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02.04 Oncology Important Points

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Overview

  1. Warning signs of cancer (CAUTION)
    1. Change in bowel pattern
    2. A sore that does not heal
    3. Unusual bleeding
    4. Thickening of breast, testicle, skin
    5. Indigestion
    6. Obvious change in mole
    7. Nagging cough

Nursing Points

General

  1. All cancer diagnoses must be confirmed with a biopsy and/or histologic examination
  2. Cancer Staging
    1. Stage 0: carcinoma in situ
    2. Stage I: local tumor growth
    3. Stage II: limited spreading
    4. Stage III: regional spreading
    5. Stage IV: metastasis to other organ

Assessment

  1. Testicular Cancer
    1. Instruct client to perform monthly self examination
      1. Best performed after warm shower
  2. Cervical Cancer
    1. Women should have regular gynecological examinations with Pap smear testing
    2. Every 3 years routine
    3. Annually if abnormal
  3. Breast Cancer
    1. Metastasis can easily occur via the lymph nodes
    2. Risk Factors
      1. Early menarche
      2. Late menopause
    3. BSE (Breast Self Examination)
      1. Perform monthly 7-10 days after menses
    4. Do not perform blood pressure checks or invasive procedures on an arm that has had a mastectomy
      1. Risk for Lymphedema
  4. Prostate Cancer
    1. Men after 50 should have regular prostate examinations
    2. Removal of the prostate gland can be achieved via Transurethral Resection of the Prostate (TURP)

Therapeutic Management

  1. Chemotherapy Precautions
    1. Administered by nurse with specialty training
    2. Considered a toxic biohazardous material – handle only with special ‘chemo’ gloves (thicker)
    3. Will cause decreased immune system
      1. Neutropenia
      2. Anemia
      3. Thrombocytopenia
    4. Initiate neutropenic and bleeding precautions
    5. Patient may require antiemetics or antihistamines during chemotherapy to manage symptoms
  2. Radiation
    1. Can cause burns to skin → keep skin hydrated after radiation

Nursing Concepts

  1. Cellular Regulation
  2. Comfort
  3. Infection Control
  4. Health Promotion

Patient Education

  1. Monthly self-exams (breast, testicle)
  2. Trust your instinct – if something doesn’t seem right, tell your provider
  3. Changes to normal appearance or pattern usually indicate a problem

Reference Links

Study Tools

Video Transcript

This lesson is going to cover a few other points about cancer and treatment that you need to know to care for and educate your patients. Now, oncology is considered a specialty, so we won’t go into too much detail, but we’re gonna hit the highlights.

First, we want you guys to learn this mnemonic about the warning signs of cancer. You may see these in your patients, or even friends or family, so it’s important that you know these. The mnemonic is CAUTION. C-change in bowel pattern – if you’re regular and suddenly start seeing diarrhea or even constipation. Or especially blood in the stool, that’s an indication of a problem. A sore that doesn’t heal or unusual bleeding or bruising. T-thickening of breast tissue, testicle, or skin or any kind of mass can indicate a malignancy. I-Indigestion, especially if it’s persistent – of course we want to rule out any kind of cardiac source first. O-Obvious change in a mole. In the skin cancer lesson in Integumentary, we’ll talk about how to determine if a mole might be malignant. And finally N stands for nagging cough. Any kind of persistent symptoms – persistent fatigue, persistent cough, persistent indigestion – they all indicate that something could be wrong. So we want to encourage patients to trust their instincts when something doesn’t seem right and get checked out.

As far as diagnosis, an official diagnosis can only be made with a biopsy or histologic exam – that’s looking at the cells under the microscope and seeing the abnormal growth. Once we’ve confirmed the malignancy, we stage it based on the extent of the spread or metastasis. If it’s localized in one place and not growing, it’s stage 0. The more it spreads, the higher the staging number until we hit Stage 4, which indicates it has spread to other organs or organ systems. Of course, the higher the stage, the more severe the diagnosis and the poorer the prognosis.

Now we just want to review some key points of common cancers in females and males. Now – a key point here is that men can also get breast cancer – they also have breast tissue, though just less of it. Breast cancer has a high risk of metastasizing because of the proximity to the lymph system. Women who had early menarch or late menopause are at higher risk. Patients, especially women should be encouraged to do monthly breast self exams. The best time is about a week after menses, that’s when you’re most likely to find a lump. If the patient has had a mastectomy or lymph node removal, we don’t do blood pressures or IV sticks on that arm – we call this a Limb Alert. We can do damage to the lymph system and cause lymphedema.

The best way to detect cervical cancer is with regular pap smears. Current recommendations are to get one every 3 years unless you’ve had abnormal findings, in which case it should be checked annually. Advocates for cervical cancer have called it a silent killer because sometimes it’s asymptomatic until it hits advanced stages. Or symptoms are generalized and mistaken for bad period cramps. So we advocate for pap smears to make sure we aren’t missing something.

Now, testicular cancer and prostate cancer are specific to males. Testicular cancer is the most common cancer in males age 15-25 and is usually found because of a lump or mass felt on the testicles. Therefore – it’s important that patients do testicular self exams monthly. Best time to do that is right after a warm shower.

Prostate cancer is most common in males over 50 who should be getting regular prostate exams every year after the age of 50. If necessary, and especially if it’s localized, the prostate can be removed with a TURP procedure – that’s Transurethral Resection of the Prostate – we talked about this in the BPH lesson in the GI/GU course.

Finally, we just want you to be aware of some precautions with cancer treatments. Now, chemotherapy does require specialty training to administer, so you don’t need to know that – just know that it’s considered a biohazardous chemical, and has to be handled and disposed of carefully. Chemotherapy works by killing fast-growing cells like cancer cells, but that includes ALL fast-growing cells, even the healthy ones. So that’s why we see hair loss and damage to mucous membranes in the mouth and the gut – it can also cause damage to nerves or local reactions where the chemo is injected. The other big issue is that it also decreases and suppresses the bone marrow – meaning it’s going to decrease their immune system. We’ll see neutropenia, anemia, and thrombocytopenia. Altogether this is called pancytopenia – Pan means ALL, cyto means cells, and -penia means low – so pancytopenia is low levels of all blood cells – white, red, and platelets.

Now, the big thing you need to know about radiation is that it can cause burns, so we make sure to keep the skin hydrated and soothed with aloe or lotion after radiation treatments.

So just to recap these important points. We use the mnemonic CAUTION to remember common warning signs of cancer. Encourage patients – if something doesn’t seem right, say something to the provider. We use a biopsy or microscopic examination to diagnose and stage cancers based on the extent of the spread of the tumor. We need to encourage patients to get regular pap smears or prostate exams and to do monthly breast or testicular self-exams so that these common cancers can be detected early. And, when patients are in treatment, we need to make sure we manage their symptoms. A lot of patients find that the treatment and side effects can be more difficult than the cancer itself.

So that’s it for oncology and important points about cancer. Let us know if you have any questions. Now, go out and be your best selves today. An, as always, happy nursing!

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