Cancer Nursing

by Yarbro, Connie Henke; Frogge, Margaret Hansen; Goodman, Michelle

• ISBN13: 9780763747206
• ISBN10: 0763747203
• Edition: 6th
• Format: Hardcover
• Copyright: 2005-04-18
• Publisher: Jones & Bartlett

Summary

Rapid changes in oncology necessitate a comprehensive, up-to-date reference for oncology nurses. For seventeen years, best-selling Cancer Nursing: Principles and Practice has filled this need, supplying oncology nurses with cutting-edge, current information. Now, in its Sixth Edition, Cancer Nursing reflects the constantly shifting progress in the science of oncology, as well as emerging new therapies, new treatment modalities, the latest results from clinical trials, updates on new chemotherapeutic agents and targeted therapies, and new perspectives on supportive care.

Table of Contents

Preface	xxix
Contributors	xxxi
Part I The Cancer Problem	1	(66)
Biology of Cancer	3	(23)
Carrie J. Merkle
Lois J. Loescher
Introduction	4	(1)
Theories and Research Models of Tumor Development	4	(2)
Theory of Clonal Evolution	4	(1)
Research Models of Tumor Development	4	(2)
Properties of Cancer and Transformed Cells	6	(2)
Genetic Influences Associated with Cancer	8	(6)
Mutations	8	(1)
Mechanisms to Repair DNA Damage	9	(1)
Polymorphisms	10	(1)
Oncogenes	11	(2)
Tumor Suppressor Genes	13	(1)
DNA Repair Genes	13	(1)
Cytogenetic Abnormalities	13	(1)
The Cell Cycle	14	(1)
Events of the Cell Cycle	14	(1)
The Cell Cycle and Cancer	15	(1)
Apoptosis	15	(3)
Characteristics of Cells Undergoing Apoptosis	16	(1)
Genes and Proteins Involved in Apoptosis	17	(1)
Metastasis	18	(4)
Factors Contributing to Metastasis	18	(3)
Metastasis Suppressor Genes	21	(1)
The Metastatic Cascade	21	(1)
Models of Invasion and Metastasis	22	(1)
Treatment of Metastasis	22	(1)
Conclusion	22	(1)
References	22	(4)
Immunology	26	(14)
Susan M. Bauer-Wu
Janice Post-White
Introduction	27	(1)
Overview	27	(1)
Components of the Immune System	27	(4)
Structures of the Immune System	27	(1)
Cells of the Immune System	27	(3)
Soluble Mediators of the Immune System	30	(1)
Mechanisms of Adaptive Immunity	31	(4)
Humoral Immune Response	31	(3)
Cell-Mediated Immune Response	34	(1)
Delayed-Type Hypersensitivity	35	(1)
Cell-Mediated Cytotoxicity	35	(1)
Tumor Surveillance	35	(1)
Tissue Destruction from Immune Responses	35	(1)
Factors Affecting Immune Responses	36	(2)
Stress	36	(1)
Aging	37	(1)
Gonadal Hormones	37	(1)
Behavioral Factors	37	(1)
Implications for Nursing Practice	38	(1)
References	38	(2)
Epidemiology	40	(27)
Alecia Malin
Introduction	41	(1)
Basic Considerations in Epidemiological Research	41	(9)
Study Designs	41	(7)
Defining the Disease	48	(1)
Eligibility and Exclusionary Criteria	48	(1)
Defining the Population	49	(1)
Statistical Plan	49	(1)
Potential Sources of Bias and Confounding Variables	49	(1)
Data Sources	50	(1)
Causes of Cancer	50	(7)
Tobacco	50	(1)
Passive Smoking	50	(1)
Diet	51	(1)
Alcohol	52	(1)
Physical Activity	53	(1)
Occupational Exposures	53	(1)
Pollution	53	(1)
Viruses and Other Biological Agents	54	(1)
Radiation	54	(2)
Drugs	56	(1)
Biomarkers	57	(1)
Host Characteristics Influencing Cancer Susceptibility	58	(2)
Age	58	(1)
Sex	58	(1)
Genetic Predisposition	58	(2)
Ethnicity and Race	60	(1)
Socioeconomic Factors	60	(1)
Reproductive History	60	(1)
Other Applications of Epidemiology in Oncology	60	(2)
Cancer Pain	60	(2)
Application of Epidemiology to Nursing Practice	62	(1)
References	62	(5)
Part II Prevention, Detection, and Diagnosis	67	(114)
Cultural Diversity Among Individuals with Cancer	69	(26)
Joanne K. Itano
Introduction	70	(2)
Overview	70	(1)
Epidemiology	70	(2)
Ethnicity and Cancer	72	(14)
Blacks	73	(2)
Asian and Pacific Islanders	75	(4)
Hispanics	79	(3)
American Indians/Alaskan Natives	82	(4)
Nursing Issues	86	(4)
Cancer, Poverty, and Ethnicity	86	(1)
Strategies to Enhance Access to Health Care	87	(1)
Culturally Appropriate Public/Patient Education	88	(1)
Clinical Trials and Cancer Research	89	(1)
Resources	90	(2)
Conclusion	92	(1)
References	92	(3)
Dynamics of Cancer Prevention	95	(13)
Judith J. Smith
Rose Mary Padberg
Introduction	96	(1)
Development of Cancer Prevention	96	(1)
Framework of Cancer Prevention	96	(3)
Multistep Carcinogenesis	96	(1)
Field Carcinogenesis	97	(1)
Cancer Prevention Model	98	(1)
Cancer Prevention Research	99	(6)
Chemoprevention	99	(4)
Vaccines	103	(1)
Tobacco Use	103	(1)
Diet and Nutrition	104	(1)
Cancer Prevention and Public Policy	105	(1)
Nursing Implications	105	(1)
Conclusion	106	(1)
References	106	(2)
Screening and Detection for Asymptomatic Individuals	108	(18)
Suzanne M. Mahon
Introduction	109	(1)
Conceptual Considerations in Cancer Screening	109	(1)
Definitions	109	(1)
Outcomes	109	(1)
Cancer Risk Assessment: The First Step in the Cancer Screening Process	110	(4)
Family History	110	(1)
Past Medical History/Lifestyle Factors	111	(1)
Absolute Risk	111	(1)
Relative Risk	112	(1)
Attributable Risk	113	(1)
Explanation of Risk with Clinical Models	113	(1)
Principles of Cancer Risk Communication	113	(1)
Oral Communication of Risk	114	(2)
Technological Communication of Risk	115	(1)
Visual Aids in Risk Communication	115	(1)
Psychological Concerns	116	(1)
Documentation of Risk Assessment	116	(1)
Measures of the Accuracy of Screening Tests	116	(2)
Accuracy	117	(1)
Sensitivity	117	(1)
Specificity	117	(1)
Positive Predictive Value	117	(1)
Negative Predictive Value	117	(1)
Improving the Accuracy of Screening	117	(1)
Implementing Cancer Screening	118	(3)
Development of Screening Guidelines	118	(2)
Informed Consent	120	(1)
Follow-up	120	(1)
Nursing Implications	121	(3)
Education of Healthcare Professionals	121	(1)
Administrative Considerations	121	(1)
Economic Considerations	121	(1)
Practice Considerations	122	(1)
Legal Considerations	123	(1)
Interactions with the Media	123	(1)
Future Research	123	(1)
Conclusion	124	(1)
References	124	(2)
Genetic Risk for Cancer	126	(27)
Paula Trahan Rieger
Judith Kehs Much
Introduction	127	(1)
Human Genome Project	127	(1)
Cancer Risk Assessment	127	(2)
Medical History	128	(1)
Family History	128	(1)
Models for Determining Risk	128	(1)
Hereditary Cancer Syndromes	129	(6)
Patterns of Inheritance	131	(1)
Characteristics of Hereditary Cancer Syndromes	132	(1)
Hereditary Breast and Ovarian Cancer Syndromes	133	(1)
Hereditary Colon Cancers	134	(1)
Cancer Genetic Counseling	135	(3)
Definition	135	(1)
Services Provided	135	(2)
Healthcare Professionals Involved in Cancer Genetic Counseling	137	(1)
Patient Education	138	(1)
Problems and Issues Related to Cancer Genetic Counseling and Genetic Testing	138	(7)
Setting for Testing	138	(1)
Informed Consent	138	(1)
Accuracy of the Test and Interpretation of Results	139	(1)
Psychosocial Issues	140	(1)
Management of Risk	141	(4)
Models for Cancer Risk Counseling Programs	145	(1)
Implications for Oncology Nurses	146	(1)
Future Directions	147	(2)
New Technology for Testing	148	(1)
Populational Screening	148	(1)
Information Management	148	(1)
Timing of Testing	148	(1)
Training of Healthcare Professionals	149	(1)
References	149	(4)
Diagnostic Evaluation, Classification, and Staging	153	(28)
Kathleen Farley Omerod
Diagnostic Evaluation	154	(18)
Factors Affecting the Diagnostic Approach	154	(1)
Nursing Implications	155	(2)
Laboratory Techniques	157	(3)
Tumor Imaging	160	(9)
Invasive Diagnostic Techniques	169	(3)
Classification and Nomenclature	172	(1)
Basic Terminology	172	(1)
Benign and Malignant Tumor Characteristics	172	(1)
Tumor Classification System	173	(1)
Tumors of Unknown Origin	173	(1)
Staging and Grading Classifications	173	(4)
Staging the Extent of the Disease	173	(3)
Patient Performance Classification	176	(1)
Grading	176	(1)
Future Trends	177	(1)
Conclusion	178	(1)
References	178	(3)
Part III Treatment	181	(440)
Quality of Life as an Outcome of Cancer Care	183	(18)
Carol Estwing Ferrans
Introduction	184	(1)
Quality of Life as a Prognostic Indicator	184	(1)
Using Quality of Life Information in Cancer Care	184	(3)
New Therapy Versus Standard Therapy	185	(1)
Two Standard Therapies with Similar Survival Outcomes	185	(1)
Long-Term Negative Effects of Therapy	185	(1)
Treatment Versus Supportive Care Only	185	(1)
Negative Effects of Therapy to Prevent Recurrence	186	(1)
Supportive Care	186	(1)
Using Quality of Life Questionnaires in Clinical Practice	187	(1)
What Is Quality of Life?	187	(4)
Conceptual Model of Quality of Life	188	(1)
Domains of Quality of Life	189	(1)
Scope of Quality of Life for Research and Clinical Practice	189	(2)
Measuring Quality of Life	191	(3)
Choosing Instruments to Measure Quality of Life	191	(1)
Generic Versus Disease-specific Instruments	191	(1)
Status and Evaluation Questions	192	(1)
Importance and Preference Measures	193	(1)
Populations Presenting Special Challenges	194	(3)
Proxy ratings	194	(1)
Cognitive Impairment	195	(1)
Children	195	(1)
End of Life	196	(1)
Culture and Language Differences	196	(1)
Future Directions	197	(1)
References	197	(4)
Principles of Clinical Research and Development	201	(11)
Mary S. McCabe
Overview	202	(1)
The Clinical Trials Process	202	(3)
Types of Clinical Trials	202	(1)
Phases of Clinical Trials	202	(3)
Nonclinical Trial Access to Experimental Agents: Special Access Programs	205	(1)
Group C Program	205	(1)
Treatment Referral Center (TRC)	205	(1)
Expanded Access Program	205	(1)
Special Exception (Compassionate Use/Compassionate Exception)	205	(1)
Clinical Trials Design and Implementation	206	(1)
The Clinical Protocol	206	(1)
Research Team Members	206	(1)
Protection of Research Participants	206	(2)
Informed Consent	207	(1)
Institutional Review Board	208	(1)
Federal Oversight Agencies	208	(1)
Barriers to Clinical Trials Participation	208	(1)
Cancer Clinical Trials Programs	209	(1)
NCI Cooperative Group System	209	(1)
NCI Cancer Centers Program	209	(1)
Current Issues	209	(2)
Quality of Life Evaluations	209	(1)
Dissemination of Research Results	210	(1)
Future Trends	211	(1)
References	211	(1)
Surgical Therapy	212	(17)
Theresa Wicklin Gillespie
Introduction	213	(1)
Roles of Surgery in Oncology Care	213	(5)
Prevention and Early Detection	213	(1)
Diagnosis	214	(1)
Staging of Disease	215	(1)
Resection for Cure	216	(1)
Resection with Minimal Residual Disease	216	(1)
Resection in Advanced Disease	216	(1)
Reconstruction	217	(1)
Surgery as Ancillary Intervention	218	(1)
Clinical Decision Making in Surgical Therapy	218	(1)
Tumor Characteristics	218	(1)
Patient Characteristics	218	(1)
Environmental Factors	219	(1)
Impact of Nursing Care on Surgical Outcomes	219	(3)
Short-Term Outcomes	219	(1)
Long-Term Outcomes	220	(1)
Preoperative Teaching and Counseling	220	(1)
Postoperative Teaching and Counseling	221	(1)
Rehabilitation	221	(1)
Trends in Surgical Oncology	222	(1)
Organ Preservation	222	(1)
Neoadjuvant Therapy	223	(1)
Sentinel Node Biopsy and Mapping	223	(1)
Special Considerations for Nursing Care	223	(3)
Older Patients and Surgical Therapy	223	(1)
Oncologic Emergencies	224	(1)
Perioperative Blood Transfusion	224	(1)
Anxiety and Pain Control	225	(1)
Nutritional Support	225	(1)
Risk Assessment and Surveillance After Surgery	226	(1)
Conclusion	226	(1)
References	226	(3)
Principles of Radiation Therapy	229	(21)
Tracy K. Gosselin-Acomb
Introduction	230	(1)
History of Radiation Therapy	230	(1)
Goals of Treatment Approaches	231	(1)
Applied Radiation Physics	231	(2)
High Linear Energy Transfer and Charged Particle Radiation Therapy	233	(2)
Neutron Beam Therapy	234	(1)
Heavy Charged Particle Therapy	234	(1)
Negative Pi-meson Therapy	235	(1)
Radiobiology	235	(5)
Cellular Response to Radiation	235	(3)
Radiobiology of Brachytherapy	238	(1)
Capitalizing on Radionuclides and Radioimmunotherapy	239	(1)
Chemical and Thermal Modifiers of Radiation	240	(4)
Radiosensitizers and Radioprotectors	240	(1)
Combined Modality Therapy	241	(1)
Hyperthermia	242	(2)
Incidental and Accidental Radiation Exposure	244	(2)
Chronic Low-Dose Exposure	244	(1)
Total Body Radiation Syndrome	244	(1)
Radiation Effects on the Embryo and Fetus	245	(1)
Radiation-Induced Malignancies	246	(1)
Conclusion	246	(1)
References	246	(4)
Radiation Treatment Planning	250	(33)
Susan Weiss Behrend
Introduction	251	(1)
Treatment Planning and Simulation Processes	251	(2)
Treatment Simulators	252	(1)
Port Films	253	(1)
The Treatment Plan	253	(1)
Delivery of Radiation Therapy: Machines and Complementary Equipment	253	(3)
Linear Accelerator	253	(1)
Collimation	253	(1)
Orthovoltage Units	254	(1)
Megavoltage Units	254	(1)
Machine Design	255	(1)
Proton Therapy	255	(1)
Principles of External Beam Radiation Dosing/Dosimetry	256	(3)
Dose Delivery of Radiation	257	(1)
Field-Modifying Instruments	258	(1)
Tissue Compensation	258	(1)
Patient Positioning and Immobilization Techniques	259	(2)
Immobilization Devices	261	(3)
Positioning Devices	262	(2)
Treatment Techniques and Delivery: Advanced Topics	264	(17)
Computed Tomography-Based Simulation	264	(3)
Conformal Radiation Therapy: 3D Treatment Planning	267	(1)
Intensity-Modulated Radiation Therapy	268	(1)
Stereotactic Radiosurgery	268	(2)
Image-Guided Cyberknife Radiosurgery	270	(1)
Brachytherapy	271	(2)
Partial Breast Irradiation	273	(2)
Unsealed Radionuclide Therapy	275	(1)
Radioimmunotherapy	275	(1)
Multimodality Fusion	276	(1)
B-Mode Acquisition and Targeting System	276	(1)
Image-Guided Radiation Therapy: CT-on-Rails	277	(3)
Respiratory Gating	280	(1)
Conclusion	281	(1)
References	281	(2)
Radiation Therapy: Toxicities and Management	283	(32)
Karen E. Maher
Introduction	284	(1)
Radiobiology	284	(1)
Tissue and Organ Response to Radiation	285	(2)
Acute Effects	286	(1)
Subacute Effects	286	(1)
Late Effects	287	(1)
Assessment and Management of Skin Reactions, Fatigue, and Myelosuppression	287	(7)
Role of the Radiation Therapy Nurse	287	(1)
Skin Reaction (Radiodermatitis)	288	(4)
Fatigue	292	(1)
Myelosuppression	293	(1)
Acute Radiation Toxicities and Management: Site Specific	294	(10)
Brain	295	(2)
Head and Neck	297	(3)
Breast	300	(1)
Chest and Lung	300	(1)
Abdomen and Pelvis	301	(2)
Extremity	303	(1)
Eye	303	(1)
Late Effects of Radiation: Site Specific	304	(9)
Central Nervous System	305	(2)
Head and Neck	307	(1)
Lung	308	(1)
Heart	309	(1)
Breast/Chest Wall	309	(1)
Abdomen and Pelvis	310	(1)
Genitourinary System	310	(1)
Reproductive System	311	(1)
Secondary Malignancies	312	(1)
Conclusion	313	(1)
References	313	(2)
Chemotherapy: Principles of Therapy	315	(36)
Peter V. Tortorice
Historical Perspective	316	(1)
Cancer Chemotherapy Drug Development	317	(1)
Preclinical Evaluation	317	(1)
Clinical Trials	318	(1)
Scientific Basis of Chemotherapy	318	(4)
The Cell Cycle	318	(1)
Tumor Cell Kinetics	318	(1)
The Effects of Cytotoxic Chemotherapy on Tumor Cells	319	(1)
Targeted Therapies for Cancer	320	(2)
Cytotoxic Drug Selection Criteria	322	(1)
Managing Chemotherapy Resistance	323	(4)
Theoretical Basis for Cytotoxic Drug Resistance	323	(1)
Types of Drug Resistance	324	(2)
Tumor Cell Death and Cytotoxic Drug Resistance	326	(1)
Chemotherapy as a Treatment for Cancer	327	(3)
Primary and Adjuvant Chemotherapy	327	(1)
Therapeutic Strategies	327	(3)
Pharmacology of Chemotherapeutic Drugs	330	(16)
Pharmacokinetics of Antineoplastic Drugs	330	(2)
Drug Interactions in the Patient Receiving Chemotherapy	332	(1)
Antineoplastic Drugs	332	(11)
Tyrosine Kinase Inhibitors	343	(1)
Proteasome Inhibitors	344	(1)
Hormonal Therapy	344	(1)
Differentiation Agents	345	(1)
Conclusion	346	(1)
References	346	(5)
Chemotherapy: Principles of Administration	351	(61)
Beth Kelly Hayden
Michelle Goodman
Chemotherapy Administration	352	(4)
Professional Qualifications	352	(1)
Handling Hazardous Drugs	352	(2)
Patient and Family Education	354	(1)
Safe Practice Considerations	354	(2)
Drug Administration	356	(14)
Dose Calculation	356	(1)
Pretreatment Considerations	357	(2)
Routes of Administration	359	(11)
Vascular Access Devices	370	(11)
General Management	370	(7)
Complication Management	377	(4)
Conclusion	381	(1)
References	381	(2)
Appendices	383	(29)
Chemotherapy Toxicities and Management	412	(46)
Dawn Camp-Sorrell
Introduction	413	(1)
Pretreatment Evaluation: Risk Analysis	413	(1)
Quality of Life and Chemotherapy Toxicity	414	(1)
Self-Care	414	(1)
Patient Education and Follow-up	415	(1)
Chemotherapy Toxicities	415	(38)
Grading of Toxicities	415	(3)
Systemic Toxicities	418	(23)
Organ Toxicities	441	(12)
Conclusion	453	(2)
References	455	(3)
Principles of Bone Marrow and Hematopoietic Cell Transplantation	458	(20)
Tammy Baltic
Marie Bakitas
Introduction	459	(1)
The ABCs of Bone Marrow Transplantation	459	(1)
Historical Developments	460	(2)
Types of Transplantation	462	(2)
Syngeneic	462	(1)
Allogeneic	462	(1)
Autologous	463	(1)
Umbilical Cord Blood	464	(1)
Transplantation Indications and Outcomes	464	(4)
Hematologic Malignancies	464	(2)
Solid Tumors	466	(1)
Nonmalignant Diseases	466	(1)
Outcomes	467	(1)
Hematopoietic and Immunologic Concepts of Transplantation	468	(1)
Normal Hematopoiesis and Peripheral Blood Stem Cells	468	(1)
Hematopoietic Stem Cells	468	(4)
Mobilization	468	(2)
Recombinant Hematopoietic Growth Factors	470	(1)
Expansion of Stem Cells	470	(1)
Purging	470	(1)
Human Leukocyte Antigen	470	(1)
Prophylaxis and Treatment of Graft-versus-Host Disease	471	(1)
Immunosuppression	471	(1)
T-cell depletion	471	(1)
Graft-versus-Disease Effect	472	(1)
ABO Mismatch	472	(1)
Standards for Transplantation	472	(2)
National Marrow Donor Program	473	(1)
International Bone Marrow Transplant Registry/Autologous Bone Marrow Transplant Registry	473	(1)
Future Directions	474	(1)
Financial/Reimbursement Issues	474	(1)
Outpatient and Home Care Issues	474	(1)
Targeted Therapy	474	(1)
Web Sites	475	(1)
Conclusion	475	(1)
References	475	(3)
Techniques of Hematopoietic Cell Transplantation	478	(16)
Debra Wujcik
Introduction	479	(1)
Patient Evaluation	479	(2)
Physical Evaluation	479	(1)
Psychosocial Evaluation	480	(1)
Financial Evaluation	480	(1)
Education	480	(1)
Cells for Transplantation	481	(5)
Bone Marrow Harvest	481	(2)
Blood Cell Apheresis	483	(3)
Human Cord Blood	486	(1)
Cell Processing and Storage	486	(2)
Cell Identification	486	(1)
Processing	487	(1)
Tumor Contamination	487	(1)
Conditioning Therapy	488	(2)
Total Body Irradiation	488	(1)
Chemotherapy	488	(1)
Reinfusion	489	(1)
Inpatient Issues	490	(1)
Outpatient Issues	490	(1)
Conclusion	491	(1)
References	491	(3)
Complications of Hematopoietic Cell Transplantation	494	(16)
Lowell Anderson-Reitz
Introduction	495	(1)
Acute Complications	495	(6)
Acute Graft-versus-Host Disease	495	(2)
Infection	497	(1)
Gastrointestinal Complications	498	(1)
Hepatic Complications	498	(1)
Neurologic Complications	499	(1)
Hematologic Complications	499	(1)
Pulmonary Complications	500	(1)
Cardiac Complications	501	(1)
Renal Complications	501	(1)
Late Complications	501	(5)
Chronic Graft-versus-Host Disease	501	(1)
Infectious Complications	502	(1)
Ophthalmologic Complications	503	(1)
Urologic Complications	503	(1)
Oral/Dental Complications	503	(1)
Pulmonary Complications	503	(1)
Endocrine Complications	504	(1)
Avascular Necrosis	504	(1)
Secondary Malignancies	504	(1)
Neurologic Complications	505	(1)
Graft Failure	505	(1)
Gonadal Dysfunction	505	(1)
Osteoporosis	505	(1)
Supportive Management	506	(1)
Nutritional Support	506	(1)
Pain Management	506	(1)
Vaccinations	506	(1)
Psychosocial Issues	506	(1)
Quality of Life	506	(1)
Conclusion	506	(1)
References	506	(4)
Biologic and Targeted Therapy	510	(49)
Linda A. Battiato
Introduction	511	(1)
Foundation Concepts for Biotherapy	511	(3)
Immune Defense Against Malignancy: An Overview	511	(1)
Origins of Biotherapy	512	(1)
Recombinant DNA Technology	513	(1)
Anticancer Cytokine Therapy	514	(9)
Interferon	514	(4)
Interleukins	518	(3)
Combination Therapy	521	(1)
Tumor Necrosis Factors	522	(1)
Activated Cell Therapy (Adoptive Immunotherapy)	522	(1)
Monoclonal Antibodies	523	(13)
Manufacture of Antibodies and the Hybridoma Technique	523	(1)
Structure of Monoclonal Antibodies	524	(1)
Monoclonal Antibodies in Cancer Therapy	525	(11)
Fusion Proteins	536	(1)
Denileukin Diftitox	536	(1)
Other Immunomodulating Agents	537	(2)
Cancer Vaccines	539	(4)
Tumor Antigens	539	(1)
Vaccine Approaches	540	(1)
Tumor Vaccine Adjuvants	541	(1)
Clinical Use of Cancer Vaccines	542	(1)
Targeted Therapy	543	(8)
Signal Transduction	543	(2)
Non-EGFR Tyrosine Kinase-Inhibitors	545	(1)
EGFR Inhibitors	546	(3)
Angiogenesis	549	(1)
Angiogenesis Inhibitors	549	(2)
Targeted Therapy: Nursing Considerations	551	(2)
Preparation, Administration, and Safe Handling of Biologic and Targeted Agents	551	(1)
Biologic and Targeted Therapy: Future Directions	552	(1)
References	553	(6)
Gene Therapy	559	(16)
Dale Halsey Lea
Introduction	560	(1)
Genetic Disorders	560	(1)
Principles and Goals of Gene Therapy	560	(2)
Gene Therapy Defined	560	(1)
Gene Identification and Characterization	561	(1)
Gene Transfer Methods	561	(1)
Vectors for Gene Transfer	562	(2)
Viral Vectors	562	(2)
Nonviral Vectors	564	(1)
Clinical Protocols for Gene Therapy	564	(4)
The Severe Combined Immunodeficiency Disease Protocol	564	(1)
Gene Therapy Regulation	565	(1)
Cancer Gene Therapy	565	(3)
Ethical, Social, and Legal Issues in Gene Therapy	568	(3)
Assessing Clinical Benefits	568	(1)
Participant Selection and Informed Consent	569	(1)
Safety Issues	569	(1)
Equal Access to Gene Therapy and Confidentiality of Genetic Information	570	(1)
Emerging Ethical Issues in Gene Therapy	570	(1)
Practice Implications for Oncology Nurses	571	(1)
Provider of Genetic Services	571	(1)
Nursing Research	571	(1)
Future Issues for Oncology Nurses	572	(1)
References	573	(2)
Hematopoietic Therapy	575	(15)
Barbara Holmes Gobel
Introduction	576	(1)
Hematopoietic Growth Factors	576	(5)
Hematopoiesis	576	(5)
Transfusion Therapy	581	(6)
Red Blood Cell Therapy	581	(1)
Platelet Therapy	582	(2)
Plasma Therapy	584	(1)
Transfusion Reactions and Complications	584	(3)
Conclusion	587	(1)
References	587	(3)
Complementary and Alternative Medicine (CAM) Therapies	590	(31)
Georgia M. Decker
Colleen Lee
Introduction	591	(3)
Defining Complementary and Alternative Medicine (CAM) Therapies	591	(1)
Historical Perspective	592	(2)
Use of CAM Therapies in the United States	594	(2)
Consumer Issues	594	(2)
Role of Evidence-Based Practice	596	(1)
Regulation of Dietary Supplements	597	(1)
Efficacy and Safety of Common CAM Modalities	597	(3)
Clinical Cancer CAM Research	598	(1)
Clinical Trials	598	(1)
Ethical Considerations in Cancer CAM	598	(1)
Methodological Challenges	599	(1)
Pathways for Pursuing Cancer CAM Research	599	(1)
Integration of Evidence-Based Health Care and CAM Therapies	600	(8)
The Biomedical and Biopsychosocial Models	600	(1)
Locating Relevant and Reliable Research	601	(7)
Symptom Management	608	(1)
Anorexia	609	(1)
Depression	609	(1)
Pain	609	(1)
Role of Oncology Nursing in Cancer CAM	609	(4)
Conducting an Integrative Assessment	612	(1)
Reliable Sources for Cancer CAM Information	613	(1)
Future Trends	613	(1)
References	614	(7)
Part IV Cancer Symptom Management	621	(250)
Cancer-Related Distress	623	(16)
Marlene Zichi Cohen
Elizabeth D. Carlson
Introduction	624	(1)
Historical Perspective	624	(1)
Language	624	(1)
Incidence of Distress Associated with Cancer	625	(1)
Etiology of Risk Factors for Distress	626	(1)
Barriers to Identification and Treatment	626	(2)
Patient Barriers	626	(1)
Clinician Barriers	627	(1)
System Barriers	628	(1)
Clinical Manifestations of Distress	628	(4)
Successful Adaptation	628	(1)
Mild Distress	628	(2)
Moderate Distress	630	(1)
Severe Distress	630	(2)
Assessment of Distress	632	(1)
Interventions	633	(1)
Symptom Management Strategies	633	(1)
Cognitive-Behavioral Strategies	633	(1)
Someone Who Cares	634	(1)
Complementary Strategies	634	(1)
Pharmacological Management	634	(1)
Conclusion	634	(1)
References	635	(4)
Assessment of Cancer Pain	639	(23)
Patrick J. Coyne
Ashby C. Watson
Deborah B. McGuire
Katherine A. Yeager
Introduction	640	(1)
Scope of the Cancer Pain Problem	640	(4)
Significance	640	(3)
Prevalence	643	(1)
Definitions of Pain	643	(1)
Cancer Pain as a Multidimensional Phenomenon	644	(4)
Physiological Dimension	644	(1)
Sensory Dimension	645	(1)
Affective Dimension	646	(1)
Cognitive Dimension	646	(1)
Behavioral Dimension	647	(1)
Sociocultural Dimension	647	(1)
Implications of the Multidimensional Model	648	(1)
Professional Issues	648	(2)
Organizational Efforts	648	(1)
Obstacles to Successful Management	649	(1)
Improvements in Management	649	(1)
Delivery of Pain Management Services	650	(1)
Principles of Assessment and Management	650	(7)
Nursing's Scope of Practice and Responsibilities	650	(1)
Assessment and Documentation	651	(2)
Special At-Risk Populations	653	(2)
Special Populations	655	(2)
Conclusion	657	(1)
References	657	(5)
Management of Cancer Pain	662	(36)
Bridget A. Cahill
Introduction	663	(1)
Specialized Pain Care	663	(1)
End-of-Life Issues	663	(1)
Interventions	664	(1)
Treatment of Underlying Pathology	664	(4)
Chemotherapy	664	(1)
Radiation Therapy	665	(1)
Surgery	666	(2)
Change in Perception/Sensation of Pain	668	(22)
Pharmacologic Therapy	668	(19)
Technology-Supported Pain Care	687	(1)
Drug Therapy for the Elderly	687	(1)
Nerve Blocks and Neuroablative Procedures	688	(1)
Complementary and Alternative Medicine	689	(1)
Diminishing the Emotional and Reactive Components of Pain	690	(3)
Cutaneous Stimulation	690	(1)
Immobilization/Mobilization and Functional Status	691	(1)
Distraction	691	(1)
Relaxation and Guided Imagery	692	(1)
Comprehensive Cognitive/Behavioral/Educational Methods	692	(1)
Education and Information	692	(1)
Conclusion	693	(1)
References	693	(5)
Infection	698	(25)
Brenda K. Shelton
Scope of the Problem	699	(3)
Definitions	699	(2)
Incidence	701	(1)
Etiology and Risk Factors	702	(1)
Physiologic Alterations	702	(5)
Normal Anatomy, Physiology, and Scientific Principles	702	(5)
Pathophysiology	707	(1)
Clinical Manifestations	707	(1)
Assessment and Grading	708	(2)
Patient and Family History for Risk Factors	708	(1)
Physical Examination	708	(1)
Diagnostic Studies	708	(2)
Therapeutic Approaches and Nursing Care	710	(5)
Prevention	710	(4)
Management	714	(1)
Conclusion	715	(5)
References	720	(3)
Bleeding	723	(18)
Barbara Holmes Gobel
Scope of the Problem	724	(1)
Physiology of Bleeding	724	(1)
Hemostasis	724	(1)
Coagulation	724	(1)
Fibrinolysis	725	(1)
Pathophysiology of Bleeding	725	(6)
Platelet Abnormalities	725	(2)
Hypocoagulation	727	(1)
Tumor Effects	728	(1)
Treatment Effects	729	(2)
Infection-Related Effects	731	(1)
Miscellaneous Effects	731	(1)
Assessment for Bleeding	731	(3)
Patient/Family History	731	(1)
Physical Examination	732	(1)
Screening Tests	732	(2)
Therapeutic Approaches and Nursing Care	734	(5)
Prevention of Bleeding	734	(2)
Management of Bleeding	736	(2)
Blood Component Therapy	738	(1)
Conclusion	739	(1)
References	739	(2)
Fatigue	741	(20)
Mei R. Fu
Roxanne W. McDaniel
Verna A. Rhodes
Scope of the Problem	742	(4)
Definitions	742	(1)
Incidence	742	(1)
Etiology and Risk Factors	743	(3)
Physiologic Alterations	746	(1)
Pathophysiology	746	(1)
Clinical Manifestations	747	(1)
Assessment of Fatigue	747	(3)
Patient and Family History	748	(1)
Physical Examination	748	(2)
Diagnostic Studies	750	(1)
Therapeutic Approaches and Nursing Care	750	(7)
Prevention	750	(1)
Management	751	(6)
Future Trends	757	(1)
References	757	(4)
Nutritional Disturbances	761	(30)
Regina S. Cunningham
Maureen B. Huhmann
Scope of the Problem	762	(2)
Definitions	762	(1)
Incidence	762	(1)
Risk Factors	763	(1)
Normal Nutritional Physiology	764	(1)
Pathophysiology	765	(3)
Cancer-Induced Changes in the Reference Compartment	765	(1)
Cancer-Induced Changes in the Controller	766	(1)
Treatment-Induced Changes in the Reference Compartment	767	(1)
Treatment-Induced Changes in the Controller	767	(1)
Clinical Manifestations	768	(1)
Screening, Assessment, and Grading	768	(5)
Nutritional Screening	768	(1)
Nutritional Assessment	769	(2)
Calculating Energy Needs	771	(1)
Laboratory Tests	771	(1)
Physical Examination	772	(1)
Dietary Information	773	(1)
Functional Assessment	773	(1)
Nutrition-Related Symptom Assessment	773	(1)
Therapeutic Approaches and Nursing Care	773	(8)
Nutritional Interventions	774	(1)
Nutritional Prescription	774	(3)
Nutritional Strategies	777	(2)
Enteral and Parenteral Nutrition	779	(1)
Physical Activity	780	(1)
Complementary and Alternative Nutritional Interventions	780	(1)
Conclusion	781	(6)
References	787	(4)
Hypercalcemia	791	(17)
AnnMarie K. McDonnell Keenan
Rita S. Wickham
Scope of the Problem	792	(1)
Definition	792	(1)
Incidence	792	(1)
Etiology and Risk Factors	792	(1)
Hypercalcemia of Malignancy: Physiologic Alterations	793	(2)
Humoral Hypercalcemia of Malignancy	794	(1)
Local Osteolytic Hypercalcemia	794	(1)
Normal Anatomy and Physiology: Scientific Principles	795	(3)
Normal Calcium Homeostasis	795	(1)
Calciotropic Hormones	795	(1)
Bone	796	(1)
Normal Bone Remodeling	797	(1)
The Role of the Kidney	798	(1)
The Role of the Gastrointestinal Tract	798	(1)
Clinical Manifestations	798	(1)
Neuromuscular	799	(1)
Gastrointestinal	799	(1)
Renal	799	(1)
Cardiovascular	799	(1)
Assessment and Grading	799	(1)
Diagnostic Work-up for Hypercalcemia	800	(1)
Therapeutic Approaches and Nursing Care	800	(6)
Goals of Therapy	801	(1)
Saline Diuresis	801	(4)
Dialysis	805	(1)
Prevention	805	(1)
Other General Measures and Nursing Care	805	(1)
Continuity of Care	806	(1)
Conclusion	806	(1)
References	806	(2)
Paraneoplastic Syndromes	808	(17)
Terri S. Armstrong
Introduction	809	(1)
Endocrine Paraneoplastic Syndromes	809	(1)
Scope of the Problem	809	(2)
Definitions	809	(1)
Incidence	809	(1)
Etiology and Risk Factors	810	(1)
Pathophysiology	811	(1)
Clinical Manifestations	812	(1)
Assessment	812	(1)
Diagnostic Studies	812	(1)
Therapeutic Approaches and Nursing Care	813	(1)
Neurologic Paraneoplastic Syndromes	813	(1)
Scope of the Problem	813	(2)
Definitions	814	(1)
Incidence	814	(1)
Etiology and Risk Factors	814	(1)
Pathophysiology	815	(1)
Clinical Manifestations	815	(1)
Assessment	815	(1)
Diagnostic Studies	815	(1)
Therapeutic Approaches and Nursing Care	816	(1)
Hematologic Paraneoplastic Syndromes	816	(1)
Scope of the Problem	816	(1)
Definitions	816	(1)
Incidence	817	(1)
Etiology and Risk Factors	817	(1)
Pathophysiology	817	(1)
Clinical Manifestations	818	(1)
Assessment	818	(1)
Diagnostic Studies	818	(1)
Therapeutic Approaches and Nursing Care	818	(1)
Renal Paraneoplastic Syndromes	818	(1)
Scope of the Problem	818	(1)
Definitions	818	(1)
Incidence	818	(1)
Etiology and Risk Factors	818	(1)
Pathophysiology	819	(1)
Clinical Manifestations	819	(1)
Assessment and Grading	819	(1)
Diagnostic Studies	819	(1)
Therapeutic Approaches and Nursing Care	819	(1)
Miscellaneous Paraneoplastic Syndromes	820	(1)
Cutaneous Paraneoplastic Syndromes	820	(1)
Cancer Anorexia-Cachexia Syndrome	820	(1)
Tumor Fever	820	(3)
Ocular Paraneoplastic Syndromes	823	(1)
Conclusion	823	(1)
References	823	(2)
Malignant Effusions and Edema	825	(16)
Diane G. Cope
Introduction	826	(1)
Pleural Effusions	826	(6)
Scope of the Problem	826	(1)
Physiologic Alterations	826	(1)
Clinical Manifestations	827	(1)
Assessment	827	(1)
Therapeutic Approaches and Nursing Care	828	(4)
Future Trends	832	(1)
Pericardial Effusions	832	(4)
Scope of the Problem	832	(1)
Physiologic Alterations	832	(1)
Clinical Manifestations	833	(1)
Assessment	833	(1)
Therapeutic Approaches and Nursing Care	834	(2)
Future Trends	836	(1)
Malignant Peritoneal Effusions	836	(3)
Scope of the Problem	836	(1)
Physiologic Alterations	836	(1)
Clinical Manifestations	837	(1)
Assessment	837	(1)
Therapeutic Approaches and Nursing Care	837	(2)
Future Trends	839	(1)
References	839	(2)
Sexual and Reproductive Dysfunction	841	(30)
Linda U. Krebs
Scope of the Problem	842	(1)
Physiological Alterations	842	(2)
Clinical Manifestations: Effect of Cancer Therapy on Gonadal Function	844	(10)
Surgery	844	(5)
Radiation Therapy	849	(1)
Chemotherapy	850	(3)
Biological Response Modifiers	853	(1)
Targeted Therapies	853	(1)
Stem Cell and Marrow Transplantation	853	(1)
Therapeutic Approaches and Nursing Care	854	(4)
Sexual Counseling	854	(1)
Nursing Assessment and Management	855	(1)
Fertility Considerations and Procreative Alternatives	856	(1)
Reproductive Counseling	856	(1)
Semen Cryopreservation and Sperm Recovery	857	(1)
In Vitro Fertilization/Embryo Transfer	858	(1)
Pregnancy and Cancer	858	(5)
Medical Management of Commonly Associated Cancers	859	(2)
Effects of Treatment and Malignancy on the Fetus	861	(1)
Nursing Management of the Pregnant Patient	862	(1)
Conclusion	863	(1)
References	863	(8)
Part V Oncologic Emergencies	871	(88)
Cardiac Tamponade	873	(14)
Roberta Kaplow
Scope of the Problem	874	(1)
Definitions	874	(1)
Incidence	874	(1)
Etiology and Risk Factors	874	(1)
Physiologic Alterations	874	(1)
Normal Anatomy and Physiology	874	(1)
Pathophysiology	874	(1)
Clinical Manifestations	875	(2)
Assessment and Grading	877	(3)
Physical Exam	877	(1)
Diagnostic Tests	877	(3)
Grading	880	(1)
Therapeutic Approaches and Nursing Care	880	(5)
Prevention	880	(1)
Management	880	(3)
Continuity of Care	883	(2)
Conclusion	885	(1)
References	885	(2)
Disseminated Intravascular Coagulation	887	(8)
Barbara Holmes Gobel
Scope of the Problem	888	(1)
Definitions	888	(1)
Incidence	888	(1)
Etiology and Risk Factors	888	(1)
Physiologic Alterations	889	(1)
Pathophysiology	889	(1)
Clinical Manifestations	890	(1)
Assessment	890	(1)
Therapeutic Approaches and Nursing Care	891	(2)
Prevention of Complications	891	(1)
Management	891	(2)
Continuity of Care	893	(1)
Conclusion	893	(1)
References	893	(2)
Septic Shock	895	(15)
Susan Moore
Scope of the Problem	896	(1)
Definitions	896	(1)
Incidence	896	(1)
Etiology and Risk Factors	897	(1)
Physiologic Alterations	897	(1)
Normal Physiology	897	(1)
Pathophysiology	897	(1)
Clinical Manifestations	898	(3)
Assessment and Grading	901	(2)
Patient History	901	(1)
Physical Exam	901	(1)
Diagnostic Studies	902	(1)
Therapeutic Approaches and Nursing Care	903	(4)
Prevention	903	(1)
Management	904	(3)
Conclusion	907	(1)
References	908	(2)
Spinal Cord Compression	910	(15)
Anne Marie Flaherty
Scope of the Problem	911	(1)
Definition	911	(1)
Incidence	911	(1)
Pathophysiology	911	(2)
Anatomy of the Spinal Cord	911	(1)
Etiology	912	(1)
Pathogenesis	913	(1)
Site of Compression	913	(1)
Clinical Manifestations and Physical Assessment	913	(2)
Back Pain	913	(1)
Motor Weakness and Motor Loss	914	(1)
Sensory Disturbances and Sensory Loss	914	(1)
Autonomic Dysfunction	915	(1)
Diagnostic Evaluation	915	(1)
Plain Films and Bone Scans	915	(1)
Magnetic Resonance Imaging	915	(1)
Myelogram with Computerized Tomography	916	(1)
Therapeutic Approaches and Nursing Care	916	(7)
Medical Management	916	(4)
Symptom Management	920	(3)
Conclusion	923	(1)
References	923	(2)
Superior Vena Cava Syndrome	925	(15)
Susan Moore
Scope of the Problem	926	(1)
Definitions	926	(1)
Incidence	926	(1)
Etiology and Risk Factors	926	(1)
Physiologic Alterations	926	(3)
Normal Anatomy and Physiology	926	(3)
Pathophysiology	929	(1)
Clinical Manifestations	929	(3)
Assessment and Grading	929	(3)
Therapeutic Approaches and Nursing Care	932	(5)
Management	932	(4)
Continuity of Care	936	(1)
Conclusion	937	(1)
References	938	(2)
Syndrome of Inappropriate Antidiuretic Hormone	940	(6)
AnnMarie K. McDonnell Keenan
Scope of the Problem	941	(1)
Definitions	941	(1)
Incidence	941	(1)
Etiology and Risk Factors	941	(1)
Physiologic Alterations	941	(2)
Normal Physiology and Scientific Principles	941	(1)
Pathophysiology	942	(1)
Clinical Manifestations	943	(1)
Assessment and Grading	943	(1)
Therapeutic Approaches and Nursing Care	943	(2)
Conclusion	945	(1)
References	945	(1)
Tumor Lysis Syndrome	946	(13)
Jean Lydon
Scope of the Problem	947	(1)
Definition	947	(1)
Incidence	947	(1)
Etiology and Risk Factors	947	(1)
Physiologic Alterations	948	(1)
Clinical Manifestations	949	(1)
Assessment and Grading	949	(1)
Therapeutic Approaches and Nursing Care	950	(7)
Conclusion	957	(1)
References	957	(2)
Part VI The Care of Individuals with Cancer	959	(704)
AIDS-Related Malignancies	961	(18)
James C. Pace
Laura E. Gallagher
Introduction	962	(1)
An Overview of HIV Disease	962	(1)
Malignancies and HIV Disease	962	(1)
Kaposi's Sarcoma	962	(6)
Epidemiology	963	(1)
Etiology and Related Pathophysiology	963	(1)
Prevention, Screening, and Early Detection	964	(1)
Clinical Manifestations	964	(1)
Assessment	964	(1)
Diagnosis	965	(1)
Prognostic Factors for Survival and Staging System of AIDS-Related KS	965	(1)
Therapeutic Approaches for AIDS-Related KS	966	(1)
Nursing Care	967	(1)
Non-Hodgkin's (AIDS-Related) Lymphoma	968	(4)
Epidemiology	969	(1)
Etiology and Related Pathophysiology	969	(1)
Prevention, Screening, and Early Detection	970	(1)
Clinical Manifestations	970	(1)
Assessment	970	(1)
Diagnosis	970	(1)
Therapeutic Approaches for Non-Hodgkin's Lymphoma	971	(1)
Treatment for Relapsed or Refractory Disease	971	(1)
Nursing Care	972	(1)
Cervical Cancer	972	(3)
Epidemiology	972	(1)
Etiology and Related Pathophysiology	972	(1)
Pathogenesis and Staging	973	(1)
Clinical Manifestations	973	(1)
Assessment	973	(1)
Diagnosis	973	(1)
Prevention and the HIV-Positive Patient	974	(1)
Therapeutic Approaches for Cervical Cancer	974	(1)
Nursing Care	974	(1)
Other Malignancies	975	(1)
The Double Trauma; AIDS and Malignancy	975	(1)
Conclusion	976	(1)
References	976	(3)
Bone and Soft-Tissue Sarcomas	979	(26)
M. Jayne Kennedy Sumner
Introduction	980	(1)
Epidemiology	980	(1)
Etiology	980	(1)
Screening and Early Detection	980	(1)
Pathophysiology	981	(1)
Clinical Manifestations	981	(1)
Assessment	981	(4)
Patient and Family History	981	(1)
Physical Examination	982	(1)
Diagnostic Studies	982	(3)
Prognostic Indicators	985	(1)
Classification and Staging	985	(1)
Therapeutic Approaches and Nursing Care	985	(1)
Surgery	985	(9)
Bone	985	(9)
Soft-Tissue Surgery	994	(1)
Metastatic Sarcoma	994	(1)
Radiotherapy	994	(2)
Chemotherapy	996	(1)
Description of Selected Sarcomas	996	(6)
Osteosarcoma	996	(1)
Chondrosarcoma	997	(2)
Fibrosarcoma	999	(1)
Ewing's Sarcoma	999	(1)
Soft-Tissue Sarcomas	1000	(1)
Metastatic Bone Tumors	1001	(1)
Symptom Management and Supportive Care	1002	(1)
Pain	1002	(1)
Limitations of Mobility	1002	(1)
Continuity of Care: Nursing Challenges	1002	(1)
Future Trends	1003	(1)
References	1003	(2)
Bladder and Renal Cancers	1005	(17)
Laura S. Wood
Dorothy Calabrese
Introduction	1006	(1)
Bladder Cancer	1006	(1)
Epidemiology	1006	(1)
Etiology	1006	(1)
Pathophysiology	1006	(1)
Clinical Manifestations	1006	(1)
Assessment	1007	(1)
Physical Examination and Diagnostic Studies	1007	(1)
Prognostic Indicators	1007	(1)
Classification and Staging	1007	(1)
Therapeutic Approaches	1008	(2)
Carcinoma in Situ	1008	(1)
Superficial, Low-Grade Tumors	1008	(1)
Invasive Tumors	1009	(1)
Radiation Therapy	1010	(1)
Chemotherapy	1010	(1)
Nursing Care	1010	(3)
Preoperative Nursing Care	1010	(1)
General Postoperative Care	1011	(1)
Nursing Care of the Patient with an Ileal Conduit	1011	(1)
Follow-up Care for the Patient with an Ileal Conduit	1012	(1)
Nursing Care of the Patient with a Continent Urinary Diversion	1012	(1)
Kidney Cancer	1013	(1)
Epidemiology	1013	(1)
Etiology	1013	(1)
Prevention, Screening, and Early Detection	1014	(1)
Pathophysiology	1014	(1)
Clinical Manifestations	1015	(1)
Assessment	1015	(1)
Classification and Staging	1016	(1)
Therapeutic Approaches	1016	(3)
Surgery	1016	(1)
Radiation	1017	(1)
Chemotherapy	1018	(1)
Biotherapy	1018	(1)
Nursing Care	1019	(1)
Symptom Management and Supportive Care	1019	(1)
Conclusion	1020	(1)
References	1020	(2)
Breast Cancer	1022	(67)
Dianne D. Chapman
Susan Moore
Introduction	1023	(1)
Etiology	1024	(6)
Hormonal Factors	1024	(2)
Family History	1026	(2)
Diet	1028	(1)
Obesity	1028	(1)
Alcohol	1029	(1)
Radiation	1029	(1)
Aspirin	1029	(1)
Breast Biopsy	1029	(1)
Carcinoma in Situ	1030	(1)
Prevention, Screening, and Early Detection	1030	(4)
Ductal Lavage	1031	(1)
Chemoprevention	1031	(1)
Biomarkers	1032	(1)
Exercise	1033	(1)
Prophylactic Mastectomy	1033	(1)
Multidisciplinary Breast Centers	1034	(1)
Genetic Counseling Programs	1035	(2)
Pathophysiology	1037	(1)
Cellular Characteristics	1037	(1)
Patterns of Metastasis	1038	(1)
Clinical Manifestations	1038	(12)
Diagnostic Studies	1038	(9)
Prognostic Indicators	1047	(3)
Assessment	1050	(2)
Classification and Staging	1050	(2)
Therapeutic Approaches and Nursing Care	1052	(4)
Surgery	1052	(3)
Radiation Therapy	1055	(1)
Breast Cancer in Special Populations	1056	(4)
Males	1056	(1)
Young Women	1057	(1)
Elders	1058	(1)
African American Women	1058	(2)
Breast Reconstruction	1060	(7)
Saline Tissue Expanders	1062	(1)
Permanent Saline Prostheses	1062	(1)
Latissimus Dorsi Flap	1063	(1)
TRAM Flap	1063	(1)
DIEP Flap	1063	(1)
Free Flap	1063	(2)
Nipple-Areolar Construction	1065	(2)
Systemic Adjuvant Therapy	1067	(2)
Local-Regional Breast Cancer	1067	(1)
Locally Advanced Breast Cancer	1068	(1)
Metastatic Breast Cancer	1069	(4)
Routes of Metastasis	1070	(1)
Chemotherapy	1070	(2)
Endocrine Therapy	1072	(1)
Symptom Management and Supportive Care	1073	(4)
Chronic Lymphedema	1075	(2)
Continuity of Care	1077	(2)
Support Systems	1077	(1)
Nursing Challenges	1077	(2)
Future Trends	1079	(2)
References	1081	(8)
Central Nervous System Cancers	1089	(48)
Karen Belford
Introduction	1090	(1)
Brain Tumors	1090	(1)
Epidemiology	1090	(1)
Etiology	1090	(2)
Genetic Factors	1090	(1)
Radiation	1091	(1)
Immunosuppression and Viral Factors	1091	(1)
Chemical and Environmental Factors	1091	(1)
Electromagnetic Fields	1091	(1)
Pathophysiology	1092	(11)
Anatomy and Physiology	1092	(4)
Physiology of Intracranial Pressure	1096	(1)
Gliomas	1097	(3)
Meningiomas	1100	(1)
Vestibular Schwannomas (Acoustic Neuromas)	1100	(1)
Primary Central Nervous System Lymphomas	1101	(1)
Brain Metastases	1101	(2)
Pattern of Spread	1103	(1)
Clinical Manifestations	1103	(4)
Generalized Effects of Increased Intracranial Pressure	1103	(1)
Focal Effects	1104	(1)
Displacement of Brain Structures	1105	(2)
Assessment	1107	(3)
Diagnostic Studies	1108	(1)
Prognostic Indicators	1109	(1)
Classification and Staging	1110	(1)
Therapeutic Approaches and Nursing Care	1110	(10)
Surgery	1110	(4)
Radiation Therapy	1114	(3)
Chemotherapy	1117	(2)
Biotherapy	1119	(1)
Spinal Cord Tumors	1120	(1)
Epidemiology	1120	(1)
Etiology	1120	(1)
Pathophysiology	1120	(3)
Anatomy and Physiology	1120	(1)
Extradural Tumors	1121	(1)
Intradural Tumors	1122	(1)
Pattern of Spread	1123	(1)
Clinical Manifestations	1123	(1)
Assessment	1124	(1)
Diagnostic Studies	1124	(1)
Prognostic Indicators	1125	(1)
Classification and Staging	1125	(1)
Therapeutic Approaches and Nursing Care	1125	(1)
Surgery	1125	(1)
Radiation Therapy	1126	(1)
Chemotherapy	1126	(1)
Symptom Management and Supportive Care	1126	(4)
Continuity of Care: Nursing Challenges	1130	(1)
Conclusion	1131	(1)
References	1131	(6)
Cervical Cancer	1137	(18)
Susan Vogt Temple
Introduction	1138	(1)
Epidemiology	1138	(1)
Etiology	1138	(1)
Prevention, Screening, and Early Detection	1139	(1)
Preinvasive Disease	1140	(1)
Squamous Intraepithelial Lesions	1140	(1)
Assessment	1141	(1)
Therapeutic Approaches and Nursing Care	1141	(2)
Invasive Disease	1143	(1)
Pathophysiology	1143	(2)
Cellular Characteristics	1143	(1)
Progression of Disease	1143	(2)
Clinical Manifestations	1145	(1)
Assessment	1145	(1)
Physical Examination	1145	(1)
Diagnostic Studies	1145	(1)
Prognostic Indicators	1146	(1)
Classification and Staging	1146	(1)
Therapeutic Approaches and Nursing Care	1146	(4)
Stage IA	1147	(1)
Stages IB and IIA	1147	(1)
Stages IIB, III, and IVA	1148	(1)
Recurrent or Persistent Disease	1149	(1)
Symptom Management and Supportive Care	1150	(1)
Conclusion	1151	(1)
References	1151	(4)
Colon, Rectal, and Anal Cancers	1155	(60)
Gail M. Wilkes
Colon Cancer	1156	(1)
Introduction	1156	(1)
Epidemiology and Etiology	1157	(3)
Prevention, Screening, and Early Detection	1160	(9)
Primary Prevention	1164	(1)
Secondary Prevention and Screening	1165	(4)
Early Detection Efforts	1169	(1)
Pathophysiology	1169	(5)
Cellular Characteristics	1169	(3)
Progression of Disease and Patterns of Spread	1172	(2)
Clinical Manifestations	1174	(1)
Assessment	1175	(2)
Patient and Family History	1175	(1)
Physical Examination	1175	(1)
Diagnostic Studies	1176	(1)
Prognostic Indicators	1177	(1)
Classification and Staging	1177	(2)
Therapeutic Approaches and Nursing Care	1179	(7)
Surgery	1179	(3)
Radiation Therapy	1182	(1)
Chemotherapy	1183	(3)
Molecular Targeted Therapy	1186	(1)
Symptom Management and Supportive Care	1186	(5)
Bowel Obstruction	1186	(3)
Fistula	1189	(1)
Progressive Disease	1189	(1)
Long-Term Monitoring and Follow-up	1190	(1)
Conclusion	1191	(1)
Rectal Cancer	1191	(1)
Introduction	1191	(1)
Epidemiology and Etiology	1191	(1)
Prevention, Screening, and Early Detection	1191	(1)
Pathophysiology	1192	(1)
Cellular Characteristics	1192	(1)
Progression of Disease and Patterns of Spread	1193	(1)
Clinical Manifestations	1193	(1)
Assessment	1193	(1)
Patient and Family History	1193	(1)
Physical Examination	1194	(1)
Diagnostic Studies	1194	(1)
Prognostic Indicators	1194	(1)
Classification and Staging	1194	(1)
Therapeutic Approaches and Nursing Care	1195	(4)
Surgery	1195	(2)
Radiation Therapy	1197	(1)
Chemotherapy	1198	(1)
Molecularly Targeted Therapy	1198	(1)
Symptom Management and Supportive Care	1199	(2)
Perineal Wound Healing	1199	(1)
Stoma and Colostomy Management	1199	(1)
Sexual Dysfunction	1200	(1)
Ureteral Obstruction	1200	(1)
Liver Metastases	1201	(1)
Follow-up	1201	(1)
Conclusions	1201	(1)
Anal Cancer	1201	(1)
Introduction	1201	(1)
Epidemiology and Etiology	1201	(1)
Prevention, Screening, and Early Detection	1202	(1)
Pathophysiology	1202	(2)
Cellular Characteristics	1203	(1)
Progression of Disease	1203	(1)
Clinical Manifestations	1204	(1)
Assessment	1204	(1)
Patient and Family History	1204	(1)
Physical Examination	1204	(1)
Diagnostic Studies	1204	(1)
Prognostic Indicators	1204	(1)
Classification and Staging	1204	(1)
Therapeutic Approaches and Nursing Care	1204	(2)
Surgery	1204	(1)
Radiation Therapy	1205	(1)
Chemotherapy	1205	(1)
Molecular Targeted Therapy	1205	(1)
Symptom Management and Supportive Care	1206	(1)
Long-Term Monitoring and Follow-up	1206	(1)
Conclusion	1207	(1)
References	1208	(7)
Endocrine Malignancies	1215	(29)
Michelle Goodman
Rita Wickham
Introduction	1216	(1)
Thyroid Tumors	1216	(1)
Epidemiology	1217	(1)
Etiology	1217	(1)
Pathophysiology	1218	(1)
Papillary and Follicular Tumors	1218	(1)
Medullary Tumors	1218	(1)
Anaplastic Tumors	1219	(1)
Clinical Manifestations	1219	(1)
Assessment	1219	(1)
Classification and Staging	1220	(1)
Therapeutic Approaches and Nursing Care	1220	(2)
Surgery	1220	(1)
Radiation Therapy	1221	(1)
Chemotherapy	1221	(1)
Parathyroid Tumors	1222	(1)
Epidemiology	1223	(1)
Etiology	1223	(1)
Pathophysiology	1223	(1)
Clinical Manifestations	1223	(1)
Assessment	1224	(1)
Therapeutic Approaches and Nursing Care	1224	(1)
Surgery	1224	(1)
Chemotherapy	1224	(1)
Palliative Care	1224	(1)
Pituitary Tumors	1225	(1)
Epidemiology	1225	(1)
Etiology	1225	(1)
Pathophysiology	1225	(1)
Clinical Manifestations	1226	(1)
Hormone Effects	1226	(1)
Assessment	1226	(1)
Classification and Staging	1227	(1)
Therapeutic Approaches and Nursing Care	1227	(3)
Surgery	1227	(1)
Radiation Therapy	1228	(1)
Drug Therapy	1229	(1)
Nursing Care	1229	(1)
Adrenal Tumors	1230	(1)
Adrenocortical Tumors	1231	(1)
Epidemiology	1231	(1)
Etiology	1231	(1)
Pathophysiology	1231	(1)
Clinical Manifestations	1231	(1)
Assessment	1232	(1)
Classification and Staging	1232	(1)
Therapeutic Approaches and Nursing Care	1233	(1)
Surgery	1233	(1)
Chemotherapy	1233	(1)
Symptom Management and Supportive Care	1234	(1)
Pheochromocytoma	1234	(1)
Epidemiology	1234	(1)
Etiology	1234	(1)
Pathophysiology	1234	(1)
Clinical Manifestations	1235	(1)
Assessment	1235	(1)
Classification and Staging	1235	(1)
Therapeutic Approaches and Nursing Care	1236	(1)
Surgery	1236	(1)
Radiation Therapy	1236	(1)
Chemotherapy	1236	(1)
Symptom Management and Supportive Care	1236	(1)
Multiple Endocrine Neoplasia	1237	(1)
Multiple Endocrine Neoplasia 1	1238	(1)
Etiology	1238	(1)
Multiple Endocrine Neoplasia 2	1238	(1)
MEN2A	1238	(1)
MEN2B	1238	(1)
Etiology	1239	(1)
Assessment and Screening	1239	(1)
Therapeutic Approaches and Nursing Care	1240	(1)
Conclusion	1240	(1)
References	1240	(4)
Endometrial Cancer	1244	(14)
Lois A. Almadrones
Introduction	1245	(1)
Epidemiology	1245	(1)
Etiology	1245	(1)
Prevention, Screening, and Early Detection	1246	(1)
Pathophysiology	1247	(1)
Cellular Characteristics	1247	(1)
Progression of Disease and Patterns of Spread	1247	(1)
Clinical Manifestations	1248	(1)
Assessment	1249	(1)
Patient and Family History	1249	(1)
Physical Examination	1249	(1)
Diagnostic Studies	1249	(1)
Prognostic Indicators	1249	(1)
Classification and Staging	1249	(1)
Therapeutic Approaches and Nursing Care	1250	(3)
Early-Stage Disease	1250	(3)
Advanced or Recurrent Disease	1253	(1)
Symptom Management and Supportive Care	1253	(2)
Future Trends	1255	(1)
References	1255	(3)
Esophageal Cancer	1258	(17)
Nancy D. Tsottles
Anita M. Reedy
Introduction	1259	(1)
Epidemiology	1259	(1)
Etiology	1260	(1)
Prevention, Screening, and Early Detection	1260	(1)
Pathophysiology	1261	(1)
Cellular Characteristics	1261	(1)
Progression of Disease	1261	(1)
Patterns of Spread	1261	(1)
Clinical Manifestations	1261	(1)
Assessment	1261	(2)
History	1262	(1)
Physical Examination	1262	(1)
Diagnostic Studies	1262	(1)
Prognostic Indicators	1263	(1)
Classification and Staging	1263	(1)
Therapeutic Approaches and Nursing Care	1263	(8)
Barrett's Esophagus	1264	(1)
Local and Locoregional Esophageal Cancer	1265	(5)
Nonresectable or Metastatic Disease	1270	(1)
Symptom Management and Supportive Care	1271	(1)
Conclusion	1272	(1)
References	1272	(3)
Gallbladder and Bile Duct Cancer	1275	(19)
JoAnn Coleman
Gallbladder Cancer	1276	(7)
Introduction	1276	(1)
Epidemiology	1276	(1)
Etiology	1276	(1)
Prevention, Screening, and Early Detection	1277	(1)
Pathophysiology	1277	(1)
Clinical Manifestations	1277	(1)
Assessment	1278	(1)
Classification and Staging	1279	(1)
Therapeutic Approaches and Nursing Care	1279	(4)
Symptom Management and Supportive Care	1283	(1)
Future Trends	1283	(1)
Bile Duct Cancer	1283	(7)
Introduction	1283	(1)
Epidemiology	1284	(1)
Etiology	1284	(1)
Prevention, Screening, and Early Detection	1285	(1)
Pathophysiology	1285	(1)
Clinical Manifestations	1286	(1)
Assessment	1286	(1)
Classification and Staging	1287	(1)
Therapeutic Approaches and Nursing Care	1287	(3)
Symptom Management and Supportive Care	1290	(1)
Future Trends	1290	(1)
Conclusion	1290	(1)
References	1291	(3)
Head and Neck Malignancies	1294	(36)
Ellen Carr
Introduction	1295	(1)
Epidemiology	1295	(1)
Anatomy	1296	(3)
Nasal Fossa and Paranasal Sinuses	1296	(1)
Skull Base	1296	(1)
Nasopharynx	1296	(1)
Oral Cavity	1297	(1)
Oropharynx	1297	(1)
Salivary Gland	1297	(1)
Larynx	1298	(1)
Hypopharynx and Neck	1299	(1)
Etiology and Risk Factors	1299	(3)
Carcinoma of the Nasal Cavity and Paranasal Sinuses	1299	(1)
Carcinoma of the Nasopharynx	1299	(1)
Carcinoma of the Major or Minor Salivary Glands	1300	(1)
Carcinoma of the Oral Cavity	1300	(1)
Carcinoma of the Lip	1301	(1)
Carcinoma of the Larynx	1301	(1)
Carcinoma of the Hypopharynx	1302	(1)
Clinical Manifestations	1302	(2)
Skull Base Malignancies	1302	(1)
Nasal Cavity, Paranasal Sinuses, and Nasopharyngeal Malignancies	1302	(1)
Oral Cavity and Oropharynx Malignancies	1303	(1)
Laryngeal Malignancies	1304	(1)
Hypopharyngeal Malignancies	1304	(1)
Pathophysiology	1304	(1)
Cellular Characteristics	1304	(1)
Progression of Disease	1304	(1)
Assessment	1305	(2)
Magnetic Resonance Imaging	1306	(1)
Computed Tomography	1306	(1)
Positron Emission Tomography	1306	(1)
Classification and Staging	1307	(1)
Therapeutic Approaches and Nursing Care	1307	(7)
Surgery	1307	(2)
Radiation Therapy	1309	(2)
Chemotherapy	1311	(1)
Treatment Strategies for Specific Head and Neck Cancers	1312	(2)
Future Management Strategies	1314	(1)
Symptom Management and Supportive Care	1315	(9)
Swallowing	1315	(1)
Swallow Therapy	1316	(1)
Speech	1316	(1)
Mucositis	1317	(1)
Oral Care	1317	(2)
Xerostomia	1319	(1)
Loss of Taste	1320	(1)
Dental Prophylactic Care	1321	(1)
Trismus	1321	(1)
Pain Management	1321	(1)
Tracheostomy Care	1321	(1)
Nutritional Management	1322	(1)
Enteral Therapy	1323	(1)
Psychosocial Support	1323	(1)
Quality-of-Life Issues	1323	(1)
Continuity of Care	1324	(1)
References	1324	(6)
Leukemia	1330	(25)
Debra Wujcik
Introduction	1331	(1)
Epidemiology	1331	(1)
Etiology	1331	(1)
Genetic Factors	1331	(1)
Radiation	1331	(1)
Chemicals	1332	(1)
Drugs	1332	(1)
Viruses	1332	(1)
Pathophysiology	1332	(1)
Clinical Manifestations	1332	(1)
Assessment of Acute Leukemia	1333	(3)
Patient History	1333	(1)
Physical Examination	1333	(1)
Diagnostic Studies	1334	(2)
Classification	1336	(1)
Acute Myelogenous Leukemia	1336	(1)
Classification	1336	(1)
Therapeutic Approaches	1337	(2)
Induction Therapy	1337	(1)
Postremission Therapy	1337	(2)
Acute Lymphocytic Leukemia	1339	(1)
Classification	1339	(1)
Therapeutic Approaches	1339	(1)
Induction Therapy	1339	(1)
CNS Prophylaxis	1340	(1)
Postremission Therapy	1340	(1)
Myelodysplastic Syndromes	1340	(2)
Chronic Myelogenous Leukemia	1342	(1)
Assessment	1343	(1)
Patient History	1343	(1)
Physical Examination	1343	(1)
Diagnostic Studies	1343	(1)
Therapeutic Approaches	1344	(1)
Chronic Phase	1344	(1)
Terminal Phase	1344	(1)
Chronic Lymphocytic Leukemia	1345	(1)
Assessment	1345	(1)
Patient History	1345	(1)
Physical Examination	1345	(1)
Diagnostic Studies	1345	(1)
Therapeutic Approaches	1346	(1)
Hairy Cell Leukemia	1346	(1)
Etiology	1346	(1)
Therapeutic Approaches	1346	(1)
Supportive Care	1347	(4)
Education	1347	(1)
Physical Care	1347	(1)
Symptom Management	1348	(3)
Psychosocial Support	1351	(1)
Conclusion	1351	(1)
References	1351	(4)
Liver Cancer: Primary and Metastatic Disease	1355	(24)
Nina N. Gremon
Introduction	1356	(1)
Epidemiology	1356	(1)
Hepatocellular Carcinoma	1356	(1)
Liver Metastases	1356	(1)
Etiology	1357	(1)
Hepatocellular Carcinoma	1357	(1)
Liver Metastases	1358	(1)
Prevention, Screening, and Early Detection	1358	(1)
Pathophysiology	1359	(1)
Cellular Characteristics	1359	(1)
Progression of Disease	1359	(1)
Clinical Manifestations	1359	(1)
Assessment	1360	(2)
Patient and Family History	1360	(1)
Physical Examination	1360	(1)
Diagnostic Studies	1361	(1)
Classification and Staging	1362	(1)
Therapeutic Approaches and Nursing Care	1363	(9)
Hepatocellular Carcinoma	1363	(2)
Liver Metastases	1365	(1)
Postoperative Care	1366	(1)
Post-Transplantation Care	1367	(1)
Palliative Treatments	1367	(4)
Radiation Therapy	1371	(1)
Systemic Chemotherapy	1372	(1)
Gene Therapy	1372	(1)
Symptom Management and Supportive Care	1372	(2)
Conclusion	1374	(1)
References	1374	(5)
Lung Cancer	1379	(35)
Carol S. Knop
Introduction	1380	(1)
Epidemiology	1380	(1)
Etiology	1381	(2)
Tobacco	1381	(1)
Cannabis	1381	(1)
Environmental Tobacco Smoke	1382	(1)
Radon	1382	(1)
Asbestos	1382	(1)
Occupational Agents	1382	(1)
Indoor Pollution	1382	(1)
Genetic Susceptibility	1382	(1)
Dietary Factors	1383	(1)
Other Risk Factors	1383	(1)
Prevention	1383	(3)
Smoking Prevention and Cessation	1383	(1)
Chemoprevention	1384	(2)
Screening and Early Detection	1386	(3)
Sputum Cytology	1387	(1)
Chest X-ray	1387	(1)
Low-Dose Spiral Chest CT	1388	(1)
Bronchoscopy and Fluorescence Bronchoscopy	1388	(1)
Pathophysiology	1389	(1)
Cellular Characteristics	1389	(1)
Progression of Disease	1389	(1)
Clinical Manifestations	1390	(1)
Signs and Symptoms Related to the Primary Tumor	1390	(1)
Signs and Symptoms Related to Intrathoracic Extrapulmonary Spread	1390	(1)
Symptoms Related to Extrathoracic Spread	1391	(1)
Paraneoplastic Syndromes: Signs and Symptoms Indirectly Related to Tumor	1391	(1)
Assessment	1391	(7)
History	1391	(1)
Physical Exam	1392	(1)
Preoperative Evaluation	1393	(1)
Diagnostic Studies	1394	(2)
Prognostic Indicators	1396	(2)
Classification and Staging	1398	(1)
Non-Small Cell Lung Cancer	1398	(1)
Small Cell Lung Cancer	1398	(1)
Therapeutic Approaches	1399	(8)
Multidisciplinary Thoracic Oncology Programs	1399	(1)
Surgery	1400	(2)
Radiation Therapy	1402	(1)
Other Local Therapies	1403	(1)
Chemotherapy	1404	(2)
Biologic Therapy	1406	(1)
Symptom Management and Supportive Care	1407	(2)
Pain	1407	(1)
Dyspnea	1408	(1)
Cough	1408	(1)
Surveillance and Long-Term Follow-up	1409	(1)
Conclusion	1409	(1)
References	1409	(5)
Lymphomas	1414	(46)
Sharon D. Manson
Carlene Porter
Introduction	1415	(1)
Lymphoid Tissues and the Immune System	1415	(3)
Diagnosis	1418	(3)
Clinical Manifestations	1418	(1)
Biopsy	1419	(1)
Staging	1419	(1)
Laboratory Tests	1420	(1)
Radiographic Tests	1420	(1)
International Prognostic Index	1421	(1)
Hodgkin's Disease	1421	(1)
Historical Perspective	1421	(1)
Epidemiology	1421	(1)
Etiology	1422	(1)
Histological Classification and Patient Presentation	1422	(2)
Nodular Lymphocyte-Predominant Hodgkin's Lymphoma	1422	(1)
Classical Hodgkin's Lymphoma	1423	(1)
Treatment Modalities	1424	(2)
Radiation Therapy	1424	(1)
Chemotherapy	1424	(2)
Stem Cell Transplant	1426	(1)
Future Directions	1426	(1)
Prognosis	1426	(1)
Non-Hodgkin's Lymphoma	1426	(1)
Historical Perspective	1426	(1)
Epidemiology	1426	(1)
Etiology	1427	(1)
Histological Classification Systems	1428	(1)
Rappaport Classification	1428	(1)
International Working Formula	1428	(1)
REAL Classification	1428	(1)
WHO Classification	1428	(1)
Characteristics and Management of B-Cell NHL	1429	(9)
Small Lymphocytic Lymphoma/Chronic Lymphocytic Leukemia	1429	(2)
Follicular Lymphoma	1431	(1)
MALT Lymphoma	1432	(1)
Mantle Cell Lymphoma	1433	(1)
Diffuse Large B-Cell Lymphoma	1433	(1)
Burkitt's Lymphoma	1434	(2)
AIDS-Related Lymphoma	1436	(1)
Lymphoblastic Lymphoma: Precursor B- or T-Cell Lymphoblastic Leukemia/Lymphoma	1437	(1)
Post-Transplant Lymphoproliferative Disorder	1438	(2)
Characteristics and Management of T-Cell NHL	1440	(3)
Cutaneous T-Cell Lymphoma	1440	(2)
Anaplastic Large Cell Lymphoma	1442	(1)
Peripheral T-Cell Lymphoma, Unspecified	1443	(1)
Treatment Modalities	1443	(6)
Chemotherapy	1444	(1)
Radiation Therapy	1444	(1)
Targeted Therapy	1444	(4)
New Therapies	1448	(1)
Acute Complications of Therapy	1449	(2)
Chronic Complications of Therapy	1451	(2)
Fatigue	1451	(1)
Pulmonary Dysfunction	1452	(1)
Thyroid Dysfunction	1452	(1)
Cardiovascular Toxicity	1452	(1)
Reproductive Changes	1452	(1)
Secondary Myelodysplasia and Malignancies	1452	(1)
Conclusion	1453	(1)
References	1453	(7)
Multiple Myeloma	1460	(30)
Joseph D. Tariman
Introduction	1461	(1)
Epidemiology	1461	(1)
Etiology	1461	(1)
Risk Factors	1462	(1)
Prevention, Screening, and Early Detection	1462	(1)
Pathophysiology	1462	(2)
Role of Cytokines	1463	(1)
Clinical Manifestations	1464	(4)
Skeletal Involvement	1465	(1)
Infection	1465	(1)
Bone Marrow Involvement	1465	(1)
Renal Insufficiency	1466	(1)
Metabolic Syndromes	1467	(1)
Neurologic Involvement	1468	(1)
Assessment	1468	(2)
Prognostic Factors	1469	(1)
Diagnostic Criteria	1470	(1)
Classification and Staging	1470	(1)
Therapeutic Approaches and Nursing Care	1471	(9)
Primary Conventional Treatment (Patients without Transplant Options)	1471	(3)
Primary Treatment (Patients with Transplant as an Option)	1474	(2)
Maintenance Therapy	1476	(1)
Conventional and Novel Therapies for Relapsed and Refractory Myeloma	1476	(1)
Radiation Therapy	1477	(1)
Bisphosphonates	1478	(1)
Investigational Novel Therapeutic Agents	1479	(1)
Symptom Management and Nursing Care	1480	(3)
Neuromuscular Symptoms	1481	(1)
Psychosocial Issues	1481	(1)
Protective Mechanisms	1481	(1)
Respiratory Symptoms	1482	(1)
Gastrointestinal Symptoms	1482	(1)
Genitourinary Symptoms	1482	(1)
Conclusion	1483	(1)
References	1484	(6)
Ovarian Cancer	1490	(33)
Virginia R. Martin
Introduction	1491	(1)
Epidemiology	1491	(1)
Etiology	1491	(4)
Reproductive and Hormonal	1491	(3)
Environmental	1494	(1)
Genetics	1494	(1)
Prevention, Screening, and Early Detection	1495	(2)
Pelvic Examination	1495	(1)
CA-125	1495	(1)
Ultrasonography	1496	(1)
Pathophysiology	1497	(1)
Biology	1497	(1)
Prognostic Factors	1498	(1)
Clinical Manifestations	1498	(1)
Assessment	1499	(1)
Classification and Staging	1499	(1)
Therapeutic Approaches and Nursing Care	1500	(8)
Surgery	1500	(1)
Treatment of Epithelial Ovarian Cancer	1501	(6)