ONCOLOGY BULLETS

The most common assessment finding in Hodgkins disease is the presence of a

large and painless lymph node(s), often located in the neck. Biopsy of the node
reveals the presence of Reed-Sternberg cells.
Special swish and spit mixtures are available to treat mucositis (stomatitis)
and many contain a local anesthetic combined with anti-inflammatory agents.
The client should be taught not to swallow these mixtures.
Radiation therapy is effective on tissues directly within the path of the radiation
beam.
Breast self-examination should be done monthly 7 to 10 days after menses.
Postmenopausal clients should select a specific day of the month and perform
BSE monthly on that day.
The client with multiple myeloma is at risk for pathological fractures.
Testicular self-examination needs to be performed monthly. A day of the month is
selected and the examination is performed on the same day each month.
Pain is what the client describes or says that it is. Do not undermedicate the
cancer client who is in pain.
Premalignant changes for cervical cancer are described on a continuum from
dysplasia, which is the earliest premalignancy change, to carcinoma in situ, the
most advanced premalignant change.
The risk of prostate cancer increases in men with each decade after the ae of 50.
Postmenopausal clients or clients who have had a hysterectomy should select a
specific day of the month and perform breast self-examination (BSE) monthly on
that day.
Pain is a very individualized experience. It is what the client describes or says it
is.
Monthly testicular self-examination is the method of early detection of testicular
cancer. The nurse needs to teach the client the procedure for performing this
self-examination.
Hospice care is a concept of care for terminally ill clients that include the idea of
intensive caring rather than intensive care. The client and the family are the
focus of nursing care, and the goal is to relieve pain and facilitate an optimal
quality of life.
The nurse must assess the clients pain; pain is what the client describes or says
that it is. The nurse must not undermedicate the cancer client who is in pain.

 The nurse should obtain a drug history from the client before the administration
of an opioid analgesic. Some medications may be contraindicated if the client
has a history of opioid dependency because these medications can precipitate
withdrawal symptoms.
A coping mechanism involves any effort to decrease anxiety.
For the client using defense mechanisms, the nurse should assist the client to
identify the source of anxiety and explore methods to reduce anxiety.
Denial is the disowning of consciously intolerable thoughts and impulses.
Outcomes related to care during illness and the dying experience should be
based on the clients wishes.
The nurse should provide the client with alopecia from chemotherapy with
information on purchasing a wig. The nurse should also inform the client that the
hair will grow back, but may be a different color and texture.
Parenteral nutrition is the administration of a nutritionally complete formula
through a central or peripheral intravenous catheter.
For the client who has undergone a nephrectomy, the nurse should monitor
specifically for abdominal distention, decreases in urinary output, and alterations
in level of consciousness as signs of bleeding; the nurse should also check the
bed linens under the client for bleeding.
The nurse should monitor the clients progression through the stages of grieving.
Not all clients will progress in the same manner, and may progress from one
stage to another in no logical order.
The client undergoing external radiation therapy does not emit radiation and
does not pose a hazard to anyone else.
Teach the client how to perform testicular self-examination (TSE); a day of the
month is selected and the exam is performed on the same day each month after
a shower or bath when the hands are warm and soapy and the scrotum is warm.
The nurse should teach the client receiving radiation therapy to wash the
irradiated area gently each day with warm water alone or mild soap and water.
The client should use the hand rather than a washcloth to wash the area.
Malignancies of the abdomen may be treated with the instillation of
chemotherapeutic agents into the peritoneal cavity or with external radiation.
Following laryngectomy (radical neck dissection) place the client in a semiFowlers to Fowlers position to maintain a patent airway and minimize edema.
Minimal bleeding is associated with cervical laser surgery.

 The nurse should teach the client how to perform testicular self-examination
(TSE). The nurse should tell the client to gently lift each testicle, and that each
one should feel like an egg, should be firm but not hard, and smooth with no
lumps. Also teach the client to notify the physician if any changes are noted.
Fibrocystic breast changes occur most frequently in women between 35 and 50
years of age but often begin as early as 20 years of age.
After radical vulvectomy, monitor the client closely for signs of infection.
Infertility is a concern after bilateral orchiectomy. Options such as sperm banking
should be discussed with the client in the preoperative period.
Risk factors for cervical cancer include early first intercourse (before age 17),
multiple sex partners, or male partners with multiple sex partners.
With carcinoma of the breast, the mass is usually felt in the upper outer
quadrant, beneath the nipple, or in the axilla.
The epidural method of administration of pain medication reduces the amount
needed to control pain; therefore the client experiences fewer side effects.
After mastectomy with axillary lymph node dissection, the client is at risk for
lymphedema.
Estrogens are steroids that stimulate female reproductive tissue.
Instruct the client who underwent cryosurgery with laser therapy to avoid
intercourse and the use of tampons while vaginal discharge is present.
If a breast reconstruction was performed after the mastectomy, the client will
probably return from surgery with a surgical brassiere and prosthesis in place.
In the postoperative period after mastectomy, initiate pain control measures
before beginning prescribed exercises to promote participation in the exercise
plan.
Monitor the platelet count closely in clients receiving chemotherapy because of
the risk for thrombocytopenia.
Teach the client how to perform the BSE, and tell the client that the selfexamination needs to be performed monthly.
The client who had a hysterectomy or the postmenopausal client should select a
specific day of the month and perform BSE monthly on that day.
Superior vena cava syndrome is an oncological emergency. Other oncological
emergencies include sepsis and disseminated intravascular coagulation (DIC),
syndrome of inappropriate antidiuretic hormone (SIADH), spinal cord
compression, hypercalcemia, and tumor lysis syndrome.

 To ensure safety, the physician should be consulted before beginning a

complementary and alternative therapy regimen.
The physician is notified if extravasation at an infusion site occurs because
tissue necrosis can occur.
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.
No intravenous injections, no blood pressure measurements, and no
venipunctures for blood draws should be done in the arm on the side of the
mastectomy.
Nurses who are pregnancy need to avoid chemotherapy preparation or the
administration of chemotherapy.
The client receiving chemotherapy needs to be instructed to assess the oral
cavity for inflammation at least daily. If inflammation or ulceration is noted, the
health care provider needs to be notified.
Monitor the client receiving chemotherapy for fever, sore throat, other signs of
infection, and unusual bleeding; these could indicate neutropenia or
thrombocytopenia.
Following cryosurgery, instruct the client to avoid intercourse and the use of
tampons while the discharge is present.
For the dying client, the nurse should provide care based on the cultural and
religious practices and beliefs of the client.
Coping mechanisms are behaviors used to decrease stress and anxiety.
Side effects from chemotherapy result from the effects of the antineoplastic
medication on normal cells.
Following mastectomy, the nurse should position the client in a semi-Fowlers
position, with the affected arm elevated above the level of the heart to promote
drainage and prevent lymphedema.
The client with a low neutrophil count is at risk for developing a life-threatening
infection. The nurse needs to implement measures to protect the client and
monitor for signs of infection.
Anesthesia is not required for cryosurgery. The client should be informed that
cramping may occur during this procedure.
Infection is a primary concern following radical vulvectomy. Monitor the client
closely for signs of infection.

 The risk for prostate cancer increases in men with each decade after the age of
50.
Infection is a major cause of death in the immunosuppressed client.
Laser therapy may be used to treat cervical cancer when all boundaries of the
lesion are visible during colposcopic examination.
Following conization for the treatment of cervical cancer, long-term follow-up
care is needed, because new lesions can develop.
For the client with severe hypercalcemia, renal dialysis may be necessary if
medications fail to reduce the serum calcium level.
The nurse should instruct the client to perform a monthly skin assessment and
look for any new lesions or lesions that have changed in size or in other
characteristics.
The nurse should instruct the client to follow the American Cancer Societys
guidelines for screening for colorectal cancer.
BSE should be performed 7 to 10 days after the menses; postmenopausal clients
or clients who have had a hysterectomy should select a specific day of the
month and perform BSE monthly on that day.
Performing a TSE monthly on the same day each month allows for early
detection of any abnormalities.
Malignant melanoma is highly metastatic, and a persons survival depends on
early diagnosis and treatment.
No procedures, such as intravenous (IV) insertions or blood pressure
measurements, should be performed on the affected side for the client who has
undergone a mastectomy.
For the client with a colostomy, the nurse should monitor the pouch system for
proper fit and signs of leakage and empty the pouch when it is one-third full.
No intravenous insertions, no injections, no blood pressure measurements, and
no venipunctures should be done in the arm on the side of the mastectomy. The
arm on the side of the mastectomy is protected, and any intervention that could
traumatize the affected arm is avoided.
A Papanicolaou smear is a painless screening test for cervical cancer. A
specimen is obtained during speculum examination, and the nurse helps prepare
the specimen for laboratory analysis.
Hodgkins disease is characterized by the presence of Reed-Sternberg cells
noted in a lymph node biopsy specimen.

 Ovarian cancer grows rapidly, spreads fast, and is often bilateral. In most cases,
it is not diagnosed until it advanced stage.
Decreased physical mobility contributes to or worsens hypercalcemia. Early
signs include fatigue, anorexia, nausea, vomiting, constipation, and polyuria.
More serious include severe muscle weakness, diminished deep tendon reflexes,
paralytic ileus, dehydration, and changes in the electrocardiogram.
For the client receiving external radiation, high doses of radiation can cause
sickness. Some signs and symptoms of radiation sickness include nausea and
vomiting, diarrhea, fever, electrolyte imbalances, neurological and
cardiovascular impairment, leukopenia, purpura, and hemorrhage.
Diagnosis for breast cancer is made by breast biopsy through a needle aspiration
or by surgical removal of the tumor with microscopic examination for malignant
cells.
Breast cancer is classified as invasive when it penetrates the tissue surrounding
the mammary duct and grows in an irregular pattern.
The client who has undergone a mastectomy should not use a straight razor to
shave under the arms because of the risk of infection; she should use an electric
razor instead.
A common side effect of extensive irradiation is malaise and fatigue.
Pain from renal cancer is usually a late manifestation and is localized in the flank
area.
When communicating with a client always focus on the clients thoughts,
feelings, concerns, anxieties, and fears.
Instruct the client receiving radiation therapy to avoid exposure to the sun and
other extreme temperature changes.
A Papanicolaou smear is a painless screening test for cervical cancer; the
specimen is obtained during the speculum examination, and the nurse helps
prepare the specimen for laboratory analysis.
Multiple myeloma causes decreased production of immunoglobulin and
antibodies and increased levels of uric acid and calcium, which can lead to renal
failure.
Testicular cancer most often occurs in individuals between the ages of 15 and 40
years.
Monitor complete blood cell count, particularly the white blood cells, frequently
in a client receiving chemotherapy; if leukopenia develops, the physician is
notified.

 No IVs, no injections, no blood pressure measurements, and no venipunctures

should be done in the arm on the side of the mastectomy. The arm on the side of
the mastectomy is protected, and any intervention that could traumatize the
affected arm is avoided.
Airway is the priority for a client with lung or laryngeal cancer. Additionally
superior vena cava (SVC) syndrome occurs when the SVC is compressed or
obstructed by tumor growth (commonly associated with lung cancer and
lymphoma).
Leukemia affects the bone marrow, causing anemia from decreased
erythrocytes, infection from neutropenia, and bleeding from decreased platelet
production (thrombocytopenia); laboratory tests should be monitored regularly
and the appropriate precautions should be instituted.
Monitor the platelet count closely in clients receiving chemotherapy because of
the risk for thrombocytopenia.
Always check the physicians prescription regarding positioning for the client
who had a thoracotomy, lung wedge resection, lobectomy of the lung, or
pneumonectomy.
Regular physical examinations and mammograms should be done as prescribed
for the early detection of cancer.
During a Papanicolaou test, the specimen is obtained during the speculum
examination, and the nurse helps prepare the specimen for laboratory analysis.
Radiation therapy may be prescribed for localized intrathoracic lung and for
palliation of obstructions, dysphagia, superior vena cava syndrome, and pain.
Prepare the client with cancer of the prostate for external beam radiation or
brachytherapy, which may be prescribed alone or with surgery, preoperatively or
postoperatively, to reduce the lesion and limit metastasis.
Monitor the neutrophil count closely in a client receiving chemotherapy because
of the risk for neutropenia and infection.
The normal platelet count is 150,000 to 400,000 cells/mm3.
For cervical cancer, metastasis usually is confined to the pelvis, but distant can
occur through lymphatic spread.
The risks associated with conization used to treat microinvasive cervical cancer
include hemorrhage, uterine perforation, incompetent cervix, cervical stenosis,
and preterm labor in future pregnancies.

 Common sites of metastasis of bladder cancer include the liver, bones, and
lungs. As the tumor progresses, it can extend into the rectum, vagina, other
pelvic soft tissues, and retroperitoneal structures.
Bladder wash specimens and biopsy may be done to confirm the diagnosis of
bladder cancer.
The intravesical instillation of an alkylating chemotherapeutic agent into the
bladder for the treatment of bladder cancer provides a concentrated topical
treatment with little systemic absorption.
Potential complications following creation of a ureterostomy include infection,
skin irritation, and obstruction to urinary flow as a result of strictures at the
opening of the stoma.
If severe lymphedema occurs following mastectomy, diuretics and a low-salt diet
may be prescribed.
Hodgkins disease is characterized by the presence of Reed-Sternberg cells
noted in a lymph node biopsy specimen.
After pelvic exenteration, monitor the client for altered respiratory status,
hemorrhage, shock, and deep vein thrombosis.
For the client receiving chemotherapy and radiation that affects the reproductive
organs, offer the opportunity for sperm and ova banking before treatment for
clients of childbearing age.
Increased intracranial pressure may result from edema in the central nervous
system in the client receiving radiation.
For the client receiving radiation therapy for bowel cancer, in addition to
monitoring for fistula formation, monitor for signs of bowel perforation, which
include low blood pressure, rapid and weak pulse, distended abdomen, and
elevated temperature.
Hypersensitivity syndrome can occur while taking allopurinol (Zyloprim),
although it is rare. It is characterized by rash, fever, eosinophilia, and liver and
kidney alterations (medication is withheld and the physician is notified).
In the client receiving chemotherapy, a low white blood cell count (neutropenia)
is common. The plan of care centers on the immune system and protecting the
client from infection.
No single causative agent has been identified as a cause for gastric cancer, but
it is believed that Helicobacter pylori infection and a diet of smoked, highly
salted, processed, or spiced foods have carcinogenic effects; other risk factors
include smoking, alcohol and nitrate ingestion, and a history of gastric ulcers.

 If a client has an NG tube connected to suction, the nurse should wait 30 to 60

minutes after medication administration before reconnecting the tube to the
suction apparatus to allow adequate time for medication absorption.
The client should follow the American Cancer Societys guidelines for screening
for colorectal cancer.
Monitor the client with a colon tumor for signs of complications, which include
bowel perforation with peritonitis, abscess or fistula formation (fever associated
with pain), hemorrhage (signs of shock), and complete intestinal obstruction.
Prepare the client with colon cancer for radiation preoperatively to facilitate
surgical resection and postoperatively to decrease the risk of recurrence or to
reduce pain, hemorrhage, bowel obstruction, or metastasis.
Immediately after surgery for abdominal perineal resection, profuse
serosanguineous drainage from the perineal wound is expected. The nurse does
not need to notify the physician at this time.
A patent airway is a primary concern for a client with laryngeal cancer.
Pulmonary fibrosis can occur as a result of chemotherapy and radiation and can
be detected on chest x-ray.
Instruct the client receiving radiation therapy not to remove the markings or
tattoos that have been placed on the body. These marks are important in
ensuring radiation is being aimed at the right area of the body.
A lead container and long-handled forceps should be kept in the clients room at
all times during internal radiation therapy. If the implant becomes dislodged, the
nurse should pick up the implant with long-handled forceps and place it in the
lead container.
Pericarditis and myocarditis can occur in the client receiving chemotherapy and
radiation for up to 1 year after treatment has ended.
Life-threatening manifestations that can occur as a result of superior vena cava
syndrome include airway obstruction, hemorrhage, cyanosis, mental status
changes, decreased cardiac output, and hypotension.
Place the client who has undergone radical neck dissection in a semi-Fowlers or
Fowlers position to maintain a patent airway and minimize edema at the
surgical site.
Teaching regarding cancer prevention is a vital nursing role. Avoidance of known
or potential carcinogens and avoidance or modification of the factors associated
with the development of cells is important in cancer prevention.

 Therapeutic management for aplastic anemia focuses on restoring function to

the bone marrow and involves immunosuppressive therapy and bone marrow
transplantation (treatment of choice if a suitable donor exists).
The nurse implements neutropenic precautions when the clients white blood cell
values fall sufficiently below the normal level. The nurse should also monitor for
fever, sore throat, or other signs and symptoms of infection.
Encouraging independence in the hospitalized client facilitates recovery and
leads to readiness for discharge to home.
Leukemia may be acute, with a sudden onset, or chronic, with a slow onset and
persistent symptoms over a period of years.
Multiple myeloma causes decreased production of immunoglobulin and
antibodies and increased levels of uric acid and calcium, which can lead to renal
failure.
Cancer of the osteogenic type usually is found in the metaphysis of long bones,
especially in the lower extremities, with most tumors occurring in the femur.
Postmenopausal clients or clients who have had a hysterectomy should select a
specific day of the month and perform breast self-examination monthly on that
day.
The primary treatment modalities for Hodgkins disease are radiation and
chemotherapy; each may be used alone or in combination, depending on the
clinical stage of the disease.
When teaching a client how to do breast self-examination (BSE), instruct the
client to raise the arms overhead and check for any changes in the shape of the
breasts, dimpling of the skin, or any changes in the nipple.
Pelvic exenteration, the removal of all pelvic contents, including bowel, vagina,
and bladder, is a radical surgical procedure performed for recurrent cancer if no
evidence of tumor outside the pelvis and no lymph node involvement exist.
Monitor vaginal bleeding following hysterectomy. More than one saturated pad
per hour may indicate excessive bleeding.
Encourage the client who has undergone mastectomy to perform breast selfexamination on the remaining breast.
When teaching proper techniques regarding breast self-examination (BSE),
instruct the woman to perform the examination monthly 7 to 10 days after
menses. Postmenopausal clients or clients who have had a hysterectomy should
select a specific day of the month and perform BSE monthly on that day.

 Side effects of radiation therapy include local skin changes and irritation,
alopecia (hair loss), fatigue (most common side effect of radiation), and altered
taste sensation. The effects vary according to the site of treatment.