NSG210 Week 09 Lecture: Cancer (Oncologic Management)
Course: NSG210 Medical-Surgical Nursing, Fall 2026 Week: 09 (Oct 19-23), lecture Oct 21, Alterations in Protection Exam: Exam 3
Source: lecture deck raw/nsg210_wk09_CANCER.pptx (41 slides, no speaker notes). Slides 9-11 are an image of the American Cancer Society screening table; slide 21 is an image of an implanted port and a tunneled central catheter. Where the slides differ from the textbook, the slide value is given with the textbook value noted.
Textbook: Hinkle Ch. 12 nsg210-hinkle-ch12-oncologic-management.
Objectives (slide 1)
- Differentiate benign and malignant tumors
- Describe the nurse’s role in health education and prevention
- Differentiate the goals of cancer care: prevention, diagnosis, cure, control, palliation
- Describe the roles of surgery, radiation, and chemotherapy
- Use the nursing process in caring for patients with cancer
- Identify potential complications and the related nursing care
Benign vs Malignant (slides 2-3)
| Benign | Malignant |
|---|---|
| Encapsulated, slow growing | Expands rapidly |
| Similar to normal cells | No resemblance to tissue of origin |
| Does not recur or metastasize | Metastasizes |
| Does not destroy tissue | Damages surrounding tissue |
| No systemic symptoms |
How cancer spreads:
- Lymphatic (most common)
- Hematogenous (through the blood)
- Angiogenesis: the tumor grows its own new capillaries for oxygen and nutrients
Risk Factors (slide 4)
- Heredity, stress, age (70% of cancers occur over age 65)
- Diet: preservatives, high fat, low fiber
- Occupation: asbestos, radiation; sun exposure
- Infections: HPV (cervical cancer), EBV (Hodgkin lymphoma)
- Tobacco: lung, oral, laryngeal, esophageal, gastric, pancreatic, bladder cancers
- Alcohol
Slide 4 says 70% of cancers occur over 65; slide 40 says more than 60%.
Terms (slide 5)
| Term | Tissue |
|---|---|
| Carcinoma | Epithelial tissue |
| Sarcoma | Connective tissue, muscle, bone |
| Leukemia, myeloma, lymphoma | Blood and lymphatic system |
Prevention and Detection (slides 6-8)
- Primary prevention: lower risk in healthy people (community education, avoiding carcinogens, diet and lifestyle; for example anti-tobacco and nutrition programs)
- Secondary prevention: screening and early detection (for example breast and testicular self-exams, Pap tests); education and surveillance for high-risk groups
ACS “CAUTION” warning signs:
- Change in bowel or bladder habits
- A sore that does not heal
- Unusual bleeding or discharge
- Thickening or lump in the breast or elsewhere
- Indigestion or difficulty swallowing
- Obvious change in a wart or mole
- Nagging cough or hoarseness
Screening Guidelines (slides 9-11, image of the ACS table)
| Cancer | Who | Test and frequency |
|---|---|---|
| Breast | Women 40-54 | Mammogram; option to start annually at 40-44; annually at 45-54 |
| Breast | Women 55+ | Every 2 years, or keep annual; continue while life expectancy is 10+ years |
| Cervical | Women 21-29 | Pap every 3 years |
| Cervical | Women 30-65 | Pap plus HPV test every 5 years (preferred) or Pap alone every 3 years |
| Cervical | Women 66+ | Stop if 3 or more negative Paps or 2 or more negative co-tests in the past 10 years; also stop after total hysterectomy |
| Colorectal | Men and women 50+ | Yearly stool test (gFOBT or FIT), or flexible sigmoidoscopy every 5 years, or barium enema every 5 years, or colonoscopy every 10 years, or CT colonography every 5 years |
| Endometrial | Women at menopause | Counsel to report unexpected bleeding or spotting |
| Lung | Ages 55-74, current or former smokers (quit within 15 years), 30 pack-years | Low-dose CT, after shared decision-making; not a substitute for quitting |
| Prostate | Men 50+ with 10+ years life expectancy | Informed decision about PSA and DRE |
| Cancer checkup | Age 20+ | Thyroid, testicles, ovaries, lymph nodes, mouth, skin, plus counseling at periodic exams |
This table is an older ACS version. The textbook summary says colorectal screening starts at 45 (to age 75), not 50. Use the textbook value unless the instructor says otherwise.
Staging, Grading, and Tumor Markers (slides 12-13)
- Staging: extent of disease at diagnosis. TNM = Tumor size, lymph Nodes, Metastasis (local, regional, distant)
- Grading: how abnormal the cells look under the microscope. Well differentiated means a better prognosis; poorly differentiated means a worse one
| Marker | Cancer |
|---|---|
| CEA | Colon, lung, breast, ovary, pancreas |
| Alpha-fetoprotein (AFP) | Liver (hepatocellular), seminoma |
| hCG (slide says “HGG”) | Gonadal germ cell tumors |
| Calcitonin | Medullary thyroid cancer |
| PSA | Prostate |
| Immunoglobulins | Multiple myeloma |
| CA-125 | Epithelial ovarian cancer |
Surgery (slide 14)
Removing the entire cancer is the best and most common treatment. Purposes: curative, diagnostic (biopsy), prophylactic, palliative, reconstructive.
Radiation Therapy (slides 15-17)
- About 50% of patients get radiation at some point
- Can cure Hodgkin lymphoma, seminoma, cervical cancer
- Also used for control when surgery is not possible, to prevent leukemia spreading to the brain or spinal cord, and for palliation of metastases
- Rapidly dividing tissues are most sensitive
| Type | How |
|---|---|
| External (teletherapy) | Source at a distance from the patient |
| Brachytherapy (internal, interstitial, intracavitary) | Radioactive source placed in or next to the tumor; high dose to tumor, low dose to normal tissue |
Side effects:
- Skin (external): blanching, erythema, desquamation, sloughing, bleeding
- Painful mucous membrane ulcers; fewer secretions, so more infection risk
- GI: nausea, vomiting, diarrhea, bleeding
- Lungs: radiation pneumonitis (slide says “radiation pneumonia”)
- Implants cause similar effects, and the patient’s body fluids need special handling
Chemotherapy (slides 18-20)
- Antineoplastic drugs kill cells by disrupting function and reproduction; mainly for systemic disease
- Can be combined with surgery or radiation to shrink tumors
- Goal: destroy enough tumor that the immune system can clear the rest
- Dose based on body surface area (BSA), physical status, and prior response
Extravasation: vesicants leaking into tissue cause necrosis, sometimes needing skin grafts. A vascular access device (implanted port or tunneled central catheter, slide 21) may be placed. Textbook adds: if extravasation is suspected, stop the infusion immediately, follow the antidote protocol, and notify the provider.
Drug Classes (slides 22-23)
| Class | How it works | Examples |
|---|---|---|
| Alkylating agents | Damage DNA directly | Cyclophosphamide (Cytoxan), cisplatin |
| Nitrosoureas | Damage DNA directly | Streptozocin, carmustine |
| Antimetabolites | Block building blocks for DNA and RNA | 5-fluorouracil, methotrexate |
| Topoisomerase I inhibitors | Block enzymes for DNA replication | Topotecan, irinotecan |
| Topoisomerase II inhibitors | Same | Etoposide, teniposide |
| Antitumor antibiotics | Bind DNA, block RNA synthesis | Doxorubicin (Adriamycin), bleomycin, daunorubicin, mitomycin |
| Mitotic inhibitors (plant alkaloids): vinca alkaloids | Block cell division | Vincristine, vinblastine |
| Mitotic inhibitors: taxanes | Same | Paclitaxel, docetaxel |
| Hormonal agents | Bind hormone receptors to change growth | Steroids, androgens, estrogens, tamoxifen |
Chemotherapy Toxicity by System (slides 24-27)
Hits fast-growing cells: GI lining, bone marrow, hair follicles.
| System | Effects | Nursing |
|---|---|---|
| GI | Nausea and vomiting (most common, up to 24-48 hours), mucositis, diarrhea; mostly from antimetabolites and antitumor antibiotics | Antiemetics such as ondansetron or granisetron (block serotonin receptors) |
| Bone marrow | Myelosuppression. Nadir = point of lowest blood counts (textbook: 7-14 days after chemo) | Frequent CBC; protect from infection and injury |
| Renal | Cisplatin and methotrexate are nephrotoxic; cyclophosphamide causes hemorrhagic cystitis; uric acid from cell breakdown | Monitor BUN, creatinine, GFR; hydrate; alkalinize urine; allopurinol |
| Cardiac | Doxorubicin can cause irreversible heart damage at high doses | MUGA scan for ejection fraction, ECG, watch for heart failure |
| Pulmonary | Bleomycin can cause pulmonary fibrosis | Monitor pulmonary function |
| Reproductive | Possible sterility; fertility may return | Sperm banking before treatment |
| Neurologic | Vincristine: peripheral neuropathy, loss of deep tendon reflexes, paralytic ileus | Check bowel patterns |
Biologic Response Modifiers (slides 28-29)
Change the immune relationship between tumor and patient; based on the idea that cancer suppresses the immune system, so treatment restores or boosts immune defenses.
- BCG: melanoma, bladder, colon cancer
- Interferons: antiviral and antitumor
- Monoclonal antibodies
- Lymphokines and cytokines
Pain Management (slides 30-33)
- Goal: enough relief to function as the patient wishes; for the terminally ill, to die relatively pain free
- Basis: opioids, non-opioids, and adjuvant drugs
- Other options: nerve blocks or spinal anesthetic injections, surgically cutting nerves, radiation to shrink tumors, behavioral approaches
- Oral route as long as it works; give on a regular schedule, around the clock
- If oral is not enough: scheduled or continuous IV
- Manage side effects: constipation, nausea, vomiting, itching
- Morphine and transdermal fentanyl are the most common drugs for cancer pain
- Do not stop high-dose opioids abruptly (withdrawal)
Alternative Treatments (slides 34-35)
- Give factual information and clarify misconceptions
- Open the door to discussing alternative methods; do not judge or ridicule
- Involve patient and family; suggest diet, exercise, and sleep habits; offer support groups
- Know what alternative therapies the patient uses and watch for adverse effects or interactions
Nursing Care (slides 36-37)
- Tissue integrity: stomatitis, radiation skin reactions, alopecia, metastatic skin lesions
- Nutrition: anorexia, malabsorption, cachexia
- Pain, fatigue, body image and self-esteem, grieving
- Complications: infection, septic shock, bleeding and hemorrhage
Home and Community Care (slides 38-39)
- Care shifts to patient and family, so teaching starts with the most immediate needs
- Review side effects and changes to report, verbally and in writing
- Follow-up visits and phone calls; home care referral; the home care nurse coordinates care
Older Adults (slide 40)
- More than 60% of new cancers are in people over 65
- More chemo toxicity from declining organ function
- Higher risk of atelectasis, pneumonia, wound infection
- Often delay reporting symptoms, blaming age
- Plan teaching around sensory loss and memory deficits
Hospice (slide 41)
- For patients who cannot be treated successfully, with a life expectancy of 6 months or less; refer in a timely way
- Multidisciplinary care for the patient and family
- Focus: quality of life, symptom palliation, psychosocial and spiritual care, grief
See also nsg210-death-dying-workshop.
Likely Exam Points
- Lymphatic spread is most common
- Well differentiated means a better prognosis
- CAUTION warning signs
- Tumor markers: PSA (prostate), CA-125 (ovary), AFP (liver), CEA (colon), calcitonin (medullary thyroid)
- Nadir is the lowest blood count; protect from infection and bleeding
- Cyclophosphamide: hemorrhagic cystitis, so push fluids. Doxorubicin: cardiotoxicity, so check ejection fraction. Bleomycin: pulmonary fibrosis. Vincristine: neuropathy and ileus. Cisplatin and methotrexate: kidneys
- Vesicant extravasation causes tissue necrosis
- Cancer pain: oral, around the clock; morphine and fentanyl patch; do not stop opioids abruptly
- Hospice: life expectancy 6 months or less