prevention and detection final

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March 16, 2006 Cellular Aberrations 1

Prevention and Detection

of Cancer


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Objectives

Discuss the prevention and control of

cancer in all levels

Primary preventionSecondary prevention

Discuss the nurses role in secondary

prevention Define tumor staging and grading


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Cellular Aberrations 3

Primary Prevention

Simple measures taken early to avoidthe development of cancer

Modification of Risk Factors: Lifestyle - greatest impact

Smoking

Diet

Limit exposure to UV light & STDs

Vaccines (HBV)


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Cancer Prevention

Skin avoid exposure to sunlight

Oral annual oral examination

Breast monthly BSE from age 20 Lungs avoid cigarette smoking.

Annual chest x-ray

Colo rectal digital rectal exam forpersons , 50y & above, FOBT


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Colorectal

FOBT- start 50 y/ annual.

FIT, flexible sigmoidoscopy-every 5y at

ages 50y. DCBE- every 5y,start 50y.

2011 Cellular Aberrations 5


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Cervical Cancer Screening Test

Population 18y & above.

Pap Test- 3 y after having vaginal

intercourse. But not later than 21 y/oscreening done : yearly, conventional

PapTest , & every 2 years liquid PAP Test.

Age 30 every 2-3 yrs either cervicalcytology or every 3 yrs with HPV DNA

test w/ C. Cytology.



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Cervical Cancer Screening Test

70 y/o women with no abnormal PAP

TEST in 10 yrs who have total

hysterectomy may choose to cervicalcancer screening test.

Endometrialbleeding or spotting

symptom.

Ca related check up for 20y/o & above for

men and women.



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Dietary Recommendations

Against Cancer

Avoid Obesity Cut down on total fat intake Eat more high fiber foods raw fruits

and vegetables Include food rich in Vitamin A & C in daily

diet

Include cruciferous vegetables in thediet Moderation in alcohol consumption Moderation in salt, cured, smoked and

nitrate cured foods


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Secondary Prevention

Targets specific populations andrefers to activities such as screening

of high risk groups with cancer orprecursor to cancer Mammography

Papanicolaou testing

Sigmoidoscopy

PSA (prostate specific antigen) testing


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Cancer Prevention

Rectal biopsy Proctoscopic examination Guaiac stool examination for ages 50

and above

Uterus annual pap smear from age40

Basic annual physical examinationand blood examination


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Warning Signals of Cancer

Changes in bowel and bladder habits A sore that does not heal Unusual bleeding or discharge Thickening or lump in the breast or

elsewhere Indigestion or difficulty in swallowing

Obvious change in wart or mole Nagging Cough or hoarseness Unexplained anemia Sudden weight loss


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Diagnostic Tests

Tumor marker identificationanalysis of

substance found in blood or other body

fluids that are made by the tumors or bythe body in response to the tumor

Example: breast, colon, ovarian, prostate


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March 16, 2006Cellular Aberrations

13

Tumor Markers

Used for screening, diagnosis,establishing prognosis, monitoringtreatment and detecting recurrent

disease Depends on:

Sensitivity

Specificity Proportionality

Feasibility


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Useful Markers

HCG (Human Chorionic Gonadotropin) hormone usually used by the placenta-choriocarcinoma, h mole

CA 125 is used in ovarian cancer PSA (Prostate Specific Antigen) PAP (Prostatic Acid Phosphatase)

prostate cancer -fetaprotein (AFP) CEA (carcinoembryonic antigen) breast,

lung cancer


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Diagnostic Tests

Nuclear Medicine Imaging usesintravenous injection or ingestion of

radioisotope substances followed byimaging of tissues that haveconcentrated the radioisotopes

Bone Marrow biopsy (BMA) dx forleukemia, staging for lymphoma, orcheck for bone marrow involvement


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Diagnostic Tests

Positron Emission Tomography (PETScan) biologic activity of malignantcells Positron Emission Tomography(PET Scan)

RadioImmunoconjugates monoclonalantibodies are labeled with a

radioisotope and injectedintravenously into the patient The antibodies are visualized by

scanners


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Diagnostic Tests

Diagnostic Surgery biopsy Excisional biopsy

Incisional biopsy Needle biopsy

Exfoliative Cytology


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Tumor Staging and Grading

Staging determine the size of thetumor and the existence ofmetastasis Example: TNM System

T refers to the extent of the primarytumor ( size, involvement of surroundingstructures, depth of invasion)

N refers to the lymph node involvementand size or number

M extent of metastasis


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TNM System (in breast CA)

TXprimary tumor cannot be assessed

T0no evidence of primary tumor

TisCarcinoma in situ

T1 - < 2 cm in greatest dimension

T22-5 cm in greatest dimension

T3 - > 5 cm in greatest dimension

T4tumor of any size w/ direct extension to thechest wall or skin (eg. Peau dorange, skinulceration, satellite nodes, inflam carcinoma)


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NXRegional lymph node cannot be assessed

N0No regional lymph node metastasis

N1Metastasis to movable ipsilateral axillary

lymph node (s)

N2Metastasis to ipsilateral axillary lymph

node(s) fixed to one another or other structures

N3metastasis to ipsilateral internal mammarylymph node(s)


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MXdistant metastasis cannot be assessed

M0no distant metastasis

M1Distant metastasis, includingmetastasis to ipsilateral supraclavicular

lymph node(s)


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Stage Grouping (Breast CA)

Stage 0 Tis N0 M0

Stage I T1 N0 M0

Stage IIA - T0,1 N1 M0T1 N1 M0

T2 N0 M0

Stage IIB - T2 N1 M0

T3 N0 M0


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Stage Grouping (Breast CA)

Stage IIIA T0 N2 M0

T1 N2 M0

T2 N2 M0T3 N1,2 M0

Stage IIIB T4 any N M0

Any T N3 M0

Stage IV Any T any N M1


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Tumor Staging and Grading

Grading refers to the classification ofthe tumor cells Seek to define the type of tissue from

which the tumor cells retain the functionaland histologic characteristics of the tissueof origin

GI well differentiated grade GII moderately well differentiated grade GIII to IV poorly to very poorly well-

differentiated


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Drill

1. 3cm breast cancer with one involved

lymph node and bone metastases

2. 2.4cm breast cancer with 2 positivemovable axillary nodes, no mets

prevention and detection final

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