Category: Cancer

Abstract

The article explored the psychological stress experienced by mothers who have cancerous children. The author proposed that support groups are advantageous in stress reduction among mothers of cancerous children. The author did an experimental research to establish his findings. The research is current and relevant to contemporary health issues. The sample size was somewhat small to come up with results that could be generalized. However, the findings can be used in practice in that mothers of cancerous children can be encouraged to join social support groups to cope with stress.

Introduction

The article titled, Informal Social Support: A Collaborative Stress Management Initiative for Mothers of Cancer Children researched on how cancer in children affects the psychological health of their mothers. The author based his research on the fact that few research initiatives have been carried out to establish the problems a mother faces when her child has been diagnosed with cancer. The research seeks to determine how a mother is impacted and the strategies that can be employed to assist the mother and help her cope.

Overview of the research

The author supported his research by suggesting a new initiative that involves social support to help the mother. Being informal, the support is initiated by clinical staff in hospitals. Thus, the process should begin prior to the childs diagnosis so that appropriate support is established once the family is aware of the childs condition. Thus, Al-Momani used various survey strategies to collect decisive information to inform his research. Nursing students and health care workers were used during the research to determine the effectiveness of these strategies (Al-Momani, 2013).

Initial objectives/Hypotheses and results

Al-Momanis initial objective was to come up with the best strategies to deal with stress in mothers of terminally ill children. It was hypothesized that having a social support group is advantageous in stress reduction among mothers. Stress is seen as a situation that can impact negatively on a persons health (Langeveld, 2009). It becomes hard for the family, especially the mother, to handle the news of a child diagnosed with cancer. Such mothers are easily stressed because treatment of the condition in many cases involves the mother and the child.

The mother is significantly affected by the childs cancerous condition since such a condition is unique, especially in cases where no family member has suffered from cancer before (Eiser, 2004). When a child has cancer, the mother is involved during treatment and caring for the child. Cancer has been portrayed as a dangerous disease through the media, thus many people are aware that it can cause death. This increases the stress on the mother. Some mothers might even go as far as thinking that their child will die sooner when cancer is diagnosed. This makes them more fearful, leading to increased stress levels and negative impact on the mothers health. Such mothers can go as far as choosing to stay with the child at all times and refuse to interact with anyone close to them (Svavarsdottir & Sigurdardottir, 2013).

Prior research conducted has shown that both parents are affected by such diagnosis, with reported traumatic stress symptoms. The symptoms are characterized by avoidance, intrusive thoughts, and physiologic arousal. Thus, various stress reactions, including uncertainty, depression and anxiety, are witnessed in the parent. These symptoms mostly arise after the childs diagnosis, but they decrease over time. This is dependent on the severity of the cancer. The parents exhibit stress reactions for a longer duration if the cancer is severe (Al-Momani, 2013).

Research Methods

Literature review

The author was able to provide a detailed literature review. Al-Momani based his research on the observations of professionals within the medical field who were exposed to mothers with terminally ill children. The literature review provided definitions of various terms that the author intended to use in his research and explanations of various occurrences in hospitals and homes as observed by professionals.

Various academic sources were reviewed by the researcher in the course of trying to show their application in the research initiative and identifying the research gap. Many authors have already researched on the effect of cancer diagnoses on the child, but the mother has been ignored in many cases. This should not happen because the mother is always affected by the diagnosis. For instance, the author details a situation where mothers admitted to hospitals with their children spend most of the time crying. They become stressed because of their childs condition. The child also becomes harder to treat as they become sad and cry when they realize that their mother is crying. Thus, both the mother and the child play an important role in ensuring that the sick child is treated effectively.

How current and relevant is the study?

The research is current and relevant to todays existing health issues. Cases of childhood cancer are on the increase. The childs family is highly affected and not the child alone. In any case, the mother is more informed about what the child suffers from in comparison to the child. Thus, the child may not feel scared about the consequences of their ailment, but the mother is left to suffer as she develops stress and becomes pitiful of their childs health. Many research findings have suggested social support for the sick individual. Many of the studies have not considered the needs of the mother (Svavarsdottir & Sigurdardottir, 2013), thus Al-Momani came up with a research finding that is current and applicable.

Research type: Experimental

The specific objective of the research was to find the extent to which informal social support groups can be of assistance in dealing with stress among mothers of cancerous children. The research utilized an experimental design whereby mothers were surveyed on the impact of informal social groups. This group comprised of nursing students and health workers within a hospital. The survey was conducted to determine how much the mothers were helped and whether it led to a reduction in their stress levels. An experimental and a control group were used to ensure that the results were accurate and applicable. The researcher conducted a survey to determine the stress levels of mothers before the initiative to establish the definite changes that occurred due to the initiative (Al-Momani, 2013).

Sample size

The sample size of the research comprised of all mothers of cancerous children. The researcher established a requirement that all the mothers were to be fluent and able to read and write. Moreover, the child should have been admitted to the hospital within the last 24 hours after they were diagnosed with cancer. The author used convenience sampling to obtain an appropriate number of mothers to participate in the research. Mothers who agreed to participate, but did not want to commit to the initiative were considered as the control group. The research involved 120 mothers, with 80 agreeing to participate. An exclusion criterion was then used to establish an equal number for both control and experimental groups. This involved variables like whether a mother had undergone psychological support prior to the diagnosis, literacy levels, and whether they worked as health care professionals (Al-Momani, 2013). This strategy was able to establish a research group without bias.

Practicality of the research

The results obtained from the research are practical in real life situations. From the results, it was established that a higher percentage of mothers were satisfied by the initiative. Overall, 80% of mothers in the experimentation group regarded informal social support as helpful in the reduction of stress levels. Many of the mothers realized that their stress levels reduced significantly and it was easier to cope after the initiative. The author suggested that health professionals should take part in various strategies to help mothers of terminally ill children. Establishing support groups within hospitals is one of the most effective strategies that can help mothers discuss their problems. The mother and medical professionals, like nurses, provide a vital avenue for stress reduction and insight for the mothers. For instance, nursing students can be involved with caring for the child as the mother goes home or takes the time off from caring for their ill child.

Personally, I think the best application of the research results should involve the family as well. The entire extended family should be there to provide emotional and moral support. The child also feels motivated when there is moral support from the family. Thus, it becomes easier for the child to undergo a treatment regime.

Suggested Improvements

The research could have been improved if it considered a larger sample size. Having a larger sample size would facilitate valid generalizations that are easily applicable. The collection of samples depending on convenience and self-reports was also a weakness of the researchers methods of data collection. Thus, the author would have collected information that could lead to better generalizations if a larger sample size was considered and use questionnaires to collect data in place of self-reports.

Is the writing straightforward?

The writing used in the article is straightforward. The author was able to detail the methods he used to collect data and the resulting conclusions. Moreover, the author minimized the use of technical terms, thus it was easy to read and understand the article.

Suggestions for further research

Further research should be conducted because various factors within the hospital environment can be sources of stress. For instance, certain information about the childs diagnosis should not be revealed to the mother. The procedures might be frightening, and this can easily lead to increased stress levels.

Conclusion

The research was able to show the various strategies that can be used to reduce stress amongst mothers with children suffering from cancer. The researcher was able to detail the various problems that mothers of cancerous children face in reality, yet they have been overlooked. Mothers are easily impacted by the health of their children, thus knowledge that a child is suffering from cancer can be a major cause of stress. It is, therefore, important to establish mechanisms within hospitals to take care of both the mother and the child. The mothers stress levels and psychological wellbeing should also be addressed to ensure that she is not affected negatively by the childs health condition.

References

Al-Momani, S. M. (2013). Informal social support: a collaborative stress management initiative for mothers of cancer children. International Journal of Psychological Studies, 5(2), 19-31.

Eiser, C. (2004). Children with cancer: the quality of life. New York, NY: Routledge.

Langeveld, N. (2009). Cured of cancer : from childhood to adulthood quality of survival. Amsterdam: Amsterdam University Press.

Svavarsdottir, E. K., & Sigurdardottir, A. O. (2013). Benefits of a brief therapeutic conversation intervention for families of children and adolescents in active cancer treatment. Clinical Journal of Oncology Nursing, 40(5), E346-E357.

Introduction

Since recently, alternative and complementary therapies have been making their way into medical science. The present article reports on one of many research studies that aim to contribute to the body of knowledge regarding complementary therapy for patients with cancer. Specifically, the authors focused on photographic art therapy, its impact on cancer patients, and their preferences with regards to photography viewing. The findings suggest that viewing photographic art is enjoyable for the majority of patients and that most of the preference for a certain category of photographs is driven by their psychophysical and psychological features, as well as the patients individual differences and their mood. The purpose of the present paper is to review the article, comment on the authors methods and findings, and evaluate the impact of this study on nursing practice.

Research Question

The study addressed several research questions. However, the main question was What category of photographs do cancer patients prefer in particular? (Hanson, Schroeter, Hanson, Asmus, & Grossman, 2013). The question is rather specific and implies the need to identify a particular category of pictures that would be appealing to the vast majority of patients. Other research questions addressed general attitudes to photographs, rejected picture categories, and preferred delivery formats. Therefore, research questions set by the study largely shape its application to nursing practice, as the results can be used to support decoration choices in nursing homes and hospitals for cancer patients.

Research Design

The authors used a quantitative design, focusing on a single group of participants in an attempt to explore and describe their attitudes to photography viewing. The choice of design somewhat contrasts the aims of the study, as a quantitative design does not allow for investigating individual opinions and experiences in depth (Parahoo, 2014). This is the key weakness of quantitative research design. Also, quantitative research requires a large sample of participants and is thus more difficult to implement. However, it also has some benefits. Firstly, the results of qualitative research can be generalized to other populations, as they include statistical data and the sample is usually quite large, which is probably the main reason as to why the authors used this design in the study(Parahoo, 2014). Moreover, quantitative research presents a lower risk of bias because quantitative data is objective and can be verified (Parahoo, 2014). Nevertheless, despite the strengths of the chosen research design, a qualitative design would be more appropriate to review the participants experiences and attitudes.

Sample Description

The sample included 44 men and 36 women aged between 19 and 85 years old who have been diagnosed with cancer and hospitalized for treatment. The total sample size is 80, which is too small for the study. First of all, it would not allow generalizing results to other populations. Secondly, it might not be enough to determine statistically significant trends and correlations. Another possible gap of the chosen sample is that it included participants of all ages. As age can impact peoples attitudes to art, it would be useful to focus on a particular age group in the study.

Data Collection

The study was collected using a computerized online survey tool, which included the Visual Arts Research Survey. Data collectors included RNs who worked in a different unit of the hospital. The authors of the study addressed some ethical considerations, including patients privacy, confidentiality, and informed consent. There were no significant gaps in the process of data collection.

Limitations

The study had several significant limitations. First of all, the research design chosen by the authors was inconsistent with the goals of the study. The authors attempted to address patients experiences with and attitudes to art in order to enable health professionals to make informed decisions about complementary therapy. Nevertheless, quantitative research design does not provide sufficient insight into the participants views, thus limiting the possibility of addressing all of the research questions. Besides, the choice of data collection tool was also a major limitation. The online survey produced by the researchers was rather small and did not allow the participants to leave comments or clarifications about their answers. Overall, a mixed-method study using a combination of surveys and interviews for data collection would be a more appropriate option for this research. Where surveys and quantitative analysis would provide sufficient scope, qualitative data would offer insight into the participants experiences, which were the primary focus of the research.

Another significant limitation was the chosen sample and its structure. Firstly, the authors recruited participants from one hospital, which limited the size of the sample. As noted by Parahoo (2014), the goal of quantitative research is to allow for the generalization of results. With a sample size of 80 persons who were all recruited from a single facility, the research fails to provide sufficient scope to generalize results to other populations. This limits the possibility of applying the study to practice, as the results could be different from the present research. Secondly, the authors included patients from all age groups, which affected the validity of the results. Age is an essential factor that influences our attitudes to art, which is why it was crucial to control for age differences when analyzing responses.

The third limitation of the study is the written report produced by the authors. Although it appears to be fairly structured and comprehensive, the sections devoted to theoretical framework and discussion of results are rather concise, which impairs the analysis of results and their presentation. Including more information about past research on the topic, as well as discussing the results and their meaning to cancer care in detail, would strengthen the article and improve its value for contemporary nursing practice.

Findings of the Study

As a result of data analysis, the authors found that 96% of the participants enjoyed viewing the photographs (Hanson et al., 2013). The most popular category of photos was landscape (28%), followed by animals (15%) and people (14%). The authors also noted the influence of individual character differences and mood on the patients attitudes to pictures. Overall, the findings respond to all of the research questions identified in the study. However, they fail to offer enough depth and cannot be generalized to other populations. The credibility of the findings is mediocre. Although the researchers used quantitative data, which is considered to be rather reliable, they fail to address several significant concerns, which affects the credibility of the study.

Summary and Conclusions

All in all, the present study fits into the recent trend of exploring alternative and complementary therapies. The study attempted to raise vital questions and could be applied to nursing practice if carried out properly. In particular, the authors addressed the question of What category of photographs do cancer patients prefer in particular? and found that landscape photographs were the most appealing to the participants. However, there are significant concerns associated with the design of the study that affects its credibility and makes it impossible to generalize the findings to other populations. The results of the study serve to answer the research questions specified by researchers but do not offer enough depth or insight into the issue. Although the study cannot be used in practice due to design failures, it is possible to apply it to guide future research, aimed at achieving a deeper understanding of the topic.

References

Hanson, H., Schroeter, K., Hanson, A., Asmus, K., & Grossman, A. (2013). Preferences for photographic art among hospitalized patients with cancer. Oncology Nursing Forum, 40(4), 337-345.

Parahoo, K. (2014). Nursing research: Principles, process and issues. (3rd ed.). London, UK: Palgrave Macmillan.

Abstract

This section of the research drive presents a synthesis of the consulted literature on the subjects of the relationship between Type C personality and the cancer risk factor. The presentation comes in the background of a protracted focus on the Type A and Type B person types researches while contemporary researches have presented crucial findings on the dynamics of Type C personality in relation to risk of cancer. This has laid critical implications and imperatives for medical and health practitioners who are subsequently prompted by empirical research findings to consider feasible ways of dealing with persons diagnosed with cancer in relation to their personality types. The paper thus entails an outline of the merits of Cognitive Behavioral therapy and Ego-Oriented intervention theories for special groups of people such as cancer victims.

Introduction

Contemporary researches in human anatomy and have presented emergent nuances and insights on the close relations between personality a type and the cancer risk factor. Many researches in the nursing and health scientific bodies have been focused almost exclusively on the Type A and B personalities. Recent research endeavors have unearthed the dynamics of Type C (wherein C stands for Cancer) personality with the high-risk factor. The paper seeks to zero in on the actual scientific relationship between the features o the personality classified as C and the aspects of gene and hormonal activity that leads to the build-up of cancer cells. The key conceptual framework will be characterised by the established scientific realities that type C personalities are more given to negative and detrimental negative emotions that lead to suppression and enervation of the functionalities of the immune system which is designed to fight and eliminate the generation and proliferation of cancer cells.

Clinical Question

In the scientific c framework which constitutes facts on the characteristics of Type personalities, the emerging clinical question is, how are Type C personalities more vulnerable to the risk of cancer with special attention to the relationship between the characteristics of the Type C persons and the, their emotional disposition and its impact on their immune system.

Synthesis of literature

This research exercise is not being conducted in a vacuum. The research exercise fits into a broad body of knowledge that has had numerous contributions from various scholars, empirical researchers, professionals and students who have carried similar or related research exercises. Also, the scope and objectives of this research endeavor occur within related and implied theoretical and scientific frameworks which are closely tied to the focus areas of the study in the domains of Cancer and personality types in relation to cancer risk factors. As such the researcher is spurred to consider the multiple contributions relevant and related to this research endeavor. The researcher will present a literature review conducted in locating the object of this study within the broader confines of the bodies of knowledge in focus.

Specific publications have been conducted on cancer-related subjects closely linked to the scope and objectives of this research endeavor. An overview of the Cancer and Abnormal Breast Cancer Genes will be valuable in the probe of the notions of type C personality as a risk factor for cancer. The following captures current knowledge contributions made on cancer and abnormal breasts cancer genes in relation to the type C personality variable. The detailing provides a knowledge foundational background germane for charting new avenues of further researches around the scientific dynamics of cancers and their risk factor s particularly related to personality.

Contemporary bodies of abnormal genes research knowledge hold that many cases of hereditary breast cancer are relatable to two genes which are the breast cancer gene one (BRCA1) and breast cancer gene two (BRCA2). BRCA1 has been classified as a human gene. Particular mutations of the human gene have been linked with the phenomenal surge in the vulnerability to breast cancer and other forms of cancer as well. BRCA1 is also categorised as a tumor suppressor gene. Aparicio S, (2000) notes that the nature of mutations of particulate genes is closely related to the variable of personality types. The researcher has linked particulate mutations and their characteristics to the findings on personality Type C and its close relations to the risk of cancer.

Tumor suppressor genes which are also known as antioncogene are the kind of genes that safeguard a cell from a single stride on the development towards cancer. Aparicio S. (2000) outlines that, The BRCA1 tumor suppressors keep genomic veracity as a way of averting wanton proliferation. The mutation of the tumor suppressor gene leads to the loss or diminishing of its functionalities which in turn can plunge the cell into cancer. Crollius, H. R (2000) underscores in light of research findings around the dynamics of BRCA1 tumor suppressors, it vital for especially Type C persons to ensure that their immune system is not suppressed as this will hinder the work of the body mechanisms devised for the fighting and elimination of cancer cells.

Pennisi, E. (2003) unveils that The initial tumor suppressor discovered was the Retinoblastoma protein (pRb) in human retinoblastoma nonetheless there is overwhelming evidence that can be used to place pRb in tumor survival dynamic classifications. BRCA1 and BRCA2 irregularities especially in Type C persons precipitate cancer inflections and studies have also shown that such genetic deformities expose women to ovarian cancer.

From another angle, there have been contributions on the links between personality type and the cancer risk in close analysis of the dynamics of the BRCA2 human gene. BRCA2 is another human gene responsible for the mend of chromosomal harm. The gene is classified together with BRCA1 under tumor suppressor genes. This type of gene is responsible for the moderation of the cycle of cell proliferation by a way of arresting cell growth and division and ensuring that cell growth, as well as division, obtains in a controlled and regulated manner. Briggs, H. (2001) points out that The BRCA2 gene resides on the long (q) wing of chromosome 13 at point 12.3 (13q12.3), from base pair 31,787,616 to base-pair 31,871,804. On other hand, Briggs (Opcit) points out that, The BRCA1 gene resides on the long (q) wing of chromosome 17 at band 21, from base pair 38,449,843 to base-pair 38,530,933. The BRCA1 gene (IPR011364) constitutes Zinc finger, C3HC4 type (RING finger) Pfam PF00097 and BRCA1 C Terminus (BRCT) domain Pfam PF00533. Liang F et al. (2000) point that The gene also holds nuclear localisation signal and nuclear export signal themes. There are striking similarities in the functionalities of the BRCA1 and BRCA2 although research has shown that the structures of the two genes are widely different. The important contribution by the scholars here is the observation that the two genes function in acute optimality in environs where the immune system is not suppressed and enhances the mechanism of the identified human genes for the moderation of the cycle of cell proliferation in the means of containing cell growth and division.

Claverie, J. (2001) presents another angle to the subject of type C personality and the cancer risk factor. The scholar presents that proteins produced by the two different genes are critical for the mending of harmed DNA. BRCA2 protein can hold and regulate protein generated by the RAD51 gene to mend gaps in DNA. According to research outcomes, the breaks can be triggered by various natural and medical radiation as well as other environment-related factors but one of the salient causes has been identified as the case where chromosomes exchange genetic material during a particular kind of cell proliferation in the production of sperms and eggs. The mending of harmed DNA which has direct and indirect impacts on the fighting and elimination of cancer cells obtains effectively when the bodys immune system is operating optimally. This has been used to attest to high prevalence of cancer cases in Type C personalities who are more given to negative emotions like anger and distress which enervate the functionalities of the human immune system.

Notably, researchers have unveiled that the BRCA1 gene relates with the RAD51 protein and also that through the mending harmed DNA the three proteins play a critical function in contributing to the stabilisation of the human genome. Like BRCA1, BRCA2 is thought to moderate the role played by other genes. (Sue Wilkinson & Celia Kitzinger 2000) The BRCA1 Gene is also thought to be involved in key activities of embryo development. Precedent researches in Cancer and Abnormal Breast Cancer Genes have unearthed that there are particular dynamics of the BRCA2 gene that trigger a heightened risk for breast cancer. Studies conducted on the gene have led to the identification of around 450 mutations of the BRCA2 gene most of which have proven capacity to heighten the vulnerability to cancer in cases of immunity system lapses caused by factors such as negative emotions. BRCA2 are normally slot-ins or exclusions of a nominal figure of DNA base mends. Mark Petticrew et al (2002) note that DNA is the construction matter for chromosomes in genes. According to scholars, the series of mutations culminate in uncharacteristic and acute shortages of the protein product of BRCA2. Owing to this, the protein product does not play its role appropriately. Previous studies have also led to supposition that the deformed BRCA2 protein is further incapacitated in immune system malfunctions in functionalities of fixing mutations that obtain in other genes. This resultantly leads to the accumulation of mutations which in turn causes an uncontrolled cell division which is highly likely to precipitate a tumor.

Initial researches conducted on BRCA1 had indicated that that the gene co-purifies with the human RNA Polymerase II holoenzyme in HeLa units. The research outcomes meant that BRCA1 is an element of the holoenzyme. Following research outcomes nonetheless were the basis for the refutation of these findings. Hollon, T. (2000) notes that On the contrary researches showed that the salient compound including BRCA1 in HeLa cells is a 2 megadalton composite constituting SWI/SNF. L. Temoshok (2001) presents that mutations in the BRCA1 gene particularly in Type C individuals heighten the vulnerability to prostate cancers as well as fallopian channel cancers. The researchers have also linked precancerous lesions in the fallopian channel with BRCA1 gene mutations.

Many researches in the past have focused almost invariable so on the Type B and Type C personalities. Contemporary researches have unveiled emergent knowledge on what has been termed Type C personality where C stands for cancer. Blatny M et al (2003) notes that type persons have acute difficulty when it comes to pressing motions and these normally retain things within themselves and keep in protracted denial of what they could be feeling in reality. The scholar states that the type C person is naturally inclined to avoid and evade conflict and perceived discomfort. Johan Denollet (1998) describes such a person as pathologically nice. These exercise extreme forms of control over what they say and what they do. This seems to stand well when everything is flowing until they get to situations where they face normal stress. In situations of normal stress type C personalities often collapse.

Scientific theories advance that all persons generate cancer cells within their bodies. For the great part of the numbers of the Type A and type B personalities, white blood cells identify and annihilate the dangerous cancer cells. The link established between type C personalities and the prevalence of cancer in type C personality categories is that stress, which is hazardous to the immune system triggers the secretion of hormones through the adrenal glands to facilitate the flight and fright reactions. In situations where an individual is constantly subjected to the detrimental forces of tension and anxiety, there is sustained transmission of cortisol as well as other adrenal hormones. Scientific enquiry has proved that these hormones suppress the immune system. (Johan Denollet 1998))The potentially grave consequences of the suppression of the immune system are hinged on the fact that when the immune system is suppressed it is incapacitated to fight and eliminate proliferating cancer cells as they are generated in the human body. When the generated cancer cells are left alone they reproduce and multiply and these lead to the development of tumors.

Peter Coleman (1997) has observed that in conventional medicine there has been discovered that persons who are diagnosed with cancer better their chances of weathering the scourge of cancer when there are integrated to support groups and get some special forms of psychiatric therapy. Cancer suffers accumulate a better prognoses after undergoing special forms of psychiatric therapy and this attests to the strong links between personality type and cancer dynamics. Notes under sustained psychiatric therapy conditions, researches has proved that a significant number of cancer victims have better chances of being cured.

Mark Petticrew et al (2002) make recommendations based on findings of the researches focusing on the links between personality Type C and the risk of cancer. The scholars present that individuals have to keep stuffing emotions and striving to eradicate the feeling that one is angry or upset. From a psychological platform, the scholars advance that there are merits to be gained when persons adopt and assert a self-less dispositions which will constitute putting oneself last and considering others first. This helps to de-orient from ones negative and detrimental feelings and disposition such as anger and self-pity. This is will enable the individual to palliate the negative feelings and emotions that suppress the immune system triggering the free activity of the cancer cells(Mark Petticrew et al 2002)

Nursing implications

The findings presented on eth links between type C personality and the cancer risk factor lay an imperative for paradigmatic shift in nursing and health practice. Health practitioners aiming to tap into the merits of psychic therapy must consider the merits of approaches like cognitive behavioral therapy. Cognitive Behavioral Therapy (also known as cognitive behavior therapy, CBT) is defined as a psychotherapeutic model designed to influence problematic as well as dysfunctional emotions, behaviors as well as cognition through a goal-focused systematic process. CBT has often used an inclusive term of reference to other forms of psychological therapy that derive from the theoretical framework from the behavioristic learning model as well as cognitive psychology. The term is also used to refer to all methods and approaches of transformation that are based on the theories outlined above.

Wetterling T et al (2000) note that CBT therapies have more emphasis on largely cognitive solutions while some of them are rather typically more behavioral. In the application of cognitive-oriented therapies the aim is to establish and monitor mind processes, the thoughts, as well examine and monitor the subjects assumptions and beliefs and behaviors associated with unhealthy negative emotions. The process entails the establishment of thoughts and behaviors which are dysfunctional and also meaningful. The salient objective in the application of these processes is to replace to transcend with identified deformities.

The theory entails the exploration of an established relationship between cognition, emotion and behavior. Tomlinson et al (1996) note that the theory is an assortment of short-term ensembles designed for psychotherapy. The theory is hailed for its cross-cultural applicability. CBT focuses on modifying Cognitive distortions. Salient aspects and focus of CBT include dichotomous thinking, mind reading, emotional responses, personalisation and perfectionism. Common CBT interventions entail the focus on the recognition of automatic thoughts, assessment and response variables. The key techniques of the model entail relaxation, breathing deeply and meditating as well as the employ of verbal self-instruction among a host of other techniques

Judith, J Beck (1995) has outlined the following as the useful treatment principles.

Cognitive treatment is based on an evolving formulation of the clients situation and client problem in cognitive terms. The focus is on the relationship between cognitive treatment and therapeutic relationship, Problem-focus as well decisive orientation on goals.

In practice, the CBT model has been applied in scenarios demanding a turnaround or total overhaul of a subjects problem attributes. The model application entails framing up a solution to a clients attitudinal or any other rated problems from the way the person thinks. This is attributable to the fact that the model holds that our feelings and actions culminate from the way we think. The logic following from that premise is that anything wrong about a persons conduct is based on their wrong way of thinking. As such the model holds that if the way of thinking of the subjects can be changed their behaviors will be turned around for the better as well. In close relation to the Type C personality therapy, the model will help replace a victims source of negative emotion ( negative thoughts) with positive one and this will eliminate the suppression of immune systems and thus better cancer unraveling the cancer scourge. The model sidelines the impact of external factors that constitute a clients environment. The application of the model downplays the effects of eternal factors like people, situations as well as events on the behavioral patterns of an individual. The merits of this approach are based on that the change of the way we think can yield a better attitudes and approach to issues even the actual problem scenario has not changed.

The ego-orientated intervention also presents considerable merits in cognisance of the implications laid by findings on Type C personality and the cancer risk factor. The theory holds that the subject scenario will improve if his/her self-esteem and ego, as well as self-concept, are bolstered. The DSM-IV (American Psychiatric Association 1994) outlines that substance abuse is a maladaptive pattern of substance use the results in clinically significant impairment or distress, as manifested by one or more of the items outlined below:

• Failure to meet major social role obligations at work, school or even in domestic precincts
• Engaging in physically dangerous activities, substance-related legal problems, and perpetual substance use regardless of its evident negative personal and interpersonal effects.

Kendall RE (1983) notes that substance because may or maybe without psychological dependence. There has been paradigmatic and perspective shift from the view of symptoms of negative emotions that catalyse the activity and proliferation of cancer cells and as negative evil conduct into more pro-activist approaches that seek to understand the dynamism of the problem and find feasible solutions to it.

Health and social work practitioners who have made use of the mental health model in close relation to the Ego-Orientated approach in dealing with the problem of depression and addiction normally regard substance abuse as part of the efforts by the Type C personality victim to implement means of self-medication. This abuse of substance has also been viewed by many practitioners as an expression of a way of handling entrenched personal predicaments. This implies that psycho-dynamically inclined medical and health practitioners shift from attacking the abuse problem directly and rather adopt a holistic and far-reaching approach in the understanding that the former will would result in the diminishing of the victims self-esteem and ego.

The other perspective grounded on the learning model holds negative emotions as emanating from maladaptive, conditioning and the acquisition of new behavior. The thrust reinforces the support for individuals to gain control over their predicament via bolstering the victims self-concept and hence self-esteem. The core tenet and perspective on the subject of negative emotion-related social therapy dwells on that the problem has to be placed within the broader precincts of the factors that characterise the environment of the affected individual. The practical application of the model has in several social therapy cases employed in the thrust of bolstering subjects morale and self-concepts. The external factors that can also be used to map a framework that constitutes the source of an individuals problems culminating can be social like poverty, unemployment, etc. In practice this perspective has also been used when problems of such nature facing individuals are contextualised within broader socio-cultural and sometimes political factors. This perspective argues for the interventions that will focus on reducing the environmental stresses that push people to negative emotion which suppress immune system and its capacity to fight the generation and proliferation o cancer cells.

Gaps in the research

There exist gaps in the research domains bordering on the dynamics of the Type C personality and the cancer risk factor. Further researches have to be conducted to illuminate the minute scientific dynamics that characterise the generation of particulate cancer cells like in cervical, breast and prostate cancers among a host of others. The establishments illuminating the bearing that personality types have on the cancer risk factor form the primary basis for more specific scientific enquires into the particulate nature of the developments of various cancer forms. This is expected to lay valuable insights in the enhancing of nursing and medical practice in dealing with cancer victims.

Conclusion

What is deducible from the qualitative evaluation for presented research data and insights point to the reality of the existence of critical and crucial relations between personality type and the cancer risk factor.

With the foregoing in mind it is evident that insights presented from research findings of the characteristics of Type C personalities and the implications these have on the immune system and the risk of cancer, that nursing practice must be modeled in tandem with considerations of the personality type implications. What can be concluded also is that the forms of cancer development, its characteristics and hence its treatment can be homogeneous. Personality Type C needs particular psychotherapeutic remedies from those offered to type A and B personalities as implied by presented research findings.

References

Aparicio, S. (2000). How to Count&Human Genes, Nature Genetics, NYK, pp 54

Briggs, H. (2000). Dispute Over Number of Human Genes, BBC News Online. Ewing, pp 64

Beth, P. G (2000). Analysis of Expressed Sequence Tags Indicates 35,000 Human Genes, Nature Genetics, pp 54

Blatny, M (2001). Type C personality (cancer personality): current view and implication for future research, Oak Books, London, UK, pp, 186

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Abstract

The primary purpose of this paper is to draw attention to current issues related to the treatment of cancer and the role of nurses. Several articles on this topic will be reviewed, and a synopsis appraisal for each one will be provided to get a better understanding of objectives of these studies and approaches used by researchers. Core findings will also be discussed, and the focus on techniques that were used to control bias is also critical. Such information can be utilized by professional nurses and applied in practice. Moreover, it is easier to identify which areas are the most problematic and need to be researched.

It is imperative to mention that cancer is an enormous global problem that is being frequently discussed. Healthcare providers are focused on best available evidence to ensure that patients are provided with high-quality services. This topic is vital because trained professionals should have an understanding of what approaches can be used to improve the outcomes. Moreover, the experience that is gained can be utilized in research, and nurses will be able to improve some of the processes to increase their level of efficiency. It is recognized as an enormous issue in the United States, and registered nurses acknowledge the fact that treatment has numerous side-effects that may be quite problematic and could lead to long-term complications (Wilmoth, Hatmaker-Flanigan, LaLoggia, & Nixon, 2011). Health professionals in others countries also want to draw attention to the fact that some aspects of this condition are understudied, and much more attention should be devoted to psychological factors. Researchers in Korea have identified that the treatment may affect relationships, and it is a responsibility of a trained professional to offer advice and support in such situations (Chung & Hwang, 2012). Furthermore, such knowledge would help trained nurses to understand the needs of the patient and how they may be addressed.

Study #1

Citation

Wilmoth, M. C., Hatmaker-Flanigan, E., LaLoggia, V., & Nixon, T. (2011). Ovarian cancer survivors: Qualitative analysis of the symptom of sexuality. Oncology Nursing Forum, 38(6), 699-708.

In a study by Wilmoth et al. (2011) alterations in sexuality that can be caused by the treatment of ovarian cancer are explored. A description of complications and changes that are experienced by participants is provided. The study is important because issues related to sexuality are frequently undervalued, and such information would help health care providers to improve the experience of patients. The sample size is 13 and individuals that are ill or were diagnosed recently have participated, and researchers believed that exclusion criteria are not needed. Eight women were in the age group of 33-69, and 5 were 40-75. The number of participants may seem small, but it is not an easy task to convince women and five individuals have declined an invitation. Moreover, the sample size is appropriate for a small study.

The received information is valid because a particular set of questions has been used throughout the whole study. Interviews were used as a tool of data collection, and a research instrument has been developed. Answers were recorded with a use of a device and transcription was also utilized. The authors avoid bias by focusing on the experience of patients and based their statements on collected data. Provided information suggests that individuals have a different understanding of the concept of sexuality. The authors have tried to minimize the number of generalized statements in this article. Results of the study indicate that the process of treatment had a tremendous impact on the sexuality of patients and age was not viewed as a significant factor that affected the perspective of individuals. Psychological and social factors play a critical role in this case and have affected the way this problem was viewed by participants (Wilmoth et al., 2011). The results of the study are related to the idea that psychological factors must be taken into account, and such information can be used when developing techniques and approaches that would help the patients to deal with such problems.

Study #2

Citation

Chung, C., & Hwang, E. (2012). Couples experiences of breast cancer in Korea: A descriptive qualitative study. Cancer Nursing, 35(3), 211-220.

A study by Chung & Hwang (2012) is focused on issues that are associated with breast cancer, and how the diagnosis and treatment affect relationships. This article is vital because the authors wanted to focus on the experience and provide a description of issues that couples may have to deal with because of this condition. The sample size is 14, and only dyads that included women diagnosed with breast cancer were selected. Individuals that suffered from recurrence or metastasis were not picked. The number of participants is reasonable in this case because the authors wanted to prove the thesis. The data was collected with a use of interviews, and the information received is valid because the process was monitored and a phenomenon was evaluated. Participants were invited to a room, and each session lasted close to eighty minutes. Answers were recorded with a use of an electronic device and later analyzed. Participants have verified the transcription to ensure that it is accurate.

The authors have tried to address possible bias by using same questions. Moreover, some of the patients were excluded because of factors that have affected their experience. Coding was utilized to ensure that particular patterns are identified, and researchers could focus on aspects that are most important. The authors use quotes to make sure that the audience has a better understanding of statements and ideas that were voiced by patients. Researchers have found that the diagnosis of breast cancer in Korea has led to numerous complications. Moreover, spouses were also affected most of the time and such issues as stress and depression were introduced in most cases. A similarity in the reaction between this region and Western countries has been noted. Sexual problems were also noted, and they have complicated relationships in most cases. Moreover, authors suggest that communication had to be improved to address some of the issues (Chung & Hwang, 2012). This article proves that much more attention should be devoted to psychological changes that cancer patients have to deal with during the process of treatment.

Study #3

Citation

Rustoen, T., Gaardsted, T., Leegaard, M., & Wabl, A. K. (2009). Nursing pain management  A qualitative interview study of patients with pain, hospitalized for cancer treatment. Pain Management Nursing, 10(1), 48-55.

A study by Rustoen, Gaardsrud, Leegaard, & Wabl (2009) is focused on issues associated with pain management that individuals have to deal with when they are being hospitalized. Moreover, another goal is to determine if their expectations are reasonable. The description of the experience of patients that suffer from pain because of cancer and how they view the role of trained nurses is vital, and would help to improve outcomes. The sample size is 18 patients, 7 were men and 11 females. Only individuals that suffered from breast or prostate cancer were included. Individuals that did not have skeletal metastasis were excluded. The number of patients is relatively small in this case, but researchers believed that this approach is convenient. The information is valid because particular points and terms were clearly defined.

A professional nurse has conducted several in-depth interviews with each participant to collect the necessary information. Data about age, occupation and diagnosis of patients was also recorded. Audiotapes were utilized, and interviews were transcribed for further analysis. A set of questions has been used in every case to avoid possible bias, and participants were informed that a nurse may provide advice only when the process is finished to ensure that they are not distracted. Specific data such as direct quotes is presented in this case. However, their number is limited, and the authors are more focused on the discussion of patterns and similarities. The findings of this study indicate that patients think that the role of registered nurses in the process of treatment is vital. However, they did not have an understanding of responsibilities that such professionals had, and it was not an easy task to evaluate their level of performance. Another aspect that should not be overlooked is that some patients have voiced their opinions that materials that were provided were essential and have helped to increase their knowledge about pain management (Rustoen et al., 2009). This article supports the statement that the focus on psychological needs of patients may enhance their experience.

Study #4

Citation

Verbrugghe, M., Duprez, V., Beeckman, D., Grypdonck, M., Quaghebeur, M., Verschueren, C.,&Van Hecke, A. (2016). Factors influencing adherence in cancer patients taking oral tyrosine kinase inhibitors: A qualitative study. Cancer Nursing, 39(2), 153-162.

A study by Verbrugghe et al. (2016) analyzes the experience of individuals that take drugs orally to determine primary causes of non-adherence. It is possible to state that it is important because factors that could affect the perception of cancer patients are taken into account. 30 people have participated, and the authors have utilized interviews to collect necessary information. 18 were men and 12 were women, and the age varied from 36 to 88. The sample size is appropriate for such small studies. The information is valid because participants were monitored and answers were verified. Questions were based on the review of factors that are frequently associated with non-adherence. The technique has been altered to ensure that the data received is more structured. Observations were also written down on paper because such information was viewed as vital by researchers and they wanted to include it in the analysis.

The authors of the study collected demographic data after interviews to ensure that possible bias is avoided. Direct quotes are provided in this case, but their number is relatively small. Findings of this study indicate that patients are incredibly worried about their survival and afraid that the quality of life may be affected because of the use of such medicines. Also, many individuals have noted that side effects are quite problematic and hard to handle most of the time. The level of trust is another factor that should be noted, and trained nurses should take this aspect into account to make sure that individuals understand that their treatment is based on evidence. It is also mentioned that many patients have been anxious because such condition is quite stressful and it could have prevented them from taking medications (Verbrugghe et al., 2016). The study is related to the overall idea that health care professionals should consider needs of a patient to achieve positive outcomes.

In conclusion, it is evident that the ways in which this problem is viewed in different countries are quite similar, and many researchers have recognized that the focus on psychological aspects is beneficial and may help to improve the experience of patients. It can be seen that the process of treatment may have a long-term impact on the lives of individuals, and it is a responsibility of registered nurses to provide help and recommendations. Such professionals should consider the needs of patients throughout the whole process because support is an aspect that is valued by most people and increases their level of satisfaction. Overall, it is possible to state that such information is crucial, and the experience of individuals that have to deal with this disease needs to be researched.

References

Chung, C., & Hwang, E. (2012). Couples experiences of breast cancer in Korea: A descriptive qualitative study. Cancer Nursing, 35(3), 211-220.

Rustoen, T., Gaardsrud, T., Leegaard, M., & Wabl, A. K. (2009). Nursing pain management  A qualitative interview study of patients with pain, hospitalized for cancer treatment. Pain Management Nursing, 10(1), 48-55.

Verbrugghe, M., Duprez, V., Beeckman, D., Grypdonck, M., Quaghebeur, M., Verschueren, C.,&Van Hecke, A. (2016). Factors influencing adherence in cancer patients taking oral tyrosine kinase inhibitors: A qualitative study. Cancer Nursing, 39(2), 153-162.

Wilmoth, M. C., Hatmaker-Flanigan, E., LaLoggia, V., & Nixon, T. (2011). Ovarian cancer survivors: Qualitative analysis of the symptom of sexuality. Oncology Nursing Forum, 38(6), 699-708.

Introduction

Lung cancer is a disease manifested in malignant tumor located in lungs. Like any other type of cancer, tumors in lungs have a characteristic of an uncontrolled cell growth that takes places in lung tissues. Because of the effects of metastasis, lung tumors may spread far beyond tissues of lungs affecting other organs. Most of the lung cancers are categorized as carcinomas. There are two main types of lung cancer: small-cell lung carcinoma (SCLC) and non-small-cell lung carcinoma (NSCLC). There are also common symptoms associated with this disease; those symptoms are coughing (in particular cases, hemoptysis included), decrease in body weight, breath shortness, and severe or mild pain in chest (depends on progression of the disease). Long-term tobacco smoking causes most cases of lung cancer.

Diagnosis Etiology

According to Cruz, Tanoue and Matthay (2011), there are numerous factors contributing to lung cancer etiology: tobacco smoking (the most prominent cause), other types of smoking, genetic, racial, and ethnical predisposition, and even causes that do not relate to smoking. All in all, although smoking is the primary cause, there is no sure way to protect oneself from lung cancer. The types of smoking that do not relate to cigarettes consumption are cigar or pipe smoking. These are associated with increased risk of lung cancer. Lifetime nonsmokers and people who have smoked fewer than one hundred cigarettes during their life are called never smokers. These people, however, also may have lung cancer.

Epidemiology

Ridge, McErlean and Ginsberg (2013) describe a lot of factors that form the basis of medical sciences knowledge of lung cancer. Also, Alberg, Brock, Ford, Samet and Spivack (2013) conclude their research on epidemiology of lung cancer with stating that a consideration of the epidemiology of lung cancer consistently reinforces one major theme: The pandemic of lung cancer is a consequence of the tragic and widespread addiction to cigarettes (p. 18). All in all, the researchers state that  regarding racial factors  white Americans are less affected by lung cancer than African Americans, while white and black American women have equal chances of developing this condition. Survival rates for people of Asian descent are significantly higher.

Pathophysiology

The term normal lung structure is used if lungs are not affected by any diseases (including lung cancer) and function well. Normal lung structure and functionality are defined by bronchi, bronchioles, alveoli, and blood vessels running through alveoli. Naturally, as the tumor develops, lung functions are affected, and lungs can no longer operate properly. Bronchi and alveoli are blocked or disrupted by the growing tumor which may cause a cough, pneumonia, shortness of breath, blood coughing, etc. The symptoms caused by lung cancer are divided into local and systemic ones. Local symptoms relate to the tumors mass or ulceration. Systemic symptoms are not directly connected to the metastatic growth of the tumor (body weight decrease, fever, fatigue, etc.).

As already mentioned, lung cancer is categorized as carcinoma. Carcinomas name stems from their visible image under the microscope. The most general type of lung cancer in the US is adenocarcinoma. This type, in turn, may be described as papillary, micropapillary, acinar, mucinous, and solid. Again, the names are given based on the form that the cells appear in under the microscope (these are also referred to as growth patterns). Even in just one tumor, cell structure may differ. Depending on how the tumor looks, physicians are able to tell if it has good or bad prognosis. However, due to the possible mixture of various types of tumor growth patterns, it is not always possible to predict outcomes.

Should the tumor be removed in its entirety, pathologists are able to perform the so-called gross examination. This term refers to the measured size of tumor determined from the naked-eye perspective. The size of the tumor is mostly reported based on how big the tumor is across in the largest area. This part of the tumor is referred to as the tumors greatest dimension. Naturally, the significance of the tumors size often lies in the fact that smaller tumors have better outcomes. Nevertheless, the stage that lung cancer progresses to is vital as well. If the tumor is big enough, it is on a higher stage and is, therefore, harder to treat and recover from resulting in worse outcomes and predictions.

Clinical Manifestations

The typical symptoms that lung cancer causes are worsening cough, blood coughing, rust-colored sputum, pain in chest that gets worse with certain actions (deep breathing, coughing, laughing), hoarseness, weight and appetite loss, breath shortness, general exhaustion and weakness, repeating and worsening infections (pneumonia, bronchitis, etc.), wheezing. If lung cancer has already spread to distant organs, it may cause bone pain, headaches, numbness in limbs, dizziness, inability to correctly balance body position, seizures, skin and eyes turning yellow (jaundice), lumps near skin layers of the body. Moreover, tumor growing on top of lungs may cause a number of face and eye nerves-related symptoms (Horner syndrome). Other syndromes caused by lung cancer are superior vena cava syndrome, paraneoplastic syndromes, and others.

Pertinent history findings will be the most probable causes for a patient to consult a physician. The most significant findings include the symptoms mentioned above. These symptoms may be severe enough to alert a person to attend a hospital. Coughing, coughing up blood, skin and eyes jaundice, unyielding infections  these are the most probable pertinent history findings. Physical examination may reveal additional symptoms that were not directly visible to a patient. These include undetected and unexplained body weight loss, low-grade fever. A more thorough examination will also reveal tumors presence or that of metastases in bones, liver, brain, spinal cord or lymph nodes and skin. These locations are the most common for metastases to manifest. The early-stage-lung-cancer often remains undetected and unreported.

There are numerous red flag symptoms that may manifest in patients. However, it is seldom that patients will immediately report these symptoms to doctors. There are at least eight red flag symptoms that require thorough examination despite their cause. These symptoms are constant or almost constant coughing, long-term coughing changing pattern, breath shortness, coughing up blood or rusty-colored phlegm (sputum), chest or shoulder pain, significant loss of appetite that lasts for an extended period of time, severe fatigue, and noticeable body weight loss. Naturally, it is especially important to take into account these symptoms for smokers and people that have genetic or racial predispositions to cancer. Family history may provide significant insight into how likely it is for a person to suffer from lung cancer.

Diagnostic Possibilities

The most common way to diagnose lung cancer is radiography. It is an imaging technique that is based on using x-rays to reveal the internal structures of various objects. The tumors density allows physicians to detect them on x-ray images. However, numerous researches were carried out to discover and develop new ways of diagnosing lung and other types of cancer, for example, studies by Cazzoli et al. (2013) and Oki et al. (2013). However, one of the most promising types of diagnosing lung cancer is elucidated in research by Oxnard et al. (2014). The authors provide a new quantitative assay for plasma-based tumor genotyping which has been technically optimized for translation into clinical practice (p. 1702).

The research has a purpose of ensuring that tumor genotyping using cell free plasma DNA (cfDNA) has the potential to allow noninvasive assessment of tumor biology, yet many existing assays are cumbersome and vulnerable to false positive results (Oxnard et al., 2014, p. 1). The researchers collected plasma from patients that developed advanced stages of lung cancer that they used as a basis for ddPCR assays for epidermal growth factor receptor (EGFR), KRAS proto-oncogene, and BRAF gene mutations. The results identified a reference range for EGFR L858R and exon 19 deletions in specimens from KRAS-mutant lung cancer (Oxnard et al., 2014, p. 1). Such results allowed the authors to reach 100% specificity with a significant level of sensitivity.

This type of research is so important because the research was a success even on theoretical stage. This allows authors to confidently state that their mean of lung cancer detection is ready to be transitioned into practice. The authors equipped their method of detecting lung cancer with a number of ways that maximize positive predictive value and ensure proper quality control. Thus, rather high levels of sensitivity are achieved. These precautions, as well as the nature of method itself, allow it to have a significantly high level of specificity as well. Due to the high levels of sensitivity and specificity, true positive and true negative predictive values dominate in measured results. Therefore, the research will most likely have a great impact on medical practices.

Patient Education

The most important piece of information that must be distributed amongst the patient is the fact that lung cancer is one of the most lethal of common diseases. Even amongst types of cancer, lung cancer is probably the most lethal one (25% of all cancer deaths). It is also important to know that more women die from lung cancer than from other types of cancer (breast, ovarian, uterine), and more men die from it than from, for instance, prostate and colon cancer. The patients need to know that the most important step to prevent lung cancer is ceasing to smoke and secondhand smoke. Also, it is important to remember that appropriate screening is most effective to prevent and detect lung cancer.

If lung cancer is, in fact, present, a patient may need hospitalization if any of the mentioned symptoms have already manifested in them. After receiving a proper physical examination, the patient will know if they need treatment. As with almost any other type of cancer, the patient is presented with a variety of treatment options depending on the tumors size, overall disease progression and various other conditions. These options include chemotherapy, surgical treatment, radiation therapy, targeted drug therapy, clinical trials (experimental treatment), and palliative care that will most likely be necessary. The safest way to treat cancer will probably be a surgery because other treatment options may result in lasting side-effects that may be rather severe. The treatment must be chosen wisely.

Reference Page

Alberg, A. J., Brock, M. V., Ford, J. G., Samet, J. M., & Spivack, S. D. (2013). Epidemiology of lung cancer. Chest, 143(5), 1-29.

Cazzoli, R., Buttitta, F., Nicola, M. D., Malatesta, S., Marchetti, A., Rom, W. N., & Pass, H. I. (2013). MicroRNAs derived from circulating exosomes as noninvasive biomarkers for screening and diagnosing lung cancer. Journal of Thoracic Oncology, 8(9), 1156-1162.

Cruz, C. S. D., Tanoue, L. T., & Matthay, R. A. (2011). Lung cancer: Epidemiology, etiology, and prevention. Clinics In Chest Medicine, 32(4), 1-61.

Oki, M., Saka, H., Kitagawa, C., Kogure, Y., Murata, N., Adachi, T., & Ando, M. (2013). Rapid on-site cytologic evaluation during endobronchial ultrasound-guided transbronchial needle aspiration for diagnosing lung cancer: A randomized study. Respiration, 85(1), 486-492.

Oxnard, G. R., Paweletz, C. P., Kuang, Y., Mach, S., OConnel, A., Messineo, M. M., & Jänne, P. A. (2014). Noninvasive detection of response and resistance in EGFRmutant lung cancer using quantitative next-generation genotyping of cell-free plasma DNA. Clinical Cancer Research, 20(6), 1698-1705.

Ridge, C. A., McErlean, A. M., & Ginsberg, M. S. (2013). Epidemiology of lung cancer. Seminars in Interventional Radiology, 30(2), 93-98.

Introduction

Esophageal cancer is cancer of the trachea (esophagus) (Chabner, 2010, p. 41). The trachea is an elongated, void muscular tube that is about ten meters in length. It connects the throat and the stomach. This condition can also be referred to as malignancy of the esophagus. This esophageal cancer mainly starts affecting the inner layer of the tracheal wall and spreads to the outer parts. There are two major types of cancer: Squamous cell carcinoma and Adenocarcinoma (Jobe, Thomas, & Hunter, 2009). The former starts in the squamous cells found in the esophagus. The squamous cell carcinoma affects the upper, middle and lowers parts of the esophagus. The adenocarcinoma begins affecting the glandular tissue located in the lower part of the esophagus.

Esophageal tumors are characterized by dysphagia or difficulty in swallowing, pain and other signs. These are diagnosed with biopsy where body tissues and fluids are checked to investigate the cause of an ailment (Chabner, 2010, p. 76). Small tumors that are also localized can be readily treated surgically while larger tumors are not operable thus they are treated with palliative care. Their persistence can be delayed by chemotherapy or radiotherapy (Chabner, 2010, p. 77) or a combination of the two. In some instances, the two treatments can call for an operation for larger tumors. Prognosis (determination of the cause of) (Chabner, 2010, p. 9) is dependant on two factors which are the extent of the disease and other health problems.

Discussion

Symptoms

The most common symptoms of esophageal cancer are dysphagia (Chabner, 2010, p. 161) and odynophagia. The former is used to mean difficulty in swallowing while the latter means painful swallowing (Ginex, Hanson & Frazzitta, 2005). Most patients experience dysphagia first but Odynophagia may also be present (Jobe et al., 2009). During this time, fluids and soft food can easily be swallowed while hard foods such as meat are difficult to swallow. Pain or a severe burning sensation in the trachea may be experienced everyday and this is worsened when one shallows food. Hoarse coughs may be experienced as a result of the tumor blocking its way.

Tumor may interfere with normal peristalsis (the rhythmic contraction of the alimentary canal muscles that moves food along the digestive system) (Chabner, 2010, p. 152). This may cause the regurgitation of food and vomiting. Due to the nature of the surface of the tumor, bleeding may easily occur. This is due to the fact that people do not have major symptoms until half of the trachea is blocked. At this point the tumor has spread a great deal. Incase the disease has spread to other parts, there may be other symptoms that are related to this disease, a good example is lung metastasis (the rapid spread of cancer into other parts of the body) which may cause suffocation (Chabner, 2010, p. 115).

Causes

The risk factors that are associated with this condition are age where most patients are over 60 years, sex where it is most common in men, heredity where people with close relatives are more likely to contact it, smoking and heavy drinking, and Plummer-Vinson syndrome among others (Ginex at al., 2005). They increase the chances of suffering from this type of cancer. On the other hand, decreased risk is common in individuals who use aspirin or related drugs, consume coffee moderately, consuming foods rich in cruciferous among others. These are some of the factors that have been associated with decreased cases of this type of cancer. Majority of esophageal tumors are malignant (with fatal effects on health) (Chabner, 2010, p. 115) since those that are benign are about 0.5%. Leiomyoma which refers to the smooth muscle tumor forms less than 10% of the total number of cases.

Treatment

The stage at which the cancer is in at the time of diagnosis (Chabner, 2010, p. 9), the condition of the patient and the degree to which the cancer has spread determines the type of treatment to be applied. In case the cancer has not spread to other organs, surgery (Chabner, 2010, p. 89) may be performed so that the affected portion can be removed. In some instances, surgery may also entail the removal of lymph nodes from the stomach, spleen and the chest (Jobe et al., 2009). After that another section of the lower bowel is attached to the remaining section of the esophagus through medical procedures. After the surgery, patients may receive chemotherapy and radiotherapy treatments. Generally, good nutrition and adequate dental care are important in dealing with this condition.

Patients who cannot swallow at all are treated by the insertion of a stent. These are important since they assist the patient in swallowing food. Further, they help in occluding fistulas. A nasogastric tube serves an important function of enhancing the process of feeding the patient while the tumor treatment is given (Ginex et al., 2005). Some patients call for the insertion of a hole in the skin which gives a direct entry into the stomach. A nasogastric tube and gastronomy are important most especially if the patient tends to aspirate food or saliva into the airways. Another method that can be used in the treatment is Esophagectomy. This is the removal of a section of the esophagus hence shortening the length of the remaining esophagus. Other sections of the digestive system for instance the colon is pulled towards the chest cavity and interjected. The common types of esophagectomy are thoracoabdominal, two stage Ivor Lewis approach and three stage McKeown approach.

The use of Chemotherapy in treatment is dependent on the type of tumor although it seems to be based on cisplatin. Ongoing medical studies attempt to compare the various combinations of chemotherapy. This kind of treatment can be administered after surgery or before or in cases where surgery is not possible. Radiotherapy is also given under the same conditions as the former. This may also be used in patients with localized disease that can not be treated via surgery, where radical radiotherapy may be used to cure.

Generally, the prognosis of this condition is quite poor. This is due to the fact that most of the patients start the treatment at advanced stage. If this cancer is diagnosed in its earliest stages, then the chances of survival for the cancer victim are high (Ginex et al., 2005). This is not possible in most cases since this condition does not have significant symptoms. Most patients go for medical check up because they are experiencing difficulty in swallowing food; this is a sign that is shown at the later stages of cancer growth.

Conclusion

Cancer of the trachea is commonly referred to as esophageal cancer. Dysphasia and odynophagia are the most common symptoms that are associated with this disease. The disease has poor prognosis since majority of the people seek treatment when the cancer is full blown, this is due to the fact that this condition does not have major symptoms. Chemotherapy and Radiotherapy are two major types of treatments that are used to treat this condition.

Reference

Chabner, D. (2010). The language of medicine (9^th ed). Saunders, 1-161.

Ginex, P., Hanson, J. & Frazzitta, B. L. (2005). Esophageal cancer: 100 questions and answers. Jones & Bartlett Learning.

Jobe, B. A., Thomas, C. R., & Hunter, J. G. (2009). Understanding Esophageal Cancer: the principles and practice. Demos Medical Publishing.

In their article, Stern et al. (2019) address the connection between cancer and physical activity, diet, and obesity in Latin America and the USA. The significance of this research is determined by the fact that due to increased globalization, transitions in dietary practices may be observed. That is why children and adults are vulnerable to particular risk factors for their health connected with food and lifestyle regardless of the place of residence (Stern et al., 2019). In the present day, despite the healthy immigrant hypothesis that states that Latin Americans that immigrate to the USA are healthier in comparison with native-born Americans, the Hispanic community evidence the same chronic disease patterns as the USA, including adult and childhood obesity (Stern et al., 2019, p. 449). At the same time, the latter substantially contributes to the development of cancer and other chronic diseases.

Multiple factors lead to obesity among children and adults in America, including a diet characterized by huge amounts of sugar, red meat, and processed foods, marketing, a sedentary lifestyle, and fast food consumption. However, obesity and an unhealthy diet along with low physical activity and smoking increase the risk of mouth, pharynx larynx, colorectal, esophagus, breast, pancreas, stomach, liver, and prostate cancers (Stern et al., 2019). As childrens health is regarded as a nations top priority, various strategies that aim to reduce obesity are proposed. The most efficient and affordable practice includes school-based interventions, such as a physical activity change and balanced nutrition. Another strategy that requires more effort but provides long-lasting results changes in macro- and microenvironments where children grow up (Stern et al., 2019). It implies the changes in the whole familys lifestyle, the availability of fresh vegetables and fruits, the use of active toys, smaller portions in restaurants, and the construction of parks.

In this article, Greenberg et al. (2018) investigate the connection between the consumption of chocolate and the risk of cardiovascular disease (CVD). The expediency of this research is determined by the significance of the CVD issue as this illness is regarded as the main cause of mortality worldwide, including in the United States (Greenberg et al., 2018, p. 41). In turn, evidence suggests that chocolate may improve insulin sensitivity and endothelial function and lower blood pressure. Previous meta-analyses showed the connection between a habitual intake of chocolate and the occurrence of CVD, however, the majority of participants were seniors and people with pre-existing major chronic diseases. Thus, to confirm or reject these findings, the authors conducted their own multivariable Cox regression analyses that aimed to investigate the connection between chocolate intake by postmenopausal women and the risk of CVD (Greenberg et al., 2018). The analyses were based on medical records and food frequency questionnaires that were used to measure chocolate intake.

According to the studys results, there is no connection between the consumption of chocolate and the development of CVD and stroke in postmenopausal women without pre-existing chronic diseases. At the same time, the study partially explains the findings of previous research  substantial inverse associations between CVD and chocolate consumption may be attributable to an individuals decrease in chocolate intake after a chronic disease, such as diabetes or cancer, was diagnosed. In general, according to research, this association may be connected with a patients age and the presence of already existing serious chronic diseases.

References

Greenberg, J. A., Manson, J. E., Neuhouser, M. L., Tinker, L., Eaton, C., Johnson, K. C., & Shikany, J. M. (2018). Chocolate intake and heart disease and stroke in the Womens Health Initiative: A prospective analysis. The American Journal of Clinical Nutrition, 108(1), 41-48.

Stern, M. C., Barnoya, J., Elder, J. P., & Gallegos-Carrillo, K. (2020). Diet, physical activity, obesity and related cancer risk: Strategies to reduce cancer burden in the Americas. Salud Pública de México, 61, 448-455.

Introduction

Cancer is a common problem and one of the key causes of death in the population. Risk factors associated with the development of cancer cells relate to radiation exposure, damage to the body by pathogens, as well as hereditary predisposition. Different types of neoplasms are named according to their location. It is noteworthy that cancer is typical not only for humans but also for animals.

Disease Background

The movement of cancer cells in the body is carried out through the blood and lymphatic systems. The danger of neoplasms lies in the fact that their development is unpredictable and difficult to control. If cancer cells affect organs and tissues, this process is called metastasis, and in this case, it is extremely difficult, and sometimes impossible, to fight cancer.

Incidents

Numerous risk factors can cause the development of cancer cells in the body. There are types of cancer that affect individual organs and systems. In addition, neoplasms are often classified according to gender and age, since the corresponding manifestations in different categories of the population are common.

Risk Factors and Causes of Cancer

Neoplasms form in the body for various reasons, and lifestyle is one of the criteria that explain the emergence of cancer cells. Human genetic predisposition is also a common cause of oncology. In some situations, risk factors are combined when a person has relatives with cancer in the family history and lives in an environment where exposure to radiation and pathogens stimulates the development of neoplasms. In this case, the risks increase significantly, which explains the need to follow cancer prevention rules.

Symptoms and Signs

The symptomatology of cancer depends on several factors  the place of occurrence, the stage of the disease, and other criteria. Often, cancer patients experience pain caused by metastases, may feel weak, unable to digest the food they eat, experience constant bleeding, and suffer from other unpleasant symptoms.

Types of cancer

Distinctive types of oncological neoplasms are characterized by the emergence of different body systems. Among the most common forms, it is customary to distinguish sarcoma, carcinoma, leukemia, lymphoma, myeloma, and some other types. Teams of oncologists are involved in the treatment of types of cancer.

Diagnosis

Diagnosing cancer is carried out through special screening tests designed to identify predisposition to the development of neoplasms and identify the current stages of the disease. X-ray examinations, CT and MRI scans, and other methods are used to identify cancer. The testing of blood samples is also often performed to check and control the growth of tumors.

Biopsy

One of the most common methods for detecting cancerous tumors in the body is a biopsy. This procedure implies removing a piece of tissue from the affected organ for appropriate laboratory tests to check the presence of neoplasms. This procedure is almost always performed in cancer patients because it is one of the most reliable and accurate practices for determining whether an organ is affected and how severe the illness is. In addition, with its help, oncologists can diagnose the stage of cancer and what treatment is optimal to prevent the development of the disease.

Cancer Staging

Cancer tumors that do not metastasize may be successfully treatable. There are several stages of the disease, which determine the degree of damage to organs and tissues. The specifics of determining the stage depend on several criteria  the size of the tumor, its location, the volume of metastases, and some other characteristics. The degree of damage to the lymphatic system is an important factor in determining whether the disease is actively progressive or not. In the advanced stages, effective cancer treatment is unlikely, while in the early stages, oncologists may use different practices to help patients.

Methods of Staging

While speaking about the specific principles of staging, one should consider two possible steps. Per the aforementioned diagnostic criteria, the TNM practice is utilized. This methodology involves determining the size of the tumor (T), the degree of involvement of the lymph nodes as a result of the spread of the disease (N), and the presence and severity of metastases in the body (M). The second step is the designation of the stage by the corresponding Roman numerals to classify cancer following its severity  from I to IV.

Treatment and Prognosis

To successfully fight cancer, this is important to consider the stage of the disease and the type of neoplasm. Chemotherapy and radiotherapy are effective methods, and in some cases, these practices are combined. In the later stages, the only possible intervention is palliative care. Any predictions regarding recovery can only be made if the disease does not progress and the chance of remission remains. Otherwise, the risk of error remains as the tumor may continue to grow.

Prevention

Cancer prevention is an essential aspect of life, especially in densely populated regions with poor air quality. Harmful micro-particles can provoke cellular changes in the body, thereby causing tumors. Therefore, polluted air is a risk factor that stimulates neoplasms. Moreover, passive smoking is also a dangerous condition, and avoiding tobacco smoke is an important preventive condition. Another risk factor is smoking, and this bad habit should be avoided. Prolonged exposure to the sun can cause pathological changes in the skin. Some viruses can also cause cancer, and timely treatment is a critical prerequisite for maintaining good health.

Rna-based Detection of Gene Fusions in Formalin-fixed and Paraffin-embedded Solid Technique

The practice under consideration is a convenient and effective tool for detecting cancerous tumors at different stages. By storing specimens in formalin, clinicians can store the collected materials for a long time and study them. The genetic principle of screening makes it possible to detect even the slightest prerequisites for the development of neoplasms.

Clinical Implications

The application of the RNA-based detection technique is characterized by numerous valuable implications regarding both diagnostic and therapeutic principles. Different types of cancer can be identified by this technique, including individual predispositions. In addition, different types of neoplasms can be detected, which expands the range of the technology application. Traditional and outdated practices cannot help achieve the same screening result as the RNA-based method. In the course of work, the interaction between members of the clinical team is an important condition.

Specific Requirements

In the process of applying the RNA-based detection technology, special principles of operation should be taken into account. This is crucial to pay particular attention to the collection and storage of samples because these procedures directly affect the results of the screening. At all stages, including initial and final analysis, comparing intermediate outcomes is mandatory to identify potential discrepancies and avoid them. In different types of cancer, gene fusions are distinctive and require appropriate control.

Conclusion

The analysis of cancer as one of the most common causes of death shows that there are many types of this disease. Diagnosis and treatment options depend on the specific stage, which is critical to identify timely. There are many risk factors, and both treatment and preventive practices should be followed. One of the innovative screening technologies is RNA-based gene detection. With its help, different types of cancer can be timely identified by following the appropriate principles of sample collection, storage, and analysis.

References

American Cancer Society. (2017). Cancer facts & figures 2017.

Gatalica, Z., Xiu, J., Swensen, J., & Vranic, S. (2019). Molecular characterization of cancers with NTRK gene fusions. Modern Pathology, 32(1), 147-153.

Kirchner, M., Neumann, O., Volckmar, A. L., Stögbauer, F., Allgäuer, M., Kazdal, D., Budczies, J., Rempel, E., Brandt, R., Talla, S. B., von Winterfeld, M., Leichsenring, J., Bochtler, T., Krämer, A., Springfeld, C., Schirmaher, P., Penzel, R., Endris, V., & Stenzinger, A. (2019). RNA-based detection of gene fusions in formalin-fixed and paraffin-embedded solid cancer samples. Cancers, 11(9), 1309.

Lei, J. T., Shao, J., Zhang, J., Iglesia, M., Chan, D. W., Cao, J., Anurag, M., Singh, P., He, X., Kosaka, Y., Matsunuma, R., Crowder, R., Hoog, J., Phommaly, C., Goncalves, R., Ramalho, S., Peres, R. M. R., Punturi, N., Schmidt, C., & Ellis, M. J. (2018). Functional annotation of ESR1 gene fusions in estrogen receptor-positive breast cancer. Cell Reports, 24(6), 1434-1444.

The high prevalence rate of cancer and heart disease, even among the military personnel, has necessitated the need to underline not only the use of drugs in the military personnel, but also the role of nutrition in eradicating cancer and heart disease. This has been attributed to the fact that the high dependence on tobacco, instead of a healthy diet, has affected the readiness of the military personnel, thus weakening the countys security department.

Over the years, eating habits have provoked scientific groups to study the nutritional value of food with regard to prevention of cancer as well as heart disease. Willett & Skerrett (2005) allege that reviewing the nutritional value in foods and the way it affects health, especially on people suffering from cancer and cardiovascular diseases, helps to substantiate the importance of verifying nutritional value of every meal served, since there are a number of contradictory views derived from various nutritionists studies. My personal experience in relation to cancer plays a very crucial role in substantiating facts about cancer and heart disease.

Nutritional value in meals has become a major concern in my life from the time I was diagnosed with a carcinoid tumor in the month of January this year. I had developed a very big tumor, which was almost the size of a golf ball. The tumor, however, was successfully removed, and in a bid to prevent a future reoccurrence of the tumor, I had to undergo a complete lifestyle change, especially with my diet. Given the slight improvement on the CGA blood test, which was from 131 to 99 from the month of March to May, my healthy eating habits have contributed greatly towards living healthier. In addition, being a survivor in the third stage of cancer, I am certain that I am on my way to achieving the normal CGA test, which is normally from 20 to 94. But is there any relationship between nutrition and cancer? Does cancer emanate from genetic factors?

According to Weinberg (1999), cancer emanates from uncontrolled growth of cells, which eventually destroy the genes. The spread of the tumor is facilitated by the presence of blood or lymph in the body. Given the high prevalence rate of cancer [1 in every 3], various scientific studies have delved into the study of identifying the very person who is at risk of being infected with cancer. Basing my knowledge on the inference of Weinberg (1999), who cites that the presence of foreign bodies, including smoke from tobacco, as well as internal origin play a major role in damaging DNA cells, I am in a position of evaluating the real cause of cancer in my life. The fact that I have never smoked and cancer does not run in my family eliminates the hereditary factors as well as the presence of foreign bodies from smoke in relation to cancer in my life.

Willett & Skerrett (2005) assert that nutrition plays a key role in eradicating the cancer as well as heart disease. However, eradicating cancer and heart disease has faced contradictory inferences, as some nutritionists are of the view that proper eating habits revolve around taking foods that serve the role of improving the health status as opposed to shedding weight. Therefore, consumption of fruits and vegetables in plenty is recommended because they contain photochemicals, which, according to Edlin & Golanty (2009), play a key role in eliminating toxins emanating from consumption of inorganic foods as well as refined oils that we consume in our day-to-day life.

High protein foods, on the other hand, are discouraged because they facilitate the growth of tumors if consumed in amounts above the required. Therefore, much emphasis should be put on consuming cruciferous vegetables, as they are rich in sulforaphane as well as isothiocyanates chemicals, which play a crucial role in prevention of cancer. Tomatoes, peaches, grapefruits, watermelon, and papaya should also be consumed in abundance, since the lycopene chemical found in them plays a crucial role in preventing oxidative damage, thus reducing the chances of being infected with cancer as well as heart disease. More so, even though much has not been credited to grapes, onions, and apples, they contribute greatly in decreasing chances of being infected with cancer as well as heart disease, since they are rich in photochemical known as flavanoids, according to Edlin & Golanty (2009).

Being a member of an active military service, which I am now serving for the 18^th year, I need to incorporate sugar in my diet. However, the type of sugar that my family and I consume should only come from organic sugar or healthy sweeteners, since, according to Barnard (2004), refined sugar attracts growth of tumors. Given the current policy of providing information concerning nutritional value and the amount of calories in meals, one key question still remains: how much effort do you put in verifying the nutritional value of chemicals within diverse fruits and vegetables with regard to control of cancer and heart disease?

References

Barnard, R. J. (January 01, 2004). Prevention of Cancer Through Lifestyle Changes. Evidence-based Complementary and Alternative Medicine, 1(3), 233-239.

Edlin, G., & Golanty, E. (2009). Health and wellness. Sudbury, Mass: Jones and Bartlett.

Weinberg, R. A. (1999). One Renegade Cell: The Quest for the Origin of Cancer. New York: Basic Books.

Willett, W. C., & Skerrett, P. J. (2005). Eat, drink, and be healthy: The Harvard Medical School guide to healthy eating ; a Harvard Medical School book co-developed with the Harvard School of Public Health : [includes new recipes and important new information about the just revised USDA guidelines]. New York: Free Press.

Although the available limited evidence suggested a protective role of APN on ovarian carcinogenesis, additional studies are necessary to elucidate its function in ovarian tumor onset and progression.

Low APN blood levels were also associated with an increased risk and a worse prognosis of endometrial cancer. Additionally, a low expression of AdipoR1 in endometrial cancer cells is associated with advanced tumor stage [Tumminia et al., 2019]. The mechanism by which APN inhibits the growth of endometrial cancer cells is unknown. However, several hypotheses have been formulated implying: i) activation of AMPK (resulting in cell growth suppression and apoptosis); ii) the extracellular signal-regulated protein kinase (ERK) and Akt pathway inhibition; iii) reduction of Cyclin D1 expression [Moon et al., 2011]; iv) a pro-apoptotic effect [Cust et al., 2007].

Several studies highlight the central role of APN and its receptors in prostate cancer, even if some evidence appears to be contradictory [Hu et al., 2016]. APN concentration in prostate cancer patients was significantly lower than healthy controls; additionally, it was related to prostate cancer development and progression [Goktas et al., 2005]. A lower AdipoR1 and AdipoR2 expression was observed in prostate neoplastic tissues compared with healthy prostate tissue [Michalakis et al., 2007]. Growing evidence indicates that APN exerts an anti-proliferative action in prostate cancer cells, inhibiting dihydrotestosterone-activated cell proliferation [Bub et al., 2006]. The ectopic overexpression of APN in prostate cancer cell lines inhibited mTOR-mediated neoplastic cells proliferation [Gao et al., 2015]. In contrast with these results, several authors showed no significant association between APN expression and prostate malignancy [Baillargeon et al., 2006], or a significant positive correlation between APN concentrations and incidence of low or intermediate-risk prostate cancer [Ikeda et al., 2015]. Higher APN plasma levels were detected in subjects with cancer stage T3 (advanced outside) than in subjects with T2 (confined within the prostate). Furthermore, some evidence indicates that AdipoR2 expression is directly associated with prostate cancer progression and metastasis [Rider et al., 2015]. Additional studies are needed to better clarify the role of APN in prostate cancer.

Adipose Tissue, Adiponectin and Low Chronic Inflammation

In adipose tissue form obese subjects, the balance between adipocytes and immune cells is lost. Clusters of enlarged adipocytes become distant from the blood vessels, leading to a local area of hypoxia that underlies the inflammatory response. Obesity, indeed, is a state of low- grade chronic inflammation [Boutari et al., 2018].

Several immune cell types are involved in the development of adipose tissue inflammation: neutrophils and mast cells promote inflammation whereas eosinophils and myeloid-derived suppressor cells are supposed to play a protective role. Recently, a prominent role emerged for B- and T-lymphocytes and natural-killer cells in adipose tissue inflammation. Additionally, an enhanced recruitment of M1 pro-inflammatory adipose tissue macrophages (ATMs) may occur during weight gain [Ouchi et al., 2011].

Infiltrating macrophages might surround and phagocytose damaged or necrotic adipocytes to form a syncytial arrangement, known as crown-like structures (CLSs). Macrophages constituting CLSs in adipose tissue have been associated with nuclear factor-kappa B (NF-B) activation and increased secretion levels of several pro-inflammatory mediators, thus creating a positive feedback to further sustain chronic inflammation [Ouchi et al., 2011].

The cross-talk between adipocytes and cancer cells is mediated by cytokines, specifically IL-1, IL-6 and TNF-, ROS generation, adipokines and other molecules released by adipose tissue contributing to local and systemic inflammation and able to control proliferation and invasion in different cancer cell types [Avgerinos et al., 2019]. On the other hand, malignant cells can induce phenotype alteration of adjacent adipocytes; reduction of their lipid content and release of adipokine and other tumor-promoting substances, such as matrix metalloproteinases [Dirat et al., 2011].

Recently, a role for inflammasome in the adipose tissue inflammation of obese subjects has also been described. Inflammasome, a macromolecular complex composed of Nod (Nucleotide-binding and oligomerization domain)-like receptors (NLRP1, NLRP3, and NLRC4), the adaptor apoptosis-associated speck-like protein containing a caspase-recruitment domain (ASC), and the enzyme caspase-1 (CASP-1), is a novel innate immune pathway required for triggering the maturation of proinflammatory cytokines, including IL-1_ and IL-18 [Lamkanfi et al., 2014]. Adipocytes express multiple inflammasome related genes, including Nod-like receptor pathway genes [NLRP3 and PYCARD (PYD-PYRIN-PAAD-DAPIN and CARD-caspase-recruitment Domain Containing)], CASP1, and other TLR (Toll-like receptor)-regulated genes [IL1B, CCL2 (C-C Motif Chemokine Ligand 2), and TNF] and this adipocyte signature significantly increased in obese versus lean subjects [Yin et al., 2014]. Activated inflammasome and increased IL-1 production in cancer-associated macrophages generates an inflammatory microenvironment promoting tumor growth and metastasis in animal and human cancer models [Guo et al., 2016]. The complicated function of inflammasomes raises new challenges for the treatment of obese cancer patients.

The inflammatory environment of obesity is mitigated by weight loss, as demonstrated by an attenuation of endothelial dysfunction in women that lost weight [Hagman et al., 2017].

The “Obesity paradox”

Obesity is associated with a greater cancer reoccurrence risk, a poorer cancer prognosis and a reduced survival compared to normal-weight patients [Lennon et al., 2016]. However, some opposite evidence shows that obesity reduce cancer incidence and improve cancer survival. The controversial results indicate that the association between obesity and cancer biology is complex. Recently, a study excluded obesity alone as a risk factor for increased cancer mortality in both genders [Kuk et al., 2018]. Additionally, body fatness reduced the nerve sheath cancer risk [Wiedmann et al., 2017]; overweight or obesity represent a protective factor, and reduce the mortality of bladder [Pavone et al., 2018] and lung cancer patients [Zhang et al., 2017] after surgery or chemotherapy. A meta‐analysis also showed that obese patients with esophageal cancer had better long-term survival than non-obese patients [Kayani et al., 2012]. This finding is termed “obesity paradox”. Potential explanations of the obesity paradox in cancer patients may include methodologic issues such as the use of BMI as a measure of adiposity that does not fully characterize the intricate biology and physiology of excess body fat. BMI cannot differentiate between lean mass and adipose tissue, and show high variation depending upon gender, age, ethnicity and race. Additionally, BMI may underestimate the Visceral Adipose Tissue (VAT), resulting in potential biases of the association between obesity/overweight and cancer towards the null effect. Computed tomography represents the gold standard method for direct quantification of VAT but it is not feasible for population-based studies [Allott et al., 2015]. Somatometric measures, such as Waist Circumference (WC) and Waist-to Hip Ratio (WHR), surrogates of visceral adiposity, may be better indicators for cancer risk, particularly colon and postmenopausal breast cancers, than BMI [Sung et al, 2019]. However, also WC and WHR poorly approximate visceral adiposity, because they characterize both VAT and subcutaneous adipose tissue (SAT) at the waist level [Avgerinos et al., 2019].

Obesity and therapy

Obesity is characterized by a systemic and local environment (i.e. dysglycemia, abnormal blood pressure, dyslipidemia, hyperinsulinemia and etc.) that could reduce the response to chemotherapy. For example, BMI was associated with poor prognosis in patients affected by colon cancer who received surgical resection of primary tumor and adjuvant chemotherapy with capecitabine and oxaliplatin [Lashinger et al., 2014]. In bevacizumab-treated mCRC patients, high visceral fat and BMI were significantly associated with absence of a response and increased-progression. BMI was negatively associated to response to standard first-line chemotherapy with platinum and taxanes in ovarian cancer patients [Califano et al., 2014]. These results could be related to the expression by adipose tissue of angiogenic factors (in particular VEGF) [Ottaiano et al., 2017]. Additionally, hyperinsulinemia, by stimulating the proliferation of many cancer cells, could contributes to chemoresistance to 5-fluorouracil, antracyclines, taxanes, and other drugs upregulating P-glycoprotein [Wei et al., 2015]. The main concern is that obese patients are not adequately represented in pharmacokinetic studies, so there is no satisfactory information about the clinical setting. The most common strategy in order to treat obese patients is based on dose-capping or dose-fixed regimens. The first consequence of this “depotentiation” attitude may be the use of subtherapeutic strategies, associated with disease recurrence and mortality. The America Society of Clinical Oncology suggest that standard attitude for dose calculation of chemotherapy (using the full weight) should be adopted in obese patients.

Specific Therapies for Obese Patient?

A healthy lifestyle characterized by the limited calories in the diet, physical exercise and moderate alcohol consumption should be considered as the most important prevention for obesity and cancer [Sung et al., 2019]. A balanced and healthy diet may control factors that sustain obesity-related disease (i.e., IGF-1, insulin, leptin) [Avgerinos et al., 2019]. In addition, vigorous aerobic exercise leads to a peak of circulating APN levels [Saunders et al., 2012]

As the correlation between obesity and cancer become evident, there was an increased interest in testing diabetes and cholesterol-lowering drugs, commonly used by patients with obesity and metabolic syndrome.

Emerging evidence showed that metformin could decrease incidence and mortality of cancer in patients affected by type-2 diabetes and is associated to a less aggressive clinical cancer outcome. The positive effects of metformin could be related to a general metabolic normalization, by inducing hepatic gluconeogenesis and reducing IR of peripheral tissues resulting in lower insulin and IGF-1 levels [Gallagher et al., 2015]. In vitro evidence suggests that metformin restricts tumor growth and induces apoptosis through insulin-independent mechanisms, involving the activation of the AMPK affecting the mTOR pathway which plays a crucial role in tumor development, progression and resistance to chemotherapy [Safe et al., 2018]. Furthermore, metformin decreases cancer recurrence by directly inducing cancer stem cell death [Gallagher et al., 2015].

In addition, glycemic control with metformin can restore adipokines concentrations, increasing APN and decreasing pro-inflammatory adipokine levels in both humans and mice [Avgerinos et al., 2019]. Meta-analyses indicate that metformin is associated with decreased cancer risk and mortality [Wu et al., 2015]. Clinical trials using metformin alone or in combination with standard therapy in several cancer types, either as a preventive or therapeutic strategy are ongoing [Heckman-Stoddard et al., 2017]. However, the design of most trials has been questioned because of the insufficient underlying molecular rationale and the wide inclusion criteria [Mazzarella et al, 2015].

Thiazolidinediones (TZDs), pharmacological agents acting as peroxisome proliferator-activated receptor gamma (PPARγ) agonists, were extensively used to treat diabetes in the past. Activation of PPAR-γ by TZDs could restrict cell proliferation by decreasing insulin concentration and also influencing key pathways of the Insulin/IGF-1 axis, such as MAPK, PI3K/mTOR and Glycogen synthase kinase (GSK)3-β/Wnt/β-catenin cascades, which modulate cancer cell survival and differentiation [Vella et al., 2017]. Additionally, the PPARγ agonists TZDs, rosiglitazone and pioglitazone augment the circulating level of APN directly enhancing its gene and protein expression in a dose-dependent manner [Parida et al., 2019]. TZDs can also induce cancer cell cycle blockade by activating the phosphatase and tensin homolog (PTEN), and can sensitize cancer cells to TNF-related apoptosis-inducing ligand (TRAIL)-induced death by repressing cyclin D3 expression in a PPARγ- independent manner. TZD treatment causes cell growth arrest and apoptosis of non-small cell lung carcinoma cells by a mechanism involving growth arrest and DNA damage inducible protein (GADD153) [Ackerman et al., 2017]. Nevertheless, the use of PPAR-γ agonists as anti-neoplastic agents have reached conflicting results in clinical trials [Vella et al., 2017].

Therapies targeting APN

Hypoadiponectinemia has been consistently associated with a higher risk of cancer [Tumminia et al, 2019]. Several studies demonstrated that increasing plasma APN levels or mimicking some of its cancer-protective properties are able to mitigate the deleterious effects of metabolic dysfunctions on tumor development and progression [Vansaun et al., 2013]. Therefore, pharmacological increase of serum APN levels, up-regulation of AdipoRs expression, or synthesis of AdipoRs agonists could represent promising therapeutic strategies.

Using a high-throughput assay, several natural compounds showing AdipoRs agonist activity were identified. These compounds, acting preferably on AdipoR1 (e.g., matairesinol, arctiin, arctigenin, gramine) or AdipoR2 (e.g., syringin, parthenolide, taxifoliol, deoxyschizandrin) shared important anti-cancer properties, including anti-proliferative and anti-inflammatory effects [Sun et al., 2013]. ADP355, a peptide-based APN receptor agonist, prevented the proliferation of AdipoRs-positive cancer cell lines. ADP 355 showed high affinity with AdipoR1, and through the regulation of the canonical APN-regulated pathways (i.e., AMPK, Akt, STAT3, and ERK1/2), reduced breast tumor growth both in vitro and in vivo [ Otvos et al., 2015]. Additionally, three peptides BHD1028, BHD43, and BHD44 have been designed to mimic APN actions. BHD1028 showed the highest affinity with AdipoR1 and the main activation of AMPK already at low concentration, more than ADP 355 [Kim et al., 2018].

AdipoRon (AdipoR) is the first oral AdipoRs agonist able to bind and activate AdipoR1 and AdipoR2, that successfully re-established APN functions, mainly activating AMPK and PPARγ pathways in obesity-related type 2 diabetes [Okada-Iwabu et al, 2013]. Initial reports have also investigated the possible anti-cancer role of AdipoR in preclinical models, especially in pancreatic and ovarian cancer [Akimoto et al., 2018; Ramzan et al., 2019].

However, modifying AdipoRs interactions could also result in unfavorable effects. In this regard, several possible side effects derived from chronic APN treatment such as infertility, cardiac damage and reduced bone density [Holland et al., 2013]. Further studies are needed to elucidate the clinical relevance of such therapeutic approaches.

Statins have been reported to be effective in increasing circulating APN levels. Statins function by releasing cellular oxidative stress, resulting in increased APN multimerization and secretion. Among them, Ramipril, Quinapril, Losartan, Telmisartan, Irbesartan and Candesartan have shown promising results in clinical trials. They function by enhancing APN secretion via PPARγ, though some of them are also known to induce transcription. Other potential drugs include non-statin anti-hyperlipidemic drugs like Fenofibrate and Zetia, non-TZD anti-diabetic drugs, such as Acarbose and the sulfonylurea Glimepiride and Sulfonylureas [Parida et al., 2019].

CONCLUSIONS

A growing body of basic, translational, and clinical investigation explored the connections between obesity and cancer. There is strong evidence for more than one mechanism involved: obesity-driven chronic inflammation, abnormal insulin/IGF-1 axis, dysregulated hormonal signaling, altered production of several adipokines, fatty acid metabolism or a combination of these. However, their relative importance and details of their molecular basis need more investigation. Reversing obesity-associated dysfunction and inflammation of the adipose tissue by lifestyle interventions such as weight loss, physical activity and dietary modifications as well as bariatric surgery could represent a public health relevant contribution to decrease cancer risk or progression. Further studies in basic and translational research are essential to delineate the ontological role of adipokines and their interplay in obesity-related cancer pathogenesis. Additional prospective and longitudinal studies could reveal the clinical utility of obesity related biomarkers in cancer prognosis and monitoring. Finally, novel more effective and adipokine-oriented therapeutic interventions could open the way for targeted oncotherapy.