Handbook of Psychology

Cancer: A Basic Primer 269

survival rate was about 1 in 4. The “ve-year survival rate has
improved during the past 60
years„approximately 4 in 10
cancer patients are expected to be alive “ve years after they
are diagnosed. The “ve-year relative survival rate for all can-
cers combined is approximately 59%.

Staging Cancer

Staging is the process of de“ning the extent or seriousness of
a given cancer type, as well as a means to denote the degree
of spread of the cancer cells from the origin of site to other
parts of the body. The American Joint Commission on Cancer
developed a classi“cation system that incorporates three
related variables: T (tumor); N (nodes); and M (metastasis).
The T relates to the size of the primary tumor and whether it
has invaded nearby tissues and structures. The N involves
the degree to which lymph nodes have been affected by the
primary tumor. When there is lymph node involvement, this
means that the cancer has likely spread from the primary site
and is more likely to spread to other sites. Last, M refers to
whether the cancer has actually spread to other organs and
the degree to which it has metastasized.
Cancers are then classi“ed according to stages as a means
of determining how far a cancer has progressed and whether
and where it has spread. Labeled 0 to IV,there are “ve can-
cer stages. In addition, depending on the type of cancer,
stages are sometimes subdivided (e.g., IIA, IIB). The higher
the stage, the more advanced the cancer. Practically, a cancer
in the early stage will likely be small and con“ned to a pri-
mary site. Advanced-stage cancers will likely be large and
have spread to lymph nodes or other structures.

Cancer Treatment

Cancer treatment varies and includes surgery, radiation,
chemotherapy, immunotherapy, and bone marrow transplan-
tation. Any of these can be used as a primary treatment,
which is the major intervention for a particular cancer type.
Adjuvant therapy is given after the primary treatment has
been implemented as part of a comprehensive treatment pro-
tocol. For example, a woman may have surgery to remove a
breast tumor (primary treatment), followed by chemotherapy
(adjuvant therapy). Adjuvant therapy eliminates those cancer
cells not possible to remove during surgery. Neo-adjuvant
therapy occurs prior to the primary treatment in order to
control known or potential sites of metastasis. Prophylactic
treatment is targeted to a site where a high risk for cancer
development exists. For example, because small cell carci-
noma of the lung has a high propensity for metastasis to the

brain, prophylactic radiotherapy can be used to prevent such

metastasis.

Surgery

Surgery is the oldest and most common form of cancer treat-

ment, resulting in the removal of a primary tumor, the sur-

rounding tissue, and affected lymph nodes. Surgery is also

performed to remove tumors that are metastatic, recurrent,

or residual. Surgery can also be prophylactic, for example, a

woman who has had breast cancer may have her second

breast removed to reduce the risk of cancer recurrence.

Chemotherapy

This approach is used for the treatment of hematological

tumors and for solid tumors that have metastasized to other

areas. Chemotherapy is a systemic intervention that alters the

cancer cell life processes. The drug, or antineoplastic agent,

does not have the ability to select only the malignant cells,

however, so both normal and malignant cells are damaged.

Side effects occur from the damage to rapidly dividing cells.

Some agents damage other cells, such as renal cells, because

of the agents• biochemical effects.

Radiation

High-energy waves or particles during radiation damage the

DNA molecules in cancer cells, resulting in their eventual

death. Normal cells within the “eld of treatment are also

killed by radiation therapy which can lead to side effects.

However, normal cells have the capacity to repair themselves,

while the cancer cells do not. Side effects of radiation, unlike

chemotherapy, are accumulative. Acute effects occur within

the “rst six months of treatment. Chronic effects occur after

the “rst six months. Nausea, vomiting, diarrhea, hair loss, and

anemia can result from radiation therapy depending on the

site of the treatment. These side effects generally resolve after

the cells have had time to repair and resume normal function.

The most common side effect of radiation therapy is fatigue.

Long-term effects of radiation therapy are usually the result

of permanent cell damage in the area receiving the therapy.

Examples of chronic side effects are pulmonary pneumonitis,

“brosis (pulmonary and bladder), and sterility.

Immunotherapy

The use of biological response modi“ers (BRMs) to treat

cancer is a newer treatment that uses the individual•s own