Page 34 Complete Your CE Test Online - Click Here normal amounts of hormones, can cause many different symptoms. Neuroendocrine tumors may be benign or malignant [202]. ● ● Carcinoid tumors: Carcinoid tumors are a type of neuroendocrine tumor. These slow-growing tumors are usually found in the gastrointestinal system (most often in the rectum and small intestine). Carcinoid tumors may spread to the liver or other sites in the body, and they may secrete substances such as serotonin or prostaglandins, causing carcinoid syndrome [202]. Carcinoid syndrome occurs in about 10% of people with these tumors, and depending on where it is and where it has spread can cause symptoms like: flushing of the face, usually without sweating; abdominal pain or cramping; diarrhea; wheezing or dyspnea; and tachycardia [95]. These symptoms, especially the flushing and diarrhea, may be triggered or exacerbated by stress, alcohol, or foods containing tyramine (such as aged cheeses or pickled meats) [95]. Carcinoids that affect the small intestine can also cause nausea, vomiting, jaundice, dyspepsia, and bloating [166]. Signs and symptoms of cancer 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. Certain cancers are visible almost from the beginning. Skin cancer and melanomas, for example, are often found by the patient. Like most cancers, early intervention increases the chance of survival and decreases the risk of complications of treatment. Typically, very early cancers do not cause pain or other noticeable symptoms. Patients often take pain more seriously than other symptoms, and should be encouraged to see their primary care providers if they have a kind of pain that is new to them, especially if it persists. Cancer can cause pain, along with many other different kinds of signs and symptoms. What the patient is likely to notice in the way of symptoms depends on what type of cancer it is, how advanced it is, and where it is located in the body (see the subsection “Does metastatic cancer have symptoms?” in the section “How does cancer spread?”). 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 [38,198]. ● ● Skin changes, such as: ○ ○ 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, such as: ○ ○ 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, such as: ○ ○ 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, including: ○ ○ 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 due to 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 [198]. 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 them. 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. Here are some examples of tissue changes that are not cancer, but in some cases, are treated or at least monitored [202]: ● ● 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 [202]. 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 [202].