CELLULAR ABERRATIONS

OVERVIEW

 Cell appearance (morphology)

 Each normal mature cell type is differentiated, with a
Distinct and recognizable appearance, size, and shape.
 The size of a normal cell nucleus is usually small,
compared with the size of the rest of the cell, Including
the cytoplasm.
 Normal cells generally have a small N:C ratio
 As cells matures, the nucleus, cytoplasm ratio decrease.
OVERVIEW

 The body is made up of approximately 37.2 trillion

human cell
 Normal cells acts as the body’s basic building blocks.
 Control their growth using external signals.
 Undergo program cell death (apoptosis) as part of
normal cell development.
 Stick together by maintaining selective adhesions.
 Differentiate into specialized cells with specific
functions.
1. cell membrane
which surrounds 2. The cytoplasm which
and protects the cell is the watery interior of
the cell which contains
ions, proteins, and
organelles

3. Organelles which carry

out all activities necessary for
the cell to live, grow, and
reproduce
Red Blood Cells Nerve Cells

Cardiac Muscle Cells

 Anatomy of the Generalized Cell

 Cells are not all the same

 All cells share general structures
 Cells are organized into 3 main regions
Nucleus
Cytoplasm
Plasma Membrane
The Nucleus
 Controll center of the cell
 Contains genetic material (DNA)
 Three Regions
1. Nuclear Membrane- barrier of nucleus
2. Nucleolus- site for ribosomes production
3. Chromatin-
 Scattered through the nucleus
 condenses to form chromosomes when
the cell divides.
 Chromosomes- made up of thousand of
genes.
genes- contains long strings of DNA
CANCER
 All cancers begin in cells CANCER
 Cancer starts with changes in
one or a small group of cells.
• A disease process that begins when
an abnormal cell is transformed by
the genetic mutation of the cellular
DNA.
 This abnormal cell forms a clone and
begins to proliferate
abnormally, ignoring growth- regulating
signals in the environment
surrounding the cell.
 Mutations can happen during cell division ( mitosis).
 Different mutations before a normal cells turns into cancer cells:
1. A cell starts making too many proteins.
2. A cell stops making proteins.
3. Abnormal proteins maybe produced.
 It can take many years for a damaged cell to divide and
grow and form into a tumor big enough to cause symptoms.
 They can caused inside of our cells and outside the body, and
 Some people inherit defective genes that make them more
likely to develop cancer.
CANCER
 Third leading cause of morbidity and mortality in
the Phil.

 Leading sites:
 Lung
 breast
 cervix
 liver
 colon
 rectum
 prostate
 stomach
 75% occur after age 50 yrs
 Only 3% occur at age 14 and below

 Estimate:
 One in every 1,800 Filipinos
 Filipino cancer patients seek medical
advice only when symptomatic or at
advanced stages
 The division (mitosis) of normal cells is precisely controlled.
 Cancerous cells divide repeatedly out of control,
eventhough they are not needed.
 They crowd out other normal cells and function abnormally.
 They can also destroy the correct function of major organs.
 Cell Cycle and Cancer

 Neoplasm- abnormal growth of cells

 Benign Neoplasms are not cancerous
- Encapsulated: Do not invade neighboring tissue
 Malignant neoplasms are cancerous
- Not encapsulated; readily infiltrate and destroy neighboring tissues
- may also detach and lodge in distant places.
 Development of Cancer /
CARCINOGENESIS
3 Steps Cellular Process
 INITIATION: results from an irreversible genetic alteration, most
likely one or more simple mutations in the DNA.
 Change in cell genetic structure (mutation)
 Spontaneous
 Carcinogens
Physical
 Radiation: X-rays, radium, nuclear explosion/waste, ultraviolet
 Trauma or chronic irritation (GERD)
Chemical
 Drugs: arsenicals, stilbestrol, urethane
 Cigarette: mouth/esophagus/pharynx/larynx/lungs
 Alcohol: liver, mouth, esophagus, colon, breast
 Hormones (anabolic steroids: liver)
 Diet: High fat, low fiber
 Nitrites and food additives, dyes, sweeteners
 Genetics:
 May be caused by inherited genetic defects
 Breast, prostate, ovarian, melanoma, leukemia, colon

 Viral theory
 Epstein-Barr, Human Papilloma, genital herpes
 Development of Cancer /
CARCINOGENESIS
 INITIATION- results from an irreversible genetic alteration,
most likely one or more simple mutations in the DNA.
 PROMOTION- genome mediated causing reversible proliferation
of altered cells

 PROGRESSION- characterized by karyotype instability and

increased growth of tumor, increased invasiveness, and
metastasis
 METASTASIS- Metastasis involves the spread of cancer cells from the primary
site to other parts of the body through the bloodstream or the lymph system
Metastasis
 Angiogenesis
 Invade surrounding tissues
 Detach from primary tumor
 Penetrate (enzymes) walls of
lymph/vessels
Metastasis
 Most frequent sites:
 Lungs
 Brain
 Bones
 Liver
 Adrenal glands
 Normal Cell vs Cancer Cell – The Key Differences
Normal Cells Cancer Cells

Cell shape  Uniform  Irregular

Growth  Controlled (in the presence of external signals  Uncontrolled (absence of
• Respond to signals from other cells which tell external signals)

Ability to invade
them they have reached the boundary.  Do not respond to these signals and extend into
nearby tissues nearby tissues.
Ability to • Make substances called adhesion molecules  Lacks adhesion molecules
metastasize
Immortality  developed a way to defy death .making them
• Have limited life span immortal
• Mature into specialized cells  Remain immature and undifferentiated
Maturation
 Classification of Cancer
 Anatomic Site
 Histology (Grading)
 Extent of disease (Staging)
 Anatomic Classification
 TISSUE OF ORIGIN:

Carcinoma- Most common; formed by the epithelial cells

 Skin and glands
 mucous membrane: RT, GIT, GUT)
 Sarcoma:
 Cancers that form in bone and soft tissues, including muscle, fat,
blood vessels, lymph vessels, and fibrous tissues.
 Lymphoma
Cancer that begins in lymphocytes( T cells or B cells).
 Anatomic Classification
 TISSUE OF ORIGIN:
leukemia: Cancers that begin in the blood-forming tissue of the bone
marrow
 Hematopoietic system
Multiple Myeloma; Cancer that begins in plasma cells , another type of
immune cell.

Adenocarcinoma: Cancer that forms in epithelial cells that produce fluids

or mucus

Basal Cell Carcinoma: Cancer that begins in the lower or basal (base)
layer of the epidermis
 Anatomic Classification of Tumors
Site Benign Malignant
Surface e. Papilloma Carcinoma
Glandular e Adenoma Adenocarcinoma

Fibrous Fibroma Fibrosarcoma

Cartillage Chondroma Chondrosarcoma
Muscle Rhabdomyoma Rhabdomyosarcoma
bone osteoma osteosarcoma

Meninges Meningioma Meningeal sarcoma

Nerve cells ganglioneuroma neuroblastoma

Lymphoid Hodgkin’s lymphoma

Plasma cells Multiple myeloma
leukocytes leukemia
Tumor
 Malignant
 Benign
 Systemic
 Localized
 Not encapsulated
 Encapsulated
 With metastasis
 No metastasis  Rapid growth
 Slow growth
 Not differentiated
 Differentiated
Histologic Classification

 Appearance of cells and degree of differentiation

 Grade 1: slightly different (mild dysplasia)

 Grade 11: more abnormal (mod. dysplasia)
 Grade 111: very abnormal (severe dysplasia)
 Grade 1V: immature and primitive (anaplasia)

*dysplasia-change in size, shape of a normal cell

*anaplasia-loss of resemblance from a normal cell
Extent of Disease
 Clinical Staging:
 Stage 0: cancer in situ. (in place)
 Stage 1: tissue of origin. (submucosa)
 Stage 11: local spread. (muscularis)
 Stage 111:regional spread (serosa)
 Stage 1V:metastasis – has spread to
distant parts of the body
Extent of Disease  N: (0-3): degree of spread to regional
lymph nodes
TNM Classification
 Nx: Cancer in nearby lymphnodes cannot
 T: (0-4): size or direct extent of
be measured
the primary tumor
N0: tumor cells absent from regional
T1: only in the inner layer lymph nodes
T2: extend into the muscles N1: tumor cells spread to closest or small
T3: extend into the outer lining of the number of regional lymph nodes
muscle N2: tumor cells spread to an extent
Tx: main tumor cannot be measured number of regional lymphnodes.
To: main tumor cannot be found N3: tumor cells spread to most distant or
numerous regional lymph nodes
M: (0/1): presence of metastasis
M0: no distant metastasis
M1: metastasis to distant organs (beyond
regional lymph nodes)
 Cancer Prevention
 Primary Prevention
 Avoidance of potential carcinogens
 Removal of at risk tissues (moles, colon polyps,
breast)
 Secondary Prevention
 Use of screening strategies to detect cancer early,
at a time when cure or control is more likely
Prevention of Cancer
 Reduce or avoid exposure to carcinogens
 Eat balanced diet; reduce fat, preservatives
 Regulate exercise >30 min X 5 days
 Adequate rest (6-8 hrs)
 Health exam
 Eliminate stressors
 Know seven warning signs of cancer
 Practice self-exam
 Learn and practice cancer screenings
 Seek immediate medical care
Warning Signs
C Change in bowel/bladder habits
A A sore that does not heal
U Unusual bleeding/discharge
T Thickening/lump in breast/elsewhere
I Indigestion/difficulty swallowing
O Obvious change in wart or mole
○ ABCDE
 N Nagging cough/hoarseness
 Breast Self-Examination
 Monthly: 20 yrs
– MONTHLY 2-3 OR FEW DAYS AFTER
MENSES
– REGULAR
– SAME DAY EACH MONTH
– IRREGULAR
 A day of the month that is easily to remember
 Inspection
 Front mirror: contour, nipple retraction,
dimpling
Breast Self-Examination
 Palpation (shower)
 Flat pads three
fingers (Opposite
hand)
 Motion: Circular
 Repeat with other
breast
Breast Self-Examination
 Lying down
 Raise one arm and
tuck behind head
 Palpate breast
Screening Guidelines
 BREAST:
 Monthly BSE starting 20
 20-39: CBE Q 3 yrs
 40 yrs old: annual mammogram, CBE

Mammography
 X-ray of the breast
 Nursing management:
 No deodorant, perfume, powders,
ointment
 Uncomfortable
 Pap smear: 3 yrs after having sex but not later
than 21 yrs (Y)

 Time: Between period

 NO: douche/vaginal meds/sex w/in 24
h.
 Position: Lithotomy
 Brush, cotton-tipped applicator, spatula
Testicular Self-Examination
 Monthly: same date
 Palpation:
 Shower: soapy
hands
 Hold scrotum in the
palm:
 compare weight
 Roll each testicle:
first 2 fingers and
thumb
Testicular Self-Exam
 Warning signs that men should look for:
 Painless swelling
 Feeling of heaviness
 Hard lump (size of pea)
 Sudden collection of fluid in the scrotum
 Dull ache in the lower abdomen or in
groin
 Pain in a testicle or in scrotum
Screening Guidelines
 COLON AND RECTUM: PROSTATE
 Age 50: Beginning age: 50
 Yearly FOBT Annually: PSA and DRE
 Q 5 yrs:
 Sigmoidoscopy
 Double-contrast barium
○ Phil: DRE : FOBT and Sigmoidoscopy
 Q 10 yrs:
 Colonoscopy
 Digital Rectal Exam
 Position:
 Bend over
 Side lying fetal
Detection of Cancer
 Biopsy
 Exfoliative cytology-scraping of
tissue
 Endoscopy
 X-Ray
 CT Scan
 MRI- magnetic field visualization
Biopsy
 Definitive
 Cellular differentiation
 Anatomic tissue
 Benign or malignant

 Types:
 Needle Aspiration: fluid/tissue with large needle
 Incisional: tissue from tumor (scalpel/dermal
punch)
 Excisional: removal of entire tumor
SURGERY
 Prevention/Prophylaxis:
 At risk tissue is removed
 Cure and Control:
 When all visible and microscopic
tumor is removed
 Debulking or cytoreductive: tumor
cannot be completely removed:
attached to vital organ
 Reconstructive/rehabilitative
surgery: enhance appearance
CHEMOTHERAPY RADIATION
 systemic therapy R -educes bone marrow activity
 Use of chemicals as A- norexia
 Affects normal and malignant D ry mouth
cells I rritation of mucosa
A lopecia
T eratogenic/toxic effects
I mpaired skin integrity
O ver fatigue
N ausea & vomiting
 Types of Radiation
 EXTERNAL RADIATION (TELETHERAPY):
 Daily radiation exposure
 Client does not emit radiation
 INTERNAL RADIATION (BRACHYTHERAPY):
 Close radiation

 Unsealed sources:
 radioisotope circulate in the body
 contaminate body fluids (urine, saliva,sweat, feces)
 Oral (I131), IV, instillation into cavity

 Sealed implants:
 radioisotope enclosed (container: seeds, ribbons).
 Client emits radiation while implant is in place.
 Temporary or permanent
 RADIATION
EXTERNAL INTERNAL (BRACHYTHERAPY)
(TELETHERAPY)

FOCUS: SKIN CARE UNSEALED SEALED

DO’S DON’T’S  PATIENT AND EXCRETA ARE  PRIORITY: PREVENT
 KEEP SKIN  REMOVE INK BIOHAZARD UP TO 48-72 HOURS DISLODGEMENT
DRY MARKING OF ADMINISTRATION  CBR WITHOUT BRP
 CLEAN: MILD  APPLY  FLUSH TOILET TWICE  FLAT ON BED UP TO LOW
SOAP AND LOTION,DEO  DISINFECT TOILET WITH BLEACH FOWLERS
H2O DORANTS  WASH SOILED LINEN  IF NOT TOLERATED
 REPORT: ETC. SEPARATELY CLEANSE PRIOR TO
MOIST EXCEPT FOR  DON’T SHARE BATHROOM WITH INSERTION
DESQUAMATI SUNSCREEN PREGNANT & SMALL CHILDREN
ON  EXPOSURE
 WEAR: LIGHT TO
LOSE EXTREME
CLOTHING TEMP.
 TIGHT
CLOTHING
FITTING
Precautions: SEALED RADIATION
 Private Rm; Hang caution sign on door
 Organize task to minimize exposure
 TDS: Time (30 mins/shift), Distance (6 ft),
Shielding (lead); Dosimeter badge
 NO: pregnant and below 16
 Linen must remain room until implant is
removed
Dislodged Radiation Source
 Never handle radium:
 Long forceps and put lead
container notify radiation officer
 If unable to locate: prohibit visitors
 Precautions for Unsealed
Radiation
 Wear gloves, gowns when handling client,
excreta or dressings
 Collect eating utensils, dressings, linen:
impermeable bags; label and dispose
 Collect excreta: shielded container
 Home teaching:
 Wash hands after bathroom; Flush toilet several
times
 Wash laundry separately
 Drink plenty of water
 PRINCIPLES OF RADIATION

S heild : lead apron

T ime: 30 mins. Per shift
D istance: 6 feet away

In case of DISLODGEMENT:
Lead apron
Long handled forceps
Lead-lined container (keep it)
 SUMMARY OF RADIOACTIVITY

RADIATION RADIOACTIVITY
THERAPY PATIENT EXCRETIONS

EXTERNAL X X
INTERNAL √ X
(SEALED)
EXTERNAL √ √
(UNSEALED)
 Common Side Effects of
Chemotherapy and Radiation
 Bone Marrow Suppression
 Thrombocytopenia (<100,000/mm3)
 NV: 150,000- 400,000
 Protect client from physical injury
 Electric shaver only
 Avoid: aspirin,NSAIDS, IM, rectal temp/supp
 Monitor blood counts, stool and urine
 High fiber diet, inc fluids
 Assess and teach increased bleeding (epistaxis,
petechiae, ecchymosis)
 Teaching: avoid bump/bruising skin
 Neutropenia (Neutrophils <1,000/mm3)
 NV: 1,800 – 7,800/mm3
 Wash hands – before contact with client
 NO fresh fruits, vegetables, raw foods
 NO flowers, pets, visitors with infection,
crowd
 Client wears mask in public area
 Bathe daily; moisturizer to prevent dry skin
 Monitor for signs of infection: fever: notify
MD
 Neupogen IV/SQ:
 Granulocyte stimulating factor
Side Effects
 Anemia
 Adequate rest period
 Monitor hemoglobin/hematocrit
 Administer O2 as needed
 Stomatitis
 Self-examine
 Soft toothbrush/toothettes
 Mouth care Q 2 to 4 Hrs
 No commercial mouthwash; plain water/saline sol
 Rinse with viscous lidocaine before meals
 K-Y jelly: cracked lips
 Suck on popsicles to provide moisture

 Soft, bland high-protein, high calorie

 GI System:
 Nausea and Vomiting
 Administer antiemetics every 4-6 hrs before chemotherapy
 Withhold foods/fluids 4-6 hrs before chemotherapy
 Provide bland foods in small amounts after treatment

 Diarrhea
 Antidiarrheals (lomotil, kaopectate)
 Good perineal care
 Increase fluids as tolerated
 Monitor potassium, sodium, chloride levels
 Low residue diet increase potassium
Side Effects
 Integ: Alopecia (hair loss)
 Radiation: local/chemo: body
 Head covering: caps, scarves,
turbans, wigs
 Light brushing
 Trim hair before start tx
 Frequent linen change
 Hair loss temp, re-growth in
one month after chemotherapy
 New hair color, texture,
thickness
Side Effects
 Radiation skin changes: dry to moist
desquamation
 Gently: mild soap/tepid water, pat dry
 Expose to air. No excessive heat/cold
 Do not apply any lotion, creams, etc unless
prescribed
 Itching: may use cornstarch
 NO tight clothing: bra, girdles, belt
 NO exposure of site to sun (hat/sunscreen)
 Neurologic System
 Alkaloids (vincristine) may cause neurologic damage
 Peripheral neuropathies, hearing loss, loss of DTR, paralytic ileus

 Respiratory System:
 Pneumonia: radiation and chemotherapy
 Monitor for dry, hacking cough, fever and dyspnea
 Renal System
 Fluids/frequent voiding (metabolites)
 Allopurinol (Zyloprim

 Reproductive System
 Infertility
 Banking sperm
 Reliable method contrception during Tx
 Fatigue:
 Accumulation metabolites from cell
breakdown
 Teaching:
 Expected side effect
 Encourage to rest
ONCOLOGY DISORDERS
Colorectal Cancer
 Nursing Assessment:
 Risk:  Hematochezia, melena
 Family hist,  Constipation/diarrhea
 IBD  pencil/ribbon like stools
 Diet: high red  Feeling of incomplete evacuation
meat, low fiber diet  Anorexia, weakness, weight loss
 Alcohol, smoking,  Lab:
obesity  Fecal Occult blood
 DRE: detect mass
 Double contrast Barium enema
 Sigmoidoscopy, colonoscopy
Colorectal Cancer
 Med Management:
 Radiation
 Chemotherapy: 5-FU, leucovorin
 Surgery: resection with anastomosis; Colostomy
 Nursing Management:
 Prepare for surgery: Colostomy
 Neomycin, cathartics, enema
 Diet: Low residue or liquid (1-2 days)
 Post-Op care:
 I and O, IV, NGT
 Diet:
 Odor causing: Fish, eggs,garlic,cheese,
asparagus, onions, spices
 Gas causing:Cabbage,broccoli,onions,
mushrooms,corn,peas
 Hardens stool: Hard-boiled eggs, liver, meat,
cheese, rice, bananas, chocolate
 Proctoscopy and Sigmoidoscopy: visualization
of the rectum and sigmoid colon
 Colonoscopy- visualization of the colon
 Clear liquid-noon
 NPO after midnight, bowel cleansing
 Midazolam (Versed) IV for sedation
 Glucagon may be given )relax muscles
 Monitor for signs of perforation/peritonitis,
bleeding
 Fever, Guarding, abd distention and pain,
restlessness, tachycardia
Diagnostic tests:
Gastric Cancer
 Risk:
 Smoked food, salted meat/fish, pickled veg
 Smoking, obesity
 Family history
 Pernicious anemia, H. pylori infection, gastritis

 Assessment:
 Uneasy sense of fullness after meals
 As disease progress: Loss of appetite, N/V,
fatigue
Gastric Cancer
 Dx:
 EGD,biopsy
 CT scan
 Management:
 Total gastrectomy, subtotal gastrectomy
 Small frequent feed
 Assess for dumping syndrome
 External beam radiation
 Chemotherapy: 5FU, platinol, cisplatin,
leucovorin
Lung Cancer
 Risk Factors:
 Smoking, asbestos

 Nursing Assessment:
 Dyspnea, wheeze
 Dry - productive cough
 Hoarseness, Hemoptysis
 Dx:
 Broschoscopy with biopsy
Lung Cancer
 Nursing Management:
 Adequate rest
 Diet:
 high protein, high cal
 Force fluids
 Prepare for Surgery
 Segmentectomy
 Partial lung lobe
 Chest tubes
Lung Cancer
 Lobectomy- lobe of lung
 With chest tube; lay patient on unaffected
side to help lungs expand

 Pneumonectomy-removal entire lung

 No chest tube bec fluid accumulation in
empty space desired
 Lay patient affected side
 Bladder cancer
 Risk:
 Smoking, dye (rubber
and cable)

 Assessment:
 Painless hematuria
 Dysuria, Frequency,
urgency
 DX:
 IVP, CT, MRI
 Cystoscopy, biopsy
Bladder Cancer
 Management:
 Surgical therapy
 Transurethral resection (cystoscope) with fulguration (cautery)
 Cystectomy with urinary diversion
 Radiation
 Chemotherapy:
 Systemic: Cisplatin, vinblastine, adriamycin, methotrexate
 Intravesical: weekly for 6-12 wks
○ Empty bladder,position changed Q 15 min (2 hrs)
○ Hemorrhagic Cystitis: increase fluid
Urinary Diversions:
 Incontinent ileal conduit:
 Ureters to small portion
ileum
 Stoma: urostomy
 Urine flow constant; w
external collection device

 Continent: Kock’s pouch,

 Segment of small
bowel/colon used as pouch
 Holds urine w/o leakage,
self-catheterization
Stoma Care
 Pre-Op:  Stoma Care:
 Diet: low-residue 2  Prevent irritation:
d.; clear liquid 24 hrs soap and water
 Meds:  Appliance: 2-3 mm
 NeomycinCathartics larger than stoma;
(Golytely), enemas change Q 3-5
 Post-Op: Observe: days/leak
 ileus : keep NGT
patent
 Stoma necrosis:
dusky/cyanotic
 Cystoscopy
 Urethra and bladder are visualized
 Cystoscope, general anesthesia
 Nursing management:
 Explain, informed consent
 NPO post midnight, cleansing
enema
 IV fluids/oral fluid before procedure
 Position: lithotomy
 Assess for back pain/bladder spasm
 Sitz bath, analgesics
 Urine: pink-tinged
Intravenous Pylelography/Excretory Urogram
 X-ray of the pelvis and abdomen
 Constrast dye injected
 Nursing management
 Consent, allergies
 Laxative evening before
 NPO
 Supine position
 Dye via IV
 Warm flushed sensation
 Adequate IV fluids/oral for dye
excretion
Breast Cancer
 Nursing Assessment:
 Risk:  Lump: UOQ (glands)
 Family history  Hard, irregular shape,
 > 50 nonmobile, painless
 Obesity, fat intake,  Nipple discharge
alcohol, radiation (clear/blood)
 Nipple retraction, Peau d’
orange, dimpling
 Dx:
 Mammography, biopsy
 Carcinoembryonic antigen
(CEA)
Breast Cancer
 Management:
 Surgery
 Lumpectomy
 Mastectomy: breast tissue, nipple
 Modified radical: axillary lymph nodes included
 Radical Mastectomy: pectoral muscles removed
○ Semi-Fowler’s pos, affected arm elevated on a pillow
○ Care of surgical drain (Jackson-Pratt), use gloves emptying
○ NO BP, venipunctures affected arm
○ ROM exercise
 External radiation/brachytherapy
 Chemotherapy
 Adriamycin, Cytoxan
CERVICAL CANCER
 Risk:
 Low socioeconomic status
 Sex before 17 yrs, multiple partners
 Human papillomavirus (HPV), smoking

 Assessment:
 Intermenstrual bleed, watery – foul smell
 Late: pain, weight loss, anemia
Cervical Cancer
 Dx:
 Pap smear: Q 3 yrs: 3 yrs after sex but no late than 21 yrs
 Colposcopy with biopsy

 Management:
 Vaccine: 3 shots over six months
 Preserve fertility: conization, laser (beam energy absorbed by fluid),
cryosurgery, cautery
 Invasive:
 Hysterectomy
 Chemotherapy: cisplatin
 Radiation: external (cobalt), internal (radium)
Cervical Cancer
Prostate Cancer
 Androgen dependent-adenocarcinoma
PROSTATE CANCER
 Risk:
 Age > 50
 Ethnicity: African Americans
 Family history, High-fat diet

 Assessment:
 Asymptomatic
 BPH manifest: dysuria, hesitancy, dribbling,
frequency,nocturia, urgency, retention, dec
stream
 Metastasis: pain lumbosacral area
Prostate Cancer
 Dx:
 DRE (Hard nodule, irregular)
 Prostate Specific Antigen (NV: 0 -4- 0.7mcg/L)
 Biopsy, CT, MRI

 Management:
 Radical prostatectomy: retropubic, perineal
resection
 Nerve-sparing: erectile dysfunction
(pudental n.), urinary incontinence
 Indwelling cath and a drain (surgical site)
PROSTATE CANCER
 Laparoscopic prostatectomy
 Cryosurgery
 Radiation: External beam/brachytherapy
 Chemotherapy
 Hormonal: antiandrogen, androgen blocker
(Nilandron), estrogen (DES)
 Orchiectomy