Ca Particulars

PARTICULAR CANCER Dr. Anthony P. Toledo

BREAST CANCER 





is a malignant ( cancerous) tumor that starts from cells of the breast. The disease occurs mostly in women, but in men can get breast cancer as well most breast cancers begin in the ducts ( ductal carcinoma), some begin in the lobules ( lobular carcinoma), and rest in other tissues if breast cancer cells reach the underarm lymph nodes and continue to grow, they cause the nodes to swell. Once cancer cells have reached these nodes they are more likely to spread to other organs of the body as well

BREAST CANCER

ETIOLOGY - Unknown, but areas under        

investigation includes: Smoking Age Family history Early menarche Late menopause Nulliparous or first child after age 34 High fat Use of oral contraceptive

CLINICAL MANIFESTATION Non tender lump, usually in upper quadrant pain (late)  Axillary Lymphadenopathy (late)  Fixed nodular breast mass (late) 

PROTECTIVE FACTORS   

Exercise Breast feeding Pregnancy before 30 years old

ASSESSMENT FINDINGS 

   

Mass – the most common location is the upper outer quadrant (UOQ) Mass is NON-tender. Fixed, hard with irregular borders Skin dimpling Nipple retraction Peau d’ orange

LABORATORY FINDINGS  

Biopsy procedure Mammography

BREAST CANCER STAGING - TNM staging  I - < 2cm  II – 2 to 5 cm, ( + ) LN  III - > 5cm, ( + )LN  IV – metastasis

MEDICAL MANAGEMENT  



Chemotherapy Tamoxifen therapy – blocks estrogen receptor sites Radiation therapy

SURGICAL MANAGEMENT  

 

Radical Mastectomy – removal of tumor, pect. Major, pect. Minor + LN Modified Radical Mastectomy –pect. Minor remains, removal of tumor, pect. major + LN ( most commonly done Lumpectomy Quadrantectomy

Radical Mastectomy

NURSING INTERVENTION PRE-OP  Explain breast cancer and treatment options  Reduce fear and anxiety and improve coping abilities  Promote decision making abilities  Provide routine pre-op care:  Consent, NPO, meds, teaching about breathing exercise

NURSING INTERVENTION POST-OP  Position patient  Supine  Affected extremity elevated to reduce edema  Relieve pain and discomfort  Moderate elevation of extremity  IM/IV injection meds  Warm shower on 2nd post-op  Maintain skin integrity  Immediate post-op, snug dressing with drainage  Maintain patency of drain  Monitor for hematoma with in 12 hour and apply bandage and ice refer to surgeon  Drainage is removed when the discharge is ledd than 30 ml in 24 hour, inform the doctor to remove JP  Lotions, creams are applied only when the incision is healed in 4-6 weeks

NURSING INTERVENTION           

Promote activity Support operative site when moving Hand, shoulder exercise done on 2nd day Post-op mastectomy exercise 20 minutes TID No BP or Iv procedure on the operative site Heavy lifting is avoided Elevate the arm at the level of the heart On a pillow for 45 minutes TID to relieve transient edema Gardening is prohibited Arm > elbow Elbow > shoulder

LUNG CANCER rapid growth of abnormal cells in the lungs  caused by smoking, second smoke, exposure to harmful substance such as arsenic, asbestos, radioactive dust, or radon 

LUNG CANCER

LUNG CANCER

TYPES a. Small cell lung cancer  less common but they grow more quickly and are more likely to metastasize b. Non-small cell lung cancer 1. adenocarcinoma  most common type of lung cancer 2. squamous cell carcinoma  -second most common type of lung cancer

MEDICAL MANAGEMENT   

Radiation therapy Chemotherapy Surgery

Surgical Procedures

Surgical Procedures

ASSESSMENT FINDINGS 1.Persistent cough ( may be productive of blood tinged ) 2.Chest pain 3.Dyspnea 4.Unilateral wheezing 5.Friction rub 6.Possible paralysis of the diaphragm 7.Fatigue 8.Anorexia 9.Nausea and vomiting 10.Pallor 11. Diagnostic tests : - Chest X-ray may show presence of tumor or evidence of metastasis to surrounding structures - Sputum or cytology reveals malignant cell - Bronchoscopy: biopsy reveals malignancy - Thoracentesis: pleural fluid contains malignant cells

NURSING INTERVENTIONS    

 

Provide support and guidance to the client as needed Provide relief/control pain Administer medications as ordered and monitor effects/side effects Control nausea: administer medications as ordered, provide oral hygiene, provide small and more frequent feedings Provide nursing care for a client with thoracotomy Provide client teaching and discharge planning concerning  Disease process, diagnostic and therapeutic interventions  Side effects of radiation and chemotherapy  Realistic information about prognosis

OVARIAN CANCER 

The ovary is common site of primary as well as metastatic lesions from other cancers. Most cases affect women ages 50 to 59. Hereditary plays part and many physician advocate pelvic examination every 6 months for women who have one or two relatives with ovarian cancer. Transvaginal ultrasound and Ca-15 antigen testing are helpful in those at high risk for this condition.

OVARIAN CANCER

Clinical Manifestation    

 

Increased abdominal girth Pelvic pressure Bloating Indigestion, flatulence, increased waist size Leg pain and pelvic pain Slight anorexia

Medical Management     

Total hysterectomy Bilateral salpingo-oophorectomy Chemotherapy Radiation therapy Pharmacologic    

cyclophosphamide doxubricin Cisplastin Caboplastin

Nursing Intervention        

Administer intravenous therapy to alleviate fluid and electrolyte imbalances Provide adequate nutrition Provide post-operative care after intestinal bypass to alleviate obstruction Provide pain relief and managing drainage tubes Provide small frequent meals Decrease fluid intake Administer diuretic agents Provide quite environment

Complications  

 

spread of the cancer to other organs progressive function loss various organs ascites ( fluid in the abdomen) blockage of the intestines

Diagnostic Exams      

Pelvic Exam Ultrasound CA-125 assay Lower GI series or Barium enema CT Scan Biopsy

CT Scan

UTERINE CANCER 

Most uterine cancers are endemetriod. It is fourth most common cancer in the world. Cumulative exposure to estrogen is considered the major risk factors. It is a shaped like an upside down pear and sits inside the pelvis. it is also known as cancer of the womb, endometrial cancer, cancer of the lining of the womb

UTERINE CANCER

Risk Factors Age : at least 55 years; median age 61 years  Postmenopausal bleeding  Obesity  Unopposed estrogen therapy 

Assessment abnormal uterine bleeding  pre or post menopause  hyperplasia  prolonged menstruation 

Diagnostic Physical examination  Dilatation and curettage  X-rays  Blood tests 

Dilatation and Curettage

Medical Managements Total hysterectomy  Bilateral salpingo-oophorectomy  Radiation therapy  Chemotherapy 

Bilateral SalpingoOophorectomy

Nursing Interventions        

Institute routine pre and post-op care Assess for hemorrhage, infection or other post surgical complications Support woman and family through procedure encourage expression of feelings and reactions to procedure Allow woman to verbalize concerns about sexuality post surgery Maintain the patient on low residue diet to prevent bowel movements which might dislodge apparatus Observe for symptoms of radiation sickness – nausea, vomiting and elevated temperature Observe for any symptoms that might suggest radiation injury to the intestine diarrhea, report these if they occur Tell the patient the importance of monthly follow up visits to her physician for the first 6 months to assess effects of radiation on tumor

OROPHARYNGEAL CANCER



Is a disease in which cancer cells are found within the anatomical borders of the oropharynx. The majority of oropharyngeal cancers are squamous carcinomas.

OROPHARYNGEAL CANCER

Etiology   

Use of alcohol Use of Tabacco Being infected with the human papilloma virus (HPV)

Clinical Manifestation      



A sore throat that persist Pain of difficulty with swallowing Unexplained weight loss Voice changes Ear pain A lump in the back of the throat of mouth

A lump in the neck

Treatment  

 

Radiation therapy A clinical trial of chemotherapy that is followed by surgery or radiation therapy A clinical trial of chemotherapy combined with radiation therapy A clinical trial of new ways to provide radiation therapy

Radiation Therapy

CANCER OF THE LARYNX







Is a malignant tumor in the larynx (voice box ), potentially curable if detected early Less than 1% of all cancers, common in men than in women ages 50-70 years of age. Occurs in : glottic area ( vocal cords ), supraglottic area, subglottis area

CANCER OF THE LARYNX

Risk Factors for laryngeal cancer

Carcinogens : - tobacco - asbestos - paint fumes - wood dust - chemicals 

Risk Factors for laryngeal cancer Others - straining the voice - chronic laryngitis - nutritional deficiencies - history of alcohol abuse - age - gender - race - weakened immune system 

Clinical Manifestations    



Hoarseness of more than 2 weeks Cough or sore throat A lump felt on the neck Dysphagia, dyspnea, unilateral nasal obstruction Pain radiating to the ear

Assessment and Diagnostic Findings      

History, Physical Assessment Indirect laryngoscopy Biopsy CT MRI PET

Indirect Laryngoscopy

Medical Management    

Surgery Radiation therapy Chemotherapy Speech therapy

Surgical Management 

Laryngectomy- surgical removal of part of all of the larynx and surrounding structures Partial laryngectomy  Hemilaryngectomy  Total laryngectomy 

Surgical Procedure

Nursing Diagnosis 





Ineffective airway clearance related to excess mucus production secondary to surgical alterations in the airway Imbalance nutrition less than body requirement related to inability to ingest food Self care deficit related to pain, weakness, fatigue, musculoskeletal impairement

Complications Respiratory distress  Hemorrhage  Infection  Wound breakdown 

Nursing Interventions    

 



Teaching the patient preoperatively Reducing anxiety and depression Maintaining a patent airway Promoting alternative communication methods Adequate nutrition Promoting positive body image and selfesteem Monitoring and managing potential complications

COLORECTAL CANCER 

The colon and rectum are part of the digestive tract. Together, they comprise the large intestine, or large vowel, which is located in the abdomen between the small intestine and the anus. Cancer that originate in the colon or rectum may be called colon cancer, rectal cancer or colorectal cancer. Colon cancer is the term most commonly used to refer to this type of cancer.

COLORECTAL CANCER

Etiology Family history  Chronic inflammatory bowel disease  Polyps  Low fiber diet 

Clinical Manifestation        

Change in bowel habits Passage of blood in stools Unexplained anemia Anorexia, Weight loss Fatigue Right side abdominal pain Left side abdominal pain, cramping, narrowing stools, constipation and distention

Diagnosis Digital rectal examination  Fecal occult blood test  Fiber optic sigmoidoscopy  Biopsy  Colonoscopy 

Colonoscopy

Treatment   





Chemotherapy Radiation therapy Segmental resection with anastomosis Abdomino perineal traction with sigmoid colostomy Ileostomy

CANCER OF THE STOMACH 





Most often develops the distal third and may spread thru the walls of the stomach into adjacent tissues, lymphatics and abdominal organs Most death occur in 40 years of age but occasionally occur in younger people Men have higher incidence of gastric cancer than women

CANCER OF THE STOMACH

Symptoms Early  

Indigestion or burning sensation ( heartburn) Loss of appetite specially meat

Late       

Abdominal pain Nausea and vomiting Diarrhea or constipation Bloating of the stomach after meals Weight loss Weakness and fatigue Bleeding which can lead to anemia

Clinical Manifestation     

Pain relieved by antacids Anorexia Dyspepsia Weight loss Constipation

Medical Management Chemotherapy  Radiation therapy  Pharmacologic drugs 

cisplastin  Irrinotecan  Doxorubicin 

Nursing Intervention        

Encourage the family to support the patient Offer reassurance and support coping measures Explain the procedures and treatment Encourage the patient to eat small frequent portion of non irritating foods Monitor IV therapy Record intake and output Monitor daily weights Assess for signs of dehydration

LIVER CANCER 

Hepatic tumors may be malignant or benign. Benign liver tumors were the uncommon until the wide spread use of oral contraceptives. Primary liver tumors are associated with chronic liver diseases Hepatitis B and C infection and Cirrhosis.

LIVER CANCER

LIVER CANCER

Clinical Manifestation      

Weakness Anorexia Nausea and vomiting Right upper quadrant discomfort Blood tinged ascites Friction rub over liver

Diagnostic Findings Increase serum levels of bilirubin  Alkaline phosphates  Lactic dehydrogenase 

Medical Management Chemotherapy  Percutaneous biliary drainage  Lobectomy  Radiation therapy 

Nursing Intervention 



 

Provide emotional support to the client Provide care of the client receiving radiation therapy Provide care with abdominal surgery Provide nutritional status

WILM’S TUMOR 





is a malignant tumor that rises from the metanephric mesoderm cell of the upper role of the kidney. It occurs in association with congenital anomalies such aniridia ( lack of the color in the iris ) Also known as “ Nephroblastoma ”

Wilm’s tumor

Assessment nephroblastoma is usually discovered early in life (6 mos to 5 yr; peak at 3 to 4yr)  Although it apparently arises from an embryonic structure present in child before birth. Nephroblastoma may manifest w/ hematoria and low grade fever occurs between of rennin production 

Diagnosis CT- scan  Glomerular filtration rate  Blood urea nitrogen 

Therapeutic Management Nephrectomy ( excision of affected kidney)  Chemotherapy w/ dactinomycin 

Nephrectomy

STAGING NEPHROBLASTOMA   





I - tumor confined to the kidney and completely removes surgically. II - tumor extending beyond the kidney but completely removes surgically. III - Regional spread of the diseases beyond the kidney w/ residual abdominal dse. Post operative. IV - metastases to lung, liver, bone distance lymph nodes or other distance sites V - Bilateral diseases.

Complication       

small bowel Obstruction Fibrotic scarring Hepatic damage from radiation to the lesion can occurs Nephritis In girls, radiation related damage to the ovaries may result sterility Interstitial pneumonia Scoliosis

PROSTATE CANCER 







is the most common cancer in the men other than non melanoma skin cancer the second most common cause of cancer death in American men older than 55 y/o It is estimated that 189,000 new cases of prostate cancer and 30,200 death occurs annually Increase risk prostate cancer only 47 % of the men in sample who were 40 y/o or Older had prostate cancer screening as part of annual physical examination.

PROSTATE CANCER

PROSTATE CANCER

PROSTATE CANCER

Risk Factors  

 

Increasing age rapidly with the age of 50 years. Prostate cancer is common in the United states and northwestern Europe but is rare in Asia, Africa, Central America and South America. Familial predisposition Diet high in red meat and fat increase.

Sign and Symptoms      

Difficulty and frequency of urination Urinary retention Decrease size and force of urinary stream Blood in the urine or semen Painful ejaculation Hematoria

Symptoms related to metastases        

backache hip pain perineal and rectal discomfort anemia weight loss weakness nausea oligoria

Diagnosis        

every man older than 40 y/o should have DRE as part of the regular health checkup Rectal palpitation of the gland Transurethral section Open Prostatectomy Transrectal needle biopsy Transrectal Ultrasound ( TRUS) X- ray ( to identify bone metastasis CT- scan

Medical Management 1. Surgical management

- Radical prostatectomy (removal of the prostate and seminal vesicle) 2. Radiation therapy - teletherapy w/ linear accelator or interstitial irradiation ( implantation of radioactive seeds of iodine or palladium)

Medical Management 3. Hormonal therapy- used to control rather than cure prostate cancer. A. TURP – the most common procedure used, can be carried out through endoscopy. B. SUPRAPUBIC PROSTATECTOMY - Is one method of removing the gland through an abdominal incision C.PERINEAL PROSTATECTOMY - Removing the gland through an incision in the perineum D. RETROPUBIC PROSTATECTOMY - is more common then the supra pubic approach. This procedure is suitable For large gland located high in the pelvis.

NURSING INTERVENTION       

Reducing anxiety Relieving discomfort Providing instruction Preparing patient Maintaining fluid balance Relieving pain Monitoring for hemorrhage and infection

From the looks of the expression on the dog's face, he is really into saying his prayers 

The End!!!

GOD BLESS !!!