1. Nursing management of
patients With oncological
conditions.
Mr. ANILKUMAR B R
Assit Professor
Medical- surgical nursing

2. Learning Objectives
•Describe the etiology, patho physiology,
clinical manifestations, diagnostic
manifestations, diagnostic measures and
nursing management of patients with
oncology .

3. Structure & characteristics of normal & cancer
cells

4. Structure & characteristics of normal &
cancer cells

5. Structure & characteristics of normal & cancer cells
•There are many differences between cancer
cells and normal cells. Some of the differences
are well known, whereas others have only been
recently discovered and are less well understood.

6. Cancer Cells vs. Normal Cells
1. Large number of dividing cells
2. Large variably shaped nuclei
3. Large nucleus to cytoplasm ratio
4. Variation in size and shape
5. Loss of normal cell functioning
and features
6. Disorganized arrangement
7. Poorly defined tumour boundary

7. What is Cancer ?
•Derived from Latin word
‘cancrum’ meaning crab.
• It is a group of diseases
characterized by uncontrolled cell
division leading to the growth of
abnormal tissue / tumor.

8. Cancer is a group of diseases characterized by
uncontrolled growth and spread of abnormal cells.
Cancer is caused by external factors and internal factors
which may act together to initiate or promote carcinogenesis.
External Factors - chemicals, radiation, viruses, and
lifestyle.
Internal Factors – hormones, immune condition, and
inherited mutations.

9. Oncology
•Oncology branch of medicine deals with
etiology, diagnosis, treatment and prevention of
cancer.
• Onco - is a Greek word meaning tumor .

10. 1. Alopecia: hair loss
2. Biopsy: a diagnostic procedure to remove a small sample of
tissue to be examined microscopically to detect malignant cells
brachytherapy: delivery of radiation therapy through internal
implants.
3. Carcinogenesis: process of transforming normal cells into
malignant cells.
4. Extravasation: leakage of medication from the veins into the
subcutaneous tissues
5. Metastasis: spread of cancer cells from the primary tumor to
distant sites
6. Myelosuppression: suppression of the blood cell–producing
function of the bone marrow

11. 1. Nadir: lowest point of white blood cell depression after
therapy that has toxic effects on the bone marrow.
2. Neutropenia: abnormally low absolute neutrophil count
4.Palliation: relief of symptoms associated with cancer
5. Stomatitis: inflammation of the oral tissues, often associated
with some chemotherapeutic agents
6. Staging: process of determining the size and spread, or
metastasis, of a tumor
7.Thrombocytopenia: decrease in the number of circulating
platelets.
8.Xerostomia: dry oral cavity resulting from decreased function
of salivary glands

12. • Neoplasia means ‘new growth’
• Neoplasm means ‘tumour/ cancer’
• Benign: Cells grow as a compact mass and remain at
their site of origin.
• Malignant: Growth of cells is uncontrolled Cells can
spread into surrounding tissue and spread to distant sites.
• Carcinogenesis: Is the process during which normal
genes are damaged so that cells lose normal control
mechanisms of growth and proliferate out of control.

13. TYPES OF
CANCER CELLS
BENGIN
CANCER
CELLS
MALIGNANT
CANCER
CELLS

14. Benign and Malignant cancer cells

15. CHARACTERISTICS BENIGN MALIGNANT
Cell characteristics Cells are well
differentiated
Cells are
undifferentiated
Mode of growth Tumor grows by
expansion and does not
infiltrate the
surrounding tissues;
usually encapsulated
Grows at the periphery
and sends out processes
that infiltrate and
destroy the surrounding
tissues
Rate of growth Rate of growth is usually
slow
Rate of growth is variable
and depends on level of
differentiation

16. CHARACTERISTICS BENIGN MALIGNANT
Metastasis Does not spread
by metastasis
Gains access to the blood and
lymphatic channels and
metastasizes to other areas of
the body
General effects Is usually a localized
phenomenon that
does not cause
generalized effects
unless its location
interferes with vital
functions
Often causes generalized
effects, such as anemia,
weakness, and weight
loss

17. CHARACTERISTICS BENIGN MALIGNANT
Tissue destruction Does not usually cause
tissue damage unless
its location interferes
with blood flow
Often causes extensive tissue
damage as the tumor
outgrows its blood supply or
encroaches on blood flow to
the area; may also produce
substances that cause cell
damage
Ability to cause
death
Does not usually cause
death unless its
location interferes with
vital functions
Usually causes death unless
growth can be controlled

18. Aetiology of cancer
• CAUSES OF CANCER?
VIRUSES ANDBACTERIA
PHYSICALAGENTS ( sunlight)
CHEMICAL AGENTS ( Tabacco)
GENETIC or HEREDITY FACTORS
DIETARYFACTORS
HORMONALFACTORS

19. VIRUSES ANDBACTERIA
 Herpes simplex virus type II, cytomegalovirus, and
human papillomavirus types 16, 18, 31, and 33 are
associated with dysplasia and cancer of the cervix.
 The hepatitis B virus is implicated in cancer of the liver;
the human T-cell lymphotropic virus may be a cause of some
lymphocytic leukemias and lymphomas; and the human
immunodeficiency virus (HIV) is associated with Kaposi’s
sarcoma.
 The bacterium Helicobacter pylorihas been associated with
an increased incidence of gastric malignancy, perhaps
secondary to inflammation and injury of gastric cells.

20. Physical agents
• Physicalfactors associatedwith carcinogenesis include exposureto
sunlight or radiation, chronic irritation or inflammation, and
tobacco use.

21. Chemical agents
 About 75% of all cancers are thought to be related to the
environment.
 Tobacco smoke, thought to be the single most lethal
chemical carcinogen, accounts for at least 30% of cancer
deaths.
 Smoking is strongly associated with cancers of the lung,
head and neck, esophagus, pancreas, cervix, and
bladder.
 Chewing tobacco is associated with cancers of the oral
cavity and primarily occurs in men younger than 40
years of age.

22. •Tobacco smoking: causes cancers of the lung,
oesophagus, larynx (voice box), mouth, throat,
kidney, bladder, pancreas, stomach and cervix;

23. Chemical agents

24. Dietary factors

25. Dietary factors
Dietary factors are thought to be related to 35% of
all environmental cancers.
Dietary substances can be proactive (protective),
carcinogenic, or co-carcinogenic.
The risk for cancer increases with long-term
ingestion of carcinogens or co-carcinogens or
chronic absence of proactive substances in the diet.

26. Dietary factors
 Dietary substancesassociatedwith anincreasedcancerrisk
include fats, alcohol, salt-cured or smokedmeats, foods
containing nitrates and nitrites, and ahigh caloric dietary
intake.
 Foodsubstancesthat appear to reduce cancerrisk include
high- fiber foods, cruciferous vegetables(cabbage,
broccoli, cauliflower, Brusselssprouts, kohlrabi),
carotenoids(carrots, tomatoes, spinach,apricots, peaches,
dark-green and deep- yellow vegetables),and possibly
vitamins Eand C,zinc,and selenium.

27. HormonalAgents
• Tumor growth may be promoted by disturbances in
hormonal balance either by the body’s own (endogenous)
hormone production or by administration of exogenous
hormones.
 Cancers of the breast, prostate, and uterus are thought to
depend on endogenous hormonal levels for growth.
 Diethylstilbestrol (DES) has long been recognized as a cause of
vaginal carcinomas.
 Oral contraceptives and prolonged estrogen replacement
therapy are associated with increased incidence of
hepatocellular, endometrial, and breast cancers, whereas they
appear to decrease the risk for ovarian and endometrial cancers.

28. GENETIC or HEREDITY FACTORS
•Inherited mutations in the BRCA1 and BRCA2 genes
are associated with hereditary breast and ovarian
cancer syndrome, which is a disorder marked by an
increased lifetime risk of breast and ovarian cancers
in women.
•Several other cancers have been associated with this
syndrome, including pancreatic and prostate cancers,
as well as male breast cancer.

30. Prevention of cancer
• Prevention is a priority in oncology nursing because at least
one third of all cancers are preventable.
• Between 30-50% of all cancer cases are preventable.
Prevention offers the most cost-effective long-term strategy
for the control of cancer.
• National policies and programmes should be implemented to
raise awareness, to reduce exposure to cancer risk factors and
to ensure that people are provided with the information and
support they need to adopt healthy lifestyles.

31. Preventable riskfactors of cancer
 Tobacco (Worldwide, tobacco use is the single greatest avoidable
risk factor for cancer mortality and kills approximately 6 million
people each year, from cancer and other diseases. )
 Obesity
 Physical inactivity
 Alcohol
 Sun exposure
 Infections
 Environmental Pollution
 Occupational carcinogens

32. Physical inactivity, dietary factors, obesity and being
overweight
• Dietary modification is another important approach to cancer
control. There is a link between overweight and obesity to many
types of cancer such as oesophagus, colorectum, breast,
endometrium and kidney.
• Diets high in fruits and vegetables may have an independent
protective effect against many cancers. Regular physical activity
and the maintenance of a healthy body weight, along with a
healthy diet, considerably reduce cancer risk.
• In addition, healthy eating habits that prevent the development of
diet-associated cancers will also lower the risk of other non-
communicable diseases.

33. Alcohol use
•Alcohol use is a risk factor for many cancer types
including cancer of the oral cavity, pharynx, larynx,
oesophagus, liver, colorectum and breast. Risk of
cancer increases with the amount of alcohol
consumed.
•For several types of cancer, heavy drinking of alcohol
combined with tobacco use substantially increases the
risks of cancer.

34. Infectious
• in 2012, approximately 15% of all cancers were
attributable to infectious agents such as helicobacter
pylori, human papilloma virus (HPV), hepatitis B and
C, and Epstein-Barr virus.

35. Occupational carcinogens
•More than 40 agents, mixtures and exposure
circumstances in the working environment are
carcinogenic to humans and are classified as
occupational carcinogens.
•Occupational cancers are concentrated among specific
groups of the working population, for whom the risk
of developing a particular form of cancer may be
much higher than for the general population.

36. Epidemiology of cancer
Epidemiology –“Epidemiology is the study of the distribution
and determinants of health-related states or events in specified
populations, and the application of this study to control of
health problems.”
Cancer epidemiology is the branch of epidemiology concerned
with the disease cancer.
Cancer Incidence – refers to the number of new cases of
cancer
Cancer mortality – refers to the number of deaths due to
cancer. Cancer mortality rates reflect the overall risk of dying
of cancer in a population.

37. Epidemiology of cancer
• in India is likely to have over 17.3 lakh new cases
of cancer and over 8.8 lakh deaths due to the
disease by 2020 with cancers of breast, lung and
cervix.
•Cancers of oral cavity and lungs in males and
cervix and breast in females account for over 50%
of all cancer deaths in India.

38. Epidemiology of cancer
•

39. • India
• 2.5 million living with cancer
• 7 lakh diagnosed every year
• 3.5 lakh deaths every year

40. Worldwide
INCIDENCE
• Lung (12.3%)
• Breast (10.4%)
• Colorectal (9.3%)
MORTALITY
• Lung (17.4%)
• Stomach (10.4%)
• Liver (8.8%)

41. In India
Males
• Oral cancer
• Oesophagus
• Stomach
• Trachea/
bronchus
Females
• Cervix
• Breast cancer
• Oral
• Oesophagus

42. LEVELS OF PREVENTION OF CANCER
PRIMARY
PREVENTION
SECONDARY
PREVENTION
TERATARY
PREVENTION

43. PRIMARY PREVENTION
 By acquiring the knowledge and skills necessary to
educate the community about cancer risk, nurses in all
settings play a key role in cancer prevention.
 Assisting patients to avoid known carcinogens is one way to
reduce the risk for cancer.
 The principal role of an oncology nurse as a provider of
information and education in the prevention and early
detection of cancer requires a basic understanding of the
etiology and epidemiology of the disease.

44. PREVENTION & DETECTION
1. Promoting risk factors awareness to general public
2. Promoting healthy behaviors
3. Limiting alcohol consumption
4. Hepatitis B virus infant vaccination
5. Control of STDs
6. Changing risk behaviors
7. Teaching skills for early detection programs ( BSE &
TSE)
8. Promoting participation in detection programs such as
Mammography, Digital rectal examination etc.

45. Breast self Examination(BSE)

46. Testicular Self Examination (TSE)

47. Mammography & Digital rectal examination ( DRE)

48. Secondary prevention (applied during the pre-
clinical phase)
•Secondary prevention of cancer involves the use of
tests to detect a cancer before the appearance of
signs or symptoms. (Screening activities are an
important component of secondary prevention).
•secondary prevention strategies use screening and
early detection programs in an attempt to identify
cancer early in its development, to reduce the
morbidity and mortality by improving the outcome
of disease that has already developed.

49. Tertiary prevention
•Tertiary prevention (appropriate in the clinical
phase) is the use of treatment and rehabilitation
programmes to improve the outcome of illness
among affected individuals.

50. Screening for early detection of cancer
WHAT IS SCREENING AND WHY DOES IT NEED TO BE
DONE
•Cancer screening aims to detect cancer before symptoms
appear.
•This may involve blood tests, urine tests, other tests, or
medical imaging.
•The benefits of screening in terms of cancer prevention,
early detection and subsequent treatment must be
weighed against any harms.

51. What is Cancer Screening
•Screening is the presumptive identification of
unrecognized disease or defects by means of tests,
examinations, or other procedures that can be
applied rapidly. Or
•Cancer Screening: refers to detection of disease
through tests, exams, and other procedures

52. A. Breast Cancer Screening (for female age b/w 25 to 40
years BSE) > 40 y/o Mammography.
B. Cervical Cancer Screening (Cervical cytology) and
PAPANICOLAOU’S (PAP) TEST
C. Colorectal Cancer Screening (colonoscopy, CT-scan,
colonography and FOBT
D. Genetic Screening (Genetic testing is recommended when
there is 1. Personal or family history suggesting genetic
cancer susceptibility)

53. A.Lung Cancer Screening
B. Prostate Cancer Screening (DRE and PSA
are the two components used in Prostate
Screening
C. Head and Neck Cancer Screening

54. The seven warning signs of cancer
• To remember the seven early warning signs of cancer, think of the
word CAUTION:
• Change in bowel or bladder habits.
• A sore that does not heal.
• Unusual bleeding or discharge.
• Thickening or lump in the breast, testicles, or elsewhere.
• Indigestion or difficulty swallowing.
• Obvious change in the size, color, shape, or thickness of
a wart, mole, or mouth sore.
• Nagging cough or hoarseness.

55. Staging of cancer
•Cancer staging is the process of determining how much
cancer is in the body and where it is located.
•Staging describes the severity of an individual's cancer
based on the magnitude of the original (primary) tumor
as well as on the extent cancer has spread in the body.
•Understanding the stage of the cancer helps to develop
a prognosis and design a treatment plan for
individual patients.

56. What are the Different Types of Staging?
1. Clinical Staging : determines how much cancer
there is based on the physical examination, imaging
tests, and biopsies of affected areas.
2. Pathologic Staging: can only be determined from
individual patients who have had surgery to remove
a tumor or explore the extent of the cancer.

57. What are the Different Types of Staging?
• Post-Therapy or Post-Neoadjuvant Therapy Staging :
determines how much cancer remains after a patient is
first treated with systemic (chemotherapy or hormone
therapy) and/or radiation therapy.
• Restaging: is used to determine the extent of the disease
if a cancer comes back after treatment. Restaging helps
determine the and the best treatment options for cancer
that has reoccurred.

58. Elements of Cancer Staging Systems?
In most cases, the stage is based on four main
factors:
I. Location of the primary (original) tumor
II. Tumor size and extent of tumors
III. Lymph node involvement (whether or not the
cancer has spread to the nearby lymph nodes)
IV. Presence or absence of distant metastasis (whether
or not the cancer has spread to distant areas of the
body)

59. The TNM Staging System
The TNM system is the most widely used cancer staging system.
In the TNM system:
1. The T refers to the size and extent of the main tumor.
The main tumor is usually called the primary tumor.
2. The N refers to the number of nearby lymph nodes
that have cancer.
3. The M refers to whether the cancer has metastasized.
This means that the cancer has spread from the
primary tumor to other parts of the body.

60. The TNM staging sysytem
•When your cancer is described by the TNM
system, there will be numbers after each
letter that give more details about the
cancer—for example, T1 ,N0, MX or T3 N1
M0.

61. Primary tumor (T)
1. TX: Main tumor cannot be measured.
2. T0: Main tumor cannot be found.
3. T1, T2, T3, T4: Refers to the size and/or extent
of the main tumor. The higher the number after
the T, the larger the tumor or the more it has
grown into nearby tissues.
4. T's may be further divided to provide more
detail, such as T3a and T3b.

62. Regional lymph nodes (N)
1. NX: Cancer in nearby lymph nodes cannot be
measured.
2. N0: There is no cancer in nearby lymph nodes.
3. N1, N2, N3: Refers to the number and location of
lymph nodes that contain cancer. The higher the
number after the N, the more lymph nodes that
contain cancer.

63. Distant metastasis (M)
1.MX: Metastasis cannot be measured.
2.M0: Cancer has not spread to other parts
of the body.
3.M1: Cancer has spread to other parts of the
body.