A Brain Cancer PowerPoint Presentation

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13/12/2010 1 Brain CancerColon Cancer Dr Ibraheem Bashayreh, RN, PhD

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13/12/2010 2 Significance The brain is the center of thoughts, emotions, memory and speech. Brain also control muscle movements and interpretation of sensory information (sight, sound, touch, taste, pain etc)

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13/12/2010 3 Background Estimated 18,400 primary malignant brain tumors will be diagnosed in 2004 —10,540 in men & 7,860 in women. Approximately 12,690 people will die from these tumors in 2004. Accounts for 1.4% of all cancers Accounts for 2.4% of all cancer related deaths

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13/12/2010 4 Brain tumor an abnormal growth of cells within the brain or inside the skull which can be cancerous or non-cancerous (benign) It is defined as any intracranial tumor created by abnormal and uncontrolled cell division, normally either - in the brain itself (neurons, glial cells (astrocytes, oligodendrocytes, ependymal cells), lymphatic tissue, blood vessels), - in the cranial nerves (myelin-producing Schwann cells), - in the brain envelopes (meninges), skull, pituitary and pineal gland, - or metastatic tumors

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13/12/2010 5 Brain tumor Primary (true) brain tumors are commonly located in the - posterior cranial fossa in children - anterior 2/3 of the cerebral hemispheres in adults, although they can affect any part of the brain.

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13/12/2010 6 Risk Factors * Most brain cancers happen for reasons unknown, however some small risk factors are * Environmentsl risk factor Smoking Diet Occupation Mobile phone Radiation exposure Exposure to vinyl chloride * Immunosupression - * Linked with Genetic abnormalities -

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13/12/2010 7 Brain tumor Tumors can effect any part of the brain and depending on what part(s) of the brain it affects can have a number of symptoms. Seizures Difficulty with language Mood changes Change of personality Changes in vision, hearing, and sensation. Difficulty with muscle movement Difficulty with coordination control

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13/12/2010 8 WHO CLASSIFICATION

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13/12/2010 9 GLIOMA a type of tumor that starts in the brain or spine. It is called a glioma because it arises from glial cells The most common site of gliomas is the brain occurs in adults over 45 years of age 90% of all brain tumors are Gliomas Classification Classified - by cell type, - by grade, - by location.

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13/12/2010 10 By cell type

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13/12/2010 11 Astrocytoma Astrocytes brain cells abnormally dividing causing tumors called astrocytomas. Astrocytes are glial cells that help nourish neurons– they help repair damage How the astroytomas are classified How close the cells are together within the tumor How abnormal the cells are How many of the cells are proliferating Whether or not there are blood vessels growing near the tumor Whether or not some of the cancer cells have degenerated or not

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13/12/2010 12 Astrocytomas--Treatments If tumors have not infiltrated normal brain tissue then surgery can be a cure Low-grade Astrocytomas are not curable by surgery. However through surgery as much of the tumor as possible is removed and then the patient usually goes through radiation treatment.

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13/12/2010 13 Astrocytomas--Treatment High-grade Astrocytomas are not curable by surgery. After surgery has removed as much of the tumor as possible the patient can go through radiation treatment and chemotherapy. Most common drug given to these patients after chemotherapy is BCNU (Carmustine)

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13/12/2010 14 Oligodendrogliomas These tumors start in mutated oligodendrocyte brain cells Oligodendrocytes make myelin which help neurons transmit signals through the axons These tumors may spread through cerebrospinal fluid pathways but typically do not usually spread to locations outside of the brain or spinal cord.

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13/12/2010 15 Oligodendrogliomas--Treatments Because these tumors infiltrate normal brain tissue these tumors are not cured through surgery. However removal of part of the tumors can relieve some symptoms and prolong life. If the tumor is causing disabilities to the patient after surgery the patient may go through chemotherapy, perhaps followed by radiation treatments.

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13/12/2010 16 Ependymomas Mutated ependymal cells Ependymal cells line the ventricles in the central area of the brain and they line part of the pathway through which the cerebrospinal fluid travels Theses mutated cells may block the cerebrospinal fluid from exiting the ventricles causing the ventricles to enlarge (hydrocephalus)

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13/12/2010 17 Ependymomas--Treatments These tumors do not usually infiltrate normal brain tissue and are therefore curable through surgery. If surgery is unable to completely remove the tumors the patient may try radiation therapy.

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13/12/2010 18 Diagnosis These tumors can be detected through a MRI, CT scan or a PET scan (Positron emission tomography is a nuclear medicine imaging technique which produces a three-dimensional image or picture of functional processes in the body. Once detected, depending on where the tumor is located, a biopsy officially is used to diagnosis cancer.

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13/12/2010 19 Prognosis For people ages 15-44 five year survival rate is 55% For people ages 45-64 five year survival rate is 16% For people over 65 five year survival rate is 5%

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13/12/2010 20 Colon Cancer

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13/12/2010 21 What is the Colon The Colon comprises the end of the long, coiled, tubular digestive tract located in the Abdomen It basically acts as a waste processor Takes digested food in the form of Solid waste pushing it out of the rectum and anus The Colorectal tube is a prime location for the development and growth of small polyps or tumors

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13/12/2010 22 Colon; The Cancer Its Self It starts with a simple cell the mutates and grows into a polyps If a polyp is allowed to remain in the colon it can grow into a cancerous tumor that can invade other organs. Colon cancer is the second leading cause of cancer deaths

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13/12/2010 23 Colon cancer Sigmoid colon is the most common site Predominantly adenocarcinoma If early 90% survival 34 % diagnosed early 66% late diagnosis

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13/12/2010 24 Colon cancer PATHOPHYSIOLOGY Benign neoplasm DNA alteration malignant transformation malignant neoplasm  cancer growth and invasion  metastasis (liver)

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13/12/2010 25 Colon cancer ASSESSMENT FINDINGS1. Change in bowel habits- Most common 2. Blood in the stool 3. Anemia 4. Anorexia and weight loss 5. Fatigue 6. Rectal lesions- tenesmus, alternating D and C

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13/12/2010 26 Colon cancer Diagnostic procedures & findings 1. Fecal occult blood 2. Sigmoidoscopy and colonoscopy 3. BIOPSY 4. CEA- carcino-embryonic antigen

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13/12/2010 27 Colon cancer Complications of colorectal CA 1. Obstruction 2. Hemorrhage 3. Peritonitis 4. Sepsis

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13/12/2010 28 Colon cancer Risk factors 1. Increasing age 2. Family history 3. Previous colon CA or polyps 4. History of IBD 5. High fat, High protein, LOW fiber 6. Breast Ca and Genital Ca 7. Have an inflammatory disease If you eat a lot of animal sources If your not physically active Or Obese

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13/12/2010 29 Stages of Colon Cancer Stage 0- In Stage 0, the cancer is at a very early stage and is located only in the inner lining of the colon. The recommended treatment for Stage 0 colon cancer is surgical removal of the tumor, along with parts of the colon on either side of the tumor site. If detected early, colon cancer is highly curable and has a low risk for recurrence.

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13/12/2010 30 Stages of Colon Cancer (continued) Stage 1- in this stage, the cancer has grown through several layers of the colon, but is still confined to the wall of the colon. It has not spread to nearby organs as yet. Surgery is the recommended treatment at Stage I. Stage I is also highly curable, with a low risk for recurrence.

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13/12/2010 31 Stages of Colon Cancer (continued) Stage 2- In Stage II, the cancer has spread (metastases) to nearby organs or tissues, but not to the lymph nodes. Lymph nodes are small, bean-shaped structures where cells are stored; nodes can trap cancer cells or bacteria traveling through the body. The recommended treatment for Stage II is surgical removal of the tumor. Adjuvant therapy (chemotherapy and radiation therapy) is also suggested for Stage II patients with recurrences.

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13/12/2010 32 Stages of Colon Cancer (continued) Stage 3- In this stage, the cancer has spread outside the large intestine to regional lymph nodes, but not to other body parts. Treatment for Stage III colon cancer includes surgical removal of a section of the colon and rejoining the remaining ends (anastomosis). Surgery is usually followed by chemotherapy. Studies have shown that the number of lymph nodes involved affects the outcome. Patients with 1-3 nodes involved have significantly greater survival rates than those with 4 or more nodes involved.

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13/12/2010 33 Stages of Colon Cancer (continued) Stage 4- Stage IV is the most advanced stage of colon cancer. The cancer has spread beyond the colon, rectum or regional lymph nodes to distant organs or tissue (such as liver, ovaries and lungs). Although cancer is not usually curable at this stage, surgery is still the recommended treatment. Surgical resection of the colon and reconnection of the large intestine is done so as to blockage of the colon and any other local complications. Chemotherapy and/or radiation are generally given for palliative purposes.

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13/12/2010 34 Symptoms of Colon Cancer Persistent Constipation Diarrhea Blood in the Stool And Unexplained Fatigue

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13/12/2010 35 The Difference between a Normal Colon and a Colon with Cancer

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13/12/2010 36 The Difference between a Normal Colon and a Colon with Cancer (Continued) The Colon on the Left is a normal Colon and the Colon on the right is a Colon with Cancer. You can see the difference of the two The normal Colon has a bigger opening and the Colon with cancer has a small opening There is also a difference in color. The normal Colon is more yellowish and the Colon with cancer is more tanish. Notice that the Colon with cancer has more veins and the normal Colon has fewer

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13/12/2010 37 Colon cancer MEDICAL MANAGEMENT 1. Chemotherapy 2. Radiation therapy

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13/12/2010 38 Colon cancer SURGICAL MANAGEMENT Surgery is the primary treatment Based on location and tumor size Resection, anastomosis, and colostomy (temporary or permanent)

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13/12/2010 39 Surgery Surgery or "resection" of the colon involves cutting away the portion of the colon that is diseased, and reconnecting the two healthy parts (anastomosis). In a small percentage of patients with colon cancer (about 15 percent) the surgeon will be unable to reconnect the healthy parts. In such a case, a temporary or permanent colostomy is used. A colostomy is a surgical opening (stoma) through the wall of the abdomen into the colon, which provides a new path for waste material to leave the body. A special bag is worn to collect the body's waste.

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13/12/2010 40 Colon Cancer Preventions Colon cancer can be prevented and cured through early detection Changing your eating habits( more fiber and less fats) Don’t smoke and drink less

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13/12/2010 41 Future Research You may have heard that taking aspirin prevents colon cancer. This is an exciting area of research, and studies are currently underway to evaluate whether aspirin can prevent the recurrence of precancerous colon polyps.

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13/12/2010 42 Colon Cancer Deaths (Continued) Approximately 6% of Americans will develop colon cancer and 40% of those will die of the disease There are about 134,000 new cases and 55,000 deaths occur annually 90% of deaths are over people 45 years old

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13/12/2010 43 Colon cancer NURSING INTERVENTION Pre-Operative care 1. Provide HIGH protein, HIGH calorie and LOW residue diet 2.Provide information about post-op care and stoma care 3. Administer antibiotics 1 day prior

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13/12/2010 44 Colon cancer NURSING INTERVENTION Pre-Operative care 4. Enema or colonic irrigation the evening and the morning of surgery 5. NGT is inserted to prevent distention 6. Monitor UO, F and E, Abdomen PE

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13/12/2010 45 Colon cancer NURSING INTERVENTION Post-Operative care 1. Monitor for complications Leakage from the site, prolapse of stoma, skin irritation and pulmo complication 2. Assess the abdomen for return of peristalsis

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13/12/2010 46 Colon cancer NURSING INTERVENTION Post-Operative care 3. Assess wound dressing for bleeding 4. Assist patient in ambulation after 24H 5.provide nutritional teaching Limit foods that cause gas-formation and odor (Cabbage, beans, eggs, fish, peanuts) Low-fiber diet in the early stage of recovery

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13/12/2010 47 Colon cancer NURSING INTERVENTION Post-Operative care 6. Instruct to splint the incision and administer pain meds before exercise 7. The stoma is PINKISH to cherry red, Slightly edematous with minimal pinkish drainage 8. Manage post-operative complication

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13/12/2010 49 Colon cancer NURSING INTERVENTION: COLOSTOMY CARE Colostomy begins to function 3-6 days after surgery The drainage maybe soft/mushy or semi-solid depending on the site

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13/12/2010 50 Colon cancer NURSING INTERVENTION: COLOSTOMY CARE BEST time to do skin care is after shower Apply tape to the sides of the pouch before shower Assume a sitting or standing position in changing the pouch

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13/12/2010 51 Colon cancer NURSING INTERVENTION: COLOSTOMY CARE Instruct to GENTLY push the skin down and the pouch pulling UP Wash the peri-stomal area with soap and water Cover the stoma while washing the peri-stomal area

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13/12/2010 52 Colon cancer NURSING INTERVENTION: COLOSTOMY CARE Lightly pat dry the area and NEVER rub Lightly dust the peri-stomal area with nystatin powder

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13/12/2010 53 Colon cancer NURSING INTERVENTION: COLOSTOMY CARE Measure the stomal opening The pouch opening is about 0.3 cm larger than the stomal opening Apply adhesive surface over the stoma and press for 30 seconds

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13/12/2010 54 Colon cancer NURSING INTERVENTION: COLOSTOMY CARE Empty the pouch or change the pouch when 1/3 to ¼ full (Brunner) ½ to 1/3 full (Kozier)

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13/12/2010 55 THE END

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9/12/2009 56 Benign prostate hypertrophy (BPH) Prostate CancerBreast cancer Dr Ibraheem Bashayreh, RN PhD

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9/12/2009 57 What is the Function of the Prostate? The prostate is a walnut-sized gland located behind the base of the penis, in front of the rectum and below the bladder It surrounds the urethra, the tube-like channel that carries urine and semen through the penis The primary function of the prostate is to produce seminal fluid, the liquid in semen that protects, supports, and helps transport sperm

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9/12/2009 58 Benign Prostatic Hypertrophy (BPH) Enlargement of prostate gland which obstructs urinary out flow Urinary stream decreases, with dysuria Gradual dilation of ureters and kidney due to stasis Age related and slow progressing, usually>50 Cause is unknown – possible arteriosclerosis, changes in hormone levels, or inflammation

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9/12/2009 59 Benign Prostatic Hypertrophy (BPH) Subjective symptoms Urgency, frequency, burning, and hesitancy Decreased force of urination Nocturia Objective symptoms Voiding small amounts Hematuria Urinary retention Infection Enlarged prostate on exam Renal insufficiency

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9/12/2009 60 Benign Prostatic Hypertrophy (BPH) Diagnostic tests Client history Physical exam Residual cath IVP:An intravenous pyelogram (IVP) is an x-ray examination of the kidneys, ureters and urinary bladder that uses iodinated contrast material injected into veins. BUN (The blood urea nitrogen ) and creatitine levels UA and C&S Cystoscopy

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9/12/2009 61 Benign Prostatic Hypertrophy (BPH) Treatment Drugs Testosterone ablating agents – diethystilbestrol (DES) Testosterone sparing – Proscar, which reduces the size of the gland Alpha blockers – Flomax, relax smooth muscle in the bladder neck and prostate

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9/12/2009 62 Benign Prostatic Hypertrophy (BPH) Surgical removal TURP Subrapubic, retropubic, or perineal prostectomy Other methods to improve function Sexual intercourse, hot sitz baths, or prostatic massage- which releases prostatic fluid pressure

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9/12/2009 63 Benign Prostatic Hypertrophy (BPH) Post- op care routine + With TURP will have a catheter, possibly 3-way for irrigation Watch for blood clots Keep accurate I/O Give pain RX and antispasmotics Encourage fluids

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9/12/2009 64 Benign Prostatic Hypertrophy (BPH) Complications At risk for UTI and retention Erectile dysfunction Hemorrhage Urinary leakage Sterility

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9/12/2009 65 What is Cancer? A group of 100 different diseases The uncontrolled, abnormal growth of cells Cancer may spread to other parts of the body

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9/12/2009 66 What is Prostate Cancer? The most common type of cancer in men and second most frequent cause of cancer-related death in men An estimated 192,280 men diagnosed in the United States in 2009 A malignant (cancerous) tumor that begins in the prostate gland Some prostate cancers grow very slowly and may not cause problems for years Prostate cancer is somewhat unusual in that cancer that has spread can be successfully treated

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9/12/2009 67 What are the Risk Factors for Prostate Cancer? Age Race/ethnicity (Black men at highest risk) Family history Diet Hormone Other

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9/12/2009 68 Prostate Cancer and Early Detection Prostate-specific antigen (PSA) test Digital rectal examination (DRE) Discuss screening with your doctor

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9/12/2009 69 What are the Symptoms of Prostate Cancer? Frequent urination, or weak or interrupted urine flow Pain or burning during urination, or blood in the urine or semen The urge to urinate frequently during the night Different symptoms if the cancer has spread: pain in the back, weight loss, fatigue None of the symptoms are specific to prostate cancer, could be caused by an enlarged prostate, a condition called benign prostate hyperplasia (BPH)

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9/12/2009 70 How is Prostate Cancer Diagnosed? PSA test DRE Diagnosis is confirmed with a biopsy Transrectal ultrasound (TRUS) Imaging tests can determine if the cancer has spread

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9/12/2009 71 Prostate Cancer Staging Staging is a way of describing a cancer, such as the size of a tumor and if or where it has spread Staging is the most important tool doctors have to determine a patient’s prognosis Staging is described by the TNM system (Classification of Malignant Tumours): the size and location of the Tumor, whether cancer has spread to nearby lymph Nodes, and whether the cancer has Metastasized (spread to other areas of the body) Another staging system assigns letters (A,B,C,D) to describe the cancer Treatment depends on the stage of the cancer

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9/12/2009 72 Prostate Cancer Grading Grade describes how much cancer cells look like normal cells (for example, do the cells look almost normal or very abnormal?) The grade of the cancer can help the doctor predict how quickly the cancer will spread The Gleason System is the most common grading system and describes the cell patterns seen under the microscope

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9/12/2009 73 Stage I or Stage A Prostate Cancer Stage I cancer is found only in the prostate and usually grows slowly

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9/12/2009 74 Stage II or Stage B Prostate Cancer Stage II cancer has not spread beyond the prostate gland, but involves more than one part of the prostate, and may tend to grow more quickly

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9/12/2009 75 Stage III or Stage C Prostate Cancer Stage III cancer has spread beyond the outer layer of the prostate into nearby tissues or to the seminal vesicles, the glands that help produce semen

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9/12/2009 76 Stage IV or Stage D Prostate Cancer Stage IV cancer has spread to other areas of the body such as the bladder, rectum, bone, liver, lungs, or lymph nodes

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9/12/2009 77 How is Prostate Cancer Treated? Treatment depends on stage of cancer More than one treatment may be used Active surveillance (watchful waiting) for some early-stage cancers Surgery Radiation therapy Hormone therapy Chemotherapy

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9/12/2009 78 Cancer Treatment: Active Surveillance A way to monitor early-stage, slow-growing, prostate cancer Appropriate when cancer treatment would cause more discomfort than the disease itself Mostly used for older men or men who are unwell from other illnesses Treatment begins when the tumor shows signs of growing or spreading

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9/12/2009 79 Cancer Treatment: Surgery Used to try to cure cancer before it spreads outside the prostate Usually the prostate and nearby lymph nodes are removed Urinary incontinence and sexual side effects may result from surgery; these side effects are treatable Cryosurgery (destroying cancer cells by freezing) is still experimental; has high risk of impotence

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9/12/2009 80 Cancer Treatment: Radiation Therapy The use of high-energy x-rays to destroy cancer cells Used to try to cure disease or control symptoms External-beam: outside the body Brachytherapy: the insertion of radioactive pellets into the prostate Intensity-modulated radiation therapy (IMRT): small beams of radiation are aimed at a tumor from many angles Side effects may include bowel and urinary problems, rash, and dry, reddened, or discolored skin

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9/12/2009 81 Cancer Treatment: Hormone Therapy Reduces level of male sex hormones to slow growth of cancer Used to treat prostate cancer that has grown after surgery and radiation therapy or to shrink large tumors before surgery and radiation therapy Can be done surgically or through medication Hormone therapy may cause a variety of side effects, including a risk of metabolic syndrome

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9/12/2009 82 Cancer Treatment: Chemotherapy Use of drugs to kill cancer cells No standard chemotherapy for prostate cancer Docetaxel (Taxotere) and prednisone help men with advanced prostate cancer live longer Other medications may help control symptoms

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9/12/2009 83 Breast Cancer The most common form of cancer among women The second most common cause of cancer related mortality 1 of 8 women (12.2%) One third of women with breast cancer die from breast cancer

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9/12/2009 84 Risk Factors for Breast Cancer Female (1% male) Aging Relative (mother or sister) Menstrual history early on set late menopause Child birth After the age of 30

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9/12/2009 85 Exogenous Estrogen Hormonal replacement therapy(HRT) 30% increased risk with long term use Oral Contraceptives(OC) risk slight risk returns to normal once the use of OC’s has been discontinued

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9/12/2009 86 Risk Factors for Breast Cancer Radiation exposure Breast disease Atpyical Hyperplasia Intraductal carcinoma in situ Intralobular carcinoma in situ Obesity Diet Fat Alcohol

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9/12/2009 87 Breast Cancer Prognosis When cancer is confined to the breast, the 5-year relative survival rate is 96.8%; cancer spread to surrounding tissue, 5-year rate is 75.9%; disease has metastasized, the rate is 20.6%

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9/12/2009 88 Normal breast physiology and anatomy Symmetry and balance Size weight menstrual cycle pregnancy and lactation Texture Shape age

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9/12/2009 89 Abnormal signs and symptoms Puckering Dimpling Retraction Nipple discharge Thickening of skin or lump or “knot” Retracted nipple

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9/12/2009 90 Abnormal signs and symptoms Change in breast size Pain or tenderness Redness Change in nipple position Scaling around nipples Sore on breast that does not heal

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9/12/2009 91 Staging of Breast Cancer The American Joint Committee on Cancer (AJCC) has designated staging by TNM T= tumor size N = lymph node involvement M = metastasis

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9/12/2009 92 Stage 1 Tumor < 2.0 cm in greatest dimension No nodal involvement (N0) No metastases (M0)

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9/12/2009 93 Stage II Tumor > 2.0 < 5 cm or Ipsilateral axillary lymph node (N1) No Metastasis (M0)

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9/12/2009 94 Stage III Tumor > 5 cm (T3) or ipsilateral (On the same side ) axillary lymph nodes fixed to each other or other structures (N2) involvement of ipsilateral internal mammary nodes (N3) Inflammatory carcinoma (T4d)

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9/12/2009 95 Stage IV (Metastatic breast cancer) Any T Any N Metastasis (M1)

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9/12/2009 96 Figure 47-14

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9/12/2009 97 Types of breast cancer In situ (an early form of carcinoma defined by the absence of invasion of surrounding tissues ) Intraductal (DCIS) Intralobular (LCIS) Invasive Infiltrating ductal carcinoma Tubular carcinoma Medullary carcinoma Mucinous carcinoma

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9/12/2009 98 Methods of Detection Clinical exam by MD or nurse Mammography Monthly breast self-exam (BSE)

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9/12/2009 99 Clinical examination Performed by doctor or trained nurse practitioner Annually for women over 40 At least every 3 years for women between 20 and 40 More frequent examination for high risk patients

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9/12/2009 100 Mammography X-ray of the breast Has been shown to save lives in patients 50-69 Data mixed on usefulness for patients 40-49 Normal mammogram does not rule out possibility of cancer completely

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9/12/2009 101 Breast Cancer Medical treatment Lumpectomy, simple mastectomy, and radical mastectomy Staging: the tumor-node-metastasis classification Critical factor determined—whether the cancer cells are estrogen receptors or nonreceptors Tamoxifen: selective estrogen receptor modulator (SERM) prescribed for the estrogen receptors Chemotherapy, hormone therapy, radiation therapy, biologic therapy, or a combination of these may be employed before, during, or after surgery

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9/12/2009 102 Figure 47-13

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9/12/2009 103 Breast Cancer Interventions Disturbed Body Image Risk for Injury Impaired Physical Mobility Deficient Knowledge

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9/12/2009 104 GOOD LUCK ANY QUESTIONS