Hematologic Neoplasms

Michelle Disla
Catherine Feger
Kevin Gomez
Harpreet Kaur
Jhane Figueroa
Nomenclature
- “Oma” = benign neoplasm
1. Mesenchymal tumors
a. Chondroma: cartilaginous tumor
b. Fibroma: fibrous tumor
c. Osteoma: bone tumor

2. Epithelial tumor

d. Adenoma: tumor forming glands

e. Papilloma: tumor with finger like
projections
f. Polyp: tumor that projects above
a mucosal surface
 ● When hematopoiesis (the rapid and
continuous turnover of blood cells) is
disrupted - the cells can proliferate
What is a hematologic excessively which causes the development of
hematologic neoplasms.
neoplasm? ● Hematologic neoplasms are multiple
malignant diseases that come from myeloid
or lymphoid cells.
● These malignant diseases include:
○ Leukemias:
■ Acute Myeloid Leukemia (AML)
■ Chronic Myeloid Leukemia (CML)
■ Acute Lymphocytic Leukemia (ALL)
■ Chronic Lymphocytic Leukemia (CLL)
○ Myeloproliferative Disorders:
■ Polycythemia Vera
■ Essential Thrombocythemia
■ Primary Myelofibrosis
○ Lymphomas:
■ Hodgkin
■ Non-Hodgkin Lymphoma
○ Others:
■ Multiple Myeloma
■ Myelodysplastic Syndromes (MDS)
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Acute Myeloid Leukemia (AML)
Is a cancer of the bone marrow and the blood
Progresses rapidly without treatment
Affects mostly cells that aren't fully
developed- these cells can't carry out their
normal functions
The factors that raise your risk of AML include:
- Being male
- Smoking, especially after age 60
-
-
Having had chemotherapy or radiation therapy
Treatment for acute lymphoblastic leukemia (ALL) as a child
- Exposure to the chemical benzene
- A history of another blood disorder such as myelodysplastic syndrome
Assessment/Labs & diagnostic testing
- A physical exam
- A medical history
- Blood tests, such as a complete blood count (CBC) and blood smear
- Bone marrow tests
- Genetic tests to look for gene and chromosome changes
Nursing Care
- Place in a private room. Limit visitors as indicated. Prohibit live plants or flowers.
Restrict fresh fruits and make sure they are properly washed or peeled (to prevent
pathogens)
- Closely monitor temperature. Note correlation between temperature elevations and
chemotherapy treatments. Observe for fever associated with tachycardia, hypotension,
subtle mental changes.
- Prevent chilling. Force fluid
Nutrition → eat food that strengthen immune system
Medications → chemotherapy & blood transfusions
Therapeutic Procedures and Interprofessional Care
- Chemotherapy is the major form of treatment for leukemia. This drug treatment uses
chemicals to kill leukemia cells.
 Health promotion and disease prevention

- Making lifestyle changes and avoiding certain risk factors, but this
is not true for most cases of CML. The only potentially avoidable
Chronic Myeloid radiation

Assessment and expected findings

Leukemia (CML) - Anemia, leukopenia, neutropenia, thrombocytopenia

Labs & diagnostic testing

A slowly progressing and uncommon type - Complete blood cell count, bone marrow sample, blood chemistry
of blood-cell cancer that begins in the bone test, genetic testing, CT scans

marrow. Nursing Care → similar to AML

- Inspect oral mucous membranes. Provide good oral hygiene

- Skin care

Nutrition → strengthen immune system

Medications → chemotherapy, hematopoietic stem cell transplantation

(transplanting stem cells to restore a person's immune system)

Therapeutic Procedures and Interprofessional Care

- Chemotherapy is the best form of treatment

- Promote good nutrition - because chemotherapy causes weight loss
and anorexia, it’s encouraged to eat a high-calorie and high-protein
food and beverages
 Acute Lymphocytic Leukemia (ALL)
Acute proliferation of immature lymphoid cells (lymphoblasts) in the bone marrow and peripheral blood
Health promotion and disease prevention Nursing Care

- There is no known way to prevent most cases of leukemia. - Absence of pain is priority
- Risk factors: - Ability to provide self-care and to cope with the diagnosis and
- Radiation exposure (possibly benzene exposure) prognosis
- Hereditary chromosomal abnormalities - Activity tolerance and adequate nutrition
- Viral exposures (Human T-lymphotropic virus type I and II and
Epstein-Barr Virus)
Nutrition
Assessment and expected findings
- Variety of fruits and vegetables
- Whole grains
- Flu-like malaise, fatigue, oozing gums, nose bleeds, tiny red spots on the skin, Fat free or low fat dairy
-
discoloration of skin Low fat proteins like poultry or lean meat
-
- Other symptoms include: liver, splenic and testicular enlargement Healthy oils like olive oil
-
Labs & diagnostic testing Medications
- Bone marrow aspiration biopsy → Sample is sent to a lab for testing to look for - Methotrexate is drug of choice , but sometimes cytarabine or a steroid
leukemia cells like Prednisone can be used as well
- Spinal fluid test → Spinal tap may be used to collect sample of spinal fluid -
this fluid is tested to see whether cancer cells have spread to the spinal fluid
- Imaging test → X-rays, CT scan, or ultrasound scan may help determine Therapeutic Procedures and Interprofessional Care
whether the cancer has spread to the brain and spinal cord or other parts of
the body - Chemotherapy is the best form of treatment
- Blood cell count → Blood test may reveal too many or too few WBC, not - Promote good nutrition - because chemotherapy causes weight loss
enough RBC, and not enough platelets and anorexia, it’s encouraged to eat a high-calorie and high-protein food
- Blood test may also show the presence of blast cells - immature cells normally found in and beverages
the bone marrow
Chronic Lymphocytic Leukemia (CLL)
What is CLL?
- Develops from a type of white blood cell called B cells
- Progresses slow - usually affecting older adults
Health promotion and disease prevention
- Very few risk factors for CLL include:
- Age (over 50 y/o), exposure to certain chemicals, family
history, gender, and race/ethnicity
Assessment and expected findings
- Many patients are asymptomatic and are diagnosed incidentally during
routine physical examination or during treatment for another disease.
- Enlarged lymph nodes - most common presenting symptom
- Predisposition to repeated infections such as pneumonia, herpes simplex
labialis, and herpes zoster
- Patients can develop “B symptoms” which includes fevers, drenching
sweats (especially at night), and unintentional weight loss
Labs & diagnostic testing
- Complete blood count (CBC) → high WBC, low levels of RBC and low
platelet count
- Flow cytometry → most important test to confirm a diagnosis - in this
test, chemicals or dyes are applied to the leukemia cells in the lab - this
will provide more information about the leukemia and its subtype
Nursing Care (similar to ALL)
- Absence of complication and pain
- Ability to provide self-care and to cope with the diagnosis and prognosis
- Activity tolerance and adequate nutrition
Nutrition
- Mediterranean diet → high in vegetables, fruits, legumes, nuts, beans, cereals, grains, fish, and
unsaturated fats such as olive oil
- AVOID cold hot dogs and cold deli lunch meat, dry-cured uncooked salami, raw milk products,
raw or undercooked beef and shellfish, unpasteurized fruit juice, and undercooked eggs
Medications
- Some of the more commonly used drug treatments include: Ibrutinib (Imbruvica), alone or with
rituximab (Rituxan)
Therapeutic Procedures and Interprofessional Care
- Treatment options depend on several factors, such as the stage of your cancer, whether you're
experiencing signs and symptoms, your overall health, and your preferences
- Supportive care may include: cancer screenings, routine check-ups, vaccinations that prevent
infections such as pneumonia and influenza
Polycythemia Vera
What is Polycythemia Vera?
- Polycythemia vera is a rare blood disorder in which there is an increase in all blood cells, particularly red blood cells. The increase in blood cells makes your blood thicker. This can
lead to strokes or tissue and organ damage.
Health Promotion and Disease Prevention:
- Gender (men> Women), Age (>60), Exposure to intense radiation and to toxic substances, and the JAK2 Mutation -This mutation leads to hyperactive JAK (Janus kinase) signaling,
causing the body to make the wrong number of blood cells.
Assessment and Expected Findings:
- Reddish complexion and an enlarged spleen.
- Increased blood volume can cause headaches, dizziness, tinnitus, fatigue, paresthesias, and blurred vision.
- Increased blood viscosity can cause angina, claudication, dyspnea, and thrombophlebitis, particularly if the patient has atherosclerotic blood vessels. For this reason, blood
pressure is often elevated.
- Uric acid may be elevated as well, resulting in gout and renal stone formation
- Generalized pruritus (itching), which may be caused by histamine release due to an increased number of basophils.
- Erythromelalgia, a burning sensation in the fingers and toes, may be reported and is only partially relieved by cooling.
Lab and Diagnostic Testing:
- Diagnosis is based on an elevated hemoglobin or hematocrit and either the presence of a mutation of the JAK2 gene or a low serum erythropoietin level.
- Myeloid proliferation within the marrow can result in elevated white blood cells and platelets, as well.
Nursing Care:
- Assess for symptoms carefully and regularly throughout the illness trajectory.
- Symptom management- example, for pruritus (excessive itching) the nurse may recommend bathing in tepid or cool water and to avoid rigorous towel drying.
- Educate about life complications from the disease such as thrombosis and hemorrhage. Educate the patient about maintaining a healthy lifestyle and signs and symptoms for
both thrombosis and hemorrhage.
Nutrition:
- Eat well-balanced meals complete with fresh fruits and vegetables, whole grains, lean protein, and low-fat dairy.
- Patients should be encouraged to modify their cardiovascular risk factors within their control (e.g., smoking, obesity).
Medications:
- Antihistamines,
- These medications are used if phlebotomy is not enough to reduce the red blood cells: Hydroxyruea (Droxia, Hydrea), Interferon alfa-2b (Intron A), Ruxolitinib (Jakafi) and Busulfan
(Busulfex, Myleran).
- Low dose aspirin to reduce risk of blood clots.
Therapeutic Procedures and Interpersonal Care:
- Blood withdrawals (phlebotomy) -to decrease the patient's blood volume and reduce excess blood cells. How often depends on the severity of the patient condition.
- Treatment focuses on reducing the patients risk of complications and to reduce your symptoms.
- Ultraviolet light treatment to relieve the patient's itching discomfort.
 Essential Thrombocythemia
Defining Information:
- A chronic disorder in which your body produces too many platelets.
Health Promotion and Disease Prevention:
- Gender, Women are 1.5 times more likely than men to develop essential thrombocythemia. Age >60,
- People older than 60 are most likely to develop the condition, although 20% of ET sufferers are under the age of 40, JAK2 Mutation, and CALR
mutation.
Assessment and Expected Findings:
- Patients are normally asymptomatic.
- Symptoms typically occur when platelet count exceeds 1 million/mm3: Headache, Vision disturbances or silent migraines, Dizziness or
lightheadedness, Coldness or blueness of fingers or toes and Burning, redness, and pain in the hands and feet
- When bleeding is present as a symptom of essential thrombocythemia, it can manifest as: Easy bruising, nosebleeds or heavy periods and
Gastrointestinal bleeding or blood in the urine
Labs and Diagnostic:
- Blood tests, Bone Marrow Biopsy, and Gene mutation analysis of blood cells.
Nursing Care:
- Assess patients for a history of prior thrombotic or hemorrhagic events.
- Educate about the risks of hemorrhage and thrombosis.
- Inform about signs and symptoms of thrombosis, particularly the neurologic manifestations, such as visual changes, numbness, tingling, and
weakness.
- Educate patient regarding the medications that they are taking.
Nutrition:
- Eat a well balanced diet, exercise regularly, quit smoking.
Medications:
- Hydroxyurea (Droxia, Hydrea.), Anagrelide (Agrylin), Interferon alfa-2b (Intron A) or peginterferon alfa-2a (Pegasys), and low dose aspirin to
reduce the risk of thrombosis.
Therapeutic Procedures and Interpersonal Care:
- Treatment of essential thrombocythemia depends on your risk of blood clots or bleeding episodes. If you're younger than 60 and have had no
signs or symptoms, you may simply need periodic medical checkups.
 Labs & diagnostic testing
Hodgkin Lymphoma ●
○ Excisional lymph node biopsy
○ Chest x-ray
● Defining information ○ CT Scan
○ Rare but has a high cure rate - 5 year survival ○ PET Scan
for stage I or II is 90% or 65% for more ○ CBC, platelet count, ESR and liver and kidney function
extensive disease like stage IV
tests
○ More common in men than women
○ Has two peaks of occurrence - ages 15 to 34 ● Nursing Care
and after age 60 ○ Since this is a curable cancer, the nurse should
● Health promotion and disease prevention encourage the patient to reduce factors that increase
○ There are not many known risk factors for the chances of developing second cancer - i.e. tobacco
Hodgkin Lymphoma but HIV is known to and alcohol use, excessive sunlight, exposure to other
increase risk - so limiting risk factors that can carcinogens
prevent HIV can potentially help prevent the ○ Manage side effects of chemo and radiation
disease ● Nutrition
● Assessment and expected findings ○ No specific diet restrictions - just an overall healthy and
○ Enlarged of one or more lymph nodes on one balanced diet should be followed
side of neck - usually painless and firm but not
hard
● Medications/Treatment
○ Other manifestations are very similar to ○ 2 to 4 months of Chemo followed by radiation therapy
sign/symptoms of infection to target site(s)
● Therapeutic Procedures and Interprofessional Care
○ Regular screenings for other types of cancer
○ Survivorship program HK
 ● Defining information
○ 6th most commons type of cancer in the US
○ Survival rate is 69% at 5 years and 59% at 10 years
● Health promotion and disease prevention
Non-Hodgkin ○ Linked to exposure to pesticides, solvents, dyes and
defoliating agents - like Agent Orange
Lymphoma ● Assessment and expected findings
○ NHL is very complex and diverse - assessment and
findings will vary based on where the disease is present in
the body.
● Labs & diagnostic testing
○ CT
○ PET Scans
○ Bone marrow biopsies
○ CSF analysis
● Nursing Care
○ Manage side effects of chemo and radiation
○ Manage risk of infection
○ Nursing care will differ based on where the lymphoma is
in the body
● Nutrition
○ No specific diet restrictions - just an overall
healthy and balanced diet should be followed
● Medications/Treatment
○ Chemotherapy followed by radiation therapy
● Therapeutic Procedures and Interprofessional Care
○ Regular cancer screenings
○ Survivorship program
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 ● Nursing Care
○ Pain management

Multiple Myeloma ○ Management of side effects of chemo,

radiation or pharmaceutical therapies
● Defining information ● Nutrition
○ 2nd most common hematologic cancer in the US ○ No specific diet restrictions - just an overall
○ 5 year survival rate is 47% healthy and balanced diet should be
○ Median age is 70
followed
● Health promotion and disease prevention
○ Linked to exposure to Agent Orange
● Medications/Treatment
● Assessment and expected findings ○ Corticosteroids
○ Renal insufficiency or renal failure ○ Autologous stem cell transplant
○ Hyperviscosity ○ Immunomodulatory drugs
○ Infection
○ Proteasome inhibitors
○ Anemia
○ Bone pain in back or ribs ○ Chemotherapy
○ Hypercalcemia from bone destruction ○ Radiation Therapy
● Labs & diagnostic testing ● Therapeutic Procedures and Interprofessional
○ Serum protein electrophoresis
Care
○ Urine protein electrophoresis
○ Serum free light chain analysis ○ Physical therapy
○ Bone marrow biopsy ○ Occupation therapy
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