ADDITIONAL ONCO DISORDERS

I.LYMPHOMA: HODGKIN’S DISEASE

A.Description
1.Lymphomas classified as Hodgkins and Non Hodgkins depending on the cell type, are characterized by
abnormal proliferation of lymphocytes.
2.Hodgskins disease is a malignancy of the lymph nodes that originates in a single lymph njode or a chain
of lymph nodes
3. Metastasis occurs to other, adjacent lymph structures and eventually invades nonlymphoid tissue.
4. The disease usually involves lymph nodes, tonsils, spleen, and bone marrow
5.Possible causes include viral infections, clients treated with combination chemotherapy for Hodgkin’s
disease have a greater risk of developing acute leukemia and Non-Hodgkin’s lymphoma, among other
sexondary malignancies.
6.Prognosis depends on the stage of the disease

B. Assessment
1.Fever
2.Malaise, fatigue and weakness
3.Night sweats
4. Loss of appetite and significant weight loss
5.Anemia and thrombocytopenia
6.Enlraged lymph nodes, spleen and liver
7. Positive biopsy of lymph nodes, with cervical nodes most often affected first
8. Positive computed tomography (CT) scan of the liver and spleen

C. Interventions
1.First earlier stages, without mediastinal node involvement, the treatment of choice is extensive
external radiation of the involved lymph node regions
2.With more extensive disease, radiation and multiagent chemotherapy is used.
3. Monitor for side effects related to chemotherapy or radiation therapy.
4. Monitor for signs of infection and bleeding
5. Maintain infection and bleeding precautions
6. Discuss the possibility of sterility with the client receiving chemotherapy and/or radiation, and inform
the client of fertility option such as sperm banking.

II. Multiple Myeloma

A. Description
1.A malignant proliferation of plasma cells within the bone
2. The abnormal plasma cells an abnormal antibody found in the blood and urine
3. Multiple myeloma causes decreased production of immunoglobulin and antibodies and
increased levels of uric acid and calcium, which can lead to kidney failure.
4. The disease typically develops slowly and the cause is unknown

B. Assessment
1. Bone pain, especially in the ribs, spine and pelvis
2. Weakness and fatigue
3. Recurrent infection
4. Anemia
5. Urinalysis shows proteinuria and elevated total serum protein
6. Osteoporosis
1
ADDITIONAL ONCO DISORDERS

7. Thrombocytopenia and leukopenia

8. Elevated calcium and uric acid levels
9. Kidney failure
10. Spinal cord compression and paraplegia
11. Bone marrow aspiration shows abnormal number of immature plasma cells.

NOTE: The client with multiple myeloma is at risk for pathological fractures. Therefore, provide skeletal
support during moving, turning and ambulating and provide a hazard free environment

C. Interventions
-Administer chemotherapy as prescribed
-Provide supportive care to control symptoms and prevent complications , especially bonr
fractures, hypercalcemia, kidney failure and infections.
-Maintain neutropenic and bleeding precautions as necessary
-Encouraged the consumption of at least 2L of fluids per day to offset potential problems
associated with hypercalcemia, hyperuricemia, and proteinuria and encourage additional fluids
as indicated and tolerated
-Monitor for signs of kidney failure. Collect 24 hour urine as prescribed
-Encourage ambulation to prevent renal problems and to slow down bone resorption
-Administer IV fluids and diuretics as prescribed to increase renal excretion of calcium
-Administer blood transfusions as prescribed for anemia
-Adminsiter analgesics as prescribed and provide nonpharmacological therapies to control pain
-Adminsiter antibiotics as prescribed for infection
-Prepare client for local radiation therapy if prescribed
-Instruct the client in home care measures and signs and symptoms of infection
-Administer bisphosphonate medications as prescribed to slow down bone damage and reduce
pain and risk of fractures

III. INTESTINAL TUMORS

A. Description
1.Intestinal tumors are malignant lesions that develop in the cells lining the bowel wall or
develop in the cells lining the bowel wall or develop as adenomatous polyps in the colon or
rectum.
2.Tumor spread is by direct invasion and through the lymphatic and circulatory systems
3. Complications include bowel perforation with peritonitis, abscess and fistula formation,
haemorrhage and complete intestinal obstruction

B. Risk Factors for Colorectal Cancer

1. Age older than 50 years old
2. Familial polyposis, family history of colorectal cancer
3. Previous colorectal polyps, history of colorectal cancer
4. History of chronic inflammatory bowel disease
5. History of ovarian or breast, endometrial and stomach cancer

C. Assessment
1. Blood in the stool (most common manifestation)
-directed by FOBT, Colonoscopy
2.Anorexia, vomiting and weight loss
2
ADDITIONAL ONCO DISORDERS

3. Anemia
4.Abnormal stools
-Ascending colon tumor : diarrhea
-Descending colon TUMOR: Constipation or some diarrhea or flat, ribbon like stools caused by
partial obstruction
-Rectal tumor: alternating constipation and diarrhea
5.Guarding or abdominal distention, abdominal mass (late sign)
6. Cachexia (late sign)
7.Masses noted on colonoscopy, CT Scan, sigmoidoscopy

D. General Interventions
1. Monitor for signs of complications, which include bowel perforation with peritonitis, abscess
or fistula formation (fever associated with pain), hemorrahge (signs of shock) and complete
intestinal obstruction
2. Monitor for signs of bowel perforation, which include low blood pressure, rapid and weak
pulse, distended abdomen and elevated temprerature
3. Monitor for signs of intestinal obstruction, which includes vomiting (may be fecal contents),
pain, constipation, and abdominal distention; provide comfort measures
4. Note that an early sign of intestinal obstruction is increased peristalsis activity, which
produces an increase in bowel sounds; as the obstruction progresses, hypoactive bowel
sounds may be heard.
5. Prepare for radiation preoperatively to facilitate surgical resection and postoperatively to
decrease the risk of recurrence.

E. Nonsurgical intervention
1. Preoperative radiation for local control and postoperative radiation for palliation may be
prescribed.
2. Postoperative chemotherapy to control symptoms and the spread of the disease.

F. COLOSTOMY, ILEOSTOMY
1. Instruct the client in prescribed bowel preparation may be prescribed.
2. Antibiotics may be given as ordered to reduced the bacterial content in the colon.
3. Postoperative colostomy
a. Monitor the pouch system for proper fit and signs of leakage ; empty the pouch when
1/3 full.
b. Monitor the stoma for its size, unusual bleeding, color changes or necrotic tissue.
c. Expect liquid stool from an ascending colon colostomy, loose to semiformed stool from
a transverse colon colostomy, or close to normal stool from a descending colon
colostomy.
d. Note that the normal stoma color is red or pink, indicating high vascularity.
e. Note that a pale pink stoma indicates low haemoglobin and haematocrit levels.
f. Assess the functioning of the colostomy.
g. Expect that stools will be liquid postoperatively but will become more solid, depending
on the area of the colostomy.
h. Expect liquid stool from an ascending colon colostomy, loose to semiformed stool from
a transverse colon colostomy or close to normal stool from a descending colon
colostomy.
i. Fecal matter should not be allowed to remain on the skin.
3
ADDITIONAL ONCO DISORDERS

j. Administer analgesics and antibiotics as prescribed

k. Instruct the client to avoid foods that cause excessive gas formation and odor
4. Postoperative Ileostomy
a.Healthy stoma is red in color
b.Postoperative drainage will be dark green and progress to yellow as the client begins to
eat.
c. Stool is liquid
d.Risk for dehydration and electrolyte imbalance exists

4
ADDITIONAL ONCO DISORDERS

*MORPHINE SULFATE
-Watch out for MORPHINE TOXICITY
Myosis
Out of it (sedation)
Respiratory depression
Pneumonia (aspiration)
Hypotension
Infrequency
Nausea
Emesis

Antidote for Morphine toxicity

-Naloxone

*ONCOLOGIC EMERGENCIES
a. SEPSIS AND DISSEMINATED INTRAVASCULAR COAGULATION (DIC)
-increased risk for infection (sepsis)

b. SIADH (SYNDROME OF INAPPROPRIATE ANTIDIURETIC HORMONE)

-mild symptoms: weakness, muscle cramps, loss of appetite and fatigue
-serious signs: weight gain, personality changes, confusion, extreme muscle weakness

-Excessive amounts of water are reabsorbed by the kidney and put into the systemic circulation. . The
increased water causes hyponatremia and some degree of fluid retention . The syndrome is manage by
treating the condition and cause and usually includes fluid restriction, increased sodium intake and
medication with a mechanism of action that is antagonistic to antidiuretic hormone. Sodium levels are
monitored closely because of hypernatremia can develop suddenly as a result of treatment. In short the
common treatment are radiation, chemotherapy, serum sodium level monitoring and medication of
anatagonistic antidiuretic hormone

c.Spinal Cord Compression

-back pain
-neurological deficits; numbness, tingling of lower extremities, loss of urethral, vaginal and rectal
sensation and muscle weakness

d. Hypercalcemia
-early signs: fatigue, anorexia, nausea, vomiting, constipation and polyuria
-serious signs: severe muscle weakness, diminished deep tendon reflex, paralytic ileus, dhn, changes in
ecg
-Serum calcium level of of 12 ng/dl

e.Superior Vena Cava Sydrome

early sign:periorbital edema particularly in the morning
late sign: cyanosis and mental status changes

f. Tumor Lysis Sndrome

5
ADDITIONAL ONCO DISORDERS

*SCREENING
a. TSE (testicular self examination)
-done monthly after a hot shower in a standing position

b. BSE (breast self examination)

-b. it is done regularly, 7 days after the onset of the menstruation period

c. FOBT (fecal occult blood test)

-no red meats 3 days before the test
-no vit c 3 days before the test

d. colonoscopy
-done every 5 to 10 years

*MASTECTOMY
-Post mastectomy
*No IV’s, no injection, no bp taking, no venepuncture should be done on the affected arm on the
mastectomy side. The arm on the side of the mastectomy is protected, and any intervention that could
traumatized the affected arm is avoided because of the risk of lymphedema on this side
*Position the client in a semi fowler position , turn from the back to the unaffected arm elevated above
the level of the heart to promote drainage and prevent lymphedema

*COLORECTAL CANCER
-Risk factors
a.Age older than 50 years old
b.Family history of the disease
c.colorectal polyps
d.chronic inflammatory bowel disease

-Post operative bowel resection

a. Immediately after surgery, profuse serosanguineous drainage from the perineal wound is expected.
The HCP should change the dressing as prescribed.
b. Following abdominal resection the nurse would expect the colostomy to begin to function within 72
hours after surgery, although it may take up to 5 days. The nurse should assess for a return of
peristalsis , listen for bowel sounds and check for passage of flatus. Absent of bowel sounds would not
indicate the return of peristalsis.

*RADIATION THERAPY
-Radiation therapy destroys not only cancer cells but also normal cell, but with minimal damage to
normal cells
-Radiation therapy:
a.External
b. Internal

Nursing management for patients with implants

-No children and pregnant visitors
-Limit visitors to 30 minutes per day
6
ADDITIONAL ONCO DISORDERS

-Distance should be at least 6 ft

-If the implant is dislodge, the nurse should use a lead shield and use a long handle tong to pick up the
implant and put it on a lead container. NEVER PICK UP THE IMPLANT WITH YOUR HANDS
-Placing the client in a private room
-The nurse should wear a lead shield when caring for the patient

*MULTIPLE MYELOMA
-Malignant proliferation of plasma cells within the bond
-excessive numbers of abnormal plasma cells invades the bone marrow and ultimately destroys the
bone, invasion of the lymph nodes, spleen and liver occurs.
-Findings indicative of multiple myeloma are an increased number of plasma cells in the bone marrow,
anemia, hypercalcemia caused by the released of calcium from the deteriorating bone tissue and an
elevated blood urea nitrogen level.
-Hypercalcemia caused by bone destruction is priority concern in the client with multiple myeloma. The
nurse should administer fluids in adequate amounts to maintain a urine output of 1.5 to 2L/day; this
requires about 3 L of fluid intake per day.

*BLADDER CANCER
-Bladder cancer is a papillomatous growth in the bladder urothelium that undergoes malignant changes
and that may infiltrate the bladder wall.
-Signs and Symptoms:
a. Hematuria (MOST COMMON SYMPTOMS)
b. Frequency, dysuria, urgency
c. Clot induced obstruction
-Ureterostomy
a. Empty when 1/3 full
b. Urinary pouch in place as long as it is not leaking and change every 5 to 7 days
c. Change the appliance every morning
d. When taking a bath direct the water away from the stoma

*CHEMOTHERAPY
-The client who is at risk of bleeding due to low in platelet count should observe the following:
a. The patient should use electric razor
b. Should not take aspirin (blood thinner)
c. Should avoid contact sports
d. Should use soft bristle toothbrush
-The dosage of chemotherapy drugs given to the patient is based on the BSA of the patient. This should
be done by taking the height and weight of the patient on the day of the treatment.
e.The normal platelet count is 150,000 to 450,000 mm3. When the platelet count decreases the client is
risk for bleeding

-The client with low white blood cells (neutropenia) is at risk of having infection. The nurse should
instruct the patient to
a. Should always wear mask
b. Avoid crowded places
c. Teach the client and family about the need for hand hygiene
d. Should not eat uncook meats

7
ADDITIONAL ONCO DISORDERS

-Chemotherapeutic drugs is given in different ways, most of the chemotherapeutic drugs is given via IV
route. When giving chemo drugs via IV, precautions should be made in order to prevent extravasation.
Extravasation happens when chemo drugs leaks in the muscles. If extravasation happens the nurse
should:
1.Stop the infusion and inform the HCP
2. Ice and or heat may be prescribed for application to the site and an antidote may be prescribed to be
administered into the site

Antitumor antibiotics medication

1.Bleomycin
2.Doxorubicin
3.Valrubicin
4.Daunorubicin
-these are antineoplastic medications that causes interstitial pneumonitis, which can progress to
pulmonary fibrosis. Pulmonary function test along with haematological, hepatic and renal function tests
needs to be monitored. The nurse needs to monitor lung sounds for dyspnea and crackles which
indicate pulmonary toxicity. This medication needs to be discontinued and immediately refer to the ROD
if pulmonary toxicity occurs.

Hormonal Medications and Enzyme

Antiestrogen
1.Anastrazole
2.Fulvestrant
3.Raloxifen
4.Toremifene
5.Tamoxifen

Progestins
1.Medroxyprogesteron
2.Megestrol acetate

Other Hormonal AntagonistEnzymes

1.Mitotane
2.Asparginase

Mitotane and asparginase are contraindicated if hypersensitivity exists, in pancreatitis, of if the client
has history of pancreatitis. These medications impairs pancreatic functions and pancreatic function test
should be performed before therapy begins and when a week or more has elapsed between dose
administration. The patient should be monitored for pancreatitis, which include nausea, vomiting and
abdominal pain

Progestins suppresses the release of luteinizing hormones from the anterior pituitary by inhibiting
pituitary functions and regressing the size of the tumor. It is usually used in precaution in individuals
with venous thromboembolism.

8
ADDITIONAL ONCO DISORDERS

Antiestrogens, are widely used for the treatment of breast cancer. Produces objective tumor shrinkage
in advanced breast cancer, reduces the risk of relapse in women treated for invasive breast cancer, and
prevents breast cancer in high-risk women. It should not be used to treat other cancers

These drugs increases calcium, cholesterol and triglyceride levels. Before administration CBC and serum
calcium level should be assessed. These blood levels should be monitored periodically during the
therapy. The nurse should assess for hypercalcemia while the client is taking this medication. Signs of
hypercalcemia include increased in urine output, excessive thirst, nausea and vomiting, constipation,
hypotob=nicety of muscles and deep bone and flank pain.

Alkylating medications
1.Cisplatin
2.Thiotepa
3.Oxaliplatin
4.Busulfan
5.Chlorambucil

Chlorambusil may cause gonadal suppression

Cisplatin may cause ototoxicity
Busulfan may cause hyperurecemia, the nurse should monitor the uric acid level of the patient

Topoisomerase Inhibitors
1.Irinotecan
2.Topotecan
3.Teniposide
4Etoposide

Side effects:
1.Alopecia
2.Orthostatic Hypotension
3.Diarrhea

Mitotic Inhibitors
1.Vinblastine
2,Vincristine
3.Vinerolbine

An adverse effect of these type of medication is peripheral neuropathy, which occurs in almost every
client. Peripheral neuropathy can be manifested as numbness and tingling in the fingers and toes.
Depression of the Achilles tendon reflex may be the first clinical sign indicating peripheral neuropathy.

*PAIN MANAGEMENT
Causes of pain in cancer patients:
a.Bone destruction
b.Obstruction of an organ
c.Compression of peripheral nerved
d. Infiltration of tissue
9
ADDITIONAL ONCO DISORDERS

e.Inflammation

-In assessing the patients pain. The client’s report is a critical component of pain assessment. The nurse
should ask the client to describe the pain and listen carefully to the words the client uses to describe the
pain. The patients pain scale is the most important way to assess the patients pain

*GASTRIC CANCER
a. Following gastrectomy , drainage from the nasogastric tube is normally bloody for 24 hours
postoperatively, changes to brown tinged, and is then yellow or clear. Bloody drainage is expected in the
immediate postoperative period, the HCP should continue to monitor the drainage.
b. Postoperatively the client is usally kept on NPO until peristalsis returns (bowel sounds) , usually in 4 to
6 days. When signs of bowel function returns, clear fluid are given to the patient.

*HODGKINS
-Hodgkins disease is a chronic disease progressive neoplastic disorder of lymphoid tissue characterized
by the painless enlargement of lymph nodes with progression to extralymphatic sites, such as the spleen
and liver.

*OVARIAN CANCER
-Clinical manifestation of ovarian cancer include abdominal distention, urinary frequency and urgency,
pleural effusion, malnutrition, pain from pressure caused by the growing tumor and the effects or
urinary or bowel obstruction, constipation, ascites with dyspnea and ultimately general severe pain.

*PROSTATE CANCER
-In prostate cancer the manifestation that the cancer cell has invaded the bones are back pain and hip
pain. It is usually determined through monitoring the calcium level which usually indicates hyercalcemia
bwhich can be seen through changes in the electrocardiogram (late sign)

10