Cancer Development, Prevention & Introductory Nursing Considerations

Course & Unit Orientation

  • Unit will sequentially cover:
    • Cancer development & prevention
    • Skin cancer
    • Lung cancer
    • Caring for patients with cancer
  • Content integrates knowledge from Microbiology, A&P, Pharmacology (e.g., Mr. Holboy’s drug lectures)
  • Medication chart + test blueprint to be posted on Canvas
  • Goal: “Think like a nurse.” Always ask:
    • Why do I need to know this?
    • How will it change my care for the patient?

Incidence & General Facts

  • ≈\approx 1 in 2 men and 1 in 3 women will develop invasive cancer in their lifetime
  • Millions live long, healthy lives after diagnosis; hospitalized patients represent the more complex subset
  • Two umbrella categories:
    • Blood cancers (e.g., leukemia, lymphoma) – not covered in depth in this section
    • Solid‐tumor cancers – focus of current lectures

Definition & Pathophysiology of Cancer

  • At its simplest: cells that have lost normal regulatory control
  • Key video take-aways:
    • Cells normally obey genetic/biochemical “command & control” systems
    • Loss of control ⇒\Rightarrow unchecked proliferation, formation of a mass (tumor)
    • Ability to spread = metastasis
    • Cancers differ between (and within) organs → personalized/precision medicine essential
    • Three “classic” treatments: Surgery • Radiation • Chemotherapy
    • Evolving options: genomic profiling, targeted therapy, hormone manipulation, immunotherapy, integrative oncology (nutrition, acupuncture, etc.)

3 Phases of Carcinogenesis

  1. Initiation
    • Irreversible mutation in cellular DNA
    • Triggered by carcinogens, radiation, viral insertion, etc.
  2. Promotion
    • Mutated cell exposed to promoting agents (e.g., cigarette smoke, chronic inflammation, estrogen from adipose tissue, UV light)
    • Reversible if promoting stimulus is removed & immune system eradicates rogue cells
  3. Progression
    • Continued genetic instability, angiogenesis, local invasion, distant spread
    • Clinical disease becomes evident

Normal vs. Cancer Cells

  • Normal cells
    • Well-differentiated – resemble “parent” cells (structure & function)
    • Exhibit apoptosis (programmed death)
    • Obey contact inhibition (stop dividing when crowded)
    • Stable chromosome number: 2323 pairs
  • Cancer cells
    • Poorly/undifferentiated (anaplasia); may revert to embryonic-like state
    • Immortal – evade apoptosis; continuous replication
    • Lack contact inhibition → pile up & invade
    • Aneuploidy: abnormal chromosome counts
    • Grow disordered, rapid, invasive

Benign Tumors

  • Non-cancerous; usually encapsulated & grow by expansion (not invasion)
  • Cells generally resemble tissue of origin
  • Do not metastasize via blood/lymph, except rare entities (e.g., endometriosis implants, leiomyomatosis)
  • Clinical issues: space occupation, organ compression, surgical risk (e.g., massive chest fibroid)

Diagnostic Modalities

  • Definitive test = Biopsy
    • Needle aspiration
    • Incisional (remove slice)
    • Excisional (remove entire mass)
  • Imaging
    • CT, MRI, PET, mammography, ultrasound
  • Endoscopy
    • Colonoscopy, bronchoscopy, EGD, cystoscopy, etc.
  • Laboratory
    • CBC & chem panels (e.g., leukocytosis in leukemia)
    • Tumor markers (CEA, PSA, CA-125, etc.)
    • Liver function tests, pulmonary function tests
  • Bone-marrow examination when hematologic involvement suspected

Staging & Classification

Traditional Stage 0-IV
  • Stage 0 – Carcinoma in situ (earliest form; pre-invasive)
  • Stage I – Localized, small tumor
  • Stage II – Larger tumor ± local lymph nodes
  • Stage III – Regional spread, significant nodal involvement
  • Stage IV – Distant metastasis
TNM System
  • T (Tumor) – size/extent (T0-T4)
  • N (Node) – lymph-node involvement (N0-N3)
  • M (Metastasis) – M0 (none) or M1 (present)
  • Example: T2 N1 M0 testicular cancer = moderate tumor, 1 regional node, no distant spread (early stage)

Risk Factors (Multifactorial)

  • Genetic predisposition (e.g., BRCA1/2BRCA1/2, APC genes)
  • Lifestyle / exposures
    • Tobacco (smoking, vaping, chewing)
    • Alcohol (dose dependent)
    • Recreational drugs (e.g., marijuana smoke)
    • Diet: high fat, processed meats; excess simple sugars via obesity/estrogen link
    • Physical inactivity & obesity
  • Environmental / occupational
    • UV radiation (sunburns, tanning beds)
    • Ionizing radiation (health-care, military, nuclear, airline crews)
    • Chemicals: asbestos, coal dust, Agent Orange, industrial solvents
  • Biologic factors
    • Chronic inflammation / infection (H. pylori, HPV, hepatitis B/C)
    • Immunosuppression (HIV, transplant meds)
  • Sociodemographic
    • Age (risk increases with longevity)
    • Poverty: housing conditions, poor diet, limited screening access, chronic stress

Levels of Prevention

  • Primary (Health Promotion / Risk Reduction)
    • Vaccinations (HPV, HBV)
    • Smoking cessation, diet counseling, exercise programs, sunscreen use
    • Public policy: clean air, workplace safety
  • Secondary (Screening / Early Detection)
    • Mammography, Pap smear, colonoscopy, low-dose CT for high-risk smokers
    • Self-exams (breast, testicular, skin)
    • Genetic testing/counseling for high-risk families
  • Tertiary (Treatment & Complication Prevention)
    • Surgery, chemotherapy, radiation, targeted or hormonal therapy
    • Rehabilitation, lymphedema management, psychosocial support

Common Warning Signs – “CAUTION” Mnemonic

C – Change in bowel or bladder habits
A – A sore that does not heal
U – Unusual bleeding or discharge
T – Thickening or lump in breast, testis, elsewhere
I – Indigestion or dysphagia
O – Obvious change in wart or mole
N – Nagging cough or hoarseness

Additional red flags:

  • Unexplained weight loss ≥10 lb
  • Fatigue, night sweats
  • Persistent pain or headaches (e.g., glioblastoma cases)
  • Hemoptysis, dark sputum
  • Post-menopausal vaginal bleeding, rectal bleeding

Holistic & Integrative Considerations

  • Treat whole patient – physical, psychosocial, spiritual
  • Manage side-effects proactively: nausea, mucositis, fatigue, immunosuppression
  • Supportive modalities: nutrition consults, acupuncture, chiropractic, stress-reduction, counseling
  • Keep body strong, immune system optimized to tolerate therapy

Nursing Implications & Critical-Thinking Reminders

  • Assess personal & family history → advocate for earlier screening when indicated
  • Educate on risk-factor modification and self-exams
  • Apply prevention levels to every patient interaction
  • Recognize that not all patients with cancer are terminal; balance realism with hope
  • Stay within scope: specialized chemo administration requires additional credentialing
  • Use staging/diagnostic info to anticipate complications and plan care
  • Always correlate new symptoms (e.g., bleeding, cough, neuro changes) with potential oncologic etiologies
  • Documentation: include TNM/stage, treatment plan, patient education given, psychosocial assessment