1. Blueprint
DeWitt Ch. 18 w/ excerpts from 53, 54,
& 65

2.  Most prevalent form of CA in women
 In early stages, survival rate is 90%
 80% of breast lumps are benign
 Types:
 Ductal carcinoma
 Lobular carcinoma
 Medullary carcinoma
 Mucinous carcinoma
 Tubular ductal carcinoma
 Inflammatory breast cancer
 Located – may be in any part of the breast, but
48% are located in the upper outer quadrant
and 17% are located in the nipple area

3. Monthly Breast Self Exams after each period. Postmenopause on the same
day each month.
Physical Exam every 3 years until 4, then base line mammogram @ 40
Black women are more likely to die from it
White women have highest incidence

4.  Feel like:
 Painless mass
 Firm
 Irregular shaped
 Fixed to underlying structure

5.  S/S
 Dimpling of the skin
 Nipple discharge
 Retraction of the nipple
 Edema
 Differences in nipple size
 Lymph nodes may be enlarged
 Treatment:
 Lumpectomy
 Simple Mastectomy
 Radical Mastectomy
 Removal of lymph nodes
 Radiation/chemo

6.  Radiographic technique
 “gold standard” for detecting cysts or tumors
 Used as a screening test for breast cancer
 National Cancer Institute rec. women begin receiving
annual mammograms at 40 years of age
 When mammogram is scheduled:
 Nurse explains radiographic procedure
 Instructs client to omit using a deoderant with aluminum
hydroxide or body talk on the day of the test to avoid artifacts
on the x-ray film
 Nurse provides a premoistened wipe to cleanse the axillae just
before the test
 Determine through H & P how often the client performs BSE’s
and has patient demonstrate technique
 Ensures privacy throughout examination
 Advises client to either have annual mammogram at same
facility or have records transferred

7.  Excision of the breast
 Discharge a few hours after recovery from anesthesia
 Types:
 Lumpectomy – only the tumor is removed; some axillary lymph nodes may
be excised at the same time for microscopic examination
 Partial or segmental – the tumor and some breast tissue and some lymph
nodes are removed
 Simple or total – all breast tissue is removed and no lymph node dissection
 Radical – breast, axillary lymph nodes, and pectoralis major and minor
muscles are removed

8.  Nurse should instruct patient about:
 Wound and drain care
 The availability of family assistance at home
 To look for and report signs of infection
 Arm exercises to perform & stress the importance
 Arrange for follow up with surgeon
 Self-administration of prescribed drug therapy
 Inform patient that some residual numbness or tingling on the chest wall & inner side
of the arm may occur and take as long as 1 year to go away
 Discuss the selection and use of prosthesis
 Advise against lifting/carrying more than 10 lbs.
 None of the following on the affected arm after surgery:
 Needle sticks
 Blood pressures
 Lifting more than 10 lbs

9.  The prostate gland contains more than the usual number of
normal cells
 Occurs as men age
 Outward expansion of the gland is of no clinical
importance/inward encroachment diminishes the diameter of the
prostatic section of the urethra & interferes with bladder emptying
 DRE reveals enlarges and elastic gland; cytoscopy exposes the
extent of the infringement; & PSA test demonstrate urine with
residual slightly elevated antigen levels
 Medically and surgically managed
 Teach patients about:
 Maintaining optimal bladder emptying
 Surgical clients require support and information to ally anxiety
 Teach deep breathing and explain that the client will have continuous
bladder irrigation for 24 hours after surgery
 Urethral catheterization before surgery is necessary for clients with sudden
or acute retention

10.  Infections with carcinogenic agents such as HPV and herpes
increase risk
 Atypical cells white or pigmented raised patches most
commonly involve the labia majora, but can occurs in the
labia minora, clitoris, and Bartholin glands
 Slow growing but can spread
 Pruritis and genital burning are the most frequent early
symptoms
 Vulvectomy (removal of the vulva) with or without removal
of the lymp nodes (radical vulvectomy) si the standard
 Laser photovaporization is being used as an alternative
 When cancer is inoperable…wet dressings and perineal
irrigations with a deodorizing solutin help control the odor
and the infection that usually occur in the ulcerating
neoplasm

11. GOAL – to destroy malignant cells without permanently damaging
healthy tissue
Cell death occurs immediately or after no more reproduction can
occur
High-energy ionizing radiation used to destroy cancer cells by
disrupting cell function and division and alteration of DNA molecules

12. Do not apply any lotions, etc. to the radiation area
Do not wash the markings
Will be marked with a marker or tattoo
Usually have daily treatments over several weeks
Damage to the cell’s DNA, impairing reproduction
Cell death
Malignant cells are more sensitive to radiation

13. Brachytherapy
Radioactive
source that is
implanted or
placed on the
tumor
implanted
inside the
patient’s body
Poses a threat
to others

14. Inserted in the body
in a sealed
container directly
into the tumor body
Can be held in place
with an applicator
Precautions:
•Private room preferably
lead lined
•Sign on door
•No children or pg
women
•Limit time in room
•Use lead aprons,
monitoring devices
•30 minutes total per shift
•Monitor for accidentally
dislodged sources

15. Precautions:
Wear gloves
Body fluids
require spec.
considerations
b/c radiation
is excreted in
urine, saliva,
sweat, and
feces
Use separate
eating utensils
Wash clothes
separately
Drink plenty
of fluids

16.  Bone marro suppression/myelosuppression
 Anemia
 Leukopenia (low WBC)
 Thrombocytopenia (low platelet count)
 Alopecia
 Anorexia…stomatitis
 Dry mouth
 Erythema to the area
 Harm to fetus, sterility, impotence

17. 1. Change in bowel/bladder function
2. Sores that don’t heal
3. Unusual bleeding/discharge
4. Thickening or lump in breast or other parts
5. Indigestion/difficulty swallowing
6. Recent change in wart/mole
7. Nagging cough/hoarseness

18. I. Stage I – malignant cells are confined to the
tissue of origin
II. Stage II – spread to local area usually the
lymph nodes
III. Stage III – larger tumor or spread to
surrounding tissues or both
IV. Stage IV – Metastasized to distant body parts

19. Benign
• Relatively harmless unless location impairs function
of vital organs
• Do not spread to other parts of the body
• May cause problems if they put pressure on or
obstruct organs
Benign Tumors
• Grow slowly, steadily
• Remain localized and encapsulated
• When palpated are smooth, easily defined and
moveable
• Have less profuse blood supply
• Cells resemble original tissue
• When removed recurrence is rare
• Rarely fatal

20. Malignant
• Invasive
• Capable of spreading
Malignant Tumors
•Grow rapidly and upredictably
•Invade surrounding tissue and spread to other tissues
(metastasize)
•Rarely encapsulated
•When palpated, have irregular borders and are immovable
•Cells are NOT similar to original tissue
•Have greater than normal blood supply
•Destroy surrounding tissue by depriving it of oxygen,
nutrients and space
•Recurrence is common when removed
•Fatal if not treated

21. Chemical
Agents
• Account for
75% of all
cancers
• Exposure to:
• tobacco
• asbestos
• coal dust,
etc.
Environmental
factors
• Sunlight
• Radiation
• pollution
Diet
• Diets high in:
• Fat
• Salt smoked
meats
• Alcohol
• Nitrates
Viruses
• Cell changes
due to
invasion of
virus DNA
• Kaposi’s
sarcoma
• Helicobacter
pylori
Medically
Prescribed
Interventions
• Immunosuppr
essive drugs
• Hormone
replacements

22. •Surgical excision
•Tissue samples of removed massNeedle
•Immediate examination of the cells once tumor is removed
•Specimen is frozen, sliced, & observedFrozen Section
•Flexible tubes with special fiber cameras to look at specific
body areas
Endoscopy
•stomach
Gastroscopy
•lungs
Bronchoscopy
•colon
Colonoscopy

23. •When entire tumor cannot be removed, as much as possible is
removedDebulking
•Tumor + small amt. of surrounding healthy tissue is removed
Local Excision
•Removes tumor, lymph nodes, any involved adjacent structures
and surrounding tissue that poses a risk for metastasisWide or Radical Excision
•Done with local recurrence of CA
•More extensive than previous surgerySalvage
•Client is at high risk for developing CA
•Usually done for breast/reproductive CAProphylactic
•Relieve uncomfortable symptoms for prolong life
•NOT a curePalliative

24. Can be used to:
• Cure cancer
• Prevent metastasis
• Slow tumor growth
• Destroy tumor cells
• Relieve symptoms
Agents can be:
• Cell-cycle specific
• Cell-cycle non specific
Can be given:
• Orally
• IV
• IM
• intraperitoneally
• Intraarterially
• intrapleurally
• topically
• Intracathecally
• Directly into a cavity

25.  Cytotoxic
 Alkylating drugs & mitotic inhibitors interfere
with the process of cell division
 Antineoplastic antibiotics and antimetabolites
interfere with DNA & RNA
 Hormones used in treating cancers that use
hormones as growth factors
 Drugs may be used alone or in combinations

26.  N/V
 Alopecia
 Dry skin
 Myelosupression (All BC is low)
 May have toxic effects on:
 Lungs
 Heart
 Nerve tissue
 Kidneys
 Bladder
 Tissue necrosis (extravasion)

27.  Collected by apheresis (process of separating
blood into components for later reinfusion)
 Peripheral blood stem cell transplant
 3 types:
 Autologous = self
 Allogeneic = compatible donor
 Syngeneic = identical twin

28.  #1 Cause of CA deaths
 Increased number of diagnoses R/T
 Aging population
 Cigarette smoke
 Increased air pollution
 Exposure to industrial pollution
 4 major cell types:
 Epidermold/squamous
 Large cell/undifferentiated
 Adenocarcinoma
 Small cell/oat cell

29.  Slow growing
 Arise from the bronchi and bronchioles leading
to obstruction
 Mets to the thorax and small bowel
 25-35% of all lung tumors

30.  Arise in the peripheral bronchi
 No well-defined growth patterns
 Usually DX as a bulky tumor
 Mets early to the CNS
 5 – 20% of all lung tumors

31.  Arise from the mucus glands
 Patchy growth throughout lung fields
 Lead to malignant pleural fusion
 25-35% of lung tumors

32.  MOST malignant form of lung cancer
 Arises from the bronchi
 Hypersecretes antidiuretic hormone
 Mets to the mediastinum, liver, bone, bone marrow,
CNS, adrenal glands, pancreas, and other endocrine
organs
 Prognosis – symptoms do not appear until disease is
well established
 Long term survival rate is low
 S/S:
 Nagging cough
 Bloody sputum
 Weight loss
 SOBOE

33. ALL
•Acute lympocytic
leukemia
•Onset is usually
younger than 5,
rarely over 15
•Increased
lymphocytes,
decrease RBCs &
platelets
CLL
•Chronic
lymphocyctic
•Onset = over 40
•Most common in
adults
•Increased
lymphocytes,
normal or low
RBCs and platelets
AML
•Acute
myelogenous
•Decrease in
myeloid formed
cells
•Occurs in all age
ranges
CML
•Chronic
myelogenous
•Same as AML but
greater number of
normal cells
•Onset = older than
20, increasing
incidence with age
•Genetic link

34.  Fatigue
 Infections
 Bruising
 Spleen/lymph enlargement
 Bleeding in the nose, mouth, & GI tract

35.  Malignancy involving the plasma cells or B-lymphocyte cells in
the bone marrow.
 Prognosis is poor with estimated survival rate of 1 to 5 years.
 PathophysiologyAbnormal plasma cells release osteoclast
activating factor
 Osteoclast breaks down bone cells
 Increases blood calcium
 Greatly increases risk of fractures
 Release proteins that damage kidneys and reduce production of
antibodies
 Treated:
 Steroids
 Chemotherapy
 Bone marrow transplants
 Stem cell transplants
 Treatment does not cure but prolongs life

36.  Hodgkins
 Age of onset is 15 – 40 and then older than 55.
 Has Reed-Sternberg cells
 Orderly growth
 More curable

37.  Account for 3% of cancer
 May reach considerable size before detection.
 S/S include:
 Anemia
 Weakness
 weight loss.
 Gross hematuria and flank pain are late signs.
 Treatment:
 Removal of the kidney (nephrectomy)
 Not responsive to chemotherapy or radiation. However,
radiation may be used as a palliative measure.

38.  Abnormal osteoblast or myeloblast (marrow cells)
that exhibit rapid and uncontrolled growth
 Usually located around the knee in the distal
femur or proximal fibula.
 S/S include:
 pathological break
 limp or abnormal gait
 Usually the tumor has already spread
 Treatment:
 Amputation
 ChemotherapyRadiation

39.  Endometrial cells that migrate out of the uterus
and attach to other organs in the pelvic cavity
 Builds and bleeds like the tissue within the uterus,
causing pain and local inflammation
 Considered benign uterine growth
 Complications:
 Obstruction of organs in pelvic area:
 Bladder
 bowels
 Urethra
 Treatment:
 Drugs that decrease endometrionic growth
 Laparoscopy
 ***Hysterectomy***

40.  Metastasizes widely to the abdomen through the
peritoneal fluid
 Incidence is low, mortality is high
 Vague or no symptoms until the cancer is well
advanced
 Most S/S are attributed to the GI tract
 Treatment:
 If confined to the ovaries:
 surgical removal
 chemotherapy and radiation
 Advanced cancer is treated palliatively with:
 hysterectomy
 chemo and radiation

41.  Cancer cell that forms in the fat tissue
 Usually benign

42.  Malignant Melanoma
 Arises from pre-existing moles anywhere on the body
 Raised brown or black lesions
 Poor prognosis because of distant metastases
 S/S:
 Appearance of a growth or change in color of the skin
 Diagnosed by visualization and biopsy
 Treated:
 Surgical excision,
 cryosurgery or
 radiation therapy for basal cell and squamous cell
 Radical excision of tumor and adjacent tissues and
chemotherapy for melanoma
 Skin grafting may be necessary

43.  Cancer of the Testes
 Rapidly metastasizing malignancy
 Occurs between 18 and 40
 Involve sperm forming germ cells
 S/S:
 Gradual or sudden swelling of the scrotum
 Hard, non-tender lump felt on palpation
 Aching in testes
 Abdominal pain (late sign)
 Treated:
 Orchiectomy and ligation of the affected testicle
 Chemotherapy
 Radiation

44.  Prostate Cancer
 Most common in men older than 50
 Third most common cause of cancer deaths in men
 Grows slowly
 High survival rate if detected
 Early cause unknown but R/T diets high in fat
 S/S:
 Decreased urinary flow
 difficulty starting stream
 Back pain
 Hematuria
 Hemospermia
 Erectile dysfunction
 Diagnosis:
 Rectal exam
 Elevated PSA
 Biopsy
 IVP to detect urinary tract dysfunction
 Treatment:
 Prostatectomy (TURP) – Transurethral resection of the prostate
 Bilateral orchiectomy
 Hormone therapy
 Radiation

47. Tumor of
brain/spine
Starts in glial cells
Types:
•Astrocytomas –
anywhere in
brain/spinal cord
•Brain stem gliomas –
lowest part of brain
•Epedymomas – inside
brain
•Oligodendrogliomas –
cerebrum
•Glioblastoma –
advanced astrocytoma
23% of all primary
brain tumors
S/S:
•N/V
•Seizures
•Weakness in arms/legs
•Speech difficulties or
changes
•Lack of coordination
while walking
•Vision
changes/abnormal eye
movements
•Drowsiness
•Memory/personality
changes
Treatment:
•Radiation
•Chemo
•Antiangiogenesis
•Immune system

48.  Lymphatic obstruction
 Condition of localized fluid retention and
tissue swelling caused by compromised
lymphatic system
 No cure for lymphedema, but it can be
controlled with diligent care of the affected
limb