Cancer, medically known as “carcinoma,” is a type of malignant tumor that originates in epithelial tissue. The term “cancer” generally refers to all malignant tumors. Compared to benign tumors, malignant tumors grow rapidly and are highly invasive. They can spread from their primary site to other parts of the body, causing serious harm to the human body.
Epidemiology
Contagious
Not contagious.
High-risk population
The disease is more prevalent among people who have irregular lifestyles, smoke and drink.
Causes
Overview
The development of cancer is a complex, multi-step process that can be caused by a combination of chemical, physical, biological, and genetic factors. The role of environmental and genetic factors varies from tumor to tumor.
Basic cause
1. Related pathogenic factors
(1) Chemical factors: There are many types of chemical carcinogens. Currently, it is believed that the most important chemical carcinogens for the overall cancer risk of humans are the various carcinogens in cigarettes. In addition to cigarettes, other chemical carcinogens mainly include combustion, organic synthesis, and certain food ingredients. In addition, certain physiological and pathological processes in the human body, such as inflammation, oxidative stress, and repeated tissue damage, can also produce carcinogenic chemical oxygen free radicals.
(2) Physical factors: The physical carcinogenic factors that have been confirmed so far mainly include ionizing radiation, ultraviolet radiation and some mineral fibers (such as asbestos fibers).
(3) Biological factors: including viruses, bacteria, parasites, etc.
(4) Genetic susceptibility factors: It is currently believed that the vast majority of tumors are caused by environmental factors. For people exposed to the same environment, some develop tumors while others do not. This may be due to the tumor susceptibility in the individual’s genetic characteristics.
2. Pathogenesis
(1) Under the long-term synergistic effects of internal and external factors, susceptible cells in the body may cause changes in genetic material, leading to gene mutations and abnormal functional regulation, thereby promoting abnormal cell proliferation and transformation to form new organisms.
(2) Tumor cells lose their normal growth regulation function and have the ability to grow autonomously or relatively autonomously, and can continue to grow even after the tumorigenic factors stop.
Risk factors
1. Smoking.
2. Drinking.
3. Obesity.
4. Eating high-salt, smoked, pickled, or moldy foods.
5. Food is too hard, too hot, or eaten too fast.
6. Excessive exposure of skin to sunlight.
7. Long-term contact with fuel, leather, rubber, plastic, paint and other chemical products.
8. Lack of fresh vegetables and fruits in food.
symptom
Overview
A lump is often the first clinical manifestation, and other symptoms may include pain, bleeding, ulcers, obstruction, etc., which vary depending on the location and nature of the tumor.
Typical symptoms
1. Lump
For superficial or superficial cancers, a mass is often the first manifestation, accompanied by dilated or enlarged veins. Deeper or visceral masses are less palpable but may cause symptoms of organ compression or hollow organ obstruction. Skin cancers may present with lesions in the corresponding area. Metastatic disease may manifest as enlarged lymph nodes, bone and visceral nodules, and masses.
2. Pain
The expansive growth, ulceration or infection of the tumor may irritate or compress the peripheral nerves or nerve trunks, causing local tingling, throbbing pain, burning pain, dull pain or radiating pain, which is often unbearable, especially at night; tumors can cause lesions in hollow organs and produce colic, such as intestinal colic caused by intestinal obstruction caused by cancer.
3. Ulcers
If cancers of the body surface or gastrointestinal tract grow too rapidly, they can become necrotic due to insufficient blood supply or ulcerate due to secondary infection. Malignant tumors often have a cauliflower-like appearance or ulcers on the surface, and may have a foul odor and bloody discharge.
4. Bleeding
Cancers on the body surface or those communicating with the outside of the body can cause ulceration or rupture of blood vessels, which can lead to bleeding.
(1) Gastric cancer may cause vomiting of blood or black stools.
(2) Colorectal cancer may cause bloody stools or bloody stools with mucus.
(3) Urinary system cancer may cause hematuria, often accompanied by local colic.
(4) Lung cancer may cause hemoptysis or blood in sputum.
(5) Cervical cancer may cause bloody leucorrhea or vaginal bleeding.
(6) Rupture of liver cancer can cause intra-abdominal bleeding.
5. Obstruction
Tumors can cause obstruction of hollow organs, and symptoms may vary depending on their location.
(1) Pancreatic head cancer and bile duct cancer may be accompanied by obstructive jaundice, resulting in yellowing of the skin and sclera, weight loss, fatigue, etc.
(2) Gastric cancer with pyloric obstruction can cause vomiting.
(3) Intestinal cancer can cause intestinal obstruction, abdominal pain, bloating, vomiting, constipation, etc.
(4) Bronchial cancer can cause atelectasis, resulting in chest tightness, dry cough, and difficulty breathing.
6. Oppression
Cancer presses on surrounding tissues, causing symptoms.
(1) Compression of the recurrent laryngeal nerve can cause hoarseness.
(2) Compression of the superior vena cava may cause venous distension on the face, neck, upper limbs, and upper chest, as well as edema of the subcutaneous tissue.
(3) Compression of the esophagus may cause difficulty in swallowing.
7. Metastatic symptoms
(1) Regional lymph node enlargement.
(2) Venous return to the corresponding part is obstructed, causing limb edema or varicose veins.
(3) Bone metastasis may cause pain or palpable nodules, or even pathological fractures.
(4) Lung cancer, liver cancer, and stomach cancer can cause carcinogenic chest effusion and ascites, which manifest as dull chest pain, difficulty breathing, abdominal distension, abdominal pain, and weight loss.
8. Systemic symptoms
Cancers of different systems will have corresponding symptoms.
(1) Cancers of the respiratory system, such as lung cancer, may cause symptoms such as coughing, sputum production, and hemoptysis.
(2) Cancers of the digestive system, such as liver cancer and bile duct cancer, may cause symptoms such as abdominal pain, bloating, jaundice, nausea, and vomiting.
(3) Cancers of the urinary system, such as kidney cancer and bladder cancer, may cause symptoms such as frequent urination, urgency, pain, urinary retention, and urinary incontinence.
(4) Cancers of the female reproductive system, such as vaginal cancer and endometrial cancer, may cause symptoms such as vaginal bleeding and vaginal discharge.
9. Paraneoplastic syndrome
It can be caused by certain substances secreted by the tumor or abnormal immune function.
(1) In a small number of lung cancer cases, due to the production of endocrine substances by the tumor, non-metastatic systemic symptoms may be clinically presented, such as osteoarthritis syndrome (clubbing, osteoarticular pain, periosteal hyperplasia, etc.), Cushing syndrome, Lambert-Eaton syndrome, male breast enlargement, multiple myelopathy, etc.
(2) 10% to 20% of renal cancer patients may develop paraneoplastic syndrome, which is manifested by hypertension, anemia, weight loss, cachexia, fever, polycythemia, abnormal liver function, hypercalcemia, hyperglycemia, increased erythrocyte sedimentation rate, neuromuscular disease, amyloidosis, galactorrhea, abnormal coagulation mechanism, etc.
10. Systemic symptoms
(1) Early-stage malignant tumors often have no obvious systemic symptoms. Common nonspecific systemic symptoms include anemia, low-grade fever, weight loss, and fatigue. If cancer affects nutritional intake (such as digestive tract obstruction) or is complicated by infection and bleeding, obvious systemic symptoms may appear.
(2) Cachexia is often a manifestation of systemic failure in the late stage of malignant tumors, which may cause extreme weight loss, skin and bones, general weakness, and extreme pain.
complication
Tumor fever, cachexia, hypercalcemia, syndrome of inappropriate antidiuretic hormone secretion, carcinoid syndrome, etc.
examine
Scheduled inspection
The doctor will first conduct a comprehensive physical examination, followed by relevant laboratory tests and imaging examinations such as blood routine, urine routine, tumor markers, CT, MRI, etc. In order to confirm the diagnosis, the doctor may also require relevant pathological examinations.
Physical examination
1. Check the tumor’s location, size, shape, hardness, surface temperature, blood vessel distribution, presence of capsule, and mobility.
2. In addition to routine examinations of lymph nodes throughout the body, special attention should be paid to the examination of possible lymph node metastases, such as the axillary and supraclavicular lymph nodes for breast cancer; the cervical lymph nodes for pharyngeal tumors; the inguinal lymph nodes for anal or vaginal cancer; and liver palpation and rectal digital examination for intra-abdominal tumors.
Laboratory tests
1. Routine examination of blood, urine and stool
Patients with gastrointestinal cancers may present with anemia and occult blood in the stool. Intestinal cancers may also present with bloody stools containing mucus. Urinary tract tumors may present with hematuria. Erythrocyte sedimentation rate (ESR) is often elevated. Abnormal findings on routine examinations are not specific for malignancy, but such positive results can often provide valuable clues to the diagnosis.
2. Serological examination
Biochemical methods can be used to measure tumor markers produced by tumor cells and distributed in the blood, secretions, and excretions. Most tumor markers have poor specificity. However, they can serve as auxiliary diagnostic tools and have a certain value in assessing treatment efficacy and follow-up.
(1) Enzyme examination: Liver cells can secrete alkaline phosphatase (AKP), so serum AKP in patients with liver cancer is often elevated, but it may also be elevated in patients with obstructive jaundice due to obstructed bile excretion. In prostate cancer, serum acid phosphatase may be elevated. In patients with prostate cancer bone metastasis and proliferative bone reaction, both acid and alkaline phosphatase may be elevated. Liver cancer may have varying degrees of elevated lactate dehydrogenase (LDH), and primary or metastatic liver cancer may sometimes have elevated 5-nucleotide phosphodiesterase isoenzymes and v-glutamyl transferase II (GGT-III).
(2) Glycoprotein: Serum α-acid glycoprotein, digestive system cancer CA19-9, CA50, etc. are increased in patients with lung cancer.
(3) Hormones: Endocrine cancers may cause increased hormone secretion, leading to endocrine-tumor syndrome. For example, pancreatic islet cell carcinoma may be accompanied by excessive insulin secretion leading to hypoglycemia; oat cell carcinoma of the lung may cause increased antidiuretic hormone and hyponatremia. Human chorionic gonadotropin (hCG) has been widely used in the diagnosis and treatment of choriocarcinoma.
(4) Tumor markers: Carcinoembryonic antigen (CEA) can be elevated in colon cancer, gastric cancer, lung cancer, and breast cancer. Monitoring CEA after colorectal cancer surgery has a good effect on predicting recurrence; alpha-fetoprotein (AFP) can be elevated in liver cancer and malignant teratoma. It is used for liver cancer screening in my country with good results; IgA antibodies against Epstein-Barr virus antigens (VCA-IgA antibodies) are specific to nasopharyngeal carcinoma. The positive rate of serum VCA-IgA antibodies in patients with nasopharyngeal carcinoma is about 90%, while that in normal people is only 6% to 35%. It can be used for screening.
Imaging examinations
1. X-ray
Ordinary X-rays include fluoroscopy, plain film, and angiography, which can be used to observe the morphology and blood vessels of cancer; special X-ray development techniques include selenium electrostatic X-rays (dry plate photography) and molybdenum target X-ray tube photography, which can be applied to soft tissue and breast tissue.
2. Ultrasound
Safe, simple, and non-invasive, it is currently widely used in the diagnosis of tumors in the liver, gallbladder, pancreas, spleen, thyroid, breast, brain, uterus, and ovaries, and is very valuable in distinguishing between cystic and solid masses. Ultrasound-guided biopsy has a success rate of 80% to 90%. Computer-assisted ultrasound and color Doppler flow imaging are currently commonly used to assist in diagnosis.
3. CT
It is often used in the differential diagnosis of solid organ cancer, solid masses and lymph nodes.
4. MRI
The images of the nervous system and soft tissues are particularly clear.
5. Radionuclide imaging
Radionuclides commonly used in tumor diagnosis include more than ten types, including 99tin, 131iodine, 198gold, 32phosphorus, 133xenon, 67gallium, 169ytterbium, and 113indium. Clinically, radionuclide examinations for thyroid cancer, liver cancer, and colorectal cancer typically reveal lesions larger than 2 cm in diameter.
6. Positron emission tomography (PET)
The diagnosis rate for colon cancer, lung cancer, breast cancer, ovarian cancer, etc. can be as high as about 90%. Currently, most of the examinations used are combined examinations of PET and CT.
7. Endoscopic examination
Laparoscopy uses laparoscopic and endoscopic techniques to directly observe tumors or other lesions in hollow organs, the chest cavity, the abdominal cavity, and the mediastinum. Cells or tissue can be obtained for pathological examination and diagnosis, and small lesions, such as polyp removal, can be treated. X-rays can also be performed by inserting a catheter into the ureter, common bile duct, or pancreatic duct. Commonly used instruments include esophagoscopy, gastroscopy, fiberscope, proctoscopy, sigmoidoscope, tracheoscope, laparoscope, mediastinoscope, cystoscope, colposcope, and hysteroscope.
Pathological examination
1. Histopathological examination
Different sampling methods are used according to the location, size, and nature of the tumor.
(1) Puncture biopsy: A small piece of tissue is obtained under local anesthesia using a specially designed needle. The specimen obtained can be used for histological diagnosis. Puncture biopsy is usually used for solid masses in subcutaneous soft tissue or certain internal organs. Its disadvantage is that puncture biopsy may promote tumor metastasis, so the indications should be strictly controlled.
(2) Forceps biopsy: It is mostly used for superficial tumors on the body surface or cavity mucosa, especially exophytic or ulcerative tumors. It is suitable for the skin, lips, oral mucosa, nasopharynx, cervix, etc., and can also be used to obtain tumor tissue during endoscopic examination.
(3) Excisional biopsy: If the tumor can be completely removed surgically, an excisional biopsy is performed, or a portion of the tissue is removed during surgery for rapid (frozen) section diagnosis. For pigmented nodules or moles, especially those suspected of melanoma, excision or puncture is generally not performed, and complete excision and examination should be performed. All types of biopsies have the potential to promote the spread of malignant tumors, so they should be performed shortly before surgery or during surgery.
2. Tumor molecular diagnosis
(1) Immunohistochemical examination of pathological tissue: It has the advantages of strong specificity, high sensitivity, accurate positioning, and the combination of morphology and function. It is of great significance in improving the accuracy of tumor diagnosis, determining tissue origin, discovering small cancer foci, correctly staging, and judging the degree of malignancy.
(2) Genetic examination of pathological tissue: Use current gene sequencing technology to directly sequence relevant genes in pathological tissue to understand their mutation status and guide clinical treatment. Currently, there are some gene mutations or amplifications in lung cancer, breast cancer, and colon cancer that are directly related to the efficacy of corresponding targeted drug treatment.
(3) Liquid biopsy: A method of obtaining tumor molecules from various body fluids for biopsy. Liquid biopsy has the advantages of being less invasive and repeatable. It has particular advantages for detecting drug-resistant gene mutations that are prone to occur during treatment. However, the methods of liquid biopsy are still under continuous improvement and cannot completely replace traditional pathological tissue biopsy.
Other tests
1. Flow cytometry (FCM)
It is a method used to understand cell differentiation, analyze chromosome DNA ploidy type, DNA index, etc., and combine it with the tumor pathological type to determine the malignancy of the tumor and infer its prognosis.
2. Clinical cytology examination
The advantages of cytology are simplicity, low cost, and the absence of anesthesia. However, its disadvantage is that in most cases, it can only provide a qualitative cytological diagnosis. Diagnosis of highly differentiated single or small numbers of tumor cells can sometimes be difficult, and standardized diagnostic criteria are not readily available. Cells can be obtained from naturally exfoliated cells in body fluids (such as from pleural effusion and ascites), mucosal cells (obtained via esophageal smears, cervical scrapings, etc.), or tumor cells obtained through fine needle aspiration.
diagnosis
Diagnostic principles
A preliminary diagnosis can be made based on the patient’s symptoms and relevant examinations, and its definitive diagnosis depends on pathological examination.
Diagnostic basis
1. The following ten symptoms are not characteristic symptoms of malignant tumors, but are often considered to be early signs of malignant tumors:
(1) A lump is found anywhere on the body and gradually grows in size;
(2) ulcers that do not heal for a long time are found on any part of the body;
(3) Irregular vaginal bleeding or increased leucorrhea in middle-aged and older women;
(4) Discomfort behind the sternum, burning pain, foreign body sensation, or progressive dysphagia when eating;
(5) Dry cough or blood in sputum that does not go away after long-term treatment;
(6) Long-term indigestion, progressive loss of appetite, and unexplained weight loss;
(7) Changes in bowel habits or blood in stool;
(8) Nasal congestion and nose bleeding;
(9) The mole becomes larger or ulcerated and bleeds;
(10) Painless hematuria.
2. Diagnosis of tumors
The diagnosis of tumors mainly relies on histopathological examination.
3. Tumor staging
The staging of malignant tumors helps to formulate rational treatment plans, accurately evaluate treatment efficacy, and determine prognosis. The TNM staging system proposed by the International Union Against Cancer is currently the most widely used staging system.
(1) T refers to the primary tumor, N refers to the lymph nodes, and M refers to distant metastasis. These three items determine the stage. Different combinations of TNM are diagnosed as different stages, which can be divided into four stages: I, II, III, and IV.
(2) A number from 0 to 4 is added after the letter to indicate the degree of tumor development, based on the size of the lesion and the depth of invasion. 1 represents small, 4 represents large, and 0 represents none. When the tumor volume cannot be determined clinically, it is represented by T x . The specific format is T 1 N 0 M 0 .
(3) Tumor staging includes clinical staging (CTNM) and postoperative clinical pathological staging (PTNM).
(4) The specific standards for TNM classification of various tumors are agreed upon by various professional conferences.
treat
Treatment principles
Tumors are primarily treated with surgery, chemotherapy, and radiotherapy. The specific treatment plan is determined based on the nature of the tumor, the stage, and the patient’s overall condition. Generally speaking, for stage I malignant solid tumors, surgery is the primary treatment; for stage II, local treatment is the primary approach, including resection of the primary tumor or radiotherapy, including treatment of possible metastases, supplemented by effective systemic chemotherapy; for stage III, a combination of treatments is used, including pre-, post-, and intraoperative radiotherapy or chemotherapy; and for stage IV, systemic treatment is the primary approach, supplemented by local symptomatic treatment.
Drug treatment
1. Endocrine therapy
Also known as hormone therapy, this involves the use of hormones or anti-hormonal drugs to alter the levels of hormones that tumors rely on for growth, thereby inhibiting tumor growth. Because hormones selectively target tumor tissue, they have no inhibitory effect on normal tissue and thus do not cause bone marrow suppression. Commonly used drugs include tamoxifen, letrozole, goserelin, fulvestrant, and bicalutamide.
2. Molecular targeted therapy
Targeted drugs can interfere with the proliferation and spread of tumor cells through various mechanisms. Available drugs include rituximab and imatinib.
3. Immunotherapy
Immunotherapy is a method of using the human immune system to fight tumors. Currently, there are three types of immunotherapy: cellular immunotherapy, antibody-based therapy that blocks abnormal immune checkpoints, and tumor therapeutic vaccines.
Related drugs
Tamoxifen, letrozole, goserelin, fulvestrant, bicalutamide, rituximab, imatinib
Surgical treatment
Surgery remains the preferred treatment for most early-stage and relatively early-stage solid tumors. For malignant solid tumors, surgery offers a greater chance of cure if the cancer cells have not yet spread. Oncology surgery can be categorized by its intended purpose: preventive surgery, diagnostic surgery, radical surgery, palliative surgery, and cytoreductive surgery.
1. Preventive surgery
It is used to treat precancerous lesions and prevent them from becoming malignant or developing into advanced cancer. Early surgical removal of the following precancerous lesions can prevent the development of malignant tumors. For example, cryptorchidism is a risk factor for testicular cancer; testicular repositioning surgery in childhood can reduce the likelihood of testicular cancer. Patients with familial polyposis coli can benefit from prophylactic colectomy. If these patients do not undergo prophylactic colectomy, approximately half of them will develop colon cancer by age 40, and almost 100% will develop colon cancer after age 70.
2. Diagnostic surgery
Accurate diagnosis is the foundation of cancer treatment and must be based on histology, requiring representative tissue specimens. Furthermore, radiotherapy and chemotherapy also require pathological evidence. Therefore, diagnostic surgery provides a reliable basis for accurate diagnosis, precise staging, and, ultimately, appropriate and rational treatment. Three procedures, including excisional biopsy, incisional biopsy, and laparotomy, are suitable for different situations.
3. Palliative surgery
The purpose is to relieve symptoms, reduce pain, improve quality of life, prolong survival, and reduce and prevent complications.
4. Radical surgery
It refers to the surgical removal of all tumor tissue and any surrounding tissue and regional lymph nodes that may be affected by the tumor, in order to achieve a complete cure. Broadly speaking, radical surgery includes tumor resection, wide resection, radical surgery, and extended radical surgery.
5. Cytoreductive surgery
For large malignant tumors that cannot be cured by surgery alone, subtotal resection can be performed followed by other non-surgical treatments such as chemotherapy, radiotherapy, and biological therapy to control residual tumor cells. Cytoreductive surgery is only suitable for patients with ovarian and testicular cancers whose residual tumor can be effectively controlled with other treatments after subtotal resection of the primary lesion.
Chemoradiotherapy
1. Chemotherapy (chemotherapy)
(1) Indications: Chemotherapy is suitable for malignant tumors that can be cured by chemotherapy alone, such as small cell lung cancer; tumors that can achieve long-term remission, such as bladder cancer; and tumors that have a certain effect when combined with other treatments, such as cervical cancer.
(2) Chemotherapy drugs: including cyclophosphamide, fluorouracil, mitomycin, vincristine, etc.
(3) Chemotherapy methods: including induction chemotherapy, adjuvant chemotherapy and conversion chemotherapy.
(4) Side effects: Since chemotherapy drugs also have certain effects on normal cells, especially normal cells in a proliferative state, various adverse reactions may occur after medication. Common ones include: thrombocytopenia, nausea, vomiting, diarrhea, oral ulcers, hair loss, hematuria, etc.
2. Radiation therapy (radiotherapy)
Currently, approximately 70% of cancer patients require radiotherapy for various purposes at various stages during their disease course. Side effects include bone marrow suppression (leukopenia and thrombocytopenia), fatigue, anorexia, insomnia, skin and mucosal changes, gastrointestinal reactions, and acute or chronic radiation damage to localized irradiated tissues. Routine monitoring of white blood cells and platelets is essential during treatment. Treatment should be suspended if white blood cell counts drop to 3×10⁻¹⁹ / L or platelet counts drop to 80×10⁻¹⁹ / L.
Other treatments
1. Interventional therapy
It is one of the most important methods for treating tumors, with advantages such as minimally invasive, safe, effective, few complications and short hospital stay. It includes intra-arterial chemotherapy, transarterial embolization, radiofrequency ablation, and percutaneous ethanol injection.
2. Special treatment
Thyroid cancer can be treated with radioactive nuclides, which use the biological effects of the ionizing radiation of beta rays emitted by 131I to destroy residual thyroid tissue and cancer cells, thereby achieving the treatment goal; some liver cancer patients can undergo liver transplantation; skin cancer can use photodynamic therapy, laser and cryotherapy.
3. Treatment of tumor emergencies
(1) Superior vena cava syndrome (SVCS): When the superior vena cava is compressed, the vascular wall is invaded, or thrombosis forms in the blood vessels, resulting in obstruction, symptoms such as dyspnea, swelling of the head and face, cough and chest pain, dysphagia, facial edema, cyanosis and edema of the upper limbs, and hoarseness may occur. Generally, keeping the patient in bed, with the head elevated, oxygen inhalation, diuresis, and sodium restriction can alleviate compression symptoms to a certain extent. Steroid hormones can reduce inflammatory responses, improve obstruction, and reduce cerebral edema. When SVCS symptoms are obvious, fluid replacement from the superior vena cava drainage area should be avoided, and fluid can be infused through a lower limb vein. Some patients can be treated with balloons or expandable metal stents to dilate the blocked blood vessels.
(2) Tumor combined with infection: When the pathogen is not identified, broad-spectrum anti-infective treatment can be used empirically. Once the pathogen is identified, antibiotics can be used in a targeted manner based on drug sensitivity results.
(3) Acute abdomen: Tumors continue to expand, necrotize, and liquefy during their growth, and may rupture under tension. The clinical manifestations are related to the size of the tumor rupture and the rate and amount of bleeding. The main treatment measures are active hemostasis, maintaining blood volume, and performing surgery when necessary.
(4) Spinal cord compression: It is a common central nervous system emergency in late-stage tumors. The most common symptom is that the lesion is not painful, but may be accompanied by sensory impairment, muscle weakness, muscle atrophy, movement disorders, etc. High-dose hormone shock and radiotherapy can be used to reduce spinal cord edema, relieve pain, and alleviate compression symptoms. Some patients with localized lesions can undergo surgical treatment. For chemotherapy-sensitive tumors, chemotherapy can also achieve good results.
(5) Hypercalcemia: It is a common and life-threatening tumor metabolic emergency. It can cause pathophysiological changes in multiple organs such as the neuromuscular system, gastrointestinal tract, kidneys, and heart, requiring early diagnosis and emergency treatment. It can reduce serum calcium by increasing urinary calcium excretion and reducing bone reabsorption. Glucocorticoids can prevent bone reabsorption, inhibit vitamin D metabolism, and exert a calcium-lowering effect. Bisphosphonates can prevent the occurrence of adverse bone events.
(6) Malignant body cavity effusion: Malignant effusion in the pleural, abdominal, and pericardial cavities often occurs in the late stages of malignant tumors and can be the first clinical symptom of cancer. A small amount of effusion has little impact on the quality of life, while a large amount of effusion can affect the normal function of organs, and in severe cases, lead to functional loss or even death. Chemotherapy or radiotherapy can be selected based on the sensitivity of the tumor. For tumors that are not sensitive to chemotherapy or radiotherapy, or for patients who have failed multiple lines of treatment, local puncture and drainage or intracavitary medication can be used to relieve symptoms. Treatment can be supplemented with albumin intravenous nutritional support and diuretics to promote the discharge of effusions.
(7) Embolism: Due to the common hypercoagulability of patients with malignant tumors and the state of their blood vessels, thrombosis is prone to occur. If limb swelling and pain, skin pigmentation changes, chest tightness and shortness of breath worsen, be alert to the formation of embolism in large blood vessels. Indicators such as D-dimer can be monitored, and corresponding vascular ultrasound or CT examinations can be performed in parallel. Special attention should be paid to the occurrence of fatal conditions such as pulmonary embolism. Once a hypercoagulable state is assessed and there is a risk of embolism, anticoagulant treatment should be actively administered.
(8) Allergic reactions to anti-tumor drugs: Angioedema and urticaria are the most common symptoms caused by anti-tumor drugs. Other clinical manifestations include abdominal pain, chest tightness, upper airway obstruction, bronchospasm, and hypotension. Laryngeal edema accompanied by hypotension often leads to death. Some allergic reactions only occur when the infusion rate is fast and can be relieved by slowing down the drip rate or taking anti-allergic treatment. Severe allergic reactions should be detected early and the drug should be stopped immediately. Corticosteroids, antihistamines, and intravenous infusions should be used.
(9) Tumor lysis syndrome (TLS): If a large number of tumor cells die rapidly and intracellular components are released into the circulation, metabolic disorders including hyperuricemia, hyperkalemia, hyperphosphatemia and hypocalcemia may occur, and eventually acute oliguric renal failure may occur. This syndrome is common in the treatment of highly proliferative lymphomas, leukemias, reproductive system tumors, soft tissue sarcomas and other tumors. Tumors that are sensitive to chemotherapy, have large size, high white blood cell counts before treatment, elevated LDH (lactate dehydrogenase), high uric acid, low blood volume and renal insufficiency are high-risk factors for TIS. During anti-tumor treatment, the risk of TLS should be predicted in a timely manner and preventive treatment should be given, including intravenous hydration, urine alkalinization, diuresis promotion, correction of electrolyte imbalance, and monitoring of renal function and electrolytes.
(10) Anti-tumor drugs causing bleeding or gastrointestinal perforation: Anti-angiogenic drugs are commonly used targeted drugs for the treatment of tumors. The serious adverse reactions of these drugs are poor wound healing or rupture and bleeding of hollow organs such as the gastrointestinal tract. Therefore, before using these drugs, it is necessary to assess the possibility of these serious adverse reactions and avoid using such drugs within 4 weeks before and after surgery. Once they occur, if conservative medical treatment is ineffective, surgical exploration is required to detect the bleeding or gastrointestinal perforation caused by anti-tumor drugs and timely surgical intervention is performed.
(11) Treatment of radiotherapy reactions: Hormones can be used to control radiation inflammation, while antibiotics can be used to help control acute reactions caused by bacterial infections. Large amounts of vitamins can promote metabolism and repair.
4. Palliative care
(1) Indications: When treatments to control the disease and prolong life are ineffective or fail to achieve the desired goals, palliative care should be the primary treatment. The NCCN Palliative Care Guidelines recommend that palliative care be considered for the following patients: uncontrolled symptoms, severe complications, moderate to severe discomfort related to cancer diagnosis and treatment, and life expectancy ≤ 6 months.
(2) Purpose: The goal of palliative care is to prevent and relieve pain and provide the best possible quality of life, without being limited by disease stage or other treatments.
(3) Content and methods: Palliative care focuses on the expectations of patients and their families regarding cancer treatment and quality of life. It helps patients maintain their optimal living conditions through various means, provides psychological care for patients and their families, and thus improves their living conditions. This includes psychological intervention, treatment of cancer pain, symptomatic treatment of symptoms such as nausea and vomiting, and appropriate nutritional support.
5. Hospice care
Hospice care provides comprehensive care and support to terminally ill patients and their families, ensuring respect for the patient’s life, relieving symptoms, and improving the physical and mental health of their families, enabling the patient to complete their final journey in peace, comfort, and dignity.
Treatment cycle
The treatment cycle for cancer is generally 3-6 months, but there may be individual differences due to factors such as the severity of the disease, treatment plan, timing of treatment, and personal constitution.
Treatment costs
There may be significant individual differences in treatment costs, and the specific costs are related to the selected hospital, treatment plan, medical insurance policy, etc.
Prognosis
General prognosis
The prognosis is generally poor, depending on the type of cancer, discovery, and treatment time.
Hazards
Can cause death.
Self-healing
It cannot heal itself.
Curative
It is generally difficult to cure.
Cure rate
It depends on the type of cancer.
Radical
It cannot be completely cured.
Recurrent
After surgical resection, there is a possibility of recurrence.
Metastatic
Most cases may metastasize.
Lifecycle
The survival period of different cancers is different.
daily
Overview
Family members should give more care and support to patients, and help them recognize and understand the disease; during the period of recuperation at home, they should pay attention to rest, do appropriate physical exercise, keep warm, and prevent colds; after a period of recovery, they should follow the doctor’s advice for regular check-ups.
Psychological care
Patients often experience anxiety, uneasiness, irritability and other psychological problems due to the uncomfortable symptoms of the disease. Family members should pay more attention to and comfort the patients, relieve negative emotions, encourage patients to face the disease correctly, build confidence in treatment, and actively cooperate with treatment.
Life Management
1. Create a comfortable, quiet and relaxing living environment, open windows regularly for ventilation, and maintain appropriate indoor temperature and humidity.
2. Pay attention to rest, avoid fatigue, and ensure adequate sleep.
3. Engage in appropriate physical exercise to enhance physical fitness and improve immunity.
4. Pay attention to weather changes, add or remove clothes in time to prevent colds.
5. Quit smoking and drinking, and develop good living habits.
Follow-up Instructions
Follow the doctor’s advice for regular checkups and follow up if you feel unwell.
diet
Dietary adjustment
A scientific and reasonable diet can ensure the normal functioning of the body, help control the disease, maintain the treatment effect, and promote recovery from the disease.
Dietary recommendations
1. The diet should be as light, nutritious, easily digestible, and rich in vitamins as possible. The food should be diverse and well-balanced.
2. Eat small meals frequently. For patients who have undergone radiotherapy, chemotherapy, or surgery, their digestive function is weakened. Increasing the frequency of meals can reduce the burden on the digestive tract and increase food intake.
3. Eat more vegetables and fruits (such as asparagus, carrots, spinach, tomatoes, potatoes, kiwis, etc.), soybeans and their products, edible fungi, nuts, seaweed, coix seed, milk, eggs and other foods.
Dietary taboos
Try to avoid fried, smoked, grilled, spicy, greasy, and raw foods.
prevention
Preventive measures
1. Stay away from areas with strong radiation.
2. When going out, take precautions against sunburn and avoid exposing your skin to sunlight for a long time, especially to avoid sunburn.
3. Quit smoking.
4. Use less smoked, fried and pickled foods.
Medical Guide
Outpatient indications
1. Unidentified nodules, lumps, or persistent ulcers found anywhere on the body;
2. Unidentified mass found during physical examination;
3. Accompanied by long-term local pain and discomfort;
4. Accompanied by long-term fever, weight loss, loss of appetite, anemia, etc.;
5. Elderly people, especially those with a family history of cancer, experience the above symptoms;
6. Other severe, persistent or progressive symptoms and signs occur.
The above requires prompt medical consultation.
Treatment department
Cancer patients often choose the medical department based on the location of the disease.
1. If you have any swelling, ulcer, or enlarged mole on the body surface, you can go to the general surgery or dermatology department for treatment;
2. If you experience irregular vaginal bleeding or increased leucorrhea, you can go to the gynecology department for treatment;
3. If you experience pain behind the sternum, indigestion, difficulty swallowing, blood in the stool, etc. when eating, you can go to the gastroenterology department for treatment;
4. If you experience hematuria, frequent urination, or urgency, you can go to the urology department for treatment;
5. If you experience dry cough, sputum, hemoptysis, etc., you can go to the respiratory department for treatment.
Medical preparation
1. Make an appointment in advance and bring your ID card, medical insurance card, medical card, etc.
2. A more comprehensive physical examination may be performed, and you can wear clothing that is easy to put on and take off.
3. Special examinations such as biochemistry and gastrointestinal endoscopy may be performed. Please pay attention to the fasting time.
4. If you have had medical treatment recently, please bring relevant medical records, examination reports, laboratory test results, etc.
5. If you have taken some medicine to relieve symptoms recently, you can bring the medicine box with you.
6. Family members can be arranged to accompany the patient to seek medical treatment.
7. Patients can prepare a list of questions they want to ask in advance.
Questions your doctor may ask
1. What discomforts do you currently have?
2. How long have you been experiencing this condition?
3. Have your symptoms gotten worse or better since you first started having them? What could be the cause?
4. Have you ever had similar symptoms before?
5. Have you ever received treatment before? How was it treated? What was the effect?
6. Have you lost any significant weight recently?
7. What are your usual eating habits? Do you often eat greasy, overly hot, smoked, or grilled food?
8. Do you smoke or drink alcohol? How long have you been doing this? How much do you drink on average per day?
9. Is there anyone in your family who has a similar situation?
What questions can patients ask?
1. Is my condition serious? Can it be cured?
2. Why do these situations happen to me?
3. What treatment do I need? Do I need hospitalization? Do I need surgery?
4. How long will it take for me to recover?
5. Are there any risks associated with these treatments?
6. Will it relapse?
7. If taking medication, what are the usage, dosage and precautions of the medication?
8. What tests do I need to do?
9. I have other diseases. Will this affect my treatment?
10. How should I take care of myself after returning home?
11. Do I need follow-up examinations? How often?
