Textbook of Medical-Surgical Nursing 3e

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Chapter 11

Oncology: Nursing management in cancer care

Table 11-4  Diagnostic Aids Used to Detect Cancer Test Description Tumour marker identification Analysis of substances found in body—tissues, blood

Examples of diagnostic uses

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   genes found in tumours or body tissues. Assists in   diagnosis, selection of treatment, prediction of   response to therapy, and risk of progression or   recurrence Use of magnetic fields and radiofrequency signals to   create sectioned images of various body structures Use of narrow-beam x-ray to scan successive layers of Use of x-rays that identify contrasts in body tissue   densities; may involve the use of contrast agents High-frequency sound waves echoing off body tissues   are converted electronically into images; used to   assess tissues deep within the body Direct visualisation of a body cavity or passageway by   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 Uses intravenous injection or ingestion of radioisotope   substances followed by imaging of tissues that have   concentrated the radioisotopes Through the use of a tracer, provides black and white   or colour-coded images of the biological activity of a   particular area, rather than its structure. Used in   detection of cancer or its response to treatment Use of a PET scanner and a CT scanner in one   machine to provide an image combining anatomic   detail, spatial resolution and functional metabolic   abnormalities Monoclonal antibodies are labelled with a radioisotope   and injected intravenously into the patient; the   antibodies that aggregate at the tumour site are   visualised with scanners Use of x-ray images of the breast   tissue for a cross-sectional view

Breast, lung, kidney, ovarian, brain cancers, leukaemia   and lymphoma (many uses of genetic profiling are

  considered investigational)

Mammography

Breast cancer

Magnetic resonance imaging

Neurological, pelvic, abdominal, thoracic, breast

  (MRI)

  cancers

Computed tomography (CT)

Neurological, pelvic, skeletal, abdominal, thoracic

  cancers

Fluoroscopy

Skeletal, lung, gastrointestinal cancers

Ultrasonography (ultrasound)

Abdominal and pelvic cancers

Endoscopy

Bronchial, gastrointestinal cancers

Nuclear medicine imaging

Bone, liver, kidney, spleen, brain, thyroid cancers

Positron emission    tomography (PET)

Lung, colon, liver, pancreatic, head and neck cancers;   Hodgkin’s and non-Hodgkin’s lymphoma and

  melanoma

PET fusion

See PET

Radioimmunoconjugates

Colorectal, breast, ovarian, head and neck cancers;

  lymphoma and melanoma

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

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