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Unit 3
Applying concepts from the nursing process
Diagnosis of cancer
A cancer diagnosis is based on assessment of physiological and
functional changes and results of the diagnostic evaluation.
Patients with suspected cancer undergo extensive testing
to: (1) determine the presence of tumour and its extent;
(2) identify possible spread (metastasis) of disease or invasion
of other body tissues; (3) evaluate the function of involved
and uninvolved body systems and organs; and (4) obtain
tissue and cells for analysis, including evaluation of tumour
stage and grade. The diagnostic evaluation is guided by infor-
mation obtained through a complete history and physical
examination. Knowledge of suspicious symptoms and of the
behaviour of particular types of cancer assists in determining
which diagnostic tests are most appropriate (Table 11-4).
A patient undergoing extensive testing is usually fearful of
the procedures and anxious about the possible test results. The
nurse can help relieve fear and anxiety by explaining the tests
to be performed, the sensations likely to be experienced and
the patient’s role in the test procedures. The nurse encourages
the patient and family to voice their fears about the test results,
supports the patient and family throughout the test period, and
reinforces and clarifies information conveyed by the doctor.
The nurse also encourages the patient and family members
to communicate and share their concerns and to discuss their
questions and concerns with each other.
Tumour staging and grading
A complete diagnostic evaluation includes identifying the
stage and grade of the tumour. This is accomplished before
treatment begins to provide baseline data for evaluating
outcomes of therapy and to maintain a systematic and consis-
tent approach to ongoing diagnosis and treatment. Treatment
Nurs ing Research Prof ile :
Evidence -based practice
Factors associated with
mammographic decisions of
Chinese-Australians
Summary
In Australia, a National Screening Program (BreastScreen)
has been in place since 1991 providing free mammograms
for all women over the age of 50 (NHMRC National Breast
Cancer Centre, 1998). Given that Australia is a multicultural
nation, breast screening promotional efforts have also been
targeted at women whose first language is not English.
Relevant printed material is available in 19 languages
including Chinese. Nevertheless, non-English-speaking
background (NESB) women have had markedly lower
screening rates (48.9%) than English-speaking women
(58.5%). The purpose of the study by Kwok, Cant and
Sullivan (2005) is to explore and investigate the factors
associated with mammographic decisions of Chinese-
Australian women.
Nursing implications
The results of this study indicate the need to consider the
beliefs and concerns of NESB women when promoting
developing and implementing screening programs. Further,
healthcare professionals need to have an understanding
of the cultural, educational, and socio-economic factors
that influence NESB women attending breast screening.
In addition, this study also yields several health education
and policy implications for designing and providing culturally
sensitive screening services by specifically addressing the
identified barriers.
For more information on this study, see Nursing research
profile 11-2 in the related ancillary file for this chapter.
CHART
11-2
Breast
Colon/rectum
Prostate
Cervix
Cancer-related checkups
F
M/F
M
F
M/F
20–39
$
40
50–59
$
50
$
50 (or
,
50 if at
high risk)
20–69
$
20–39
40
1
Clinical breast examination (CBE)
Breast self-examination (BSE)
Clinical breast examination (CBE)
Breast self-examination (BSE)
Mammogram
Faecal occult blood test
and
Flexible sigmoidoscopy
or
Colonoscopy
Prostate-specific antigen and digital
rectal examination (DRE)
Papanicolaou (Pap) test*
Pelvic examination
Checkup that includes examination for
cancers of the thyroid, testicles, ovaries,
lymph nodes, oral cavity and skin as well
as counselling about health practices and
risk factors
Every 3 years
Every month
Every year
Every month
Every year
Every 2 years
Every 5 years
Every 10 years
Not recommended;
patient discretion
Every 2 years
Every 2 years
Every 3 years
Every year
Table 11-3 RECOMMENDATIONS FOR EARLY DETECTION OF CANCER IN ASYMPTOMATIC,
AVERAGE-RISK PEOPLE
Site
Gender
Age
Evaluation
Frequency
*After three or more consecutive satisfactory normal examinations, the Pap test may be performed less frequently at the discretion of the doctor.
Adapted from the National Health and Medical Research Council (NHMRC). (2009).
Cancer: Clinical Practice Guidelines
. Available at:
cancer.htm.
