Cancer

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Author:
dsherman
ID:
108496
Filename:
Cancer
Updated:
2011-10-14 13:58:22
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types cancer
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Risk Factors/Etiology
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  1. Vulva Cancer
    • Eitology:
    • Squamous cell
    • Most lesions on labia

    • Risk Factors:
    • HX of venereal warts
    • herpes simplex type II
    • HPV
    • > 40 years of age
    • cervical cancer
    • diabetes mellitus
    • obesity
    • smoking

    • Prevention:
    • Monthly vulvar self-examination
    • annual pelvic exam
    • practice safe sex

    • Clinical Manifestations:
    • sore that does not heal
    • bleeding is a late sign
    • irritation or itching
    • lichen sclerosis
    • thick gray patchy areas need to be looked at

    • Daignistics:
    • pelvic exam
    • papsmear
    • colposcopy

    • Treatment:
    • simple vulvectomy-removal vulva, labia majora/minora, and possible clitoris
    • skinning vulvectomy-removal of superficial vulvar skin and replacement of removed skin with split thickness grafts
    • radical vulvectomy-removal of everything including subq tissue, inguinal

    immodium will be perscribed to stop BM and prevent infection after surgery
  2. ovarian cancer
    • Etiology:
    • adenocarcinoma & squamous cell carcinoma
    • tumor is 6 inches before it is palpable
    • no baby = raised estrogen
    • leading cause of death of all reproductive cancers
    • prognosis is not good

    • Risk Factors:
    • HX of other cancer
    • nulliparity
    • >40 years of age
    • infertility
    • familial assoaciation (heradity)

    • Prevention:
    • Breast Feeding
    • oral contraceptives at least 5 years
    • multiparity
    • normal weight

    • Clinical Manifestations:
    • mild signs including abdominal pain, bloating, GI disturbances
    • could be asymptomatic just a feeling of fullness

    • Diagnostics:
    • pelvic exam
    • ultrasound
    • CA-125
    • Lower GI series or Barium enema
    • CT sacn
    • Biopsy
  3. Fallopian tube cancer
    • Rarest
    • PID
    • Nulliparity
    • infertility
    • asymptomatic lower abdominal pain/pressure, some bleeding
    • radiation/chemo
    • salpingectomy: removal of both fallopian tubes
  4. Endometrial cancer
    • Etiology:
    • adenocarcinoma
    • slow growth
    • young, postmenopausal women
    • curable if discovered early

    • Risk Factors:
    • age over 60
    • family history, gene mutation of HNPCC
    • over exposure to estrogen
    • HTN (hypertention)
    • obesity
    • late menopause
    • Diabetes Mellitus
    • no children (nulliparity)
    • smoking
    • tamoxifen

    • Prevention:
    • weight management
    • at risk if on HRT (hormone replacement theropy)
    • Pelvic exams to check for enlarged uterus

    • Diagnostics:
    • transvaginal ultrasound and endometrial biopsy are the gold standard teat
    • sailine may be infused during ultrasound then a biopsy is collected via thin flexible suction curette
    • CA125 tumor marker
    • Chest X-Ray to check for mestasis
    • genetic testing for HNPCC
    • IVP
    • barium enema
    • hysteroscopy (look at the uterus) and proctosigmoidoscopy (going up through rectum)

    • Clinical Manifestations:
    • post-menopausal bleeding Most common
    • baginal discharge (often watery/bloody)
    • low back/abdominal pain

    • Treatment:
    • total hysterectomy
    • radiation- external; internal for stage II and III (side effects local)
    • chemotherapy for stage III or IV (doxorubicin, cisplatin, paclitaxel)
    • hormone therapy for stage I and II or for palliative treatment of stage IV
    • low pelvic pain
  5. cancer of the cervix
    • Etiology:
    • squamous cells
    • caused by certain types of HPV
    • prognosis is good if caught early

    • Risk Factors:
    • sexual contact
    • HPV
    • viral infections
    • Multiparity
    • younger age
    • socioeconomic status
    • smoking
    • STD's
    • African American, Native american
    • Oral Contraceptive use
    • Intrauterine exposure to DES (used to prevent miscarrrage)

    • Prevention:
    • treat infections early
    • limit sex partners
    • use barrier contractption
    • pap test (2-3 years)
    • HPV vaccine (Guardasil) 3 injections

    • Clinical Manifestaitons:
    • painless vaginal bleeding
    • leg pain
    • flank pain

    • Diagnostics:
    • pelvic exam
    • pap smear
    • colposcopy-apply 3% acetic acid solution to cervix, looks at vagina and cervix

    • Treatment:
    • Loop eletrosurgical excision procedure (LEEP)
    • -loop wire transmits painless electrical current and cuts away effected tissue
    • Hysterectomy, conization, cryosurgery, laser therapy
    • radiation for stage II
    • chemo-Cisplatin
  6. Vaginal Cancer
    • less than 2%
    • usually extension of cervical or vulvar cancer
    • age over 50
    • STD's
    • Multiple pregnancies
    • metastasis is early
    • signs and symptoms
    • painless vaginal bleeding, foul discharge, pain, pruitis
  7. Bladder cancer
    • Etiology:
    • Transtitional cell carcinoma
    • squamous cell carcinoma

    • Risk Factors:
    • > 60 years of age
    • tobacco #1 cause
    • male
    • family hx
    • exposure to toxins (hair dressing supplies, furniture polish, other chemicals)
    • treatment with cyclophosphamide or arsenic (cancer treatments)
    • whites 2x more likely to get it

    • Prevention:
    • DO NOT SMOKE
    • take precautions with chemicals

    • Dignostics:
    • cystoscopy w/retrograde urography
    • urine tests
    • IVP

    • Clinical Manifestations:
    • Hematuria/or w/o pain ***FIRST SIGN***
    • pain during urination
    • frequent urinationor urge to urinate
    • signs similer to UTI

    • Treatment:
    • Nonsurgical
    • 1) prophylactic immunotherapy w/intravesical instillation of BCG
    • 2) multi agent chemo prolongs life
    • 3) radiation
    • surgical
    • 1)possible complete removal of the bladder (cystectomy)
    • Four surgical options:
    • 1) Illeal conduit-long term treatment of bladder cancer, take part of the ileim and make conduit (pipe) out of it, used to divert the urine out. ***normal to have shreds of mucous in the urine bag with urine***
    • 2) continent pouch
    • 3) bladder reconstruction
    • 4) ureterostomy
    • 5)TURBT
  8. Colorectal cancer
    • Etiology:
    • Adenocarcinoma
    • starts as a polyp
    • bleeding bright red at rectum from decending colon
    • bleeding dark blood from ascending colon

    • Risk Factors:
    • older than 50 #1 risk factor
    • genetic predispostion
    • personal or family hx
    • ulcverative colitis
    • crohns disease
    • type 2 diabetes
    • inflammatory bowel disease
    • high fat diet (animal fat)
    • more common in men
    • 3rd most common cancer

    • Prevention:
    • modify diets to lower fat, refined carbohydrates, and low fiber foods
    • encourage baked or broiled foods
    • CRC screening every 10 years after age 50, w/o family history
    • aspirin prevents CRC
    • no smoking
    • increasing physical activity

    • Diagnostics:
    • sigmoidoscopy-provides visualization of lower colon using fiberoptic scope, polyps visualixed and samples can be taken for biopsy (polyps are usually removed)
    • colonoscopy-provides views of the entire large bowel from rectum to ileocecal valve. As with sigmoidoscopy polyps can be seen, removed and take for biopsy there is a risk for perferation

    • Clinical Manifestations:
    • Most common RECTAL BLEEDING, anemia, change in stool
    • fatigue
    • ribbon like stools
    • gas pain, cramping
    • distended abdmonen
    • back pain
    • pressure on other organs
    • constipation
    • also very common to have no symptoms

    • Lab Test:
    • H&H decreased
    • fecal occul blood test (FOBT) is positive
    • can yield false positive
    • No ASA, Vitamin C, red meat 48 hours before test
    • Carcinoembryonic antigen (CEA) is elevated (Normal 2.5)
    • Treatments:

    • Radiation: more commonly used for palliative care
    • Drug: after surgery
    • 1) IV 5- w/folinic acid, Xeloda
    • 2) common side effects diarrhea, mucositis, leukopenia, mouth ulcers, peripheral neuropathy
    • surgery:
    • removal of the tumor
    • assess for:
    • low grade fever up to 24 hours
    • takes 48 hours for bowels to move
    • main priority bleeding
    • main complication pneumonia
    • possible ostomy
    • colon resection removal of the tumor and regional lymph nodes with anastomosis
    • coloctomy colon removal with colostomy (permanent or temporary) OR ileostomy
    • abdominooperineal resection invilves removal of the anus, the rectum, and part of the sigmoid colon along with the asssociated (regional) lymph nodes, through incisions made in the abdomenn and perineum. the end of the remaining sigmoid colon is brought out permanently as an opening, called a colostomy, on the surface ot the abdomen
  9. Prostate cancer
    • Etiology:
    • Adenocarcinoma
    • Metastasize to mostly bone
    • don't want to mess areound with prostate right away because impotence and incontinence will occur

    • Risk Factors:
    • familial association
    • Diet high fat, vitamin D&E deficiencies
    • African Americans
    • occupational and environmental
    • increased age

    • Prevention:
    • healthy diet and exercise
    • digital rectal exam w/PSA
    • PSA should be under

    • Clinical Manifestation:
    • No signs or symptoms
    • problems urinating
    • sexual dysfunction

    • Diagnostics:
    • Transonography
    • IVP
    • biopsy

    • Treatment:
    • Surgery:
    • laparoscopic radical prostatectomy (LRP)
    • Open radical prostatectomy
    • transuretheral resection of the prostate (TURP)
    • bilateral orchiectomy (palliative)
    • cryotherapy
    • Radiation (external or internal) or systemic for palliation
    • Drug: Therapy (androgen deprivation trerapy or chemo)
    • treat with androgen antagonist, may get a voice change from drugs (Eulexin, casodex, nilandron)
    • chemotherapy-docetaxel (Taxotere) may be combined with other drugs

    • Postop care of radical prostatectomy
    • hydrate with IV therapy
    • caring for wound drains
    • prevent emboli
    • prevent pulmonary complications
    • antibiotics
    • analegesics
    • laxatives
    • indwelling urinary catheter
    • antispasmodic
    • COMPLICATIONS, urinary incontinence, erectile dysfunction
    • LH-RH agonist-Lupron/Zoladex
  10. Testicular cancer
    • Etiolohy:
    • Rarely bilateral
    • germ cell tumors (seminoma, non-seminoma)

    • Risk Factors:
    • familial association
    • cryptorchidism (undecended testicals)
    • Hx or trauma or infection

    • Prevention:
    • testicular self-examination

    • Clinical Manifestations:
    • asymptomatic
    • mass or lump
    • testicular swelling or hardness

    • Diagnostics:
    • Physical exam
    • alpha-fetaprotein (AFP)
    • bets human chorionic gonadotropin (hCG)
    • Lactate dehydrongenase (LDH)
    • ultrasonography
    • CXR, CT, MRI
    • IVP
    • Blood test
    • inguinal exploration

    • Treatments:
    • Surgery
    • Radiation-shield other testicle
    • Drug Therapy- cisplatin & etoposide
    • post-op-*have ice, immobility

    • Risk for Sexual Dysfunction:
    • interventions include
    • oligospermia, azoospermia
    • health teaching about reproduction, fertility, and sexuality
    • Sperm storage
  11. Penile Cancer
    • Risk Factors:
    • Ucircumcised males
    • poor hygiene
    • chronic irritation
    • age

    • Clinical Manifastatins:
    • painless, wart like growth or ulcer

    • Interventions:
    • Circumcision
    • partial or total penectomy
  12. Anal Cancer
    • Etiology:
    • adenocarcinoma
    • treatment is very effective
    • most patients can often be cured

    • Risk Factors:
    • fairly rare
    • mainly adults around age 60
    • smoking
    • infections HPV virus
    • receicing anal intercourse
    • anal fistulas
    • multiple sex partners
    • anal swelling, redness, or soreness that occurs frequently
    • more common in men

    • Clinical Manifestations:
    • rectal bleeding
    • rectal itching
    • pain in anal area
    • change in diameter or stool
    • abnormal discharge from anus
    • swollen lymph nodes in anal or groin areas
  13. Breast Cancer
    • Etiology:
    • Ductal epitherial carcinoma
    • adenocarcinoma
    • 2nd leading cause of cancer death
    • most lumps in upper, outer breast
    • cannot be totally prevented

    • Risk Factors:
    • over exposure to estrogen
    • 85% over 45 years of age (highest risk factor)
    • early menstruation & late menopause
    • start mamograms at age 40
    • alcohol
    • genetic and family history
    • breast abnormalities
    • environmental factors (radiation) & diet high in fat

    • Prevention:
    • Mammography (start at age 40, every 1-2 years)
    • clinical breast exam (GYN apt)
    • self-breast examiniation- 5 days after menses, or if breast feeding right after your done feeding
    • Genetic testing (BRCA1 and BRCA2 gene)

    • Diagnostics:
    • monthly SBE
    • yearly mammography
    • biopsy
    • genetic testing (BRCA1 &BRCA2)
    • tumor marker-CEA-125
    • hormone receptor assays

    • Clinical Manifestations:
    • lump
    • skin changes
    • nipple changes
    • nipple discharge
    • orange peel like apperance

    • Treatment:
    • simple: just breast tissue
    • Modified: breast, lymph
    • radical: breast, lymph, muscle, skin
    • *tamoxifen can prevent breast cancer by blocking estrogen receptor sites, but increases the risk for osteoporosis
    • surgery is the #1 treatment

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