Devastation and fear of the known are common feelings for those who receive news of having Cancer. Every year, over a million people will be diagnosed with cancer annually according to the American Cancer Association. When first receiving a cancer diagnosis, it is difficult for clients and loved ones to really understand any information provided immediately after the diagnosis is given. Every cancer is also staged from a biopsy of the site, and as a nurse, it is important to really understand the type of cancer along with the current stage.
There is a multitude of cancer information available, but really the nurse needs to be prepared to provide accurate information to patients and families. This paper will provide a brief description of the stages of cancer, some of the side effects from treatments available, and care of the patient with cancer.
Staging of Cancer
A physician will stage a cancer from 0 to IV to determine just how large the tumor is and how systemic it has become.
“By moving through the bloodstream or lymphatic system, cancer cells can spread from the primary site to lymph nodes or to other organs, where they may form new tumors” (National Cancer Institute). The TNM system is often used to determine the current stage of cancer. From the TNM system the size of the tumor, at which length the nodes are involved, and what extent the lymph nodes are exposed are used to determine the stage. Metastasis is the final part of staging cancer, which is spreading of the cancer to other areas of the body that are from the original site of the cancer.
This leads to a grading system that helps determine the appropriate treatment plan or prognosis for the patient.
Carcinoma in Situ
Stage 0, also known as in Situ, is the earliest phase of cancer. A cell mutates into a cancer cell along with other cells in the same area, which forms a tumor in that tissue. This is not a diagnosis of cancer in Breast Cancer, but rather indicates an increased risk of cancer. Further treatment varies for those in Stage 0. Some patients may be observed while others may be started on tamoxifen, but there are of course risks associated with this medication such as increased risk of pulmonary embolism, venous thrombosis, stroke and Uterine Cancer.
“The NSABP-P-1 trial of 13,388 high-risk women comparing tamoxifen to placebo demonstrated an overall 49% decrease in invasive breast cancer, with a mean follow-up of 47.7 months” (National Institute of Cancer). Some patients may participate in clinical trials to reduce chances of further spread of the cancer while others may opt for more extreme prophylaxis such as a bilateral mastectomy.
Cancer Stage I, II, III
Stages I, II, and III all stand for disease being actually present. The higher level of staging could indicate a larger tumor. It could also indicate a more systemic disease process involving the lymph system. Once it has spread into the lymph system, the cancer can then spread to nearby organ systems. Along with tumor excision and removal of any effected lymph nodes, concurrent use of medications like tamoxifen in treatment of breast cancer, and the use of radiation and/or chemo therapy are all used in treatment plans at these stages of disease manifestation.
At Stage I, the tumor is small measuring less than 2cm and has not spread into nearby lymph nodes. As the cancer progresses, Stage II has a larger tumor measuring two to five centimeters, but has not inundated the surrounding tissues and has not spread from the current infected tissues, but it can sometimes be found in the associated lymph nodes. Stage III contains not only a larger tumor and is usually found in the nearby lymph nodes.
The final stage is Stage IV, where it is found that the cancer has spread from the original site to another organ system or systems. An example of this would be a primary diagnosis of Lung Cancer, but the cancer is found in the bones or the liver. No stage is great, but this stage is the worst because of the spreading of the disease to other organ systems. Often, the Prognosis is also determined on how much the cancer has spread and how severe the secondary tumors are. Treatment often involves radiation and surgical removal of the tumor.
Side Effects of Treatment
Treatment is often difficult for patients and families as there are some undesirable side effects associated with many treatment options. Side effects will vary depending on the location of the treatment. “Radiation on the lower trunk for gynecologic cancer and cancer in the prostate leads to diarrhea, frequent voiding and pain as well as affected sexuality. When head and neck area are irradiated, mouth dryness, taste changes, swelling, pain in the mouth and throat, loss of appetite and eating problems occur” (Pederson, Koktved, & Nielsen, 2013). Another treatment is Chemotherapy. Patients receiving chemotherapy often experience nausea, vomiting, and poor appetite.
Breast Cancer, as previously mentioned, in the early stages like In Situ, is often treated with tamoxifen or an aromatase inhibitor. “Tamoxifen is used in situations in which the cancer is a hormone receptive positive cell growth which accounts for over 75% of all breast cancer diagnoses” (Corter, Findlay, Broom, Porter, & Petrie, 2013. The possible adverse side effects are frightening and life altering happen to anyone.
It is important to not forget about the psychological toll these side effects can play. Patients have lives outside of their cancer diagnosis and treatment such as work and family responsibilities, or are just starting to enjoy retirement. Cancer does not pick and choose who it effects, so anyone could potentially suffer from this disease. “Emotional distress is common among cancer patients as a result of the diagnosis of a life-threatening disease, aggressive medical treatments, changes in lifestyle that occur, and the direct effects of the tumor” (Meijer, et al., 2013). Life can be stressful alone because of all the requirements, adding on stress to life such as diagnosis and treatment plans needed to combat cancer puts these patients at a high risk of Depression. Those providing care must always assess patients for depression at each appointment.
Not every patient will be the same, experience the same side effects, or respond the same to the treatments. Providers must be aware of this and be ready to provide information to patients and families related to the diagnosis and treatment.
There is hope at some point there will be a database with all the information of all patients’ cancer cell mutations to help improve treatment. “Even within the same tumor, cells may be altered in different ways, so a therapy that works for many patients may be utterly ineffective for the one sitting in the doctor’s office” (Edwards, 2014). Every patient is an individual, a person, not a number. The provider may have given the same diagnosis a hundred times, for that patient, it is probably the first time, and it is devastating. If providers can think of it as the first time, hopefully there will be an increased sense of empathy to this patient’s situation. The patient will have to endure a multitude of physical and psychological symptoms that may forever change their life because of their cancer diagnosis.
As a nurse, provide information on support available in the community and online patients and families. This diagnosis involves all in the family and is not just centralized for the patient. There may be support groups for patients and for families or caregivers available within the community. The American Cancer Society is a online support that has a vast amount of easy to understand information on numerous forms of cancers, stages of cancer, typical treatments, and support resources for patients and care givers. By providing this information early during the diagnosis is important, because after the intial shock of the diagnosis, this is an easy resource for people to start looking at information that is specific to their diangosis. This helps patients and families become advocates of their own care, whether it be to aggressive treatment or to improve the quality of end stages of cancer, rather than quantity.
Corter, A. L., Findlay, M., Broom, R., Porter, D., & Petrie, K. J. (2013). Beliefs about medicine and illness are associated with fear of cancer recurrence in women taking adjuvant endocrine therapy for breast cancer.
British Journal of Health Psychology, 18(1), 168-181. Retrieved from http://eds.b.ebscohost.com.library.gcu.edu:2048/eds/detail/detail?vid=8&sid=89dc87e3-ef39-4bfe-a28a-b07f6af34781%40sessionmgr111&hid=116&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#db=s3h&AN=84763245 Edwaryds, C. (2014). Using patient data for personalized cancer treatments. Communications of the ACM, 57(4), 13-15. doi:10.1111/j.1471-6712.2012.01085.x Meijer, A., Roseman, M., Delisle, V., Milette, K., Levis, B., Syamchandra, A., . . . Thombs, B. D. (2013, July). Effects of screenign for psychological distress on patient outcomes in cancer: A systemic review. Journal of Psychosomatic Research, 75(1), 1-17. Retrieved from http://www.sciencedirect.com.library.gcu.edu:2048/science/article/pii/S002239991300038X Pederson, B., Koktved, D., & Nielsen, L. L. (2013). Living with side effects from cancer treatment-a challenge to target information. Scandinavian Journal of Caring Sciences, 27(3), 715-723. doi:10.1111/j.1471-6712.2012.01085.x