Primary prevention is therefore the most effective and economic method of controlling cancer. Once removed, benign tumours rarely recur. The most commonly diagnosed cancers in the UK are breast, lung, colorectal and prostate; together these four cancers make up over 50% of all new cancers each year (Cancer Research UK 2009). However, accurate staging of the extent of the disease is vital for the following reasons: The most common internationally used method of defining disease stage is the TNM system (Sobin & Wittekind 2002), in which: Agreed staging criteria exist for each cancer, such as those staging systems used for lung cancer (Box 31.3), gynaecological, testicular cancers, etc. They cannot make decisions about their treatment or the future if they are not fully aware of their diagnosis. (See Useful websites, e.g. The value of screening women of 40 years or younger remains controversial, consequently professional clinical judgement and a woman’s choice should guide decision-making. However, as with PSA, CA125 may be elevated in non-malignant conditions. The 20 most commonly diagnosed cancers (ex NMSC), UK, 2006 (Cancer Research UK, info.cancerresearchuk.org/cancerstats/incidence/commoncancers/, Cancer is associated with increasing age. Testing for these particular genes and others is now available commercially. Relatives may ask that their family member be protected from the, Supporting patients and families at diagnosis, Listen to some patients talking about their diagnosis at Health talk online (2008) lung cancer stories –, www.healthtalkonline.org/Cancer/Lung_Cancer. During scientific research on viruses and how they propagate and reproduce within their host, scientists discovered extremely important genes involved in regulation of cell growth. Caring for child cancer patients is physically demanding and emotionally exhausting for nurses. Neurologic assessments are per-formed to detect Nursing for cancer patients. The principle of beneficence obligates health care professionals to prevent harm and ‘do good’ for their patients. Data establishing a direct causal relationship with sunlight are more complex, but suggest a promotional role of sunlight in the cause of melanoma. Genetic changes or mutations may be either, Certain hormones are thought to promote some tumours. also directed toward Establish effective systems, i… Serous membranes such as the pleura or the peritoneum may be invaded by tumours, either locally from the primary tumour or from nearby metastases. No proximal invasion, Tumour >3 cm in diameter, within 2 cm from carina or invading the visceral pleura or partial atelectasis, Tumour of any size extending into the chest wall, diaphragm, pericardium, mediastinal pleura or within 2 cm of carina, total atelectasis, Tumour of any size with invasion of mediastinal organs or vertebral body, malignant pleural effusion, Positive nodes in ipsilateral hilar nodes, Positive ipsilateral, mediastinal and subcarinal nodes, Positive contralateral mediastinal or hilar nodes, scalene or supraclavicular nodes, Pelvic and abdominal lymph node involvement, Mediastinal and/or supraclavicular lymph node involvement. Genetic changes or mutations may be either somatic (acquired) or germline (inherited). 4). decreased fatigue, Exhibits improved body image and self-esteem, Experiences no complications, such as infection, or (See Further reading, e.g. ulcer disease, and de-creased fat digestion. applicators may be used in place of a toothbrush for painful oral tissues. Primary cancer prevention includes activities such as: Media reporting of cancer risk development requires cautious interpretation and should be put into perspective by reference to the original studies on which it is based. It allows clinicians to determine a patient’s eligibility to enter a clinical trial of a new treatment. Increasing knowledge about newer biological factors such as HER2/neu receptors and proliferative index (rate of cell division in the tumour) has altered the way adjuvant treatments (see p. 812) are prescribed and these indicators are increasingly used to predict prognosis. They secrete hormones and 21) (Box 31.2). /L). The staging of a cancer is the process whereby the extent of the disease is established; this involves a variety of tests (see the appropriate chapter for the staging of a particular tumour site). An important component of the nurse’s role is Accepted screening techniques include mammography and clinical breast examination, although Baxter (2001) has concluded that breast self-examination is of no benefit in routine screening. Individuals with impaired immunity are more susceptible to cancer; for example, people with HIV disease have a higher incidence of Kaposi’s sarcoma than the normal population (see Ch. These factors include physical agents, chemical agents, viruses and diet. As an oncology nurse, you will have to keep track of numerous details throughout the day for each patient. Hypercalcaemia is the most common oncological emergency and is associated with cancer of the breast, bone, lung and kidney. Alterations in tissue integrity throughout the gastrointestinal tract are surgery) are termed neoadjuvant. Projects have been developed to assist smokers to quit, particularly in areas with high levels of deprivation, prisons, the army and working men’s clubs. What a Cancer Caregiver Does. Cancer is the second cause of mortality in the world. Preventive action will be taken only after the individual has balanced the benefits of that action against its physical, psychological and financial costs (Smith 2005). For many, their fondest memories are ingrained in the walls of their cherished home. bowel and bladder incon-tinence, immobility, immunosuppression, multiple skin For such people, possible avoidance of lung cancer is not worth the cost of surrendering the immediate gratification and social status offered by smoking. Some brain tumours metastasise along the spinal cord in this fashion. alterations in oxygenation and electrolyte balances. Nursing plays a key role in this development and both student nurses and newly qualified health care professionals need to understand the multidisciplinary nature of cancer management within and outside the hospital, appreciating the roles of all those providing patient care. F) or Since the introduction of the Papanicolaou (‘Pap’) smear test in the mid 1960s, there has been a steady decline in mortality rates in the UK. Foods that are difficult to chew or are hot or spicy are Impaired tissue integrity: malignant skin lesions, Imbalanced nutrition, less than body requirements, COLLABORATIVE PROBLEMS/POTENTIAL COMPLICATIONS, Syndrome of inappropriate secretion of antidiuretic products or EPO are administered as prescribed. The completion of the Human Genome Project is accelerating the discovery of such markers (see Useful websites). J Nurs Care, an open access journal. The Japanese have a low incidence of breast cancer in comparison to the UK and USA but a high incidence of stomach cancer. Psychologists have developed a Health Belief Model (Strecher & Rosenstock 1997) to predict an individual’s preventive health behaviour and account for some of the factors which determine attitudes to health and illness. ), Epidemiological studies provide data about possible causes of different forms of cancer and inform the strategies for cancer prevention and screening. Any tissue subjected to constant irritation or to a disease process has an increased susceptibility to malignant change. Around 75% of people diagnosed with cancer are aged 60 years and over (Cancer Research UK 2009). Oral swabs with spongelike As many as It is important for health care professionals to clarify their meaning for patients, as the uncertainty surrounding cancer and cancer recurrence creates distress for the patient and their family. Secondary prevention aims to detect early-stage, curable cancer. Physical ther. As the scientific evidence for the chemical signals is complex this text will concentrate on the key genetic components involved. Comprehensive long-term strategies are continually being developed to shape cancer services, focusing on all aspects of the patient’s cancer journey, ensure equity of care and invest in equipment and the cancer workforce. CHAPTER 31 Nursing the patient with cancer Susanne Cruickshank, Karen Campbell Introduction 789 Oncology as a specialty 789 The fundamental process of cancer 789 Epidemiology of cancer 792 Aetiology of cancer 794 Cancer prevention and screening 795 Medical intervention and the nurse’s role 797 Diagnosis and staging 797 Aims of treatment 800 Treatment modalities 800… the oesophagus, causing dysphagia, compression of major blood vessels such as the superior vena cava, causing ischaemia, oedema of the head, neck and right arm, and dyspnoea, compression of neighbouring tissues and organs, e.g. We also produce a list of nursing resources as well as nursing and chemotherapy patient education programs and materials. Survivors of the atomic bomb explosions in Hiroshima and Nagasaki in Japan experienced a high incidence of leukaemia and skin cancer. carefully for changes indicating blood loss. In addition, clinic schedules should allow time to provide support. Several government publications have taken on ‘The Cancer Challenge’, with measures to promote a ‘pro-health’ culture (Department of Health 2000, Scottish Executive Health Department [SEHD] 2004). However, a benign tumour can cause problems or even death in certain sites. Carcinogenic chemicals present occupational hazards. They typically act as a resource to patients and families as well as other nurses. Stomatitis is characterized by mild redness (erythema) and edema Increased incidence of cancer and its growing trend have drawn attention to care for these patients. Palliative care is care given to improve the quality of life of patients who have a serious or life-threatening disease, such as cancer. Mutation of the BRCA2 gene, which is most commonly associated with breast cancer risk, causes a fivefold increased risk of prostate cancer; this risk can be more than sevenfold higher in men under 65 years (CRUK, 2013b). The chemical signals are protein components of growth factors, receptors, and messenger and regulatory proteins. associated with un-treated infection. Cigarette smoking has now clearly been identified as a major cause of cancers of the mouth, pharynx, larynx, bladder and pancreas, whilst contributing to many others. The disease is then staged using the above information, as follows: Dan, a 22-year-old student, discovered a testicular swelling but chose to ignore it, initially because he misinterpreted it as a sports injury and he was busy with exams, and later because he felt embarrassed and frightened. The pa-tient’s lips are lubricated to keep One in three people in the UK risk developing cancer in their lifetime. Light-skinned or freckled individuals who are unable to manufacture sufficient protective melanin are particularly at risk (see, Ninety per cent of all lung cancers can be attributed to tobacco smoking. They may to achieve adequate blood levels of the medications. Pediatric Hematology/Oncology Nurse — Provides specialized nursing care to children and teens with cancer or blood disorders, performs assessments, administers chemotherapy and other medications, monitors for side effects, and educates patients and families about diagnosis and treatment. Malignant cells also seem to lose contact inhibition, failing to recognise their boundaries and to cease growth on meeting a different tissue type. Reflect on your own attitudes and beliefs concerning cancer. or, if severe, by painful ulcerations, bleeding, and secondary in-fection. Listen to some patients talking about their diagnosis at Health talk online (2008) lung cancer stories – www.healthtalkonline.org/Cancer/Lung_Cancer. The nurse has an important role providing both practical information prior to and following each test, and emotional support. Dan lived too far away to travel to the department each day; otherwise the necessary tests could have been performed while he was an outpatient. Clinical nurse specialists (CNS) are another type of APN that have advanced education in a specific field of nursing, such as cancer care. There are wide ranges in the estimates of sensitivity and specificity. Young people in general are motivated by short-term rather than long-term rewards. The Unlike years ago, patients are now normally told their diagnosis, with a discussion of prognosis – often a medical uncertainty – and the level of information is tailored to the individual’s needs. The Million Women Study (2003) found that the use of combined oestrogen plus progesterone hormone replacement therapy (HRT) also increases the risk of breast cancer. 35). Different forms of treatment are known to be effective for specific tumours and at specific disease stages. These important areas are explored further in this chapter. Tumours grow by repeated cell divisions; their rate of growth is often defined in terms of doubling time. Political action has included a comprehensive ban on tobacco advertising, a smoking ban in public places and the workplace, the setting up of new stop-smoking clinics and a smokers’ helpline, nicotine replacement patches and bupropion available on prescription, as well as a major health education campaign in schools aimed at preventing youngsters from starting to smoke (Department of Health 2000, SEHD 2004). However, cancer patients in nursing homes have been a stimulus for the diffusion of palliative care in long-term care generally. Response to treatment can be described as: Only gold members can continue reading. Risk is more dependent on duration of smoking than on consumption. and texture of the new hair may be different. The denser breast tissue of premenopausal women makes mammograms difficult to interpret in this age group. An essential aspect of communication is that everyone understands and attaches the same meaning to language used. In the UK mammography is routinely offered every 3 years to women aged between 50 and 70 years. non-invasive – do not invade locally or metastasise. Barriers to cervical screening include lack of sensitivity and trust in health professionals, possible feelings of guilt and embarrassment, judgemental attitudes, and a lack of privacy and supportive care in clinics (Fitch et al 1998). A tumour may be benign or malignant. Patients are monitored for Among the cancers for which molecular diagnostics has had an impact is chronic myeloid leukaemia (CML). Dan asked the specialist nurse to explain the results and treatment options to him and his parents who were extremely concerned. Carcinogens are factors that both initiate and promote changes in the cell which lead to cancer. However, epidemiological studies have identified certain causative factors, termed ‘carcinogens’. procedures carried out for diagnosis and therapy. Education develops the skills of critical analysis, problem-solving, critical and creative thinking, the ability to question, review and evaluate literature as well as encouraging personal growth and development. Cancer care is changing rapidly with advances in technology and emerging treatments improving survival rates. Treatments, such as radiotherapy, used to reduce tumour size before other treatment (e.g. The test must have both a high degree of sensitivity, reducing the risk of false-negative results, and specificity, reducing the psychological trauma and expense of treating false-positive results. that coat or protect oral mucosa are used to promote comfort and prevent The matter is seldom as simple as the choice between lying and truth-telling, and each case must be considered individually. hemoglobin and hemat-ocrit levels are monitored for deficiencies, and blood Cancers that occur with increased frequency in families are components of various hereditary cancer syndromes, e.g. Thrombocytopenia, a 12). All have the potential to make a real difference in practice. Antibiotics may be prescribed to treat infections after cultures of ), pain control, promoting nutrition, and emotional support. Experiences no complications, such as infection, or T denotes the size or extent of local invasion of the primary tumour. The incidence of cancer in the UK is one of the highest in the northern hemisphere. Explain process as appropriate. The nurse administers fluids and blood Still, cancer patients often require specialized health care assistance as they undergo chemotherapy, radiation, and surgery. Reflect on how you could modify your own lifestyle to reduce cancer risk. It provides a better estimation of prognosis. The Health Belief Model states that an individual feels vulnerable to a disease if they believe they are susceptible to developing it and believe the disease to be serious. For best home nursing care plan for breast cancer contact Care24 for good care of breast cancer patient. These include to: 1. Colorectal cancer is the third most common cancer in both men and women and accounted for 41,581 cases in the UK in 2011. Such damage may occur from either error in DNA replication during mitosis or exposure to environmental agents. Nursing Care Plans. implementation of new cancer prevention programmes, e.g. The transition from cure to palliative therapy may occur gradually over time but should always be discussed openly with the patient. fever may be related to a variety of noninfectious conditions, including the It is now widely accepted that quality of life in cancer patients is an important consideration and may be improved by psychological interventions at specific stages (Cruickshank et al 2008). Many of our clients wish to stay in their own home after being diagnosed with cancer. Screening is routinely offered every two years to people aged 60–69 years (in England) and 50–74 years (in Scotland). Therefore damage in this gene results in an inability to programme the cell to die. Stomatitis may also occur with radiation to the avoided to minimize further trauma. empiric therapy most often includes a combination of medications to. It can profoundly affect every aspect of life, encompassing physical, psychological, social or spiritual aspects. A few select authors will be chosen to ... Latest Entry: 12/31/2020 The Impact of Delays in Low-Income Women’s Breast Cancer Experiences Some of these, but by no means all, are now subject to control through regulation or ban. People who stop smoking even well into middle age avoid most of their subsequent risk of lung cancer, and stopping before middle age avoids more than 90% of the risk attributable to tobacco (Peto et al 2000). Baggott et al 2002.). People with an unclear result will have the FOB test repeated. Creative dietary therapies, enteral (tube) feedings, or PN may be Cancer susceptibility genes such as BRCA1 and BRCA2 have been identified in breast and ovarian cancer. Accordingly, this was the treatment course chosen following further discussion with Dan. Men whose mother was diagnosed with breast cancer have a 19-24% increased risk of prostate cancer (CRUK, 2013b). Excessive alcohol, ingested over long periods of time, contributes to cancers of the mouth, pharynx, oesophagus and liver. The 20 most commonly diagnosed cancers are shown in Figure 31.2. Thereafter the test is offered at 5-year intervals until women reach the age of 64. doi: 10.4172/2167-1168.1000e136. Although all cancers have a genetic origin at the cellular level, this does not mean that all cancer is inherited. However, the age range for routine invitation for screening is to be extended to include women aged 47 to 73. Where an abnormal result occurs the person is offered an appointment with a specialist nurse to discuss colonoscopy (see Ch. smoking cessation, healthy eating. Would you seek medical advice quickly, assume it to be completely innocent and forget it, or would you think it could be cancer but wait and hope the lump goes away? pharmacologic and nonpharmacologic strategies to manage pain. Although multiple studies on stomatitis have been published, the optimal The risk of cancer recurrence is always present when a diagnosis has been given. They then become enmeshed in the next capillary network they encounter. Study Material, Lecturing Notes, Assignment, Reference, Wiki description explanation, brief detail. Another gene implicated in the replication repair process is called the mismatched repair gene. water may be necessary for patients who cannot tolerate a toothbrush. Most tumours retain sufficient characteristics of the normal differentiated cell to allow recognition of the type of tissue from which they were derived, which is the basis for the classification of tumours by tissue type (Table 31.2). 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