Lesson 2: Cancer

Basics

Module 3: The Basics of Health Care

Oncology Patient Navigator Training:
The Fundamentals
Acknowledgements
This work was supported by Cooperative Agreement #1U38DP004972-02 from the
Centers for Disease Control and Prevention. Its contents are solely the responsibility of
the authors and do not necessarily represent the official views of the Centers for Disease
Control and Prevention.

Portions of this lesson are adapted with permission from:

• The Patient Navigator Training Collaborative of the Colorado School of Public Health.
• The National Cancer Institute.
• The Institute for Integrative Oncology Navigation at Smith Center for Healing and the
Arts.

We would also like to thank:

• The American Society of Clinical Oncology for giving us permission to use their video.
• GetPalliativeCare.org for giving us permission to use their video.
Competencies
This lesson covers the following Core Competencies
for Patient Navigators:

2.2 Demonstrate familiarity with and know how to access and

reference evidence-based information regarding cancer
screening, diagnosis, treatment and survivorship.

2.3 Demonstrate basic knowledge of cancer, cancer treatment

and supportive care options, including risks and benefits of
clinical trials and integrative therapies.
Learning Objectives
• Demonstrate a basic understanding of cancer
• Demonstrate a basic understanding of cancer
screening and testing to detect cancer
• Summarize basic cancer treatment options
• Identify supportive care services and options
that are generally available
• Identify and use professional resources
Checkpoint

What is cancer?
a) Foreign cells
b) Uncontrolled cell growth
c) Interacting cells
d) Lack of cells
What is Cancer?

Click here to watch the video

Sources: American Society of Clinical Oncology, 2012; American Cancer Society, 2015.
Normal Cells versus Cancer Cells

Source: National Cancer Institute,2014

Benign versus Malignant Tumors

Benign Malignant
• Non-cancerous • Cancerous
• Do not grow • Invade tissue
into other or spread
tissue
Source: National Cancer Institute – What is Cancer. 2015.
Different Kinds of Cancer
• Start in the cells that cover external and internal
Carcinomas organs or glands

• Start in cells in the supporting tissues of the body,

Sarcomas such as bone, cartilage, fat, connective tissue, and
muscle

• Start in the lymph nodes and tissues of the body’s

Lymphomas immune system

• Start in the immature blood cells that grow in the

Leukemias bone marrow

Source: National Cancer Institute – What is Cancer. 2015.

How are cancers named?
adeno- • gland

chondro- • cartilage

erythro- • red blood cell

hemangio- • blood vessels

hepato- • liver

lipo- • fat

lympho- • lymphocyte

melano- • pigment cell

myelo- • bone marrow

myo- • muscle

osteo- • Bone
Source: National Cancer Institute, 2009
Invasion and Metastasis

Source: National Cancer Institute, 2014

Checkpoint

What factors may increase risk for cancer?

a) Tobacco
b) Diet
c) Alcohol
d) Physical Activity
e) Obesity
f) All of the above Source: National Cancer Institute, 2014.
Cancer Prevention
Americans can prevent 1/3 of the most common
cancers.

• Staying lean
• Eating smart Preventable
Cancers
• Moving more

1/3 of breast cancers

1/2 of colorectal cancers
2/3 of esophageal cancers
Source: American Institute for Cancer Research. 2015.
Cancer Risk Factors
• Some infections
• Immunosuppressive medicine
• Radiation
• Inherited genes
Lynch
BRCA 1 BRCA 2
Syndrome
Sources: National Cancer Institute, 2014; National Cancer Institute, 2015;
American Society of Clinical Oncology, 2014; National Cancer Institute, 2013.
Cancer Prevention
Although there is no way to completely prevent a diagnosis of
cancer, health behaviors can reduce the risk for cancer.

Avoid Excessive Consume Fruits

Avoid Tobacco
Sun Exposure and Vegetables

Avoid Cancer Exercise

Limit Alcohol
Viruses regularly

Avoid Exposure Get screening

to Carcinogens tests and go to
at Work check-ups
Source: National Cancer Institute – Understanding Cancer Series, 2009
Signs and Symptoms
Someone with cancer may have general symptoms
such as unexplained weight loss; fever; fatigue,
which is extreme tiredness; pain; or changes in the
skin or eyes. They may also have symptoms that
vary and are related to the type of cancer they
have. Always refer patients to a clinician or the
health care team if asked to explain symptoms or
diagnosis.
Source: National Cancer Institute – Understanding Cancer Series, 2009
Early Cancer May Not Have Any
Symptoms
Some patients may visit the doctor only when
they feel pain or when they notice changes like a
lump in the breast or unusual bleeding or
discharge. However, early cancer may not have
any symptoms, which is why routine screenings
and doctor’s visits are so vital for early detection.
Cancer Detection and Diagnosis
• Cancer can be diagnosed with biopsies, blood tests,
urine tests, colonoscopies or sigmoidoscopies, x-
rays, ultrasounds, bone scans, CT scans, MRI’s
and/or surgery.
• When cancer is found, a doctor will determine what
type it is and how fast it is growing.
• In some cases, finding cancer early may decrease a
person’s risk of dying from the cancer. For this
reason, improving our methods for early detection is
currently a high priority.
Source: National Cancer Institute – Understanding Cancer Series, 2009
Screening
U.S. Preventive Services Task Force (USPSTF)
American Cancer Society (ACS)
American College of Obstetricians and Gynecologists (A
COG)

Screening is critical for early detection of:

Cervical cancer Colorectal cancer
Breast cancer Lung Cancer
Prostate cancer
Source: National Cancer Institute – Understanding Cancer Series, 2009
Cervical Cancer Screening

Source: National Cancer Institute, 2009

Breast Cancer Screening

Source: National Cancer Institute—Mammograms. 2014

Prostate Cancer

Source: National Cancer Institute – Alan Hoofring (Illustrator). N.d.

Colorectal Cancer Screening
Fecal occult blood test (FOBT)
• Detects small amounts of blood in stool

Sigmoidoscopy
• Uses lighted instrument in rectum and lower colon

Colonoscopy
• Uses lighted instrument in colon, including upper
colon Source: National Cancer Institute – Tests to Detect Colorectal
Cancer and Polyps. 2014
Lung Cancer Screening

Source: US Preventive Services Task Force. 2013

Biopsy

Source: National Cancer Institute, 2010

Microscopic Appearance of Cancer
Cells
Normal connective tissue Cancerous connective tissue

Source: National Cancer Institute – Dr. Cecil Fox (Photographer)

Tumor Grading
General Relationship Between
Tumor Grade and Prognosis
100%

Low grade
Patient
Survival
Rate
High grade

1 2 3 4 5
Years
Source: National Cancer Institute – Understanding Cancer Series, 2009
Cancer Staging
• Is helpful to a doctor when planning the appropriate treatment

• Is used when estimating a person’s chance of recovery

• Can aid in identifying appropriate clinical trials that are

suitable for a patient

• Is used to help care providers exchange information about a

patient and any results of clinical trials

Source: National Cancer Institute – Understanding Cancer Series, 2009

TNM Staging System
T N M
Amount of tumor Lymph nodes Metastasis (spread)
• TX: Tumor cannot • NX: Lymph nodes • MX: Metastasis
be evaluated cannot be cannot be
• T0: No evidence evaluated evaluated
of tumor • N0: No lymph • M0: No
• Tis: Carcinoma in node involvement metastasis
situ • N1-N3: Degree of • M1: Metastasis is
• T1-T4: regional lymph present
Size/extent of node involvement
tumor

Source: National Cancer Institute – Cancer Staging, 2015

TNM Staging System
Stage 0 • Carcinoma in situ
• Higher numbers mean the
Stage I,
disease is more extensive,
Stage II,
such as larger tumor size
Stage III
and/or spread
• Spread to distant
Stage IV
tissues/organs
Source: National Cancer Institute – Cancer Staging, 2015
Personalized Medicine

Source: American Society of Clinical Oncology – What is

Personalized Cancer Medicine? 2015
How are genetic tests used?
• Gene mutations play a role in the development
of all cancers
• In some cases, inherited mutations may play a
major role

Source: National Cancer Institute – Daniel Sone

(Photographer)
Cancer treatment

Now that we’ve talked about how cancer is

prevented, found and diagnosed, let’s talk
about how cancer is treated.
Cancer Treatment
Depends on cancer type and stage
• Surgery
• Radiation
• Chemotherapy
• Targeted therapy
• Palliative treatment
Source: National Cancer Institute – Understanding Cancer Series, 2009
Surgery and Radiation

• Surgery
• Radiation
Possible side effects include:
• swelling
• skin changes
• fatigue

Source: National Cancer Institute – Understanding Cancer Series, 2009

Chemotherapy

Possible side effects:

• Fatigue
• Nausea
• Vomiting
• Hair Loss
• Mouth sores
• Pain Source: National Cancer Institute – Understanding Cancer Series, 2009
Neo-adjuvant and Adjuvant Treatment
Neo-adjuvant Adjuvant
(Given before) (Given after)

Chemotherapy Chemotherapy
Radiation therapy Radiation therapy
Hormone therapy Hormone therapy
Targeted therapy
Biological therapy
Source: National Cancer Institute – Understanding Cancer Series, 2009
Targeted Therapy
• “Molecularly targeted drugs” or “precision
medicines”
• Tumor tissue is tested
• Different from standard chemotherapy
• Some types of targeted therapies:
- Hormone therapy, angiogenesis inhibitors,
immunotherapies, monoclonal antibodies
Source: National Cancer Institute – Targeted Cancer Therapies. 2013
Hormone Therapy
Drugs given to block the body’s natural
hormones to slow or stop the growth of cancer

Breast Prostate
cancer cancer
Side effects depend on the drug used
Sources: National Cancer Institute – Hormone Therapy for Breast Cancer,
2012; National Cancer Institute – Hormone Therapy for Prostate Cancer, 2014
Palliative Medicine

Click here to watch the video Source: GetPalliativeCare.org

Supportive Care Services
Psychosocial support services

Rehabilitation
• Lymphedema therapy
• Physical therapy
• Occupational therapy
• Speech therapy
Spiritual support/chaplaincy services

Hospice
Sources: Smith Center for Healing and the Arts, 2014;
Silver, 2013; LIVESTRONG. 2015
Complementary and Alternative Medicine

“A group of diverse medical and health care

systems, practices and products that are not
generally considered to be part of the
conventional medicine.”

Sources: Smith Center for Healing and the Arts, 2014; National Center for
Complimentary and Alternative Medicine, 2013
Comparing Complementary and
Alternative Medicine
Complementary Alternative
Used together with conventional Used in place of
medicine conventional medicine
Example: Using acupuncture for Example: Using traditional
pain management, while also using medicine from other cultures
medications and physical therapy. to treat cancer instead of
chemotherapy, radiation or
surgery recommended by a
medical doctor
Sources: Smith Center for Healing and the Arts, 2014; National
Center for Complimentary and Alternative Medicine, 2013
Complementary Health Approaches
• Nutrition
• Supplements
• Meditation
• Chiropractic
• Acupuncture
• Massage
Sources: Smith Center for Healing and the Arts, 2014; National
Center for Complimentary and Alternative Medicine, 2013
Possible Benefits of Complementary
Approaches
Improve response to standard medical treatment

Manage side effects of cancer treatment

Prevent or manage cancer symptoms

Improve survival

Enhance a sense of well-being and quality of life

Source: Smith Center for Healing and the Arts, 2014

Possible Risks of Complementary
Approaches

• Few studies on safety and effectiveness

• No approaches work beyond a shadow of doubt
• Can harm patients
• Can interfere with drugs

Source: Office of Women’s Health, n.d.

Evidence-based Cancer Information
American Cancer Society
• cancer.org

American Society of Clinical Oncology

• cancer.net

Centers for Disease Control and Prevention

• cdc.gov

LIVESTRONG
• livestrong.org

National Cancer Institute

• cancer.gov

U.S. Preventive Services Task Force

• http://www.uspreventiveservicestaskforce.org
Conclusion
• Demonstrate a basic understanding of cancer
• Demonstrate a basic understanding of cancer screening
and testing to detect cancer
• Summarize basic cancer treatment options
• Identify supportive care services and options that are
generally available
• Identify and use professional resources
References
• American Cancer Society (n.d.). Cancer screening guidelines. https://www.cancer.org/healthy/find-cancer-early/cancer-
screening-guidelines.html
• American Cancer Society. What Is Cancer? (2015). http://www.cancer.org/cancer/cancerbasics/what ‐is ‐cancer.
• The American College of Obstetricians and Gynecologists. (n.d.). Cancer screening guidelines.
https://www.acog.org/search#q=cancer%20screening%20guidelines&sort=relevancy
• American Institute for Cancer Research. (2015). How many? Americans can prevent 1/3 of the most common cancers.
http://www.aicr.org/learn‐more‐about ‐ cancer/infographics ‐cancer ‐preventability.html.
• American Society of Clinical Oncology. (n.d.). Guidelines, tools, & resources. https://www.asco.org/research-guidelines/quality-
guidelines/guidelines
• American Society of Clinical Oncology. (2012). What is cancer? http:// http://www.cancer.net/navigating-cancer-care/cancer-
basics/what-cancer (Video link)
• BioDigital. (2008). 3D Medical animation‐what is cancer? [Video file]. http://www.cancer.net/navigating ‐cancer ‐care/cancer ‐
basics/what‐cancer.
• Cancer.Net. (2014). Lynch syndrome. http://www.cancer.net/cancer‐ types/lynch ‐syndrome.
• Cancer.Net. (2015). What is personalized cancer medicine?
http://www.cancer.net/navigating‐cancer ‐care/how‐cancer ‐treated/personalized ‐and ‐targeted ‐therapies/what ‐personalized ‐
cancer‐medicine.
• Center to Advance Palliative Care. (2014). David’s Palliative Care Story [Video file]. http://getpalliativecare.org/videos ‐podcasts ‐
livechats/. LIVESTRONG Foundation.
• LIVESTRONG Foundation. Rehabilitation after cancer. (2015). http://www.livestrong.org/we‐can‐help/healthy ‐living ‐after ‐
treatment/rehabilitation‐after‐ cancer/.
References (cont.)
• Medical News Today. (2015). The numbers are in: As many as 2 in 3 smokers will die from their habit.
http://www.medicalnewstoday.com/releases/289925.php?tw.
• MedicineNet.com. (2014). Cancer causes: Poor diet, lack of physical activity or being overweight.
http://www.medicinenet.com/cancer_causes/page7.htm.
• National Cancer Institute. (2014). BRCA1 & BRCA2: Cancer risk & genetic testing.
http://www.cancer.gov/cancertopics/genetics/brca ‐fact ‐sheet.
• National Cancer Institute. (2015). Cancer causes and risk factors. http://www.cancer.gov/cancertopics/causes.
• National Cancer Institute. (2014). Cancer prevention overview PDQ ®.
http://www.cancer.gov/cancertopics/pdq/prevention/overview/patient/page3.
• National Cancer Institute. (2015). Cancer staging. http://www.cancer.gov/cancertopics/factsheet/detection/staging.
• National Cancer Institute. (2013). Genetic testing for hereditary cancer syndromes.
http://www.cancer.gov/cancertopics/genetics/genetic ‐testing ‐fact ‐sheet
• National Cancer Institute. (2012). Hormone therapy for breast cancer. http://www.cancer.gov/cancertopics/types/breast/breast‐
hormone‐therapy‐fact‐sheet.
• National Cancer Institute. (2014). Hormone therapy for prostate cancer.
http://www.cancer.gov/cancertopics/types/prostate/prostate ‐hormone ‐therapy ‐fact ‐sheet.
• National Cancer Institute. (2014). Mammograms. http://www.cancer.gov/cancertopics/factsheet/Detection/mammograms.
• National Cancer Institute. (2014). Targeted cancer therapies. http://www.cancer.gov/cancertopics/treatment/types/targeted‐
therapies/targeted‐therapies‐ fact‐sheet.
References (cont.)
• National Cancer Institute. (2014). Tests to detect colorectal cancer and polyps.
http://www.cancer.gov/cancertopics/factsheet/Detection/colorectal ‐screening.
• National Cancer Institute. (2009). Understanding cancer series. https://www.cancer.gov/about-cancer/understanding.
• National Cancer Institute. (2015). What is cancer? Retrieved from: http://www.cancer.gov/cancertopics/what ‐is ‐cancer.
• National Center for Complementary and Integrative Health. (2014). Are you considering a complementary health approach?
Retrieved from: https://nccih.nih.gov/health/decisions/consideringcam.htm.
• National Comprehensive Cancer Network. (n.d.). NCCN guidelines and clinical resources. Retrieved from:
https://www.nccn.org/professionals/physician_gls/default.aspx#site
• Office of Women’s Health. (n.d.). Complementary and alternative medicine. Retrieved from:
http://www.womenshealth.gov/publications/our ‐publications/the ‐healthy ‐ woman/alternative_medicine.pdf.
• Silver, J.K., Baima, J., & Mayer, R.S. (2013). Impairment ‐driven cancer rehabilitation: An essential component of quality care
and survivorship. CA: A Cancer Journal for Clinicians, 63(5), 295–317. doi: 10.3322/caac.21186.
• U.S. Preventive Services Task Force. (2013). Lung cancer screening: recommendation summary. Retrieved from:
http://www.uspreventiveservicestaskforce.org/Page/Topic/recommendation ‐ summary/lung ‐cancer ‐screening.
• U.S. Preventive Services Task Force. (n.d.). Recommendation tools – A and B recommendations.
• https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-and-b-recommendations#:~:text=The
%20USPSTF%20recommends%20offering%20or,healthy%20diet%20and%20physical%20activity.&text=The%20USPSTF
%20recommends%20screening%20for%20hepatitis%20B%20virus%20(HBV)%20infection,at%20increased%20risk%20for
%20infection.
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