learning Objectives - Describe the management of patients with oncology
Hours - 15
Teaching and Learning Activities - Lecture cum discussion Explain using charts, graphs models, films, and slides Case discussion Seminar Drug book Lecture cum discussion Topic presentation Posting to cancer Hospital/ unit Structured discussion Seminar
Assessment Methods - Short answers Objective type Essay type Assessment of skills with check list
Content of the chapter
a) Nursing management of patients with
oncological conditions
– Structure & characteristics of normal &
cancer cells
– Nursing Assessment-History and Physical
assessment
– Prevention, Screening, Early detection,
Warning signs of cancer
– Epidemiology, Etiology, Classification,
Pathopysiology, staging, clinical
manifestations, diagnosis, treatment
modalities and medical & surgical nursing
management of oncological conditions
– Common malignanacies of various body
systems: Oral, larynx, lung, stomach and
Colon, Liver, Leukemias and lymphomas,
Breast, Cervix, Ovary, uterus, Sarcoma,
Brain, Renal, Bladder, Prostate etc
b) Oncological emergiences
c) Modalities of treatment
– Immunotherapy
– Radiotherapy
– Surgical Interventions
– Stem cell and Bonemarrow transplants
– Gene therapy
– Other forms of treatment
d) Psychosocial aspects of cancer
e) Rehabilitation
f) Palliative care: symptom and pain
management, Nutritional support
g) Home care
h) Hospice care
i) Stomal Therapy
j) Special therapies
k) Psycho social aspects
l) Nursing procedures
m) Alternate therapies
n) Drugs used in treatment of oncological
disorders
Oncology Nursing – Detailed Guide
Oncology nursing deals with caring for patients with cancer, from prevention, diagnosis, treatment, rehabilitation, palliative care, to end-of-life care. It integrates physical, psychosocial, and educational interventions to improve outcomes and quality of life.
a) Nursing Management of Patients with Oncological Conditions
1. Structure and Characteristics of Normal and Cancer Cells
- Normal cells:
- Regulated growth and division
- Differentiated with specific functions
- Undergo apoptosis (programmed cell death) when damaged
- Organized into tissues
- Cancer cells:
- Uncontrolled proliferation
- Loss of differentiation (anaplasia)
- Ability to invade surrounding tissues (invasion) and spread to distant organs (metastasis)
- Evade apoptosis
- Angiogenesis: stimulate new blood vessel growth to nourish tumor
- Abnormal cell structure visible under microscope
Understanding these differences helps anticipate tumor behavior, complications, and treatment response.
2. Nursing Assessment
History:
- Presenting symptoms: fatigue, weight loss, pain, lumps, bleeding, persistent cough
- Duration and progression of symptoms
- Past illnesses, surgeries, or radiation exposure
- Family history of cancer
- Lifestyle factors: smoking, alcohol, diet, chemical exposure
- Psychological and social status: anxiety, depression, social support
Physical Assessment:
- Inspection: lumps, skin changes, oral lesions, abnormal swelling
- Palpation: masses, lymph nodes
- Organ-specific signs (e.g., jaundice in liver cancer, hematuria in bladder cancer)
- Functional status: ability to perform Activities of Daily Living (ADLs)
- Nutritional assessment
Diagnostic Measures:
- Blood tests: CBC, tumor markers (e.g., PSA, CA-125, CEA)
- Imaging: X-ray, Ultrasound, CT scan, MRI, PET scan
- Biopsy: tissue diagnosis to confirm cancer type
- Endoscopy: for GI and respiratory tumors
3. Prevention, Screening, and Early Detection
- Primary prevention: healthy diet, physical activity, avoid carcinogens, vaccinations (HPV, Hepatitis B)
- Screening programs: mammography, Pap smear, colonoscopy, PSA testing
- Early warning signs: unexplained weight loss, lumps, persistent cough, bleeding, changes in bowel/bladder habits
- Patient education on self-examination (breast, testicular, skin)
4. Epidemiology, Etiology, Classification, Pathophysiology
- Epidemiology: study of cancer incidence, prevalence, and risk factors
- Etiology: genetics, lifestyle, environmental factors, viruses (HPV, EBV), chemicals
- Classification: based on tissue of origin
- Carcinomas: epithelial cells
- Sarcomas: connective tissue and bone
- Leukemias: blood and bone marrow
- Lymphomas: lymphatic system
- CNS tumors: brain and spinal cord
- Pathophysiology: uncontrolled cell proliferation, invasion, metastasis
- Staging: TNM (Tumor size, Node involvement, Metastasis)
- Clinical manifestations: pain, fatigue, organ-specific symptoms
- Diagnosis: biopsy, imaging, lab tests
- Treatment modalities: surgery, chemotherapy, radiotherapy, immunotherapy
5. Common Malignancies
- Head & Neck: oral, laryngeal—difficulty swallowing, hoarseness
- Respiratory: lung—cough, hemoptysis, dyspnea
- Gastrointestinal: stomach, colon, liver—bleeding, abdominal pain, anorexia
- Hematologic: leukemia, lymphoma—fatigue, fever, infection, enlarged lymph nodes
- Reproductive: breast, cervix, ovary, uterus—lumps, abnormal bleeding
- Genitourinary: renal, bladder, prostate—hematuria, urinary symptoms
- Musculoskeletal & Nervous: sarcomas, brain tumors—pain, neurological deficits
6. Medical & Surgical Nursing Management
- Medical: chemotherapy, radiotherapy, immunotherapy, targeted therapy
- Surgical: tumor excision, mastectomy, colectomy, debulking
- Nursing care:
- Preoperative: education, emotional support, baseline vitals
- Postoperative: pain management, infection prevention, wound care, monitor for complications (bleeding, DVT)
- Monitoring response to medical treatment (side effects, toxicities)
b) Oncological Emergencies
- Spinal cord compression: sudden weakness, bladder/bowel dysfunction
- Superior vena cava syndrome: facial swelling, dyspnea
- Hypercalcemia: nausea, confusion, arrhythmias
- Tumor lysis syndrome: metabolic disturbances after chemotherapy
- Nursing care: early recognition, immediate intervention, collaboration with physicians
c) Modalities of Treatment
1. Immunotherapy: enhances immune system to attack cancer; monitor for immune-related adverse events.
2. Radiotherapy: targeted high-energy radiation; care includes skin protection, monitoring fatigue, nutritional support.
3. Surgical Interventions: pre- and post-op care, pain management, infection prevention.
4. Stem Cell/Bone Marrow Transplants: neutropenic precautions, infection monitoring, nutritional and emotional support.
5. Gene Therapy: experimental, monitor adverse effects, educate patients.
6. Other treatments: hormonal therapy (breast/prostate), targeted therapy for specific molecular markers.
d) Psychosocial Aspects of Cancer
- Emotional impact: anxiety, depression, fear of death
- Social issues: isolation, financial stress
- Body image concerns: e.g., post-mastectomy
- Nursing interventions: counseling, support groups, family education, stress-relief techniques
e) Rehabilitation
- Physical therapy for mobility and strength
- Occupational therapy for ADLs
- Speech therapy for head/neck cancers
- Psychological rehabilitation
f) Palliative Care
- Focus on comfort and quality of life
- Symptom and pain management with analgesics, opioids
- Nutritional support
- Emotional, spiritual, and family support
g) Home and Hospice Care
- Home care: medication management, wound/stoma care, nutritional guidance, monitoring complications
- Hospice care: end-of-life care, symptom relief, emotional and spiritual support, maintaining dignity
h) Stomal Therapy
- Care of colostomy, ileostomy, urostomy
- Skin care around stoma
- Education on appliance management
i) Special & Alternate Therapies
- Hyperthermia, photodynamic therapy, complementary therapies (music therapy, yoga, relaxation techniques)
- Focus on symptom relief, quality of life
j) Nursing Procedures
- Administration of chemotherapy and supportive medications
- Monitoring for side effects and complications
- IV therapy, catheter care, wound care, drain care
- Stoma management
k) Drugs Used in Oncology Nursing
- Chemotherapy: Cyclophosphamide, Doxorubicin
- Targeted therapy: Trastuzumab, Imatinib
- Hormonal therapy: Tamoxifen, Leuprolide
- Immunotherapy: Checkpoint inhibitors (Nivolumab)
- Analgesics: Opioids for pain management
- Antiemetics: Ondansetron, Metoclopramide
- Growth factors: G-CSF for neutropenia
Conclusion
Oncology nursing is holistic and patient-centered, addressing physical, emotional, social, and spiritual needs. Early detection, careful monitoring during treatment, rehabilitation, and palliative care improve survival and quality of life. Nurses are advocates, educators, and coordinators of comprehensive care.