Part three: Kidney cancer, leukemia, and liver cancer
Identifieur interne : 005C18 ( Istex/Corpus ); précédent : 005C17; suivant : 005C19Part three: Kidney cancer, leukemia, and liver cancer
Auteurs : Charles KempSource :
- American Journal of Hospice and Palliative Care [ 1049-9091 ] ; 1999-03.
Abstract
This is the third of a six-part series on metastatic spread and natural history of 18 common tumors. Part one summarized symptom/problem anticipation, cancer metastasis, and the 18 tumors that each cause more than 6,000 deaths per year in the United States. Bladder and brain cancers were discussed, with information given on tumor types, metastatic spread and invasion, and common symptoms. Part two charted the natural histories, problems, and assessment parameters of advanced breast, colon and rectum (colorectal), and esophageal cancers. Part three presents the natural histories, problems, and assessment parameters of advanced kidney cancer, leukemia, and liver cancer. Each of these cancers is presented separately, with information given on mortality rates, the most common tumor types, sites of metastases, common problems, and common oncologic emergencies. Sites of spread, resulting problems (including site-specific symptoms), and assessment parameters are presented as tables. Material is presented so that clinicians will be able to anticipate the spread of these cancers and can thus identify problems early in their development so that that they are more easily managed.
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DOI: 10.1177/104990919901600211
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">Part three: Kidney cancer, leukemia, and liver cancer</title><author wicri:is="90%"><name sortKey="Kemp, Charles" sort="Kemp, Charles" uniqKey="Kemp C" first="Charles" last="Kemp">Charles Kemp</name><affiliation><mods:affiliation>Baylor University School of Nursing, Dallas, Texas</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:C49AE3773DBADF5CEAF0BF9E32211B53D37A8D9C</idno><date when="1999" year="1999">1999</date><idno type="doi">10.1177/104990919901600211</idno><idno type="url">https://api.istex.fr/document/C49AE3773DBADF5CEAF0BF9E32211B53D37A8D9C/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">005C18</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">005C18</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Part three: Kidney cancer, leukemia, and liver cancer</title><author wicri:is="90%"><name sortKey="Kemp, Charles" sort="Kemp, Charles" uniqKey="Kemp C" first="Charles" last="Kemp">Charles Kemp</name><affiliation><mods:affiliation>Baylor University School of Nursing, Dallas, Texas</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">American Journal of Hospice and Palliative Care</title><idno type="ISSN">1049-9091</idno><idno type="eISSN">1938-2715</idno><imprint><publisher>Sage Publications</publisher><pubPlace>Sage CA: Thousand Oaks, CA</pubPlace><date type="published" when="1999-03">1999-03</date><biblScope unit="volume">16</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="479">479</biblScope><biblScope unit="page" to="486">486</biblScope></imprint><idno type="ISSN">1049-9091</idno></series><idno type="istex">C49AE3773DBADF5CEAF0BF9E32211B53D37A8D9C</idno><idno type="DOI">10.1177/104990919901600211</idno><idno type="ArticleID">10.1177_104990919901600211</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">1049-9091</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">This is the third of a six-part series on metastatic spread and natural history of 18 common tumors. Part one summarized symptom/problem anticipation, cancer metastasis, and the 18 tumors that each cause more than 6,000 deaths per year in the United States. Bladder and brain cancers were discussed, with information given on tumor types, metastatic spread and invasion, and common symptoms. Part two charted the natural histories, problems, and assessment parameters of advanced breast, colon and rectum (colorectal), and esophageal cancers. Part three presents the natural histories, problems, and assessment parameters of advanced kidney cancer, leukemia, and liver cancer. Each of these cancers is presented separately, with information given on mortality rates, the most common tumor types, sites of metastases, common problems, and common oncologic emergencies. Sites of spread, resulting problems (including site-specific symptoms), and assessment parameters are presented as tables. 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Part one summarized symptom/problem anticipation, cancer metastasis, and the 18 tumors that each cause more than 6,000 deaths per year in the United States. Bladder and brain cancers were discussed, with information given on tumor types, metastatic spread and invasion, and common symptoms. Part two charted the natural histories, problems, and assessment parameters of advanced breast, colon and rectum (colorectal), and esophageal cancers. Part three presents the natural histories, problems, and assessment parameters of advanced kidney cancer, leukemia, and liver cancer. Each of these cancers is presented separately, with information given on mortality rates, the most common tumor types, sites of metastases, common problems, and common oncologic emergencies. Sites of spread, resulting problems (including site-specific symptoms), and assessment parameters are presented as tables. 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<contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Kemp</surname><given-names>Charles</given-names></name><degrees>RN, CRNH</degrees><aff>Baylor University School of Nursing, Dallas, Texas</aff></contrib></contrib-group>
<pub-date pub-type="ppub"><month>3</month><year>1999</year></pub-date><volume>16</volume><issue>2</issue><fpage>479</fpage><lpage>486</lpage><abstract>
<p><italic>This is the third of a six-part series on metastatic spread and natural history of 18 common tumors. Part one summarized symptom/problem anticipation, cancer metastasis, and the 18 tumors that each cause more than 6,000 deaths per year in the United States. Bladder and brain cancers were discussed, with information given on tumor types, metastatic spread and invasion, and common symptoms. Part two charted the natural histories, problems, and assessment parameters of advanced breast, colon and rectum (colorectal), and esophageal cancers.</italic></p>
<p><italic>Part three presents the natural histories, problems, and assessment parameters of advanced kidney cancer, leukemia, and liver cancer. Each of these cancers is presented separately, with information given on mortality rates, the most common tumor types, sites of metastases, common problems, and common oncologic emergencies. Sites of spread, resulting problems (including site-specific symptoms), and assessment parameters are presented as tables. Material is presented so that clinicians will be able to anticipate the spread of these cancers and can thus identify problems early in their development so that that they are more easily managed.</italic></p>
</abstract><custom-meta-wrap><custom-meta xlink:type="simple"><meta-name>sagemeta-type</meta-name><meta-value>Journal Article</meta-value></custom-meta><custom-meta xlink:type="simple"><meta-name>cover-date</meta-name><meta-value>March/April 1999</meta-value></custom-meta><custom-meta xlink:type="simple"><meta-name>search-text</meta-name><meta-value> Abstract This is the third of a six-part series on metastatic spread and natural his- tory of 18 common tumors. Part one summarized symptom/problem antic- ipation, cancer metastasis, and the 18 tumors that each cause more than 6,000 deaths per year in the United States. Bladder and brain cancers were discussed, with information given on tumor types, metastatic spread and invasion, and common symptoms. Part two charted the nat- ural histories, problems, and assess- ment parameters of advanced breast, colon and rectum (colorectal), and esophageal cancers. Part three presents the natural histories, problems, and assessment parameters of advanced kidney can- cer, leukemia, and liver cancer. Each of these cancers is presented separately, with information given on mortality rates, the most common tumor types, sites of metastases, common problems, and common oncologic emergencies. Sites of spread, resulting problems (includ- ing site-specific symptoms), and assessment parameters are present- ed as tables. Material is presented so that clinicians will be able to anticipate the spread of these can- cers and can thus identify problems early in their development so that that they are more easily managed. Kidney cancer Kidney (renal) cancer is the four- teenth leading cause of cancer death overall with 10,322 deaths in 1993 and 11,600 deaths estimated in 1998. Kidney cancer affects about twice as many men as women.1-2 Renal cell carcinomas, usually adenocarcinomas, are the most com- mon tumor type.3 Spread is via blood to liver, lungs, and bones; via lymph; and by direct extension to adjacent structures, including to the renal vein, vena cava, and viscera.4 The contralateral kidney also may be affected and uremia is common. Metastases to the skin also may occur.5 Problems of kidney cancer include those common to metastatic disease in liver, lungs, bones, and nodes. Flank pain, palpable renal mass, and hematuria are the "classic triad" of renal carcinoma symptoms.6 Anemia, weight loss, night sweats, fever, and (in men) sudden onset of varicocele are common.7 Liver dysfunction in the absence of hepatic involvement also occurs, and hyponatremia and hyperkalemia are common.5 Para- neoplastic syndromes and "unusual" problems3,6,8 associated with renal cancer include: · hypercalcemia; · other metabolic disorders in- cluding hyponatremia and hyper- kalemia; · increased erythrocyte sedimen- tation rate (ESR); · anemia; · hypertension; · cachexia; 479American Journal of Hospice & Palliative Care Volume 16, Number 2, March/April 1999 Part three: Kidney cancer, leukemia, and liver cancer Charles Kemp, RN, CRNH Metastatic spread and common symptoms Charles Kemp, RN, CRNH, Baylor University School of Nursing, Dallas, Texas. 480 American Journal of Hospice & Palliative Care Volume 16, Number 2, March/April 1999 Table 1. Kidney cancer: Spread, problems, and assessment Metastatic spread Problems Assessment parameters Kidney Classic symptoms Classic triad of renal cancer symptoms: Flank pain, abdominal mass, hema- turia. Weakness, anemia; anorexia Uremia Note that renal failure is rarely a result of primary renal cancer. Symptoms include oliguria or anuriam, fatigue, headache, anorexia, nausea and vomit- ing, fetid breath, and changes in mentation Obstruction Obstructive uropathy:* hesitancy, urgency, nocturia, frequency, < force of stream, urinary tract infection. Partial kidney obstruction: polyuri alternat- ing with oliguria Lymph Lymphadenopathy Involvement of lymph nodes may result in lymphedema: (subcutaneous) with edema, pain cellulitis, lymphangitis; or enlarged internal nodes may result in pressure on internal structures such as vessels or viscera Liver Pain Liver pain may be upper right abdominal or non-specific, characteristic of visceral pain; may radiate to right scapula and worsen at night Ascites Abdominal distension, bulging flanks, fluid wave, weight gain and discomfort; anorexia, early satiety, indigestion, < bowel mobility; dyspnea, orthopnea, tachypnea; weakness, fatigue Lung(s) Dyspnea, other respiratory Sx Pleural effusion: dyspnea + cough and chest pain (trachea displacement toward unaffected side with large effusion.) Breath sounds usually decreased, but may vary according to area of lung. Pleural effusions are usually unilateral Pneumonia: dyspnea + elevated temperature, chills, purulent or rusty spu- tum, decreased breath sounds. Pleural effusion also may be present Embolus:* Sudden onset of dyspnea + rapid breathing, rapid heart rate, cough, chest pain, and blood in sputum Obstruction:* Progressive or rapidly increasing dyspnea, blood in sputum, noisy breathing, chronic cough, choking, and/or pneumonia Pre-existing conditions such as COPD or ascites also may cause dyspnea Brain Central nervous system symptoms Increased intracranial pressure:* Progressive pain usually present, may be more severe in the morning. Classic triad of increased ICP = papilledema (often with visual changes), vomiting and headache Confusion, seizures or other CNS problems also may result from brain metastases or paraneoplastic syndromes Bone Pain Bone pain is usually localized, constant, dull, aching, or sharp; worse at night * Oncologic emergencies · neuromuscular disorders; · secondary amyloidosis; and · fever of unknown origin (FUO). Oncologic emergencies associated with renal cancers include increased intracranial pressure, spinal cord compression, bronchial obstruction, ureteral obstruction, and hypercal- cemia.3,6,9 Table 1 lists metastatic sites typical of kidney cancer as well as problems and assessment parameters linked to those sites. Leukemia Leukemia is the seventh leading cause of cancer death in the United States with 19,707 deaths in 1993 and 21,600 deaths estimated in 1998. Leukemia affects slightly more men than women, and is the leading cause of cancer death in children.1-2 The most common types of leukemias causing death in Western countries10-12 (in descending order) are: 1. Acute myeloid (or myeloge- nous) leukemia (AML), which affects mostly adults; 2. Chronic lymphocytic leuk- emia (CLL), which affects most- ly older people and is the most common type of leukemia; 3. Chronic myeloid (or myel- ogenous) leukemia (CML), which affects all ages; and 4. Acute lymphocytic leukemia (ALL), which affects mostly children. While all leukemias are similar in 481American Journal of Hospice & Palliative Care Volume 16, Number 2, March/April 1999 Problems of therapy, e.g., opioids, corticosteroids, tricyclic antidepressants, radiation, chemotherapy Fatigue cachexia, dysphagia, anemia, or other debilitating effects of advanced disease Various problemsOther Other metabolic disorders, including hyponatremia and hyperkalemia, increased erythrocyte sedimentation rate (ESR), anemia, hypertension, cachexia, neuromuscular disorders, secondary amyloidosis, fever of unknown origin Hypercalcemia:* (Often non-specific) symptoms include fatigue, weakness, anorexia, nausea, polyuria, polydipsia, and constipation; progressing to changes in mentation, seizures, and coma Paraneoplastic syndromes, other distant effects Distant effects In renal cancer, lesions are usually found on lower abdominal wall, genitalia, scalp; also on nose, eyelids, or fingertips LesionsSkin Spinal cord compression (from pathological fracture or compression of cord without fracture): back pain is the first symptom and may be local (somatic: constant, dull, aching) or radicular or both; exacerbated by movement, neck flexion, straight leg raising; decreased by sitting up; and tender to percus- sion. Neurological deficits usually follow pain, may begin subtly and include extremity weakness, ataxia, stumbling, urine retention, bowel dysfunction, numbness Cord compression Assessment parametersProblemsMetastatic spread Table 1 (continued). Kidney cancer: Spread, problems, and assessment * Oncologic emergencies 482 American Journal of Hospice & Palliative Care Volume 16, Number 2, March/April 1999 Pre-existing conditions such as COPD or ascites may contribute to dyspnea Pneumonia: dyspnea + elevated temperature, chills, purulent or rusty sputum, decreased breath sounds. Pleural effusion also may be present Pleural effusion: dyspnea + cough and chest pain (trachea displacement toward unaffected side with large effusion). Breath sounds usually decreased, but may vary according to area of lung. Pleural effusions are usually unilateral Dyspnea, cough, hemoptysis Lung(s) Hemorrhage, bleeding, abdominal painGI disturbances Abdominal distension, bulging flanks, fluid wave, weight gain, and discomfort; anorexia, early satiety, indigestion, < bowel mobility; dyspnea, orthopnea, tachypnea; weakness, fatigue Ascites Liver pain may be upper right abdominal or non-specific, characteristic of visceral pain; may radiate to right scapula and worsen at night Pain, hepatomegalyLiver, GI tract Lymphedema: enlarged lymph, edema, obstruction of adjacent organs or structures (see obstructive uropathy below), pain LymphadenopathyLymph Changes in mentation + shortness of breath may indicate leukostasis Confusion, seizures or other CNS problems also may result from brain involvement. Cranial nerve involvement à findings related to specific cranial nerve affected Increased intracranial pressure (ICP)* (from cerebral infiltration or meningeal leukemia): Progressive pain, may be more severe in the morning. Classic triad of increased ICP = papilledema (often with visual changes), vomiting, and headache CNS symptoms Brain, central nervous system (CNS) Thrombocytopenia, erythrocytopenia, other processes result in anemia: weakness fatigue, tachycardia, headache, dyspnea Fever of unknown origin may or may not be related to infectionFatigue Granulocytopenia, neutropenia: signs and symptoms of infection in early stages may be absent; infections may be bacterial or viral; may include pneumonia, sep- ticemia, skin infections (e.g., herpes) perirectal abscess, GI or GU tract, cellulitis Infection Thrombocytopenia: bleeding occurs in skin, mucus membranes, and GI or GU tracts. Disseminated intravascular coagulation also may occur Bleeding Bone marrow dysfunction Assessment parametersProblemsMetastatic spread Table 2. Leukemia: Spread, problems, and assessment * Oncologic emergencies many respects, differences do exist, especially with respect to patients being more or less prone to the vari- ous common problems of leukemia. For the purposes of hospice or pallia- tive care, the leukemias may be con- sidered together--except, of course in a specialized setting, e.g., hematology palliative unit. Infection, bleeding, anemia, fati- gue, and pain are among the most seri- ous and common problems of ad- vanced disease. Infections or related complications are the most common cause of death in CLL and may include pneumonia, septicemia, urinary tract infection, perirectal abscess or celluli- tis; infections may be viral or bacteri- al, and some may be opportunistic.12-13 Because early manifestations of infection may be subtle, slight changes indicating infection must be methodically sought. Anemia is al- most universal and bleeding (related 483American Journal of Hospice & Palliative Care Volume 16, Number 2, March/April 1999 Fatigue cachexia, dysphagia, or other debilitating effects of advanced disease Pericardial effusion resulting in cardiac tamponade:* dyspnea + cough, chest pain relieved by leaning forward. There may be syncope, weakness, pleural effusion, edema, distension of neck veins, tachypnea, and the clinical triad of tachycardia, muffled heart tones, and hypotension Problems of therapy, e.g. opioids, corticosteroids, tricyclic antidepressants, radiation, chemotherapy; late effects of therapy include cardiomyopathy with congestive failure and pericarditis Various problemsOther Testicular swelling, painTestes Visual changes, especially blurringEyes Involvement of CNS (see above)BrainSanctuary sites Oral lesions and gingival problems commonLesionsOral cavity Leukemia cutis (infiltration), purpura, ecchymosis, petechiae, infection, e.g., herpes, pain Skin lesionsSkin Pain and swelling are common (somatic pain).PainBones, joints Hematuria, flank pain, flank mass. Nephrotic syndrome is usually a paraneoplas- tic syndrome rather than a result of tumor invasion or metastases Genitourinary (GU) symptoms Obstructive uropathy* (ureteral): hesitancy, urgency, nocturia, frequency, < force of stream, polyuria alternating with oliguria ObstructionKidney Assessment parametersProblemsMetastatic spread Table 2 (continued). Leukemia: Spread, problems, and assessment * Oncologic emergencies 484 American Journal of Hospice & Palliative Care Volume 16, Number 2, March/April 1999 Problems related to debilitation Problems of therapy, e.g., opioids, corticosteroids, tricyclic antidepressants, NSAIDs, other cancer treatment Fever of unknown origin sometimes considered a PNS Weakness, fatigue, cachexia, muscle wasting common in liver cancerVarious problemsOther Other PNSs include hypercalcemia,* carcinoid syndrome, dysfibrinogene- mia, sexual changes, and porphyria cutanea tarda; cachexia may be consid- ered as PNS Potential for vascular deterioration; risk for heart and other end-organ damage Hypercholesterolemia Elevated hematocrit, hemoglobin, and red blood cell count leading to hyper- viscosity with resulting changes in mentation, headache, fatigue, dizziness; and increased cardiac workload Erythrocytosis (polycythemia) Sudden onset: sweating, tremors, hunger; chronic: weakness, fatigue, dizzi- ness, confusion, somnolence, seizures, coma Hypoglycemia Paraneoplastic syn- dromes (PNSs) Regional lymphadenopathy resulting in pressure on viscera or vessels if extensive LymphadenopathyLymph Respiratory muscle weakness: dyspnea + general weakness, anorexia, severe weight loss (cachexia), and/or the presence of a paraneoplastic syndrome Pneumonia: dyspnea + elevated temperature, chills, purulent or rusty spu- tum, decreased breath sounds; pleural effusion also may be present Pleural effusion: dyspnea + cough and chest pain (trachea displacement toward unaffected side with large effusion); breath sounds usually decreased, but may vary according to area of lung; pleural effusions are usually unilateral DyspneaLung(s) Epigastric fullness, pressure, discomfort; early satiety, constipation, diar- rhea; anorexia, cachexia General abdominal symptoms Bleeding into the peritoneal cavity from vessels of, or associated with, the liver may occur and be extensive Bleeding Abdominal distension, bulging flanks, fluid wave, weight gain, and discomfort; anorexia, early satiety, indigestion, < bowel mobility; dyspnea, orthopnea, tachypnea; weakness, fatigue. Jaundice is common in later stages Ascites Liver pain may be upper right abdominal or non-specific, characteristic of visceral pain; may radiate to right scapula and worsen at night PainLiver, regional Assessment parametersProblemsMetastatic spread Table 3. Liver cancer: Spread, problems, and assessment * Oncologic emergencies to thrombocytopenia or, less fre- quently, disseminated intravascular coagulation) may be found in the skin, mucous membranes, and gastroin- testinal (GI) or genitourinary (GU) tracts.10,13 Fatigue, weakness, and dys- pnea may be related to anemia or other processes. Weight loss is common throughout the course of illness and is universal in later stages. The course of leukemia is most often slow with much treatment; hence, patients may be physically and emotionally ex- hausted by the end stages. Bone or joint pain from leukemic infiltration is common, especially in children. The central nervous system (CNS), eyes, and testes are known as "sanctuary sites" for localized relapse, especially in ALL.14 Of these, the CNS is the most commonly affected. Headache or other neuro- logic changes such as nausea, vomit- ing, vision blurring, or cranial nerve (CN) changes may herald CNS involvement, including increased intracranial pressure. Changes in mentation, especially when accom- panied by shortness of breath, may signal leukostasis--white cell clot- ting (sludging) in microvascula- ture--which is most common in AML.11 Leukemic infiltration of eyes causes visual changes and infiltration of testes causes testicular swelling. Other problems frequently found in patients with leukemia are lym- phadenopathy, fever (related to infec- tion or increased metabolic rate), night sweats, abdominal pain and organomegaly, and weight loss.13 Patients with advanced disease may also be liable to late effects of therapy, including cardiomyopathy (with con- gestive failure and pericarditis) and neuropsychiatric symptoms.15 Pleural effusions or pleural leukemic infil- trates may occur late in the disease, with the latter associated with pul- monary infection such as pneumocys- tic carinii pneumonia. The later stages of chronic myeloid leukemia may be marked by the occurrence of "blast crisis," charac- terized by fever of unknown origin, increased anemia and thrombocy- topenia, and decreased response to any therapy. A good response to ther- apy in a blast crisis may results in meningeal leukemia.16 Death is usu- ally from infection, bleeding, or other complications.11 The oncologic emergencies most common in patients with leukemia are increased intracranial pressure (including from cerebral hemorrhage and carcinomatosis meningitis), obstructive uropathy, and cardiac tamponade. Tumor lysis syndrome is usually a complication of treatment, and includes hyperuricemia, hyper- kalemia, hyperphosphatemia, and hypocalcemia--with the outcome of cardiac arrhythmias, acute renal fail- ure, tetany.9-10, 14 Table 2 lists metastatic sites typical of leukemia as well as problems and assessment parameters linked to those sites. Liver cancer Primary liver (hepatic) and biliary passages cancer is the fourteenth leading cause of cancer death overall with a total of 10,063 deaths in 1993 and an estimated 13,300 deaths in 1998.1-2 Liver cancer is especially common in persons from sub- Saharan Africa and parts of Asia, and is also associated with cirrhosis, hepatitis, and other factors.17 The liver is a common site of metastases from many cancers at other sites, especially GI. Liver involve- ment is usually a grim sign, and the extent of hepatic tissue replacement by tumor is the primary prognostic indicator. Signs and symptoms of advanced liver metastases include jaundice, ascites, increased abdominal girth, hepatomegaly, fever, pain, anorexia, fatigue, weight loss, and abdominal fullness.18 Most primary hepatic tumors are fast growing hepatocellular carcino- mas with a high mortality rate. Most tumor growth is within the liver and metastases do not always occur. Metastases are usually to lung(s), por- tal vein, and lymph.19 Common symptoms of liver cancer include abdominal pain, epigastric pressure, fullness, and discomfort. As mentioned above, anorexia, weight loss, and fatigue are common, as are hepatosplenomegaly, ascites, jaun- dice, and fever.17,19 Paraneoplastic syndromes (PNSs) are common in hepatic cell carcino- ma. The most important/common PNSs are hypoglycemia, erythrocy- tosis, and hypercholesterolemia.20 Other PNSs include hypercalcemia, dysfibrinogenemia, carcinoid syn- drome, sexual changes, and porphyr- ia cutanea tarda.17 Death from a primary hepatic neo- plasm is usually from liver failure21 or related to the wasting and weak- ness of the disease.22 In the latter case, patients may develop rapidly progressive pulmonary congestion and pneumonia. Oncologic emergencies associated with hepatic cancer include hypercal- cemia and hypoglycemia.17,21 References 1. American Cancer Society: Cancer facts and figures. Atlanta, American Cancer Society, 1997. 2. Landis SH, Murray T, Bolden S, et al: Cancer statistics. CA-A Cancer Journal for Clinicians. 1998; 48(1): 6-29. 3. Richie JP, Kantoff PW, Shapiro CL: Renal cell carcinoma. In Holland JF,BastRC,Morton DL, et al (eds.): Cancer medicine. 4th ed. Bal- timore, Williams & Wilkins, 1997; 2085-2096. 4. Lind J, Hagan L: Bladder and kidney can- cer. In Groenwald SI, Frogge MH, Goodman M, Yarbro CH (eds.): Cancer nursing: Principles and practice. 4th ed. Boston, Jones and Bartlett, 1997; 889-915. 5. Waller A, Caroline NL: Handbook of pal- liative care in cancer. Boston, Butterworth- Heinemann, 1996. 485American Journal of Hospice & Palliative Care Volume 16, Number 2, March/April 1999 6. Kassabian VS, Graham SD: Urologic and male genital cancers. In Murphy GP, Lawrence W, Lenhard RE (eds.): Clinical oncology. 2nd ed. Atlanta, American Cancer Society, 1995; 293-303. 7. Sokoloff MH, deKernion JB, Figlin RA, Belldegrun A: Current management of renal cell carcinoma. CA-A Cancer Journal for Clinicians. 1996; 46(5): 284-302. 8. Young RC: Metastatic renal-cell carcino- ma: What causes occasional dramatic regressions? New England J Med. 1998; 338(18): 1305-1306. 9. Glick JH, Glover D: Oncologic emergen- cies. In Murphy GP, Lawrence W, Lenhard RE (eds.): Clinical oncology. 2nd ed. Atlanta, American Cancer Society, 1995; 597-618. 10. Foon KA, Casciato DA: Chronic leukemias. In Casciato DA, Lowitz BB (eds.): Manual of clinical oncology. Boston, Little, Brown and Company, 1995; 402-417. 11. Foon KA, Casciato DA: Acute leukemia. In Casciato DA, Lowitz BB (eds.): Manual of clinical oncology. Boston, Little, Brown and Company, 1995; 431-445. 12. Krause JC: Chronic lymphocytic leukemia: A brief review. Cleveland Clinical J Med. 1998; 65(1): 42-48. 13. Ososki RL: Leukemia. In Otto S (ed.): Oncology nursing. 3rd ed. St. Louis, Mosby, 1997; 284-311. 14. Scheinberg DA, Maslak P, Weiss M: Acute leukemias. In DeVita VT, Hellman S, Rosenberg SA (eds.): Cancer: Principles and practice of oncology. 5th ed. Philadelphia, JB Lippincott, 1997; 2293-2321. 15. Maguire-Eisen M, Edmonds KS: Leukemias. In Clark JC, McGee RF (eds.): Core curriculum for oncology nursing. Philadelphia, WB Saunders, 1992; 480-487. 16. Silver RT: Chronic myeloid leukemia. In Holland JF, Frei E, Bast RC, et al (eds.): Cancer medicine. 3rd ed. Philadelphia, Lea and Febiger, 1993; 1934-1946. 17. Carr BI, Flickinger JC, Lotze MT: Hepa- tobiliary cancers. In DeVita VT, Hellman S, Rosenberg SA (eds.): Cancer: Principles and practice of oncology. 5th ed. Phila- delphia, JB Lippincott, 1997; 1087-1114. 18. Daly JM, Kemeny, NE: Metastatic cancer to the liver. In DeVita VT, Hellman S, Rosenberg SA (eds.): Cancer: Principles and practice of oncology. 5th ed. Philadelphia, JB Lippincott, 1997; 2551- 2570. 19. Coleman J: Esophageal, stomach, liver, gallbladder, and pancreatic cancers. In Groenwald SI, Frogge MH, Goodman M, Yarbro CH (eds.): Cancer nursing: Principles and practice. 4th ed. Boston, Jones and Bartlett, 1997; 1082-1144. 20. Engstrom PF, McGlynn K, Hoffman JP: Primary neoplasms of the liver. In Holland JF, Bast RC, Morton DL, et al (eds.): Cancer medicine. 4th ed. Baltimore, Williams & Wilkins, 1997; 1923-1938. 21. Tabbarah HJ: Gastrointestinal tract can- cers. In Casciato DA, Lowitz BB (eds.): Manual of clinical oncology. Boston, Little, Brown and Company, 1995; 145-182. 22. Frogge MH, Groenwald SL, Goodman M, Yarbro CH (eds.): Cancer nursing: Principles and practice. 3rd ed. Boston, Jones and Bartlett, 1997, 806-844. 486 American Journal of Hospice & Palliative Care Volume 16, Number 2, March/April 1999 </meta-value></custom-meta></custom-meta-wrap></article-meta></front><back><ref-list>
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</ref-list></back></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Part three: Kidney cancer, leukemia, and liver cancer</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Part three: Kidney cancer, leukemia, and liver cancer</title></titleInfo><name type="personal"><namePart type="given">Charles</namePart><namePart type="family">Kemp</namePart><namePart type="termsOfAddress">RN, CRNH</namePart><affiliation>Baylor University School of Nursing, Dallas, Texas</affiliation></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><originInfo><publisher>Sage Publications</publisher><place><placeTerm type="text">Sage CA: Thousand Oaks, CA</placeTerm></place><dateIssued encoding="w3cdtf">1999-03</dateIssued><copyrightDate encoding="w3cdtf">1999</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">This is the third of a six-part series on metastatic spread and natural history of 18 common tumors. Part one summarized symptom/problem anticipation, cancer metastasis, and the 18 tumors that each cause more than 6,000 deaths per year in the United States. Bladder and brain cancers were discussed, with information given on tumor types, metastatic spread and invasion, and common symptoms. Part two charted the natural histories, problems, and assessment parameters of advanced breast, colon and rectum (colorectal), and esophageal cancers. Part three presents the natural histories, problems, and assessment parameters of advanced kidney cancer, leukemia, and liver cancer. Each of these cancers is presented separately, with information given on mortality rates, the most common tumor types, sites of metastases, common problems, and common oncologic emergencies. Sites of spread, resulting problems (including site-specific symptoms), and assessment parameters are presented as tables. Material is presented so that clinicians will be able to anticipate the spread of these cancers and can thus identify problems early in their development so that that they are more easily managed.</abstract><relatedItem type="host"><titleInfo><title>American Journal of Hospice and Palliative Care</title></titleInfo><genre type="journal">journal</genre><identifier type="ISSN">1049-9091</identifier><identifier type="eISSN">1938-2715</identifier><identifier type="PublisherID">AJH</identifier><identifier type="PublisherID-hwp">spajh</identifier><part><date>1999</date><detail type="volume"><caption>vol.</caption><number>16</number></detail><detail type="issue"><caption>no.</caption><number>2</number></detail><extent unit="pages"><start>479</start><end>486</end></extent></part></relatedItem><identifier type="istex">C49AE3773DBADF5CEAF0BF9E32211B53D37A8D9C</identifier><identifier type="DOI">10.1177/104990919901600211</identifier><identifier type="ArticleID">10.1177_104990919901600211</identifier><recordInfo><recordContentSource>SAGE</recordContentSource></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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