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Cancer Detection
and Testing
Detecting cancers early is an important
step in preventing significant health
problems.
Give the accurate manage for the present
illness(stage) of patient
False positive
- if the test indicates that a patient has a
disease when she does not
Four Possible
Outcomes in
Detecting
True negative
Cancer
- test indicates the patient is disease-
free, and this is indeed the case
False negative
- test indicates the patient is healthy when
in fact the patient has the disease
Sensitivity and
Specificity of
Medical Tests
Sensitivity refers to how accurately a test
identifies people who have the disease.
Specificity refers to how accurately a test
identifies people who do not have the disease
The best medical tests have high sensitivity
and high specificity.
SENSITIVITY
It refers to the proportion of the times that
a test yields true positives.
The closer the sensitivity is to 100%, the
more likely a positive result actually means
that the patient has a disease.
The sensitivity of a medical test is a measure
of how well the test identifies people who
have a particular disease.
SPECIFICITY
It refers to the proportion of the time
that a test yields true negatives
.
Blood
cancers may be detected using this test if
too many or too few of a type of blood cell or
abnormal cells are found. eg., Leukemias
NON-INVASIVE
A. Complete blood count (CBC)
Leukocyte ( WBC)
Are major players in the immune system and
help defend against infection and disease.
WBC can be divided into two main groups:
Phagocytes
Lymphocytes
NON-INVASIVE
A. Complete blood count (CBC)
Leukocyte ( WBC)
Phagocytes-
Are cells that are able to consume and break
down foreign material, invading microbes and
broken down cells/cell parts.
They get their name from the Greek
'phagein', to eat.
NON-INVASIVE
A. Complete blood count (CBC)
Leukocyte ( WBC)
Lymphocytes-
These are recognition cells responsible for
initiating the specific immune response of the
immune system.
Three Major Types of Lymphocytes
B cells
T cells
natural killer cells (NK cells)
NON-INVASIVE
A. Complete blood count (CBC)
T- Cells
Formed by the pluripotent stem cells in
the bone marrow, T-cells mature in the
thymus (a small organ located in the upper
portion of the chest).
Two Subtypes of T cells;
cytotoxic T cells (CD8 cells)
helper T cells (CD4 cells).
NON-INVASIVE
A. Complete blood count (CBC)
T- Cells
Cytotoxic T cells (CD8 cells)
bind specifically to targetcells; virally infected cells,
cancer cells, or any foreign cells. After binding,
cytotoxic T cells directly destroy the target cell.
Helper T cells (CD4 cells)
release special chemicals that help activate other cells
of the immune response, including; B cells, cytotoxic T
cells, other helper T cells, NK cells, and macrophages.
NON-INVASIVE
A. Complete blood count (CBC)
B- Cells Natural killer
These cells are produced from cells (NK cells)
the pluripotent stem cells in
the bone marrow and stay in It bind to virally
the marrow to mature.
infected cells and
B cells bind to their specific cancer cells and
antigens, become activated
'plasma' cells and secrete
directly kill them.
large amounts antibodies.
NON-INVASIVE
A. Complete blood count (CBC)
Granulocytes Neutrophils
granulescontain Are usually the first
chemicals and proteins cells to arrive at the
(from cells) control scene of infection or
inflammatory and inflammation
immune functions.
Theyengulf and
Granulocytesare also destroy foreign
capable of engulfing matter and then die,
and destroying foreign forming pus
matter
NON-INVASIVE
A. Complete blood count (CBC)
Eosinophils Basophils
normocytic (normal)
hypochromic (low
concentration, pale color),
macrocytic (large)
normochromic (normal
MCH describes the concentration, normal color)
average weight of the hyperchromic (increased
hemoglobin in the RBC's. concentration, bright red
A small RBC will have a color).
smaller MCH.
General Detection
and Laboratory
Techniques
Urine cytology- reveal cancer cells that
could come from the bladder, ureters or
kidneys
Blood protein testing- examine various
proteins in your blood (electrophoresis)
can aid in detecting certain abnormal
immune system proteins
General Detection
and Laboratory
Techniques
Tumor marker tests- chemicals made
by tumor cells that can be detected in your
blood
prostate-specific antigen (PSA)- for prostate
cancer
cancer antigen 125 (CA 125)- for ovarian
cancer
Calcitonin- for medullary thyroid cancer
alpha-fetoprotein (AFP)- for liver cancer
human chorionic gonadotropin (HCG)- for germ
cell tumors, such as testicular cancer and
ovarian cancer
General Detection (DIAGNOSTIC TECHNIQUES)
ULTRASOUND
(UTZ)
is an ultrasound-based
diagnostic imaging
technique used to
visualize subcutaneous
body structures
A computer program is
used to analyze the
echoes of sound waves
sent into the body
and generates an
image on screen.
ULTRASOUND
(UTZ)
Purpose of UTZ
Are good exams to gain important
information about a suspicious mass
• contrast agent is not used an MRI can •size and location of benign or malignant
show: growths
•The shape, size, appearance, and location •enlarged lymph nodes
of organs, bones, and joints •changes in blood flow
•The presence of abnormal growths extracellular volume
•Signs of inflammation or infection
Positron Emission
Tomography
(PET)
Is an imaging technique that uses
radioactive molecules to create a dynamic
image of internal tissues and organs.
It produce images that reveal the activity
of living tissue.
PET scans use radioactively labeled tracers
(radiotracers) that are injected into the
bloodstream
PET SCAN
Preparation:
Drink plenty of water, but do not eat or drink anything
(except water) for 6 hours before your exam
Take your medications normally and drink them with
ample water
Make sure you arrive at the imaging center on time, the
compound used for the scan breaks down rapidly and if
you are late, the images may not be as good
Wear loose fitting clothing
Do not wear any jewelry; watches, chains, rings,
piercings, etc
Computed
Tomography
CT’s Scan
usesspecial
x-ray
equipment to
obtain cross-
sectional
pictures of the
body
Computed
Tomography
Use In CancerCT’s
to: Scan
To detect or confirm the presence of a tumor;
To provide information about the size and
location of the tumor and whether it has spread;
To guide a biopsy (the removal of cells or tissues
for examination under a microscope);
To help plan radiation therapy or surgery; and
useslow dose x-
ray to create an
image of a
breast.
Cancer Specific
Techniques
Direct Visualization
Direct Visualization
Sigmoidoscopy uses a small tube containing
viewing equipment to view the colon.
Virtual Colonoscopy uses an MRI or CT scan to
create an image of the inside of the colon.
Bronchoscopy
Endoscopy
Cystoscopy
Exploratory Surgery
Cancer Specific
Techniques
Pap smears use a sample of cells from the
cervix to detect cervical cancer. Pap
smears may also detect ovarian and
uterine cancers that have migrated to the
cervix.
Prostate specific antigen (PSA) test
measures levels of a glycoprotein in the
blood. Elevated levels of PSA are
associated with prostate cancer
Sentinel Lymph
Node Biopsy (SLN)
Use to detect metastasis
the hypothetical first lymph node or
group of nodes reached by metastasizing
cancer cells from a tumor
used in the staging of certain types of
cancer to see if they have spread to any
lymph node
Grading and
Staging
GRADING STAGING
Evaluation of degree of The process of describing the
differentiation of cancer local extent of the disease or
cells the spread of cancer from
Grade 1- the least the original site
malignant
To Essential in determining the
Grade 4- the most choice of therapy and
malignant assessing prognosis
Grade 1- the most
differentiated
Based on information about
To the tumor size and location in
Grade 4- the least the body, and whether or not
differentiated it has spread to other areas
of the body
“TNM” Staging
System
Measure tumors in three
ways:
Primary Tumor (T)
Node (N)
Metastasize (M)
“TNM” Staging
System
Tumor
B. Systemic Treatment
1. Cytotoxic Chemotherapy
2. Hormonal Therapy
SURGERY
The first line of treatment for many solid
tumors. M
single cancer cell is invisible to the naked eye
but can regrow into a new tumor, a process
called recurrence
A local treatment used to remove visible tumors
or the entire organ
Purposes:
Diagnose
Cure
Control
Pallative
SURGERY
Local Excision- simple surgery with small
margin of normal tissue surrounding
tumor.
Nursing
Marks must not remove
Care
Keep the skin dry
Talcum and Lotions are contraindicated
Avoid strong sunlight, extremes
temperature, constricting clothes.
No Eating (NPO)
Patient is not the SOURCE of Radiation
after the procedure.
Types of Radiation
Therapy
Internal Radiation Therapy
Involves the placement of specially
prepared radioisotopes directly
into near the tumor itself or into
the systemic circulation
Also called “brachytherapy”
Types of Internal
Radiation Therapy
Sealed Source RT
(Brachytherapy)
Un Sealed- Source RT
Sealed- Source RT
Sealed radiation source is
placed in a cavity or adjacent
to cancer.
The
more
shielding you
have, the less
radiation you will
receive.
Advantages of
Radiotherapy
Destroys quickly dividing cells at the margins
of tumors. Surgery may miss these cells
leading to recurrence of disease.
Can successfully eradicate growth without
permanently damaging the adjacent normal
In conjunction with other treatments, may
cure tumors that are not responsive to any
single agent.
II. SYSTEMIC TREATMENT
HORMONAL THERAPY BIOLOGIC TREATMENTS
Stem cells for transplantation are obtained from any of these three
places.
Transplant in
Cancer
A. Stem Cell Transplant
a procedure that is used
in conjunction with high-
dose chemotherapy
more effective than
conventional
chemotherapy in
destroying myeloma cells
restore blood cell
production
Types of Stem Cell
Transplants
Bone marrow transplant
stem cell-containing bone marrow is collected, stored,
and infused following high-dose chemotherapy and/or
radiation therapy.
Peripheral blood stem cell (PBSC) transplant
Procedure in which blood containing mobilized stem cells
is collected by apheresis, stored, and infused following
high-dose chemotherapy and/or radiation therapy.
Cord blood transplants refer to transplants where the
stem cells are obtained from umbilical cord bld
Types of
Transplants
according to Donor
Autologous transplants, patients receive
their own stem cells.
Syngeneic transplants, patients receive stem
cells from their identical twin.
Allogeneic transplants, patients receive stem
cells from their brother, sister, or
parent. A person who is not related to the
patient (an unrelated donor) also may be
used.
THE CANCER PAIN
PROBLEM
PAIN
In cancer is the most feared
and distressing symptom
of the disease.
THE CANCER PAIN
PROBLEM
WHO reveals that everyday at least 4
million people suffer from cancer pain.
30 – 50% of cancer patients undergoing
treatment, and up to 95% of patients with
advanced disease, suffer from pain.
More than 50% of patients still suffered
from unrelieved cancer pain.
WHO: 3 Step Analgesic Ladder
For Cancer Pain Management
Basic Principles:
BY THE MOUTH
If the patient can swallow, oral
administration is the route of choice.
WHO: 3 Step Analgesic Ladder
For Cancer Pain Management
BY THE CLOCK
Analgesics should be given regularly and
prophylactically.
BY THE LADDER
Use a few drugs well than many badly.
WHO Three-Step
Analgesic Ladder
• Step I For mild to moderate pain non-opioids
(treatment of choice). may or may not be combined
with adjuvant drugs (drugs that are used to hasten
or add to the primary mode of treatment).
• Step II For moderate pain, who did not feel relief
after using only non-opioids, a combination of opioids
and non-opioids should be tried. Again, adjuvants may
or may not be used.
• Step III For moderate to severe pain, opioids should
be used, with or without non-opioids, and with or
without adjuvants.
WHO Three-Step
Analgesic Ladder
Cancer :
Management
C – Comfort
A- Altered Body Image
N – Nutrition
C – Chemotherapy
E- Evaluate the Response in
Treatment
R - Rest
SUMMARY
Early detection and screening of high risk
individuals play significant roles in
treating cancer.
Patient and family caregivers should be
involved in all aspects of nursing care.
Various treatment modalities are available
to cure, control and palliate cancer.
SUMMARY
Safety Standards of treatment must
always implemented.