CANCER
Cancer – growth and proliferation of disease cell, an alteration, or transformed. problem
in the mechanism
Normal Cells –repair cells
Cancer happens at any age, any time.
- Usually occurs 60-65 years above.
- Higher incidence in Men because of lifestyle
- Higher incidence to Urban areas than Rural areas
Leading causes of cancer death
- 1st. Lung Cancer
- 2nd Male: Prostate Cancer, Female: Breast Cancer
- 3rd Colorectal Cancer
CLASSICICATION OF TUMOR
1. GRADING. Identifying type of tissue from which the tumor originated and the degree
in which the tumor cell retains structural characteristics. Identify or classify the type of
tissue inside the tumor or inside the mass.
Differentiation – Extent to which our tissue cell resemble the normal cell
- Gx. Grade cannot be assessed
- G1. Well differentiated grade (Cells resembled to parent cells)
- G2. Moderately well differentiated cell
- G3. Poorly differentiated (Aggressive)
- G4. Undifferentiated (Aggressive)
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2. STAGING
T – Tumor
N – Nodal involvement
M – Metastasis
TNM CLASSIFICATION
Tx – tumor cannot be adequately assessed
Nx – nodal involvement cannot be adequately assessed
Mx – metastasis cannot be adequately assessed
T0 – no evidence of primary tumor
N0 – no evidence of nodal involvement
M0 – no evidence of metastasis
TIS – Carcinoma in situ or Tumor in situ = tumor will remain where it originated.
Considered as 1st stage of cancer
T1, T2, T3, T4. Progressive increase in tumor size
N1, N2, N3. Progressive increase of nodal involvement
M1, M2, M3. Progressive increase of metastasis
Interpretation ex: T1, N0, M0 = There is a presence of tumor but small in size, no
nodal involvement and no evidence of metastasis.
T0, N1, N0 = Possible. Some tumors will not grow. Cancer in lymphatic systems are the
examples.
THERAPEUTIC MODALITIES
1.) Surgical Intervention. Will remove the tumor or part of the tumor.
- Preventive Surgery / Profilactic Surgery – Removal of precancerous lesions or
benign tumors
- Diagnostic surgery – the definitive way to diagnose cancer.
+ Total biopsy, for small tumor. Remove the whole tumor
+ Subtotal biopsy / Incisional biopsy – part of the tumor is being removed. Done for
patients with large tumor.
+ Fine needle aspiration biopsy – aspirate tissue sample
+ Frozen section biopsy – fresh. Directly examine or speedy diagnosis.
- Reconstructive – Improvement of the structure and function of an organ
+ Transverse rectus abdomenin flap? – patients with breast cancer and surge
+Latisimus dorsimos flap? –
+ Tissue expander -
- Palliative Surgery – Relief of distressing signs and symptoms; retardation of
metastasis. To promote life of the patient without cure
2.) Chemotherapy.
- Destroy all malignant cells without excessive destruction to normal cells.
- To control tumor growth if cure is no longer possible.
- Use as adjuvant therapy. Given after surgery / post-operative. To kill the cancer cells
left inside the body after surgery.
Neo-adjuvant – preoperatively, to decrease or shrink tumor
- Palliative
CLASSIFICATION OF CYTOTOXIC DRUGS
1.) Cell Cycle Specific – drugs that act on a certain phase
2.) Cell cycle non-specific – drugs that act on any phase and in the resting phase.
SAFE HANDLING OF CHEMOTHERAPEUTIC AGENTS:
1. Wear mask, gloves and back-closing gown
2. Skin contact with drug must be washed immediately with soap and water. With eyes
too
3. Sterile alcohol- wet cotton pledget should be used when breaking a vial
4. Expel air bubbles on wet cotton
5. Wipe external surfaces of syringes and IV bottles
6. Clearly label IV bottle with ANTINEOPLASTIC CHEMOTHERAPY
7. Used needles and syringes should be disposed to container marked with “leak-proof”,
puncture – proof”
8. Dispose half – empty vial, IV bottles into bag, marked with “Hazardous waste”
9. Handwashing before and after removal of the gloves
10. Trained personnel only should be involved with the use of the drug
11. Ideally, preparation should be in laminar flow conditions with filtered air.
3.) Radiation Therapy
- Primary curative cure
- Adjunct to other therapy
- Palliative
External radiation therapy – administered through a machine.
- Advantage, skin sparing effect (maximum effect of external radiation is more on tumor
and less in skin.)
Internal radiation therapy – administered within or near the tumor
Room of the patient- should have long pickup forceps and radiation pig. If the seeds
dislodged, pick up using these two and place seeds back.
- Seeds. implanted to cavities
Types – sealed (Brachytherapy), unsealed (IV, oral)
SIDE EFFECTS OF CHEMO
- Alopecia (2-3 weeks)
Radiation therapy depends on the side, dose, kind
- Head, sore throat
- Abdomen, nausea and vomiting
PRINCIPLE OF RADIATION THERAPY
D – distance. Atleast 3 feet when not performing any procedure
If visitor, atleast 6 feet from the client
T – time. Limit a total of 30 minutes per shift
Pregnants not able to take care
5 rems per year. Exposure to radiation using dorsimeter badge
S- shielding. Use lead shield during contact with patient
OTHER MODALITIES
1. Immunotherapy – STIMULATE the immune system to destroy tumor cells. BCG
immunotherapy
2. |Bone marrow transplant –
Allogenic – bone marrow coming from unrelated, parent, brother
Autologous – bone marrow harvested, frozen, treated
Syngeneic- bone marrow coming from identical twin.
3. Photodynamic therapy – usually done to treat superficial tumors.
Use photophrin – agent injected to the bloodstream, 24 – 72 hrs exposed to light.
Produce active form of oxygen which will destroy cancer cells (damage blood vessels)
