Cancer is described in Blackwell’s Dictionary of Nursing as ‘A general term for a variety of malignant growths in many parts of the body, often used synonymously with tumour, neoplasm or malignancy. The growth is purposeless, parasitic, invasive, and flourishes at the expense of the human host. Although the basic aetiology is not known, cancer is considered curable if discovered early and if all cancer cells are removed by surgery or destroyed by radiation. The characteristics are the tendency to cause local destruction, to spread by metastases, to recur and to cause toxaemia. Cancer is broadly classified as either carcinoma, which includes malignant tumours of the skin or mucous membranes, or as sarcoma, which includes tumours of connective tissue’.
Corner (1996) found that there has been increasing interest in the attitudes that the general public and health care professionals hold towards cancer, the effect these have on an individual's likelihood to present early with symptoms, and the quality of care patients with the disease receive from carers. The research appears to indicate that the attitudes of both groups are largely negative and stereotyped, and cancer is seen as being more devastating than other life threatening diseases. These attitudes have been associated with patterns of poor communication and care for cancer patients. Despite the known benefits of screening, early detection and advances in treatment modalities, negative attitudes to cancer persist among the public and health care professionals, and cancer remains the most feared disease in modern society. Attitudes to cancer may create a barrier to communication between patients and health care professionals, hinder early detection, treatment and rehabilitation, and may influence decision making about referral to specialist services and the selection of appropriate treatments.
Case study.
John was a 27 year old man, he was married and had a six month old daughter, whilst having a shower noticed a lump in his testicle, he ignored it for a while but when it did not ‘disappear’ he made an appointment to see his General Practitioner (GP). According to Kelley (1999), We are all ignorant, on different subjects. We all remain ignorant until we can accept the facts. John was quickly referred on to an oncologist, within a week he had been diagnosed with a stage 2 seminona of his right testicle.
Assessing how far the cancer has spread is called staging (Couchman,2009).
The stages are:
stage 1 - cancer is only in the testicle
stage 2 - cancer has spread to the lymph nodes in the abdomen
stage 3 - there are cancer cells in the lymph nodes in the chest or above the collarbone
stage 4 - cancer has spread to other organs, often the lungs
John underwent surgery for a right orchidectomy and had lymph nodes removed from his abdomen, he was kept in hospital for several days then discharged with an appointment for chemotherapy the following week. In 2007 1,990 men in the UK were diagnosed with testicular cancer, it accounts for 1-2% of all cancers in men and more than 90% of testicular cancers are cured by their initial treatment. Testicular cancer has the highest cure rate amongst cancers even if it has metastasised (CRUK, 2010).
John arrived in the day case unit where I work for his chemotherapy, 6 weeks after his initial appointment with his GP and described his experience to date ‘as a whirlwind’ he felt as though he had been watching himself in a kind of ‘out off body experience’ going to all of the appointments and surgery and although he had consented to all the procedures had not understood them as everything had happened so quick. In the words of a testicular cancer survivor “I don't really remember thinking anything. I felt it. When I heard "the bad news" I went numb. I was overcome with a hot wave of numbness. That's the best description I know... overcome with a wave of heat that permeated every inch of my body, and in its wake I was left feeling numb. I remember trying to absorb everything the doctor was telling me. All I can remember is staring intensely at his mouth, his lips moving in slow motion. It was like tunnel vision. If you've ever been so exhausted and fatigued that you lost peripheral vision... that's what it was like for me... I saw nothing but the doctors mouth as he spoke, I'll never forget it. I walked into my home. I was a wreck, but I tried to maintain my composure. It quickly crumbled though when I saw my wife and daughter. I burst into tears. Hysterical, I tried to relay everything the doctor had told me as best I could remember. My wife cried, gathered herself and took control” (Parsons, 2004). Cancer patients often find themselves overwhelmed and in need of help. Many find that turning to , friends or support groups for help often makes it easier to cope with their illness, the Department of Health (DOH, 2007) support this and state that patient and carer involvement in decisions relating to care and management is vital.
Although Johns cancer was treatable and he had a 90% chance of a cure, the diagnosis effected his life in so many ways, he could not hold his daughter for months after his treatment, he said that thoughts of her growing up without a daddy tormented him, all he wanted to do was to ‘love and protect her forever’ but the cancer made him think that he did not have ‘forever’ and it scared him. He said in the most his friends and family were supportive but he was ashamed to ask for help from anyone including health professionals because on the outside he was a strong healthy young man but he felt like he was dying within. Effective communication is paramount in relationships between the health professional and the patient. It enables the development of a rapport, facilitates the exchange of information and is central to informed treatment decision making and patient autonomy (DOH, 2007).
John had one session of chemotherapy and as far as I know he is living his life cancer free.
According to CRUK (2010) there are about 200 different types of cancer. They can start in any type of body tissue. What affects one body tissue may not affect another. Cancer is multifactorial, there is no single cause for any one type of cancer but research shows that most types of cancer becomes more common as we get older.
Cancer can be defined as the result of unregulated cell division. Cancer cells divide when they are not supposed to, don't stop dividing when they are supposed to and don't die when they should. In the worst cases, the cancer cells leave the area in which they arose and travel to other parts of the body. Cancer cells do not look or act like the normal cells from which they originate. In cancer cells, changes to key genes cause the cells to act abnormally. The changes are often the result of changes to the DNA (mutations) in the cells. Because there are many different things that are capable of causing mutation, there are an equally large number of causes of cancer (CRUK, 2010).
The development of cancer takes place in a multi-step process. As the cells become more abnormal, they gain new capabilities, such as the ability to release growth factors and digestive enzymes. The cells continue to divide, impacting nearby normal cells, often reducing the function of the affected organ. Even abnormal cancer cells die sometimes and a tumour that is large enough to feel can take years to reach that size. Although not all cancers share exactly the same steps, there are some general features that are shared in the development of many types of cancer. Another critical step in the growth of a tumor is the development of a blood supply (angiogenesis). Blood provides nutrients, carries away waste and the blood vessels provide a way for cancer cells to move around the body. When a tumour successfully spreads to other parts of the body and grows, invading and destroying other healthy tissues, it is said to have metastasized.
Carcinogens are a class of substances that are directly responsible for damaging DNA, promoting or aiding cancer. Tobacco, asbestos, arsenic, radiation such as gamma and x-rays, the sun, and compounds in car exhaust fumes are all examples of carcinogens. When our bodies are exposed to carcinogens, free radicals are formed that try to steal electrons from other molecules in the body. These free radicals damage cells and affect their ability to function normally (Corner & Bailey, 2001). Most people don't realize that cancer is preventable in many cases. Learning what causes cancer and what the risk factors are is the first step in cancer prevention. Many cancer risk factors can be avoided, thus reducing the likelihood of developing cancer, although, some cancer risks like genetics cannot be avoided.
In conclusion, Cancer is no longer the death sentence people perceive it to be, factors including improved healthcare and treatment, have contributed to an enormous increase in the number of people living with and beyond cancer, meaning an estimated two million people in the UK are now classed as cancer survivors and people suffering from some cancers are twice as likely to survive as patients diagnosed in the early 1970s (Cooley, 2010). By the mid 1990s, changes in service provision and treatments, such as a planned and coordinated approach in , radiotherapy and combination chemotherapy, led to a steady increase in five year survival rates and a decrease in mortality in adult cancers in the UK (National Audit Office, 2004).
New analysis shows the percentage of women likely to survive breast cancer for at least 10 years has jumped from less than 40% to 77%, while the figure for both sexes for bowel cancer has risen from 23% to 50%. Professor Michel Coleman, head of ’s cancer survival group, which calculated the figures, said: “These big increases in long-term survival since the 1970s reflect real progress in cancer diagnosis and treatment, and they confirm the immense value of having a National Cancer Registry that holds simple information about all cancer patients diagnosed during the last 30 to 40 years.” (Nursing times, 2010).
Education is a critical influence in the continuing development of cancer nurses and nursing practice, Gould et al (2004) suggest that nurse educationists in cancer and palliative care might be more effective if they spent more time working in the clinical setting. The Calman Hine report (1995) set out a number of principles governing the provision and delivery of cancer services. Equal access for all patients to uniform high-quality care, regardless of their geographical location, was a priority and establishing the need for site-specific specialist nurses was highlighted, and the report said that patients should have access to nurses with appropriate experience and skill.
The Royal College of Nursing (RCN, 1996) has identified that, within the field of oncology and palliative care, nurses deliver 80% of direct care to patients that is why it is so important that nurses get it right from the start. Cancer is becoming more of a chronic illness that people are living with, rather than a dying and it is our responsibility to educate patients and act as their advocates (Corner, 1996).
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