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When the Provider Becomes the Patient: What I Learned From COVID-19

When the Provider Becomes the Patient: What I Learned From COVID-19

The Case of the Late Head and Neck Lymphedema

Clinical practice

The Case of the Late Head and Neck Lymphedema

Our Patients Give Us Peace in Unexpected Circumstances

Oncology nurse pride

Our Patients Give Us Peace in Unexpected Circumstances

Behind Our Masks, I See You, I Hear You

Behind Our Masks, I See You, I Hear You

Connect With Your Patients on a Human Level as Well as a Healthcare Level

Oncology nurse-patient relationship

Connect With Your Patients on a Human Level as Well as a Healthcare Level

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Genetics & genomics

Genetic Disorder Reference Sheet: Von Hippel-Lindau Syndrome

An inherited disorder characterized by the formation of benign and malignant tumors and cysts throughout the body, Von Hippel-Lindau syndrome (VHL) occurs with an altered VHL tumor suppressor gene with autosomal dominant transmission. Estimated incidence is 1 in 36,000 people, both males and females equally, and the mean age of onset is 26 years. About 20% of patients with VHL are the first person in their family to have the pathogenic variant (i.e., de novo). The diagnosis is made with germline biomarker testing.

Genetics & genomics

The Oncology Nurse’s Role in Identifying Patients for Cancer Genetics Counseling

During personal and family medical history assessments, many patients report multiple cancer diagnoses in their family or concerns that other family members might be at increased risk for developing cancer. Patients and families might also ask their nurse about risk or parameters for genetic testing. Timely and appropriate referral to genetics professionals for counseling and possible testing for germline risk of malignancy enables individuals at increased risk to follow recommended surveillance and consider surgery and other preventive strategies, ultimately decreasing their risk of cancer-related morbidity and mortality.

Genetics & genomics

Genetic Disorder Reference Sheet: PALB2

PALB2 refers to partner and localizer of BRCA2. The gene was isolated in 2007 and is the third most common gene associated with breast cancer risk. Both men and women are at increased risk for developing multiple cancers if they have a pathogenic PALB2 variant (see sidebar).

Genetics & genomics

Genetic Disorder Reference Sheet: CDH1 and Hereditary Diffuse Gastric Cancer

Pathogenic variants in the CDH1 gene are associated with hereditary diffuse gastric cancer (HDGC), a poorly differentiated adenocarcinoma that infiltrates into the stomach wall. It causes the stomach wall to thicken without forming a distinct mass, which limits effective screening strategies.

January 18, 2022

Genetics & genomics

Genetic Disorder Reference Sheet: Familial Adenomatous Polyposis

Individuals with 10–100+ polyps may have a germline pathogenic variant in the APC gene, placing them at higher risk for developing colorectal, gastrointestinal, and other cancers. The condition is known as familial adenosis polyposis (FAP), and loss of function in the APC gene is the first step in the adenoma-to-carcinoma sequence. Some people have an attenuated form (aFAP), with delayed polyp growth and fewer polyps (see sidebar). As many as 20% are de novo, meaning that they are the first in their family to have an identified pathogenic variant.

November 04, 2021

Genetics & genomics

Genetic Disorder Reference Sheet: ATM Pathogenic Variants

An estimated 1%–2% of adults have one pathogenic ataxia telangiectasia mutated (ATM) gene variant (heterozygous) and are considered carriers. People who are homozygous (two altered copies) have ataxia-telangiectasia (A-T), a hereditary condition that often appears in childhood and is characterized by progressive neurologic problems that lead to difficulty walking and an increased risk for developing various malignancies. Children with A-T may begin staggering and appear unsteady (ataxia) shortly after learning to walk.

October 18, 2021

Genetics & genomics

Genetic Disorder Reference Sheet: MUTYH-Associated Polyposis

MUTYH-associated polyposis (MAP) is an autosomal recessive hereditary cancer syndrome. It’s most commonly seen in people of northern European ancestry, where an estimated 1 in 20,000–40,000 have MAP (two pathogenic variants on opposite chromosomes) and 1%–2% have one MUTYH pathogenic variant.

Clinical practice

Genetic Disorder Reference Sheet: BRCA1 and BRCA2 Hereditary Cancers

BRCA1- or BRCA2-associated hereditary breast and ovarian cancer is the most common form of hereditary breast and ovarian cancer. The prevalence of BRCA1 and BRCA2 pathogenic variants in the general population is estimated at 1 in 400–500 people, although it increases to 1 in 40 for those of Ashkenazi Jewish ancestry, which is linked to three founder pathogenic variants (BRCA1 c.68_69delAG, BRCA1c.5266dupC, and BRCA2 c.5946delT).

Genetics & genomics

Genetic Disorder Reference Sheet: CHEK2 Gene Pathogenic Variants

The CHEK2 (checkpoint kinase 2) tumor suppressor gene provides cells with instructions for making a protein known as CHK2, which becomes active when the cell’s DNA is damaged or strands of it break. CHEK2 halts cell division and enables either cell repair or destruction. Without a properly functioning CHEK2 gene, cells lose a key restraint on their growth which may lead to uncontrolled cells and possibly malignancy. CHEK2*1100delC is the most common pathogenic variant and most prevalent in European populations.

Genetics & genomics

Genetic Disorder Reference Sheet: Lynch Syndrome (Hereditary Nonpolyposis Colorectal Cancer)

Lynch syndrome, now referred to as hereditary nonpolyposis colorectal cancer (HNPCC), was first identified in a family in 1895. In 1966, Henry Lynch reported a series of families with colon and other cancers in the Nebraska area. Today, the evidence shows that HNPCC is associated with germline pathogenic variants in the MLH1, MSH2, MSH6, PMS2, and EPCAM genes.

January 25, 2021

Pancreatic cancer

Pancreatic Cancer Risk Factors, Diagnosis, Treatment, Side Effects, and Survivorship Considerations

Pancreatic cancer is the ninth most common cancer in the United States, accounting for 3% of all cancers but causing 7% of cancer-related deaths, which equates to about 57,500 diagnoses and 47,050 deaths each year. The average person’s risk for pancreatic cancer is about 1 in 64.

December 03, 2020

Breast Cancer Prevention, Screening, Diagnosis, Treatment, Side Effect, and Survivorship Considerations

In the United States, breast cancer is the most commonly diagnosed cancer in women. One in eight women will develop invasive disease in their lifetime with approximately 270,00 new cases diagnosed in the United States in 2019. Caucasian women have the highest incidence rate, whereas African American women are most likely to die from the disease. The five-year survival rate is 91%, with an estimated 3.8 million breast cancer survivors living in the United States.

October 15, 2020

Genetics & genomics

As True Detectives, Genetics Professionals Uncover the Meaning of True or Noninformative Negative Results

Patients who watch crime shows think that DNA testing is as simple as taking a cheek swab and getting the results in two minutes so the case is solved at the end of the 42-minute episode. The reality? DNA can be identified from buccal cells in a cheek swab, but results take several weeks to obtain and are not always a simple negative or positive.

August 18, 2020

Treatment side effects

Glioblastoma Diagnosis, Treatment, Side Effect Management, and Survivorship Recommendations

Glioblastoma or glioblastoma multiform (GBM) is a primary central nervous system tumor. Approximately 23,890 new brain tumors are diagnosed in the United States each year, with GBM accounting for 38%. GBM can present as a primary diagnosis or evolve from a lower grade brain tumor.

August 06, 2020

Genetics & genomics

Help Patients Understand Genomic Variants of Unknown Significance

Patients approach genetic testing, either for germline (inherited) or somatic (tumor) alterations, hoping it will provide valuable information about their cancer risk, prognosis, or treatment options. Next-generation sequencing makes it possible to test for panels of 40 or more genes simultaneously. By testing more genes, the possibility of finding an actionable, informative result improves, but so does the chance of having a result with one or more variants of unknown clinical significance.

Melanoma Prevention, Screening, Treatment, and Survivorship Recommendations

It is no coincidence that May is Melanoma Awareness Month. As Americans take to the great outdoors, they also must take caution to protect their skin and prevent melanoma.

Genetics & genomics

Family Risk Factors May Indicate Need for Genetics Counseling Referrals

Genetics testing is not just about one family member; the results have implications for an entire family. Results of genetic testing can be confusing, and families often need assistance understanding what it means for them. Genetics counseling before and after testing is very important to help individuals and families understand the results of genetic testing when they are received and over time.

Genetics & genomics

What Happens During a Genetics Counseling Session?

When referring patients for genetics counseling and possible testing for hereditary risk, oncology nurses can help relieve their trepidation and anxiety by explaining what to expect during the visit. See the sidebar for key indications for referral.

Cancer screening

Colorectal Cancer Prevention, Screening, Treatment, and Survivorship Recommendations

Colorectal cancer (CRC) is the third most common cancer affecting men and women in the United States. When CRC is found at an early stage before it has spread, the five-year relative survival rate is about 90%, yet it remains a leading cause of cancer-related death among both genders.

Ovarian Cancer: Prevention, Screening, Treatment, and Survivorship Recommendations

Even though its incidence is less common, ovarian cancer is the fifth leading cause of death from cancer in women, according to the American Cancer Society. It also estimated more than 22,000 new cases of ovarian cancer in 2019, with a five-year survival of 47% for all stages.

February 06, 2020

Genetics & genomics

Germline and Somatic Variants: What Is the Difference?

Cancer occurs from pathogenic genetic variants (formerly referred to as mutations) that involve changes in the order of the base pairs, including substitutions, deletions, additions, or shifts. Pathogenic variants can be divided into two broad categories based on the tissue from which they originate.

January 14, 2020

Genetics & genomics

Continued Conversation Shows That Nurses Need More Genetics Education

During the 44th Annual ONS Congress in April 2019, some sessions featured a Continuing the Conversation event following the main session. As a speaker, this might have been the best part for me. It was filled with unexpected, wonderful surprises and great conversations with oncology nursing colleagues.

Genetics & genomics

Why Pretesting Counseling Is Critical in the Age of Consumer Genetic Tests

On March 6, 2018, 23andMe—an at-home genetic testing company—announced their direct-to-consumer genetic test (DTCGT) would include DNA results for the three common founder BRCA mutations commonly seen in people with Ashkenazi Jewish ancestry. This was big news because DNA results for the BRCA mutations had been previously available on the 23andMe panel report until the U.S. Food and Drug Administration removed them in 2013.

Oncology nurse pride

A Career in Nursing Offers Plethora of Challenging, Satisfying Opportunities

It’s the season for graduations. My husband and I recently celebrated our youngest daughter’s graduation from Saint Louis University School of Nursing—just as we did for our two older daughters. As I reflected on this time of celebration, I was reminded of when I was asked to write for Continuing the Legacy: More Voices of Oncology Nurses, an ONS book that shares the narrative history of oncology nursing through individual nurse stories. I wrote about a patient who taught me a lot during our time together. At the end of each story, the authors were asked to reflect on their contributions and their experiences. With all of the celebrations lately, I had to look back on what I wrote.

Genetics & genomics

How DNA Revolutionized Oncology Care

April 25, 2018, marks National DNA Day. Why the hype? National DNA Day commemorates the successful completion of the Human Genome Project in 2003, and the discovery of DNA's double helix in 1953. Without DNA, understanding the diseases and treatments for cancer would be nearly impossible. Genetics and genomics play huge roles in treating malignancy, and it’s crucial to the care of patients with cancer for oncology nurses to understand genetics and genomics.

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To discuss the information in this article with other oncology nurses, visit the ONS Communities.

To report a content error, inaccuracy, or typo, email pubONSVoice@ons.org.

Suzanne Mahon RN, DNSc, AOCN®, AGN-BC

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