Detection, Prevention, and

Diagnosis of Cancer
Abu bakar
 PRIMARY PREVENTION
• By acquiring the knowledge and skills necessary to educate the community about
cancer risk, nurses in all settings play a key role in cancer prevention.
• Assisting patients to avoid known carcinogens is one way to reduce the risk for
cancer.
• Another way involves adopting dietary and various lifestyle changes that
epidemiologic and laboratory studies show influence the risk for cancer.
• Several clinical trials have been undertaken to identify medications that may help
to reduce the incidence of certain types of cancer.
• Recently, a breast cancer prevention study supported by the National Cancer
Institute was conducted at multiple medical centers throughout the country.
• The results of this study indicated that the medication tamoxifen can reduce the
incidence of breast cancer by 49% in postmenopausal women identified as at high
risk for breast cancer.
• Nurses can use their teaching and counseling skills to encourage patients to
participate in cancer prevention programs and to promote healthful lifestyles.
 SECONDARY PREVENTION
• The evolving understanding of the role of genetics in cancer cell
development has contributed to prevention and screening efforts.
• Individuals who have inherited specific genetic mutations have an
increased susceptibility to cancer.
• For example, individuals who have familial adenomatosis polyposis
have an increased risk for colon cancer.
• Women in whom the BRCA-1 and BRCA-2 genes have been
identified have an increased risk for breast and ovarian cancer.
• To provide individualized education and recommendations for
continued surveillance and care in high-risk populations, nurses
need to be familiar with ongoing developments in the field of
genetics and cancer.
• Many centers across the country are offering innovative cancer risk
evaluation programs that provide in-depth screening and follow-up
for individuals who are found to be at high risk for cancer.
• Similarly, nurses in all settings can develop programs
that identify risks for patients and families and that
incorporate teaching and counseling into all
educational efforts, particularly for patients and
families with a high incidence of cancer.
• The American Cancer Society has developed a public
education program, “Taking Control,” that integrates
diet, exercise, and general health habit tips that people
can follow to reduce their risk for cancer.
• Nurses and physicians can encourage individuals to
comply with detection efforts as suggested by the
American Cancer Society (Table 16-3).
 Diagnosis of Cancer
• A cancer diagnosis is based on assessment for physiologic and
functional changes and results of the diagnostic evaluation.
• Patients with suspected cancer undergo extensive testing to (1)
determine the presence of tumor and its extent, (2) identify
possible spread (metastasis) of disease or invasion of other body
tissues, (3) evaluate the function of involved and uninvolved body
systems and organs, and (4) obtain tissue and cells for analysis,
including evaluation of tumor stage and grade.
• The diagnostic evaluation is guided by information obtained
through a complete history and physical examination.
• Knowledge of suspicious symptoms and of the behavior of
particular types of cancer assists in determining which diagnostic
tests are most appropriate
 Staging
• Staging determines the size of the tumor and the existence of
metastasis.
• Several systems exist for classifying the anatomic extent of disease.
• The TNM system is frequently used.
• In this system, T refers to the extent of the primary tumor, N refers
to lymph node involvement, and M refers to the extent of
metastasis.
• A variety of other staging systems are used to describe the extent of
cancers, such as central nervous system cancers, hematologic
cancers, and malignant melanoma, that the TNM system does not
describe appropriately.
• Staging systems also provide a convenient shorthand notation that
condenses lengthy descriptions into manageable terms for
comparisons of treatments and prognoses.
 Grading
• Grading refers to the classification of the tumor
cells.
• Grading systems seek to define the type of tissue
from which the tumor originated and the degree
to which the tumor cells retain the functional and
histologic characteristics of the tissue of origin.
• Samples of cells to be used to establish the grade
of a tumor may be obtained through cytology
(examination of cells from tissue scrapings, body
fluids, secretions, or washings), biopsy, or surgical
excision
• This information assists the health care team to predict the
behavior and prognosis of various tumors.
• The tumor is assigned a numeric value ranging from I to IV.
• Grade I tumors, also known as well-differentiated tumors,
closely resemble the tissue of origin in structure and
function.
• Tumors that do not clearly resemble the tissue of origin in
structure or function are described as poorly differentiated
or undifferentiated and are assigned grade IV.
• These tumors tend to be more aggressive and less
responsive to treatment than well-differentiated tumors.
 Continued ………….

• Stadium I :
Tumor ini bersifat invasif. Tumor telah tumbuh menembus
lapisan terdalam dan masuk ke jaringan yg lebih dalam. Tidak
ditemukan sel kanker pada kelenjar getah bening.
• Stadium II :
Tumor bisa dalam berbagai ukuran, tapi tumor ini belum
menyerang organ-organ tubuh di sekitarnya. Sel-sel kanker
ditemukan pada kelenjar getah bening di sekitarnya.
• Stadium III :
Tumor telah menyebar ke organ tubuh di sekitarnya
pembuluh besar atau kelenjar getah bening di sisi yang sama
ataupun di sisi yang berlawanan dari tumor tersebut.
• Stadium IV:
Pertumbuhan yang ganas bisa ditemukan di lebih dari satu
tempat atau Sel-sel kanker dapat ditemukan di bagian lain
tubuh, misalnya di otak, kelenjar adrenal, hati atau tulang.