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ONCOLOGY II
Early Detection and Prevention
• The downward trend in the mortality rate is due to early
detection and prevention of cancer.
• The nurse plays a prominent role in cancer management and
its prevention at all levels starting from screening, counseling,
early detection, prevention, treatment with chemotherapy and
final outcome.
Primary prevention
• Primary prevention aims at healthy persons before its
development.
• Measures include alterations of lifestyle behaviors that
eliminate or minimize exposure to carcinogens.
• Certain modifiable factors associated with cancer risks, such as
smoking, poor dietary habits alcohol consumption exposure to
radiation and environmental and occupational carcinogens; the
removal or avoidance can reduce the risk of cancer
development
Role of nurse in prevention of cancer
• 1) Dietary changes - Nurses advise increasing high-fiber food
intake such as fruits, vegetables, and whole grains cereals
which are rich sources of antioxidant vitamins.
• Also advise for reducing intake of salt-rich & nitrate rich foods
fats and oils, smoking & alcoholism
• 2) Education to the public regarding reduction exposure or
avoidance of exposure to known carcinogens, i.e radiations,
envirionment and occupational exposure
Role of nurse in prevention of cancer contd..
• 5) Role of physical exercise:- Nurse educates the public
regarding the role of exercise in the prevention of cancer.
She/he promotes regular exercise programs is public
• 4) Intermittent rest: - The nurse explains the importance of
intermittent rest during activity and good sound sleep at
night (restful night)
• 5) Regular health check up:- The nurse promotes health
check up for early detection
• 6) Eliminate stressors: Avoid Stressors or Stressful activities.
Enjoy consistent period relaxation and leisure.
Secondary prevention
• Secondary prevention aims at early detection of cancer
before manifestations appear, so as to plan prompt
treatment. As a result of early detection, premalignant
lesions may be excised, arrested, or reversed, or cancer
treatment is instituted earlier for better prognosis
Secondary prevention contd…
• The American cancer society has recommended
screening for prevention because of following reasons:
• The disease is detected at the presymptomatic stage
• Prognosis is good if diagnosis is made early
• Create awareness among public
• Effective treatment is available for the disease if
diagnosed early
• Benefits of screening are more than its risk
High risk patients and screening procedure
Site Persons at higher risk i.e
risk factors
Screening
procedure
Lung *History of heavy smoking
(pack/day) for old age >
50 yrs (50- 80 yrs).
• History of chronic lung
disease
• *Exposure to airbone
carcinogens e g :-
asbestos, uranium
hydrocarbons.
* Spiral CT
scanning
High risk patients and screening procedure contd..
Site Persons at higher risk i.e risk factors Screening procedure
Colorectal
cancer
• History of familial adenomatous
polyposis, ulcerative colitis/regional
ileitis
• History of intake of high fats and low
fiber to diet
• Positive family history of colorectal
cancer
• Age >50 yrs.
• History of change in bowel habits
recently
• History of passage of black stools
• History of smoking, alcohol and
sedentary Lifestyles.
• Test for occult blood
in stool
• Digital rectal
examination
• Annually after the
age of 40 yrs
• Sigmoidoscopy after
every 3-5 yrs after
the age of 50 yrs
• Early colonoscopy
High risk patients and screening procedure contd..
Site Persons at higher risk i.e risk factors Screening procedure
Cervical
cancer
• History of first inter course at an early
age (<20 yrs) with multiple partners.
• History STDS
• Poor personal/menstrual hygiene
• History of Herpes virus (type 2)
infection or AIDS or Humas Papilloma
virus (HPV) infection
• History of symptoms related to
cervical disease, i.e vaginal discharge/
bleeding, pain, or bleeding after
Sexual intercourse.
• Pap smear
• Colposcopy
High risk patients and screening procedure contd..
Site Persons at higher risk i.e risk
factors
Screening
procedure
Prostate cancer • Old age > 55 yrs
• History of exposure to
cadmium
• Positive family history of
prostatic cancer
• Symptoms of prostate
hypertrophy/ hyperplasia
such as dysuria, thinning of
stream of urine, nocturnal
frequency and hematuria
• Digital rectal
exam at the age
of 50 yrs
• Detection of
prostrate
specific antigen
(PSA)
High risk patients and screening procedure contd..
Site Persons at higher risk i.e
risk factors
Screening
procedure
Endometrial
cancer
• History of infertility
• History of intake of
prolonged oestrogen
therapy for a long period
• Obesity & ovarian
dysfunction
• Uterine bleeding
• Pelvic exam
• Pap smear
• Endometrial
biopsy
High risk patients and screening procedure contd..
Site Persons at higher risk i.e risk
factors
Screening
procedure
Skin
cancer
• History of prolonged exposure
to sun/ radiation
• Positive family history of skin
cancer
• History of chronic skin disease
• History of sore or lesion that
does not heal
• Observation of
skin lesion esp.
mole for any
change in size,
shape, colour or
surface
appearance
• Skin biopsy
High risk patients and screening procedure contd..
Site Persons at higher risk i.e risk
factors
Screening procedure
Breast
cancer
• History of early menarchae,
late menopause, nulliparity,
infertility
• History of first pregnancy after
the age of 30 yrs
• Family history of breast cancer
• Obesity or increase weight
• Symptoms :- Nipple discharge,
a nodule, breast pain etc
• Breast self
examination
• Breast exam by
health
professionals every
3 yrs in young
women (20- 40 yrs)
and every year
after 40 yrs
• Routine baseline
mammography
Chemoprevention
• It means use of drugs for the prevention of cancer. eg:-Beta
carotene and retinoic acid are shown to cause regression in
leukoplakia.
• Tamokifen reduces the incidence of contralateral breast cancer
in pts on adjuvant chemotherapy.
Nursing assessment
History collection
• It should include the history of cancer among the client’s blood
relatives and exposure to environmental factors at workplaces,
theory of smoking alcoholism, drug history, dietary habit,
lifestyle and change in bowel pattern. History should also
include the degree of coping of a patient who has previous
experience with cancer in a relative / friend.
• Detail history has to be taken regarding warning signs.
Physical examination
Inspection: the appearance of skin lesions, an inspection of
tumor size, shape
Palpation: uterus, liver, ovaries, prostate gland, breast, testicles
Inspection, palpation, percussion, and auscultation to be
done system wise detail.
Investigations
• 1) Routine test:-
–Complete blood count, PTT
–Blood chemistry; i.e urea, sugar, creatinine, albumin,
bilirubin, enzymes (SGOT/SGPT)
–Liver cancer- increase bilirubin, alkaline phosphate &
glutamine oxaloacetic transaminase
–Prostate cancer- Acid phosphatase
Investigations contd..
• 2) Radiological tests:-
–Plain x-ray chest and abdomen
–Ultrasonography
–Computed tomography
–Magnetic resonance imaging
–Radio isotope scans for liver, brain, bone and lung cancer.
–Lymphangiography
–Positron-emission Tomography
Investigations contd..
• 3) Hormonal assays:-
–ACTH, Insulin, Parathormone, Erythropoietin, TSH etc.
• 4) Bone marrow aspiration- leukaemia
• 5) Tumor markers
Tumor markers
Tumor marker Cancer type Tissue analyzed
ALK Gene arrangements Non small cell lung cancer,
anaplastic large cell
lymphoma
Tumor tissue
Beta- 2 macroglobulin
(B2M)
Multiple myeloma
Chronic lymphocytic
leukaemia
Blood urine CSF fluid
Beta Human Chorionic
Gonadotrophin (β HCG)
Choriocarcinoma
Testicular cancer
urine/Blood
BCR- ABL Chronic myeloid leukaemia Blood and bone marrow
Tumor markers
Tumor marker Cancer type Tissue analyzed
BRAF- mutation V600
E
Cutaneous melanoma
Colorectal cancer
Tumor tissue
CA 15-3
CA 27, 29
Breast cancer Blood
CA 19-9 Pancreatic cancer
Gall bladder
Gastric cancer
Blood
Tumor markers
Tumor marker Cancer type Tissue analyzed
CA 125 Ovarian cancer Blood
Calcitonin Medullary thyroid cancer Blood
Carcino embryonic
antigen
Colorectal cancer
Breast cancer
Blood
CD-20 Non Hodgkin lymphoma Blood
Chromogranin A (Cg A) Neuro endocrine tumor Blood
Chromosomes 3, 7, 17
and 9 p 21
Bladder cancer Urine
Cytokeratin fragments 21-
12
Lung cancer Blood
Tumor markers
Tumor marker Cancer type Tissue analyzed
Estrogen receptors (ER)
Progestron receptors (PR)
Breast cancer Tumor tissue
Fibrin/Fibrinogen Bladder cancer Urine
HE4 Ovarian cancer Blood
HER-2/neu Breast cancer
Gastric cancer
Oesophageal cancer
Tumor tissue
Immunoglobulins Multiple myeloma Blood & Urine
KIT Gastro intestinal stoma
tumor
Tumor tissue
Tumor markers
Tumor marker Cancer type Tissue analyzed
Prostate specific
antigen
Prostate cancer Blood
Thyroglobulin Thyroid cancer Tumor tissue
Urokinase
Plasminogen activator
(uPA)
Plasminogen activator
inhibitor PAI-1
Breast cancer Tumor tissue
Lactate dehydrogenase Germ cell tumor Blood
Investigations contd..
• 6) Special tests
–Mammography
–GI tract radiological studies
–Malabsorption tests
• 7) Biopsy (FNAC, Surgical incision)
–Incisional biopsy- surgical removal of small portion of tissue
for inspection
–Excisional biopsy- entire tissue removal
–Needle aspiration- insertion of needle and fluid aspiration
Investigations contd..
–Transcutaneous- insertion of fine needle in to tissue such as
breast, prostate, salivary gland
–Steriotactic biopsy- safe & efficient procedure for evaluating
lesions of brain & breast. Site is firmly immobilized lesion is
scanned for location and small incision is made for easy
insertion of small fiberoptic instrument
Steriotactic biopsy

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Adult health nursing oncology prevention and management

  • 2. Early Detection and Prevention • The downward trend in the mortality rate is due to early detection and prevention of cancer. • The nurse plays a prominent role in cancer management and its prevention at all levels starting from screening, counseling, early detection, prevention, treatment with chemotherapy and final outcome.
  • 3. Primary prevention • Primary prevention aims at healthy persons before its development. • Measures include alterations of lifestyle behaviors that eliminate or minimize exposure to carcinogens. • Certain modifiable factors associated with cancer risks, such as smoking, poor dietary habits alcohol consumption exposure to radiation and environmental and occupational carcinogens; the removal or avoidance can reduce the risk of cancer development
  • 4. Role of nurse in prevention of cancer • 1) Dietary changes - Nurses advise increasing high-fiber food intake such as fruits, vegetables, and whole grains cereals which are rich sources of antioxidant vitamins. • Also advise for reducing intake of salt-rich & nitrate rich foods fats and oils, smoking & alcoholism • 2) Education to the public regarding reduction exposure or avoidance of exposure to known carcinogens, i.e radiations, envirionment and occupational exposure
  • 5. Role of nurse in prevention of cancer contd.. • 5) Role of physical exercise:- Nurse educates the public regarding the role of exercise in the prevention of cancer. She/he promotes regular exercise programs is public • 4) Intermittent rest: - The nurse explains the importance of intermittent rest during activity and good sound sleep at night (restful night) • 5) Regular health check up:- The nurse promotes health check up for early detection • 6) Eliminate stressors: Avoid Stressors or Stressful activities. Enjoy consistent period relaxation and leisure.
  • 6. Secondary prevention • Secondary prevention aims at early detection of cancer before manifestations appear, so as to plan prompt treatment. As a result of early detection, premalignant lesions may be excised, arrested, or reversed, or cancer treatment is instituted earlier for better prognosis
  • 7. Secondary prevention contd… • The American cancer society has recommended screening for prevention because of following reasons: • The disease is detected at the presymptomatic stage • Prognosis is good if diagnosis is made early • Create awareness among public • Effective treatment is available for the disease if diagnosed early • Benefits of screening are more than its risk
  • 8. High risk patients and screening procedure Site Persons at higher risk i.e risk factors Screening procedure Lung *History of heavy smoking (pack/day) for old age > 50 yrs (50- 80 yrs). • History of chronic lung disease • *Exposure to airbone carcinogens e g :- asbestos, uranium hydrocarbons. * Spiral CT scanning
  • 9. High risk patients and screening procedure contd.. Site Persons at higher risk i.e risk factors Screening procedure Colorectal cancer • History of familial adenomatous polyposis, ulcerative colitis/regional ileitis • History of intake of high fats and low fiber to diet • Positive family history of colorectal cancer • Age >50 yrs. • History of change in bowel habits recently • History of passage of black stools • History of smoking, alcohol and sedentary Lifestyles. • Test for occult blood in stool • Digital rectal examination • Annually after the age of 40 yrs • Sigmoidoscopy after every 3-5 yrs after the age of 50 yrs • Early colonoscopy
  • 10. High risk patients and screening procedure contd.. Site Persons at higher risk i.e risk factors Screening procedure Cervical cancer • History of first inter course at an early age (<20 yrs) with multiple partners. • History STDS • Poor personal/menstrual hygiene • History of Herpes virus (type 2) infection or AIDS or Humas Papilloma virus (HPV) infection • History of symptoms related to cervical disease, i.e vaginal discharge/ bleeding, pain, or bleeding after Sexual intercourse. • Pap smear • Colposcopy
  • 11. High risk patients and screening procedure contd.. Site Persons at higher risk i.e risk factors Screening procedure Prostate cancer • Old age > 55 yrs • History of exposure to cadmium • Positive family history of prostatic cancer • Symptoms of prostate hypertrophy/ hyperplasia such as dysuria, thinning of stream of urine, nocturnal frequency and hematuria • Digital rectal exam at the age of 50 yrs • Detection of prostrate specific antigen (PSA)
  • 12. High risk patients and screening procedure contd.. Site Persons at higher risk i.e risk factors Screening procedure Endometrial cancer • History of infertility • History of intake of prolonged oestrogen therapy for a long period • Obesity & ovarian dysfunction • Uterine bleeding • Pelvic exam • Pap smear • Endometrial biopsy
  • 13. High risk patients and screening procedure contd.. Site Persons at higher risk i.e risk factors Screening procedure Skin cancer • History of prolonged exposure to sun/ radiation • Positive family history of skin cancer • History of chronic skin disease • History of sore or lesion that does not heal • Observation of skin lesion esp. mole for any change in size, shape, colour or surface appearance • Skin biopsy
  • 14. High risk patients and screening procedure contd.. Site Persons at higher risk i.e risk factors Screening procedure Breast cancer • History of early menarchae, late menopause, nulliparity, infertility • History of first pregnancy after the age of 30 yrs • Family history of breast cancer • Obesity or increase weight • Symptoms :- Nipple discharge, a nodule, breast pain etc • Breast self examination • Breast exam by health professionals every 3 yrs in young women (20- 40 yrs) and every year after 40 yrs • Routine baseline mammography
  • 15. Chemoprevention • It means use of drugs for the prevention of cancer. eg:-Beta carotene and retinoic acid are shown to cause regression in leukoplakia. • Tamokifen reduces the incidence of contralateral breast cancer in pts on adjuvant chemotherapy.
  • 16. Nursing assessment History collection • It should include the history of cancer among the client’s blood relatives and exposure to environmental factors at workplaces, theory of smoking alcoholism, drug history, dietary habit, lifestyle and change in bowel pattern. History should also include the degree of coping of a patient who has previous experience with cancer in a relative / friend. • Detail history has to be taken regarding warning signs.
  • 17. Physical examination Inspection: the appearance of skin lesions, an inspection of tumor size, shape Palpation: uterus, liver, ovaries, prostate gland, breast, testicles Inspection, palpation, percussion, and auscultation to be done system wise detail.
  • 18. Investigations • 1) Routine test:- –Complete blood count, PTT –Blood chemistry; i.e urea, sugar, creatinine, albumin, bilirubin, enzymes (SGOT/SGPT) –Liver cancer- increase bilirubin, alkaline phosphate & glutamine oxaloacetic transaminase –Prostate cancer- Acid phosphatase
  • 19. Investigations contd.. • 2) Radiological tests:- –Plain x-ray chest and abdomen –Ultrasonography –Computed tomography –Magnetic resonance imaging –Radio isotope scans for liver, brain, bone and lung cancer. –Lymphangiography –Positron-emission Tomography
  • 20. Investigations contd.. • 3) Hormonal assays:- –ACTH, Insulin, Parathormone, Erythropoietin, TSH etc. • 4) Bone marrow aspiration- leukaemia • 5) Tumor markers
  • 21. Tumor markers Tumor marker Cancer type Tissue analyzed ALK Gene arrangements Non small cell lung cancer, anaplastic large cell lymphoma Tumor tissue Beta- 2 macroglobulin (B2M) Multiple myeloma Chronic lymphocytic leukaemia Blood urine CSF fluid Beta Human Chorionic Gonadotrophin (β HCG) Choriocarcinoma Testicular cancer urine/Blood BCR- ABL Chronic myeloid leukaemia Blood and bone marrow
  • 22. Tumor markers Tumor marker Cancer type Tissue analyzed BRAF- mutation V600 E Cutaneous melanoma Colorectal cancer Tumor tissue CA 15-3 CA 27, 29 Breast cancer Blood CA 19-9 Pancreatic cancer Gall bladder Gastric cancer Blood
  • 23. Tumor markers Tumor marker Cancer type Tissue analyzed CA 125 Ovarian cancer Blood Calcitonin Medullary thyroid cancer Blood Carcino embryonic antigen Colorectal cancer Breast cancer Blood CD-20 Non Hodgkin lymphoma Blood Chromogranin A (Cg A) Neuro endocrine tumor Blood Chromosomes 3, 7, 17 and 9 p 21 Bladder cancer Urine Cytokeratin fragments 21- 12 Lung cancer Blood
  • 24. Tumor markers Tumor marker Cancer type Tissue analyzed Estrogen receptors (ER) Progestron receptors (PR) Breast cancer Tumor tissue Fibrin/Fibrinogen Bladder cancer Urine HE4 Ovarian cancer Blood HER-2/neu Breast cancer Gastric cancer Oesophageal cancer Tumor tissue Immunoglobulins Multiple myeloma Blood & Urine KIT Gastro intestinal stoma tumor Tumor tissue
  • 25. Tumor markers Tumor marker Cancer type Tissue analyzed Prostate specific antigen Prostate cancer Blood Thyroglobulin Thyroid cancer Tumor tissue Urokinase Plasminogen activator (uPA) Plasminogen activator inhibitor PAI-1 Breast cancer Tumor tissue Lactate dehydrogenase Germ cell tumor Blood
  • 26. Investigations contd.. • 6) Special tests –Mammography –GI tract radiological studies –Malabsorption tests • 7) Biopsy (FNAC, Surgical incision) –Incisional biopsy- surgical removal of small portion of tissue for inspection –Excisional biopsy- entire tissue removal –Needle aspiration- insertion of needle and fluid aspiration
  • 27. Investigations contd.. –Transcutaneous- insertion of fine needle in to tissue such as breast, prostate, salivary gland –Steriotactic biopsy- safe & efficient procedure for evaluating lesions of brain & breast. Site is firmly immobilized lesion is scanned for location and small incision is made for easy insertion of small fiberoptic instrument