Title Other cancers high alert must knows.pdf ✅

ONCOLOGY PNLE TIPS! ★ Biopsy is always confirmatory! If there is no biopsy in the choices, try to look for a “-scopy” procedure. ★ If asked about the early sign, use the “CAUTION US” mnemonic as your guide. ★ Weight loss, pain, & fatigue is part of the late signs of cancer. ★ Radiation, chemotherapy, and surgery are part of the treatment options of cancer. ★ External radiation= think of local effects (affects the skin and mucosa near the target area, there can be tissue abnormalities such as fistula formation. ★ Chemotherapy= think of bone marrow suppression ★ The word “vigorous” is usually a red flag. ★ Basis of treatment planning: staging (TNM) TESTICULAR CANCER ● ⭐#1 RISK FACTOR: 1. Increased testosterone; 2. Cryptorchidism (undescended testicle) ● ⭐EARLY SIGN: 1. LUMP! (Painless, fixed, asymmetrical) 2. Heaviness on the scrotum ● LATE SIGN: Lower back pain ● ⭐SCREENING: Testicular self-exam ❖ Monthly ❖ Standing up ❖ After warm shower (relaxed, easy to palpate) ❖ Contraindicated: After cold shower ❖ ⭐Use thumb and forefinger to roll and palpate ● CONFIRMATORY: ORCHIECTOMY WITH BIOPSY Note: Biopsy is contraindicated to avoid tumor spread. We need to remove the affected testicle. CERVICAL CANCER ● ⭐#1 CAUSE: HPV (Human Papillomavirus) Note: Genital warts is a symptom of HPV ● ⭐ EARLY SIGN: 1. Unusual bleeding or discharge (spotting between menstruation or after sex) 2. Dyspareunia (painful sex) ● LATE SIGN (Worsened S/sx): 1. Severe vaginal bleeding or discharge 2. Flank pain (Advanced stage → pressure to the ureters → backflow of urine to the kidneys → hydronephrosis) 3. Pelvic pain (d/t pressure of tumor to bladder or bowel) ● ⭐PREVENTION: HPV vax (3 injections over 6 months) → GARDASIL & CERVARIX ● ⭐SCREENING: Pap Smear (Papanicolaou Smear) ❖ Start by age of 21 or earlier if sexually active ❖ 21-29 y.o: every 3 years ❖ 30-65 y.o: every 5 years if with HPV testing, every 3 years if pap smear only ● ⭐EXCEPTION TO PAP SMEAR: TOTAL HYSTERECTOMY (Removal of uterus and cervix → no risk) ● CONFIRMATORY: Biopsy PROSTATE CANCER ● ⭐#1 RISK FACTOR: Increased androgens (testosterone and dihydrotestosterone) ● ⭐EARLY SIGN: r/t bladder obstruction (urinary hesitancy, urinary retention, frequent UTI, etc.) Note: This is due to the anatomy of the prostate that surround the urethra and bladder neck, which can be compressed as the tumor enlarges. ● LATE SIGN: 1. PAIN (bone pain at the back or hips → d/t metastasis to the bone) 2. Hematuria 3. Neuro S/Sx (possible spinal cord compression), etc. ● ⭐SCREENING: 1. Digital Rectal Exam (DRE), 2. Prostate Specific Antigen (PSA) Note: When ordered together, carry out PSA first before DRE to prevent false high results of PSA. DRE stimulates the prostate thus increasing the release of PSA. ● CONFIRMATORY: Transrectal Ultrasound Guided Biopsy ● SURGERY: Radical Prostatectomy, TURP LUNG CANCER ● ⭐#1 RISK FACTOR: Smoking ● ⭐EARLY SIGN: Persistent cough, hemoptysis ● LATE SIGN: Wheezing or stridor, recurrent pneumonia or bronchitis, clubbing of fingers, pleural effusion ● SCREENING: Chest x ray initially ● CONFIRMATORY: Bronchoscopy with biopsy, needle biopsy ● 2 TYPES: 1. Non small cell: most common 2. Small cell: less common, most aggressive, can have early metastasis. COLORECTAL CANCER ● ⭐#1 RISK FACTOR: 1. Adenomatous polyps (precancerous lesions) 2. Age > 50 y.o, 3. High fat, low fiber diet (modifiable) Begins as a polyp on the inner lining of the colon or rectum that grows over an extended period of time, typically 10-20 years ● EARLY SIGNS: often asymptomatic (cause of late detection!) or non-specific until advanced Non specific s/sx: fatigue, anemia, abdominal or back pain, weight loss ● ⭐LATE SIGN: Changes in bowel movement (diarrhea, constipation, narrowing of stools, blood in stool, etc.) ● SCREENING: Highly encouraged since no s/sx until advanced. ❖ Begins at age 45 y.o ❖ Annually: Fecal occult blood test (FOBT), fecal immunochemical test (FIT) ❖ Every 3 years: Stool DNA test ❖ Every 5 years: Sigmoidoscopy, double contrast barium enema, CT colonography ❖ ⭐ Every 10 years: COLONOSCOPY ● CONFIRMATORY: COLONOSCOPY/ BIOPSY ● ⭐Recommended diet for prevention: Low fat, high fiber GASTRIC CANCER ● ⭐#1 RISK FACTOR: H. pylori infection ● ⭐EARLY SIGN: Indigestion, epigastric discomfort, early satiety, anorexia, mild nausea, vague abdominal pain, etc. ● LATE SIGN: weight loss, persistent vomiting, melena or occult blood in the stool, ascites, etc. ● ⭐PATHOGNOMONIC SIGN: Virchow’s node: enlarged, hard, left supraventricular lymph node (see google for picture) SKIN CANCER ● ⭐#1 RISK FACTOR: Prolonged sun exposure/ UV radiation ● PREVENTION: Avoid midday sun, sunscreen and protective clothing, regular skin checks ● 3 TYPES: 1. Basal Cell Carcinoma ❖ Most common type ❖ ⭐“Waxy nodule” 2. Squamous Cell Carcinoma ❖ Originates in upper layer of the epidermis ❖ ⭐“Crusting lesion” 3. ⭐Melanoma ❖ Involves melanocytes (melanin-producing cells) ❖ ⭐“Irregular, color changing lesion ❖ ⭐Most deadly form of skin Ca, highly metastatic ❖ ⭐ABCDE ASSESSMENT FOR MELANOMA Asymmetry: mole or lesion is asymmetric Border: irregular Color: varies across the mole or lesion Diameter: > 6 mm Evolving: changing in appearance, color, occurrence of bleeding over time ● ⭐CHEMOTHERAPY: 5- FLUOROURACIL ● CONFIRMATORY: Skin biopsy ● SURGERY: Excisional surgery KAPOSI’S SARCOMA ● Type of cancer that forms in the tissue beneath the skin or mucous membrane ● ⭐#1 CAUSE: Immunosuppression (HIV/AIDS), HHV-8 (Human Herpesvirus-8) ● EARLY SIGN: flat, painless, non blanching purplish or reddish skin patches usually on lower extremities, face or oral mucosa. ● ⭐PATHOGNOMONIC SIGN: purple, red macules or nodules on palate or skin in HIV positive individuals. ● LATE SIGN: ulcerating or bleeding lesions, painful skin nodules, lymphedema, respiratory s/sx (dyspnea, cough, hemoptysis), GI s/sx (GI bleeding abdominal pain) ● CONFIRMATION: Biopsy ● TX: ART (antiretroviral) BLADDER CANCER ● ⭐#1 RISK FACTOR: Smoking ● ⭐EARLY SIGN: painless gross hematuria ● LATE SIGN: pelvic or flank pain, urinary frequency, urgency, dysuria, bladder outlet obstruction, weight loss, fatigue ● CONFIRMATORY: Cystoscopy with biopsy LIVER CANCER ● ⭐#1 RISK FACTOR: Chronic hep B infection ● EARLY SIGN: pain (dull pain at RUQ or epigastric or back), anemia, fatigue, mild hepatomegaly ● LATE SIGN: jaundice, ascites, peripheral edema, portal HTN, esophageal varices ● COMPLICATION: liver rupture → hemoperitoneum, shock ● CONFIRMATORY: Liver biopsy LEUKEMIA ● Cancer of the bone marrow ● ⭐ Overgrowth of cancerous WBC → immature WBCs “OVERCROWDS” the bone marrow → which prevents the growth of RBCs, platelets, and normal WBCs. ● ⭐Problem: ❖ Decreased RBC → anemia ❖ Decreased platelets → bleeding risk ❖ Decreased WBCs → infection risk ❖ ⭐Elevated immature WBCs/ “BLAST CELLS” → bone pain ❖ Note: Refer to oncology notes of “pancytopenia” ● #1 RISK FACTOR: Ionizing radiation ● CONFIRMATORY TEST: Bone marrow aspiration biopsy ● PATHOGNOMONIC SIGN: presence of increased “blast cells” in the bone marrow ● TYPES: ❖ Based on what type of stem cell the cancer starts in: If cancer starts in MYELOID CELLS (eosinophils, basophils, neutrophils) → MYELOGENOUS LEUKEMIA If cancer starts in LYMPHOID CELLS (T or B cells) → LYMPHOCYTIC LEUKEMIA ❖ Based on onset Acute → sudden, rapid progression Chronic → gradual, slow progression TYPE COMMON IN Acute Lymphocytic Leukemia (ALL) ⭐Most common leukemia in CHILDREN “ALL= ALLiit” Responsive to chemo & potentially curable Acute Myelogenous Leukemia (AML) Most common acute leukemia in adults ⭐ (+) AUER RODS → reddish, needle-like structures found in the cytoplasm Chronic Lymphocytic Leukemia (CLL) Most common chronic leukemia in adults ⭐ Older adults > 60 y.o Chronic Myelogenous Leukemia (CML) Middle age adults ⭐ (+) Philadelphia chromosomes LYMPHOMA ● Cancer of the lymphatic system → abnormal proliferation of lymphocytes ● RISK FACTOR: Immunosuppression, viral infections (e.g. Epstein-barr virus: esp in non hodgkin) ● CONFIRMATORY: Biopsy of the lymph nodes ● ⭐ B SYMPTOMS OF LYMPHOMA: Fever Night sweats Unexplained weight loss (10%) ● ⭐2 TYPES: 1.⭐HODGKIN: (+) REED STERNBERG CELLS: better prognosis, peaks at mid adolescence; episodes of B symptoms is more common 2.⭐NON HODGKIN: (-) REED STERNBERG CELLS: poor prognosis, older age MULTIPLE MYELOMA ● Proliferation of plasma cells in the bone bone marrow leading to: 1.⭐Excess production of abnormal immunoglobulins (M protein) → this is the PATHOGNOMONIC SIGN, and it leads to increased viscosity of the blood 2. Bone destruction → due to osteoclast activating factors → ⭐HYPERCALCEMIA 3. Light chains (Bence-Jones proteins) → seen in urine which can damage the kidneys ● ⭐NOTE: Main nursing intervention is HYDRATION to dilute excess calcium & address the viscous blood! ● #1 RISK FACTOR: Old age > 65 y.o. ● EARLY SIGN: Persistent bone pain (usually at the back or ribs) ● LATE SIGN: “CRAB” CALCIUM ELEVATED, Renal failure, Anemia, Bone lesions/ pain ● CONFIRMATORY: Bone marrow biopsy (> 10% abnormal plasma cells) ● TREATMENT: Stem cell transplant Note: Breast cancer was discussed in our lecture. All the best! “Your hardwork will never betray you.” - Ms. Diane