Page 16 Complete Your CE Test Online - Click Here Nursing consideration: Most cancers are asymptomatic until they are at an advanced stage. This is why the American Cancer Society, the U.S. Preventive Services Task Force, and other health organizations have specific recommendations about screening asymptomatic people for common types of cancer. Signs and symptoms can mean a lot of things, and there is a difference between the two. A sign is something that can be observed by others, such as skin lesions or abnormal breath sounds. A symptom is something that the person notices but it may not be easy to observe by others, such as tiredness or headache. This is by no means an exhaustive list, but it does cover some of the more common signs and symptoms related to cancer. ● ● Skin changes. ○ ○ New mole or a change in an existing mole. ○ ○ A lesion or sore that does not heal. ○ ○ Hyperpigmentation. ○ ○ Jaundice. ○ ○ Hirsutism (excessive or abnormal hair growth). ● ● Breast changes. ○ ○ Change in size or shape of the breast or nipple. ○ ○ Change in texture or color of breast skin. ● ● A thickening or lump (in lymph nodes or other soft tissues). ● ● Hoarseness or cough that does not go away. ● ● Changes in bowel habits. ● ● Difficult or painful urination. ● ● Problems with eating. ○ ○ Dyspepsia or other discomfort after eating. ○ ○ Dysphagia (trouble swallowing). ○ ○ Anorexia. ● ● Weight gain or loss with no known reason. ● ● Abdominal pain. ● ● Unexplained night sweats. ● ● Unusual bleeding or discharge. ○ ○ Blood in the urine. ○ ○ Vaginal bleeding (especially after menopause). ○ ○ Blood in the stool. ● ● Fatigue or weakness. It is important that patients know that most often these signs and symptoms are not caused by cancer. They may also be caused by benign tumors, infections, or other problems. But patients should know that if they persist for a couple of weeks, that it is a good idea to seek care so that abnormalities can be diagnosed and treated as early as possible. Women older than 21 years and men and women aged 50 or older should begin cancer screening tests. If your patient has a family history of cancer (especially in first-degree relatives), or some other risk factor, there may be special screening guidelines that apply to her. A first- degree relative is defined as a biological parent, child, or sibling of the patient. A history of cancer in a first-degree relative is typically more significant to the patient’s cancer risk than cancer in another family member (See “Cancer Screening Guidelines”). Tissue changes that are not malignant Some genetic mutations in cells will eventually cause cancer unless they are detected early. Some tissue changes are benign and may not require treatment at all unless they cause other problems. Following are some examples of tissue changes that are not cancer but, in some cases, are treated or at least monitored. Hyperplasia occurs when cells within a tissue divide faster than normal and extra cells are produced. These proliferative cells and the way they are organized within the tissues look normal under a microscope. Hyperplasia can be caused by a number of conditions, including chronic irritation. Dysplasia is a more serious condition than hyperplasia. In dysplasia, there is also a proliferation of extra cells. But in dysplasia, the cells look abnormal and there are changes in how they are organized in the tissue. In general, the more abnormal the cells and tissue look, the greater the chance that cancer will eventually develop. Some types of dysplasia may need to be monitored or treated. An example of dysplasia is an abnormal mole (such as a dysplastic nevus) that forms on the skin. A dysplastic nevus can develop into melanoma, although most do not. An even more serious condition is carcinoma in situ. Although it is sometimes called cancer, carcinoma in situ is not cancer because the abnormal cells have not grown or spread beyond the original tissue. Because some carcinomas in situ may become cancer, they are usually treated or removed. However, they are not generally reported to cancer registries as cancer. Benign tumors and brain tumors Unlike malignant tumors, benign tumors do not spread into, or invade, nearby tissues. Although they are sometimes quite large, they usually do not grow back when they are removed, whereas malignant tumors can. Brain tumors are a special exception. Unlike most benign tumors elsewhere in the body, benign brain tumors can become life-threatening simply by pressing on vessels and tissues in the brain nearby. Because it is encased in the skull, brain tissue has nowhere to expand in response to tumor growth. This pressure can result in tissue death, neurologic deficits, and fatalities if unchecked. Cancer Staging Treatment depends on diagnosis (primary site and type of cancer) and stage. For example, early stage solid tumors can often be treated by surgery alone; later stage ones may require chemotherapy or radiation. Staging Stage refers to the extent of the cancer, such as tumor size, invasion, and metastases. Cancer treatments and prognosis are based on the cancer type and stage, and clinical trials are often limited by stage. A cancer is always referred to by the stage at diagnosis even if it later progresses or metastasizes. Information about how a cancer has progressed over time is added to the original stage. How stage is determined To learn the stage of disease, procedures typically include imaging studies, lab tests, and biopsy. The biopsy may be taken with a needle, endoscope, or incision. A pathologist looks at the tissue sample and does further testing on it. Systems that describe stage There are many staging systems. The TNM staging system (following) is used for many types of cancer, whereas others are specific to a particular type of cancer. The stage information typically appears on the pathology report. Most staging systems include information about the following: ● ● Tumor location. ● ● Cell type. ● ● Tumor size. ● ● Lymph node involvement. ● ● Metastases to other organs. ● ● Tumor grade (how abnormal the cells look, which is a marker for aggressiveness). The TNM staging system ● ● Most hospitals and medical centers use the TNM system as their main method for cancer reporting. Different staging systems are often used for brain and spinal cord tumors and blood cancers. The T refers to the size and extent of the primary tumor. ● ● The N refers to the number of nearby lymph nodes that contain cancer. ● ● The M refers to whether the cancer has metastasized. When cancer is described by the TNM system, there will be numbers after each letter that give more details about the cancer. For example, T1N0MX or T3N1M0. The following explains what the letters and numbers mean. Primary tumor (T) ● ● TX: Main tumor cannot be measured. ● ● T0: Main tumor cannot be found. ● ● T1, T2, T3, T4: Refers to the size or extent of the main tumor. The higher the number after the T, the larger the tumor or the more it has invaded nearby tissues. Ts may be further divided to provide more detail, such as T3a and T3b based on specific criteria for that cancer.