NCM 106 Cellular Aberration

Sir Siroy
Cellular Aberration
Group of disorder characterized by abnormal cell
growth and the ability to metastasize with potential
killing the host
Term cancer refers to the group of disease in
which cells grow and spared unrestrained throughout
the body
Normal cells mutate into abnormal cells that take
over normal tissue, eventually harming and
destroying the host
Latin word Carab cancer
Synonymous with neoplasm
Biology of cancer
Cell is the functional unit of the body in humans and
animals
The type of cell: EUKARYOTIC (contains nucleus)
Whist bacteria are prokaryotic
Being multi-cellular humans are made from
100,000,000,000,000 cells, all are derived from a
single fertilized ovum
Cancer
Single word, incorporates a vast diversity of diseases
since there are as many tumor types as there are cell
types in the human body.
It is not a single disease, but a group of
heterogeneous disease that share common biologic
properties (e.g. clone cell growth and invasive
ability)
Cancer research revolution has also demonstrated
that all cancers are genetic and share common
MOLECULAR PATHOENSIS
All CA are the result of mutations in oncogenes. Each
specific cancer occurs thru mutation in specific genes
Oncogene a gene that played a normal role in the cell as a
proto-oncogene and that has been altered by mutation and now
may contribute to the growth of a tumor
-it is a gene that has potential cause cancer
Gene the basic biological unit of heredity a segment of DNA
needed to contribute to a function
Proto-oncogene a normal gene that can become an oncogene
due to mutations
-To help regulate cell growth and differentiation
Chromosomes thread like linear stand of DNA and
associated proteins in the nucleolus of eukaryotic cells that
carries the genes and functions in the transmission of heredity
information.

Proliferation of growth pattern

Cell proliferation is the process by which cells divide

and reproduce in normal tissue, cell proliferation is
regulated so that the number of cell dying or being
shed.

Benign Growth Pattern

The most significant growth patter are:
-Hypertrophy
-Hyperplasia
-Metoplasia
-Dysplasia
Hypertrophy an increase in cell size resulting in an increase
in organ size. It commonly results from increases workload,
hormonal stimulation, or compensation directly..
Hyperplasia reversible increase of number of cells in
response to a specific growth stimulant
Ex: endometrial hyperplasia and BP are the result of
excessive hormone stimulation. But cancer can develop if the
growth mechanisms become defective
Metaplasia
- The conversion of one cell type to another type not usually in
the involved tissue
-It can be induced by inflammation, vitamin deficiencies,
chronic irritation, or various chemical agents
Ex: Substitution of columnar epithelial cells of the
respiratory irritations such as cigarette smoking
-The process is reversible
Dysplasia Abnormal change in size, shape or organization of
cells. The common stimulus creating a dysplasia is radiation,
inflammation of toxic chemicals or chronic irritation
Ex: chronic bronchitis (smokers)
-reversible if stimulus is removed
-some forms of dysplasia are known as precancerous
lesions

The cell cycle

(Cell cycle/Cell Division cycle)
Series of events that takes place in a cell leading to its
division and duplication (Replication)
The cell cycle consists of 4 distinct phases:
- G1 phase
- S phase
- G2 phase
- M phase (mitosis)
Composed of 2 processes:
-Mitosis chromosomes are divided between 2
daughter cells
-Cytokiness cells cytoplasm divides in half
forming distinct cells
G0 Phase Cells that have temporary or reversibly
stopped dividing are said to have entered a state of
quiescent
post-mitotic both quiescent and senescent cells
Example of cells entering into quiescent state are
neurons (non-proliferative cells)
Phases of Cell Cycle
Interphase Before the cell division, it needs to take
in nutrients. All the preparation are done during
interphase
Three (3) of interphase
I.
G1 Phaseor the growth phase - from the end
of the previous m phase until the beginning
of the DNA synthesis, duration is highly

II.

III.

IV.

variable even among different cell of the

same species
S Phase starts when DNA synthesis
commences; when it is complete, all
chromosomes have been replicated ie each
chromosomes has 2 (sister) chromatids
G2 Phase
Cell enters G2 which lasts until the
cell enters mitosis
Produtiion of microtubules
Inhibition of protein synthesis is
during G2 prevents the cell growth
Mitosis (m phase / mitotic phase)
Relatively brief m phase consists of
nuclear division
(KARYOKINESIS) divided into 5
phases
Prophase
Metaphase
Anaphase
Telophase
Cytokinesis
KARYOKINESIS cellular
division

Synthetic inhibitors Arrest cell cycle and useful as

antineoplastic and anticancer agent
Cell cycle checkpoint Used by the cell to monitor
and regulate the progress of the cell cycle. The cell
cant proceed to the next phase until checkpoint
requirements have been met
if cell s lack nutrient, cannot progress to the next
phase

Role of Cylin and Cyclin Dependent Kinases

Regulatory molecules (CHON enzymes)
Cyclin form the regulatory molecules and has no
catalytic
CDK the catalytic subunits but inactive in the
absence of cyclin when CDK is activated by cyclin it
performs a common biochemical reaction called
Phospharylation that a activates target CHON to
orchestrate coordinated cntry into the next phase of
cell cycle

Cell-cycle Time
The amount to time regulated for a cell to move from
one mitosis to another mitosis, or the sum of M, G1,
S, G2
The length of the total cell cycle varies with the
specific type of cell
A common misconception is that the rate of Cancer
cells proliferation is faster than that of a normal cell.
Usually cancer cells proliferate at the same rate as the
normal cells of the tissue or origin

The difference is that the proliferation of cancer cells

isCONTINUOUS
The growth rate tumors are expressed in doubling
time. DOUBLING TIME is the length of time it
takes for the tumor to double its volume.
The average Doubling Time for most primary solid
tumors is approximately 2 months
Rapidly growing tumors such as testicular cancer
may double every month, whereas prostate may
double every year.
Terminologies*:
Oncology study of tumors of neoplasm
Oncos Greek word for tumor
Cancer Common term for all malignant tumors
Neoplasia New growth
Neoplasm new growth of tissue that has no purpose
or function in the body
Tumor Broad term to identify any growth within
the body
Carcinogen Any substance that initiates and
promotes cancer formation
Mutation Any substance that promotes the
formation of potentially dangerous changes called
mutations in genes
Teratogen Substance that cross placenta from
mother to the child and harm the fetus
Benign Condition, tumor or growth that is not
cancerous, this means that it does not spread to other
parts of the body or destroy nearby tissue
Malignant Tumors are ambitious. Malignant tumors
have 2 goals: 1.) to survive and 2.) to conquer new
territory
Carcinogenesis /Oncogenesis creation of cancer. A
process by which normal cells are transformed into
cancer cells, it is characterized by a progression of
changes on cellular and genetic level that to undergo
cell division, thus forming a malignant mass
Apoptosis Process of programmed cell death

Differences between Benign and Malignant Tumor*

Benign
Malignant
-Mobilemass
- fixed
-Smooth andround
-irregular shaped
- Have surrounding fibrous
-no capsule
capsule
- cells multiply
- multiply rapidly
- tumor grow by expanding
- tumor grows by invading
and pushing awayand
and destroyingsurrounding
against surrounding tissue
tissue
-Not attachedto surrounding -Attached to surrounding
tissue
tissue
-Never spreads
- almost always spreads
-Easier to remove and does
- Difficult to remove and
not recur after excision
recurs after excision

Diagram Representation of General Pathophysiology of Cancer

Acquired
(environmental)
DNA damaging
agents
Chemicals
Radiation
Viruses

Activation growth
promoting oncogenes

Normal Cell

DNA
damage
Failure of
DNA Repair

Mutation in
the genome
of somatic
cells
Inactivation of
tumor
suppressor
genes

Unregulated cell
proliferation

Inherited mutation in:

-Genes affecting DNA repairs
-Genes affecting cell growth
or apoptosis

Alteration in
genes that
requires
apoptosis

Decreased
apoptosis

Clonal Expansion
Angiogensis
Additional
mutation

Escape from
immunity
Tumor progression

Malignant
neoplasm
Invasion of
metastasis

Theories of Carcinogensis
Proposes the process of transforming a normal cell
into a cancer cell
Consists of stages:

I.

II.

III.

Initiation
Cells are exposed to an initiating
agent or carcinogen that makes
them susceptible to manage
transformation
Initiating agents: Chemical,
biological, physical agents, viral,
environmental, lifestyle, genetic
factors, theses are capable of
producing irreversible changes in
the DNA of a cell
Promotion
Promoting agents or
cocarcinogenscause unregulated
accelerated growth in previously
initiated cells.
Is reversible if the promoting
agents are removed during agents
of carcinogenesis
Examples are hormones, plants
products, chemicals and drugs
Chemical carcinogensare called
complete carcinogens because they
can initiate and promote malignant
transformation
Ex: Cigarette
The effect of cocarcinogensmay be
inhibited by certain cancer
reversing or cancer-suppressing
agents.
EX: Vitamins, mineral,
caretenoids, flavonoids, or
certain host characteristics
(eg. Immune function,
age, hormonal factors) or
both.
Progression
Tumor cells acquire malignant
characteristics that include changes
in growth rate invasive potential,
metastatic frequency, morphologic
traits, and responsiveness to
therapy.

(2nd Day)
Immunology and epidemiology
Carcinogenic factors it is becoming increasingly evident
that cancer occurs because of interactions among multiple risk
factors of repeated exposure to a single carcinogenic agent
Risk factors of Cancer:
Having risk factor for cancer means that a person is more
likely to develop the disease at some point in his/her
life.However, having one or more risk factors does not
necessary mean that a person will get cancer. Some people
with one or more risk factors never develop the disease, while
other people who so develop cancer have no apparent risk
factors. This has to do with the pt IMMUNE SYS.
1.

2.

Genetics est. that 5% to 10% of all cancer result

from heredity or genetic predisposition. Heredity
cancer syndromes are characterized by the same pr
related cancer in multiple family member in multiple
generation
Hormonal factors hormones are important
regulators of growth. By stimulating proliferation,

hormones may increase the risk of mutation and at

the same time stimulate the replication of the mutated
cell, thus hormones are complete carcinogen.
EX: a direct carcinogen effect or estrogen is known
from the occurrences of vaginal and clear..
3. Environment agents 75% of cancers occur as the
result of environmental exposure.
-CHEMICALS
-Cancer of the scrotum in chimney sweeps
was due to their exposure to coal tars (1775
London)
-Bladder cancer among workers exposed
to aromatic amines (chemical used in dying
and pigment industry a century later in
Germany.
-Since then, more than 1000 of chemicals
have been examined for their potential to
cause cancer. Most chemical
isprocarcinogen.
-EX: Soot, coal tar products and cigarette
smoke
- Exposure too many chemicalcarcinogens
are associated w lifestyle risk factors such as
smoking, diet and alcohol consumption.
4. Radiation 2 forms:
-ultraviolet
-ionizing
-sources of UVR including the sun, welding, arcs,
germicidal lights
-UVR induces a change in DNA--DNA damage -- if
not repaired causing malignant transformation
squamous cell cancer of the exposed area of the skin
- Prolonged exposure
-recreational or occupational activities
-lighter skin pigmentation
-greater intensity
-duration of exposure
- The majority of ionizing radiation exposure is from
natural sources such as:
-cosmic rays
-radioactive ground minerals
-gases like radon, radium and uranium
-it can also occur from exposure to
-dx and therapeutic sources like:
-Gamma radiation (x-rays
-radiation therapies
-imaging studies
-atomic power
-nuclear weapons
-gamma radiation comes naturally from the rocks and
soil as low level radiation
-Visible and infrared light are form of nonionizing radiation
-Electromagnetic radiation with a wavelength bet
10- 2m (or cm) is call microwave radiation
EX: of microwave radiation are microwave
ovens and mobile phones
-there are non-ionizing but still has potential hazard
and should be used in caution
Radon gas-inhalation of this gas is dangerous
-cosmic radiation comes from the outer space. Some studies
have shown aircrew to have higher than average number of
cancers like Cancer of the brain, prostate, skin, breast , colon,
and leukemia
5.

Oncogenic viruses can induce or cause cancer and

contribute to human carcinogenesis by infecting the

6.

7.

host DNA resulting in proto-oncogenic changes and

cell mutation
Five (5) DNA viruses have been linked to cancer in
humans:
a) Human Papillomavirus (HPV) Cervical
cancer, anal cancer
b) Epstein-Barr virus (EBV) Burkitts
lymphoma, B-cells lymphoma,
nasopharyngeal cancer
c) Hepatitis B virus (HBV) hepatocellular
cancer
d) Hepatitis C virus (HBC) hepatocellular
cancer
e) Human herpes virus-8 (HHV-8) Kaposis
sarcoma
f) Human immunosuppressive virus (HIV)
important cofactor in many human cancers
because of its immunosuppressive effects
Bacteria and parasites gastric infection with the
Helicobacter pylori bacteria to the dev of gastric
lymphoma and gastric cancer
Infection with Schistosomahematobium parasitelinked to bladder cancer and liver cancer
Immune system deficiencies or immunodeficiency
is a stat in which the immune sys ability to fight
infectious disease is compromised or entirely absent
Types of immunodeficiency:
-Primary immunodeficiency
Inborn, some people are born with
defects in their immune system
-Secondary immunodeficiency
results of particular external
processes of disease: the resultants
state is called secondary of
acquired immunodeficiency
Common causes of acquired
immunodeficiency are
malnutrition, aging, and particular
medications like chemotherapy,
disease-modifying anti-rheumatic
drugs, immune

In spite of the immune systems ability to identify and destroy

cancer cells, some cancer cells are capable of by passing
surveillance, thus escaping and causing cancer.
8. Gender more men develop cancer that women.
More men die from cancer than women
9. Age with few exceptions cancer becomes more
prevalent in older persons. Over half of all cancers
occur in person age 65 or older
10. Race and Ethnicity incidence and mortality varies
among racial and ethnic groups. African American
men have 2.4 % higher incidence rate and 40%
higher in mortality rate that white men.
-Different kinds of cancer have diff risk factors: some of the
major risk factors associated with particular types of cancer
include the following:
Risk factors of the lungs:
-tobacco use, including cigarettes, cigar,
chewing tobacco and snuff
-radiation exposure
-second-hand smoke
Risk factors of oral cancer*
-tobacco use (cigarette, cigar, pipe,
smokeless tobacco)

-Excessive alcohol use

-excessive irritation (ill-fitting dentures)
-Vitamin A deficiency
Risk factors for laryngeal cancer:
-Tobacco use
-poor nutrition
-alcohol
-weakened immune system
-occupational exposure to wood dust, paint
fumes
-Age: more than 60 years old
Risk factors of Bladder cancer:
-Tobacco use
-occupational exposure: dyes, solvents
-chronic bladder inflammation
Risk factors of Renal Cancer:
-Tobacco use
-Obesity
-Diet: well-cooked meat
-Occupation exposure: asbestos, organic
solvents
-Age; 50-70 years old
Risk factors of Cervical Cancer*
-Tobacco use
-HPV
-Chlamydia infection
-Diet: low in fruits and vegetables
-Family history of cervical cancer
Risk factors of Esophageal Cancer:
-Tobacco use
-Gender: 3 times more common in men
-alcohol
-Diet: low in fruits and vegetables
Risk factors of Brest Cancer:
-Early menarche/late menopause
-age: changes in hormone levels throughout
life, such as age a first menstruation,
number of pregnancies and age at
menopause
-High fat diet
-Obesity
-Physical inactivity
-Alcohol in take
-women with a mother of sister who have
had breast are more likely to develop the
disease
Risk factors of Prostate cancer:
-Only men
-Advance age
-Race: more common among African
American men than among white men
-High fat diet
-Men with a father or brother who has had
prostate cancer are more likely to get
prostate cancer
Risk factors of Liver Cancer:
-Certain types of viral hepatitis
-cirrhosis of the liver
-Long term exposure to aflatoxin
(carcinogenic substance produced by a
fungus that often contaminates peanuts,
wheat, soybeans, corn and rice)
Risk factors of Skin cancer:
-Unprotected exposure to strong sunlight

-Fair complication
-Occupational exposure
Risk factors of Colonic Cancer:
-Personal/family hx of polyps
-high fat diet and/or low fiber diet
-history of ulcerative colitis
-Age: > 50 years
Risk factors of Uterine/endometrial Cancer:
-estrogen replacement therapy
-early men
TEN LEADING SITES OF CANCER ON 1998 BOTH
SEXES, PI
Disease
Number
%
Lung
11,123
15.6
Breast
9436
13.2
Liver
5,249
7.3
Cervix
4,536
6.3
Leukemia
3,147
4.4
Colonn
2,963
4.1
Thyroid
2,584
3.6
Stomach
2,563
3.6
Nasopharynx
2,200
3.1
Lymphomas
2,088
2.9

THE LEADING SITES OF CANCER ON FEMALE, 1998

PI
Disease
Number
%
*Breast
9,325
25.9
Cervix
4,536
12.6
Lung
2,649
7.4
Thyroid
2,068
5.8
Ovary
2032
5.7
Leukemia
1488
4.1
Colon
1415
3.9
Liver
1343
3.7
Stomach
1052
2.9
Corpus Uteri
1052
2.9
TEN LEADING SITES OF CANCER ON MALES, 1998,
PI
Disease
Number
%
*Lung
8,474
26.7
Liver
3,906
12.3
Prostate
2,026
6.4
Leukemia
1,659
.52
Colon
1548
4.9
Stomach
1511
4.8
Nasopharynx
1475
4.6
Lymphoma
1253
3.9
Rectum
1142
3.6
Oral
810
2.4
Quiz leakage:
Risk Factors of Breast, Cervical and Prostate Cancer
Cell cycle: understand
Diff bet Benign and malignant 5-10 exact
5 multiple choice
Enumeration

_________________________________________________

Unit III: Prevention, Detection, Diagnosis

PREVENTION:
-Primary cancer prevention guidelines is aimed at measures
to ensure that the cancer never develop
-Secondary prevention is aimed that detecting and
treatmentthe cancer early, during the most curable stage.
-several chemo-preventive agents have been found to
effectively reduce cancer risk and re currently I use
-Ex: anti-androgens, carotenoids, ASA, NSAIDs, celecoxib.
Etc
-Research on nutritional supplements and pharmaceutical
agents with potential cancer prevention benefits is going
-Ex: Lycopence, lutein, garlic, aloe vera, polysaccharides, tea,
polysaccharides, grape seed, gotulola, omega 3 fatty acids,
vitamin C, E, D, zinc (ants) and many more
-as the saying goes (an ounce of prevention is much much
better than a kilogram of cure
-Prevention rather than cure is the ultimate way to defeat
cancer so you should absolutely make sure your dietary intake
contains copious amounts of a wide range of anticancer
nutrients every single dat.
-Vaccines are begin designed to prevent cancer
-Immunization may, one day, result in the elimination of
certain cancer.
- Further reductions in cancer incidence through elimination
of occupational and environmental risks, changes in lifestyle,
focusing on healthy choices in diet and exercise.
The American Cancer Society estimates that 80% if all cancer
may be associated with environmental w\exposures and are
potentially, preventable and 1/3 of all cancer deaths in 2006 is
directly to tobacco use, poor nutrition, physical in activity
resulting to obesity.
Preventive measures to specific risk factors:
1. Alcohol use drink in moderation. No more than I
drink a day for women and no more than 2 in men
2. Chemical exposure follow instructions and safety
tips to avoid or reduce contact with harmful
substances both at work and at home. Like careful in
handling pesticides, paints, solvents ect
3. Family history of cancer If you think you have a
pattern of a certain type of cancer in our family, talk
to your doctor and will suggest exams that can detect
cancer early.
4. Poor diet and exercise, or being overweight eat
well; a healthy diet includes plenty of food high in
fiber, vitamins and minerals, breads and cereals,
fruits and vegetables, limit diet rich in fat like butter,
red meats etc.
Assignments:
Types of cancer
Research: update
2 nsg dx (risk and actual)
Outcome criteria
And intervention
Present
Pass before midterm
-be active and maintain a healthy wt. Brisk walking for at least
30 min or 5 or more days a week.

5. Viruses and bacteria-the FDA (DOH/PHIL) approved a vaccine for the

prevention of cervical cancer
-avoid unprotected sex or share needles. HIV, HPV
prevention
-vaccine for hepa B
6. psychosocial factors- psychological stress from the
environment or society or people that surrounds us. Ex.
Marital problems, death of loved ones, health problems,
financial crises ect.
-stress releases stress hormones-epinephrine, cortisol to
hep the body to react with more strength and speedincreases Bb, heart rate, blood sugar.
-small amount of stress is beneficial but chronic
(persisting or progressing) is harmful. It can lead into
unhealthy behavior like overeating, smoking etccancer
risk.
-stress weakens immune system
KEY AREAS FOR PRIMARY PREVENTION OF
CANCERS (DOH/PHIL)
Quiz tom
1. Promote lifestyle change.
smoking cessation- quit smoking for active smokers.
Prevent passive smoking. Advise smokers not to
smoke inside living areas and workplace to prevent
exposure of others to secondhand smoke.
2. Increase intake of dietary fiber by eating more leafy
green and yellow vegetables, fruits and unrefined
cereals. Betacaratene, vitamins A,C,E.
3. Eat less fatty foods
4. Limit consumption of smoked, charcoal-broiled, saltcured, and salt-pickled foods.
5. Avoid moldy foods
-control obesity through proper nutrition and
exercise.
-drink alcoholic beverages in moderation.
6. Advocate an environment supportive of a healthy
lifestyle.
-promote a smoke-free environment
-sooner a cancer is diagnosed and treatment begins,
the better the chances of living longer and enjoying a
better quality of life.
SCREENING FOR CANCER DOH/PHIL
-early detection and prompt treatment are keys to curing
cancer (note: cure rate in cancer is relative and depends on
the type of cancer).
The earlier cancer is detected, the more likely it is to be cured.
Early detection techniques enable health care providers to
screen for and diagnose cancer while it is localized and
potentially curable.
-The acronym CAUTION US (ACS) provides a systematic
way of remembering the cancer
C-change I bowel or bladder habits
A-a sore that does not heal
U-unusual bleeding or discharge
T-thickining or lump in the breast or else where
I-indigestion and difficulty in swallowing
O-obvious change in wart or mole

-warts sor moles are circumscribed cutaneous discolorations to

skin elevations that should not increase in size, nor elcerate.
N-nagging cough or hoarshness of voice
-evaluate for symptoms related for persistent cough and its
quality eg dry
U-unexplained anemia
S-sudden wt loss
SPECIFIC GUIDELINES FOR EARLY DETECTIN OF
COMMON CANCER:
There are many types of cancers. Therefore, guidelines for
screening and early detectin will vary depending on the type
of CA.
BREAST CANCER
Warning signs
-skin changes
-edema
-inflammation peau de orange orange peel like skin
-ulceration
-prominent venous pattern
Nipple abnormalities
-retraction
-rashes or discharge
ABNORMAL CONTOURS
-variation in size and shape of breast
EARLY DETECTION
1. Breast self-examination-cheapest and most affordable
screening procedure.
this can be easily taught to women to increase
awareness and promote self-care.
best time to do BSE is one week after menstrual
period while taking a shower, facing the mirror
standing up or lying down
2. Yearly breast examination by a health care providerthis is to detect masses/lumps missed by the client or
to confirm presence of mass detected by client on
BSE. If lumps or lymph nodes swelling is present,
assess also for the following:
-location
-number of lumps or nodes (solitary or multiple)
-consistency: soft or hard
-size (estimation)
-fixed or movable
-tenderness along the area
3. Breast mammography
-if a mass is detected and confirmed by the health worker, a
mammogram usually confirms it.
-baseline M is suggested for all women between the ages 3539 and yearly after age 40.
-if with family history of breast cancer, M should be started at
age 30.
-put in mind that BSE does not take the place of a
Mammography or vice versa.
REMEMBER!!
BSE
-should be done monthly, a week after onset of menstrual
period.
-by age 20, women should have developed the habit of doing
BSE monthly;----teach BSE to women early in their teens.
-breasts tend to undergo changes during:
-pre-menstrual period;--perform BE a week after
menstrual period

-pregnancy
-lactation.
CERVICAL CANCER
-often asymptomatic
-abnormal vaginal bleed (e.g. post-coital bleeding)
EARLY DETECTION:
-paps smear is the primary screening tool for women over age
18.
-Paps smear should be done in between menses (2 weeks after
menses). A woman should not douche, have intravaginal
medications nor have sexual intercourse 24 hours prior to test.
-should be done annually for 2 consecutive years and at least
every 3 years until age 65 for those with normal findings
-for persons at high risk, it should be done yearly. This include
those who are: sexually active, have multiple partners,
commercial sex workers.
COLON RECTAL CANCER
-change in stool
-rectal bleeding
-pressure on the rectum
-abdominal pain
EARLY DETECTION:
-annual digital rectal exam starting at age 40
-annual stool blood test starting at age 50
-annual inspection of colon
PROSTATE CANCER
Symptoms of urethral obstruction:
-urinary frequency
-nocturia
-decrease in stream
-post-void dribbling
EARLY DETECTION:
-digital rectal exam for men
-Prostate specific antigen (PSA) determination a blood test,
confirms diagnosis.
LUNG CANCER
-persons with a long history of smoking and/or smoking 2 or
more packs of cigarette a day
-chronic cough or nagging cough
-dull intermittent, localized pain
-history of wt loss
EARLY DETECTION
-CXR q6months for patients who have history of smoking 2
packs a day
-sputum cytology
DIAGNOSTIC EVALUATION, STAGING, AND NURSING
RESPONSIBILITIES.
LUNG CANCER
-a. starndard roentgenogram or x-ray on chest. Detect any
abnormalities in the lungs.
Nursing responsibilities
-avoid excessive exposure of client and self
-remove radiopaque objects that can interfere with the results
-explain procedure to client.
-b. sputum cytology- examine a sample of sputum under a
microscope to determine whether abnormal cells are present
Nursing responsibilities

-no special prep is required. Just instruct client to cough our

sputum in a sterile container and label properly,
BREAST CANCER
-A. Mammogram or mammography- is a special type of x-ray
imaging used to create detailed images of the breast.
-b. clinical breast examination- a physical exam of the breast
done by a health professional.
NR
-explain the procedure that this is done to find a lump or
change in the breast that may mean serious problem, such as
CA.
-MRI-radiowaves and magnetic field are used to view soft
tissues. Useful in diagnosing tumors.
NR
-explain procedure
-be aware that it is contraindicated to clients with metallic
-implants, pacemaker, sharpnels, hearing aids, obesity.
-remain still through out the procdure.
-4. Tissue
UTERINE CANCER
-A. Transvaginal sonography- a procedure used to examine
the vagina, uterus, fallopian tube, ovearies and bladder. An
instrument (utz probe) is inserted into the vagina that causes
sound wavest to bounce off organs inside the pelvis. Thie
sound waves create echoes that are sent to a computer, which
creates a picture called a sonogram.
NR
-explain
-that eliminates the need for full bladder. This procedure of
full bladder is true only to abdominal utz (1quart/1L) in 2
hours and dont void. Full bladder serves as a landmark to
define other pelvic organs.
-b. hysteroscopy- is the inspection of the uterine cavity by
endoscopy with access through the cervix. It allows for the
diagnosis of intrauterine pathology and serves as a method for
surgical intervention.
-c. sonohysterography- new technique developed to better
image the uterine cavity. It uses an infusion of sterile saline
through a soft plastic catheter placed in the cervix in
conjunction with transvaginal UTZ.
-it distends the uterine cavity, giving improved visualization of
uterine and endometrial pathology
NR
-explain, mimimally invasive procedure.
-change clothing into hospital gown
-perform one week after mensttuation to avoid the risk of
infection.
-not for pregnant women
-no special prep before exam-30 min procedure.
CERVICAL CANCER
-a. pap smear- (apapanicolaou test)- test for cervical ca in
women. Involves collecting cells from your cervix.
-simple test and takes less than 5 minutes. Slightly
uncomfortable but not painful.
-can detect changes in your cervical cells that suggest ca may
develop in the future.
-screening test for malignant and premalignant changes in the
cervix
NR
-explain the procedure, positioning-speculum and spatula.

-are done to women who have no symptoms of ca and have no

findings suggesting a ca. Thus, it is done only to normal
women.
PROSTATE CANCER
-a. digital rectal exam- insertion of a gloved-lubricated finger
into the rectum and feel the prostate for hard, lumpy or
abnormal areas.
NR
-explain the procedure
-slight, momentary discomfort during the test
-normal activities after the exam
-b. Prostate-specific antigen (PSA)- is a protein produced by
cells of the prostate gland. The test measures the PSA level in
the blood. It is a biological marker or tumor marker.
-level below 4.o ng/ml-normal
- it can be raised by a ca cells, BPH, prostatitis, urethral cath,
surgery, rectal penetration, prolonged exercise, and
ejaculation.
COLORECTAL CA
-a. fecal occult blood test- checks for hidden (occult) blood in
the stool.
-positive result- bleeding from upper or lower GIT. Maybe
peptic ulcer or malignancy.
-this doesnt detect colon ca but is often used in clinical
screening
NR
-explain
-stool is collected in a container send it right away to lab
-if positive maybe recommended for sigmoidoscopy or
colonoscopy
-b. Sigmoidoscopy- an examination of the rectum and lower
colon using a sigmoidoscope.
NR
-explain
-done in OR
-C.- Colonoscopy-exam of the rectum and entire colon by
using a colonoscope.
NR
-same as sigmoidoscopy
-d.-double contrast barium enema- a series of x-rays of the
colon and rectum are taken after a liquid containing barium is
put into the rectum.
NR
-explian
-liquid diet before exam for 24 to 48 hours
-NPO post midnite
-cleansing enema or laxitives
-encourage to consume plenty of fluids before and after the
exam. Prevents dehydration and constipation. Barium is a
dehydrating substance.
-normal to have white stool for a few days after the procedure.
OTHER TEST
1.Tumor Marker- are substances, usually protein, that are
produced by the body in response to ca growth or by the

cancer tissue itself and maybe detected in blood, urine, or

tissue samples. But this alone is not diagnostic for CA ex.
PSA
2. Radioisotope Scan- way of imaging bones, organs, and
other parts of the body using a small dose of a radioactive
chemical.
NR
-explain the procedure
-injected IV like Na pertechnate/radioactive iodine
-care for iv sites
Possibility..
STAGING: is used to determine the extent of disease in an
individual patient. The tumor-node metastasis (TNM) system
of the American Joint Committee on Cancer (AJCC)
T= characteristics of a givien tumor (size, depth of invasion,
involvement of surroundings structures)
N=presence or absence of involved nodes and size or number
of involved nodes.
M= presence of absence of metastasis.
TNM results ..
Stage 4 disease is generally metastatic.
Stage 1 disased is confined to the organ of origin
A. T2N1M1 breast cancer is stage 4, where as a T2N1
M0 breast cancer is stage 2
-such system allows the clinician to assign a prognosis
usually guides treatment
-Why is staging important
1. extent to which a disease has spread is prognostic.
2.extent of disease often dictates treatment
3. Accurate staging allows collection of data that eventually
provides information is collected by a tumor registry.
Key areas 6
Caution us!
IV Treatment
Principles of various modalities of management against cancer
1.Surgery- branch of medicine that uses manual and
instrumental means to deal with diagnosis and treatment of
injury, deformity and disease.
2.Surgical oncology- defined as the branch of surgery focusing
on the surgical management of malignant neoplasms,
including biopsy, staging and surgical resection.
-important option in the treatment of cancer
-potentially, surgical oncology procedure may be used to
prevent a cancer occurrence in the high risk patient removal of
mass (breast) or cyst to patient who has a familial tendency.