Approach Care

Part I

When a person has cancer symptoms or result from their screening test indicates presence of cancer, a physician must find out the cause. A doctor may need to know the medical history of their person or their family and carry out a physical examination, order other procedures or test like scans or lab tests. Lab tests are necessary to test the levels of substances in body fluids such as urine and blood since high or low levels may be due to cancer. Abnormal laboratory tests, however, do not necessarily indicate presence of cancer hence doctors cannot rely on such tests alone for diagnostic purpose (American Cancer Society, 2015). Hence the use of imaging procedures and biopsy may require for significant results.

 Imaging procedures are used in creating pictures inside the body which assist in detecting the presence of a tumor. This process can be done through the following methods. CT Scan is one such methods where X-ray machine connected to a computer captures pictures of a body organ with much detail and contrast material like dye highlights those areas that are inside the body to make the pictures readable. Nuclear scan involves a person receiving a small quantity of radioactive material (tracer) in form of injection (National Cancer Institute, 2015). The tracer flows through the bloodstream and collect in some organs or bones.  Radioactivity is measured by a scanner which then creates pictures of the organ or bones on a film or computer screen. Imaging procedures through ultrasound involves a device which transmits sound waves that can be heard after bouncing off body tissues like an echo. The process is referred to as sonogram. MRI involves a linking a strong magnet to a computer, which is then used to create detailed pictures of body parts. The pictures can be seen on a monitor are later printed on a film. For PET Scan, a tracer is injected into the body and 3-D pictures are made to show the areas where the tracer collects inside the body (National Cancer Institute, 2015).  The scans assist in showing the functioning of tissues and organs.

In many cases, there is a need for a doctor to carry out a biopsy while diagnosing cancer. Biopsy involves removing a tissue sample which is then looked at under a microscope by a pathologist to check whether it is cancer.  The removal of the tissue is done by use of a needle where fluid or tissue is withdrawn or an endoscope where internal body parts are looked at by inserting it through natural openings such as a person’s mouth. Cells or tissues are then removed by use of a special tool through this tube.  Tissues may be removed through incisional or excisional surgery. Incisional surgery involves removing only a part of this tumor while excisional involves removing the whole tumor together with some normal tissue surrounding this tumor (National Cancer Institute, 2015).  After removing the tumor and confirming that cancer is present, the doctor will need to assess the speed of cancer growth or its aggressiveness. This will be done under a microscope to check how these tumor cells are different or alike as compared to one another. Tumor cells that look similar to the normal tissues from which they were removed are referred to as well differentiated(National Cancer Institute, 2015). Those tumor cells that do not resemble any particular tissues or are slightly similar the ones from which they were removed are referred to as undifferentiated or poorly differentiated tumors and they tend to be quite aggressive since they have fast growth , spread earlier and their outcomes are poorer than tumor cells that are well differentiated(National Cancer Institute, 2015).  

Cancer stage refers to the degree to which cancer has grown and how far it has spread in the body organs. Staging of cancer is necessary to help the doctor in understanding the seriousness of the disease and the chances of the patient to survive. It is also helps in planning for the best treatment and identifying clinical trials that can offer treatment options. The stage at which cancer was diagnosed is used to refer to it and any information on how it has changed with time is added to the initial stage and therefore, the stage does not change (American Cancer Society, 2015). There are various staging systems and like TNM are used for numerous cancer types.  Many of the staging systems include information such as tumor location, kind of cell, tumor size, whether cancer has reached the lymph nodes or various body parts and tumor status.  In TNM staging method, T stands for extent and size of tumor, N for lymph nodes having cancer and M to whether it has metastasized. Cancer described by this system has numbers attached to every letter providing more details about the disease. It also described in stages from 0 to IV. In stage 0 there abnormal cells that have not spread to other tissues and in stage I to III indicates the number of present tumor cells such that the greater the number the more it has spread to next tissues.  Stage IV indicates that cancer has spread further (American Cancer Society, 2015).

Part II

Cancer and cancer treatments can result to various complications that can be short-term or long-term where effect occurs years after administering of the treatment. These complications can involve pain, neurologic complications and extreme weight loss (American Cancer Society, n.d).  Pain can result from cancer itself or treatment although not every cancer is painful. Most of the pain is caused by tumor pressing against nerves, bones and other organs in ones’ body. At times pain result from treatments such as chemotherapy drugs which causes tingling and numbness or burning sensations in areas where they are injected. Acute pain result from injury damage and may last for short while. Chronic pain results from changes in nerves when cancer presses on those nerves or chemicals from tumor(American Cancer Society, n.d).

Cancer also affects the nervous system and can lead to significant mortality or morbidity and such effects can be direct or indirect. Direct effects are due to cancer involvement directly with the spine, brain or the PNS (Peripheral Nervous System) (Giglio & Gilbert, 2013).  Indirect effects are reflected in Paraneoplastic Neurologic Syndromes. Cancer treatment may also cause damages to the nervous system.  Paraneoplastic Syndromes refers to those disorders whose cause is cancer without direct metastases, infiltration or PNS and CNS strucuture compression involved (Giglio & Gilbert, 2013).  Weight loss is accompanied by fatigue and muscle loss especially during treatment. A major cause of this complication is cancer itself. While the body is trying to fight the cancer, the body secretes cytokines which bring about reduced appetite, muscle loss and hence muscle loss. Treatment methods – chemotherapy and radiation - lead to reduced appetite, and other side effects like vomiting, nausea and sores in the mouth and these affects one’s ability to eat.  Fatigue leads to decrease in physical activities and exercise further causing muscle and weight loss. 

To reduce the psychological and physical side effects of cancer, the presence of nurses, seeking support and the use of medications can be applied effectively. The presence of the oncology nurses can be useful in closing the gap between cancer diagnosis and a severe psychological effect while the patient is undergoing treatment. Patients with diagnosis that are life-threatening may feel alone and may have issues with an uncertain future, the possibility of treatment failure, spread of cancer and possible death. The presence of the nurses helps in developing trust with patients and hence potential stressors can be identified and hence nurses can use this opportunity to offer emotional support (Osterman, Schwartz & Asselin, 2010).  Another method to lessen these effects is to seek support from the oncology nurses through caregivers or families of the patient. Whereas nurses’ support has positive effect on the wellbeing of the patients, the nurses should work closely with relatives and other caregivers to offer emotional support that is very essential. Such support could be tailored towards the psychological and physical needs of the patients while they are battling cancer (Mick, 2008). In addition, use of medication is necessary in lessening these effects or symptoms. This involves caregivers attaining the knowledge on how pain and psychiatric medication administering should be adjusted and monitored effectively. This can help in stabilizing the physical effects such as pain and weight loss.

References

American Cancer Society,(2015).  Cancer Staging .Retrieved from: https://www.cancer.org/treatment/understanding-your-diagnosis/staging.html

National Cancer Institute, (2015). Diagnosis. Retrieved from: https://www.cancer.gov/about-cancer/diagnosis-staging/diagnosis

Osterman, P., Schwartz, D., Asselin, M., (2010).An exploratory study of nurses' presence in daily care on an oncology unit. 45(3): 197-205

Mick, J.,(2008). Factors affecting the evolution of oncology nursing care. Clinical Journal of Oncology Nursing (CLIN J ONCOL NURS). 12(2): 307-313.

Giglio, P., Gilbert, M.R., (2013).Neurologic Complications of Cancer and its Treatment. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3637950/