ONCOLOGICAL DISORDERS Assessment of Leukemia

• Anorexia
1. LEUKEMIA • Fatigue
• Malignant exacerbation in the number of • Weakness
immature leukocytes in the bone marrow. • Weight loss
• Maybe Acute (immature cells) or Chronic • Bleeding
(mature cells) • Petechiae
• Hyperthermia
Immature cells and mature cells reproduce in an
• Lymphadenopathy (enlargement of the
uncontrollable rate
lymph nodes) & Splenomegaly (enlargement

of the spleen)
Cell will go to the blood stream and lymphatic system • Palpitations & Tachycardia
• Orthostatic Hypotension
• Pallor and DOB on exertion
Organs will fail and not function properly • Headache
• Bone pain and Joint swelling
• Abnormal WBCs count
Crowd healthy cells - prevents bone marrow from • Decreased hgb and hct levels
producing
• Decreased platelet count
• Positive bone marrow biopsy
Risk factors: • Reveals a large percentage of immature
• Genetic cells – BLASTS
• Viral
• Immunologic Interventions
a. Prevent Infection (skin, respiratory, and GIT)
• Environment
• Protective isolation precautions
Classification of Leukemia o Hand washing and wearing or
a. Acute Lymphocytic – Age of onset: less than masks
15 years o Avoid crowds
b. Chronic Lymphocytic – Age of onset: after o Mouth care for mucositis (painful
50 years; twice as common in men as in inflammation and ulceration of the
women mucous membranes lining the
c. Acute Myelogenous – Age of onset: digestive tract)
between 15-39 years b. Prevent Bleeding
d. Chronic Myelogenous – Age of onset: after • Use caution when taking the BP
50 years • Measure abdominal girth – to check if there
is internal bleeding
Lymphocytic- Lymphocytes • Avoid injections, rectal suppositories,
Myelogenous – Monocytes enemas and thermometers
• Pad side rails and sharp corners of the bed
Lymphoblastic or Lymphocytic Leukemia • Avoid NSAIDs and ASA (promotes bleeding)
• The cancerous change takes place in a type of c. Fatigue and Nutrition
marrow cell that normally goes on to form • Well – balanced diet and small frequent
lymphocytes, which are infection – fighting feedings (High Calorie, CHON, CHO)
immune system cells • Adequate rest periods
• Most lymphocytic leukemia involve a specific d. Additional Interventions
subtype of lymphocyte, the B cell • Chemotherapy
• Antibiotics
Myeloid or Myelogenous Leukemia • Anti – viral meds
• The cancerous change takes place in a type of • Anti – fungal meds
marrow cell that normally goes on to form red • Colony stimulating factors as prescribed
blood cells, some other types of white cells, and • Bone marrow transplant
platelets
 3 main consequences of leukemia that cause the Precipitating Factors
most danger are:
• Neutropenia causing infections
• Anemia causing impaired oxygenation
• Thrombocytopenia leading to bleeding
tendencies
2. HODGKIN’S LYMPHOMA (HODGKIN’S DISEASE)
• Malignancy of the lymph nodes, tonsils, spleen,
and bone marrow that is characterized by the
presence of the REED- STERNBERG
(considered Lymphoid cell; most cases it is B
cell, clonal, and giant cell) cell in the nodes
• Is a cancer of the lymphatic system
Etiologic factors:
• Viral Infections Predisposing Factors
• Previous exposure to Alkylating chemical agents
• Genetics
Assessment of Cervical Cancer
Assessment of Hogkin’s Disease
• Fever
• Malaise, Fatigue, Weakness
• Night sweats
• Anorexia
• Anemia & Thrombocytopenia
• Enlarged lymph nodes, spleen, and liver
• Positive biopsy of lymph nodes
• Positive CT scan of the liver and spleen
• Bone pain
• Low – socio economic groups (most are
engaged in prostitution)
• Early first marriage, Early and frequent
intercourse (because the body is not yet
mature)
• Multiple sexual partners (increase risk of
STD, HIV)
• High Parity
• Poor Hygiene (prone to infection)
• Sex with uncircumcised males
• Smoking
• Chronic cervical infection
• Overweight status
• Poor hygiene
• Family history
• PAINLESS vaginal bleeding, post
menstrually and post – coitally
• Foul – smelling vaginal discharge
• Pelvic, lower back leg, or groin pain
• Anorexia
• Leakage of urine and feces from the vagina
• Dysuria
• Hematuria
• Cytological changes – changes in squamous
cell

Interventions Pap Smear: Screening

a. Extensive External Radiation of the involved
lymph node regions Class I Normal cells
b. Chemotherapy
Class II Atypical cells are present
Stage I and II
ABVD – Adriamycin (doxorubicin), Bleomycin, without abnormal
Vinblastine, and Dacarbazine features
Stage III and IV
Class III Cells have abnormal
ABVD + MOPP – Mechlorethamine, Oncovin
(Vincristine), Procarbazine, Prednisone features, suggestive but
c. Maintain infection and bleeding precautions not conclusive of
d. Male patients, offer options related to sperm
malignancy
banks
Class IV Cells and clusters fairly
3. CERVICAL CANCER conclusive of malignancy
• # 4 worldwide, #2 local Class V Cells and cell clusters
• Pre invasive – limited to the cervix
conclusive of malignancy
• Invasive – Cancer in the cervix and other pelvic
structures
 Diagnostic Tests • Klinefelter’s syndrome (XXY)
a. Colposcopy • Hepatic schistosomiasis
• Visualization of the cervix • Exposure to ionizing radiation
• Examines the cervix, tissues of vagina and • Prolonged heat exposure
vulva
b. Pap smear Clinical Manifestations
• Painless lump beneath the areola
Interventions • Nipple discharge, retraction, crusting or
a. Non – Surgical ulceration
• Chemotherapy
• Cryosurgery Assessment of Breast Cancer
• External and Internal Radiation • Mass felt during BSE – upper outer quadrant
• Laser Therapy • Nipple retraction of elevation
• Asymmetry of the affected breast
b. Surgical • Bloody or clear nipple discharfe
• Conization / Cold knife cone biopsy – • Skin dimpling – peau d’orange skin
removes sample abnormal tissue from • Axillary lymphadenopathy
cervix • Lymphedema of affected arm
• Hysterectomy • Presence of lesion on mammography
• Pelvic Exenteration – removal of organs in
the pelvic cavity (bladder, urethra, anus). PT Characteristics of Breast Cancer
will have colonoscopu and urinary diversion • A poorly defined, firm lump that is non –
tender and fixed to the skin
4. BREAST CANCER
• Is classified as invasive when it penetrates Mammography
the tissue surrounding the mammary duct General Guideline:
and grows in an irregular pattern • Begin screening 10 years earlier than the
• Growth of cancer in the cells of the breast age at which the youngest family member
developed breast cancer but not before 25
Precipitating Factors years old
• Family history
• Early menarche & late menopause Breast cancer can be detected early if breast self –
• Nulliparity exam (BSE) is done
• Obesity • Best performed after menses
• High fat diet o Premenopausal 5 to 7 days
• Age (>30 y/o) o Postmenopausal once a month
• Alcohol / smoking • Recommended to be performed in early 20’s
• Gender (American Cancer Society)

Breast Cancer in Men Interventions

• The American Cancer Society estimates for 1. Non – surgical
breast cancer in men in the United States • Chemotherapy
o About 2,240 new cases of invasive • Radiation therapy
breast cancer will be diagnosed • Hormonal Manipulation – Nolvadex
among men (tamoxifene)
o About 410 men will die from breast 2. Surgical
cancer • Lumpectomy – removal of the lump itselt
• Simple mastectomy – breast tissue, nipple
Risk Factors are removed
• A first degree male or female relative with 3. Modified Radical Mastectomy
breast CA • Breast tissue, nipple, and lymph nodes are
• Presence of the BRCA2 gene (breast cancer removed
genes)
4. Halsted Radical Mastectomy
• Breast tissue, nipple, lymph nodes, and
underlying muscles are removed

Mastectomy Indications
• The tumor involve the nipple – areola
complex
• The tumor is larger than 7 cm
• The tumor exhibits extensive intraductal
disease involving multiple quadrants of the
breast
• The woman cannot comply with radiation
therapy

Complications of Mastectomy
• Lymphedema
• Infection
• Seroma
• Hematoma
• Cellulitis