Internal Radiation

-sealed (uses beta particles)

-“brachytherapy”/Internal radium implant/cesium or cervidil implant
-intracavity (invasive)
-use radioactive seeds, ribbons, capsules, beads
-implantation- O.R.
(+) Contact Radio Precaution- you need to follow the CDC guidelines
ALARA Precaution-to lessen exposure
 AS
 Low
 As
 Reasonably
 Achievable Exposure

Guidelines: FF TDS
Time- 30 min/shift
Distance- 5 min (3-6 ft away)- the farther the better
Shielding – Visit
= 6 visits
(-) Body Fluid Radiation Precaution

After implantation – Private Single Room

Dislodged (implant)
Bedside Items—Long Forceps
-Lead container/PIG

Blue -Cardiac Arrest

Red -Medical Emergency/Fire
Black- Bomb
Yellow- Biohazard
Pink- OB/Pediatric Emergency/Kidnap
White-All is Clear/Mass Casualty
Purple-Full House (Madaming Patient)

Floating Nurse
-reliever
-walang ginagawa

Treatment of Cancer- Iodine 131

For Diagnosing iodine 123
BREAST Cancer
99% - female
1% male
Common Site: Upper Outer Quadrant (near axilla)

Predisposing Factor (RISK):

-Hormonal Imbalance (Estrogen)
-Early Menarche/Late Menopause
(Average Menarche is 9-13)
(Menopause-Cessation Normal 45-50 y.o)
-Obesity
-Nulliparous
-Lifestyle/Diet
-Hereditary (Genetics)
-Cancer marker (BRCA1)- Blood Test
-Radiation/Chemical exposure

Early Sx:
-Dimpling/Lumps(Painless/Non Movable/Fixed)

Late Sx:
-Orange (texture) Peel SKin (depends on the patient’s skin color) “Peau D Orange”
-Mastodynia (excessive pain in the breast)

Other Sx:
Abnormal Nipple Discharge
Skin Discoloration
Mastitis
Obvious Deformity (Breast/Nipple)
Weight Loss
Anemia
Malnutrition

Dx Test:
Confirmatory: Biopsy
Different Types of Biopsy
 Excisional-entire removal of tumor/lesion/growth, if the tumor is less than 5 cm (small tumor)
 Incisional- partial removal of the tumor, tumor is more than 5 cm (big tumor)
 FNA-Fine Needle Aspiration - least invasive, good dx testfor bleeding tendencies
Pathology: Cytology
Ex.
1.Frozen Section
- commonly done while operation is on-going
-Fast Result (Average: 30-45 min before you get the result)
-will tell if it benign/malignant only
Paraffin Test
-provides perfect details (more detailed)
-slow result (Ave:

Screening Test:
-not accurate but easier method to analyze cancer

BSE (Breast Self Examination)

-Done both standing and lying
Standing position- best time when taking a bath in front of a mirror
Motion of hands- circular motion, wave , wedge/clock method (best method)
Best: Outer to Inner palpation
Hands Up-palpate, Hands on Waist-Palpate,Hands Down -palpate
Done- after menstruation (7-10 days after menstruation)

If menopause/Irregular mens- check same day, each month

Mammogram/Mammography
-if there is strong family history of Breast CA
-start 10 years earlier than the age of the relative was dx
-not less than 25 yrs old/not more than 45 y.o
-repeated annually
(7-10 days after mens)

If (-) - Family History

Initial Test:
Baseline test (35-39 y.o)
-40-49 y.o -- done Q 2 years
>50-- annual

Mgmt:
-Radiation
-Chemotherapy
-Surgery
-Mastectomy
Common S/E or CX:
Lymphedema
5-10 years

Elevate the arm to lessen te edema

Cytostatic-- to prevent cell multiplication (mitosis)

-combined with other tx modality

DOC: Tamoxifen (Nolvadex) --Anti-estrogen/hormone--para di dumami

S/E: Bone Pain

Types of Mastectomy::
Total Mastectomy/Simple Mastectomy- BAN
 Breast tissue affected
 Areola
 Nipple

Radical Mastectomy: BANLP

 Breast Tissue
 Areola
 Nipples
 Lymph nodes (axillary)
 Pectoralis Muscle

Modified Radical Mastectomy - BANL

 Breast Tissue
 Areola
 Nipples
 Lymph Nodes

Partial Mastectomy
 Portions of the breast tissue

TESTICULAR CANCER
Predisposing factors:
Leading Cause: Hormonal Imbalance (Testosterone)
Hx of Cryptorchidism (undescended testes)
Genetics/Hereditary
Lifestyle/Diet
Hyperejaculation: Underuse/Overuse
Recurrent Infection
Clinical manifestations:
Early Sx:
Pea Size shape lump (non movable/fixd)
Obvious deformity/assymetry
Discoloration
Scotal Heaviness
Lower back pain
Anemia
Weight loss
Pain (lae)

Screening Test
TSE
After warm shower (relx ang testicle)
Cold temp-stimulates cremasteric reflex “

Radiation
Chemo
Surgery (Orchiectomy)

LUNG CANCER
-LAOS
-

Tumor Lysis Syndrome

Cause: Excessive fast or over administration of chemotherapy (cytotoxic) drug

Rapid breakdown of abnormal cells (tumor)

Metabolic crisis
(Overproduction of Metabolic Waste/Electrolyte imbalance)

Clinical Manifestation:
-Hyperkalemia/Hyponatremia (brady arrythmia)
Sodium (cation) postive-add
-Hypocalcemia/Hyperphosphatemia
Calcium=Fibrinogen (Clotting Factor 1)
-Inc Uric Acid (Hyperuricemia)
-Lactic Acidosis-Pain

Met. Acidosis (Kidneys)

Increase-Decrease RR - Apnea
Kussmauls: Continuous rapid deep breathing, no apnea
(compensatory for excssive acidosis)
Good because it’s trying to balance acidosis
Eupnea- Normal Breathing

Tumor Lysis
LIHAM
Lactic Acidosis
Increase uric acid level
Hyperkalemia
Acidosis
Metabolic

MGMT:
Stop temporarily/Slow down Chemo
Hydration (IVF/OFI)
Emergency Hemodialysis
MEDS:
Kayexalate (Na Polysterene)---K+ Binder
Insulin and IVF (Dextrose)
Febosustat
TMN Classification (Tumor, Metastasis and Nodes)
-describe and define the extent of tumor
-a method of staging of cancer
-to check he amountand severity of CA

T-Primary Tumor
T0- NO TUMOR
TX- Tumor can’t be assessed (require more detailed exams)
T1- < 3 cm
T2- 3-5 cm
T3 - 5-7 cm
T4- > 7 cm
T1S- Carcinoma Insitu (in place) -- cancer is present but no tumor

Benign