Approach to Care
Grand Canyon University
According to the American Cancer Society, half of all men and one third of all women will develop cancer within their lifetime (Cancer.org). These figures are staggering. Cancer is a leading cause of morbidity and mortality worldwide and is a terrifying and unpredictable disease for many cancer sufferers. As such, it is imperative that healthcare workers have a thorough understanding of the various cancer diagnoses, treatments, and preventative strategies necessary to combat this devastating plague. Skills at managing not only the illness itself, but also the psychological and social side effects that accompany treatment must also be at the forefront of effective care strategies. Diagnosing Cancer
Because the term “cancer” encompasses a broad range of diseases, diagnosing this disease will vary according to the affected tissues or regions from which it originates. According to Webster’s, the definition of cancer is “a malignant tumor of potentially unlimited growth that expands locally by invasion and systemically by metastasis.” It is this unlimited growth and the subsequent invasion of healthy tissue that makes cancers so deadly and aggressive treatment so vital.
A suspected diagnosis of cancer generally begins with an examination of the presenting signs and symptoms. These symptoms will vary according to the type, location and extent of the cancer itself. Local symptoms of cancer are usually restricted to the primary site of the cancer. These symptoms may include new lumps or nodules, swelling, bruising or bleeding in or around the diseased tissue. Metastatic symptoms may include enlarged lymph nodes, organomegaly (commonly seen in the liver and spleen) and bone pain and/or fractures. Systemic symptoms include weight loss, fatigue, sweating and anemia. While none of these symptoms is diagnostic, they are helpful in providing a starting point for a complete cancer workup.
Lab tests for cancer may include tests for various tumor markers which are suggestive of neoplasms. Tumor markers are substances produced by cancer cells that are found either in or on the tumor cells or in the blood, spinal fluid, or urine (McCance 2010.) For example, liver and germ cell tumors produce alpha fetoprotein (AFP) into the blood, and prostate tumors secrete prostate specific antigen (PSA) into the blood (McCance). A significant problem in diagnosing cancer using tumor marker assays, however, is that nonmalignant conditions can also produce tumor markers. Therefore, while the presence of such markers may suggest a neoplasm, they are not used in and of themselves to make a definitive diagnosis of cancer.
Whatever the initial complaints or lab tests show, once the diagnosis is suspected and a tumor has been identified, it is essential that tumor tissue be obtained to establish a definitive diagnosis and correctly classify the disease (McCance 2010). Various methods of tissue removal for examination include excisional, incisional and core biopsy, fine needle aspiration, and exfoliative cytology. The technique selected generally depends on the size, location, and type of tumor discovered, but regardless of the technique the goal is pathological examination under a microscope for the histological hallmarks of cancer. These hallmarks of cancer cells include the loss of cellular differentiation, irregularities of the size and shape of the nucleus, and the loss of normal tissue structure (McCance 2010). Further classification of the cancer can be facilitated by tests such as immunohistological stains, flow cytometry, electron microscopy, chromosome analysis, and nucleic acid-based molecular studies (McCance 2010). Staging
Once the diagnosis of cancer has been made, it is important that the cancer be staged in order to determine the extent to which it has spread. Cancer is generally staged in four...