Metastatic

Disease
Screening
KENNESAW STATE UNIVERSITY
NURS 7762 Advanced
Pathophysiology/Pharmacology
Alisha Gelder
 Topic Outline
METASTATIC DISEASE
INTRODUCTION - DIAGNOSTICS - THE
WHAT IS GOOD, THE BAD, &
METASTASIS? THE UGLY

APPLICATION TO
CONCLUSIONS
NURSING PRACTICE
 Objectives
Describe the impact of
After completion of this presentation,
metastatic disease on
the learner will be able to:
morbidity/mortality rates.

Explain the known processes

by which cancers metastasize. Compare the risks/benefits of
traditional diagnostics to
newer methods.

Review the application of the

List existing methods used to
nursing process to patients
diagnose metastatic disease.
undergoing metastatic
diagnostic testing.
 Introduction

Metastatic Disease
 What is Metastasis?
Definition
• Process by which cancer cells
spread to other parts of the
body.
• Pathology of metastatic
cancer cells matches those of
primary cancer, not the tissue
where it is found.
• Remote spread of cancer is
called Stage IV
Importance
• Metastatic disease accounts
for 10-90% of cancer related
deaths
• Non-metastatic cancer can
often be cured, metastatic
cancer usually requires
different treatment regimens
and survivability is much lower
(< 30%).
Metastatic Disease
• Increases risks for pain, infection, and
occurrence of oncological emergencies (i.e.,
Tumor Lysis Syndrome, Paraneoplastic
Syndrome)
• Can be diagnosed before the primary cancer
is found = Cancer of Unknown
Origin/Metastatic Cancer of Unknown
Primary
How Does Cancer Metastasize?
Local Spread Lymph Nodes
Small clumps of tumor cells
Cancer cells grow into and
break off and travel through
invade nearby healthy
the lymph system to other
tissue
parts of the body

Blood Vessels Angiogenesis

Small clumps of tumor Encourage new blood vessels
cells break off and travel to grow and support new
through the blood system tumor growth
to other parts of the body
Metastatic
Disease
Diagnostics
Traditional Methods
Imaging
MRI, CT, and PET Scans, Mammograms, X-Rays

Clinical Examination
Assessment methods: Percussion, Palpation, Inspection
Metastasis vs New Primary?
Further Testing Risks
• Biopsies: Needle, • General: Infection, bleeding,
Scraping, Aspiration, atelectasis, pneumothorax
Resection • Advanced: Fracture, seizure,
stroke
• Tissues: Bone, Bone
Marrow, Kidney, Liver, • Inconclusive results
Lung, Brain, Lymph Node • Lack of adequate sample
Is there a better
way to test for
metastatic
disease?
 Laboratory Tests
Tumor Markers Genomic Markers
Protein or other substance that is made at higher Found in tumors and tumor fragments that are
amounts by cancer cells shed into body fluids
Examples: CA-125, Calcitonin, CD20, PSA Examples: BRCA1, BRCA 2, HER2, EGFR)

• Can be specific to a cancer type or

• Show tumor gene mutations, patterns of
associated with multiple cancers
tumor gene expression, nongenetic changes
• Provide information about a cancer
in tumor DNA
⚬ How aggressive (staging)
• Can help monitor if treatment has stopped
⚬ Response to treatment
working
• 2 types: Circulating and Tumor Tissue
 New Methods
Liquid Biopsy and
Circulating Tumor DNA
• Fast, safe, non-surgical access to tumor's
genetic information
• Monitor disease progression/mutation
• Lung, colorectal, prostate, renal cell
carcinoma, pancreatic, glioblastoma, MM,
HCC, breast, esophageal, and bladder
Blood test that looks for tumor DNA
circulating in the blood stream
Used in conjunction with traditional
imaging/assessment, provides non-
invasive way to decide between
metastatic disease or new primary cancer
 New Methods
• Precursor to metastatic
disease
Circulating
Tumor Cell • 100x more likely to seed
(CTC) metastasis than single
Clusters CTCs

• Clusters easily broken

Associated with shorter down with traditional lab
progression-free survival techniques
and decreased overall • GA Tech has developed
patient survival new way to isolate CTC
Clusters
 New Methods: Cluster-Wells

Researchers at GA Tech's School of Electrical and Computer Engineering have developed the
Cluster-Wells technology for gently isolating CTC Clusters from unprocessed whole blood specimens
 So what?
• Study/measurement of CTC Clusters
gives new insight into the metastatic
process - which gives hope for prevention
• Can facilitate development of cancer
treatments
Application
to
Practice
 Nursing Process
Assessment
Diagnosis

Evaluation

Planning

Implementation
Nursing Process: Assessment
General Symptoms
• New/worsening pain
Complete history and • Changes in bowel/bladder
physical assessment • Changes in appetite
• Changes in
LOC/Orientation

Cancer Specific Cancer Specific

• Diagnosis with staging • Date of initial diagnosis
• Treatment regimen(s) • Date of last imaging
past & present • Recent labs (CBC w/ Diff,
• Current regimen CMP, UA)
cycle/day status
 Diagnosis

• Acute pain
• Risk for Infection
• Risk for Impaired Skin Integrity
• Anticipatory Grieving
• Fear/Anxiety
• Knowledge Deficit
 Plan/Evaluation
Acute Pain Risk for Infection
• Patient will verbalize pain is reduced or • The patient will remain free from infection as
controlled evidenced by the absence of fever and
incisional drainage

Risk for Impaired Skin

Integrity Anticipatory Grieving
• Coping enhancement
• Patient will display optimal healing without
signs of infection
 Plan/Evaluation
Fear/Anxiety Knowledge Deficit
• Patient will verbalize ways to cope with • Patient will participate in the learning process
increasing fear/anxiety • Patient will verbalize understanding of their
disease process and treatment regimen
 Interventions
Acute Pain Risk for Infection
• Assess pain level, quality, location, radiation, • Monitor for s/s of infection
onset, intensity, exacerbating/alleviating • Monitor labs
factors • Administer antibiotics/growth factors as
• Administer pain medication as ordered ordered

Risk for Impaired Skin Anticipatory Grieving

Integrity
• Monitor incision/drain sites
• Perform dressing changes as ordered
• Provide factual information about medical
diagnosis, treatment, and prognosis
• Provide realistic choices about aspects of
care
• Assist patient in identifying available
resources
 Interventions
Fear/Anxiety

• Provide calm environment

• Educate patient on their diagnosis
• Evaluate support systems
• Promote relaxation techniques
Intervention: Education
Treatment Regimen
• Length/expectations of regimen
• Symptoms/SE of new medications
• What/when to report to physician
Metastatic Disease
• Available resources
• Diagnostic process
(testing/imaging/procedures)
Pain Management
• Pain management regimen
• SE of pain medications
• Take as ordered
Infection Prevention
• Hand hygiene
• Self isolation
• Monitoring invasive lines, incision/drain sites
• Growth Factors, antibiotics
• Wound care
 Conclusions
• Metastatic disease increases cancer
mortality - responsible for 10-90% cancer
related deaths
• Traditional diagnostic methods for
metastatic disease are invasive and time-
consuming, and come with risk for harm to
patient
 Conclusions
• New developments in diagnostic testing
are promising for improved timing, more
focused diagnosis = personalized cancer
treatment
• Less invasive, much lower risk for
harm/injury
 Conclusions
• New developments are experimental =
COSTLY and LIMITED AVAILABILITY
• More research is needed to expand
availability and improve/perfect technique
to lower costs
Thank you for
listening!
Don't hesitate to ask any questions!
 References:
Boya, M., Ozkaya-Ahmadov, T., Swain, B. E., Chu, C.H., Asmare, N., Civelekoglu, O., Liu, R., Lee, D., Tobia, S.,
Biliya, S., McDonald, L. D., Nazha, B., Kucuk, O., Sanda, M. G., Benigno, B. B., Moreno, C. S., Bilen, M. A.,
McDonald, J. F., & Sarioglu, A. F. (2022). High throughput, label-free isolation of circulating tumor cell
clusters in meshed microwells. Nature Communications, 13, Article 3385. https://doi.org/10.1038/s41467-
022-31009-9

Cancer Quest - Emory University. (2007, July 30). Angiogenesis [Video]. YouTube.
https://www.youtube.com/watch?v=qghs7ZvetbA

Cancer Quest - Emory University. (2007, July 30). Metastasis [Video]. YouTube.
https://www.youtube.com/watch?v=rrMq8uA_6iA&t=14s

Dillekas, H., Rogers, M. S., & Straume, O. (2019). Are 90% of deaths from cancer cause by metastasis?.
Cancer Medicine, 8(12), 5574-5576. https://doi.org/10.1002/cam4.2474
 References:
Hao, X. and Kim, R. D. (2021). The application of circulating tumor DNA in the screening, surveillance, and
treatment monitoring of colorectal cancer. Annals of Surgical Oncology, 28, 1845-1858.
https://doi.org/10.1245/s10434-020-09002-7

Hong, Y., Fang, F., & Zhang, Q. (2016). Circulating tumor cell clusters: What we know and what we expect
(review). International Journal of Oncology, 49(6), 2206-2216. https://doi.org/10.3892.ijo.2016.3747
Lone, S.,N., Nisar, S., Masoodi, T., Singh, M., Rizwan, A., Hashem, S., El-Rifai, W., Bedognetti, D., Batra, S. K.,
Haris, M., Bhat, A. A., & Macha, M. A. (2022). Liquid biopsy: a step closer to transform diagnosis, prognosis,
and future of cancer treatments. Molecular Cancer, 21, Article 79 (2022). https://doi.org/10.1186/s12943-
022-01543-7
National Cancer Institute. (2021, May 11). Tumor markers. https://www.cancer.gov/about-cancer/diagnosis-
staging/diagnosis/tumor-markers-fact-sheet

Penn Medicine. (n.d.). Liquid biopsy diagnostic tool. https://www.pennmedicine.org/research-at-

penn/research-specialty-areas/liquid-biopsy