M (mitosis: prophase metaphase anaphase telophase) G1 (growth). Rapidly dividing cells S (synthesis of DNA) G2 (growth) G0 (quiescent G1 phase). Most normal cells are in this phase
CLASSIFICATION OF NEOPLASMS
A.
BENIGN NEOPLASIA
1. CELLS ADHERE TO EACH OTHER AND THE GROWTH REMAINS CIRCUMSCRIBED.
2. GENERALLY NOT LIFE THREATENING UNLESS THEY OCCUR IN A RESTRICTED AREA (E.G., SKULL)
CLASSIFICATION OF NEOPLASMS
B.
MALIGNANT NEOPLASIA
1. CELLS INFILTRATE SURROUNDING TISSUE 2. CELLS INVADE OTHER TISSUES AND PRODUCE SECONDARY LESIONS
3. MAY SPREAD (METASTASIZE) BY DIRECT EXTENSION, LYMPHATIC PERMEATION AND EMBOLIZATION, AND DIFFUSION OF CANCER CELLS BY MECHANICAL MEANS
2.
3. 4. 5.
6.
7. 8. 9. 10. 11.
ADENOMA GLANDULAR TISSUE LEIOMYOMA SMOOTH MUSCLE CHONDROMA CARTILAGINOUS TISSUE OSTEOMA BONE OSTEOBLAST HEMANGIOMA BLOOD VESSELS LYMPHANGIOMA LYMPHATICS NEUROMA NERVE CELLS LIPOMA ADIPOSE TISSUE PAPILLOMA ETHELIAL TISSUE RHABDOMYOMA SKELETAL TISSUE FIBROMA FIBROUS TISSUE
4.
5. 6. 7. 8. 9.
ADENOCARCINOMA GLANDULAR EPITHELIAL TISSUE CARCINOMA EPITHELIAL SURFACE TISSUE SARCOMA CONNECTIVE TISSUE OSTEOSARCOMA BONE OSTEOBLASTS HEMANGIOSARCOMA BLOOD VESSELS LYMPHANGIOSARCOMA LYMPHATICS NEUROFIBROSARCOMA (NEURILEMIC SARCOMA) NERVE SHEATH LIPOSARCOMA ADIPOSE TISSUE MELANOMA - MELANOCYTES
MALIGNANT TUMORS ARE CLASSIFIED BY A UNIVERSAL SYSTEM OF STAGING CLASSIFICATION, THE TNM SYSTEM
1. 2.
3.
4.
M DESIGNATES METASTASIS
NUMBERS 0 TO 4 DESIGNATE DEGREE OF INVOLVEMENT TIS DESIGNATES CARCINOMA IN SITU, OR ONE WHICH IS NONINFILTRATING
5.
STAGING
DETERMINES THE SIZE OF THE TUMOR AND THE EXISTENCE OF STAGING THE TNM SYSTEM IS FREQUENTLY USED
2.
GRADING
REFERS TO THE CLASSIFICATION OF THE TUMOR CELLS DEFINES THE TYPE OF TISSUE ORIGIN OF THE TUMOR AND THE DEGREE TO WHICH THE TUMOR CELLS RETAIN THE FUNCTIONAL AND HISTOLOGIC CHARACTERISTICS OF THE TISSUE ORIGIN
DESCRIPTION
CANNOT BE ADEQUATELY ASSESSED
CARCINOMA
PROGRESSIVE
N SUBCLASSES NX N0 N1,N2,N3,N4
REGIONAL REGIONAL
INCREASING
DESCRIPTION
ASSESSED
DISTANT
WELL-DIFFERENTIATED
GRADE
G2
G3,G4
MODERATELY
POORLY
WELL-DIFFERENTIATED GRADE
EPIDEMIOLOGY OF CANCER
AGE;
NINETY PERCENT (90%) OF ALL CANCERS ARE RELATED TO LIFESTYLE AND ENVIRONMENTAL FACTORS COMBINATION OF RISK FACTORS PROVIDE A HIGHER INCIDENCE OF SPECIFIC CANCERS
ACQUIRING INVASIVE CHARACTERISTICS THAT THEY CAN INFILTRATE TISSUES AND GAIN ACCESS TO LYMPH AND BLOOD VESSELS
2.
SECONDARY INVOLVES DETECTION AND SCREENING TO ACHIEVE EARLY DIAGNOSIS AND PROMPT INTERVENTION TO HALT THE CANCER PROCESS
DESCRIPTION
ANALYSIS
POTENTIAL USES
OF BREAST, COLON, LUNG, SUBSTANCES FOUND IN OVARIAN, TESTICULAR, THE BODY OR BODY FLIDS PROSTATE CANCERS MADE BY THE TUMOR OR BY THE BODY RESPONSE TO A PARTICULAR TUMOR NEUROLOGIC, PELVIC, ABDOMINAL, THORACIC CANCERS
MAGNETIC CREATES SECTIONAL RESONANCE IMAGING IMAGES OF BODY STRUCTURES USING MAGNETIC FIELDS AND RADIOFREQUENCY SIGNALS
SUCCESSIVE LAYERS OF TISSUE FOR CROSS-SECTIONAL VIEW THROUGH THE USE OF NARROW X-RAY BEAM
IDENTIFIES
NEUROLOGIC, PELVIC, SKELETAL, ABDOMINAL, THORACIC CANCERS SKELETAL, LUNG, GASTROINTESTINAL CANCERS
FLUOROSCOPY
DESCRIPTION
HIGH-FREQUENCY
POTENTIAL USES
ABDOMINAL AND PELVIC CANCERS
SOUND WAVES ECHOING OFF BODY TISSUES ARE CONVERTED ELECTRONICALLY INTO IMAGES
USED
VISUALIZATION OF A BODY CAVITY OR PASSAGEWAY BY INSERTION OF AN ENDOSCOPE INTO A BODY CAVITY OR OPENING
ALLOWS
DESCRIPTION
USES
POTENTIAL USES
BONE, LIVER, KIDNEY, SPLEEN, BRAIN, THYROID CANCERS
INTRAVENOUS INJECTION OR INGESTION OF RADIOISOTOPE SUBSTANCES FOLLOWED BY IMAGING OF TISSUES THAT HAVE CONCENTRATED THE RADIOISOTOPES
RADIOIMMUNOCONJUGATES
MONOCLONAL
ANTIBODIES ARE LABELED WITH A RADIOISOTOPE AND INJECTED INTRAVENOUSLY INTO THE PATIENT
THE
COLORECTAL,
AND MELANOMA
DESCRIPTION
COMPUTED
POTENTIAL USES
LUNG, LIVER, COLON, AND PANCREATIC CANCERS
GENDER
MALE AND FEMALES MALES AND FEMALES MALES AND FEMALES MALES
AGE
50 AND OLDER
FREQUENCY
EVERY 5 YEARS
FECAL OCCULT BLOOD TEST DIGITAL RECTAL EXAMINATION PROSTATE EXAMINATION BREAST SELFEXAMINATION
50 AND OLDER
EVERY YEAR
40 AND OLDER
EVERY YEAR
50 AND OLDER
EVERY YEAR
FEMALES
20 AND OLDER
EVERY MONTH
GENDER
FEMALES
ALL
AGE
FREQUENCY
WOMEN WHO ARE OR WHO HAVE BEEN SEXUALLY ACTIVE,WHO HAVE REACHED 18 YEARS OF AGE, SHOULD HAVE AN ANNUAL PAPS SMEAR TEST AND PELVIC EXAMINATION
AFTER
A WOMAN HAS HAD 3 OR MORE CONSECUTIVE SATISFACTORY NORMAL ANNUAL EXAMINATIONS, THE PAP TEST MAY BE PERFORMED LESS FREQUENTLY AT HER PHYSICIANS DIISCRETION BREAST CLINICAL FEMALES EXAMINATION MAMMOGRAPHY FEMALES 20 TO 40 OLDER THAN 40 40 AND OLDER EVERY 3 YEARS EVERY YEAR EVERY YEAR
1.
USED TO DESTROY MALIGNANT CELLS BY INTERFERING WITH REPRODUCTION OF THE CANCER CELL ACT AT SPECIFIC POINTS IN THE CYCLE OF CELL DIVISION (CELL-CYCLE SPECIFIC) OR AT ANY PHASE OF THE CYCLE OF CELL DIVISION (CELL-CYCLE NONSPECIFIC)
1.
AFFECT ANY RAPID DIVIDING CELL WITHIN THE BODY, THUS HAVING THE POTENTIAL FOR TOXICITY DEVELOPMENT IN HEALTHY, FUNCTIONAL TISSUE (BONE MARROW, HAIR FOLLICLES, GI MUCOSA); TO REDUCE THE POSSIBILITY OF TOXICITY, COMBINATION THERAPY IS OFTEN USED AVAILABLE IN ORAL, PARENTERAL (IM, SC, IV), INTRAARTERIAL, INTRATHECAL, AND TOPICAL PREPARATIONS
4.
NURSING CONSIDERATION
ONLY NURSES FAMILIAR WITH ADVERSE EFFECTS AND TOXICITIES OF CHEMOTHERAPY AND BIOTHERAPY SHOULD ADMINISTER THESE DRUGS
ANTICANCER AGENTS ARE CONSIDERED MUTAGENIC, TERATOGENIC, AND CARCINOGENIC AND SHOULD BE HANDLED, ADMINISTERED AND DISPOSED ACCORDINGLY
PATIENT SHOULD BE ENCOURAGED TO REPORT UNUSUAL SYMPTOMS AND ADVERSE EFFECTS.
CURE, TO ERADICATE THE CANCER AND PROMOTE LONG TERM PATIENT SURVIVAL CONTROL, TO ARREST TUMOR GROWTH
Chemotherapy
Goal is to kill rapidly dividing cells with drugs and leave other cells unharmed
Certain normal cells also divide rapidly
Hair cells Bone marrow Epithelial cells lining the digestive tract
Cause DNA damage or inhibit replication and transcription May trigger apoptosis
ANTINEOPLASTIC DRUGS
1.
2.
3. 4. 5. 6. 7.
ALKYLATING AGENTS ANTIBIOTICS ANTIMETABOLITES HORMONES IMMUNE AGENTS MISCELLANEOUS AGENTS COMMON COMBINATIONS OF NEOPLASTIC AGENTS
ALKYLATING AGENTS
A.
B.
ANTIBIOTICS
A.
CELL-CYCLE NON-SPECIFIC; INHIBIT RNA AND PROTEIN SYNTHESIS IN RAPIDLY DIVIDING CELLS EXAMPLES
1. 2. 3. 4. 5. 6. DACTINOMYCIN DAUNORUBICIN DOXORUBICIN HYDROCHLORIDE MITHRAMYCIN MITOMYCIN PROCARBAZINE HYDROCHORIDE
B.
ANTIMETABOLITES
A.
CELL-CYCLE SPECIFIC; INHIBIT PROTEIN SYNTHESIS IN RAPIDLY DIVIDING CELLS DURING S PHASE EXAMPLES
1. 2. 3. 4. 5. 6. 7. AZATHIOPRINE CYTARABINE FLOXURIDINE FLUOROURACIL HYDROXYUREA MERCAPTOPURINE METHOTREXATE
B.
HORMONES
A.
CELL CYCLE NON-SPECIFIC; INHIBIT RNA AND PROTEIN SYNTHESIS IN TISSUES THAT ARE DEPENDENT ON THE OPPOSITE (SEX) HORMONE FOR DEVELOPMENT
B.
EXAMPLES
1. 2. 3. 4. 5. ANDROGENS ESTROGENS PROGESTINS STEROIDS (PREDNISONE) OTHER
IMMUNE AGENTS
A.
INVOLVES INTRODUCTION OF NONCANCEROUS ANTIGENS OR OTHER AGENTS INTO THE BODY TO STIMULATE PRODUCTION OF LYMPHOCYTES AND ANTIBODIES
B.
EXAMPLES
1. BACILLUS OF CALMETTE-GUERIN (BCG) VACCINE: PROVIDE ACTIVE IMMUNITY 2. INTERFERON ALFA-2a AND 2b
MISCELLANEOUS AGENTS
A.
LEUCOVORIN CALCIUM
1. A REDUCED FORM OF FOLIC ACID 2. ANTIDOTE TO FOLIC ACID ANTAGONISTS
MISCELLANEOUS AGENTS
B.
PACLITAXEL
1. INHIBITS THE REORGANIZATION OF THE MICROTUBULE NETWORK THAT IS NEEDED FOR INTERPHASE AND MITOTIC CELLULAR FUNCTIONS
2. CAUSES ABNORMAL BUNDLES OF MICROTUBULES DURING CELL CYCLE AND MULTIPLE ESTERS OF MICROTUBULE DURING MITOSIS
MISCELLANEOUS AGENTS
C.
VINBLASTIN
1. AN ALKALOID EXTRACTED FROM PERIWINKLE 2. ARRESTS MITOSIS DURING METAPHASE, BLOCKING CELL DEVISION
2.
3. 4. 5.
6.
7. 8. 9. 10. 11. 12.
ANOREXIA, NAUSEA, VOMITING DIARRHEA BONE MARROW DEPRESSION STOMATITIS BLOOD DYSCRASIA BONE MARROW DEPRESSSION ALOPECIA NEUROTOXICITY HEPATOTOXICITY HYPERURICEMIA KIDNEY FAILURE DOXORUBICIN: CARDIAC TOXICITY BCG: ALLERGIC REACTIONS, ANAPHYLAXIS
RADIATION
PURPOSE:
A. B.
DIAGNOSIS TREATMENT
1. 2. 3. CURATIVE: DESTROYS NEOPLASM BY IRRADIATION PALLIATIVE: SHRINKS NEOPLASM BY IRRADIATION ADJUVANT: USED IN CONJUNCTION WITH CHEMOTHERAPY OR SURGERY TO SHRINK OR DESTROY NEOPLASM
RADIATION
EXAMPLES
A.
B.
RADIATION
EXAMPLES
C.
1. 2. 3.
D.
E.
F.
2. GONADS
EXTERNAL BEAM RADIOTHERAPY OR TELETHERAPY DELIVERS RADIATION TO A TUMOR BY MEANS OF AN EXTERNAL MACHINE (COBALT OR LINEAR ACCELERATOR) AT A PREDERMINED DISTANCE.
INTERNAL RADIATION THERAPY OR BRACHYTHERAPY DELIVERS RADIATION BY SYSTEMIC, INTERSTITIAL, OR INTRACAVITY MEANS
1. SYSTEMIC (METABOLIZED) INVOLVES ADMINISTRATION BY INTRAVENOUS OR ORAL ROUTES INTERSTITIAL INVOLVES IMPLANTATION WIRES, OR SEEDS INTO THE TISSUE OF NEEDLES,
2.
3.
INTRACAVITY RADIATION INVOLVES PLACING AN IMPLANT INTO A BODY CAVITY AND MAY REQUIRE A SURGICAL PROCEDURE
BIOTHERAPY
ALSO USE
KNOWN AS IMMUNOTHERAPY
OF SUBSTANCES (NATURAL OR SYNTHETIC) THAT STIMULATE THE BODYS IMMUNE SYSTEM TO FIGHT DISEASE BY AFFECTING BIOLOGICAL RESPONSES IN HOST-TUMOR INTERACTIONS
SURGICAL TREATMENTS
DEBULKING
REMOVE THE ENTIRE TUMOR INCLUDING LYMPH NODES USED WHEN THE SIZE OF THE TUMOR HAS GROWN LARGE ENOUGH TO CAUSE SYMPTOMS THAT AFFECT QUALITY OF LIFE. ADJUVANT THERAPY IS MORE EFFECTIVE AFTER THIS TYPE OF SURGERY
PALLIATIVE
SURGERY
USED TO RELIEVE COMPLICATIONS, SUCH AS PAIN, ULCERATION, OBSTRUCTION, HEMORRHAGE OR PRESSURE. EXAMPLE IS CORDOTOMY TO RELIEVE INTRACTABLE PAIN
PROPHYLACTIC
SURGERY
INVOLVES THE REMOVAL OF NONVITAL TISSUES OR ORGANS WITH A HIGH POTENTIAL FOR DEVELOPING CANCER IN PATIENTS WITH PERSONAL OR FAMILIAL RISK FACTORS FOR A PARTICULAR TYPE OF CANCER.
GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY
ASSESSMENT:
1.
OBTAIN A DESCRIPTION OF ONSET AND PROGRESSION OF SYMPTOMS PERFORM PHYSICAL ASSESSMENT TO DETERMINE GENERAL STATE OF HEALTH AND NUTRITION DETERMINE CLIENTS UNDERSTANDING OF DISEASE AND TREATMENT PLAN
2.
3.
GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY
ANALYSIS/NURSING DIAGNOSES
1.
2.
GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY
ANALYSIS/NURSING DIAGNOSES
3.
4.
5.
GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY
6.
7.
MUCOUS
MEMBRANE
GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY
8.
9.
TO
10.
GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY
PLANNING/IMPLEMENTATION:
1.
2.
GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY
3.
INSTRUCT CLIENT REGARDING SPECIAL MEASURES TO LIMIT INFECTION AND INJURY (E.G., GENTLE ORAL HYGIENE, PREVENTION OF PATHOLOGIC FRACTURES)
EXPLAIN SIDE EFFECTS THAT INFLUENCE APPEARANCE AND ENCOURAGE POSITIVE ADAPTATIONS (E.G, PURCHASE OF WIGS, SCARVES, HATS)
4.
GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY
5.
IMPLEMENT MEASURES TO REDUCE OR ELIMINATE NAUSEA SUCH AS ANTIEMETICS, HYPNOSIS, RELAXATION MODALITIES, SMALL FREQUENT FEEDINGS, ADJUSTMENT OF MEAL TIMES IN RELATION TO THERAPY, AVOIDANCE OF SPICY FOODS
GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY
6.
GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY
7.
OFFER EMOTIONAL SUPPORT TO CLIENT AND FAMILY; ANSWER QUESTIONS AND ENCOURAGE VERBALIZATION OF FEARS
8.
ENCOURAGE CONSERVATION OF CLIENTS DECREASING ENERGY ENCOURAGE CLIENT TO LOOK GOOD, FEEL GOOD PROGRAM
9.
GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY
10.
SUPPORT NATURAL DEFENSE MECHANISMS OF CLIENT; ENCOURAGE INTAKE OF FOODS RICH IN THE IMMUNE=STIMULATING NUTRIENTS, ESPECIALLY VITAMINS A,C, AND E, AND MINERAL SELENIUM (WHOLE GRAINS AND SEEDS); IF CLIENT IS TAKING METHOTREXATE, ENCOURAGE INTAKE OF FOODS HIGH IN FOLIC ACID OR SUPPLEMENTAL FOLIC ACID WHICH IS NEEDED BY BLOODFORMING ORGANS
GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY
11.ENCOURAGE
OPTIMAL INTAKE OF HIGH NUTRIENT DENSITY FOODS; BLAND OR MECHANICAL SOFT DIET MAY BE INDICATED IF STOMATITIS EXISTS; ROUTINELY MONITOR WEIGHT
GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY
12. ENCOURAGE
WOMEN OF CHILDBEARING AGE TO USE BIRTH CONTROL MEASURES WHILE RECEIVING THERAPY BECAUSE OF MUTAGENIC/TERATOGENIC EFFECTS; AVOID USE OF BIRTH CONTROL PILL MALE CLIENTS REGARDING USE OF SPERM BANK IF PERMANENT INFERTILITY MAY RESULT
13. COUNSEL
GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY
14. KEEP
CLIENT WELL HYDRATED (3000 ML/24 HR); MONITOR INTAKE AND OUTPUT CLIENT FOR PAIN; ADMINISTER ANALGESICS AS NEEDED; PROVIDE FOR CLIENT COMFORT
15. ASSESS
GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY
16.
ENCOURAGE CLIENT TO BECOME INVOLVED IN DECISION MAKING; SUPPORT CLIENTS DECISIONS WHENEVER POSSIBLE, EVEN IF THEY DIFFER FROM THE NURSES PHILOSOPHY
GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY
17.
c.
d.
e.
GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY
17.
FOR
CLIENTS
RECEIVING
AVOID SKIN CONTACT WITH DRUGS DURING PREPARATION FOR ADMINISTRATION; WEAR GLOVES; IF CONTACT OCCURS, RINSE AREA WELL WITH WATER
g. AVOID USE OF RECTAL THERMOMETERS, ENEMAS, IM INJECTIONS, AND RAZOR BLADES BECAUSE OF INCREASED BLEEDING TENDENCY h. MONITOR RENAL FUNCTION FOR NEPHROTOXICITY i. MONITOR TOXICITY VITAL SIGNS; MONITOR FOR CARDIAC
GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY
18.
GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY
18.
GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY
19. SPECIFIC
a. AVOID OVEREXPOSURE TO THE CLIENT AND USE THE PRINCIPLE OF TIME, DISTANCE, AND SHIELDING
b. POSTPONE ROUTINE IMPLANT IS IN PLACE HYGIENE WHILE
GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY
19.
GENERAL NURSING CARE OF CLIENTS WITH NEOPLASTIC DISORDERS RECEIVING EITHER CHEMOTHERAPY OR RADIATION THERAPY EVALUATION/OUTCOMES
1. 2. 3. 4. 5.
2.
3. 4. 5. 6. 7.
ACUTE LEUKEMIA BLADDER CANCER BONE CANCER BREAST CANCER CERVICAL CANCER COLORECTAL CANCER ESOPHAGEAL CANCER
9.
10. 11. 12. 13. 14.
HODGKINS DISEASE LARYNGEAL CANCER LIVER CANCER LUNG CANCER MALIGNANT BRAIN TUMOR PANCREATIC CANCER OVARIAN CANCER
16.
17. 18. 19. 20.
PROSTATE CANCER RENAL CANCER STOMACH CANCER TESTICULAR CANCER THYROID CANCER UTERINE (ENDOMETRIAL) CANCER
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