📘 Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
✅ I. Introduction / Definition
Cancer is a group of diseases characterized by the uncontrolled growth and spread of abnormal cells. If not detected and treated early, it can lead to invasion of surrounding tissues and distant metastasis, resulting in significant morbidity and mortality.
✅ “Cancer is defined as the abnormal and uncontrolled proliferation of cells, which can invade nearby tissues and spread to distant organs through the blood or lymphatic system.”
📖 II. Types of Cancer
Type
Description
Carcinoma
Cancer of epithelial cells (e.g., breast, lung, colon).
Sarcoma
Cancer of connective tissues (e.g., bone, muscle).
Leukemia
Cancer of blood-forming tissues (bone marrow).
Lymphoma
Cancer of lymphatic system (e.g., Hodgkin’s, Non-Hodgkin’s).
Melanoma
Cancer of melanocytes (skin cancer).
Myeloma
Cancer of plasma cells (bone marrow).
📖 III. Causes / Risk Factors
Genetic Factors: Family history of cancer, genetic mutations (BRCA1, BRCA2).
📖 V. Clinical Manifestations (General Signs & Symptoms)
Unexplained weight loss and loss of appetite.
Persistent fatigue and weakness.
Unusual bleeding or discharge.
Lump or mass in any part of the body.
Persistent cough, hoarseness, or difficulty swallowing.
Changes in bowel or bladder habits.
Non-healing sores or ulcers.
Skin changes: New moles or changes in existing moles.
⚠️ Mnemonic for Cancer Warning Signs: C A U T I O N C – Change in bowel or bladder habits. A – A sore that does not heal. U – Unusual bleeding or discharge. T – Thickening or lump in breast or elsewhere. I – Indigestion or difficulty swallowing. O – Obvious change in a wart or mole. N – Nagging cough or hoarseness.
📖 VI. Diagnostic Evaluation
Test
Purpose
Biopsy
Confirms cancer diagnosis by examining tissue.
Tumor Markers
CEA, CA-125, PSA (used for monitoring).
Imaging Studies
X-ray, CT Scan, MRI, PET Scan to identify tumor location and metastasis.
Blood Tests
Assess overall health and organ function.
Endoscopy/Colonoscopy
For GI tract cancers.
Mammography
Breast cancer screening.
📚🩺 Tumor Markers
📘 Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
✅ I. Introduction / Definition
Tumor Markers are biological substances produced by cancer cells or by normal cells in response to cancer. These markers are found in blood, urine, body fluids, or tissues and help in diagnosing, monitoring, and predicting prognosis of cancer.
✅ “Tumor markers are specific proteins, hormones, enzymes, or antigens associated with malignancies, used primarily for cancer detection and monitoring treatment response.”
📖 II. Types of Tumor Markers and Their Clinical Significance
Tumor Marker
Associated Cancers
Normal Range
AFP (Alpha-Fetoprotein)
Liver cancer (Hepatocellular carcinoma), Testicular cancer
Not always specific to cancer; may be elevated in benign conditions.
Not suitable as standalone diagnostic tools—must be combined with clinical evaluation and imaging.
False positives and false negatives can occur.
📖 V. Nurse’s Role in Tumor Marker Testing
Educate the patient about the purpose of the test.
Ensure correct specimen collection (blood/urine).
Monitor the patient for emotional distress related to cancer diagnosis.
Assist the patient with regular follow-ups and reporting results to physicians.
Provide psychological support, especially if results suggest malignancy.
📚 Golden One-Liners for Quick Revision:
CA-125 is primarily used for detecting ovarian cancer.
PSA is the most widely used tumor marker for prostate cancer screening.
AFP is associated with liver and testicular cancers.
Tumor markers cannot replace biopsy for definitive diagnosis.
Beta-hCG is elevated in choriocarcinoma and testicular cancers.
✅ Top 5 MCQs for Practice
Q1. Which tumor marker is primarily used for ovarian cancer detection? 🅰️ CA-19-9 ✅ 🅱️ CA-125 🅲️ AFP 🅳️ PSA
Q2. What is the normal reference value of PSA in a healthy adult male? 🅰️ <2 ng/mL 🅱️ <3 ng/mL ✅ 🅲️ <4 ng/mL 🅳️ <5 ng/mL
Q3. Beta-hCG is commonly elevated in which malignancy? 🅰️ Breast cancer 🅱️ Colorectal cancer ✅ 🅲️ Testicular cancer 🅳️ Lung cancer
Q4. Which tumor marker is associated with pancreatic cancer? 🅰️ CA-125 🅱️ CA-15-3 ✅ 🅲️ CA-19-9 🅳️ CEA
Q5. Which tumor marker is useful in monitoring medullary thyroid cancer? 🅰️ Thyroglobulin 🅱️ CEA 🅲️ CA-19-9 ✅ 🅳️ Calcitonin
📚🗂️ Classification of Cancer: Stage, Grade & TNM
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Medical-Surgical Nursing Exams
🔰 I. Definition:
Cancer classification includes evaluating the extent (stage) and appearance/aggressiveness (grade) of cancer. This helps determine treatment, prognosis, and survival outcomes. The TNM system is a universal method for describing tumor status in solid cancers.
“Cancer classification involves assigning a stage and grade to describe how far cancer has spread and how abnormal the cells appear microscopically.”
📖 II. Cancer Staging (Extent of Spread):
Stage
Description
Stage 0
Carcinoma in situ (confined to site of origin)
Stage I
Small, localized tumor without lymph node involvement
Stage II
Larger tumor, may involve nearby lymph nodes
Stage III
Locally advanced tumor with extensive lymph node involvement
Stage IV
Distant metastasis to other organs (e.g., liver, lungs, brain)
📖 III. Cancer Grading (Cell Appearance & Aggressiveness):
Grade
Description
Grade 1 (Low grade)
Well-differentiated; cells look like normal cells; slow-growing
Imaging: X-ray, CT, MRI, PET to determine stage and metastasis
Surgical staging: May involve lymph node sampling
Molecular testing: For precision staging in some cancers
Tumor markers: May support staging in some cancers (e.g., PSA, CA-125)
📖 VII. Management Based on Classification:
Stage/Grade
Typical Treatment
Early stage, low grade
Surgery or local radiation
Moderate stage/grade
Combined chemo, surgery, and/or radiation
Advanced stage or high grade
Aggressive chemo, targeted or palliative care
Metastatic (Stage IV)
Systemic therapy + supportive care
📖 VIII. Nursing Responsibilities:
Educate patients about meaning of stage/grade and treatment options
Support during diagnostic tests (biopsy, scans)
Provide psychological support post-diagnosis
Monitor for treatment response and side effects
Educate on prognosis and importance of regular follow-up
Reinforce screening and early detection for family members at risk
📚 Golden One-Liners for Quick Revision:
Staging = how far the cancer has spread
Grading = how abnormal the cancer cells look
Stage 0 = carcinoma in situ
Grade 4 = anaplastic cells, most aggressive
TNM is the global system for solid tumor staging
T4N3M1 = advanced cancer with large tumor, multiple nodes, and metastasis
✅ Top 5 MCQs for Practice:
Q1. What does Grade 1 cancer indicate? 🅰️ Poorly differentiated cells ✅ 🅱️ Well-differentiated cells 🅲️ Very aggressive tumor 🅳️ Anaplastic cells
Q2. In the TNM classification, ‘N1’ refers to: 🅰️ Large tumor ✅ 🅱️ Regional lymph node involvement 🅲️ Distant metastasis 🅳️ Normal cell appearance
Q3. Which cancer stage indicates metastasis to distant organs? 🅰️ Stage I 🅱️ Stage II 🅲️ Stage III ✅ 🅳️ Stage IV
Q4. Grading of cancer is based on: 🅰️ Tumor size 🅱️ Patient age ✅ 🅲️ Cellular differentiation 🅳️ Hormonal status
Q5. Which is the most widely accepted cancer staging system for solid tumors? 🅰️ WHO system 🅱️ Grading system ✅ 🅲️ TNM system 🅳️ ABC system
📚💉 Chemotherapy
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Medical-Surgical Nursing Exams
🔰 I. Definition:
Chemotherapy is the use of cytotoxic drugs to kill or stop the growth of cancer cells. It may be used alone or in combination with other therapies (surgery, radiotherapy, immunotherapy) depending on the type and stage of cancer.
“Chemotherapy refers to systemic treatment that targets rapidly dividing cells, aiming to cure, control, or palliate cancer.”
📖 II. Classification / Types:
Type of Chemotherapy
Purpose
Curative
To destroy all cancer cells and achieve cure (e.g., leukemia)
Adjuvant
Given after surgery to eliminate residual cancer cells
Neoadjuvant
Given before surgery to shrink tumors
Palliative
To relieve symptoms and improve quality of life in advanced cancer
Combination chemotherapy
Uses multiple drugs to enhance effectiveness and prevent resistance
As part of conditioning for bone marrow transplantation
Used to prevent recurrence in high-risk cases
📖 IV. Pathophysiology (In Brief):
Chemotherapy drugs target rapidly dividing cells.
Cancer cells are killed through interference in DNA synthesis or cell division.
Normal fast-growing cells (e.g., GI mucosa, hair, bone marrow) are also affected → leads to side effects.
📖 V. Clinical Manifestations (Side Effects):
Bone marrow suppression: Anemia, leukopenia, thrombocytopenia
GI symptoms: Nausea, vomiting, diarrhea, mucositis
Alopecia (hair loss)
Fatigue and weakness
Immunosuppression → infections
Neuropathy (tingling, numbness)
Skin changes, nail discoloration
Organ toxicity: Cardiac, renal, hepatic
📖 VI. Diagnostic Evaluation (Before and During Therapy):
CBC: WBC, Hb, Platelets
Renal function: Serum creatinine, BUN
Liver function tests (LFTs)
ECG/Echo: For cardiotoxic drugs (e.g., doxorubicin)
Tumor markers (as per cancer type)
Infection screening: Blood/urine cultures if febrile
📖 VII. Management:
🟢 1. Drug Administration:
Routes: IV (common), oral, IM, SC, intrathecal
Given in cycles (e.g., every 3 weeks)
Doses adjusted based on body surface area (BSA) and organ function
🟢 2. Supportive Measures:
Antiemetics: Ondansetron, dexamethasone
Growth factors: G-CSF for neutropenia
Hydration and diuretics for renal protection
Blood transfusions if needed
Protective isolation for neutropenic patients
📖 VIII. Nursing Responsibilities:
Verify drug orders, dosages, and route carefully
Maintain strict IV line care and monitor for extravasation
Assess for and manage side effects (N/V, mucositis, fatigue)
Monitor CBC, renal and liver function tests regularly
Implement neutropenic precautions
Educate patients on:
Hygiene and oral care
Avoiding crowds and infection sources
Reporting signs of infection or bleeding immediately
Coping with hair loss and body image changes
📚 Golden One-Liners for Quick Revision:
Chemotherapy targets rapidly dividing cancer cells
Side effects occur due to damage to normal dividing cells
Bone marrow suppression is the most critical side effect
Antiemetics and growth factors help manage toxicity
Strict aseptic precautions are essential during neutropenia
✅ Top 5 MCQs for Practice:
Q1. What is the most serious complication of chemotherapy? 🅰️ Alopecia 🅱️ Vomiting ✅ 🅲️ Bone marrow suppression 🅳️ Skin rash
Q2. Neutropenia from chemotherapy increases the risk of: 🅰️ Hypertension 🅱️ Hair loss ✅ 🅲️ Infection 🅳️ Constipation
Q3. Which route is most commonly used for chemotherapy? 🅰️ Oral 🅱️ Intramuscular ✅ 🅲️ Intravenous 🅳️ Subcutaneous
Q4. A commonly used antiemetic in chemotherapy is: 🅰️ Ibuprofen 🅱️ Omeprazole ✅ 🅲️ Ondansetron 🅳️ Paracetamol
Q5. Before administering chemotherapy, which test is essential? 🅰️ Lipid profile ✅ 🅱️ Complete blood count 🅲️ X-ray chest 🅳️ ECG only
📚🔆 Radiation Therapy (Radiotherapy)
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Medical-Surgical Nursing Exams
🔰 I. Definition:
Radiation Therapy is the use of high-energy radiation (such as X-rays, gamma rays, or electrons) to destroy or damage cancer cells by breaking their DNA and preventing their ability to divide and grow.
“Radiotherapy is a localized cancer treatment that targets tumors with ionizing radiation to kill or shrink malignant cells while preserving surrounding normal tissue.”
📖 II. Classification / Types:
Type
Description
External Beam Radiation Therapy (EBRT)
Most common; radiation delivered from outside the body
Internal Radiation (Brachytherapy)
Radioactive sources placed inside or near the tumor
Systemic Radiation Therapy
Radioactive substances (e.g., Iodine-131) taken orally or IV to target specific cancers
📖 III. Causes / Indications:
Head and neck cancers
Brain tumors
Breast and prostate cancer
Cervical and uterine cancers
Lung cancer
Palliative care: Relieve pain, bleeding, or compression
As adjuvant therapy: After surgery or chemotherapy
📖 IV. Pathophysiology (In Brief):
Ionizing radiation damages cellular DNA, especially in rapidly dividing cancer cells.
Leads to cell death or loss of reproductive ability.
Normal tissues can also be affected but have a better capacity for repair.
Fractionated doses allow maximum tumor destruction with minimal normal tissue damage.
📖 V. Clinical Manifestations (Side Effects):
Localized side effects depending on area treated:
Skin: Redness, dryness, peeling, radiation burns
Head & neck: Mucositis, dry mouth, taste change
Chest: Cough, difficulty swallowing, pneumonitis
Abdomen/pelvis: Diarrhea, nausea, cystitis
General: Fatigue, anorexia, immunosuppression
📖 VI. Diagnostic Evaluation:
CT/MRI/PET scans: To localize the tumor precisely
Simulation planning: 3D imaging to map treatment fields
Blood tests: CBC, renal, liver function (for baseline)
Consent and safety checks prior to therapy
📖 VII. Management:
🟢 1. Treatment Planning:
Simulation: Mapping of target site
Dose calculation: Total radiation dose and fractionation schedule
Shielding: To protect nearby organs (e.g., lead shields)
🟢 2. During Treatment:
Delivered daily (Mon–Fri) over several weeks
Patients must remain still during treatment
🟢 3. Supportive Therapy:
Skin care: Non-irritating moisturizers, no perfumed soaps
Oral care for mucositis
Anti-emetics, analgesics as needed
Nutritional support
📖 VIII. Nursing Responsibilities:
Provide pre-radiation education (expectations, precautions)
Q5. What should a nurse advise regarding skin care during radiation? 🅰️ Use alcohol-based lotions 🅱️ Apply talcum powder ✅ 🅲️ Use mild soap and avoid scrubbing 🅳️ Use ice packs daily
📚🧬 Immunotherapy (Biological Therapy)
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Medical-Surgical Nursing Exams
🔰 I. Definition:
Immunotherapy is a cancer treatment that uses the body’s immune system to fight cancer by enhancing or restoring the ability of immune cells to detect and destroy cancer cells.
“Immunotherapy is a biologic therapy that stimulates or manipulates the immune system to recognize and kill cancer cells more effectively.”
📖 II. Classification / Types:
Type
Description
Checkpoint Inhibitors
Block immune checkpoints (e.g., PD-1, CTLA-4) to enhance T-cell activity
Monoclonal Antibodies (mAbs)
Lab-made antibodies that bind specific cancer cell markers (e.g., Rituximab)
Cytokines
Immune system modulators like interleukins and interferons
Cancer Vaccines
Stimulate immune response against cancer (e.g., HPV vaccine)
CAR-T Cell Therapy
T-cells are genetically modified to target cancer cells
Oncolytic Virus Therapy
Uses genetically modified viruses to kill cancer cells and stimulate immunity
📖 III. Causes / Indications:
Melanoma
Non-small cell lung cancer (NSCLC)
Renal cell carcinoma
Hodgkin’s lymphoma
Bladder, head & neck cancers
Leukemias (CAR-T cell therapy)
Used in refractory or relapsed cancers
📖 IV. Pathophysiology (In Brief):
Cancer cells can evade immune detection by suppressing immune checkpoints.
Immunotherapy works by releasing these brakes or activating immune cells.
Immune cells (especially T-cells) recognize and destroy cancer cells.
This response can be tumor-specific, long-lasting, and self-sustaining in some patients.
📖 V. Clinical Manifestations (Side Effects):
Immune-Related Adverse Events (irAEs):
Skin: Rash, pruritus
GI: Colitis, diarrhea
Endocrine: Hypothyroidism, adrenal insufficiency
Lung: Pneumonitis (cough, dyspnea)
Liver: Hepatitis, elevated liver enzymes
Flu-like symptoms: Fever, chills, fatigue
📖 VI. Diagnostic Evaluation:
Baseline labs: CBC, LFT, RFT, TSH
Tumor markers and imaging to assess response
Autoimmune panels (if suspected irAEs)
ECG/ECHO for cardiac status (in some mAbs)
Pulmonary function tests if pneumonitis suspected
📖 VII. Management:
🟢 1. Immunotherapy Administration:
Given IV (most common) or subcutaneously
Administered in cycles over weeks/months
Requires monitoring for delayed side effects
🟢 2. Management of Side Effects:
Corticosteroids (e.g., prednisone) for severe irAEs
Thyroid hormone replacement for hypothyroidism
Antidiarrheals and hydration for colitis
Immunosuppressants if unresponsive to steroids
📖 VIII. Nursing Responsibilities:
Monitor for immune-related adverse effects (fever, diarrhea, rash, SOB)
Administer medications and hydration as prescribed
Provide emotional support and manage treatment anxiety
Educate on:
Delayed onset of symptoms (up to weeks after treatment)
Reporting any new symptoms promptly
Importance of treatment adherence and follow-up labs
Encourage nutritional support and rest
📚 Golden One-Liners for Quick Revision:
Immunotherapy enhances natural immune response against cancer
Checkpoint inhibitors block signals that prevent T-cell attack
CAR-T therapy is genetically engineered T-cell therapy
Main side effects are immune-related, not cytotoxic
Treated with steroids or immunosuppressants, not chemo drugs
✅ Top 5 MCQs for Practice:
Q1. The main mechanism of immunotherapy is to: 🅰️ Kill cancer cells directly 🅱️ Suppress all immune activity ✅ 🅲️ Stimulate the immune system to fight cancer 🅳️ Increase chemotherapy absorption
Q2. Which of the following is a type of checkpoint inhibitor? 🅰️ Interleukin-2 🅱️ Cisplatin ✅ 🅲️ Nivolumab 🅳️ Doxorubicin
Q3. Which cancer is commonly treated with CAR-T cell therapy? 🅰️ Breast cancer 🅱️ Colon cancer ✅ 🅲️ Acute lymphoblastic leukemia 🅳️ Basal cell carcinoma
Q4. A major nursing concern with immunotherapy is: 🅰️ Nausea and vomiting 🅱️ Anemia ✅ 🅲️ Autoimmune-type side effects (e.g., rash, colitis) 🅳️ Fluid retention
Q5. Which of the following is used to manage immune-related side effects? 🅰️ Antibiotics ✅ 🅱️ Corticosteroids 🅲️ Iron supplements 🅳️ Growth factors
📚🩺 Oral Cancer
📘 Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
✅ I. Introduction / Definition
Oral Cancer is a malignant growth occurring in any part of the oral cavity, including the lips, tongue, cheeks, floor of the mouth, hard and soft palate, sinuses, and pharynx. It is a common form of head and neck cancer and is often associated with lifestyle habits.
✅ “Oral cancer is a malignant neoplasm of the oral cavity characterized by uncontrolled growth of abnormal cells, which can invade surrounding tissues and metastasize.”
📖 II. Common Sites of Oral Cancer
Lips (Lower Lip Most Common).
Lateral Borders of the Tongue.
Floor of the Mouth.
Buccal Mucosa (Cheeks).
Hard and Soft Palate.
Oropharynx and Tonsillar Region.
📖 III. Causes / Risk Factors
Tobacco Use (Smoking and Chewing) – Main cause.
Alcohol Consumption – Synergistic effect with tobacco.
Nutritional Deficiencies (Iron, Vitamin A, and C).
Age Above 40 Years.
📖 IV. Pathophysiology
Exposure to carcinogens leads to genetic mutations in epithelial cells.
Uncontrolled proliferation of abnormal cells leads to tumor formation.
Tumor invades adjacent tissues and can spread to regional lymph nodes and distant organs (metastasis).
Common histological type: Squamous Cell Carcinoma (90-95%).
📖 V. Clinical Manifestations (Signs & Symptoms)
Non-healing ulcer or sore in the mouth (>2 weeks).
Painless lump or thickening in the oral cavity.
White patches (Leukoplakia) or Red patches (Erythroplakia).
Difficulty in chewing, swallowing (Dysphagia), and speaking.
Persistent sore throat or hoarseness.
Unexplained bleeding in the mouth.
Numbness of the tongue or other parts of the mouth.
Swelling of jaw or loosening of teeth.
Weight loss and fatigue in advanced stages.
📖 VI. Diagnostic Evaluation
Test
Purpose
Oral Examination
Inspection for visible lesions or ulcers.
Biopsy
Confirms diagnosis (Gold Standard).
CT Scan / MRI of Head and Neck
Assess local invasion and lymph node involvement.
PET Scan
Detect distant metastasis.
Fine Needle Aspiration Cytology (FNAC)
Lymph node involvement.
HPV DNA Testing
In cases of suspected HPV-related cancers.
📖 VII. Management
🟢 A. Preventive and Supportive Care:
Tobacco and Alcohol Cessation Programs.
Promote good oral hygiene and regular dental check-ups.
Public awareness about early signs of oral cancer.
HPV Vaccination to reduce virus-associated cancers.
🟡 B. Treatment Modalities:
Treatment
Purpose
Surgery
Wide excision of tumor, Mandibulectomy if required.
Radiotherapy
Alone or post-surgery to reduce recurrence.
Chemotherapy
Used in advanced cases or along with radiotherapy.
Targeted Therapy
Cetuximab for HPV-positive tumors.
Reconstructive Surgery
To restore appearance and function post-tumor removal.
📖 VIII. Nurse’s Role in Oral Cancer Management
Educate patients on early warning signs and prevention strategies.
Provide psychological support and counseling.
Assist in nutritional management (soft, high-protein diet post-surgery).
Care for surgical wounds and maintain oral hygiene.
Monitor for side effects of radiotherapy (mucositis, xerostomia) and chemotherapy.
Support patients with speech therapy and rehabilitation after surgery.
📚 Golden One-Liners for Quick Revision:
Leukoplakia and Erythroplakia are pre-cancerous lesions of oral cancer.
Squamous Cell Carcinoma is the most common type of oral cancer.
Smoking and chewing tobacco are the leading risk factors.
Biopsy is the gold standard for diagnosis.
HPV vaccination can help prevent HPV-related oropharyngeal cancers.
✅ Top 5 MCQs for Practice
Q1. What is the most common histological type of oral cancer? 🅰️ Adenocarcinoma ✅ 🅱️ Squamous Cell Carcinoma 🅲️ Basal Cell Carcinoma 🅳️ Sarcoma
Q2. Which of the following is considered a pre-cancerous lesion of the oral cavity? 🅰️ Oral thrush 🅱️ Canker sores ✅ 🅲️ Leukoplakia 🅳️ Dental caries
Q3. What is the gold standard test for diagnosing oral cancer? 🅰️ CT Scan 🅱️ MRI 🅲️ HPV Testing ✅ 🅳️ Biopsy
Q4. Which lifestyle factor has the strongest association with oral cancer? 🅰️ High sugar intake 🅱️ Coffee consumption ✅ 🅲️ Tobacco use 🅳️ Sedentary lifestyle
Q5. Which of the following vaccines helps prevent oropharyngeal cancer? 🅰️ Hepatitis B vaccine ✅ 🅱️ HPV vaccine 🅲️ Influenza vaccine 🅳️ Measles vaccine
📚🩺 Lung Cancer
📘 Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
✅ I. Introduction / Definition
Lung Cancer is a malignant tumor originating in the tissues of the lungs, primarily from the lining of the bronchi or alveoli. It is one of the most common and deadliest cancers worldwide, often associated with smoking and environmental exposures.
✅ “Lung cancer is an uncontrolled growth of abnormal cells in one or both lungs that can invade nearby tissues and spread to distant organs (metastasis).”
📖 II. Types of Lung Cancer
Type
Description
Common Sites
Non-Small Cell Lung Cancer (NSCLC)
85% of cases, slower growing.
Adenocarcinoma, Squamous Cell Carcinoma, Large Cell Carcinoma.
Small Cell Lung Cancer (SCLC)
15% of cases, aggressive and fast-growing.
Strongly linked to smoking.
Mesothelioma
Cancer of the pleura (often linked to asbestos exposure).
Checkpoint inhibitors like Nivolumab, Pembrolizumab.
Palliative Care
Pain management and symptom relief in advanced cases.
📖 VIII. Nurse’s Role in Lung Cancer Management
Encourage and support smoking cessation efforts.
Educate about early warning signs and importance of screening.
Provide care before and after thoracic surgeries.
Monitor for chemotherapy and radiotherapy side effects.
Provide psychological support and counseling to patients and families.
Assist in oxygen therapy and breathing exercises to improve lung function.
📚 Golden One-Liners for Quick Revision:
Smoking is the leading cause of lung cancer.
Non-Small Cell Lung Cancer (NSCLC) is the most common type of lung cancer.
Low-Dose CT Scan (LDCT) is recommended for screening in high-risk individuals.
Bronchoscopy with biopsy is the gold standard diagnostic test.
Small Cell Lung Cancer (SCLC) is highly aggressive and associated with early metastasis.
✅ Top 5 MCQs for Practice
Q1. What is the most common type of lung cancer? 🅰️ Small Cell Lung Cancer ✅ 🅱️ Non-Small Cell Lung Cancer 🅲️ Mesothelioma 🅳️ Sarcoma
Q2. Which test is considered the gold standard for diagnosing lung cancer? 🅰️ Sputum cytology 🅱️ Chest X-ray ✅ 🅲️ Bronchoscopy with biopsy 🅳️ Pulmonary function test
Q3. Which therapy targets EGFR mutations in lung cancer? 🅰️ Chemotherapy 🅱️ Immunotherapy ✅ 🅲️ Targeted therapy (Erlotinib) 🅳️ Radiotherapy
Q4. Which of the following is an early warning sign of lung cancer? 🅰️ Sudden weight gain 🅱️ Hemoptysis 🅲️ Skin rash 🅳️ Jaundice
Q5. What is the recommended screening test for high-risk individuals for lung cancer? 🅰️ Chest X-ray 🅱️ MRI ✅ 🅲️ Low-Dose CT Scan (LDCT) 🅳️ Ultrasound
📚🩺 Breast Cancer
📘 Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
✅ I. Introduction / Definition
Breast Cancer is a malignant tumor that originates from the cells of the breast, commonly from the lining of the milk ducts or lobules. It is the most common cancer among women worldwide and a leading cause of cancer-related deaths.
✅ “Breast cancer is characterized by the uncontrolled growth of abnormal breast cells that can invade nearby tissues and metastasize to distant organs.”
📖 II. Types of Breast Cancer
Type
Description
Ductal Carcinoma In Situ (DCIS)
Non-invasive, confined to milk ducts.
Invasive Ductal Carcinoma (IDC)
Most common type; invades breast tissues.
Invasive Lobular Carcinoma (ILC)
Starts in lobules, spreads to nearby tissues.
Triple-Negative Breast Cancer (TNBC)
Lacks estrogen, progesterone, and HER2 receptors; aggressive type.
Inflammatory Breast Cancer (IBC)
Rare and aggressive; involves skin changes.
Paget’s Disease of the Nipple
Affects nipple and areola region.
📖 III. Causes / Risk Factors
Gender (Female, though males can also be affected).
Age above 40 years.
Family history and genetic mutations (BRCA1, BRCA2 genes).
Early menarche and late menopause.
Nulliparity or first pregnancy after 30 years.
Prolonged use of Hormone Replacement Therapy (HRT).
Obesity and sedentary lifestyle.
Alcohol consumption and smoking.
Exposure to radiation.
📖 IV. Pathophysiology
Genetic mutations lead to abnormal growth of breast epithelial cells.
These abnormal cells proliferate uncontrollably, forming a mass or tumor.
Tumor invades nearby tissues and can metastasize through blood and lymph nodes.
Common metastatic sites include bones, lungs, liver, and brain.
📖 V. Clinical Manifestations (Signs & Symptoms)
Painless lump in the breast or underarm (most common early sign).
Change in breast size or shape.
Skin dimpling or puckering (Peau d’orange appearance).
Nipple discharge (especially bloody).
Inverted or retracted nipple.
Redness or scaling of the breast skin or nipple.
Swelling of the breast or arm (advanced stage).
📖 VI. Diagnostic Evaluation
Test
Purpose
Clinical Breast Examination (CBE)
Initial physical assessment.
Mammography
Screening and detection of small tumors.
Ultrasound Breast
Differentiates between cystic and solid masses.
Fine Needle Aspiration Cytology (FNAC)
Initial cytological diagnosis.
Core Needle Biopsy
Confirms histopathology (Gold Standard).
MRI of Breast
Detects extent of tumor and metastasis.
Hormone Receptor Tests
Estrogen, Progesterone, and HER2 receptor status for treatment planning.
📖 VII. Management
🟢 A. Preventive and Supportive Care:
Encourage regular Breast Self-Examination (BSE).
Promote annual mammography screening after 40 years of age.
Educate about the importance of early detection.
Genetic counseling for women with BRCA mutations.
🟡 B. Treatment Modalities:
Treatment
Purpose
Surgery
Lumpectomy or Mastectomy.
Radiotherapy
Post-surgical to reduce recurrence.
Chemotherapy
For advanced stages or aggressive cancers.
Hormonal Therapy
Tamoxifen, Letrozole (used if hormone receptor-positive).
Targeted Therapy
Trastuzumab (Herceptin) for HER2-positive cancers.
Immunotherapy
Pembrolizumab in specific cases.
📖 VIII. Nurse’s Role in Breast Cancer Management
Educate patients about Breast Self-Examination (BSE) techniques.
Provide psychological support and counseling to cope with body image changes.
Care for post-mastectomy wounds and monitor for complications like lymphedema.
Administer chemotherapy safely and manage side effects.
Encourage nutritional support and rehabilitation therapy.
Support patients participating in cancer survivor groups.
📚 Golden One-Liners for Quick Revision:
BRCA1 and BRCA2 gene mutations increase the risk of breast cancer.
Mammography is the gold standard for breast cancer screening.
HER2-positive cancers respond to Trastuzumab (Herceptin).
Monthly Breast Self-Examination should be done 5-7 days after menstruation.
✅ Top 5 MCQs for Practice
Q1. What is the most common early symptom of breast cancer? 🅰️ Pain in the breast ✅ 🅱️ Painless lump in the breast 🅲️ Nipple discharge only 🅳️ Skin ulcer
Q2. Which test is considered the gold standard for confirming breast cancer diagnosis? 🅰️ Mammography 🅱️ Ultrasound ✅ 🅲️ Core Needle Biopsy 🅳️ MRI
Q3. Which drug is used in hormone receptor-positive breast cancer? 🅰️ Trastuzumab ✅ 🅱️ Tamoxifen 🅲️ Cisplatin 🅳️ Methotrexate
Q4. Which age group is recommended to start annual mammography screening? 🅰️ 30 years 🅱️ 35 years ✅ 🅲️ 40 years 🅳️ 50 years
Q5. The “Peau d’orange” appearance in breast cancer indicates: 🅰️ Infection 🅱️ Benign tumor ✅ 🅲️ Lymphatic obstruction 🅳️ Normal skin changes
📚🩺 Laryngeal Cancer
📘 Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
✅ I. Introduction / Definition
Laryngeal Cancer is a malignancy that originates in the tissues of the larynx (voice box). It typically arises from the squamous cells lining the larynx and is strongly associated with lifestyle factors like smoking and alcohol consumption.
✅ “Laryngeal cancer is a malignant tumor of the larynx, often presenting with hoarseness, throat pain, and difficulty in speaking or swallowing.”
📖 II. Types of Laryngeal Cancer (Based on Site)
Site
Common Symptoms
Supraglottic (Above vocal cords)
Sore throat, difficulty swallowing.
Glottic (Vocal cords)
Hoarseness of voice (most common site).
Subglottic (Below vocal cords)
Breathing difficulty, advanced disease symptoms.
📖 III. Causes / Risk Factors
Tobacco Smoking (Major Risk Factor).
Excessive Alcohol Consumption.
HPV Infection (Human Papillomavirus).
Exposure to Industrial Chemicals and Wood Dust.
Chronic Laryngitis and Vocal Cord Strain.
Age above 55 years.
Male Gender (Higher Incidence).
📖 IV. Pathophysiology
Exposure to carcinogens leads to mutation in laryngeal epithelial cells.
Uncontrolled proliferation of abnormal cells results in tumor formation.
The tumor may invade the vocal cords, airway structures, and metastasize to cervical lymph nodes and distant organs.
📖 V. Clinical Manifestations (Signs & Symptoms)
Persistent hoarseness of voice (>2 weeks).
Sore throat and chronic cough.
Dysphagia (difficulty swallowing).
Lump or swelling in the neck (lymphadenopathy).
Stridor or breathing difficulty (advanced cases).
Ear pain (referred otalgia).
Unintentional weight loss and fatigue.
Hemoptysis (rare in advanced cases).
📖 VI. Diagnostic Evaluation
Test
Purpose
Laryngoscopy (Direct/Indirect)
Visual examination of larynx and tumor localization.
Biopsy
Confirms diagnosis (Gold Standard).
CT Scan / MRI of Neck
Assess tumor extent and lymph node involvement.
PET Scan
Detect distant metastasis.
Chest X-ray
Rule out lung metastasis.
📖 VII. Management
🟢 A. Preventive and Supportive Care:
Smoking and Alcohol Cessation Programs.
Early treatment of chronic laryngitis and throat infections.
Use of HPV Vaccination to reduce risk.
Educate high-risk individuals about early warning signs.
🟡 B. Treatment Modalities:
Treatment
Purpose
Radiotherapy
First-line treatment for early-stage tumors.
Surgery
Partial or Total Laryngectomy based on tumor extent.
Chemotherapy
For advanced disease or combined with radiation.
Targeted Therapy
Cetuximab for EGFR-positive tumors.
Voice Rehabilitation
Post-laryngectomy speech therapy.
📖 VIII. Nurse’s Role in Laryngeal Cancer Management
Assist in pre-operative counseling and preparation for laryngectomy.
Provide tracheostomy care if performed post-surgery.
Educate patients on alternative communication methods (electrolarynx, writing, esophageal speech).
Monitor for complications like aspiration, infection, and airway obstruction.
Provide emotional and psychological support to cope with body image and speech loss.
Support in nutritional therapy as swallowing difficulties are common.
📚 Golden One-Liners for Quick Revision:
Glottic cancer is the most common type of laryngeal cancer.
Persistent hoarseness of voice is the earliest symptom.
Direct laryngoscopy with biopsy is the gold standard for diagnosis.
Total laryngectomy leads to permanent loss of natural voice; requires speech rehabilitation.
HPV vaccination can reduce the risk of head and neck cancers.
✅ Top 5 MCQs for Practice
Q1. What is the most common early symptom of laryngeal cancer? 🅰️ Neck swelling ✅ 🅱️ Persistent hoarseness of voice 🅲️ Cough with hemoptysis 🅳️ Difficulty breathing
Q2. Which diagnostic test is considered the gold standard for diagnosing laryngeal cancer? 🅰️ Chest X-ray 🅱️ Ultrasound of Neck ✅ 🅲️ Direct Laryngoscopy with Biopsy 🅳️ PET Scan
Q3. What is the main risk factor associated with laryngeal cancer? 🅰️ Diabetes ✅ 🅱️ Tobacco smoking 🅲️ Hypertension 🅳️ Low fiber diet
Q4. Which type of surgery involves complete removal of the larynx? 🅰️ Partial Laryngectomy ✅ 🅱️ Total Laryngectomy 🅲️ Glossectomy 🅳️ Thyroidectomy
Q5. What is the primary nursing responsibility after laryngectomy? 🅰️ Encourage oral feeding immediately 🅱️ Avoid communication with the patient ✅ 🅲️ Provide tracheostomy care and facilitate alternative communication 🅳️ Keep the patient in a supine position
📚🩺 Stomach Cancer (Gastric Cancer)
📘 Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
✅ I. Introduction / Definition
Stomach Cancer, also known as Gastric Cancer, is a malignant tumor that arises from the lining of the stomach, most commonly from glandular epithelium. It is often diagnosed at an advanced stage due to vague early symptoms.
✅ “Gastric cancer is a malignant neoplasm of the stomach characterized by abnormal, uncontrolled cell growth, which can invade nearby tissues and metastasize to distant organs.”
📖 II. Types of Stomach Cancer
Type
Description
Adenocarcinoma
Most common (95%); originates from glandular cells of the stomach lining.
Lymphoma
Cancer of lymphatic tissue in the stomach (e.g., MALT lymphoma).
Gastrointestinal Stromal Tumor (GIST)
Arises from mesenchymal tissue.
Carcinoid Tumors
Originate from neuroendocrine cells.
📖 III. Causes / Risk Factors
Infection with Helicobacter pylori (H. pylori) – Major risk factor.
Diet high in smoked, salted, and pickled foods.
Smoking and alcohol consumption.
Chronic gastritis and gastric ulcers.
Pernicious anemia (Vitamin B12 deficiency).
Family history and genetic factors (CDH1 gene mutation).
Previous partial gastrectomy.
Obesity and sedentary lifestyle.
📖 IV. Pathophysiology
Chronic inflammation due to H. pylori or other irritants leads to gastric mucosal damage.
Tumor invades deeper layers of the stomach wall and may spread via the lymphatic system and bloodstream.
Common sites of metastasis: Liver, lungs, peritoneum, and bones.
📖 V. Clinical Manifestations (Signs & Symptoms)
Early Stage (Often Asymptomatic or Nonspecific):
Indigestion, bloating after meals.
Mild discomfort in the upper abdomen.
Loss of appetite.
Late Stage (Advanced Disease):
Unintentional weight loss and fatigue.
Persistent abdominal pain or discomfort.
Nausea and vomiting (sometimes with blood).
Melena (black, tarry stools).
Dysphagia (difficulty swallowing) if tumor near cardia.
Palpable abdominal mass in advanced cases.
📖 VI. Diagnostic Evaluation
Test
Purpose
Upper GI Endoscopy (EGD)
Visualizes tumor; biopsy for confirmation (Gold Standard).
Barium Swallow X-ray
Detects filling defects in the stomach.
CT Scan of Abdomen and Pelvis
Evaluates tumor spread and metastasis.
PET Scan
Detects distant metastases.
Tumor Markers
CEA, CA 19-9 (used for monitoring).
H. pylori Testing
Urea breath test, stool antigen test.
📖 VII. Management
🟢 A. Preventive and Supportive Care:
Eradication of H. pylori infection.
Dietary modifications to reduce intake of smoked and salted foods.
Encourage early screening in high-risk individuals.
Promote healthy lifestyle and avoid tobacco and alcohol.
🟡 B. Treatment Modalities:
Treatment
Purpose
Surgical Management
– Partial or Total Gastrectomy (main curative treatment).
Chemotherapy
– Neoadjuvant or adjuvant to shrink tumor and prevent recurrence.
Radiotherapy
– Often combined with chemotherapy.
Targeted Therapy
– Trastuzumab for HER2-positive tumors.
Palliative Care
– Symptom management in advanced stages.
📖 VIII. Nurse’s Role in Stomach Cancer Management
Assist in pre- and post-operative care for gastrectomy patients.
Provide nutritional counseling, including advice on small, frequent meals and high-protein diets.
Educate patients on the signs of dumping syndrome post-gastrectomy.
Monitor for complications such as anemia, vitamin B12 deficiency, and weight loss.
Provide psychological support and counseling.
Educate about H. pylori eradication therapy and its importance.
📚 Golden One-Liners for Quick Revision:
Adenocarcinoma is the most common type of gastric cancer.
H. pylori infection is the primary risk factor.
Endoscopy with biopsy is the gold standard for diagnosis.
Dumping syndrome is a common complication after gastrectomy.
Trastuzumab is used in HER2-positive gastric cancers.
✅ Top 5 MCQs for Practice
Q1. Which infection is most commonly associated with gastric cancer? 🅰️ E. coli ✅ 🅱️ H. pylori 🅲️ Streptococcus 🅳️ Salmonella
Q2. What is the gold standard diagnostic test for stomach cancer? 🅰️ Barium swallow X-ray ✅ 🅱️ Endoscopy with biopsy 🅲️ PET scan 🅳️ Abdominal ultrasound
Q3. Which type of gastric cancer is most common? 🅰️ Lymphoma ✅ 🅱️ Adenocarcinoma 🅲️ Carcinoid tumor 🅳️ Sarcoma
Q4. What is a common post-gastrectomy complication? 🅰️ Hypertension 🅱️ Constipation ✅ 🅲️ Dumping syndrome 🅳️ Hyperglycemia
Q5. Which tumor marker is associated with monitoring gastric cancer? 🅰️ PSA 🅱️ CA-125 ✅ 🅲️ CA 19-9 🅳️ AFP
📚🩺 Liver Cancer (Hepatic Cancer)
📘 Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
✅ I. Introduction / Definition
Liver Cancer is a malignant tumor that originates either in the liver cells (primary liver cancer) or spreads to the liver from other organs (secondary/metastatic cancer). The most common primary liver cancer is Hepatocellular Carcinoma (HCC).
✅ “Liver cancer is a malignancy of liver cells, primarily caused by chronic liver disease and viral hepatitis infections, leading to abnormal and uncontrolled cell proliferation.”
📖 II. Types of Liver Cancer
Type
Description
Hepatocellular Carcinoma (HCC)
Most common primary liver cancer, originates from hepatocytes.
Cholangiocarcinoma
Cancer of the bile ducts (also called bile duct cancer).
Hepatoblastoma
Rare, primarily seen in children.
Secondary (Metastatic) Liver Cancer
Cancer that spreads to the liver from other organs (e.g., colon, breast, lungs).
📖 III. Causes / Risk Factors
Chronic Hepatitis B and C Virus Infections (HBV, HCV).
Avoid excessive alcohol consumption and manage NAFLD.
Regular screening for high-risk patients (e.g., cirrhosis patients).
🟡 B. Treatment Modalities:
Treatment
Purpose
Surgical Resection
Curative in localized tumors without cirrhosis.
Liver Transplantation
Best option for eligible patients with end-stage liver disease and small tumors.
Radiofrequency Ablation (RFA)
Used for small tumors to destroy cancer cells.
Transarterial Chemoembolization (TACE)
Used to block tumor blood supply and deliver chemotherapy.
Targeted Therapy
Sorafenib, Lenvatinib for advanced HCC.
Immunotherapy
Nivolumab, Pembrolizumab in advanced cases.
Palliative Care
Symptom management in terminal stages.
📖 VIII. Nurse’s Role in Liver Cancer Management
Educate patients about HBV vaccination and prevention strategies.
Assist in managing symptoms like ascites, jaundice, and encephalopathy.
Monitor and support patients undergoing chemotherapy, TACE, and immunotherapy.
Provide nutritional support to prevent malnutrition.
Offer psychological support and counseling for patients and families.
Ensure proper care for patients on palliative and hospice care.
📚 Golden One-Liners for Quick Revision:
Hepatocellular carcinoma (HCC) is the most common type of liver cancer.
Chronic HBV and HCV infections are the leading causes of liver cancer.
Alpha-Fetoprotein (AFP) is a key tumor marker for HCC.
TACE and RFA are non-surgical interventions for liver cancer management.
Liver transplantation offers the best curative option for eligible patients.
✅ Top 5 MCQs for Practice
Q1. What is the most common primary liver cancer? 🅰️ Cholangiocarcinoma 🅱️ Hepatoblastoma ✅ 🅲️ Hepatocellular Carcinoma 🅳️ Adenocarcinoma
Q2. Which viral infection is a major risk factor for liver cancer? 🅰️ HIV 🅱️ HPV ✅ 🅲️ Hepatitis B Virus 🅳️ Epstein-Barr Virus
Q3. Which tumor marker is most commonly used for liver cancer detection? 🅰️ CEA ✅ 🅱️ AFP (Alpha-Fetoprotein) 🅲️ CA-125 🅳️ PSA
Q4. Which treatment modality is used to block blood supply to liver tumors? 🅰️ RFA 🅱️ Liver Transplant ✅ 🅲️ TACE (Transarterial Chemoembolization) 🅳️ Chemotherapy
Q5. What is a common complication of advanced liver cancer? 🅰️ Hypertension 🅱️ Diabetes ✅ 🅲️ Ascites 🅳️ Hypothyroidism
📚🩺 Colon Cancer (Colorectal Cancer)
📘 Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
✅ I. Introduction / Definition
Colon Cancer, also known as Colorectal Cancer when involving the rectum, is a malignancy that develops from the inner lining of the large intestine (colon) and/or rectum. It often begins as a benign polyp, which may become cancerous over time.
✅ “Colon cancer is a malignant tumor of the large intestine characterized by abnormal cell growth, which can invade surrounding tissues and metastasize.”
📖 II. Types of Colon Cancer
Type
Description
Adenocarcinoma
Most common (95%), arises from glandular epithelial cells.
Mutation in tumor suppressor genes (e.g., APC gene) leads to polyp formation.
Over time, benign polyps undergo dysplasia and malignant transformation.
Tumor invades the muscular layers of the colon and can metastasize through blood and lymphatic vessels.
Common sites of metastasis include liver, lungs, bones, and peritoneum.
📖 V. Clinical Manifestations (Signs & Symptoms)
Change in bowel habits (diarrhea or constipation).
Narrowing of stools (pencil-thin stools).
Rectal bleeding or blood in stools (hematochezia or melena).
Persistent abdominal pain, cramps, or bloating.
Unintentional weight loss and fatigue.
Iron deficiency anemia (due to chronic blood loss).
Sensation of incomplete evacuation after defecation.
📖 VI. Diagnostic Evaluation
Test
Purpose
Fecal Occult Blood Test (FOBT)
Detects hidden blood in stool (screening test).
Colonoscopy
Gold standard for visualization and biopsy of suspicious lesions.
Sigmoidoscopy
Examines lower part of the colon.
CT Colonography (Virtual Colonoscopy)
Non-invasive imaging technique.
CEA (Carcinoembryonic Antigen)
Tumor marker used for monitoring.
CT Scan of Abdomen and Pelvis
Detects metastasis and tumor staging.
Biopsy
Confirms histological diagnosis.
📖 VII. Management
🟢 A. Preventive and Supportive Care:
Encourage regular colorectal cancer screening starting at age 45-50 years.
Promote a high-fiber, low-fat diet rich in fruits and vegetables.
Encourage regular physical activity and maintain healthy body weight.
Educate about the risks of tobacco and alcohol consumption.
Genetic counseling for individuals with a family history of colorectal cancer.
🟡 B. Treatment Modalities:
Treatment
Purpose
Surgical Resection
Colectomy or Hemicolectomy to remove tumor.
Chemotherapy
Used in advanced stages or post-surgery (e.g., 5-FU, Capecitabine).
Radiotherapy
More common for rectal cancers.
Targeted Therapy
Cetuximab, Bevacizumab for metastatic disease.
Palliative Care
Symptom relief in advanced stages.
📖 VIII. Nurse’s Role in Colon Cancer Management
Educate patients about the importance of screening and early detection.
Provide pre- and post-operative care following bowel surgeries.
Monitor for signs of bowel obstruction or bleeding.
Manage chemotherapy side effects such as diarrhea, mucositis, and neutropenia.
Offer nutritional counseling and colostomy care if required.
Provide psychological support and counseling for patients and families.
📚 Golden One-Liners for Quick Revision:
Adenocarcinoma is the most common type of colon cancer.
Colonoscopy is the gold standard diagnostic and screening test.
CEA (Carcinoembryonic Antigen) is a tumor marker used for monitoring.
High fiber diet and regular screening reduce the risk of colon cancer.
Common metastasis site for colon cancer is the liver.
✅ Top 5 MCQs for Practice
Q1. What is the gold standard test for diagnosing colon cancer? 🅰️ Sigmoidoscopy 🅱️ FOBT ✅ 🅲️ Colonoscopy 🅳️ CT Scan
Q2. Which tumor marker is commonly used to monitor colon cancer? 🅰️ AFP 🅱️ CA-125 ✅ 🅲️ CEA 🅳️ CA 19-9
Q3. What is a typical early symptom of colon cancer? 🅰️ Vomiting 🅱️ Increased urination ✅ 🅲️ Change in bowel habits 🅳️ Severe back pain
Q4. Which of the following is a known genetic risk factor for colon cancer? 🅰️ Turner’s Syndrome ✅ 🅱️ Lynch Syndrome 🅲️ Down Syndrome 🅳️ Klinefelter Syndrome
Q5. Which dietary habit increases the risk of colon cancer? 🅰️ High fiber diet 🅱️ Low fat diet ✅ 🅲️ High intake of red and processed meat 🅳️ High intake of fruits and vegetables
📚🩺 Cervical Cancer
📘 Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
✅ I. Introduction / Definition
Cervical Cancer is a malignant tumor arising from the cervix uteri, which is the lower part of the uterus connecting to the vagina. It is the second most common cancer in women globally, highly preventable through early screening and vaccination.
✅ “Cervical cancer is characterized by the uncontrolled growth of abnormal cells in the cervix, commonly associated with persistent Human Papillomavirus (HPV) infection.”
📖 II. Types of Cervical Cancer
Type
Description
Squamous Cell Carcinoma
Most common (80-90%), arises from the squamous epithelial lining of the cervix.
Adenocarcinoma
Arises from the glandular epithelial cells of the endocervix.
Adenosquamous Carcinoma
Contains both squamous and glandular components.
📖 III. Causes / Risk Factors
Persistent HPV Infection (Types 16 & 18 most oncogenic).
Early onset of sexual activity and multiple sexual partners.
Smoking and tobacco use.
Long-term use of oral contraceptives.
Multiple pregnancies.
Poor genital hygiene.
HIV infection and other immunosuppressive conditions.
Low socioeconomic status and lack of regular screening.
📖 IV. Pathophysiology
HPV infection causes genetic mutations in cervical epithelial cells.
Leads to precancerous changes known as Cervical Intraepithelial Neoplasia (CIN):
CIN I: Mild dysplasia
CIN II: Moderate dysplasia
CIN III: Severe dysplasia (Carcinoma in situ)
If untreated, progresses to invasive cervical cancer, spreading to adjacent tissues (uterus, vagina, bladder) and distant metastasis via lymphatic and blood circulation.
📖 V. Clinical Manifestations (Signs & Symptoms)
Early Stage (Often Asymptomatic):
Post-coital bleeding (bleeding after sexual intercourse).
Intermenstrual bleeding.
Foul-smelling vaginal discharge.
Late Stage (Advanced Disease):
Persistent pelvic and lower back pain.
Heavy vaginal bleeding.
Dysuria and hematuria (bladder invasion).
Rectal bleeding or constipation (rectal invasion).
Leg swelling due to lymphatic obstruction.
Cachexia (severe weight loss and fatigue).
📖 VI. Diagnostic Evaluation
Test
Purpose
Pap Smear Test
Primary screening tool to detect precancerous changes.
HPV DNA Testing
Identifies high-risk HPV types.
Colposcopy
Detailed examination of cervix using magnification.
HPV Vaccination (Cervarix, Gardasil) recommended for girls and young women aged 9-26 years.
Promote regular Pap Smear Screening (every 3 years from age 21-65).
Practice safe sexual behaviors and maintain genital hygiene.
Educate about early recognition of warning signs.
🟡 B. Treatment Modalities:
Treatment
Purpose
Surgical Management
– Early-stage: Cone biopsy, Simple or Radical Hysterectomy.
Radiotherapy
– External beam radiation and brachytherapy.
Chemotherapy
– Cisplatin-based regimens often combined with radiation.
Targeted Therapy
– Bevacizumab (anti-angiogenic agent) for advanced cases.
Palliative Care
– Symptom management in terminal stages.
📖 VIII. Nurse’s Role in Cervical Cancer Management
Educate on the importance of HPV vaccination and regular screening.
Provide pre- and post-operative care for hysterectomy patients.
Support patients during radiotherapy and chemotherapy.
Offer guidance for managing side effects like vaginal dryness, fatigue, and diarrhea.
Provide psychological support and emotional counseling.
Assist patients in palliative care and end-of-life management.
📚 Golden One-Liners for Quick Revision:
HPV types 16 and 18 are responsible for nearly 70% of cervical cancer cases.
Pap smear is the most effective screening method for early detection.
Bevacizumab is a targeted therapy drug used in advanced cervical cancer.
Post-coital bleeding is a classic early warning sign of cervical cancer.
HPV vaccination is most effective before the onset of sexual activity.
✅ Top 5 MCQs for Practice
Q1. What is the most common causative agent of cervical cancer? 🅰️ Epstein-Barr Virus ✅ 🅱️ Human Papillomavirus (HPV) 🅲️ Herpes Simplex Virus 🅳️ Hepatitis B Virus
Q2. Which test is considered the gold standard for diagnosing cervical cancer? 🅰️ Pap Smear 🅱️ HPV DNA Test ✅ 🅲️ Cervical Biopsy 🅳️ Colposcopy
Q3. Which age group is most appropriate for HPV vaccination? 🅰️ 30-40 years ✅ 🅱️ 9-26 years 🅲️ 50-60 years 🅳️ 65-75 years
Q4. Which symptom is an early warning sign of cervical cancer? 🅰️ Severe abdominal pain 🅱️ Menstrual irregularities only ✅ 🅲️ Post-coital bleeding 🅳️ Headache
Q5. Which chemotherapy drug is commonly used in cervical cancer treatment? 🅰️ Methotrexate ✅ 🅱️ Cisplatin 🅲️ Doxorubicin 🅳️ Tamoxifen
📚🩺 Ovarian Cancer
📘 Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
✅ I. Introduction / Definition
Ovarian Cancer is a malignant tumor that originates in the tissues of one or both ovaries. It is often called the “silent killer” because it is usually detected at an advanced stage due to vague and non-specific early symptoms.
✅ “Ovarian cancer is characterized by the abnormal and uncontrolled proliferation of cells in the ovaries, with a high tendency for peritoneal spread and distant metastasis.”
📖 II. Types of Ovarian Cancer
Type
Description
Epithelial Tumors
Most common (85-90%); arise from the surface epithelium of the ovary.
Germ Cell Tumors
Common in younger women; arise from egg-producing cells.
Stromal Tumors
Arise from hormone-producing tissues.
Metastatic Ovarian Cancer
Secondary cancer from other primary sites like breast, colon, or stomach.
📖 III. Causes / Risk Factors
Family History (BRCA1 and BRCA2 Mutations).
Age above 50 years.
Nulliparity or infertility.
Early menarche and late menopause.
Hormone Replacement Therapy (HRT).
Obesity and high-fat diet.
Use of fertility drugs.
Endometriosis.
📖 IV. Pathophysiology
Genetic mutations and hormonal factors lead to uncontrolled cell proliferation in the ovarian tissue.
Tumor cells spread easily through the peritoneal cavity, causing ascites and implantation on peritoneal surfaces.
Common metastasis sites include the liver, lungs, peritoneum, and lymph nodes.
📖 V. Clinical Manifestations (Signs & Symptoms)
Early Stage (Often Asymptomatic):
Mild abdominal discomfort or bloating.
Early satiety (feeling full quickly).
Late Stage (Advanced Disease):
Persistent abdominal bloating and distention (ascites).
Pelvic or abdominal pain.
Changes in bowel habits (constipation).
Unexplained weight loss.
Urinary frequency and urgency.
Menstrual irregularities.
Palpable pelvic or abdominal mass.
📖 VI. Diagnostic Evaluation
Test
Purpose
Pelvic Examination
Initial assessment of pelvic masses.
Transvaginal Ultrasound (TVUS)
Visualizes ovarian tumors.
Serum CA-125 Level
Tumor marker elevated in epithelial ovarian cancer.
CT/MRI of Abdomen and Pelvis
Assess tumor spread and staging.
PET Scan
Detect distant metastases.
Laparoscopy / Exploratory Laparotomy
Direct visualization and biopsy (Gold Standard).
📖 VII. Management
🟢 A. Preventive and Supportive Care:
Prophylactic oophorectomy in high-risk women (BRCA mutations).
Encourage regular pelvic exams and ultrasound screening in high-risk individuals.
Educate about recognizing early warning signs.
Genetic counseling for families with a history of ovarian or breast cancer.
🟡 B. Treatment Modalities:
Treatment
Purpose
Surgical Management
Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy (TAH-BSO) and debulking surgery.
Chemotherapy
Platinum-based agents (Cisplatin, Carboplatin) with Paclitaxel.
Radiotherapy
Less commonly used but may be given for palliative care.
Targeted Therapy
Bevacizumab (anti-angiogenic), PARP inhibitors (Olaparib) for BRCA-positive cases.
Palliative Care
Symptom management in terminal stages.
📖 VIII. Nurse’s Role in Ovarian Cancer Management
Educate women about family history and genetic risks (BRCA testing).
Provide pre- and post-operative care, including abdominal wound care.
Manage chemotherapy side effects like nausea, vomiting, and myelosuppression.
Assist in the management of ascites and nutritional counseling.
Offer psychological support and counseling for body image changes and fertility concerns.
Provide care for patients in palliative and hospice care settings.
📚 Golden One-Liners for Quick Revision:
CA-125 is the most commonly used tumor marker for ovarian cancer.
BRCA1 and BRCA2 mutations significantly increase ovarian cancer risk.
Ovarian cancer is often called the “silent killer” due to late diagnosis.
TAH-BSO is the standard surgical procedure for advanced ovarian cancer.
Bevacizumab and PARP inhibitors are targeted therapies used in advanced cases.
✅ Top 5 MCQs for Practice
Q1. Which tumor marker is most commonly used for monitoring ovarian cancer? 🅰️ CEA 🅱️ AFP ✅ 🅲️ CA-125 🅳️ CA 19-9
Q2. What is the standard surgical treatment for advanced ovarian cancer? 🅰️ Myomectomy 🅱️ Simple Hysterectomy ✅ 🅲️ Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy (TAH-BSO) 🅳️ Ovarian cystectomy
Q3. Which genetic mutation increases the risk of ovarian cancer? 🅰️ BRCA1 and BRCA2 🅱️ APC Gene 🅲️ P53 Gene 🅳️ RET Gene
Q4. Which chemotherapy agents are commonly used in ovarian cancer treatment? 🅰️ Methotrexate and Doxorubicin ✅ 🅱️ Cisplatin and Paclitaxel 🅲️ Vincristine and Bleomycin 🅳️ Cyclophosphamide and Tamoxifen
Q5. Which of the following is a late symptom of ovarian cancer? 🅰️ Headache 🅱️ Chest pain ✅ 🅲️ Ascites and abdominal distension 🅳️ Skin rash
📚🩺 Uterine Cancer (Endometrial Cancer)
📘 Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
✅ I. Introduction / Definition
Uterine Cancer, commonly referred to as Endometrial Cancer, arises from the inner lining of the uterus (endometrium). It is the most common gynecological cancer and is often detected early due to abnormal uterine bleeding.
✅ “Uterine cancer is a malignant neoplasm of the endometrial lining characterized by abnormal cell proliferation, often presenting with postmenopausal bleeding.”
📖 II. Types of Uterine Cancer
Type
Description
Endometrial Carcinoma
Most common (80-90%), arises from the endometrial lining.
Uterine Sarcoma
Rare, arises from muscle or connective tissue of the uterus.
Carcinosarcoma
Mixed tumor containing both carcinoma and sarcoma components.
📖 III. Causes / Risk Factors
Unopposed Estrogen Exposure.
Obesity and Metabolic Syndrome.
Nulliparity or Infertility.
Early menarche and late menopause.
Prolonged use of Estrogen Replacement Therapy.
Polycystic Ovarian Syndrome (PCOS).
Tamoxifen Therapy for Breast Cancer.
Diabetes Mellitus and Hypertension.
Family history of endometrial or colon cancer (Lynch Syndrome).
📖 IV. Pathophysiology
Prolonged estrogen exposure without progesterone balance leads to endometrial hyperplasia.
Hyperplasia progresses to atypical hyperplasia and eventually to carcinoma.
Cancer invades the myometrium and may spread via lymphatic channels and bloodstream.
Common metastasis sites: Lungs, liver, bones, and lymph nodes.
📖 V. Clinical Manifestations (Signs & Symptoms)
Postmenopausal bleeding (classic early symptom).
Intermenstrual bleeding in premenopausal women.
Pelvic pain or cramping.
Abnormal watery or blood-tinged vaginal discharge.
Enlarged uterus or pelvic mass in advanced cases.
Weight loss and fatigue (in advanced stages).
📖 VI. Diagnostic Evaluation
Test
Purpose
Transvaginal Ultrasound (TVUS)
Measures endometrial thickness (>4 mm in postmenopausal women is suspicious).
Endometrial Biopsy
Gold standard for diagnosis.
Hysteroscopy with Biopsy
Direct visualization and sampling of endometrial tissue.
CT/MRI Pelvis
Staging and assessment of metastasis.
CA-125
Tumor marker used for monitoring advanced disease.
📖 VII. Management
🟢 A. Preventive and Supportive Care:
Encourage weight management and regular physical activity.
Manage underlying conditions like diabetes and hypertension.
Educate on the risks of unopposed estrogen therapy.
Genetic counseling for families with Lynch Syndrome.
🟡 B. Treatment Modalities:
Treatment
Purpose
Surgical Management
Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy (TAH-BSO) is the standard treatment.
Radiotherapy
Used in high-risk or advanced cases (external beam or brachytherapy).
Chemotherapy
Paclitaxel and Carboplatin are commonly used.
Hormonal Therapy
Progestins (e.g., Megestrol acetate) for hormone receptor-positive tumors or inoperable cases.
Palliative Care
For symptom relief in advanced stages.
📖 VIII. Nurse’s Role in Uterine Cancer Management
Educate women about early signs such as postmenopausal bleeding.
Provide pre- and post-operative care after hysterectomy.
Support patients during radiotherapy and chemotherapy sessions.
Monitor for complications like lymphedema, urinary incontinence, and infection.
Offer emotional support and counseling, especially regarding fertility loss.
Provide care for patients in palliative and hospice care.
📚 Golden One-Liners for Quick Revision:
Endometrial carcinoma is the most common type of uterine cancer.
Postmenopausal bleeding is the hallmark symptom.
Transvaginal ultrasound and endometrial biopsy are key diagnostic tools.
TAH-BSO is the gold standard surgical treatment.
Obesity and unopposed estrogen exposure are major risk factors.
✅ Top 5 MCQs for Practice
Q1. What is the most common early symptom of uterine (endometrial) cancer? 🅰️ Pelvic pain ✅ 🅱️ Postmenopausal bleeding 🅲️ Abdominal distension 🅳️ Painful intercourse
Q2. Which diagnostic test is the gold standard for confirming endometrial cancer? 🅰️ Pap Smear 🅱️ CA-125 Test ✅ 🅲️ Endometrial Biopsy 🅳️ CT Scan
Q3. Which of the following is the standard surgical treatment for uterine cancer? 🅰️ Myomectomy 🅱️ Ovarian cystectomy ✅ 🅲️ TAH-BSO (Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy) 🅳️ Cervical conization
Q4. Which risk factor is most associated with endometrial hyperplasia and cancer? 🅰️ Low estrogen levels ✅ 🅱️ Unopposed estrogen therapy 🅲️ High calcium intake 🅳️ Low body weight
Q5. Which hormone therapy is used in the management of inoperable or hormone-positive endometrial cancer? 🅰️ Tamoxifen 🅱️ Estrogen replacement therapy ✅ 🅲️ Progestins (Megestrol acetate) 🅳️ Androgens
📚🩺 Prostate Cancer
📘 Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
✅ I. Introduction / Definition
Prostate Cancer is a malignant tumor originating in the prostate gland, which is part of the male reproductive system. It typically develops slowly and is often asymptomatic in the early stages but can become aggressive and metastasize if untreated.
✅ “Prostate cancer is characterized by uncontrolled growth of abnormal cells in the prostate gland, commonly affecting elderly men and associated with elevated PSA levels.”
📖 II. Types of Prostate Cancer
Type
Description
Adenocarcinoma
Most common type (95%), arises from glandular tissue.
Small Cell Carcinoma
Rare, aggressive neuroendocrine tumor.
Squamous Cell Carcinoma
Very rare, poor prognosis.
📖 III. Causes / Risk Factors
Age above 50 years (risk increases with age).
Family history of prostate or breast cancer.
African American ethnicity (higher risk and aggressive tumors).
High-fat diet and obesity.
Elevated testosterone levels.
Smoking and sedentary lifestyle.
Exposure to toxic chemicals (e.g., cadmium).
📖 IV. Pathophysiology
Genetic mutations and hormonal factors lead to abnormal proliferation of prostate glandular cells.
Tumor invades surrounding tissues including the seminal vesicles, bladder, and rectum.
Metastasis occurs via lymphatics and blood vessels, commonly affecting bones (pelvis, spine), lungs, and liver.
📖 V. Clinical Manifestations (Signs & Symptoms)
Early Stage (Often Asymptomatic):
Increased frequency of urination, especially at night (nocturia).
Weak or interrupted urine flow.
Difficulty starting or stopping urination.
Late Stage (Advanced Disease):
Hematuria (blood in urine).
Painful ejaculation.
Bone pain (pelvis, spine) due to metastasis.
Urinary retention or incontinence.
Weight loss and fatigue.
📖 VI. Diagnostic Evaluation
Test
Purpose
Digital Rectal Examination (DRE)
Detects prostate enlargement or nodules.
Serum PSA (Prostate-Specific Antigen)
Elevated in prostate cancer; used for screening and monitoring.
Transrectal Ultrasound (TRUS)
Visualizes prostate abnormalities.
Prostate Biopsy (TRUS-guided)
Gold standard for confirming diagnosis.
Bone Scan / CT / MRI
Detect metastasis.
Gleason Score
Assesses tumor aggressiveness based on biopsy.
📖 VII. Management
🟢 A. Preventive and Supportive Care:
Encourage regular PSA screening and DRE after age 50 (earlier if high risk).
Promote a healthy, low-fat diet rich in fruits and vegetables.
Educate about the importance of physical activity and maintaining ideal body weight.
🟡 B. Treatment Modalities:
Treatment
Purpose
Active Surveillance
For low-risk, slow-growing cancers.
Surgical Management
Radical Prostatectomy (complete removal of the prostate).
Hormone therapy is the mainstay for advanced prostate cancer.
✅ Top 5 MCQs for Practice
Q1. What is the most common type of prostate cancer? 🅰️ Squamous Cell Carcinoma ✅ 🅱️ Adenocarcinoma 🅲️ Small Cell Carcinoma 🅳️ Transitional Cell Carcinoma
Q2. Which test is used to assess prostate-specific antigen levels? 🅰️ CEA Test ✅ 🅱️ PSA Test 🅲️ AFP Test 🅳️ CA-125 Test
Q3. Which hormone therapy is commonly used in advanced prostate cancer? 🅰️ Estrogen 🅱️ Testosterone ✅ 🅲️ Leuprolide 🅳️ Progesterone
Q4. Which bone is most commonly affected by metastatic prostate cancer? 🅰️ Skull 🅱️ Humerus ✅ 🅲️ Pelvic Bones and Spine 🅳️ Radius
Q5. What does a high Gleason score indicate? 🅰️ Low-grade tumor 🅱️ Non-cancerous tissue ✅ 🅲️ High-grade, aggressive tumor 🅳️ Benign prostatic hyperplasia
📚🩺 Bladder Cancer
📘 Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
✅ I. Introduction / Definition
Bladder Cancer is a malignant tumor arising from the tissues of the urinary bladder, primarily affecting the transitional epithelium (urothelium) lining the bladder. It is more common in men and typically presents with painless hematuria.
✅ “Bladder cancer is characterized by uncontrolled proliferation of abnormal urothelial cells, which may invade the bladder wall and metastasize if left untreated.”
Most common (90%); arises from the urothelial lining.
Squamous Cell Carcinoma
Associated with chronic bladder irritation and infections.
Adenocarcinoma
Rare; arises from glandular cells.
📖 III. Causes / Risk Factors
Cigarette Smoking (Major Risk Factor).
Occupational Exposure to Industrial Chemicals (Aromatic Amines, Benzidine).
Chronic Urinary Tract Infections and Cystitis.
Prolonged Indwelling Catheter Use.
Exposure to Arsenic in Drinking Water.
History of Pelvic Radiation Therapy.
Family History of Bladder Cancer.
📖 IV. Pathophysiology
Carcinogens (e.g., chemicals from smoking) accumulate in urine and cause genetic mutations in urothelial cells.
Leads to uncontrolled proliferation of abnormal cells, forming superficial or invasive tumors.
Cancer may invade deeper layers of the bladder wall and metastasize via lymphatic and blood vessels.
Common metastasis sites include pelvic lymph nodes, lungs, bones, and liver.
📖 V. Clinical Manifestations (Signs & Symptoms)
Painless Hematuria (Blood in urine)—Hallmark symptom.
Increased urinary frequency and urgency.
Burning sensation during urination (dysuria).
Pelvic or lower back pain in advanced cases.
Urinary retention or obstruction in severe cases.
Unintentional weight loss and fatigue (advanced stages).
📖 VI. Diagnostic Evaluation
Test
Purpose
Urine Cytology
Detects malignant cells in urine.
Cystoscopy
Direct visualization of bladder and biopsy (Gold Standard).
CT Urography / MRI
Assess tumor size, location, and spread.
Intravenous Urography (IVU)
Evaluates urinary tract abnormalities.
Urine Tumor Markers
NMP22, BTA tests for monitoring.
Bone Scan / PET Scan
Detect distant metastasis.
📖 VII. Management
🟢 A. Preventive and Supportive Care:
Educate about smoking cessation.
Avoid exposure to industrial chemicals and occupational carcinogens.
Encourage adequate hydration to flush out potential toxins.
Early treatment of chronic UTIs and bladder irritation.
🟡 B. Treatment Modalities:
Treatment
Purpose
Transurethral Resection of Bladder Tumor (TURBT)
For superficial tumors.
Intravesical Therapy
BCG vaccine or chemotherapy instilled into bladder for superficial cancer.
Radical Cystectomy
Complete removal of bladder in advanced cases.
Chemotherapy
Used before or after surgery; Cisplatin-based regimens.
Radiotherapy
Inoperable tumors or palliative care.
Immunotherapy
BCG instillation stimulates local immune response.
📖 VIII. Nurse’s Role in Bladder Cancer Management
Educate patients about early symptoms and importance of regular checkups.
Provide pre- and post-operative care for TURBT or cystectomy.
Assist in intravesical therapy procedures.
Monitor for complications like infection, bleeding, and urinary retention.
Provide care for patients with urinary diversions (ileal conduit or neobladder).
Offer psychological support for body image and sexual health concerns.
Educate about stoma care if applicable.
📚 Golden One-Liners for Quick Revision:
Painless hematuria is the most common early sign of bladder cancer.
Transitional cell carcinoma is the most prevalent type.
Cystoscopy with biopsy is the gold standard for diagnosis.
Smoking is the major preventable risk factor.
Intravesical BCG therapy is effective for superficial bladder cancer.
✅ Top 5 MCQs for Practice
Q1. What is the most common symptom of bladder cancer? 🅰️ Severe abdominal pain ✅ 🅱️ Painless hematuria 🅲️ Persistent headache 🅳️ Jaundice
Q2. Which test is the gold standard for diagnosing bladder cancer? 🅰️ CT Scan 🅱️ Urine Cytology ✅ 🅲️ Cystoscopy with Biopsy 🅳️ Ultrasound
Q3. Which of the following is a major risk factor for bladder cancer? 🅰️ High calcium intake ✅ 🅱️ Cigarette smoking 🅲️ Low salt diet 🅳️ Hypertension
Q4. Which therapy involves direct instillation of drugs into the bladder? 🅰️ Oral chemotherapy 🅱️ Intravenous chemotherapy ✅ 🅲️ Intravesical therapy 🅳️ Radiation therapy
Q5. Which medication is commonly used for intravesical immunotherapy in bladder cancer? 🅰️ Methotrexate 🅱️ Paclitaxel ✅ 🅲️ BCG Vaccine 🅳️ Doxorubicin
📚🩺 Gliomas (Brain Tumors)
📘 Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
✅ I. Introduction / Definition
Gliomas are a group of primary brain tumors originating from the glial cells that support and protect neurons in the central nervous system (CNS). They can occur in the brain or spinal cord and are classified based on the type of glial cell involved and the tumor’s aggressiveness.
✅ “Gliomas are tumors derived from glial cells of the brain or spinal cord, often classified by cell type (astrocytes, oligodendrocytes, ependymal cells) and graded according to their malignancy.”
📖 II. Types of Gliomas
Type
Origin Cell
Common Locations
Astrocytomas
Astrocytes
Cerebrum, Cerebellum.
Glioblastoma Multiforme (GBM)
High-grade astrocytoma (Grade IV)
Cerebral hemispheres.
Oligodendrogliomas
Oligodendrocytes
Frontal lobes.
Ependymomas
Ependymal cells
Ventricular system, spinal cord.
Mixed Gliomas
Multiple glial cell types
Various locations.
📖 III. Causes / Risk Factors
Genetic Mutations (IDH1, IDH2, TP53).
Exposure to Ionizing Radiation.
Family History of Brain Tumors.
Neurofibromatosis Type 1 and 2.
Li-Fraumeni Syndrome.
Male Gender (higher incidence).
Age (High-grade gliomas more common after age 45).
📖 IV. Pathophysiology
Genetic alterations in glial cells lead to uncontrolled proliferation.
Low-grade gliomas grow slowly, but high-grade tumors like Glioblastoma Multiforme (GBM) are highly invasive and rapidly growing.
Tumor expansion increases intracranial pressure (ICP), compresses brain structures, and may disrupt cerebrospinal fluid (CSF) flow.
Metastasis is rare outside the CNS but local invasion is aggressive.
📖 V. Clinical Manifestations (Signs & Symptoms)
General Symptoms of Increased ICP:
Persistent headache (worse in the morning).
Nausea and vomiting.
Papilledema (optic disc swelling).
Neurological Deficits (Depending on Tumor Location):
Seizures.
Cognitive and personality changes.
Motor weakness or paralysis.
Visual disturbances (blurring, field defects).
Speech difficulties (aphasia).
Balance and coordination issues (cerebellar tumors).
📖 VI. Diagnostic Evaluation
Test
Purpose
MRI with Contrast
Gold standard for tumor visualization.
CT Scan
Initial imaging in emergencies.
MR Spectroscopy
Differentiates tumor from other lesions.
Biopsy (Stereotactic or Open)
Confirms histological type and grade.
Genetic Testing
IDH mutation status for prognosis.
Lumbar Puncture
Rarely used; CSF analysis in some cases.
📖 VII. Management
🟢 A. Supportive Care:
Control intracranial pressure with medications (e.g., Mannitol, Dexamethasone).
Manage seizures with antiepileptics.
Provide psychological support for cognitive changes.
🟡 B. Treatment Modalities:
Treatment
Purpose
Surgical Resection
Craniotomy to remove as much tumor as possible.
Radiotherapy
External beam radiation or stereotactic radiosurgery (Gamma Knife).
Chemotherapy
Temozolomide is the first-line drug for high-grade gliomas.
Targeted Therapy
Bevacizumab (anti-angiogenic therapy).
Palliative Care
Symptom control in advanced, inoperable cases.
📖 VIII. Nurse’s Role in Glioma Management
Monitor for neurological status changes (GCS, pupil response).
Administer and monitor effectiveness of anticonvulsants and corticosteroids.
Educate patient and family about treatment side effects.
Assist in post-craniotomy care (monitor for CSF leaks, infection).
Provide emotional support and rehabilitation guidance.
Assist with palliative and end-of-life care when necessary.
📚 Golden One-Liners for Quick Revision:
Glioblastoma Multiforme (GBM) is the most aggressive form of glioma.
MRI with contrast is the gold standard diagnostic tool.
Temozolomide is the preferred chemotherapeutic agent for gliomas.
Bevacizumab helps reduce tumor blood supply in GBM.
Seizures and increased intracranial pressure are common complications.
✅ Top 5 MCQs for Practice
Q1. What is the most aggressive type of glioma? 🅰️ Astrocytoma ✅ 🅱️ Glioblastoma Multiforme (GBM) 🅲️ Oligodendroglioma 🅳️ Ependymoma
Q2. Which imaging modality is the gold standard for diagnosing gliomas? 🅰️ CT Scan 🅱️ X-ray ✅ 🅲️ MRI with Contrast 🅳️ Ultrasound
Q3. Which chemotherapeutic agent is commonly used for high-grade gliomas? 🅰️ Cisplatin 🅱️ Methotrexate ✅ 🅲️ Temozolomide 🅳️ Vincristine
Q4. Which medication is used as a targeted therapy for glioblastoma? 🅰️ Tamoxifen 🅱️ Methotrexate ✅ 🅲️ Bevacizumab 🅳️ Leuprolide
Q5. What is a common neurological symptom associated with gliomas? 🅰️ Hypertension ✅ 🅱️ Seizures 🅲️ Diarrhea 🅳️ Jaundice
📚🦴 Osteosarcoma
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
✅ I. Introduction / Definition
Osteosarcoma is the most common primary malignant bone tumor, arising from primitive bone-forming mesenchymal cells.
It typically affects children, adolescents, and young adults, commonly during growth spurts.
✅ “Osteosarcoma is a high-grade malignant tumor of bone that originates from osteoblasts and produces immature bone (osteoid).”
📖 II. Classification / Types
Type
Description
Conventional Osteosarcoma
Most common, aggressive; occurs in long bones.
Telangiectatic Osteosarcoma
Rare, resembles aneurysmal bone cyst.
Surface Osteosarcoma
Parosteal and periosteal types, less aggressive.
Secondary Osteosarcoma
Occurs due to radiation or Paget’s disease.
📖 III. Common Sites of Osteosarcoma
Metaphysis of long bones:
Distal femur
Proximal tibia
Proximal humerus
📖 IV. Causes / Risk Factors
Rapid bone growth during adolescence
Previous exposure to radiation therapy
Genetic conditions:
Retinoblastoma (RB1 gene mutation)
Li-Fraumeni syndrome (TP53 mutation)
Paget’s disease of bone
Chronic osteomyelitis (rare)
📖 V. Pathophysiology (In Brief)
Malignant osteoblasts form osteoid tissue abnormally.
Rapid proliferation invades surrounding bone and soft tissue.
Metastasis occurs early, especially to the lungs and other bones.
Tumor disrupts normal bone architecture and leads to pain, swelling, and functional loss.
📖 VI. Clinical Manifestations
Localized bone pain, often worse at night or during activity
MRI / CT Scan: Local tumor extension, soft tissue involvement
Bone Scan: To detect metastasis
Chest CT: For pulmonary metastasis
Biopsy: Confirm histopathological diagnosis
Blood Tests:
Elevated alkaline phosphatase
Elevated LDH (lactate dehydrogenase)
📖 VIII. Management of Osteosarcoma
🟢 1. Medical Management
Neoadjuvant Chemotherapy (before surgery):
Drugs: Methotrexate, Doxorubicin, Cisplatin
Adjuvant Chemotherapy (after surgery):
To kill residual cancer cells and reduce recurrence
🟢 2. Surgical Management
Limb-Salvage Surgery: Preferred when feasible
Amputation: If tumor extensively invades soft tissues or neurovascular bundles
Rotationplasty: Functional alternative to amputation in children
Pulmonary Metastasectomy: For resectable lung metastasis
📖 IX. Nursing Responsibilities
Provide preoperative and postoperative care
Educate patient and family about chemotherapy and its side effects
Monitor for signs of infection, bleeding, or wound complications
Support in prosthesis use and rehabilitation
Provide psychological support and promote body image adaptation
Encourage nutritional support and pain management
Coordinate multidisciplinary care (physiotherapist, oncologist, counselor)
📚 Golden One-Liners for Quick Revision:
Osteosarcoma commonly affects distal femur and proximal tibia.
Sunburst appearance on X-ray is characteristic.
Lung metastasis is most common and life-threatening.
Neoadjuvant chemotherapy + surgery + adjuvant chemotherapy is the standard treatment.
Limb-sparing surgery is preferred over amputation when feasible.
✅ Top 5 MCQs for Practice
What is the most common site for osteosarcoma? 🅰️ Vertebrae 🅱️ Skull ✅ 🅲️ Distal femur 🅳️ Pelvis
Which radiographic sign is typical in osteosarcoma? 🅰️ Onion peel appearance 🅱️ Ground glass opacity ✅ 🅲️ Sunburst appearance 🅳️ Soap bubble lesion
Which organ is the most frequent site of metastasis in osteosarcoma? 🅰️ Liver 🅱️ Brain ✅ 🅲️ Lungs 🅳️ Intestines
Which chemotherapy drug is commonly used in osteosarcoma? 🅰️ Vincristine 🅱️ Cyclophosphamide ✅ 🅲️ Doxorubicin 🅳️ Etoposide
Which test is definitive for diagnosing osteosarcoma? 🅰️ X-ray 🅱️ CT scan 🅲️ Blood test ✅ 🅳️ Biopsy
📚🩺 Leukemia
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Community Health Nursing Exams
✅ I. Introduction / Definition
Leukemia is a malignant disorder of the blood-forming tissues, especially the bone marrow and lymphatic system, characterized by uncontrolled proliferation of abnormal white blood cells.
It can be acute or chronic, and lymphocytic or myeloid in origin.
✅ “Leukemia is a cancer of white blood cells characterized by excessive, abnormal proliferation of immature leukocytes in the bone marrow and blood.”
📖 II. Classification / Types
Type
Description
Acute Lymphocytic Leukemia (ALL)
Rapid progression; common in children.
Acute Myeloid Leukemia (AML)
Affects myeloid line; more common in adults.
Chronic Lymphocytic Leukemia (CLL)
Slow progression; affects older adults.
Chronic Myeloid Leukemia (CML)
Involves Philadelphia chromosome; slow progression.
📖 III. Causes / Risk Factors
Exposure to ionizing radiation
Genetic predisposition (e.g., Down syndrome)
Certain chemotherapy drugs (alkylating agents)
Smoking
Exposure to benzene and other industrial chemicals
Viral infections (HTLV-1, Epstein-Barr virus)
📖 IV. Pathophysiology (In Brief)
Mutation in bone marrow stem cells.
Abnormal WBCs multiply uncontrollably, crowding out normal cells.
Decreased RBCs, platelets, and functional WBCs → Anemia, bleeding, and infections.
Infiltration into liver, spleen, lymph nodes, and CNS may occur.
Monitor for signs of infection, bleeding, and anemia
Maintain strict neutropenic precautions
Educate on importance of oral hygiene and skin care
Manage chemotherapy side effects (nausea, mucositis, alopecia)
Monitor labs (CBC, electrolytes) and prepare for transfusions
Provide psychological support to patient and family
Educate on treatment plan and follow-up needs
📚 Golden One-Liners for Quick Revision:
ALL is the most common leukemia in children.
CML is associated with the Philadelphia chromosome.
Bone marrow biopsy is the gold standard for diagnosis.
Leukemia leads to pancytopenia due to marrow suppression.
Neutropenic precautions are essential to prevent infection.
✅ Top 5 MCQs for Practice
Which leukemia is most common in children? 🅰️ AML 🅱️ CML ✅ 🅲️ ALL 🅳️ CLL
Which chromosome is associated with CML? 🅰️ 21 🅱️ X ✅ 🅲️ Philadelphia chromosome (22q11) 🅳️ Y
Which test is definitive for diagnosing leukemia? 🅰️ CBC 🅱️ Peripheral smear ✅ 🅲️ Bone marrow biopsy 🅳️ ESR
Which symptom is NOT commonly associated with leukemia? 🅰️ Frequent infections ✅ 🅱️ Hypertension 🅲️ Anemia 🅳️ Bruising
Which of the following is a nursing priority in a leukemic patient receiving chemotherapy? 🅰️ Restrict protein intake ✅ 🅱️ Prevent infection 🅲️ Encourage heavy exercise 🅳️ Avoid oral care
📚🧬 Lymphoma
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Medical-Surgical Nursing Exams
🔰 I. Definition:
Lymphoma is a malignant cancer of the lymphatic system, which includes the lymph nodes, spleen, thymus, and bone marrow. It results from abnormal proliferation of lymphocytes, a type of white blood cell, and can affect immunity and lead to widespread organ involvement.
“Lymphoma is a cancer that begins in the cells of the immune system (lymphocytes) and typically presents as swollen lymph nodes without pain.”
📖 II. Classification / Types:
Type
Description
Hodgkin’s Lymphoma (HL)
Presence of Reed-Sternberg cells; often begins in a single lymph node group; predictable spread.
Non-Hodgkin’s Lymphoma (NHL)
More common; no Reed-Sternberg cells; can involve multiple lymph nodes and extranodal sites (e.g., GI tract, CNS).
📖 III. Causes / Risk Factors:
Infection with Epstein-Barr virus (EBV) or HIV
Weakened immune system (e.g., post-transplant, AIDS)
Q4. First-line treatment for lymphoma includes: 🅰️ Surgery ✅ 🅱️ Chemotherapy and/or radiotherapy 🅲️ Iron therapy 🅳️ Physical therapy
Q5. Which monoclonal antibody is used in B-cell NHL? 🅰️ Trastuzumab 🅱️ Bevacizumab ✅ 🅲️ Rituximab 🅳️ Adalimumab
📚🧬 Multiple Myeloma
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Medical-Surgical Nursing Exams
🔰 I. Definition:
Multiple myeloma is a malignant cancer of plasma cells (a type of white blood cell that produces antibodies), originating in the bone marrow. It leads to the uncontrolled proliferation of abnormal plasma cells, resulting in bone destruction, anemia, immune suppression, and kidney damage.
“Multiple myeloma is a neoplastic proliferation of monoclonal plasma cells in bone marrow, producing abnormal immunoglobulins and causing systemic complications.”
📖 II. Classification / Types:
Type
Description
Smoldering Myeloma
Early form without symptoms; may progress
Symptomatic Multiple Myeloma
Active disease with organ damage
Non-secretory Myeloma
Plasma cells don’t release detectable M-protein
Light Chain Myeloma (Bence Jones myeloma)
Produces only light chains; affects kidneys severely
📖 III. Causes / Risk Factors:
Age >60 years
Male gender
African descent
Exposure to radiation, pesticides, or industrial chemicals (e.g., benzene)
Family history of myeloma or monoclonal gammopathy
Obesity and chronic inflammation
📖 IV. Pathophysiology (In Brief):
Malignant plasma cells multiply in bone marrow.
These cells produce abnormal immunoglobulin (M-protein).
Accumulation of plasma cells → bone destruction, marrow suppression.
Light chains may deposit in kidneys → renal damage.
Results in hypercalcemia, anemia, bone pain, infections, renal failure.
📖 V. Clinical Manifestations:
Bone pain (especially in back, ribs, pelvis)
Anemia – fatigue, pallor
Recurrent infections (due to poor antibody production)
Common signs: Bone pain, anemia, renal failure, infections
Bisphosphonates help reduce skeletal complications
Bone marrow biopsy is confirmatory
✅ Top 5 MCQs for Practice:
Q1. Which abnormal protein is typically found in urine in multiple myeloma? 🅰️ Albumin ✅ 🅱️ Bence Jones protein 🅲️ Hemoglobin 🅳️ Transferrin
Q2. What is the hallmark feature of bone involvement in multiple myeloma? 🅰️ Sclerosis 🅱️ Diffuse calcification ✅ 🅲️ Punched-out lytic lesions 🅳️ Osteophytes
Q3. The most common presenting symptom of multiple myeloma is: 🅰️ Chest pain ✅ 🅱️ Bone pain 🅲️ Diarrhea 🅳️ Jaundice
Q4. Which of the following is used in the treatment of multiple myeloma? 🅰️ Metformin 🅱️ Ciprofloxacin ✅ 🅲️ Bortezomib 🅳️ Omeprazole
Q5. Which test shows the “M-spike” in multiple myeloma? 🅰️ CBC 🅱️ X-ray ✅ 🅲️ Serum protein electrophoresis 🅳️ Creatinine test
📚🧬 Bone Marrow Transplant (BMT)
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Medical-Surgical Nursing Exams
🔰 I. Definition:
Bone Marrow Transplant is a medical procedure in which damaged or diseased bone marrow is replaced with healthy hematopoietic stem cells, either from the patient (autologous) or from a donor (allogeneic), to restore normal blood cell production.
“BMT is used to treat cancers like leukemia, lymphoma, and other marrow failure conditions by infusing healthy stem cells into the patient.”
📖 II. Classification / Types:
Type
Description
Autologous BMT
Stem cells are harvested from the patient before high-dose chemotherapy and re-infused later.
Allogeneic BMT
Stem cells come from a donor (matched sibling or unrelated donor).
Syngeneic BMT
Stem cells from an identical twin (genetically identical).
Umbilical Cord Blood Transplant
Stem cells are taken from umbilical cord blood after delivery.
📖 III. Causes / Indications:
Leukemia (ALL, AML, CML, CLL)
Lymphoma (Hodgkin’s, Non-Hodgkin’s)
Multiple Myeloma
Aplastic Anemia
Thalassemia Major
Sickle Cell Anemia
Severe Combined Immunodeficiency (SCID)
Bone marrow failure syndromes
📖 IV. Pathophysiology (In Brief):
Bone marrow becomes damaged/diseased due to cancer, chemotherapy, or genetic disorders.
Abnormal or deficient stem cells fail to produce healthy blood cells.
Transplantation of healthy hematopoietic stem cells restores RBC, WBC, and platelet production.
The new marrow engrafts and begins producing healthy cells.
📖 V. Clinical Manifestations (Post-BMT Complications):
Fever, chills (sign of infection)
Mucositis (mouth sores)
Bleeding, bruising (due to thrombocytopenia)
Graft-versus-host disease (GVHD) in allogeneic BMT
Monitor for signs of GVHD (rash, diarrhea, liver enzymes)
Administer immunosuppressants and antibiotics as prescribed
Ensure nutritional support and hydration
Provide oral care to prevent mucositis
Educate patient and family about:
Infection prevention
Long-term follow-up
Medication compliance
📚 Golden One-Liners for Quick Revision:
BMT replaces damaged bone marrow with healthy stem cells
Autologous BMT uses patient’s own cells
Allogeneic BMT carries risk of GVHD
HLA matching is critical for donor compatibility
Nurses play a key role in infection control and patient education
✅ Top 5 MCQs for Practice:
Q1. Which type of bone marrow transplant uses the patient’s own stem cells? 🅰️ Allogeneic ✅ 🅱️ Autologous 🅲️ Syngeneic 🅳️ Cord blood
Q2. A major complication of allogeneic BMT is: 🅰️ Anemia 🅱️ Mucositis ✅ 🅲️ Graft-versus-host disease 🅳️ Constipation
Q3. Bone marrow transplant is commonly used in which condition? 🅰️ Osteoarthritis 🅱️ Tuberculosis ✅ 🅲️ Leukemia 🅳️ Myopia
Q4. Which test is done to ensure donor compatibility in BMT? 🅰️ ABO blood grouping ✅ 🅱️ HLA typing 🅲️ ESR 🅳️ Mantoux test
Q5. The primary nursing goal after BMT is to: 🅰️ Encourage exercise 🅱️ Limit fluid intake ✅ 🅲️ Prevent infections 🅳️ Stop immunosuppressants
📚🚨 Oncological Emergencies
📘 Highly Important for GNM/BSc Nursing, NHM, AIIMS, NORCET, GPSC & Medical-Surgical Nursing Exams
Definition:
Oncological emergencies are acute, life-threatening complications arising either due to cancer itself or its treatment. They may be metabolic, hematologic, or structural, and require immediate recognition and intervention to prevent morbidity or death.
“Oncological emergencies are urgent conditions in cancer patients requiring rapid diagnosis and treatment to avoid severe complications or death.”
📚🫁 Superior Vena Cava Syndrome (SVCS)
🔰 I. Definition:
Superior Vena Cava Syndrome (SVCS) is a medical emergency caused by obstruction or compression of the superior vena cava, leading to impaired venous drainage from the head, neck, upper chest, and upper limbs, resulting in venous congestion and edema.
“SVCS is the clinical manifestation of impaired blood flow through the superior vena cava due to tumor compression, thrombosis, or fibrosis.”
📖 II. Classification / Types:
Type
Description
Malignant SVCS
Caused by cancers (e.g., lung cancer, lymphoma, metastases) — most common
Non-malignant SVCS
Caused by thrombosis (e.g., central venous catheters, pacemakers), infections, or mediastinal fibrosis
📖 III. Causes / Risk Factors:
Bronchogenic carcinoma (especially small cell lung cancer)
Non-Hodgkin’s lymphoma / Hodgkin’s disease
Metastatic tumors in mediastinum
Thrombosis from central venous catheters or pacemakers
Can cause airway compromise and cerebral edema in severe cases.
📖 V. Clinical Manifestations:
Swelling of face, neck, arms, and upper chest
Dilated neck and chest veins
Dyspnea, cough, hoarseness
Cyanosis of lips or face
Headache, dizziness, confusion (due to cerebral edema)
Stridor or orthopnea (airway compression)
Visual disturbances
📖 VI. Diagnostic Evaluation:
Chest X-ray – Mediastinal widening, mass
CT Scan with contrast – Identifies cause, location, and severity
MRI – For soft tissue assessment
Venography – For vascular evaluation
Biopsy – Of tumor or lymph node (if malignancy suspected)
Doppler ultrasound – If thrombosis is suspected in SVC or subclavian vein
📖 VII. Management:
🟢 1. Immediate Symptom Relief:
Elevate head of bed (↑ venous return)
Oxygen therapy
Diuretics to reduce edema
Steroids (e.g., dexamethasone) to reduce inflammation and tumor swelling
🟢 2. Definitive Treatment:
Radiotherapy – For radiosensitive tumors (e.g., lymphoma)
Chemotherapy – In lung cancers, lymphomas
Anticoagulation or thrombolysis – If due to thrombus
Stent placement (endovascular) – For quick relief in severe SVCS
Surgery – Rare; for tumor resection or bypass graft
📖 VIII. Nursing Responsibilities:
Assess for signs of respiratory distress or airway obstruction
Position patient upright (semi-Fowler’s) to reduce pressure
Administer oxygen, corticosteroids, and diuretics as prescribed
Monitor vital signs, neurological status, and fluid balance
Provide a calm environment to reduce anxiety
Prepare for emergency airway management if needed
Educate patient on avoiding tight clothing/jewelry around the neck or chest
📚 Golden One-Liners for Quick Revision:
SVCS = obstruction of superior vena cava → venous congestion of upper body
Most common cause = lung cancer
Facial swelling and dyspnea are hallmark signs
CT chest is best for diagnosis
Treatment includes steroids, chemotherapy, radiotherapy, and stenting
Airway and cerebral edema are life-threatening complications
✅ Top 5 MCQs for Practice:
Q1. The most common cause of SVCS is: 🅰️ Heart failure 🅱️ Tuberculosis ✅ 🅲️ Lung cancer 🅳️ Renal failure
Q2. A classic clinical sign of SVCS is: 🅰️ Edema in lower limbs 🅱️ Jaundice ✅ 🅲️ Swelling of face and neck 🅳️ Diarrhea
Q3. Which diagnostic tool is most definitive for SVCS? 🅰️ ECG 🅱️ Ultrasound abdomen ✅ 🅲️ Contrast-enhanced CT chest 🅳️ Urine routine test
Q4. What is the initial nursing action in SVCS? 🅰️ Lie the patient flat ✅ 🅱️ Elevate the head of bed 🅲️ Administer iron supplements 🅳️ Encourage ambulation
Q5. Which of the following drugs is commonly used in SVCS to reduce tumor swelling? 🅰️ Metformin 🅱️ Paracetamol ✅ 🅲️ Dexamethasone 🅳️ Amoxicillin
📚💥 Tumor Lysis Syndrome (TLS)
🔰 I. Definition:
Tumor Lysis Syndrome (TLS) is a life-threatening oncologic emergency that occurs when a large number of cancer cells are destroyed rapidly, releasing their intracellular contents (potassium, phosphate, nucleic acids) into the bloodstream, leading to electrolyte imbalances and acute renal failure.
“TLS is a metabolic emergency resulting from massive tumor cell breakdown, most often after chemotherapy in high-grade malignancies.”
📖 II. Classification / Types:
Type
Description
Spontaneous TLS
Occurs without treatment in highly proliferative tumors
Therapy-Induced TLS
Occurs after chemotherapy or radiotherapy, most common form
Preventable with hydration, allopurinol, rasburicase
Dialysis may be required in severe renal failure
✅ Top 5 MCQs for Practice:
Q1. Tumor Lysis Syndrome is most commonly associated with: 🅰️ Breast cancer ✅ 🅱️ Acute leukemias and lymphomas 🅲️ Carcinoma of cervix 🅳️ Basal cell carcinoma
Q2. Which electrolyte abnormality is NOT typically seen in TLS? 🅰️ Hyperkalemia 🅱️ Hyperuricemia ✅ 🅲️ Hypercalcemia 🅳️ Hyperphosphatemia
Q3. A drug used to prevent uric acid formation in TLS is: 🅰️ Furosemide 🅱️ Calcium gluconate ✅ 🅲️ Allopurinol 🅳️ Heparin
Q4. A life-threatening complication of TLS is: 🅰️ Hypertension 🅱️ Hyperglycemia ✅ 🅲️ Acute kidney failure 🅳️ Bradycardia
Q5. Which of the following is a nursing priority in TLS? 🅰️ Ambulation ✅ 🅱️ Monitor electrolyte levels and renal function 🅲️ Fluid restriction 🅳️ High-protein diet
📚🧠 Spinal Cord Compression (SCC)
🔰 I. Definition:
Spinal Cord Compression (SCC) is an oncological emergency that occurs when a tumor or lesion compresses the spinal cord or its blood supply, leading to neurological deficits such as pain, paralysis, and loss of bladder or bowel control.
“SCC is a condition where the spinal cord is compressed by a tumor, abscess, or vertebral collapse, causing progressive neurological dysfunction.”
📖 II. Classification / Types:
Type
Description
Malignant SCC
Caused by tumor metastasis (most common)
Non-malignant SCC
Caused by infections (abscess), herniated discs, trauma
Radiation therapy – For radiosensitive tumors (e.g., lymphoma)
Chemotherapy – In systemic malignancy causing SCC
Pain management – Opioids, NSAIDs
🟢 2. Surgical Management:
Decompression laminectomy – To remove tumor or relieve pressure
Spinal stabilization – For structural support
📖 VIII. Nursing Responsibilities:
Perform frequent neurological assessments
Monitor pain, reflexes, muscle strength, bladder/bowel function
Administer steroids and pain relief as prescribed
Educate on log-rolling technique and spinal precautions
Assist with mobility aids and fall prevention
Provide emotional support for sudden functional loss
Prepare patient and family for rehabilitation planning
📚 Golden One-Liners for Quick Revision:
SCC is an oncologic emergency causing neurologic impairment
Most common presenting symptom = back pain
SCC is commonly due to metastatic tumors (breast, lung, prostate)
MRI is the investigation of choice
Treated with steroids, radiotherapy, or surgical decompression
✅ Top 5 MCQs for Practice:
Q1. The most common cause of spinal cord compression in adults is: 🅰️ Trauma ✅ 🅱️ Metastatic cancer 🅲️ Tuberculosis 🅳️ Herniated disc
Q2. The earliest and most common symptom of SCC is: 🅰️ Paralysis 🅱️ Incontinence ✅ 🅲️ Back pain 🅳️ Fever
Q3. The gold standard diagnostic tool for SCC is: 🅰️ X-ray 🅱️ CT scan ✅ 🅲️ MRI 🅳️ PET scan
Q4. First-line drug used to reduce edema in SCC is: 🅰️ Paracetamol 🅱️ Morphine ✅ 🅲️ Dexamethasone 🅳️ Diazepam
Q5. A nursing priority in managing SCC is: 🅰️ Encourage fluid restriction ✅ 🅱️ Monitor neurologic status and prevent falls 🅲️ Restrict movement completely 🅳️ Start high-protein diet immediately
📚🧪 Hypercalcemia of Malignancy
🔰 I. Definition:
Hypercalcemia of malignancy is an oncologic metabolic emergency caused by elevated levels of calcium in the blood, usually due to cancer-related factors, and leads to neurological, renal, and gastrointestinal complications.
“Hypercalcemia is defined as a serum calcium level >10.5 mg/dL and becomes life-threatening at levels >14 mg/dL.”
📖 II. Classification / Types:
Type
Mechanism
Humoral Hypercalcemia
Most common; due to secretion of parathyroid hormone-related protein (PTHrP) by tumors
Local Osteolytic Hypercalcemia
From direct bone destruction by metastases (e.g., multiple myeloma, breast cancer)
Vitamin D-mediated
Seen in lymphomas causing increased vitamin D levels
Ectopic PTH secretion
Rare; tumors produce actual parathyroid hormone
📖 III. Causes / Risk Factors:
Breast cancer
Lung cancer (especially squamous cell carcinoma)
Multiple myeloma
Lymphomas
Prolonged immobility in cancer patients
Bone metastasis
Dehydration, thiazide diuretics
📖 IV. Pathophysiology (In Brief):
Tumors secrete PTHrP or cause bone destruction.
Leads to release of calcium from bones and increased renal calcium reabsorption.
Results in elevated serum calcium → affects muscles, kidneys, brain, and heart.
PTH: Suppressed in malignancy-related hypercalcemia
PTHrP: Elevated in humoral hypercalcemia
Serum creatinine/BUN: Evaluate renal function
ECG: Short QT interval, possible arrhythmias
📖 VII. Management:
🟢 1. Immediate Interventions:
IV hydration with normal saline (first-line)
Loop diuretics (e.g., furosemide) to promote calcium excretion
Bisphosphonates (e.g., zoledronic acid, pamidronate) – inhibit bone resorption
Calcitonin – quick but short-acting calcium-lowering agent
Dialysis – in patients with severe renal failure or refractory hypercalcemia
🟢 2. Long-Term Management:
Treat the underlying malignancy (chemotherapy, radiotherapy)
Discontinue calcium-raising medications
📖 VIII. Nursing Responsibilities:
Monitor serum calcium, ECG, I/O, mental status
Ensure adequate hydration and IV fluid administration
Administer prescribed bisphosphonates or calcitonin
Assess for muscle weakness, lethargy, constipation
Provide safety measures for confused or lethargic patients
Educate on symptom recognition and medication compliance
📚 Golden One-Liners for Quick Revision:
Calcium >10.5 mg/dL = hypercalcemia
Most common cause in cancer = PTHrP secretion or bone metastasis
Classic symptoms = “Stones, Bones, Groans, Moans”
First-line treatment = IV fluids + loop diuretics
Bisphosphonates are drug of choice in malignancy-related hypercalcemia
✅ Top 5 MCQs for Practice:
Q1. What is the normal upper limit of serum calcium? 🅰️ 8.5 mg/dL 🅱️ 9.5 mg/dL ✅ 🅲️ 10.5 mg/dL 🅳️ 11.5 mg/dL
Q2. Which cancer is most commonly associated with hypercalcemia? 🅰️ Colon cancer ✅ 🅱️ Lung cancer (especially squamous cell type) 🅲️ Thyroid cancer 🅳️ Skin cancer
Q3. Which medication is used to reduce bone resorption in hypercalcemia? 🅰️ Prednisolone ✅ 🅱️ Zoledronic acid 🅲️ Digoxin 🅳️ Metformin
Q4. Which ECG change is seen in hypercalcemia? 🅰️ Prolonged QT interval ✅ 🅱️ Shortened QT interval 🅲️ ST elevation 🅳️ T wave inversion
Q5. A nursing priority in managing a patient with hypercalcemia includes: 🅰️ Restricting fluids 🅱️ Encouraging bedrest ✅ 🅲️ Ensuring adequate IV hydration and monitoring ECG 🅳️ Giving calcium supplements