In this article, you'll learn the most important facts about prostate, colorectal and lung cancer. Learn about risk factors, signs and symptoms, prevention, screening, treatment, medication and surgeries for these cancers.
These cancers, their pathophysiology, treatment, and important patient teaching are covered in our Medical-Surgical flashcards (Immune system), and Cathy’s videos follow along with the cards.
Medical-Surgical Nursing - Flashcards
Prostate Cancer
Screening
The most important screenings for prostate cancer are measuring the prostate-specific antigen (PSA) level and performing a digital rectal exam (DRE).
A DRE is what is usually meant by the colloquial term "prostate exam." Both the PSA screening and DRE should be done annually starting when the patient turns 50. If a patient is at higher risk of prostate cancer because of a family history or other reasons, then these exams can begin earlier.
One important note to remember is that the PSA blood draw should be done before a DRE. The DRE can actually cause an increased level of PSA, so if the DRE is done first, the PSA value will be artificially high.
Risk factors
There are several risk factors for prostate cancer to be aware of, including old age and a high-fat diet.
African-Americans are statistically at a higher risk for prostate cancer. It is important to note the word statistically. Race does not play a biologically predetermined role in this disease, but the risks are higher statistically for Black patients for a variety of reasons, including the social and environmental determinants of health — financial resources; access to adequate and nondiscriminatory health care, including preventative care like prostate exams; and more.
Genetics are another risk factor for prostate cancer — if a patient has a family member who has had prostate cancer, they are at a much higher risk.
Signs and symptoms
The prostate cancer symptom that's most important to know about are the urinary symptoms, like urinary retention, hesitancy, and frequency. The patient may have frequent bladder infections, as well as hematuria (blood in the urine) and nocturia (increased peeing at night).
If you remember from your anatomy class, the urethra runs right in the middle of the prostate gland, so if the prostate gland has a tumor and becomes enlarged, it puts pressure on the urethra, which leads to urinary symptoms.
Lab values and diagnosis
Prostate-specific antigen (PSA)
Prostate-specific antigen is a protein produced by the cells in the prostate, and its levels in the blood can be increased when there is a problem with the prostate. A PSA level over 4.0 ng/mL can be an indicator of prostate cancer.
It's important to note that PSA levels can also be elevated if the patient has benign prostatic hyperplasia (BPH), which is a non-cancerous enlargement of the prostate that can happen with age. So if a patient's PSA level comes back over 4, further investigation is needed to determine if it's due to cancer or BPH.
Another diagnostic tool is a transurethral ultrasound, which uses sound waves to create an image of the prostate.
The diagnostic that can give a definitive diagnosis is a biopsy of the prostate.
Treatment
There are several treatment options available for a patient with prostate cancer. The medication route is hormone therapy, with a drug like leuprolide. Leuprolide is one of many important medications covered in our Pharmacology flashcards for nursing students. Chemotherapy and radiation can also be used to kill the cancer.
The patient may require surgery, like the aptly-named prostatectomy, which is a removal of a portion or all of the prostate gland. In some cases, the patient may also require an orchiectomy, which is a removal of the testicles, which is done in order to stop the production of testosterone, since testosterone fuels the growth of prostate cancer.
Colorectal Cancer
Colorectal cancer, also known as bowel cancer, colon cancer, or rectal cancer, is any cancer that affects the colon and/or rectum.
Screening
There are several screening tools for colorectal cancer, but the most important one to know about is a colonoscopy. A colonoscopy starting at age 50 is the best screening tool for colorectal cancer. Colonoscopies are done every 10 years after that, if the first results are normal. If a patient ends up having a polyp, they will likely have follow-up colonoscopies more often.
A patient might opt to undergo a sigmoidoscopy every 5 years instead. A sigmoidoscopy only examines the lower part of the colon (the sigmoid colon), as opposed to a colonoscopy, which examines the whole large intestine. A colonoscopy is more highly recommended than a sigmoidoscopy for that reason.
Risk factors
There are some risk factors associated with colorectal cancer that are important to know about, including old age, a high-fat diet, a diet high in red meat, genetics, smoking, obesity, alcohol, and physical inactivity.
Signs and symptoms
Signs and symptoms associated with colorectal cancer include rectal bleeding, and a change in the bowel color, shape, or consistency. If you have a patient who suddenly has a dramatic change in their bowel movements, they should definitely notify their provider.
Lab values and diagnosis
There are several diagnostic tests to know about when it comes to colorectal cancer. A colonoscopy with a biopsy is known as the gold standard for diagnosing colorectal cancer. In addition, a positive fecal occult blood test (FOBT) can be an indicator of colorectal cancer. Imaging, like a CT or MRI, could also be done on the patient to try to get a visual of the cancer.
Treatment
The treatment options available for colorectal cancer are chemotherapy and radiation. Surgical intervention may be warranted as well, such as a partial colectomy where a portion of the colon is removed. These patients will likely have colostomies for life, and will need to be taught how to care for their ostomy.
Lung Cancer
Screening
Unlike prostate exams for prostate cancer and pap smears for cervical cancer, there is no regular screening for lung cancer that everyone who gets a checkup undergoes with some regularity. Some individuals are more at risk than others, for example: smokers. Higher-risk individuals like smokers may opt to get an annual low-dose CT scan each year to screen for lung cancer.
Risk factors
The main risk factor for lung cancer is pretty well known—smoking. Other risk factors for lung cancer include secondhand smoke, pollution, and exposure to asbestos. Men are at greater risk of getting lung cancer than women.
Signs and symptoms
The signs and symptoms of lung cancer include a couch, blood-tinged mucus, chest pain, shortness of breath, weight loss, fatigue, and a dull chest percussion. When you percuss the chest, you are expecting resonance. If you don't hear resonance and you hear a dull sound, that is suspect for a lung tumor. Dull sounds usually happen over denser areas, and since the lungs are normally filled with air, that's why you expect to hear resonance. If a tumor is on the lung, the lungs' density has increased and so the percussion sound can change.
If you have ever put your ear against a wall and knocked along the wall to find the stud, this is a similar concept. The stud area is denser and has a duller sound.
Labs and diagnosis
In order to diagnose lung cancer, a CT scan can be a helpful starting point, to get an image of the possible tumor. In addition, a bronchoscopy can be done with a needle biopsy to definitively diagnose lung cancer.
Treatment
There are several treatment options available for lung cancer, including chemotherapy and targeted therapy. Targeted therapy helps to prevent damage to healthy cells, as opposed to chemotherapy which can damage healthy cells. Radiation is also an option for treatment of lung cancer, as well as photodynamic therapy.
The patient may need to undergo surgery, like a lobectomy, which is the surgical removal of a lobe or portion of the lung, or a pneumonectomy, which is a removal of the entire lung.
Cathy’s teaching on these cancers is intended to help prepare you for Medical-Surgical nursing exams. The Medical-Surgical Nursing video series is intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI and NCLEX.
2 comments
I really like the way of explanation.
Thank you, Cathy. The review was clear and concise.