Cancers, Hematologic Malignancies & Related Conditions

🧭 Cancers, Hematologic Malignancies & Related Conditions

• Scope: common solid tumors (lung, breast, cervical, laryngeal/oropharyngeal, colorectal, prostate, ovarian, gastric, skin) + hematologic cancers (acute/chronic leukemias, multiple myeloma) + treatment-related/oncologic conditions (mucositis, vesicant extravasation, transplant infection risk, etc.).

• Stage vs Grade: Stage (TNM) = anatomic spread; Grade (G1–G4) = cellular abnormality/aggressiveness.

• Prevention: Primary (HPV/HBV vaccination, smoking cessation, sun protection). Secondary (mammography, Pap/HPV testing, colonoscopy).

• Safety anchors: Febrile neutropenia → cultures then broad IV anti-pseudomonal antibiotics within 60 min; vesicant extravasation (e.g., doxorubicin) → stop → aspirate → cold compress + antidote → elevate → escalate; head/neck radiation → meticulous oral care + lifelong dental follow-up.

🧍‍♀️ Solid Cancers & Related Conditions

Definition/Patho	Key Risks	Hallmark/Clues	Diagnostics/Screening	First-Line Tx/Management	Nursing Responsibilities & Priorities
🫁 Lung cancer (non–small cell / small cell)	Cigarette smoke; radon; asbestos/silica; prior chest radiation; family history	Persistent cough, hemoptysis, weight loss; paraneoplastic (SIADH, hypercalcemia); SVC (superior vena cava) syndrome	Chest X-ray/CT; PET-CT; bronchoscopy or endobronchial ultrasound (EBUS); core biopsy; pulmonary function tests (PFTs) for surgery	NSCLC: surgery/radiation/immunotherapy/targeted; SCLC: chemo-radiation	Smoking cessation; dyspnea strategies; monitor immune-related adverse events; pre-op PFT education; red flags (new neuro/bone pain)
🌰 Benign pulmonary nodule/tumor	Prior infections; granulomas; hamartoma	Small, well-circumscribed, slow growth	Low-dose CT surveillance using risk calculators	Serial CT per guidelines; biopsy only if risk rises	Teach surveillance schedule; reduce radiation anxiety; prompt reporting of new symptoms
🎀 Breast cancer	BRCA/family history; early menarche/late menopause; obesity; alcohol; hormone therapy	Fixed, non-tender mass; skin dimpling/peau d’orange; pathologic nipple discharge; axillary nodes	Mammogram ± ultrasound; core needle biopsy; ER/PR/HER2 (estrogen/progesterone/HER2) status; MRI for high risk	Lumpectomy + radiation or mastectomy; endocrine therapy; chemo/targeted	Monthly self-exam timing; drain/ROM teaching; lymphedema precautions (no BP/venipuncture); manage endocrine side effects
🧴 Fibrocystic breast change (benign)	Premenopausal; caffeine sensitivity (some)	Cyclic tender nodularity; fluctuates with menses	Ultrasound; mammogram if indicated; benign biopsy if uncertain	Supportive: NSAIDs, well-fitting bra; limit caffeine if helpful	Reassure benign nature; teach to return for non-cyclic or persistent masses
👗 Cervical cancer (HPV-related)	High-risk HPV-16/18; smoking; early sexual activity; multiple partners; immunosuppression	Often silent; post-coital bleeding; discharge; Tis N0 M0 = Stage 0 (in situ)	Pap/HPV co-test → colposcopy/biopsy; staging imaging	Excision for Tis (LEEP/cone); stage-based surgery or chemoradiation; HPV vaccination	Vaccine counseling; Pap recall tracking; post-LEEP bleeding instructions; smoking cessation
🗣️ Laryngeal / Oropharyngeal cancers	Tobacco + alcohol; HPV-16 (oropharynx); poor oral hygiene	Hoarseness >2–3 weeks; sore throat/otalgia; dysphagia; neck mass	Flexible laryngoscopy; biopsy; HPV testing; staging CT/MRI	Radiation ± chemotherapy; partial/total laryngectomy; speech-language therapy	Airway readiness; aspiration precautions; humidification; stoma care; mucositis bundle; lifelong dental follow-up after radiation
🚽 Colorectal cancer	Age ≥45–50; family history; inflammatory bowel disease; obesity; low fiber; red/processed meats	Often silent; iron-deficiency anemia; change in habits; rectal bleeding	Colonoscopy every 10 years if average risk & normal; FIT yearly alternative; biopsy confirms	Polypectomy; stage-based surgery ± chemo/radiation	Bowel-prep coaching; post-polypectomy warnings; ostomy teaching if needed; interval reinforcement
♂️ Prostate cancer (post-op focus)	Age; family history; African ancestry; high saturated fat	Many LUTS are benign; PSA elevation; firm nodule on exam	PSA + digital rectal exam (DRE); MRI-fusion biopsy	Active surveillance vs prostatectomy vs radiation ± androgen deprivation	After prostatectomy: no heavy lifting ≥6 wks; pelvic-floor exercises; catheter care; report clots/retention; sexual/urinary side-effect support
🥚 Ovarian cancer	Age; BRCA/family history; nulliparity; endometriosis	Abdominal distention/bloating, early satiety, pelvic pressure	Pelvic exam; transvaginal ultrasound (TVUS); CA-125 trend; surgical staging	Cytoreductive surgery + platinum-based chemotherapy	Track girth/weights; nutrition support; VTE precautions; cisplatin toxicity watch; symptom diary
🍣 Gastric cancer	Helicobacter pylori; smoked/salted/spiced foods; nitrosamines; smoking	Early satiety, weight loss, epigastric pain; anemia	Esophagogastroduodenoscopy (EGD) + biopsy; staging CT	Gastrectomy ± peri-operative chemotherapy	Small, low-sugar meals; separate fluids; monitor dumping; B12/iron follow-up; NG care per order
☀️ Skin cancers (melanoma / basal cell / squamous cell)	UV/tanning; fair skin; immunosuppression	Melanoma: ABCDE changes; BCC: pearly rolled edge; SCC: scaly/bleeding plaque	Dermoscopy; excisional biopsy for melanoma; margins by type	Wide excision; sentinel node for select melanoma; RT/topicals for non-melanoma; systemic therapy if advanced	Sun protection (SPF ≥30, clothing, shade); wound care; teach self-skin checks and urgent return for changing lesions
🦷 Head & neck radiation late effects	Prior head/neck radiation	Xerostomia, dental caries, trismus, osteoradionecrosis	Dental exams; jaw ROM checks	Saliva substitutes; fluoride trays; SLP/jaw therapy	Daily oral care; lifelong dental follow-up; avoid extractions without oncology/dentistry input

🧪 Hematologic Malignancies & Related

Definition/Patho	Key Risks	Hallmark/Clues	Diagnostics/Screening	First-Line Tx/Management	Nursing Responsibilities & Priorities
🧒 ALL (acute lymphoblastic leukemia)	Childhood; prior chemo/radiation; genetic syndromes	Bone/joint pain, fever, petechiae/bruising, pallor	CBC (anemia, thrombocytopenia), blasts; marrow; lumbar puncture for CNS	Multi-agent chemo ± CNS prophylaxis; transplant select	Bleeding/infection precautions; transfusion support; oral care; fever = emergency
👴 CLL (chronic lymphocytic leukemia)	Older adults	↑ Lymphocytes, lymphadenopathy, fatigue; ± thrombocytopenia	CBC with differential; flow cytometry	Observe vs targeted (BTK/BCL-2 inhibitors)	Infection risk counseling; vaccine updates (avoid live vaccines if immunosuppressed); fatigue strategies
⚡ AML (acute myeloid leukemia)	Prior MDS/chemo; toxins	Cytopenias, infections, bleeding; APL subtype has DIC risk	CBC, blasts; marrow; coagulation studies	Induction chemo; ATRA/arsenic for APL; transplant select	Neutropenic fever protocol; tumor lysis watch; DIC monitoring (APL)
📈 CML (chronic myeloid leukemia)	BCR-ABL fusion (Philadelphia chromosome)	Fatigue, splenomegaly; very high WBC	CBC; BCR-ABL PCR	Tyrosine kinase inhibitors (imatinib class)	Adherence coaching; side-effect monitoring; serial PCR tracking
🦴 Multiple myeloma (malignant plasma cells)	Age; MGUS history	CRAB: hyperCalcemia, Renal injury, Anemia, Bone lesions/pain	SPEP/UPEP (serum/urine protein electrophoresis), serum free light chains; marrow; skeletal imaging	Triplet chemo; steroids; bisphosphonates; transplant candidate-dependent	Hydration; renal-safe meds; fracture prevention; infection prophylaxis; monitor calcium/creatinine
🔗 Hodgkin lymphoma	EBV association; young adult/older adult peaks	Painless cervical node; “B” symptoms (fever, night sweats, weight loss)	Excisional node biopsy (Reed–Sternberg cells); PET-CT	Combined chemo-radiation by stage	Fertility preservation talk; late-effect screening (thyroid, CV); infection precautions during therapy
🧬 Non-Hodgkin lymphoma (e.g., DLBCL)	Age; immunosuppression	Rapidly enlarging node/mass; “B” symptoms	Core/excisional biopsy; PET-CT; subtype markers	Immunochemotherapy (e.g., R-CHOP)	Tumor lysis risk planning; infection precautions; cardiac monitoring if anthracycline-based
🧯 Myelodysplastic syndrome (MDS)	Older age; prior chemo/radiation	Macrocytic anemia; bleeding/infections	CBC; marrow dysplasia	Supportive care; hypomethylating agents; transplant select	Transfusion support; infection/bleeding teaching; iron overload monitoring
🩸 Myeloproliferative neoplasms (PV/ET/MF)	JAK2 mutations common	PV: pruritus after bathing, ↑Hct; ET: thrombosis/bleeding; MF: massive spleen	CBC; JAK2 testing	Phlebotomy (PV); cytoreduction; JAK inhibitors	Teach thrombosis signs; hydrate; manage itch (PV); spleen precautions
🪫 Aplastic anemia (related condition)	Drugs, toxins, autoimmune	Pancytopenia; infections/bleeding	CBC; hypocellular marrow	Immunosuppression; transplant	Strict infection/bleeding precautions; transfusions per thresholds

🧯 Treatment-Related & Oncologic Conditions

Definition/Patho	Key Risks	Hallmark/Clues	Diagnostics/Screening	First-Line Tx/Management	Nursing Responsibilities & Priorities
👄 Mucositis (chemo/radiation)	Antimetabolites; head/neck radiation	Oral pain/ulcers; thrush; ↓ intake	Oral checks; weights	Salt + baking soda rinses; topical anesthetics; antifungals; oral ice with 5-FU	Analgesia before meals; soft/high-calorie diet; avoid alcohol/citrus rinses; dietician referral
💉 Vesicant extravasation (e.g., doxorubicin)	Peripheral IV; vesicants	Burning, swelling, erythema at site	Clinical	Stop → aspirate → cold (anthracyclines) / warm (vinca) + antidote → elevate → escalate	Photo/document; verify blood return before vesicants; late-injury education
🧬 HSCT (hematopoietic stem cell transplant) recipients	Myeloablative conditioning	Profound neutropenia; GVHD (graft-versus-host disease)	CBC; LFTs; skin/GI checks	Protective isolation; antimicrobial prophylaxis; GVHD prevention	No sick visitors; strict hand hygiene; safe-food handling; daily GVHD surveillance; revaccination plan
🧻 Radiation dermatitis/skin care	External-beam radiation	Erythema → dry/moist desquamation	Skin checks	Gentle cleansers; approved emollients; non-adhesive dressings	Do not remove skin marks; avoid sun/heat/ice on field; loose cotton clothing
🤢 Chemotherapy-induced nausea/vomiting (CINV)	Highly emetogenic drugs (e.g., cisplatin)	Acute/delayed nausea, dehydration risk	Risk assessment by regimen	5-HT3 antagonist + NK1 antagonist + dexamethasone before high-risk regimens; add olanzapine PRN	Give 30 min pre-chemo; send home scheduled antiemetics; hydration plan
🧷 Peripheral neuropathy (vinca/taxane)	Vincristine, paclitaxel	Stocking-glove numbness/tingling; constipation/ileus (vinca)	Neuro/bowel checks	Dose adjust; neuropathy meds; bowel regimen	Foot safety; fall prevention; start laxatives day 1 with vincristine
❤️ Anthracycline cardiotoxicity	Cumulative doxorubicin/epirubicin	Dyspnea, edema; ↓EF	Baseline/serial echocardiogram	Dexrazoxane select; limit lifetime dose	Monitor HF signs; report new SOB/edema promptly; avoid extra fluids if symptomatic
🧂 Cisplatin nephro/ototoxicity & electrolytes	Cumulative cisplatin	Rising creatinine; tinnitus/hearing loss; low magnesium	Creatinine, Mg; audiology	Pre/post-hydration; magnesium repletion	Daily weights/I&O; tinnitus checks; avoid nephrotoxins
⚡ Tumor lysis syndrome (TLS)	High-burden, chemo-sensitive tumors	↑K, ↑Phos, ↓Ca, ↑uric acid; AKI; arrhythmias	Electrolytes, uric acid; telemetry	Aggressive IV fluids; allopurinol or rasburicase; correct electrolytes	Telemetry; seizure precautions; strict I&O; avoid K/Phos loads
🫀 Superior vena cava (SVC) syndrome	Mediastinal mass	Facial/neck swelling, venous distention, dyspnea supine	Clinical + imaging	Elevate HOB; oxygen; urgent onc/rad-onc	Airway/oxygenation first; rapid escalation; avoid lying flat

🧩 NGN — Set 2 (12 Items)

1) Multiple Response — Primary Prevention

Select primary prevention actions:

• ☐ Human papillomavirus vaccination

• ☐ Annual mammography

• ☐ Smoking cessation program

• ☐ Yearly fecal immunochemical test

• ☐ Daily broad-spectrum sunscreen and shade

Answer: HPV vaccine; Smoking cessation; Sunscreen/shade.

2) Single Best — Read “Tis N0 M0”

• ☐ Stage I small invasive tumor

• ☐ Stage 0 (carcinoma in situ), no nodes/metastasis

• ☐ Stage II nodal disease

• ☐ Stage III local invasion

Answer: Stage 0.

3) Sequence — Doxorubicin Extravasation

Order: Stop → Aspirate → Cold + antidote → Elevate & notify.Answer: 2 → 3 → 1 → 4.

4) Calc + Priority — ANC

WBC 2.0×10⁹/L; neutrophils 30%; bands 10% → ANC = 800/µL.Priority: Reinforce neutropenic precautions; report any fever ≥38.0–38.3 °C; no rectal route.

5) Matrix — Chemo ↔ Toxicity

A. Cisplatin → 4 (nephro/ototoxicity; ↓Mg; highly emetogenic)B. Cyclophosphamide → 1 (hemorrhagic cystitis)C. Vincristine → 2 (neuropathy/ileus)D. Doxorubicin → 3 (cardiomyopathy; vesicant)

6) Multiple Response — Head/Neck Radiation Oral Care

Correct: salt–bicarb rinses, dental evaluation + lifelong follow-up, topical anesthetic before meals.Avoid: alcohol/lemon/spicy mouthwashes.

7) Single Best — Laryngeal Cancer Risk

Answer: Cigarette smoking (alcohol synergistic).

8) Multiple Response — Ovarian “Belly” Monitoring

Correct: girth & daily weights, symptom diary, assess dyspnea.Avoid: high-salt diet; delaying referral.

9) Drag & Drop — TLS Start-Up

Order: Baseline labs + telemetry → IV hydration → Uric-acid lowering → Strict I&O + seizure precautions.Answer: 2 → 1 → 3 → 4.

10) Single Best — Benign Lung Nodule

Answer: Serial surveillance CT per guideline.

11) Single Best — Colonoscopy Interval

Answer: Every 10 years if average risk & normal today.

12) Priority — Febrile Neutropenia

Answer: Peripheral + central cultures, then start broad IV anti-pseudomonal antibiotics within 60 minutes. Avoid rectal temps.