Oncology Nursing

Oncology Nursing:-An oncology nurse is a specialized nurse who cares for cancer patients. These nurses require advanced certifications and clinical experiences in oncology further than the typical baccalaureate nursing program provides. Oncology nursing care can be defined as meeting the various needs of oncology patients during the time of their disease including appropriate screenings and other preventive practices, symptom management, care to retain as much normal functioning as possible, and supportive measures upon the end of life.

What is oncology?
Oncology is the branch of medicine that researches, identifies, and treats cancer. A physician who works in the field of oncology is an oncologist.

Oncologists must first diagnose cancer, which is usually carried out via biopsy, endoscopy, X-ray, CT scanning, MRI, PET scanning, ultrasound, or other radiological methods. Nuclear medicine can also be used to diagnose cancer, as can blood tests or tumor markers. Oncology is often linked with hematology, which is the branch of medicine that deals with blood and blood-related disorders.

Treatment

Once a diagnosis is made, the oncologist discusses the disease stage with the patient. Staging will dictate the treatment of cancer. Chemotherapy — which is defined as the destruction of cancer cells — may be used, as well as radiation therapy. Surgery is used to remove tumors. Hormone therapy is used to treat certain types of cancers, and monoclonal antibody treatments are gaining popularity. Research into cancer vaccines and immunotherapies is ongoing. Palliative care in oncology treats pain and other symptoms of cancer.

Treatment team

Cancer is often treated in a team effort, with at least two or three types of oncologists, including medical, surgical, or radiation. The oncology treatment team may also include a pathologist, a diagnostic radiologist, or an oncology nurse. In the event of a new or a difficult-to-treat case of cancer, the oncology care team may consult a tumor board, made up of various medical experts from all relevant disciplines. The tumor board reviews the case and recommends the best course of cancer treatment for the patient.

Oncology nurse

The oncology nurse has many roles, from helping with cancer screening, detection, and prevention, to the intensive care focus of bone marrow transplantation. Work settings for oncology nurses also vary and include acute care hospitals, ambulatory care clinics, private offices, radiation therapy facilities, and home care agencies. Oncology nurses work with adult and pediatric patients with cancer.

Pediatric Oncology

Pediatric oncology is a medical specialty that focuses on cancer care for children.

The National Cancer Institute estimates that 10,270 new cases of cancer will be diagnosed in children in 2017. Of these, 1,190 children will die from the disease.

Pediatric oncology is an important medical field that treats all pediatric cancer types, including acute lymphocytic leukemia,

1. Oncology Nursing Prepared By : Spika Khatiwada

2. Oncology : The branch of medical science dealing with tumors including the origin, development, diagnosis and treatment of benign and malignant tumors. Oncology is the branch of science that deals with the study of cancer Definition

3. Cancer is a group of neoplastic diseases in which there is a transformation of normal body cells into malignant ones. OR Uncontrolled and rapid growth of abnormal cells in human body and its invasion to adjoining parts of the body which may also spread to other distant organ from original site is called Metastasis . Cancer

4. A tumor , also known as neoplasm is an abnormal mass of tissue which may be solid or fluid- filled that can be either benign ( non-cancerous) or malignant (cancerous). Benign Tumors aren’t cancerous and can often be removed. In most of the cases they don’t possess any health risk and don’t come back. Malignant Tumor are cancerous, they can invade nearby tissues and spread to other parts of the body. Tumor

5. A carcinogen is something that can cause cancer. Examples includes cancer causing chemicals, viruses and environmental exposures. Physical carcinogens : UV rays and ionizing radiations Chemical carcinogens : Asbestos, Tobacco ,Smoke A rsenic Biological Carcinogens : Infection from micro-organisms Carcinogens

6. Ciggerate smoking Infections Radiation exposures Immunosuppressive medicines Diet Alcohol Obesity Environmental factors Risk factors of cancer

7. T he TNM Staging System The TNM system is the most widely used cancer staging system. Most hospitals and medical centers use the TNM system as their main method for cancer reporting.   TNM classification of the cancer

8. In the TNM system: The T refers to the size and extent of the main tumor. The main tumor is usually called the primary tumor The N refers to the number of nearby lymph nodes that have cancer. 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.

9. Primary tumor (T) TX: Main tumor cannot be measured. T0: Main tumor cannot be found. 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. T's may be further divided to provide more detail, such as T3a and T3b.

10. Regional lymph nodes (N) NX: Cancer in nearby lymph nodes cannot be measured. N0: There is no cancer in nearby lymph nodes. 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.

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

12. Differences between Benign and malignant Tumors

13. Seven warning signs and symptoms of cancer according to WHO Unusual bleeding/ discharge A sore that doesn’t heal Change in bowel and bladder habit Lump in breast or other parts of body Nagging cough Obvious change in color in moles (ABCD) Difficulty swallowing Warning signs and symptoms

14. It is divided according to boarder categories Carcinoma : cancer that begins in the skin or in tissues that line or cover internal organs (epithelial tissues) (epithelial cells are found in breast, skin, cervix, stomach prostate) Sarcoma : cancer that begins in bone, cartilage, fat, muscle, blood vessels or other connective tissues. Leukemia : cancer that starts in blood forming tissues such as the bone marrow and causes large numbers of abnormal blood cells to be produced and enter the blood. Types Of Cancer

15. Leukemia

16. Lymphoma : cancers that begins in the cells of immune systems. Central nervous system cance r: cancers that begin in the tissues of the brain and spinal cord.

17. Level of prevention : Primary prevention Secondary prevention Tertiary prevention Cancer prevention

18. Cancer prevention is a reduction in the risk of developing clinically evident cancer. The primary prevention focuses on minimizing or eliminating exposure to carcinogenic agents which can be done by: Dietary modification Prevention and control of infectious agents Control of excessive exposure to radiation Control of the sunlight exposure Control of the chemical/environmental risk factors Personal Hygiene maintenance Prevention and control of occupational hazards

19. Secondary Prevention means early detection and treatment of cancer. It is best achieved through effective use of screening. Early detection Early diagnosis Screening

20. Tertiary prevention is focused on monitoring for and preventing the recurrence of the originally diagnosed cancer and screening for second primary cancers and long term effects of treatment in cancer survivors. The focus of this form of prevention is aimed at detecting complications and second cancers in long term survivors when treatment is most likely to be effective and ultimately improve their quality of life.

21. It may include tumors markers identifications, imaging studies, mammography, MRI,CT ,USG , endoscopy, smear, biopsy, nuclear medicine imaging. Different diagnostic procedures for cancer

22. A cancer may be suspected of various reasons, but the definitive diagnosis of most malignancies must be confirmed by histological examination of the cancerous cells by a pathologist. Tissue can be obtained from a biopsy or surgery. It means removal of small pieces of living tissue from an organ or a part of body for microscopic examination for the diagnostic purpose of benign, malignant other tumor. Biopsy

23. Excisional biopsy Incisional Biopsy Tru -cut biopsy Punch biopsy Types of biopsy

24. Incisional Biopsy

25. Excisional Biopsy

26. Tru -cut biopsy

27. Punch Biopsy

28. Before Procedure: Explain the procedure Collect all preoperative report blood grouping, complete blood count, bleeding time, clotting time consent Assess vitals Ready the biopsy set and assist if necessary Gowning the patient and position maintain. Expose the area of biopsy Patient preparation

29. After procedure: Assess the vital sign Positioning the patient Label the sample correctly Explain about the medication, follow-up and report dressing and suture removal. Proper dispatch the sample to the library Recording and reporting.

30. It is a specific type of imaging that uses low doses X-ray system modalities without any effect or hazards. It is used for the early detection and diagnosis of the breast disease in the women including both symptomatic or asymptomatic disease. Screening Mammography Diagnostic Mammography Mammogram

31. Women of 40 or more years of age or after menopause Family hx of breast disease Women on hormonal therapy Women having palpable lump Frequently exposed to chemical or radiation Women who have cosmetic surgery and silicone implants Criteria for Screening Mammography

32. Women having obvious lump with family hx Women having obvious signs and symptoms of breast cancer Women recommended for mammography by the physician or the doctors Women who has previous breast surgery Women w ho has auxillary and clavicles lymphadenopathy Criteria for Diagnostic Mammography

33.   Pap smear test is a test of sample of cells taken form the woman’s cervix or vagina. The test is done to look for the changes in the cells of cervix and vagina. The purpose of this test is to detect early cancer of the cervix and to identify the conditions such as infections and inflammation of cancer. PAP smear test

34. Nurse should advise patient to make an appointment other than during menstruation (Before appointment ) Avoid intercourse for 2 days Refrain from douching for 1 day Cease the use of vaginal medication for at least 48 hours. Patient preparation

35. 1.  Inform and explain the procedure to patient 2 . Advice patient to void . 3 . Provide privacy . 4 . Assist patient to be in Lithotomy position to her on examining table 5 . Drape patient permit minimal exposure. Pre-Procedure

36. Post procedure Observe for any kind of discharge through vagina Perineal care as needed Comfortable position Documentation Proper dispatch of the sample

37. VIA is the naked eye inspection of the cervix after application of 3–5% acetic acid. VIA is safe, rapid, reliable and inexpensive. Acetic acid acts by coagulating the protein of the surface epithelium. Pre-cancers contain more protein which gets coagulated and gives an whitish (ace to white) appearance . Wait for at least 1 minute for acetic acid to be absorbed and white area to appear. VIA(Visual Inspection with acetic acid)

38. Distinct white opaque area indicates a positive test. VIA negative women should get a repeat test done after 5 years

39. Visual inspection with Lugol’s iodine (VILI), also known as Schiller’s test, uses Lugol’s iodine instead of acetic acid. It involves performing a vaginal speculum exam during which a health care provider applies Lugol’s iodine solution to the cervix, viewing the cervix with the naked eye to identify color changes on the cervix, Determining whether the test result is positive or negative for possible precancerous lesions or cancer. VILI

40. Nuclear Imaging

41. The major types of treatment are : Chemotherapy Radiotherapy Immunotherapy Hormonal Therapy Surgery/ Bone marrow transplantation Rehabilitation Cancer treatment modalities

42. Chemotherapy is the treatment of cancer using specific chemical agents or drugs that are destructive to malignant cells and tissues. The term comes from two words that mean "chemical" and "treatment." Cytotoxic literally translated means ‘toxic to cells ’. It may be combined with surgery or radiotherapy or both to reduce tumor size pre-operatively. Chemotherapy

43. Primary Chemotherapy Adjuvant Chemotherapy Neo-adjuvant Chemotherapy Concurrent Chemotherapy Modes of Chemotherapy

44. Cure Control Palliation Prevention Goals of chemotherapy

45. Tumor lysis syndrome Haematopoietic effect GI effects Hepatic effect Renal Effects Integumentary effects Reproductive effects Neurological effects Side effects of chemotherapy

46. Imbalanced nutrition less than body requirement related to disease process and treatment. Impaired tissue integrity related to cancer treatment Disturbed body image and situational low self esteem related to changes in appearance,roles and function Risk for infection related to altered immunological response Risk for injury related to side effects secondary to chemotherapy Nursing Management

47. RT uses high energy radiation such as X-ray or gamma rays to destroy cancer cells and stop them form growing and multiplying. It is the method of cure for certain localized cancer. Radiation is used alone in cases where a tumor is unsuitable for surgery. More often it is used for conjunction with surgery and chemotherapy . Radiation Therapy

48. Radiation destroys a cell’s ability to reproduce by damaging its DNA, delaying mitosis to repair DNA or inducing apoptosis. Mode of action

49. Teletherapy (External Beam Radiation Therapy) Brachytherapy (Internal radiation Therapy) Types

50. Alpha Rays Beta Rays Gamma Rays Types of radioactive rays

51. In general, skin reactions from mild erythema to moist desuamation and fatigue may occur after radiation therapy. Side effects like skin tenderness are generally limited to the area receiving radiation. Radiation doesn’t usually cause hair loss and nausea like chemotherapy Side effects begin during the 2 nd and 3 rd week of treatment and may last for several weeks after final treatment. Side effects of RT

52. Side effects also depends on the site of the radiation such as radiation for head and neck causes dry mouth, dental problems, mucositis . Radiation at pelvic area causes cystis , diarrhoea and constipation

53. Some Common Side effects of radiation therapy are: Fatigue The skin becomes red,dry,itchy and colour change. Alopecia Anorexia Some patients may experience Nausea and vomiting

54. Answer the queries and allay the fear of patient and family about the effects of radiation on other parts. Explain about procedure of radiation therapy e.g. it is painless, duration of treatment, importance of taking nutritious diet including plenty of fluids and avoid alcohol, tobacco strictly. Patient may resume sexual activities if he or she is comfortable Nursing care for patients with radiation therapy

55. Assess patients skin and oropharyngeal mucosa and maintain personal hygiene and good oral care. Assess the nutritional status well Protect the treatment area form sunlight Advice not to rub, scrub on treated skin area Advice to wear soft, cotton clothes Don’t apply very hot or cold on the treatment area and avoid cosmetics Advice to take frequent small meals

56. Watch for the side effects and manage each effect properly Check the blood count Stop the radiation if he/she has complained diarrhea, fever or abnormal report. Proper recording and reporting.

57. It uses body’s own immune system to destroy cancer cells. It isn't widely used as it requires many clinical trails. Immunotherapy targets the immune system rather than the cancer cells. Immunotherapy

58. Check-point Inhibitors Monoclonal antibodies Adoptive cell transfer Topoisomerase Inhibitors Cancer Vaccines ( Sipuleucel -T , laherparepvec (T-VEC) Immunomodulators Types of Immunotherapy

59. Hormone Therapy

60. It is a standard treatment used to treat cancer of prostate, breast and uterus. Hormone therapy involves blocking the production or action of these hormones as a result, growth of tumor slows down. In some cases hormone therapy is used in combination with other treatments such as chemotherapy and radiotherapy. Hormone therapy

61. Hot-flashes Loss of bone density Loss of libido Weight gain Mood swings Fatigue Nausea and Vomiting Side-Effects

62. This is the process of replacing the bone marrow with healthy cells especially performed in case of blood cancer. Bone Marrow Transplant

63. Surgery is the removal of the visible tumor and near by tissues .It is the most frequently used for cancer treatment. It can be prophylactic, palliative or reconstructive It can be used for treatment, prevention and diagnosis. It can be used to remove the entire tumor, debulk a tumor or to ease cancer symptoms Surgery

64. Pre-operative management Intra-operative management Post-operative management Nursing Care of patient undergoing surgery

65. It is a treatment to relieve symptoms rather than cure. It helps people to live more comfortably. Relief from physical, psychosocial and spiritual problem can be achieved in 90 percentage of advance cancer. Palliative care is the approach that improves the quality of life of patients and their families facing problems with life threatening illness through the prevention and relief of suffering by means of early identification, treatment of pain, other problems, physical, psychological and spiritual. (WHO 2002) Palliative care

66. Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage and described in terms of such damage. Causes of pain in cancer: Pain form the tumor Pain from the cancer treatment Pain form other associated symptoms. Pain Management in Cancer

67. Acute Pain: pain that comes quickly, may be sever but lasts for short period of time. Incidental pain: pain occurring on particular movements. Chronic pain: pain that may range from mild to severe and persists over a long period of time. Breakthrough pain: chronic pain that occurs in patients with chronic pain and is controlled by medications. Types of pain

68. Assessment of pain Management of pain. Non-analgesic methods (massage, application of heat and cold, TENS, relaxation therapy) Radiofrequency ablation Cryotherapy Stimulation induced analgesia Spinal cord stimulation Accupunture Psychological technique Nursing management in pain relief

69. The WHO ladder of pain management: Step I: Mild Pain (Non-Opioid drug PCM,NSAIDs +/- adjuvant drugs. Step 2: If pain persists weak opioid drug tramadol or increase +/- non- opioid drug Codeine +/_ adjuvant drugs. Step 3:If pain persists strong opioid drug Morphine or increases +/- non opioid drug Methadone +/- adjuvant drugs Pharmacological Management (WHO ladder )

70. Bone/Muscle/pelvic pain = NSAIDS Neuropathic pain = Amitryptaline Colic Pain = Buscopan Nerve compression= Steriod Adjuvant Drugs

71. Cognitive therapy Behavioral therapy Heat and cold application Massage Relaxation therapy Diversion Cryotherapy Accupunture Physiotherapy/Radiotherapy/Surgery Non-Pharmacological Methods

72. Terminally ill cancer patients are end stage patients where care is more focused to reduce symptoms. At terminal phase care received by the patient is the palliative care or hospice care. Care is provided on 4 categories To relieve physical symptoms To reduce psychological symptoms Social needs Spiritual needs Care of Terminally ILL cancer patients

73. Acute/chronic pain r/t injury or chronic disability Activity intolerance r/t generalized weakness, immobility, pain Anticipatory grieving r/t death Ineffective family coping r/t psychological crisis General nursing measures

74. Assessment of overall patient condition Pain management Personal hygiene Bowel/bladder care Nutritional Management Psychological support to patient and family members Hospice care Nursing interventions

75. The spiritual care can be integrated into the treatment in variety of ways Good IPR and exploration of spiritual believes Individual and group prayer Counseling and communication services Support with end of life issues and decisions Making provision for rituals,pray Spiritual Care

76. Loss Grief Mourning Bereavement Loss,Grief , Mourning and Bereavement

77. According to Kubler Ross (DABDA), it includes Denial Anger Bargaining Depression Acceptance Stages of Grieving

78. Hospice isn't a place or just a building, but a concept of care or a way of caring people in which the end of life is viewed as a developmental stage. Hospice care focuses on caring, not curing and only life but also death All hospice care is palliative but all palliative care isn’t hospice. Hospice Care(EOLC)

79. Death must be accepted Patients care is best managed by an interdisciplinary team whose members communicate regularly with each other Pain and other symptoms of terminally illness must be managed Home care of dying is necessary Bereavement care must be provided to family members Research and education must be ongoing Principles

80. Helping people live through their final days and die with dignity and comfort among family and friends Provide care which integrates and nurtures the mind, body and spirit. Facilitate decision making by individual and their families Goals of hospice care

81. Doctors Nurses Home health aids Spiritual counselors Social workers Volunteers Bereavement counselors Hospice Team

82. Patient assessment Patient and family education Co-ordination of care Direct patient c are Symptoms management and supportive care Role of oncology nurse

83. Prognosis Pain management With holding and withdrawing medications Resuscitation Mechanical Ventilation Nutrition and hydration Antibiotic treatment Ethical Issues in EOLC