WHAT IS CANCER?
Human is built of cells. Cells with similar functions and structure form tissue. From the tissue, different human organs are made of. The cells of the body are not only from the beginning programmed with their functions, but also life span. Nerve cells (eg. Brain-forming) are being formed during human development and produced during this period must last for life. If, during adult’s life, nerve cell is destroyed in the process of aging or, for example, after injury, in its place a new nerve cell does not arise. There is only a chance that neighbouring cells will take over the functions of it (hence the regeneration of brain function after a stroke) (according to the latest reports, some nerve cells in certain situations can divide throughout a person’s life, but it is not a permanent cyclical division and does not alter the substance of our whole argument). Bone marrow cells which produce components of blood cell counts (cells) are divided into specific times during the cycle of human life. The lifetime of a red blood cell is approximately 90 days, after this period blood cell dies, and is removed from the blood, and in its place in the bone marrow is formed a new blood cell. A special role in the human body takes an epithelial tissue. Forming a skin and mucous membranes, it separates the inside of the body from the external environment; is also fundamental in building blocks of glands (bodies secrete a variety of substances, eg. hormones, enzymes, milk, mucus, etc.). Throughout our lives cells of epithelial tissue form and die. The speed of the cycle depends on many factors, but all of it is strictly programmed if one cell is lost in the space formed again.
How is a cancer being created? Let’s imagine that the cell begins to divide at a faster rate than it is with the current needs of the body or die in its own time. With these abnormal cells further cells with similar properties as stem cell can develop. In such, at some point a mechanism of the body can develop a solution which is the result of excessive growth of cells, and that is cancer.
What are disturbances of normal cell cycle caused by? In some cases, this is a drawback of cells formed during development of the organism or acquired together with genes from their parents. This defect can appear later in life, leading to the creation of human cancer. Often, however, abnormal cell cycle may be the result of her external factors (such as chemicals, hormones and physical factors, eg. sunlight, ionizing energy) particularly vulnerable to the influence of external factors are cells of epithelial tissue. Within the chronic cigarette smoke irritated mucous membranes of the respiratory system may develop cancer. Cancer can develop in the skin exposed for years to sunlight. Chronic impact of certain hormones on the glandular epithelium of the mammary glands can lead to the development of breast cancer.
TREATMENT
The basic methods of cancer treatment are surgery, radiotherapy and chemotherapy. Depending on the objectives we distinguish radical treatment, palliative and symptomatic.
When the goal of cancer treatment is the complete destruction of the tumor and cure the patient we talk about radical treatment. Surgery plays the most important role in the radical treatment of cancer. It is used as a method alone or in combination with radiotherapy, chemotherapy or hormone therapy. The nature of the tumor and its stage (size, presence of lymph node metastasis) depends on what methods of cancer treatment should be used and in what order. Part of cancers can be cured by surgery alone. However, regardless of the possibility of using chemotherapy, hormonal therapy or radiation therapy when used in combination with surgery the chances of recovery of the patient depend on the quality of surgery.
Surgical treatment should consist of excision of the entire tumor and lymph node metastases. The exception here is ovarian cancer where it left during the operation of tumor foci in the abdominal cavity can be destroyed by chemotherapy. In other cases, radical surgical treatment of cancer involves the complete removal of all outbreaks of the disease. As I mentioned cancer increases as invasive. It is therefore not possible to lay out the tumor from the surrounding tissue, malignant tumor must be excised with a margin of healthy tissue. In some cases, cut-out margin is the organ in which the tumor developed. Many times, however, when we cannot remove the entire organ margin of healthy tissue was determined based on the analysis of efficacy (eg. proved that a margin of healthy tissue around the cancer of the mouth should be at least 5mm because patients who were excised tumor with a smaller margin have a higher risk of relapse diseases). The skill of the surgeon depends precisely on whether the cancer is cut in an appropriate manner.
PSYCHO-ONCOLOGY
Psycho-oncology is a relatively young field of science. For its originator is considered PhD Jammie Holland, director of the Department of Psychiatry and Behavioural Sciences Oncology Centre them. Sloan-Kettering in New York. The beginnings of this field are considered to rise in 1984, the International Psycho-oncology Society. The basic objectives of its activities are: prevention and cancer prophylaxis and support of people suffering from oncological and their relatives by the disease.
Psycho-oncology is a science, which was established on the border between psychology and oncology. It assumes a close relationship and a significant impact on the psyche of man’s physical condition and emphasizes the role of psychological factors in the process of cancer treatment and recovery. Psycho-oncology has in terms of its three main areas of interest:
– cancer prevention;
– help people suffering from malignant and their relatives;
– education personnel who deal with the aforementioned groups.
Prevention of cancer – in the context of psycho – relies primarily on increasing public awareness of the threat of cancer, of which social groups are affected the most and how it can be treated. In practice, this means above all promoting research prevention of cancer, the organization of events that expand the knowledge on early detection of the disease, its symptoms and methods of self-control. The success of treating disease depends largely on early diagnosis and rapid treatment to take. Helping people suffering and their relatives is a support on many levels – mitigating the effects of psychological diagnosis, build a proper picture of the disease, try to accept it and work out ways of coping with the disease.
Psycho-oncology has much to offer for relatives of cancer patients, for example psychological support, in terms of both: care about the well-being of the patient advocacy and work on improving communication and contact with the family or relationships. Another area of interest is psycho educational activities addressed to professionals working every day with cancer patients and their loved ones – doctors, nurses, support staff and medical students. They are mainly aimed at enhancing and improving communication with the patient. Psycho-oncology, although it is a relatively young field, noticeably expanding – creating new institutions practicing holistic approach to the patient, there is also more and more research on the subject. Increasingly, it is also said about the relationship between medicine and psychology and the need to care for your mental well-being, as an important element of general health care. Psycho-oncologist is psychologist who completed higher education and in addition to the psychological field, has specialized in oncology. In addition to the certified psycho-oncologists, we can often meet psychologists who specialize in working with cancer patients. These specialists are well aware of the specificity of cancer and found in the mechanisms and qualified to work with oncological patients or their loved ones.
PSYCHOLOGICAL REACTIONS ON CANCER AT VARIOUS PHASES
Cancer is a serious situation, aroused a lot of different, sometimes very difficult emotions and feelings. Many of the mentioned emotions continues throughout the period of the disease, until recovery, others appear episodically or may not occur at all. This depends on both the severity of the disease and individual patient’s mental faculties. This is what we remember, emotions and feelings with which psychologists working with cancer patients face in their work frequently, the emotions that the individual phases of the disease are particularly strong or specific to a given phase.
PHASE ONE – DIAGNOSIS
The moment of diagnosis is usually traumatic moment. Even if the disease was
suspected, if we have seen the symptoms, diagnosis often is the moment in which we lose the ground under our feet. Hence the emotions that arise, are exceptionally strong and negatively charged. This is a good time to look for support – to start working with a psychologist, who will find themselves in a new situation, to understand the emotions that arise and learn to cope better with the disease.
Feelings and emotions that may arise:
• shock
• anger, wrath
• bow
• desperation
• regret
• a sense of injustice and questions: “Why this happens to me?”, “What for?”
PHASE TWO – TREATMENT
This is the phase in which the most the patient had already adapted to the disease, get used to it and give himself under medical care. However, in this phase also appear difficult emotions, especially in connection with the medical procedure and side effects of treatment or fear of the environment
reaction. Stage of treatment is the period in which the patient is much weaker and more likely to need help from relatives.
Feelings and emotions that may arise:
• shame
• the desire to isolate themselves, to hide the disease and treatment effects
• fear of the effects of therapy
• the fear of treatment – eg. before going to sleep for surgery, postoperative complications
• fear of pain
• a sense of helplessness and hopelessness
• a sense of loss of control
• fear of being reliant and the need to ask for help.
PHASE THREE – Remission AND TERMINATION OF TREATMENT
Contrary to appearances, this phase can also be difficult. About the time of remission and the end of treatment used to be thought of as the awaited, longed, forgetting how much stress it entails. Firstly, the whole patent’s world , which until now was focused on the fight against the disease is changing once again. Moreover, in this phase there is a new fear – fear of metastasis or recurrence of the disease. Sometimes it happens so that compounds that have survived the disease, people who have supported in the difficult moments, they are not able to function together in the absence of disease. This can happen because there is a desire to forget about illness, cut off from it. This is the phase in which they can appear depressive episodes. Then especially use the help of a specialist.
Feelings and emotions that may arise:
• fear of recurrence or metastasis
• fear of returning to “normality” – work, friends, regular activity
• the difficulty of finding themselves in the absence of disease.
PHASE FOUR – REVERSE OR METASTASIS
This is often the most difficult stage of the disease, sometimes more difficult than the diagnosis. This is the phase in which it becomes clear that there is no quick and full recovery- hope and the prospect of a cure disappear.
Feelings and emotions that may arise:
• loss of hope
• desperation
• bow
• fear of death
• fear of re-treatment, pain, side effects
• anger.
STAGE FIVE – PRETERMINAL AND TERMINAL
From the medical point of view in this phase chances of returning to previous health are small. At this stage, the support of the psychologist is important to minimize the psychological pain of the patient and his family. A psychologist can help prepare patient and relatives to death, make communication between them easier and that the mere fact of leaving the sick person will be milder.
Feelings and emotions that may arise:
• fear of death
• fear of pain
• anxiety about loved ones who remain.
THE ROLE OF THE PSYCHOLOGIST
The role of the psychologist changes in different stages of the disease – the support and assistance in the acceptance and understanding of the situation, the role of educational and developmentally supportive, working with the attitudes and beliefs, to work with people in mourning. At each of these stages is the most important above all the presence and the support it provides psychologist and openness and willingness to accompany the experience of difficult emotions.
How can a psychologist help:
• support in finding and using the natural resources of the patient
• assistance in alleviating emotional and facilitate their expression
• assistance in adaptation to illness
• restore the balance that has been upset disease
• presence, listening
• debunking myths about cancer
• preparation to the different stages of the disease or waiting patient treatments
• learning relaxation and visualization
• support in the experience difficult emotions
• work on bid farewell.
Conclusion
Psychological impact on cancer developed in the nineties of the last century. Despite the diversity of types of interactions their goal is similar: they have primarily
improve the quality of life and help in cope with the situation of developing breast cancer. However, when we use psychological impact, we should consider the following important issues that give Rowland and Massie.
According to these authors confirmed that patients with cancer using interventions aimed at the mastery of knowledge, management skills and reduce the level of distress function better than patients who do not participate in the interventions. This applies to reduce the level of anxiety, increasing the sense of control, improve body image, a higher level of satisfaction with care and better sexual functioning, and as well as greater level of adherence to medical advice. None of the studies showed no deterioration in patients who have used the psychological impact, compared with those who underwent treatment without this form of assistance.
References:
Rowland JH., Massie MJ. (2000), Psychosocial issues and interventions. W: Harris JR (red.). Diseases of the breast. Philadelphia: Lippincot Williams & Wilkins, s. 1009-31.
Cassileth BR. (1995), The aim of psychotherapeutic intervention in cancer patients. Support Care Cancer, 3: 267-9.
Edelman S, Kidman AD. (1999), Description of a group Cognitive Behaviour Therapy programme with cancer patients. Psychooncology, 8: 306- 314.
Moorey S, Greer S. (1989), Psychological therapy for patients with cancer: A new approach. Oxford: Heinemann Medical Books.
Bloch S, Kissane D. (2000), Psychotherapies in psycho-oncology. Br J Psychiatry, 177: 112-6.
Kissaane DW, Bloch S, Miach P. (1997), Psychooncology, 6.
Gross J. (1989), Emotional expression in cancer onset and progression. Soc Sci Med, 28: 1239-48.
Moorey S, Greer S, Bliss J. (1998), A comparison of adjuvant psychological therapy and supportive counselling in patients with cancer. Psychooncology, 7: 218-28.
Walker LG, Heys SD, Eremin O. (1999), Surviving cancer: do psychosocial factors count? J Psychosom Res, 47: 497-503.
Miller, A. B., Hoogstraten, B., Staquet, M. and Winkler, A. (1981), Reporting results of cancer treatment. Cancer, 47: 207–214.