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Stages in Carcinogenesis
Initiation exposure of normal cells to carcinogens Promotion cigarette smoking, alcohol abuse or dietary components that act on the transformed cell Progression uncontrolled growth of malignant tumor capable of metastatic activity
Carcinogenesis Theories
Environment Theory environmental factors are implicated directly or indirectly in cancer development
Physical sexual development, reproductive patterns and sexual practices Chemical tobacco, alcohol, drugs, radiation, occupational, pollution, diet
Carcinogenesis Theories
Genetic Theory inherited disorders (deranged gene, chromosomal defect) or altered DNA may result in changes that render the cell vulnerable to malignant transformation; cancer families tend to inherit the same type of cancer and develop the disease at an early age
Carcinogenesis Theories
Viral Theory viruses have been isolated and identified as the cause of cancer in mice, rabbits and frogs but not ascertained in human beings e.g. cervical cancer may result from a virus introduced into the cervix during sexual intercourse
Carcinogenesis Theories
Immunological Theory failure of the normal immune mechanism may predispose one to certain cancers e.g high incidence of tumors in early childhood and old age periods when the immune system is weak
Terminologies
Hyperplasia increase in the size of an organ because of an increase in cell number Hypertrophy increase in the size of an organ because of an increase in cell size Metaplasia a reversible process in which one adult cell type in an organ is replaced by another adult cell type
Terminologies
Dysplasia alteration in adult cells characterized by changes in their size, shape, and organization Atrophy decrease in cell size Anaplasia reversed cellular development to a primitive cell type Neoplasia abnormal cellular changes and growth of new tissues
Steps in BSE
Stand or sit in front of the mirror note contour changes, asymmetry, nipple discharge, color of skin (orange peel skin), presence of dimpling, puckering or retraction Supine position with a small pillow or folded bath towel under the shoulder of the breast to be examined with the arm raised over the head
Steps in BSE
The other hand palpates or kneads breast in a circular motion starting from the outside inwards Press the nipple to check for any discharge Repeat palpation while in the shower
Steps in TSE
Examine for testicular tumor periodically preferably done during a shower or bath. Use both hands to palpate. Carefully examine all scrotal contents. Locate the epididymis; this is the cord like structure at the back of the testis. The spermatic cord and vas extends upward from the epididymis.
Steps in TSE
Feel each testis between the thumb and the first two fingers of each hand. Note size, shape, abnormal tenderness. Stand infront of the mirror and look for changes in size and shape of the scrotum.
Cancer Classification
Grading
defines the origin of the tumor and degree to which tumor cells retain the functional and histologic characteristics of tissue origin; usually done by pathologist (histologic classification)
Grading
G1 well differentiated G2 moderately well differentiated G3 poorly differentiated G4 very poorly differentiated with high degree of malignancy
Cancer Classification
Staging determines the size of the tumor and extent metastasis; determines extent of the disease
Stage 0 in situ Stage I limited to tissue of origin; localized Stage II limited local spread Stage III extensive local and regional spread Stage IV metastasis
Staging
TNM Staging provides categorization of primary lesion and extent of involvement in the clinical assessment of cancer
T primary tumor extent N lymph node involvement M metastasis
T
TX tumor cannot be adequately assessed T0 no incidence of primary tumor TIS tumor in situ T1, T2, T3, T4 progressive increase in tumor size and involvement
N
NX regional lymph node cannot be assessed clinically N0 regional lymph node demonstrable abnormal
M
MX not assessed M0 no known distant metastasis M1 distant metastasis present in site
Treatment Goals
Complete irradication of malignancy Prolong survival in the presence of malignancy Relief of associated symptoms with cancer disease process
Cancer Management
Surgery
Diagnostic biopsy Radical surgery (wide resection) remove all tumors without disturbing the structure or function of host extensively, useful in early stages; if invasive not curative
Enbloc resection excision of original growth and lymph channel around are
Cancer Management
Prophylactic remove pre-cancerous lesion prewhile it is still harmless and non-malignant non Palliative retard growth of tumor; relieve signs and symptoms of tumor; prevent complication
Cancer Management
Radiotherapy to destroy the malignant tumors without unduly harming surrounding tissues
Tumor must e radiosensitive and rapidly dividing, poorly differentiated, embryonic and immature, characterized by increased metabolic activity
Cancer Management
Tumor must be located in areas where they can be treated with large doses of radiation without causing serious injury to neighboring tissues; tumors located deep within the body cant be safely irradiated
Means of Administration
External Radiotherapy skin mark, tatoo, ports (X marks) to localize the are to be exposed to external radiation
External Radiotherapy
X-ray machine Low voltage roentgen therapy skin cancer High voltage roentgen therapy deep seated cancer
External Radiotherapy
Radioisotopes Teletherapy cobalt 60 or cesium 137; enclosed and shielded in protective casing cobalt bomb; sealed radiation
Advantages of Teletherapy
Eradicates and destroys deep internal cancer without seriously damaging skin Fewer cases of radiation sickness May be incorporated into external molds Can be applied topically to eyes and skin, ears, lips, mouth, scalp, larynx and penis
Means of Administration
Internal Radiotherapy placement of especially separated isotopes into the tumor or systematic circulation
Internal Radiotherapy
Interstitial Therapy
placed in beads, seeds, needles, catheter and ribbons implanted in tumor Eg. Cobalt 60, Iodine 125, Tantalium 182
Internal Radiotherapy
Systematic Therapy
Intravenous Eg. Na phosphate (32 P) polycythemia vera, myelogenous leukemia
Internal Radiotherapy
Modes of Administration
Sealed completely enclosed by nonnonradioactive material therefore cannot circulate through patients body Unsealed given by IV, mouth or instillation directly into body cavity, not enclosed in radioactive containers
External hazard due to emission of gamma or beta rays from the patients body Internal hazard due to radio active contamination of one or all or patients body fluid
Radiation Sickness
Nursing Interventions: Bedrest Small frequent feedings Increased calories, increased protein diet Adequate fluid intake Administer vitamins, sedatives, antihistamine, antiemetics Monitor intake and output
Skin Reaction
Nursing Interventions: Inspect skin integrity Apply lanolin, petroleum jelly or cod liver oil to affected area Avoid ointments, powder, lotion or any irritant Wash with water only, no soaps Avoid constricting clothes loose for adequate air circulation Avoid extremes of temperatures
Time
Less time spent close to pt, less exposure
Cancer Management
Chemotherapy
Use of combination chemotherapeutic agents to cure or palliate cancer or as an adjuvant therapy
Misc. drugs
Interferon natural glucoprotein antiviral effect
Methods of Administration
Oral pill or liquid Subcutaneous injection
through automatic syringe or subcutaneous injection pump
Intravenous
Non-vesicants do little damage to soft tissues Non Eg. 5-FU, Methotrexate 5 Vesicants cause soft tissue necrosis
Eg. Nitrogen mustard, Vinblastine, Vincristine
Methods of Administration
Irritants produces burning or minor inflammation without necrosis
Methods of Administration
Vascular access graft
Use of dacron graft into the vein
Intraperitoneal
Tenchoff catherter into abdominal cavity Eg. Cancer of liver, ovary, colon and rectum
Antidiarrheal drugs Clearliquid if tolerated Good perineal care Monitor K, Na and Cl levels
Avoid bumps or bruise of skin Protect from physical injury Avoid aspirin and aspirin products Avoid IM injection Monitor blood count
Anemia
Adequate rest period H and H monitoring O2 PRN
Scalp tourniquets Scalp hypothermia ice pack Wig during treatment Hair grows back 6 mos after chemotherapy