Various problems arise in cancer patients during their illness. These may be related to the treatment which the patient undergoes. These problems need effective management.
Management of Pain
Whenever a patient with cancer complains of pain, a careful diagnostic work up is required. Such a work up is designed to define as precisely as possible, the cause of pain. When a cancer causes pain, it does so by different mechanisms. These are:
1. Compression of nervous tissue, i.e. peripheral nerve root, or spinal cord, by cancer infiltration directly, or by bone in the case of pathologic bone fracture or vertebral collapse.
2. Direct infiltration of nervous tissue or interference with its blood supply by the cancer mass.
3. Obstruction of a passage, e.g. bowel.
4. Inflammation in pain-sensitive structures directly or by infection.
5. Cancer-associated nerve sense disturbance (neuropathy) caused probably by some secretion from the cancer cells.
Once the cause of pain is established, it is managed either by removal of the cause or by suppression of pain.
Removal of the Cause
· Surgery: Removal of an obstructing colon cancer.
· Radiation therapy: Directed to painful bone metastases or to the whole liver beset with painful metastases.
· Chemotherapy: Combination chemotherapy in breast cancer metastatic to bone.
· Miscellaneous: Antibiotics for an infected skin ulcer, corticosteroids for cerebral edema and its attendant headache in primary and metastatic brain cancers.
Suppression of Pain
When a direct attack on the cause of pain is not possible, or when the response to primary pain control is delayed, symptomatic approach is indicated. Here treatment is directed at modification of neural processing of the painful stimulus or of its perception. Diverse and often complementary therapeutic measures are available ranging from the administration of Aspirin to major neurosurgical operation.
For many patients, especially those with chronic pain and short life expectancies, pain management is centered around the use of analgesics. Mild analgesics like Aspirin or Patacetamal, provide satisfactory relief for a while. The use of stronger analgesic drugs (including potent narcotics) then becomes necessary.
Anti-anxiety and anti-depression medication may also be needed in the control of pain in many cases of cancer.