Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
D. Epidemiology of Cancer
1. Incidence of cancer
a. Cancer affects every age group though most cancer and cancer
deaths occur in people older than 65 years of age
b. Cancer ranks 3rd as the cause of morbidity in the Philippines
c. Highest incidence of all cancer is prostate cancer
d. Highest cancer incidence in males in order of frequency: prostate
cancer, lung cancer and colorectal cancer
e. Highest cancer incidence in females in order of frequency: breast
cancer, lung cancer and colorectal cancer
2. Common sites of cancer and their sites of metastasis
2. Physical Carcinogens
– Radiation
– Chronic Irritation- GERD
3. Viral Carcinogens
- some viral infections tend to increase risk of cancer
Ex: Epstein Barr
Genital herpes
Papillomavirus
Hepatitis B
Human cytomegalovirus
4. Dietary Factors
- diets in high fat, low in fiber and those containing nitrosamines found in
preserved meats and pickled foods promote certain cancers such as colon,
breast, esophageal and gastric
Metastasis
- ability of cancer cells to spread from the original site of the tumor to distant organs
Stages:
1. Detachment
* tumor cell loses cohesiveness and it has increasing motility
* tumor cell detaches from the primary tumor and create defects in the
basemement membranes with resulting stromal invasion and spread into the
circulation
2. Migration
* Cancer cells migrate via the lymph or blood circulation or by direct
extension
* the lymphatic system provides the most common pathway for the initial
spread of malignant cancer cells
* The blood vessels carry cancer cells from the primary tumor to the capillary
beds of the lungs, liver and bones
* Direct tumor extension of tumors to adjacent tissues also occurs
3. Dissemination
* Cancer cells are established at the secondary site which may result from
entrapment due to the size of the tumor clump, adherence to cells at the new
site through specific interactions, or by binding to exposed basement
membrane
4. Angiogenesis
* Vascularization of the tumor
- they are killed by cytotoxic T cells that have receptors for specific tumor
antigens and by interferon-activated natural killer (NK) lymphocytes
and macrophages
- macrophages phagocytize the pathogen and present it as antigen to T and
B lymphocytes
Classification of Neoplasms
1. Benign – from latin word “benigunus”- kind
2. Malignant
Comparision of the characteristics of Benign and Malignant neoplasm
Characteristic Benign Neoplasm Malignant Neoplasm
Speed Growth Grows slowly Usually grows rapidly
Usually continues to grow Tends to grow relentlessly
throughout life unless throughout life
surgically removed Rarely, neoplasm may
May have periods of regress spontaneously
remission
Mode of Growth Grows by enlarging and Grows by infiltrating
expanding surrounding tissues
Always remains localized; May remain localized (in
never infiltrates situ) but usually infiltrates
surrounding tissues other tissues
Cancer Prevention
1. Skin: Avoid exposure to sunlight
2. Oral: Annual oral examination
3. Breast: Monthly BSE from age 20
4. Lungs: Avoid cigarette smoking; annual chest x-ray
5. Colon: DRE for person over age 40. Rectal biopsy, proctosigmoidoscopic
examination, Guiac stool examination for persons age 50 and above
6. Uterus: annual Pap’s smear from age 40
7. Basic: annual physical examination and blood examination
1. Tumor markers are protein substances found in the blood or blody fluids
2. Are released either by the tumor itself, or by the body as a defense in response to
the tumor (called host response)
3. Tumor markers are derived from the tumor itself. And include the ff:
a. Oncofetal antigens, present normally in fetal tissue, may indicate an
anaplastic process in tumor cells; carcinoembyonic antigen (CEA)
and alpha-fetoprotein (AFP) are examples of oncofetal antigens.
b. Hormones are present in large quantities in the human body;
however, high levels of hormones may indicate a hormone-secreting
malignancy; hormones that may be utilized as tumor markers include
the antidiuretic hormone (ADH), calcitonin, catecholamines, human
chorionic gonadotropin (HCG), and parathyroid hormone (PTH)
c. Isoenzymes that are normally present in a particular tissue may be
released into bloodstream if the tissue is experiencing rapid,
excessive growth as the result of tumor; are examples include
neuron-specific enolase (NSE) and prostatic acid phosphatase (PAP)
d. Tissue-specific proteins identify the type of tissue affected by
malignancy; an example of a tissue-specific protein is the protastic-
specific antigen (PSA) utilized to identify prostate cancer
4.Host-response tumor makers include the following:
a. C-reactive protein
b. Interleukin-2
c. Lactic dehydrogenase
d. Serum Ferritin
e. Tumor necrosis factor
Staging
1. The TNM tumor system is utilized for classifying tumors
a. T indicates the tumor size
Surgical Intervention
1. Preventive surgery- removal of precancerous lesions or benign tumors
2. Diagnostic surgery- biopsy
3. Curative surgery- removal of an entire tumor
4. Reconstructive surgery – improvement of structures and function of an organ
5. Palliative surgery – relief of distressin signs and symptoms; retardations of metastasis
2. Gene therapy
a. Current use in investigational
b. Increases susceptibility of cancer cells to the destruction by other treatments;
insertion of specific genes enhances ability of client’s own immune system to
recognize and destroy cancer cells
3. Photodynamic theory
a. Used to treat specific superficial tumors such as those of the surface of
bladder, bronchus, chest wall, head, neck and peritoneal cavity
b. Photofirin, a photosensitizing compound, is administered intravenously where
it is retained by malignant tissue
c. Three days after injection, the drug is activated by a laser treatment which
continues for 3 more days
d. The drug produces a cytotoxic oxygen molecule (singlet oxygen)
e. During intravenous administration, monitor for chills, nausea, rash, local skin
reactions, and temporary photosensitivity
f. Drug remains in tissues 4-6 weeks after injection; direct or indirect exposure
to sun activates drug, resulting in chemical sunburn; educate client to protect
skin from exposure to sun
Manifestations
1. Lump in upper outer quadrant of breast, usually nontender but may be tender
2. dimpling of breast tissue surrounding nipple, or bleeding from the nipple
3. Asymmetry with affected breast being higher
4. Regional lymph nodes swollen and tender
Management
1. Radiation therapy
2. Mastectomy
a) Segmental mastectomy – or lumpectomy; removes the tumor and margin of
breast tissue surrounding the tumor
b) simple mastectomy – removal of the complete breast but no other structures
c) Modified radical mastectomy – removal of the breast and axillary lymph
nodes but chest wall muscles are not resected
d) Radical mastectomy – removal of the breast, axillary lymph nodes and
underlying chest wall muscles
e) Breast reconstruction – may be performed at the time of mastectomy or may
be done at a later time; can be accomplished through submuscular breast
implant, placing an implant after using a tissue expander, using muscles with
intact blood supply from the back or abdomen, or creating a free muscle flap
with the gluteus maximus muscle
3. Medication therapy
a. Tamoxifen (Novadex) interferes with estrogen activity for treating advanced
breast cancer
b. Chemotherapy – when axillary nodes are involved
B. PROSTATE CANCER
- unregulated growth of abnormal cells in the prostate gland
Etiology/pathophysiology
1. Adenocarcinoma is most common type; high levels of testosterone may play a
Role
2. Usually begins in peripheral tissue on back and sides of the gland
3. Metastasis via lymph and venous changes is common; bony tissue is major
site of distant metastasis- especially pelvic bones and spine
4. Is seen predominantly over 40 years of age
Clinical Manifestations
1. Clients in early stages often show no symptoms; tumor may be found during
digital prostate exam
2. Genitourinary: dysuria, frequency, reduced force of stream, hematuria,
nocturia,abnormal prostate found on DRE
3. Musculoskeletal: back pain, migratory bone pain, bone or joint pain
4. Neurologic: nerve pain, muscle spasms, bowel or bladder dysfunction,
bilateral weakness of lower extremities