Oncology Nursing

Growth & Division:

• Follow cell cycle control with regulatory checkpoints.
• Undergo contact inhibition (stop growing when touching neighboring cells).
• Follow apoptosis (programmed cell death) to remove damaged cells.
• Shape & Size: Irregular shape, vary in size (pleomorphism).

Key Differences Between Normal & Cancer Cells

Feature	Normal Cells	Cancer Cells
Growth Control	Regulated cell cycle	Uncontrolled division
Contact Inhibition	Present	Absent
Apoptosis (Cell Death)	Normal	Evades apoptosis
Nucleus	Single, small	Large, irregular
Chromosomes	Stable	Genetically unstable, mutated
Differentiation	Well-differentiated	Poorly differentiated
Adhesion	Strong	Weak (metastasis)
Angiogenesis	Regulated	Excessive
Function	Performs specialized roles	Loss of function
Spread	Localized	Invades tissues & metastasizes

IV. Clinical Importance

• Benign Tumor: Well-differentiated, does not invade nearby tissues, slow growth.
• Malignant Tumor (Cancer): Poorly differentiated, rapid growth, spreads (metastasis).
• Metastasis: Cancer cells break away from the original site and spread via blood or lymph.

Important Competitive Exam Questions

1. Which feature is NOT seen in cancer cells?
   a) Contact inhibition
   b) Uncontrolled growth
   c) Genetic instability
   d) AngiogenesisAnswer: a) Contact inhibition
2. Which of the following is a characteristic of malignant cells?
   a) Well-defined nuclear shape
   b) High apoptosis rate
   c) Loss of cell adhesion
   d) Stable DNA structureAnswer: c) Loss of cell adhesion
3. Which process allows cancer cells to spread to distant organs?
   a) Apoptosis
   b) Contact inhibition
   c) Metastasis
   d) DifferentiationAnswer: c) Metastasis

🔥 Tumor Markers – High-Yield Points for Competitive Exams 🔥

What are Tumor Markers?

• Tumor markers are biological substances (proteins, hormones, enzymes, or genes) produced by cancer cells or by the body in response to cancer.
• They help in cancer detection, diagnosis, prognosis, monitoring treatment response, and recurrence detection.

⚡ Important Tumor Markers & Associated Cancers

Tumor Marker	Cancer Type	Significance
Alpha-Fetoprotein (AFP)	Liver (Hepatocellular carcinoma), Germ cell tumors (Testicular, Ovarian Cancer)	Used for diagnosis & monitoring treatment
Carcinoembryonic Antigen (CEA)	Colorectal, Gastric, Pancreatic, Breast, Lung Cancer	Marker for recurrence and metastasis
Prostate-Specific Antigen (PSA)	Prostate Cancer	Screening & monitoring response to treatment
CA-125	Ovarian Cancer	Used for diagnosis & monitoring
CA 19-9	Pancreatic, Gallbladder, Biliary Tract Cancer	Used for prognosis & treatment response
CA 15-3 & CA 27-29	Breast Cancer	Monitoring recurrence
Beta-Human Chorionic Gonadotropin (β-hCG)	Germ Cell Tumors, Choriocarcinoma, Testicular Cancer	Diagnosis & monitoring response
Lactate Dehydrogenase (LDH)	Lymphoma, Leukemia, Germ Cell Tumors	Used as a prognostic marker
Thyroglobulin	Thyroid Cancer (Papillary & Follicular Carcinoma)	Used after thyroidectomy
Calcitonin	Medullary Thyroid Cancer	Marker for diagnosis & recurrence
Neuron-Specific Enolase (NSE)	Neuroblastoma, Small Cell Lung Cancer (SCLC)	Diagnosis & prognosis
S-100	Melanoma, Schwannoma	Used in melanoma detection
Chromogranin A (CgA)	Neuroendocrine Tumors (Carcinoid, Pheochromocytoma)	Diagnosis & prognosis
BCR-ABL (Philadelphia Chromosome)	Chronic Myeloid Leukemia (CML), Acute Lymphoblastic Leukemia (ALL)	Molecular marker for targeted therapy
Myeloperoxidase (MPO)	Acute Myeloid Leukemia (AML)	Diagnosis of AML
Beta-2 Microglobulin (B2M)	Multiple Myeloma, Lymphomas	Prognostic marker
RET Proto-Oncogene Mutation	Medullary Thyroid Cancer, MEN Syndromes	Genetic testing for hereditary risk
HER2/neu (ERBB2)	Breast Cancer, Gastric Cancer	Predicts response to Trastuzumab (Herceptin)

🔥 High-Yield Key Points for Exams

✅ Best tumor marker for Prostate Cancer: PSA
✅ Best tumor marker for Liver Cancer (Hepatocellular Carcinoma): AFP
✅ Best tumor marker for Ovarian Cancer: CA-125
✅ Best tumor marker for Pancreatic Cancer: CA 19-9
✅ Best tumor marker for Thyroid Cancer: Thyroglobulin (Differentiated), Calcitonin (Medullary)
✅ Most specific genetic marker for Chronic Myeloid Leukemia (CML): BCR-ABL (Philadelphia Chromosome)
✅ Best marker for Multiple Myeloma: Beta-2 Microglobulin (B2M)
✅ HER2/neu is positive in: Breast & Gastric Cancer (Targeted Therapy: Trastuzumab)

📝 Competitive Exam Practice MCQs

1. Which tumor marker is most commonly used for screening and monitoring prostate cancer?

a) CA 19-9
b) AFP
c) PSA
d) CEA
✅ Answer: c) PSA

2. CA-125 is a tumor marker for which type of cancer?

a) Breast Cancer
b) Ovarian Cancer
c) Lung Cancer
d) Prostate Cancer
✅ Answer: b) Ovarian Cancer

3. Which tumor marker is used for monitoring pancreatic cancer?

a) CEA
b) CA 15-3
c) CA 19-9
d) NSE
✅ Answer: c) CA 19-9

1. Cancer Prevention:

• Primary Prevention: Avoidance of carcinogens, HPV & Hepatitis B vaccination, healthy lifestyle.
• Secondary Prevention: Early detection via screening tests.
• Tertiary Prevention: Prevent recurrence, rehabilitation after treatment.

2. Cancer Screening & Early Detection

Cancer Type	Screening Test	Recommended Population
Breast Cancer	Mammography	Women > 40 years
Cervical Cancer	Pap Smear, HPV DNA Test	Women 21-65 years
Colorectal Cancer	Colonoscopy, Fecal Occult Blood Test (FOBT)	Adults > 50 years
Lung Cancer	Low-dose CT scan	Smokers > 55 years
Prostate Cancer	PSA (Prostate-Specific Antigen)	Men > 50 years

3. Warning Signs of Cancer (CAUTION Mnemonic)

• C – Change in bowel or bladder habits
• A – A sore that does not heal
• U – Unusual bleeding or discharge
• T – Thickening or lump in the breast or elsewhere
• I – Indigestion or difficulty swallowing
• O – Obvious change in a wart or mole
• N – Nagging cough or hoarseness

III. Epidemiology & Etiology of Cancer

1. Epidemiology:

• Most Common Cancers: Lung, breast, colorectal, prostate, stomach.
• High Mortality Rate: Lung, liver, stomach, colorectal, breast.

2. Etiology (Causes of Cancer)

• Genetic Factors: BRCA1/2 (Breast & Ovarian Cancer), p53 mutation.
• Environmental Factors: Radiation, UV exposure, carcinogens (smoking, alcohol).
• Infections: HPV (Cervical), Hepatitis B & C (Liver), H. pylori (Gastric).
• Lifestyle Factors: High-fat diet, obesity, sedentary lifestyle, tobacco.

IV. Classification of Cancer

• Based on Origin:
  • Carcinoma – Epithelial tissues (e.g., breast, lung, colon).
  • Sarcoma – Connective tissues (bone, muscle, cartilage).
  • Leukemia – Blood-forming organs.
  • Lymphoma & Myeloma – Lymphatic system.

V. Pathophysiology of Cancer

• Normal cells undergo mutations → Loss of control over the cell cycle
• Hallmarks of Cancer (Hanahan & Weinberg’s Theory):
  • Uncontrolled proliferation
  • Evasion of apoptosis
  • Sustained angiogenesis
  • Tissue invasion & metastasis

VI. Staging of Cancer (TNM Classification)

Stage	T (Tumor Size)	N (Lymph Node Involvement)	M (Metastasis)
Stage 0	In situ (localized)	No lymph involvement	No metastasis
Stage I	Small, localized	No lymph spread	No metastasis
Stage II	Larger tumor	Nearby lymph nodes affected	No metastasis
Stage III	Large, deeply invaded	Extensive lymph involvement	No metastasis
Stage IV	Any size	Any lymph involvement	Distant metastasis present

VII. Clinical Manifestations of Cancer

• Systemic Symptoms: Weight loss, fatigue, anemia, night sweats, fever.
• Localized Symptoms: Lump, ulcer, bleeding, pain, organ dysfunction.
• Paraneoplastic Syndromes: Hypercalcemia (lung cancer), SIADH (small cell lung cancer).

VIII. Diagnosis of Cancer

• Blood Tests: Tumor markers (PSA, CEA, AFP, CA-125).
• Biopsy: Gold standard for diagnosis.
• Imaging:
  • X-ray: Lung cancer.
  • CT/MRI: Tumor staging.
  • PET Scan: Metastasis detection.
• Cytology: Pap smear (Cervical Cancer).

IX. Treatment Modalities in Cancer

1. Surgery

• Curative: Early-stage tumors.
• Palliative: Symptom relief.

2. Radiation Therapy

• External Beam Radiation – Kills cancer cells using high-energy rays.
• Brachytherapy (Internal Radiation) – Radioactive material placed inside the body.

3. Chemotherapy

• Cytotoxic drugs target rapidly dividing cells.
• Side Effects: Bone marrow suppression, nausea, vomiting, alopecia.

4. Immunotherapy & Targeted Therapy

• Monoclonal Antibodies (e.g., Trastuzumab for HER2+ Breast Cancer).
• Checkpoint Inhibitors (e.g., Pembrolizumab for Lung Cancer).

5. Hormonal Therapy

• For hormone-sensitive cancers like Breast (Tamoxifen) & Prostate (Androgen Blockers).

6. Stem Cell Transplant

• For hematological cancers (Leukemia, Lymphoma).

X. Nursing Management of Cancer Patients

1. Preoperative & Postoperative Care:

• Preoperative: Emotional support, informed consent, preparation for surgery.
• Postoperative: Pain management, wound care, infection prevention.

2. Chemotherapy Care

• Monitor for neutropenia (infection risk).
• Prevent nausea (antiemetics like Ondansetron).

3. Radiation Therapy Care

• Skin care (avoid perfumes, sun exposure).
• Monitor for radiation burns & fatigue.

4. Palliative & End-of-Life Care

• Pain management (opioids).
• Psychological support (counseling, hospice care).

🔥 High-Yield Summary

✅ Most common cancer worldwide: Lung Cancer
✅ Most common cancer in women: Breast Cancer
✅ Most common cancer in men: Prostate Cancer
✅ Gold Standard for Cancer Diagnosis: Biopsy
✅ TNM Staging: Stage IV = Distant Metastasis
✅ Early Detection: CAUTION Mnemonic
✅ Common Treatment Modalities: Surgery, Chemotherapy, Radiation, Immunotherapy
✅ Emergency in Cancer: Tumor Lysis Syndrome (Electrolyte Imbalance)
✅ Palliative Care Goal: Symptom control & quality of life

I. Types of Radiation Therapy

1. External Beam Radiation Therapy (EBRT)

• Definition: High-energy radiation is delivered externally using a linear accelerator.
• Uses: Most common for solid tumors (breast, lung, prostate, brain, colorectal).
• Advantages: Precise targeting, avoids invasive procedures.
• Side Effects: Skin burns, fatigue, nausea, hair loss (site-specific).

🔹 Subtypes of EBRT:

Type	Description	Uses
3D Conformal Radiation Therapy (3D-CRT)	Uses 3D imaging for precise targeting	Brain, prostate, lung, colorectal cancer
Intensity-Modulated Radiation Therapy (IMRT)	Uses varying intensity beams to protect normal tissues	Head & Neck, Prostate, Cervical cancers
Image-Guided Radiation Therapy (IGRT)	Uses real-time imaging (CT/MRI) to adjust radiation delivery	Lung, Liver, Pancreas, Prostate cancer
Stereotactic Radiosurgery (SRS)	Single high-dose beam for precise brain tumor treatment	Brain tumors (e.g., Acoustic neuroma, Metastases)
Stereotactic Body Radiation Therapy (SBRT)	High-dose radiation to small tumors in the body	Lung, Liver, Pancreas tumors
Proton Beam Therapy	Uses proton particles instead of X-rays for deeper tumor penetration	Pediatric tumors, Brain tumors, Prostate cancer

2. Brachytherapy (Internal Radiation Therapy)

• Definition: Radioactive materials (seeds, wires, catheters, implants) are placed inside or near the tumor.
• Uses: Cervical, Prostate, Breast, Esophageal, and Head & Neck Cancers.
• Advantages: High precision, minimal effect on nearby normal tissues.
• Side Effects: Local swelling, pain, irritation.

🔹 Types of Brachytherapy:

Type	Description	Uses
Low-Dose Rate (LDR) Brachytherapy	Small radioactive seeds implanted permanently	Prostate Cancer
High-Dose Rate (HDR) Brachytherapy	Temporary high-dose source placed for minutes/hours	Cervical, Breast, Head & Neck Cancers
Interstitial Brachytherapy	Radioactive implants placed within the tumor	Prostate, Soft Tissue Sarcomas
Intracavitary Brachytherapy	Radioactive source placed inside a body cavity	Cervical, Uterine, Vaginal Cancer

3. Systemic Radiation Therapy (Radionuclide Therapy)

• Definition: Radioactive drugs or isotopes are given orally or intravenously to target cancer cells throughout the body.
• Uses: Thyroid Cancer, Bone Metastases, Neuroendocrine Tumors.
• Side Effects: Nausea, bone marrow suppression, fatigue.

🔹 Types of Systemic Radiation Therapy:

Type	Description	Uses
Radioactive Iodine Therapy (I-131)	Iodine-131 taken orally to destroy thyroid cells	Thyroid Cancer, Hyperthyroidism
Radium-223 (Xofigo) Therapy	Targets bone metastases to relieve pain & slow tumor growth	Prostate Cancer with bone metastases
Lutetium-177 Therapy (Lu-177)	Targets neuroendocrine tumors and prostate cancer	Neuroendocrine tumors (NETs), Prostate Cancer

II. Emerging & Advanced Radiation Therapy

Type	Description	Uses
Flash Radiation Therapy	Ultra-fast radiation therapy with reduced side effects	Still in research phase
Borated Neutron Capture Therapy (BNCT)	Uses boron compounds with neutron beams	Brain Tumors, Head & Neck Cancers
Carbon Ion Therapy	Heavy ion radiation therapy	Resistant & deep-seated tumors

III. High-Yield Key Points for Competitive Exams

✅ Most common type of radiation therapy: External Beam Radiation Therapy (EBRT)
✅ Most precise radiation therapy for brain tumors: Stereotactic Radiosurgery (SRS)
✅ Best radiation therapy for prostate cancer: Brachytherapy (LDR/HDR)
✅ Which therapy uses iodine-131? Systemic Radiation Therapy for Thyroid Cancer
✅ Radiation therapy with least damage to surrounding tissues: Proton Beam Therapy
✅ Best treatment for bone metastases: Radium-223 (Xofigo)
✅ Which therapy uses high-dose, focused radiation for small tumors? SBRT (Stereotactic Body Radiation Therapy)

📝 Competitive Exam Practice MCQs

1. Which radiation therapy involves the insertion of radioactive sources directly inside or near the tumor?

a) External Beam Radiation Therapy (EBRT)
b) Brachytherapy
c) Systemic Radiation Therapy
d) Proton Beam Therapy
✅ Answer: b) Brachytherapy

2. Which type of radiation therapy is commonly used for treating thyroid cancer?

a) Stereotactic Radiosurgery (SRS)
b) Image-Guided Radiation Therapy (IGRT)
c) Radioactive Iodine Therapy (I-131)
d) Proton Beam Therapy
✅ Answer: c) Radioactive Iodine Therapy (I-131)

3. The most precise radiation therapy for brain tumors is:

a) 3D Conformal Radiation Therapy (3D-CRT)
b) Brachytherapy
c) Stereotactic Radiosurgery (SRS)
d) Systemic Radiation Therapy
✅ Answer: c) Stereotactic Radiosurgery (SRS)

🔥 Common Malignancies of Various Body Systems – High-Yield Notes for Competitive Exams 🔥

Cancer is classified based on site of origin, tissue type, and spread pattern. Below is a system-wise classification of common malignancies along with their key features.

I. Head & Neck Cancers

1. Oral Cancer (Squamous Cell Carcinoma)

• Risk Factors: Tobacco, betel nut, alcohol, HPV infection.
• Common Sites: Tongue, floor of the mouth, buccal mucosa.
• Signs: Non-healing ulcer, white/red patches (leukoplakia, erythroplakia), difficulty in swallowing.
• Diagnosis: Biopsy, CT, MRI.
• Treatment: Surgery, radiation, chemotherapy.

2. Laryngeal Cancer

• Risk Factors: Smoking, alcohol, HPV, GERD.
• Symptoms: Hoarseness, difficulty in swallowing, lump in throat, cough with blood.
• Diagnosis: Laryngoscopy, Biopsy, CT/MRI.
• Treatment: Surgery (laryngectomy), radiation, chemotherapy.

II. Respiratory System

3. Lung Cancer

• Types:
  • Non-Small Cell Lung Cancer (NSCLC) (85%) – Adenocarcinoma, Squamous cell carcinoma, Large cell carcinoma.
  • Small Cell Lung Cancer (SCLC) (15%) – Aggressive, rapid metastasis.
• Risk Factors: Smoking, pollution, asbestos, radon exposure.
• Symptoms: Chronic cough, hemoptysis, weight loss, chest pain.
• Diagnosis: Chest X-ray, CT scan, Bronchoscopy, Biopsy.
• Treatment: Surgery (early stage), Radiation, Chemotherapy, Immunotherapy.

III. Gastrointestinal System

4. Stomach Cancer (Gastric Carcinoma)

• Risk Factors: H. pylori infection, smoked foods, high salt diet, smoking.
• Symptoms: Indigestion, weight loss, abdominal pain, anemia.
• Diagnosis: Endoscopy with biopsy, CT scan.
• Treatment: Gastrectomy, Chemotherapy, Radiation.

5. Colorectal Cancer

• Risk Factors: Low-fiber diet, obesity, smoking, IBD (Inflammatory Bowel Disease).
• Symptoms: Blood in stool, change in bowel habits, weight loss.
• Diagnosis: Colonoscopy, Biopsy, CEA marker.
• Treatment: Surgery, Chemotherapy, Targeted therapy.

6. Liver Cancer (Hepatocellular Carcinoma – HCC)

• Risk Factors: Chronic hepatitis B & C, cirrhosis, alcohol, aflatoxins.
• Symptoms: Abdominal pain, jaundice, hepatomegaly, ascites.
• Diagnosis: AFP marker, Liver biopsy, MRI.
• Treatment: Liver transplant, Resection, Sorafenib (targeted therapy).

IV. Hematological Malignancies

7. Leukemias

Type	Description	Common Age Group
Acute Lymphoblastic Leukemia (ALL)	Most common in children	Pediatric
Acute Myeloid Leukemia (AML)	Affects myeloid cells	Adults
Chronic Lymphocytic Leukemia (CLL)	Slow-growing, most common in elderly	Older adults
Chronic Myeloid Leukemia (CML)	Associated with Philadelphia Chromosome (BCR-ABL)	Middle-aged adults

• Symptoms: Fatigue, fever, easy bruising, recurrent infections.
• Diagnosis: Peripheral blood smear, Bone marrow biopsy.
• Treatment: Chemotherapy, Bone marrow transplant, Tyrosine kinase inhibitors (Imatinib for CML).

8. Lymphomas (Cancer of Lymphatic System)

Type	Features
Hodgkin’s Lymphoma	Reed-Sternberg cells, localized, better prognosis
Non-Hodgkin’s Lymphoma (NHL)	More aggressive, multiple nodes involved

• Symptoms: Painless lymph node swelling, night sweats, fever.
• Diagnosis: Lymph node biopsy, PET scan.
• Treatment: Chemotherapy (CHOP regimen), Radiation, Immunotherapy.

V. Female Reproductive System

9. Breast Cancer

• Risk Factors: BRCA1/2 mutations, estrogen exposure, obesity.
• Symptoms: Lump in the breast, nipple retraction, skin dimpling (Peau d’orange).
• Diagnosis: Mammography, Biopsy, HER2/ER/PR testing.
• Treatment: Surgery (Lumpectomy, Mastectomy), Chemotherapy, Hormonal therapy (Tamoxifen).

10. Cervical Cancer

• Risk Factors: HPV infection, smoking, multiple sexual partners.
• Symptoms: Abnormal vaginal bleeding, pelvic pain, post-coital bleeding.
• Diagnosis: Pap smear, HPV DNA test, Biopsy.
• Treatment: Radiation, Chemotherapy, Surgery (Hysterectomy).

11. Ovarian Cancer

• Risk Factors: BRCA1/2 mutation, infertility, early menarche/late menopause.
• Symptoms: Abdominal bloating, pelvic pain, early satiety.
• Diagnosis: CA-125 marker, Pelvic ultrasound, Biopsy.
• Treatment: Surgery, Chemotherapy.

12. Uterine (Endometrial) Cancer

• Risk Factors: Obesity, Estrogen exposure, PCOS.
• Symptoms: Postmenopausal bleeding, pelvic pain.
• Diagnosis: Endometrial biopsy, Ultrasound.
• Treatment: Hysterectomy, Radiation.

VI. Connective Tissue & Musculoskeletal Cancers

13. Sarcoma

• Types: Osteosarcoma (Bone), Rhabdomyosarcoma (Soft tissue).
• Symptoms: Bone pain, swelling, fractures.
• Diagnosis: X-ray, MRI, Biopsy.
• Treatment: Surgery, Chemotherapy, Radiation.

VII. Nervous System

14. Brain Tumors

• Types: Glioblastoma (most aggressive), Meningioma, Astrocytoma.
• Symptoms: Headache, seizures, vision changes.
• Diagnosis: MRI, CT, Biopsy.
• Treatment: Surgery, Radiation, Chemotherapy.

VIII. Urinary & Male Reproductive System

15. Renal (Kidney) Cancer

• Risk Factors: Smoking, hypertension, obesity.
• Symptoms: Hematuria, flank pain, weight loss.
• Diagnosis: CT scan, Renal biopsy.
• Treatment: Nephrectomy, Immunotherapy.

16. Bladder Cancer

• Risk Factors: Smoking, exposure to industrial chemicals.
• Symptoms: Painless hematuria, frequent urination.
• Diagnosis: Cystoscopy, Biopsy.
• Treatment: TURBT (Transurethral Resection), BCG Therapy.

17. Prostate Cancer

• Risk Factors: Age >50, Family history, High-fat diet.
• Symptoms: Urinary urgency, weak stream, hematuria.
• Diagnosis: PSA test, Biopsy, MRI.
• Treatment: Surgery, Radiation, Androgen deprivation therapy.

🔥 High-Yield Key Points for Competitive Exams

✅ Most common cancer worldwide: Lung Cancer
✅ Most common cancer in men: Prostate Cancer
✅ Most common cancer in women: Breast Cancer
✅ Most common cancer in India: Oral Cancer (Men), Breast Cancer (Women)
✅ Gold standard test for Leukemia: Bone Marrow Biopsy
✅ Which cancer is linked with HPV infection? Cervical Cancer
✅ Which tumor marker is used for prostate cancer? PSA

🔥 High-Yield Oncology Notes for Competitive Exams 🔥

b) Oncological Emergencies

These are life-threatening conditions that require immediate medical intervention in cancer patients.

Emergency	Causes	Symptoms	Management
Tumor Lysis Syndrome (TLS)	Rapid tumor breakdown (leukemia, lymphoma)	Hyperkalemia, Hyperuricemia, Acute kidney injury	Hydration, Allopurinol, Rasburicase
Superior Vena Cava Syndrome (SVCS)	Compression by lung tumor, lymphoma	Facial/neck swelling, Dyspnea, Jugular vein distension	Radiation, Corticosteroids, Stenting
Spinal Cord Compression	Vertebral metastases (breast, lung, prostate cancer)	Back pain, Weakness, Bladder/bowel dysfunction	Dexamethasone, Radiation, Surgery
Hypercalcemia of Malignancy	Bone metastases (lung, breast, myeloma)	Fatigue, Nausea, Confusion, Polyuria	IV fluids, Bisphosphonates (Zoledronic Acid)
Neutropenic Sepsis	Chemotherapy-induced neutropenia	Fever, Chills, Hypotension	IV antibiotics, G-CSF (Filgrastim)
Pericardial Effusion/Tamponade	Metastatic cancer (lung, breast, leukemia)	Hypotension, Muffled heart sounds, Dyspnea	Pericardiocentesis, Chemotherapy
Syndrome of Inappropriate ADH (SIADH)	Small cell lung cancer	Hyponatremia, Seizures, Confusion	Fluid restriction, Hypertonic saline

c) Modalities of Cancer Treatment

1. Immunotherapy (Biologic Therapy)

• Boosts the immune system to attack cancer cells.
• Types:
  • Checkpoint Inhibitors: Pembrolizumab, Nivolumab (PD-1 inhibitors).
  • Monoclonal Antibodies: Trastuzumab (HER2+ Breast Cancer), Rituximab (Lymphoma).
  • CAR-T Cell Therapy: Used in Leukemia, Lymphoma.
  • Cytokines: Interferons, Interleukins.

2. Surgical Interventions

• Curative Surgery: Tumor removal in early-stage cancers.
• Palliative Surgery: Reduces symptoms in advanced cancer.
• Debulking Surgery: Reduces tumor size before chemotherapy/radiation.

3. Stem Cell & Bone Marrow Transplants

• Used for: Leukemia, Lymphoma, Multiple Myeloma.
• Types:
  • Autologous: Patient’s own stem cells.
  • Allogeneic: Donor stem cells.
  • Syngeneic: Identical twin donor.

4. Gene Therapy

• Modifies genes to stop cancer cell growth.
• Techniques: CRISPR, Viral Vectors.
• Used in: Melanoma, Hematologic cancers.

5. Other Forms of Treatment

• Targeted Therapy: Inhibits cancer cell growth using specific molecules (e.g., Imatinib for CML).
• Radiation Therapy: EBRT, Brachytherapy.
• Hormonal Therapy: Tamoxifen (Breast Cancer), Androgen Blockers (Prostate Cancer).

d) Psychosocial Aspects of Cancer

• Emotional Impact: Depression, Anxiety, Fear of Death.
• Financial Burden: Costly treatment, Loss of income.
• Social Issues: Stigma, Isolation.
• Coping Strategies: Counseling, Support Groups, Family Therapy.

e) Rehabilitation

• Physical Rehabilitation: Post-surgical mobility, Physiotherapy.
• Speech Therapy: After head, neck, or brain cancer.
• Occupational Therapy: Assisting in daily activities.

f) Palliative Care

1. Symptom & Pain Management

• Pain Control: Opioids (Morphine, Fentanyl), NSAIDs, Nerve Blocks.
• Other Symptoms:
  • Nausea/Vomiting: Ondansetron, Metoclopramide.
  • Dyspnea: Oxygen therapy, Morphine.
  • Fatigue: Physical activity, Nutrition.

2. Nutritional Support

• Cancer Cachexia: High-protein, High-calorie diet.
• Enteral/Parenteral Nutrition: If oral feeding is not possible.

g) Home Care

• Pain management at home.
• Wound care for surgical patients.
• Emotional support to family & caregivers.

h) Hospice Care

• For terminal cancer patients (<6 months life expectancy).
• Focus on comfort, dignity, quality of life.
• Provided at home, hospice centers, or hospitals.

i) Stomal Therapy

• For patients with colostomy, ileostomy, urostomy.
• Care: Stoma hygiene, Preventing skin irritation, Emotional support.

j) Special Therapies

• Hyperthermia Therapy: Uses heat to kill cancer cells.
• Photodynamic Therapy (PDT): Uses light-sensitive drugs to kill tumors.
• Cryotherapy: Freezing cancer cells.

k) Psycho-Social Aspects of Cancer

• Mental Health Support: Psychological counseling, Relaxation techniques.
• Family Support: Educating family members about patient care.

l) Nursing Procedures in Oncology

• Chemotherapy Administration: PPE use, Safe handling.
• Radiation Therapy Nursing Care: Skin care, Fatigue management.
• Pain Management: Opioid titration, Non-pharmacologic interventions.
• IV Cannulation & Blood Transfusion: Bone marrow suppression management.

m) Alternative Therapies

• Yoga & Meditation: Helps reduce stress & pain.
• Ayurveda & Herbal Medicine: Some herbs like turmeric have anti-cancer properties.
• Acupuncture: Helps in chemotherapy-induced nausea.

n) Drugs Used in Treatment of Oncological Disorders

Drug Class	Examples	Used For
Alkylating Agents	Cyclophosphamide, Cisplatin	Breast, Lung, Lymphoma
Antimetabolites	Methotrexate, 5-FU	Leukemia, Colon Cancer
Anthracyclines	Doxorubicin	Breast, Lymphoma
Topoisomerase Inhibitors	Etoposide, Irinotecan	Lung, Colon Cancer
Mitotic Inhibitors	Paclitaxel, Vincristine	Breast, Ovarian, Lung
Targeted Therapy	Imatinib, Trastuzumab	CML, Breast Cancer
Hormonal Therapy	Tamoxifen, Anastrozole	Breast Cancer
Checkpoint Inhibitors	Pembrolizumab, Nivolumab	Melanoma, Lung Cancer
Bisphosphonates	Zoledronic Acid	Bone metastases
Corticosteroids	Dexamethasone, Prednisone	Reduce inflammation, Edema

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🔥 High-Yield Key Points for Competitive Exams

✅ Most Common Oncological Emergency: Tumor Lysis Syndrome
✅ Best Drug for CML: Imatinib (Targeted Therapy)
✅ Checkpoint Inhibitor for Lung Cancer: Pembrolizumab
✅ Hormonal Therapy for Breast Cancer: Tamoxifen
✅ Treatment for Bone Metastases: Zoledronic Acid (Bisphosphonate)
✅ Most Common Side Effect of Chemotherapy: Myelosuppression (Bone Marrow Suppression)
✅ Gold Standard for Palliative Pain Management: Morphine