NCLEX-RN EXAMINATION FULL REVIEW ON ONCOLOGY
2023
General Information
▪ Definitions
▪ cancer is a term used for diseases in which abnormal cells
divide without control and are able to invade other tissues
▪ cancer types
▪ lymphoma and myeloma: cancers that begin in the
cells of the immune system
▪ carcinoma: cancer that begins in the skin or in tissues
that line or cover internal organs
▪ leukemia: cancer that starts in blood-forming tissue,
e.g., bone marrow, and causes large numbers of
abnormal blood cells to be produced and enter the
blood
▪ sarcoma: cancer that begins in bone, cartilage, fat,
muscle, blood vessels, or other connective or
supportive tissue
▪ central nervous system cancers: cancers that begin in
the tissues of the brain and spinal cord
▪ types of tumors
▪ benign: refers to a tumor or growth that is not
cancerous
▪ malignant: the uncontrolled growth of abnormal cells in
the body, i.e., cancerous cells, which are spread
through metastasis
▪ metastatic cancer: cancer that has spread from the place
where it first started (primary site or site of origin) to another
place in the body (the secondary site)
▪ almost any cancer can form metastatic tumors
▪ most common sites of cancer metastasis: lungs,
bones, liver
▪
Read the World Health Organization's Cancer Fact Sheet for
information about the impact of cancer worldwide.
5. staging: describes and classifies extent or spread of malignancy (most, but not all,
cancers are staged this way)
, Cancer Extent of Malignancy
Staging
T based on the size of the original (primary) tumor and whether or not it has
grown into nearby tissues
N whether or not the cancer has spread to the nearby lymph nodes
M whether or not the cancer has spread to distant areas of the body
TNM or Modified Duke System
Developed by the American Joint Committee on Cancer
6. grading: describes the degree of malignancy according to the type of tumor cell
o indicates the degree of cell undifferentiation
o cancers with more abnormal-looking cells tend to grow and spread faster
Cancer Grading Degree of Malignancy
stage 0 carcinoma in situ
stage I localized with tumor limited to the tissue of origin
stage II limited spread
stage III extensive local and regional spreading
stage IV distant metastasis
Most cancers are graded using a number from 1 to 3 or 4; the lower the number, the more the cancer cells look
like normal tissue.
2. Etiology
o generally unknown but may be caused by interacting factors
o cellular changes result from an interaction between a person's genetic factors
and 3 categories of external agents
▪ physical carcinogens, e.g., ultraviolet radiation
▪ chemical carcinogens, e.g., asbestos, components of tobacco smoke,
arsenic
▪ biological carcinogens, e.g. infections from certain viruses, bacteria or
parasites
o familial risk for certain cancers, e.g., lung, stomach, breast, colon, rectum, and
uterine
, o cancer is the second most common cause of death in the U.S
▪ leading causes of cancer death among men: lung, prostate, colorectal,
liver
▪ leading causes of cancer death among women: lung, breast, colorectal
(see risk factors for developing breast cancer)
▪
The National Cancer Institute has information about the cause,
diagnosis, prevention, and treatment and the continuing care of
cancer patients and their families.
Learn more about cancer and prevention at the American Cancer
Society Web site.
3. Warning signs: The seven warning signs of cancer (see below) and cancer screening
recommendations
Seven Warning Signs of Cancer
C Change in bowel or bladder habits
A A sore that does not heal
U Unusual bleeding or discharge from any part of the body
T Thickening or a lump in the breast or elsewhere
I Indigestion or difficulty swallowing
O Obvious change in a wart or mole
N Nagging cough or hoarseness
National Cancer Institute, U.S. National Institutes of Health
4. Diagnostics
o history and physical exam - depends on location of tumor
o radiographic studies, e.g., chest x-ray, mammogram
o biopsy: obtaining tissue for histological examination
▪ needle biopsy: aspiration of cells
▪ incisional biopsy: removal of a wedge of suspected tissue from a larger
mass
, ▪ excisional biopsy: complete removal of entire lesion or mass
▪ staging biopsy: multiple needle or incisional biopsies of suspected
metastasis
▪ sentinel lymph node biopsy (SLNB): to determine extent (stage) of
cancer
▪ vacuum-assisted biopsy: vacuum-assisted tissue biopsy (ex:
Mammotome breast biopsy)
o cytological studies, e.g., Papanicolaou's (Pap) smear
o proctoscopic examination, including guaiac for occult blood
o liver function studies
o imaging - using computerized tomography (CT scan), magnetic resonance
imaging (MRI)
o tumor markers - identifying biochemicals made and released by tumor cells, e.g.,
prostate-specific antigen (PSA), carcinoembryonic antigen (CEA), alpha-
fetoprotein
5. Treatment - based on stage and grade of tumor, treatment objective is to remove all traces of
the cancerous tissue
o surgery - specific to site and type of malignancy
o chemotherapy - use of chemical agents in the treatment or control of the disease
(adjuvant therapy)
How Chemotherapy Treatments Are Delivered
topical oral sublingual
subcutaneous intramuscular intravenous
PICC line non-tunneled catheters tunneled catheters
intraventricular (ommaya intraperitoneal (single use, intra-arterial
reservoir) & intrathecal Tenckhoff catheters, Port-a-
(lumbar puncture) cath)
intravesicular (med given intrapleural (chemo is inserted implantable (wafers with meds
through urinary catheter into a chest tube to control are implanted in former site of
directly into the bladder) malignant pleural effusions) brain tumor to kill tumor cells)
o radiation therapy - destroys cancer cells, with minimal exposure of normal cells to the
damaging effects of radiation (adjuvant therapy)
▪ external beam radiation (the source of the radiation is external to the client)
▪ brachytherapy: the radiation source comes into direct, continuous contact
with tumor tissues for a specific time (the source of the radiation is within the
client)
1. unsealed radiation source - administration is by oral or intravenous
route or by installation into a body cavity
2023
General Information
▪ Definitions
▪ cancer is a term used for diseases in which abnormal cells
divide without control and are able to invade other tissues
▪ cancer types
▪ lymphoma and myeloma: cancers that begin in the
cells of the immune system
▪ carcinoma: cancer that begins in the skin or in tissues
that line or cover internal organs
▪ leukemia: cancer that starts in blood-forming tissue,
e.g., bone marrow, and causes large numbers of
abnormal blood cells to be produced and enter the
blood
▪ sarcoma: cancer that begins in bone, cartilage, fat,
muscle, blood vessels, or other connective or
supportive tissue
▪ central nervous system cancers: cancers that begin in
the tissues of the brain and spinal cord
▪ types of tumors
▪ benign: refers to a tumor or growth that is not
cancerous
▪ malignant: the uncontrolled growth of abnormal cells in
the body, i.e., cancerous cells, which are spread
through metastasis
▪ metastatic cancer: cancer that has spread from the place
where it first started (primary site or site of origin) to another
place in the body (the secondary site)
▪ almost any cancer can form metastatic tumors
▪ most common sites of cancer metastasis: lungs,
bones, liver
▪
Read the World Health Organization's Cancer Fact Sheet for
information about the impact of cancer worldwide.
5. staging: describes and classifies extent or spread of malignancy (most, but not all,
cancers are staged this way)
, Cancer Extent of Malignancy
Staging
T based on the size of the original (primary) tumor and whether or not it has
grown into nearby tissues
N whether or not the cancer has spread to the nearby lymph nodes
M whether or not the cancer has spread to distant areas of the body
TNM or Modified Duke System
Developed by the American Joint Committee on Cancer
6. grading: describes the degree of malignancy according to the type of tumor cell
o indicates the degree of cell undifferentiation
o cancers with more abnormal-looking cells tend to grow and spread faster
Cancer Grading Degree of Malignancy
stage 0 carcinoma in situ
stage I localized with tumor limited to the tissue of origin
stage II limited spread
stage III extensive local and regional spreading
stage IV distant metastasis
Most cancers are graded using a number from 1 to 3 or 4; the lower the number, the more the cancer cells look
like normal tissue.
2. Etiology
o generally unknown but may be caused by interacting factors
o cellular changes result from an interaction between a person's genetic factors
and 3 categories of external agents
▪ physical carcinogens, e.g., ultraviolet radiation
▪ chemical carcinogens, e.g., asbestos, components of tobacco smoke,
arsenic
▪ biological carcinogens, e.g. infections from certain viruses, bacteria or
parasites
o familial risk for certain cancers, e.g., lung, stomach, breast, colon, rectum, and
uterine
, o cancer is the second most common cause of death in the U.S
▪ leading causes of cancer death among men: lung, prostate, colorectal,
liver
▪ leading causes of cancer death among women: lung, breast, colorectal
(see risk factors for developing breast cancer)
▪
The National Cancer Institute has information about the cause,
diagnosis, prevention, and treatment and the continuing care of
cancer patients and their families.
Learn more about cancer and prevention at the American Cancer
Society Web site.
3. Warning signs: The seven warning signs of cancer (see below) and cancer screening
recommendations
Seven Warning Signs of Cancer
C Change in bowel or bladder habits
A A sore that does not heal
U Unusual bleeding or discharge from any part of the body
T Thickening or a lump in the breast or elsewhere
I Indigestion or difficulty swallowing
O Obvious change in a wart or mole
N Nagging cough or hoarseness
National Cancer Institute, U.S. National Institutes of Health
4. Diagnostics
o history and physical exam - depends on location of tumor
o radiographic studies, e.g., chest x-ray, mammogram
o biopsy: obtaining tissue for histological examination
▪ needle biopsy: aspiration of cells
▪ incisional biopsy: removal of a wedge of suspected tissue from a larger
mass
, ▪ excisional biopsy: complete removal of entire lesion or mass
▪ staging biopsy: multiple needle or incisional biopsies of suspected
metastasis
▪ sentinel lymph node biopsy (SLNB): to determine extent (stage) of
cancer
▪ vacuum-assisted biopsy: vacuum-assisted tissue biopsy (ex:
Mammotome breast biopsy)
o cytological studies, e.g., Papanicolaou's (Pap) smear
o proctoscopic examination, including guaiac for occult blood
o liver function studies
o imaging - using computerized tomography (CT scan), magnetic resonance
imaging (MRI)
o tumor markers - identifying biochemicals made and released by tumor cells, e.g.,
prostate-specific antigen (PSA), carcinoembryonic antigen (CEA), alpha-
fetoprotein
5. Treatment - based on stage and grade of tumor, treatment objective is to remove all traces of
the cancerous tissue
o surgery - specific to site and type of malignancy
o chemotherapy - use of chemical agents in the treatment or control of the disease
(adjuvant therapy)
How Chemotherapy Treatments Are Delivered
topical oral sublingual
subcutaneous intramuscular intravenous
PICC line non-tunneled catheters tunneled catheters
intraventricular (ommaya intraperitoneal (single use, intra-arterial
reservoir) & intrathecal Tenckhoff catheters, Port-a-
(lumbar puncture) cath)
intravesicular (med given intrapleural (chemo is inserted implantable (wafers with meds
through urinary catheter into a chest tube to control are implanted in former site of
directly into the bladder) malignant pleural effusions) brain tumor to kill tumor cells)
o radiation therapy - destroys cancer cells, with minimal exposure of normal cells to the
damaging effects of radiation (adjuvant therapy)
▪ external beam radiation (the source of the radiation is external to the client)
▪ brachytherapy: the radiation source comes into direct, continuous contact
with tumor tissues for a specific time (the source of the radiation is within the
client)
1. unsealed radiation source - administration is by oral or intravenous
route or by installation into a body cavity
