CANCER

Neoplastic disorder that can involve all body organs with

manifestations that vary according to the body system

affected and type of tumor cells
body's cells become abnormal and divide without

control. Cancer cells may invade nearby tissues. And they

may spread through the bloodstream and lymphatic
system to other parts of the body.
disease of the cell in which the normal mechanisms for

control of growth and proliferation have been altered

 Philippines:
In the Philippines, cancer ranks third in leading causes of

morbidity and mortality after communicable diseases and

cardiovascular diseases
75% - occur after age 50 years
3% occur at age 14 years and below.
for every 1800 Filipinos, one will develop cancer annually

 World:
According to GLOBOCAN, an estimated 12.7 million new

cancer cases and 7.6 million deaths occurred in 2008.

The most commonly diagnosed cancers worldwide are:
lung (1.61 million, 12.7% of the total)
breast (1.38 million, 10.9%)
colorectal cancers (1.23 million, 9.7%)
The most common causes of cancer death are :
lung (1.38 million, 18.2% of the total)
stomach (0.74 million, 9.7%)
liver cancers (0.69 million, 9.2%)

 NORMAL CELL GROWTH

-Mature normal cells- uniform in size and have nuclei that

are characteristic of the tissue to w/c the cells belong

-Nucleus of normal cells-chromosomes containing

deoxyribonucleic acid (DNA) molecules carries the genetic

information that controls the synthesis of polypeptides
(proteins)
GENES- subunits of chromosomes and consist of portions of
DNA that specify the production of particular sets of
proteins; control the development of specific traits

 THE CELL CYCLE

4 phases
1. Gap1 or G1-cell enlarges and synthesizes CHON to prepare

for DNA replication; cells prepares to replicate and enter into

the synthesis phase
2. Synthesis(S) phase- DNA is replicated and the

chromosomes in the cell are duplicated

3. Gap2 or G2- the cell prepares itself for mitosis

4. Mitosis- division of the parent cell into two exact copies

called daughter cells, each having identical genetic material

 DIFFERENTIATION

- a normal process occurring over many cell cycles that

allows cells to specialize in certain tasks

Ex. Some epithelial cell lining the lungs develop into tall

columnar cells with cilia

Three classes of genes appear to play a role in the

development of cancer:
1. Proto-oncogenes encourage and promote the normal

growth and division of cells. When they are defective, they

become oncogenes. Oncogenes are overactive protooncogenes that cause excessive cell multiplication that can
lead to tumors.

 2. Tumor suppressor genes act as brakes on cell growth.

They prevent cells from multiplying uncontrollably. If these

genes are defective there is no control over cell growth and
tumors can result.
3. DNA repair genes ensure that each strand of DNA is

correctly copied during cell division. When these genes do

not function properly, the replicated DNA is likely to have
errors. This causes defects in other genes and can lead to
tumor formation in some cases.

 THEORIES

1. Cellular Transformation and Derangement Theory

- conceptualizes that normal cells may be transformed into

cancer cells due to exposure

to some etiologic agents
2. Failure of the Immune Response Theory
- advocates that all individuals possess cancer cells. However,

the cancer cells are recognized by the immune response

system. So, the cancer cells undergo destruction. Failure of
the immune response system leads to inability to destroy the
cancer cells.

 THEORIES OF CARCINOGENESIS
CELLULAR MUTATION
This theory suggests that carcinogens cause mutations in cellular DNA
CARCINOGENESIS- process of transforming normal cells into

malignant cells

1. Initiation- involves permanent damage in the cellular DNA as a result

of exposure to a carcinogen (ex. Radiation, chemicals) that was not

repaired or had a defective repair
- the first step, initiators (carcinogens), such as chemicals, physical
factors, and biologic agents, escape normal enzymatic mechanisms and
alter the genetic structure of the cellular DNA.
2. Promotion- may lasts for years and includes conditions such as

smoking or alcohol use, that act repeatedly on the already affected cells
- repeated exposure to promoting agents (co-carcinogens) causes the
expression of abnormal or mutant genetic information even after long
latency periods.

 3. Progression- further inherited changes acquired during

the cell replication develop into a cancer

- The cellular changes formed during initiation and
promotion now exhibit increased malignant behavior. These
cells now show a propensity to invade adjacent tissues and to
metastasize.

 RISK FACTORS:

1. VIRUSES AND BACTERIA

-Viruses as a cause of human cancers are hard to determine

because viruses are difficult to isolate.

- Viruses are thought to incorporate themselves in the

genetic structure of cells, thus altering future generations of

that cell populationperhaps leading to a cancer
- they damage cells and induce hyperplastic cells can

progress to malignant cells

- weakens immunologic defenses against neoplasms

*cancers associated to different viruses

HERPES SIMPLEX VIRUS TYPES I AND II (HSV-1 AND HSV-2)

- carcinoma of the lip
- cervical carcinoma
- kaposis sarcoma
HUMAN CYTOMEGALOVIRUS (HCMV)
- kaposis sarcoma
- prostate cancer
EPSTEIN- BARR VIRUS (EBV)
-Burkitts lymphoma
HUMAN HERPESVIRUS-6 (HHV-6)
Lymphoma
HEPATITIS B VIRUS (HBV)
Primary hepatocellular cancer
PAPILLOMAVIRUS
Malignant melanoma
Cervical, penile, and laryngeal cancers
HUMAN T-LYMPHOTROPIC VIRUSES (HTLV)
Adult T-cell leukemia and lymphoma
T- cell variant of hairy-cell leukemia
Kaposis sarcoma

 2. PHYSICAL AGENTS

*Ultraviolet radiation-skin cancer

- sun-related skin cancers @ Northern European extraction

with very fair skin, blue or green eyes, and light-colored hair
are more vulnerable; elderly people with decreased pigment;
darker skin
Exposure to ionizing radiation can occur with repeated

diagnostic x-ray procedures or with radiation therapy used to

treat disease. Fortunately, improved x-ray equipment
appropriately minimizes the risk for extensive radiation
exposure.

 Radiation therapy used in disease treatment or exposure to

radioactive materials at nuclear weapon manufacturing sites

or nuclear power plants is associated with a higher incidence
of leukemia, multiple myeloma, and cancers of the lung,
bone, breast, thyroid, and other tissues
Background radiation from the natural decay processes that

produce radon has also been associated with lung cancer.

Homes with high levels of trapped radon should be
ventilated to allow the gas to disperse into the atmosphere.
- Radon is a naturally formed radioactive gas found in the

basement of many homes

 3. CHEMICAL AGENTS
*Genotoxic- alter DNA replication
- industrial and environmental carcinogens- polycyclic

hydrocarbons found in soot; benzopyrene, found in cigarette

smoke; arsenic found in pesticides
*Promotional agents
- wood and leather dust; polymesters (used in plastic and paints),

carbon tetrachloride, asbestos, and phenol

*Natural substances
-end products of metabolism that are produced in excess

amounts or are ineffectively eliminated such as bile acids-from

high-fat diet

*food preservatives
- sodium saccharine; nitrosamines ;nitrosindoles - found in

pickled and salty foods

 4. DRUGS AND HORMONES

*Chemotherapeutic drugs used to disrupt the cell cycle of

malignant cells- genotoxic

- Can also be promotional- drastically reducing the number of
leukocytes, they impair immune system
- busulfan, chlorambucil, cyclosphosphamide
*recreational drugs-genotoxic betel nut chewed by many Pacific

Islanders and the immunosuppressant promoters heroin and

cocaine
Gonadotrophic hormones-mediate cancers of the reproductive
organs
*Estrogen, Diethylstilbestrol (DES)- linked to cervical,

endometrial, and breast cancer

*Oral contraceptives and prolonged estrogen replacement therapy

are associated with increased incidence of hepatocellular,

endometrial, and breast cancers

 4. GENETIC OR FAMILIAL FACTORS

- Cancers associated with familial inheritance include

retinoblastomas, nephroblastomas, pheochromocytomas,

malignant neurofibromatosis, and breast, ovarian,
endometrial, colorectal, stomach, prostate, and lung cancers.
5. POOR DIET/ OBESITY
*Dietary substances associated with an increased cancer risk

include fats, alcohol, salt-cured or smoked meats, foods

containing nitrates and nitrites, and a high caloric dietary
intake.
*High-fat, low fiber foods- promote colon, breast, and sex
hormone
*fish and meat-excessively fried/ broiled-carcinogenic
compounds scan form-can cause tumors in the mammary
glands, colon, liver, pancreas, and bladder

CELLULAR ALTERATIONS/ PROLIFERATION

1. HYPERPLASIA
- is an increase in the number or density of normal cells
- occurs in response to stress, increased metabolic demands, or
elevated levels of hormones
- under normal DNA control
- ex. Hyperplasia of uterine cells in response to rising levels of
estrogen during pregnancy
2. METAPLASIA
- change in the normal pattern of differentiation such that dividing
cells differentiate into cell types not normally found in that
location in the body
- protective response to adverse conditions

- under normal DNA control and reversible when stressor or

other disruptive condition ceases

cells change from one type to another

 3. DYSPLASIA

- represents a loss of DNA control over differentiation

occurring in response to adverse conditions

- dysplastic cells show abnormal variation in size, shape, and
appearance and a disturbance in their usual aarangement
- ex. Changes in the cervix in response to continued
irritation, such as from the human papillomavirus (HPV)
4. ANAPLASIA
- regression of a cell to an immature or undifferentiated cell

type
- no longer under DNA control
- occurs when a damaging or transforming event takes place
inside the dividing, still undifferentiated cell. Leading to loss
of useful function

 The cell cycle has its own internal controls, called checkpoints.

There are two main checkpoints, one at the G1 /S transition and

another at G2 /M.
the G1 /S checkpoint checks for DNA damage. If DNA damage

is present, the DNA repair machinery and mechanisms that

arrest the cell cycle are put in motion. The delay in cell-cycle
progression provides the time needed for DNA repair; if the
damage is not repairable, apoptotic pathways are activated
to kill the cell.
Thus, the G1 /S checkpoint prevents the replication of cells

that have defects in DNA, which would be perpetuated as

mutations or chromosomal breaks in the progeny of the cell.
DNA damaged after its replication can still be repaired as long

as the chromatids have not separated.

 The G2 /M checkpoint monitors the completion of DNA replication and

checks whether the cell can safely initiate mitosis and separate sister
chromatids.

This checkpoint is particularly important in cells exposed to ionizing

radiation.
Cells damaged by ionizing radiation activate the G2 /M checkpoint and arrest
in G2 ; defects in this checkpoint give rise to chromosomal abnormalities.
To function properly, cell-cycle checkpoints require sensors of DNA damage,

signal transducers, and effector molecules.

The sensors and transducers of DNA damage appear to be similar for the G1 /S
and G2 /M checkpoints.
They include, as sensors, proteins of the RAD family and ataxia telangiectasia

mutated (ATM) and as transducers, the CHK kinase families. The checkpoint
effector molecules differ, depending on the cell-cycle stage at which they act. In
the G1 /S checkpoint, cell-cycle arrest is mostly mediated through p53, which
induces the cell-cycle inhibitor p21.

Defect in cell-cycle checkpoint components is a major cause of genetic

instability in cancer

 Neoplasia literally means the process of "new growth,"

and a new growth is called a neoplasm.

The term tumor was originally applied to the swelling

caused by inflammation.
Neoplasms also may induce swellings, but by long

precedent, the non-neoplastic usage of tumor has

passed into limbo; thus, the term is now equated with
neoplasm.
Oncology (Greek oncos = tumor) is the study of

tumors or neoplasms. Cancer is the common term for

all malignant tumors.

 Classification of Cancer
Classification of cancer determines appropriate treatment

and helps determine the prognosis.

Classification is made according to the :
site of origin
histology (or cell analysis; called grading)
the extent of the disease (called staging)

 This classification describes the type of tissue in which the

cancer cells begin to develop.

Here are some common examples of site of origin

classification:
Adenocarcinomaoriginates in glandular tissue
Blastomaoriginates in embryonic tissue of organs
Carcinomaoriginates in epithelial tissue (i.e., tissue that

lines organs and tubes)

Leukemiaoriginates in tissues that form blood cells
Lymphomaoriginates in lymphatic tissue
Myelomaoriginates in bone marrow
Sarcomaoriginates in connective or supportive tissue (e.g.,
bone, cartilage, muscle)

 TYPES OF NEOPLASM

Neoplasm- mass of new tissue(collection of cells) that grows

independently of its surrounding structures and has no

physiologic purpose
Are said to be autonomous because of the following:
1. They grow at a rate uncoordinated with the needs of the body
2. They function independently of usual homeostatic controls

3. They share some of the properties of the parent cells but with

altered size and shape

4. They do not benefit the host and in some cases are actively
harmful

 TUMOR INVASION AND METASTASIS

Invasion
1. Ability to cause pressure atrophy

- pressure of growing tumor=causes atrophy and necrosis of

adjacent tissues=malignancy moves in vacated space
2. Ability to disrupt the basement of normal cells

- cancer cells bind to elements of basement to basement

membrane=secrete enzymes=degrade physical barrier=movement
into normal tissues, lymph and blood circulation
3. Motility

- reduced adhesiveness- easily separate from the neoplasm= move

into surrounding body fluids and tissues
4. Response to chemical signals from adjacent tissues

- Chemotaxis(movt of cells in response to a chemical stimulus)=

calls tumor cells into normal tissues

 Metastasis

- process by which a tumor cell leaves the primary tumor,

travels to a distant site via the circulatory system, and

establishes a secondary tumor.
1. Invasion neoplastic cells from primary tumor invade
into surrounding tissue with penetration of blood or lymph.
2. Spread tumor cells spread through lymph or circulation

or by direct expansion
3. Establishment and growth tumor cells are established

and grow in secondary site: lymph nodes or in organs from

venous circulation

 METASTATIC MECHANISMS

1. Lymphatic spread- most common mechanism; transport

of tumor cells into the lymphatic circulation; Malignant

cells also may penetrate lymphatic vessels by invasion.
- Breast tumors frequently metastasize in this manner
through axillary, clavicular, and thoracic lymph channels.
2. Hematogenous spread-malignant cells are disseminated

through the bloodstream. Hematogenous spread is directly

related to the vascularity of the tumor
3. Angiogenesis- Malignant cells also have the ability to

induce the growth of new capillaries from the host tissue to

meet their needs for nutrients and oxygen.

 Tumor Grading

Grading involves examining tumor cells that have been

obtained through biopsy under a microscope. The

abnormality of the cells determines the grade of the cancer.
Increasing abnormality increases the grade, from 14.
Grading of a cancer is based on the degree of differentiation

of the tumor cells and the number of mitoses within the

tumor as presumed correlates of the neoplasm's
aggressiveness.
Thus, cancers are classified as grades I to IV with increasing

anaplasia

 Grade 1- Cells slightly abnormal and well differentiated

Grade 2- Cells more abnormal and moderately

differentiated
Grade 3- Cells very abnormal and poorly differentiated
Grade 4- Cells immature and undifferentiated

 Staging determines the size of the tumor and the existence

of metastasis
The TNM system is frequently used. In this system, T refers

to the extent of the primary tumor, N refers to lymph node

involvement, and M refers to the extent of metastasis
Cancer staging is a system used to describe the anatomic

extent of a malignant process in an individual patient.

Staging systems may incorporate relevant clinical prognostic

factors such as tumor size, location, extent, grade, and

dissemination to regional lymph nodes or distant sites

 The staging of cancers is based on the size of the primary

lesion, its extent of spread to regional lymph nodes, and the

presence or absence of blood-borne metastases.
Two major staging systems are currently in use, one

developed by the Union Internationale Contre Cancer

(UICC) and the other by the American Joint Committee
(AJC) on Cancer Staging.
The UICC employs a classification called the TNM system

T for primary tumor, N for regional lymph node involvement,

and M for metastases.

 The TNM staging varies for each specific form of cancer, but

there are general principles. With increasing size, the

primary lesion is characterized as T1 to T4. T0 is added to
indicate an in situ lesion.
N0 would mean no nodal involvement, whereas N1 to N3

would denote involvement of an increasing number and

range of nodes.
M0 signifies no distant metastases, whereas M1 or sometimes

M2 indicates the presence of blood-borne metastases and

some judgment as to their number

Primary Tumor (T)

TX

Primary tumor cannot be assessed (e.g., shave biopsy or

regressed melanoma)

T0

No evidence of primary tumor

Tis

Melanoma in situ

T1

Melanoma 1.0 mm in thickness with or without ulceration

T2

Melanoma 1.012 mm in thickness with or without ulceration

T3

Melanoma 2.014 mm in thickness with or without ulceration

T4

Melanoma greater than 4.0 mm in thickness with or without

ulceration

Regional Lymph
Nodes (N)
NX

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Metastasis in one lymph node

N2
Metastasis in two to three regional nodes or intralymphatic
regional metastasis without nodal metastases
N3

Metastasis in four or more regional nodes, or matted metastatic

nodes, or satellite(s) with metastasis in regional node(s)

Distant
Metastasis (M)

MX

Distant metastasis cannot be assessed

M0

No distant metastasis

M1

Distant metastasis

M1a

Metastasis to skin, subcutaneous tissues, or distant lymph nodes

M1b

Metastasis to lung

M1c

Metastasis to all other visceral sites or distant metastasis at any

site associated with an elevated serum lactate dehydrogenase
(LDH)

Clinical Stage
Grouping
Stage 0

Tis

N0

M0

Stage IA

T1a

N0

M0

Stage IB

T1b

N0

M0

T2a

N0

M0

T2b

N0

M0

T3a

N0

M0

T3b

N0

M0

T4a

N0

M0

Stage IIC

T4b

N0

M0

Stage III

Any T

N1

M0

Any T

N2

M0

Any T

N3

M0

Any T

Any N

M1

Stage IIA

Stage IIB

Stage 1v

 PREVENTION AND DETECTION

1. PRIMARY PREVENTION
a. Cancer prevention focuses on reducing modifiable risk

factors in the external and internal environment that

increase a persons susceptibility to cancer development.

b. General factors that influence cancer incidence and

mortality include sex, age, geographic location,

socioeconomic status, ethnic or cultural background,
personal habits, occupation, and personal and family health
habits.

 2. SECONDARY PREVENTION
- involves detection and case-finding efforts to achieve early

diagnosis
a. Recognizing early signs and symptoms and seeking prompt

treatment can significantly reduce morbidity and mortality

of several types of cancer
Cancer signs: CAUTION US!

 Warning Signs of Cancer

CAUTIONUS

Change in bowel or bladder habits

A person with colon cancer may have diarrhea or

constipation, or he may notice that the stool has become

smaller in diameter
A person with bladder or kidney cancer may have
urinary frequency and urgency

 A sore that does not heal

Small, scaly patches on the skin that bleed or do not heal

may be a sign of skin cancer

A sore in the mouth that does not heal can indicate oral
cancer
Unusual bleeding or discharge
Blood in the stool is often the first sign of colon cancer
Similarly, blood in the urine is usually the first sign of

bladder or kidney cancer

Postmenopausal bleeding (bleeding after menopause) may
be a sign of uterine cancer

 Thickenings or lumps
Enlargement of the lymph nodes or glands (such as the

thyroid gland) can be an early sign of cancer

Breast and testicular cancers may also present as a lump
Indigestion or difficulty in swallowing
Cancers of the digestive system, including those of the
esophagus, stomach, and
pancreas, may cause indigestion, heartburn, or difficulty
swallowing
Obvious change in a wart or mole
Moles or other skin lesions that change in shape, size, or
color should be reported

 Nagging or persistent cough or hoarseness

Cancers of the respiratory tract, including lung

cancer and laryngeal cancer, may cause

a cough that does not go away or a hoarse(rough) voice

Unexplained anemia
-Sudden unexplained weight loss

 NURSING ASSESSMENT
Family History
Obtain information about both maternal and paternal

sides of family
Obtain cancer history of at least three generations
Look for clustering of cancers that occur at earlier ages,
multiple primary cancers in one individual, cancer in
paired organs and two or more close relatives with the
same type of cancer suggestive of hereditary cancer
syndromes

 Physical assessment
Physical findings that may predispose the patient to

cancer, such as multiple colonic polyps, suggestive of

polyposis syndrome
Skin findings such as atypical moles, that may be
related to familial melanoma syndrome

 Warning signs
Unexplained weight loss: An unexplained weight loss of 10

pounds or more may be the first sign of cancer. This

happens most often with cancers of the pancreas, stomach,
esophagus, or lung.
Fever: Fever is very common with cancer, but it more often
happens after cancer has spread from where it started.
Almost all patients with cancer will have fever at some
time, especially if the cancer or its treatment affects the
immune system. This can make it harder for the body to
fight infection. Less often, fever may be an early sign of
cancer, such as blood cancers like leukemia or lymphoma.

 Fatigue: Fatigue is extreme tiredness that does not get

better with rest. It may be an important symptom as cancer

grows. It may happen early, though, in cancers like
leukemia. Some colon or stomach cancers can cause blood
loss. This is another way cancer can cause fatigue.
Pain: Pain may be an early symptom with some cancers like
bone cancers or testicular cancer. A headache that does not
go away or get better with treatment may be a symptom of a
brain tumor. Back pain can be a symptom of cancer of the
colon, rectum, or ovary. Most often, pain due to cancer is a
symptom of cancer that has already spread from where it
started (metastasized).

 Skin changes: Along with cancers of the skin, some other

cancers can cause skin symptoms or signs that can be seen.

These signs and symptoms include:
o Darker looking skin (hyperpigmentation)
o Yellowish skin and eyes (jaundice)
o Reddened skin (erythema)
o Itching (pruritis)
Excessive hair growth
o Along with the general symptoms, there are certain other
common symptoms and signs which could suggest cancer.
Again, there may be other causes for each of these, but it is
important to see a doctor about them as soon as possible.S

 Change in bowel habits or bladder function: Long-term

constipation, diarrhea, or a change in the size of the stool

may be a sign of colon cancer. Pain when passing urine,
blood in the urine, or a change in bladder function (such as
needing to pass urine more or less often than usual) could
be related to bladder or prostate cancer. Report any
changes in bladder or bowel function to a doctor.
Sores that do not heal: Skin cancers may bleed and look
like sores that do not heal. A long-lasting sore in the mouth
could be an oral cancer. This should be dealt with right
away, especially in people who smoke, chew tobacco, or
often drink alcohol. Sores on the penis or vagina may either
be signs of infection or an early cancer

 White patches inside the mouth or white spots on the

tongue: White patches inside the mouth and white

spots on the tongue may be leukoplakia. Leukoplakia
is a pre-cancerous area that is caused by frequent
irritation. It is often caused by smoking or other
tobacco use. People who smoke pipes or use oral or spit
tobacco are at high risk for leukoplakia. If it is not
treated, leukoplakia can become oral cancer.

 Unusual bleeding or discharge: Unusual bleeding can

happen in early or advanced cancer. Blood in the

sputum (phlegm) may be a sign of lung cancer. Blood
in the stool (or a dark or black stool) could be a sign of
colon or rectal cancer. Cancer of the cervix or the
endometrium (lining of the uterus) can cause
abnormal vaginal bleeding. Blood in the urine may be
a sign of bladder or kidney cancer. A bloody discharge
from the nipple may be a sign of breast cancer.

 Thickening or lump in the breast or other parts of the

body: Many cancers can be felt through the skin. These

cancers occur mostly in the breast, testicle, lymph
nodes (glands), and the soft tissues of the body. A
lump or thickening may be an early or late sign of
cancer and should be reported to a doctor, especially if
youve just found it or notice it has grown in size.

 Indigestion or trouble swallowing: Indigestion or

swallowing problems may be signs of cancer of the

esophagus (the swallowing tube that goes to the
stomach), stomach, or pharynx (throat). But like most
symptoms on this list, they are most often caused by
something other than cancer.

 Recent change in a wart or mole or any new skin

change: Any wart, mole, or freckle that changes color,

size, or shape, or that loses its sharp border should be
seen by a doctor right away. Any other skin changes
should be reported, too. A skin change may be a
melanoma which, if found early, can be treated
successfully.

 Nagging cough or hoarseness: A cough that does not

go away may be a sign of lung cancer. Hoarseness can

be a sign of cancer of the voice box (larynx) or thyroid
gland

 CANCER SCREENING
Cancer Site

Population

Test or Procedure

Frequency

Breast

Women, age 20+

Breast selfexamination

Monthly, starting at
age 20

Clinical breast
examination

Every 3 years, ages

2039
Annual, starting at
age 40

Mammography

Annual, starting at
age 40

Cancer Site

Population

Test or Procedure

Frequency

Colorectal

Men and women,

age 50+

Fecal occult blood

test

Annual, starting at
age 20

Flexible
sigmoidoscopy

Every 5 years,
starting at age 50

Fecal occult blood

test and flexible
sigmoidoscopy

Annual FOBT and

flexible
sigmoidoscopy every
5, years, starting at
age 50

Colonoscopy

Colonoscopy every
10 years, starting at
age 50

Cancer
Site

Population

Test or Procedure Frequency

Prostate

Men, age 50+

Digital rectal
Offer PSA and DRE annually, starting
examination (DRE) at age 50, for men who have life
and prostateexpectancy of at least 10 years
specific antigen
test (PSA)

Cervix

Women

Pap test

Cervical cancer screening beginning 3

years after first vaginal intercourse,
but no later than 21 years of age;
screening every year with
conventional Pap tests or every 2 years
using liquid-based Pap tests; at or
after age 30, women who have had
three or more normal Pap tests and no
abnormal Pap tests in the last 10 years,
and women who have had a total
hysterectomy, may choose to stop
cervical cancer screening

1.

Breast Self Examination

Breast Self-Examination (BSE) - involves checking the

breasts to help detect breast problems or changes

Importance of BSE
It helps to notice any changes in the breasts
It helps individual stay in touch with their body and take
charge of their own health.
It helps find changes in the breasts that could happen
between mammograms and/or clinical breast exams by a
health professional

The Best Time to do BSE

It is best to check the breasts when they are least painful.
Menstruating - seven to ten days after the start of your

menstrual period.
Irregular periods or

menopaused women/ Pregnant - /

no longer menstruating, the breast self-examination
(BSE) should be performed on the same day every month

Breastfeeding mothers - after feeding the baby.

Women using oral contraceptives - each month on the

day you begin a new package of pills.

In Performing BSE, one are looking for:

A hard lump or knot in or near the breast or in your
underarm
A change in the way your breasts look or feel
Some other changes to look out for:
Dimpling, puckering, or ridges of the skin on the breast
A nipple that is pushed inward rather than sticking out
Redness, warmth, swelling, or pain
Itchy, scaly sore or rash on the nipple
Nipple discharge other than breast milk
Change in color, shape, size, or texture of a breast

STEP 1
Using a mirror, inspect your breasts with your arms at
your sides, with your hands on your hips, and with
your arms raised while flexing your chest muscles

STEP 2
Look for any changes in contour, swelling, dimpling of
skin, or appearance of the nipple. It is normal if your
right and left breasts do not match exactly.

STEP 3
Using the pads of your fingers, press firmly on your breast,
checking the entire breast and armpit area. Move around
your breast in a circular, up-and-down, or wedge pattern.
Remember to use the same method every month. Check
both breasts

STEP 4
There are three patterns you can use to examine your
breast: the circular, the up-and-down, and the wedge
patterns. Use the pattern that is easiest for you, and
use the same pattern every month.

STEP 5
Gently squeeze the nipple of each breast and report
any discharge to your doctor immediately.

STEP 6
Examine both breasts lying down. To examine the right
breast, place a pillow under your right shoulder and place
your right hand behind your head. Using the pads of your
fingers, press firmly, checking the entire breast and armpit
area. Use the same pattern you used while standing. Repeat
for your left breast.

TSE
The testicular-self examination is recommended monthly after a

warm bath or shower when the scrotal skin is relaxed.

TSE is performed once a month and should be done on the same

day of each month, as an aid to help the client remember to

perform the exam
The client should stand to examine the testicles.
Using both hands, with fingers under the scrotum and thumbs on

top, the client should gently roll the testicles, feeling for any
lumps.
. The scrotum is held in one hand and the testicle is rolled

between the thumb and forefinger of the other hand.

Papanicolaou test
done by obtaining and examining cells from the uterine
cervical os. The cells are obtained during pelvic examination.
A Pap smear is usually painless.
The test cannot be performed during menstruation.
The client needs to be instructed to avoid douching for at least
24 hours prior to the test.
There is no reason to restrict fluids on the day of the test.

Preparations
The health care should ask the following before the
procedure
Are taking any medications or birth control pills
Have had an abnormal Pap smear
Might be pregnant

Within 24 hours of the test, avoid:

Douching
Having intercourse
Taking a tub bath
Using tampons

 *Avoid scheduling Pap smear while the patient is

menstruating, because blood and cells from the uterus

may affect the accuracy of the Pap smear. Empty your
bladder just before the test.
*Tell the patient that she may have some discomfort,

similar to menstrual cramps, and a feeling of pressure

during the procedure.

 Procedure
Insert a speculum into the woman's vagina, which

spreads the vagina open and allows access to the cervix

The health care provider then collects a sample of cells
from the outer opening or os of the cervix by scraping
it with an Aylesbury spatula
An endocervical brush is rotated in the central
opening of the cervix.
The cells are placed on a glass slide and taken to
the laboratory to be checked for abnormalities.

 Screening should start within 3 years after first having

vaginal intercourse or by age 21. After the first test:

Woman should have a Pap smear ever 2 years to check

for cervical cancer.

If she is over age 30 or your Pap smears have been

negative for 3 times in a row, pap smear could be done

every 3 years

 After age 65-70, most women can stop having Pap smears as

long as they have had three negative tests within the past 10
years.
If she has a new sexual partner after age 65, she should begin

having Pap smear screening again.

*Women who have had a total hysterectomy (uterus and

cervix removed) and have not had any previous history of

cervical dysplasia (abnormal cells), cervical cancer, or any
other kind of pelvic cancer, may not need to have Pap smears.

 3. Rectal examination - is an manual examination of

the anus, rectum, and prostate for men

This examination may be used:

for the diagnosis of rectal tumors and other forms

of cancer
for the diagnosis of prostatic disorders, notably tumors

and benign prostatic hyperplasia

for the diagnosis of appendicitis or other examples of

an acute abdomen (i.e. acute abdominal symptoms

indicating a serious underlying disease);

 for the estimation of the tonicity of the anal sphincter,

which may be useful in case of fecal

incontinence or neurologic diseases, including
traumatic spinal cord injuries;
in females, for gynaecological palpations of internal
organs
for examination of the hardness and color of the feces
(ie. in cases of constipation, and fecal impaction);
prior to a colonoscopy or proctoscopy.
to evaluate hemorrhoids
In newborns to exclude imperforate anus

Procedure
1. The patient is positioned on the left side with the knees

close to the chest. Sometimes the patient is asked to stand up

and lean over the examination table.
2. The health care practitioner examines the anus and the

surrounding skin for hemorrhoids, tags, fissures and

abscesses.
3. After lubricating the gloved finger and anus, the examiner

gently slides the finger into the anus and follows the contours
of the rectum.

 4. The examiner notes the tone of the anus and feels

the walls and the edges for texture, tenderness and

masses as far as the examining finger can reach.
5. The examiner evaluates the prostate for nodules and

tenderness. Stool on the finger should be examined for

blood, color, texture and tested for fecal occult blood.

DIGITAL RECTAL EXAM

is a screening test that allows a doctor to check the prostate

gland in men or the lower colon/rectum in men and women

for cancer or other abnormalities.
in association with a vaginal examination, a DRE can check

for cancer of the uterus and ovaries in women. A DRE can

also be used to check the other organs and structures in the
pelvis.
During a DRE for a man, the doctor determines the size and

consistency of the prostate, feeling for bumps, irregularities,

soft or hard spots, or other abnormalities. The doctor also
examines the wall and consistency of the lower
colon/rectum.

 Preparing for the procedure

A DRE does not require advance preparation. You should tell

your doctor if you have hemorrhoids or anal fissures (broken

skin around the anus), which might be aggravated by the
DRE.
You will be asked to sign a consent form
During the procedure

A DRE takes only a few minutes to complete in a private

examination room at your doctor's office. It is performed

without sedation; your doctor may ask you to relax and take a
deep breath as the procedure begins.

 You will be asked to take off your clothes below the waist and

given a gown to wear or a cloth to wrap around you during

the DRE.
A man is examined in one of two ways: while standing

(bending forward at the waist, leaning against an exam table)

or while lying on his side on an examination table (with his
knees pulled up to his chest in the fetal position).
A woman is usually examined while lying on her back on an

examination table, with her feet in raised stirrups, as part of a

gynecologic examination

 The doctor will gently insert a lubricated, gloved finger into

the rectum. For men, this is done to feel the back of the
prostate or the colon/rectum. For women, the goal is to feel
the reproductive organs, as well as the bowel. The doctor may
also feel for abnormalities in the internal organs by applying
pressure on the lower abdomen or pelvic area with the other
hand.
If a man's prostate is enlarged, he may feel some discomfort

or mild pain when the doctor examines his prostate. (Pain is

unusual unless there is a large, inflamed, infected or
cancerous prostate.)

 He may also feel the need to urinate. A woman may feel

discomfort but typically no pain when the doctor presses

on her abdomen to feel her internal organs.
After the procedure
You can resume your normal activities immediately after a

DRE. Slight bleeding from the rectum can happen after

the examination, particularly if you have hemorrhoids or
anal fissures. Tell your doctor if you experience significant
rectal bleeding.