Cancer Basics: From Cell Changes to Metastasis

Caitlin Hope

Welcome to the show! I'm Caitlin Hope with Professor Heather Murphy, and I wanna start with the most useful mental picture for cancer: one cell just... stops following the unit policy. It ignores the normal signals to grow, stop growing, and die off when it's supposed to.

Heather Murphy

A simple way to think about it is this: cell changes or damage can come from inherited traits, errors in cell division, or environmental factors.

Caitlin Hope

Right -- apoptosis is the word NCLEX loves. If a question says the cancer cell keeps reproducing instead of dying on schedule, that's your clue. And then these cells get extra rude and start making their own blood supply through angiogenesis, which is honestly such a wild concept.

Heather Murphy

That word, angiogenesis -- that's one I always want students to grab. New blood vessel growth. Because if the tumor can feed itself, it can keep expanding. Then we teach the progression: normal tissue, hyperplasia, dysplasia, carcinoma in situ.

Caitlin Hope

Let me do the quick bedside-teacher version. Hyperplasia: more cells, but they still LOOK normal. Dysplasia: abnormal cells show up. Carcinoma in situ: a group of abnormal cells stays in one location without spreading. That's the big divider -- still local, still contained.

Heather Murphy

Exactly. And once it breaks beyond that original spot, now we're talking invasive disease. Then metastasis means spread to distant areas. In the slides, they show a primary tumor with lung and liver metastases. Students mix up primary and secondary tumors all the time.

Caitlin Hope

Oh, constantly. So here's the correction I use with new nurses: the primary cancer is where it STARTED. Metastatic or secondary tumors are where it traveled. So if breast cancer spreads to bone, it's still breast cancer that metastasized to bone -- not magically bone cancer now.

Heather Murphy

That is such an NCLEX distinction. And naming helps. Cancers are often named by body part of origin -- breast, skin, lung -- or by cell type, like squamous cells or lymphocytes.

Caitlin Hope

So if a stem gives you squamous cell carcinoma of the lung, they're basically handing you both clues: cell type AND body site. I love that because once you see the pattern, different cancers stop feeling like random trivia cards.

Heather Murphy

Yes, they become organized. Then staging gives the next layer. TNM is the most commonly used system: T for size and extent of the primary tumor, N for nearby lymph nodes, M for metastasis. And stages run 0 through IV.

Caitlin Hope

Wait -- stage 0 is the one students should connect with in situ, right?

Heather Murphy

Exactly right. In situ means abnormal cells are only where they first formed. Then you may also hear localized, regional, and distant. Localized is one organ. Regional means spread to nearby lymph nodes, tissues, or organs. Distant means metastasized far away.

Caitlin Hope

And from a nursing brain, that matters because spread changes EVERYTHING -- symptoms, treatment intensity, safety risks, prognosis, teaching. It also changes how scared families are, if we're honest.

Heather Murphy

It does. Which is why I always tell students: before you memorize seven cancer types, understand the rule-breaking cell first. If you know how normal becomes abnormal, how local becomes invasive, and how invasive becomes metastatic, you've built the scaffold for the whole topic.

Heather Murphy

The most common cancers you’ll keep hearing about are breast, lung, prostate, colorectal, pancreatic, skin, and brain or CNS tumors.

Caitlin Hope

That repetition is actually comforting. Like, if you're studying and you keep seeing smoking pop up -- lung, pancreatic, colorectal, prostate risk too -- that's not accidental. Same with age. Prostate is a big one there: age 50 and older, average diagnosis around 67. The good news about prostate cancer is that it is slow to grow so it has a high survival rate.

Heather Murphy

And prostate is the number one listed cancer for males in the slides, while breast is number one for females. For breast cancer, risk factors include the genetic markers of BRCA1 and BRCA2 mutations, advanced age, family history, obesity, alcohol use, radiation exposure, dense breast tissue, and estrogen exposure such as early puberty, late menopause, or hormone replacement therapy.

Caitlin Hope

And the symptoms students need to spot for breast cancer are very visual and tactile: mass or lump, swelling, discharge, nipple retraction, skin changes, swollen lymph nodes. Yearly mammograms start at age 40. Sometimes a woman will need an ultrasound, MRI, or biopsy to further diagnose if the mammogram shows anything potentially abnormal. This can be scary for a woman, but it is important to detect and treat early.

Heather Murphy

Then there is lung cancer -- the huge risk factor is smoking, about 80%. Add radon gas, secondhand smoke, asbestos, radiation, air pollution, diesel exhaust, metals, chemicals. Hallmark findings: cough, hemoptysis (blood in the sputum), shortness of breath, fatigue, weight loss, chest pain, recurrent respiratory infections, wheezing, hoarse voice.

Caitlin Hope

Hemoptysis is one of those words that should make students sit up straighter. Blood or rust-colored sputum. That's not a casual detail. And lung screening gets interesting because low-dose CT is for high-risk patients, but a lot of lung cancers still get found late.

Heather Murphy

Right -- that's the tension. Early detection improves survival dramatically. The slide says overall five-year survival for lung cancer is 22%, but when diagnosed early, it jumps to 60%. Huge difference.

Caitlin Hope

Then colorectal: usually starts as polyps, and polyps bigger than 1 centimeter or having 3 or more raises risk. Symptoms are changes in bowel habits, blood in stool, rectal bleeding, anemia, abdominal discomfort, weight loss, fatigue.

Heather Murphy

You may hear different screening ages depending on the source, but the American Cancer Society now recommends colon cancer screening beginning at age 45. Then only every 10 years unless there is a risk. The big takeaway is that routine colorectal screening saves lives because the incidence drops with screening.

Caitlin Hope

Love that. Now pancreatic cancer is the one that breaks your heart a little. Risk factors include smoking, type 2 diabetes, pancreatitis, family history, genetic conditions, increased body weight, heavy alcohol use. But there is NO routine screening and it gets misdiagnosed a lot. This makes a pancreatic cancer diagnosis worrisome, because it is often caught after it has already metastasized.

Heather Murphy

And the survival statistic there is only 6%. That's the number I never forget. Symptoms are jaundice, itching, dark urine, light-colored stools, pain, anorexia, weight loss, nausea, vomiting.

Caitlin Hope

That combo -- jaundice plus dark urine plus pale stools -- screams bile flow problem around the pancreas. That's a really strong cue cluster. Let's talk more about skin cancer: UV radiation and tanning beds, family history, advanced age, moles, immunosuppression. First there is basal cell, which is the most common and also the one least likely to spread thank goodness. Usually it is just a quick bedside removal. The second type, squamous cell, is a little more serious, but when caught and removed early, the survival rate is high. Last but not least is melanoma. This is the least common but unfortunately the most serious because it tends to metastasize.

Heather Murphy

Getting annual skin screenings, even if you are not at risk is important for early skin cancer detection of any kind. In fact, in non-white clients, as many as 30% to 40% of skin cancer cases include lesions on the plantar surface of the foot. Students need to remember skin checks are not just for sun-exposed shoulders and noses.

Caitlin Hope

Check your feet -- literally. Last two: brain/CNS tumors can cause headaches, seizures, nausea, vomiting, visual changes, balance issues, behavioral changes. And unlike many others, primary brain tumors usually do not spread outside the brain. On the other hand, many brain tumors have originated or metastasized from other parts of the body, making it a secondary tumor. That's a sneaky distinction. So the big study move? Match risk factor, hallmark symptom, and screening clue. If you can do that, these cancers stop blurring together.

Caitlin Hope

Okay, bedside priorities. Across cancers, treatment buckets are surgery, radiation, chemotherapy, hormone therapy, targeted therapy, and biotherapy or immunotherapy. NCLEX usually isn't asking you to become an oncologist. It's asking: what can hurt this patient TODAY, and what should the nurse do first?

Heather Murphy

For example, if a breast cancer patient has radiation or brachytherapy which is internal radiation, consider how the skin and tissue around the breast may be impacted. Would we want our patient wearing an underwire bra? Probably not, because that could irritate the skin more. Think soft wireless bra is best.

Caitlin Hope

That little practical detail -- wireless bra -- is such a nurse answer. Then chemotherapy safety. If it's a single pill, wear chemo gloves. All other handling: chemo gown, double chemo gloves, face and eye protection, and respiratory protection if needed. Spills mean PPE and spill kit. Do not just wipe it up with a towel.

Heather Murphy

And extravasation is HIGH yield. Vesicant (highly toxic) medication leaks into tissue and causes severe damage. The slide says stop the medication, notify the provider, and there may be aspiration of remaining drug from the line. Students sometimes confuse that with simple infiltration.

Caitlin Hope

Let me try to say it back the quick way: infiltration is bad, extravasation is tissue-destroying bad. If chemo is involved and the site looks wrong, stop first. Don't keep infusing and hope for the best. That is never the answer.

Heather Murphy

Never. Then bloodwork concerns after chemo: thrombocytopenia and neutropenia. What is the difference? Thrombocytopenia means low platelets and bleeding risk. Think soft toothbrush, fall precautions, and avoid aspirin or ibuprofen. The patient may need a blood transfusion or corticosteroid, which can boost platelet counts. Neutropenia means low neutrophils which are part of the white blood cells, meaning the body will have trouble fighting off infections. This usually occurs 7 to 10 days after chemo, and infection risk skyrockets.

Caitlin Hope

And the interventions are classic NCLEX: remove fresh flowers, avoid raw foods, avoid sick visitors, and perform good handwashing. If I see neutropenia plus a fever, my internal alarm goes FULL volume.

Heather Murphy

Yes, there are a lot of complications that are associated with cancer. Pain, fatigue, peripheral neuropathy, GI effects like nausea, vomiting, diarrhea, anorexia, mouth sores, dehydration, and lymphedema. Lymphedema is swelling of the lymph nodes so the patient may state their arms or hands feel heavy and don't work quite the same as before. Cancer also brings psychosocial and financial stressors, and nurses cannot ignore that layer.

Caitlin Hope

Honestly, some of the best nursing isn't glamorous. It's noticing the mouth sores before the patient stops eating. Catching the new confusion before it becomes delirium. Seeing the bruising before the platelet count comes back ugly. And during advanced stage cancer, a patient may actually start getting confused and experience delirium, which can be difficult for family members.

Heather Murphy

Which brings us right into clinical judgment. Recognize cues, analyze cues, generate solutions, take action, evaluate outcomes. That is the exam framework, but it's also real practice.

Caitlin Hope

So final NCLEX mindset: assess FIRST. If the stem gives infection clues after chemo, think neutropenia. If it gives bleeding clues, think thrombocytopenia. If the patient on IV chemo has pain and swelling at the site, think extravasation. If the symptoms fit the organ -- like jaundice with pancreatic cancer or hemoptysis with lung cancer -- let the cancer type guide you.

Heather Murphy

And don't just memorize lists. Ask, what is this symptom telling me about the tumor, the treatment, or the blood counts? When students begin thinking that way, the questions get much less intimidating.

Caitlin Hope

Less intimidating is the dream. Thanks for hanging out with us, and next time you see a cancer question, don't panic -- just ask which rule the cell broke, and what danger that creates for the patient right now.