Cancer

Aetiology, Pathophysiology, Clinical Manifestations, Classification, and Management of Cancer

🔹 Aetiology (Causes of Cancer)

Cancer arises due to:

Genetic mutations (inherited or acquired)
Carcinogens (e.g., tobacco smoke, UV radiation, asbestos)
Infectious agents (HPV, Hepatitis B/C)
Lifestyle factors: diet, alcohol, inactivity, obesity
Chronic inflammation or immune dysfunction

🔹 Pathophysiology

DNA mutations cause deregulated cell cycle control, allowing unchecked cell division
Cancer cells evade apoptosis, induce angiogenesis, and can metastasize

🔹 Clinical Manifestations

Unintended weight loss
Fatigue
Pain or abnormal lumps
Skin changes
Persistent cough or bleeding
Functional decline depending on site

🔹 Benign vs Malignant Tumours

Feature	Benign Tumours	Malignant Tumours
Growth Rate	Slow	Rapid
Encapsulation	Usually encapsulated	Poorly defined and infiltrative
Metastasis	Absent	Present
Recurrence	Rare	Common
Differentiation	Similar to normal tissue	Poorly differentiated
Systemic Effects	Minimal	Frequent (e.g., weight loss, fatigue)

🔹 Common Cancers and Mortality in Australia

Women: Breast, colorectal, melanoma, lung, uterine
Men: Prostate, melanoma, colorectal, lung, lymphoma
Deadliest cancers: Lung (both sexes), bowel, prostate (men), breast (women), pancreas

How is Cancer Diagnosed?

Due to the variability of cancer multiple steps are involved in the diagnosis process, including:

Patient history and physical examination
Initial tests such as blood tests, urine tests, medical imaging (Xrays, MRI,CT, PET scan)
Tissue/cell biopsy (depending on the location, may be obtained via a needle, surgical incision, or scope (e.g., colonoscope)
Microscope examination to determine specific type of cancer and any cell markers to guide treatment

🔹 How Cancer Develops

Mutations enable uncontrolled proliferation
Cancer cells avoid immune detection, resist apoptosis, and can spread (metastasize)

🔹 Risk Factors

Modifiable:

Smoking, alcohol, obesity, poor diet, infections (HPV, HBV), UV exposure

Non-modifiable:

Age, genetics, personal/family history

🔹 Cancer Staging Systems

TNM System:

T: Size/extent of tumour (T0–T4)
N: Lymph node involvement (N0–N3)
M: Distant metastasis (M0 or M1)

Numbered Staging System:

Stage 0: Cancer in situ
Stage 1: Localized
Stage 2: Larger/local spread
Stage 3: Regional lymph involvement
Stage 4: Distant metastasis

Cancer Treatment

Cancer (Ca) treatment will also vary in modality depending on the overall goal of treatment. These include:

Definitive - a single primary modality (e.g. surgery to remove a melanoma)
Concurrent - multiple treatments at the same time (e.g., a patient receiving both chemotherapy and radiation)
Adjuvant - treatment given after the primary treatment to reduce or destroy any remaining Ca cells (e.g. chemo following surgical removal of tumour)
Neo-adjuvant - treatment given before the primary treatment to help reduce the size of the tumour (e.g. chemo prior to surgery)
Maintenance/Lifelong - some treatments can be taken for a person's life in order to control the cancer (e.g. immune or targeted therapies)

🔹 Cancer Treatment Options in Australia

Treatment	Summary	Aim & Technique	Adjuncts	Common Side Effects
Surgery	Removal of tumor tissue	Cure or reduce tumor burden; open or laparoscopic techniques	May precede/follow chemo or radiotherapy	Pain, infection, bleeding, loss of function
Radiotherapy	High-energy rays destroy cancer cells	Targeted tumour control; external or internal (brachytherapy)	Often combined with chemo or post-surgery	Fatigue, skin burns, hair loss, nausea
Chemotherapy	Drugs to kill rapidly dividing cells	Cure, shrink, or control spread; IV/oral regimens in cycles	Commonly with radiotherapy or surgery	Nausea, hair loss, fatigue, low immunity
Hormone Therapy	Blocks hormones that fuel certain cancers	Treat hormone-sensitive cancers like breast/prostate	Often long-term oral or injectable meds	Hot flashes, mood changes, bone loss
Immunotherapy	Activates the immune system against cancer	Target checkpoint inhibitors or immune pathways	May be combined with chemo/targeted drugs	Inflammation, flu-like symptoms, fatigue
Targeted Therapy	Targets specific mutations/proteins	Block cancer growth signals; oral/IV delivery	Often in advanced or specific genetic cancers	Rash, diarrhea, liver toxicity
Palliative Care	Symptom and comfort management	Focus on quality of life, not cure	Used across all stages as needed	Depends on intervention; minimal harm-focused

Nursing care for cancer patient

🔹 Guiding Principles of the Australian Cancer Plan

The Plan is guided by eight overarching principles:

Person-centred – Designed with and for patients, families, and carers
Equity-focused – Prioritises fairness and eliminating outcome disparities
Future-focused – Anticipates emerging challenges and innovation
Strengths-based – Builds upon community and system strengths
Evidence- and data-driven – Relies on data to guide action and monitor progress
Collaborative – Promotes cross-sector partnerships
Culturally safe and responsive – Prioritises respectful care, especially for Aboriginal and Torres Strait Islander peoples
Sustainable and accountable – Ensures transparent, long-term change

🔹 Importance of Person-Centred Care in the Plan

Empowers patients to be active participants in their care decisions
Supports culturally safe, inclusive service delivery
Ensures care is holistic, addressing physical, emotional, social, and spiritual needs
Promotes navigation services to guide patients through complex cancer systems
Enhances communication, respect, and trust between care providers and consumers

🔹 Strategic Objective 2: Enhanced Consumer Experience

Ambition: Empower all people affected by cancer as partners in care through systems that are responsive, equitable, and culturally safe.

Goal: Within 2 years, co-design, test, and implement person-centred integrated navigation models nationwide.

Actions:

Develop and trial a national framework for multidisciplinary navigation
Partner with consumers and priority populations to shape care pathways
Evaluate the models for long-term implementation

Justification:

Addresses the fragmentation and inaccessibility of current cancer care systems
Promotes trust and health equity, especially for vulnerable populations
Enhances patient experience, treatment adherence, and health outcomes

🔹 Priority Populations: Disparities & Equity Strategies

Population Group	Current Health Disparities	Equity Strategies
Aboriginal and Torres Strait Islander People	Higher cancer incidence, lower survival, cultural barriers to care	Culturally safe care pathways, Indigenous-led plans and service design
CALD Communities	Language and literacy barriers, reduced access and understanding	Cultural competency training, improved interpreter use, tailored materials
Rural and Remote Residents	Higher mortality, lower survival, limited access to services	Optimal care pathways for rural areas, telehealth and regional investment
Lower Socioeconomic Groups	Higher exposure to risk factors, poorer survival	Reduce financial and access barriers, community outreach programs
People with Disability	Lack of tailored services, inaccessible facilities	Data improvement, inclusive and accessible service design
LGBTIQA+ Communities	Poorer mental/physical health, discrimination in care	Inclusive training for staff, tailored and co-designed care approaches