Cancer Case

Cancer: Diagnosis, Staging, Complications, Treatment

Cancer is a complex disease in which the normal processes that keep cell division in check breaks down and the cells will begin to divide at a rapid rate. Cancer cells do not need signals tomake it grow, but does so on its own. The way a cancer cell behaves depends on what has gonewrong. Some cancer cells divide and produce more cancer cells and the tumor mass stays whereit began. Other cancer cells are able to invade normal tissue, enter the bloodstream, and metastasize to other parts of the body. (Goldman, 2011)

Cancer may be diagnosed during a routine medical examination or during a visit to the doctor because of symptoms the person is having. In some cases, the family doctor may recommend a surgeon perform a biopsy of the tissue and the tumor mass. A pathologist then examines the characteristics of the tissue under a high-powered microscope and by using a variety of techniques, determines the tumor type. The tumor is given a pathological grade according to how malignant the tissue looks under the microscope. The grades are given words such as differentiated, moderately differentiated, or poorly differentiated or may be given numbers. At the time of a biopsy, a pathologist can give the surgeon initial information by quickly freezing a sample of the tissue, cutting a thin piece, staining it, and then examining its histological characteristics under a microscope. The surgeon will then know whether to remove the rest of the tumor and how much tissue needs to be removed. For a more accurate diagnosis, the removed tissue is placed in a block of paraffin, sliced into sections, stained, and examined under the microscope. The results will take several days. Immunologic studies and molecular studies may also be done to diagnose some cancers, and to determine the type of cell involved. In order to stage certain leukemias and lymphomas, lumbar puncture is performed. (Coleman, 1998) When the diagnosis is made it consists of identifying the cancer, locate where it began, and determine if it has affected other parts of the body.

Staging systems are used to indicate the extent of the patient's cancer, an appropriate treatment regimen, and the prognosis. The clinical stage of cancer can be determined through the use of a physical exam, blood tests, and imaging studies. Some staging systems us ordinal numbers, others use Roman numerals and still others use letters of the alphabet. In all staging systems, the higher the number or letter, the greater the amount of the body involved in the cancer. More complicated staging systems such as the TNM system are used in which various parts of the cancer are graded separately. In the TNM system, the T refers to the size of the tumor, N tells whether lymph nodes are involved, and M indicates whether the cancer has metastasized. (Coleman, 1998)

When recommending a treatment, the oncologist uses information gathered from staging studies as well as the natural history of the tumor. Some cancers are very aggressive, while others remain stable for a long period of time without treatment. In determining a patient's prognosis, the size and stage of the tumor, features and biological properties of the tumor, and abnormalities revealed by blood tests are all considered. Oncologists must also consider the risk-benefit ratio of the treatment considered. A risk-benefit ratio is the assessment of benefits versus the possible risks to the a patient is worth to take. Some risks or side effects of treatment may include damage to an organ such as the heart, liver and kidney. This occurs because the dosage of drugs or radiation is more than the organ can tolerate. Because more patients receiving radiation and chemotherapy are surviving cancer, there is an increase of incidences of radiation-induced heart disease (RIHD), or deterioration of the heart. There are also cardiac side effects from chemotherapy which