Chapter 11
Oncology: Nursing management in cancer care
235
resemble the tissue of origin in structure and function.
Tumours that do not clearly resemble the tissue of origin in
structure or function are described as poorly differentiated or
undifferentiated and are assigned grade IV. These tumours
tend to be more aggressive and less responsive to treatment
than well-differentiated tumours.
Management of cancer
Treatment options offered to cancer patients should be based
on realistic and achievable goals for each specific type of
cancer. The range of possible treatment goals may include
complete eradication of malignant disease (
cure
), prolonged
survival and containment of cancer cell growth (
control
), or
relief of symptoms associated with the disease (
palliation
).
The healthcare team, the patient and the patient’s family
must have a clear understanding of the treatment options
and goals. Open communication and support are vital as
the patient and family periodically reassess treatment plans
and goals when complications of therapy develop or disease
progresses.
Multiple modalities are commonly used in cancer treat-
ment. A variety of therapies, including surgery, radiation
therapy, chemotherapy and biological response modifier
(BRM) therapy, may be used at various times throughout
treatment. Understanding the principles of each and how they
options and prognosis are determined on the basis of staging
and grading.
Staging
determines the size of the tumour and the existence
of metastasis. Several systems exist for classifying the anatom-
ical extent of disease. The TNM system is frequently used.
In this system, T refers to the extent of the primary tumour,
N refers to lymph node involvement and M refers to the extent
of metastasis (Chart 11-3). A variety of other staging systems
are used to describe the extent of cancers, such as central
nervous system cancers, haematological cancers and malignant
melanoma, which the TNM system does not describe appro-
priately. Staging systems also provide a convenient shorthand
notation that condenses lengthy descriptions into manageable
terms for comparisons of treatments and prognoses.
Grading
refers to the classification of the tumour cells.
Grading systems seek to define the type of tissue from which
the tumour originated and the degree to which the tumour
cells retain the functional and histological characteristics of
the tissue of origin (differentiation). Samples of cells to be used
to establish the grade of a tumour may be obtained through
cytology (examination of cells from tissue scrapings, body
fluids, secretions or washings), biopsy or surgical excision.
This information assists the healthcare team to predict
the behaviour and prognosis of various tumours. The tumour
is assigned a numeric value ranging from I to IV. Grade I
tumours, also known as well-differentiated tumours, closely
Table 11-4 Diagnostic Aids Used to Detect Cancer
Test
Description
Examples of diagnostic uses
Tumour marker identification Analysis of substances found in body—tissues, blood
Breast, colon, lung, ovarian, testicular, prostate
or other body fluids that are made by the tumour or
cancers
by the body in response to the tumour
Genetic profiling
Analysis for the presence of mutations (alterations) in
Breast, lung, kidney, ovarian, brain cancers, leukaemia
genes found in tumours or body tissues. Assists in
and lymphoma (many uses of genetic profiling are
diagnosis, selection of treatment, prediction of
considered investigational)
response to therapy, and risk of progression or
recurrence
Mammography
Use of x-ray images of the breast
Breast cancer
Magnetic resonance imaging
Use of magnetic fields and radiofrequency signals to
Neurological, pelvic, abdominal, thoracic, breast
(MRI)
create sectioned images of various body structures
cancers
Computed tomography (CT)
Use of narrow-beam x-ray to scan successive layers of
Neurological, pelvic, skeletal, abdominal, thoracic
tissue for a cross-sectional view
cancers
Fluoroscopy
Use of x-rays that identify contrasts in body tissue
Skeletal, lung, gastrointestinal cancers
densities; may involve the use of contrast agents
Ultrasonography (ultrasound)
High-frequency sound waves echoing off body tissues
Abdominal and pelvic cancers
are converted electronically into images; used to
assess tissues deep within the body
Endoscopy
Direct visualisation of a body cavity or passageway by
Bronchial, gastrointestinal cancers
insertion of an endoscope into a body cavity or
opening; allows tissue biopsy, fluid aspiration and
excision of small tumours. Used for diagnostic and
therapeutic purposes
Nuclear medicine imaging
Uses intravenous injection or ingestion of radioisotope
Bone, liver, kidney, spleen, brain, thyroid cancers
substances followed by imaging of tissues that have
concentrated the radioisotopes
Positron emission
Through the use of a tracer, provides black and white
Lung, colon, liver, pancreatic, head and neck cancers;
tomography (PET)
or colour-coded images of the biological activity of a
Hodgkin’s and non-Hodgkin’s lymphoma and
particular area, rather than its structure. Used in
melanoma
detection of cancer or its response to treatment
PET fusion
Use of a PET scanner and a CT scanner in one
See PET
machine to provide an image combining anatomic
detail, spatial resolution and functional metabolic
abnormalities
Radioimmunoconjugates
Monoclonal antibodies are labelled with a radioisotope
Colorectal, breast, ovarian, head and neck cancers;
and injected intravenously into the patient; the
lymphoma and melanoma
antibodies that aggregate at the tumour site are
visualised with scanners
