non-Hodgkins Lymphoma
Treatment:
 based on actual classification & stage of disease, prior

treatment, & px’s ability to tolerate therapy

 Radiation alone maybe beneficial in localized non-

aggressive forms
 In aggressive types, combination chemotherapy are

given in early stages

 Intermediate forms – chemotherapy + radiotherapy

for st. I & II disease

 Urinary bladder Cancer
 ETIOLOGY AND RISK FACTORS
 65 Yrs.- median age
 Smoking
 Cyclophosphamide exposure
 Schistoma haematobium
 Urinary bladder Cancer
Manifestations:
 Hematuria- mOst common symptom

 Urinary changes may accompany later

 Usually asymptomatic at early stages

 Diagnosis:
 Urinalysis- hematuria
 IVP- decreased bladder filling
 Cystoscopy- diagnostic
 Urinary bladder Cancer
 Treatment:
 Based on extent of disease
 Surgical Resection
 Intravesical chemotherapy
 Quiz
1 a 64 y.o patient status post- hemi colectomy
was tachycardic. Examination of the mucus
membrane showed a dry mouth. What is
your assessment to the possible cause of
tachycardia in this patient?
 infection
 3rd spacing
 Dehydration
 sepsis
2 difference between a benign fr malignant
neoplasm include all of the ff except
 well differentiated
 poorly demarcated
 no metastatic potential
 non invasive
3. radiation therapy is effective in actively
dividing cells. All of the ff are ex of those
except
 GIT
 Fatty tissues
 Nerve
 skin
4. screening should be done to detect cancers.
Routine Screening tests involves all of the
following except
 breast exam
 DRE
 Ultrasound
 Occult blood exam
5. chemotherapy was advised in a patient
diagnosed w/ skin Cancer. Vinblistine was
the agent ordered. You know that vinblistine
is a vesicant type of agent and causes
 extravasation
 intravasation
 nephrotoxicity
 ototoxicity
6. Most frequent cause of fever w/in 24 hrs in a
post-op patient is….
7-9. internal Radiation therapy poses a risk for
both patient and caregiver. Give 3 ways to
avoid unnecessary exposure
10. Most common manifestation of lung cancer
in early stages is…..