Summary

31.1 Oncological Disorders

• Cancer is thought to be caused by systemic issues, environmental exposures, and genetic determinants.
• Cancer is characterized by uncontrolled and abnormal cell growth, which typically develops over years due to repeated insults to the cell’s genetic material.
• Tumors are malignant or benign. Malignant growths are cancerous, grow uncontrollably, and invade other areas of the body. Benign tumors grow slowly and do not spread.
• Preventable causes of mutations that may lead to cancer include smoking, alcohol consumption, poor nutrition, and viruses. Nonmodifiable causes of mutations that may lead to cancer include age, biological sex, ethnicity, and genetics.
• Signs and symptoms are unique to each type of cancer, but fatigue and unexplained weight loss are the most commonly reported clinical manifestations.
• Cancers are named and classified based on where they start in the body. A carcinoma is a cancer that creates solid tumors in epithelial tissue. A sarcoma is rare and is often related to bone cancers. A lymphoma applies to any cancer that begins in the lymphatic system. A leukemia refers to cancers of the blood-forming tissues, such as bone marrow.
• The major types of cancers are brain cancer, bone cancer, breast cancer, colon and rectal cancer, lung cancer, skin cancer, and blood cancer.

31.2 Detection and Prevention of Cancer

• Detection and diagnosis involve a combination of screening tests at recommended intervals; imaging studies, such as x-ray, MRI, or CT scans; and biopsies. Blood tests are useful to detect specific tumor markers, proteins, or substances that indicate the likely presence of cancer. They also help gauge the effectiveness of treatment or check for recurrence during periods of remission.
• Grading and staging systems standardize diagnosis, the likely prognosis, and the treatments to consider. Grading describes the cellular characteristics and aggressiveness of cancer cells and, by extension, how sensitive the cells will be to treatment. The higher the grade, the more abnormal the cells appear.
• The staging system is different for every type of cancer, but it generally refers to whether the tumor is confined to one space or has spread to other areas of the body. The basic TNM system represents the anatomic extent of solid tumors and gauges the size and extent of tumor (T), lymph node involvement (N), and systemic involvement or metastasis (M) for prognostic implications. There are other staging systems that can also be applied to specific types of cancer, such as blood, skin, or colon cancer.
• Prevention focuses on reducing the risk of developing cancer. There are three levels of prevention: primary, secondary, and tertiary. Primary prevention promotes healthy lifestyle choices. Secondary prevention involves detecting cancer with screenings when treatment has the best chance of a desired outcome. The focus of tertiary prevention is reduction of symptoms and complications related to the disease process including getting the correct treatments, symptom management, emotional and social supports, and maintaining or regaining physical and emotional health after treatment has ended.

31.3 Care of the Patient with Cancer

• To assist the patient in managing complications, the nurse must evaluate physiological, psychological, and situational factors. Holistic assessment is required. Specific assessment will depend on the type of cancer and the patient’s current treatment plan. Generally, the nurse will look for signs of cachexia, and assess skin color to determine proper perfusion, good oxygenation, and any evidence of jaundice or bleeding. Treat fatigue, pain, gastrointestinal issues, hematological complications, altered nervous system functions, and any skin impairments.
• An oncological emergency, which includes metabolic emergencies, hematologic emergencies, and structural emergencies, is an acute issue that may cause mortality or morbidity.
• Nursing care for individuals with cancer addresses physical, psychosocial, cultural, and spiritual needs. Nurses look for cues in abnormal test results, new symptoms, and changes in the patient’s condition that indicate additional testing or intervention is needed. Nurses must also manage side effects and complications. To evaluate outcomes, nurses assess often for the patient’s understanding of their condition, treatment plan, and self-care instructions, adjusting whenever the patient’s outcomes are not being met or when there are changes to the plan of care.
• Treatment options vary widely based on individual patient factors, including age, overall health, type of cancer, and stage of progression. Medical therapies may include surgery to remove tumors or affected tissues, targeted therapies that attack specific molecules, hormone therapy for hormone-driven cancers, stem cell transplants to replace diseased bone marrow, and genetic profile-specific medicine. The most commonly used therapies are external or internal radiation, chemotherapy, and immunotherapy drugs. Nurses play a key role in administering radiation, chemotherapy, and immunotherapy drugs, monitoring for side effects, and managing symptoms to improve quality of life.
• Cancer care requires a truly comprehensive coordination of care among interdisciplinary team members. The complex and ongoing nature of cancer care often requires specialized providers that are unique to patients with cancer.

31.4 Survivorship

• Survivorship in cancer care recognizes that many individuals continue to live after their initial diagnosis and treatment. Some survivors are completely cancer-free whereas others are living with cancer. Anyone with a history of cancer is considered to be in survivorship. Challenges faced by cancer survivors may be psychological, social, emotional, spiritual, or physical.
• Remission signifies a period when cancer is not detectable or actively growing. Recurrence indicates that the cancer has resurfaced and is no longer under control or stable. Secondary cancer can arise from factors that contributed to the initial cancer or develop because of previous cancer treatments. The risk of cancer tends to increase with age, irrespective of an individual’s cancer history.
• The primary responsibilities of the nurse in survivorship care are health promotion and symptom management. The nurse also reinforces teaching about follow-up appointments, diagnostic testing for surveillance of ongoing remission or recurrence, medication adherence, side effect management, and when to seek medical attention.
• Providing a range of support options in collaboration with health-care providers, services, and support groups is crucial for comprehensive survivorship care.