ONCOLOGY NURSING

Oncology
Branch of medicine that deals with the study, detection, treatment and management of neoplasia
What Is Cancer?
Complex of diseases which occurs when normal cells mutate into abnormal cells which take over normal tissue
eventually harming and destroying the host
International Incidence
Still the 2nd leading cause of death
Nearly 1 in 6 deaths is caused by cancer
Nearly 70% of cancer deaths occur in low to middle income countries
Late stage presentation
Inaccessible diagnosis and treatment
25% are caused by cancer-causing infections (HPV, Hepatitis)
Tobacco use: most important risk factor (22%)
Five Leading Cancer Risk Factors
High body mass index
Low fruit and vegetable intake
Lack of physical activity
Tobacco use
Alcohol use
Five Common Causes of Cancer Death
Lung (1.69 M)
Liver (788,000)
Colorectal (774,000)
Stomach (754,000)
Breast (571,000)
Philippine Incidence
Cancer is the third leading cause of morbidity and mortality in the Philippines.
Breast, lung, colorectal, liver, and cervical cancers are the most commonly diagnosed types of cancer, and are
the leading causes of cancer-related mortality.
Prevalence
Cancer is a disease associated with aging
In children: leukemia
Top three causes of mortality:
o Women: breast, cervix, lung
o Men: lung, prostate, liver
Risk Factors
Heredity – 5-10% of cancers
o Breast and colon --- well documented
o Lung, ovarian and prostate
Age – 70% of cancer occur in clients above 65 years old
o 5 cycles of mutation is necessary to cause permanent damage to cells
o Immune response alters with aging
o Accumulation of free radicals over time
o Hormonal changes associated with aging
o Cumulative stressors
Gender
o Thyroid cancer --- females
o Bladder cancer --- males
Poverty
o Inadequate access to health care
o Diet and stress
Stress
o Elevated cortisol and epinephrine results in systemic fatigue and impaired immunologic surveillance
o Type C people --- those who tend to others needs to the exclusion of their own
o Depression – shuts down energizing chemicals
Diet
o Genotoxic – nitrosamines, nitrosindoles found in salted, pickled and preserved foods (esophageal and
gastric cancer)
o High fat, low fiber --- colon, breast and sex-hormone dependent tumors

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 o Excessive frying and broiling --- potent carcinogenic compounds form causing breast, colon, liver,
pancreas and bladder cancer
o Repeated frying produces high levels of polycyclic hydrocarbons
o Sodium saccharine, red food dyes, coffee
Infection
o Some viruses and bacteria are implicated in the development of certain types of cancer
o Viruses interact with the chromosomal DNA of the cells they infect, converting protooncogenes to
oncogenes
 Hepatitis B and Hepatitis C viruses - Hepatocellular carcinoma
 Human Papilloma Virus (HPV) - Skin and cervical carcinomas
 Epstein-Barr Virus (EPV) - Burkitt’s lymphoma and nasopharyngeal carcinoma
 Cytomegalovirus - Kaposi’s sarcoma
 Bacteria (H. pylori) – gastric cancer
Occupation
o Farmers and outdoor workers --- solar radiation
o Health care workers --- ionizing radiation and carcinogenic substances
o Polycyclic hydrocarbons and benzopyrenes (genotoxic) – smokers, miners, coal and gas workers,
chimney sweeps
o Arsenic (genotoxic) – pesticides manufacturers
o Vinyl chloride (promotional) – plastic workers, painters
o Methylaminobenzine (genotoxic) – fabric workers, rubber and glue workers
o Asbestos (promotional) – construction workers
o Wood and leather dust (promotional) – woodworkers, carpenters, leather toolers
o Chemotherapy drugs (genotoxic) – drug manufacturers, nurses, pharmacists
Tobacco users
o The genotoxic carcinogenic substances in tobacco are weak, so stopping smoking may reverse the
damage
o Related to: oropharyngeal, esophageal, laryngeal, gastric, pancreatic and bladder cancer
o Smokers who lack alpha-1 antitrypsin are also at risk
o Nitrosamines from second hand smoke may put a nonsmoker at risk for cancer
Alcohol use
o Promotes cancer by modifying the metabolism of carcinogens in the liver, increasing the effectiveness of
carcinogens in some tissues
 Oral esophageal and laryngeal cancers
Recreational drug use
o Considered promoters because they suppress the immune system
o Cause chromosomal damage leading to DNA mutations
Obesity
o Related to an increased risk of hormone-dependent cancers
 Breast, bowel, ovary, endometrium, prostate cancers
Sun exposure
o Now considered to be a problem of all people regardless of skin color due to ozone layer damage
o Fair and old people are at higher risk
Characteristics of Cancer
Uncontrolled growth and spread of abnormal cells
Proliferation (rapid reproduction by cell division)
Metastasis (spread or transfer of cancer cells from one organ or part to another not directly connected)
Normal Cell Growth
Cell cycle;
o Gap 1 – cell enlarges and synthesizes proteins to prepare for DNA replication
o Synthesis phase (S) – DNA is replicated and the chromosomes are duplicated
o Gap 2 – cell prepares itself for mitosis
o Mitosis – cell division
Cell cycle is controlled by cyclins serving as checkpoints
o A malfunction of these regulators can cause rapid proliferation of immature cells
Differentiation
A normal process occurring over many cell cycles that allows cells to specialize in certain tasks
When adverse conditions occur in body tissues, protective adaptations can produce alterations in cells
o Hyperplasia
o Metaplasia
o Dysplasia
o Anaplasia

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Patterns of Cell Proliferation
Hyperplasia
o An increase in the number of normal cells; under normal DNA
Metaplasia
o Differentiation to cell types not normally found in the body location; under normal DNA control
Dysplasia
o change in the DNA cell structure and orientation to one another, characterized by loss of DNA control
over differentiation and abnormal variation in size, shape and appearance
Anaplasia
o Regression of a cell to an immature or undifferentiated cell type
Etiology of Cancer
External
o Chemicals
o Physical agents
o Biologic agents
Internal
o Hormones
o Immune conditions
o Genetic mutations
Theories of Carcinogenesis
Cellular Mutation
o Suggests that carcinogens cause mutations in the cellular DNA
o Occurs in three stages:
 Initiation
Carcinogens alter the DNA of the cell
Cell will either die or mutate
 Promotion
Repeated exposure to carcinogens
Expression of abnormal gene
 Progression
Irreversible period
o Cells undergo NEOPLASTIC transformation then malignancy
Loss of Normal Growth Control
o In normal tissues, the rates of new cell growth and old cell death are kept in balance.
o In cancer, this balance is disrupted.
Oncogenes
o Genes that promote cellular proliferation and are capable of triggering cancerous characteristics
 BRCA 1 and BRCA 2 – breast cancer
o A decrease in the body’s immune surveillance may allow expression of oncogenes
o When oncogenes arise in normal cells, they can contribute to the development of cancer by instructing
cells to make proteins that stimulate excessive cell growth and division.
Tumor Suppressor genes
o Normally suppress oncogenes
o May become inactive due to deletion or mutation
 P53 – sarcomas, cancer of breast and brain
Carcinogens
o Genotoxic carcinogens:
 Directly alter DNA and cause mutations
o Promoters:
 Cause other adverse biologic effects such as cytotoxicity, hormonal imbalances, altered
immunity or chronic tissue damage
 Do not cause cancer in the absence of previous cell damage (initiation) and often require high
level and long-term contact with the altered cells
What Causes Cancer?
Heredity
• Cancer is not considered an inherited illness because most cases of cancer, perhaps 80 to 90 percent, occur in
people with no family history of the disease.
• Cancer development is influenced by the inheritance of certain kinds of genetic alterations.
• These alterations tend to increase an individual’s susceptibility to developing cancer in the future.
Immunosuppression
Failure of the immune system to respond to and eradicate cancer cells.
Immunosuppressed individuals are more susceptible to cancer.
Known Etiologic Agents
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  Viruses
o Genotoxicity – insertion of viral RNA to cell DNA
o Promotion – infects lymphocytes and monocytes
 Drugs
o Genotoxicity – disrupts cell cycle
o Promotion – decreases no. of WBC’s, causes immunosuppression
 Hormones
o Genotoxicity – alteration in the molecular structure
o Promotion – alteration of immune response or endocrine balance
 Chemical agents
o Genotoxicity – alteration in DNA replication (polycyclic hydrocarbons found in soot, benzopyrene found
in cigarette smoke, arsenic found in pesticides)
o Promotion – (wood and leather dust, polymer and esters used in plastics and paints, carbon
tetrachloride, asbestos, phenols, food contaminants such as Aspergillus fungi that produce aflatoxin)
 Physical agents
o Genotoxicity – activates oncogenes and suppress antitumor activity
o Physical Factors
 Radiation
 X-rays
 Radium
 Nuclear explosion or waste
 Ultraviolet rays
o Trauma or Chronic irritation
 GERD
 Cervical dysplasia
 Oral cancer
 Chemical Factors
o Nitrates and food additives
o Polycyclic hydrocarbons
o Dyes
o Alkylating agents
o Drugs
o Cigarette smoke
o Hormones
 Lifestyle
o Diet
 High animal fat – breast cancer, colon cancer
 Low fiber – colon cancer
 Hormonal influences
o Prostate cancer
o Breast cancer
o Endometrial cancer
Mechanism of Cancer Spread
 Invasion
o direct migration and penetration by cancer cells into neighboring tissues.
 Metastasis
o ability of cancer cells to penetrate into lymphatic and blood vessels, circulate through the bloodstream,
and then invade normal tissues elsewhere in the body.
Classification of Cancer
 Benign
o Tumors that cannot spread by invasion or metastasis
o Only grow locally
 Malignant
o Tumors that are capable of spreading by invasion and metastasis
o “Cancer” applies only to malignant tumors
Stages of Metastasis
 Invasion
o neoplastic cells from primary tumor invade into surrounding tissue with penetration of blood or lymph.
 Spread
o tumor cells spread through lymph or circulation or by direct expansion
 Establishment and growth
o tumor cells are established and grow in secondary site: lymph nodes or in organs from venous
circulation
Route of Spread of Cancer
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  Lymphatic
o Most common
 Hematogenous
o Blood-borne, commonly to liver and lungs
 Direct spread
o Seeding of tumors
o May be via body cavities or natural passages
 Iatrogenic
o Secondary to medical treatment
Classification of Tumors
 Carcinomas: epithelial tissue
o Body surfaces, lining of body cavities etc: (adenocarcinoma)
 Sarcomas: connective tissue
o Striated muscle, bone, etc (osteosarcoma)
 Lymphomas and leukemias
o Hematopoietic system
 Nervous tissue tumors
o Nerve cells-neuroblastoma
 Myeloma
o Develops in the plasma cells of bone marrow
Nomenclature of Neoplasia
 According to tissue parenchyma
o Hepatoma- liver
o Osteoma- bone
o Myoma- muscle
 According to pattern and structure
o Fluid-filled CYST
o Glandular ADENO
o Finger-like PAPILLO
o Stalk POLYP
 According to embryonic origin
o Ectoderm ( usually gives rise to epithelium)
o Endoderm (usually gives rise to glands)
o Mesoderm (usually gives rise to Connective tissues)
Nomenclature of Benign Tumors
 Suffix- “OMA” is used
o Adipose tissue- LipOMA
o Bone- osteOMA
o Muscle- myOMA
o Blood vessels- angiOMA
o Fibrous tissue- fibrOMA
Nomenclature of Malignant Tumors
 Derived from ectoderm (epithelium), endoderm (glands)
o Use the suffix- “CARCINOMA”
 Pancreatic Adenocarcinoma
 Squamous cell Carcinoma
 Derived from mesoderm (connective tissues)
o Use the suffix “SARCOMA”
 Fibrosarcoma
 Myosarcoma
 Angiosarcoma
 Exceptions
o “OMA” but Malignant
 HepatOMA, lymphOMA, gliOMA, melanOMA
o THREE germ layers
 “TERATOMA”
o Non-neoplastic but “OMA”
 HEMATOMA
Effects of Cancer
 Disruption of Function- can be due to obstruction or pressure
o Prostatic tumor – urinary obstruction
o Colon cancer – bowel obstruction
o Kidney tumor – renal failure
o Lung tumor – SVC compression
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 o Liver tumor – liver failure, portal hypertension
 Hematologic Alterations
o GIT tumors – disrupt absorption of Vitamin B12 and iron
o Tumors accumulate and store folate and purine by depriving the bone marrow of these substances
which are needed for erythropoeisis
o Renal tumors – produce erythropoeitin which cause polycythemia leading to blood viscosity, clotting
and thrombosis
 Infection
o Formation of fistula between bowel and bladder
 Skin breakdown
o Immune tissues tumors - liver, leukemia, spleen, Peyer’s patches, lymphoma
 Hemorrhage
o Tumor erosion through blood vessels can cause extensive bleeding which may lead to shock or anemia
 Anorexia-Cachexia Syndrome
o Cachexia - wasted appearance of client; may be secondary to pain, infection, depression, side effects of
chemotherapy, radiation
o Neoplastic cells divert nutrition to their own use
o Tumors increase glucose metabolism initially which cause anorexia as negative feedback
o Tumors secrete substances that decrease appetite by altering taste and smell causing anorexia
o Pain, infection and depression also contribute to anorexia
o Increased metabolic rate due to presence of cachectin and TNF-alpha
 Paraneoplastic Syndromes
o Indirect effects of cancer which are caused by cancers that set ectopic sites of hormone production
 Breast, ovarian and renal cancer  ↑ PTH  hypercalcemia
 Oat cell and other lung cancers
 ↑ secretion of insulin→ hypoglycemia
 ↑ Antidiuretic hormone (ADH) → fluid retention, HTN & peripheral edema
 ↑ Adrenocorticotropic hormone (ACTH)  excessive secretion of cortisone  fluid retention,
↑ glucose levels
 Pain
o Major concern of clients and families associated with cancer
o Caused by direct tumor involvement or side effects of therapy
o Types of cancer pain:
 Acute pain – hyperactive SNS
 Chronic pain – personality changes, alterations of functional abilities and lifestyle changes
 Physical Stress
o Increased general adaptation syndrome activity  body tries to respond and destroy neoplasm
o Increased immunologic activity
o Increased inflammatory response activity
o Nutritional, fluid and electrolyte alterations
 Psychologic Stress
o Grief, hopelessness, guilt, anger, fear, isolation, body image concerns, sexual dysfunction
ASSESSMENT
Nursing History
o Health History – chief complaint and history of present illness (onset, course, duration, location,
precipitating and alleviating factors)
o Cancer signs: CAUTION US!
Warning Signs of Cancer
o Change in bowel or bladder habits
o A sore that does not heal
o Unusual bleeding or discharge
o Thickenings or lumps
o Indigestion or difficulty in swallowing
o Obvious change in a wart or mole
o Nagging or persistent cough or hoarseness
o Unexplained anemia
o Sudden unexplained weight loss
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

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  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
Warning Signs of Malignant Melanoma
A – Asymmetry
B – Border irregularity
C – Color
D – Diameter
E – Elevation
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
 Cancer cells utilize substances needed by the bone marrow to produce blood cells
Sudden unexplained weight loss
 Cancer cells utilize nutrients needed by body cells causing cachexia syndrome

Cancer Screening

Cytologic Examination
o Exfoliation from an epithelial surface
 Pap’s smear, bronchial washings
o Aspiration of fluid from body cavities or blood
 WBC, pleural fluid, cerebrospinal fluid
o Needle aspiration of solid tumors
 Breast, lung, prostate, liver
Papanicolaou “Pap” Smear
o Developed by George N. Papanicolaou in 1943
o Materials that can be examined are:
 Cervical scrapings
 Bronchial secretions and washings
 Urine sediment
 Coughed up sputum
 Aspirated gastric secretions
 Mammary gland discharge fluid
Pap’s Smearing
o A screening technique called the Pap test (or Pap smear) allows early detection of cancer of the cervix, the
narrow portion of the uterus that extends down into the upper part of the vagina. In this procedure, a
doctor uses a small brush or wooden scraper to remove a sample of cells from the cervix and upper vagina.
The cells are placed on a slide and sent to a laboratory, where a microscope is used to check for
abnormalities. Since the 1930s, early detection using the Pap test has helped lower the death rate from
cervical cancer more than 75 percent.
o Should abnormalities be found, an additional test may be necessary. There are now 13 high-risk types of
human papillomaviruses (HPV) recognized as the major causes of cervical cancer. The U.S. Food and Drug
Administration has approved an HPV test that can identify their presence in a tissue sample. This test can
detect the viruses even before there are any conclusive visible changes to the cervical cells.
Pap’s Smear Grading
 Class I – Normal
 Class II – Inflammation
 Class III – Mild to moderate dysplasia
 Class IV – Probably malignant
 Class V – Malignant
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 o The examiner will repeat the Pap smear if the result is Class III
o If the cells are Class IV, biopsy will be done

Blood, Urine and Body Fluids Tests

 Used to rule out nutritional disorders and other noncancerous conditions that may be causing the client’s
symptoms
o CBC – anemia, infection, impaired immunity
o Blood chemistry – nutritional disturbances, electrolyte imbalances
o Fecal occult blood test (FOBT) - detects invisible amounts of blood in the feces, a possible sign of several
disorders, including colon cancer.
Tumor Markers
 Substances released by cancer cells during growth and development or by other cells in response to the
presence of cancer.
 May be found on the cell membrane of the tumor or in the blood, cerebrospinal fluid, or urine.
Uses of Tumor Markers
1. Screening people who are at high risk of cancer
2. Diagnosing a specific type of cancer in conjunction with clinical manifestations
3. Monitoring the effectiveness of therapy
4. Detecting recurrence
Guidelines for Use of Tumor Markers as Diagnostic Tool
 The disease may be too far advanced to treat by the time the tumor cell marker level is elevated.
 Most tumor cell markers are not specific enough to identify one certain type of cancer.
 Some nonmalignant diseases, also are associated with tumor cell markers
Types of Tumor Markers
 Antigens
o Present in fetal tissue but normally suppressed after birth
o AFP (alpha feto-protein), CEA (carcino-embryonic antigen)
 Hormones
o HCG (human chorionic gonadotropin), ADH (anti-diuretic hormone), PTH (parathyroid hormone),
calcitonin, catecholamines
 Proteins
o Narrow down the type of tissue that may be malignant
o Serum immunoglobulin
 Enzymes
o Rapid , excessive growth of tumors may cause some of the enzymes and isoenzymes normally present in
that particular tissue to spill into the bloodstream
o Prostatic acid phosphatase (PAP)
Oncologic Imaging Procedures
o Xray
o Ultrasound
o Magnetic resonance imaging
o CT scans
o Mammography
o Nuclear imaging
o Angiography

X-ray Imaging
Least expensive and least invasive
Limited use because they do not easily distinguish among calcifications, benign cystic growths and true
malignancies
The method of choice for lung cancer but does not reveal tumors until they have reached about 1cm in size
Contraindicated for pregnant women
Nursing Considerations:
o Remove metallic accessories, buckles in belts, wired undergarments
Computerized Axial Tomography
An X-ray technique that produces sequential cross-sectional body images at progressive depths
Helps to differentiate malignant and nonmalignant masses and accurately identify their size and location
Occasionally, an oral or intravenous contrast agent is administered to increase the sensitivity of the CT scan
Nursing Considerations (if contrast medium is used)
o Check for allergies
o WOF anaphylactic/allergic reactions
o Advise client that there will be a warm sensation and metallic taste upon introduction of the dye
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 o Contraindicated for pregnant clients
Magnetic Resonance Imaging
Identifies abnormalities without the use of contrast dyes or radiation
MRI provides clear images of internal structures in response to the magnetic field created by harmless low
energy radio waves
Nursing Considerations:
o Explain that the client will be placed in side an enclosed machine and that there will be thumping
sounds that may be frightening to the client
o Contraindicated in pregnant women due to an increase in the temperature of amniotic fluid
Ultrasound Procedures
High frequency ultrasound can be used to demonstrate the interfaces around organs and within pathologic
masses
Noninvasive way to demonstrate and follow the growth of neoplasms without radiation exposure
Used to diagnose prostate cancer , and to guide needle biopsy
Nuclear Imaging
Involves the use of a special scintillation scanner in conjunction with the ingestion or injection of specific
radioactive isotopes
The principle underlying the technology is that certain isotopes have an affinity for specific tissues
Malignancies in these tissues sequester an abnormally large amount of the isotope, which can be traced and
measured by the scintillation scanner
Nursing Considerations:
o Anti-anxiety medication
o Antiemetics
o NPO or clear fluids post midnight
o Contraindicated in pregnant women
o For I131 use a straw to administer the liquid orally to lessen the exposure of the oral mucosa to the
radioactive isotope
Mammography
Mammography is a screening tool that can detect the possible presence of an abnormal tissue mass.
By itself, it is not accurate enough to provide definitive proof of either the presence or the absence of breast
cancer.
If a mammogram indicates the presence of an abnormality, further tests must be done to determine whether
breast cancer actually is present.
Nursing Considerations:
o Inform the client that there will be some discomfort during the procedure
o Instruct the client to refrain from application of talc, lotion, deodorant on the breasts and armpits prior
to the procedure
Angiography
Involves injecting a radiopaque dye into a major blood vessel proximal to the organ or tissue to be examined
Performed when the precise location of the tumor cannot be identified or there is a need to visualize the
tumor’s extent prior to surgery
Nursing Considerations
o Requires preparation similar to that for minor surgery ---clear fluids, skin prep, administration of
sedatives
o Instruct client that injection of dye may cause a hot, flushing sensation or nausea or vomiting; check for
allergies to the dye
Biopsy
A surgical excision of a small piece of tissue for microscopic examination
o Excisional biopsy
 Excision of the entire tumor for examination
o Incisional biopsy
 Excision of a part of the tumor for examination
o Needle or aspiration biopsy
 Aspiration of a core of tissue from a suspicious nodule or mass rather than excising it
Direct Visualization
Invasive but do not require the use of radiography
Allow visual identification of the organs and usually permit biopsy of suspicious lesions or masses
o Sigmoidoscopy – viewing the sigmoid colon with a fiberoptic flexible sigmoidoscope
o Cystoscopy – viewing the urethra and bladder
o Endoscopy – viewing the UGIT
o Bronchoscopy – inspecting the tracheobronchial tree
Obtain informed consent
Place specimen (if biopsy is done) in a properly labeled container that is sealed tightly
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 Keep emergency equipment available in case of respiratory complications
Pre-procedure for UGI endoscopy:
o Bowel preparation: NPO for 8 hours
o Explanation of the procedure: client will feel a fullness in the throat or sense of gagging during the test;
client will be unable to speak as the endoscope enters the esophagus
o Position: left Sim’s or left lateral position
Pre-procedure for LGI endoscopy:
o Bowel prep but may have light breakfast
o Explanation of the procedure: client will feel discomfort and the urge to defecate as the instruments are
inserted; the client will feel gas pains because the physician uses air to distend the bowel for better
visualization
o Position: knee-chest position face down or left Sim’s position
o Drape the client
Post-procedure:
o NPO until the gag reflex returns (for UGI)
o Cool fluids and normal saline gargles to relieve hoarseness and sore throat
o Watch out for bleeding, fever, abdominal pain, blood in the stool, difficulty with swallowing and
dyspnea
Tumor Staging and Grading
Staging determines size of tumor and existence of metastasis
Grading classifies tumor cells by type of tissue
The TNM system is based on the extent of the tumor (T), the extent of spread to the lymph nodes (N), and the
presence of metastasis (M).
TNM Staging
Primary Tumor (T)
T0 No evidence of primary tumor
Tis Carcinoma in situ (early cancer that has not spread to neighboring tissue)
T1, T2, T3, T4 Size and/or extent of the primary tumor
Regional Lymph Nodes (N)
N0 No regional lymph node involvement (no cancer found in the lymph nodes)
N1, N2, N3 Involvement of regional lymph nodes (number and/or extent of spread)
Distant Metastasis (M)
M0 No distant metastasis (cancer has not spread to other parts of the body)
M1 Distant metastasis (cancer has spread to distant parts of the body)

Tumor Grading
Refers to the classification of the tumor cells.
Seeks to define the type of tissue from which the tumor originated and the degree to which the tumor cells
retain the functional and histologic characteristics of the tissue of origin.
Done through Cytology, Biopsy, Surgical Excision.
Cancer Prevention
Avoid Tobacco
Protection from Excessive Sunlight
Limit Alcohol and Tobacco
Limit Fat in the Diet
Consume Fruits and Vegetables
Avoid Cancer Viruses
Avoid Carcinogens at Work
Avoid Industrial Pollution

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