Cancer is a general term used to describe a disturbance of cellular growth and refers to a group of diseases and not a single disease entity. There are currently more than 150 different known types of cancer. Because cancer is a cellular disease, it can arise from any body tissue, with manifestations that result from failure to control the proliferation and maturation of cells.
There are four main classifications of cancer according to tissue type: (1) lymphomas (cancers originating ininfection-fighting organs), (2) leukemias (cancers originating in blood-forming organs), (3) sarcomas (cancers originating in bones, muscle, or connective tissue), and (4) carcinomas (cancers originating in epithelial cells). Within these broad categories, a cancer is classified by histology, stage, and grade.
Through years of observation and documentation, it has been noted that the metastatic behavior of cancers varies according to the primary site of diagnosis. This behavior pattern is known as the “natural history.” An example is the metastatic pattern for primary breast cancer. Breast cancer most commonly spreads to the bone-lung-liver-brain.
Knowledge of the etiology and natural history of a cancer type is important in planning the patient’s care and in evaluating the patient’s progress, prognosis, and physical complaints.
CARE SETTING
Cancer centers may focus on staging and major treatment modalities for complex cancers. Treatment for managing adverse effects such as malnutrition and infection may take place in short-stay, ambulatory, or community settings.
More cancer patients are receiving care at home because of personal choice and healthcare costs.
RELATED CONCERNS
End of life/hospice care
Fecal diversions: postoperative care of ileostomy and colostomy
Hysterectomy
Leukemias
Lung cancer: postoperative care
Lymphomas
Mastectomy
Prostatectomy
Psychosocial aspects of care
Radical neck surgery: laryngectomy (postoperative care)
Sepsis/septicemia
Total nutritional support: parenteral/enteral feeding
Urinary diversions/urostomy (postoperative care)
Patient Assessment Database
Depends on organs/tissues involved and stage of disease.
Refer to appropriate plans of care for additional assessment information.
ACTIVITY/REST
May report: Weakness and/or fatigue
Changes in rest pattern and usual hours of sleep per night; presence of factors affecting sleep, e.g., pain, anxiety, night sweats
Limitations of participation in hobbies, exercise, usual activities
CIRCULATION
May report: Palpitations, chest pain on exertion
May exhibit: Changes in BP, fluctuations in heart rate
EGO INTEGRITY
May report: Stress factors (financial, job, role changes) and ways of handling stress (e.g., smoking, drinking, delay in seeking treatment, religious/spiritual belief)
Concern about changes in appearance, e.g., alopecia, disfiguring lesions, surgery, profound weight loss, edema and/or weight gain
Denial of diagnosis, feelings of powerlessness, hopelessness, helplessness, worthlessness, guilt, loss of control, depression
May exhibit: Denial, withdrawal, anger
ELIMINATION
May report: Changes in bowel pattern, e.g., blood in stools, pain with defecation, constipation
Changes in urinary elimination, e.g., pain or burning on urination, hematuria, frequent urination
May exhibit: Changes in bowel sounds, abdominal distension, diarrhea, dysuria, frequency, incontinence
FOOD/FLUID
May report: Poor dietary habits (e.g., low-fiber, high-fat, additives, preservatives)
Anorexia, nausea/vomiting; difficulty swallowing, mouth sores
Food intolerances
May exhibit: Changes in weight; severe weight loss, cachexia, wasting of muscle mass
Changes in skin moisture/turgor; edema
NEUROSENSORY
May report: Dizziness; syncope, lack of coordination, unstable balance
Numbness/tingling of extremities; sensation of coldness, difficulty performing fine motor skills (e.g., buttoning shirt)
PAIN/DISCOMFORT
May report: No pain, or varying degrees, e.g., mild discomfort to severe pain (associated with disease process)
RESPIRATION
May report: Smoking (tobacco, marijuana), living with someone who smokes
Asbestos or dust exposure (e.g., coal, sandstone)
History of chronic respiratory disease
Dyspnea with exertion
SAFETY
May report: Exposure to toxic chemicals, carcinogens (occupation/profession or environment)
Excessive/prolonged sun exposure
May exhibit: Skin rashes, ulcerations; dry, leatherlike skin
SEXUALITY
May report: Sexual concerns, e.g., impact on relationship, change in level of satisfaction, impotence
Nulligravida older than 30 years of age; multigravida; multiple sex partners, early sexual activity, genital herpes; exposure to HPV (human papillomavirus)
SOCIAL INTERACTION
May report: Inadequate/weak support system
Marital history (regarding in-home satisfaction, support, or help)
Concerns about role function/responsibility
TEACHING/LEARNING
May report: Family history of cancer, e.g., multiple family members/mother, grandmother, aunt, or sister with breast cancer
Primary site, date discovered/diagnosed
Metastatic disease: Additional sites involved (if none, natural history of primary will provide important information for looking for metastasis)
Treatment history: Previous treatment for cancer—place and treatments given
Discharge plan DRG projected mean length of stay: Depends on specific system affected and therapeutic needs
considerations: May require assistance with finances, medications/treatments, wound care/supplies, transportation, food shopping and preparation, self-care, homemaker/ maintenance tasks, provision for child care; changes in living facilities/hospice
Refer to section at end of plan for postdischarge considerations.
DIAGNOSTIC STUDIES
Test selection depends on history, clinical manifestations, and index of suspicion for a particular cancer.
Endoscopy: Used for direct visualization of body organs/cavities to detect abnormalities.
Scans (e.g., magnetic resonance imaging [MRI], CT, gallium) and ultrasound: May be done for diagnostic purposes, identification of metastasis, and evaluation of response to treatment.
Biopsy (fine-needle aspiration [FNA], needle core, incisional/excisional): Done to differentiate diagnosis and delineate treatment and may be taken from bone marrow, skin, organ, and so forth. Example: Bone marrow biopsy is done in myeloproliferative diseases for diagnosis, in solid tumors for staging.
Tumor markers (substances produced and secreted by tumor cells and found in serum, e.g., carcinoembryonic antigen [CEA], prostate-specific antigen [PSA], alpha-fetoprotein, human chorionic gonadotropin [HCG], prostatic acid phosphatase, calcitonin, pancreatic oncofetal antigen, CA 15–3, CA 19–9, CA 125, and so on): Helpful in diagnosing cancer but more useful as prognostic indicator and/or therapeutic monitor. For example, the serum CEA level is frequently elevated when colon cancer begins to enlarge or invade tissue.
Screening chemistry tests, e.g., electrolytes (sodium, potassium, calcium), renal tests (BUN/Cr), liver tests (bilirubin, AST, alkaline phosphatase, LDH), bone tests (calcium): Depend on individual condition, risk factors.
CBC with differential and platelets: May reveal anemia, decreased Hb/Hct, changes in RBCs and WBCs; reduced or increased platelets.
Chest x-ray: Screens for primary or metastatic disease of lungs.
NURSING PRIORITIES
1. Support adaptation and independence.
2. Promote comfort.
3. Maintain optimal physiological functioning.
4. Prevent complications.
5. Provide information about disease process/condition, prognosis, and treatment needs.
DISCHARGE GOALS
1. Patient is dealing with current situation realistically.
2. Pain alleviated/controlled.
3. Homeostasis achieved.
4. Complications prevented/minimized.
5. Disease process/condition, prognosis, and therapeutic choices and regimen understood.
6. Plan in place to meet needs after discharge.
There are four main classifications of cancer according to tissue type: (1) lymphomas (cancers originating ininfection-fighting organs), (2) leukemias (cancers originating in blood-forming organs), (3) sarcomas (cancers originating in bones, muscle, or connective tissue), and (4) carcinomas (cancers originating in epithelial cells). Within these broad categories, a cancer is classified by histology, stage, and grade.
Through years of observation and documentation, it has been noted that the metastatic behavior of cancers varies according to the primary site of diagnosis. This behavior pattern is known as the “natural history.” An example is the metastatic pattern for primary breast cancer. Breast cancer most commonly spreads to the bone-lung-liver-brain.
Knowledge of the etiology and natural history of a cancer type is important in planning the patient’s care and in evaluating the patient’s progress, prognosis, and physical complaints.
CARE SETTING
Cancer centers may focus on staging and major treatment modalities for complex cancers. Treatment for managing adverse effects such as malnutrition and infection may take place in short-stay, ambulatory, or community settings.
More cancer patients are receiving care at home because of personal choice and healthcare costs.
RELATED CONCERNS
End of life/hospice care
Fecal diversions: postoperative care of ileostomy and colostomy
Hysterectomy
Leukemias
Lung cancer: postoperative care
Lymphomas
Mastectomy
Prostatectomy
Psychosocial aspects of care
Radical neck surgery: laryngectomy (postoperative care)
Sepsis/septicemia
Total nutritional support: parenteral/enteral feeding
Urinary diversions/urostomy (postoperative care)
Patient Assessment Database
Depends on organs/tissues involved and stage of disease.
Refer to appropriate plans of care for additional assessment information.
ACTIVITY/REST
May report: Weakness and/or fatigue
Changes in rest pattern and usual hours of sleep per night; presence of factors affecting sleep, e.g., pain, anxiety, night sweats
Limitations of participation in hobbies, exercise, usual activities
CIRCULATION
May report: Palpitations, chest pain on exertion
May exhibit: Changes in BP, fluctuations in heart rate
EGO INTEGRITY
May report: Stress factors (financial, job, role changes) and ways of handling stress (e.g., smoking, drinking, delay in seeking treatment, religious/spiritual belief)
Concern about changes in appearance, e.g., alopecia, disfiguring lesions, surgery, profound weight loss, edema and/or weight gain
Denial of diagnosis, feelings of powerlessness, hopelessness, helplessness, worthlessness, guilt, loss of control, depression
May exhibit: Denial, withdrawal, anger
ELIMINATION
May report: Changes in bowel pattern, e.g., blood in stools, pain with defecation, constipation
Changes in urinary elimination, e.g., pain or burning on urination, hematuria, frequent urination
May exhibit: Changes in bowel sounds, abdominal distension, diarrhea, dysuria, frequency, incontinence
FOOD/FLUID
May report: Poor dietary habits (e.g., low-fiber, high-fat, additives, preservatives)
Anorexia, nausea/vomiting; difficulty swallowing, mouth sores
Food intolerances
May exhibit: Changes in weight; severe weight loss, cachexia, wasting of muscle mass
Changes in skin moisture/turgor; edema
NEUROSENSORY
May report: Dizziness; syncope, lack of coordination, unstable balance
Numbness/tingling of extremities; sensation of coldness, difficulty performing fine motor skills (e.g., buttoning shirt)
PAIN/DISCOMFORT
May report: No pain, or varying degrees, e.g., mild discomfort to severe pain (associated with disease process)
RESPIRATION
May report: Smoking (tobacco, marijuana), living with someone who smokes
Asbestos or dust exposure (e.g., coal, sandstone)
History of chronic respiratory disease
Dyspnea with exertion
SAFETY
May report: Exposure to toxic chemicals, carcinogens (occupation/profession or environment)
Excessive/prolonged sun exposure
May exhibit: Skin rashes, ulcerations; dry, leatherlike skin
SEXUALITY
May report: Sexual concerns, e.g., impact on relationship, change in level of satisfaction, impotence
Nulligravida older than 30 years of age; multigravida; multiple sex partners, early sexual activity, genital herpes; exposure to HPV (human papillomavirus)
SOCIAL INTERACTION
May report: Inadequate/weak support system
Marital history (regarding in-home satisfaction, support, or help)
Concerns about role function/responsibility
TEACHING/LEARNING
May report: Family history of cancer, e.g., multiple family members/mother, grandmother, aunt, or sister with breast cancer
Primary site, date discovered/diagnosed
Metastatic disease: Additional sites involved (if none, natural history of primary will provide important information for looking for metastasis)
Treatment history: Previous treatment for cancer—place and treatments given
Discharge plan DRG projected mean length of stay: Depends on specific system affected and therapeutic needs
considerations: May require assistance with finances, medications/treatments, wound care/supplies, transportation, food shopping and preparation, self-care, homemaker/ maintenance tasks, provision for child care; changes in living facilities/hospice
Refer to section at end of plan for postdischarge considerations.
DIAGNOSTIC STUDIES
Test selection depends on history, clinical manifestations, and index of suspicion for a particular cancer.
Endoscopy: Used for direct visualization of body organs/cavities to detect abnormalities.
Scans (e.g., magnetic resonance imaging [MRI], CT, gallium) and ultrasound: May be done for diagnostic purposes, identification of metastasis, and evaluation of response to treatment.
Biopsy (fine-needle aspiration [FNA], needle core, incisional/excisional): Done to differentiate diagnosis and delineate treatment and may be taken from bone marrow, skin, organ, and so forth. Example: Bone marrow biopsy is done in myeloproliferative diseases for diagnosis, in solid tumors for staging.
Tumor markers (substances produced and secreted by tumor cells and found in serum, e.g., carcinoembryonic antigen [CEA], prostate-specific antigen [PSA], alpha-fetoprotein, human chorionic gonadotropin [HCG], prostatic acid phosphatase, calcitonin, pancreatic oncofetal antigen, CA 15–3, CA 19–9, CA 125, and so on): Helpful in diagnosing cancer but more useful as prognostic indicator and/or therapeutic monitor. For example, the serum CEA level is frequently elevated when colon cancer begins to enlarge or invade tissue.
Screening chemistry tests, e.g., electrolytes (sodium, potassium, calcium), renal tests (BUN/Cr), liver tests (bilirubin, AST, alkaline phosphatase, LDH), bone tests (calcium): Depend on individual condition, risk factors.
CBC with differential and platelets: May reveal anemia, decreased Hb/Hct, changes in RBCs and WBCs; reduced or increased platelets.
Chest x-ray: Screens for primary or metastatic disease of lungs.
NURSING PRIORITIES
1. Support adaptation and independence.
2. Promote comfort.
3. Maintain optimal physiological functioning.
4. Prevent complications.
5. Provide information about disease process/condition, prognosis, and treatment needs.
DISCHARGE GOALS
1. Patient is dealing with current situation realistically.
2. Pain alleviated/controlled.
3. Homeostasis achieved.
4. Complications prevented/minimized.
5. Disease process/condition, prognosis, and therapeutic choices and regimen understood.
6. Plan in place to meet needs after discharge.
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