Part two: Breast cancer, colorectal cancer, and esophageal cancer
Identifieur interne : 002148 ( Istex/Corpus ); précédent : 002147; suivant : 002149Part two: Breast cancer, colorectal cancer, and esophageal cancer
Auteurs : Charles KempSource :
- American Journal of Hospice and Palliative Medicine [ 1049-9091 ] ; 1999-01.
Abstract
This is the second of a six-part series on metastatic spread and natural history of 18 common tumors. Part one summarized symptom/problem anticipation, cancer metastasis, and the 18 tumors that each cause more than 6,000 deaths per year in the United States. Bladder and brain cancer were discussed, with information given on tumor types, metastatic spread and invasion, and common symptoms. Part two charts the natural histories of breast, colorectal, and esophageal cancers. Each of these cancers is presented separately, with information given on mortality rates, the most common tumor types, sites of metastases, common problems, and common oncologic emergencies. Sites of spread, resulting problems (including site-specific symptoms), and assessment parameters are presented as tables. Material is presented so that clinicians will be able to anticipate the spread of these cancers and thus identify problems early in their development so that the problems are more easily managed.
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DOI: 10.1177/104990919901600111
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ISTEX:48EE8D3371BBE6E7124F557826436DEA3FD3EED1Le document en format XML
<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">Part two: Breast cancer, colorectal cancer, and esophageal cancer</title><author wicri:is="90%"><name sortKey="Kemp, Charles" sort="Kemp, Charles" uniqKey="Kemp C" first="Charles" last="Kemp">Charles Kemp</name><affiliation><mods:affiliation>Baylor University School of Nursing, Dallas, Texas</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:48EE8D3371BBE6E7124F557826436DEA3FD3EED1</idno><date when="1999" year="1999">1999</date><idno type="doi">10.1177/104990919901600111</idno><idno type="url">https://api.istex.fr/document/48EE8D3371BBE6E7124F557826436DEA3FD3EED1/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">002148</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">002148</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Part two: Breast cancer, colorectal cancer, and esophageal cancer</title><author wicri:is="90%"><name sortKey="Kemp, Charles" sort="Kemp, Charles" uniqKey="Kemp C" first="Charles" last="Kemp">Charles Kemp</name><affiliation><mods:affiliation>Baylor University School of Nursing, Dallas, Texas</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">American Journal of Hospice and Palliative Medicine</title><idno type="ISSN">1049-9091</idno><idno type="eISSN">1938-2715</idno><imprint><publisher>Sage Publications</publisher><pubPlace>Sage CA: Thousand Oaks, CA</pubPlace><date type="published" when="1999-01">1999-01</date><biblScope unit="volume">16</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="403">403</biblScope><biblScope unit="page" to="411">411</biblScope></imprint><idno type="ISSN">1049-9091</idno></series><idno type="istex">48EE8D3371BBE6E7124F557826436DEA3FD3EED1</idno><idno type="DOI">10.1177/104990919901600111</idno><idno type="ArticleID">10.1177_104990919901600111</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">1049-9091</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">This is the second of a six-part series on metastatic spread and natural history of 18 common tumors. 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Part one summarized symptom/problem anticipation, cancer metastasis, and the 18 tumors that each cause more than 6,000 deaths per year in the United States. Bladder and brain cancer were discussed, with information given on tumor types, metastatic spread and invasion, and common symptoms. Part two charts the natural histories of breast, colorectal, and esophageal cancers. Each of these cancers is presented separately, with information given on mortality rates, the most common tumor types, sites of metastases, common problems, and common oncologic emergencies. Sites of spread, resulting problems (including site-specific symptoms), and assessment parameters are presented as tables. 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<contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Kemp</surname><given-names>Charles</given-names></name><degrees>RN, CRNH</degrees><aff>Baylor University School of Nursing, Dallas, Texas</aff></contrib></contrib-group>
<pub-date pub-type="ppub"><month>1</month><year>1999</year></pub-date><volume>16</volume><issue>1</issue><fpage>403</fpage><lpage>411</lpage><abstract>
<p><italic>This is the second of a six-part series on metastatic spread and natural history of 18 common tumors. Part one summarized symptom/problem anticipation, cancer metastasis, and the 18 tumors that each cause more than 6,000 deaths per year in the United States. Bladder and brain cancer were discussed, with information given on tumor types, metastatic spread and invasion, and common symptoms.</italic></p>
<p><italic>Part two charts the natural histories of breast, colorectal, and esophageal cancers. Each of these cancers is presented separately, with information given on mortality rates, the most common tumor types, sites of metastases, common problems, and common oncologic emergencies. Sites of spread, resulting problems (including site-specific symptoms), and assessment parameters are presented as tables. Material is presented so that clinicians will be able to anticipate the spread of these cancers and thus identify problems early in their development so that the problems are more easily managed.</italic></p>
</abstract><custom-meta-wrap><custom-meta xlink:type="simple"><meta-name>sagemeta-type</meta-name><meta-value>Journal Article</meta-value></custom-meta><custom-meta xlink:type="simple"><meta-name>cover-date</meta-name><meta-value>January/February 1999</meta-value></custom-meta><custom-meta xlink:type="simple"><meta-name>search-text</meta-name><meta-value> Abstract This is the second of a six-part series on metastatic spread and natural history of 18 common tumors. Part one summarized symptom/problem antici- pation, cancer metastasis, and the 18 tumors that each cause more than 6,000 deaths per year in the United States. Bladder and brain cancer were discussed, with information given on tumor types, metastatic spread and invasion, and common symptoms. Part two charts the natural histo- ries of breast, colorectal, and esophageal cancers. Each of these cancers is presented separately, with information given on mortality rates, the most common tumor types, sites of metastases, common problems, and common oncologic emergencies. Sites of spread, resulting problems (includ- ing site-specific symptoms), and as- sessment parameters are presented as tables. Material is presented so that clinicians will be able to anticipate the spread of these cancers and thus identify problems early in their devel- opment so that the problems are more easily managed. Breast cancer Breast cancer is the second leading cause of cancer death among women (43,555 deaths among women and 355 deaths among men in 1993). It is estimated that there will be 43,900 deaths from breast cancer in 1998.1,2 The mean time from diagnosis to death from breast cancer is 6.7 years and most fatal breast cancers are uni- lateral invasive ductal carcinomas.3 Metastatic spread is often detected first in regional (especially sentinel) lymph, but distal metastases may already have occurred or may occur without evidence of lymph involve- ment.4 There is great variation in tumor growth rate (doubling time) and clinical course in breast cancer. Breast cancer does not metastasize to a single focus,5 hence the norm in advanced disease is multiple sites of metastases and multiple problems. The most common significant sites of distal metastases (on autopsy) are liver, lung, and bone (> 60 percent), and thyroid and brain (> 20 percent). The most common sites of bone metastases are the red marrow of the axial skele- ton, the proximal ends of long bones, ribs, and the vertebral column.6 Other sites of metastases include (in descend- ing order of frequency) but are not lim- ited to: skin and soft tissue (especially local-regional), kidney, skeletal mus- cle, and the heart.6,7 Of the cancers with highest morbidity and mortality, breast cancer is the most likely to metastasize to skin (19.5 percent) and, after prima- ry bone cancer, second most likely to metastasize to skeletal muscle.8 Pain is more common among pa- tients with breast cancer than most other primary sites, perhaps because of its high incidence (second only to prostate cancer) of bone metastasis.9 Pain, pathological fractures, lymphe- dema, and skin lesions as well as sequelae of liver, lung, and other metastasis present difficult clinical challenges. Pathological fractures, central nervous system symptoms, malignant pleural effusions, and ure- mia are common clinical problems. Paraneoplastic problems associated 403The American Journal of Hospice & Palliative Care January/February 1999 Part two: Breast cancer, colorectal cancer, and esophageal cancer Charles Kemp, RN, CRNH Metastatic spread and common symptoms Charles Kemp, RN, CRNH, Baylor University School of Nursing, Dallas, Texas. 404 The American Journal of Hospice & Palliative Care January/February 1999 Table 1. Breast cancer: Spread, problems, and assessment Metastatic spread Problems Assessment parameters Bone Pain without pathological fracture Bone pain is usually localized to some extent and may be described as constant, aching, gnawing, sharp; it is often worse at night and may not be relieved by lying down. Pain may also be from other processes. Pathological fracture Severe, sharp, localized pain. Spinal cord compression from pathological frac- ture is possible. Spinal cord compression* (from pathological fracture or compression of cord without fracture): back pain is the first symptom and may be local (somatic: con- tact, dull, aching) or radicular or both; exacerbated by movement, neck flexion, straight leg raising; decreased by sitting up; and tender to percussion. Neurological deficits usually follow pain, may begin subtly and include extremi- ty weakness, ataxia, stumbling; urine retention, bowel dysfunction, numbness. Metabolic changes Hypercalcemia*: (often non-specific) symptoms include fatigue, weakness, anorexia, nausea, polyuria, polydipsia, and constipation; progressing to changes in mentation, seizures, coma. Regional lymph and structures Lymphadenopathy Involvement of lymph nodes may result in lymphadema (subcutaneous) with edema, pain, cellulitis, lymphangitis; or enlarged internal nodes may result in pressure on internal structures such as vessels, e.g., superior vena cava or viscera. Cardiac changes (also see metastases to heart below) Superior vena cava syndrome*: dilated neck or thoracic veins; facial edema, plethora; tachypnea; cyanosis; edema upper extremities; cough, hoarseness. Pericardial effusion à cardiac tamponade*: retrosternal chest pain relieved by sitting forward; orthopnea; cough; tachypnea; tachycardia; < cardiac output (< cerebral blood, peripheral cyanosis, < systolic and pulse pressures, pulsus paradoxus); occasional nausea and vomiting, and abdominal pain. Liver Pain Pain may be upper right abdominal or non-specific and characteristic of visceral pain; may radiate to right scapula and may worsen at night. Ascites Abdominal distension, bulging flanks, fluid wave, weight gain, and discomfort; anorexia, early satiety, indigestion, < bowel mobility; dyspnea, orthopnea, tachypnea; weakness, fatigue Lung(s) Dyspnea, cough, hemopty- sis (multiple etiologies) Pleural effusion: dyspnea and cough and chest pain (trachea displacement toward unaffected side with large effusion). Breath sounds usually decreased, but may vary according to area of lung. Pleural effusions are usually unilateral. Pneumonia: dyspnea and elevated temperature, chills, purulent or rusty sputum, decreased breath sounds. Pleural effusion may also be present. Embolus: Sudden onset of dyspnea and rapid breathing, rapid heart rate, cough, chest pain, and blood in sputum. Pre-existing conditions such as COPD or ascites also may cause dyspnea. Obstruction*: progressive or rapidly increasing dyspnea, blood in sputum, noisy breathing, chronic cough, choking, and/or pnemonia. *Oncologic emergencies 405The American Journal of Hospice & Palliative Care January/February 1999 Infection is a frequent cause of death; carcinomatosis is more common in breast cancer than with any other tumor except for melanoma. Fever of unknown origin (common with liver involvement). Disseminated intravascular coagulation* Problems of therapy, e.g., opioids, corticosteroids, antidepressants, radiation, chemotherapy Fatigue, cachexia, dysphagia, or other debilitating effects of advanced disease. Paraneoplastic syndromes, including acanthosis nigricans, neuromuscular disorders, and hypercalcemia Anemia from several potential etiologies: weakness, anorexia, headache, tachycardia Various problemsOther Thyroid nodules, hoarseness, dysphagia; stridor; lymphadenopathyRegional changesThyroid Oliguria or anuria, fatigue, headache, anorexia, nausea and vomiting, fetid breath, lethargy, changes in mentation Uremia Hematuria, flank pain, flank mass. Nephrotic syndrome is usually a paraneoplas- tic syndrome rather than a result of tumor invasion or metastases. GU symptomsKidney Arrhythmias, congestive heart failure; see pericardial effusion and cardiac tamponade. Cardiac changesHeart Metastatic lesions are often painful and have an unpleasant odor; skin lesions also may be due to inflammatory carcinoma, Paget's disease, or ulceration from underlying disease. LesionsSkin Confusion, seizures or other CNS problems also may result from brain metas- tases. Increased intracranial pressure: progressive pain usually present, may be more severe in the morning. Classic triad of increased ICP = papilledema (often with visual changes), vomiting, and headache. Disequilibrium may occur. CNS symptomsBrain, meninges Assessment parametersProblems Metastatic spread Table 1. Breast cancer: Spread, problems, and assessment (continued) *Oncologic emergencies with advanced breast cancer include acanthosis nigricans, neuromuscular disorders, and hypercalcemia.3 While exact figures are not available, it is known that patients with breast cancer often die from infection and, after patients with melanoma, are more likely to die from carcinomatosis.10 Haskell, et a1.11 report that about 50 percent of patients with breast cancer die from "the malignant process itself." The oncologic emergencies most common in patients with breast cancer are pericardial effusion leading to car- diac tamponade, increased intracra- nial pressure (including from carcino- matosis meningitis), spinal cord compression, airway obstruction, dis- seminated intravascular coagulation, and hypercalcemia.12,13 Hypercalcemia and spinal cord compression are the most common oncologic emergencies in breast cancer.13 See Table 1 for a list of sites common to metastatic spread in breast cancer as well as assessment parameters. Colorectal cancer Colorectal cancer is the second lead- ing cause of cancer death overall with 57,405 deaths in 1993 and an estimated 56,500 deaths in 1998 (47,700 colon and 8,800 rectum). Colorectal cancer deaths are about equally divided be- tween women and men.1,14 Almost 60 percent of primary col- orectal tumors are in the left or descending colon, sigmoid colon, or rectosigmoid. The most common tumor type found in the colon is adenocarci- noma; and in the appendix, rectum, and small bowel, carcinoid tumors are common. Tumors of the anus are com- monly epidermoid or cloagenic tu- mors.15 Metastatic spread (except for carcinoid tumors) is usually to region- al lymph (perineal, inguinal, retroper- ineal) first. Distal sites are primarily liver, lung, and bone, with liver metastases nearly always preceding lung metastases.8 Adjacent structures also may be invaded, causing such problems as recto-vaginal fistulas and/or pelvic pain or tenesmus.16 Many patients with colorectal can- cer have a colostomy; the combination of the colostomy and cachexia, along with other processes of advanced can- cer, result in significant challenges in care. With or without a colostomy, bowel problems are common. Bowel obstruction occurs most frequently with tumors of the descending and sigmoid colon.15,16 Patients with col- orectal cancer tend to experience less pain than those with other primary tumors except for brain.9 A significant number of patients with colorectal cancer develop widespread metastases to pelvic organs and nerve plexi, with an attendant difficult to manage mix of neuropathic, visceral, and somatic perineal pain. Steele15 has developed a helpful guide showing expected variations in symptoms in colon and rectal cancer: Ascending (right) colon cancer is characterized by ill-defined pain, brick-red bleeding, weakness, and infrequent obstruction. Descending (left) colon cancer is characterized by colicky pain (wors- ened by eating), red blood mixed with the stool, infrequent weakness, and frequent obstruction. Rectal cancer is characterized by steady, gnawing pain; bright red blood coating the stool; infrequent weak- ness; and infrequent obstruction. Perforation (usually through the tumor) also occurs, and carries a sig- nificantly increased risk of death.16 The systemic effects of carcinoid tumors usually occur only when there is liver metastasis. Symptoms, which vary according to tumor site, include flushing, diarrhea, bronchoconstric- tions, enlarged and painful liver, and cardiac lesions. Bowel obstruction occurs from fibrosis of the mesentery and cannot be treated surgically.17 Most patients with colorectal cancer die from infection (in descending order): septicemia, pneumonia, or peritonitis; and patients with colorec- tal cancer are more likely to die from hemorrhage than are patients with any other type of cancer.10 The oncologic emergency most often associated with colorectal tumors is obstructive uropathy.12 See Table 2. Esophageal cancer Carcinoma of the esophagus is the 12th leading cause of cancer death overall, with a male to female ratio of approximately 3:1. In 1993 there were 10,450 deaths from carcinoma of the esophagus and the estimated number of deaths in 1998 is 11,900.1,2 The most common tumor type in esophageal cancer is squamous cell in the upper and middle sections of the esophagus, and increasingly, adenocar- cinoma in the thoracic esophagus, i.e., below the clavicles, where most esophageal cancers occur.18 Both squa- mous cell carcinoma and adenocarcino- ma may take different forms, including malignant ulcer (site of hemorrhage), circumferential stricture, or mass within the esophageal lumen.19 Carcinoma of the upper (cervical) esophagus tends to spread by invasion of adjacent struc- tures, including carotid arteries, pleura, recurrent laryngeal nerves, trachea, and larynx. Tumors of the middle (thoracic) esophagus tend to spread to the left main stem bronchus, pleura, and related structures. Tumors of the lower (lower thoracic and cardiac) esophagus tend to invade the pericardium, aorta, dia- phragm, and phrenic nerve.20 Lymph- atic spread follows patterns similar to direct spread, with about 75 percent of patients presenting at diagnosis with mediastinal node or distant metasta- sis.21 Hematogenous spread moves commonly to the liver, lungs, bone, and kidneys. Brain metastases occur in almost 20 percent of patients.8,19 The most common problem of carcinoma of the esophagus is dyspha- gia, which usually does not occur until 406 The American Journal of Hospice & Palliative Care January/February 1999 407The American Journal of Hospice & Palliative Care January/February 1999 Table 2. Colorectal cancer: Spread, problems, and assessment Metastatic spread Problems Assessment parameters Colon Bowel obstruction Colon obstruction: intermittent (colicky) or continuous pain, nausea and vomiting, diarrhea, or constipation. In colon obstruction, the abdomen is distended and bowel sounds are hyperactive. Constipation May or may not be related to obstruction. Nausea and vomiting May or may not be related to obstruction. Anorexia Bleeding/anemia Persistent bleeding, especially with rectal cancer. Anemia: weakness, fatigue, anorexia, headache, tachycardia, dyspnea Regional lymph structures Lymphadenopathy Lymphedema: (area or lower extremities); pain; cellulitis, lymphangitis Obstructive uropathy Obstructive uropathy*: hesitancy, urgency, nocturia, frequency, < force of stream, urinary tract infection Partial kidney obstruction: polyuria alternating with oliguria Fistula Pain, odor, discharge depending on site Perineal pain Severe pain, most often neuropathic, but also mixed neuropathic with visceral and/or somatic. Liver Pain Liver pain may be upper right abdominal or non-specific, characteristic of visceral pain; may radiate to right scapula and worsen at night. Ascites Abdominal distension, bulging flanks, fluid wave, weight gain, and discomfort; anorexia, early satiety, indigestion, < bowel mobility; dyspnea, orthopnea, tachypnea; weakness, fatigue Lung(s) Dyspnea, other pulmonary Pneumonia: dyspnea and elevated temperature, chills, purulent or rusty sputum, decreased breath sounds. Pleural effusion may also be present. Pleural effusion: dyspnea and cough and chest pain (trachea displacement toward unaffected side with large effusion). Breath sounds usually decreased, but may vary according to area of lung. Pleural effusions are usually unilateral. *Oncologic emergencies there is about 90 percent tumor in- volvement/narrowing of the lumen.19 Dysphagia generally begins with solids, progresses to liquids, and even to saliva. Odynophagia (painful swallowing) is present in about 50 percent of patients. Dysphagia leads to at least three major problems: (1) malnutrition, weight loss, and eventually cachexia; (2) dehydration; and (3) aspiration pneu- monia from food spilling over into the lungs or from regurgitation. A chronic cough may result from aspiration or a tracheoesophageal fistula. Hoarseness indicates laryngeal nerve involvement, and chronic hiccups and paralysis of the arm or diaphragm indicate phrenic nerve involvement. Hemoptysis may be due to an ulcerative tumor or, if massive, may indicate aortic or carotid involvement. Pain can arise from the primary tumor, especially if ulcerative, or from invasive or metastatic extension.19-21 Pain in the ear indicates pharyngeal metastases.22 Palliative care may include eso- phagectomy (but this measure has a morbidity rate > 20 percent and a one- to two-month recovery period), radiation therapy, esophageal dilata- tion, photodynamic therapy, and/or endoprosthesis.20,23 Death commonly occurs from in- anition (profound debilitation) or pneumonia.21 The oncologic emergen- cies typically associated with carcino- ma of the esophagus include hyper- calcemia, tracheal obstruction, and increased intracranial pressure.12,20 Invasion of the aorta or carotid arteries 408 The American Journal of Hospice & Palliative Care January/February 1999 Table 2. Colorectal cancer: Spread, problems, and assessment (continued) Metastatic spread Problems Assessment parameters Embolus*: sudden onset of dyspnea and rapid breathing, rapid heart rate, cough, chest pain, and blood in sputum. Obstruction*: progressive or rapidly increasing dyspnea, blood in sputum, noisy breathing, chronic cough, choking, and/or pneumonia. Pre-existing conditions, such as chronic obstruction pulmonary disease or ascites, also may cause dyspnea. Bone Pain Bone pain is usually localized, constant, dull, aching, or sharp; worse at night. Spinal cord compression* from pathologic fractures of the spine or compression of cord without fracture is possible. Pain may be associated with other processes. Other Various problems Carcinoid syndrome: usually occurs only when there is liver metastases. Symptoms may include flushing, diarrhea, bronchoconstrictions, enlarged and painful liver, cardiac lesions, bowel obstruction. Fatigue, cachexia, dysphagia, anemia, other problems of advanced debilitating disease Problems of therapy, e.g., opioid, corticosteroids, antidepressants, radiation, chemotherapy. Skin integrity may become a major challenge if rectal discharge develops; or if colostomy present and the patient loses significant weight. *Oncologic emergencies 409The American Journal of Hospice & Palliative Care January/February 1999 Table 3. Esophageal cancer: Spread, problems, and assessment Metastatic spread Problems Assessment parameters Primary tumor growth, regional extension Decreased esophageal lumen Dysphagia: inability to swallow solids, liquids, and eventually in some cases, saliva. (Dysphagia also may be due to involvement of esophageal nerve plexus.) Odynophagia: Painful swallowing Cachexia, weight loss from inability to eat or drink; dehydration Aspiration pneumonia from food spill-over (see pneumonia below) Tracheal obstruction*: hemoptysis, wheezing, cough, dyspnea, stridor Fistula Chronic cough after swallowing liquids may be due to cough-swallow sequence from tracheoesophageal fistula or obstruction. Regional nerve involvement Hoarseness from laryngeal nerve involvement Chronic hiccups, arm paralysis and/or diaphragm paralysis from phrenic nerve involvement Dysphagia for solids and liquids from esophageal nerve plexus damage Pain Pain: related to the above. Pain from esophageal obstruction tends to be retrosternal, throat, or intrascapular. Bleeding Hemorrhage* (massive) from carotid artery or aorta involvement Hemoptysis from ulcerative primary tumor Lung(s) Dyspnea Pleural effusion: dyspnea and cough and chest pain (trachea displacement toward unaffected side with large effusion). Breath sounds usually decreased, but may vary according to area of lung. Pleural effusions are usually unilateral. Pneumonia: dysp- nea and elevated temperature, chills, purulent or rusty sputum, decreased breath sounds. Pleural effusion also may be present. Embolus*: sudden onset of dyspnea and rapid breathing, rapid heart rate, cough, chest pain, and blood in sputum *Oncologic emergencies may result in massive hemorrhage. See Table 3. References 1. American Cancer Society: Cancer facts and figures. Atlanta, 1997. 2. Landis SH, Murray T, Bolden S, et al: Cancer statistics, CA-A Cancer Journal for Clinicians. 1998; 48(1): 6-29. 3. Haskell CM, Casciato DA: Breast cancer. In Casciato DA, Lowitz BB (eds.): Manual of clinical oncology. Boston, Little, Brown and Company, 1995; 183-199. 4. Dowlatshahi K, Fan M, Snider HC, et al: Lymph node micrometastases from breast carcinoma. Cancer. 1997; 80(8): 1188-1197. 5. Henderson IC: Breast cancer. In Murphy GP, Lawrence W, Lenhard RE (eds.): Clinical oncology. Altanta, American Cancer Society, 1995; 198-219. 6. Mundy GR: Mechanisms of bone metasta- sis. Cancer. 1997; 80(8): 1546-1556. 7. Harris J, Morrow M, Norton L: Malignant tumors of the breast. In DeVita VT, Hellman S, Rosenberg SA (eds.): Cancer: Principles & practice of oncology. 5th ed. Philadelphia, J.B. Lippincott, 1997; 1502-1539. 8. Weiss L: Comments on hematogenous metastatic patterns in humans as revealed by 410 The American Journal of Hospice & Palliative Care January/February 1999 Table 3. Esophageal cancer: Spread, problems, and assessment (continued) Metastatic spread Problems Assessment parameters Obstruction*: Progressive or rapidly increasing dyspnea, blood in sputum, noisy breathing, chronic cough, choking, and/or pneumonia. Pre-existing conditions such as COPD or ascites also may cause dyspnea. Liver Pain Pain may be upper right abdominal or non-specific and characteristic of visceral pain; may radiate to right scapula and may worsen at night. Ascites Abdominal distension, bulging flanks, fluid wave, weight gain, and discomfort; anorexia, early satiety, indigestion, < bowel mobility; dyspnea, orthopnea, tachyp- neal weakness, fatigue Bone Pain Bone pain is usually localized to some extent and may be described as constant, aching, gnawing, sharp; often worse at night and may not be relieved by lying down. Pain may be from other processes. Spinal cord compression is possible, but is not common is esophageal cancer. Metabolic changes Hypercalcemia*: (often non-specific) symptoms include fatigue, weakness, anorex- ia, nausea, polyuria, polydipsia, and constipation; progressing to changes in menta- tion, seizures, and coma Brain CNS symptoms Increased intracranial pressure: progressive pain usually present, may be more severe in the morning; classic triad of increased ICP = papilledema (often with visual changes), vomiting, and headache Confusion, seizures, headache, or other CNS problems also may result from brain metastases. Other Various problems Problems of therapy, e.g., opioids, corticosteroids, tricyclic antidepressants, radiation, chemotherapy Fatigue, cachexia, other debilitating problems of advanced disease *Oncologic emergencies autopsy. Clinical and Experimental Meta- stasis. 1992; 10(3): 191-199. 9. Wachtel T, Allen-Masterson S, Reuben D, et al: The end stage cancer patient: Terminal common pathway. The Hospice Journal. 1988; 4(4): 43-80. 10. Inagaki J, Rodriguez V, Bodey GP: Causes of death in cancer patients. Cancer. 1974; 33(2): 568-573. 11. Haskell CM, Giuliano AE, Thompson RW, et al: Breast cancer. In Haskell CM (ed.): Cancer treatment. 3rd ed. Philadelphia, WB Saunders Company, 1990; 123-164. 12. Glick JH, Glover D: Oncologic emergen- cies. In Murphy GP, Lawrence W, Lenhard RE (eds.): Clinical oncology. 2nd ed. Altanta, American Cancer Society, 1995; 597-618. 13. Waller A, Caroline NL: Handbook of palliative care in cancer. Boston, Butter- worth-Heinemann, 1996. 14. American Cancer Society: Cancer facts and figures. 1998; http://www.cancer.org/ media/fact.html. 15. Steele G: Colorectal cancer. In Murphy GP, Lawrence W, Lenhard RE (eds.): Clinical oncology. 2nd ed. Altanta, Amer- ican Cancer Society, 1995; 236-250. 16. Jessup JM, Menck HR, Fremgen A, et al: Diagnosing colorectal carcinoma: Clinical and molecular approaches. CA-A Cancer Journal for Clinicians. 1997; 47(2): 70-92. 17. Carlson HE, Lowitz BB, Casciato DA: Endocrine neoplasms. In Casciato DA, Lowitz BB (eds.): Manual of clinical oncol- ogy. 3rd ed. Boston, Little, Brown and Company, 1995; 268-287. 18. Ellis FH, Huberman M, Busse P: Cancer of the esophagus. In Murphy GP, Lawrence W, Lenhard RE (eds.): Clinical oncology. 2nd ed. Altanta, American Cancer Society, 1995; 293-303. 19. Skinner DB, Altorki NK, Minsky BD, et al: Neoplasms of the esophagus. In Holland JF, Bast RC, Morton DL, et al (eds.): Cancer Medicine. 4th ed. Baltimore, Williams & Wilkins, 1997; 1861-1878. 20. Coleman J: Esophageal, stomach, liver, gallbladder, and pancreatic cancers. In Groenwald SI, Frogge MH, Goodman M, Yarbro CH (eds.): Cancer nursing: Prin- ciples and practice. 4th ed. Boston, Jones and Bartlett, 1997; 1082-1144. 21. Tabbarah HJ: Gastrointestinal tract can- cers. In Casciato DA, Lowitz BB (eds.): Manual of clinical oncology. 3rd ed. Boston, Little, Brown and Company, 1995; 145-182. 22. Calcaterra TC, Juillard GJF: Head and neck neoplasms: Larynx and hypopharynx. In Haskell CM (ed.): Cancer treatment. 3rd ed. Philadelphia, WB Saunders Company, 1990; 389-395. 23. Martins RG, Lynch TJ: Esophageal can- cer: Are you up to date? Internal Medicine. 1998; 18(8): 18-36. 411The American Journal of Hospice & Palliative Care January/February 1999 </meta-value></custom-meta></custom-meta-wrap></article-meta></front><back><ref-list>
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</ref-list></back></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Part two: Breast cancer, colorectal cancer, and esophageal cancer</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Part two: Breast cancer, colorectal cancer, and esophageal cancer</title></titleInfo><name type="personal"><namePart type="given">Charles</namePart><namePart type="family">Kemp</namePart><namePart type="termsOfAddress">RN, CRNH</namePart><affiliation>Baylor University School of Nursing, Dallas, Texas</affiliation></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><originInfo><publisher>Sage Publications</publisher><place><placeTerm type="text">Sage CA: Thousand Oaks, CA</placeTerm></place><dateIssued encoding="w3cdtf">1999-01</dateIssued><copyrightDate encoding="w3cdtf">1999</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">This is the second of a six-part series on metastatic spread and natural history of 18 common tumors. Part one summarized symptom/problem anticipation, cancer metastasis, and the 18 tumors that each cause more than 6,000 deaths per year in the United States. Bladder and brain cancer were discussed, with information given on tumor types, metastatic spread and invasion, and common symptoms. Part two charts the natural histories of breast, colorectal, and esophageal cancers. Each of these cancers is presented separately, with information given on mortality rates, the most common tumor types, sites of metastases, common problems, and common oncologic emergencies. Sites of spread, resulting problems (including site-specific symptoms), and assessment parameters are presented as tables. Material is presented so that clinicians will be able to anticipate the spread of these cancers and thus identify problems early in their development so that the problems are more easily managed.</abstract><relatedItem type="host"><titleInfo><title>American Journal of Hospice and Palliative Medicine</title></titleInfo><genre type="journal">journal</genre><identifier type="ISSN">1049-9091</identifier><identifier type="eISSN">1938-2715</identifier><identifier type="PublisherID">AJH</identifier><identifier type="PublisherID-hwp">spajh</identifier><part><date>1999</date><detail type="volume"><caption>vol.</caption><number>16</number></detail><detail type="issue"><caption>no.</caption><number>1</number></detail><extent unit="pages"><start>403</start><end>411</end></extent></part></relatedItem><identifier type="istex">48EE8D3371BBE6E7124F557826436DEA3FD3EED1</identifier><identifier type="DOI">10.1177/104990919901600111</identifier><identifier type="ArticleID">10.1177_104990919901600111</identifier><recordInfo><recordContentSource>SAGE</recordContentSource></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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