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Common Terminology
Cellular Aberration:an alteration in the cellular structures and functions Neoplasm: new growth, abnormal cellular reproduction Tumor: a growth of neoplastic cells clustered together Benign:characterized by abnormal cell division but does not metastasize
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Malignant:abnormal cell division with ability to invade surrounding cells, metastasize and recur Cancer: malignant growth accompanied by abnormal cell division, invasion of surrounding tissues and metastasis to distant sites Metastasis:ability of the cancer cells to disseminate and establish growth in another area of the body at a distance from its origin
Etiologic Factors
Viruses: Oncogenic Viruses (prolonged or frequent viral infections may cause breakdown of the immune system) Carcinogens: factors in the environment that act to cause cell mutation
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Chemical Carcinogens E.g. Industrial Compounds (vinyl chloride: asbestos, polycyclic aromatic hydrocarbons: air pollution, fertilizers, dyes: aniline dye, hair bleach, drugs: nicotine
Other carcinogens
Physical Carcinogens E.g. Radiation: radioactive isotopes, ultraviolet rays Physical Irritation:pipe smoking, multiple deliveries
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Hormones: HRT Genetics: familial patterns like retinoblastoma, lung Ca, breast Ca ONCOGENE: repressed genetic code
Predisposing Factors
Age: Older individual and young children are more prone Gender: both gender are predispose Women: reproductive organs Men: reproductive and life styles
On factors
Urban VS Rural Dwellers: more exposure to carcinogens Geographical Distribution: influence of environmental factors like diet
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Occupation: chemical and industrial hazards Heredity: familial history Stress: decrease immunocompetence Pre cancerous lesions Lifestyle: smoking, diet
Pathogenesis of Cancer
Cellular Transformation and Derangement Theory:cellular transformation as a result of exposure to agents Failure of the Immune Response Theory: inability of the immune system to destroy cancer cells
Mechanisms of Carcinogenesis
Berenblum (1940) proposed the two step mutational model INITIATION: related to the carcinogens that initiates the mutation process; alteration of the DNA structure PROMOTION: also called co-carcinogens that stimulates replication of mutant cells
Examples
Soot, tar
Site of Action
lips, tongue, oral cavity
Pathophysiologic Mechanisms
The DNA virus infects the cell; it becomes incorporated into the genes; DNA that is infected is transmitted to subsequent generations The RNA virus infects the cell; the virus contribute to the genetic information of the host cell; the viruses uses an enzyme to be protected and not be destroyed by the immune system Reverse Transcriptase: enzyme that binds with DNA altering genetic endowment of the cell
Resulting Alterations: 1. Anemia: cancer cells produce chemicals that interfere with RBC production; increase iron uptake of cancer cells; bleeding 2. Hypercalcemia: parathyroid like hormones are produced and increasing bone breakdown; enhanced by immobilization and dehydration
Diagnostic Tests
Cytologic Examination Biopsy Ultrasound MRI Radiologic Exams Radiodiagnostic Techniques CT Scan Laboratory Tests: Prostatic Acid Phosphatase, Prostatic Specific Antigen, Carcinoembryonic Antigen Endoscopic Exams Monoclonal Antibodies
Cancer Prevention
Skin: Avoid over exposure to sun light Oral: Annual oral Examination Breast: Monthly BSE from age 20 Lungs: avoid smoking; annual chest x-ray Colon: Digital rectal Exam for 40 years old and above; rectal biopsy; proctoscopic exam; guiac stool examination for 50 years and above Uterus: Annual Pap smear Basic: Annual PE
Dietary Recommendations
Cut down on total fat intake Eat more high fiber food ( raw fruits and vegetables; whole grain cereals Include food rich in Vitamin A and C in daily diet Include cruciferous vegetables in the diet Moderation on alcoholic beverages Moderation in use of salt
Surgical Interventions
Classification of Interventions: a. Preventive: excision of pre cancerous lesions b. Diagnostic: Biopsy/Fresh frozen section c. Curative: Removal of the entire tumor (en bloc resection) d. Reconstructive: Improvement of structure and function e. Palliative: relief of distressing symptoms; retardation of metastasis E.g. Oophorectomy in breast Ca
Surgical Intervention
Chemotherapy
Objectives: 1. To destroy all malignant tumor cells without excessive destruction of normal cells 2. To control tumor growth
Action of Chemotherapy
Chemotherapy damages the genes inside the nucleus of cells. Some drugs damage cells at the point of splitting. Some damage them while they are busy making copies of all their genes before they split. Cells that are at rest (most normal cells, for instance) are much less vulnerable to chemo damage. With more than one type of drug, there is more chance of killing more cells.
The combination will include chemo drugs that damage cells at these different stages in the process of cell division. The fact that chemo drugs kill dividing cells helps to explain why chemotherapy causes side effects. It affects healthy body tissues that grow all the time. The skin, hair and digestive system, for example. The hair is always growing. The skin and the lining of the digestive system is constantly renewing itself. And tissues that are growing have dividing cells - that are at risk from chemotherapy
Normal cells can repair damage more quickly than cancer cells. So the damage to healthy cells doesn't usually last. Most side effects disappear once the treatment is over, and many only occur for the days while receiving the drugs (for example, sickness or diarrhoea).
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Cancer fatigue is the most common side effect of cancer treatment and affects between 7 and 9 out of 10 people (70 - 90%). Many people with cancer say that it is the most disruptive side effect of all. Fatigue is often worse for people who: Have a combination of treatments Have a cancer in its advanced stages and Are elderly
more on tips
If toothpaste stings, or brushing teeth becomes a problem, try a 'bicarbonate of soda' mouth wash instead (one teaspoon dissolved in a mug of warm water) Use dental floss daily but be careful not to harm gums Keep lips moist by using Vaseline or a flavoured lip balm Avoid neat spirits, tobacco, hot spices, garlic, onion, vinegar and salty food when your mouth is sore Choose meals that are moist with gravies and sauces, to make swallowing easier Drink at least one and a half litres (3 pints) of fluid a day - tea or coffee, fruit and vegetable juices, soft drinks or water Eating fresh pineapple can keep your mouth fresh and moist but avoid acidic fruits (eg oranges, grapefruit) if your mouth is sore
Contraindications
Infection: anti cancer drugs are immunosuppresives Recent Surgery: drugs retards wound healing Impaired Renal and Hepatic Function: drugs are nephrotoxic and hepatotoxic
Chemotherapy Room
New Trend
In the not-so-distant past, initial attempts at scalp cooling were made by placing crushed ice in plastic bags on the patient's head. This first anti-hair-loss treatment was followed by vinyl-filled crylon gel caps. But these products have limited therapeutic value; crushed ice melts and gel-insulated caps are uncomfortably cold
SCS II
A painless hair-loss prevention device for patients undergoing chemotherapy. Designed as a hat, the SCS II cap is worn on the patient's head providing comfort and ease of use. Ultimately hair loss is prevented and problems previously associated with cold therapy treatment are eliminated.
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Label Iv bottle with ANTINEOPLASTIC CHEMOTHERAPY Contaminated needles should be disposed on a special container leak proof- puncture proof container Dispose half used agents on a special plastic bag labeled with hazardous waste Hand washing!
Radiation Therapy
High energy X-rays are used to kill cancer cells. The radiation doses in radiotherapy are also higher than those for normal X-ray procedures. Cancer cells are more sensitive to radiation than normal cells. So targeting cancer cells with radiation damages them and causes the tumour to shrink.
more on radiotherapy
It involves simulation and treatment planning, where the area to be treated is carefully defined and the radiation dose to be given is meticulously verified. Radiotherapy may be used as a sole treatment method or in conjunction with surgery and chemotherapy.
Types of Radiation
Sealed- also known as brachytherapy; a wire is placed near the tumor Unsealed- administered through IV or orally
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Teaching Guidelines
It is painless Lie still while the therapy is on going Treatment lasts for few minutes Machines produces sound and moves Personnel will not be inside the room Communication is possible; a monitor is placed outside the room No residual radioactivity after the procedure; resume normal activities