| Subjective Data | Objective Data | Risk Factors | Annual Incidence | Specific Treatment | |
|---|---|---|---|---|---|
| GASTROINTESTINAL TRACT | |||||
| Oral cancer | Difficulty chewing, swallowing, moving tongue or jaws, history of heavy smoking, alcohol uses, or chewing tobacco | Sore that bleeds and does not heal; persistent red or white patch; diagnosis by biopsy; early detection: dental checks | Heavy smoking and drinking, user of chewing tobacco, men > age 40 (affects twice as many men as women) | 30, 750 new cases:8440 estimated deaths | Surgery, with reconstructive surgery useful for cure and palliatively (see care of cancer patient having surgery Radiation using simulated computer localization to avoid destruction of normal Tissue |
| Esophageal cancer | Dysphagia – difficulty in swallowing: discomfort described as lump in throat, pressure in chest, pain: fatigue, lethargy, apathy, depression: anorexia | Weight loss; regurgitation, vomiting; diagnostic tests – barium swallow, esophagoscopy, biopsy | Over age 50, alcoholism, use of tobacco; increasing risk in nonwhite women, in people with achalasia ( inability to relax lower esophagus with swallowing) or hiatal hernias | 12,500 new cases; 12,200 estimated deaths | Surgery: resection with anastomosis, or removal with gastronomy Radiation: best form of therapy Chemotherapy: antineoplastic drugs ineffective; medication to reduce symptoms of pain, discomfort, and anxiety; see nursing care plan/implementation for patient with cancer (p. 609); having radiation therapy (pp. 612-614); having chemotherapy (pp. 611-612); having surgery (pp. 609-610) |
| Stomach cancer | Vague feeling of fullness, pressure, or epigastric pain following ingestion of food; anorexia, nausea intolerance of meat; malaise | Eructation, regurgitation, vomiting; melena, hematemesis, anemia; jaundice, diarrhea, ascites; big belly, upper gastric area; often palpable mass | Men, lower socioeconomic classes, colder climates, early exposure to dietary carcinogens, blood group A, pernicious anemia, atrophic achlorhydric gastritis | 22,400 new cases; 28,100 estimated deaths | Surgery: gastrectomy ( see gastric surgery, p. 522, for nursing care). Radiation: not as useful because dosage needed would cause side effects unlikely to be tolerated by patient Chemotherapy: alone or in conjuction with surgery; antitumor antibiotics, antimetabolites, nitrosoureas, hematinics ( see nursing care plan for patient having chemotheraphy, pp. 611-612) |
| Pancreatic cancer | Anorexia, nausea; pain in upper abdomen, radiating to back; dyspnea | Jaundice, vomiting, weight loss; determination of solid mass in ares of pancreas by computed to mography and ultrasound; tissue identification by thin needle percutaneous biopsy | Excessive use of alcohol; exposure to dry – cleaning chemicals, gasoline; coffee ans decaffeinated coffee; possibly diabetes and chronic pancreatitis | 27,600 new cases; 28,100 estimated deaths | Surgery: removal ( must then have supplemental pancreatic enzymes; some patients become insulin – dependent diabetics) or bypass to relieve obstruction ( see nursing care plan/implementation for patient with diabetes, pp. 526-527) Chemotheraphy: pain relief, antiemetics, sulin, pancrelipase, 5 – flurouracil cyclophosphamide ( 5 – FU), cytoxan, carmustines (BCNU), methotrexate, vincristine, mitomycin-C, (see nursing care plan/implementation for patient having chemotherApy, pp.611-612) Radiation: intraoprative high dose to pancreatic tumors with external high beam; palliative radiation therapy for pain ( see nursing care plan/implementation for patient having radiation therapy, pp.612-614; see nursing care plan/implementation for patient with cancer, p.609) |
| Skin Skin cancer: basal cell | Reported painless lesion | Scaly plaques, papules that ulcerate; pale, waxy, pearly nodule or red sharply outlined patch; unusual skin condition, change in size or color, or other darkly pigmented growth or mole | Exposure to sun , coal tar, pitch, arsenic compounds, creosote, radium; fair complexion | 900,000 new cases; 7,300 estimated deaths; 44,200 of those malignant melanoma | Surgery: electrodesiccation (dehydration of tissue by use of needle electrode); cryosurgery ( destruction of tissue by application of extreme cold) ( see care of cancer patient, pp. 609 Radiation therapy ( see care patient having radiation therapy, pp.612-614) Prevention: avoid sun from 10 A.M. - 3 P.M., use protective clothing, sunblock lotion |
| Nervous System Brain | Headache: steady, intermittent, severe (may be intensified by physical activity); easy fatigability; forgetfulness, disorientation, impaired judgement; visual disturbances; blackouts | Vomiting, may be projectile; sight loss, auditory changes; signs of increased intracranial pressure; seizures; paresthesia; behavior changes, diagnostic studies – CT scan, arteriography, cytology of cerebrospinal fluid | None known for primary tumors; brain is common site for metastasis | 17,600 cases ( brain and spinal cord); 13,200 estimated deaths |
Surgery: craniotomy with excision of lesion; venticular shunt to allow for drainage of fluid ( see nursing care plan/implementation for patient wiyh cancer, p. 609) Radiation: cobalt (local or entire CNS); total brain radiation causes alopecia, which may be permanent ( see nursing care plan/implementation for patient having radiation therapy, pp. 612-614); could be used alone, with surgery, or with chemotherapy Chemotherapy: antineoplastic alkylating agents; nitrosoureas ( cross blood - brain barrier to reduce tumor) – carmustine )BCNU), lomustine (CCNU), semustine( methyl - CCNU); cerebral diuretics to reduce edema; anticonvulsants; anagesics; sedatives ( see nursing care plan/implementation for patient having chemotherapy, pp. 661-612) |
| ENDOCRINE | |||||
| Thyroid cancer | Painless nodule; dysphagia; difficulty breathing | Enlarged thyroid , thyroid nodule; thyroid lymph nodes; hoarseness; hypofunctional nodule seen on isotopic imaging scanning; needle biopsy for cytology studies | Radiation exposure on childhood | 18,100 new cases; 1200 estimated deaths |
Surgery: total thyroidectomy, possible radical neck dissection ( see Thyroidectomy, pp. 598-599) Radiation: external, or radio active iodine ( see care of patient having a radiation therapy, pp. 612-614) Chemotherapy: chlorambucil, doxorubicin, vincristine (Leukeran, adriamycin, Oncovin, respectively) ( see care of patient having chemotherapy, pp. 611-612) |
| BLOOD AND LYMPH TISSUES | |||||
| Hodgkin’s Disease | Fatigue; generalized pruritis; anorexia | Painless enlargement of lymph nodes, especially in cervical area; fever; night sweats; hepatosplenomegaly; anemia; peak age of incidence, 15 – 35; diagnostic test – biopsy shows of presence Reed – sternberg cells; x-rays, scans, laparotomy | For young adults 15 – 35 yr old, not clearly defined, some relationship to socioeconomic status, men – women ratio is 1.5:1; increased frequency among caucasians | 7500 new cases; 1300 estimated deaths |
Staging and Treatment:
Stage I - involement of a single node or a single node region; excision of lesion, and total nodal radiation ( see care of patient having radiation therapy, pp.612-614), Stage II – involvement of two or more lymph node regions on same side of diaphragm; excision of lesion and radiation ( see care of patient having radiation theraphy, pp. 612-614) Stage III – involvement of lymph node regions of both sides of the diaphragm, which may include the spleen; combination of radiation and chemotherapy Stage IV – involvement of one or more extra lymphatic organs or tissues, with or without lymphatic involvement; treated with chemotherapy alone, radiation therapy alone, or both Presence or absence of symptoms of night sweats, significant fever, and weight loss; treated with chemotherapy, MOPP protocol – Mustargen ( mechlorethamine HCI, alkylating agent) Oncovin (vincristine, plant alkaloid), procarbazine (antineoplastic); prednisone (corticosteroid) |
| Non-Hodgkin’s Lymphoma | Night sweats | Nontender lymphadenopathy, enlarged liver and spleen, weight loss, fever | Age 50 – 60 yr old | 53,600 new cases; 23,800 estimated deaths | Stage I – rarely observed, but remission possible with radiation therapy Stage II – radiation therapy Stage III and IV – combination chemotherapy, with or without radiation therapy |
| Multiple myeloma | Weakness, history of frequent infections, especially pneumonias; severe bone pain on motion; neurological symptoms, paralysis | Fractures of long bones; deformity of; strenun, ribs, vertebrae, pelvis; hepatosplenomegaly; anemia and bleeding tendencies Elevated uric acid | Exposure to ionizing radiation; middle aged or older women | 13,200 new cases; 11,400 estimated deaths |
Surgery: relieve spinal cord compression; orthopedic procedures to relieve or support bone problems ( see nursing care plan/implementation for patients with internal fixation for fractures, pp. 576-580; patient with spinal cord injuries when paralysis occurs, p. 591) Radiation: for some lesions ( see nursing care plan/implementation for patients having radiation therapy, pp.612-614) Chemotherapy: alkylating agents; antitumor antibiotics; plant alkaloids; hormones – melphalan and prednisone ( see nursing care plan/implementation for patients having chemotherapy, pp. 612-614) |
| URINARY ORGANS | |||||
| Kidney cancer | Anorexia, nausea, fatigue; abdominal flank pain | Painless, gross hematuria; firm, non tender, palpable kidney; vomiting and weight loss; complications – hypertension, nephrotic syndrome, lung metastasis Lab and Diagnostic tests: IVP, urinalysis - presence of red cells and albumin; CBC - decrease in red cells and leukocytes, reduction in serum albumin, elevation of alpha globulin | More common among men than women blacks, radiation exposure, possible familial influence, common site of metastasis from lung breast | 30,000 new cases; 1900 estimated deaths | Surgery: nephrectomy ( see pre/postoperative nursing care, pp.545) Radiation: local and irradiation of metastatic sites when tumor is radio sensitive ( see nursing care plan/implementation foe patient having radiation therapy, pp. 612-614) Chemotherapy: plant alkaloids - vincristine (Oncovin), anti tumor antibiotics – dactinomycin (Actinomycin D), doxorubicin ( Adriamycin); alkylating agents – cyclophosphamide (Cytoxan) (see nursing care plan/implementation for patient having chemotherapy, pp. 611-612) |
| GENITAL ORGANS | |||||
| Testicular cancer | Aching or dragging sensation in groin, usually painless | Gynecomastia; enlargement, swelling, lump, hardening of testes; young adult men; early diagnosis—monthly testicular self-exam (see Figure 7-18, p. 622) | Second most common malignancy among men age 25-40 yr; possibly exposure to chemical carcinogens; trauma, orchitis; gonadal dysgenesis; cryptorchidism (undescended testicles) | 7400 new cases; 300 estimated deaths; 95-100% 5 yr survival rate for early-detected nonmetasta- < sized lesions |
Surgery: orchiectomy (sec nursing
care plan/implcmcntation for the preop and postop patient, pp. 501,505,509,510) Radiation: see nursing care plan/implementation for patient having radiation therapy, pp. 612-614 Chemotherapy: cisplatin, Bleomycin, Etoposide, steroids (see nursing care plan/implcmcntation for patient having chemotherapy, pp. 611-612) |
| Cervical cancer | Vague pelvic or low back discomfort, pressure, or pain | Intermenstrual, postcoital, or postmenopausal bleeding; vaginal discharge—serosanguincous and malodorous hypermenorrhea; abdominal distention with urinary frequency; abnormal Pap test (see Table 7-42); recommended guidelines by American Cancer Society: Pap test annually; after three consecutive normal tests, MD may recommend less frequent testing; pelvic/uterine exam every 3 yr | Early age at first intercourse; multiple sex partners; low socioeconomic status; exposure to herpesvirus 2 | 14,500 new cases; 6400 estimated deaths |
Staging (see Table 7-44)
Stage 0 - carcinoma in situ; no
distinct tumor observable; stage may last for 8-10 yr; cure rate 100% following treatment of
wedge or cone resection of cervix during childbearing years, or simple hysterectomy Stage 1 - malignant cells infiltrate cervical mucosa; lesion bleeds easily; cure rate 80% with treatment of hysterectomy Stage II - neoplasm spreads through cervical muscular layers, involves upper third of vaginal mucosa; cure rate 50% with treatment of radical hysterectomy Stage III - neoplasm involves lower third of vagina; cure rate 25% with pelvic exenteration Stage IV - involves metastasis to bladder, rectum, and surrounding tissues; considered incurable Radiation: external or internal or both, in conjunction with surgery or alone, depending on stage of disease or condition of patient (sec nursing care plan/implcmcntation for patient having radiation therapy, pp. 612-614) Chemotherapy: progestin, antineoplastics, megcstrol (Megace), medroxyprogesterone (Curretab, Provera); alkylating agents - dacarbazine (DT1C) |