NCM 106 – Cellular Aberration
Proliferation of growth pattern
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.
 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 variable even among different cell of
the same species
II. S Phase – starts when DNA synthesis
commences; when it is complete, all
chromosomes have been replicated ie each
chromosomes has 2 (sister) chromatids
III. 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
IV. 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
can’t 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 not recur after excision recurs after excision
-Easier to remove and does - Difficult to remove and

Diagram Representation of General Pathophysiology of Cancer

Acquired (environmental)
DNA damaging agents Normal Cell
Chemicals
Radiation
DNA damage Inherited mutation in:
Viruses
-Genes affecting DNA repairs
-Genes affecting cell growth or
apoptosis
Failure of DAN
Repair

Mutation in the
genome of
somatic cells Alteration in genes
that requires
Activation growth promoting apoptosis
oncogenes Inactivation of
tumor suppressor
genes

Unregulated cell Decreased apoptosis

proliferation

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. 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
II. 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.
III. Progression
 Tumor cells acquire malignant
characteristics that include
changes in growth rate invasive
potential, metastatic frequency,
morphologic traits, and
responsiveness to therapy.
nd
(2 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. 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
2. 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 non-ionizing
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
host DNA resulting in proto-oncogenic changes and
cell mutation
6. Five (5) DNA viruses have been linked to cancer in
humans:
a) Human Papillomavirus (HPV) – Cervical
cancer, anal cancer
b) Epstein-Barr virus (EBV) – Burkitt’s
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) – Kaposi’s
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 parasite-
linked to bladder cancer and liver cancer
7. 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
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 speed-
increases 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 etc—cancer
risk.
 -stress weakens immune system There are many types of cancers. Therefore, guidelines for
screening and early detectin will vary depending on the type
KEY AREAS FOR PRIMARY PREVENTION OF CANCERS of CA.
(DOH/PHIL)

1. Promote lifestyle change. BREAST CANCER

–smoking cessation- quit smoking for active Warning signs
smokers. Prevent passive smoking. Advise smokers -skin changes
not to smoke inside living areas and workplace to -edema
prevent exposure of others to secondhand smoke. -inflammation “peau de orange” –orange peel like skin
2. Increase intake of dietary fiber by eating more leafy -ulceration
green and yellow vegetables, fruits and unrefined -prominent venous pattern
cereals. Betacaratene, vitamins A,C,E. Nipple abnormalities
3. Eat less fatty foods -retraction
4. Limit consumption of smoked, charcoal-broiled, salt- -rashes or discharge
cured, and salt-pickled foods. ABNORMAL CONTOURS
5. Avoid moldy foods -variation in size and shape of breast
-control obesity through proper nutrition and
exercise. EARLY DETECTION
-drink alcoholic beverages in moderation. 1. Breast self-examination-cheapest and most
6. Advocate an environment supportive of a healthy affordable screening procedure.
lifestyle. –this can be easily taught to women to increase
-promote a smoke-free environment awareness and promote self-care.
-sooner a cancer is diagnosed and treatment begins, –best time to do BSE is one week after menstrual
the better the chances of living longer and enjoying a period while taking a shower, facing the mirror
better quality of life. standing up or lying down
2. Yearly breast examination by a health care provider-
this is to detect masses/lumps missed by the client
SCREENING FOR CANCER DOH/PHIL
or to confirm presence of mass detected by client on
BSE. If lumps or lymph nodes swelling is present,
-early detection and prompt treatment are keys to curing
assess also for the following:
cancer (note: “ cure rate” in cancer is relative and depends on
-location
the type of cancer).
-number of lumps or nodes (solitary or multiple)
-consistency: soft or hard
The earlier cancer is detected, the more likely it is to be
-size (estimation)
cured. Early detection techniques enable health care
-fixed or movable
providers to screen for and diagnose cancer while it is
-tenderness along the area
localized and potentially curable.
3. Breast mammography
-if a mass is detected and confirmed by the health worker, a
-The acronym CAUTION US (ACS) provides a systematic way
mammogram usually confirms it.
of remembering the cancer …
-baseline M is suggested for all women between the ages 35-
39 and yearly after age 40.
C-change I bowel or bladder habits
-if with family history of breast cancer, M should be started
A-a sore that does not heal
at age 30.
U-unusual bleeding or discharge
-put in mind that BSE does not take the place of a
T-thickining or lump in the breast or else where
Mammography or vice versa.
I-indigestion and difficulty in swallowing
O-obvious change in wart or mole
REMEMBER!!
-warts sor moles are circumscribed cutaneous discolorations
BSE
to skin elevations that should not increase in size, nor
-should be done monthly, a week after onset of menstrual
elcerate.
period.
N-nagging cough or hoarshness of voice
-by age 20, women should have developed the habit of doing
-evaluate for symptoms related for persistent cough and its
BSE monthly;----teach BSE to women early in their teens.
quality eg dry
-breasts tend to undergo changes during:
U-unexplained anemia
-pre-menstrual period;--perform BE a week after
S-sudden wt loss
menstrual period
-pregnancy
SPECIFIC GUIDELINES FOR EARLY DETECTIN OF COMMON
-lactation.
CANCER:
CERVICAL CANCER
-often asymptomatic
-abnormal vaginal bleed (e.g. post-coital bleeding) Nursing responsibilities
EARLY DETECTION: -no special prep is required. Just instruct client to cough our
-pap’s smear is the primary screening tool for women over sputum in a sterile container and label properly,
age 18.
-Pap’s smear should be done in between menses (2 weeks BREAST CANCER
after menses). A woman should not douche, have intravaginal
-A. Mammogram or mammography- is a special type of x-ray
medications nor have sexual intercourse 24 hours prior to
imaging used to create detailed images of the breast.
test.
-b. clinical breast examination- a physical exam of the breast
-should be done annually for 2 consecutive years and at least
done by a health professional.
every 3 years until age 65 for those with normal findings
NR
-for persons at high risk, it should be done yearly. This include
-explain the procedure that this is done to find a lump or
those who are: sexually active, have multiple partners,
change in the breast that may mean serious problem, such as
commercial sex workers.
CA.
-MRI-radiowaves and magnetic field are used to view soft
COLON RECTAL CANCER tissues. Useful in diagnosing tumors.
-change in stool NR
-rectal bleeding -explain procedure
-pressure on the rectum -be aware that it is contraindicated to clients with metallic
-abdominal pain -implants, pacemaker, sharpnels, hearing aids, obesity.
EARLY DETECTION: -remain still through out the procdure.
-annual digital rectal exam starting at age 40 -4. Tissue
-annual stool blood test starting at age 50
-annual inspection of colon UTERINE CANCER
-A. Transvaginal sonography- a procedure used to examine
PROSTATE CANCER the vagina, uterus, fallopian tube, ovearies and bladder. An
Symptoms of urethral obstruction: instrument (utz probe) is inserted into the vagina that causes
-urinary frequency sound wavest to bounce off organs inside the pelvis. Thie
-nocturia sound waves create echoes that are sent to a computer,
-decrease in stream which creates a picture called a sonogram.
-post-void dribbling NR
EARLY DETECTION: -explain
-digital rectal exam for men -that eliminates the need for full bladder. This procedure of
-Prostate specific antigen (PSA) determination a blood test, full bladder is true only to abdominal utz (1quart/1L) in 2
confirms diagnosis. hours and don’t void. Full bladder serves as a landmark to
define other pelvic organs.
LUNG CANCER -b. hysteroscopy- is the inspection of the uterine cavity by
endoscopy with access through the cervix. It allows for the
-persons with a long history of smoking and/or smoking 2 or
diagnosis of intrauterine pathology and serves as a method
more packs of cigarette a day
for surgical intervention.
-chronic cough or nagging cough
-c. sonohysterography- new technique developed to better
-dull intermittent, localized pain
image the uterine cavity. It uses an infusion of sterile saline
-history of wt loss
through a soft plastic catheter placed in the cervix in
EARLY DETECTION
conjunction with transvaginal UTZ.
-CXR q6months for patients who have history of smoking 2
-it distends the uterine cavity, giving improved visualization of
packs a day
uterine and endometrial pathology
-sputum cytology
NR
-explain, mimimally invasive procedure.
DIAGNOSTIC EVALUATION, STAGING, AND NURSING
-change clothing into hospital gown
RESPONSIBILITIES.
-perform one week after mensttuation to avoid the risk of
infection.
LUNG CANCER -not for pregnant women
-a. starndard roentgenogram or x-ray on chest. Detect any -no special prep before exam-30 min procedure.
abnormalities in the lungs.
Nursing responsibilities
CERVICAL CANCER
-avoid excessive exposure of client and self
-a. pap smear- (apapanicolaou test)- test for cervical ca in
-remove radiopaque objects that can interfere with the
women. Involves collecting cells from your cervix.
results
-simple test and takes less than 5 minutes. Slightly
-explain procedure to client.
uncomfortable but not painful.
-b. sputum cytology- examine a sample of sputum under a
microscope to determine whether abnormal cells are present
-can detect changes in your cervical cells that suggest ca may
develop in the future. OTHER TEST
-screening test for malignant and premalignant changes in 1.Tumor Marker- are substances, usually protein, that are
the cervix produced by the body in response to ca growth or by the
NR cancer tissue itself and maybe detected in blood, urine, or
-explain the procedure, positioning-speculum and spatula. tissue samples. But this alone is not diagnostic for CA ex. PSA
-are done to women who have no symptoms of ca and have 2. Radioisotope Scan- way of imaging bones, organs, and
no findings suggesting a ca. Thus, it is done only to normal other parts of the body using a small dose of a radioactive
women. chemical.
NR
PROSTATE CANCER -explain the procedure
-a. digital rectal exam- insertion of a gloved-lubricated finger
-injected IV like Na pertechnate/radioactive iodine
into the rectum and feel the prostate for hard, lumpy or
-care for iv sites
abnormal areas.
Possibility…..
NR
-explain the procedure
STAGING: is used to determine the extent of disease in an
-slight, momentary discomfort during the test
individual patient. The tumor-node metastasis (TNM) system
-normal activities after the exam
of the American Joint Committee on Cancer (AJCC)
-b. Prostate-specific antigen (PSA)- is a protein produced by
cells of the prostate gland. The test measures the PSA level in
T= characteristics of a givien tumor (size, depth of invasion,
the blood. It is a biological marker or tumor marker.
involvement of surroundings structures)
-level below 4.o ng/ml-normal
N=presence or absence of involved nodes and size or number
- it can be raised by a ca cells, BPH, prostatitis, urethral cath,
of involved nodes.
surgery, rectal penetration, prolonged exercise, and
M= presence of absence of metastasis.
ejaculation.

TNM results …..

COLORECTAL CA
-a. fecal occult blood test- checks for hidden (occult) blood in
Stage 4 disease is generally metastatic.
the stool.
Stage 1 disased is confined to the organ of origin
-positive result- bleeding from upper or lower GIT. Maybe
peptic ulcer or malignancy.
A. T2N1M1 breast cancer is stage 4, where as a T2N1
-this doesn’t detect colon ca but is often used in clinical
M0 breast cancer is stage 2
screening
-such system allows the clinician to assign a prognosis
NR
usually guides treatment
-explain
-stool is collected in a container send it right away to lab
-Why is staging important
-if positive maybe recommended for sigmoidoscopy or
1. extent to which a disease has spread is prognostic.
colonoscopy
2.extent of disease often dictates treatment
-b. Sigmoidoscopy- an examination of the rectum and lower
3. Accurate staging allows collection of data that eventually
colon using a sigmoidoscope.
provides information is collected by a tumor registry.
NR
-explain
Key areas 6
-done in OR
Caution us!
-C.- Colonoscopy-exam of the rectum and entire colon by
using a colonoscope.
IV Treatment
NR
Principles of various modalities of management against
-same as sigmoidoscopy
cancer
-d.-double contrast barium enema- a series of x-rays of the
colon and rectum are taken after a liquid containing barium is
1.Surgery- branch of medicine that uses manual and
put into the rectum.
instrumental means to deal with diagnosis and treatment of
NR
injury, deformity and disease.
-explian
2.Surgical oncology- defined as the branch of surgery focusing
-liquid diet before exam for 24 to 48 hours
on the surgical management of malignant neoplasms,
-NPO post midnite
including biopsy, staging and surgical resection.
-cleansing enema or laxitives
-important option in the treatment of cancer
-encourage to consume plenty of fluids before and after the
-potentially, surgical oncology procedure may be used to
exam. Prevents dehydration and constipation. Barium is a
prevent a cancer occurrence in the high risk patient removal
dehydrating substance.
of mass (breast) or cyst to patient who has a familial
-normal to have white stool for a few days after the
tendency.
procedure.