blood cancers

med/surg II exam 3

Where do most blood cancers originate, and what physiological process do they disrupt?

Most blood cancers originate in the bone marrow. They disrupt the normal production and function of blood cells as maturing stem cells become abnormal or cancerous.

What three mature blood cell types develop from hematopoietic stem cells in the red bone marrow?

White blood cells (WBCs), platelets, and red blood cells (RBCs).

What anatomical system is affected by lymphomas and myelomas, and what is its primary physiological purpose?

The lymph system, which is a core component of the body's immune system.

What specific cell type gives rise to Multiple Myeloma?

Plasma cells in the bone marrow.

How does a single mutated plasma cell lead to bone marrow dysfunction in Multiple Myeloma?

The abnormal plasma cell multiplies rapidly and crowds out healthy blood-producing cells in the bone marrow.

What specific chromosome anomaly is linked to the etiology of Multiple Myeloma?

Chromosome 14.

What primary hematological vulnerability occurs in clients with blood cancers due to lymphocyte impairment and chemotherapy?

Severe risk of infection secondary to impaired lymphocyte function and chemotherapy-induced neutropenia.

What are the two main categories of lymphoma, and which one is much rarer?

Hodgkin lymphoma and Non-Hodgkin lymphoma. Hodgkin lymphoma is a much rarer form.

How many subtypes of cancer fall under the category of Non-Hodgkin lymphoma?

More than 70 subtypes.

What global percentage of diagnosed cancers does Non-Hodgkin lymphoma account for?

Approximately 3% of all diagnosed cancers worldwide.

What is the 5-year survival rate for the most common forms of Non-Hodgkin lymphoma?

Around 74%.

What age groups are primarily affected by Hodgkin lymphoma?

Younger adults ages 20 to 39 and older adults past age 65.

Which specific viral and bacterial infections are linked as comorbidities to Non-Hodgkin lymphoma?

Hepatitis C, Human Immunodeficiency Virus (HIV), Epstein-Barr Virus (EBV), and Helicobacter pylori (H. pylori).

Which sex is more frequently affected by Non-Hodgkin lymphoma?

Men are affected more than women.

What age and sex demographic predominantly develops Multiple Myeloma?

Males over the age of 70 (accounting for 1.8% of new annual U.S. cancer diagnoses).

What are the hallmark clinical manifestations and lab findings of Multiple Myeloma?

Anemia, persistent bone pain, fatigue, elevated creatinine, unexplained weight loss, and hypercalcemia.

What process in Multiple Myeloma causes hypercalcemia?

Bone demineralization (breakdown of bone releasing calcium into the blood).

What clinical "red flag" manifestations indicate hypercalcemia in a client with Multiple Myeloma?

Increased thirst (polydipsia), increased urination (polyuria), bone and abdominal pain, nausea, vomiting, and altered mental status.

What kidney function lab value is characteristically elevated in Multiple Myeloma?

Creatinine (and BUN), reflecting renal damage.

What 24-hour urine test is ordered during the diagnostic evaluation of Multiple Myeloma?

A 24-hour urine test for protein.

What specialized diagnostic lab test is performed on plasma cells for Multiple Myeloma?

Plasma cell FISH (Fluorescence In Situ Hybridization).

What are the key modifiable risk factors associated with blood cancers?

Obesity, tobacco abuse, alcohol abuse, workplace/industrial chemical exposures, and sun/radiation exposure.

What specific chemical and environmental exposures increase the risk for Multiple Myeloma?

Radiation, Agent Orange, insecticides, and alcohol abuse.

What workplace environmental exposures are linked to Non-Hodgkin lymphoma?

Exposure to workplace chemicals, tobacco smoke, and radiation.

How does workplace chemical exposure interact with preexisting viral infections (HIV or Hepatitis C)?

Individuals with HIV or Hepatitis C who are exposed to industrial chemicals are more prone to developing Non-Hodgkin lymphoma.

What nonmodifiable risk factors are shared across blood cancers?

Advancing age, male sex, family history of blood cancer, and preexisting autoimmune diseases.

How does client age at diagnosis affect response to cancer treatment?

Children generally respond better to treatment than adults.

Why are older adults living alone at heightened safety risk during cancer treatment?

Severe fatigue and weakness make it difficult to perform ADLs independently, creating a high fall and injury risk.

What systemic manifestation is shared by both lymphoma and Multiple Myeloma?

Unexplained weight loss and severe fatigue.

Where does lymph node swelling (lymphadenopathy) typically present in a client with lymphoma?

Swelling of lymph nodes in the neck, groin, and underarms (axilla).

What skin manifestation is specifically associated with lymphoma?

Pruritus (skin that feels intensely itchy).

What systemic "B symptoms" are characteristic of lymphoma?

Persistent fever, drenched night sweats, and unexplained weight loss.

What respiratory clinical sign can occur in clients with lymphoma?

Shortness of breath (dyspnea).

Why do clients receiving cancer treatment develop severe anemia?

Treatments like chemotherapy destroy healthy rapidly dividing red blood cell precursors in the marrow alongside cancer cells.

What causes anorexia and loss of appetite in blood cancer clients?

Metabolic changes, hypercalcemia (in myeloma), treatment side effects, and nausea.

What diagnostic procedure confirms a diagnosis of lymphoma?

A lymph node biopsy or excisional removal of an affected lymph node.

What two primary anatomical sites are used for a bone marrow aspiration and biopsy?

The posterior iliac crest or the breastbone (sternum).

What components are extracted during a bone marrow biopsy needle procedure?

A small piece of bone, bone marrow, and blood.

What imaging modalities are used in the diagnostic workup for blood cancers?

CT scans and MRI scans.

What blood test evaluates white blood cells, neutrophils, red blood cells, and platelets?

A Complete Blood Count (CBC) with differential.

Why is microscopic analysis by a pathologist essential for diagnosing blood cancers?

To examine bone marrow and blood tissue for the presence of abnormal or malignant cells.

How does cytotoxic chemotherapy work, and what healthy cells are affected?

Chemotherapy uses cytotoxic drugs that target and kill rapidly dividing cells, affecting both cancer cells and healthy cells (leading to immunosuppression, nausea, mucositis, and hair loss).

What is radiation therapy, and when is it utilized in blood cancers?

High-energy x-rays used to destroy cancer cells; used alone or combined with other therapies for localized disease or symptom relief (palliation).

What drug classes and advanced cell therapies fall under immunotherapy for blood cancers?

Monoclonal antibodies, immune checkpoint inhibitors, and CAR T-cell therapy.

What is the difference between an autologous and an allogeneic stem cell transplant?

An autologous transplant replaces marrow using stem cells harvested from the client's own body. An allogeneic transplant uses stem cells from a matched donor.

How does targeted therapy differ from traditional cytotoxic chemotherapy?

Targeted therapy interferes with specific molecules involved in cancer cell growth, minimizing damage to normal cells and causing fewer systemic side effects.

NCLEX Priority: What is the #1 priority for a nurse caring for a client with a blood cancer?

Infection prevention and early identification of fever/sepsis due to severe immune suppression and neutropenia.

What specific infection control measures must the nurse teach to a neutropenic client?

Strict hand hygiene, following food safety practices (avoiding raw foods), avoiding crowds, and avoiding contact with sick individuals or visitors.

What red flag symptoms must a blood cancer client report to their provider immediately?

Fever, active bleeding / unexpected bruising, or acute shortness of breath.

What energy conservation techniques should the nurse teach to manage severe cancer-related fatigue?

Schedule frequent rest periods throughout the day, cluster activities, prioritize essential tasks when energy peaks, and ask for assistance with daily activities.