Oncology Nursing Lecture Week 2 PDF

NCM 112: Oncology Nursing e z , RN, MANc RJ Marqu Prevention, 0 Screening and Early 2 Detection  Prevention PRIMARY PREVENTION - activities are aimed at prevention before pathologic change has begun - can help reduce cancer risk through altera...

NCM 112: Oncology Nursing e z , RN, MANc RJ Marqu Prevention, 0 Screening and Early 2 Detection  Prevention PRIMARY PREVENTION - activities are aimed at prevention before pathologic change has begun - can help reduce cancer risk through alteration of lifestyle behaviors to eliminate or reduce exposure to carcinogens > adapting more healthy diet > limiting exposure to sun and other sources of UV radiation > modifying sexual practices > avoiding cigarettes smoking and alcohol drinking > decreasing exposure to environmental and occupational carcinogens SECONARY PREVENTION - early detection, provides the opportunity to detect precancerous lesions or early-stage cancers, to treat them promptly  Early Detection American Cancer Society (ACS) Recommendations for the Early Detection of Cancer in Asymptomatic People 0 - cancer-related check-up: AGE FREQUENCY 1 20 to 40 years every 3 years 40 years and annual older  AGE BREAST EXAMINATIONS and FREQUENCY 02 20 to 39 years - have clinical breast exam (CBE) every 3 years - perform breast self-exam (BSE) monthly 40 years and - annual mammogram older - annual CBE - perform breast self-exam (BSE) monthly AGE COLON AND RECTUM EXAMINATIONS and 03 FREQUENCY 50 years and - annual fecal occult blood tests older - flexible sigmoidoscopy every 5 years (men/women) - colonoscopy every 10 years - double-contrast barium enema every 5 -10 years - digital rectal exam (DRE) done at the same time as sigmoidoscopy, colonoscopy or double- contrast barium enema  AGE PROSTATE EXAMINATIONS and FREQUENCY 04 50 years and - annual prostate-specific antigen (PSA) blood older test - annual DRE PROFILE UTERINE EXAMINATIONS and FREQUENCY 05 women who are CERVIX or have been - annual Pap smear test and pelvic exam sexually active (after 3 or more consecutive satisfactory exams with normal findings, may be performed less or 40 years and frequently) older - HPV test is recommended started ENDOMETRIUM menopause - endometrial biopsy  Dietary Recommendations American Cancer Society (ACS) Recommendations Against Cancer 1. Avoid obesity 2. Cut down on total fat intake 3. Eat more high fiber foods, like raw fruits and vegetables, whole grain cereals 4. Include foods rich in vit A and C in daily diet 5. Include cruciferous vegetables in the diet like broccoli, cabbage, cauliflower, Brussel sprouts 6. Be moderate in the consumption of alcoholic beverages 7. Be moderate in the consumption of salt-cured, smoked-cured and nitrate- cured foods  Common Causes of Cancer BREAST CANCER - early menarche - late menopause - nulliparous or older than 30 years at the birth of a first child LUNG CANCER - tobacco abuse - asbestos - radiation exposure - air pollution COLORECTAL CANCER - greater incidence in men - familial polyposis - ulcerative colitis - high-fat, low-fiber diet  Common Causes of Cancer PROSTATE CANCER - common among males who are 50 years and older - African-American have the highest incidence in the world - (+) family history - exposure to cadmium CERVICAL CANCER - sexual behavior: > first intercourse at an early age > multiple sexual partners > sexual partner who has had multiple sexual partners - (+) HPV and AIDS - low socioeconomic status - cigarette smoking  Common Causes of Cancer HEAD AND NECK - more common among males CANCER - alcohol and tobacco use - poor oral hygiene - long term sun exposure - occupational SKIN CANCER - individuals with fair complexion - (+) family history - moles (nevi) - exposure to coal tar, creosote, arsenic, radium - sun exposure between 11am to 3pm Warning Signals of Cancer C change in bowel or bladder habits A a sore that does not heal U unusual bleeding or discharge U unexplained anemia U unexplained sudden weight loss T thickening or lump in the breast or elsewhere I Indigestion or difficulty swallowing O obvious change in wart or mole N nagging cough or hoarseness of voice  Staging and Grading of STAGING Neoplasia - determining the size of the tumor and existence of metastases - necessary at the time of diagnosis to determine: > extent of disease (local vs metastatic); > prognosis > proper management GRADING - classification of tumor cells  Staging and Grading of Stage Neoplasia What it means Stage 0 Abnormal cells are present but have not spread to nearby tissue. Also called carcinoma in situ, or CIS. CIS is not cancer, but it may become cancer. Stage I, Stage II, and Stage Cancer is present. The higher the number, the larger the III (may also be written as cancer tumor and the more it has spread into nearby Stage 1, Stage 2, and Stage tissues. 3) Stage IV (may also be The cancer has spread to distant parts of the body. written as Stage 4)  Staging and Grading of Neoplasia NOMENCLATURE OF NEOPLASIA - tumor is named according to: 1. PARENCHYMA 3. EMBRYONIC ORIGIN Hepatoma- liver Ectoderm- usually gives Osteoma- bone rise to Myoma- muscle epithelium Endoderm- glands 2. PATTERN AND STRUCTURE, either Mesoderm- connective gross or microscopic tissues Fluid-filled- Cyst Glandular- Adeno Finger-like- Papillo Stalk- Polyp  Staging and Grading of Neoplasia BENIGN TUMOR MALIGNANT TUMOR - suffix used, -”OMA” 1. Ectodermal, endodermal, glandular, epithelial adipose tissue- LipOMA - suffix used, -”CARCINOMA” bone- osteOMA muscle- myOMA Pancreatic AdenoCARCINOMA blood vessels- angiOMA Squamous Cell CARCINOMA fibrous tissue- fibrOMA 2. Mesodermal, connective tissue origin - suffix used, -”SARCOMA” FibroSARCOMA MyoSARCOMA AngioSARCOMA  Staging and Grading of Neoplasia 1. -”OMA” but Malignant HepatOMA, LymphOMA, GliOMA, MelanOMA 2. THREE-germ layers, -”TERATOMA” 3. Non-neoplastic but -”OMA” HematOMA  TNM Classification - a system developed by American Joint Committee of Cancer (AJCC) that can be applied to all tumor types T- primary/main tumor size TX – primary tumor is unable to be assessed TO – no evidence of primary tumor TIS – carcinoma in situ (abnormal cells are present but have not spread to nearby tissue) T1, T2, T3, T4 – increasing size and/or local extent of primary tumor N- presence or absence of regional nearby lymph node involvement NX – regional lymph nodes are unable to be assessed NO – no regional lymph nodes involvement N1, N2, N3 – increasing involvement of regional lymph nodes M- presence or absence of distant metastases MX – unable to be assessed MO – absence of distant metastases Cancer Detection Examinations CYTOLOGIC EXAMINATION OR PAPANICOLAOU TEST (PAP’S EXAM, PAP SMEAR) - cytologic specimen can be obtained from tumors that tend to shed cells from their surface > GI tract through endoscopy > GU tract through colposcopy of the cervix and vagina > cystoscopy of the bladder > laparoscopy of the pelvic and abdominal cavity Cancer Detection Examinations CYTOLOGIC EXAMINATION OR PAPANICOLAOU TEST (PAP’S EXAM, PAP SMEAR) - interpretation of Papanicolaou Test results are as follows: Class I Normal follow-up examination every 1-3 yrs as recommended by physician Class II Inflammation may require Pap exam in 3-6 mos as prescribed Class III Mild to moderate dysplasia Class IV Probably malignant Require biopsy as prescribed Class V Possibly malignant Cancer Detection Examinations BIOPSY - involves obtaining tissue samples by needle aspiration, or incision of tumor 1. NEEDLE BIOPSY - done by aspiration of tumor cells with needle and syringe 2. EXCISION BIOPSY - done by removing the entire tumor (small) 3. INCISION OR SUBTOTAL BIOPSY - done by taking only a part of the tumor (large) Cancer Detection Examinations RADIOLOGIC EXAMINATIONS - ultrasound (UTZ) - magnetic resonance imaging (MRI) - radiodiagnostic tests - computerized axial tomography (CT scan) - endoscopic examinations Cancer Detection Examinations LABORATORY BLOOD TESTS 1. HEMATOLOGIC (CBC) - hemoglobin (hgb) and hematocrit (hct) low in anemia, may indicate malignancy - leukocytes (wbc) immature WBCs high in leukemia, lymphomas mature WBCs low in leukemia and metastatic dse in bone marrow - platelets high in chronic myelocytic leukemia (CML), Hodgkin’s dse low in acute lymphocytic leukemia (ALL), acute myelocytic leukemia (AML), multiple myeloma, bone marrow depression Cancer Detection Examinations LABORATORY BLOOD TESTS 2. TUMOR MARKERS - alpha-feto-protein (AFP) elevated in lung, testicular, pancreatic, colon, gastric CAs and choriocarcinoma - carcinoembryonic antigen (CEA) elevated in colorectal, breast lung, stomach, pancreatic and prostate CAs - human chorionic gonadotropin (HCG) elevated in choriocarcinoma, germ cell, testicular CA - prostatic acid phosphatase elevated in metastatic prostate CA - prostatic-specific antigen (PSA) elevated in prostate CA THANK YOU