NCM 106 Cellular Aberration Sir Siroy Cellular Aberration Group of disorder characterized by abnormal cell growth and

nd 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.

Proliferation of growth pattern 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

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

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 cant 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

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 -Smooth andround - fixed -irregular shaped

- Have surrounding fibrous capsule - cells multiply - tumor grow by expanding and pushing awayand against surrounding tissue -Not attachedto surrounding tissue -Never spreads -Easier to remove and does not recur after excision

-no capsule

- multiply rapidly - tumor grows by invading and destroyingsurroundin g tissue -Attached to surrounding tissue - almost always spreads - Difficult to remove and recurs after excision

Diagram Representation of General Pathophysiology of Cancer Acquired (environmental) DNA damaging agents Chemicals Radiation Viruses Normal Cell

DNA damage Failure of DAN Repair

Inherited mutation in: -Genes affecting DNA repairs -Genes affecting cell growth or apoptosis

Activation growth promoting oncogenes

Mutation in the genome of somatic cells Inactivation of tumor suppressor genes

Alteration in genes that requires apoptosis

Unregulated cell proliferation Angiogensis Escape from immunity Clonal Expansion

Decreased apoptosis Additional mutation

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 cancersuppressing 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. (2nd 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 (xrays -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) Burkitts 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) Kaposis 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 1. 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, diseasemodifying 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. 1. Gender more men develop cancer that women. More men die from cancer than women 2. Age with few exceptions cancer becomes more prevalent in older persons. Over half of all cancers occur in person age 65 or older 3. 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 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 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 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) factors of Skin cancer: -Unprotected exposure to strong

Risk

Risk

Risk

Risk 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 TEN LEADING SITES OF CANCER ON 1998 BOTH SEXES, PI Disease Number % Lung Breast Liver Cervix 11,123 9436 5,249 4,536 15.6 13.2 7.3 6.3

Leukemia Colonn Thyroid Stomach Nasopharynx Lymphomas

3,147 2,963 2,584 2,563 2,200 2,088

4.4 4.1 3.6 3.6 3.1 2.9

Quiz leakage: Risk Factors of Breast, Cervical and Prostate Cancer Cell cycle: understand Diff bet Benign and malignant 5-10 exact 5 multiple choice Enumeration _________________________________________________

Unit III: 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

THE LEADING SITES OF CANCER ON FEMALE, 1998 PI Disease Number % *Breast Cervix Lung Thyroid Ovary Leukemia Colon Liver Stomach Corpus Uteri 9,325 4,536 2,649 2,068 2032 1488 1415 1343 1052 1052 25.9 12.6 7.4 5.8 5.7 4.1 3.9 3.7 2.9 2.9

TEN LEADING SITES OF CANCER ON MALES, 1998, PI Disease Number % *Lung Liver Prostate Leukemia Colon Stomach Nasopharynx Lymphoma Rectum Oral 8,474 3,906 2,026 1,659 1548 1511 1475 1253 1142 810 26.7 12.3 6.4 .52 4.9 4.8 4.6 3.9 3.6 2.4

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 etccancer risk. -stress weakens immune system KEY AREAS FOR PRIMARY PREVENTION OF CANCERS (DOH/PHIL) Quiz tom 1. Promote lifestyle change. smoking cessation- quit smoking for active smokers. Prevent passive smoking. Advise smokers not to smoke inside living areas and workplace to prevent exposure of others to secondhand smoke. 2. Increase intake of dietary fiber by eating more leafy green and yellow vegetables, fruits and unrefined cereals. Betacaratene, vitamins A,C,E. 3. Eat less fatty foods 4. Limit consumption of smoked, charcoalbroiled, salt-cured, and salt-pickled foods. 5. Avoid moldy foods

-control obesity through proper nutrition and exercise. -drink alcoholic beverages in moderation. 6. Advocate an environment supportive of a healthy lifestyle. -promote a smoke-free environment -sooner a cancer is diagnosed and treatment begins, the better the chances of living longer and enjoying a better quality of life. SCREENING FOR CANCER DOH/PHIL -early detection and prompt treatment are keys to curing cancer (note: cure rate in cancer is relative and depends on the type of cancer). The earlier cancer is detected, the more likely it is to be cured. Early detection techniques enable health care providers to screen for and diagnose cancer while it is localized and potentially curable. -The acronym CAUTION US (ACS) provides a systematic way of remembering the cancer C-change I bowel or bladder habits A-a sore that does not heal U-unusual bleeding or discharge T-thickining or lump in the breast or else where I-indigestion and difficulty in swallowing O-obvious change in wart or mole -warts sor moles are circumscribed cutaneous discolorations to skin elevations that should not increase in size, nor elcerate. N-nagging cough or hoarshness of voice -evaluate for symptoms related for persistent cough and its quality eg dry U-unexplained anemia S-sudden wt loss SPECIFIC GUIDELINES FOR EARLY DETECTIN OF COMMON CANCER: There are many types of cancers. Therefore, guidelines for screening and early detectin will vary depending on the type of CA. BREAST CANCER Warning signs -skin changes -edema -inflammation peau de orange orange peel like skin -ulceration -prominent venous pattern Nipple abnormalities -retraction -rashes or discharge ABNORMAL CONTOURS -variation in size and shape of breast EARLY DETECTION

1. Breast self-examination-cheapest and most affordable screening procedure. this can be easily taught to women to increase awareness and promote selfcare. best time to do BSE is one week after menstrual period while taking a shower, facing the mirror standing up or lying down 2. Yearly breast examination by a health care provider- this is to detect masses/lumps missed by the client or to confirm presence of mass detected by client on BSE. If lumps or lymph nodes swelling is present, assess also for the following: -location -number of lumps or nodes (solitary or multiple) -consistency: soft or hard -size (estimation) -fixed or movable -tenderness along the area 3. Breast mammography -if a mass is detected and confirmed by the health worker, a mammogram usually confirms it. -baseline M is suggested for all women between the ages 35-39 and yearly after age 40. -if with family history of breast cancer, M should be started at age 30. -put in mind that BSE does not take the place of a Mammography or vice versa. REMEMBER!! BSE -should be done monthly, a week after onset of menstrual period. -by age 20, women should have developed the habit of doing BSE monthly;----teach BSE to women early in their teens. -breasts tend to undergo changes during: -pre-menstrual period;--perform BE a week after menstrual period -pregnancy -lactation. CERVICAL CANCER -often asymptomatic -abnormal vaginal bleed (e.g. post-coital bleeding) EARLY DETECTION: -paps smear is the primary screening tool for women over age 18. -Paps smear should be done in between menses (2 weeks after menses). A woman should not douche, have intravaginal medications nor have sexual intercourse 24 hours prior to test. -should be done annually for 2 consecutive years and at least every 3 years until age 65 for those with normal findings -for persons at high risk, it should be done yearly. This include those who are: sexually active, have multiple partners, commercial sex workers.

COLON RECTAL CANCER -change in stool -rectal bleeding -pressure on the rectum -abdominal pain EARLY DETECTION: -annual digital rectal exam starting at age 40 -annual stool blood test starting at age 50 -annual inspection of colon PROSTATE CANCER Symptoms of urethral obstruction: -urinary frequency -nocturia -decrease in stream -post-void dribbling EARLY DETECTION: -digital rectal exam for men -Prostate specific antigen (PSA) determination a blood test, confirms diagnosis. LUNG CANCER -persons with a long history of smoking and/or smoking 2 or more packs of cigarette a day -chronic cough or nagging cough -dull intermittent, localized pain -history of wt loss EARLY DETECTION -CXR q6months for patients who have history of smoking 2 packs a day -sputum cytology DIAGNOSTIC EVALUATION, STAGING, AND NURSING RESPONSIBILITIES. LUNG CANCER -a. starndard roentgenogram or x-ray on chest. Detect any abnormalities in the lungs. Nursing responsibilities -avoid excessive exposure of client and self -remove radiopaque objects that can interfere with the results -explain procedure to client. -b. sputum cytology- examine a sample of sputum under a microscope to determine whether abnormal cells are present Nursing responsibilities -no special prep is required. Just instruct client to cough our sputum in a sterile container and label properly, BREAST CANCER -A. Mammogram or mammography- is a special type of x-ray imaging used to create detailed images of the breast. -b. clinical breast examination- a physical exam of the breast done by a health professional. NR -explain the procedure that this is done to find a lump or change in the breast that may mean serious problem, such as CA.

-MRI-radiowaves and magnetic field are used to view soft tissues. Useful in diagnosing tumors. NR -explain procedure -be aware that it is contraindicated to clients with metallic -implants, pacemaker, sharpnels, hearing aids, obesity. -remain still through out the procdure. -4. Tissue UTERINE CANCER -A. Transvaginal sonography- a procedure used to examine the vagina, uterus, fallopian tube, ovearies and bladder. An instrument (utz probe) is inserted into the vagina that causes sound wavest to bounce off organs inside the pelvis. Thie sound waves create echoes that are sent to a computer, which creates a picture called a sonogram. NR -explain -that eliminates the need for full bladder. This procedure of full bladder is true only to abdominal utz (1quart/1L) in 2 hours and dont void. Full bladder serves as a landmark to define other pelvic organs. -b. hysteroscopy- is the inspection of the uterine cavity by endoscopy with access through the cervix. It allows for the diagnosis of intrauterine pathology and serves as a method for surgical intervention. -c. sonohysterography- new technique developed to better image the uterine cavity. It uses an infusion of sterile saline through a soft plastic catheter placed in the cervix in conjunction with transvaginal UTZ. -it distends the uterine cavity, giving improved visualization of uterine and endometrial pathology NR -explain, mimimally invasive procedure. -change clothing into hospital gown -perform one week after mensttuation to avoid the risk of infection. -not for pregnant women -no special prep before exam-30 min procedure. CERVICAL CANCER -a. pap smear- (apapanicolaou test)- test for cervical ca in women. Involves collecting cells from your cervix. -simple test and takes less than 5 minutes. Slightly uncomfortable but not painful. -can detect changes in your cervical cells that suggest ca may develop in the future. -screening test for malignant and premalignant changes in the cervix NR -explain the procedure, positioning-speculum and spatula.

-are done to women who have no symptoms of ca and have no findings suggesting a ca. Thus, it is done only to normal women. PROSTATE CANCER -a. digital rectal exam- insertion of a glovedlubricated finger into the rectum and feel the prostate for hard, lumpy or abnormal areas. NR -explain the procedure -slight, momentary discomfort during the test -normal activities after the exam -b. Prostate-specific antigen (PSA)- is a protein produced by cells of the prostate gland. The test measures the PSA level in the blood. It is a biological marker or tumor marker. -level below 4.o ng/ml-normal - it can be raised by a ca cells, BPH, prostatitis, urethral cath, surgery, rectal penetration, prolonged exercise, and ejaculation. COLORECTAL CA -a. fecal occult blood test- checks for hidden (occult) blood in the stool. -positive result- bleeding from upper or lower GIT. Maybe peptic ulcer or malignancy. -this doesnt detect colon ca but is often used in clinical screening NR -explain -stool is collected in a container send it right away to lab -if positive maybe recommended for sigmoidoscopy or colonoscopy -b. Sigmoidoscopy- an examination of the rectum and lower colon using a sigmoidoscope. NR -explain -done in OR -C.- Colonoscopy-exam of the rectum and entire colon by using a colonoscope. NR -same as sigmoidoscopy -d.-double contrast barium enema- a series of xrays of the colon and rectum are taken after a liquid containing barium is put into the rectum. NR -explian -liquid diet before exam for 24 to 48 hours -NPO post midnite -cleansing enema or laxitives -encourage to consume plenty of fluids before and after the exam. Prevents dehydration and constipation. Barium is a dehydrating substance. -normal to have white stool for a few days after the procedure. OTHER TEST 1.Tumor Marker- are substances, usually protein, that are produced by the body in response to ca growth or by the cancer tissue itself and maybe detected in blood, urine, or tissue samples. But this alone is not diagnostic for CA ex. PSA

2. Radioisotope Scan- way of imaging bones, organs, and other parts of the body using a small dose of a radioactive chemical. NR -explain the procedure -injected IV like Na pertechnate/radioactive iodine -care for iv sites Possibility.. STAGING: is used to determine the extent of disease in an individual patient. The tumor-node metastasis (TNM) system of the American Joint Committee on Cancer (AJCC) T= characteristics of a givien tumor (size, depth of invasion, involvement of surroundings structures) N=presence or absence of involved nodes and size or number of involved nodes. M= presence of absence of metastasis. TNM results .. Stage 4 disease is generally metastatic. Stage 1 disased is confined to the organ of origin

-such system allows the clinician to assign a prognosis usually guides treatment -Why is staging important 1. extent to which a disease has spread is prognostic. 2.extent of disease often dictates treatment 3. Accurate staging allows collection of data that eventually provides information is collected by a tumor registry. Key areas 6 Caution us! IV Treatment Principles of various modalities of management against cancer 1.Surgery- branch of medicine that uses manual and instrumental means to deal with diagnosis and treatment of injury, deformity and disease. 2.Surgical oncology- defined as the branch of surgery focusing on the surgical management of malignant neoplasms, including biopsy, staging and surgical resection. -important option in the treatment of cancer -potentially, surgical oncology procedure may be used to prevent a cancer occurrence in the high risk patient removal of mass (breast) or cyst to patient who has a familial tendency.

A. T2N1M1 breast cancer is stage 4, where

as a T2N1 M0 breast cancer is stage 2