Welcome to the second installment of Navigation Refresh, a new, recurring feature in the Journal of Oncology Navigation & Survivorship that aligns with and provides updates on the major sections of patient navigation training.
In this issue, we will cover the continuum of cancer care, cancer risk factors, detection, diagnosis, and treatment. Understanding the basics of cancer and what cancer care involves is foundational for oncology patient navigators.
Cancer is the uncontrolled multiplication and growth of abnormal cells that can spread in the body. The disease is named based on the location of where the cancer starts in the body. For example, lung cancers start in the lungs. There are more than 100 different kinds of cancer. In lung cancer, for example, there are numerous types of cancer, including small cell, adenocarcinoma, squamous cell, and large cell lung cancers.
A unique characteristic of cancer is that cancer cells can invade nearby tissues and organs and may also spread to other parts of the body through the bloodstream or lymphatic system. The term “malignant” describes a tumor that is cancerous and can spread to other tissue and areas of the body. Metastatic cancer is cancer that has spread to distant tissue and organs. For example, lung cancer metastatic to the liver is still lung cancer, but it has traveled to the liver. Benign tumors are not cancer, and they do not grow into other tissue or travel to other organs (Table 1).
The cancer control continuum is a way of describing the stages of cancer from etiology and prevention to detection, diagnosis, treatment, and posttreatment survivorship (Figure):
We often do not know the single factor that caused a particular cancer growth to start. There are modifiable risk factors and nonmodifiable risk factors. We know that some things can increase our chances of cancer, such as using tobacco or drinking alcohol. Exposure to radiation from the sun, ultraviolet rays or radon is also a risk factor. Therefore, ways to reduce chances of cancer happening include not using tobacco or alcohol; using sun protection, such as long sleeves and sunscreen; engaging in physical activity; and testing for radon.
Ways to reduce chances of cancer happening include not using tobacco or alcohol; using sun protection, such as long sleeves and sunscreen; engaging in physical activity; and testing for radon.
Infections like HPV and hepatitis may also put a person at greater risk for some cancers. Getting the HPV vaccine is a risk reduction behavior. Environmental toxins are risk factors, too, which is why it is so important to have clean air to breathe, safe water to drink, and accessible food that is fresh and full of nutrients and vitamins. Environmental factors are not usually in the control of people exposed to these toxins. This is why government intervention to address environmental toxins can be critical.
Nonmodifiable risk factors include a family history of cancer and specific genes that predispose people for cancer. We will talk more about genetic risks in a future issue.
It is important to know that it is never someone’s fault that cancer happens. Some risk factors are modifiable and some risks are not. Also, changing behavior is complicated. We may do things that are not good for us as a way of thinking we are protecting ourselves from something worse. This is very human. Approaching risk reduction with compassion is key.
Cancer screening is important, because it allows doctors to find cancer at the earliest detectable stage. Early cancer may not have symptoms. If cancer can be found before there are symptoms, it is more likely that treatment will be most successful.
Screening is not available for all cancers. Table 2 includes simplified screening guidelines for the general population. People should always check with their doctor to see if their family history, risk factors, or other circumstances affect when and how they should be screened for cancer.
Biopsies tell pathologists where the tumor originated in the body and can guide the most appropriate form of treatment by telling doctors about the characteristics of a particular cancer.
A screening exam may lead to a cancer diagnosis. Once cancer is detected through imaging, such as x-rays, ultrasounds, bone scans, CT scans, MRIs, blood tests, and urine tests, cancer can be diagnosed with biopsies. Biopsies tell pathologists where the tumor originated in the body and can guide the most appropriate form of treatment by telling doctors about the characteristics of a particular cancer.
Liquid biopsies are biopsies of the blood. Colonoscopies and sigmoidoscopies are specific exams for detecting colorectal cancer. Colonoscopies can also remove precancerous polyps to prevent cancer from developing.
Cancer treatment options may include a combination of surgery, radiation, chemotherapy, targeted therapy, immunotherapy, hyperthermia, photodynamic therapy, and hormone therapy. Table 3 features some common ways that cancer is treated.
Supportive care in cancer therapy is a combination of physical, psychological, social, and spiritual support for patients and their families. It’s intended to improve quality of life and help manage the side effects of cancer and its treatment. Supportive care for cancer patients and survivors includes many different types of therapies, including physical therapy, speech therapy, lymphedema therapy, and mental health counseling.
Support groups, spiritual support, and emotional support from friends, family, community groups, patient navigators, and peers can also help people adjust to experiences of cancer and cancer survivorship. People with a history of cancer often seek out nutrition information, physical programs like yoga and aerobics, meditation, and information on complementary and supplemental therapies and supplements.
Palliative care is a special type of supportive care. Palliative treatment refers to symptom management for pain relief and is often confused for hospice, which is end-of-life care. Palliative care can and should be provided to relieve pain at any point a person experiences preventable pain from cancer or its treatment.
Remember, you can always access the free Oncology Patient Navigator Training: The Fundamentals and lots of resources at bit.ly/PNTraining. Our updated training will tentatively be released in March 2025. Keep checking back for updates!
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