Chapter 12: Managing Patients with Oncologic Disorders

Managing Patients with Oncologic Disorders begins by distinguishing the cellular characteristics of benign versus malignant neoplasms, detailing the mechanisms of invasion and metastasis, and explaining the three-step process of carcinogenesis involving initiation, promotion, and progression. The text emphasizes the nurse’s pivotal role across the cancer continuum, from primary prevention strategies like lifestyle modification and immunization to secondary prevention through rigorous screening guidelines for breast, cervical, colorectal, lung, and prostate cancers. Diagnostic protocols are explored in depth, utilizing the TNM classification system to determine tumor stage and histologic grading to assess cellular differentiation. A major portion of the chapter is dedicated to medical and surgical treatment modalities, including diagnostic biopsies, curative or palliative surgeries, and reconstructive procedures. It extensively details radiation therapy delivery methods such as external-beam radiation and brachytherapy, alongside the nursing management of toxicities like radiodermatitis and fatigue. The summary covers antineoplastic pharmacotherapy, distinguishing between cell cycle-specific and nonspecific chemotherapy agents, and outlines critical safety standards for administering vesicants to prevent extravasation. Advanced treatment options are analyzed, including hematopoietic stem cell transplantation (allogeneic, autologous, and syngeneic) and the management of graft-versus-host disease. Furthermore, the chapter explains the mechanisms of modern immunotherapy, such as checkpoint inhibitors, CAR T-cell therapy, and monoclonal antibodies, as well as targeted therapies that inhibit specific molecular pathways like tyrosine kinases and vascular endothelial growth factors. Finally, it addresses the complex nursing management of treatment-related complications, including myelosuppression (neutropenia, thrombocytopenia, anemia), stomatitis, and cancer-related anorexia-cachexia syndrome (CACS), and provides critical protocols for handling oncologic emergencies such as superior vena cava syndrome, spinal cord compression, hypercalcemia, and tumor lysis syndrome.