Oncology - Study Unit 1.12

Distinction Between “Cancer” and “Tumour”

• Cancer

  • Umbrella term for >200 diseases characterised by:

  • Uncontrolled mitotic division of abnormal cells.

  • Potential to invade adjacent tissues and metastasise to distant sites.

  • Functional/structural cellular abnormality is the core feature.

• Tumour (Neoplasm)

  • Any abnormal mass of tissue (“new growth”).

  • May be benign (non-cancerous) or malignant (cancerous).

Early-Detection: Warning Signs

Adults – “CAUTION” Mnemonic

• C – Change in bowel or bladder habits.

• A – A sore that does not heal.

• U – Unusual bleeding or discharge from any orifice.

• T – Thickening or lump in breast or elsewhere.

• I – Indigestion or difficulty swallowing.

• O – Obvious change in a wart or mole.

• N – Nagging cough or persistent hoarseness.

Children – “SAINT-SILUAN EYE” Schema (CHOC Foundation)

• SEEK medical help early for persistent symptoms (public-health imperative).

• EYE

  • White reflex (leukocoria), new squint, new blindness, bulging eyeball.

• LUMP

  • Any unexplained mass—abdomen, pelvis, head/neck, limbs, testes, glands.

• UNEXPLAINED

  • Fever >2 weeks, weight loss, pallor, fatigue, easy bruising/bleeding.

• ACHING

  • Persistent bone/joint/back pain, frequent fractures.

• NEUROLOGICAL SIGNS

  • Change or deterioration in gait, balance, speech.

  • Regression of milestones, headache >1 week (± vomiting), enlarging head circumference.

Neoplasms: Benign vs Malignant (Key Differential Features)

Treatment Modalities

1 – Surgical Management (Local / Regional)

• Diagnostic: e.g.

  • Biopsy (incisional, excisional, needle) to confirm histology.

• Prophylactic:

  • Risk-reducing mastectomy or oophorectomy in BRCA-positive patients.

• Therapeutic:

  • Primary curative resection of solid tumours.

• Supportive (Adjunctive):

  • Port insertion, feeding gastrostomy, or colostomy to facilitate other therapies.

• Palliative:

  • Debulking to relieve obstruction, pain, or bleeding when cure impossible.

• Rehabilitative:

  • Reconstructive (e.g., breast reconstruction post-mastectomy).

• Combination:

  • Several categories blended (e.g., prophylactic + reconstructive).

2 – Radiation Therapy (RT)

• Goal: cure, control micrometastasis, or palliation of symptoms.

• Physics Basics

  • Ionising radiation damages DNA → inability to replicate → cell death (preferentially in rapidly dividing cells).

• External-Beam RT (Teletherapy)

  • Linear accelerator produces high-energy X-rays or \gamma-rays.

  • Can also deliver proton or heavy-ion beams (↑ dose conformity, ↓ exit dose).

• Internal RT (Brachytherapy)

  • Radioactive source placed in/near tumour.

  • Two source categories:

  • Sealed: seeds, needles, wafers (e.g., ^{131}\text{I} seeds in prostate; after-loading systems).

  • Unsealed: systemic radiopharmaceuticals (e.g., oral ^{131}\text{I} for thyroid ablation).

• Common Side-Effects (location-dependent)

  • General: fatigue, bone-marrow suppression.

  • Skin/mucosa: erythema → desquamation, oral ulcers.

  • GI tract: nausea, diarrhoea if abdomen/pelvis treated.

3 – Chemotherapy (Systemic)

• Rationale: Addresses occult micrometastases that surgery/RT miss.

• Regimen Phases

  • Induction: high-dose, multi-agent, aims for complete remission.

  • Consolidation: repeat induction regimen to prolong remission.

  • Intensification: escalated doses for curative intent.

  • Maintenance: low-dose, long-term to delay relapse.

• Contra-Indications

  • Active infection.

  • Recent surgery (impairs wound healing).

  • Significant renal/hepatic dysfunction.

  • Recent RT (cumulative marrow suppression).

  • Pregnancy (teratogenic; targets rapidly dividing fetal cells).

  • Pre-existing marrow failure.

• Major Toxicities

  • Myelosuppression (↓ RBC, WBC, platelets) → infection, anaemia, bleeding.

  • GI: nausea, vomiting, mucositis, diarrhoea.

  • Alopecia (hair-follicle destruction).

  • Organ-specific: cardiomyopathy (doxorubicin), pulmonary fibrosis (bleomycin).

  • Reproductive: infertility, teratogenicity, chromosomal damage.

  • Neurotoxicity: peripheral neuropathy (vincristine, taxanes).

  • Constitutional: profound fatigue.

Psychosocial & Ethical Dimensions

Kübler-Ross Five Stages of Grief (Applied to Cancer Diagnosis / Terminal Illness)

1. Denial – “The doctor is wrong.”

2. Anger – Directed at family, clinicians, deity.

3. Bargaining – Spiritual negotiation, e.g., promises to a higher power.

4. Depression – Reaction to perceived loss/impending death.

5. Acceptance – Acknowledgement; focus on quality of remaining life.

Patient Support Principles

• Symptom relief/management (pain, nausea, dyspnoea, fatigue).

• Holistic comfort: physical, psychological, spiritual.

• Continuous emotional support for patient & family.

Nursing Roles & Responsibilities

• Facilitate unrestricted visiting hours (unless infection-control limits, e.g., COVID-19).

• Encourage and educate family involvement in care.

• Provide comfort measures (positioning, hygiene, analgesia).

• Offer honest information—avoid false hope.

• Uphold respect, privacy, cultural/religious customs.

• Maintain open, compassionate communication.

Supporting the Family

• Bereavement counselling pre- and post-death.

• Encourage expression of emotions; validate grief.

• Promote rotation of caregivers to prevent exhaustion.

• Allow cultural/faith-based last rites when feasible (modified during pandemics).

• Demonstrate empathy, understanding, and respect at every stage.