Cancer — Hematologic and Lymphatic — Precision Clinical Education

Pathophysiology

Leukemia: Overproduction of nonfunctioning leukocytes that crowd out healthy RBCs, WBCs, and platelets
Lymphoma: DNA mutation in B cells (80%), T cells, or NK cells. Mutated lymphocytes replicate in lymphoid tissues. Hodgkin lymphoma has large multinucleated Reed-Sternberg cells as its diagnostic hallmark
Multiple myeloma: Malignancy of maturing B cells (plasma cells) that secrete cytokines signaling osteoclasts to dismantle bone tissue. Produces nonfunctioning M-proteins and Bence Jones proteins (toxic to renal tubules)
Hematologic cancers interfere with normal blood cell production, causing anemia, thrombocytopenia, and immunocompromise
Hypercalcemia in myeloma: excessive calcium released from dismantled bone causes confusion, nausea, and kidney damage

General: Fatigue (anemia), frequent infections (low functional WBCs), easy bruising or bleeding (low platelets)
Lymphoma: Painless enlargement of lymph nodes (neck, axilla, groin). "B" symptoms (fever, drenching night sweats, weight loss)
Myeloma: Deep bone pain (back, ribs). Spontaneous/pathologic fractures with minimal trauma
Leukemia: Petechiae, ecchymosis, purpura. Profound fatigue. Deep bone/joint pain (marrow infiltration)
Constitutional: drenching night sweats, unexplained weight loss, persistent low-grade fever

Painless, firm, fixed lymph nodes: Distinguish malignant (fixed, nontender) from reactive (mobile, tender) nodes
Petechiae and purpura: Direct evidence of dangerously low platelet count — avoid pressure
Deep bone pain in spine, pelvis, or ribs: Hallmark of myeloma. Contraindicated for deep pressure due to fracture risk
Fever: Systemic contraindication for massage
Tumor lysis syndrome: Medical emergency during initial chemotherapy. Massive necrosis of malignant cells causes life-threatening renal failure
Any lump >5 cm or intractable pain not improving with rest: Immediate physician referral

Goal: Palliative care to reduce pain, anxiety, depression, and improve sleep quality
Myeloma — fracture risk: Extreme bone fragility requires highly conservative pressure and positioning. Avoid joint traction and high-velocity movements
Rigorous circulatory massage: Contraindicated during active disease — may overstress the client's homeostatic capacity
Platelet precaution: If platelets are extremely low (<20,000), use pressure no greater than "applying lotion" to prevent internal bleeding
Lymphedema risk: Node surgery or radiation creates lifelong risk of protein-rich fluid accumulation. MLD may be required
Infection risk: Severely immunocompromised clients require strict IPAC protocols. Postpone if therapist has any active illness
Amyloidosis: Myeloma is a common precursor to secondary amyloidosis (inflammatory proteins accumulating in vital organs)
Treatment side effects: See chemotherapy and radiation-therapy. For targeted therapies (imatinib/Gleevec for CML), watch for edema and hand-foot syndrome

Distinguish the three major types: leukemia (marrow), lymphoma (lymph nodes), myeloma (plasma cells)
Reed-Sternberg cells = Hodgkin lymphoma. Philadelphia chromosome = CML. Bence Jones proteins = myeloma. M-Spike = myeloma
"B" symptoms (fever, night sweats, weight loss) indicate systemic lymphoma involvement
Petechiae and purpura are direct evidence of dangerously low platelet count
NHL is an AIDS-indicator disease

Hematologic cancers are disseminated from onset. The three types are leukemia, lymphoma, and multiple myeloma
Myeloma patients have extreme bone fragility from osteoclast-mediated bone destruction. Pressure and positioning must be highly conservative
Rigorous circulatory massage is contraindicated during active disease. Gentle supportive touch is appropriate
Reed-Sternberg cells diagnose Hodgkin lymphoma. Bence Jones proteins indicate myeloma. Philadelphia chromosome is associated with CML
If platelets are below 20,000, pressure should be no more than "applying lotion"