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CANCER 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. - A class of disease in which a group of cells display uncontrolled growth (division beyond the normal limits), invasion (intrusion on and destruction of adjacent tissues), and sometimes metastasis (spread to other lo9cations in the body via lymph or blood). The following are the 3 Malignant Properties of Cancer. Malignant uncontrolled growth, invasion, metastasis. Benign Tumors self-limited, and do not invade or metastasize. Oncology branch of medicine concerned with the study, diagnosis, treatment, and prevention of cancer. Most cancers form a tumor, but some, like leukemia, do not. Cancers are caused by abnormalities in the genetic material of the transformed cells. These abnormalities may be due to the effects of CARCINOGENS. CARCINOGENS a substance or agent that causes cancer. EXTERNAL FACTORS Chemical Carcinogens Alcoholic Beverages (liver, esophagus, mouth, breast, colon) Tobacco (lungs, esophagus, mouth, pharynx, larynx) Anabolic steroids (liver) Arsenic (lung, skin) Asbestos (lung, peritoneum) Benzene (leukemia) Diesel Exhaust (lung) Hair dyes (bladder) Pesticides (lungs) UV rays (skin, eyes) Physical Carcinogens Radiation Chronic irritation (GERD) Viral Carcinogens Epstein Barr Genital Herpes Papilloma virus Human Cytomegalovirus (CMV) Dietary factors High fat, low fiber Those containing Nitrosamines (found in preserved meats and pickled foods promote certain cancers of the colon, breast, esophageal, and gastric)

INTERNAL FACTORS Errors in DNA replication/inherited (genetics)

CLASSIFICATION BASED ON ORIGIN Carcinoma cancer that arises in epithelium, the tissue that lines the skin and internal organs of the body. It may occur in any tissue containing epithelial cells. Lymphoma cancer of the lymph nodes, including Hodgkins and Non-Hodgkins Lymphoma. Leukemia any of a group of malignant diseases in which the bone marrow and other bloodforming organs produce increased numbers of certain types of WBC. Overproduction of these white cells, which are immature or abnormal forms, suppresses the production of normal white cells, red cells, and platelets. This leads to increased susceptibility to infection, anemia, and bleeding. Sarcoma any cancer of connective tissue. These tumors may occur in any part of the body, as they arise in the tissues that make up an organ rather than being restricted to a particular organ. They can arise in fibrous tissue, muscle, fat, bone, cartilage, synovium, blood and lymphatic vessels, and various other supportive tissues. TERMINOLOGIES Surgical Excision the removal of a tumor by surgeon Surgical Margins the evaluation by a pathologist of the edges of the tissue removed by the surgeon to determine if the tumor was removed completely Grade a number established by a pathologist to describe the degree of resemblance of the tumor to the surrounding benign tissue Stage a number established by the oncologist to describe the degree of invasion of the body by the tumor Recurrence new tumors that appear at the site of the original tumor after the surgery Metastasis new tumors that appear far from the original tumor Median survival time a period often measured in months or years, over which 50% of the cancer patients are expected to be alive Transformation the concept that a low grade tumor transforms to a high grade tumor over time Chemotherapy treatment with drugs Radiation therapy treatment with radiations Adjuvant therapy treatment either chemotherapy or radiation therapy, given after surgery to kill the remaining cancer cells Neoadjuvant therapy - treatment either chemotherapy or radiation therapy, given before surgery to shrink a tumor to make its resection easier Prognosis the probability of cure after the therapy

DIAGNOSIS OF CANCER requires the histologic examination of a biopsy specimen, although the initial indication of malignancy can be symptomatic/radiographic imaging abnormalities. LUNG CANCER Squamous cell carcinoma (most common); dyspnea; wheezing; dry to productive cough; hemoptysis; hoarseness; cheast pain; history of cigarette smoking and recurrent infection. COLON/RECTAL CANCER Change in bowel habits; diarrhea or constipation; rectal bleeding; abdominal cramps and vague discomfort; signs of intestinal obstruction; palpable mass; history of low fiber diet. BREAST CANCER Firm, non tender, painless lump or mass; nipple retraction or discharge; palpable mass; (+) mammography; in women >50 with history; early menarche; late menopause.

UTERINE CANCER Post menopausal uterine bleeding; intermenstrual bleeding; common among obese, nulliparous; prolonged estrogen therapy; post menopause (+) pap smear PROSTATE CANCER Difficulty voiding, with smaller and less forceful urine flow; urgency; dribbling and retention (increase residual urine volume); frequency common in age with (+) history BLADDER CANCER Initially painless hematuria; flank or pelvic pain; dysuria; frequency and urgency common in men, cigarette smokers and excessive coffee drinkers. LARYNGEAL CANCER Persistent hoarseness; cough and hemoptysis; enlarged cervical lymph nodes; dysphagia and dyspnea, common among voice abusers, smokers, and alcoholics. Most cancers can be treated and some cured, depending on the specific type, location, and stage. Once diagnosed, cancer is usually treated with a combination of surgery, chemotherapy and radiotherapy. 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 Colon DRE for person over age 40. Rectal biopsy, proctosigmoidoscopic examination, Guiac stool examination for persons age 50 and above CANCERS NINE WARNING SIGNS

Change in bladder or bowel habits A sore that does not heal Unusual bleeding or discharge Thickening or lump in breast or elsewhere Indigestion or difficulty in swallowing Obvious change in wart or mole Nagging cough or hoarseness Unexplained anemia Sudden loss of weight

CHEMOTHERAPY Use of antineoplastic agents with a primary action of interfering with the supply and utilization of building blocks of nucleic acids, as well as interfering with intact molecules of DNA and RNA, both needed for cellular metabolism, replication and growth. Problem is they lack specificity, hence attacking even normal cells. SIDE EFFECTS Nausea and Vomiting Stomatitis MANAGEMENT Small, frequent, high calorie, high potassium, high protein diet; foods should be easy to swallow; frequent mouth care; pleasant environment; FEEDING: NGT, IV, hyperalimentation Soft toothbrushes, frequent mouth care, oral salt mouth gargle; avoid commercial mouthwash that contain high alcohol; avoid hot drinks or food; bland food is best Advice short hair before treatment; gentle combing, use wig or scarf when necessary; advice that hair will re-grow (but with altered texture, and possibly color) Low residue diet, increase fluids; avoid hot or cold drinks and food Avoid uncontrolled crowds and sources of infection; balanced diet; skin care

Alopecia

Diarrhea Infections

RADIATION THERAPY The treatment of cancer by exposure to a radioactive substance Radiosensitive cancer cells can be treated with radiation. RADIATION THERAPY
EXTERNAL RADIATION INTERNAL RADIATION, SEALED INTERNAL RADIATION, UNSEALED

Cobalt or linear acceleration Series of daily radiation exposures as patient is left alone in a room. Masks must not be removed during entire treatment course. Keep skin dry; cornstarch is the only topical application allowed. Talcum and lotions are contraindicated. Avoid strong sunlight; extremes of temperature; tight constricting clothings; strong alcohol mouthwash; fatigue; crowded places. Do not eat 2-3 hours before treatment and 2 hours after to prevent nausea.

Radium, indium, cesium Sealed radiation source is placed in a cavity or adjacent to cancer

Radio-isotope, radionuclide Source of radiation is given orally, intravenously, or instilled in cavity. THE INTERNAL RADIATION PRINCIPLES
DISTANCE SHIELDING

TIME

The shortest possible (not more than 30 minutes per shift)

As far as possible Protective lead (can spend more apron time at distance of 20 feet) Douche, enema, perineal Isolate patient in private room prep, with foley catheter Radiation is excreted in urine, before insertion of cervical perspiration, vomitus, and radium. feces Flat position 8 days in radioactive iodine, Never handle radium directly, and 14 days in radioactive use long handled forceps phosphorus. Keep linen in room until Careful handling of gowns, source of radiation are dressing, utensils, and linens. completely accounted for. Always use gloves and gowns No exposure for pregnant and Wear detection badge to children determine exposure.