| Assessment | Risk Factors | Specific Treatment |
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| Subjective Data | Objective Data |
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| GASTROINTESTINAL TRACT |
| Oral cancer | Difficulty chewing, swallowing, moving tongue or jaws; history of heavy smoking, alcohol use, 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) | |
| 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 | |
| Stomach cancer | Vague feeling of fullness, pressure, or epigastric pain following ingestion of food; anorexia, nausea, meat intolerance; 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 | - Surgery: gastrectomy (see gastric surgery, Physiological Integrity, care)
- Radiation: not as useful because dosage needed would cause side effects unlikely to be tolerated by client
 Chemotherapy alone or in conjunction with surgery: antitumor antibiotics, antimetabolites, nitrosoureas, hematinics (see nursing care plan for client having chemotherapy, Physiological Integrity)
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| Pancreatic cancer | Anorexia, nausea; pain in upper abdomen, radiating to back; dyspnea | Jaundice, vomiting, weight loss; determination of solid mass in area of pancreas by computed tomography and ultrasound; tissue identification by thin-needle percutaneous biopsy | Excessive use of alcohol; exposure to dry-cleaning chemicals, gasoline; coffee and decaffeinated coffee; possibly diabetes and chronic pancreatitis | - Surgery: removal (must then have supplemental pancreatic enzymes; some clients become diabetic, type 1) or bypass to relieve obstruction (see nursing care plan/implementation for client with diabetes, Physiological Integrity)
- Chemotherapy: pain relief, antiemetics, insulin, pancrelipase, 5-fluorouracil cyclophosphamide (5-FU), Cytoxan, carmustine (BCNU), methotrexate, vincristine, mitomycin-C (see nursing care plan/implementation for client having chemotherapy, Physiological Integrity)
- Radiation: intraoperative high dose to pancreatic tumors with external high beam; palliative radiation therapy for pain (see nursing care plan/implementation for client having radiation therapy, Physiological Integrity; see nursing care plan/implementation for client with cancer, Physiological Integrity)
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| 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 | - Surgery: electrodesiccation (dehydration of tissue by use of needle electrode); cryosurgery (destruction of tissue by application of extreme cold; see care of cancer client, Physiological Integrity).
- Radiation therapy (see care of client having radiation therapy, Physiological Integrity)
- Prevention: avoid sun from 10 a.m. to 3 p.m.; use protective clothing, sunblock lotion
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| NERVOUS SYSTEM |
| Brain | Headache: steady, intermittent, severe (may be intensified by physical activity); nausea; lethargy, easy fatigability; forgetfulness, disorientation, impaired judgment; 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 | - Surgery: craniotomy with excision of lesion; ventricular shunt to allow for drainage of fluid (see nursing care plan/implementation for craniotomy, Physiological Integrity)
- Radiation: cobalt (local or entire CNS); total brain radiation causes alopecia, which may be permanent (see nursing care plan/implementation for client having radiation therapy, Physiological Integrity); 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; analgesics; sedatives (see nursing care plan/implementation for client having chemotherapy, Physiological Integrity)
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| ENDOCRINE |
| Thyroid cancer | Painless nodule; dysphagia; difficulty breathing | Enlarged thyroid, thyroid nodule; palpable thyroid, lymph nodes; hoarseness; hypofunctional nodule seen on isotopic imaging scanning; needle biopsy for cytology studies | Radiation exposure in childhood | - Surgery: total thyroidectomy, possible radical neck dissection (see IV. THYROIDECTOMY, Physiological Integrity)
- Radiation: external, or with radioactive iodine (131I) (see care of client having radiation therapy, Physiological Integrity)
- Chemotherapy: chlorambucil, doxorubicin, vincristine (Leukeran, Adriamycin, Oncovin, respectively) (see care of client having chemotherapy, Physiological Integrity)
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| BLOOD AND LYMPH TISSUES |
| Hodgkin’s disease | Fatigue; generalized pruritus; anorexia | Painless enlargement of lymph nodes, especially in cervical area; fever, night sweats; hepatosplenomegaly; anemia; peak age of incidence, 15–35;
- Diagnostic tests—biopsy shows presence of Reed-Sternberg cells; x-rays, scans, laparotomy
| For young adults from 15 to 35 yr old, not clearly defined, some relationship to socioeconomic status; men-women ratio is 1.5:1; increased frequency among White persons | Staging and treatment: - Stage I—involvement of a single node or a single node region; excision of lesion, and total nodal radiation (see care of client having radiation therapy, Physiological Integrity)
- Stage II—involvement of two or more lymph node regions on same side of diaphragm; excision of lesion and radiation (see care of client having radiation therapy, Physiological Integrity)
- Stage III—involvement of lymph node regions on both sides of the diaphragm, which may include the spleen; combination of radiation and chemotherapy
- Stage IV—involvement of one or more extralymphatic 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—Mustargen (mechlorethamine HCl, alkylating agent), Oncovin (vincristine, plant alkaloid), procarbazine (antineoplastic); prednisone (corticosteroid) (see care of client having chemotherapy, Physiological Integrity)
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| Non-Hodgkin’s lymphoma | Night sweats | Nontender lymphadenopathy, enlarged liver and spleen, weight loss, fever | Ages 50–60 yr | - 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
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| Multiple myeloma | Weakness; history of frequent infections, especially pneumonias; severe bone pain on motion; neurological symptoms, paralysis | - Fractures of long bones; deformity of: sternum, ribs, vertebrae, pelvis; hepatosplenomegaly; anemia and bleeding tendencies
Elevated uric acid | Exposure to ionizing radiation; middle-aged or older women | - Surgery: relieve spinal cord compression; orthopedic procedures to relieve or support bone problems (see nursing care plan/implementation for clients with internal fixation for fractures, Physiological Integrity; client with spinal cord injuries when paralysis occurs, Physiological Integrity)
- Radiation: for some lesions (see nursing care plan/implementation for clients having radiation therapy, Physiological Integrity)
- Chemotherapy: alkylating agents; antitumor antibiotics; plant alkaloids; hormones—melphalan and prednisone (see nursing care plan/implementation for clients having chemotherapy, Physiological Integrity)
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| URINARY ORGANS |
| Kidney cancer | Fatigue; abdominal or flank pain; night sweats | Painless, gross hematuria; firm, nontender, palpable kidney; weight loss; fever of unknown origin (FUO); testicular enlargement. Complications: hypertension; nephrotic syndrome; metastasis to lung, brain, liver, bones (e.g., scapula or pelvis); vena cava involvement
Laboratory and diagnostic tests: CT scans (chest, abdomen, pelvis) with contrast; MRI; bone scan; urinalysis—presence of red cells and albumin; CBC—decrease in red cells and leukocytes, reduction in serum albumin, elevation of alpha globulin and calcium | More common among men than women, Whites than Blacks; lymphoma; smoking; exposure to chemicals used in leather manufacturing; radiation exposure; possible familial influence; common site of metastasis from lung | - Surgery: stereotactic surgery; gamma knife (for brain metastasis); nephrectomy (see Nursing care plan/implementation for pre/postoperative care, The Perioperative Experience)
- Radiation: irradiation of metastatic sites when tumor is radiosensitive (see Nursing care plan/implementation for client having radiation therapy, Physiological Integrity)
- Chemotherapy: plant alkaloids—vincristine (Oncovin); antitumor antibiotics—dactinomycin (Actinomycin D), doxorubicin ( Adriamycin ), gemcitabine ( Gemzar ); alkylating agents—cyclophosphamide (Cytoxan); IL-2; interferon alpha (see Nursing care plan/implementation for client having chemotherapy, Physiological Integrity)
- Clinical trials: Avastin, bone marrow transplant, Bay 43
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| 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-examination (see Figure 6-17. Testicular Self-Examination) | Second most common malignancy among men ages 25–40 yr; possibly exposure to chemical carcinogens; trauma, orchitis; gonadal dysgenesis; cryptorchidism (undescended testicles) | Surgery: orchiectomy (see Nursing care plan/implementation for the pre-operative and postoperative client, The Perioperative Experience). Radiation: see nursing care plan/implementation for client having radiation therapy, Physiological Integrity)
Chemotherapy: cisplatin, bleomycin, etoposide, steroids (see nursing care plan/implementation for client having chemotherapy, Physiological Integrity) |
| Cervical cancer | Vague pelvic or low back discomfort, pressure, or pain | Intermenstrual, post-coital, or post-menopausal bleeding, vaginal discharge—serosanguineous and malodorous hypermenorrhea; abdominal distention with urinary frequency; abnormal Pap test (see Table 6-40. Papanicolaou (Pap) Smear Classes ); recommended guidelines by American Cancer Society: Pap test annually; after three consecutive normal tests, physician may recommend less frequent testing; pelvic/uterine examination every 3 yr | Early age at first intercourse; multiple sex partners; low socioeconomic status; exposure to herpes simplex virus type 2 | Staging (see Table 6-42. International System of Staging for Cervical Carcinoma )
- 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 I—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 client (see nursing care plan/implementation for client having radiation therapy, Physiological Integrity)
- Chemotherapy: progestin, antineoplastics, megestrol (Megace), medroxyprogesterone (Curretab, Provera); alkylating agents—dacarbazine (DTIC)
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