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CANCER
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Oncology Nurse
y provide care and support for patients who have beendiagnosed with cancer
y required to administer chemotherapy and to otherwisehelp manage symptoms related to their patients'
illnesses
y coordinate care with other health care providers,including oncologists, and share their expertise with
colleagues and patient
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Cellular Aberration
ythe act of deviating from the ordinary,
usual, or normal type of cell where itcan alter or destruct in the normalgrowth of cell or tissue
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CanceryIs a complex of diseases which
occur when the normal cells
mutate into abnormal cells that
take over normal tissue,
eventually harming anddestroying the host
National Cancer Institute
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Cancery A large group of disease characterize by:
Uncontrolled growth and spread of abnormal cells
Proliferation
Metastasis
y Altered cellular mechanism with progressive and
uncontrolled multiplication of cells with selective ability to
invade, metastasize and cause mechanical effects of
pressure, obstruction and interruption of blood supply
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Cancer
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Cancer Statistics
y A ll Sites of Cancer
y Estimated new Cancer 1,479,350
y
Male - 766,130y Female - 713,220
y Estimated Deaths 562,340
y Male - 292,540
y Female - 269,800
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2009 Estimated US Cancer the act of deviating from the ordinary, usual, or normal typeDeaths*
y Lung & bronchus 30%
y Prostate 9%
y Colon & rectum 9%
y Pancreas 6%
y Leukemia 4%y Liver & intrahepatic 4%
bile duct
y Esophagus 4%
y Urinary bladder 3%
y Non-Hodgkin 3%
lymphoma
y Kidney & renal pelvis 3%
y A ll other sites 25%
y ©2009, A merican Cancer Society, Inc.
Men
292,540
Women
269,800 26% Lung & bronchus
15% Breast
9% Colon & rectum
6% Pancreas5% Ovary
4% Non-Hodgkinlymphoma
3% Leukemia
3% Uterine corpus
2% Liver & intrahepaticbile duct
2% Brain/ONS
25% All other sites
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Mortality, 2006
Rank cause of Death
y 1. Heart Diseases 631,636 26.0y
y 2. Cancer 559,888 23.1
y 3. Cerebrovascular diseases 137,119 5.7y
y 4. Chronic lower respiratory diseases 124,583 5.1y
y 5. A ccidents (unintentional injuries) 121,599 5.0y
y 6. Diabetes mellitus 72,449 3.0y
y 7. A lzheimer disease 72,432 3.0y
y 8. Influenza & pneumonia 56,326 2.3y
9. Nephritis* 45,344 1.9
y 10. Septicemia 34,234 1. 4
y ©2009, A merican Cancer Society, Inc.y
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Incident
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Etiology/ Causative Factor
y Extrinsic Factor
y Viruses and bacteria
y Chemical Carcinogens
y Radiation Carcinogens
y Iatrogenic Chemical
agents
y Intrinsic Factor
y Hormonal Factor
y Genetic Factor
y Physical Stressor
y Dietary Factors
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Viruses and Bacteriay second most important risk factor for cancer
development in humans
causes the cell to become malignant
alter the activity of cell
viral genetic information inserted to chromosomes of infected cell
nucleic acids of virus stored in cell
Virus infected a person
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A. Viruses and Bacteria
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Viruses and Bacteria
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Viruses and Bacteria
HIV causes an immune
deficiency that makes
people more susceptible to
viral infection
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Vir s s ct ri
y H elicobacter pylori, which cancause stomach ulcers, has beenassociated with the development of can
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B. Chemical carcinogensChemical carcinogens such
as asbestos, nitrosamine andpolycyclic hydrocarbons
A lter cell behavior,function andreplication
DNA mutation
(mutagens) andcancer(carcinogens)
Some chemical such asalcohol
Stimulate rateof cell
division
Less enzymes to repairdamaged DNA
Increasingmutation and
cancer
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c rc g s
y Cigarette smoke contains more thantwo dozen different chemicals
capable of causing cancer
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B. Chemical carcinogens
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C. Iatrogenic chemical agents
yChemotherapy drugs
yImmunosuppressive agents
The breakdown of immune surveillance as a
possible etiology of cancer
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D. Radiation Carcinogens
y Prolonged or repeated exposure to certaintypes of radiation can cause cancer
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E. Hereditary Factors
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E. Hereditary Factors
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F. Dietary Factors
Obesity
High fat diet
Diets low in fiber
Diets high in smoked or salted foods
Preservatives and Food additives
A
lcohol
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H. AGE
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Cancers Nine Warning Signs
y
C hange in bowel or bladder habitsy A sore that does not heal
y U nusual bleeding or discharge
y T hickening or lump in breast or elsewhere
y I ndigestion or difficulty in swallowingy O bvious change in wart or mode
y N agging cough or hoarseness
y U nexplained anemia
y S udden loss of weight
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Chemicals andradiation
Alter/dama inenes
viruses
introduce their o nenes into cells
hereditary
passes on alterations inenes
Genes are altered, or"mutated," in various ays
CA NCER
Oncogenesis
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What is Staging?y Staging describes the extent or severity of an
individuals cancer
y
It is base on the extent of the original (primary)tumor and the extent of spread in the body.
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Staging is important:y Staging helps the doctor plan a persons treatment.
y The stage can be used to estimate the persons prognosis(likely outcome or course of the disease).
y Knowing the stage is important in identifying clinicaltrials (research studies) that may be suitable for aparticular patient.
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Elements of Staging Systemsy Location of the primary tumor
y Tumor size and number of tumors,
y L ymph node involvement
y Cell type and tumor grade
y Presence or absence of metastasis
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TNM System:
TheTNM system is based on :
y the extent of the tumor (T)
ythe extent of spread to the lymph nodes (N)
y the presence of metastasis (M).
y A number is added to each letter to indicate the size or
extent of the tumor and the extent of spread.
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Primary Tumor (T)y TX - Primary tumor cannot be evaluated
y T0 No evidence of primary tumor
yTis - Carcinoma in situ (early cancer that has notspread to neighboring tissue)
y T1, T2, T3, T4 - Size and/or extent of the primary tumor
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Regional Lymph nodesy NX - Regional lymph nodes cannot be evaluated
y N0 - No regional lymph node involvement (no cancer
found in the lymph nodes)y N1, N2, N3 - Involvement of regional lymph nodes
(number and/or extent of spread)
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Distant Metastasis (M)y M X - Distant metastasis cannot be evaluated
y M0 - No distant metastasis (cancer has not spread to
other parts of the body)y M1 - Distant metastasis (cancer has spread to distant
parts of the body)
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Examples:y breast cancerT3 N2 M0
y It refers to a large tumor that has spread outside thebreast to nearby lymph nodes, but not to other parts of the body.
y Prostate cancerT2 N0 M0
y It means that the tumor is located only in the prostateand has not spread to the lymph nodes or any other partof the body.
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y Stage I ( T1, N0, MO)- Early Stage
y Stage II (T2, N1, M0) local Spread
yStage III ( T3, N2, M0)- extensive spread but nometastasis.
y Stage IV (T4, N3, M+) A dvanced stage, with distantmetastasis
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5 Main Categories of Cancery In situ is early cancer that is present only in the layer of
cells in which it began.
y Localized is cancer that is limited to the organ in whichit began, without evidence of spread.
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y Regional is cancer that has spread beyond the
original (primary) site to nearby lymph nodes ororgans and tissues.
y Distant is cancer that has spread from the primary
site to distant organs or distant lymph nodes.
y Unknown is used to describe cases for which thereis not enough information to indicate a stage.
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Why Cancer Detection and Testing Important?
y Detecting cancers early is an important step in
preventing significant health problems.
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Four Possible Outcomes.
y True Positive
y False Positive
y TrueNegative
y FalseNegative
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y W hen a test is performed to detect a disease,
there are four possible outcomes:
yTrue positive - test indicates that a patient
has a disease that the patient does indeedhave
yFalse positive - test indicates that a patienthas a disease when they do not
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yTrue negative - test indicates the patientis disease-free, and this is indeed the case
yFalse negative - test indicates the patientis healthy when in fact the patient has the
disease
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Non - Invasive Invasive Techniques A nalysis of Biopsy
Complete Blood Count(CBC)
ltrasoundMR I
T canCT can
Fine Needle AspirationCore Needle Biopsy
Immunohistochemistry (I C)Fluorescent In itu
y ridization (FI )
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CBCy It provides information about the number, parts,
shape, and structure of the different cell types found inblood.
y 3 main types of blood cells:
y WBC
y R BC
y
Platelets
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MRI
y Used to evaluate suspected malignancies of the CNSbecause of its ability to perform multi-planar images and
ease of instillation of contrast media.
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MRI
W hen contrast agent is not used anMR I can show:
W hen contrast agent is usedMR I can show:
contrast agent is not used an MRI can
show:The shape, size, appearance, andlocation of organs, bones, and jointsThe presence of abnormal growthsSigns of inflammation or infection
size and location of benign or
malignant growthsenlarged lymph nodeschanges in blood flowextracellular volume
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Positron Emission Tomography
(PET) y Uses nuclear medicine with the precise localization to
penetrate bodys metabolism to measure blood volume/flow and protein metabolism.
y In oncology, it detect the metabolic changes precedeanatomic changes.
y PET scans use radioactively labeled tracers(radiotracers) that are injected into the bloodstream
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PET Scanning is able to:y Differentiate scar or radiation necrosis from active
tumor.
y
Determine if a mass lesion is malignant or benign.y Characterize enlarged lymph nodes as malignant or
benign.
y Evaluate early tumor treatment response.
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Computed Tomographyy It uses x-rays in the same way as a conventional x-ray
but instead of taking one image a CT scanner takesmultiple images, or slices.
y It can provide a 3 dimensional image of an internalstructure, it can detect differences in tissue density.
yUltrasound uses reflection of sound waves tocreate an image of a part of the body
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FineNeedle A spirationCoreNeedle Biopsy
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Biopsyy Is the removal of cells, tissue, or fluid for examination.
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Types of Biopsyy Excisional biopsy- removes all suspicious tissue.
y Incisional biopsy- removes a sample of tissue from a
mass.y Needle A spiration- aspiration of small amount of core
tissue from a suspicious area.
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Invasive Techniques
y Fine needle aspiration (FNA ) uses a small needle tocollect small samples of a lesion.
y Core needle biopsy uses a larger needle to collectsamples of a lesion
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FineNeedle A spiration CoreNeedle Biopsy
Sample Removed Removes only a very small portion of the lesion
Removes a small portion in most
cases, occasionally removes the
entire lesion
Needle Size 22-27 gauge 11-18 gauge
Pathology Type Cytopathology Histopathology
Interpretation Time Immediately Delayed
Diagnostic Abilities
Limited ability to specifically diagnose benign
lesions
No ability to differentiate between in situ and
invasive breast cancer
Strong ability to specificallydiagnose benign lesions.
Some ability to differentiate
between in situ and invasive breast
cancer.
Disadvantages Cannot be used for additional studyMore invasive, time consuming,
expensive
AdvantagesInexpensive, quick, readily available, and very
safe
Can be used for additional study
and has more specific diagnosticabilities than FNA
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Examination of Tissue Samples
y Immunohistochemistry (IHC)
y Fluorescence in SituH ybridization (FISH)
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y Is a cytogenetic technique used to detect and localizethe presence or absence of specific DNA sequences onchromosomes.
y FISH uses fluorescent probes that bind to only those
parts of the chromosome with which they show a highdegree of sequence similarity.
Fluorescence in Situ
Hybridization (FISH)
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Cancer Specific Techniques
y Mammography uses low dose x-ray to create an imageof a breast.
y Sigmoidoscopy uses a small tube containing viewingequipment to view the colon.
y Virtual Colonoscopy uses an MRI or CT scan to createan image of the inside of the colon.
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y Pap smears use a sample of cells from the cervix todetect cervical cancer. Pap smears may also detectovarian and uterine cancers that have migrated to the
cervix.
y Prostate specific antigen (PS A ) test measures levels of a glycoprotein in the blood. Elevated levels of PS A areassociated with prostate cancer
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Sentinel Lymph Node Biopsy (SLN)y is used to detect metastasis.