Care Of Cancer Research Paper Examples
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Cancer is a large group of diseases characterized by uncontrolled spread and growth of abnormal cells (American Cancer Society, 2011.) In 2012, there were over 14 million cases of cancer registered worldwide, and almost 32.5 million people previously diagnosed with cancer were alive by the end of 2012. Cancer is one of the most common causes of death globally with over 8.2 million people died from cancer in the World in 2012 (Cancer Researh UK, 2015.)
The main purpose of cancer diagnosis and treatment programs is to cure or sufficiently prolong the life of cancer patients and also to assure the best possible quality of life to survivors. Diagnosis of cancer typically involves detailed evaluation of the patient’s history, physical clinical examinations, and also analysis of results of laboratory tests, specific to type of cancer and location in the body (Davis, 2014.) Also the diagnostic procedures include review of imaging data including ultrasound, thoracoscopy, endoscopy, mediastinoscopy, X-rays, CT and MRI scans, that can visualize the location of the cancer, the size of the tumor, and the spread of cancer. Patology reports and surgical reports include information about microscopic examination of small tissue samples obtained by biopsy, fine-needle aspiration or removed during surgery (WHO, 2008; American Joint Committee of Cancer.) In body areas that cannot be well visualized with the above mentioned methods, for example, inside the patient’s bones or inside lymph nodes, the physicians use radionuclide scanning (Davis, 2014.)
The staging of cancer depends on the variety of factors; the key factors include location of the primary tumor, its size; cell type; involvement of the nearby lymph nodes; presence of metastasis in the distant body areas. There’s a relation between the cancer stage and survival rates of patients. The determining the stage of cancer is one of the basic inputs for defining the treatment strategy for the patient. Types of staging include clinical (based on tests and imaging data) and surgical or pathologic, based on the information and samples obtained during surgery (American Cancer Society, 2012.) There are two most widely used systems of cancer staging. The TMN staging is applied mostly for larger tumors, and the Roman numeral or stage grouping method is applied to almost all types of cancer.
TNM staging system, developed and maintained by the International Union for Cancer Control (UICC) and also the American Joint Committee on Cancer (AJCC), assesses the three key elements: tumor, nodes and metastasis. Tumor size, measured in millimeters or centimeters, varies, according to this classification from TX (cannot be measured), T0 (primary tumor cannot be located), Tis (in situ cancer involving only cells of superficial tissue layer) to T1-T4, where the greater the number is, the larger the tumor is. “Node” factor assesses the spread of cancer to the lymph nodes and is classified as follows: NX (nodes can’t be assessed), N0 (cancer didn’t involved the nearby nodes) and N1-N3 depending on location, size of the involved lymph nodes. Metastasis indicator assesses whether the cancer spread to the distant body areas; MX means no enough data for evaluation; M0- no metastasis, and M1 – the cancer involved distant organs. T,N and M factors, when assessed, are combined in order to determine the stage in Roman numeral form, from I to IV, sometimes including substage marked with letters A or B (American Cancer Society, 2012.) According to Roman numeral classification, 0 stage refers to carcinoma in situ, stages I-III describe cancer spread to a larger extent, involving nearby organs or lymph nods, and stage IV means that the cancer spread to the distant organs and tissues (Davis, 2014.)
Definition of stage on the basis of the above factors in specific to the type of cancer. For example, in staging lung cancer, there’s a challenging issue whether the presence of separate isolated tumor cells in lymph nodes has the prognostic significance (Dacic, 2012.) For breast cancer, there’re also specific issues and challenges in staging, for example, when there’s direct skin invasion, when micrometastases are detected, when multiple tumors are present in the breast (Singletary & Connolly, 2006.) Some clinics use alternative staging systems for some types of cancer, for example, there is Barcelona Clinic Liver Cancer (BCLC) staging system (Forner et al., 2014.) Central nervous system cancers, cancers of the blood (lymphoma, leukemia, multiple myeloma, etc.), and also childhood cancers have unique staging systems. The stage of cancer refers to a stage defined when the cancer was initially diagnosed and in most cases doesn’t change over time, if the cancer progresses or responds to the treatment and decreases, the additional information is added to the medical records (American Cancer Society, 2012.)
The patients with cancer often suffer from numerous complications and side effects of treatment, causing not only physical discomfort, bul also psychological problems. The list of possible complications of cancer and adverse effects of its treatment is very long, but some of the common complications include loss of appetite, nausea, pain, immune system depression, anemia, hair loss, insomnia (Davis, 2014.) Some complications are very serious, for example, cardiovascular problems, and can affect prognosis and in general quality of the patient’s life.
It’s necessary to review several possible complications. For example, radiotherapy, chemotherapy and surgery applied to treat various forms of cancer, can cause cardiovascular problems in patients, such as hypertension, bradycardia, arrhythmia, myocardial ischemia, infarction, thromboembolism, etc. Cardiotoxicity of chemotherapeutic drugs has significant negative impact on the prognosis of survival rate of patients wih cancer. For example, cyclophosphamide, used as chemotherapeutic agent, has several cardiotoxic mechanisms, for example, myocardial ischemia resulted from coronary vasospasm, ischemic myocardial damage caused by intracapillary microemboli. Detection of ischemia and acute coronary syndrome is based on the patient’s clinical presentation, changes in ECG, and increased level of in cardiac enzymes. Treatment, according to the standards of American Heart Association, include percutaneous coronary intervention, anticoagulant and antiplatelet therapy, use of aspirin and beta-blockers (Yeh & Bickford, 2009.)
Another serious, but underreported complication of cancer treatment, such as radiation and high dozes of chemotherapy, is thyroid dysfunction manifesting in forms of hypothyroidism, thyroiditis, Graves' disease, and thyroid cancers. The physiological effects of thyroid dysfunction include “cardiovascular, renal, gastrointestinal, neurological, and endocrine abnormalities” (Kurtin, 2009.) The most dangerous symptoms, in which the disease can manifestate, include psychosis, adrenal insufficiency, heart failure, and coma. The hypothyroidism in patients under radiological treatment and chemotherapy can be prevented through administration of thyroid-protective agents such as solution of potassium iodide, Lugol's solution, etc. Common treatment of hypothyroidism is aimed at replacing the naturally produced thyroxine with levothyroxine, which, in most cases, is highly effective. The reassessment and ongoing monitoring of thyroid fnction is necessary (Kurtin, 2009.)
The systemic cancer and also cancer treatment can cause averiety of neurological complications, both direct and indirect. According to Van Horn (2013), “oncology nurses must develop a high index of suspicion for neurologic complications when examining or interviewing patients who present with neurologic symptoms or deficits and have a known systemic cancer.” Penetration of metastasis to central nervous system (mainly to the cerebellum or to the hindbrain), as a result of such malignant diseases as lung cancer, skin cancer, breast cancer, etc., may cause such symptoms as gait disorders, headaches, dysmetria, seizures, visual changes, nausea and vomiting, facial asymmetry, difficulties with swallowing, etc. The patients may experience cognitive deficits, dementia or delirium, withdraws from social interaction, difficulties with speech and language understanding. Involvement of the central and peripheral nervous system into the malignant process woesen the prognosis for patients with cancer.
Undirect neulogic complications are caused mainly by adverse effects of cancer treatment or may appear as a physiologic response to the primary cancer (Van Horn, 2013.) Chemotherapy can cause ototoxicity, peripheral neuropathy, autonomic nervous system dysfunction with a variety of symptoms. Radiotherapy, particularly, cranial irradiation, can cause encephalopathy, transient brachial plexopathy, myelopathy; late symptoms include cognitive deficit, headache, focal neurologic deficits, and seizures (Van Horn, 2013.) Treatment of the above mentioned neurologic complications vary depending on the type, patient’s health condition, etc.
Hair loss often accompanies chemotherapy and is a source of psychological discomfort for patients, especially for women. It’s necessary to pay attention to the patient’s complains, to understand how distressing it can be and to provide the necessary support and counseling. It’s necessary to explain that the hair loss is temporary condition. Hair loss can be prevented via wearing a cold cap. Some patients can choose to wear a wig.
Cancer is a very serious disease often accompanied with numerous complications. For nurses and physicians it’s necessary to know the possible complications and side effects of treatment, to prevent them where possible, and, if the risk of complication realizes, to detect the complications timely and to provide the necessary care and psychological support.
American Cancer Society (2011). Global Cancer Facts & Figures 2nd Edition. Atlanta: American Cancer Society. Retrieved from http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-027766.pdf
American Cancer Society (2012). Staging. Retrieved from http://www.cancer.org/treatment/understandingyourdiagnosis/staging
Cancer Research UK (2015). Worldwide Cancer. January 2015. Retrieved from http://publications.cancerresearchuk.org/downloads/Product/CS_KF_WORLDWIDE.pdf
Davis, Ch.P. (2014). Cancer. Medicine.Net, 12/22/2014. Retrieeved from http://www.medicinenet.com/cancer/page6.htm
World Health Organization (2008). Diagnois and Treatment. Cancer control : knowledge into action : WHO guide for effective programmes ; module 4. Retrieved from http://www.who.int/cancer/modules/FINAL_Module_4.pdf
American Joint Committee of Cancer (n.d.) Cancer Staging References. Retrieved from https://cancerstaging.org/references-tools/Pages/What-is-Cancer-Staging.aspx
Dacic, Sanja,M.D., PhD. (2012). Dilemmas in lung cancer staging. Archives of Pathology & Laboratory Medicine, 136(10), 1194-7. Retrieved from http://search.proquest.com/docview/1362249992?accountid=12779
Singletary, S. E., & Connolly, J. L. (2006). Breast cancer staging: Working with the sixth edition of the AJCC cancer staging manual. Ca : A Cancer Journal for Clinicians, 56(1), 37-47. Retrieved from http://search.proquest.com/docview/211967015?accountid=12779
Forner, A., Díaz-González, Á., Liccioni, A., & Vilana, R. (2014). Prognosis prediction and staging. Best Practice & Research, 28(5), 855-65. doi:http://dx.doi.org/10.1016/j.bpg.2014.08.002
Yeh, E. T. H., & Bickford, C. L. (2009). Cardiovascular complications of cancer therapy: Incidence, pathogenesis, diagnosis, and management. Journal of the American College of Cardiology, 53(24), 2231-2247. doi:http://dx.doi.org/10.1016/j.jacc.2009.02.050
Kurtin, Sandra E, RN, MS,A.O.C.N., A.N.P.-C. (2009). Hypothyroidism: A growing complication of cancer treatment. Oncology, 23(11), 41-45. Retrieved from http://search.proquest.com/docview/325070316?accountid=12779
Van Horn, Alixis, RN, MSN, APRN-C, CHPN, & Harrison, Cynthia, RN,M.S.N., N.P. (2013). Neurologic complications of cancer and cancer therapy. Clinical Journal of Oncology Nursing, 17(4), 418-24. Retrieved from http://search.proquest.com/docview/1431164189?accountid=12779
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