Page 16 Complete Your CE Test Online - Click Here blood cells can result in anemia, thrombocytopenia, and leukopenia, which can cause fatigue, hypoxia, abnormal bleeding, and an increased risk of infection. There are four common types of leukemia, which are grouped based on how the speed of disease progression (acute or chronic) and on the type of hematopoietic cell the cancer starts in (i.e. lymphoblastic or myeloid) [202]. Lymphoma Lymphoma is cancer that begins in T lymphocytes or B lymphocytes (commonly called T cells and B cells). These white blood cells normally help fight infection and are part of the immune system. In lymphoma, abnormal lymphocytes build up in lymph nodes, lymph vessels, and other organs of the body. There are two main types of lymphoma [202]: ● ● Hodgkin’s lymphoma: People with this disease have abnormal lymphocytes that are called Reed-Sternberg cells. These lymphocytes usually originate from B cells. ● ● Non-Hodgkin lymphoma: This is a large group of cancers that start in lymphocytes. The cancers can grow quickly or slowly and can originate from B cells or T cells. Multiple myeloma Multiple myeloma begins in plasma cells, another type of immune cell. The abnormal plasma cells, called myeloma cells, crowd the bone marrow and form tumors in bones all through the body. Multiple myeloma is also called plasma cell myeloma and Kahler disease. Melanoma Melanoma is cancer that begins in cells that become melanocytes, which are specialized cells that make melanin (the pigment that gives skin its color). Most melanomas form on the skin, but melanomas can also form in other pigmented tissues, such as the eye [202]. They can also form under the nails and more rarely, on mucous membranes such as the mouth or genital and perianal areas [33]. Brain and spinal cord tumors There are different types of brain and spinal cord tumors. These tumors are named based on the type of cell in which they formed and where the tumor first formed in the central nervous system. For example, an astrocytic tumor begins in star-shaped brain cells called astrocytes, which help keep nerve cells healthy. Brain tumors can be benign or malignant, but any that continue to grow can be life-threatening [202]. Less common cellular-based cancer types ● ● Germ cell tumors: Germ cell tumors begin in the cells that normally give rise to sperm or eggs in the testes or ovaries. These tumors can occur almost anywhere in the body (because germ cells can develop in other parts of the body), although extragonadal germ cell tumors happen most often in the pineal gland, mediastinum, or retroperitoneum. They can be either benign teratomas or malignant (seminomas and nonseminomas) [162]. ● ● Neuroendocrine tumors: Neuroendocrine tumors arise from cells that release hormones into the blood in response to a signal from the nervous system. These tumors, which may make higher-than- 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