Oncology is part of study focused on the cancer

Introduction to oncology nursing
By Mr. Gedion Zerihun
(BSc, MSc in Adult health nursing)
Comprehensive BSc
May, 2024
Mizan-Aman, Ethiopia
01/06/2024 1

Objective
Define oncology, neoplastic
Describe Risk factor/causes
Describe Biology of cancer cells
Describe Pathophysiology of cancer cells
Identify Types of malignancy
Discuss nomenclature and features neoplasm
Identify common types of cancer (Breast, Lung, Prostate…)
Cancer Detection and diagnostic modalities (2hrs)
Treatment modalities and nursing role (4hrs)

Introduction To Cancer Concepts
Oncology is the branch of medicine dealing with tumors.
Oncology nursing is also called cancer nursing; it is an important
component of medical-surgical nursing care.
Cancer is second only to heart disease in mortality rates in the United
States.
Documentation of the benefits of early cancer detection and its impact
on treatment exist from the beginning of the nineteenth century.
Today microscopic technology and genetic engineering provide
physicians with a better understanding of tumor growth and cell
activity and a means for early cancer detection and intervention.

Benign Tumors
Normal cells that reproduce abnormally result in neoplasms, or
tumors.
Neoplasm is a term that combines the Greek word neo, meaning
“new,” and plasia, meaning “growth,” to suggest new tissue growth.
A neoplasm is an enlargement of tissue and the formation of an
abnormal mass.
A neoplasm develops as cells multiply.
Not all neoplasms contain cancer cells; however, a neoplastic cell is
responsible for producing a tumor and shows a lively growing cell.
New neoplastic growth is very difficult to detect until it contains about
500 cells and is approximately 1 cm.

Cont’….
A benign tumor is defined as a cluster of cells that is not normal to the
body but is noncancerous.
Benign tumors grow more slowly and have cells that are the same as
the original tissue.
An organ containing a benign tumor usually continues to function
normally, whereas an organ affected with a cancerous tumor
eventually ceases to function.
Malignant, a term often used as a synonym for cancer, is defined as
a growth that resists treatment.

A comparison of benign and malignant tumors
Benign Malignant
Growth Rate Typically slow expansion Often rapid with cell numbers doubling normal
cell growth; malignant cells infiltrate
surrounding tissue
Cell Features Typical of the tissue of origin Atypical in varying degrees of the tissue or
origin; altered cell membrane; contains tumor-
specific antigens
Tissue Damage Minor Often causes necrosis and ulceration of tissue
Metastasis Not seen; remains localized at origin
site
Often spreads to form tumors in other parts of
the body
Recurrence after
Treatment
Seldom recurrence after surgical
removal
Recurrence can be seen after surgical removal
and following radiation and chemotherapy
Related
Terminology
Hyperplasia, polyp, and benign
neoplasia
Cancer, malignancy, and malignant neoplasia
Prognosis Not injurious unless location causes
pressure or obstruction to vital organs
Death if uncontrolled

Cancer
Cancer is a group of cells that grows out of control, taking over the
function of the affected organ.
Cancer cells are described as poorly constructed, loosely formed,
and without organization.
A simplistic definition is “confused cell”
Cancer is not contagious.

Pathophysiology
Cancer is not one disease, but many diseases with different causes,
manifestations, treatments, and prognoses.
Caused by mutation of cellular genes.
Cancer takes on the characteristics of the cell it mutates and then takes
on characteristics of the mutation.
Growth-regulating signals in the cell’s surrounding environment are
ignored as the abnormal cell growth increases.
Normal cells are limited to about 50 to 60 divisions before they die.

Pathophysiology
Cancer cells do not have a division limit and are considered immortal.
The progression from a normal cell to a malignant cell follows a
pattern of mutation, defective division and abnormal growth cycles,
and defective cell communication.
Cell mutation occurs when a sudden change affects the chromosomes,
causing the new cell to differ from the parent.
The malignant cell enzymes destroy the gluelike substance found
between normal cells, which disrupts the transfer of information used
for normal cell structure.

Cont’..
Cancer cell growth and reproduction involves a two-step process.
The first step in cancer growth is called initiation.
Initiation causes an alteration in the genetic structure of the cell
(DNA).
Cell alteration is associated with exposure to a carcinogen.
The cellular change primes the cell to become cancerous.

Cont….
Promotion is the second type of cancer cell growth.
It occurs after repeated exposure to carcinogens causes initiated cells
to mutate.
During the promotion step, a tumor forms from mutated cell
reproduction.
A healthy immune system can often destroy cancer cells before they
replicate and become a tumor.
It is important to remember that any substance that weakens or alters
the immune system puts the individual at risk for cell mutation.

Cancer Classification/ nomenclature
Cancers are identified by the tissue affected, speed of cell growth,
cell appearance, and location.
Neoplasms occurring in the epithelial cells are called carcinomas.
Carcinoma is the most common type of cancer and includes cells of the skin,
gastrointestinal system, and lungs.
Cancer cells affecting connective tissue, including fat, the sheath that
contains nerves, cartilage, muscle, and bone, are called sarcomas.
Leukemia is the term used to describe the abnormal growth of white
blood cells.
Cancers involving cells of the lymphatic system, lymph nodes, and
spleen are called lymphomas.

Spread of Cancer
Neoplastic cells that remain in one area are considered localized, or in
situ, cancers.
These tumors may be difficult to visualize on clinical examination and
are detected through microscopic cell examination.
In situ tumors are often removed surgically and require no further
treatment.
Metastasis is the term used to describe the spread of the tumor from
the primary site into separate and distinct areas.

Cont’…
Metastasis is the stage at which cancer cells acquire invasive
behavior characteristics and cause the surrounding tissue to change.
Metastasis occurs primarily because cancer cells break away more
easily than normal cells and can survive for a time independently from
other cells.
There are three steps in the formation of a metastasis.
Cancer cells are able to (1) invade blood or lymph vessels,
(2) move by mechanical means, and
(3) lodge and grow in a new location.

Con’…
Metastatic tumors carry with them the cell characteristics of the
original or primary tumor site.
As a result, surgeons are able to determine the original tumor site
based on metastatic cell characteristics. For example, lung tissue found
in the brain suggests a primary lung tumor with metastasis to brain
tissue.
Common sites of metastasis are the lungs, liver, bones, and brain.

Risk Factors
Risk Factors
Increased risk of cancer is linked to several environmental factors.
An evaluation of cancer begins with assessment of well-known risk
factors such as specific
Viruses;
Exposure to radiation,
Chemicals, and irritants;
Genetics;
Diet; and
General immunity.

Viruses
Certain viruses, such as the oncoviruses (RNAtype viruses), are linked to
cancer in humans.
Retrovirus is an enzyme produced by RNA tumor viruses and is found in
human leukemia cells.
The Epstein-Barr virus (EBV), which causes infectious mononucleosis, is
also associated with Burkitt’s lymphoma.
Herpes simplex virus II has been associated with cervical and penile
cancers.
Papillomavirus associated with genital warts is considered one cause of
cervical cancer in women.
Chronic hepatitis B is linked with liver cancer.

Radiation
There is an increased incidence of cancer in persons exposed to prolonged
or large amounts of radiation.
Ionizing radiation involving x-rays; alpha, beta, and gamma rays; and
ultraviolet rays such as sunlight play a major role in promoting leukemia
and skin cancers, primarily melanomas.
Persons exposed to radioactive materials in large doses, such as a radiation
leak or an atomic bomb, are at risk for leukemia, breast, bone, lung, and
thyroid cancer.
Controlled radiation therapy is used to treat cancer patients by destroying
rapidly dividing cancer cells.
Radiation can also damage normal cells.
The decision to use radiation is made after careful evaluation of the tumor’s
location and vulnerability to other treatments.

Chemicals
Chemicals are present in air, water, soil, food, drugs, and tobacco smoke.
Chemical carcinogens are implicated as triggering mechanisms in
malignant tumor development.
Length of exposure time and degree of exposure intensity to chemical
carcinogens are associated with risk for cancer development.
Smoking accounts for 87% of lung cancer worldwide.
Chemical agents, as in tobacco, are more toxic when used with alcohol.
Alcohol and tobacco are the most frequent causes of cancers of the mouth
and throat.
Chemicals used in manufacturing, such as vinyl chloride, are associated
with liver cancer.

Cont.’…
Irritants;-Chronic irritation or inflammation caused by irritants such
as snuff or pipe smoke often cause cancer in local areas.
Nevi (moles) that are chronically irritated by clothing, especially
clothing contaminated by chemical residue, may become
malignant.
Asbestos found in temperature and sound insulation has been
proven to cause a particularly virulent type of lung cancer.
Genetics:- Genetics plays a large part in cancer formation.
Certain breast cancers are linked to a specific gene mutation.
Skin and colon cancers have a genetic tendency.
People with Down syndrome (a chromosomal abnormality) have a
higher risk of developing acute leukemia.

Diet
Diet is a large factor in both cause and prevention of malignancies.
People who eat high-fat, low-fiber diets are more prone to develop
colon cancers.
Diets high in fiber reduce the risk of colon cancer.
High-fat diets are linked to breast cancer in women and prostate
cancer in men.
Consumption of large amounts of pickled, smoked, and charbroiled
foods has been linked with esophageal and stomach cancers.
A diet low in vitamins A, C, and E is associated with cancers of the
lungs, esophagus, mouth, larynx, cervix, and breast.

Hormones
Hormonal agents that disturb the balance of the body may also promote cancer.
Long-term use of the female hormone estrogen is associated with cancer of the
breast, uterus, ovaries, cervix, and vagina.
It has been found that children born of mothers who took diethylstilbestrol (DES)
during pregnancy have an increased incidence of reproductive cancers.
DES is a synthetic hormone with estrogen-like properties used in the past to
prevent miscarriage.
Tumors of the breast and uterus are tested for estrogen or progesterone influence.
If a breast tumor is malignant, the tumor is tested and treatment varies depending
on whether it is positive for estrogen or progesterone dependence.

Immune Factors
A healthy immune system destroys mutant cells quickly on formation.
An individual with altered immunity is more susceptible to cancer
formation when exposed to small amounts of carcinogens compared
with someone with a healthy immune system.
Immune system suppression allows malignant cells to develop in large
numbers.
Individuals with acquired immunodeficiency syndrome (AIDS) have a
compromised immune system and an increased risk for certain
cancers.

Diagnosis of Cancer
A diagnosis of cancer can be a very frightening experience.
Often people try to mask symptoms because they are so frightened of the
disease.
Exploring patient attitudes and perceptions about the disease helps you
construct an effective teaching plan.
A careful and thorough assessment of the patient’s present and past
medical and surgical history and pertinent family history are obtained.
A complete physical examination provides both objective and subjective
data.
The most conclusive information about the health of tissue is acquired by
examining cell activity through biopsy.

Diagnosis of Cancer …….
Biopsy
Accurate identification of a cancer can only be done by
biopsy (the surgical removal of tissue cells).
Microscopic examination of a piece of suspected tissue or
aspirated body fluid can confirm the presence of mutant cells.
Incisional biopsy is an invasive procedure that involves the
surgical removal of a small amount of tissue for inspection.
Tissue can also be removed during endoscopic procedures
(insertion of a tube to observe the inside of a hollow organ or
cavity), such as a lung biopsy done during bronchoscopy.

Diagnosis of Ca…..
Biopsy
Excisional biopsy is used to remove an entire tissue mass.
Needle aspiration biopsy involves insertion of a needle into
tissue for fluid or tissue aspiration
Transcutaneous aspiration involves the insertion of a fine
needle into tissue such as breast, prostate, or salivary gland
and is used for diagnosing metastatic cancers.

Diagnosis of cancer …
Laboratory Tests
Blood, serum, and urine tests are important in establishing
baseline values and general health status.
Laboratory values are used with other assessment findings.
An elevated white blood cell (WBC) count is expected if the
patient has evidence of infection; however, an increase in WBCs
without infection raises suspicion of leukemia.
Fifty percent of patients with liver cancer have increased levels
of bilirubin, alkaline phosphatase, and glutamic-oxaloacetic
transaminase.
Bone marrow aspiration is a major tool for diagnosis of
leukemia.

Diagnosis of cancer …
Tumor markers, also called biochemical markers, are proteins,
antigens, genes, hormones, and enzymes produced and secreted by
tumor cells.
Tumor markers help confirm a diagnosis of cancer, detect cancer
origin, monitor the effect of cancer therapy, and determine cancer
remission.

Tumor markers…..
Tumor markers include the following:
Prostatic acid phosphatase (PAP)—high levels noted in prostate
cancer
PSA—elevated levels associated with prostate cancer
Cancer antigen (CA) 15-3—elevated levels noted in breast cancer;
useful in monitoring patient response to therapy for metastatic breast
cancer
CA 125—increased levels in ovarian, cervical, liver, and pancreas
cancers
CA 19-9—used to diagnose and evaluate pancreatic and hepatobiliary
cancer; levels elevated in cancer
Carcinoembryonic antigen (CEA)—increased levels suggest tumor
activity

Cytological Study
Cytology is the study of the formation, structure, and function of cells.
Cytological diagnosis of cancer is obtained primarily through Pap
smears of cells shed from a mucous membrane (e.g., cervical or oral
smear).
Test results are based on the degree of cell abnormality.
Normal results reflect no cellular changes.
Slight cellular changes are considered normal, with a possible link to
abnormal cells seen in infection.
Severe cellular changes reflect a higher probability of precancerous or
cancerous cellular activity.

Radiological Procedures
X-ray examination is a valuable diagnostic tool in detecting cancer of the
bones and hollow organs.
Routine chest x-ray examination is one diagnostic test used in detecting
lung cancer.
Mammography is a reliable and non invasive low radiation x-ray
procedure for detecting breast masses.
Contrast media x-ray studies are used to detect abnormalities of bone and
the gastrointestinal and urinary systems.
Computed tomography (CT) provides a three-dimensional, cross-
sectional, computerized picture of the body.
CT scans are important in the diagnosis and staging of malignancies and
can detect minor variations in tissue thickness.

Nuclear Imaging Procedures
Nuclear medicine imaging involves camera imaging of organs or
tissues containing radioactive media.
Positron emission tomography (PET) scanning provides
information about cellular biochemical and metabolic activity.
PET scans have been useful in brain imaging.
Ultrasound Procedures
This technology helps detect tumors of the pelvis and breast.
Ultrasound may also be used to distinguish between benign and
malignant breast tumors.
Magnetic Resonance Imaging
Endoscopic Procedures

Staging
Tumor staging is used to determine the stage of solid-tumor masses,
providing valuable information about the potential success of
treatment plans.
Tumor staging is important in the development of an international
system that can compare statistics among cancer centers.
The most common system used for staging tumors is called tumor,
node, metastasis (TNM).

Tumor, Node, Metastasis, (TNM)Staging, and Tissue
Involvement
Classification Staging Tissue Involvement
Primary tumor (T) Tis Stage I Tumor in situ, indicates no invasion of other
tissues
T1, T2, T3, T4 Stage II Ranges indicate progressive increase in
tumor size with local metastasis
Regional lymph node
involvement (N)
N0 (No nodes)
N1, N2, N3
Stage III
Metastasis to regional lymph
nodes
Metastasis (M)
M0 (No metastasis)
M1
Stage IV
Distant metastasis

Treatment for Cancer
There are three main types of treatment for cancer:
Surgery,
Radiation therapy, and
Chemotherapy.
Surgery
Surgery can be used to cure cancer when it is possible to remove the
entire tumor.
Prophylactic surgery is used to remove moles or lesions that have the
potential to become malignant.
Surgery may also be done for palliation (symptom control). The goals
of palliative surgery are less discomfort and an improved quality of life.
Reconstructive surgery can be done for cosmetic enhancement or for
return of function of a body part.

Radiation
Radiation is used commonly in the treatment of cancer for control
or palliation, and it can be curative if the disease is localized.
The decision to use radiation is commonly based on cancer site and
size.
Radiation destroys cancer cells by affecting cell structure and the cell
environment.
Palliative radiation is used to reduce the size of a large cancerous
lesion and consequently reduce pressure and pain.

Nursing care of the patient receiving radiation
treatment.
Symptoms of tissue reaction to radiation treatment can be expected
Fatigue.
Nausea, vomiting, and anorexia.
Mucositis (inflammation of the mucous membranes, especially of
the mouth and throat).
Xerostomia (dry mouth).
Skin reactions. a second-degree burn
Bone marrow depression.

Chemotherapy
Chemotherapy is chemical therapy that uses cytotoxic drugs to treat
cancer.
Cytotoxic drugs can be used for cure, control, or palliation of and
are described according to how they affect cell activity.
Chemotherapy is usually more effective when multiple drugs are
given in multiple doses.
Factors influencing the effectiveness of chemotherapy are tumor type,
available chemotherapeutic drugs, and genetics.
Routes of administration;-Drugs may be given via oral, intramuscular,
intravenous, or topical routes.

Chemotherapy cont’..
Alkylating agents bind with DNA to stop the production of RNA;
Carmustine (BCNU), Cisplatin
Antimetabolites substitute for nutrients or enzymes in the cell life
cycle; Floxuridine (FUDR), Fludarabine (Fludara)
Mitotic inhibitors interfere with cell division; Irinotecan (Camptosar)
Antibiotics inhibit DNA and RNA synthesis; and
Bleomycin, Dactinomycin (Cosmegen), Daunorubicin
Hormonal agents alter the hormonal structure of the body.

Chemotherapy con’…
Vesicant drugs are given only by the (IV)intravenous route.
These drugs cause blistering of tissue that eventually leads to necrosis if
they infiltrate, or leak out of the blood vessel, into soft tissue
Central Lines. Central lines are intravenous catheters that terminate in the
superior vena cava near the right atrium of the heart.
This is a large vessel that allows for dilution of vesicant drugs and
reduces the risk of infiltration.
Side effects of chemotherapy.
Toxicities in patients receiving chemotherapy vary according to the
medications given; however, some general side effects are commonly
associated with chemotherapy drugs.

Side effect of Chemotherapy cont’…
Bone Marrow.
Chemotherapy is toxic to the bone marrow, where the blood cells are
produced. Patient may develop:-
Low WBC counts (leukopenia), increasing their susceptibility to infection and
sepsis.
A reduction in platelets (thrombocytopenia) increases the risk of bruising and
bleeding and can require platelet transfusions.
Increased risk of anemia occurs with the reduction of red blood cells and may
require blood transfusions.
Gastrointestinal Tract.
Patients often become nauseated and vomit or experience diarrhea.
Stomatitis is a common complaint and is discussed under side effects of
radiation.

Hair.
Alopecia (hair loss) is common with many chemotherapy drugs.
This is a temporary condition, and growth of the new hair usually
starts when the chemotherapy medication is stopped.
Alopecia involves the entire body and includes eyebrows,
eyelashes, and axillary and pubic hair.
Reproductive System.
The effects of chemotherapy or radiation can cause temporary or
permanent alterations of the reproductive system.

Neurological System.
Drugs may affect the neurological system.
An adverse reaction to vincristine is neurotoxicity, Which may result in
tingling or numbness in the extremities and in severe cases may cause foot
drop from muscle weakness.
Less common complications include renal toxicities, such as pain and
burning on urination, and hematuria.
Doxorubicin (Adriamycin) has been associated with permanent heart
damage, and bleomycin can cause pulmonary fibrosis.
Severe toxic side effects can be controlled by carefully limiting the
amount of medication given and constantly monitoring the patient for
complications.

Complications And Nursing Implications
Malnutrition
Anorexia, malabsorption, and cachexia are common examples of nutritional
problems.
Cachexia is characterized by loss of body weight, adipose tissue, visceral protein,
and skeletal muscle
Clients who have cancer are at increased risk for weight loss and anorexia.
The presence of carcinoma in the body increases the amount of energy
required for metabolic function.
Cancer can impair the body’s ability to ingest, digest, and absorb nutrients.
Adverse effects of cancer treatment can affect the desire for food or the ability
to eat.
Findings include nausea and vomiting, changes in taste, anorexia, pain,
diarrhea, early satiety, dry mouth, thickened saliva, and irritation to the
gastrointestinal tract.

Complications and Nursing Implications
Nursing Actions
Educate the client about managing the expected effects of
treatment.
Administer antiemetics and antacids as prescribed.
Monitor relevant laboratory data (albumin, ferritin, transferrin).
Encourage frequent oral hygiene.
Incorporate client preferences into meal planning, when possible.
Teach the client to consume adequate protein and calories.

Paraneoplastic syndromes
Paraneoplastic syndromes result when T cells in the body attack
normal cells rather than cancerous ones.
They result in changes in neurological function (movement, sensation,
mental function).
Management includes minimizing the immune system response by
administration of steroids, immune factors, plasmapheresis, or
irradiation.

Nursing Actions
Recognize manifestations of paraneoplastic syndrome.
Administer medications as prescribed.
Provide a safe environment until client returns to baseline mental
status.
Use aids for vision or hearing deficits, as indicated

Oncologic Emergencies
Superior Vena Cava Syndrome (SVCS)
Compression or invasion of the superior vena cava by tumor, enlarged lymph
nodes, intraluminal thrombus that obstructs venous circulation, or drainage of the
head, neck, arms, and thorax.
Typically associated with lung cancer, SVCS can also occur with breast cancer,
Kaposi’s sarcoma, thymoma, lymphoma, and mediastinal metastases.
If untreated, SVCS may lead to cerebral anoxia (because not enough oxygen
reaches the brain), laryngeal edema, bronchial obstruction, and death.
Clinical manifestations
Gradually or suddenly impaired venous drainage giving rise to:
Progressive shortness of breath (dyspnea), cough, hoarseness, chest pain, and
facial swelling
Edema of the neck, arms, hands, and thorax and reported sensation of skin
tightness and difficulty swallowing

Superior Vena Cava Syndrome (SVCS)
oncologic eme ….
Possibly engorged and distended jugular, temporal, and arm veins
Dilated thoracic vessels causing prominent venous patterns on the chest wall
Increased intracranial pressure, associated visual disturbances, headache, and
altered mental status
Diagnosis is confirmed by:
Clinical findings
Chest x-ray
Thoracic computed tomography (CT) scan
Thoracic magnetic resonance imaging (MRI) Intraluminal thrombosis is
identified by venogram.

(SVCS) management
Medical
 Radiation therapy to shrink tumor size and relieve symptoms
Chemotherapy for chemosensitive cancers
Anticoagulant or thrombolytic therapy for intraluminal thrombosis
Percutaneously placed intravascular stents are increasingly being used
to reopen the occluded SVC
Surgery (less common),
Supportive measures such as oxygen therapy, corticosteroids, and
diuretics

(SVCS) management
Nursing
 Identify patients at risk for SVCS
Monitor and report clinical manifestations of SVCS
Monitor cardiopulmonary and neurologic status
Avoid upper extremity venipuncture and blood pressure measurement
Facilitate breathing by positioning the patient properly; this helps to promote
comfort and reduce anxiety produced by difficulty breathing resulting from
progressive edema
Promote energy conservation to minimize shortness of breath

Syndrome of inappropriate antidiuretic hormone (SIADH)
SIADH occurs when excessive levels of antidiuretic hormones are
produced.
Because antidiuretic hormones help the kidneys and body to
conserve the correct amount of water, SIADH causes the body to
retain water.
This results in a dilution of electrolytes (such as sodium) in the
blood.
It is most commonly associated with lung and brain cancers.
Key findings include nausea and vomiting (early); lethargy,
hostility, seizures, and coma.

Clinical manifestation
Serum sodium levels lower than 125 mEq/L (125 mmol/L): symptoms of
hyponatremia including personality changes, irritability, nausea, anorexia,
vomiting, weight gain, fatigue, muscular pain (myalgia), headache, lethargy,
and confusion
Serum sodium levels lower than 115 mEq/L (11 mmol/L): seizure, abnormal
reflexes and gait, papilledema, coma, and death; edema is rare
Diagnostic
Decreased serum sodium level
Increased urine osmolality
Increased urinary sodium level

Nursing Actions
Monitor the client for hyponatremia and low serum osmolality.
Administer furosemide (Lasix), 0.9% sodium chloride IV, and/or
hypertonic sodium chloride solution as prescribed for severe
hyponatremia.
Monitor vital signs and serum sodium as Lasix promotes sodium
excretion and hypertonic sodium chloride can cause fluid overload.

Hypercalcemia
Serum calcium level exceeding 11 mg/dL (2.74 mmol/L)
A common complication of breast, lung, head, and neck cancers;
leukemias and lymphomas; multiple myelomas; and bony
metastases of any cancer.
Manifestations include anorexia, nausea, vomiting, shortened QT
interval, kidney stones, bone pain, and changes in mental status.
Nursing Actions – Administer 0.9% sodium chloride IV, furosemide
(Lasix), pamidronate, and phosphates as prescribed.

Superior vena cava syndrome
Results from obstruction (metastases from breast or lung cancers)
of venous return and engorgement of the vessels from the head and
upper body.
Manifestations include periorbital and facial edema, erythema of
the upper body, dyspnea, and epistaxis.
Nursing Actions – Position the client in a high-Fowler’s position
initially to facilitate lung expansion.
Use high-dose radiation therapy for emergency temporary relief.

Disseminated intravascular coagulation
Complex disorder of coagulation or fibrinolysis (destruction of
clots), which results in thrombosis or bleeding.
DIC is most commonly associated with hematologic cancers
(leukemia and lymphoma); cancer of prostate, gastrointestinal (GI)
tract, and lungs; chemotherapy (methotrexate, vincristine,

Oncologic Emergencies DIC
Clinical manifestation
Chronic DIC: Few or no observable symptoms or easy bruising, prolonged
bleeding from venipuncture and injection sites, bleeding of the gums, and slow
GI bleeding
Acute DIC: Life-threatening hemorrhage and infarction; clinical symptoms of
this syndrome are varied and depend on the organ system involved in
thrombus and infarction or bleeding episodes
Diagnostic
Prolonged prothrombin time (PT or protime)
Prolonged partial thromboplastin time (PTT)
Prolonged thrombin time (TT)

Oncologic Emergencies DIC
Medical
Chemotherapy, biologic response modifier therapy, radiation therapy, or
surgery is used to treat the underlying cancer
Antibiotic therapy is used for sepsis
Anticoagulants, such as heparin or antithrombin III,
Nursing Actions
Observe the client for bleeding, and apply pressure as needed.
Be prepared to administer blood clotting factors that have been lost
through bleeding and may need to be replaced with plasma
transfusions.

Spinal Cord Compression
Spinal cord compression may develop in patients with bone metastasis
when the bones collapse.
This is a very painful problem and requires pain management while
radiation is given to relieve the symptoms.
Patients may develop some motor loss when this occurs.
Often a myelogram or bone scan is used for diagnosis.

Oncologic Emergencies ……
Pericardial Effusion/Cardiac Tamponade
Pericardial effusion, or cardiac tamponade, is a condition usually
caused by direct invasion of the cancer, causing the pericardial sac to
fill with fluid.
Treatment involves draining the fluid from the heart sac by
pericardiocentesis and using sclerosing agents to keep the pericardial
sac from refilling with fluid.

Health Promotion and Disease Prevention
Consume a healthy diet (low-fat diet with increased consumption of
fruits, vegetables, and lean protein foods).
Limit intake of sugar and salt.
Maintain a healthy body weight/body mass index (BMI).
Avoid smoking and alcohol consumption.

Health Promotion and Disease Prevention
Avoid risky lifestyle choices (recreational drug use, needle sharing,
unprotected sexual intercourse).
Avoid exposure to environmental hazards (radiation, chemicals). Use
proper protection when unavoidable.
Breast feed infant exclusively for the first 6 months of life.
Engage in physical activity or exercise routinely

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