Pneumococcal Vaccine is often offered at my place of work.

I work at a
rehab/long-term care facility where you see a lot of cases of pneumonia a year.
According to Capriotti & Frizzell (2016) this vaccine is recommended every 5 to
10 years for older adults. We offer it to patients upon arrival if they have not had it.
It helps prevent the development of pneumococcal bacteria and diseases like
pneumonia, meningitis, sinusitis, and otitis media (CDC, 2017).

“Bacterial vaccines are derivatives of killed microorganisms or extracts of antigens

or toxins” (Capriotti & Frizzell, p. 205) This vaccine is part of what is called
“Subunit Vaccines” Subunit Vaccines which “uses only specific, purified
macromolecules derived from the pathogen” (Owen et al, p. 581)

There are two types of this vaccine. First one is called pneumococcal
polysaccharide vaccine or PPSV23, which is given to adults usually over the age
65. Owen et al (2013) note that this vaccine “activate B cells…resulting in IgM
production” (p. 581). The second type of this vaccine is the pneumococcal
conjugate vaccine or PCV13, which is given to children younger than 2 years old
due to the PPSV23 not being able to create immunity in children, and it “consists
of 13 antigenically distinct capsular polysaccharides…induces formation of
opsonizing antibodies” (Owen et al, p. 582)

Capriotti, T., & Frizzell, J. P. (2016). Pathophysiology: introductory concepts and clinical
perspectives. Philadelphia: F.A. Davis Company.

Owen, J. A., Punt, J., Stranford, S. A., Jones, P. P., & Kuby, J. (2013). Kuby
immunology. New York: W.H. Freeman.
  Discuss a patient case or personal experience (no patient names or
identifiers to ensure HIPPAA guidelines) you are familiar with and
explain the following types of:
o Neoplasm/cancer
o Pathophysiology
o Prognosis
o Treatment modalities of the neoplasm/cancer

Cervical cancer is the 3rd most common type of cancer in women worldwide and
mostly affects women is their 40s and 50s (Capriotti & Frizzell, p.960). The most
significant predisposing condition are HPV infection and genetics. “Almost 100%
of cervical cancer test positive for HPV” (Capriotti & Frizzell, p. 961). Diagnostic
techniques usually include biopsy and a Pap smear. “Commonly an abnormal pap
smear alerts the individual of a problem”. Although Shepherd (2012), agrees with
the cone biopsy method for diagnosing cervical cancer, he also states that “cervical
cancer is most accurately staged by MRI. This will specifically identify and define
a cervical tumor and should preferably be carried out before any form of diagnostic
cone biopsy.” (p.293)

Pathophysiology:

There are two major kinds of cellular changes noted during cervical cancer, SCC,
which occurs within epithelial cells, and adenocarcinoma, which involves
glandular cells (Capriotti & Frizzell, p.961). Waggoners (2003) states that “about
80% of primary cervical cancers arise from pre-existing squamous dysplasia.
Adenocarcinoma of the cervix accounts for about 20% of invasive cervical
cancers” (p. 2218). The earliest preinvasive changes that occur on the cervix are
termed squamous intraepithelial lesions. The intraepithelial lesions are first limited
to the cervical epithelium; as invasion occurs, neoplastic cells penetrate the
underlying basement membrane. (Capriotti & Frizzell, p 961).

Prognosis:

According to Waggoner (2003), staging of the cancer is a key indicator of survival

rates, noting that “a 5-year survival approaches 100% for patients with tumors of
stage IA and averages 70-85% for those with stage IB1 and smaller IIA lesions”
(p.2218). He also noted that the survival rate for more advanced tumors is
influenced heavily by “…the volume of disease, the patient's age, and
comorbidities. Overall, 5-year disease-free survival is 50-70% for stages IB2 and
IIB, 30-50% for stage III, and 5-15% for stage IV” (p.2218)
Treatment:

Treatment is heavily influenced by the staging of the cancer. Cervical cancer is

staged as the following: Stage 0, I, IA, IB, II, IIA, IIB, III, and IV, IVA,IVB. (p.
962) For stage 0 also known as carcinoma in situ, usually local excisional
measures such as cryosurgery, laser ablation, and loop excision are used (Capriotti
& Frizzell, p 961).

For stage IA, which is “commonly detected in women who are symptom free with
cervices that seem normal on gross examination” (Waggoner, p.2219) Surgery is
mostly the treatment of choice. Radical hysterectomy, and total hysterectomy
procedures are performed. If lymph nodes are involved, radiation therapy is
needed. For stages II, II, and IVA, radical hysterectomy with bilateral pelvic
lymphadenectomy and combined external beam radiation with brachytherapy is
needed. For stage IVB, therapy is used to provide pain relief, as well as, radiation
therapy and systemic chemotherapy if metastasis is present. (Capriotti & Frizzell, p
961).

Capriotti, T., & Frizzell, J. P. (2016). Pathophysiology: introductory concepts and clinical
perspectives. Philadelphia: F.A. Davis Company.

Shepherd, J. H. (2012). Cervical cancer. Best Practice & Research Clinical Obstetrics &
Gynaecology, 26(3), 293-309. doi:10.1016/j.bpobgyn.2011.12.004

Waggoner, S. E. (2003). Cervical cancer. The Lancet, 361(9376), 2217-25. Retrieved from

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