General Principles of Cancer

Introduction to Cancer

Cancer is a group of diseases marked by uncontrolled cell growth and division, which can invade surrounding tissues and spread to distant organs. Understanding the basic biology of cancer is essential for effective prevention, diagnosis, and management.

• Definition: Cancer (malignant neoplasm) is characterized by abnormal, uncontrolled cell proliferation.

• Normal Cell Growth: Healthy cells grow, divide, and die in a regulated manner, supporting tissue maintenance and repair. Apoptosis is the process of programmed cell death.

• Cancer Cell Characteristics:

  • Uncontrolled division and loss of normal regulation

  • Ability to invade and metastasize

  • Abnormal differentiation and resistance to apoptosis

  • Angiogenesis: formation of new blood vessels to support tumor growth

Benign vs. Malignant Tumors

Tumors are classified based on their growth patterns and potential to spread.

• Benign Tumors: Slow-growing, localized, non-invasive, and non-metastatic. May cause symptoms by compressing nearby structures.

• Malignant Tumors: Rapid, uncontrolled growth, invasive, capable of metastasis, and can cause tissue destruction and organ dysfunction.

Cancer Development and Carcinogenesis

Cancer develops through a multistep process involving genetic and environmental factors.

• Initiation: Genetic mutations occur due to carcinogens or inherited factors.

• Promotion: Abnormal cells proliferate under the influence of growth-promoting factors.

• Progression: Additional mutations lead to aggressive tumor growth and metastasis.

Risk Factors for Cancer

• Nonmodifiable: Age, family history, inherited mutations, personal cancer history, genetic syndromes.

• Modifiable: Tobacco, alcohol, obesity, inactivity, poor diet, UV exposure, occupational hazards.

• Infectious: HPV, hepatitis B/C, Epstein-Barr virus, Helicobacter pylori.

Cancer Classification

• Carcinomas: From epithelial tissue (e.g., breast, lung, colorectal, prostate).

• Sarcomas: From connective tissue (e.g., bone, muscle, cartilage).

• Leukemias: From blood-forming tissues; abnormal blood cell production.

• Lymphomas: From lymphatic tissue (Hodgkin and non-Hodgkin types).

• Multiple Myeloma: From plasma cells, affecting bone marrow and antibody production.

Cancer Staging and Grading

• TNM Staging:

  • T: Tumor size/extent

  • N: Lymph node involvement

  • M: Distant metastasis

• Cancer Stages:

  • Stage 0: In situ

  • Stage I: Localized

  • Stage II: Larger/limited regional

  • Stage III: Extensive regional

  • Stage IV: Distant metastasis

• Tumor Grading: Describes cell abnormality and differentiation; higher grade = more aggressive.

Nursing Considerations

• Assess risk factors and family history

• Educate on prevention and screening

• Support patients emotionally and address misconceptions

• Promote early reporting of symptoms

Cancer Screening and Diagnostics

Purpose of Screening and Diagnostics

Early detection and accurate diagnosis are crucial for effective cancer management.

• Screening: Identifies possible cancer before symptoms; improves outcomes.

• Diagnostic Testing: Confirms cancer, identifies type and extent, guides treatment.

Common Cancer Screening Methods

• Breast Cancer: Mammography, clinical breast exam, additional imaging as needed.

• Cervical Cancer: HPV testing, Pap smear, age/risk-based intervals.

• Colorectal Cancer: Colonoscopy, FIT, stool DNA, CT colonography.

• Prostate Cancer: PSA testing, digital rectal exam, shared decision-making.

• Lung Cancer: Low-dose CT for high-risk individuals.

Diagnostic Procedures

• Biopsy: Tissue removal for microscopic examination; confirms diagnosis.

• Imaging: CT, MRI, PET, ultrasound, X-ray.

• Laboratory Testing: CBC, metabolic panel, tumor markers, liver/kidney function.

• Endoscopy: Colonoscopy, bronchoscopy, cystoscopy, upper GI endoscopy.

Tumor Markers

Tumor markers are substances produced by cancer cells or by the body in response to cancer.

• Not diagnostic alone; interpret with clinical findings and other tests.

• Often used to monitor treatment or recurrence.

Nursing Responsibilities for Diagnostic Testing

• Before: Explain procedure, verify consent, review allergies/medications, follow prep instructions, assess anxiety.

• After: Monitor for complications, assess pain/vitals, observe for bleeding/infection, provide instructions, explain result timelines.

Patient Education

• Follow screening guidelines

• Report unusual symptoms

• Understand screening vs. diagnosis

• Keep follow-up appointments

• Discuss risk factors with provider

Cancer Treatment Options

Goals of Cancer Treatment

• Curative: Eliminate cancer, prevent recurrence

• Control: Slow growth, reduce size, delay progression

• Palliative: Reduce symptoms, improve comfort and quality of life

Surgical Treatment

• Types: Diagnostic, curative, debulking, palliative, reconstructive

• Nursing: Assess risk, monitor vitals/pain/wound, observe for complications, encourage mobility, provide education

Chemotherapy

• Definition: Use of drugs to destroy or inhibit cancer cells

• Mechanism: Targets rapidly dividing cells (including some normal cells)

• Common Adverse Effects: Myelosuppression, nausea/vomiting, alopecia, mucositis, fatigue, GI changes, neuropathy, infertility

• Nursing: Monitor labs, assess for infection/bleeding, manage side effects, use precautions, recognize extravasation

• Safety Concerns: Neutropenia, thrombocytopenia, anemia, nausea/vomiting, tumor lysis syndrome

Radiation Therapy

• Types: External beam, internal (brachytherapy)

• Adverse Effects: Fatigue, skin irritation, local inflammation, mucositis, nausea

• Nursing: Assess/protect skin, avoid unapproved creams, encourage rest/nutrition, monitor site-specific effects

• Brachytherapy Safety: Follow radiation protocols, use time/distance/shielding, follow patient/visitor restrictions

Immunotherapy

• Definition: Stimulates the immune system to attack cancer

• Types: Checkpoint inhibitors, CAR T-cell therapy, monoclonal antibodies

• Adverse Effects: Immune-mediated inflammation (pneumonitis, colitis, hepatitis, endocrine dysfunction, skin reactions)

• Nursing: Monitor for new/worsening symptoms, report immune-related events, educate patients on when to seek help

Targeted Therapy

• Definition: Targets specific molecular changes in cancer cells

• Nursing: Monitor for specific adverse effects, assess labs, evaluate response, reinforce adherence

Hormone Therapy

• Definition: Blocks/reduces hormones that support certain cancers

• Examples: Estrogen therapy (breast), androgen deprivation (prostate)

• Adverse Effects: Hot flashes, sexual dysfunction, bone loss, mood changes, fatigue

Nursing Care During Cancer Treatment

• Assess nutrition, labs, pain, fatigue, infection

• Provide emotional support and education

• Encourage activity as appropriate

• Coordinate with oncology team

Cancer Disorders

Breast Cancer

• Risk Factors: Age, family history, genetic mutations, hormonal factors, prior cancer

• Manifestations: Lump, size/shape changes, skin dimpling, nipple changes, lymph node enlargement

• Diagnostics: Mammography, ultrasound, MRI, biopsy

• Treatment: Surgery, chemotherapy, radiation, hormone/targeted therapy

• Nursing: Assess site, monitor lymphedema, encourage exercises, support emotionally, educate on drain care

Lung Cancer

• Risk Factors: Tobacco, secondhand smoke, radon, occupational exposures

• Manifestations: Cough, hemoptysis, dyspnea, chest pain, weight loss, infections

• Diagnostics: Imaging, CT, bronchoscopy, biopsy

• Treatment: Surgery, chemotherapy, radiation, immunotherapy, targeted therapy

• Nursing: Assess respiratory status, monitor oxygen, manage pain, support cessation, encourage hygiene

Colorectal Cancer

• Risk Factors: Age, family history, polyps, IBD, obesity, smoking

• Manifestations: Bowel habit changes, blood in stool, discomfort, fatigue, weight loss, anemia

• Diagnostics: Colonoscopy, biopsy, imaging, labs

• Treatment: Surgery, chemotherapy, radiation (selected), targeted therapy

• Nursing: Monitor bowel function, assess nutrition, provide ostomy education, monitor for complications

Prostate Cancer

• Risk Factors: Age, family history, genetic mutations

• Manifestations: Often asymptomatic early, urinary changes, bone pain (advanced)

• Diagnostics: PSA, rectal exam, biopsy, imaging

• Treatment: Surveillance, surgery, radiation, hormone/systemic therapy

• Nursing: Monitor urinary function, assess sexual health, provide education, discuss coping

Leukemia

• Definition: Cancer of blood-forming tissues, abnormal WBC production

• Manifestations: Fatigue, fever, infections, bruising, bleeding, bone pain, anemia

• Diagnostics: CBC, blood smear, bone marrow biopsy

• Treatment: Chemotherapy, targeted/immunotherapy, stem cell transplant

• Nursing: Monitor infection/bleeding, assess fatigue, maintain precautions, provide oral care, monitor labs

Lymphoma

• Types: Hodgkin, Non-Hodgkin

• Manifestations: Painless lymph node enlargement, fever, night sweats, weight loss, fatigue

• Diagnostics: Biopsy, imaging, labs

• Treatment: Chemotherapy, radiation, immunotherapy, targeted therapy

Multiple Myeloma

• Definition: Malignancy of plasma cells in bone marrow

• Manifestations: Bone pain, fractures, anemia, hypercalcemia, renal dysfunction, infection risk

• Diagnostics: Protein studies, bone marrow biopsy, imaging, CBC, renal tests

• Nursing: Assess pain, monitor renal/calcium, fall precautions, encourage hydration, monitor infection

Pain Management in Clients Who Have Cancer

Understanding Cancer Pain

• Definition: Pain from tumor growth, tissue invasion, treatment, or complications

• Types:

  • Nociceptive: Tissue injury/inflammation (somatic: bone/muscle/skin; visceral: organs)

  • Neuropathic: Nerve injury/compression (burning, shooting, tingling)

  • Breakthrough: Sudden, temporary increase despite ongoing control

  • Treatment-Related: After surgery, radiation, chemotherapy

Pain Assessment

• Tools: Numeric scale (0–10), verbal descriptor, visual analog, FLACC, behavioral tools

• PQRST: Provocation, Quality, Region, Severity, Timing

• Additional: Location, duration, pattern, aggravating/relieving factors, effect on sleep/mobility, emotional impact

Pharmacologic Pain Management

• Nonopioids: Acetaminophen, NSAIDs

• Opioids: Morphine, hydromorphone, oxycodone, fentanyl

• Adjuvants: Gabapentin, pregabalin, antidepressants, corticosteroids

• Nursing: Assess pain, monitor respiratory/sedation/bowel, fall precautions, evaluate effectiveness, administer as prescribed

Opioid Safety

• Adverse Effects: Respiratory depression, sedation, constipation, nausea, urinary retention, hypotension

• Interventions: Monitor vitals, follow facility protocols, bowel regimen, educate on safety, monitor for toxicity

• Naloxone: Opioid antagonist for respiratory depression; monitor for recurrence, continue emergency care

Nonpharmacologic Pain Management

• Physical: Repositioning, heat/cold, massage, relaxation, gentle activity

• Psychological: Guided imagery, meditation, breathing, cognitive-behavioral, emotional support

• Complementary: Acupuncture, music therapy, therapeutic touch

Palliative Care and Hospice

• Palliative Care: Symptom relief, quality of life, any stage, may be concurrent with curative treatment

• Hospice Care: Comfort for end-of-life, supports patients/families, prioritizes symptom management

• Nursing: Assess symptoms, respect goals, support family, provide culturally sensitive care, advocate for comfort

Key Nursing Priorities and Clinical Judgment

• Recognize risk factors and promote prevention

• Encourage screening and early detection

• Understand diagnostic procedures

• Monitor for treatment complications (infection, bleeding, toxicity)

• Provide safe medication administration

• Assess and manage pain

• Support nutrition and hydration

• Provide emotional support

• Promote quality of life and patient-centered care

Clinical Situations and Priority Actions

NCLEX/ATI Key Takeaways

• Biopsy is needed to confirm cancer diagnosis

• Tumor markers alone are not diagnostic

• Neutropenia increases infection risk

• Thrombocytopenia increases bleeding risk

• Cancer pain requires regular, individualized assessment and management

• Promptly assess new/worsening symptoms during treatment

• Palliative care is appropriate throughout serious illness

• Nursing care should prioritize safety, symptom management, education, and quality of life