Chapter 45: Adult Oncological and Hematological Problems

Cancer develops when cells undergo malignant transformation and lose regulatory mechanisms controlling growth, leading to uncontrolled proliferation that can metastasize through local seeding, hematogenous spread, or lymphatic dissemination. Diagnostic confirmation requires tissue biopsy to establish histological diagnosis, while tumor grading assesses cellular differentiation and mitotic activity, and staging determines disease extent and prognosis at presentation. Treatment modalities include surgical intervention for diagnosis, curative resection, tumor debulking, or palliative symptom management; chemotherapy using cytotoxic agents that damage rapidly dividing cells in addition to malignant tissue, causing myelosuppression and requiring infection and hemorrhage precautions; radiation therapy targeting neoplastic cells with minimal exposure to healthy tissue, including brachytherapy requiring strict radiation safety protocols; and hematopoietic stem cell transplantation for select hematological malignancies after myeloablative conditioning. The chapter details specific malignancies including leukemia characterized by immature leukocyte overproduction and requiring protective isolation, lymphomas involving abnormal lymphocyte proliferation with Hodgkin disease distinguished by Reed-Sternberg cells, multiple myeloma causing bone destruction and hypercalcemia with risk for pathological fractures, and solid tumors of the breast requiring lymphedema prevention, gastrointestinal system necessitating careful stoma management, larynx requiring voice rehabilitation, and prostate managed surgically with continuous bladder irrigation. Oncological emergencies demand rapid recognition and intervention, including sepsis with disseminated intravascular coagulation, syndrome of inappropriate antidiuretic hormone secretion causing severe hyponatremia, malignant spinal cord compression presenting with progressive neurological deficits, superior vena cava syndrome obstructing venous return, and tumor lysis syndrome releasing intracellular electrolytes and uric acid causing hyperkalemia and acute kidney injury. Hematological disorders encompass iron-deficiency anemia producing microcytic hypochromic erythrocytes requiring oral supplementation, vitamin B12 deficiency causing macrocytic anemia and neurological manifestations necessitating parenteral replacement, folate-deficiency anemia responsive to dietary sources and supplementation, and aplastic anemia involving bone marrow failure with pancytopenia requiring supportive transfusion therapy. Nursing care prioritizes adequate pain management using scheduled opioid dosing, infection prevention in immunocompromised patients, hemorrhage surveillance in thrombocytopenic individuals, and psychosocial support throughout disease trajectory and treatment.