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8/4/2019 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.
2010 Cellular Aberrations 6
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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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March 16, 2006 Cellular Aberrations 8
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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2011 Cellular Aberrations 12
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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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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TNM System (in breast CA)
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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TNM System (in breast CA)
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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March 16, 2006 Cellular Aberrations 23
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