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MARNIE and GIDGET

A DISEASE OF AGING
2
ND
LEADING CAUSE OF DEATH >65 UP.
INCIDENCE: cancer incidence peaks at 80
years old.

MEN WOMEN
PROSTATE BREAST 13% DR 18%
LUNG LUNG 12% DR 22%
COLORECTAL COLORECTAL
AMERICAN INDIANS = gallbladder cancer.
Hispanic and whites = prostate, breast, lung,
colorectal, and cervical cancer.
AF-AM = higher overall cancer incidence rate
than any racial group.
= lung, oral cavity, prostate,esophagus,
stomach, and larynx.
ASIANS = lower cancer incidence.
= stomach, liver, and colorectal, breast.
Age = most important determinant of cancer
risk.
BIOLOGIC AGING = a process that occurs
naturally in adult life and results in changes
in both structure and function.
At cellular level:
Replicating and postreplicating cells
(desenescence)
Prostatic Hypertrophy, atherosclerosis and
cancer  accel cell replication.

INITIATION – results from intense or
prolonged exposure to an external agent that
causes mutation of genetic material.

PROMOTION – when promoting agents
(external/environmental) promotes
cancerous cell growth. Transformation of the
initiated cell to a cancer cell.

PROGRESSION: TRANSFORMATION, CLONAL
PROGRESSION, METASTASIS

TRANSFORMATION – involves the conversion
of initiated cells to cancer cells.

CLONAL PROGRESSION – involves further
growth of the small cluster of transformed
cancer cells.

METASTASIS – involves a change in location
of the cancer cells from one organ or part of
the body to another that is not directly
connected.
Are genes that produce abnormal codes ofr
growth-regulating substances.
Activation  excessive production of cell-
growth-regulating substances.
Immune function declines.(IS)
Decrease or increase in hormones (solid
tumors).
The older you get, the longer you get
yourselves exposed to carcinogens.
Heredity
Mutations in DNA repair.
Aging cells tend to grow abnormally.
Oncogene activation.
Encourage older adults to consume the
recommended daily requirements of fruits
and vegetables  halt „promotion‟.

Evaluation of environmental risk factors.

Screening programs among selected high-risk
population.
The most common neoplasm in women,
increasing in incidence with advancing age.

Incidence > mortality (1990s)

80% occur in women >50.

Leading cause of death in women ages 55-74.

> incidence in af-am and White hawaiian.

Women age 40 and up.
Early menarche
Late menopause
Lengthy exposure to post menopausal
estrogen
Oral contraceptives
Nullipara
Primy at late age (after 35)
Family cancer history
High fat diet… OBESITY


MALIGNANT LUMP BENIGN LUMPS
HARD SOFT
FIXED MOBILE MASSES
IRREGULAR BORDERS (FROZEN
PEAS)
REGULAR BORDERS
NIPPLE RETRACTION OR ELEVATION – due to
tumor fixation involving underlying tissue.

SKIN DIMPLING – due to invasion of tumor
into the ligaments and fixation to the chest
wall.

Localized erythema and warmth.
Edema = “orange peel” skin.
PAIN – advanced.
BSE all women >20
Postmenopausal women should select a
consistent date for BSE.
Mammography – a tumor must be about
10mm to be palpable.
Mammography = every 2 years for 40-49 yo
Anually for 50 and older.
Depends on tumor characteristics

5-year survival rate = 100%

20-year survival rate = 53%
most easily cured of all the cancers of the
female reproductive system.

12,200 cases of invasive cervical cancer were
diagnosed in 2003, with approximately 4100
deaths from cervical cancer during the same
period.
death rate has steadily declined over the
past 50 years.
Mortality: A.A. > W.A.

Early intercourse
Multiple sex partners
Promiscuous male partner
Smoking
STD history
HPV infection (16, 18, 31, 33, 35, 39, 45, 52,
56, 58, and 59)
Coexisting infxn: c. trachomatis, HSV2, HIV
Precursor lesions  dev‟t of atypical cervical
cells  carcinoma in situ  invasive cancer
of the cervix.

Carcinoma in Situ Invasive cancer of the
cervix
Localized to the epithelial layer Spreads to deeper layers
cervicography, a noninvasive photographic
technique that provides permanent objective
documentation of normal and abnormal
cervical patterns.

Acetic acid (5%) is applied to the cervix, a
cervicography camera is used to take
photographs, and the projected cervicogram
(i.e., slide after film developing)
can be sent for expert evaluation.
accepted format for reporting cervical and
vaginal cytologic diagnoses.

was developed during a National Cancer
Institute Workshop in 1989 and updated in
1991 and 2001.

Dysplasia/Neoplasia CIN Bethesda
Benign Benign (-) intraepithelial
lesion or malignancy
Benign with
inflammation
Benign w/
inflammation
(-) intraepithelial
lesion or malignancy,
ASC-US
Mild dysplasia CIN1 LSIL, ASC - H

Moderate dysplasia CIN2 HSIL
Sever dysplasia/
carcinoma in situ
CIN3
Invasive cancer Invasive cancer Invasive cancer
ASC –US (atypical squamous cells,
undetermined significance).
SIL – squamous intraepithelial lesion
CIN – cervial intraepithelial neoplasia. A
system of grading devised to describe the
dysplastic changes of cancer precursors.
Pap smear result of atypical
glandular cells (AGCs) warrants further
evaluation by endocervical or endometrial
curettage, hysteroscopy, or, a cone biopsy
if the abnormality cannot be located or
identified through other means.
 INVASIVE cervical cancer:
 Radiation therapies:
 Intracavitary radiation provides direct access to
the central lesion and increases the tolerance of
the cervix and surrounding tissues, permitting
curative levels of radiation to be used.
 External beam radiation eliminates metastatic
disease in pelvic lymph nodes and other
structures and shrinks the cervical lesion to
optimize the effects of intracavitary radiation.

EXTENDED HYSTERECTOMY WITHOUT PLND
- removal of the uterus, fallopian tubes,
ovaries, and upper portion of the vagina.

RADICAL HYSTERECTOMY WITH PELVIC
LYMPH NODE DISSECTION
- removal of all pelvic organs, including the
bladder, rectum, vulva, and vagina.
HPV VACCINE!!!
Early detection :D
QUALITY OF LIFE – is a multidimensional
concept that includes not only functional
status and severity of symptoms, but also the
client‟s ideas about psychologic
development, sociocultural issues, ethical
issues, economic issues, and spirituality.

It is relevant to both curative and palliative
care.
Karnofsky Performance Index (KPI) – assesses
the client‟s ability to perform various
activities of daily living.
DEPRESSION – the risk of depression does not
diminish with age…
- depressive symptoms may be a side effect of
medications used to control cancer
(androgen and cortisone medications)
- MGT: individualized and supportive
interventions.
GRIEF – is a natural and expected human
reaction to loss.

SOCIAL ISOLATION – sense of being cut off
from people is an experience commonly
described to older adults with cancer.
Risk factors: physical disability/illness,
frailty, psychologic or neurologic disorders,
and environmental constraints.
RESOURCES AND SUPPORT – important NC of
Older Adults is awareness of resources and
referrals to appropriate agencies or support
groups.