Medical-Surgical Nursing: An Integrated Approach, 2E

Chapter 17

NURSING CARE OF THE ONCOLOGY CLIENT

Cancer

A disease resulting from the uncontrolled growth of cells, which causes malignant cellular tumors.

The second leading cause of death in the United States.

Incidence of Cancer

In the U.S., men have a 1 in 2 lifetime risk of developing cancer, while women have a 1 in 3 risk.

Incidence and mortality rates higher for African Americans than for Anglo Americans.

Most cancers are curable if treated early.

Most Common Cancers

In men, most common cancers are prostate, lung, and colorectal.

In women, they are breast, colorectal, lung, and uterine.

Cancer and Tobacco

In 2000, approximately 173,000 cancer deaths were estimated to be caused by tobacco.

Pathophysiology

Cancer characterized by neoplasms, abnormal growth of new tissue.

Neoplasms can be benign (not progressive, and thus, favorable for recovery) or malignant (becoming progressively worse and often resulting in death).

Metastasis

The rapid multiplication of malignant neoplasms which spread to distant body parts through the bloodstream or the lymph system.

Four Main Classifications of Cancer Lymphomas (cancers occurring in

infection-fighting organs, such as lymphatic tissue).

Leukemias (cancers occurring in blood-forming organs, such as the spleen, and in bone marrow).

Sarcomas (cancers occurring in connective tissue, such as bone).

Carcinomas (cancers occurring in epithelial tissue, such as the skin).

Carcinogens

Chemical substances that initiate or promote the development of cancer.

These agents are thought to alter the DNA in the cell nucleus.

Significant Risk Factors for Developing Cancer Environmental

(occupational exposure, secondhand smoke).

Lifestyle Factors (tobacco and alcohol use, diet, sun exposure).

Genetic Factors (high incidence in some families of certain types of cancer, e.g. breast cancer).

Viral Factors (possible link to certain viruses).

Common Diagnostic Tests for Cancer Detection

Laboratory Tests Radiologic Studies Invasive Diagnostic Techniques Biopsy is the most accurate diagnostic

test for cancer.

Staging and Grading of Tumors

Staging determines the extent of the spread of cancer.

Grading evaluates tumor cells in comparison to normal cells.

Most Common Treatment Modalities

Surgery Radiation Therapy Chemotherapy

Detection of Cancer

The earlier cancer is detected, the more likely it is to be controlled.

Cancer checkup is recommended every 3 years for persons ages 20 to 39 and annually for those 40 and over.

Surgery

The oldest form of cancer treatment and still the most common today.

Surgery is classified as: Curative (to heal or restore to health). Palliative (to relieve symptoms in more

advanced stages). Reconstructive (may follow curative or radical

surgery to reestablish function or rebuild for better cosmetic effect).

Radiation Therapy

Second most common treatment, radiation therapy, or radiotherapy, uses high-energy ionizing radiation to kill cancer.

Two types: External. Internal.

Chemotherapy May be used to cure, prevent, or relieve

cancer symptoms. Drugs used in chemotherapy are called

antineoplastics because they inhibit the growth and reproduction of malignant cells.

Chemotherapy is the treatment of choice for metastatic cancers. It is also the treatment most responsible for increasing cancer cure rates in recent years.

Biotherapy Performed with biologic response

modifiers (BRMs), agents that stimulate the body’s natural immune system to control and destroy malignant cells.

Most BRMs are still being evaluated in trial studies.

Bone Marrow Transplantation Used for cancers that respond to high

doses of chemotherapy or radiation therapy.

Treatment involves aspirating and storing a fraction of bone marrow, exposing the client to high-dose drug therapy or total body irradiation, and then reinfusing the bone marrow after the treatment is complete.

Symptom Management

Bone Marrow Dysfunction.

Nutritional Alterations.

Pain. Fatigue. Alopecia.

Dyspnea. Bowel Dysfunctions. Pathological

Fractures. Ascites. Sexual Alterations. Odors.

The oncology nurse must formulate nursing interventions to manage these problems:

Bone Marrow Dysfunction Blood counts must be monitored carefully

during and after treatment. Clients with platelet count below 50,000/mm3

should be monitored for bleeding. Skin should be inspected daily for bruises or

petechiae. Stool and urine should be monitored for occult blood. Client should be observed for bleeding from nose, vagina, rectum, mouth, and venipuncture sites.

Nutritional Alterations

Cachexia, a state of malnutrition and protein (muscle) wasting occurs in conjunction with lung, pancreatic, stomach, bowel, and prostate cancers, but rarely with breast cancer.

In some cases, untreated cachexia is the cause of death.

Symptoms of Nutritional Alterations Anorexia (loss of appetite). Nausea and vomiting. Altered taste sensation. Dysphagia (difficulty in swallowing, occurring in

clients with esophageal cancers or in those receiving radiotheraphy).

Mucosal Inflammation. Particularly stomatitis, inflammation of the

mucous membrane of the oral cavity.

Pain

Approximately 60% to 90% of all individuals with progressive malignancy will experience pain.

Pain usually does not occur until advanced stages of disease.

Most common causes are metastatic bone disease, venous or lymphatic obstruction, or nerve compression.

Fatigue

Occurs as a direct result of cancer treatment or because of anemia, chronic pain, stress, depression, insufficient rest, or inadequate nutritional intake.

Frequent rest periods should be provided for the client.

Alopecia

Defined as the thinning or loss of hair, which may be induced by chemotherapy or radiation treatments.

Drug induced alopecia is not permanent. Hair usually begins to grow back within 8 weeks after completion of treatment. Color and consistency of hair may change.

Odors

Unpleasant odors emanating from the cancer client may be a source of embarrassment. These odors may be associated with drainage, exudates, or incontinence.

Meticulous nursing care can eliminate most offending odors.

Dyspnea

One half of all clients with terminal cancer experience dyspnea, or difficulty in breathing.

Bowel Dysfunctions

Cancer clients frequently exhibit changes in bowel patterns.

Constipation, diarrhea, and subsequent perineal skin breakdown and bowel obstructions are common elimination disorders.

Pathological Fractures

These are a major problem in cancers that metastasize to bone.

The cancers weaken the bone to the point that normal activities can cause painful breaks.

Ascites

Abdominal cancers may cause ascites, or fluid accumulation in the abdomen.

Sexual Alterations

Many chemotherapy drugs can interfere with sexual functioning and reproduction.

Premenopausal women may become infertile.

Men may experience impotence, decreased libido, interrupted sperm production, and ejaculation problems.

Medical Emergencies Associated with Advanced Stage Cancers

Hypercalcemia. (occurs when serum calcium level rises higher than 10.5mg./dL. Often signals final stages of cancer).

Spinal Cord Compression (can result in permanent paralysis).

Superior Vena Cava Syndrome (collection of symptoms caused by obstruction of the superior vena cava).

Cardiac Tamponade (caused by the formation of pericardial fluid, which reduces cardiac output by compressing the heart).

Psychosocial Alterations Clients may see themselves as burdens to their

families. Family caregivers may be angry that their own

needs must go unmet. Family caregivers may feel inadequate with regard

to caring for the client. Medical equipment (e.g. hospital bed, commode

chair, or wheelchair) may need to be brought into the home. These may have an impact on family member state of mind and disposition with regard to family member with cancer.

A Cancer Client’s Goal

Quality of life, not quantity of life, is the ultimate goal for clients living with cancer.