AKAL COLLEGE OF NURSING, BARU SAHIB

TEACHING
ON
PRINCIPLES OF CANCER MANAGEMENT

Presented to: Presented by:

Ms. Divya Thakur Smriti

Assistant Professor M.Sc.(N) 2 nd Year

 INTRODUCTION

Cancer management encompasses a multifaceted approach aimed at

diagnosing, treating, and supporting patients through their cancer
journey. It involves the prevention and early detection of cancer,
accurate staging, and the use of multidisciplinary teams to create
personalized treatment plans. Treatment strategies may include
surgery, radiation, chemotherapy, targeted therapies, and
immunotherapy, often in combination, depending on the cancer type
and stage.
 DEFINITION OF CANCER
Cancer is a group of diseases
characterized by the uncontrolled
growth and spread of abnormal cells in
the body. Normally, cells grow, divide,
and die in an orderly fashion, but in
cancer, mutations in genes can lead to
the development of cells that grow and
divide uncontrollably. These abnormal
cells can form a mass called a tumour,
invade nearby tissues, and spread
(metastasize) to other parts of the body.
 CAUSES OF CANCER
1. Genetic Mutations 6. Chronic Inflammation
• Inherited Mutations (Hereditary
Cancer)
• Acquired (Somatic) Mutations
2. Environmental Factors 7. Immune System Dysfunction
• Radiation
• Carcinogens
3. Lifestyle Factors 8. Age
• Tobacco Use
• Diet and Nutrition
• Alcohol Consumption
• Physical Inactivity and Obesity
4. Infections 9. Radiation and Chemical
• Viruses: Human papillomavirus Exposures in the Workplace
(HPV), Hepatitis B and C and
Epstein-Barr virus (EBV).
• Bacteria: Helicobacter pylori
5. Hormonal Factors 10. Random DNA Errors: Due to
cell division
PATHOPHYSIOLOGY
 PRINCIPLES OF CANCER MANAGEMENT
1. Prevention
2. Early Detection and Screening
3. Diagnosis
4. Staging and Prognostication
5. Multidisciplinary Care
6. Personalized (Precision) Medicine
7. Surgery
8. Radiation Therapy
9. Systemic Therapy
10. Palliative Care
 PREVENTION OF CANCER

1. Lifestyle Modifications
a. Tobacco Avoidance
• Quit Smoking
• Avoid Second-hand Smoke
b. Healthy Diet
• Eat a Plant-Based Diet
• Limit Red and Processed Meat
• Avoid Excessive Salt and Preserved Foods
• Limit Sugary and Highly Processed Foods
 CONT…
c. Regular Physical Activity
• Exercise Regularly
• Sedentary Behavior
d. Maintain a Healthy Weight
e. Limit Alcohol Consumption

2. Environmental and Occupational

Exposure Control
a. Avoid Exposure to Carcinogens
• Sun Protection
• Avoid Occupational Carcinogens
 CONT…
3. Vaccination and Infection Control
a. Vaccination to Prevent Infection-Related Cancers
Human Papillomavirus (HPV) Vaccine
Hepatitis B Vaccine
b. Infection Prevention
Preventing H. pylori Infection: Good hygiene, safe drinking
water, and proper food handling can reduce the risk of
infection.
Preventing Hepatitis C: Avoiding risky behaviors such as
sharing needles, and screening blood products help prevent
transmission. Antiviral treatments are available for infected
individuals.
 CONT…
4. Screening and Early Detection
a. Cancer Screening Programs
• Breast Cancer: Regular mammograms starting at age 40–50, depending
on risk factors, can detect breast cancer early.
• Cervical Cancer: Pap smears and HPV testing can identify pre-
cancerous changes in the cervix. Regular screening starts in women aged
21–25.
• Colorectal Cancer: Colonoscopy, fecal occult blood testing, or stool
DNA tests starting at age 45–50 for average-risk individuals help detect
polyps or early-stage cancers.
• Prostate Cancer: Prostate-specific antigen (PSA) testing, usually
starting at age 50, helps detect prostate cancer in its early stages.
• Lung Cancer: Low-dose CT scans for high-risk individuals (e.g., long-
term smokers) can detect lung cancer early.
5. Genetic Testing and Counseling
 BRCA1/BRCA2 Mutations: Individuals with a family history of
breast or ovarian cancer can undergo genetic testing for
mutations in the BRCA1 or BRCA2 genes, which significantly
increase cancer risk. Preventive measures, such as enhanced
screening, prophylactic surgeries, or medications, can be taken.
 Other Genetic Syndromes: Families with hereditary cancer
syndromes like Lynch syndrome (associated with colorectal
cancer) or familial adenomatous polyposis may benefit from
genetic counseling and screening.
7. Regular Medical Checkups
 Health Monitoring: Regular checkups with a healthcare
provider allow for early detection of precancerous conditions,
routine health monitoring, and guidance on risk-reducing
behaviors. Blood pressure, cholesterol, and other health
metrics are also monitored, as overall health can impact
cancer risk.
 EARLY DETECTION AND SCREENING
1. Cancer Screening
 Mammography: Used to detect breast cancer. It is an X-ray of the
breast and can identify lumps or abnormal tissue before they can be felt.
 Pap Smear and HPV Testing: Used for detecting cervical cancer.
These tests identify abnormal cells in the cervix that could develop into
cancer if untreated.
 Colonoscopy: Detects colon and rectal cancer by allowing a doctor to
view the entire colon and rectum. Polyps or abnormal growths can be
removed during the procedure to prevent cancer from developing.
 Low-dose Computed Tomography (LDCT): A screening tool for lung
cancer, especially in heavy smokers. LDCT scans can detect small
nodules or tumors in the lungs.
 Prostate-Specific Antigen (PSA) Test: A blood test used to detect
prostate cancer. High levels of PSA may indicate the presence of cancer.
2. Imaging Techniques
 X-rays: Often used to detect lung and bone cancers.
 Ultrasound: Uses sound waves to create images of internal
organs. It's often used to detect tumors in organs such as the
liver, pancreas, and kidneys.
 MRI (Magnetic Resonance Imaging): Provides detailed
images of soft tissues and organs. MRIs are used to detect
cancers in areas like the brain and spinal cord.
 CT (Computed Tomography) Scan: Combines multiple X-rays
to create a cross-sectional image of internal organs, helping to
detect tumors in areas like the abdomen, chest, and pelvis.
 PET (Positron Emission Tomography) Scan: Often used
alongside a CT scan, PET scans detect the metabolic activity of
cells. Since cancer cells grow rapidly, they usually show up
brightly on PET scans.
3. Blood Tests and Biomarkers
 CA-125 Test: Measures levels of the CA-
125 protein, which may indicate ovarian
cancer.
 AFP (Alpha-fetoprotein) Test: Used to
detect liver cancer and certain testicular
cancers.
 BRCA1 and BRCA2 Genetic Tests:
Mutations in these genes can increase the
risk of breast and ovarian cancer.
 Liquid Biopsy: A new technique that
detects cancer cells or fragments of
tumor DNA in the bloodstream, even
Self-exams and Awareness
 Breast Self-exam: Regular self-checks for lumps,
changes in shape, or any unusual signs in the breast
tissue.
 Skin Self-exam: Watching for changes in the size,
shape, or color of moles and other skin growths.
 Testicular Self-exam: Men are encouraged to regularly
check for lumps, swelling, or pain in the testicles, which
may be early signs of testicular cancer.
 Biopsy
 Needle Biopsy: A thin needle is used to extract tissue
or fluid from a suspicious area.
 Surgical Biopsy: A more invasive method where a
surgeon removes an entire tumor or a part of it for
examination.
 Endoscopic Biopsy: Using a tube with a camera
(endoscope) to examine internal organs and take
samples.
 STAGING OF CANCER

 The TNM staging system is the most widely used

system for classifying the extent of cancer spread. It
helps determine the stage of cancer by describing
three key aspects:
 T (Tumor): The size and extent of the primary tumor.
 N (Nodes): Whether cancer has spread to nearby
lymph nodes.
 M (Metastasis): Whether cancer has spread to
distant parts of the body.
 TUMOR
 T0: No evidence of a primary tumor.
The cancer may not have formed a
noticeable mass or the primary tumor
has completely regressed.
 Tis (Tumor in situ): Cancer is present
only in the layer of cells where it
began and hasn’t invaded deeper
tissues. It is considered pre-cancer or
very early-stage cancer. "In situ"
means "in its place," and examples
include ductal carcinoma in situ
 T1, T2, T3, T4: These numbers indicate
increasing size and/or extent of the primary
tumor. The exact criteria for these values depend
on the type of cancer being staged. For example:
 T1: Small tumor confined to the organ of origin.
 T2: Larger tumor that may have started to grow into
nearby tissues.
 T3: Tumor is even larger or has extended more deeply
into surrounding tissues.
 T4: Tumor has grown into nearby structures or organs.
 LYMPH NODE INVOLVEMENT
 N0: No regional lymph node involvement (cancer has not
spread to nearby lymph nodes).
 N1, N2, N3: Increasing involvement of regional lymph nodes.
 N1: A small number of cancer cells have spread to one or a few nearby
lymph nodes.
 N2: More extensive involvement in nearby lymph nodes, typically
meaning that several lymph nodes are involved or the cancer cells in
the nodes are larger or more aggressive.
 N3: Significant involvement in lymph nodes, which may indicate larger
tumors or cancer that has spread to lymph nodes further away from the
primary tumor.
 METASTASIS
 M0: No distant metastasis. Cancer has not spread to other
parts of the body beyond the primary tumor and regional lymph
nodes.
 M1: Distant metastasis is present. Cancer has spread to distant
organs or tissues (e.g., the lungs, liver, brain, or bones).
 In some cases, additional numbers or letters may be used to
provide more specific details, such as M1a or M1b, depending
on the number of metastases or the locations of metastasis.
 SURGERY
1. Curative or Primary Surgery
 Objective: To completely remove the cancer.
 Example:
 Lumpectomy or Mastectomy in breast cancer.
 Prostatectomy in prostate cancer.
 Colectomy in colorectal cancer.
 Curative surgery may be followed by adjuvant therapies
like chemotherapy or radiation to eliminate any remaining
cancer cells.
 Debulking Surgery
 Objective: To remove as much of the tumor as
possible when complete removal isn't feasible.
 Example:
 Ovarian cancer: Debulking surgery can
significantly improve outcomes by reducing tumor
burden, making chemotherapy more effective.
Palliative Surgery
 Objective: To relieve symptoms and improve the
quality of life, rather than to cure the cancer.
 Example:
 Bowel obstruction: Surgery to relieve a blockage in the
intestines caused by tumors.
 Spinal cord compression: Surgery to relieve pressure on
the spinal cord caused by metastatic tumors.
 Pleural effusion: Draining fluid from the space around the
lungs caused by cancer spread to the lungs.
 Preventive (Prophylactic) Surgery
 Objective: To remove tissues or organs that are at high risk of
developing cancer before cancer actually forms.
 Example:
 Prophylactic mastectomy: The removal of one or both breasts to
reduce the risk of developing breast cancer, often in women with BRCA
gene mutations.
 Prophylactic oophorectomy: The removal of the ovaries in women
at high risk of ovarian cancer.
 Colon resection: Removal of parts of the colon in people with familial
adenomatous polyposis, a genetic condition that leads to colon cancer.
Reconstructive Surgery
 Objective: To restore the
appearance or function of body
parts after cancer treatment.
 Example:
 Breast reconstruction: After a
mastectomy, breast reconstruction
can be done using implants or tissue
from other parts of the body
(autologous reconstruction).
 Facial reconstruction: After head
and neck cancers, reconstruction can
be done to restore the face, jaw, or
throat.
 Skin grafts: For skin cancers that
Minimally Invasive Surgery (MIS)
 Objective: To reduce recovery time, pain, and
scarring by using less invasive techniques.
 Example:
 Laparoscopic Surgery: Used for many types of cancer,
including colorectal, liver, and gynecologic cancers. A
camera and instruments are inserted through small incisions.
 Robotic Surgery: A type of laparoscopic surgery where the
surgeon uses robotic arms for greater precision.
Cytoreductive Surgery with Hyperthermic
Intraperitoneal Chemotherapy (HIPEC)
 Objective: To treat cancers that have spread
within the abdominal cavity.
 Example:
 Peritoneal carcinomatosis: Often used for
cancers like ovarian cancer, colorectal cancer, or
mesothelioma that have spread throughout the
abdominal cavity.
 Laser Surgery
 Objective: To remove or shrink tumors with focused
light beams.
 Example:
 Skin cancer: Lasers can remove cancerous lesions with
minimal damage to surrounding tissues.
 Esophageal or tracheal cancer: Laser surgery can be
used to relieve blockages caused by tumors in these areas.
 CONCLUSION

The principles of cancer revolve around understanding its nature as a disease

characterized by uncontrolled cell growth and the potential to invade or spread to
other parts of the body. Key principles include the recognition of the hallmarks of
cancer—such as genetic mutations, evasion of cell death, sustained proliferative
signaling, and the ability to metastasize. Diagnosis involves advanced imaging,
biopsies, and molecular testing to determine cancer type and stage. Treatment is
based on multimodal strategies including surgery, chemotherapy, radiation, and
targeted therapies, aiming either for cure, control, or palliation, depending on the
cancer’s stage and the patient’s overall health. Central to cancer care is an
individualized approach that balances effective treatment with quality of life
considerations.
 BIBLIOGRAPHY

 Abeloff, M. D., Armitage, J. O., Niederhuber, J. E., Kastan, M. B., & McKenna, W. G. (2020).
Abeloff’s Clinical Oncology (6th ed.)
 DeVita, V. T., Lawrence, T. S., & Rosenberg, S. A. (2021). Cancer: Principles & Practice of
Oncology (12th ed.)
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