Presentation of diagnosis related to cancer by heena
MEDICAL SURGICAL NURSINGTOPIC-DIAGNOSIS RELATED TO THE CANCER PRESENTED BY MRS HEENA MEHTA IVALUTOR MR.P.YONATANSIR
VARIOS DIAGNOSTIC INVESTIGATION USED FOR DETECTION OF CANCER• For the assessment of the cancer, first step is to obtain complete history and physical examination• HISTORY
-TIME OF ONSET OF THE DIEASE -HOW LONG IT OCCURE? -WHAT IS THE PROGRESS ,EITHER SLOW OR FAST? -SEVIARITY OF THE SYSMPTOMSEITHER IT RECOVER WITH TREATMENT NOR NON EFFECTIVE -ANY TREATMENT TAKEN FOR DISEASE? -ANY DIAGNOSTIC PROCEDURE DONE OR NOT? -HOW MANY TIMES FOLLOWUP DONE ?
• ANY FAMILY HISTORY OF THE CANCER -ANY ABNORMAL HABITS FOR LONG TIME? -WHAT IS THE OCCUPATION? - WHAT IS THE FAMILY BACK GROUND? -ANY DRUG ADICTION OR NOT? -ANY COMMUNICABLE DISEASE OCCURE OR NOT,IF OCCUR IT IS CURABLE OR HARMFUL? -ANY GENETIC ABNORMALITY IN
Grade level Cellular characteristicsGrade -1 Low grade malignancy. Cells are similar to normal parent tissue and have a slow growth rate. Well differentiated in appearance and function.Grade -2 Low to moderate grade malignancy. Cells have some normal and some malignant cell features. The tissue of origin is apparent.
Grade-3 Moderate to high grade malignancy. Cells have more malignant feature than normal cell features.Grade-4 High grade malignancy. Cells have no normal cell features in appearance and function. Poorly differentiated or undifferentiated. Tissue of origin may be unknown.
STAGE 0 or CARCINOMA IN SITU;• Carcinoma in situ is very early cancer. The abnormal cells are found only in the first layer of cells of the primary site and do not invade the deeper tissues.• STAGE-1:• Cancer involves the primary site, but has not spread to nearby tissues.• STAGE- 1A:• A very small amount of cancer – visible uncer a microscope is found deeper in the tissues.
• STAGE-1B:• A larger amount of cancer is found in the tissues.• STAGE-2:• Cancer has spread to nearby areas but is still inside the primary site.• STAGE-2A:• Cancer has spread beyond the primary site.• STAGE-2B:• Cancer has spread to other tissue around the primary site.
• STAGE-3:• Cancer has spread throughout the nearby area.• STAGE-4:• Cancer has spread to other parts of the body.• STAGE-4A• Cancer has spread to organs close to the pelvic area.• STAGE-4B• Cancer has spread to distant organs, such as the lungs.
TNM CLASSIFICATION• The American joint committee of cancer(AJCC) has developed a simple classification solid tumors. T refers to lthe extent primary tumor (tumors size), N represents regional lymph node involvement and extent of metastasis is represented by the letter M.
Mandatory parameters ("T", "N", and "M")• T: size or direct extent of the primary tumor –Tx: tumor cannot be evaluated –Tis: carcinoma in situ –T0: no signs of tumor• T1, T2, T3, T4: size and/or extension of the primary tumor
• N: degree of spread to regional lymph nodes – Nx: lymph nodes cannot be evaluated – N0: tumor cells absent from regional lymph nodes – N1: regional lymph node metastasis present; (at some sites: tumor spread to closest or small number of regional lymph nodes) – N2: tumor spread to an extent between N1 and N3 (N2 is not used at all sites) – N3: tumor spread to more distant or numerous regional lymph nodes (N3 is not used at all sites)
• M: presence of metastasis –Mx: distant metastasis cannot be evaluated –M0: no distant metastasis –M1: metastasis to distant organs (beyond regional lymph node
How is cancer diagnosed?• There is no single test that can accurately diagnose cancer. The complete evaluation of a patient usually requires a thorough history and physical examination along with diagnostic testing. Many tests are needed to determine whether a person has cancer, or if another condition (such as an infection) is mimicking the symptoms of cancer.
BLOOD INVESTIGATION:HAEMETOLOGICAL, BIO- CHEMICAL
• Absolute Neutrophil Count (ANC) The ANC is calculated by multiplying the percent of neutrophils (plus bands) by the total number of white blood cells. This count is used to determine if chemotherapy can be given.• Acid Phosphatase Also called: acid phos, acid f, acid p‘tase. A test of blood serum to detect a specific enzyme produced by several tissues, particularly the prostate.
• Blood Count -A blood test used to determine the number of the various types of blood cells.• BUN (Blood Urea Nitrogen)- Chemistry study of blood serum to measure the level of urea in the blood, a sign of impaired kidney function or urinary obstruction. Normal range: 10-15 mg/100 ml.• CA-125 -Tumor marker that may be elevated in cancers of the ovary, breast, and colon.• CA-19-9 -A tumor marker that may be elevated in cancers of the colon and pancreas.• CA15-3 -A tumor marker that may be elevated in breast cancer.
• Calcium Elevated in cancer that has spread to the bone, with tumors that produce parathyroid hormone-like protein and in multiple myeloma, as well as in some non-malignant diseases.• CEA (Carcinogenic Embryonic Antigen) A tumor marker found in the blood that may indicate the presence of certain types of cancer cells. Tumor marker substances may be produced by the tumor itself or by the body in response to a cancer.• Creatinine Waste product in blood; is a measure of kidney function; if elevated may signify kidney disease..
• Ferritin Measures iron storage protein in sialic acid; low levels suggest good prognosis in head and neck malignancies.• Leukocyte Another name for white blood cells. A type of cell in the blood which helps defend the body against diseases caused by bacteria, virus, or parasites. There are three types of leukocytes: monocyte, granuloctye, and lymphocytes.
• Platelet Count Measures the number of platelets in a drop of blood. Platelet counts increase during strenuous activity and certain conditions called myeloproliferative disorders: infections, inflammations, malignancies, and when the spleen has been removed• Ploidy Analysis A test to measure the amount of DNA contained in a cell. Most cancer cells are aneuploid, which means they contain an abnormal amount of DNA.
• Proliferation Index High rates indicate actively growing tumors and a greater risk of relapse.• PSA (Prostate Specific Antigen) A substance (tumor marker) in the blood derived from the prostate gland. Its level may rise in prostatic cancer and is useful as a marker to monitor the effects of treatment.• S-Phase (Cell Cycle Analysis) Percentage of tumor cells synthesizing DNA; patients with high S-phase fraction have less favorable prognosis.
• Thyroid Hormones T3 Thyroxine (T4). The other 20% is triiodothyronine measures as T3. Sometimes the diseased thyroid gland will start producing very high levels of T3 but still produce normal levels of T4. And TSH.• Thyroblobulin Elevated levels of this serum hormone are found in follicular carcinoma and return to normal following treatment if all tumor is removed; useful for monitoring residual disease and recurrence of follicular carcinoma.
• Tumor Markers Chemicals in the blood that are produced by certain cancers. Measuring the markers is useful for diagnosis, but especially useful for following the course of treatment.• White Blood Count (WBC) Measures the number of white cells; WBC elevated during infection, inflammation, burns, leukemia, low WBC indicates bone marrow depression–may be present with some viruses, toxic reactions, German measles, infectious hepatitis, and other diseases.
• Tumor Marker is a molecule or process or a substance that can be measured with an examination (assay) both qualitatively and quantitatively in precancerous condition and cancer. Changes in these levels can be caused by tumors and normal tissue in response to the tumor. Tumor markers can be DNA, mRNA, protein o parts of proteins ( such as te process o proliferation, angiogenesis, apoptosis,
• Tumor markers can be found in significant amounts in the blood or urine of patients with cancer and can also be found in the blood and urine of patients with no cancer. Beside that Tissue, saliva, body fluids, and the cell itself can be used as a specimen for the tumor marker test
• Growth hormone (GH), which is produced in the pituitary gland under control of the hypothalamic factors growth-hormone-releasing hormone (GHRH) and somatostatin (SMS), is a key stimulator of IGF-1 production. Various IGF-binding proteins (IGFBPs) are also produced in the liver. In IGF-responsive tissues, the ligands IGF-1 and IGF-2 as well as IGFBPs can be delivered through the circulation from the liver (an endocrine source), but IGFs and IGFBPs can also be locally produced through autocrine or paracrine mechanisms
Bone Marrow Biopsy and Aspiration• A needle is inserted into the bone of the hip or breast bone to obtain a sample of bone marrow for study under a microscope.• Bone Marrow Tests• Bone marrow tests check whether your bone marrow is healthy. Bone marrow is a sponge- like tissue inside the bones. It contains stem cells that develop into the three types of blood cells that the body needs:
Stereotactic Needle Biopsy• A procedure used in the diagnosis of brain tumors. A special frame is used to hold the patients head stationary while the biopsy needle is directed to exactly the right spot. A CT scanner is used to find the correct position. This method has also been applied to very small breast cancers
Different Types Of Biopsy Procedures• Some of the more common types of breast biopsy procedures include Fine Needle Aspiration Biopsy, Core Needle Biopsy, Stereotactic Core Needle Biopsy, Vacuum Assisted Core Biopsy, Circular Rotating ‗Cookie Cutter‘ Knife, MRI (Magnetic Resonance Imaging) guidance, Ultrasound Guided Biopsy and Excisional Biopsy.
HISTOPATHOLOGY Biopsy• The surgical removal of a small piece of tissue to determine if the area is cancerous.• A biopsy is the removal of a small piece of tissue for laboratory examination.• There are several different types of biopsies.
• Basically, biopsies can be divided in to 07 groups on the basis of method of removal of tissue form the body .• Needle biopsy• Punch biopsy• Incisional biopsy• Excisional biopsy• Currettage biopsy• Extracting tissue piece by piece• Endoscopic biopsy
• Prior to removal of tissue, the most appropriate type of biopsy going to be made should be determined. This depends on varieties of factors.• Tissue to be sampled.• how suspicious the abnormality appears.• Size, shape and other characteristic of abnormalities• The location of abnormalities• Number of abnormalities•
1. Needle Biopsy• A needle is inserted through the skin to the suspicious area and cells are extracted. The needle biopsy includes Fine Needle Aspiration (FNA), vacuum assist biopsy and core needle biopsy.
• Fine Needle Biopsy• A long thin needle is inserted to the suspicious area and fluid collected into a syringe. This fluid is sent to the cytology laboratory for cellular studies. (FNA Thyroid
Vacuum Assist Biopsy• A vacuum pressure is used to collect tissue through a specially designed hollow needle. This procedure facilitates to collect multiple or large samples from the same biopsy site without having to insert the needle more than once. (Example : Breast
Core Needle Biopsy• Core needle biopsy is performed by inserting a hollow core needle through the skin to the lesion. This needle is larger than the one used in fine needle biopsy (gauge 16,14 or 11) and it has been designed with a cutting tip to extract a column or cylinder shaped of tissue from the abnormality. The core needle biopsy is performed when the fine needle biopsy didn‘t provide a definitive diagnosis. (Example : Trephine biopsy)
. Punch Biopsy• A punch or circular tool is used to extract about 6 mm deep skin layers. This technique is usually used by dermatologists. The punch biopsy is made on exposed areas especially oral mucosa. (Example : Skin biopsy, Rectum biopsy and Oral biopsy)
Incisional Biopsy• A scalpel is used to remove a small piece of tissue from large lesion. Incisional biopsy may be used for soft tissues. (Example : Biopsy from Tumors).
Excisional Biopsy• The entire lesion is removed from the body.
5. Currettage Biopsy• Removal of piece of tissue by scraping. (endometrial curretings)
6. Extracting Tissue piece by piece• Example : Transurethral Reaction of the Prostate (TURP
Endoscopic Biopsy• Endoscope is a fine flexible tube with a camera used to view the inside of the body either through a natural body orifice or a small surgical incision. The endoscope used to visualize the different parts of body is named in different names.
Conization• A small wedge shaped tissue sample is surgically removed from the cervix and examined for the detection of cancer cells.
Cervical Conization• Definition• Cervical conization is both a diagnostic and treatment tool used to detect and treat abnormalities of the cervix. It is also known as a cone biopsy or cold knife cone biopsy.• Purpose• To found a precancerous condition in the cervix.• Cervical conization also may be performed if there is an abnormal cervical smear test A biopsy is a diagnostic test in which tissue or cells are removed from the body and examined
Precautions• As with any operation that is performed under general anesthesia, the patient must not eat or drink anything for six to eight hours before surgery
Procedure• The patient lies on the table with her legs raised in stirrups, similar to the position when having a Pap test.• The patient is given general anesthesia, and the vagina is held open with an instrument called a speculum.• Using a scalpel or laser the doctor removes a cone-shaped piece of the cervix containing the area with abnormal cells.• The resulting crater is repaired by stitching flaps of tissue over the wound.
• Aftercare• An overnight stay in the hospital may be required. After the test, the patient may feel some cramps or discomfort for about a week. Women should not have sex, use tampons, or douche until after seeing their physician for a follow up appointment (a week or more after the procedure).
RADIOLOGICAL ASSESSMENT• What are the different types of diagnostic imaging?• There are three types of imaging used for diagnosing cancer: transmission imaging, reflection imaging, and emission imaging. Each uses a different process.
transmission imaging• X-rays, computed tomography scans (CT scans), and fluoroscopy are radiological examinations whose images are produced by transmission. In transmission imaging, a beam of high-energy photons is produced and passed through the body structure being examined. The beam passes very quickly through less dense types of tissue such as watery secretions, blood, and fat, leaving a darkened area on the x-ray film.
1- x-ray• X-rays are diagnostic tests that use invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs on film. X-rays may be taken of any part of the body to detect a tumor (or cancer).
How do we "see" using X-ray light?• when X-ray light shines on us, it goes through our skin, but allows shadows of our bones to be projected onto and captured by film
2-computed tomography scan (Also called a CT scan)• A CT scan is a diagnostic imaging procedure that uses a combination of x- rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x- rays.
How a CT scanner works• CT scan (or CAT scan) stands for Computerised (Axial) Tomography scan. This means a scan that takes a series of X-rays and uses a computer to put them together. The scan is is painless. The CT machine takes pictures of your body from different angles and gives a series of cross sections or slices through the part of the body being scanned.
Preparation• Change own cloth and wear hospital dress.• Remove jwellery,pin and metal from the body.• Remove artificial denture.• Some CT scans need special preparation beforehand. This is explained below for scans of different parts of the body.• For some scans, you will have a drink or injection of contrast medium. This is a dye that shows up body tissues more clearly on the scan. Before you have this, ask you about allergies or asthma as some people can be allergic to it. The injection may make you feel
Abdominal CT scans• Not to eat or drink after midnight the night before the scan• To drink a liquid contrast medium some time before the scan• To drink more of the liquid in the X-ray department
CT scans of the head• For some brain scans, you may be given an injection of the contrast medium dye beforehand to make the scan clearer
CT scans of the chest• For some chest (thoracic) scans, you may be given an injection of the contrast medium dye beforehand. This is to help show up the tissues close to the area containing the cancer, for example blood vessels
Pelvic CT scans• Not to eat or drink for some time before the scan• To have an injection of contrast medium just beforehand• Depending on the part of your pelvis being scanned, you may have an injection of a drug to slow down the normal movement of your bowel. This movement (called peristalsis) can distort the scan and make it more difficult to read.
• There is a very detailed scan of the bowel called a virtual colonoscopy (also called a CT colonography). Instead of having a tube and a camera put into your bowel to look inside (a colonoscopy).
3---- Bone scan• How the Test is Performed• A bone scan involves injecting a radioactive material (radiotracer) into a vein. The substance travels through your blood to the bones and organs. As it wears off, it gives off a little bit of radiation. This radiation is detected by a camera that slowly scans your body. The camera takes pictures of how much radiotracer collects in the bones.
How to Prepare for the Test• You must remove jewelry and other metal objects. You may be asked to wear a hospital gown.• Tell your doctor if you are or may be pregnant.• Do not take any medicine with bismuth in it, such as Pepto-Bismol, for 4 days before the test.
Why the Test is needed• Diagnose a bone tumor or cancer• Determine if a cancer that began elsewhere in your body has spread to the bones; common cancers that spread to the bones include breast, lung, prostate, thyroid, and kidney.• Diagnose a fracture, when it cannot be seen on a regular x-ray (most commonly hip fractures, stress fractures in the feet or legs, or spine fractures)
• Diagnose a bone infection (osteomyelitis)• Diagnose or determine the cause of bone pain, when no other cause has been identified• Evaluate metabolic disorders, such as osteomalacia, renal osteodystrophy, primary hyperparathyroidism, osteoporosis, co mplex regional pain syndrome, and
PROCEDURE OF BONE SCAN• First part – 20 to 30 minutes including time taken to get ready. This will• include injection of the radioactive liquid and may include having some• pictures taken straight after the injection.• • 3 – 6 hours waiting time between• • Second part – 30 to 60 minutes including time taken to get ready.• (Total 4 – 7 hours altogether)• Injection of radioactive liquid
• After the Bone Scan• You will be able to go soon after the bone scan has finished and can continue with normal activities.• Staff will need to take out the needle if it is still in your arm.• Staff will give you any special instructions• The radioactive liquid will pass out of your body in your urine within 2 days. You will not notice it as it is colourless.• Drink plenty of fluid to help get rid of the radioactive liquid
4- lymphangiogram (LAG)• Lymphangiography• radiographic examination of the lymphatic system by injection of contrast medium. The procedure serves to visualize lymph vessels in the upper and lower extremities, thethoracic duct and regional lymph nodes, particularly the axillary, inguinal, external and common iliac and para-aortic (lumbar) groups.
Indications• 1. Oily lymphangiography has been performed for a) detection of regional lymph node metastases (pelvic tumours and malignant melanomas) and in staging of malignantlymphomas, and b) chylothorax and pathologies of the thoracic duct (injuries, infectious diseases, tumour invasion).• 2. Water-soluble lymphangiography is indicated for investigation of primary and secondary lymphoedema.
5- Mammogram• A mammogram is an x-ray examination of the breast. It is used to detect and diagnose breast disease in women who either have breast problems such as a lump, pain, or nipple discharge, as well as for women who have no breast complaints.
Types of memmography• Digital mammography, also called full-field digital mammography (FFDM), is a mammography system in which the x-ray film is replaced by solid-state detectors that convert x-rays into electrical signals.• Computer-aided detection (CAD) systems use a digitized mammographic image that can be obtained from either a conventional film mammogram or a digitally acquired mammogram. The computer software then searches for abnormal areas of density, mass, or calcification that may indicate the presence
• common uses of the procedure• Mammograms are used as a screening tool to detect early breast cancer in women experiencing no symptoms and to detect and diagnose breast disease in women experiencing symptoms such as a lump, pain or nipple discharge.
• Screening Mammography Mammography plays a central part in early detection of breast cancers because it can show changes in the breast up to two years before a patient or physician can feel them.• Diagnostic Mammography Diagnostic mammography is used to evaluate a patient with abnormal clinical findings—such as a breast lump or lumps.
Preparation of patient• Do not wear deodorant, talcum powder or lotion under your arms or on your breasts on the day of the exam. These can appear on the mammogram as calcium spots.• Describe any breast symptoms or problems to the technologist performing the exam.•
How does the procedure work?• X-rays are a form of radiation like light or radio waves. X-rays pass through most objects, including the body. Once it is carefully aimed at the part of the body being examined, an x-ray machine produces a small burst of radiation that passes through the body, recording an image on photographic film or a special digital image recording plate.
Benefits• to detect small tumors. When cancers are small, the woman has more treatment options and a cure is more likely.• The use of screening mammography increases the detection of small abnormal tissue growths.. It is also useful for detecting all types of breast cancer, including invasive ductal and invasive lobular cancer.• No radiation remains in a patients body after an x-ray examination.• X-rays usually have no side effects in the
Reflection imagingReflection imaging refers to the type ofimaging produced by sending high-frequency sounds to the body part ororgan being studied. These soundwaves "bounce" off of the various typesof body tissues and structures atvarying speeds, depending on thedensity of the tissues present.
• Ultrasound, or sonography, is the most commonly used type of reflection imaging. This technique uses high-frequency sound waves and a computer to create images, called sonograms, of blood vessels, tissues, and organs. Sonograms are used to view internal organs as they function and to assess blood flow through various vessels. Tumors in the abdomen, liver, and kidneys can often be seen with an ultrasound.
• Ultrasound Uses• Ultrasound can be used as a diagnostic or screening tool to confirm medical disorders or to assist in performing medical procedures. It is also used as a therapeutic tool in treating musculoskeletal problems, renal stones (kidney stones), and gallstones
• Diagnostic or Screening Uses• Obstetrics and gynecology: Pregnancy ultrasound (or fetal ultrasound) is used to assess the progression of the fetus. Vaginal ultrasound, pelvic ultrasound, or transvaginal ultrasound is used to diagnose growths or tumors of the ovary, uterus, and Fallopian tubes. It can be used to assess non-pregnancy related issues as well: – lower abdominal pain – ovarian cysts – uterine fibroids – uterine growths – endometriosis
• Cardiology: . It is used to evaluate the flow of blood through the chambers and valves of the heart. It also assesses the strength of the heart beat and the volume of blood pumped through. Echocardiography is often used for the following: – heart valve problems, such as mitral valve prolapse or aortic stenosis; – congestive heart failure; – blood clots due to irregular heart beats such as in atrial fibrillation; – abnormal fluid collections around the heart, such as pericardial effusions; and – pulmonary artery hypertension.
• Blood vessels: . Using Doppler ultrasound technology, the flow of blood through the vessels can be observed and measured. Narrowing of vessels (stenosis) or widening of vessels (dilatation, also referred to as aneurysms) can be detected. Ultrasound testing of blood vessels includes: – carotid ultrasound, – abdominal aorta ultrasound for abdominal aortic aneurysm, and – blood clots in veins (superficial or deep venous thrombosis, or DVT).
• Abdominal structures: Abdominal ultrasound is used to evaluate the solid organs within the abdominal cavity, including the liver, gallbladder, pancreas, kidneys, and bladder. –Renal ultrasound is used to evaluate the function and structure of the kidneys. Swelling around the kidney with blockage in the urinary tract can be seen with ultrasound, making abdominal ultrasound useful in detecting kidney stones.
• Testicular ultrasound: Used to diagnose testicular torsion, epididymitis(testicle infection), and testicular masses.• Neck ultrasound: The thyroid and parathyroid glands can be imaged to detect nodules, growths, and tumors.• Breast ultrasound: Used to image the breasts and to guide biopsy of breast masses to evaluate for breast
• Knee ultrasound: Ultrasound can be used to evaluate the structures in the back of the knee to determine if a Bakers Cyst is present.• Eye ultrasound: An eye ultrasound is used to look at the back of the eye (retina). It is often used when a patient has cataracts that make looking into the eye difficult. The test may help diagnose retinal detachmentSkin ultrasound: Ultrasound can be used to help find certain types of foreign bodies that may become lodged in the skin.
–Liver ultrasound is used to find abnormalities in the liver tissue and ducts.–Gallbladder ultrasound can screen for gallstones or an infected gallbladder.–Appendix ultrasound is used in children or pregnant women, where it is necessary to avoid radiation from a CT scan (computerized
Emission imaging• Emission imaging occurs when tiny nuclear particles or magnetic energy are detected by a scanner and analyzed by computer to produce an image of the body structure or organ being examined.
8- Magnetic resonance imaging (MRI)• Definition• Magnetic resonance imaging (MRI) is the newest, and perhaps most versatile, medical imaging technology available. Doctors can get highly refined images of the bodys interior without surgery, using MRI.
• Purpose• MRI was developed in the 1980s. The latest additions to MRI technology are angiography (MRA) and spectroscopy (MRS). MRA was developed to study blood flow, while MRS can identify the chemical composition of diseased tissue and produce color images of brain function.
Prescribe an MRI scan of different areas of the body.• Brain and head. -MRI may be needed for patients with symptoms of a brain tumor, stroke, or infection (like meningitis). MRI also may be needed when cognitive and/or psychological symptoms suggest brain disease (like Alzheimers or Huntingtons diseases, or multiple sclerosis), or when developmental retardation suggests a birth defect.
• Spine-MRI is particularly useful for identifying and evaluating degenerated or herniated spinal discs.• Joint. -MRI scanning is most commonly used to diagnose and assess joint problems. MRI can provide clear images of the bone, cartilage, ligament, and tendon that comprise a joint.
• Skeleton-The properties of MRI that allow it to see through the skull also allow it to view the inside of bones.• Preparation• In some cases (such as for MRI brain scanning or an MRA), a chemical designed to increase image contrast may be given by the radiologist immediately before the exam. If a patient suffers from anxiety or claustrophobia, drugs may be given to help the patient relax.
• The patient may be asked to wear clothing without metal snaps, buckles, or zippers, unless a medical gown is worn during the procedure. The patient may be asked to remove any hair spray, hair gel, or cosmetics that may interfere with the scan.
Positron emission tomography (PET)• PET is a specialized radiology procedure used to examine various body tissues to identify certain conditions. PET may also be used to follow the progress of the treatment of certain conditions. PET is a type of nuclear medicine procedure. This means that a tiny amount of a radioactive substance, called a radionuclide (radiopharmaceutical or radioactive tracer), is used during the procedure to assist in the examination of the tissue
What is PET?• The name "PET" comes from Positron Emission Tomograp hy. It is a new scanning technique in medical research. PET allows us, for the first time, to measure in detail the functioning of distinct areas of the human brain while the patient is comfortable, conscious
How does it work?• A conventional "X- ray" is taken by firing X-rays through a person and onto a film. This "shadow" image shows some structures in the body, such as cartilage and bone.
What does a PET scan show?• Oxygen-15 can be used to label oxygen gas for the study of oxygen metabolism, carbon monoxide for the study of blood volume, or water for the study of blood flow in the brain. Similarly, fluorine-18 is attached to a glucose molecule to produce FDG for use in the observation of the brain�s sugar metabolism.
How much radiation does a patient get?• PET scans using radioactive fluorine in FDG would result in patients receiving exposures comparable to (or less than) those from other medical procedures, such as the taking of X-rays. Other scanning agents - for instance, 6-F-dopa or radioactive water - normally cause even less exposure.
DIAGNOSTIC TESTS• Barium Enema An x-ray examination of the colon using barium sulfate. Laxatives or enemas may be required beforehand.• What is Lower GI Tract X-ray Radiography (Barium Enema)?• Lower gastrointestinal (GI) tract radiography, also called a lower GI or barium enema, is an x-ray examination of the large intestine, also known as the colon. This examination evaluates the right or ascending colon, the transverse colon, the left or descending colon,
• common uses of the procedure-• A physician may order a lower GI examination to detect:• benign tumors (such as polyps).• cancer.• causes of other intestinal illnesses
• The procedure is frequently performed to help diagnose symptoms such as:• chronic diarrhea.• blood in stools.• constipation.• irritable bowel syndrome.• unexplained weight loss.• a change in bowel habits.• suspected blood loss.• abdominal pain.• to diagnose inflammatory bowel disease, a group of disorders that includes Crohns
prepare for the procedure• On the day before the procedure ,asked not to eat, and to drink only clear liquids like juice, tea, black coffee, cola or broth, and to avoid dairy products. After midnight, you should not eat or drink anything.• Instructed to take a laxative and to use an over-the-counter enema preparation the night before the examination and possibly a few hours before the procedure.
• take your usual prescribed oral medications with limited amounts of water.• to remove some or all of your clothes and to wear a gown during the exam.• to remove jewelry, removable dental appliances, eye glasses and any metal objects or clothing that might interfere with the x-ray
• Women should always inform their physician and x- ray technologist if there is any possibility that they are pregnant. Many imaging tests are not performed during pregnancy so as not to expose the fetus to radiation.
• Infants and children may undergo lower GI radiography. Usually, there is no special preparation, but your doctor will give you detailed instructions to prepare your child for the examination. The use of barium and the taking of x-ray images is similar to that described for adults.
• How does the procedure work?• X-rays are a form of radiation like light or radio waves. X-rays pass through most objects, including the body. Once it is carefully aimed at the part of the body being examined, an x-ray machine produces a small burst of radiation that passes through the body, recording an image on photographic film or a special digital image recording plate.
What will I experience during and after the procedure?• feel abdominal pressure or even minor cramping. Most people tolerate the mild discomfort easily. The tip of the enema tube is specially designed to help you hold in the barium.
• several different positions. At times, pressure may be applied to your abdomen. With air contrast studies of the bowel the table may be moved to an upright position.• After the examination, you may be given a laxative or enema to wash the barium out of your system.
• regular diet and take orally administered medications unless told otherwise by your doctor.• to return to a normal diet and activities immediately after the examination.• to drink additional water for 24 hours after the examination.
• Your stools may appear white for a day or so as your body clears the barium liquid from your system.• Some people experience constipation after a barium enema. If you do not have a bowel movement for more than two days after your exam or are unable to pass gas rectally, call your physician promptly.
Barium Swallow• IT IS THE SAME PROCEDURE AS BARIUM ENEMA BUT THE PROCEDURE DONE FOR UPPER GI TRACT DISEASE• SAME PREPARATION ,SAME METHOD AND SAME TYPE X- RAY DONE FOR UPPER GI TRACT.
ERCP (Endoscopic Retrograde Cholangio- pancreatography)• An examination of the pancreas where a tube is inserted down the throat, through the stomach and into the pancreas. A dye is injected and x- rays are taken to show abnormalities. The ERCP can also be used to obtain tissue samples for biopsy.
• Upper gastrointestinal (GI) endoscopy• Upper GI endoscopy is a procedure that uses a lighted, flexible endoscope to see and perform procedures inside the upper GI tract. The upper GI tract includes the esophagus, stomach, and duodenum—the first part of the small
• The bile and pancreatic ducts• Ducts are tubelike structures in the body that carry fluids. The bile ducts carry bile, a liquid the liver makes to help break down food. A group of small bile ducts—called the biliary tree—in the liver empties bile into the larger common bile duct.
INDICATION FOR ERCP• tumors• gallstones that form in the gallbladder and become stuck in the ducts• inflammation due to trauma or illness, such as pancreatitis—inflammation of the pancreas• infection• valves in the ducts, called sphincters, that won‘t open properly• scarring of the ducts, called sclerosis• pseudocysts—accumulations of fluid and tissue
Person prepare for ERCP• The health care provider usually provides written instructions about how to prepare for ERCP.• The upper GI tract must be empty. Generally, no eating or drinking is allowed 8 hours before ERCP.• Smoking and chewing gum are also prohibited during this time.
Medications and vitamins that may be restricted before and after ERCP include• nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen (Advil), and naproxen (Aleve)• blood thinners• high blood pressure medication• diabetes medications• antidepressants• dietary supplements.
• Patients should tell their health care provider about all health conditions they have, especially heart and lung problems, diabetes, and allergies.• Patients should also tell their health care provider about all medications they take.• Patients may be asked to temporarily stop taking medications that affect blood clotting or interact with sedatives, which are usually given during ERCP to help patients relax and stay comfortable.
PROCEDURE• . Patients receive a local anesthetic that is gargled or sprayed on the back of the throat. The anesthetic numbs the throat and calms the gag reflex.• An intravenous needle is inserted into a vein in the arm if sedatives will be given. Doctors and other medical staff monitor vital signs while patients are sedated.
• Recovery from ERCP• After ERCP, patients are moved to a recovery room where they wait for about an hour for the sedatives to wear off.. During this time, patients may feel bloated or nauseous. Patients may also have a sore throat, which can last a day or two.• Patients can go home after the sedatives wear off. Patients will likely feel tired and should plan to rest for the remainder of the day.
• Eating, Diet, and Nutrition• Unless otherwise directed, patients may immediately resume their normal diet and medications after having an ERCP. The health care provider can answer any specific questions about eating, diet, and nutrition.
• Risks associated with ERCP• Significant risks associated with ERCP include• infection• pancreatitis• allergic reaction to sedatives• excessive bleeding, called hemorrhage• puncture of the GI tract or ducts• tissue damage from radiation exposure• death, in rare circumstances.
Estrogen Receptor Assay• A test that determines if breast cancer is stimulated by the hormone estrogen.• a microscopic examination of breast tumor tissue used to determine the probable response of a tumor to endocrine therapy.
Frozen Section• A diagnostic technique done by a pathologist on a piece of tissue removed by a surgeon. The tissue is quick frozen, stained, and then examined under a microscope to determine if it is benign or malignant.
The BrushUse brush formaking sample forexamination.
Holding the brush Hold the brush like a pen in the left hand and stabilize the hand by gently resting the side of the fifth finger on the stage (or where ever you can find a place depending on your hand size and cryostatwhich approximates theangle I hold the brush in my hand. This results in the brush meeting the tissue flat over its 1/4 length.
• Turning the wheel• Turn the wheel in a continuous uniform motion without hesitation. I have seen many frozen sectionists using a brush stop at the beginning of the section, slowly grab the tissue and then start to turn the wheel.
• Movement of the brush• As the block begins to move toward the knife the brush moves downward in pace with the block. The brush can gently rest on the bottom 2mm of the block and "ride the block" pulling away just as the block meets the knife. It is the downward movement of the brush that allows you to keep a continuous motion as you grab the section.
As the blockdescends toward thebrush the brushkeeps pace with theblock by gentlyresting on the bottom2-3 mm of the blockand ―Riding the
As the blockmeets the bladeand the sectionsbegins it‘s curlthe brush leavesthe block whilecatching thecurling edge ofthesection. "Catching the curl"
• The brush jumps off the block with the curl. "The brush jumps over the blade"
• The brush holding the curl pulls the section horizontally over the stage like a pulling the covers over you in bed without pressing the tissue to the stage. "Pull over the blanket"
• Retrieving from stage• Slide levers down to gently touch the section which will float onto the slide with static or cohesive attraction. Try avoid stretching or folding the section during this process by keeping the a steady hand and the transverse axis of the slide parallel to the section.
• Retrieving from the block• 1) A section is cut leaving an attachment of medium at the top
• 2) The wheel is turned in opposite direction bring the section back to the face of the block.
• 3) Section is retrieved by placing the slide over the tissue on the face of the block.
• 1) Kidney tubules -15 seconds drying• 2) Same tissue immediately fixed in 95% ETOH
Gallium Scan• Radiographic imaging of the body which measures the amount of the radioisotope gallium that is concentrated in a specific part of the body. It is most useful in detecting nodal disease above the diaphragm. Also called: Gallium-67 scintigraphy, Ga67 scan, high dose (8-11 mCi) gallium scan.
• Preparation• • Before you receive the injection, there is no preparation. You may eat and drink• whatever you like.
• Procedure• • After you receive the injection and before the pictures are taken, be sure to have• a good bowel movement. If you need a laxative to do this, please ask for one.• • A small amount of the radioisotope will be injected into a vein. You will feel a
• Depending on the purpose of the scan, it may be done 24 or 48 hours after the• injection. Sometimes the scan is repeated daily, over 3 to 4 days, but no additional• injection will be given.• • During the scan, lie on your back on a firm table with your head flat.
• very sensitive machine (scanner) that receives and records radiation, will move• over your body from your head to your toes. Many pictures will be taken as the• scanner moves.
• After the procedure• There are no side effects, but a small amount of radioisotope may still be present in your body for up to 4 weeks.• You may urinate in the toilet as usual. Your urine and blood will be labeled• ―Radioactive‖ if sent to the laboratory during the first 4 weeks after the injection.• Your body rids itself of the compound as it does the food you eat..
Nuclear Scan• A diagnostic procedure in which a weak radioactive substance is injected into the blood stream. The body then absorbs the substance. A machine, like a giant Geiger counter, moves over the area being tested and takes pictures.
• Nuclear Medicine Scan• This is a test in which a small amount of radioactivity is used to obtain pictures of your body with a gamma camera. These pictures will help your doctor make a diagnose.
• A small amount of radioactive tracer is injected into a vein, usually in your arm. The injection is no more painful than a blood test.
• Is the radiation dangerous?• The amount of radiation you receive is small; it is comparable to that of an X- ray examination. The substances we inject are non-toxic and will not make you feel sick or drowsy. However, for radiation safety reasons children should not be brought to the Nuclear Medicine Department.
• Pap Smear A microscopic examination of cells of the cervix. This test can detect cancer of the cervix in the early stages.• Progesterone Receptor Assay• A test done of a breast cancer tissue specimen to determine if it is dependent on female hormones for growth.• IT IS SAME AS EOSTROGEN RECEPTOR ASSAY PROCEDURE.
BIBLIOGRAPHY• 1-ANSARI&KAUR,T/B OF MEDICAL SURGICAL NURSING- 2(SPECIALITIES)2011EDITION,S.VI KAS & COMPANY.PAGE NO- 7,14,15,16.• 2-BLACK (VOL- 1),MED.SUR.NSG,8TH ED. ,ELSIVIER PUBLISHER,PAGE NO 268 TO 269, 2131.