Med-Surg Immune System, part 14: Prostate, Colorectal, & Lung Cancer
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.
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.
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.
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, also known as bowel cancer, colon cancer, or rectal cancer, is any cancer that affects the colon and/or rectum.
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.
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.
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.
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.
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.
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.
In this video, we are going to continue our coverage of the most common types of cancer. If you are following along with your Medical-Surgical Nursing Edition 2.0 cards, I am on card 32 in the immune system. In this video, we will be talking about prostate cancer, colorectal cancer, and lung cancer.
Let's first talk about prostate cancer.
So the way we screen for prostate cancer is by taking the patient's PSA level, so that's prostate-specific antigen level, as well as doing a digital rectal exam, or a DRE.
We do these things starting at age 50, unless the patient's at higher risk. Then we can start them earlier.
It's important to remember that we need to first take the patient's blood to check for their PSA level before we do a digital rectal exam, and that's because if we did the digital rectal exam first, that actually causes an increased level of PSA. So if we did the DRE and then the PSA, we can end up with an artificially high level of PSA. So again, take the blood first for the PSA, then the DRE.
In terms of risk factors of prostate cancer, old age is one, as well as a high-fat diet. Race also plays a role. So African Americans are at higher risk for prostate cancer. And then genetics is another risk factor.
In terms of signs and symptoms, the urethra runs right in the middle of that prostate gland, so if there's a tumor and enlargement of that prostate gland, it can really put pressure on that urethra and cause urinary-type symptoms, so you'll have symptoms such as urinary retention, hesitancy, and frequency. The patient may have frequent bladder infections, as well as hematuria, so that's like blood in the urine, and nocturia, so that means a lot of peeing at night. So the patient may have to get up several times a night to go to the bathroom.
In terms of the labs and diagnosis of this condition, if the patient's PSA level comes back over 4, then that is suspect for prostate cancer. However, PSA levels may also be elevated if the patient has BPH, so, definitely, further investigation will be needed to be able to differentiate whether the patient has cancer or BPH.
Other diagnostic tools include using a transrectal ultrasound. And then, in terms of getting a definitive diagnosis, we would need to obtain a biopsy.
In terms of treatment, hormone therapy can be used, such as leuprolide. We can also use chemotherapy and radiation.
The patient may require surgery, such as a prostatectomy, so that is removal of a portion or all of the prostate gland.
They may also require an orchiectomy, which is removal of the testicles, and that would be done in order to stop production of testosterone, which really fuels the growth of the prostate cancer.
Alright. Now let's talk about colorectal cancer.
Screening tools used for this cancer include an FOBT, which is a fecal occult blood test. This where we're testing for the presence of blood in a stool sample. A colonoscopy starting at age 50 is probably the best screening tool for colorectal cancer. These are done every 10 years if nothing shows up in the colonoscopy. If the patient ends up having a polyp removed during a colonoscopy, chances are they're going to want to do another colonoscopy sooner than every 10 years.
The patient may also choose to do a sigmoidoscopy every 5 years instead. However, a sigmoidoscopy really examines only the lower part of the colon, as opposed to a colonoscopy, which examines the whole large intestine. So really, a colonoscopy is more highly recommended as a good screening tool for colorectal cancer.
In terms of risk factors associated with this type of cancer, older age is one, as well as a high-fat diet, especially a diet that's high in red meat. Genetics, smoking, obesity, alcohol, and physical inactivity are other risk factors.
Signs and symptoms of colorectal cancer can include rectal bleeding, as well as a change in the bowel color, shape, or consistency. So if you have a patient who suddenly has a big change in their bowel movements, they should definitely bring that to the attention of their provider.
In terms of labs and diagnosis, a colonoscopy with a biopsy is really the gold standard for diagnosing colorectal cancer. In addition, a positive FOBT would be suspect for colorectal cancer. We could also do imaging, such as a CT or an MRI.
As far as treatment, chemotherapy is an option, as well as radiation.
We may need to do surgery, so a colon resection or colectomy with the creation of a colostomy or ileostomy. This is where we reroute part of the intestine through the abdominal wall and the patient has a bag. So there's definitely some important things regarding nursing care and patient teaching when it comes to ostomies, so I definitely recommend that you watch my video on that topic in our gastrointestinal playlist.
Alright. Lastly, let's talk about lung cancer.
So we don't screen everybody for lung cancer. However, if there are at-risk individuals, like people who smoke, we can do an annual low-dose CT scan to screen them for lung cancer. So my mom's boyfriend, he's very sweet. He smokes, though, so he actually goes and gets these low-dose CT scans every year to screen for lung cancer.
In terms of risk factors associated with lung cancer, you probably can guess what they are. So smoking is the big one, in addition to secondhand smoke, pollution, exposure to asbestos, and being of a male gender also places an individual at higher risk.
In terms of the signs and symptoms of lung cancer, the patient may have a cough, blood-tinged sputum, chest pain, shortness of breath, weight loss, fatigue, and a dull chest percussion. So when you percuss the chest, you are expecting resonance. If you're not getting resonance and you're getting that dull sound, then that is suspect for a lung tumor.
In terms of the labs and diagnosis, a CT scan can be helpful. In addition we can do a bronchoscopy with a needle biopsy to definitively diagnose the lung cancer.
And then in terms of treatment, chemotherapy is an option, as well as targeted therapy. So targeted therapy helps to prevent damage to healthy cells, as opposed to chemotherapy. Radiation is also an option, as well as photodynamic therapy. We may need to do a lobectomy, so that is a surgical removal of a lobe of the lung, or we may need to do a pneumonectomy, which is removal of the entire lung.
So that is it for lung cancer, and that is it for this playlist. So if you have found value in these videos, if this has been a good review for you, be sure to like this video, and leave us a comment, and definitely subscribe to our channel. So take care and good luck studying!
Alright. So let's first talk about prostate cancer, and discuss screening. Screening for prostate cancer is done through obtaining a-- so if a patient really has changes in their bowel movements, they should definitely notify the provider because that may be a.
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