Cancer—a definition. Term represents a group of more than neoplastic diseases that involve all body organs. One or more cells lose their normal growth controlling mechanism and continue to grow uncontrolled. They tend to invade surrounding tissue and to metastasize to distant body sites.
Second leading cause of death in United States after heart hormonal cancer treatment side effects. Ranks fourth for males and first for females as cause of death; second after accidents as cause of death for children.
Greatest increase seen in lung cancer—consistent with smoking patterns. Incidence rate.
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It is predicted that the incidence of cancer in the United States could double by the middle of the century, due to growth and aging of population. Leading causes of cancer death are lungs, prostate, and colorectal for males; lungs, breast, and colorectal for females.
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Most common site of cancer for a female is the cervix. Steps in controlling cancer: Educate the public and professional people about cancer. Encourage methods of primary prevention.
Carcinogens: agents known to increase susceptibility to cancer. Chemical carcinogens: asbestos, benzene, vinyl chloride, by-products of tobacco, arsenic, cadmium, nickel, radiation, and mustard gas. Iatrogenic chemical agents: diethylstilbestrol DES ; chemotherapy; hormone treatment; immunosuppressive agents, radioisotopes, cytotoxic drugs. Radiation carcinogens: x-rays; sunlight ultraviolet light ; nuclear radiation. Viral factors: herpes simplex; Epstein—Barr; hepatitis B, and retroviruses.
Genetic factors: hereditary or familial tendencies. Demographic and geographic factors. Dietary factors: obesity; high-fat diet; diets low in fiber; diets high in smoked or salted foods; preservatives and food additives; alcohol. Psychological factors: stress. Optimal dietary patterns and lifestyle changes. Increase total fiber in diet—decreases risk of colon cancer.
Increase cruciferous vegetables cabbage, broccoli, hormonal cancer treatment side effects, Brussels sprouts. Increase vitamin A—reduced incidence of larynx, esophagus, and lung cancers.
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Increase vitamin C—aids tumor encapsulation and promotes longer survival time. Increase vitamin E—inhibits growth of brain tumors, melanomas, and leukemias. Decrease alcohol consumption. Avoid salt—cured, smoked, or nitrate-cured foods. Minimize exposure to carcinogens. Avoid oral tobacco—increases incidence of oral cancers. Avoid exposure to asbestos fibers and constant environmental dust. Avoid exposure to chemicals. Avoid radiation exposure and excessive exposure to sunlight.
Obtain adequate rest and exercise to decrease stress. Chronic stress associated with decreased immune system functioning. Strong immune system responsible for destruction of developing malignant cells.
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Participate in a regular exercise program. Get adequate rest 6—8 hours per night. Have a physical exam on a regular basis, including recommended diagnostic tests.
Risk assessment see Identified Causes and Risk Factors, p. Health history and physical assessment. Screening methods. Mammography, Pap test, prostate exam, prostate- specific antigen PSA blood test, etc. Self-care practices: breast self-examination BSE done every month on a regular time schedule; testicular self-examination TSE done every month; skin inspection.
Colonoscopy for males and females 50 years and older. Fecal occult blood test for males and females 40 years and older. Characteristics A. Benign neoplasms: usually encapsulated, remain localized, and are slow growing. Malignant neoplasms: not encapsulated, will metastasize and grow, and exert negative effects on host. Categories of malignant neoplasms.
Carcinomas—grown from hormonal cancer treatment side effects cells; usually solid tumors skin, stomach, colon, breast, rectal.
Sarcomas—arise from muscle, bone, fat, or connective tissue—may be solid. Lymphomas—arise from lymphoid tissue infection-fighting organs.
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Leukemias and myelomas—grow from bloodforming organs. Mechanisms of metastases. Transport of cancer cells occurs through the lymph system and either the cells reside in lymph nodes or pass between venous and lymphatic circulation. Tumors that begin in areas of the body that have extensive lymph circulation are at high risk for metastasis breast tissue.
The speed of metastasis is directly related to the vascularity of the tumor.
Angiogenesis: Cancer cells induce growth of new capillaries; thus cells can spread through this hormonal cancer treatment side effects. Hematogenous: Cancer cells are disseminated through the bloodstream.
The bloodstream may carry cells from one site to another liver to bone. Direct spread of cancer cells seeding where there are no boundaries to stop the growth e.
Transplantation is the transfer of cells from one site to another. Diagnostic studies will depend on suspected primary site and symptoms. Laboratory and radiologic tests often identify a problem first.
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Radiographic procedures e. Radioisotopic scanning studies e. Magnetic resonance imaging MRI. Biologic response markers useful for diagnosing primary tumors, a parameter used to measure the progress of disease or the effects of treatment. Positron emission tomography PET. Radioactive glucose is injected prior to scanning.
Areas of high glucose uptake, such as rapidly dividing cancer cells, are dramatically displayed in the scam images. PET scans reveal cellular-level metabolic changes occurring in an organ or tissue. This is important and unique because disease processes often begin with functional changes at cellular level. PET scan can measure such vital functions as blood flow, oxygen use, and glucose metabolism, which helps doctors identify abnormal from normal-functioning organs and tissues.
Other laboratory tests. Enzyme tests, such as acid phosphatase. Tumor marker: ID analysis of substances found in blood or body fluids. Grading refers to classifying tumor cells—done by biopsy, cytology, or surgical human papillomavirus untreated. Tumor grade is one of many factors that doctors consider when they develop a treatment plan for a cancer client.
It is not the same as staging. Tumor grade refers to the degree of abnormality hormonal cancer treatment side effects cancer cells compared with normal cells under a microscope.
Tumor grade is an indicator of how quickly the tumor is likely to grow and spread. Tumor grading systems differ depending on the type of cancer.
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Tumor grade may be one of the factors considered when planning treatment for a client. Biopsy: definitive diagnosis of cancer. Excisional biopsy—removes all suspicious tissue.
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Incisional biopsy—removes a sample of tissue from a mass. Needle aspiration—aspiration of small amount of core tissue from a suspicious area. Exfoliative cytology—scraping of any endothelium cells in tissue or secretions is applied to a slide and evaluated e. Tissue specimens are evaluated by frozen or permanent sections by a pathologist.
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Results from biopsy and other diagnostic procedures blood tests, x-ray studies, endoscopic procedures will determine extent of disease staging. Staging describes the size of the tumor and extent or metastasis of a malignant tumor; also quantifies severity of disease.
A useful system of staging for carcinomas is the TNM system. T: Primary tumor. N: Regional nodes. M: Metastasis. For many cancers, TNM combinations correspond to one of five stages.
Criteria for stages differ for different types of cancer.
The extent to which malignancy has increased in size Primary tumor T. TX: tumor cannot be assessed. T0: no evidence of primary tumor. TIS: carcinoma in situ. T1, T2, T3, T4: progressive increase in tumor size and involvement. Involvement of regional nodes N. NX: regional lymph nodes cannot be assessed clinically. N0: regional lymph nodes not abnormal. N1, N2, N3, N4: increasing degree of abnormal regional lymph nodes.
Metastatic development M.