Approach to Care of Cancer

Cancer is considered the second leading cause of death in the United States resulting in about 25% of deaths (Copstead, & Banasik, 2010). The term cancer encompasses a cluster of more than one hundred diseases. Though there are various kinds of cancer, all cancers start due to abnormal cells growth. The typical characteristic of a cancerous cell is that they grow out of control and invade other tissue through the bloodstream or lymph vessels. If untreated, cancers can result in serious complications and death (American cancer Society (ACS), 2012).

Although the cause of various cancers remains unknown, still there are several known causes such as: genetic factors; lifestyle factors such as smoking, alcohol use, diet, and physical activity; certain types of infections for example, HPV and HIV; and environmental exposures to different types of chemicals and radiation (ACS, 2014). It is predicted by ACS (2012) that 1/2 of all men and 1/3 of all women in the United States will develop cancer in their lifetime. The risk of many cancers could be minimized by lifestyle modification and screening.

This paper will discuss the diagnosis and staging of cancer, three complications of the disease, side effects of treatment, and methods to minimize physical and psychological effects of cancer treatments. Diagnosis There is not a single test to confirm the diagnosis of cancer; it requires series of different test to confirm the diagnosis. It usually begins with obtaining detailed history and conducting physical examination. The patient symptoms differ depending on the type and extent of the disease. Localized symptoms of cancer relate to the primary site of the disease.

The seven warning signs of cancer includes change in bowel or bladder habits, a sore that does not heal, unusual bleeding or discharge, thickening or lump in an area of the body, indigestion or difficulty in swallowing, obvious change in wart or mole, and nagging cough or hoarseness (Copstead, & Banasik, 2010). Presence of any of these signs, along with detailed history, will not confirm the diagnosis but alert the practitioner to start a complete cancer work up. The work up will include imaging studies to identify location, size, and or metastasis.

The imaging studies may include x-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, and positron emission tomography (PET) scans (National Cancer Institute, 2014). Lab test may include studies of blood, urine and other bodily fluids. It may also include tests for various tumor markers, which may be elevated due to presence of cancer (National Cancer Institute, 2014). For example, elevated prostate-specific antigen (PSA) may indicate prostate cancer, and elevated alpha-fetoprotein (AFP) may indicate liver cancer (Stanford Medicine, 2014).

All these tests may suggest presence of cancer but to establish a definitive diagnosis and properly classify the disease biopsy is essential. A cancer diagnosis is mostly confirmed by obtaining cell or tissue sample for pathology study through biopsy. There are various methods of tissue removal for examination. For example, fine needle biopsy (fine needle aspiration), core needle biopsy (core biopsy), excisional or incisional biopsy, endoscopic biopsy, and skin biopsies (ACS, 2013). Irrespective of the technique, the goal of the microscopic examination is to confirm the diagnosis of cancer.

The pathologist could usually grade and indicate the type of cancer by microscopic examination with routine processing and staining but sometimes additional tests are required. For example, immunohistochemical (IHC) or immunoperoxidase stains, electron microscopy, flow cytometry, image cytometry, cytogenetics, and Polymerase chain reaction (PCR) (ACS, 2013). Staging Grading and staging in cancer is use to predict the prognosis of a malignant tumor and to plan treatment modalities. Grading denotes to the histologic classification of tumor cells and determines the degree of anaplasia.

Normally grading systems classify tumors in 3-4 categories of increasing degrees of malignancy. Treatment is mostly determined by the staging of the tumor. Staging defines the site and spread of a tumor in an individual patient. Staging considers the tumor size, extent of local growth, lymph node and organ involvement, and presence of distant metastases. There are different staging systems in use; nonetheless, the international TNM staging system is most widely used system for cancer staging (Copstead, & Banasik, 2010).

“T” represents the main tumor, “N” indicates lymph node involvement, and “M” relates to metastasis. A numeric value is place next to each letter to specify the size and extent of the tumor and the degree of metastasis. For example, Tx means tumor is not measurable, T0 indicates no primary tumor found, Tis signifies carcinoma in situ (present but not spread), and T1-4 indicates the size and extent of the primary tumor. When referring to lymph nodes Nx means regional lymph nodes could not be evaluated, N0 denotes that no lymph node involvement present, and N1-3 indicates the degree of lymph node involvement.

When staging metastasis Mx means distant metastasis cannot be evaluated, M0 denotes that there is no distant metastasis, and M1 indicates that distant metastasis is present (National Cancer Institute, 2014). Although, most types of cancer uses TNM assessment system to stage the intensity of the cancer, particular staging criteria may vary with tumors in different organ system, such as breast cancer (Copstead, & Banasik, 2010). The outcomes of the staging process will govern the choice of cancer treatment.

The surgery, radiation therapy, or chemotherapy may be used, separately or in combination to destroy the cancer cells. Confined local tumors may be treated with surgery and radiation therapy; however indication of metastasis would require inclusion of chemotherapy in the treatment regimen (Copstead, & Banasik, 2010). Complications Complications resulting from this life threatening disease are as diverse as the numerous types of cancer itself. The severity may vary from person to person depending on the patients’ health status, stage of cancer and area or organ affected.

The complications could be divided in two broad categories, such as physical and psychological complications. Physical Complications Among various physical complications pain is the most feared complication of the disease process. The mechanism of pain could relate directly to the disease itself or indirectly due to the treatment and procedures. Cancer pain may arise due to direct pressure, obstruction, invasion of metastatic cells into organs or bone, tissue destruction, and inflammation (Copstead, & Banasik, 2010).

The treatment and procedures such as biopsies and intravenous therapy may become additional contributing factors for pain (Copstead, & Banasik, 2010). Providing adequate pain management and support for associated symptoms is a main responsibility of the healthcare team. Pain management needs to be individualized based on patient’s pain perception and response. Patients should be encouraged to report pain, but at the same time the healthcare professional needs to be mindful of social and cultural implications with respect to pain perception.

Pain management includes administration of analgesics as needed or on scheduled basis, providing options for patient-controlled analgesia, non- pharmacological interventions such as meditation, and managing activities to minimize pain (Copstead, & Banasik, 2010). Another complication of cancer is bone marrow suppression which leads to anemia, leukopenia, and thrombocytopenia. The cause of bone marrow suppression could be invasion and destruction of blood-forming cells in the bone marrow, poor nutrition, and chemotherapeutic drugs (Copstead, & Banasik, 2010).

Anemia denotes to deficient circulating red blood cells. The signs and symptoms manifested by a patient may include fatigue, tachycardia, and tachypnea due to decreased oxygen-carrying capacity. Leukopenia refers to reduction in white blood cells in circulation. This jeopardizes a patient’s capability to combat infections, thus becoming a major factor for poor prognosis. The patient may demonstrate signs and symptoms of infection such as fever, chills, cough, or diarrhea. Thrombocytopenia signifies a deficit in circulating platelets, which could lead to fatal hemorrhaging.

The patient could manifest signs and symptoms of bleeding such as bruises, hematuria, etc. These issues are managed by administration of blood products. In selected situations, growth factors, such as erythropoietin (Epogen) or granulocyte-stimulating factors (Neupogen), are also administered to improve the production of red and white blood cells (Copstead, & Banasik, 2010). Side Effects of Treatment Surgery Surgery is the first option for patients with solid, localized tumors. In addition to providing samples for biopsy, it could be curative if the cancer is detected at an early stage.

In high risk population, it is also used as a preventative intervention. Surgical intervention contains potential risks related to administration of anesthesia, risk of infection, and blood loss. Additionally, it may cause disfigurement or cause loss of function leading to physical and psychological issues (Copstead, & Banasik, 2010). Depending on the issue, patients could be provided pharmacological support in case of pain and infection and counseling for psychological concerns. For prevention of infection proper wound management is necessary.

Additionally provision of prosthesis, wigs and other such supplies could help patient cope issues of altered self-image. Chemotherapy Chemotherapy entails systemic administration of anticancer chemicals as treatment for cancers. The chemotherapy drugs are cytotoxic, as they inhibit some aspect of cell division. It requires several courses of drug therapy to ensure that all tumor cells have been killed. During the therapy, normal cells are also destroyed, in particular: rapidly dividing cells of the bone marrow, intestinal epithelia, and hair follicles (Copstead, & Banasik, 2010).

The patient may manifest signs and symptoms such as nausea, vomiting, hair loss, memory change, fatigue, infection, bleeding, mouth and throat changes, sexual dysfunction, and pain (National Cancer Institute, 2012). Educating patients about the potential side effects and providing treatment and support as the symptoms are manifested would be the key element to assist patient during the course of treatment for better compliance. Methods to Lessen Physical and Psychological Effects According to Payne and Donaghy (2010) there is close interaction between somatic, cognitive and behavioral processes.

For example any physical problem such as pain may give rise to psychological issues such as anxiety and behavioral concerns such as lack of participation in activities to avoid pain. Thus, therapeutic intervention requires unified integration of varying strategies addressing different elements in care for these patients. To cope with psychological and behavioral issues, social, emotional and professional support is crucial for a patient. This support would enable patient to deal from normal adjustment issues as well as adjustment disorders.

Patients can gain knowledge and training to cope with psychological stress through various approaches. Some of the approaches are training in relaxation, meditation, or stress management; counseling or talk therapy; cancer education session; social support in group setting; exercise, and medication for depression or anxiety (National Cancer Institute, n. d. ). There are various government and non-government organizations committed to assist cancer patients and their families such as American Cancer Society. A patient could seek support from these organizations as well.

To minimize physical effects of treatment pharmacological and non-pharmacological interventions could be adopted. Providing detail information before initiation of treatment about side effects would alleviate anxiety to knowledge deficit. Educating patient how to deal with physical effects will increase confidence and give them feeling of control over their situation. The most common side effect of chemotherapy is nausea and vomiting. Usually patients are given antiemetic to minimize this issue. In addition patient should be provided with nutritional consultation to modify diet.

Patient should be educated to take small nutritious meals and avoid foods that are hard to digest. Another side effect is leukopenia that predisposes patient to infection. Depending on patient’s WBC count, a patient may require reverse isolation or education how to prevent infection. A patient should be instructed to maintain good personal and environmental hygiene, avoid going out in public places during course of treatment, avoid direct contact with family or friends who cold or other infection, and maintain food hygiene.

Fatigue due to radiation therapy or anemia could be minimized by taking short naps of less than an hour in day time, balancing period of activity with rest, getting adequate sleep at least 8 hours, eating and drinking well and doing little exercise every day (National Cancer Institute, n. d. ). To deal with issue of pain after surgery patient could be given opioid analgesics and taught relaxation techniques such as imaginary, listening to music and or meditation. Conclusion Cancer is a life threatening illness which affects individuals of all ages.

The diagnosis and treatment modalities could have serious physical, psychological and social implications. Therefore, individuals require ongoing support from the healthcare professionals, family, friends, and the society for their survival. It is important to educate patient in minimizing and dealing with side effects of treatment. There are numerous government and non-government resources available for patient education and support. Knowledge of these resources can assist healthcare professionals in directing patient to these resources and improve patient outcomes.

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