Cancer Chapter 6 note: just a few slides have been added to the PPT different from recording there are not missing slides. 2022 NURS 3140 Pathophysiology Objectives * this slide not in recording • Examine the properties of cell differentiation to the development of a cancer cell and the behavior of the tumor. • Summarize the pathway for hematologic spread of a metastatic cancer cell • Describe various types of cancer-associated genes and cancer-associated cellular and molecular pathways. • State the importance of cancer stem cells, angiogenesis, and the cell microenvironment in cancer growth and metastasis • Differentiate benign and malignant cancers • Understand general genetic and environment risk factors • Characterize the common clinical manifestations by persons with cancer including the mechanisms involved in anorexia and cachexia, fatigue, sleep disorders, anemia, and venous thrombosis • Define the term paraneoplastic syndrome and explain its pathogenesis and manifestations. • Compare the different screening mechanisms and tumor markers in cancer diagnosis • Review the Staging of cancers TNM • Review the Key Terms posted in module • Terminology • Characteristics • Etiology • Clinical manifestations Rate of New Cancers in the USA – all types, all ages, all race/ethnicities, all genders 390/100,000 Cancer Deaths Figure 3. Leading Sites of New Cancer Cases and Deaths – 2021 Estimates Neoplasms - Cancers Normal cell cycle: normal replication of need Cancer cells: “neoplasms” • Excessive & uncontrolled proliferation • Altered cell differentiation • Results in “Neoplasms” https://youtu.be/_qn_noiZs9s This slide not in recording to help students review These are normal cell processes There is a balance between cell proliferation & programmed cell death (apoptosis) *** cell regulation*** Cancer – problem with cell growth Two Main problems Uncontrolled, rapid , excessive cellular proliferation Altered and defective cellular differentiation Normal cells: pattern of reproduction • There is a balance between cell proliferation & programmed cell death (apoptosis) • Differentiation occurs in which cells acquire the structure and functional characteristics of the cells they replace. Abnormal Cancer Cells • No adaption, do not follow laws of normal cell growth • Multiply rapidly, do not undergo apoptosis • Do not function normally Characteristics of Cancer Cells • Abnormal • Rapid proliferation • Loss of differentiation – “Altered Cell differentiation • Anaplasia: term used to describe the loss of cell differentiation •Excessive & uncontrolled proliferation •Results in “Neoplasms” • These characteristics help us determine cancer cells from normal cells Make your own table in your notes compare Normal cell Cancer cell Normal Cell Cycle page 19 Chapter 2 • G0: cells are at rest and not actively dividing • G1: Cells enter the cell cycle • S: Synthesizing new DNA in preparation for mitosis • G2: Checkpoint…, senses DNA damage and allows for repair before mitosis • M: Mitosis https://youtu.be/8BJ8_5Gyhg8 Use this video to help in learning Cancer and the Cell Cycle •Cancer cells are constantly moving through the cell cycle •Cancer cells do not have “check-points” •No repair of altered DNA sequencing •Cancer cells do not undergo apoptosis Do you remember what apoptosis is? Programmed and normal cell death Cancer associated genes – “Carcinogenesis” Inheritable genetic alteration •Proto-oncogenes: encode for normal cell proteins, normal growth factors •Oncogene: cancer causing gene •Tumor Suppressive Cells: these cells suppress the replication and proliferation of cell growth Cancer cells and associated genes - “Carcinogenesis” Inheritable genetic alteration Cancer Associated Genes: into two categories • Both increase risk for cancer development • Overactive • Underactive Both issues can be inherited genetic alteration • or a result of environmental risk factors Cancer Associated Genes Slide not in recording … read …this was added for emphasis •Most cancer-associated genes can be classified into two broad categories based on whether gene overactivity or underactivity increases the risk for cancer Cancer cells/associated genes: “Carcinogenesis” • Overactive Proto-oncogenes are normal but become Cancer causing Oncogenes • Proto-oncogenes are normal , control cell growth and proliferation • Mutated proto-oncogenes • Termed “oncogenes” allows cells to grow fast out of control • Oncogenes grow- “go” fast are similar to a gas pedal in a car • Underactive: Defective Tumor Suppression genes • Tumor Suppression genes are normal genes that slow down cell division, repair DNA mistakes and regulate apoptosis • Similar to the brake pedal on a car •Both of these issues can be inherited genetic alteration or a result of environmental risk factors 3 minute video can help with this description https://youtu.be/pOyKFgGKmHE Cancer is thought to be caused by a combination of genetic and external factors • Genetic Influence • Genetic damage or mutations • Insertion, deletion, inversion • Genetic predisposition • Presence of the BRCA1 and BRCA 2 gene shows a genetic susceptibility to breast cancer Heavy and/or consistent EXTERNAL UV Tar, nicotinelung, bladder, gastric Diet: high in red meat low in fiber • • • • Hormones Obesity Immunological Environmental • Radiation • Pollutants Hepatitis,HPV, PUD Key Associations and Causes of Cancer. Min veggiescolorectal ! Colorectal, esophagus, kidney breast pancreas, thyroid, liver Added slide Cancer is thought to be caused by a combination of genetic and external factors… Genetic Influence •Genetic Damage or mutations • Insertion, Deletion, Inversion… •Genetic Predisposition •Presence of the BRCA1 and BRCA 2 gene shows a genetic susceptibility to Breast Cancer External Factors •Hormones •Obesity •Immunologic mechanisms •Environmental factors •Radiation •Nicotine •Pollutants… Neoplasms –tumors • Tumor: abnormal mass developed r/t overgrowth and uncoordinated growth • Classified as Benign or Malignant • And we name them by adding the suffix: OMA with to the originated tissue • If malignant we add Carcinoma • Benign and malignant neoplasms are differentiated by: • Cell characteristics, growth rate and how it grows • Capacity to metastasize • Potential to cause death Neoplasms (Tumors) • Classified as Malignant or Benign • Benign • Composed of “well-differentiated” cells • Slow progressive rate of growth, same structure and function, • lost the ability to control cell proliferation, usually grow in capsule , do not invade • Malignant • Uncontrolled cell differentiation and proliferation with rapid rate of growth • Invade and destroy surrounding tissues • May compress surrounding vessels and requires blood supply Invasion and Metastasis • Cancer cells invade and metastasize • Travel from the site of origin to a distant site. • Malignant cells travel via lymph or blood stream • Cancer will grow and send out projections into surrounding tissues • This makes them difficult to remove • Synthesize and secrete enzymes the break down proteins and contribute to infiltration invasion and penetration of surrounding tissues Metastasis: the development of secondary tumors in locations distant from primary tumor Invasion and Metastasis • Cancer cells invade and metastasize • Cancer spreads seeding cells in body cavities • Seeds Travel through the blood and lymph • Certain tumors have common sites of metastasis • Lung cancer commonly metastasizes to the bone & brain • Colon cancer commonly metastasizes to the liver • Metastatic tumors often keep the characteristics of the primary tumor– so we can tell what started the problem Compare – be sure you know the differences Benign Malignant • Well differentiated • Undifferentiated • Encapsulated • No defined borders. Margins are not clearly separated from surrounding normal tissue • Grows by expansion • Not invasive • Does not spread by metastasis • Grows by invasion, spreading into surrounding tissue • Metastasizes to other areas of the body through blood or lymph channels Slide in recording is animated but all information is the same Benign and Malignant Can benign tumors cause harm? • If space occupying or compress other tissues or vessels • Cause changes in tissue function or release of hormones Malignant tumors can cause harm and death Rapid growth may cause compression and pull blood supply from other tissues and organs Leads to ischemia and necrosis Or can increase release of hormones and inflammatory mediators Categories of Malignant Cancers Solid Tumors and Hematologic Cancers Solid Tumors 1st: Initially confined to a specific tissue or organ o“Cancer in Situ” oOriginal cancer cells before spreading oCells of the original solid tumor, cells detach and enter the blood or lymph to metastasize oHematologic Cancers oInvolves cells normally found within blood and lymph oThe cells are disseminated from the beginning oExample: Leukemia and Lymphoma Carcinoma in situ A group of abnormal cells that remain in the place where they first formed. They have not spread. These abnormal cells may become cancer and spread into nearby normal tissue. Also called stage 0 disease https://www.cancer.gov/publications/dictionaries/cancer-terms/def/carcinoma-in-situ Classifying cancers: Staging and grading •The two basic staging methods for classifying cancers: •Grade and Staging • Grading : is determination and according to the histologic or cellular characteristics of the tumor • Staging according to the clinical spread of the disease. • Both methods : • Used to determine the course of the disease • Used to planning appropriate treatment plan Staging Cancer Tumors: TMN This is the SAME information as in the recording just a better graphic to view Tumor • Tx Tumor cannot be adequately assessed • T0 No evidence of primary tumor • Tis Carcinoma in situ • T1–4 Progressive increase in tumor size or involvement Node • Nx Regional lymph nodes cannot be assessed • N0 No node involvement • N1-N3 Increasing involvement of regional lymph node Metastasis • Mx Not assessed • M0 No distant metastasis • M1 Distant metastasis present, specify sites Grading Stage Microscopic Examination Determines level of differentiation • Ranges from stage 0 to stage 4 • Rates the… • size of the primary lesion • presence of nodal spread • distant metastasis Added slide Risk factors for cancer •Modifiable •Diet • High in animal fats • Low in fiber •Obesity •Alcohol •Smoking •infections • Non-modifiable • Genetic • BRCA genes • Sex • Hormones • Immunity • Immunodeficiencies • Chronic disease/inflammation • Environment • • • • Chemicals Radiation Carcinogenic exposure Viruses Cancer and clinical manifestations • Reflects; Initial signs and symptoms reflect dysfunction of primary tissue involvement • Systemic “generalized” manifestations: • Fatigue • Sleep disorders • Anorexia and cachexia • Weight loss • Anemia • Bleeding/Thrombosis • Infections • Pain • Paraneoplastic Syndrome See Table 6- 4 Added slide Risk factor : Infections Infection with certain viruses, bacteria, and parasites are an important contributor to cancer •The most notable infections implicated in new cancer cases include •Epstein-Barr virus (EBV) •Helicobacter pylori •hepatitis B and C viruses (HBV and HCV) •Human papillomavirus (HPV) • • Cancers: related to Weight loss of 10 pounds or more for no known reason • Some cancers will produce weight gain Complications of cancer Added slide… .be sure to review the table in text book for more info •Paraneoplastic syndromes •Examples: • See Table 6-4 •SIADH •Cushing syndrome •Mysathenia gravis •Nephrotic syndrome Paraneoplastic Syndrome… • Complex triggered by cancer • Not caused by the direct local effect of tumor- symptoms are Unrelated to tumor site • Symptoms related to cancer’s presence and action on the body • Not the symptoms caused by local effects • Not the symptoms caused by metastatic effects • Symptoms are related to disorders that are a consequence of the cancer. Usually, substances released and circulated in blood stream Example • Renal Carcinoma: causes release of erythropoietin and the patient end up with polycythemia • Other • Lung cancer may lead to SIADH & Cushing Syndrome • Pancreatic cancer may lead to venous thrombosis Cancer Cachexia • Loss of skeletal muscle mass • Wasted appearance due to a breakdown of muscle and fat • Cause is theorized to be the result of tumor-induced changes in the host immune responses. Screening and Diagnosis Screening and Diagnosis Screening and Diagnosis Screening: Important secondary prevention • Screening represents a secondary prevention measure for the early recognition of cancer in an otherwise asymptomatic population. • Screening can be achieved through observation (e.g., skin, mouth, external genitalia), palpation (e.g., breast, thyroid, rectum and anus, prostate, lymph nodes), and laboratory tests and procedures • Example: Papanicolaou [Pap] smear, colonoscopy, mammography • current screening or early detection has led to improvement in outcomes include cancers of the breast (mammography), cervix (Pap smear), colon and rectum (rectal examination, fecal occult blood test, and colonoscopy), prostate (prostate-specific antigen [PSA] testing and transrectal ultrasonography), and malignant melanoma (self-examination) Screening and Diagnosis •Blood: tumor markers (See Table 6-5) • Tumor markers : antigens, hormones, enzymes , proteins, antibodies , • Examples: AFP, α-fetoprotein; CA, cancer antigen; CD, cluster of differentiation; CEA, carcinoembryonic antigen; hCG, human chorionic gonadotropin; PSA, prostate-specific antigen • Cytological and histologic tests • Tissue biopsy • Immunochemistry • NON Specific and General: XRAYs, CT, MRI, Endoscopy, PET Common Tumor Markers Antigen s Liver Fetal yolk sac and gastrointestinal structures early in fetal life Primary liver cancers; germ cell cancer of the Breast tissue protein Tumor marker for tracking breast cancer; liver, lung CA 27-29 Breast tissue protein Breast cancer recurrence and metastasis CEA Embryonic tissues in gut, pancreas, liver, and breast Colorectal cancer and cancers of the pancreas, lung, and stomach AFP a feta protein CA 15-3 Breast testis Hormones Gestational trophoblastic tumors; germ cell hCG Hormone normally produced by placenta Calcitonin Hormone produced by thyroid parafollicular cells Thyroid cancer Catecholamines (epinephrine, norepinephrine) and metabolites Hormones produced by chromaffin cells of the adrenal gland Pheochromocytoma and related tumors Monoclonal immunoglobulin Abnormal immunoglobulin produced by neoplastic cells Multiple myeloma PSA Produced by the epithelial cells lining the acini and ducts of the prostate Prostate cancer CA 125 Produced by Müllerian cells of ovary Ovarian cancer CA 19-9 Produced by alimentary tract epithelium Cancer of the pancreas, colon Present on leukocytes Used to determine the type and level of differentiation of leukocytes involved in different types of leukemia and lymphoma cancer of testis Thyroid Specific Proteins Mucins and Other Glycoproteins Prostate Ovarian Pancreas, colon Cluster of Differentiation CD antigens The ends the general information portion of Cancer –next recordings will mention various types of Cancers Next is the review of different types of CA Review Types of Cancer • LUNG pages 794-796 • LIVER pages 1003-1004 • BRAIN pages 434-435 • BONE pages 1208 -1212 Lung Cancer (pages 794-796) • Leading cause of cancer-related death • 5-year survival rate is 7-14% Risk Factors • Cigarette smoke • Cause for 80% of lung cancers • Risk increased based on total number of cigarettes smoked • Cigarette Pack-Year • Number of packs smoked per day X number of years smoked. • for example, 1PPD/day or 2PPD/day • Also risk for those who have never smoked but are exposed to smoke Lung Cancer • Second-hand smoke • Asbestos- exposure in homes and work • Synergistic effect if the patient is also a smoker • May lead to mesothelioma • A specific cancer type on the pleural membrane • First-degree family member with a history of lung cancer • Doubles the risk • History of COPD and pulmonary fibrosis • Radon exposure • Radiation exposure to the chest • Genetics • Genetic mutation on chromosomes 6, 10, and 15 Second hand smoke Subtypes of Lung Cancer Divided into two main Categories •Small Cell Lung Cancer (SCLC) •Non-Small Cell Lung Cancer (NSCLC) 52 Squamous Cell (NSCLC) • Located in the central bronchi • Grows slowly • Usually associated with smoking • Common paraneoplastic syndrome of Hypercalcemia Adenocarcinoma (NSCLC) • Most common type of lung cancer • May not be associated with cigarette exposure • More often found in women and non smokers • Originate in bronchiolar or alveolar tissues • Located more peripherally • Usually large at time of diagnosis • Metastasizes early Small Cell Carcinoma (SCLC) • Distinctive cell type: Small round -oval cells the size of a lymphocyte • Grow in clusters, arises out of the bronchus • Rapid growth • Highly Malignant: Metastasizes early through blood • Brain metastasis most common • Usually providing the first S/S • Paraneoplastic syndrome: • Strongest correlation with cigarette smoke • Poorest prognosis • Only 10% will live 2 years after diagnosis Clinical Manifestations: Lung Cancer • Often silent with nonspecific symptoms • Anorexia, fatigue, weight loss, nausea/vomiting, hoarseness • Respiratory signs: appear late in disease process • Often extensive metastases by then • Cough, hemoptysis, chest pain, dyspnea • Frequently presents as pneumonia that does not respond to treatment • Paraneoplastic complications common • SIADH, hypercalcemia, polycythemia Diagnosis of lung cancer •History and physical •Imaging: Chest radiography (XRAY) , CT , MRI , Ultrasound •Bronchoscope •Cytology of sputum •Needle biopsy •PET Scan PET (positron emission tomography) scan The patient lies on a table that slides through the PET machine. The head rest and white strap help the patient lie still. A small amount of radioactive glucose (sugar) is injected into the patient's vein, and a scanner makes a picture of where the glucose is being used in the body. Cancer cells show up brighter in the picture because they take up more glucose than normal cells do. Bronchoscopy. A bronchoscope is inserted in the mouth, trachea, and major bronchi into the lung, to look for abnormal areas. A bronchoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a cutting tool. Tissue samples may be taken to be checked under a microscope for signs of disease. Endoscopic ultrasound-guided fine-needle aspiration biopsy. An endoscope that has an ultrasound probe and a biopsy needle is inserted through the mouth and into the esophagus. The probe bounces sound waves off body tissues to make echoes that form a sonogram (computer picture) of the lymph nodes near the esophagus. The sonogram helps the doctor see where to place the biopsy needle to remove tissue from the lymph nodes. This tissue is checked under a microscope for signs of cancer. “Liver” Cancer (Pages 1003-1004) • Liver metastasis is more common than primary liver cancer • Common sources: colorectal, breast , lung • Two types of primary liver malignancies • Hepatocellular Carcinoma (HCC) • Primary cancer of liver cells • Cholangiocarcinoma • Primary cancer of bile duct cells Risk Factors for Liver Cancer • Any agent that contributes to chronic liver cell damage • Chronic Hepatitis B or C infection • Cirrhosis • Chronic alcohol ingestion • Long term androgenic steroid administration • Exposure to toxins Liver Cancer Clinical Manifestations • Asymptomatic in early stages • Masked by disease (cirrhosis, hepatitis, etc.) • Advanced stages • Abdominal pain • Weight loss • Ascites • Jaundice • Hepatomegaly • Esophageal varices – portal hypertension Brain Tumor (Pages 434-435) •Primary malignant brain tumor •Originates in the brain tissue •Metastatic brain tumor •Metastasis from primary tumor elsewhere •Most common https://youtu.be/pBSncknENRc Brain Tumor Classifications • Classified according to the site of the tumor and the tissue type • Gliomas and meningiomas are most common • Gliomas • Tumors originate from the glial cells • Glial cells surround neurons and provide support and insulation • Most abundant cell type in the CNS • Types of glial cells include astrocytes, ependymal, Schwann cell Meningioma • Arise from the meningeal tissue Benign and malignant brain tumors can have similar adverse effects •Serious neurologic deficits and poor prognosis •Often difficult to surgically resect without leading to further neurological deficit •Will increase intracranial pressure, compressing brain tissue Clinical Manifestations: Brain Tumor • Intracranial tumor: focal disturbances • Changes in brain function r/t compression, infiltration disturbances in blood flow and edema or increased ICP General S/S: • Change in mental status , HA , N/V, visual changes, personality changes • Seizures • Weakness of extremities. May be one-sided • Dementia • Gait disturbances Diagnosis by MRI Bone Cancer (Pages 1208-1212) • May be primary bone cancer or metastatic bone cancer • Usually limited to the bone Major manifestations: pain, presence of mass, and decreased bone function • Pain not relieved by rest; night pain • May produce situation where bone cannot handle strain of normal use • Pathological fractures • Pressure on nerves: decreased sensation, numbness, limitation of function and movement • Types of primary bone cancers • Osteosarcoma • Ewing’s sarcoma • Chondrosarcoma • In the cartilage Types of Bone Cancers • Osteosarcoma • Develops during periods of skeletal growth • In areas of greatest bone growth • Knee, humerus, distal femur • Common in children • Can occur in older adults as well • Aggressive • Deep pain and swelling in affected area • Pathological fracture can be the first sign • Skin shiny and warm Chondrosarcoma • Rare type of cancer • Malignant tumor of cartilage • middle years and later years • Arise from point of muscle attachment to the bone • Common in shoulder, pelvis and ribs • Slow growing • late metastasis • Often painless but progress to an enlarging mass Ewing Sarcoma • Caused by genetic translocation between chromosomes 11 and 22 • Commonly affects long bones such as the femur and flat bones of the pelvis • Enlarging, tender, swollen mass • May appear as an infection with fever and leukocytosis Primary Bone Cancer: Risk Factors •High doses of radiation therapy •Hereditary retinoblastoma •Bone infarction •Chronic osteomyelitis •History of Paget’s disease •Disorder of bone remodeling Clinical Manifestations of Bone Cancer •Pain in the specific bone area •Caused by stretching of the periosteum of the involved bone or nerve entrapment. •Pathologic fractures •Affected bone appears to diminish or even crumble •Most common sites are the femur, humerus and vertebrae Other Cancers •Breast Cancer •Ovarian Cancer •Prostate Cancer •Colorectal Cancer Breast Cancer (Pages 1151-1153) • 1 out of 8 women will have breast cancer • 5-year survival rate is now 89% Risk Factors for breast cancer • Prolonged reproductive life • Over age 50 • Obesity (increased levels of estrogen in adipose tissue) • Hormone Replacement Therapy • Family history of breast cancer • Nulliparous or late childbirth (after age 30-yrs) • Genetic pre-disposition (BRCA1 and BRCA2) • Alcohol intake (>1 drink/day) ***Reducing Risk: Physical activity, independent of weight changes, reduces the risk for breast cancer, colon cancer (in men), and endometrial cancer. BRCA1 and BRCA2 Genes •Attributed to 5-10% of breast cancers • BRCA1 and BRCA2 are both defective tumor suppressor genes • Genetic testing is available to look for the presence of the BRCA Genes • If positive, genetic counseling is recommended • Some women choose prophylactic mastectomy and oopherectomy Pathophysiology of breast cancer • Normally, estrogen & progesterone act to stimulate breast growth and cell proliferation • Another cellular receptor that normally promotes breast cell growth is “human epidermal growth factor receptor 2” • If the cancer is caused from “over-expression” of the estrogen and progesterone receptors. The cancer is an “Estrogen Receptor-Positive” Cancer, “ER-Positive” • If the cancer is caused from “over-expression of the human epidermal growth factor receptor-2, the cancer is categorized as “HER2-Positive”. Breast Cancer Signs and Symptoms • 90% of palpable breast masses are non-cancerous • Typical Cancerous Tumor • Non-tender to palpation • Firm tumor • Irregular borders • Adherence to the skin or chest wall • Upper, outer quadrant of breast • By the time that a tumor is palpable, over 50% have metastasized to axillary lymph nodes Other clinical manifestations of breast cancer •Nipple discharge •Swelling in one breast •Nipple or skin retraction •Peau d’orange •Skin appears similar to orange peel Ovarian Cancer (Pages 1142-1143) • 5th leading cancer-related death in women • If diagnoses early, prognosis is good • 90-95% survival rate with early diagnosis • 20-30% 5-year survival rate if diagnosed late • No screening tool for ovarian cancer • Vague presenting symptoms • Most cases are diagnosed in the advanced stage Risk Factors for Ovarian Cancer • Older age • Nulligravity • Overweight/Obesity • Smoking • Estrogen treatment (HRT) • Infertility • Family history of ovarian cancer • Ashkenazi Jewish descent • Women who have had breast cancer • Use of talcum powder on the perineum • BRCA1 or BRCA2- Genetic 5-15% inherited • Defective tumor suppressor genes Clinical Manifestations: Ovarian Cancer Vague clinical manifestations: • Lower abdominal pain • Abdominal enlargement/bloating • Difficulty eating because of a feeling of fullness • Nausea/vomiting, constipation • Urinary frequency, dysuria • Pelvic pressure • In late stages • Palpable solid, irregular, fixed mass • Bowel obstruction Diagnosis of Ovarian Cancer • No screening test • Yearly bimanual pelvic exam recommended • CA-125 and Ultrasound recommended for high-risk women • Cancer Antigen-125 (CA-125) • Tumor marker found in multiple cancers • Also elevated with menstruation, pregnancy and liver disease • Transvaginal ultrasound • Laparotomy Prostate Cancer • Approximately 6 out of 10 men aged 65 and older develop prostate cancer. • African American men have the highest risk of developing and dying from prostate cancer. • Prostate cancer growth is dependent on the male hormone testosterone Prostate Cancer Risk Factors • Family history • Diet high in fat, red meat, fried food and dairy • Smoking • High alcohol intake Factors that may decrease the risk of prostate cancer • Diet rich in plant-based foods and vegetables • Broccoli, brussels sprouts, cabbage, cauliflower, kale • Fish oil • Moderate exercise Clinical Manifestations of Prostate Cancer • Asymptomatic in early stages • Similar symptoms as BPH • Enlarged prostate found on digital rectal exam (DRE) • Decreased force of urinary stream • Incomplete emptying of the bladder • Palpates as hard and un-moveable • Normal prostate feels rubbery • Large inguinal lymph nodes • Tenderness/pain over the lumbar region • With vertebral metastasis Screening & Diagnostic Tools • Screening includes PSA and DRE • Prostate Specific Antigen • Blood test • Low specificity for prostate cancer • May elevate with BPH • Will decrease with Statin medications • Transrectal ultrasound • Biopsy • For definitive diagnosis American Cancer Society Screening Recommendations • Age 50 if at average risk and expected to live at least 10 more years. • Because prostate cancer often grows slowly, men without symptoms of prostate cancer who do not have a 10-year life expectancy should not be offered testing since they are not likely to benefit. • Age 45 if at higher risk • African Americans • Men who have a first-degree relative (father, brother, or son) diagnosed at an early age (younger than age 65). • Age 40 if at even higher risk • More than one first-degree relative who had prostate cancer at an early age Colorectal Cancer (Pages 974-975) • Second leading cause of death from cancer • Peak incidence for colorectal cancer is between ages 60-79 years. • Incidence increases with age Colorectal Cancer Pathophysiology • Most commonly begins as a “polyp” • “Adenomatous Polyps” • Polyps with cancerous potential Colorectal Cancer Risk Factors • Genetic susceptibility factors • Obesity • Tobacco use • Physical inactivity • Insulin resistance • Diet • Low fiber • High amount of animal fat • Low in vitamin A, C and E • Inflammatory Bowel Disease Colorectal Cancer Clinical Manifestations • Asymptomatic in early stages • Symptoms begin insidiously • Fatigue, weakness • Weight loss • Melana (blood in stool) • Iron deficiency anemia • Why? • Changes in bowel habits • Diarrhea and constipation Colorectal Cancer Screening/Diagnostic Tools • Colonoscopy • DRE • What is this? You need to know! • FOBT • Fecal Occult Blood Test • Barium Enema Newest ACS Recommendations for Colorectal Cancer Screening • Those at average risk of colorectal cancer • Start regular screening at age 45 • If in good health and with a life expectancy of more than 10 years, continue regular colorectal cancer screening through the age of 75 • Ages 76 through 85 - individual decision on screening • People > 85 no longer need to get colorectal cancer screening • People at higher than average risk need colorectal cancer screening before age 45, get screened more often, and/or get specific tests. • Please Take this short Quiz- Protect yourself from Cancer https://www.cancer.org/healthy/find-cancer-early.html Please be sure to look at short posted videos while studying Thank you please post questions in discussion board or share a cool learning tool on our topic
