CANCER

Neoplastic disorder that can involve all body organs with

manifestations that vary according to the body system affected and type of tumor cells
body's cells become abnormal and divide without

control. Cancer cells may invade nearby tissues. And they may spread through the bloodstream and lymphatic system to other parts of the body.
disease of the cell in which the normal mechanisms for

control of growth and proliferation have been altered

 Philippines: In the Philippines, cancer ranks third in leading causes of

morbidity and mortality after communicable diseases and cardiovascular diseases

75% - occur after age 50 years 3% occur at age 14 years and below. for every 1800 Filipinos, one will develop cancer annually

 World: According to GLOBOCAN, an estimated 12.7 million new

cancer cases and 7.6 million deaths occurred in 2008.

The most commonly diagnosed cancers worldwide are: lung (1.61 million, 12.7% of the total) breast (1.38 million, 10.9%) colorectal cancers (1.23 million, 9.7%) The most common causes of cancer death are : lung (1.38 million, 18.2% of the total) stomach (0.74 million, 9.7%) liver cancers (0.69 million, 9.2%)

 NORMAL CELL GROWTH -Mature normal cells- uniform in size and have nuclei that

are characteristic of the tissue to w/c the cells belong

-Nucleus of normal cells-chromosomes containing

deoxyribonucleic acid (DNA) molecules carries the genetic information that controls the synthesis of polypeptides (proteins) GENES- subunits of chromosomes and consist of portions of DNA that specify the production of particular sets of proteins; control the development of specific traits

 THE CELL CYCLE

4 phases
1. Gap1 or G1-cell enlarges and synthesizes CHON to prepare

for DNA replication; cells prepares to replicate and enter into the synthesis phase
2. Synthesis(S) phase- DNA is replicated and the

chromosomes in the cell are duplicated

3. Gap2 or G2- the cell prepares itself for mitosis

4. Mitosis- division of the parent cell into two exact copies

called daughter cells, each having identical genetic material

 DIFFERENTIATION

- a normal process occurring over many cell cycles that

allows cells to specialize in certain tasks

Ex. Some epithelial cell lining the lungs develop into tall

columnar cells with cilia

Three classes of genes appear to play a role in the

development of cancer:
1. Proto-oncogenes encourage and promote the normal

growth and division of cells. When they are defective, they become oncogenes. Oncogenes are overactive protooncogenes that cause excessive cell multiplication that can lead to tumors.

 2. Tumor suppressor genes act as brakes on cell growth.

They prevent cells from multiplying uncontrollably. If these genes are defective there is no control over cell growth and tumors can result.
3. DNA repair genes ensure that each strand of DNA is

correctly copied during cell division. When these genes do not function properly, the replicated DNA is likely to have errors. This causes defects in other genes and can lead to tumor formation in some cases.

 THEORIES

1. Cellular Transformation and Derangement Theory

- conceptualizes that normal cells may be transformed into

cancer cells due to exposure to some etiologic agents

2. Failure of the Immune Response Theory - advocates that all individuals possess cancer cells. However,

the cancer cells are recognized by the immune response system. So, the cancer cells undergo destruction. Failure of the immune response system leads to inability to destroy the cancer cells.

 THEORIES OF CARCINOGENESIS CELLULAR MUTATION This theory suggests that carcinogens cause mutations in cellular DNA CARCINOGENESIS- process of transforming normal cells into

malignant cells

1. Initiation- involves permanent damage in the cellular DNA as a result

of exposure to a carcinogen (ex. Radiation, chemicals) that was not repaired or had a defective repair - the first step, initiators (carcinogens), such as chemicals, physical factors, and biologic agents, escape normal enzymatic mechanisms and alter the genetic structure of the cellular DNA.
2. Promotion- may lasts for years and includes conditions such as

smoking or alcohol use, that act repeatedly on the already affected cells - repeated exposure to promoting agents (co-carcinogens) causes the expression of abnormal or mutant genetic information even after long latency periods.

 3. Progression- further inherited changes acquired during

the cell replication develop into a cancer - The cellular changes formed during initiation and promotion now exhibit increased malignant behavior. These cells now show a propensity to invade adjacent tissues and to metastasize.

 RISK FACTORS:

1. VIRUSES AND BACTERIA

-Viruses as a cause of human cancers are hard to determine

because viruses are difficult to isolate.

- Viruses are thought to incorporate themselves in the

genetic structure of cells, thus altering future generations of that cell populationperhaps leading to a cancer
- they damage cells and induce hyperplastic cells can

progress to malignant cells

- weakens immunologic defenses against neoplasms

*cancers associated to different viruses

HERPES SIMPLEX VIRUS TYPES I AND II (HSV-1 AND HSV-2) - carcinoma of the lip - cervical carcinoma - kaposis sarcoma HUMAN CYTOMEGALOVIRUS (HCMV) - kaposis sarcoma - prostate cancer EPSTEIN- BARR VIRUS (EBV) -Burkitts lymphoma HUMAN HERPESVIRUS-6 (HHV-6) Lymphoma HEPATITIS B VIRUS (HBV) Primary hepatocellular cancer PAPILLOMAVIRUS Malignant melanoma Cervical, penile, and laryngeal cancers HUMAN T-LYMPHOTROPIC VIRUSES (HTLV) Adult T-cell leukemia and lymphoma T- cell variant of hairy-cell leukemia Kaposis sarcoma

 2. PHYSICAL AGENTS

*Ultraviolet radiation-skin cancer

- sun-related skin cancers @ Northern European extraction

with very fair skin, blue or green eyes, and light-colored hair are more vulnerable; elderly people with decreased pigment; darker skin
Exposure to ionizing radiation can occur with repeated

diagnostic x-ray procedures or with radiation therapy used to treat disease. Fortunately, improved x-ray equipment appropriately minimizes the risk for extensive radiation exposure.

 Radiation therapy used in disease treatment or exposure to

radioactive materials at nuclear weapon manufacturing sites or nuclear power plants is associated with a higher incidence of leukemia, multiple myeloma, and cancers of the lung, bone, breast, thyroid, and other tissues
Background radiation from the natural decay processes that

produce radon has also been associated with lung cancer. Homes with high levels of trapped radon should be ventilated to allow the gas to disperse into the atmosphere.
- Radon is a naturally formed radioactive gas found in the

basement of many homes

 3. CHEMICAL AGENTS *Genotoxic- alter DNA replication - industrial and environmental carcinogens- polycyclic

hydrocarbons found in soot; benzopyrene, found in cigarette smoke; arsenic found in pesticides
*Promotional agents - wood and leather dust; polymesters (used in plastic and paints),

carbon tetrachloride, asbestos, and phenol

*Natural substances -end products of metabolism that are produced in excess

amounts or are ineffectively eliminated such as bile acids-from high-fat diet

*food preservatives - sodium saccharine; nitrosamines ;nitrosindoles - found in

pickled and salty foods

 4. DRUGS AND HORMONES *Chemotherapeutic drugs used to disrupt the cell cycle of

malignant cells- genotoxic - Can also be promotional- drastically reducing the number of leukocytes, they impair immune system - busulfan, chlorambucil, cyclosphosphamide
*recreational drugs-genotoxic betel nut chewed by many Pacific

Islanders and the immunosuppressant promoters heroin and cocaine Gonadotrophic hormones-mediate cancers of the reproductive organs
*Estrogen, Diethylstilbestrol (DES)- linked to cervical,

endometrial, and breast cancer

*Oral contraceptives and prolonged estrogen replacement therapy

are associated with increased incidence of hepatocellular, endometrial, and breast cancers

 4. GENETIC OR FAMILIAL FACTORS - Cancers associated with familial inheritance include

retinoblastomas, nephroblastomas, pheochromocytomas, malignant neurofibromatosis, and breast, ovarian, endometrial, colorectal, stomach, prostate, and lung cancers.
5. POOR DIET/ OBESITY *Dietary substances associated with an increased cancer risk

include fats, alcohol, salt-cured or smoked meats, foods containing nitrates and nitrites, and a high caloric dietary intake. *High-fat, low fiber foods- promote colon, breast, and sex hormone *fish and meat-excessively fried/ broiled-carcinogenic compounds scan form-can cause tumors in the mammary glands, colon, liver, pancreas, and bladder

CELLULAR ALTERATIONS/ PROLIFERATION 1. HYPERPLASIA - is an increase in the number or density of normal cells - occurs in response to stress, increased metabolic demands, or elevated levels of hormones - under normal DNA control - ex. Hyperplasia of uterine cells in response to rising levels of estrogen during pregnancy 2. METAPLASIA - change in the normal pattern of differentiation such that dividing cells differentiate into cell types not normally found in that location in the body - protective response to adverse conditions other disruptive condition ceases

- under normal DNA control and reversible when stressor or

cells change from one type to another

 3. DYSPLASIA

- represents a loss of DNA control over differentiation

occurring in response to adverse conditions - dysplastic cells show abnormal variation in size, shape, and appearance and a disturbance in their usual aarangement - ex. Changes in the cervix in response to continued irritation, such as from the human papillomavirus (HPV)
4. ANAPLASIA
- regression of a cell to an immature or undifferentiated cell

type - no longer under DNA control - occurs when a damaging or transforming event takes place inside the dividing, still undifferentiated cell. Leading to loss of useful function

 The cell cycle has its own internal controls, called checkpoints.

There are two main checkpoints, one at the G1 /S transition and another at G2 /M.
the G1 /S checkpoint checks for DNA damage. If DNA damage

is present, the DNA repair machinery and mechanisms that arrest the cell cycle are put in motion. The delay in cell-cycle progression provides the time needed for DNA repair; if the damage is not repairable, apoptotic pathways are activated to kill the cell.
Thus, the G1 /S checkpoint prevents the replication of cells

that have defects in DNA, which would be perpetuated as mutations or chromosomal breaks in the progeny of the cell.
DNA damaged after its replication can still be repaired as long

as the chromatids have not separated.

 The G2 /M checkpoint monitors the completion of DNA replication and

checks whether the cell can safely initiate mitosis and separate sister chromatids.

This checkpoint is particularly important in cells exposed to ionizing

radiation. Cells damaged by ionizing radiation activate the G2 /M checkpoint and arrest in G2 ; defects in this checkpoint give rise to chromosomal abnormalities.
To function properly, cell-cycle checkpoints require sensors of DNA damage,

signal transducers, and effector molecules. The sensors and transducers of DNA damage appear to be similar for the G1 /S and G2 /M checkpoints.
They include, as sensors, proteins of the RAD family and ataxia telangiectasia

mutated (ATM) and as transducers, the CHK kinase families. The checkpoint effector molecules differ, depending on the cell-cycle stage at which they act. In the G1 /S checkpoint, cell-cycle arrest is mostly mediated through p53, which induces the cell-cycle inhibitor p21. instability in cancer

Defect in cell-cycle checkpoint components is a major cause of genetic

 Neoplasia literally means the process of "new growth,"

and a new growth is called a neoplasm.

The term tumor was originally applied to the swelling

caused by inflammation.
Neoplasms also may induce swellings, but by long

precedent, the non-neoplastic usage of tumor has passed into limbo; thus, the term is now equated with neoplasm.
Oncology (Greek oncos = tumor) is the study of

tumors or neoplasms. Cancer is the common term for all malignant tumors.

 Classification of Cancer Classification of cancer determines appropriate treatment

and helps determine the prognosis.

Classification is made according to the : site of origin histology (or cell analysis; called grading) the extent of the disease (called staging)

 This classification describes the type of tissue in which the

cancer cells begin to develop.

Here are some common examples of site of origin

classification:
Adenocarcinomaoriginates in glandular tissue Blastomaoriginates in embryonic tissue of organs Carcinomaoriginates in epithelial tissue (i.e., tissue that

lines organs and tubes) Leukemiaoriginates in tissues that form blood cells Lymphomaoriginates in lymphatic tissue Myelomaoriginates in bone marrow Sarcomaoriginates in connective or supportive tissue (e.g., bone, cartilage, muscle)

 TYPES OF NEOPLASM

Neoplasm- mass of new tissue(collection of cells) that grows

independently of its surrounding structures and has no physiologic purpose Are said to be autonomous because of the following:
1. They grow at a rate uncoordinated with the needs of the body 2. They function independently of usual homeostatic controls

3. They share some of the properties of the parent cells but with

altered size and shape 4. They do not benefit the host and in some cases are actively harmful

 TUMOR INVASION AND METASTASIS Invasion 1. Ability to cause pressure atrophy

- pressure of growing tumor=causes atrophy and necrosis of adjacent tissues=malignancy moves in vacated space
2. Ability to disrupt the basement of normal cells

- cancer cells bind to elements of basement to basement membrane=secrete enzymes=degrade physical barrier=movement into normal tissues, lymph and blood circulation
3. Motility

- reduced adhesiveness- easily separate from the neoplasm= move into surrounding body fluids and tissues
4. Response to chemical signals from adjacent tissues

- Chemotaxis(movt of cells in response to a chemical stimulus)= calls tumor cells into normal tissues

 Metastasis

- process by which a tumor cell leaves the primary tumor,

travels to a distant site via the circulatory system, and establishes a secondary tumor. 1. Invasion neoplastic cells from primary tumor invade into surrounding tissue with penetration of blood or lymph.
2. Spread tumor cells spread through lymph or circulation

or by direct expansion
3. Establishment and growth tumor cells are established

and grow in secondary site: lymph nodes or in organs from venous circulation

 METASTATIC MECHANISMS

1. Lymphatic spread- most common mechanism; transport

of tumor cells into the lymphatic circulation; Malignant cells also may penetrate lymphatic vessels by invasion. - Breast tumors frequently metastasize in this manner through axillary, clavicular, and thoracic lymph channels.
2. Hematogenous spread-malignant cells are disseminated

through the bloodstream. Hematogenous spread is directly related to the vascularity of the tumor
3. Angiogenesis- Malignant cells also have the ability to

induce the growth of new capillaries from the host tissue to meet their needs for nutrients and oxygen.

 Tumor Grading

Grading involves examining tumor cells that have been

obtained through biopsy under a microscope. The abnormality of the cells determines the grade of the cancer.
Increasing abnormality increases the grade, from 14. Grading of a cancer is based on the degree of differentiation

of the tumor cells and the number of mitoses within the tumor as presumed correlates of the neoplasm's aggressiveness.
Thus, cancers are classified as grades I to IV with increasing

anaplasia

 Grade 1- Cells slightly abnormal and well differentiated

Grade 2- Cells more abnormal and moderately

differentiated Grade 3- Cells very abnormal and poorly differentiated Grade 4- Cells immature and undifferentiated

 Staging determines the size of the tumor and the existence

of metastasis
The TNM system is frequently used. In this system, T refers

to the extent of the primary tumor, N refers to lymph node involvement, and M refers to the extent of metastasis
Cancer staging is a system used to describe the anatomic

extent of a malignant process in an individual patient.

Staging systems may incorporate relevant clinical prognostic

factors such as tumor size, location, extent, grade, and dissemination to regional lymph nodes or distant sites

 The staging of cancers is based on the size of the primary

lesion, its extent of spread to regional lymph nodes, and the presence or absence of blood-borne metastases.
Two major staging systems are currently in use, one

developed by the Union Internationale Contre Cancer (UICC) and the other by the American Joint Committee (AJC) on Cancer Staging.
The UICC employs a classification called the TNM system

T for primary tumor, N for regional lymph node involvement, and M for metastases.

 The TNM staging varies for each specific form of cancer, but

there are general principles. With increasing size, the primary lesion is characterized as T1 to T4. T0 is added to indicate an in situ lesion.
N0 would mean no nodal involvement, whereas N1 to N3

would denote involvement of an increasing number and range of nodes.

M0 signifies no distant metastases, whereas M1 or sometimes

M2 indicates the presence of blood-borne metastases and some judgment as to their number

Primary Tumor (T)

TX Primary tumor cannot be assessed (e.g., shave biopsy or regressed melanoma)

T0 Tis T1 T2 T3 T4

No evidence of primary tumor Melanoma in situ Melanoma 1.0 mm in thickness with or without ulceration Melanoma 1.012 mm in thickness with or without ulceration Melanoma 2.014 mm in thickness with or without ulceration Melanoma greater than 4.0 mm in thickness with or without ulceration

Regional Lymph Nodes (N) NX Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Metastasis in one lymph node

N2 Metastasis in two to three regional nodes or intralymphatic regional metastasis without nodal metastases N3 Metastasis in four or more regional nodes, or matted metastatic nodes, or satellite(s) with metastasis in regional node(s)

Distant Metastasis (M)

MX

Distant metastasis cannot be assessed

M0

No distant metastasis

M1

Distant metastasis

M1a

Metastasis to skin, subcutaneous tissues, or distant lymph nodes

M1b

Metastasis to lung

M1c

Metastasis to all other visceral sites or distant metastasis at any site associated with an elevated serum lactate dehydrogenase (LDH)

Clinical Stage Grouping Stage 0 Stage IA Stage IB Tis T1a T1b T2a Stage IIA T2b T3a Stage IIB T3b T4a Stage IIC T4b N0 N0 N0 N0 N0 N0 N0 N0 N0 M0 M0 M0 M0 M0 M0 M0 M0 M0

Stage III

Any T
Any T Any T

N1
N2 N3 Any N

M0
M0 M0 M1

Stage 1v

Any T

 PREVENTION AND DETECTION

1. PRIMARY PREVENTION
a. Cancer prevention focuses on reducing modifiable risk

factors in the external and internal environment that increase a persons susceptibility to cancer development.

b. General factors that influence cancer incidence and

mortality include sex, age, geographic location, socioeconomic status, ethnic or cultural background, personal habits, occupation, and personal and family health habits.

 2. SECONDARY PREVENTION - involves detection and case-finding efforts to achieve early

diagnosis
a. Recognizing early signs and symptoms and seeking prompt

treatment can significantly reduce morbidity and mortality of several types of cancer
Cancer signs: CAUTION US!

 Warning Signs of Cancer CAUTIONUS

Change in bowel or bladder habits

A person with colon cancer may have diarrhea or

constipation, or he may notice that the stool has become smaller in diameter A person with bladder or kidney cancer may have urinary frequency and urgency

 A sore that does not heal

Small, scaly patches on the skin that bleed or do not heal

may be a sign of skin cancer A sore in the mouth that does not heal can indicate oral cancer
Unusual bleeding or discharge Blood in the stool is often the first sign of colon cancer Similarly, blood in the urine is usually the first sign of

bladder or kidney cancer Postmenopausal bleeding (bleeding after menopause) may be a sign of uterine cancer

 Thickenings or lumps Enlargement of the lymph nodes or glands (such as the

thyroid gland) can be an early sign of cancer Breast and testicular cancers may also present as a lump Indigestion or difficulty in swallowing Cancers of the digestive system, including those of the esophagus, stomach, and pancreas, may cause indigestion, heartburn, or difficulty swallowing Obvious change in a wart or mole Moles or other skin lesions that change in shape, size, or color should be reported

 Nagging or persistent cough or hoarseness

Cancers of the respiratory tract, including lung

cancer and laryngeal cancer, may cause a cough that does not go away or a hoarse(rough) voice
Unexplained anemia -Sudden unexplained weight loss

 NURSING ASSESSMENT
Family History Obtain information about both maternal and paternal

sides of family Obtain cancer history of at least three generations Look for clustering of cancers that occur at earlier ages, multiple primary cancers in one individual, cancer in paired organs and two or more close relatives with the same type of cancer suggestive of hereditary cancer syndromes

 Physical assessment
Physical findings that may predispose the patient to

cancer, such as multiple colonic polyps, suggestive of polyposis syndrome Skin findings such as atypical moles, that may be related to familial melanoma syndrome

 Warning signs Unexplained weight loss: An unexplained weight loss of 10

pounds or more may be the first sign of cancer. This happens most often with cancers of the pancreas, stomach, esophagus, or lung. Fever: Fever is very common with cancer, but it more often happens after cancer has spread from where it started. Almost all patients with cancer will have fever at some time, especially if the cancer or its treatment affects the immune system. This can make it harder for the body to fight infection. Less often, fever may be an early sign of cancer, such as blood cancers like leukemia or lymphoma.

 Fatigue: Fatigue is extreme tiredness that does not get

better with rest. It may be an important symptom as cancer grows. It may happen early, though, in cancers like leukemia. Some colon or stomach cancers can cause blood loss. This is another way cancer can cause fatigue. Pain: Pain may be an early symptom with some cancers like bone cancers or testicular cancer. A headache that does not go away or get better with treatment may be a symptom of a brain tumor. Back pain can be a symptom of cancer of the colon, rectum, or ovary. Most often, pain due to cancer is a symptom of cancer that has already spread from where it started (metastasized).

 Skin changes: Along with cancers of the skin, some other

cancers can cause skin symptoms or signs that can be seen. These signs and symptoms include: o Darker looking skin (hyperpigmentation) o Yellowish skin and eyes (jaundice) o Reddened skin (erythema) o Itching (pruritis) Excessive hair growth o Along with the general symptoms, there are certain other common symptoms and signs which could suggest cancer. Again, there may be other causes for each of these, but it is important to see a doctor about them as soon as possible.S

 Change in bowel habits or bladder function: Long-term

constipation, diarrhea, or a change in the size of the stool may be a sign of colon cancer. Pain when passing urine, blood in the urine, or a change in bladder function (such as needing to pass urine more or less often than usual) could be related to bladder or prostate cancer. Report any changes in bladder or bowel function to a doctor. Sores that do not heal: Skin cancers may bleed and look like sores that do not heal. A long-lasting sore in the mouth could be an oral cancer. This should be dealt with right away, especially in people who smoke, chew tobacco, or often drink alcohol. Sores on the penis or vagina may either be signs of infection or an early cancer

 White patches inside the mouth or white spots on the

tongue: White patches inside the mouth and white spots on the tongue may be leukoplakia. Leukoplakia is a pre-cancerous area that is caused by frequent irritation. It is often caused by smoking or other tobacco use. People who smoke pipes or use oral or spit tobacco are at high risk for leukoplakia. If it is not treated, leukoplakia can become oral cancer.

 Unusual bleeding or discharge: Unusual bleeding can

happen in early or advanced cancer. Blood in the sputum (phlegm) may be a sign of lung cancer. Blood in the stool (or a dark or black stool) could be a sign of colon or rectal cancer. Cancer of the cervix or the endometrium (lining of the uterus) can cause abnormal vaginal bleeding. Blood in the urine may be a sign of bladder or kidney cancer. A bloody discharge from the nipple may be a sign of breast cancer.

 Thickening or lump in the breast or other parts of the

body: Many cancers can be felt through the skin. These cancers occur mostly in the breast, testicle, lymph nodes (glands), and the soft tissues of the body. A lump or thickening may be an early or late sign of cancer and should be reported to a doctor, especially if youve just found it or notice it has grown in size.

 Indigestion or trouble swallowing: Indigestion or

swallowing problems may be signs of cancer of the esophagus (the swallowing tube that goes to the stomach), stomach, or pharynx (throat). But like most symptoms on this list, they are most often caused by something other than cancer.

 Recent change in a wart or mole or any new skin

change: Any wart, mole, or freckle that changes color, size, or shape, or that loses its sharp border should be seen by a doctor right away. Any other skin changes should be reported, too. A skin change may be a melanoma which, if found early, can be treated successfully.

 Nagging cough or hoarseness: A cough that does not

go away may be a sign of lung cancer. Hoarseness can be a sign of cancer of the voice box (larynx) or thyroid gland

 CANCER SCREENING
Cancer Site Breast Population Women, age 20+ Test or Procedure Breast selfexamination Frequency Monthly, starting at age 20

Clinical breast examination

Every 3 years, ages 2039 Annual, starting at age 40

Mammography

Annual, starting at age 40

Cancer Site

Population

Test or Procedure

Frequency

Colorectal

Men and women, age 50+

Fecal occult blood test

Annual, starting at age 20

Flexible sigmoidoscopy

Every 5 years, starting at age 50

Fecal occult blood test and flexible sigmoidoscopy

Annual FOBT and flexible sigmoidoscopy every 5, years, starting at age 50 Colonoscopy every 10 years, starting at age 50

Colonoscopy

Cancer Site Prostate

Population Men, age 50+

Test or Procedure Frequency Digital rectal Offer PSA and DRE annually, starting examination (DRE) at age 50, for men who have life and prostateexpectancy of at least 10 years specific antigen test (PSA) Pap test Cervical cancer screening beginning 3 years after first vaginal intercourse, but no later than 21 years of age; screening every year with conventional Pap tests or every 2 years using liquid-based Pap tests; at or after age 30, women who have had three or more normal Pap tests and no abnormal Pap tests in the last 10 years, and women who have had a total hysterectomy, may choose to stop cervical cancer screening

Cervix

Women

1.

Breast Self Examination

Breast Self-Examination (BSE) - involves checking the

breasts to help detect breast problems or changes Importance of BSE It helps to notice any changes in the breasts It helps individual stay in touch with their body and take charge of their own health. It helps find changes in the breasts that could happen between mammograms and/or clinical breast exams by a health professional

The Best Time to do BSE It is best to check the breasts when they are least painful.
Menstruating - seven to ten days after the start of your

menstrual period.
Irregular periods or

menopaused women/ Pregnant - / no longer menstruating, the breast self-examination (BSE) should be performed on the same day every month

Breastfeeding mothers - after feeding the baby. Women using oral contraceptives - each month on the

day you begin a new package of pills.

In Performing BSE, one are looking for: A hard lump or knot in or near the breast or in your underarm A change in the way your breasts look or feel Some other changes to look out for: Dimpling, puckering, or ridges of the skin on the breast A nipple that is pushed inward rather than sticking out Redness, warmth, swelling, or pain Itchy, scaly sore or rash on the nipple Nipple discharge other than breast milk Change in color, shape, size, or texture of a breast

STEP 1 Using a mirror, inspect your breasts with your arms at your sides, with your hands on your hips, and with your arms raised while flexing your chest muscles

STEP 2 Look for any changes in contour, swelling, dimpling of skin, or appearance of the nipple. It is normal if your right and left breasts do not match exactly.

STEP 3 Using the pads of your fingers, press firmly on your breast, checking the entire breast and armpit area. Move around your breast in a circular, up-and-down, or wedge pattern. Remember to use the same method every month. Check both breasts

STEP 4 There are three patterns you can use to examine your breast: the circular, the up-and-down, and the wedge patterns. Use the pattern that is easiest for you, and use the same pattern every month.

STEP 5 Gently squeeze the nipple of each breast and report any discharge to your doctor immediately.

STEP 6 Examine both breasts lying down. To examine the right breast, place a pillow under your right shoulder and place your right hand behind your head. Using the pads of your fingers, press firmly, checking the entire breast and armpit area. Use the same pattern you used while standing. Repeat for your left breast.

TSE
The testicular-self examination is recommended monthly after a

warm bath or shower when the scrotal skin is relaxed.

TSE is performed once a month and should be done on the same

day of each month, as an aid to help the client remember to perform the exam
The client should stand to examine the testicles.
Using both hands, with fingers under the scrotum and thumbs on

top, the client should gently roll the testicles, feeling for any lumps.
. The scrotum is held in one hand and the testicle is rolled

between the thumb and forefinger of the other hand.

Papanicolaou test
done by obtaining and examining cells from the uterine cervical os. The cells are obtained during pelvic examination. A Pap smear is usually painless. The test cannot be performed during menstruation. The client needs to be instructed to avoid douching for at least 24 hours prior to the test. There is no reason to restrict fluids on the day of the test.

Preparations The health care should ask the following before the procedure
Are taking any medications or birth control pills Have had an abnormal Pap smear Might be pregnant

Within 24 hours of the test, avoid: Douching Having intercourse Taking a tub bath Using tampons

 *Avoid scheduling Pap smear while the patient is

menstruating, because blood and cells from the uterus may affect the accuracy of the Pap smear. Empty your bladder just before the test.
*Tell the patient that she may have some discomfort,

similar to menstrual cramps, and a feeling of pressure during the procedure.

 Procedure
Insert a speculum into the woman's vagina, which

spreads the vagina open and allows access to the cervix The health care provider then collects a sample of cells from the outer opening or os of the cervix by scraping it with an Aylesbury spatula An endocervical brush is rotated in the central opening of the cervix. The cells are placed on a glass slide and taken to the laboratory to be checked for abnormalities.

 Screening should start within 3 years after first having

vaginal intercourse or by age 21. After the first test:

Woman should have a Pap smear ever 2 years to check

for cervical cancer.

If she is over age 30 or your Pap smears have been

negative for 3 times in a row, pap smear could be done every 3 years

 After age 65-70, most women can stop having Pap smears as

long as they have had three negative tests within the past 10 years.
If she has a new sexual partner after age 65, she should begin

having Pap smear screening again.

*Women who have had a total hysterectomy (uterus and

cervix removed) and have not had any previous history of cervical dysplasia (abnormal cells), cervical cancer, or any other kind of pelvic cancer, may not need to have Pap smears.

 3. Rectal examination - is an manual examination of

the anus, rectum, and prostate for men

This examination may be used:

for the diagnosis of rectal tumors and other forms

of cancer
for the diagnosis of prostatic disorders, notably tumors

and benign prostatic hyperplasia

for the diagnosis of appendicitis or other examples of

an acute abdomen (i.e. acute abdominal symptoms indicating a serious underlying disease);

 for the estimation of the tonicity of the anal sphincter,

which may be useful in case of fecal incontinence or neurologic diseases, including traumatic spinal cord injuries; in females, for gynaecological palpations of internal organs for examination of the hardness and color of the feces (ie. in cases of constipation, and fecal impaction); prior to a colonoscopy or proctoscopy. to evaluate hemorrhoids In newborns to exclude imperforate anus

Procedure
1. The patient is positioned on the left side with the knees

close to the chest. Sometimes the patient is asked to stand up and lean over the examination table.
2. The health care practitioner examines the anus and the

surrounding skin for hemorrhoids, tags, fissures and abscesses.

3. After lubricating the gloved finger and anus, the examiner

gently slides the finger into the anus and follows the contours of the rectum.

 4. The examiner notes the tone of the anus and feels

the walls and the edges for texture, tenderness and masses as far as the examining finger can reach.
5. The examiner evaluates the prostate for nodules and

tenderness. Stool on the finger should be examined for blood, color, texture and tested for fecal occult blood.

DIGITAL RECTAL EXAM

is a screening test that allows a doctor to check the prostate

gland in men or the lower colon/rectum in men and women for cancer or other abnormalities.
in association with a vaginal examination, a DRE can check

for cancer of the uterus and ovaries in women. A DRE can also be used to check the other organs and structures in the pelvis.
During a DRE for a man, the doctor determines the size and

consistency of the prostate, feeling for bumps, irregularities, soft or hard spots, or other abnormalities. The doctor also examines the wall and consistency of the lower colon/rectum.

 Preparing for the procedure

A DRE does not require advance preparation. You should tell

your doctor if you have hemorrhoids or anal fissures (broken skin around the anus), which might be aggravated by the DRE. You will be asked to sign a consent form
During the procedure

A DRE takes only a few minutes to complete in a private

examination room at your doctor's office. It is performed without sedation; your doctor may ask you to relax and take a deep breath as the procedure begins.

 You will be asked to take off your clothes below the waist and

given a gown to wear or a cloth to wrap around you during the DRE.
A man is examined in one of two ways: while standing

(bending forward at the waist, leaning against an exam table) or while lying on his side on an examination table (with his knees pulled up to his chest in the fetal position).
A woman is usually examined while lying on her back on an

examination table, with her feet in raised stirrups, as part of a gynecologic examination

 The doctor will gently insert a lubricated, gloved finger into

the rectum. For men, this is done to feel the back of the prostate or the colon/rectum. For women, the goal is to feel the reproductive organs, as well as the bowel. The doctor may also feel for abnormalities in the internal organs by applying pressure on the lower abdomen or pelvic area with the other hand.
If a man's prostate is enlarged, he may feel some discomfort

or mild pain when the doctor examines his prostate. (Pain is unusual unless there is a large, inflamed, infected or cancerous prostate.)

 He may also feel the need to urinate. A woman may feel

discomfort but typically no pain when the doctor presses on her abdomen to feel her internal organs.
After the procedure
You can resume your normal activities immediately after a

DRE. Slight bleeding from the rectum can happen after the examination, particularly if you have hemorrhoids or anal fissures. Tell your doctor if you experience significant rectal bleeding.