Care offered to cancer patients should be grounded on goals that are realistic and achievable for every particular kind of cancer. The goals of management and treatments vary depending on the type of cancer and its progress in the patient. Treatment goals could be to completely eradicate the carcinoma (curing), prolonging the cancer patient’s survival and controlling the rate of malignant cell growth (controlling). The final option could be relieving the symptoms that are associated with the carcinoma (palliative care). Before deciding on the best option the patient, the healthcare team and the patient’s family must have a clear comprehension of the treatment alternatives available and goals.
Given these facts, it is of prime importance a clear and open communication be maintained between the three parties. Several treatment modalities could be used in the management of cancer. Options like chemotherapy, surgery, biological response modifier therapy and radiation therapy can be utilized at different stages of through the treatment journey. During this time all parties should understand the rationales of treatment. Before we get to this juncture cancer has to correctly diagnosed and staged. This paper will, therefore, look at the diagnosis and staging of cancer, the complications, and the interventions to manage the side effects of treatment.
Diagnosis and Staging of Cancer
A comprehensive diagnostic assessment of the cancer patient involves being able to identify the grade and the stage of the tumor. It is vital to establish these findings early before treatments commence so as to provide a baseline. The healthcare team uses the baseline as a comparison of the effect of the different treatment modalities on the cancerous tumor. The diagnosis and staging can be done further throughout the treatment period. The decisions on the best treatment options are informed to a great extent by the findings from the diagnosis staging and grading. Staging helps determine the tumor size and the presence of any form of metastasis. Several systems are used in determining anatomic extent of the disease. The most commonly used technique is the TNM system (Hallinan & Venkatesh, 2013). Within this system T is used to refer to the magnitude of the tumor. N is used to demo involvement of the lymph node and M, on the other hand, is used to denote the level of metastasis of cancer.
Grading is a means of classifying the tumor cells. The classification system aims to determine the type of tissue the tumor originally came from plus the extent to which the cells of the tumor retain histological and functional features of the tissue from which they originated. Sample cells from the tumor that will be used for the grading process are obtained from cytology. This means the examining cells from body fluids, tissue scrapings, and secretions from the body. The cells could also be obtained through biopsies or surgical excisions (Hallinan & Venkatesh, 2013). The information gathered from these test aids the treatment team predicts the behavior and the likely outcome of different tumors.
Once staging and the grading processes are done, the tumors are given a value that could range from I to IV. Tumors classified as grade I am otherwise known as well-differentiated tumors. They share a close resemblance with the original tissue from where they came. The tumors that share little or no resemblance with their original tissues are classified as undifferentiated or poorly differentiated and are given the grade IV (Hallinan & Venkatesh, 2013). Such tumors have been found to be more aggressive and less responsive to the treatment modalities as compared to the well-differentiated ones.
Cancer has a broad range of complications. Despite the many advances made in the fight against cancer infection remains the leading cause of death among the cancer patients. The defense system in the body of body of a cancer patient is compromised in many ways. The skin and the mucous membranes are the first lines of defense; they are undermined by the very many invasive treatment and diagnostic procedures. The chemotherapy and the radiation therapy also deals a huge blow to the skin, moreover the adverse effects of the patient being immobile also count.
Secondly, the cancer patient’s nutrition is severely compromised. This is often the result of nausea, vomiting, anorexia, and diarrhea. To add to that, underlying cancer changes the body’s ability to act against organisms that invade the body. The many antibiotics administered to the patient alter the normal flora of the patient’s body allowing for the pathogens to thrive in the patient’s body. Cancer is itself an immunosuppressive condition. Cancers like lymphomas and leukemia have been known to cause a deficit in the humoral immunity of the patient. Cancer that is in advanced stages can cause blockage of the hollow body organs like the small intestines, some blood vessels, and lymphatic vessels. Blockage allows for a suitable environment for bacteria to grow. The patients can go into septic shock. Bleeding and hemorrhage could be another complication of treatment. The bleeding often comes as a result of thrombocytopenia.
There is a host of other complications that result from treatment. The cancer patient is therefore at risk of these side effects of treatment. In the section on the paper will look at the side effect of therapy and the nursing interventions that can be used to help lessen the side effects. Stomatitis which is an inflammatory response of the oral tissues that develops 5 to 14 days after the patient has taken oral chemotherapeutic agents. An example of chemotherapeutic agents that could lead to Stomatitis includes doxorubicin, 5-fluorouracil, and BRMs. Up to 40% of the patients receiving oral chemotherapeutic agents experience the symptoms of Stomatitis. The patients get mild to severe erythema in the mouth (“Oral complications of cancer treatment”, 2012); they also bleed and develop painful ulcers. Stomatitis also develops as a complication of radiation therapy in the neck.
To reduce the symptom, good oral hygiene can be used. Flossing, rinsing, and brushing teeth can reduce the oral complications of treatment. The nurse can use soft bristled toothbrushes to ensure they do not traumatize the mouth of the patient (“Oral complications of cancer treatment”, 2012). Non-abrasive toothpaste should be utilized as well.
There are cancer patients who develop skin complications from radiation therapy. These patients need the care of the skin to avert more skin irritation, damage, and drying. The skin that covers the affected area should be handled with gentleness; use of cold and hot water, rub therapy, powdering, soap, lotion application should be avoided. The patients should be encouraged to wear loose fitting clothes and avoid very tight. Hydrocolloids and hydrogels can be used to prevent the pain and promote healing (Otto, 2004).
Patients may also experience temporary or permanent thinning of their hair. The hair then falls off. This is known as alopecia. The symptom results after intensive chemotherapy and radiotherapy to the patient. The alopecia often begins 2 to three weeks after the starting of treatment. Regrowth may occur eight weeks after the last treatment sessions. There are cases of some patients receiving radiotherapy having permanent alopecia (Patlak, Balogh, & Nass, 2011). The nurse should provide adequate information about alopecia to the client and the family. The patient can be advised to buy hair wigs that resemble their hair color before they begin the cancer treatment.
Many cancer patients experience severe weight loss due to treatment. The nurse should, therefore, give special attention to the cancer patient to prevent loss of weight and promote nutrition. The nurse should ensure that food is made in a manner that makes it appealing. Unpleasant smells should be avoided. Small and frequent meals should be encouraged and the patient is given supplements between the meals. Medications such as corticosteroids and progestational agents are useful in increasing appetite.
The nurse should also use pain management techniques to manage pain experienced by patients receiving cancer treatment. Treatments like surgery cause acute pain. Enough sleep and rest, mood elevation, empathy and medications like antidepressants can help increase pain tolerance. Other pharmacologic and non-pharmacologic treatments have been used in managing the pain (Patlak, Balogh, & Nass, 2011). Fatigue as a complication of chemotherapy can be handled by promoting light exercises, encouraging the client to cope with the existing fatigue and nutrition counseling to allow for adequate consumption of calories.
The patients also develop issues with self-esteem and poor self-image due to the treatment. Such patients are encouraged to discuss their problems openly with their family partner or care provider. The nurse should serve as a listener and counselor.
In a nutshell, cancer is, without a doubt, a major disease burden today that contributes immensely to the mortality and morbidity rates. The condition has to be staged and managed before treatment. Staging could be done through the TNM system. There are alternatives to the method too (Patlak, Balogh, & Nass, 2011). Treatment comes in the form of surgery, radiation therapy, and chemotherapy. These methods have a broad range of side effects and complications whose severity can be lessened through appropriate nursing interventions.
Hallinan, J. & Venkatesh, S. (2013). Gastric carcinoma: imaging diagnosis, staging and assessment of treatment response. Cancer Imaging, 13(2), 212-227. http://dx.doi.org/10.1102/1470-7330.2013.0023
Oral complications of cancer treatment. (2012). Dental Abstracts, 57(4), 187-190. http://dx.doi.org/10.1016/j.denabs.2011.11.022
Otto, S. (2004). Oncology nursing clinical reference (1st ed.). St. Louis, Mo.: Mosby.
Patlak, M., Balogh, E., & Nass, S. (2011). Patient-centered cancer treatment planning (1st ed.). Washington, D.C.: National Academies Press.