EFFECTS OF CANCER

 Disruption of Function- can be due to obstruction or pressure

 Hematologic Alterations: can impair function of blood cells
 Hemorrhage: tumor erosion, bleeding, severe anemia
 Anorexia-Cachexia Syndrome: wasted appearance of client
Paraneoplastic Syndromes: ectopic sites with excess hormone production
 ↑ Parathyroid hormone→ hypercalcemia
 ↑ secretion of insulin→ hypoglycemia
 ↑ Antidiuretic hormone (ADH) → fluid retention, HTN & peripheral edema
↑ Adrenocorticotropic hormone (ACTH): cause excessive secretion of cortisone (ie: fluid
retention, ↑ glucose levels)
 Pain: major concern of clients and families associated with cancer
 Physical Stress: body tries to respond and destroy neoplasm
 Psychological Stress
ASSESSMENT
 Nursing History
 Health History – chief complaint and history of present illness (onset, course,
duration, location, precipitating and alleviating factors)
 Cancer signs: CAUTION US!
Warning Signs of Cancer
 CAUTION US!
 Change in bowel or bladder habits
 A sore that does not heal
 Unusual bleeding or discharge
 Thickenings or lumps
 Indigestion or difficulty in swallowing
 Obvious change in a wart or mole
 Nagging or persistent cough or hoarseness
 Unexplained anemia
 Sudden unexplained weight loss
C – change in bowel, bladder habits
 Changes in color; consistency
 Size or shape of stools
 Blood present in urine or stool
 Alternating constipation and diarrhea – most characteristic manifestation of colon cancer
Discussions:
 A person with colon cancer may have diarrhea or constipation, or he may notice that the
stool has become smaller in diameter
 A person with bladder or kidney cancer may have urinary frequency and urgency
A – a sore that does not heal
Sores that:
 Don’t seem to be getting better over time
 Are getting bigger
 Getting more painful
 Are starting to bleed
Discussions:
 Because tumor causes impaired circulation and oxygenation in the area.
 Small, scaly patches on the skin that bleed or do not heal may be a sign of skin cancer
 A sore in the mouth that does not heal can indicate oral cancer
U – unusual bleeding or discharge
 Blood in the urine and stool
 Discharge from any parts of the body*
Discussions:
 Blood in the stool is often the first sign of colon cancer
 Similarly, blood in the urine is usually the first sign of bladder or kidney cancer
 Postmenopausal bleeding (bleeding after menopause) may be a sign of uterine cancer
T – thickening or lump in the breast or elsewhere
 Any lumps found in the breast when doing BSE
 Any lump in the scrotum when doing self-exam
  Other lumps found in the body
Discussions:
 Enlargement of the lymph nodes or glands (such as the thyroid gland) can be an early
sign of cancer
 Breast and testicular cancers may also present as a lump
I – indigestion or difficulty in swallowing
 Feeling pressure in throat or chest which makes swallowing uncomfortable
 Feeling full without food or with a small amount of food
Discussions:
 Cancers of the digestive system, including those of the esophagus, stomach, and
pancreas, may cause indigestion, heartburn, or difficulty swallowing
O – obvious change in wart or mole
Use the ABCD Rule:
A – asymmetry
B – Border
C – Color
D - Diameter
Discussions:
 A- are mole looks the same or different
 B- sharp or ragged
 C-colors seen in the mole
 D-is mole bigger than a pencil eraser
 Moles or other skin lesions that change in shape, size, or color should be reported
N – nagging cough or hoarseness
 Change in voice or hoarseness
 Cough that does not go away
 Sputum with blood
Discussions:
Cancers of the respiratory tract, including lung cancer and laryngeal cancer, may cause a cough
that does not go away or a hoarse (rough) voice
U – Unexplained anemia
 Kidney makes a hormone ERYTHROPOITEIN
 Which signals the bone marrow to produce RBC
 Cancer disrupt this process by slowing erythropoietin production
 With cancer, RBC wears out faster than normal and are not replaced as quickly as they
are needed
 Cancer cause bleeding which results in blood loss
Discussions:
In EACH CASE, fewer RBC means there is less hgb to carry O2 throughout the body
S – Sudden weight loss
 Tumor use your blood and nutrients and release your waste product inside your body
 Sometimes tumor release chemicals that can increase the body’s metabolism which can
lead to unexplained weight loss
Physical Assessment
 Inspection – skin and mucus membranes for lesions, bleeding, petechiae, and irritation
 Assess stools, urine, sputum, vomitus for acute or occult bleeding
 Scalp noting hair texture and hair loss
 Palpation
 Abdomen for any masses, bulges or abnormalities
 Lymph nodes for enlargement
 Auscultation – of lung sounds, heart sounds and bowel sounds
Laboratory & Diagnostic Tests
 Cancer detection examination
 Laboratory tests
 Complete blood cell count (CBC)
 Tumor markers – identify substance (specific proteins) in the blood that are made
by the tumor
 PSA (Prostatic-specific antigen): prostate cancer
  CEA (Carcinoembryonic antigen): colon cancer
 Alkaline Phosphatase: bone metastasis
 Biopsy
Diagnostic Tests
 Determine location of cancer:
 X-rays
 Computed tomography
 Ultrasounds
 Magnetic resonance imaging
 Nuclear imaging
 Angiography
Diagnosis of cell type:
 Tissue samples: from biopsies, shedded cells (e.g. Papanicolaou (PAP) smear), &
washings
 Cytologic Examination: tissue examined under microscope
Direct Visualization:
 Sigmoidoscopy
 Cystoscopy
 Endoscopy
 Bronchoscopy
 Exploratory surgery; lymph node biopsies to determine metastases
Cancer Detection and Diagnosis
Discussions:
 Detecting cancer early can affect the outcome of the disease for some cancers. When
cancer is found, a doctor will determine what type it is and how fast it is growing.
 He or she will also determine whether cancer cells have invaded nearby healthy tissue or
spread (metastasized) to other parts of the body.
 In some cases, finding cancer early may decrease a person’s risk of dying from the
cancer. For this reason, improving our methods for early detection is currently a high
priority for cancer researchers.
Early Cancer May Not Have Any Symptoms
Discussions:
 Some people visit the doctor only when they feel pain or when they notice changes like a
lump in the breast or unusual bleeding or discharge. But don’t wait until then to be
checked because early cancer may not have any symptoms.
 That is why screening for some cancers is important, particularly as you get older.
Screening methods are designed to check for cancer in people with no symptoms.
Cervical Cancer Screening
Discussions:
 A screening technique called the Pap test (or
Pap smear) allows early detection of cancer of
the cervix, the narrow portion of the uterus that
extends down into the upper part of the vagina.
 In this procedure, a doctor uses a small brush or
wooden scraper to remove a sample of cells
from the cervix and upper vagina. The cells are
placed on a slide and sent to a laboratory,
where a microscope is used to check for
abnormalities.
 Since the 1930s, early detection using the Pap
test has helped lower the death rate from
cervical cancer more than 75 percent.

Discussions:
 A screening technique called the Pap test (or Pap smear) allows early detection of cancer
of the cervix, the narrow portion of the uterus that extends down into the upper part of the
vagina.
 In this procedure, a doctor uses a small brush or wooden scraper to remove a sample of
cells from the cervix and upper vagina. The cells are placed on a slide and sent to a
laboratory, where a microscope is used to check for abnormalities.
 Since the 1930s, early detection using the Pap test has helped lower the death rate from
cervical cancer more than 75 percent.
  Should abnormalities be found, an additional test may be necessary. There are now 13
high-risk types of human papillomaviruses (HPV) recognized as the major causes of
cervical cancer.
 The U.S. Food and Drug Administration has approved an HPV test that can identify their
presence in a tissue sample. This test can detect the viruses even before there are any
conclusive visible changes to the cervical cells.
Breast Cancer Screening
Discussions:
 Breast cancer can sometimes be detected in its early stages using a mammogram, an X-
ray of the breast.
 Mammography is most beneficial for women as they age and undergo menopause.
Mammography is a screening tool that can detect the possible presence of an abnormal
tissue mass.
 By itself, it is not accurate enough to provide definitive proof of either the presence or the
absence of breast cancer. If a mammogram indicates the presence of an abnormality,
further tests must be done to determine whether breast cancer actually is present.
Prostate and Ovarian Cancer Screening
Discussions:
 The U.S. Food and Drug Administration has approved the PSA test along with a digital
rectal exam to help detect prostate cancer in men age 50 and older. Doctors often use the
PSA test and DRE as prostate cancer screening tests; together, these tests can help
doctors detect prostate cancer in men who have no symptoms of the disease.
 Most men with an elevated PSA test, though, turn out not to have cancer; only 25 to 30
percent of men who have a biopsy due to elevated PSA levels actually have prostate
cancer, so researchers are working hard to find new clues.
 Experts are trying to develop better blood tests that might alert people to malignancies
while the cancers are still in their early stages. For example, several new blood tests for
ovarian or prostate cancer are under development.
Colon Cancer Screening
Discussions:
 A procedure called a fecal occult blood test (FOBT) detects invisible amounts of blood in
the feces, a possible sign of several disorders, including colon cancer.
 The test is painless and can be done at home or in the doctor’s office along with a rectal
exam. With an application stick, a dab of a stool specimen is smeared on a chemically
 treated card, which is tested in a laboratory for evidence of blood. If blood is confirmed
in the stool, more elaborate tests may be performed to find the source of the bleeding.
 Some other options include sigmoidoscopy and colonoscopy. The former exam uses a
lighted instrument called a sigmoidoscope to find precancerous or cancerous growths in
the rectum and lower colon. The latter exam uses a lighted instrument called a
colonoscope to find precancerous or cancerous growths throughout the colon, including
the upper part.
Biopsy

Discussions:
 To diagnose the presence of cancer, a doctor must look at a sample of the affected tissue
under the microscope. Hence, when preliminary symptoms, Pap test, mammogram, PSA
test, FOBT, or colonoscopy indicate the possible existence of cancer, a doctor must then
perform a biopsy, which is the surgical removal of a small piece of tissue for
microscopic examination. (For leukemias, a small blood sample serves the same
purpose.)
 This microscopic examination will tell the doctor whether a tumor is actually present and,
if so, whether it is malignant (i.e., cancer) or benign.
 In addition, microarrays may be used to determine which genes are turned on or off in the
sample, or proteomic profiles may be collected for an analysis of protein activity. This
information will help doctors to make a more accurate diagnosis and may even help to
inform treatment planning.
Microscopic Appearance of Cancer Cells
Discussions:
Cancer tissue has a distinctive appearance under the microscope. Among the traits the doctor
looks for are a large number of irregularly shaped dividing cells, variation in nuclear size and
shape, variation in cell size and shape, loss of specialized cell features, loss of normal tissue
organization, and a poorly defined tumor boundary.