Transcript CANCER OVERVIEW

PRESENTED BY:
GUIA GAMBOA
MYLENE AGUIRRE
MARIAN MANASAN
JUNE 12, 2008
OCT 24, 2008
Number of deaths for leading causes of
death - (USA, 2006)
1. Heart disease: 631,636
2. Cancer: 559,888
3. Stroke (cerebrovascular diseases): 137,119
4. Chronic lower respiratory diseases: 124,583
5. Accidents (unintentional injuries): 121,599
6. Diabetes: 72,449
7. Alzheimer's disease: 72,432
8. Influenza and Pneumonia: 56,326
9. Nephritis, nephrotic syndrome, and
nephrosis: 45,344
10. Septicemia: 34,234
DEFINITION OF CANCER
ONCOLOGY
 Oncology is the sum of knowledge
regarding tumors; it is the branch of
medicine that deals with the study of
tumors. Oncology nursing is the care of
people with cancer.

Until the appearance of AIDS, probably
no other medical diagnosis produced as
much fear as a diagnosis of cancer.
DEFINITION OF CANCER
 Cancer is a disorder of cellular growth, life
span, and death.
 Is not one disease, but a group of diseases
characterized by the uncontrolled growth and
spread of abnormal cells.
 It is a group of abnormal cells that generally
proliferate (multiply) more rapidly than do
normal cells, lose the ability to perform
specialized functions, invade surrounding
tissues, and develop growths in other tissues
DEFINITION OF CANCER
 Normal cells have a genetically programmed
life cycle that includes a cell death known as
apoptosis.
 Many types of cancer cells lose the ability to
die properly as part of their normal life cycle.
Statistic Studies
 The American Cancer Society indicates that in
the United States men have a 1 in 2 lifetime
risk of developing cancer; for women, the risk
is 1 in 3.
 Of every five deaths in the United States, one
is from cancer, making it the second leading
cause of death (heart disease is the most
common).
Statistic Studies
 Overall, it affects people of all ages, but occurs
more frequently in the aged and the very
young.
 An estimated 30% of Americans now living will
experience cancer at some point in their lives.
 The 5-year survival rate is now 62%.
Statistic Studies
Lung cancer is the leading cause of cancer-related
death in both men and women.
Other cancers, such as breast and prostate, occur more
often than lung cancer, but they have better cure and
survival rates due to early detection and treatment.
African Americans have a higher incidence of cancer
than whites.
Asian Americans have the lowest death rate from
cancer of any ethnic group.
American Indians have a lower incidence of cancer
than any other group in the US but have the poorest
survival rate when they do get cancer.
Carcinogenesis and the Primary
Prevention of Cancer
 Carcinogenesis is the process by which normal
cells are transformed into cancer cells.
 The exact cause of most human cancers is still
unknown.
 The cause and development of each type of
cancer are likely to be multiple.
 It is not known how many tumors have a
chemical, environmental, genetic,
immunologic, or viral origin.
Carcinogenesis and the Primary
Prevention of Cancer
 Carcinogenesis is the term used for the various
factors that are possible origins of cancer.
 Primary prevention of cancer consists of
changes in lifestyle habits to eliminate or
reduce exposure to carcinogens, substances
known to increase the risk for developing
cancer.
Risk Factors for Cancer
 Smoking: Smoking is the most preventable cause of
death from lung cancer. It is estimated that 87% of people
who develop lung cancer are smokers.
 Dietary habits: Diet plays a role in the development of
cancer of the colon, rectum, and breast. A diet high in
fiber and low in fat is recommended for prevention.
 Exposure to radiation: The effects of radiation
commonly used for medical diagnosis and treatment are
known to be carcinogenic. Excessive exposure to the sun’s
ultraviolet rays is a factor in the development of basal and
squamous cell skin cancers and melanoma.
Risk Factors for Cancer
 Exposure to environment and chemical
carcinogens: There is a greater incidence of
bladder cancer among people who live in urban
areas and among those who work with dyes,
rubber, leather, chlorine and dust from cotton coal,
nickel, chromate, asbestos, and vinyl chloride.
 Smokeless tobacco: increases the risk of cancer of
the mouth, larynx, pharynx, and esophagus.
 Frequent heavy consumption of alcohol: may
result in oral cancer and cancer of the larynx, throat,
esophagus, and liver.
Food to Reduce Cancer Risk
Vegetables from the cabbage
family, such as:
Broccoli
Cauliflower
Brussels sprout
All types of cabbage and kale
Vegetables and fruits high in
beta - carotene, such as:
Carrots
Peaches
Apricots
Squash
Broccoli
Rich sources of vitamin C, such
as:
Grapefruit
Oranges
Cantaloupe
Strawberries
Red and green peppers
Broccoli
Tomatoes
Food to Reduce Cancer Risk
 The National Cancer Institute has recommended
including at least five servings of fruits and
vegetables in the daily diet.
 Lean meat, fish, skinned poultry
 Low-fat dairy products, including white cheese
rather than yellow
 Avoid salt-cured, smoked, or nitrite-cured foods
Hereditary Cancers
 Hereditary cancers are those cancers that arise
from germline mutations. Hereditary cancers
are diagnosed at an earlier age-usually 15 to
20 year earlier than cancers that are not
inherited. Often, several relatives have the
same or related cancers. Hereditary cancers
are characterized by the presence of precursor
lesions, such as polyps in colorectal cancer and
dysplastic nevi in melanoma.
 About 90% of cancer are not inherited.
Cancer Prevention and
Early Detection
Prevention and early detection of cancer includes
recognition of cancer’s seven warning signals.
1. Change in bowel or bladder habits
2. A sore that does not heal
3. Unusual bleeding or discharge
4. Thickening or lump in breast or elsewhere
5. Indigestion or difficulty in swallowing
6. Obvious change in warts or moles
7. Nagging cough or hoarseness
Screening Tests
 Colorectal tests – beginning at age 50.
 Prostate cancer detection for men- beginning at age 40 digital
rectal examination. Age 50 prostate-specific antigen (PSA)
 Pelvic examination with pap smear for women- begin at age
18 or when sexually active.
 Breast cancer detection (self-exams) – BSE monthly, 2 or 3
days after the menstrual periods ends. After menopause, a
woman should choose a specific day to help remind her. Age
40 yearly mammogram
 Skin examinations: Observe for changes in moles, freckles and
other abnormalities
Screening Tests
Breast Self Examination (BSE): READ on the subject
A common reason for delay in diagnosing cancer is that
early malignant changes do not produce pain. Cancer may
be insidious at the onset, and it may often be far
advanced before the individual experiences any
symptoms.
PATHOPHYSIOLOGY OF CANCER
Cell Mechanisms and Growth
 The basic unit of structure and function in all
living things is the cell.
 Approximately 60,000 billion cells are in the
adult human body and, although there are
many different types of cells, all of them have
certain common characteristics.
PATHOPHYSIOLOGY OF CANCER
Cell Mechanisms and Growth
Most cells have the ability to reproduce.
Whenever cells are destroyed, the remaining
cells of the same type reproduce until the
correct number have been replenished. This
orderly replacement of cells is governed by a
control mechanism that stops when the loss or
damage has been corrected. The healthy cell is
a small duplicating machine, perfectly copying
itself over and over.
Pathophysiology of Cancer
 Cancer cells are not subject to the usual
restrictions placed on cell proliferation by the
host.
 When malignant cells change, they become
unlike parent cells.
 They are not differentiated or recognizable as
being the same in size or shapes as normal
cells.
Pathophysiology of Cancer, cont..
 Cancer cells can divide and multiply, but not in
a normal manner. Instead of limiting their
growth to meet specific needs of the body,
they continue to reproduce in a disorderly and
unrestricted manner.
 The cellular features of cancer cells are a local
increase in the number of cells, loss of normal
cellular arrangement, variation in cell shape
and size, increased nuclear size, increased
miotic activity, and abnormal mitosis and
chromosomes.
Pathophysiology of Cancer, cont..
Abnormal cellular growth is classified as:
 Nonneoplastic growth
 Neoplastic growth
Pathophysiology of Cancer, cont..
Four common nonneoplastic growth patterns
 Hypertrophy – an increase in size.
 Hyperplasia - excessive proliferation of normal
cells in the normal tissue arrangement of an
organ.
 Metaplasia - conversion of one kind of tissue
into a form that is not normal for that tissue.
 Dysplasia - abnormal development of tissue.
Anaplasia – “without form”, an irreversible
change in which the structures of adult cells
 Neoplasm is the term for uncontrolled or
abnormal growth of cells. Neoplasm may be
benign ( not recurrent or progressive;
nonmalignant ) or malignant (growing worse
and resisting treatment, as in cancerous
growths).
 The growth are also called tumors, which
means swelling or enlargement. They may be
localized or invasive.
 Benign tumors may become serious because
of localized increase in growth with damage to
surrounding tissues, as in benign brain tumor.
 Malignant neoplasms may progress and
destroy surrounding tissues. They may also
metastasize from the primary site of origin to
distant sites.
Pathophysiology of Cancer
 Metastasis is the term used to describe the
movement of cancer cells from the primary
site to a secondary site.
 the process by which tumor cells are spread
to distant parts of the body.
Pathophysiology of Cancer
Metastasis can occur by the following
mechanisms:
 Direct spread of tumor cells by diffusion to
other body cavities.
 Circulation by way of blood and lymphatic
channels.
 Transplantation or direct transport of tumor
cells from one site to another. Transplantation
may occur accidentally during surgery or other
procedures when cancer cells are “carried” on
 The body’s immune system is responsible for
recognizing and destroying malignant cells.
The immune system may be weakened by
cancer-producing substances, tumor cells, and
the aging process.
 Some T cells are responsible for
immunosurveillance (the immune system’s
recognition and destruction of newly
developed abnormal cells).
 When a cell becomes malignant, it carries a
tumor-specific antigen on its membranes that
is recognized by the body as nonself and
destroyed.
 If T-cell function is suppressed by age, drugs
(corticosteroids), poor nutrition, alcohol,
serious infections, or certain disease processes
(neoplastic invasion of bone and lymph tissue),
the risk of cancer increases.
 To suppress T-cell rejection of a transplanted
organ, steroids and other drugs are
administered.
 The resultant loss of immunosurveillance
increases the risk of certain cancers.
General Characteristics of Neoplasms
Character
GROWTH
LOCATION
Containment
BORDERS
MOBILITY
Resemblance
with parent
tissues
Presence with
normal
tissues
After removal
Fatality
BENIGN
Slow, steady
Localized
Encapsulated
Smooth, well defined
Movable
Resembles parent
tissues
MALIGNANT
Rate varies, usually rapid
Metastasizes
Rarely contained
Irregular
Immobile
Little or no resemblance with
parent tissues
Crowds normal
tissues
Invades normal tissues
Rarely recurs
Rarely fatal
May recur after removal
Fatal with no treatment
Description of Tumors
Tumors are described according to the parent tissue of
the specific location in the body.
 Carcinoma – originate from the skin or in tissues
that line or cover internal organs.
 Sarcoma – originate from the muscle, bone, fat, or
other connective or supportive tissue.
 Lymphoma and Leukemia – originate from the
hematopoietic system.
Grading Tumors
Tumor grade is a system used to classify cancer cells in
terms of how abnormal they look under a microscope
and how quickly the tumor is likely to grow and
spread.
G1 – well-differentiated grade – cells differ slightly from
normal cells (mild dysplasia)
G2 – moderately well-differentiated grade – cells are
more abnormal (moderate dysplasia)
G3 – poorly differentiated grade – cells are very
abnormal (severe dysplasia)
G4 – undifferentiated - cells are immature and
primitive (anaplasia) a cell of this origin is difficult to
Staging Tumors
Clinical Staging Classification System determine the
extent of the disease process of cancer.
Stage 0: Cancer in situ
Stage I: Tumor limited to the tissue of origin;
localized tumor growth
Stage II: Limited local spread
Stage III: Extensive local and regional spread
Stage IV: Metastasis
TNM Classification System
TNM Classification System determine the extent of
disease process of cancer according to three
parameters.
T Tumor size
N Degree of regional spread to the lymph
nodes
M Metastasis
TNM Classification System
 T- Subclasses (Primary Tumor)
Tx – tumor cannot be adequately assessed
To – no evidence of primary tumor
Tis – carcinoma in situ
T1, T2, T3, T4 – progressive increase in tumor size and
involvement
 N Subclasses (Regional Lymph Nodes)
Nx –regional lymph nodes cannot be assessed
No – no regional lymph node metastasis
N1, N2, N3, N4 - increasing involvement regional lymph
TNM Classification System
 M Subclasses (Distant Metastasis)
Mx – not assessed
Mo – no (known) distant metastasis
M1, M2, M3, M4 – distant metastasis present,
specify site(s)
 The Papanicolau test, as given by the Bethesda
system (the preferred system), are as follows:
 Negative (normal), formerly class I
 Probably negative, may indicate infection; atypical
squamous cells; reactive change, formerly class II
 Suspicious, but not conclusive for malignancy; lowgrade squamous intraepithelial lesion, formely class
III
 More suspicious, strongly suggestive of
malignancy; high-grade squamous intraepithelial
lesion, formerly class IV
 Conclusive for malignancy; invasive squamous cell
carcinoma, formerly class V
Diagnosis of Cancer
Biopsy
 Incisional – removal of a portion of tissue
for examination.
 Excisional – removal of the complete
lesion, with little or no margin of
surrounding normal tissue removed.
 Needle Aspiration – aspiration of fluid or
tissue by means of a needle.
Diagnosis of Cancer
 Endoscopy - Cells or tissue can also be obtained
using an endoscope to directly visualize an
internal structure through a
body cavity or
through a small incision. Endoscopes are rigid or
flexible tubes containing a magnifying lens and a
light.
 Ex: bronchoscope (tracheobronchial tree); upper
gastrointestinal (GI) endoscopy (esophagus,
stomach, duodenum); the colonoscopy entire
colon; and the sigmoidoscope is used to examine
the sigmoid colon, rectum, and anus.
Diagnosis of Cancer
 Diagnostic Imaging
Bone Scanning - Indicated to detect
metastatic tumors; all malignancies capable of
metastasis may reach the bone, especially
those malignancies of the breasts, kidneys,
lungs prostate, thyroid gland, and urinary
bladder.
Diagnosis of Cancer
 Tomography - Tomography is the special technique of
making multiple radiographic films at different depths
of a specific area, organ, or structure. The details of
each thin section can be clearly visualized.
 Computed Tomography (CT) - Uses radiographs and a
computed scanning system to produce and record
images of specific structures at different angles. The
entire body can be scanned to detect the presence of
any abnormal lesion. CT scan is especially helpful to
detect small lesions that may not be seen by
radiographs or tomography.
Diagnosis of Cancer
 Radioisotope Studies - require the injection or
ingestion of a radioactive substance. A
scanning device is used to identify the
distribution of the substance in different areas
of the body.
 Concentration of the radioisotope in a specific
organ, such as the thyroid gland or brain,
identifies a tumor in that location (may be
primary or metastatic).
Diagnosis of Cancer
 Ultrasound Testing - is a noninvasive
procedure using high-frequency sound waves
to examine internal structures of the body. An
ultrasound beam is directed through the
tissues, which reflects back to the transducer.
Ultrasound can show the size, consistency, and
shape of the structure being studied, and it is
most helpful in distinguishing between cystic
and solid tumors. Ultrasound is not used to
examine bones or air-filled organs. The
procedure is painless.
Diagnosis of Cancer
 Magnetic Resonance Imaging (MRI) - This test
is currently used in the diagnosis of
intracranial and spinal lesions and of
cardiovascular and soft tissue abnormalities.
The person having MRI must not have any
metallic materials on the body during the test;
no jewelry may be worn. MRI cannot be done
if the person has any metallic implants in the
body, such as a pacemaker, orthopedic nail, or
aneurysm screw.
Laboratory Tests
 Measurement of Alkaline Phosphatase Blood
Level:
 Elevated if there is metastasis to bone or liver
Normal range – 4.5 – 13 U/dL
 Serum Calcitonin Level
 Elevated in cancer of the thyroid, breast or
lungs
Adult female < 25
Adult male <40
Laboratory Tests
 Carcinoembryonic Antigen (CEA) Serum Level
 production stops before birth but begins again
if a neoplasm develops.
 Elevated in colorectal CA
 Used in evaluation of CA treatment in which a
rising titer may indicate tumor recurrence
 Used less because it is also seen in non-CA
cases
 Nonsmokers <2.5 ng/ml
 smokers <5 ng/ml
Laboratory Tests
 Prostate Specific Antigen (PSA) – Gold
standard tumor marker for prostate CA

Age 0-39 <2.0 ug/L
Age 40 and above 0 - 4 ug/L
 Cancer Antigen (CA)-125 – ovarian, pancreatic
 35 units/mL
 Stool Examination for Blood – it is essential
that the person not have any of the following
foods or medications for 4 days before the
test: red meat, turnips, melons, aspirin and
vitamin c. The test must be performed on
To be continued .. Next week
and prepare for a quiz
Cancer Therapies
 Surgery
The goal of surgery is to remove all malignant cells; this may
include the removal of the tumor, surrounding tissue, and
regional lymph nodes.
Surgery in conjunction with chemotherapy and/or radiation
therapy may increase the destruction of cancer cells.
Surgery may be performed for many reasons – preventive,
diagnostic, curative, and palliative (therapy designed to
relieve or reduce intensity or uncomfortable symptoms,
but that does not produce a cure).
Cancer Therapies
 Radiation Therapy
Radiation therapy can be used to cure or control cancer
that has spread to local lymph nodes or to treat tumors
that cannot be removed.
Radiation may be used preoperatively to reduce the size of
a tumor. Postoperative radiation may be indicated to
destroy malignant cells not removed by surgery.
Radiation may also be used to slow the growth of malignant
tumors.
Radiation may be delivered externally or internally.
Radiation
Nursing Intervention for External Radiation
A specific area on the body is marked to indicate the port at
which external radiation will be directed.
These marking must not be washed off. If the are become
wet while bathing, the skin should be patted with an
absorbent towel.
This area need to be protected.
Avoid the use of any ointment, lotions, or powder on this
area. The physician may approve specific lotions or
creams for drying skin.
Radiation
Nursing Intervention for External Radiation
Protect the radiated area from direct sunlight and to avoid
applications of heat or cold because these would
increase erythema, drying, and pruritus of the skin, which
is common over an irradiated area.
A diet high in protein and calories and a fluid intake of 2 or
3 quarts per day must be encouraged.
Lethargy and fatigue are not uncommon during treatment
and that frequent rest periods are helpful.
Radiation
Nursing Intervention for Internal Radiation
Assemble materials and plan ahead to provide several nursing
interventions at the same time upon entering the patient’s
room.
Stand at the greatest distance away from the site where an
internal radiation device is in the patient’s body. Stand at least
6 feet away.
Limit the time needed for close contact near the irradiated site.
Spend no more than 10 minutes at a time. If direct, prolonged
care is needed, nurses should wear a lead apron.
Children younger than 18 years of age and pregnant women
should not be allowed to visit implant patients.
Cancer Therapies
 Chemotherapy
Chemotherapy drugs are used to reduce or slow the
growth of metastatic caner. Most chemotherapeutic
agents work by interfering with a cells’ ability to multiply
or reproduce. Drugs that interfere with a cell’s replication
(duplicating or reproducing) process damage the cell and
cause cellular death. Both malignant and normal cells are
affected by chemotherapy. Cells that multiply rapidly are
affected the most, such as cells of the hematopoietic
system, the hair follicles, and the GI system.
Chemotherapy
Side Effects of Chemotherapy
 Hematopoietic System
Leukemia – 5000 to 10,000/mm3
Neutropenia – 60% - 70% or 3000 to 7000/mm3
Anemia
Thrombocytopenia – 150,000 to 400,000/mm3
 Integumentary System
Alopecia – loss of hair
 Gastrointestinal System
Stomatitis – inflammation of the mouth
Nausea, vomiting , and diarrhea
Chemotherapy
Nursing Interventions for Chemotherapy
 Leukopenia/ Neutropenia
Monitor for signs of infection.
Vital signs every 4 hours.
Discourage fresh flowers or live plants in the room.
 Assess mouth
Perform regular, but gentle mouth care. Use soft
toothbrush or swab and rinse with normal saline or
sodium bicarbonate solution every 2 to 4 hours.
 Assess skin
Rash or eruption which may indicate infection.
Use electric razor to shave.
Clean skinfolds twice a day with soap and water.
Chemotherapy
Nursing Interventions for Chemotherapy
 Assess pulmonary function
Encourage deep breathing and coughing exercises.
 Assess urinary and bowel function
Monitor urine output and for possible signs of infection.
Monitor stool for color, consistency and presence of
blood and change in bowel habits.
 Anemia
Care should be planned to balance activities and rest.
 Thrombocytopenia
Apply direct pressure for 5 to 10 minutes if any bleeding
occurs.
Avoid contact sports, elective surgery and tooth extraction.
Chemotherapy
Nursing Interventions for Chemotherapy
Avoid picking or blowing nose forcefully.
Avoid trauma, falls, bumps, and cuts.
Avoid use of aspirin or aspirin preparations.
 Alopecia
Use of gentle shampoo, avoid hair dryers, curling irons ,
and hair coloring.
Wear protective covering.
 Nausea and vomiting
Administer antiemetics before and after therapy.
Encourage intake of fluids to prevent dehydration.
Chemotherapy
Nursing Interventions for Chemotherapy
 Diarrhea
Avoid food that irritate and stimulates peristalsis.
Encourage intake of fluids to prevent dehydration.
Side Effect of Chemotherapy and
Radiation
 Tumor Lysis Syndrome (TLS) is an oncologic emergency
that occurs in cancer patients with heavy tumor burdens
after they receive chemotherapy or irradiation , which
causes rapid lysis of malignant cells. It may occur
anywhere from 24 hrs to 7 days after antineoplatic
therapy is initiated. As malignant cells are lysed,
intracellular contents are rapidly released into the
bloodstream. This results in high level of potassium
(hyperkalemia), phosphate (hyperphosphatemia), and
uric acid (hyperuricemia), and low level of calcium
(hypocalcemia) all put the patient at risk for renal failure
and alterations in cardiac function.
Medical Management of Tumor
Lysis Syndrome
Hydration to maintain a urinary output of 150 mL/hr.
Hydration should begin 24 to 48 hrs before treatment and
continue for at least 72 hrs after treatment.
Diuretics may be used to promote the excretion of
phosphate, potassium, and uric acid. Diuretics are used to
prevent volume overload.
Allopurinol prevent uric acid formation. It is begun a few
days before treatment and should be continued for 3 to 5
days after treatment is completed.
Sodium bicarbonate is used to maintain an alkaline urine
(pH>7) to prevent uric acid crystallization.
Medical Management of Tumor
Lysis Syndrome
Cation-exchange resins (Kayexalate) are used to bind with
potassium so it can be excreted through the bowel.
Calcium gluconate given intravenously is used to correct
hypocalcemia. Cardiac monitoring is required.
Phosphate-binding gels (aluminum hydroxide) are given to
form an insoluble complex that is excreted by the bowel.
When these measures are not successful, renal dialysis may
be necessary.
Successful treatment of TLS depends on preventing renal
failure. TLS typically resolves within 7 days, once
appropriate treatment is initiated.
Cancer Therapies
 Biotherapy treatment with agents derived from biologic
sources or affecting biologic responses.
Three major mechanisms of biological response modifiers
(BRMs)
1. Increases, restores, or modifies the host defenses
against the tumor
2. Toxic to tumor
3. Modifies the tumor biology
Most of these therapies are IM or subQ injections and need to
be given over an extended time.
Cancer Therapies
 Bone Marrow Transplantation
Process of replacing diseased or damaged bone marrow
with normally functioning bone marrow.
 Peripheral Stem Cell Transplantation
Alternative to bone marrow transplant
This procedure is based on the fact that peripheral or
circulating stem cells are capable of repopulating the
bone marrow.
Advance Cancer
Pain Management
Patient with cancer may have pain at any point during the course
of the disease and its treatment. Pain is almost without
exception a late symptom of cancer. Pain control is a major
issue in the management of a person with cancer. Pain is
whatever the person experiencing the pain says it is, existing
whenever the patient says it does. It is of extreme importance
not to be judgmental concerning the patient’s complaints of
pain. Patients should not be subjected to severe suffering from
potentially controllable pain. Fear of addiction should not be a
factor when considering pain relief for the terminally ill.
Advance Cancer
Pain Management
The need for around-the-clock dosage is clear. Fixed dosage
schedules with adequate doses for pain relief provide
more constant blood levels and predictable pain relief.
Some patients have breakthrough pain that requires
additional doses, but the fixed dosage schedule should be
maintained.
Patient self control methods include distraction, massage,
relaxation, biofeedback, hypnosis, and imagery.
Nutritional Therapy
 Malnutrition
High protein , high calorie foods that provide energy and
minimize weight loss.
 Altered Taste Sensation
Add spices and other seasoning agents to mask the taste.
Lemon juice, onion, mint, basil and fruit juice marinades may
improve the taste of certain meats.
Bacon bits, onion, and pieces of ham may enhance the taste of
vegetables.
 Neutropenia
Fresh fruits and vegetables should be avoided because of the
presence of microscopic pathogens in uncooked produce.
Nutritional Therapy
 Nausea and Vomiting
Small frequent meals
Encourage adequate fluid intake
 Diarrhea
Encourage adequate fluid intake
Eliminate spicy foods and high in fat content
High protein foods with high caloric value and vitamin and mineral
supplements
Low residue foods to minimize peristalsis and bowel movement
 Stomatitis/ Mucositis
Soft or liquid diet
 Anorexia
Communication and Psychological
Support
The patient and family may become irritable and angry with
caregivers and nurse when suffering. The nurse must be very
understanding towards the patient and family under this
circumstances. By listening and administering kind and gentle
nursing care, the nurse may communicate more effectively
than with words. Touch may also be appropriate, adding the
dimension of another human being’s awareness of the
emotional distress being experienced. Nurses are in the
enviable position of being able to make cancer’s effect less
traumatic through sensitivity and creativity. It is important that
nurses learn the art of talking to patients, not at patients. A
positive attitude of patient, family, and caregivers toward
cancer and cancer treatment has a significant positive effect
on the quality of life that the patient experiences.
Communication and Psychological
Support
Factors which may determine how the patient copes with the
diagnosis of cancer:
 Ability to cope with stressful events in the past
 Availability of significant others
 Ability to express feelings and concerns
 Age at the time of diagnosis
 Extent of disease
 Disruption of body image
 Presence of symptoms
 Past experience with cancer
 Attitude associated with cancer
Terminal Prognosis
 Most patients with advanced cancer know they are dying
 Honesty and openness are the best approaches
 Spiritual activities may provide mental and emotional
strength
 Social worker assists the patient and family in planning
for home care
 Hospice services can be arranged-efforts are directed
toward relief from pain and other problems
THE END
References
Foundations and Adult Health Nursing- Christensen,
Kockrow
Basic Pharmacology for Nurses – Clayton, Stock, Harroun
American Cancer Society
National Cancer Institute