Cancer is the second leading cause of death in United States, It is the term used for group of diseases that leads to abnormal cell growth and invasion to various body parts. The abnormal cells are tumor, or malignant cells infiltrating normal body part. Approaches to cancer care are central to assignment. The aim is to understand the cancer diagnosis and staging, complications associated with it and recommend strategies for psychological and the psychological side effects of the cancer care.
The diagnostic testing for cancer refers to the series of tests and procedures, to confirm the cancer disease, to determine type, location, stage to personalise the treatment plan. The initial diagnosis of cancer takes around five days. Te sequence of the diagnosis includes review of health history, physical examination, laboratory test (urine or blood sample), biopsy, genetic testing and set of imaging techniques. During the treatment diagnosis is important to evaluate the tumor, metastasis to modify the treatment accordingly and eliminate the risk of surgery. Diagnosis is also important after completion of treatment. Technologies like PET/CT 600 allows to detect recurrence and movement of small lesions to breast, lungs, prostrates, and colon (McPherson, & Pincus, 2017).
Physicians cannot alone rely on the lab tests to diagnosis cancer and requires use of various imaging techniques. There are various imaging procedures to detect the presence of the cancer. Computed tomography scan or the CT scan helps detect the organs affected with customers with contrast pictures. Nuclear scan is used to collect the images of the organs and bones that are affected with cancer when injected with small amount of radioactive material. The nuclear scanner detects and measures the radioactivity. Other imaging technique used is the MRI and PET scan. In MRI a strong magnet filed is used and inked with computer that captures the body parts and can be printed on film. In PET scan a tracer is injected followed by capturing a 3D picture of the organs and tissues
In most cases biopsy is required to diagnose cancer. In this process a sample of tissue is collected using needle, endoscope, or surgery and is investigated by the pathologist to detect cancer. In the excisonal biopsy the entire tumor is removed and in incisional biopsy only the part of the tumour is removed. Genomic testing refers to the detection of mutations in the DNA, RNA that drives the growth of the cancer (Jambor et al., 2012).
Cancer staging refers to describing the size of cancer and its progress. It helps determine the metastasis of the cancer like breast, bowel, and lung cancer to the surrounding tissues. Understanding the stages of the cancer is important for designing the systematic treatment such as chemotherapy, targeted cancer drugs and hormone therapy. For cancers only in the lymph nodes, adjuvant treatment is preferred. The stages of cancers are determined by scans and others laboratory tests. For different cancers there are different staging systems. The most commonly known are the numbered cancer stage system and the TNM system. In the number stage system, the stage 0 refers to the in-situ cancer where the metastasis has not yet started. In-situ neoplasm refers to the group of abnormal cells and changes created by them are known as dysplasia. The cancer cells are in their place of origin. In the stage 1 of cancer, there is a small amount of spread to the nearby tissues. In the stage 2 and 3, the cancer has spread to the lymph nodes and the nearby tissues. The stage 4 refers to the advanced or metastasis cancer where the cells spread throughout the body (Slaney et al., 2014). In the TNM system, the T stands for the tumour, N for lymph nodes and M for metastases. It describes the size of the initial cancer (ehere I means small and 4 means very large) followed by its spread to the lymph nodes (0 means no spread to lymph nodes and 3 means lot of lymph nodes affected) and spread to different body organs (scores between 0 and 1 where 1 means complete spread to all the body parts). For instance, an advanced cancer, may be staged as T4N3M1 (Mirsadraee et al., 2012).
The side effects of the cancer treatment such as chemotherapy, radiotherapy are- anaemia, appetite loss, bleeding, bruising, constipation, delirium, fatigue, nausea and vomiting, poor sexual health, sleep pattern changes, urinary bladder problems, nerve problems, memory concentration, infections and hair loss (Iwamoto, 2013). The complications of cancer metastasis and treatment are cumulative effect of the psychological distress in patients. Three of the complications are discussed in this section.
Gastrointestinal complications are most common with the cancer treatment and metastasis procedure. The complications may include constipation, faecal implications, bowel obstructions, diarrhea, and radiation enteritis. Treatment to constipation includes drinking excess fluid, regular exercise, and medicines such as laxatives. Faecal impaction is treated with enemas. Diarrheal can be treated with changes in diet, and use of probiotics. Acute radiation enteritis may be treated with medicines, opiods, steroids, pancreatic enzyme, and dietary changes. Chronic radiation enteritis may require surgery. Malignant bowel obstructions are treated with surgery, stent, medication infusion, and insertion of gastrostomy tube. Fluid replacement therapy, blood transfusion, and electrolyte correction, are treatment modes for acute bowel obstruction (Nam et al., 2015).
Effective cancer treatment leads to the cardiac dysfunction and heart failure. It is mainly attributed to the chemotherapeutic agents, which cause cellular ATP depletion and apoptosis. The agents may include anthracyclines, receptor tyrosine kinase inhibitors and Her2/neu inhibitors. There are efforts taken to safe implementation of anti-tumor drugs. MRI methods are intensively used to track the changes in the myocardial tissues (Bloom et al., 2016).
Neurologic complications of cancer occur with the cancer cells exhibiting the propensity towards spreading the brain metastases and spread to CNS. These complications occur with the direct infiltration of the cancer cells into the nerve roots and it leaves devastating impact on the nervous system. The most known effects of the cancer on the nervous system are the neurologic paraneoplastic syndromes and hemorrhagic stroke. Cerebrovascular complications occur when cancer results in hypercoaguable state. Neurological complications also occur with cancer treatment. It may be radiation induced injury to the brain or chemotherapy-induced peripheral neuropathy. Symptomatic therapy for seizures and vasogenic edema (treated with corticosteroids) is the treatment for brain metastasis. Palliative care is given for Leptomeningeal Metastases (radiation therapy). Treatment of spine metastasis includes high dose steroid therapy, with dexamethasone to decrease edema. It controls pain and stabilization causes improvement in neurologic function. For metastasis to peripheral nervous system treatment includes steroids and analgesics (Nolan & DeAngelis, 2015).
The psychological effects of cancer and treatment process is associated with range of emotions including shock, disbelief, vulnerability, feeling of helplessness, guilt, insomnia, anxiety and depression. An integral part of the cancer treatment is the psychological care as the impact of the psychological side effects is as significant as the physical impact. The psychological side affect are pain, fatigue, which further undermines the patent’s mental state. The outcomes may be suicide ideation (Stanton et al., 2015). The recommendations for psychological side effects are-
References
Archer, S., Buxton, S., & Sheffield, D. (2015). The effect of creative psychological interventions on psychological outcomes for adult cancer patients: a systematic review of randomised controlled trials. Psycho?Oncology, 24(1), 1-10.
Bloom, M. W., Hamo, C. E., Cardinale, D., Ky, B., Nohria, A., Baer, L., … & Butler, J. (2016). Cancer Therapy–Related Cardiac Dysfunction and Heart Failure: Part 1: Definitions, Pathophysiology, Risk Factors, and Imaging. Circulation: Heart Failure, 9(1), e002661.
Iwamoto, T. (2013). Clinical application of drug delivery systems in cancer chemotherapy: review of the efficacy and side effects of approved drugs. Biological and Pharmaceutical Bulletin, 36(5), 715-718.
Jambor, I., Borra, R., Kemppainen, J., Lepomäki, V., Parkkola, R., Dean, K., … & Minn, H. (2012). Improved detection of localized prostate cancer using co-registered MRI and 11C-acetate PET/CT. European journal of radiology, 81(11), 2966-2972.
McPherson, R. A., & Pincus, M. R. (2017). Henry’s Clinical Diagnosis and Management by Laboratory Methods E-Book. Elsevier Health Sciences.
Mirsadraee, S., Oswal, D., Alizadeh, Y., Caulo, A., & van Beek, E. J. (2012). The 7th lung cancer TNM classification and staging system: Review of the changes and implications. World journal of radiology, 4(4), 128.
Nam, R. K., Cheung, P., Herschorn, S., Saskin, R., Su, J., Klotz, L. H., … & Narod, S. A. (2014). Incidence of complications other than urinary incontinence or erectile dysfunction after radical prostatectomy or radiotherapy for prostate cancer: a population-based cohort study. The lancet oncology, 15(2), 223-231.
Nolan, C. P., & DeAngelis, L. M. (2015). Neurologic complications of chemotherapy and radiation therapy. CONTINUUM: Lifelong Learning in Neurology, 21(2, Neuro-oncology), 429-451.
Slaney, J., Lane, M., Razo, C. A., & Kozik, G. (2014). Tumor Modelling.
Stanton, A. L., Rowland, J. H., & Ganz, P. A. (2015). Life after diagnosis and treatment of cancer in adulthood: Contributions from psychosocial oncology research. American Psychologist, 70(2), 159.
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