Core Oncology Concepts (Cellular Aberration)

🧬 Core Oncology Concepts (Cellular Aberration)

🛡️ Safety Anchors

• Neutropenic fever: cultures ×2 (include central line) → broad IV anti-pseudomonal antibiotics within 60 min; no rectal temps/suppositories.

• Antiemetics: give 30 min before chemo/RT; schedule for delayed N/V; small frequent meals.

• Chemo handling: full PPE; confirm vesicant patency; prime with non-drug fluid; hazardous waste disposal.

• Extravasation: stop, aspirate, leave catheter, compress per agent (hot/cold), antidote, elevate, document, escalate.

• Radiation: time–distance–shielding; field skin/mucosa care; visitor limits for brachytherapy; no pregnant staff/visitors.

• ESAs: monitor BP; hold for sustained rise; target Hgb ~10–11 g/dL.

• Central lines: sterile changes; scrub the hub; daily necessity review; CLABSI bundle.

🧠 Cancer Biology & Cell Behavior

Definition/Patho	Key Risks	Hallmark/Clues	Diagnostics/Screening	First-Line Tx/Management	Nursing Responsibilities & Priorities
Benign vs Malignant — benign localized/encapsulated; malignant invasive & metastatic	Age, carcinogens, family history	Benign slow growth; malignant invasion/destruction	Biopsy ± IHC	Benign observe/excise; malignant stage-based multimodal	Teach differences; prep for staging; monitor compression symptoms; coordinate referrals.
Initiation → Promotion → Progression — DNA damage to invasion	Tobacco, UV, alcohol, chronic inflammation	Removing promoters can halt growth	Exposure history; molecular tests PRN	Risk removal; surveillance	Brief counseling (smoking, alcohol, UV); document risk changes & referrals.
Apoptosis vs Mitosis — loss of programmed death	TP53, oncogenes	Uncontrolled proliferation	Path reports	Targeted/IO may restore death signaling	Translate reports; monitor IO toxicities (bowel, lung, liver, thyroid).
Angiogenesis — tumor-driven neovessels	Tumor hypoxia	Fragile/leaky neovessels	Imaging patterns	Anti-angiogenic drugs	Check BP; assess bleeding; wound-healing precautions; time procedures.
Metastasis routes — lymph, blood, serosa	Tumor/site biology	Lung → brain/bone/liver/adrenals	Node maps, CT/PET/MRI	Systemic ± local control	Screen neuro/bone/RUQ symptoms; expedite imaging for red flags.
Paraneoplastic syndromes — ectopic hormones/cytokines	SCLC, RCC, SCC, myeloma	SIADH (low Na), hyperCa, ectopic ACTH, neuropathies	Electrolytes/endocrine panels	Treat tumor + correct labs	Seizure/fall precautions; strict I&O; telemetry with K/Ca derangements.
Tumor markers — trend over time	Tumor type	PSA, CEA, CA-125, HER2	Serial blood tests	Guide therapy/monitor	Schedule labs; teach “trend not diagnosis”; prepare Q&A for rising markers.

📏 TNM Staging & Grading

Definition/Patho	Key Risks	Hallmark/Clues	Diagnostics/Screening	First-Line Tx/Management	Nursing Responsibilities & Priorities
T (Tumor) — size/depth/adjacent invasion; Tis = in situ	Organ biology	Higher T = larger/deeper	Path + imaging	Surgery ± neoadjuvant/adjuvant	Clarify Tis N0 M0 = Stage 0; pre-op optimization; drain/JP teaching.
N (Nodes) — regional lymph spread	Nodal maps	N0 none; N1–N3 increasing	Sentinel node, dissection, imaging	Node-positive → systemic ± RT	Explain mapping; lymphedema prevention (no BP/venipuncture; elevation/ROM).
M (Metastasis) — distant spread	Hematogenous spread	M0 none; M1 distant	CT/MRI/PET; bone scan	Systemic; local palliation	Support goals-of-care; plan for pain/dyspnea/appetite.
Stage grouping — combine T/N/M → 0–IV	—	Stage guides prognosis/therapy	AJCC/site guides	Stage-tailored multimodal	Coordinate consults & imaging; reinforce plan comprehension.
Grade (G1–G4) — cell abnormality	Aggressive biology	G1 well-diff → G4 undiff	Path report	Influences systemic therapy	Teach stage ≠ grade; anticipate toxicity with higher-grade therapy; set monitoring plan.

🛡️ Prevention & Screening

Definition/Patho	Key Risks	Hallmark/Clues	Diagnostics/Screening	First-Line Tx/Management	Nursing Responsibilities & Priorities
Primary prevention — stop cancer before it starts	HPV/HBV, smoking, UV, alcohol, diet, obesity	Teachable moments	HPV/HBV vaccines	Behavior change plans	Verify vaccines; UV teaching; diet/activity resources; cessation referrals.
Breast screening	Age/family	Asymptomatic	Mammogram yearly ≥40; BSE monthly	Dx imaging/biopsy if positive	Teach BSE; ensure callbacks/biopsies; track results.
Colon screening	Age ≥45–50	Often silent	Colonoscopy q10y if average risk/normal	Polypectomy; interval by findings	Explain prep; transport/post-sedation safety; reminder systems.
Cervical screening	HPV exposure	Early silent	Pap/HPV per guideline	Colposcopy if abnormal	Verify history; vaccine vs screening education; STI counseling.
Testicular self-exam	Cryptorchidism	Painless mass	Monthly after warm shower	Scrotal US if mass	Demonstrate technique; emphasize prompt evaluation.

💊 Chemotherapy (Cytotoxic) — Classes & Care

Definition/Patho	Key Risks	Hallmark/Clues	Diagnostics/Screening	First-Line Tx/Management	Nursing Responsibilities & Priorities
General & nadir	High-intensity regimens	Nadir ~day 7–14 (nitrosoureas 4–6 wk)	Timed CBCs	Cycle planning	Schedule labs by cycle day; infection/bleeding teaching; activity adjust during nadir.
ANC & febrile neutropenia — ANC = WBC × (% neutrophils + % bands)	Chemo intensity	Fever may be only sign	CBC/diff; cultures	Broad IV anti-pseudomonal within 60 min	Protective isolation; no raw foods/standing water; mask for transport; oral care q4–6 h.
Alkylating agents (cyclophosphamide)	Dose, dehydration	Hemorrhagic cystitis	UA, creatinine	MESNA + hydration	I&O; frequent voiding; report hematuria.
Platinum (cisplatin)	Cumulative dose	Nephro/ototoxicity, ↓Mg, severe N/V	Cr, Mg, audiology	Saline hydration; strong antiemetics; Mg	Daily weights; tinnitus checks; Mg repletion; 3–4 d antiemetics.
Antimetabolites (MTX, 5-FU)	Renal/hepatic	Mucositis, myelosuppression	LFTs; oral checks	Leucovorin (MTX); oral cryotherapy (5-FU)	Salt + baking soda rinses; pre-meal analgesia; nutrition consult.
Anthracyclines (doxorubicin)	Lifetime dose	Cardiomyopathy, vesicant	Baseline/serial EF	Dexrazoxane select cases	IV patency; extravasation: stop/aspirate/cold/antidote; monitor HF signs.
Vinca alkaloids (vincristine)	Neuropathy	Peripheral neuropathy, ileus; never intrathecal	Neuro/bowel checks	Dose adjust; bowel regimen	Start laxatives day 1; gait/sensation checks; extravasation: warm + hyaluronidase.
Taxanes (paclitaxel)	Infusion reactions	Neuropathy, myelosuppression	CBC; observe infusion	Steroid + H1/H2 premeds	Rescue meds ready; stop for reaction; assess neuropathy each cycle.
Topo-I (irinotecan)	Enzyme variants	Early cholinergic diarrhea; late severe diarrhea	Electrolytes	Atropine (early); high-dose loperamide (late)	Strict I&O; dehydration prevention; written diarrhea plan.
Endocrine (tamoxifen/AIs)	VTE; bone loss	Tam: VTE/endometrial CA; AIs: osteoporosis	Gyn eval; DEXA	Ca/Vit D; bone agents PRN	DVT signs; report vaginal bleeding; fall/bone-health counseling.
Targeted/Immunotherapy	Autoimmunity	irAEs: colitis, hepatitis, pneumonitis, thyroiditis	TSH, LFTs; CXR/CT if SOB	Hold drug; steroids for ≥moderate	New SOB/diarrhea/jaundice → urgent review; steroid taper education.
Antiemetics	High emetogenic regimens	Prevent acute/delayed N/V	—	High: 5-HT3 + NK1 + dex 30 min pre	Send home scheduled antiemetics; adherence checks.

☢️ Radiation Therapy

Definition/Patho	Key Risks	Hallmark/Clues	Diagnostics/Screening	First-Line Tx/Management	Nursing Responsibilities & Priorities
External-beam RT (EBRT)	Large fields; head/neck	Fatigue; dermatitis (erythema → dry/moist desquamation)	Skin/oral checks	Fractionated daily doses	Don’t remove skin marks; team-approved emollients; loose cotton; avoid sun/heat/ice on field.
Brachytherapy (sealed source)	Internal source	Exposure risk to others	Dosimetry	Time–distance–shielding	Cluster care; visitor time limits; no pregnant staff/visitors; linens per policy.
Head/neck field effects	Dose/area	Mucositis, xerostomia, dysgeusia, caries	Oral checks	Saliva substitutes; fluoride trays; analgesia	Salt + baking soda rinses; avoid alcohol/lemon rinses; pre-RT dental eval; lifelong dental care.
Thoracic RT effects	Prior lung disease, CTRT	Radiation pneumonitis (dry cough, SOB, low-grade fever)	CXR/CT; O₂ sat	Steroids; bronchodilators; O₂ PRN	Educate delayed onset; prompt reporting; rule out infection; pulse-ox monitoring.
Pelvic RT effects	Pelvic fields	Radiation cystitis/proctitis, diarrhea, sexual dysfunction	UA; stool checks	Antispasmodics; hydration; antidiarrheals; skin care	Perineal skin care; barrier creams; hydration; bladder training; sexual health resources.
Radiation recall	Doxo, gemcitabine, taxanes	Rash/peel in old RT field after chemo	Clinical pattern	Hold trigger drug; topical steroids	Teach to report field-limited rash after new chemo; document drug–RT timing.

🩸 Myelosuppression, Tumor Lysis, HSCT

Definition/Patho	Key Risks	Hallmark/Clues	Diagnostics/Screening	First-Line Tx/Management	Nursing Responsibilities & Priorities
Neutropenia (low ANC)	Chemo, marrow disease	Fever may be only sign	CBC/ANC; cultures	Broad IV antibiotics within 60 min; G-CSF PRN	Protective isolation; daily bathing; avoid rectal meds/temps; meticulous line care; call for temp ≥38.0–38.3 °C.
Thrombocytopenia (Plt <100k)	Chemo, marrow	Nose/gum bleed, petechiae, heavy menses	Platelets, H/H	Transfuse if very low/bleeding	Soft toothbrush; electric razor; avoid IM/NSAIDs/aspirin; neuro checks when ~10k (ICH risk).
Anemia (low RBC/Hgb)	Chemo/chronic disease	Fatigue, pallor, dyspnea	CBC	PRBC transfusion per symptoms; ESA select	Energy conservation; orthostasis checks; fall prevention; iron/folate if ordered.
Tumor Lysis Syndrome	High burden; fast responders	↑K, ↑Phos, ↓Ca, ↑uric acid; AKI; arrhythmias	BMP, uric acid, telemetry, UOP	IV fluids; allopurinol/rasburicase; correct electrolytes	Telemetry; seizure precautions; UOP target; avoid K/Phos loads during risk window.
HSCT (stem-cell transplant)	Intensive conditioning	Profound immunosuppression; GVHD (rash, jaundice, diarrhea)	CBC, LFTs, skin/GI checks	Protective isolation; antimicrobial prophylaxis; GVHD prevention	No sick visitors; strict hand hygiene; safe-food handling; daily GVHD checks; re-vaccination education.

🛠️ Supportive Care & Symptom Management

Definition/Patho	Key Risks	Hallmark/Clues	Diagnostics/Screening	First-Line Tx/Management	Nursing Responsibilities & Priorities
Mucositis/Stomatitis	Antimetabolites; head/neck RT	Mouth pain/ulcers, thrush, ↓intake	Oral checks, weight	Salt + baking soda rinses; topical anesthetics; antifungals; oral ice with 5-FU	Pre-meal analgesia; soft/high-calorie diet; avoid alcohol/citrus rinses; dietician referral; weights twice weekly.
Alopecia	Taxanes, anthracyclines	1–3 weeks after start	—	Scalp cooling; wigs	Scalp sun protection; coping supports (wigs/scarves); manage dry/itchy scalp.
Cancer-related fatigue	Chemo/RT, anemia, sleep issues	Limits ADLs	Fatigue scales; Hgb/TSH	Energy conservation; light exercise; treat anemia/thyroid	Schedule ADLs in best-energy window; sleep hygiene; PT/OT referrals.
Dyspnea	Thoracic tumors/effusions	Rapid shallow breaths; anxiety	Pulse ox; imaging PRN	Pursed-lip & diaphragmatic breathing; upright; fan; low-dose opioids PRN	Teach early; cluster care; consider thoracentesis referral if effusion suspected.
Fertility	Alkylators, pelvic RT	Amenorrhea/low sperm	Fertility consult	Sperm/egg banking before therapy	Initiate conversation pre-treatment; provide resources; document decisions.

👥 Ethics, Genetics, Counseling

Definition/Patho	Key Risks	Hallmark/Clues	Diagnostics/Screening	First-Line Tx/Management	Nursing Responsibilities & Priorities
Genetic predisposition testing (BRCA, Lynch)	Early/multiple family cancers	Patient declines to inform relatives	Genetic counseling	Enhanced screening; prophylactic options	Respect confidentiality; offer scripts/resources for family talks; coordinate counseling; document preferences.
Informed consent & capacity	Cognitive impairment, stress	Poor recall, indecision	Capacity screen	Re-explain; teach-back	Provide plain-language materials; verify understanding; document teach-back.
Advance care planning & goals	Advanced disease	Unclear goals	Structured tools	Align treatment with values	Schedule goals-of-care talks; update code status; palliative referral PRN.
Communication & disclosure	Cultural/language barriers	Family “don’t tell patient”	—	Use interpreters; patient-centered disclosure	Advocate for patient preferences; manage family dynamics; document.
Financial toxicity & resources	Un/under-insured	Nonadherence, missed visits	SDOH screen	Navigation to assistance	Connect to social work, charity care, transport; help with prior-auths.

🧑‍⚕️ Post-Op & Technique Pearls

Definition/Patho	Key Risks	Hallmark/Clues	Diagnostics/Screening	First-Line Tx/Management	Nursing Responsibilities & Priorities
Mastectomy/axillary dissection	Node removal, high BMI	Arm swelling (lymphedema), numbness	Limb measurements	Elevate; gentle ROM; compression if ordered	No BP/venipuncture on side; skin protection; lifelong risk-reduction; early lymphedema referral.
Prostatectomy	Pelvic floor weakness	Stress incontinence; clots	Output trends	No heavy lifting ≥6 wks; pelvic floor exercises	Teach Kegels; fluids; report heavy hematuria/clots/retention; Foley care if applicable.
Gastrectomy	Major GI surgery	Early blood-tinged NG expected	NG output trends	Monitor; intervene if brisk/late bleeding	NG per order; dumping-syndrome diet (small, low-sugar meals; separate fluids).
Head/neck surgery or RT	Airway/nutrition	Airway compromise, dysphagia, voice change	Airway checks; swallow study	Humidification; stoma care; SLP; tube feeds PRN	Suction ready; aspiration precautions; mouth care q4–6 h; communication aids.
Lung resection	COPD, pain	Atelectasis, pneumonia risk	Pulse ox; imaging	IS, ambulation, pain control	Incentive spirometry hourly; splinting; early ambulation; monitor chest tube air leak/output.
Port/central line care	Long-term IV	Infection, occlusion	Line checks	Sterile access; heparin lock per policy	Scrub hub; change caps/dressings on schedule; stop if pain/swelling; confirm blood return before vesicants.

✅ Quick Checks

1. Stage vs Grade → Stage = spread; Grade = cell abnormality.

2. Tis N0 M0 → Stage 0 (in situ, localized).

3. Earliest reliable sign of infection in neutropenia → Fever.

4. Doxorubicin extravasation first step → Stop, aspirate, cold compress, antidote, escalate.

5. Cyclophosphamide key risk/prevention → Hemorrhagic cystitis → MESNA + hydration.

6. High-emetogenic chemo prophylaxis → 5-HT3 + NK1 + dexamethasone 30 min pre + delayed phase coverage.

📝 NGN Set 1 (6 Items)

1) Multiple Response — Infection Precautions

A client 9 days after combination chemotherapy reports chills. Temp 38.4 °C. Central venous port in place. Which actions are essential now? (Select all that apply.)

• ☐ Draw peripheral and port blood cultures before antibiotics

• ☐ Begin broad-spectrum IV anti-pseudomonal antibiotics promptly

• ☐ Insert a rectal thermometer to confirm core temperature

• ☐ Avoid fresh flowers and stagnant water in room

• ☐ Perform focused head-to-toe and start continuous vitals/telemetry

Answer: Draw cultures; Begin IV anti-pseudomonal; Avoid flowers/water; Focused assessment/continuous vitals.Why: Febrile neutropenia protocol; no rectal route.

2) Sequence — Vesicant Extravasation

Place first-line steps in order when a doxorubicin IV site becomes painful with swelling:

1. ___ Apply cold compress and give antidote per protocol

2. ___ Stop the infusion immediately

3. ___ Aspirate residual drug through the existing catheter

4. ___ Elevate limb; photograph/document; urgent notification

Answer: 2 → 3 → 1 → 4.Why: Stop → aspirate → local measures/antidote → support/escalate.

3) Single Best — ESA Safety

Client on high-dose chemo receives epoetin alfa. Today BP is 150/98 from 130/84 last visit; Hct 28%. What is the priority action?

• ☐ Administer the dose as scheduled

• ☐ Hold the dose and notify HCP due to hypertension

• ☐ Give extra fluids and proceed

• ☐ Add iron and continue

Answer: Hold and notify.Why: ESA can raise BP; hypertension warrants hold despite low Hct.

4) Calculation — ANC

WBC 2.4 × 10⁹/L; neutrophils 32%; bands 6%. ANC = ?

Answer: 2.4 × (0.32+0.06) = 0.912 ×10⁹/L (912/µL) → mild-moderate neutropenia.Why: ANC = WBC × (%neut + %bands).

5) Multiple Response — Head & Neck Radiation Care

Which instructions help limit mucositis/xerostomia? (Select all that apply.)

• ☐ Rinse every 4–6 h with salt–bicarbonate solution

• ☐ Avoid alcohol-containing or lemon mouthwashes

• ☐ Use topical anesthetic before meals

• ☐ Spicy chips stimulate saliva and are encouraged

• ☐ Schedule pre-treatment dental evaluation and long-term fluoride

Answer: Rinse; Avoid alcohol/lemon; Topical anesthetic pre-meals; Dental eval/fluoride.Why: Protect mucosa and teeth; avoid irritants.

6) Single Best — Staging Concept

A pathology report states Tis N0 M0 for a cervical lesion. This corresponds to:

• ☐ Stage I

• ☐ Stage 0 (in situ)

• ☐ Stage II

• ☐ Stage III

Answer: Stage 0.Why: “Tis” = carcinoma in situ.

📝 NGN Set 2 (6 Items)

1) Matrix — Match Class ↔ Signature Toxicity

Match each drug class to its hallmark issue.A. Cyclophosphamide → ___B. Cisplatin → ___C. Vincristine → ___D. Doxorubicin → ___

1. Cardiomyopathy; vesicant risk

2. Hemorrhagic cystitis

3. Nephro- & ototoxicity; ↓Mg; highly emetogenic

4. Peripheral neuropathy; paralytic ileus

Answer: A-2, B-3, C-4, D-1.

2) Single Best — SVC Syndrome Cue

Breast cancer with mediastinal nodes: suddenly has facial plethora, distended neck/chest veins, dyspnea when supine. First nursing action?

• ☐ Elevate HOB, provide O₂, urgent notification

• ☐ Trendelenburg for venous return

• ☐ Large-volume IV fluids

• ☐ Encourage coughing

Answer: Elevate HOB, O₂, urgent escalation.Why: SVC syndrome—protect airway/oxygenation.

3) Multiple Response — Primary Prevention vs Screening

Which are primary prevention interventions? (Select all that apply.)

• ☐ HPV vaccination

• ☐ Smoking cessation counseling

• ☐ Annual mammography

• ☐ Colonoscopy every 10 years

• ☐ Broad-spectrum sunscreen and shade behaviors

Answer: HPV vaccine; Smoking cessation; Sunscreen/shade.Why: Mammogram/colonoscopy are screening (secondary prevention).

4) Drag & Drop — Tumor Lysis Priorities

Order initial actions for high-grade lymphoma starting chemo with TLS risk:

1. ___ Start aggressive IV hydration per protocol

2. ___ Place on telemetry and obtain baseline electrolytes/uric acid

3. ___ Initiate uric acid–lowering therapy (allopurinol/rasburicase)

4. ___ Institute seizure precautions and strict I&O

Answer: 2 → 1 → 3 → 4.Why: Baseline/risk monitoring → fluids → uric acid control → safety measures.

5) Single Best — Breast Surgery Knowledge

Which statement about modified radical mastectomy is accurate?

• ☐ Removes entire breast, nipple–areola, and axillary nodes; pectoralis major preserved

• ☐ Removes quadrant only with margin

• ☐ Removes breast and pectoralis major & minor with nodes

• ☐ Removes breast only without nodes

Answer: First option.Why: Pectoralis major preserved; nodes removed. (Radical removes muscles.)

6) Multiple Response — Safe Food for Neutropenia

Which menu choices are appropriate for an ANC of 700/µL? (Select all that apply.)

• ☐ Pasteurized yogurt cup

• ☐ Fresh-squeezed, unpasteurized juice

• ☐ Medium-well cooked steak

• ☐ Store-bought sushi

• ☐ Oven-baked chicken with fully cooked vegetables

Answer: Pasteurized yogurt; Medium-well steak; Oven-baked chicken with cooked veg.Why: Avoid raw/undercooked animal products and unpasteurized items.