Chapter 11 – Cancer (Detailed Study
Notes)
Introduction to Cancer
Cancer is a group of diseases characterized by the uncontrolled growth and spread of
abnormal cells. These cells do not follow the normal rules of cell division and instead
continue to grow even when they should stop (basically, the body’s control system breaks).
If left untreated, cancer cells can invade surrounding tissues and spread to distant parts of
the body through a process called metastasis (movement through blood or lymph). ⚠️HIGH
TEST: malignant tumors spread, benign tumors do not.
Cellular Basis of Cancer
Normal cells grow, divide, and die in a controlled process called the cell cycle. In cancer,
mutations in DNA disrupt this process. These mutations may be caused by carcinogens such
as chemicals, radiation, or viruses. Cancer cells often avoid apoptosis (programmed cell
death), meaning they survive longer than they should. They also lose differentiation,
becoming more primitive in appearance (anaplasia = cells look abnormal and immature,
which usually means more aggressive cancer).
Carcinogenesis
Carcinogenesis occurs in three stages: initiation, promotion, and progression. Initiation
involves genetic mutation (damage to DNA). Promotion is when these altered cells begin to
multiply. Progression is when the tumor becomes more aggressive and spreads. (Simple:
damage → growth → spread). Tumors also develop angiogenesis, which is the formation of
new blood vessels to supply nutrients to the tumor (like the tumor building its own food
supply). ⚠️HIGH TEST: cancer develops over time, not instantly.
Classification of Tumors
Tumors are classified based on tissue of origin. Carcinomas arise from epithelial tissue (skin
and organ linings), sarcomas arise from connective tissue (bone, muscle), leukemias
originate in blood-forming tissues, and lymphomas arise from lymphatic tissue. ⚠️HIGH
TEST: know the difference between these types.
Risk Factors
Risk factors include both environmental and genetic influences. Tobacco use is the leading
preventable cause of cancer. Radiation exposure (UV rays, X-rays) can damage DNA. Genetic
predisposition increases susceptibility. Certain infections such as HPV and hepatitis viruses
are linked to cancer. Lifestyle factors such as poor diet, obesity, and inactivity also
contribute. (Simple: risk factors increase chance, not guarantee cancer).
Signs and Symptoms
The CAUTION acronym is used to identify warning signs: Change in bowel/bladder habits, A
sore that does not heal, Unusual bleeding, Thickening or lump, Indigestion, Obvious change
in mole, Nagging cough. Other symptoms include unexplained weight loss, fatigue, and
persistent pain. ⚠️HIGH TEST: CAUTION signs are commonly tested.
Diagnosis
Diagnosis involves several methods. A biopsy is the only definitive way to diagnose cancer
(⚠️ALWAYS correct answer on tests). Imaging such as CT scans provides structural
information, while PET scans show metabolic activity. Blood tests may detect tumor
markers but are not diagnostic alone. (Simple: imaging finds it, biopsy proves it).
Staging and Grading
Staging determines the extent of cancer spread using the TNM system (Tumor size, Node
involvement, Metastasis). Grading refers to how abnormal the cells appear. (Simple: staging
= where cancer is, grading = how aggressive it is). ⚠️HIGH TEST: do not confuse staging
with grading.
Treatment Modalities
Treatment depends on cancer type and stage. Surgery removes tumors and may be curative
or palliative. Chemotherapy uses drugs to destroy rapidly dividing cells (affects healthy cells
too). Radiation therapy uses high-energy rays to target cancer cells. Other therapies include
immunotherapy and targeted therapy. (Simple: chemo = systemic, radiation = localized,
surgery = removal).
Side Effects of Treatment
Because treatments target rapidly dividing cells, healthy tissues are also affected. Common
side effects include nausea, vomiting, hair loss, fatigue, and bone marrow suppression. Bone
marrow suppression leads to decreased white blood cells, increasing infection risk. ⚠️HIGH
TEST: neutropenia = low neutrophils = high infection risk.
Nursing Care – Chemotherapy
Nursing care focuses on monitoring for complications and supporting the patient. Infection
prevention is critical; fever is an emergency in chemotherapy patients. Neutropenic
precautions include hand hygiene, avoiding crowds, and no fresh flowers. Patients require
education on signs of infection and medication adherence. Emotional support is essential. ⚠️
HIGH TEST: fever in chemo patient = urgent situation.
Nursing Care – Radiation Therapy
Radiation therapy requires careful skin care. Patients should avoid harsh soaps and not
remove markings used for treatment alignment. Fatigue is common. The treated area
should not be rubbed or irritated. (Simple: protect the skin and conserve energy).
Oncologic Emergencies
Oncologic emergencies include conditions that require immediate attention. Sepsis can
occur due to immunosuppression. Spinal cord compression may cause paralysis.
Hypercalcemia can lead to confusion and cardiac issues. ⚠️HIGH TEST: these are life-
threatening and require immediate action.
Patient Education
Patient education includes teaching about treatment side effects, infection prevention,
nutrition, and when to seek medical attention. Patients should be encouraged to maintain
hydration, nutrition, and follow-up care. (Simple: teach them how to stay safe at home).