NAGA COLLEGE FOUNDATION MTV AVE.

, NAGA CITY S/Y 2011-2012

(CELLULAR ABBERATION) NCM106

Prepared by: BSN-4A

MRS, PAMELA DUMANGAS RM, RN, MAN Clinical Instructor

TABLE OF CONTENTS

Group 1
LARYNGEAL CANCER ESOPHAGEAL CANCER BRAIN CANCER ORAL CANCER BREAST CANCER

y y y y y

Group 2
LUNG CANCER GASTRIC/STOMACH CANCER COLORECTAL CANCER PROSTATE CANCER CERVICAL CANCER

y y y y y

Group 3
y y y y y y BLADDER CANCER UTERIAN CANCER BONE MARROW CANCER LEUKEMIA LYMPHOMA OVARIAN CANCER

ORAL CANCER
Description: Oral cancer is part of a group of cancers called head and neck cancers. Oral cancer can develop in any part of the oral cavity or oropharynx. Most oral cancers begin in the tongue and in the floor of the mouth. These cancers are called squamous cell carcinomas. When oral cancer spreads (metastasizes), it usually travels through the lymphatic system. The cancer cells often appear first in nearby lymph nodes in the neck. Risk factors
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Tobacco: Tobacco use accounts for most oral cancers. Smoking cigarettes, cigars, or pipes; using chewing tobacco; and dipping snuff are all linked to oral cancer. The use of other tobacco products (such as bidis and kreteks) may also increase the risk of oral cancer. Alcohol: People who drink alcohol are more likely to develop oral cancer than people who don't drink. Sun: Cancer of the lip can be caused by exposure to the sun. Using a lotion or lip balm that has a sunscreen can reduce the risk. Wearing a hat with a brim can also block the sun's harmful rays. A personal history of head and neck cancer: People who have had head and neck cancer are at increased risk of developing another primary head and neck cancer. Smoking increases this risk. Some studies suggest that not eating enough fruits and vegetables may increase the chance of getting oral cancer. Scientists also are studying whether infections with certain viruses (such as the human papillomavirus) are linked to oral cancer.

Pathophysiology Risk Factors Squamous cell cancer Start as a sore/ lesion Become a malignant squamous cell cancer Invade and destroy normal tissues and extend into the surrounding structures Cancer cells may migrate away from the primary tumor and spread to other parts of the body (often to the tongue and the floor of the mouth)

Clinical Manifestations o Patches inside your mouth or on your lips that are white, a mixture of red and white, or red o White patches (leukoplakia) are the most common. White patches sometimes become malignant. o Mixed red and white patches (erythroleukoplakia) are more likely than white patches to become malignant. o Red patches (erythroplakia) are brightly colored, smooth areas that often become malignant. o A sore on your lip or in your mouth that won't heal o bleeding in your mouth o Loose teeth o Difficulty or pain when swallowing o Difficulty wearing dentures o A lump in your neck o An earache Diagnostic test Oral examination Assessment of the cervical lymph nodes to detect possible metastases Biopsies Dental x-rays: An x-ray of your entire mouth can show whether cancer has spread to the jaw. o Chest x-rays: Images of your chest and lungs can show whether cancer has spread to these areas. o CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your body. You may receive an injection of dye. Tumors in the mouth, throat, neck, or elsewhere in the body show up on the CT scan. o MRI: A powerful magnet linked to a computer is used to make detailed pictures of your body. o o o o Medical Management o Surgery o Surgical resection o Hemiglossectomy o Total glossectomy o Radial forearm free flap o Radiation therapy External radiation: The radiation comes from a machine. Patients go to the hospital or clinic once or twice a day, generally 5 days a week for several weeks.

Internal radiation (implant radiation): The radiation comes from radioactive material placed in seeds, needles, or thin plastic tubes put directly in the tissue. The patient stays in the hospital. The implants remain in place for several days. Usually they are removed before the patient goes home. o Chemotherapy Chemotherapy uses anticancer drugs to kill cancer cells. It is called systemic therapy because it enters the bloodstream and can affect cancer cells throughout the body. Nursing Diagnosis y y y Anxiety related to impending surgery and the diagnosis of cancer Impaired skin integrity related to the surgical incisions Impaired verbal communication related to radical surgery for oral cancer

Nursing Interventions o Patient is required to sign a consent form. o Prior to scheduling of the procedure the nurse should instruct the patient to inform him/her physician of any medications they are currently taking , any allergies and all health problems. o Assess the patient s nutritional status preoperatively, and a dietary consultation may be necessary. o The patient may require enteral or parenteral feedings before and after surgery to maintain adequacy nutrition. o If a radial graft is to be performed, an Allen s test on the donor arm must be performed to ensure that the ulnar artery is patent and can provide blood flow to the hand after removal of the radial artery. o Assess the patient s ability to communicate in writing before surgery . pen and paper are provided postoperatively to patients who can use them to communicate. o The patient may unable to manage oral secretions, making suctioning necessary. o Assessed color of the graft and use a Doppler ultrasound device to locate radial pulse at the graft site and assess graft perfusion.

Prepared by: Crystal Dianne Arn Abiog Jena Lyn Caray BSN4A

BREAST CANCER
Description Breast cancer is cancer arising in breast tissue. Cancer is simply a group of abnormal cells that have abnormal growth patterns. Breast cancer is the most common type of cancer in women with the exception of nonmelanoma skin cancers. It is the second leading cause of death by cancer in women, following only lung cancer. A woman has a lifetime risk of developing invasive breast cancer of about one in eight, or 13%. The breasts are made of fat, glands, and connective (fibrous) tissue. The breast has several lobes, which are divided into lobules that end in the milk glands. Tiny ducts run from the many tiny glands, connect together, and end in the nipple. Breast cancer is staged from 0 to IV.
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Stage 0 is noninvasive breast cancer, that is, carcinoma in situ with no affected lymph nodes or metastasis. This is the most favorable stage of breast cancer. Stage I is breast cancer that is less than 2 cm (3/4 in) in diameter and has not spread from the breast. Stage II is breast cancer that is fairly small in size but has spread to lymph nodes in the armpit OR cancer that is somewhat larger but has not spread to the lymph nodes. Stage III is breast cancer of a larger size, greater than 5 cm (2 in), with greater lymph node involvement, or of the inflammatory type. Stage IV is metastatic breast cancer: a tumor of any size or type that has metastasized to another part of the body. This is the least favorable stage.

Risk factors/ etiology y y Gender is the biggest risk because breast cancer occurs mostly in women. Age is another critical factor. Breast cancer may occur at any age, though the risk of breast cancer increases with age. The average woman at age 30 years has one chance in 280 of developing breast cancer in the next 10 years. This chance increases to one in 70 for a woman aged 40 years, and to one in 40 at age 50 years. A 60-year-old woman has a one in 30 chance of developing breast cancer in the next 10 years. White women are slightly more likely to develop breast cancer than African American women in the U.S. A woman with a personal history of cancer in one breast has a three- to fourfold greater risk of developing a new cancer in the other breast or in another part of the same breast. This refers to the risk for developing a new tumor and not a recurrence (return) of the first cancer Family history has long been known to be a risk factor for breast cancer. Both maternal and paternal relatives are important. There is great interest in genes linked to breast

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cancer. About 5-10% of breast cancers are believed to be hereditary, as a result of mutations, or changes, in certain genes that are passed along in families. Hormonal Causes Lifestyle and Dietary Cause Benign Breast Disease Environmental Causes

Clinical Mainifestations y y y Early breast cancer has no symptoms. It is usually not painful. Most breast lumps are not cancerous. All breast lumps, however, need to be evaluated by a doctor. Breast discharge is a common problem and is rarely a symptom of cancer. Discharge is most concerning if it is from only one breast or if it is bloody. In any case, all breast discharge should be evaluated. Nipple inversion is a common variant of normal nipples, but nipple inversion that is a new development can be of concern. Changes in the skin of the breast include redness, changes in texture, and puckering. These changes are usually caused by skin diseases but occasionally can be associated with breast cancer.

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Diagnostic Tests y Examination of the breast o A complete breast examination includes visual inspection and careful palpation (feeling) of the breasts, the armpits, and the areas around your collarbone. Mammography o Mammograms are x-rays of the breast that may help define the nature of a lump. o are also recommended for screening to find early cancer possibly ultrasonography o Ultrasound of the breast is often done to evaluate a breast lump. MRI o MRI may provide additional information and may clarify findings which have been seen on mammography or ultrasound. Biopsy is the only definitive way to diagnose breast cancer. o The only way to diagnose breast cancer with certainty is to biopsy the tissue in question. Biopsy means to take a very small piece of tissue from the body for examination and testing by a pathologist to determine if cancer is present. A number of biopsy techniques are available.

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Medical Management y Surgery is the mainstay of therapy for breast cancer. The choice of which type of surgery is based on a number of factors, including the size and location of the tumor, the type of tumor and the person's overall health and personal wishes. Breast-sparing surgery is often possible. Radiation therapy is used to kill tumor cells if there are any left after surgery. Chemotherapy consists of the administration of medications that kill cancer cells or stop them from growing. In breast cancer, three different chemotherapy strategies may be used: 1. Adjuvant chemotherapy is given to people who have had curative treatment for their breast cancer, such as surgery and radiation. It is given to reduce the possibility that the cancer will return. 2. Presurgical chemotherapy is given to shrink a large tumor and/or to kill stray cancer cells. This increases the chances that surgery will get rid of the cancer completely. 3. Therapeutic chemotherapy is routinely administered to women with breast cancer that has spread beyond the confines of the breast or local area. Hormonal therapy may be given because breast cancers (especially those that have ample estrogen or progesterone receptors) are frequently sensitive to changes in hormones. Hormonal therapy may be given to prevent recurrence of a tumor or for treatment of existing disease.

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Surgery Surgery is generally the first step after the diagnosis of breast cancer. The type of surgery is dependent upon the size and type of tumor and the patient's health and preferences.
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Lumpectomy involves removal of the cancerous tissue and a surrounding area of normal tissue. This is not considered curative and should almost always be done in association with other therapy such as radiation therapy with or without chemotherapy or hormonal therapy. Simple mastectomy removes the entire breast but no other structures. If the cancer is invasive, this surgery alone will not cure it. It is a common treatment for DCIS, a noninvasive type of breast cancer. Modified radical mastectomy removes the breast and the axillary (underarm) lymph nodes but does not remove the underlying muscle of the chest wall. Although additional chemotherapy or hormonal therapy is almost always offered, surgery alone is considered adequate to control the disease if it has not metastasized. Radical mastectomy involves removal of the breast and the underlying chest wall muscles, as well as the underarm contents. This surgery is no longer done because current therapies are less disfiguring and have fewer complications.

Nursing Interventions y Preoperartive nursing interventions o Providing education and preparation about surgical trearments  Nurse plays a role a key role in reviewing treatment options by reinforcing information provided to the patient and answering any questions.  The nurse fully prepares the patient for what to expect before, during and after surgery.  The patient should be informed that she will go home with the drain and that complete instructions about the drain care will be provided prior to discharge.  Patient should be informed

Prepared by: Zharizl Belmin BSN4A

ESOPHAGEAL CANCER
Description The esophagus is a muscular tube measuring 20-25 cm (8-10 in) long and 2-3 cm (0.75-1.25 in) wide that serves as a conduit for moving food and drink from the mouth to the stomach. Two major types of esophageal cancers exist, as follows:
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Squamous cell carcinoma arises from the epithelial cells that line the esophagus. Adenocarcinoma arises from the esophageal glands or within a segment of Barrett's esophagus. Most tumors occur in the lower esophagus.
o o o

Forty percent occur in the lowest third. Forty-five percent occur in the middle third. Fifteen percent occur in the upper third.

Risk Factors Both types of esophageal cancer more commonly affect men older than 60 years, but risk factors for adenocarcinoma are different from those of squamous cell carcinoma.
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Adenocarcinoma of the esophagus is most commonly seen within a segment of Barrett's esophagus, chronic peptic sores in the lower esophagus. This is an acquired condition characterized by precancerous cells that replace the normal cellular lining of the lowest portion of the esophagus. The condition occurs as a complication of chronic reflux of gastric contents (GERD) into the lower esophagus. Squamous cell carcinoma occurs more commonly in people who heavily use tobacco and alcohol or who have previously swallowed some caustic substance, for example lye. The disease is also more common in people who have been diagnosed with squamous cell cancer of the head and neck. Men are up to 5 times more likely than women to be diagnosed with esophageal cancer. Among men, African Americans have the highest rate, more than 2.7 times greater than the rate for non-Hispanic white men. o Incidence rates generally increase with age in all racial and ethnic groups. Cancer of the esophagus is a common cancer in developing countries of the world, where most tumors are squamous cell cancers. Important risk factors in developing countries include the following:
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Nutritional deficiencies related to lack of fresh fruit and vegetables Drinking hot beverages A range of chewing and smoking habits

In the developed world, adenocarcinoma is becoming almost as common as squamous cell cancer.

Cancer of the Esophagus Symptoms

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Symptoms of esophageal cancer usually do not show up until the disease has reached an advanced stage. The most common symptom is difficulty swallowing (dysphagia). o Initially, swallowing solids is difficult. o Over time, even swallowing liquids becomes difficult. The following symptoms may accompany cancer of the esophagus. Any of these symptoms are indications of advanced disease and should be considered as a sign to get medical attention. o Weight loss o Central chest pain o Pain upon swallowing o Vomiting o Chronic cough o Symptoms of gastrointestinal bleeding  Black stools  Vomiting blood or material that looks like coffee grounds

Diagnosis The best diagnosis is based on findings from an endoscopic examination of the esophagus.
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This study may be carried out either in a hospital or in a doctor's office. The doctor administers a topical anesthetic to the throat to suppress the gag reflex. Doctors frequently give intravenous (IV) sedation just before the procedure. The doctor then inserts an endoscope into the esophagus. An endoscope is a thin, flexible plastic tube that contains fiberoptic bundles.
o

Using a tiny camera in the endoscope, the doctor searches the surface of the esophagus for areas of concern. o Doctors define esophageal tumors in terms of their size and location.
 

Stage I - Tumor limited to the top layers of the cell lining Stage II - Tumor extending deeper into muscle layers of the esophagus or into adjacent lymph nodes  Stage III - Tumor extensively involving the wall of the esophagus, adjacent tissues, or lymph nodes  Stage IV - Tumor involving distant parts of the body (metastases) and may involve the liver, lungs, brain, or bones o These factors are important in determining the stage of the cancer and treatment options.

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The doctor can take biopsies to confirm whether the abnormality is a cancer and to determine its type. Upper gastrointestinal (GI) barium contrast studies help the doctor to detect cancers but may fail to detect small tumors more easily seen through endoscopy. Once the presence of cancer has been confirmed, the doctor tries to determine the spread of the malignancy beyond the esophagus. Doctors may use the following imagery:
o o o o

CT scan of the chest and abdomen Chest x-ray film Nuclear bone scans

Cancer of the Esophagus Treatment Treatment for esophageal cancer depends on the results of tests and your underlying health.
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People with advanced heart or lung disease may not be candidates for aggressive therapy. In many cases, the esophageal cancer has advanced too far for any available treatment to work.
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In these cases, the doctor considers the following procedures:



Placing a metal or plastic tube (stent) in the esophagus to allow passage of food and liquids  Radiation therapy  Photodynamic therapy  Widening the esophagus or laser destruction of the esophageal tumor o In otherwise healthy people with localized disease, surgery may offer the best chance at long-term survival.
  

Surgery involves removing the diseased portion of the esophagus and connecting the remaining portion to the stomach. Preoperative chemotherapy and radiation often accompany surgery. Studies now under way will determine whether combination chemotherapy and radiation therapy without surgery is as effective as surgery in lengthening long-term survival.

Prognosis When the esophageal cancer has spread to organs beyond the esophagus, long-term survival is uncommon. The chance of recovery improves when doctors detect the cancer at an early stage. But in most cases, long-term survival remains below 30%.

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Once cancer invades the muscle layer of the esophagus, most people already have developed widespread cancer. For these people, cancers invariably come back following surgical removal. Few people survive long term. Following completion of therapy, whether with surgery, radiation, chemotherapy, or a combination of these, the patient needs regular follow-up endoscopic examinations as well as repeat CT scans of the chest and abdomen. o Often, people who undergo surgery of their esophagus develop significant narrowing at the site of the surgery. They require frequent esophageal dilatations or insertion of stents.
o

Prevention
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Reducing use of tobacco and alcohol can reduce the frequency of squamous cell carcinoma of the esophagus. At least 90% of cases of this cancer in North America may be attributable to alcohol and tobacco. Adenocarcinoma of the esophagus is a frequent complication in Barrett's esophagus, which may be found in up to 20% of people with symptoms of gastroesophageal reflux disease (GERD). People with frequent symptoms of reflux (heartburn or regurgitation) should undergo screening with endoscopy. o People with Barrett's esophagus should have regular endoscopic tests to detect precancerous changes of the esophageal lining. o They also require tight control of the symptoms of gastroesophageal reflux, which may include dietary and lifestyle changes as well as medications and possible surgery, to prevent progression of Barrett;s esophagus.
o

Prepared By: Aisa Bobis Angelica Capricho BSN4A

LARYNGEAL CANCER
Description Cancer of the larynx accounts for approximately half of all head and neck cancers. It is most common in people between the ages of 60 and 70 years and it occurs four to five times more frequently in men than in women. Risk factors/ Etiology y Carcinogens o Tobacco(smoke, smokeless) o Combined effects of alcohol and tobacco o Asbestos o Secondhand smoke o Paint fumes o Wood dust o Cement dust o Chemicals o Tar products o Mustard gas of age o Leather and metals Other factors o Straining the voice o Chronic laryngitis o Nutritional deficiencies (riboflavin) o History of alcohol abuse o Familial predisposition o Age (higher incidence after 60 years) o Gender (more common in men) o Race (more prevalent in African American) o Weakened immune system

Clinical Manifestations y y y y y y y y y Hoarseness of voice more than 2 weeks duration Persistent cough Sore throat (pain and burning in the throat) Lump in the neck Dysphagia Dyspnea Unilateral nasal obstruction Persistent ulceration Foul breath

Complications y y y y y y Respiratory distress and hypoxia Hemorrhage Infection Wound breakdown Aspiration Tracheostomal stenosis

Diagnostic test y y y y y Endoscopy Optical imaging CT scan MRI Positron emission tomography

Medical Management y Surgical management 1. Vocal cord stripping o Used to treat dysplasia, hyperkeratosis and leukoplakia and is often curative for these lesions. 2. Cordectomy o which is an incision of the vocal cord, is usually performed via transoral laser. o Used for lesions limited to the middle third of the vocal cord. 3. Laser surgery ( laser microsurgery) o Useful for surgical resection of smaller laryngeal carcinomas. 4. Partial laryngectomy o Used for smaller cancers of the larynx. 5. Total laryngectomy o Complete removal of the larynx Radiation therapy o To eradicate the cancer and preserve the function of the larynx. Speech therapy o To minimize anxiety and frustration on the part of the patient and family, it is necessary to discuss the loss or alteration of speech with the nurse. Esophangeal speech o Was the primary method of alaryngeal speech taught to patient until the 1980 s. o The patient needs the ability to compress air into the esophangus and expel it setting off a vibration of the pharyngeal esophangeal segment. Electric larynx o Battery-powered apparatus projects sound in the oral cavity. Tracheoesophangeal puncture o Technique for voice restoration is simple and has few complications.

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Nursing diagnosis y y y y Ineffective airway clearance related to excess mucus production secondary to surgical alterations in the airway Impaired verbal communication related to anatomic deficit secondary to removal of the larynx and to edema Imbalanced nutrition: less than body requirements, related to inability to ingest food secondary to swallowing difficulties Disturbed body image and low self esteem secondary to major neck surgery, change in appearance, and altered structure and function.

Nursing interventions y Teaching the patient preoperatively o Nurse clarifies any misconceptions by identifying the location of the larynx, its function, the nature of the planned surgical procedure and its effect on speech. o Nurse reviews equipment and treatments for postoperative care with the patient and family, teaches important coughing and deep breathing exercises and helps the patient perform return demonstrations. Reducing anxiety and depression o Provides the patient and family with opportunities to ask questions, verbalize feelings and discuss perceptions o Address any questions and misconceptions the patient and family have. o Reassure the patient that people are available to assist and that rehabilitation is possible. o Attempts to spend uninterrupted time with the patient that is focused on building trust and reducing the patient s anxiety. o Active listening provides an environment that promotes open communication and allows the patient to verbalize feelings. o Clear instructions and explanations are given to the patient and family in a calm, reassuring manner. o Listens attentively, encourages the patient and identifies and reduces environmental stressors. Maintaining patent airway o Positioning the patient in the semi- Fowler s or Fowler s position after recovery from anesthesia. Promoting alternative communication methods Promoting adequate nutrition and hydration Promoting positive body image and self-esteem Promoting self care management Monitoring and managing potential complications Prepared by: Yaniza L. Buenafe Manilyn Ampongan BSN4A

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BRAIN CANCER
Description: Cancers of the brain are the consequence of abnormal growths of cells in the brain. Brain cancers can arise from primary brain cells, the cells that form other brain components (for example, membranes, blood vessels), or from the growth of cancer cells that develop in other organs and that have spread to the brain by the bloodstream (metastatic brain cancer). Classifications 1. Primary brain tumors The brain is made up of many different types of cells and tumors that arise from a brain cell type are termed primary brain tumors.
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Grade I: The tissue is benign. The cells look nearly like normal brain cells, and cell growth is slow. Grade II: The tissue is malignant. The cells look less like normal cells than do the cells in a grade I tumor. Grade III: The malignant tissue has cells that look very different from normal cells. The abnormal cells are actively growing. These abnormal-appearing cells are termed anaplastic. Grade IV: The malignant tissue has cells that look most abnormal and tend to grow very fast.

2. Metastatic brain tumors Metastatic brain tumors are made of cancerous cells that spread through the bloodstream from a tumor located elsewhere in the body. The most common cancers that spread to the brain are those arising from cancers that originate in the lung, breast, and kidney as well as malignant melanoma, a skin cancer. Risk factors/ Ettiology
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Radiation to the head An inherited (genetic) risk HIV infection Cigarette smoking Environmental toxins (for example, chemicals used in oil refineries, embalming chemicals, rubber industry chemicals)

Clinical Manifestations
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Headache Weakness Clumsiness Difficulty walking Seizures

Other nonspecific symptoms and signs include the following:

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Altered mental status: changes in concentration, memory, attention, or alertness Nausea, vomiting: especially early in the morning Abnormalities in vision (for example, double vision, loss of peripheral vision) Difficulty with speech Gradual changes in intellectual or emotional capacity

Diagnostic Tests
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CT scan of the brain X-ray but shows more detail in three dimensions MRI Usually, a harmless dye is injected into the bloodstream to highlight abnormalities on the scan. These include analysis of blood, electrolytes, liver function tests, and a blood coagulation profile. If the person has mental-status change as the main symptom, blood or urine tests may be done to rule out drug use.

Medical Management y Surgery o The purposes of surgery are to confirm that the abnormality seen on the brain scan is indeed a tumor, to assign a grade to the tumor, and to remove the tumor. Radiation therapy o is the use of high-energy rays to kill tumor cells and stop them from growing and multiplying. Chemotherapy o is the use of powerful drugs to kill tumor cells o The drugs are given by mouth or through an IV line. Two drugs, temozolomide (Temodar) and bevacizumab (Avastin), have recently been approved for the treatment of malignant gliomas. They are more effective and have fewer adverse effects when compared with older drugs. Temozolomide has another advantage in that it is administered orally,

eliminating the need for intravenous lines and hospital stays for chemotherapy. Nursing interventions y Compensating for self care deficit o the nurse should encourage the family to keep the patient as independent as possible for as long as possible. o Increasing assistant with self care activities is required. o Encouraged to plan for each day and to make most of the each day. o Assist the patient to find useful coping mechanisms, adaptations and compensations for solving problems that arise. o Help patients maintain some sense of control. o An individualized exercise program helps maintain strength, endurance and range of motion. Improving nutrition o Nurse should teach the family how to position the patient for comfort during meals. Meals are planned for times when the patient is rested and in less distress from pain or the effects of treatment. o The patient needs to be clean, comfortable, and free of pain for meals, in an environment, that is as attractive as possible. o Oral hygiene before meals helps to improve appetite. o The family may be asked to take the daily weight chart and record the quantity of food eaten to determine the daily calorie intake. Relieving anxiety o Spending time with the patient allows them time to talk and to communicate their fears and concerns. Enhancing family processes o The family needs to be reassured that their loved one is receiving optimal care and that attention will be paid to the patient s changing symptoms and concerns.

Prepared by Joy C. Callo Egie A. Bajado BSN4A

STOMACH CANCER
The most common form of cancer that affects the stomach is adenocarcinoma, which arises in the glands of the innermost layer of the stomach. This tumor tends to spread through the wall of the stomach and from there into the adjoining organs (pancreas and spleen) and lymph nodes. It can spread through the bloodstream and lymph system to distant organs (metastasize). Risk Factors
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Stomach cancer remains the second most frequent cause of cancer-related death worldwide, with particularly high frequencies in Japan, China, Korea, parts of Eastern Europe, and Latin America. Established risk factors for stomach cancer include the following: o Low socioeconomic status o Male sex o Advanced age o A prior diagnosis of pernicious anemia (a chronic progressive disease caused by the failure of the body to absorb vitamin B-12) o A diet deficient in fresh fruits and vegetables and rich in salted or smoked fish or meats and poorly preserved foods Treating benign stomach or duodenal ulcer disease by removing part of your stomach is associated with an increased risk of cancer developing in the remaining stomach, especially at least 15 years after the surgery. Recent studies have demonstrated a higher frequency of stomach cancer in people chronically infected with Helicobacter pylori, a common cause of chronic gastritis and peptic ulcer disease. A family history of stomach cancer is a further risk factor in the disease. People with blood type A also have an increased risk.

Stomach Cancer Symptoms

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Early symptoms of stomach cancer tend to be vague and nonspecific. Seek medical attention if you have any of the following symptoms: o Mild upper abdominal discomfort associated with nausea and loss of appetite o Difficulty swallowing because of a tumor involving the upper part of your stomach, near the esophagus o Feeling of fullness after taking only a small amount of food The following symptoms may indicate advanced disease: o Fatigue o Weight loss o Iron deficiency anemia

Overt blood loss - Vomiting blood or a material that looks like coffee grounds or passing black stools o Severe nausea and vomiting - A late symptom caused by blockage of the stomach drainage by the enlarging cancer
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Diagnosis Two procedures are used in the diagnosis of stomach cancer.

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Gastrointestinal (GI) endoscopy is superior because it allows a direct view of the area of concern. The doctor can also take a sample of tissue (biopsy) to confirm the diagnosis. Barium studies are also effective in detecting stomach cancers, although they may be less effective in detecting small tumors. o Suspicious areas seen on barium study always require further endoscopic checking. o Barium studies may have a major role in screening because they cause less discomfort compared with gastroscopy. Once doctors establish the diagnosis, further tests are performed, including the following:
o o o

A CT scan of the abdomen Chest x-ray film Nuclear bone scans: These may be helpful in ruling out advanced disease that has spread outside your stomach walls.

Stomach Cancer Treatment The treatment of stomach cancer depends on the results of tests and your overall health.
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People with advanced heart and lung disease may not tolerate aggressive therapy. In many cases, the stomach cancer may have advanced too far for any available treatment to work. You will require surgery to be cured. Your stomach is removed entirely, and your esophagus is attached to your small intestine. Surgery may relieve symptoms of obstruction. The upper end of your stomach is connected to your small bowel, bypassing the area of obstruction. Companion treatment with either chemotherapy or radiation may improve your survival following surgery. After your stomach has been removed, your doctor will monitor your disease with repeat CT scans of your abdomen and gastrointestinal endoscopy to make sure the cancer does not return.

Prognosis If you have advanced stomach cancer, your chance for recovery is poor. Whether the cancer has spread into your abdominal cavity is the crucial factor in predicting your outcome.
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The average survival time is usually less than 1 year, regardless of where the primary tumor was located. None of the available treatments seem to improve the survival time. Factors that point to poor recovery include the following: o Presence of cancer in your lymph nodes o Involvement of distant organs o Tumors involving the upper one third of your stomach Few people with these problems live 5 years. If your cancer is found at an early stage of development, your chance of long-term survival approaches 70%.

Prevention
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The number of stomach cancers has decreased because of the following: o Improved socioeconomic standards o Widespread use of refrigeration for food preservation o Adoption of diets rich in fruits and vegetables In areas where frequency of stomach cancer remains high, such as Japan, screening programs that include upper GI barium studies and, more recently, gastrointestinal endoscopy have improved survival rates. Doctors are finding more cases at an early stage of development. Eliminating Helicobacter pylori infection in people with peptic ulcer disease also may decrease rates of stomach cancer. It has been suggested that people who had portions of their stomachs removed 20 years ago or longer should receive yearly endoscopies. This is because of the increased risk of stomach cancer following such surgery. Evidence does not support mass screening of populations with lower rates of stomach cancer.

Prepared by: Meljay Sunshine Darilay BSN-4A

CERVICAL CANCER
Description y y y y y Cancer of the cervix occurs when the cells of the cervix change in a way that leads to abnormal growth and invasion of other tissues or organs of the body. Like all cancers, cancer of the cervix is much more likely to be cured if it is detected early and treated immediately. One of the key features of cervical cancer is its slow progression from normal cervical tissue, to precancerous (or dysplastic) changes in the tissue, to invasive cancer. The slow progression through numerous precancerous changes is very important because it provides opportunities for prevention and early detection and treatment. . Invasive cancer means that the cancer affects the deeper tissues of the cervix and may have spread to other parts of the body. This spread is called metastasis. Cervical cancers don't always spread, but those that do most often spread to the lungs, the liver, the bladder, the vagina, and/or the rectum.

Etiology Cervical cancer begins with abnormal changes in the cervical tissue. The risk of developing these abnormal changes has been associated with certain factors, including previous infection with human papillomavirus (HPV), early sexual contact, multiple sexual partners, cigarette smoking, and taking oral contraceptives (birth control pills). Forms of HPV, a virus whose different types cause skin warts, genital warts, and other abnormal skin and body surface disorders, have been shown to lead to many of the changes in cervical cells that may eventually lead to cancer.
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Genetic material that comes from certain forms of HPV has been found in cervical tissues that show cancerous or precancerous changes. In addition, women who have been diagnosed with HPV are more likely to develop a cervical cancer that has genetic material matching the strain of virus that caused the infection. These findings demonstrate a strong link between the virus and cervical cancer. Because HPV can be transmitted by sexual contact, early sexual contact and having multiple sexual partners have been identified as strong risk factors for the development of cervical lesions that may progress to cancer.

Cigarette smoking is another risk factor for the development of cervical cancer. The chemicals in cigarette smoke interact with the cells of the cervix, causing precancerous changes that may over time progress to cancer. Oral contraceptives ("the pill") may increase the risk for cervical cancer, especially in women who use oral contraceptives for longer than 5 years.

Clinical Manifestation As in many cancers, you may have no signs or symptoms of cervical cancer until it has progressed to a dangerous stage.
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Pain Vaginal bleeding Abnormal vaginal discharge

Diagnostic Tests As with all cancers, early diagnosis is key to successful treatment and cure. Treating precancerous changes that affect only the surface of a small part of the cervix is much more likely to be successful than treating invasive cancer that affects a large portion of the cervix and has spread to other tissues. y Papanicolaou test (Pap smear)
y y

y y y y y

The Pap smear is done as part of a regular pelvic examination. Named after the pathologist who developed the test, the Pap smear is a quick, painless, and relatively inexpensive way of screening women for precancerous or cancerous changes in their cervix. Cells from the surface of the cervix are collected on a slide and examined. Any abnormality found on a Pap smear mandates further evaluation. Diagnosis of cervical cancer requires that a sample of cervical tissue (called a biopsy) be taken and analyzed under a microscope. This tissue sample can be obtained in a number of ways. A cervical biopsy is usually done by a specialist in diseases of women's reproductive and sexual organs (a gynecologist). The biopsy is examined by a physician who specializes in diagnosing diseases by looking at cells and tissues under a microscope (a pathologist).

Colposcopy o The examination uses a type of microscope called a colposcope to inspect the cervix. The entire area of the cervix is stained with a harmless dye to make abnormal cells easier to see. The colposcope magnifies the cervix by 8-10 times, allowing easier identification of any abnormal-appearing tissue that may need biopsy. This procedure can usually be done in your gynecologist's office. These abnormalities may be an early step in the slow series of changes that can lead to cancer.

y y y

Sometimes a larger biopsy is needed to fully check for invasive cervical cancer.

y y y y y

The loop electrosurgical excision procedure (LEEP) technique uses an electrified loop of wire to take a sample of tissue from the cervix. This procedure can often be performed in your gynecologist's office. A cone biopsy is performed in the operating room while you are under anesthesia. A small cone-shaped sample of your cervix is removed for examination. Like LEEP, cone biopsy procedures result in tissue samples in which the types of cells and how much they have spread to underlying areas can be more fully determined.

Precancerous changes Over the years, different terms have been used to refer to abnormal changes in the cells on the surface of the cervix. These changes are now most often called squamous intraepithelial lesion (SIL). "Lesion" refers to an area of abnormal tissue; intraepithelial means that the abnormal cells are present only in the surface layer of cells. Changes in these cells can be divided into 2 categories.
y

Low-grade SIL: Early, subtle changes in the size and shape of cells that form the surface of the cervix are considered low grade.
y y y

These lesions may go away on their own, but over time, they may become more abnormal, eventually becoming a high-grade lesion. SIL is also called mild dysplasia or cervical intraepithelial neoplasia 1 (CIN 1). These early changes in the cervix most often occur in women aged 25-35 years but can appear in women of any age.

y High-grade SIL: A large number of precancerous cells, which look very different from

normal cells, constitute a high-grade lesion.

y y y

Like low-grade SIL, these precancerous changes involve only cells on the surface of the cervix. These lesions are also called moderate or severe dysplasia, CIN 2 or 3, or carcinoma in situ. They develop most often in women aged 30-40 years but can occur at any age.

Invasive cancer If abnormal cells spread deeper into the cervix or to other tissues or organs, the disease is then called cervical cancer, or invasive cervical cancer. Cervical cancer occurs most often in women aged 40 years or older. If the biopsy results show invasive cancer, a series of tests will be performed, all designed to see whether the cancer has spread and, if so, how far.

A chest x-ray looks for spread to the lungs.

y y y y y y y

Blood tests can indicate whether the liver is involved. A CT scan may be necessary if results are not definitive. Special x-rays or a CT scan can be used to look at the bladder. The vagina and rectum are also examined, sometimes under anesthesia. These tests are used to "stage" the cancer. By finding out how far it has spread, your health care providers can make a reasonable guess about your prognosis and the kind of treatment you will need. Cervical cancer is staged from stage 0 (least severe) to stage IV (metastatic disease, the most severe). Staging is based on size and depth of the cancerous lesion, as well as degree of spread.

Treatment Treatment of cervical cancer is directed at preventing precancerous cells from becoming cancerous cells.
y

This is usually a step-by-step process, involving the removal of cells or tissue to diagnose cancer and to find out how far it has invaded. If the deepest cells removed by biopsy were normal, no further treatment may be needed. If the deepest cells removed by biopsy were cancerous or precancerous, this means the cancer has invaded farther than the biopsy. In these cases, treatment generally starts with removal of additional tissues. As these tissues are removed, they are checked for dysplastic change to be sure all the precancerous or cancerous cells have been removed from the body or are otherwise destroyed.

y y

Medical Treatment Treatment for precancerous lesions differs from that of invasive cancer. Precancerous lesions Choice of treatment for a precancerous lesion of the cervix depends on a number of factors. These factors include whether the lesion is low or high grade, whether you want to have children in the future, your age and general health, and your preference and that of your health care provider.
y

If you have a low-grade lesion, you may not need further treatment, especially if the abnormal area was completely removed during biopsy. You should have regular Pap smears and pelvic exams.

y y

When a precancerous lesion requires treatment, cryosurgery (freezing), cauterization (burning, also called diathermy), or laser surgery may be used to destroy the abnormal area without harming nearby healthy tissue. Abnormal tissue also can be removed by LEEP or conization. Treatment for precancerous lesions may cause cramping or other pain, bleeding, or a watery vaginal discharge.

In some cases, you may choose to have a hysterectomy for precancerous changes, particularly if abnormal cells are found inside the opening of the cervix. This surgery is more likely to be done if you do not plan to have children in the future. Diagnostic procedures, such as LEEP and cone biopsy, sometimes may be treatment as well.
y y y

Both of these procedures involve taking away some of the cervical tissue for evaluation. If that evaluation finds that there were indeed abnormal cells but that those abnormal cells did not extend as far as the level where the tissue was cut, only follow-up may be needed. If there is uncertainty about whether all of the precancerous cells have been removed using a LEEP or cone biopsy procedure, then further treatments may be required.

Cryocautery may be used in some cases.

y y y y y y y

In this procedure, a steel instrument is cooled to subzero temperatures by immersion in liquid nitrogen or a similar liquid. This ultracooled instrument is then applied to the surface of the cervix. The cells are frozen, and they eventually die and are sloughed off, to be replaced by new cervical cells. Tissue may also be removed by laser ablation. A laser beam is applied to either specific areas of cervical tissue or a whole layer of tissue at the surface of the cervix. The laser destroys these cells, leaving healthy cells in their place. The success of cryocautery or laser ablation procedures is determined by a follow-up examination and Pap smear.

Invasive cancer The most widely used treatments for cervical cancer are surgery and radiation therapy. Chemotherapy Treatment for invasive cervical cancer usually involves a team of specialists. The team generally includes a gynecologic oncologist and a radiation oncologist.
y y

These doctors may decide to use one treatment method or a combination of methods. You may choose to take part in a clinical trial (research study) to evaluate new treatment methods. Such studies are designed to improve cancer treatment. Participating in a clinical

trial has both benefits and risks. See For More Information to find out about clinical trials on the Internet. Cancerous cells typically invade surrounding tissues.
y

If a biopsy shows that cancerous cells have invaded through a layer called the basement membrane, which separates the surface layers of the cervix from other underlying layers, surgery is usually required. The extent of the surgery varies, depending on the stage of the cancer.

Radiation therapy
y y y y

(also called radiotherapy) is also used to fight cervical cancer at some stages. Radiation therapy uses high-energy rays to damage cancer cells and stop them from growing. Like surgery, radiation therapy is local therapy; the radiation affects cancer cells only in the treated area. Radiation may be applied externally or internally. Some women receive both kinds.

External radiation
y y y y

Comes from a large machine, which aims a beam of radiation at your pelvis. External radiation treatments usually are given 5 days a week for 5-6 weeks. At the end of that time, an extra dose of radiation called a "boost" may be applied to the tumor site. Each treatment takes only a few minutes. Because of safety concerns and expense of equipment, radiation therapy generally is offered only at certain large medical centers or hospitals.

Internal or implant radiation

y y y y

Comes from a capsule containing radioactive material which is placed directly in the cervix. The implant puts cancer-killing rays close to the tumor while sparing most of the healthy tissue around it. It is usually left in place for 1-3 days, and the treatment may be repeated several times over the course of 1-2 weeks. You stay in the hospital while the implants are in place.

Chemotherapy is the use of powerful drugs to kill cancer cells. In cervical cancer, it is used most often when the cancer has spread to other parts of the body. Just one drug or a combination of drugs may be given.
y y

Anticancer drugs used to treat cervical cancer may be given via an IV line or by mouth. Either way, chemotherapy is systemic treatment, meaning that the drugs flow through the body in the bloodstream. They can kill cancer cells anywhere in the body.

y y

Chemotherapy is given in cycles: each cycle comprises a period of intensive treatment followed by a recovery period. Treatment usually consists of several cycles. Most patients have chemotherapy as an outpatient (in an outpatient clinic at the hospital, at the doctor's office, or at home). Depending on which drugs are given and your general health, however, you may need to stay in the hospital during treatment.

Surgery Surgery removes cancerous tissue in or near the cervix.

y y y y

If the cancer is only on the surface of the cervix, the cancerous cells may be removed or destroyed by using methods similar to those used to treat precancerous lesions. If the disease has invaded deeper layers of the cervix but has not spread beyond the cervix, an operation may remove the tumor but leave the uterus and the ovaries. If the disease has spread into the uterus, hysterectomy is usually necessary. Hysterectomy is also sometimes done to prevent spread of the cancer.

Hysterectomy Surgical removal of the entire uterus, including the cervix; sometimes the ovaries and fallopian tubes also are removed. In addition, lymph nodes near the uterus may be removed to check for spread of the cancer. Hysterectomy is major surgery.
y y y y

The decision to have a hysterectomy is made by a woman, her partner, and her health care provider. Whether hysterectomy is necessary depends on the individual circumstances. In invasive disease, a hysterectomy is usually recommended. Some women who do not plan to have children in the future may choose to undergo hysterectomy for preventive reasons. Other women who do plan to have children may wish to preserve their reproductive organs even if this increases their risk somewhat.

Hysterectomy requires a considerable recovery period.

y y

For a few days after the operation, you may have pain in your lower abdomen. The pain can be controlled by medication. You may have difficulty emptying your bladder. You may need to have a thin, plastic tube called a catheter inserted into the bladder to drain the urine for a few days after surgery. You also may have trouble having normal bowel movements. Your activities should be limited for a period of time after the surgery to allow healing to take place. Normal activities, including sexual intercourse, usually can be resumed in 4-8 weeks.

Once you have had your uterus removed, you will no longer have menstrual periods.

y y y y y

Sexual desire and the ability to have intercourse usually are not affected by hysterectomy. On the other hand, many women have an emotionally difficult time after this surgery. Your view of your own sexuality may change. You may feel an emotional loss because you are no longer able to have children. An understanding partner is important at this time. You may want to discuss these issues with your health care provider, medical social worker, or counselor.

Prevention The key to preventing invasive cervical cancer is to detect any cell changes early, before they become cancerous. Regular pelvic examinations and Pap smears are the best way to do this. How often you should have a pelvic exam and Pap smear depends on your individual situation.
y y y y

y y y y y

You should have your first Pap smear when you become sexually active, no matter how old you are. If you are not sexually active, you should have your first Pap smear at age 18 years or earlier. In both cases, you should have a Pap smear every year for at least 3 years. If these Pap smears reveal no abnormal cells and you have few risk factors for cervical cancer, the US Guide to Clinical Preventive Services recommends a repeat Pap smear at least every 3 years. Because a woman's risk factors may change with her lifestyle, many medical professionals prefer that you have a Pap smear yearly through age 65 years and older, regardless of the number of negative tests you have had in the past. If you have had precancerous changes or cancer of the cervix, your gynecologist will recommend a schedule of follow-up examinations and tests. Avoidance of human papillomavirus infection is becoming increasingly important in the prevention of precancerous and cancerous changes of the cervix. Early age at first intercourse is associated with increased risk. Abstinence is recommended as one way to prevent the transmission of HPV. Likewise, barrier protection, such as condom use, may prevent HPV infection, although this has not yet been fully studied. A vaccine to protect women from cervical cancer may be available in 5 years. Early tests found an experimental vaccine to be effective against the virus responsible for half of all cases of cervical cancer. The vaccine targets a strain of HPV. The vaccine would not be effective for women who already have HPV. Cigarette smoking is another risk factor for cervical cancer that can be prevented. Quitting smoking may decrease your chances of developing cervical cancer.

Prepared by: Maria Teresa Evangelista BSN-4A

PROSTATE CANCER
Description Cancer that forms in tissues of the prostate (a gland in the male reproductive system found below the bladder and in front of the rectum). Prostate cancer usually occurs in older men. The prostate is a glandular organ present only in males. Only men develop prostate cancer. The prostate is normally about 3 cm long (slightly more than 1 inch) and lies at the neck of the bladder and in front of the rectum.

Causes The cause of prostate cancer is unknown, but hormonal, genetic, environmental, and dietary factors are thought to play roles. The following risk factors have been linked with development of this condition:
y

Age: There is a strong correlation between increasing age and developing prostate cancer. The incidence of prostate cancer increases steadily from fewer than one in 100,000 for men 40 years of age to 1,146 per 100,000 in men 85 years of age. The median age at diagnosis of prostate cancer is 70.5 years of age. More than 80% of prostate cancers are diagnosed in men older than 65 years of age. Autopsyrecords indicate that 70% of men older than 90 years of age have at least one region of cancer in their prostate. Race: African American men are 1.6 times more likely than white men to develop prostate cancer. They are also 2.4 times more likely to die from their disease as compared to white men of a similar age. Asian Americans, on the other hand, have a much lower chance of getting prostate cancer as compared to whites or African Americans. Although, these racial criteria have been used to study and describe the disease in the past, there is no defined biologic basis for this classification. In other words, these differences in diagnosis and death rates are more likely to reflect a difference in factors like environmental exposure, diet, lifestyle, and health-seeking behavior rather than any racial susceptibility to prostate cancer. Recent evidence, however, suggests that this disparity is progressively decreasing with high chances of complete cure in men undergoing treatment for organ-confined prostate cancer (cancer that is limited to within the prostate without spread outside the confines of the prostate gland) irrespective of race. Genetic factors: Men who have a history of prostate cancer in their family, especially if it was a first-degree relative such as a father or brother, are at an increased risk. This risk may be two to three times greater than the risk for men without a family history of the disease. Earlier age at diagnosis (<60 years of age) in a first-degree relative and disease affecting more than one relative also increases the risk for developing prostate cancer.

Infection: Recent evidence has suggested the role of sexually transmitted infections as one of the causative factors for prostate cancer. People who have had sexually transmitted infections are reported as having 1.4 times greater chance of developing the disease as compared to the general population. Diet: A diet high in fat has been associated with an increased risk of prostate cancer. Chemical agents: Exposure to chemicals such as cadmium has been implicated in the development of prostate cancer. There is also some evidence to suggest that obesity leads to an increased risk of having more aggressive, larger prostate cancer, which results in a poorer outcome after treatment.

y y

There is no proven link between frequency of sexual activity and prostate cancer risk. Most men with prostate cancer have nosymptoms. This is particularly true of early prostate cancer.
y

Currently, most prostate cancers are discovered when a prostate biopsy is performed after a raised serum prostate specific antigen (S. PSA) blood test is noted. This test is frequently performed as a part of a health screening program. Sometimes, prostate cancers are discovered incidentally when a digital rectal exam is performed. A digital rectal exam is part of a thorough regular health examination. Digital refers to finger. During the digital rectal exam, the examiner inserts a gloved and lubricated finger in the rectum to feel the prostate for abnormalities. If there are some hard or irregular areas in the prostate, the physician may request for a prostate biopsy to confirm or rule out the presence of prostate cancer. (Details regarding S. PSA and prostate biopsy are available in subsequent sections.

Clinical Manifestation Symptoms usually appear when the tumor causes some degree of urinary blockage at the bladder neck or the urethra. y The usual symptoms include difficulty in starting and stopping the urinary stream, increase in frequency of urination, and pain while urinating. The urinary stream may be diminished (urinary retention), or it may simply dribble out.

Even after urination, there is a sense of bladder fullness because the bladder has not been fully emptied.

Less common symptoms are blood in the urine (hematuria), painful ejaculation, orimpotence (inability to have an erection). y y y These three symptoms are uncommon in early stages of the disease. They usually occur when the cancer is advanced. As the cancer advances to cause a greater blockage, bladder function may deteriorate further. Men with such advanced cancers sometimes experience recurring urinary tract infections.

Symptoms of metastatic disease include: y y y y Fatigue Malaise Weight loss Deep bone pain

See your health-care provider if you have any of the following symptoms: y Difficulty initiating and/or stopping a urine stream
y y y y y

Frequent urination Pain on urination Pain on ejaculation Decreasing speed of urine flow or a urine stream that stops and starts A sensation of incomplete emptying of the bladder even after passing urine

Go to the nearest hospital emergency department right away if you have any of the following symptoms: y y y y Urinary tract infection: Burning pain on urination, urgency, frequent urination, especially with fever Bladder obstruction: Not urinating or urinating very little despite drinking enough fluid; producing little urine despite straining; pain due to a full bladder Acute kidney failure: Not urinating or urinating little, with little discomfort, despite drinking enough fluid Deep bone pain, especially in the back, hips, or thighs, or bone fracture: Possible sign of advanced prostate cancer that has spread to the bones

Spinal cord compression is a true emergency and may be the first sign of cancer. It occurs when the cancer has spread to vertebrae of the spine and tailbone region. The weakened vertebrae can collapse on the spinal cord, causing symptoms and problems with function. y y Symptoms depend on the level at which the spine is compressed. Typical symptoms that might signal acute spinal cord compression include weakness in the legs and difficulty walking, increased difficulty urinating or moving your bowels, difficulty controlling your bladder or bowels, and decreased sensation, numbness, or tingling in the groin or legs. These are often preceded by pain in the hip (usually one-sided) or back lasting a few days or weeks. Such symptoms require immediate evaluation in the nearest hospital emergency department. Failure to be treated immediately can result in permanent spinal cord damage.

y y

Diagnostic Tests Blood tests: These are used to detect complications of prostate cancer. y Complete blood cell count: Your hemoglobin level and relative amounts of different blood cells are checked. Anemia is a common sequel to cancers, as are certain other blood irregularities.
y

Hepatic transaminases: These are enzymes produced in the liver. They are called alanine aminotransferase (ALT) and aspartate aminotransferase (AST). In known prostate cancer, these levels are usually elevated when the cancer has spread to the liver. However, levels of these enzymes can be abnormally high in a number of different conditions that have nothing to do with cancer. Alkaline phosphatase: This enzyme is found in the liver and in bone. It is a sensitive indicator of both liver and bone cancer. BUN and creatinine: These measures are used to assess how well the kidneys are working. Levels can be elevated in a number of conditions and may suggest an obstruction.

Prostatic specific antigen (PSA): This is an enzyme produced by both normal and abnormal prostate tissues.
y

It may be elevated in noncancerous conditions, such as prostatitis(inflammation of the prostate) and benign prostatic hypertrophy (noncancerous enlargement of the prostate), as well as in cancer of the prostate.

PSA values may be more helpful over time in following recurrence of cancer and the response to treatment than in diagnosing a previously unknown cancer. The following standards have been set for PSA levels:
o o o o

Less than 4 ng/mL: Normal value 4-10 ng/mL: Either benign disorder or cancer Greater than 10 ng/mL: Most likely cancer Less than 0.2 ng/mL: After prostate is surgically removed

Imaging studies: These reveal the size and location of the tumor in the prostate as well as the extent of spread of the disease.
y

CT scan or MRI of abdomen and pelvis: This is the best way to detect the extent of the primary cancer as well as distant metastases. Chest x-ray film: This is a simple test that shows whether cancer has spread to the lungs. Ultrasound of kidneys, bladder, and prostate: Ultrasonography can be used to look for the effects of a urinary blockage on the kidneys. This is indicated by signs of swelling within the kidney (hydronephrosis). This study can also be used to assess the bladder for any sign of urinary obstruction due to prostate enlargement by looking at the thickness of the bladder wall and the amount of urine left inside the bladder after passing urine. Cystoscopy: This is an endoscopic test which is usually performed in selected situations. A thin, flexible, lighted tube with a tiny camera on the end is inserted through the urethra to the bladder. The camera transmits images to a video monitor. This may show whether the cancer has spread to the urethra or bladder. Technetium Tc 99m bone scan: This test is like an X-ray film of the entire body taken after a mildly radioactive substance is administered into a vein. The radioactive substance highlights areas where the cancer has affected the bones. This test is usually reserved for men with prostate cancer who have deep bone pain or a fracture or who have biopsy findings and high PSA values (>10-20 ng/ml) suggestive of advanced or aggressive disease.

Biopsy: When the findings of the physical exam, lab tests, and imaging studies suggest that a cancer is present in the prostate, the diagnosis must be confirmed by taking a sample of the

tumor (biopsy). The tumor tissue is examined by a doctor who specializes in diagnosing diseases by looking at cells and tissues (a pathologist).
y y

There are several different ways of obtaining a prostate biopsy. The standard method uses transrectal ultrasonography to guide collection of the tissue sample. The sample is collected by inserting a needle into the tumor and withdrawing cells. Typically 10-12 pieces of tissue are extracted from different parts of the prostate gland to look for the presence of cancer. A pathologist then examines the pieces under the microscope to assess the type of cancer present in the prostate and the extent of involvement of the prostate with the tumor. One can also get an idea about the areas of the prostate that are invaded with the tumor by assessing which of the pieces contain the cancer and which of them do not. Another very important assessment that the pathologist makes from the specimen is the grade (Gleason's score) of the tumor. This indicates how different the cancer cells are from normal prostate tissue. Grade gives an indication of how fast a cancer is likely to grow and has very important implications on the treatment plan and the chances of cure after treatment. A Gleason score of 6 generally indicates low grade (less aggressive) disease while that of 8-10 suggests high grade (more aggressive) cancer. A grade of 7 is regarded as somewhere in between these two.

Staging: If the biopsy finding is positive for cancer, further staging procedures will be done.
y

Staging is a system of classifying tumors by size, location, and extent of spread, local and remote. Staging is an important part of treatment planning because tumors respond best to different treatments at different stages. Stage is also a good indicator of prognosis, or the chances of success after treatment. Staging is usually accomplished through imaging studies and lab tests. Prostate cancers are also assigned a grade, which indicates how different the cancer cells are from normal prostate tissue. Grade gives an indication of how fast a cancer is likely to grow.

y y y

The stages of prostate cancer are as follows:

o

Stage I (or A): The cancer cannot be felt on digital rectal exam, and there is no evidence that it has spread outside the prostate. These are often found incidentally during surgery for an enlarged prostate. Stage II (or B): The tumor is larger than a stage I and can be felt on digital rectal exam. There is no evidence that the cancer has spread outside the prostate. These are usually found on biopsy when a man has an elevated PSA level. Stage III (or C): The cancer has invaded other tissues neighboring the prostate. Stage IV (or D): The cancer has spread to lymph nodes or to other organs.

Most doctors currently use the 2002 TNM (Tumor, Node, Metastases) staging system for prostate cancer. This is based on a combination of three criteria: the extent of the primary tumor (T stage), involvement of lymph nodes by the cancer (N stage), and the presence or absence of spread to distant areas of the body in the form of metastasis (M stage). The TNM 2002 staging system is as follows:

Evaluation of the (primary) tumor ("T")

y y y

TX: cannot evaluate the primary tumor T0: no evidence of tumor T1: tumor present but not detectable clinically or with imaging
o

T1a: The tumor was incidentally found in less than 5% of prostate tissue resected (for other reasons). T1b: The tumor was incidentally found in greater than 5% of prostate tissue resected. T1c: The tumor was found in a needle biopsy performed due to an elevated serum PSA.

T2: The tumor can be felt (palpated) on examination but has not spread outside the prostate

T2a: The tumor is in half or less than half of one of the prostate gland's two lobes. T2b: The tumor is in more than half of one lobe but not both. T2c: The tumor is in both lobes.

o o y

T3: The tumor has spread through the prostatic capsule (if it is only part-way through, it is still T2).
o o

T3a: The tumor has spread through the capsule on one or both sides. T3b: The tumor has invaded one or both seminal vesicles.

T4: The tumor has invaded other nearby structures.

It should be stressed that the designation "T2c" implies a tumor which is palpable in both lobes of the prostate. Tumors which are found to be bilateral on biopsy only but which are not palpable bilaterally should not be staged as T2c. Evaluation of the regional lymph nodes ("N")
y y y

NX: The regional lymph nodes cannot be evaluated. N0: There has been no spread to the regional lymph nodes N1: There has been spread to the regional lymph nodes.

Evaluation of distant metastasis ("M")

y y y

MX: A distant metastasis cannot be evaluated. M0: There is no distant metastasis M1: There is distant metastasis. o M1a: The cancer has spread to lymph nodes beyond the regional ones. o M1b: The cancer has spread to bone. o M1c: The cancer has spread to other sites (regardless of bone involvement).

Treatment Treatments for prostate cancer are effective in most men. y y y They cause both short- and long-term side effects that may be difficult to accept. You and your life partner or family members should discuss your treatment options in detail with your urologist and other physicians. Make sure you understand which treatments are available, how effective each is likely to be, and what side effects can be expected.

You must weigh all these choices carefully before making a decision about which course to pursue.

Medical Treatment Several treatments are available for prostate cancer. y The choice of treatment depends on age, general medical condition, and the extent of the tumor spread. y Your treatment plan should be individualized for you, depending on your feelings about the different treatments and their potential side effects. y You should discuss your treatment plan with your medical team, which will probably consist of a urologist and cancer specialists (oncologists). One treatment option is known as watchful waiting. This involves monitoring your cancer to see if it gets worse and how quickly. y Often prostate cancers grow very slowly, and many men do well without treatment for some time. y For older men with other serious medical problems, the risks involved with treatment such as surgery may outweigh the potential benefits. y Watchful waiting is a conservative regimen that includes regular visits to your urologist for digital rectal exams, PSA measurements, and, if necessary, imaging tests and/or repeated prostate biopsies to assess if the cancer is becoming more aggressive over time. y One benefit to watchful waiting is that you do not experience the side effects of treatment. On the other hand, your symptoms (if any) will continue. In some cases, symptoms can be at least partly relieved with medication. y If your cancer starts to grow, your urologist may recommend treatment. y Watchful waiting is most often used for men who have very early-stage cancers and for men who are not candidates for surgery and other aggressive therapies. Radical prostatectomy: This is a major operation to remove the entire prostate gland. For more information, see Surgery.

Radiation therapy: Two types of radiation therapy are used in prostate cancer: external beam radiation therapy and brachytherapy. Both are used to treat prostate cancer that has not spread outside the prostate.
y

External-beam radiation therapy involves targeting a beam of high-energy radiation directly at the cancer. If the cancer is limited to the prostate, without capsular, lymph

y y

node, or any distant involvement, the survival rates are nearly similar to those achieved with radical prostatectomy. Radiation therapy has also been used to treat cancer in which there has been localized spread of the cancer outside of the prostate. Brachytherapy (internal or implanted radiation) is a variation of radiation therapy in which a small radioactive pellet is implanted into the prostate. An imaging technique, such as transurethral ultrasound (TRUS), CT, or MRI, is used to accurately place the radioactive pellets. This provides radiation to a smaller area than external-beam radiation and minimizes exposure of surrounding normal tissue. The pellets provide radioactivity for weeks to months and can simply be left in place once exhausted. Side effects of external beam radiation include skin burning or irritation andhair loss at the area where the radiation beam goes through the skin. Both can cause severe fatigue, diarrhea, and discomfort on urination. These effects are almost always temporary. Both treatments can cause impotence (inability to get an erection) and/or urinary incontinence (inability to hold your urine). This occurs because the radiation damages the nerve and the muscles that control these functions. These effects may be permanent, but they are less likely to be permanent with internal radiation.

Hormonal therapy: This therapy is likely to be used in cases in which the cancer has spread to distant regions. The goal of hormonal therapy is to lower levels of testosterone or to stop testosterone from working. Prostate cancer is stimulated by testosterone and other male hormones (androgens). These effects on testosterone can be achieved with surgery or with drug treatment. Often, the initial response is good, but cancer may progress over time.
y

y y y

The testes produce much of the testosterone that stimulates cancer growth. Surgical removal of both testicles (castration, or orchiectomy) is the best way to stop hormonal stimulation of the tumor. Men usually prefer medical castration to surgical castration. A luteinizing hormone-releasing hormone (LHRH) agonist, such as leuprolide (Lupron, Viadur, Eligard), goserelin (Zoladex), or buserelin (Suprefact), stops the production of testosterone. Agents that stop testosterone from working, such as flutamide (Eulexin) orbicalutamide (Casodex), are called anti-androgens. They are typically used after orchiectomy or with an LHRH agonist to more completely suppress the effects of testosterone on the cancer. Drugs that stop the adrenal glands from making androgens are sometimes used. Estrogen, in the form of diethylstilbestrol, can also be used to suppress testosterone. Because of its extensive side effects, estrogen is not used very often. Side effects of these medications vary. Orchiectomy and LHRH agonists may cause impotence, hot flashes, and loss of sexual desire. Antiandrogens may cause nausea, vomiting, diarrhea, and breast enlargement or tenderness. Any of these therapies can weaken bones.

Chemotherapy: Chemotherapy is the last treatment method to be used against prostate cancer. y Newer chemotherapy medicines, such as docetaxel (Taxotere), have shown some promise in prolonging the survival of some patients with extensive prostate cancer. They may also decrease the pain related to widespread cancer. However, this comes at the cost of significant side effects that may impact quality of life. Surgery Radical prostatectomy is surgical removal of the entire prostate. This operation is indicated for cancer that is limited to the prostate and has not invaded the capsule of the prostate, any other nearby structures or lymph nodes, or distant organs.
y y

y y

The entire prostate, seminal vesicles, and ampulla of the vas deferens are removed, and the bladder is connected to the membranous urethra to allow free urination. Complications of this procedure include urinary incontinence and impotence. Newer techniques spare the nerve that controls urination and erection. Of men who undergo these newer techniques, 98% are continent, and 60% are able to have an erection. Radical prostatectomy can be combined with radiation therapy in men with cancer that is even further isolated in the prostate area. There is an excellent survival rate if cancer has not spread. Be certain you understand the risks and benefits of this procedure before deciding to go ahead. Radical prostatectomy can be performed by open surgery, laparoscopic surgery, or by robotic surgery (robotic assisted radical prostatectomy). Currently, almost 70% of radical prostatectomy surgeries in the U.S. are performed with the help of the Da Vinci robotic system. For robot-assisted surgery, five small incisions are made in the abdomen through which the surgeon inserts tube-like instruments, including a small camera. This creates a magnified three-dimensional view of the surgical area. The instruments are attached to a mechanical device, and the surgeon sits at a console and guides the instruments through a viewing device to perform the surgery. The instrument tips can be moved in a variety of ways under the control of the surgeon to achieve greater precision in surgery. So far, studies show that traditional open prostatectomy and robotic prostatectomy have had similar outcomes related to cancerfree survival rates, urinary continence, and sexual function. However, in terms of blood loss during surgery and pain and recovery after the procedure, robotic surgery has been shown to have a significant advantage.

Transurethral resection of the prostate (TURP) is an alternative to radical prostatectomy.

y

Only part of the prostate is removed by an instrument inserted through the urethra.

y y

An electric current passes through a small wire loop at the end of the instrument. The electrical current cuts away a piece of the prostate. This procedure is used to remove tissue that is blocking urine flow in patients with extensive disease or those that are not fit enough to undergo radical prostatectomy. It is not considered a standard-of-care procedure for if cure is intended.

Nursing Interventions  Preoperative Nursing Interventions

Reduce anxiety  Establish communication with the patient  Familiarize the patient with the pre & postoperative routines and initiative measures.  Provide privacy  Establish a trusting and professional relationship  Encourage to verbalize feelings and concerns  Administer enema on the evening or on the morning before surgery - to prevent postoperative straining which can induce bleeding Relieving Discomfort  Administer prescribe meds (analgesic)  Assist with catheterization Provide Instructions  Explain the procedures to the patient. Intraoperative Nursing Interventions  Check for patient consent for surgery  Validate information  Explain the procedure  Identify incision cite & type of anesthesia  Prepare the patient for the procedure Postoperative Nursing Interventions      Maintain fluid balance Monitor urine output and fluid used for irrigation Monitor I & O Monitor Vital Signs Report any signs of electrolyte imbalance, increase BP, confusion, and respiratory distress

Relieve Pain  Administer prescribed analgesic  Apply warm compress

      

- To relieve spasm Monitor drainage tubing and irrigates the system as prescribed - To relieve any obstruction Monitor and manage potential complications Hemorrhage Infection DVT Catheter obstruction Sexual dysfunction

Other Therapy Cryotherapy: This technique involves inserting a probe through a small skin incision and freezing areas of cancer in the prostate. y This therapy is reserved for cancer localized within the prostate as well as for men who are unable to withstand the conventional therapies such as surgery or radiation. y The probe is guided to areas of cancer by using TRUS. Cancerous tissue appears on the ultrasound and allows the surgeon to monitor therapy and limit damage to normal prostate tissue. y There are several advantages to using this procedure over surgery and radiation therapy. There is less blood loss, shorter hospital stay, shorter recovery times, and less pain than with conventional surgery. y The long-term effectiveness of this procedure is unknown because it is a newer treatment.

HIFU
y

HIFU (high intensity focused ultrasound) was first developed as a treatment of benign prostatic hyperplasia (BPH) and now is also being used as a procedure for the killing of prostate cancer cells. This procedure utilizes transrectal ultrasound that is highly focused into a small area, creating intense heat of 80 C-100 C, which is lethal to prostate cancer tissue. The published clinical experience with HIFU for this application is limited and the procedure is not yet approved by the FDA for use in the United States.

Prevention Because the cause of prostate cancer is uncertain, preventing prostate cancer may not be possible. Certain risk factors, such as age, race, sex, and family history, cannot be changed. However, because diet has been implicated as a potential cause, living a healthy lifestyle may afford some protection.

y y y y

Proper nutrition, such as limiting intake of foods high in animal fats and increasing the amount of fruits, vegetables, and grains, may help reduce the risk of prostate cancer. Eating certain foods that contain substances called antioxidants (vitamins C and E and beta carotene) may be protective. Some research suggests that taking vitamin E, an antioxidant, may reduce the risk of not only prostate cancer but also other cancers. This theory remains unproven. Certain medications like finasteride(Propecia, Proscar) and dutasteride(Avodart) have been shown in some recent studies to be effective in decreasing the risk of developing prostate cancer. A discussion with your urologist with regard to these medications should be considered especially, if you have a higher risk of acquiring the disease based on your family history.

Prepared by: Mark Anthony L. Guadaa Jerome Llamado BSN-4A

COLORECTAL CANCER
Description Colorectal cancer is a cancer characterized by neoplasia in the colon, rectum, or vermiform appendix. It start in the lining of the bowel, if left untreated, it can grow into the muscle layers underneath, and then through the bowel wall. Most begin as a small growth on the bowel wall: a colorectal polyp or adenoma. These mushroom-shaped growths are usually benign, but some develop into cancer over time. Etiology/ Risk Factors: y Age: The risk of developing colorectal cancer increases with age. Most cases occur in the 60s and 70s, while cases before age 50 are uncommon unless a family history of early colon cancer is present. Polyps of the colon, particularly adenomatous polyps, are a risk factor for colon cancer. The removal of colon polyps at the time of colonoscopy reduces the subsequent risk of colon cancer. History of cancer. Individuals who have previously been diagnosed and treated for colon cancer are at risk for developing colon cancer in the future. Women who have had cancer of the ovary, uterus, or breast are at higher risk of developing colorectal cancer Heredity: Family history of colon cancer, especially in a close relative before the age of 55 or multiple relatives. Smoking: Smokers are more likely to die of colorectal cancer than nonsmokers. Diet: Studies show that a diet high in red meat and low in fresh fruit, vegetables, poultry and fish increases the risk of colorectal cancer. Physical inactivity: People who are physically active are at lower risk of developing colorectal cancer. Viruses: Exposure to some viruses (such as particular strains of human papilloma virus) may be associated with colorectal cancer. Inflammatory bowel disease. Alcohol: Drinking, especially heavily, may be a risk factor. History of gastrectomy. Obesity

y y y y y y y y y

Pathophysiology Risk factors

Adenocarcinoma (arising from the epithelial lining of the intestine)

Start as a benign polyp

May become malignant

Invade and destroy normal tissues and extend into the surrounding structures

Cancer cells may migrate away from the primary tumor and spread to other parts of the body (often to the liver, peritoneum and lungs)

Clinical Manifestations y Local symptoms o change in bowel habit o a feeling of incomplete defecation (rectal tenesmus) o increased presence of mucus o Melena o constipation o abdominal pain o abdominal distension o Vomiting Constitutional o Unexplained anemia o Fatigue o Palpitations o Pallor o Weight loss o Unexplained fever o Deep vein thrombosis

Diagnostic test o o o o o o Abdominal and rectal examination Fecal occult blood testing Barium enema Proctosigmoidoscopy Colonoscopy Sigmoidoscopy

Complications o o o o o o o Partial or complete bowel obstruction Hemorrhage Perforation Abscess formation Peritonitis Sepsis Shock

Medical Management 1. Adjuvant therapy a. Chemotherapy b. Radiation therapy c. immunotherapy 2. Surgical management a. is the primary treatment for most colon and rectal cancer. b. It may be curative and palliative. c. The type of surgery recommended depends on the location and size of the tumor. y Laparoscopic colostomy with polypectomy  minimizes the extent of the surgery needed y laparoscopic colectomy  have equivalent surgical outcomes to open colectomy and is associated with decreased length of stay, decreased use of pain medications and improve quality of life y palliative surgery o segmental resection with anastamosis o abdominoperineal resection with permanent sigmoid colostomy o temporary colostomy followed by segmental resection and anastamosis and subsequent reanastamosis of the colostomy, allowing initial bowel decompression and bowel preparation before resection.

o Permanent colostomy or ileostomy for palliation of unresectable obstructing lesions o Construction of a coloanal reservoir called a colonic. J pouch which is performed in two steps. A temporary loop ileostomy is constructed to divert intestinal flow, and the newly constructed j pouch is reattached to the anal stump. After 3 months after the initial stage,the ileostomy is reversed and intestinal continuity is restored. The the anal sphincter and therefore continence are preserved. Colostomy o Is a surgical creation of an opening into the colon. It can be temporary or permanent fecal diversion.

Nursing Diagnosis y y y y y y y Imbalanced nutrition, less than body requirements, related to nausea and anorexia. Risk for deficient fluid volume related to vomiting and dehydration Anxiety related to impending surgery and the diagnosis of cancer Risk for ineffective therapeutic regimen management related to knowledge deficit concerning the diagnosis, the surgical procedure and self care after discharge. Impaired skin integrity related to the surgical incisions (abdominal and perianal), the formation of a stoma , and frequent fecal contamination of peristomal skin. Disturbed body image related to colostomy Ineffective sexuality patterns related to presence of ostomy and changes in body image and self concept.

Nursing Interventions y Preparing the patient for surgery o Preparing the patient physically for surgery  Building patient s stamina in the days preceding surgery and cleansing and sterilizing the bowel the day before surgery  The nurse recommends a diet high in calories, protein and carbohydrates and low in residue for several days before surgery to provide adequate nutrition and minimize cramping by decreasing excessive peristalsis  A full liquid diet may be prescribed for 24 to 48 hours before surgery to decrease bulk.  If the patient is hospitalized in the days preceding surgery, parental nutrition may be required to replace depleted nutrients, vitamins and minerals.  The bowel is cleansed with laxatives, enemas or colonic irrigations the evening before and the morning of surgery.

Measures and records intake and output, including vomitus, to provide an accurate record of fluid balance.  The nurse monitors the abdomen for increasing distention , loss of bowel sounds and pain or rigidity  Important to monitor IV fluids and electrolytes  Observes for signs of hypovolemia , assess hydration status and reports decreased skin turgor, dry mucous membranes and concentrated urine. o Providing information about postoperative care, including;  Stoma care if a colostomy is to be created y Maintaining optimal nutrition y Providing wound care y Monitoring and managing complications y Removing and applying the colostomy appliance y Irrigating the colostomy y Supporting a positive body image y Discussing sexuality issues o Supporting the patient and family emotionally  Assess the patient s anxiety level and coping mechanism and suggest methods for reducing anxiety such as deep breathing exercises and visualizing a successful recovery from surgery and cancer.  Arrange a meeting with a spiritual advisor if the patient desires or with the physician if the patient wishes to discuss the treatment or prognosis.  Perioperative Nursing Interventions Preoperative Nursing Interventions 1. Patient is required to sign an informed consent. 2. Details of the procedure are discussed with the patient, including goals, technique and risk by the physician and should be repeated by the nurse for clarification as conveyed by the physician. 3. The patient should undergo a thorough physical examination of the abdomen, groin and rectum. Diagnostic examination tools used to evaluate medical conditions include gastrointestinal barium series, MRI, angiography, Ct scan and endoscopy. 4. Listen to the patient s fears and concerns, stay with the patient during period of severe stress and anxiety. 5. Patient is asked to completely clean out the bowel (mechanical cleansing). 6. Patient may also be given a prescription by the physician for oral antibiotics and explain to the patient the rationale/ action of the drug and why it is given. 7. Patient should be instructed NPO for 8 hours prior to procedure. 8. Have the patient take a bath.

Intraoperative Nursing Interventions 1. Prepare the patient for surgery. 2. Nasogastric tube is inserted through the nose and urinary catheter is inserted to keep the bladder empty. 3. Prepare the incision site aseptically. 4. Provide comfort measures and place in the desired position for the surgery. 5. Maintain quiet, warm and accessible area. 6. Maintain sterility. Post operative Nursing Interventions 1. Monitor vital signs and neuro vital signs every 15 minutes for two hours. 2. Monitor input and output. 3. Assess the operative site for color and amount of wound drainage. 4. Fluids and electrolytes are infused intravenously until the payient s diet can gradually be resumed. 5. Instruct patient how to support the operative site during deep breathing and coughing. 6. Encourage the patient to identify actions and care measures that will promote the patients comfort and relaxation. 7. Monitor the patient bowel patterns.

Prepared by Krishia Cassandra A. Ledesma BSN4A

LUNG CANCER
Description: Lung cancer is a disease that consists of uncontrolled cell growth in tissues of the lung. This growth may lead to metastasis, which is the invasion of adjacent tissue and infiltration beyond the lungs. The vast majority of primary lung cancers are carcinomas, derived from epithelial cells. Lung cancer the most common cause of cancer-related death in men and women. The main types of lung cancer are small-cell lung carcinoma and non-small-cell lung carcinoma. Non-small-cell lung carcinoma (NSCLC) is sometimes treated with surgery, while small-cell lung carcinoma (SCLC) usually responds better to chemotherapy and radiation. The most common cause of lung cancer is long-term exposure to tobacco smoke. Nonsmokers account for 15% of lung cancer cases, and these cases are often attributed to a combination of genetic factors, radon gas, asbestos, and air pollution including secondhand smoke. Risk factors/ etiology The main causes of any cancer include: y y y carcinogens (such as those in tobacco smoke) ionizing radiation viral infection

Signs and symptoms Symptoms that may suggest lung cancer include:
y y y y y y y y y y

dyspnea (shortness of breath) hemoptysis (coughing up blood) chronic coughing or change in regular coughing pattern wheezing chest pain or pain in the abdomen cachexia (weight loss), fatigue, and loss of appetite dysphonia (hoarse voice) clubbing of the fingernails (uncommon) dysphagia (difficulty swallowing). Many of the symptoms of lung cancer (bone pain, fever, and weight loss) are nonspecific

Classification y Non-small-cell lung carcinoma

The non-small-cell lung carcinomas (NSCLC) are grouped together because their prognosis and management are similar. There are three main sub-types: squamous cell lung carcinoma, adenocarcinoma, and large-cell lung carcinoma. y Small-cell lung carcinoma Small-cell lung carcinoma (SCLC) is less common. It was formerly referred to as "oat-cell" carcinoma. Most cases arise in the larger airways (primary and secondary bronchi) and grow rapidly, becoming quite large. Staging Lung cancer staging is an assessment of the degree of spread of the cancer from its original source. It is an important factor affecting the prognosis and potential treatment of lung cancer. Non-small-cell lung carcinoma is staged from IA ("one A"; best prognosis) to IV ("four"; worst prognosis). Small-cell lung carcinoma is classified as limited stage if it is confined to one half of the chest and within the scope of a single radiotherapy field; otherwise, it is extensive stage. Diagnosis y Chest radiograph - is the first step if a patient reports symptoms that may suggest lung cancer. This may reveal an obvious mass, widening of the mediastinum (suggestive of spread to lymph nodes there), atelectasis (collapse), consolidation (pneumonia), or pleural effusion. CT scan - The differential diagnosis for patients who present with abnormalities on chest radiograph includes lung cancer as well as nonmalignant diseases. These include infectious causes such as tuberculosis or pneumonia, or inflammatory conditions such as sarcoidosis.

Treatment Treatment for lung cancer depends on the cancer's specific cell type, how far it has spread, and the patient's performance status. Common treatments include: y Radiotherapy is often given together with chemotherapy, and may be used with curative intent in patients with non-small-cell lung carcinoma who are not eligible for surgery.

y y y y

Chemotherapy The chemotherapy regimen depends on the tumor type. Maintenance therapy In advanced non-small-cell lung cancer there are several approaches for continuing treatment after an initial response to therapy Adjuvant chemotherapy Adjuvant chemotherapy refers to the use of chemotherapy after apparently curative surgery to improve the outcome.

Interventional radiology Radiofrequency ablation should currently be considered an investigational technique in the treatment of bronchogenic carcinoma. It is done by inserting a small heat probe into the tumor to kill the tumor cells. Procedures include : y wedge resection (removal of part of a lobe) y segmentectomy (removal of an anatomic division of a particular lobe of the lung) y lobectomy (one lobe) y bilobectomy (two lobes) y pneumonectomy (whole lung). Pharmacologic interventions
y y y

Expectorants and antimicrobial agents to relieve dyspnea and infection. Analgesics given regularly to maintain pain at tolerable level. Titrate dosages to achieve pain control. Chemotherapy using cisplatin in combination with a variety of other agents and immunotherapy treatments may be indicated.

Nursing interventions 1. Elevate the head of the bed to ease the work of breathing and to prevent fluid collection in upper body (from superior vena cava syndrome). 2. Teach breathing retraining exercises to increase diaphragmatic excursion and reduce work of breathing. 3. Augment the patient s ability to cough effectively by splinting the patient s chest manually. 4. Instruct the patient to inspire fully and cough two to three times in one breath. 5. Provide humidifier or vaporizer to provide moisture to loosen secretions. 6. Fluids are given at a low hourly rate to prevent fluid overloud and pulmonary edema. 7. Teach relaxation techniques to reduce anxiety associated with dyspnea. Allow the severely dyspneic patient to sleep in reclining chair. 8. Encourage the patient to conserve energy by decreasing activities. 9. Ensure adequate protein intake such as milk, eggs, oral nutritional supplements; and chicken, fowl, and fish if other treatments are not tolerated to promote healing and prevent edema. 10. Advise the patient to eat small amounts of high-calorie and high-protein foods frequently, rather than three daily meals.

11. Suggest eating the major meal in the morning if rapid satiety is the problem. 12. Change the diet consistency to soft or liquid if patient has esophagitis from radiation therapy. 13. Consider alternative pain control methods, such as biofeedback and relaxation methods, to increase the patient s sense of control. 14. Teach the patient to use prescribed medications as needed for pain without being overly concerned about addiction. Prevention y Eliminating tobacco smoking y Smoking cessation is an important preventive tool in this process.

Prepared by: Thaira Hernandez Julie Ann Notado BSN4A

BLADDER CANCER
Description Bladder cancer is a disease in which the cells lining the urinary bladder lose the ability to regulate their growth and start dividing uncontrollably. This abnormal growth results in a mass of cells that form a tumor. Etiology y Unknown

Risk factors y y Smoking: Smoking is the single greatestrisk factor for bladder cancer. Smokers have more than twice the risk of developing bladder cancer as nonsmokers. Chemical exposures at work: People who regularly work with certain chemicals or in certain industries have a greater risk of bladder cancer than the general population. Organic chemicals called aromatic amines are particularly linked with bladder cancer. These chemicals are used in the dye industry. Other industries linked to bladder cancer include rubber and leather processing, textiles, hair coloring, paints, and printing. Strict workplace protections can prevent much of the exposure that is believed to cause cancer. Diet: People whose diets include large amounts of fried meats and animal fats are thought to be at higher risk of bladder cancer. Age: Seniors are at the highest risk of developing bladder cancer. Sex: Men are three times more likely than women to have bladder cancer. Race: Whites have a much higher risk of developing bladder cancer than other races. History of bladder cancer: If you have had bladder cancer in the past, your risk of developing another bladder cancer is higher than if you had never had bladder cancer. Chronic bladder inflammation: Frequent bladder infections, bladder stones, and other urinary tract problems that irritate the bladder increase the risk of developing a cancer, more commonly squamous cell carcinoma. Birth defects: Some people are born with a visible or invisible defect that connects their bladder with another organ in the abdomen or leaves the bladder exposed to continual infection. This increases the bladder's vulnerability to cellular abnormalities that can lead to cancer.

y y y y y y

Pathophysiology Carcinogens such as nitrosamines are concentrated and excreted in the urine, thereby exposing them to the cells lining the urinary tract. This exposure is prolonged in the bladder (where 95% of urothelial carcinomas arise) but malignant transformation can arise anywhere in the urinary tract, from the renal calyx to the urethral meatus Multifocal and synchronous tumours occur in 70% of newly diagnosed cases and in >50% of cases may be accompanied by areas of dysplasia up to carcinoma in situ, either in

contiguous or remote areas. Metachronous recurrences occur in >60% of patients, often at sites remote from the primary. These findings led to the concept of a "field effect" in which exposure of the urothelium to carcinogens at roughly the same concentration gives rise to an epithelium, from which occasional cells become initiated and give rise to independent clones of transformed cells. Subsequent promotion may lead to multifocal tumours, which may be synchronous or metachronous. Although the field effect is thought to explain the multifocal nature of bladder cancer, X-chromosome inactivation studies suggest a single cell origin for most tumours. However, both concepts have clinical utility: a point mutation may initiate the process, conferring a growth advantage to cells that later develop the malignant phenotype, perhaps explaining the proximity of new tumours, and the phenomena of cancer cells implanting downstream from upper tract tumours and implanting postresection. Genes participating in chemical detoxification such as glutathione S-transferase M1 and N-acetyltransferase play a role in development of bladder cancer. The first demonstration of an oncogene (ras) in human cells was in a bladder cancer cell line, but ras and other dominant genes are infrequently involved. Loss of heterozygosity in the long arm of chromosome 9 (9q) is common in non-invasive tumours that have a favourable prognosis, while loss of tumour suppressor genes Rb and p53 is associated with invasive tumours and an unfavourable prognosis. Clinical manifestations Symptoms of bladder cancer include: y y y y a burning feeling when passing urine a need to pass urine frequently feeling the need to urinate but not being able to pain in your pelvis blood in urine

Treatment Transurethral resection: The doctor may treat early (superficial) bladder cancer with transurethral resection (TUR). During TUR, the doctor inserts a cystoscope into the bladder through the urethra. The doctor then uses a tool with a small wire loop on the end to remove the cancer and to burn away any remaining cancer cells with an electric current. (This is called fulguration.) The patient may need to be in the hospital and may need anesthesia. After TUR, patients may also have chemotherapy or biological therapy.

Radical cystectomy: For invasive bladder cancer, the most common type of surgery is radical cystectomy. The doctor also chooses this type of surgery when superficial cancer involves a large part of the bladder. Radical cystectomy is the removal of the entire bladder, the nearby lymph nodes, part of the urethra, and the nearby organs that may contain cancer cells. In men, the nearby organs that are removed are the prostate, seminal vesicles, and part of the vas deferens. In women, the uterus, ovaries, fallopian tubes, and part of the vagina are removed. Segmental cystectomy: In some cases, the doctor may remove only part of the bladder in a procedure called segmental cystectomy. The doctor chooses this type of surgery when a patient has a lowgrade cancer that has invaded the bladder wall in just one area. Sometimes, when the cancer has spread outside the bladder and cannot be completely removed, the surgeon removes the bladder but does not try to get rid of all the cancer. Or, the surgeon does not remove the bladder but makes another way for urine to leave the body. The goal of the surgery may be to relieve urinary blockage or other symptoms caused by the cancer. When the entire bladder is removed, the surgeon makes another way to collect urine. The patient may wear a bag outside the body, or the surgeon may create a pouch inside the body with part of the intestine. Radiation therapy: (also called radiotherapy) uses high-energy rays to kill cancer cells. Like surgery, radiation therapy is local therapy. It affects cancer cells only in the treated area. A small number of patients may have radiation therapy before surgery to shrink the tumor. Others may have it after surgery to kill cancer cells that may remain in the area. Sometimes, patients who cannot have surgery have radiation therapy instead. 2 types of radiation therapy: 1. External radiation: A large machine outside the body aims radiation at the tumor area. Most people receiving external radiation are treated 5 days a week for 5 to 7 weeks as an outpatient. This schedule helps protect healthy cells and tissues by spreading out the total dose of radiation. Treatment may be shorter when external radiation is given along with radiation implants. 2. Internal radiation: The doctor places a small container of a radioactive substance into the bladder through the urethra or through an incision in the abdomen. The patient stays in the hospital for several days during this treatment. To protect others from radiation exposure, patients may not be able to have visitors or may have visitors for

only a short period of time while the implant is in place. Once the implant is removed, no radioactivity is left in the body. Some patients with bladder cancer receive both kinds of radiation therapy Chemotherapy y Uses drugs to kill cancer cells. The doctor may use one drug or a combination of drugs.

For patients with superficial bladder cancer, the doctor may use intravesical chemotherapy after removing the cancer with TUR. This is local therapy. The doctor inserts a tube (catheter) through the urethra and puts liquid drugs in the bladder through the catheter. The drugs remain in the bladder for several hours. They mainly affect the cells in the bladder. Usually, the patient has this treatment once a week for several weeks. Sometimes, the treatments continue once or several times a month for up to a year. If the cancer has deeply invaded the bladder or spread to lymph nodes or other organs, the doctor may give drugs through a vein. This treatment is called intravenous chemotherapy. It is systemic therapy, meaning that the drugs flow through the bloodstream to nearly every part of the body. The drugs are usually given in cycles so that a recovery period follows every treatment period. The patient may have chemotherapy alone or combined with surgery, radiation therapy, or both. Usually chemotherapy is an outpatient treatment given at the hospital, clinic, or at the doctor's office. However, depending on which drugs are given and the patient's general health, the patient may need a short hospital stay. Biological therapy: (also called immunotherapy) uses the body's natural ability (immune system) to fight cancer. Biological therapy is most often used after TUR for superficial bladder cancer. This helps prevent the cancer from coming back. The doctor may use intravesical biological therapy with BCG solution. BCG solution contains live, weakened bacteria. The bacteria stimulate the immune system to kill cancer cells in the bladder. The doctor uses a catheter to put the solution in the bladder. The patient must hold the solution in the bladder for about 2 hours. BCG treatment is usually done once a week for 6 weeks. Nursing interventions 1. 2. 3. 4. Encourage the patient to express feelings and concerns about the extent of the cancer. To relieve discomfort administer ordered analgesics for pain as necessary. Implement comfort measures and provide distractions that will enable the patient to relax. As appropriate, implement measures to prevent or alleviate complications of treatment.

5. Monitor the patient s intake and output. Question him regularly about changes in his urine elimination pattern to detect changes in his condition. 6. Observe the patient s urine for signs of hematuria (reddish tint to gross bloodiness). 7. Monitor the patient s laboratory tests, such as changes in white blood cell differential, indicating possible bone marrow suppression from chemotherapy. 8. If the patient is being given intravesical chemotherapy, watch closely for myelosuppression, chemical cystitis, and skin rash. 9. Instruct the patient and the family about the types of treatment that are being planned for him. 10. Teach the patient and family to recognize and to manage adverse effects of chemotherapy. 11. Stress the importance of notifying the doctor if the patient develops signs and symptoms of urinary tract infection or other sudden changes in his condition.

Prepared by: Mary Rose Pantua BSN 4A

LYMPHOMA
Description Lymphoma is a cancer of certain types of white blood cells (WBCs) called lymphocytes. These cells circulate throughout the body in the blood stream and in the lymphatic system, which is part of the body s immune system. There are several different types of lymphocytes, the major types being the B-lymphocyte and the T-lymphocyte.

Types of Lymphoma y Hodgkin s Lymphoma (Hodgkin s Disease) - is a type of lymphoma, which is a cancer originating from white blood cells called lymphocytes. It was named after Thomas Hodgkin, who first described abnormalities in the lymph system in 1832. Hodgkin's lymphoma is characterized by the orderly spread of disease from one lymph node group to another and by the development of systemic symptoms with advanced disease. When Hodgkins cells are examined microscopically, multinucleated Reed-Sternberg cells (RS cells) are the characteristic histopathologic finding. y Non-Hodgkin s Lymphoma - is a malignancy of the B-lymphocyte and T-lymphocyte cell lines. Abnormal lymphocytes accumulate and form masses in lymph tissue such as the lymph nodes, spleen, or other organs. Malignant lymphocytes travel through the circulation to distant sites. Common extranodal sites include the lungs, liver, gastrointestinal tract, meninges, skin, and bones. Most clients with nonHodgkin s lymphoma fall into two broad categories related to their clinical features: the nodular indolent type, and the diffuse, aggressive lymphomas. Malignant lymphocytes accumulate in lymph nodes. If the normal follicular structure of the nodes remains intact, the lymphoma is called follicular or nodular. When malignant cells destroy the follicles, the lymphoma is considered diffuse. Etiology/Causes y Unknown or multifactorial (idiopathic)

Risk Factors y y Sex: male Ages: 15 40 and over 55

y y y y y

Family history History of infectious mononucleosis or infection with Epstein-Barr virus, a causative agent of mononucleosis Weakened immune system, including infection with HIV or the presence of AIDS Prolonged use of human growth hormone Exposure to exotoxins, such as Agent Orange

Pathophysiology y Hodgkin s Lymphoma (Hodgkin s Disease)

Non-Hodgkin s Lymphoma

Etiology -unknown (idiopathic) -Studies reveal that individuals who have a weak immune system (such as autoimmune disorder), or suffering from certain types of infections (such as Human immunodeficiency virus, HIV) are at higher risk of developing non-Hodgkin's lymphoma. Although non-Hodgkin's lymphoma can occur in young people, the chances of developing this disease go up with age. Most people with non-Hodgkin's lymphoma are older than 60 years of age. Clinical Manifestations Hodgkin's lymphoma may present with the following symptoms:
y y y y

y y y y

Itchy Skin Night sweats Unexplained weight loss Lymph nodes: the most common symptom of Hodgkin's is the painless enlargement of one or more lymph nodes. The nodes may also feel rubbery and swollen when examined. The nodes of the neck and shoulders (cervical and supraclavicular) are most frequently involved (80 90% of the time, on average). The lymph nodes of the chest are often affected, and these may be noticed on a chest radiograph. Splenomegaly: enlargement of the spleen occurs in about 30% of people with Hodgkin's lymphoma. The enlargement, however, is seldom massive and the size of the spleen may fluctuate during the course of treatment. Hepatomegaly: enlargement of the liver, due to liver involvement, is present in about 5% of cases. Hepatosplenomegaly: the enlargement of both the liver and spleen caused by the same disease. Pain following alcohol consumption: classically, involved nodes are painful after alcohol consumption, though this phenomenon is very uncommon. Back pain: nonspecific back pain (pain that cannot be localized or its cause determined by examination or scanning techniques) has been reported in some cases of Hodgkin's lymphoma. The lower back is most often affected. Red-coloured patches on the skin, easy bleeding and petechiae due to low platelet count (as a result of bone marrow infiltration, increased trapping in the spleen etc. i.e. decreased production, increased removal) Systemic symptoms: about one-third of patients with Hodgkin's disease may also present with systemic symptoms, including low-grade fever; night sweats; unexplained weight loss of at least 10% of the patient's total body mass in six months or less, itchy skin (pruritus) due to increased levels of eosinophils in the bloodstream; or fatigue (lassitude). Systemic symptoms such as fever, night sweats, and weight loss are known as B symptoms; thus,

presence of fever, weight loss, and night sweats indicate that the patient's stage is, for example, 2B instead of 2A. Cyclical fever: patients may also present with a cyclical high-grade fever known as the PelEbstein fever, or more simply "P-E fever". However, there is debate as to whether or not the P-E fever truly exists.

Non-Hodgkin s lymphoma can cause many symptoms:

y y y y y y y

Swollen, painless lymph nodes in the neck, armpits, or groin Unexplained weight loss Fever Soaking night sweats Coughing, trouble breathing, or chest pain Weakness and tiredness that don t go away Pain, swelling, or a feeling of fullness in the abdomen

Most often, these symptoms are not due to cancer. Other health problems can cause some of these symptoms. Anyone with such symptoms should see a doctor to be diagnosed and treated as early as possible. Laboratory Tests
y

y y y

y y

Complete Blood Count (CBC) - may be ordered to rule out non-lymphoma conditions (such as leukemia) and/or to see if anemia or low platelet and/or white blood cells counts are present, which may indicate that lymphoma is present in the bone marrow. Bone marrow biopsy and examination to evaluate the cells present in the bone marrow. Blood smear to evaluate the quality of red and white blood cells and platelets Immunophenotyping can identify the cells involved by testing for the presence or absence of surface markers on the membrane of the cells. These markers are called clusters of differentiation (CD) and are listed numerically. By developing a list of the CDs present on the cells, it is possible to classify the cells. This test can be done by several different methods, including flow cytometry and immunohistochemistry. Cytogenetics an evaluation of the chromosomes in the nucleus of cancer cells to determine if pieces of the chromosomes have moved (translocation). Molecular genetic analysis evaluating the cancer cell s DNA for genetic changes.

Non-Laboratory Tests Primarily used to help stage and monitor lymphoma. They include:
y y y y y

Physical examination Computed tomography (CT) scans Positron emission tomography (PET) scan Chest X-ray Exploratory surgery (occasionally necessary)

Magnetic Resonance Imaging (MRI)

Staging Staging of Hodgkin s Lymphoma (HD) & Non-Hodgkin s Lymphoma

y

y y

Stage I: The lymphoma cells are in a single lymph node group (such as in the neck or underarm). Or, if the abnormal cells are not in the lymph nodes, they are in only one part of a tissue or organ (such as the lung, but not the liver or bone-marrow). Stage II: The lymphoma cells are in at least two lymph node groups on the same side of (either above or below) the diaphragm. Or, the lymphoma cells are in an organ and the lymph nodes near that organ (on the same side of the diaphragm). There may be lymphoma cells in other lymph node groups on the same side of the diaphragm. Stage III: The lymphoma is in groups of lymph nodes above and below the diaphragm. It also may be found in an organ or tissue near these lymph node groups. Stage IV: The lymphoma is throughout at least one organ or tissue (in addition to the lymph nodes). Or, it is in the liver, blood, or bone-marrow.

Treatments y Chemotherapy

Chemotherapy uses drugs to kill cancer cells. It is called systemic therapy because the drugs travel through the bloodstream. The drugs can reach cancer cells in almost all parts of the body. You may receive chemotherapy by mouth, through a vein, or in the space around the spinal cord. Treatment is usually as an outpatient in the hospital/clinic or at home. Some patients need to stay in the hospital during treatment for close observation. If a patient has lymphoma in the stomach caused by Helicobactor infection, the doctor may treat this lymphoma with antibiotics. When the infection is cured, the cancer may resolve. y Biological Therapy

People with certain types of non-Hodgkin's lymphoma may have biological therapy to boost the immune system to fight cancer effectively. Monoclonal antibodies are used for lymphoma. They are proteins that can bind to cancer cells to help the immune system kill lymphoma cells. Patients receive this treatment through a vein at the doctor's clinic or hospital.

Radiation Therapy

Radiation therapy (also called radiotherapy) uses high-energy rays to kill non-Hodgkin's lymphoma cells. It can shrink tumors and help control pain. Two types of radiation therapy are used for people with lymphoma:
 External radiation: A large machine aims the rays at the part of the body where lymphoma cells have collected. This is local therapy because it affects cells in the treated area only. Most people go to a hospital or clinic for treatment 5 days a week for several weeks.

 Systemic radiation: Some people with lymphoma receive an injection of radioactive material that travels throughout the body. The radioactive material is bound to antibodies that target and destroy lymphoma cells. y Stem Cell Transplantation receive stem cell transplantation. A transplant of to receive high doses of chemotherapy, radiation both lymphoma cells and healthy blood cells in the healthy blood-forming stem cells through a flexible or chest area. New blood cells develop from the

A person with recurrent lymphoma may blood-forming stem cell allows a person therapy, or both. The high doses destroy bone marrow. Later, the patient receives tube placed in a large vein in the neck transplanted stem cells.

Stem cell transplants take place in the hospital. The stem cells may come from the patient or from a donor. Nursing Considerations/Interventions y Assess your patient's ability to adjust to his diagnosis. Encourage him to discuss his concerns about treatment and prognosis. y Teach him about HL and NHL, its treatments, and its complications. Tell him that one of the chemotherapy drugs, doxorubicin, may cause his urine to become red for 24 hours after treatment. He may develop nausea and vomiting, "pins and needles" in his fingers and toes, constipation, diarrhea, and sores in his mouth. His hair may fall out but should grow back after therapy is done. y Assess your patient for nausea and vomiting; administer antiemetics and monitor their effectiveness. Notify the physician of uncontrolled vomiting, dehydration, or fluid and electrolyte imbalances. Teach your patient how to use antiemetics at home, and stress the importance of preventing dehydration. y To assess for bone marrow depression caused by chemotherapy, check his complete blood cell count results. Monitor for melena or occult blood in his stools, hematuria, and blood oozing from his mucous membranes. Also monitor for signs of infection, such as cough, fever, chills, and dysuria; notify the physician of abnormalities. Obtain specimens for culture and

sensitivity testing; administer prescribed antibiotics, blood products, and acetaminophen (to reduce fever). y Assess your patient's mouth for infection and mucositis. Encourage him to use a soft toothbrush and gentle, nonabrasive toothpaste. If his oral tissue bleeds or his platelet count is less than SO,OOO/mm3, teach him to use foam swabs for oral care. y If neuropathy causes your patient to develop constipation, teach him to use oral laxatives and stool softeners. However, he should avoid enemas, which can traumatize tissue and cause infection. y If he develops diarrhea, encourage him to drink plenty of potassium-rich foods. Cleanse his rectal area with soap and water after each loose stool and apply protective cream. y Teach your patient how to recognize signs of problems: If he becomes pale, bruises easily, or develops a fever, he should notify his physician immediately. To prevent infection, he should avoid crowds and people who are ill.

Prepared by: Agatha Alison D. Palafox BSN 4A

ENDOMETRIAL (UTERINE) CANCER

Description Endometrial cancer occurs when cells of the endometrium undergo a transformation and begin to grow and multiply without the control mechanisms that normally limit their growth. As the cells grow and multiply, they form a mass called a tumor. Cancer is dangerous because it overwhelms healthy cells by taking their space and the oxygen and nutrients they need to survive and function. Two main types of endometrial cancers: 1. endometrial adenocarcinomas - originate from glandular (secreting) tissue. 2. uterine sarcomas - originates in the connective tissue or muscle of the uterus Etiology and Risk Factors The exact cause of endometrial carcinoma remains unknown, although several risk factors have been identified. Possessing one of these risk factors does not mean that a woman will develop endometrial cancer but rather that her risk of developing endometrial cancer is higher than that of another woman without the risk factor. Risk factors for endometrial cancer include the following:
y

y y

Obesity: Women who are more than 50 pounds over ideal weight have a 10-times greater risk of developing endometrial cancer than women of ideal weight. Body fat produces estrogen, and women with excess fat have a higher level of estrogen than women without excess fat. The higher level of estrogen is believed to increase the risk of cancer. No pregnancies: Women who have never been pregnant have a two- to three-times higher risk than women who have been pregnant. Early puberty: Women who begin their periods before 12 years of age are at an increased risk. Early puberty increases the number of years that the endometrium is exposed to estrogen. Late menopause: Women who go through menopause after 52 years of age are at a higher risk of developing endometrial cancer than women who go through menopause earlier in life. Like early puberty, late menopause increases the number of years that the endometrium is exposed to estrogen. Treatment with unopposed estrogen: The risk of developing endometrial cancer is increased by several times in women who take estrogen replacement therapy without added progesterone. High level of estrogen: Women who have a high level of unopposed estrogen in the body are also at an increased risk. Several different conditions, such as polycystic ovarian disease, can cause a woman to have a high unopposed estrogen level.

y y

Treatment with tamoxifen: Women who have been treated with tamoxifen, a drug used to prevent and treat breast cancer, may have a slightly increased risk of developing endometrial cancer. Other cancers: Cancers of the breast, ovary, and colon are linked with an increased risk of endometrial cancer. Family history: Women who have a close relative with endometrial cancer have an increased risk of the disease.

The use of combination oral contraceptives (birth control pills) decreases the risk of developing endometrial cancer.
y y y

Women who use oral contraceptives at some time have half the risk of developing endometrial cancer as women who have never used oral contraceptives. This protection occurs in women who have used oral contraceptives for at least 12 months. The protection continues for at least 10 years after oral contraceptive use. The protection is most notable for women who have never been pregnant.

Clinical manifestations The most common symptom of endometrial carcinoma is abnormal bleeding from the vagina.
y y

In women who have been through menopause, any vaginal bleeding is abnormal and should be evaluated by a doctor. In women who have not been through menopause or who are currently going through menopause, distinguishing normal menstrual bleeding from abnormal bleeding may be difficult. A heavier or more frequent period or bleeding between periods is sometimes linked to cancer in menstruating women. During the transient period of going through menopause, the menstrual period should become shorter and shorter and the frequency should become farther apart. Any other bleeding should be reported to a doctor.

The following symptoms are much less common and usually indicate fairly advanced cancer:
y y y

Pelvic pain Mass (swelling or lump) in the pelvic area Weight loss

Seek Medical Care y y y If a woman noticed abnormal bleeding during menstruation (heavier or more frequent) If a woman is having more than slight spotting between periods Changes in bleeding or abnormal bleeding can have many different causes. Knowing the cause of a woman's bleeding is important

Endometrial Cancer Diagnosis If a woman is having abnormal vaginal bleeding or other symptoms, the evaluation starts with a detailed interview. It includes: y y y y medical history and any current conditions family's medical history menstrual and pregnancy history habits and lifestyle

This information helps the health-care provider determine the cause of the symptoms. The interview is followed by a physical examination, including a pelvic examination. If a health-care provider suspects uterine cancer, he or she might refer the woman to a specialist in cancers of the female genital tract (gynecologic oncologist). Lab tests No blood or imaging studies can confirm the diagnosis of endometrial carcinoma. Lab tests may be performed after endometrial cancer is diagnosed to ensure that a woman is able to undergo treatment and also to monitor treatment progress.
y

Tumor markers: A woman's blood may be checked for a tumor marker known as CA 125. This marker is commonly elevated in patients with ovarian cancer; however, this marker is nonspecific for endometrial cancer. CA 125 is released into the bloodstream by some ovarian and uterine tumors. A very high level of CA 125 sometimes indicates that a cancer has spread from the endometrium to other parts of the body. If a woman's blood has a high level of CA 125 at the time that her cancer is diagnosed, this marker will be checked periodically as a measure of how well the treatment is working. For example, after the uterus and tumor are surgically removed, the tumor marker level may decrease dramatically. Routine blood tests: Tests of blood chemistry, liver and kidney functions, and blood cell counts are done to check a woman's overall health and her ability to tolerate surgery and other therapy.

Imaging studies
y

Vaginal (transvaginal) ultrasound: Ultrasound is a technique that uses sound waves to take a picture of the internal organs. Ultrasound is the same technique used to look at a fetus in the uterus. To perform a vaginal (transvaginal) ultrasound, a small device called a transducer is inserted into the vagina. The device emits sound waves, which bounce off the pelvic organs and transmit a picture to a video monitor. Often, the examiner moves the transducer around slightly to get a better picture. A vaginal (transvaginal) ultrasound is safe and painless.

Hydroultrasound: Hydroultrasound is similar to vaginal (transvaginal) ultrasound, but a saline (saltwater) solution is first injected into the uterus to extend the uterine walls. This procedure can improve the picture in some cases and show the uterus in greater detail.

Ultrasound often can reveal a uterine tumor, but the findings are not always conclusive. Other imaging tests may be needed and might include the following:
y y y y

A CT scan of the pelvis would be the usual choice of a follow-up imaging test. A CT scan is like an X-ray film but shows greater detail in two dimensions. An MRI of the pelvis is another choice of a follow-up imaging test. An MRI shows great detail in three dimensions. A chest X-ray may be needed if metastasis to the lungs is suspected. A bone scan may be needed if metastasis to the bones is suspected.

Diagnostic tests
y

Endometrial biopsy: If cancer is suspected, a sample of the endometrium is obtained through a biopsy. A biopsy is the removal of a very tiny piece of tissue from the body. The tissue is examined under a microscope for abnormalities that suggest cancer. Usually, a gynecologist or a gynecologic oncologist performs the biopsy, and the endometrial tissue is examined by a pathologist (a doctor who specializes in diagnosing diseases in this way). The most widely used method for obtaining the endometrial tissue is to insert a thin tube into the endometrium through the cervix. A biopsy is usually performed in the doctor's office and takes just a few minutes. Often, the results of an endometrial biopsy give a definitive answer about cancer. Dilation and curettage: If the results of the endometrial biopsy are not conclusive, a procedure called a dilation and curettage (D&C) may be performed. In a D&C, the doctor passes a thin instrument through the dilated cervix and scrapes tissue from the endometrium. The tissue is removed and examined by a pathologist. This procedure is usually performed as outpatient surgery and requires general anesthesia or sedation. Most women have minimal discomfort after this procedure and require a short recovery time. Hysteroscopy: Sometimes, an endoscope is used to guide the endometrial biopsy or D&C. An endoscope is a thin tube with a tiny light and camera at the end. The tube is inserted into the uterus through the cervix. The endoscope sends pictures of the endometrium back to a video monitor. A hysteroscopy allows the doctor to view the inside of the uterus while collecting endometrial tissue samples.

Staging In endometrial cancer, staging is based on how far the primary tumor has spread, if at all. The staging system used for endometrial cancer was developed by the International Federation of Gynecology and Obstetrics (FIGO). The staging system for endometrial cancer is a surgical staging system, meaning that staging is based on the pathologist's findings on examining organs removed during surgery. The FIGO system uses four stages. Stage I: The tumor is limited to the corpus (upper part) of the uterus and has not spread to the surrounding lymph nodes or other organs.
y y

Stage IA: Tumor limited to the endometrium or less than one half the myometrium Stage IB: Invasion equal to or more than one half the myometrium (middle layer of the uterine wall)

Stage II: Invasion of the cervical stroma but does not extend beyond the uterus (strong supportive connective tissue of the cervix) Stage IIIA: Invasion of the serosa (outermost layer of the myometrium) and/or the adnexa (the ovaries or fallopian tubes) Stage IIIB: Invasion of the vagina and/or parametrial involvement Stage IIIC1: Cancer has spread to the pelvic lymph nodes but not to distant organs Stage IIIC2: Cancer has spread to the paraaortic lymph nodes with or without positive pelvic lymph nodes but not to distant organs Stage IV: The cancer has spread to the inside (mucosa) of the bladder or the rectum (lower part of the large intestine) and/or to the inguinal lymph nodes and/or to the bones or distant organs outside the pelvis, such as the lungs. y y Stage IVA: Tumor invasion of the bladder, the bowel mucosa, or both Stage IVB: Metastasis to distant organs, including intra-abdominal metastasis, and/or inguinal lymph nodes

The tumor grade is also defined during the staging process. Grade indicates the aggressiveness of the cancer. Generally, low-grade tumors are less likely to metastasize or recur after treatment.

Endometrial Cancer Treatment The treatment of endometrial cancer varies depending on the stage of the cancer. Staging is based on the findings from the initial surgery, which involves the removal of the entire uterus and cervix (total abdominal hysterectomy), the fallopian tubes, and the ovaries. These organs are examined to determine the extent of the cancer (staging). During this operation, cells are collected from the peritoneal cavity and tested for cancer. Usually, the lymph nodes in the pelvis and surrounding areas are removed and examined for cancer. Only then is a decision made about treatment. Medical Treatment Surgery is the main therapy for endometrial cancer. Other options include the following therapies:
y

Radiation therapy: Radiation therapy uses high-energy radiation (like X-rays) to kill cancer cells. The radiation can be given as a beam from a machine outside the body (external beam radiation) or from a tiny source placed inside the body near the cancer (brachytherapy). Radiation may be used for stages II, III, and IV, although the decision to use radiation is based on the extent of disease. Radiation therapy is usually given after surgery to kill any cancer cells remaining in the body. Radiation is also a substitute for surgery in women who cannot undergo surgery because of other medical problems. The main side effects of radiation therapy are fatigue, diarrhea, and frequency of and burning on urination as well as a local skin reaction at the site of radiation therapy. Chemotherapy: Chemotherapy uses potent drugs to kill cancer cells. The advantage of chemotherapy is that it can attack cancer cells anywhere in the body. The main disadvantage of chemotherapy is the side effects that may include nausea, hair loss, fatigue, anemia, increased susceptibility to infection, and damage to organs, such as the kidneys. Chemotherapy is mainly used for advanced endometrial cancer. Although chemotherapy does induce remission in some women, their cancers often return. Hormone therapy: Hormone therapy is the use of hormones to fight cancer cells. Hormone therapy is generally used in only advanced and metastatic endometrial cancer.

Medications Carboplatin (Paraplatin) is given alone or in combination with other chemotherapy drugs. Other drugs used to treat endometrial cancer are paclitaxel (Taxol), cyclophosphamide (Cytoxan), and doxorubicin (Adriamycin PFS).

Surgery The most widely used operation for the treatment of endometrial carcinoma is total abdominal hysterectomy. Total abdominal hysterectomy is the removal of the uterus (including the cervix). The fallopian tubes and the ovaries are also removed. Often, the surgery entails the removal of the lymph nodes (lymphadenectomy) in the pelvic and paraaortic areas. Nursing interventions Preoperative nursing interventions o Relieving anxiety  Prior to surgery, the patient must be allowed time to talk and ask questions  Nurse reinforces the information the physician has given to the patient and addresses the patient s questions and concerns. o Preparing skin for surgery  Skin preparation may include cleansing the lower abdomen, inguinal areas, upper thighs and vulva with a detergent germicide for several days before the surgical procedure. Postoperative nursing interventions o Relieving pain  Analgesic agents are administered preventively to relieve pain, increase the patient s comfort level, and allow mobility.  Patient- controlled analgesia may be used to relieve pain and promote patient comfort.  Careful positioning using pillows usually increases comfort, as do soothing back rubs.  A low Fowler s position or , occasionally, a pillow placed under the knees reduces pain by relieving tension on the incision , however, efforts must be made to avoid pressure behind the knees, which increases the risk of DVT.  Positioning the patient on her side , with pillows between her legs and against the lumbar region, provides comfort and reduces tension on the surgical wound. o Improving skin integrity  A pressure- reducing mattress may be used to prevent pressure ulcers.  Moving from one position to another position requires time and effort, use of an overbed trapeze bar may help the patient move herself more easily.  Ambulation may be attempted on the second day.  Dressing is changed as needed to ensure patient comfort, to perform wound care and irrigation and to permit observations of the surgical site.  Wound is usually cleansed daily with warm, normal saline irrigations or other antiseptic solutions as prescribed, or a transparent dressing may be in place over the wound to minimize exposure to the air and subsequent pain.

Assess and document the appearance of the surgical site and the characteristic of the drainage. o Supporting positive sexuality and sexual function  Establishing a trusting nurse-patient relationship is important for the patient to feel comfortable expressing her concerns with her sexual partner.  The nurse needs to know about any structural and functional changes resulting from the surgery.  Referral of the patient and her partner to a sex counselor may help them address these changes and resume satisfying sexual activity. o Monitoring and managing potential complications  Patient is monitored closely for local and systemic signs and symptoms of infection: purulent drainage, redness, increased pain, fever and increased white blood cell count.  The nurse assist in obtaining specimens for culture if infection is suspected and administers antibiotic agents as prescribed.  Hand hygiene is of particular importance along with wearing masks whenever there is extensive area of exposed tissue. Catheters, drains, and dressings are handled carefully with gloves on to avoid cross- contamination.  A low residue diet prevents straining on defecation and wound contamination.  Anti-embolism stockings are applied, and the patient is encouraged and reminded to perform ankle exercises to minimize venous pooling , which leads to DVT.  Prevention The best way to avoid endometrial carcinoma is to avoid the risk factors. To avoid risk factors, a woman should take the following steps:
y y y

Maintain a healthy weight by eating a moderate, nutrition-rich diet and exercising regularly. Consider taking birth-control pills if warranted by her situation and medical condition. Avoid treatment with unopposed estrogens.

Some risk factors cannot be avoided. For example, neither a previous cancer of the breast, colon, or ovaries nor a family history of these cancers can be avoided. Early puberty and late menopause are part of a person's genetic makeup and cannot be changed. Being vigilant to catch endometrial and other genital cancers early is something that can be controlled. A woman should not be afraid or ashamed to go to her health-care provider about abnormal bleeding or other unusual symptoms involving her genital tract. Putting off seeing a health-care provider prevents early diagnosis and treatment that, in turn, could prevent serious complications or even death.

Endometrial Cancer Prognosis Generally, the lower the stage (that is, the more local the cancer), the better the outlook. The pathologist's findings also affect the prognosis. After a woman's staging surgery, her doctor will discuss the specifics of the cancer with her. Fortunately, most women who have endometrial cancer are cured.

Prepared by: Micky A. Sola BSN 4A

LEUKEMIA
Description: y y y y Leukemia is a neoplastic proliferation of one particular cell type. Came from a greek word Leukos which means white and haima which stands for blood Is a type of cancer of the blood or bone marrow characterized by an abnormal increase of white blood cells. People with leukemia are at significantly increased risk for developing infections, anemia, and bleeding. Other symptoms and signs include easy bruising, weight loss,night sweats, and unexplained fevers.

FOUR MAIN TYPES OF LEUKEMIA 1. Acute lymphocytic leukemia (ALL) a. affects lymphoid cells and grows quickly. It accounts for more than 5,000 new cases of leukemia each year. ALL is the most common type of leukemia in young children. It also affects adults. 2. Chronic lymphocytic leukemia (CLL) a. affects lymphoid cells and usually grows slowly. It accounts for more than 15,000 new cases of leukemia each year. Most often, people diagnosed with the disease are over age 55. It almost never affects children. 3. Acute myeloid leukemia (AML) a. affects myeloid cells and grows quickly. It accounts for more than 13,000 new cases of leukemia each year. It occurs in both adults and children. 4. Chronic myeloid leukemia (CML) a. affects myeloid cells and usually grows slowly at first. It accounts for nearly 5,000 new cases of leukemia each year. It mainly affects adults. Risk Factors
y

Radiation: People exposed to very high levels of radiation are much more likely than others to get acute myeloid leukemia, chronic myeloid leukemia, or acute lymphocytic leukemia. o Atomic bomb explosions: Very high levels of radiation have been caused by atomic bomb explosions (such as those in Japan during World War II). People, especially children, who survive atomic bomb explosions, are at increased risk of leukemia. o Radiation therapy: Another source of exposure to high levels of radiation is medical treatment for cancer and other conditions. Radiation therapy can increase the risk of leukemia. o Diagnostic x-rays: Dental x-rays and other diagnostic x-rays (such as CT scans) expose people to much lower levels of radiation. It's not known yet whether this low level of radiation to children or adults is linked to leukemia. Researchers are studying whether having many x-rays may increase the risk of leukemia. They

o o

o o o

are also studying whether CT scans during childhood are linked with increased risk of developing leukemia. Smoking: Smoking cigarettes increases the risk of acute myeloid leukemia. Benzene: Exposure to benzene in the workplace can cause acute myeloid leukemia. It may also cause chronic myeloid leukemia or acute lymphocytic leukemia. Benzene is used widely in the chemical industry. It's also found in cigarette smoke and gasoline. Chemotherapy: Cancer patients treated with certain types of cancer-fighting drugs sometimes later get acute myeloid leukemia or acute lymphocytic leukemia. For example, being treated with drugs known as alkylating agents or topoisomerase inhibitors is linked with a small chance of later developing acute leukemia. Down syndrome and certain other inherited diseases: Down syndrome and certain other inherited diseases increase the risk of developing acute leukemia. Myelodysplastic syndrome and certain other blood disorders: People with certain blood disorders are at increased risk of acute myeloid leukemia. Human T-cell leukemia virus type I (HTLV-I): People with HTLV-I infection are at increased risk of a rare type of leukemia known as adult T-cell leukemia. Although the HTLV-I virus may cause this rare disease, adult T-cell leukemia and other types of leukemia are not contagious. Family history of leukemia: It's rare for more than one person in a family to have leukemia. When it does happen, it's most likely to involve chronic lymphocytic leukemia. However, only a few people with chronic lymphocytic leukemia have a father, mother, brother, sister, or child who also has the disease

Clinical Manifestation
y y y y y y y y

Swollen lymph nodes that usually don't hurt (especially lymph nodes in the neck or armpit) Fevers or night sweats Frequent infections Feeling weak or tired Bleeding and bruising easily (bleeding gums, purplish patches in the skin, or tiny red spots under the skin) Swelling or discomfort in the abdomen (from a swollen spleen or liver) Weight loss for no known reason Pain in the bones or joints

Diagnostic tests
y y

Physical exam: Your doctor checks for swollen lymph nodes, spleen, or liver. Blood tests: The lab does a complete blood count to check the number of white blood cells, red blood cells, and platelets. Leukemia causes a very high level of white blood cells. It may also cause low levels of platelets and hemoglobin, which is found inside red blood cells. Biopsy: Your doctor removes tissue to look for cancer cells. A biopsy is the only sure way to know whether leukemia cells are in your bone marrow. Before the sample is taken, local anesthesia is used to numb the area. This helps reduce the pain. Your doctor removes some bone marrow from your hipbone or another large bone. A pathologist uses a microscope to check the tissue for leukemia cells. There are two ways your doctor can obtain bone marrow. Some people will have both procedures during the same visit: o Bone marrow aspiration: The doctor uses a thick, hollow needle to remove samples of bone marrow. o Bone marrow biopsy: The doctor uses a very thick, hollow needle to remove a small piece of bone and bone marrow.

Cytogenetics: The lab looks at the chromosomes of cells from samples of blood, bone marrow, or lymph nodes. If abnormal chromosomes are found, the test can show what type of leukemia you have. For example, people with CML have an abnormal chromosome called the Philadelphia chromosome. Spinal tap: Your doctor may remove some of the cerebrospinal fluid (the fluid that fills the spaces in and around the brain and spinal cord). The doctor uses a long, thin needle to remove fluid from the lower spine. The procedure takes about 30 minutes and is performed with local anesthesia. You must lie flat for several hours afterward to keep from getting a headache. The lab checks the fluid for leukemia cells or other signs of problems. Chest x-ray: An x-ray can show swollen lymph nodes or other signs of disease in your chest.

Medical Management Treatment of leukemia depends on the type of leukemia, certain features of the leukemia cells, the extent of the disease, and prior history of treatment, as well as the age and health of the patient. chemotherapy to kill leukemia cells using strong anti-cancer drugs interferon therapy to slow the reproduction of LEUKEMIA cells and promote the immune system's anti-leukemia activity radiation therapy to kill cancer cells by exposure to high-energy radiation stem cell transplantation (SCT) to enable treatment with high doses of chemotherapy and radiation therapy

Nursing Interventions Control bleeding Improving nutritional intake Mouth care before and after meals Administration of analgesics before meals can increase intake Small frequent feedings of food Low microbial diets Daily body weight measurement Parental nutrition is often required to maintain adequate nutrition Easing pain and discomfort Acetaminophen is typically given for fever Sponging w/cool water may be useful Gentle back and shoulder massage may provide comfort Provide adequate sleep Decreasing fatigue Assisting the pt. to establish balance between rest and activity Maintain physical activity and exercise Pt. should be encouraged to sit up in a chair while awake rather than staying in bed Physical therapy Maintaining fluid and electrolyte balance Intake and output measurement Daily weights Assess for signs of dehydration Laboratory test (BUN, Creatinine, Hematocrit) Replacement of electrolytes( K & Mg) Improving self-care Assist the patient in providing physical hygiene Managing anxiety and grief

Prepared by Rhea L. Sola BSN4A

BONE MARROW CANCER

Description Bone marrow is the soft, spongy tissue in the center of most bones. It contains bloodforming immature cells called stem cells. Stem cells can develop into red blood cells (which carry oxygen through your body), white blood cells (which fight infection) and platelets (which help with blood clotting). When cancer forms in the blood-forming cells of the bone marrow, it is called bone marrow cancer.

Types of Bone Marrow Cancer y Multiple Myeloma: This is a type of bone marrow cancer that affects the plasma cells, which are a kind of white blood cells that occur in the bone marrow. The disease occurs due to the plasma cells growing abnormally. Normally, plasma cells produce antibodies. So, when these malignant or abnormal plasma cells divide and multiply rapidly, without order or control, as is the case in cancerous cells, it results in the production of huge amounts of abnormal antibodies, which accumulate in the blood as well as the urine. With the growth of the plasma cell tumor, the surrounding bone is also destroyed. These effects result in an impaired immune system, damage to the kidneys, and pain in the bones. The disease is referred to as multiple myeloma since it can affect multiple sites of the body where bone marrow occurs. Leukemia: This disease occurs when the bone marrow produces white blood cells that are abnormal. Leukemia is a term that defines 4 different types of diseases: Acute Lymphocytic Leukemia, or ALL; Acute Myelogenous Leukemia, or AML; Chronic Lymphocytic Leukemia, or CLL; and Chronic Myelogenous Leukemia, or CML. Acute myelogenous leukemia and acute lymphocytic are both made up of blast cells, referred to as myeloblasts or lymphoblasts. The term acute is indicative of the disease progressing rapidly, in the absence of treatment. Chronic leukemia either does not have any blast cells or they are few in number, and it progresses comparatively slowly. Lymphoma: This usually affects the lymphatic system, but sometimes can begin in the bone marrow. For example, Hodgkin lymphoma, which usually affects the lymph nodes, but can also affect the bone marrow.

Clinical Manifestations: Symptoms may include fever, fatigue, poor appetite and weight loss. However, the early symptoms of bone marrow cancer may be so sporadic and subtle that the patient may not see a doctor until the bone marrow cancer has spread to other parts of the body.

Other possible symptoms of bone marrow cancer may include:

y y y y y y y y

Pain A hard lump on the bone Swelling, stiffness, or tenderness in the bone (i.e., in or near a joint) Restriction of movement Unexplained fractures Anemia (low red blood cells) Weakness, shortness of breath, dizziness Lowered resistance to infections

Note: Symptoms may vary depending on the location and size of the cancer. Also, these symptoms do not necessarily indicate cancer. Only a doctor can determine whether or not a patient has bone marrow cancer. Multiple Myeloma Bone Marrow Cancer Multiple myeloma is a cancer of plasma cells where plasma cells infiltrate the bone marrow and spread into the cavities of large bones in the body. In this type of cancer, the bones develop osteolytic lesions or multiple holes that makes the bones fragile which means that the bones are more prone to fractures. These osteolytic lesions or multiple holes are a result of rapidly growing myeloma cells which prevents the bone-forming cells from repairing the usual damage of bones. Multiple myeloma also secretes a substance called osteoclast-activating factor which causes bone destruction. Some of the multiple myeloma bone marrow cancer symptoms include pain in the back, pain in the bones and ribs, weakness, frequent fevers and infections, nausea, weight loss, constipation, frequent urination and the person suffering from this type of bone marrow cancer is also more prone to fractures. Leukemia Bone Marrow Cancer It is a cancer of blood cells which is either detected in blood or bone marrow. There are different types of leukemia depending on which type of blood cells are affected, but most of the time it occurs in white blood cells. Leukemia is also classified depending on the speed at which the disease develops. The condition where it develops quickly and consists of immature cells is called acute leukemia and when it consists of more mature and abnormal cells and occurs at a relatively less speed, it is called chronic leukemia. Listed below are the four types of leukemia bone marrow cancers.
y y y y

Acute Myelogenous Leukemia (AML) Acute Lymphocytic Leukemia (ALL) Chronic Myelogenous Leukemia (CML) Chronic Lymphocytic Leukemia (CLL)

Acute Myelogenous Leukemia (AML) Usually, the bone marrow produces unformed cells called blasts which are further developed into white blood cells that fight various infections in the body. Where as in case of AML, the blasts are abnormal and they do not develop into white blood cells which means that the body cannot fight infections. The leukemia cells or the abnormal cells tend to grow quickly, reducing the number of normal white blood cells, red blood cells and platelets which are essential for the body. Acute myelogenous leukemia symptoms include fatigue, frequent infections, fever, sweating in the night, shortness of breath, frequent bleeding from the nose and gums, paleness, rashes and lesions on the skin, weight loss and some women might suffer from abnormal menstrual periods. Acute Lymphocytic Leukemia (ALL) It is a cancer of white blood cells where in the body produces lymphocytes which are immature white blood cells affecting the normal condition and growth of white blood cells in the body. It blocks the production of regular marrow cells and leads to reduction in the count of red cells, white cells and platelets affecting the regular functioning. Acute lymphocytic leukemia symptoms include pain in the joints, low platelet and low white blood cell count, fatigue, enlarged liver, enlarged spleen and lymph nodes, more prone to infections and bruises. Chronic Myelogenous Leukemia (CML) Similar to acute leukemia, chronic leukemia is also classified into chronic myelogenous leukemia and chronic lymphocytic leukemia. Chronic myelogenous leukemia is caused due to the growth of abnormal cells containing a chromosome rearrangement called as Philadelphia chromosome. Weakness, excessive sweating, fatigue and fever are some of the common symptoms of this type of leukemia. Besides these, the person would be more prone to bruising, bleeding and also might have a swollen spleen causing pressure under the lower left ribs. Chronic Lymphocytic Leukemia (CLL) B-cell lymphocytes are produced in the bone marrow, developed in the lymph nodes and are an essential constituent of white blood cells that fight against infections. CLL affects these Bcell lymphocytes by damaging the DNA of B-cells which prevents it from producing antibodies. Many of the signs and symptoms of chronic lymphocytic leukemia often show up in later stages and they include weakness, anemia, swollen liver, swollen lymph nodes, unusual bruising and bleeding and also frequent infections.

Lymphoma Bone Marrow Cancer Lymphoma is a cancer that affects the white blood cells that circulate in the blood stream and is part of the lymphatic system (a part of the immune system). Hodgkins lymphoma is the most common in this kind of cancer. Other types of lymphomas are known as non-Hodgkins lymphoma. Lymphoma bone marrow cancer symptoms include weight loss, back pain, fatigue, itchiness, shortness of breath, cyclical fever, enlarged liver and lymph nodes. Risk Factors:
y y y y

Certain drugs used to treat other types of cancers Continuous exposure to hazardous materials used in some types of work, including farming, rubber manufacturing, asbestos work and tire repair Exposure to certain chemicals, such as benzene and some pesticides Exposure to high doses of radiation.

Bone Marrow Cancer Treatment When choosing from bone marrow cancer treatment options, there are several factors to consider. Your age, the stage of your cancer and your overall health at the time of treatment all influence which bone marrow cancer treatments will be best for you. There are a number of treatments available for bone marrow cancer such as: y y y y y surgery radiation therapy chemotherapy bone marrow transplant many hospitals also offer other complementary therapies along with the conventional treatments such as naturopathic medicine; nutrition therapy; mind and body medicine; and spiritual counseling.

Bone Marrow Transplant A bone marrow transplant is a procedure to replace damaged or destroyed bone marrow with healthy bone marrow stem cells. 3 Types of Bone Marrow Transplant:
y

Autologous bone marrow transplant: "Auto" means "self." Stem cells are removed from you before you receive high-dose chemotherapy or radiation treatment. After these treatments are done, your stems cells are put back in your body. This is called a "rescue" transplant.

Allogeneic bone marrow transplant: "Allo" means "other." Stem cells are removed from another person, called a donor. Most times, the donor must have the same genetic makeup as the patient, so that their blood is a "match" to yours. Special blood tests are done to determine if a donor is a good match for you. A brother or sister is most likely to be a good match. However, sometimes parents, children, and other relatives may be good matches. Donors who are not related to the patient may be found through national bone marrow registries. Umbilical cord blood transplant: Stem cells are removed from a newborn baby's umbilical cord immediately after being born. The stem cells are stored until they are needed for a transplant. Umbilical cord blood cells are so immature, there is less of a concern that they will not match.

Before the transplant, chemotherapy, radiation, or both may be given. This may be done in two ways:
y y

Ablative (myeloablative) treatment: High-dose chemotherapy, radiation, or both are given to kill any cancer cells. This allows new stem cells to grow in the bone marrow. Reduced intensity (nonmyeloablative) treatment, also called a mini transplant: Today, some patients are getting lower doses of chemotherapy and radiation before a bone marrow transplant.

A stem cell transplant is done after chemotherapy and radiation is complete. The stem cells are delivered into your bloodstream through a tube called a central venous catheter. The process is similar to getting a blood transfusion. The stem cells travel through the blood into the bone marrow. Usually, no surgery is required. In many cases donor stem cells can be collected directly from the person's blood. Surgery is not needed. The donor will first receive injections for a few days. Minor surgery may be needed to collect bone marrow and stem cells from a donor. This is called a bone marrow harvest. The surgery is done under general anesthesia, which means the donor will be asleep and pain-free during the procedure. The bone marrow is removed from the hip bones. Risks after the Procedure: A bone marrow transplant may cause the following symptoms:
y y y y y y y

Pain Chills Fever Hives Chest pain Drop in blood pressure Shortness of breath

y y y y

Nausea Flushing Headache Funny taste in the mouth

Possible complications of a bone marrow transplant depend on many things, including:

y y y y y y

The disease you are being treated for If you had chemotherapy or radiation before the bone marrow transplant Your age Your overall health How good of a match your donor was The type of bone marrow transplant you received (autologous, allogeneic, or umbilical cord blood)

Complications can include:

y y y y y y y y y y y y

Infections, which can be very serious Bleeding in the lungs, the intestines, brain, and other areas of the body Anemia Stomach problems, including diarrhea, nausea, and vomiting Pain Inflammation and sorenes in the mouth, throat, esophagus, and stomach, called mucositis Damage to the kidneys, liver, lungs, and heart Cataracts Early menopause Graft failure, which means that the new cells do not settle into the body and start producing stem cells Graft-versus-host disease , a condition in which the donor cells attack your own body Delayed growth in children who receive a bone marrow transplant

Before the Procedure: Your health care provider will ask you about your medical history and do a physical exam. You will have many tests before your treatment begins. Before your transplant, you will have one or two tubes, called catheters, inserted into a blood vessel in your neck. This tube allows you to receive treatments, fluids, and sometimes, nutrition. Your doctor or nurse should discuss the emotional stress of having a bone marrow transplant. You may want to meet with a mental health counselor. It is important to talk to your family and children to help them understand what to expect.

You will need to make plans to help you prepare for the procedure and handle tasks after your transplant. Things to consider include:
y y y y y y y y

Advanced care directives Arranging medical leave from work Bank or financial statements Care of pets Household chores Insurance coverage Payment of bills Schedules and care for your children

You may need to find housing for yourself or your family near the hospital. After the Procedure: A bone marrow transplant is usually done in a hospital or medical center that specializes in such treatment. Most of the time, you will stay in a special bone marrow transplant unit in the center to limit your chance of getting an infection. All or part of an autologous or allogeneic transplant can be done on an outpatient basis. This means you do not have to stay in the hospital or medical center. How long you stay in the hospital depends on how much chemotherapy or radiation you received, the type of transplant, and your medical center's procedures. While you are in the hospital, you will be isolated because of the increased risk of infection. The health care team will closely monitor your blood count and vital signs. While you are in the hospital you may:
y y y y

Receive medications to prevent or treat infections, including antibiotics, antifungals, and antiviral drugs. Need many blood transfusions Be fed through a vein (IV) until you can eat by mouth and stomach side effects and mouth sores have gone away Be given medication to prevent graft-versus-host disease

Prognosis: How well you do after transplant greatly depends on:

y y y y

The type of bone marrow transplant How well the donor s cells matched yours What type of cancer or illness you have Your age and overall health

y y y

The type of chemotherapy or radiation therapy you had before your transplant Any complications Your genes

A bone marrow transplant may completely or partially cure your illness. If the transplant is a success, you can go back to most of your normal activities as soon as you feel well enough. Most times it takes up to 1 year to recover fully.

Prepared by: Sarah Refugia Meniza Amy A. Totanes BSN4

OVARIAN CANCER
Description Ovarian cancer is the second most common gynecologic cancer, It caused nearly 14,000 deaths in 2010 alone. During that time, the overall five-year survival rate for all other cancers improved significantly: 68% for the general population diagnosed in 2001, up from 50% in the 1970s. Ovarian cancers have a much poorer survival rate, a 47% survival rate, up from 38% in the late 1970s. Most (more than 90%) ovarian cancers are classified as "epithelial" and are believed to arise from the surface (epithelium) of the ovary. However, some evidence suggests that the fallopian tube could also be the source of some ovarian cancers. Since the ovaries and tubes are closely related to each other, it is thought that these fallopian cancer cells can mimic ovarian cancer. Other types may arise from the egg cells (germ cell tumor) or supporting cells. These cancers are grouped into the category of gynecologic cancer. Types of ovarian cancer The type of cell where the cancer begins determines the type of ovarian cancer you have. Ovarian cancer types include:
y

Cancer that begins in the cells on the outside of the ovaries. Called epithelial tumors, these cancers begin in the thin layer of tissue that covers the outside of the ovaries. Most ovarian cancers are epithelial tumors. Cancer that begins in the egg-producing cells. Called germ cell tumors, these ovarian cancers tend to occur in younger women. Cancer that begins in the hormone-producing cells. These cancers, called stromal tumors, begin in the ovarian tissue that produces the hormones estrogen, progesterone and testosterone.

The type of ovarian cancer you have helps determine your prognosis and treatment options. Signs and symptoms y y y y y y y y y y y abdominal pain or discomfort abdominal mass bloating/, increased abdominal size back pain, urinary urgency, constipation, tiredness and a range of other non-specific symptoms, as well as more specific symptoms such as pelvic pain, abnormal vaginal bleeding or involuntary weight loss. There can be a build-up of fluid (ascites) in the abdominal cavity.

difficulty eating/feeling full Older women Hereditary Infertile women endometriosis Never been pregnant and those who use postmenopausal estrogen replacement therapy Use of combined oral contraceptive pills more children a woman Early age at first pregnancy older age of final pregnancy use of low dose Use of combined oral contraceptive pills

Etiology y y y y y y y y y y y

Risk factors Certain factors may increase your risk of ovarian cancer. Having one or more of these risk factors doesn't mean that you're sure to develop ovarian cancer, but your risk may be higher than that of the average woman. These risk factors include:
y

Inherited gene mutations. A small percentage of ovarian cancers are caused by an inherited gene mutation. The genes known to increase the risk of ovarian cancer are called breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2). These genes were originally identified in families with multiple cases of breast cancer, which is how they got their names, but women with these mutations also have a significantly increased risk of ovarian cancer. Another known genetic link involves an inherited syndrome called hereditary nonpolyposis colorectal cancer (HNPCC). Women in HNPCC families are at increased risk of cancers of the uterine lining (endometrium), colon, ovary and stomach. Family history of ovarian cancer. If women in your family have been diagnosed with ovarian cancer, you have an increased risk of the disease. A previous cancer diagnosis. If you've been diagnosed with cancer of the breast, colon, rectum or uterus, your risk of ovarian cancer is increased. Increasing age. Your risk of ovarian cancer increases as you age. Ovarian cancer most often develops after menopause, though it can occur at any age. Never having been pregnant. Women who have never been pregnant have an increased risk of ovarian cancer. Hormone replacement therapy for menopause. Findings about the possible link between postmenopausal use of hormone replacement therapy and risk of ovarian cancer have been inconsistent. Some studies show a risk of ovarian cancer, while others do not.

Diagnosing ovarian cancer Tests and procedures used to diagnose ovarian cancer include:
y Pelvic examination. During a pelvic exam, your doctor carefully inspects the outer

exposed part of your genitals (vulva), and then inserts two fingers of one hand into your vagina and simultaneously presses the other hand on your abdomen to feel your uterus and ovaries. He or she also inserts a device called a speculum into your vagina. The speculum opens your vagina so that your doctor can visually check your vagina and cervix for abnormalities. y Ultrasound. Ultrasound uses high-frequency sound waves to produce images of the inside of the body. An ultrasound helps your doctor investigate the size, shape and configuration of your ovaries. To create a picture of your ovaries, your doctor may insert an ultrasound probe into your vagina. This procedure is called transvaginal ultrasound. Ultrasound imaging can create pictures of the structures near your ovaries, such as your uterus.
y Surgery to remove samples of tissue for testing. If other tests suggest you may have

ovarian cancer, your doctor may recommend surgery to confirm the diagnosis. During surgery, a gynecologic oncologist makes an incision in your abdomen and explores your abdominal cavity to determine whether cancer is present. The surgeon may collect samples of abdominal fluid and remove an ovary for examination by a pathologist. If cancer is discovered, the surgeon may immediately begin surgery to remove as much of the cancer as possible. In some cases, the surgeon may make several small incisions in your abdomen and insert special surgical tools and a tiny camera, so the procedure won't require a larger incision.
y CA 125 blood test. CA 125 is a protein found on the surface of ovarian cancer cells and

some healthy tissue. Many women with ovarian cancer have abnormally high levels of CA 125 in their blood. However, a number of noncancerous conditions also cause elevated CA 125 levels, and many women with early-stage ovarian cancer have normal CA 125 levels. For this reason, a CA 125 test isn't usually used to diagnose or to screen for ovarian cancer, but it may be used to monitor how your treatment is progressing.

Staging ovarian cancer Doctors use the results of your surgery in order to determine the extent or stage of your cancer. Your doctor may also use information from imaging tests, such as computerized tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET), to determine whether cancer has spread within the abdomen. Your cancer's stage helps determine your prognosis and your treatment options.

Stages of ovarian cancer include:

y Stage I. Ovarian cancer is confined to one or both ovaries. y Stage II. Ovarian cancer has spread to other locations in the pelvis, such as the uterus or

fallopian tubes.
y Stage III. Ovarian cancer has spread beyond the pelvis or to the lymph nodes within the

abdomen.
y Stage IV. Ovarian cancer has spread to organs beyond the abdomen, such as the liver or

the lungs

Surgery Treatment for ovarian cancer usually involves an extensive operation that includes removing both ovaries, fallopian tubes, and the uterus as well as nearby lymph nodes and a fold of fatty abdominal tissue known as the omentum, where ovarian cancer often spreads. Your surgeon also removes as much cancer as possible from your abdomen (surgical debulking). Less extensive surgery may be possible if your ovarian cancer was diagnosed at a very early stage. For women with stage I ovarian cancer, surgery may involve removing one ovary and its fallopian tube. This procedure may preserve the ability to have children in the future. Chemotherapy After surgery, you'll most likely be treated with chemotherapy drugs designed to kill any remaining cancer cells. Chemotherapy may also be used as the initial treatment in some women with advanced ovarian cancer. Chemotherapy drugs can be administered in a vein (intravenously) or injected directly into the abdominal cavity, or both methods of administering the drugs can be used. Chemotherapy drugs can be given alone or in combination. Assessment 1. First manifestation includes vague abdominal discomfort, indigestion, flatulence, anorexia, pelvic pressure, weight loss or gain, and palpable ovarian enlargement. 2. Late manifestations include abdominal pain, ascites, pleural effusion, and instestinal obstruction.

Diagnostic Evaluation 1. Pelvic sonography (with transvaginal probe) and CT scan may be done. Unfortunately, these are not sensitive to early detection of ovarian cancer. 2. Color Doppler imaging may be used to detect vascular changes within the ovaries. 3. Paracentesis or thoracentesis are done if ascites or pleural effusion is present. 4. Laparotomy is necessary to stage the disease and determine effectiveness of the treatment. 5. CA 125 is a serum tumor marker that is not reliable for screening because its level may be elevated due to inflammation; however, an increase signifies progression of disease. Therapeutic and Pharmacologic Interventions 1. Chemotherapy is more effective if tumor is optimally bulked; usually follows surgery because of frequency of advanced disease; may be given I.V. or intraperitoneally. 2. Immunotherapy with interferon or hormonal therapy with tamoxifen, an antiestrogen agent may be used. Surgical Interventions 1. Total abdominal hysterectomy with bilateral salpingooophorectomy and omentectomy is usual treatment because of delayed diagnosis. 2. Second-look laparotomy may be done after adjunct therapies to take multiple biopsy specimens and determine effectiveness of therapy. Nursing Interventions 1. Administer anxiolytic and analgesic medications as prescribed and provide support throughout the diagnostic process. 2. Administer or teach the patient or caregiver to administer antiemetics as needed for nausea and vomiting due to chemotherapy. 3. Encourage small, frequent, bland meals or liquid nutritional supplements as able. Assess the need for I.V. fluids if patient is vomiting. 4. Prepare the patient for body image changes resulting from chemotherapy. 5. Encourage the patient to prepare ahead of time with turbans, wig, hats, and so forth. 6. Stress the positive effects of the patient s treatment plan. 7. Prepare the patient for surgery as indicated. 8. Postoperatively, reposition frequently and encourage early ambulation to promote comfort and prevent adverse effects. 9. Explain to the patient that ovary removal will cause menopausal symptoms. 10. Tell the patient that disease progression will be monitored closely by laboratory tests and that a second-look laparoscopy may be necessary. Prepared by: Lea Marie Silava Emmanuel Valencia BSN-4A