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MEDICAL SURGICAL NURSING
TOPIC-DIAGNOSIS RELATED TO
        THE CANCER



        PRESENTED BY
       MRS HEENA MEHTA
          IVALUTOR
       MR.P.YONATANSIR
VARIOS DIAGNOSTIC
     INVESTIGATION USED FOR
      DETECTION OF CANCER
• For the
  assessment
  of the cancer,
  first step is to
  obtain
  complete
  history and
  physical
  examination
• HISTORY
-TIME   OF ONSET OF THE DIEASE
         -HOW LONG IT OCCURE?
  -WHAT IS THE PROGRESS ,EITHER SLOW
                OR FAST?
      -SEVIARITY OF THE SYSMPTOMS
EITHER IT RECOVER WITH TREATMENT NOR
             NON EFFECTIVE
  -ANY TREATMENT TAKEN FOR DISEASE?
 -ANY DIAGNOSTIC PROCEDURE DONE OR
                  NOT?
   -HOW MANY TIMES FOLLOWUP DONE ?
• ANY FAMILY HISTORY OF THE
  CANCER
  -ANY ABNORMAL HABITS FOR LONG
  TIME?
  -WHAT IS THE OCCUPATION?
  - WHAT IS THE FAMILY BACK
  GROUND?
  -ANY DRUG ADICTION OR NOT?
  -ANY COMMUNICABLE DISEASE
  OCCURE OR NOT,IF OCCUR IT IS
  CURABLE OR HARMFUL?
  -ANY GENETIC ABNORMALITY IN
OTHER STEP IS PHYSICAL
    EXAMINATION
• SIZE OF THE TUMOR OR
  ABNOMAL SYMPTOMS
• SIZE OF THE NODULES
• SKIN CHANGES
• COLOUR CHANGES
• OEDEMA
• PRESSURE SYMPTOMS
• SIZE OF THE BONE
• WEIGHT
• HEAD TO TOE EXAMINATION
  NURSE CAN FIND SOMANY
  ABNORMAL SYMPTOMS
• OBSTRUCTION
• PAIN
• CNS DISTURBANCE
•
STAGING AND
 GRADING OF
  TUMORS
Presentation of diagnosis related to cancer by heena
Grade level   Cellular characteristics


Grade -1      Low grade malignancy. Cells are similar to normal
              parent tissue and have a slow growth rate. Well
              differentiated in appearance and function.




Grade -2      Low to moderate grade malignancy. Cells have some
              normal and some malignant cell features. The tissue of
              origin is apparent.
Grade-3   Moderate to high grade
          malignancy. Cells have
          more malignant feature
          than normal cell
          features.

Grade-4   High grade malignancy.
          Cells have no normal cell
          features in appearance and
          function. Poorly
          differentiated or
          undifferentiated. Tissue of
          origin may be unknown.
STAGING OF CANCER
STAGE 0 or CARCINOMA IN
             SITU;
• Carcinoma in situ is very early cancer. The
  abnormal cells are found only in the first layer
  of cells of the primary site and do not invade
  the deeper tissues.
• STAGE-1:
• Cancer involves the primary site, but has not
  spread to nearby tissues.
• STAGE- 1A:
• A very small amount of cancer – visible uncer a
  microscope is found deeper in the tissues.
• STAGE-1B:
• A larger amount of cancer is found in the
  tissues.
• STAGE-2:
• Cancer has spread to nearby areas but is still
  inside the primary site.
• STAGE-2A:
• Cancer has spread beyond the primary site.
• STAGE-2B:
• Cancer has spread to other tissue around the
  primary site.
• STAGE-3:
• Cancer has spread throughout the nearby
  area.
• STAGE-4:
• Cancer has spread to other parts of the body.
• STAGE-4A
• Cancer has spread to organs close to the
  pelvic area.
• STAGE-4B
• Cancer has spread to distant organs, such as
  the lungs.
TNM CLASSIFICATION
• The American joint committee of
  cancer(AJCC) has developed a
  simple classification solid tumors. T
  refers to lthe extent primary tumor
  (tumors size), N represents regional
  lymph node involvement and extent
  of metastasis is represented by the
  letter M.
Presentation of diagnosis related to cancer by heena
Mandatory parameters ("T", "N",
              and "M")
• T: size or direct extent of the
  primary tumor
  –Tx: tumor cannot be evaluated
  –Tis: carcinoma in situ
  –T0: no signs of tumor
• T1, T2, T3, T4: size and/or
  extension of the primary tumor
• N: degree of spread to regional lymph nodes
  – Nx: lymph nodes cannot be evaluated
  – N0: tumor cells absent from
    regional lymph nodes
  – N1: regional lymph node metastasis present;
    (at some sites: tumor spread to closest or
    small number of regional lymph nodes)
  – N2: tumor spread to an extent between N1
    and N3 (N2 is not used at all sites)
  – N3: tumor spread to more distant or
    numerous regional lymph nodes (N3 is not
    used at all sites)
• M: presence of metastasis
  –Mx: distant metastasis cannot be
   evaluated
  –M0: no distant metastasis
  –M1: metastasis to distant organs
   (beyond regional lymph node
Presentation of diagnosis related to cancer by heena
How is cancer diagnosed?
• There is no single test that can
  accurately diagnose cancer. The
  complete evaluation of a patient
  usually requires a thorough history
  and physical examination along with
  diagnostic testing. Many tests are
  needed to determine whether a
  person has cancer, or if another
  condition (such as an infection) is
  mimicking the symptoms of cancer.
BLOOD INVESTIGATION:
HAEMETOLOGICAL, BIO-
     CHEMICAL
• Absolute Neutrophil Count (ANC) The
  ANC is calculated by multiplying the
  percent of neutrophils (plus bands) by the
  total number of white blood cells. This
  count is used to determine if
  chemotherapy can be given.
• Acid Phosphatase Also called: acid
  phos, acid f, acid p‘tase. A test of blood
  serum to detect a specific enzyme
  produced by several tissues, particularly
  the prostate.
• Blood Count -A blood test used to determine
  the number of the various types of blood cells.
• BUN (Blood Urea Nitrogen)- Chemistry study
  of blood serum to measure the level of urea in
  the blood, a sign of impaired kidney function or
  urinary obstruction. Normal range: 10-15
  mg/100 ml.
• CA-125 -Tumor marker that may be elevated in
  cancers of the ovary, breast, and colon.
• CA-19-9 -A tumor marker that may be elevated
  in cancers of the colon and pancreas.
• CA15-3 -A tumor marker that may be elevated
  in breast cancer.
• Calcium Elevated in cancer that has spread to
  the bone, with tumors that produce parathyroid
  hormone-like protein and in multiple myeloma,
  as well as in some non-malignant diseases.
• CEA (Carcinogenic Embryonic Antigen) A
  tumor marker found in the blood that may
  indicate the presence of certain types of cancer
  cells. Tumor marker substances may be
  produced by the tumor itself or by the body in
  response to a cancer.
• Creatinine Waste product in blood; is a
  measure of kidney function; if elevated may
  signify kidney disease..
• Ferritin Measures iron storage protein in sialic
  acid; low levels suggest good prognosis in head
  and neck malignancies.
• Leukocyte Another name for white blood cells.
  A type of cell in the blood which helps defend
  the body against diseases caused by bacteria,
  virus, or parasites. There are three types of
  leukocytes: monocyte, granuloctye, and
  lymphocytes.
• Platelet Count Measures the number of
  platelets in a drop of blood. Platelet counts
  increase during strenuous activity and certain
  conditions called myeloproliferative disorders:
  infections, inflammations, malignancies, and
  when the spleen has been removed
• Ploidy Analysis A test to measure the amount
  of DNA contained in a cell. Most cancer cells
  are aneuploid, which means they contain an
  abnormal amount of DNA.
• Proliferation Index High rates indicate actively
  growing tumors and a greater risk of relapse.
• PSA (Prostate Specific Antigen) A substance
  (tumor marker) in the blood derived from the
  prostate gland. Its level may rise in prostatic
  cancer and is useful as a marker to monitor the
  effects of treatment.
• S-Phase (Cell Cycle Analysis) Percentage of
  tumor cells synthesizing DNA; patients with
  high S-phase fraction have less favorable
  prognosis.
• Thyroid Hormones T3 Thyroxine (T4). The
  other 20% is triiodothyronine measures as T3.
  Sometimes the diseased thyroid gland will start
  producing very high levels of T3 but still
  produce normal levels of T4. And TSH.
• Thyroblobulin Elevated levels of this serum
  hormone are found in follicular carcinoma and
  return to normal following treatment if all tumor
  is removed; useful for monitoring residual
  disease and recurrence of follicular carcinoma.
• Tumor Markers Chemicals in the blood that
  are produced by certain cancers. Measuring the
  markers is useful for diagnosis, but especially
  useful for following the course of treatment.
• White Blood Count (WBC) Measures the
  number of white cells; WBC elevated during
  infection, inflammation, burns, leukemia, low
  WBC indicates bone marrow depression–may
  be present with some viruses, toxic
  reactions, German measles, infectious
  hepatitis, and other diseases.
Presentation of diagnosis related to cancer by heena
• Tumor Marker is a molecule or process
  or a substance that can be measured
  with an examination (assay) both
  qualitatively and quantitatively in
  precancerous condition and cancer.
  Changes in these levels can be caused
  by tumors and normal tissue in
  response to the tumor. Tumor
  markers can be DNA, mRNA, protein o
  parts of proteins ( such as te process o
  proliferation, angiogenesis, apoptosis,
• Tumor markers can be found in
  significant amounts in the blood or
  urine of patients with cancer and can
  also be found in the blood and urine
  of patients with no cancer. Beside that
  Tissue, saliva, body fluids, and the
  cell itself can be used as a specimen
  for the tumor marker test
HORMONAL ASSAY
• Growth hormone (GH), which is produced in the
  pituitary gland under control of the
  hypothalamic factors growth-hormone-releasing
  hormone (GHRH) and somatostatin (SMS), is a
  key stimulator of IGF-1 production. Various
  IGF-binding proteins (IGFBPs) are also
  produced in the liver. In IGF-responsive
  tissues, the ligands IGF-1 and IGF-2 as well as
  IGFBPs can be delivered through the circulation
  from the liver (an 'endocrine' source), but IGFs
  and IGFBPs can also be locally produced
  through autocrine or paracrine mechanisms
CYTOLOGY: FINE NEEDLE
     ASPIRATION
Bone Marrow Biopsy and
            Aspiration
• A needle is inserted into the bone of the hip or
  breast bone to obtain a sample of bone marrow
  for study under a microscope.
• Bone Marrow Tests
• Bone marrow tests check whether your bone
  marrow is healthy. Bone marrow is a sponge-
  like tissue inside the bones. It contains stem
  cells that develop into the three types of blood
  cells that the body needs:
Stereotactic Needle Biopsy
• A procedure used in the diagnosis of
  brain tumors. A special frame is used
  to hold the patients head stationary
  while the biopsy needle is directed to
  exactly the right spot. A CT scanner is
  used to find the correct position. This
  method has also been applied to very
  small breast cancers
Different Types Of Biopsy
            Procedures
• Some of the more common types of breast
  biopsy procedures include Fine Needle
  Aspiration Biopsy, Core Needle Biopsy,
  Stereotactic Core Needle Biopsy, Vacuum
  Assisted Core Biopsy, Circular Rotating ‗Cookie
  Cutter‘ Knife, MRI (Magnetic Resonance
  Imaging) guidance, Ultrasound Guided Biopsy
  and Excisional Biopsy.
HISTOPATHOLOGY

               Biopsy
• The surgical removal of a small piece
  of tissue to determine if the area is
  cancerous.
• A biopsy is the removal of a small
  piece of tissue for laboratory
  examination.
• There are several different types of
  biopsies.
• Basically, biopsies can be divided in to 07
  groups on the basis of method of removal of
  tissue form the body .
• Needle biopsy
• Punch biopsy
• Incisional biopsy
• Excisional biopsy
• Currettage biopsy
• Extracting tissue piece by piece
• Endoscopic biopsy
• Prior to removal of tissue, the most
  appropriate type of biopsy going to be
  made should be determined. This
  depends on varieties of factors.
• Tissue to be sampled.
• how suspicious the abnormality appears.
• Size, shape and other characteristic of
  abnormalities
• The location of abnormalities
• Number of abnormalities
•
1. Needle Biopsy
• A needle is inserted
  through the skin to
  the suspicious area
  and cells are
  extracted. The
  needle biopsy
  includes Fine Needle
  Aspiration (FNA),
  vacuum assist
  biopsy and core
  needle biopsy.
• Fine Needle
  Biopsy
• A long thin needle
  is inserted to the
  suspicious area
  and fluid collected
  into a syringe. This
  fluid is sent to the
  cytology laboratory
  for cellular studies.
  (FNA Thyroid
Vacuum Assist Biopsy
• A vacuum pressure is
  used to collect tissue
  through a specially
  designed hollow needle.
  This procedure
  facilitates to collect
  multiple or large
  samples from the same
  biopsy site without
  having to insert the
  needle more than once.
  (Example : Breast
Core Needle Biopsy
• Core needle biopsy is performed by
  inserting a hollow core needle through the
  skin to the lesion. This needle is larger
  than the one used in fine needle biopsy
  (gauge 16,14 or 11) and it has been
  designed with a cutting tip to extract a
  column or cylinder shaped of tissue from
  the abnormality. The core needle biopsy is
  performed when the fine needle biopsy
  didn‘t provide a definitive diagnosis.
  (Example : Trephine biopsy)
Presentation of diagnosis related to cancer by heena
. Punch Biopsy
• A punch or circular tool
  is used to extract about
  6 mm deep skin layers.
  This technique is
  usually used by
  dermatologists. The
  punch biopsy is made
  on exposed areas
  especially oral mucosa.
  (Example : Skin
  biopsy, Rectum biopsy
  and Oral biopsy)
Incisional Biopsy
• A scalpel is used
  to remove a small
  piece of tissue
  from large lesion.
  Incisional biopsy
  may be used for
  soft tissues.
  (Example : Biopsy
  from Tumors).
Excisional Biopsy
• The entire
  lesion is
  removed
  from the
  body.
5. Currettage Biopsy
• Removal of
  piece of
  tissue by
  scraping.
  (endometrial
  curretings)
6. Extracting Tissue piece by
               piece
• Example :
  Transurethral
  Reaction of
  the Prostate
  (TURP
Endoscopic Biopsy
• Endoscope is a fine flexible tube with a
  camera used to view the inside of the body
  either through a natural body orifice or a
  small surgical incision. The endoscope used
  to visualize the different parts of body is
  named in different names.
Presentation of diagnosis related to cancer by heena
• gastrointestinal tract – Alimentary tract
  endoscope
• Urinary bladder – Cystoscope
• Abdominal cavity – Laparoscope
• Joint cavity – Arthroscope
• Mid point of chest – Mediastinoscope
• Respiratory Tract – laryngoscope or
  Bronchoscope
• The endoscope
  can visualize the
  abnormal area on
  the lining of the
  organ and pinch off
  a tiny piece of
  tissue with forceps
  attached to a long
  cable that runs
  inside the
  endoscope.
Other various type of biopsy
Conization
• A small wedge
  shaped tissue
  sample is
  surgically removed
  from the cervix
  and examined for
  the detection of
  cancer cells.
Cervical Conization
• Definition
• Cervical conization is both a diagnostic and
  treatment tool used to detect and treat
  abnormalities of the cervix. It is also known as a
  cone biopsy or cold knife cone biopsy.
• Purpose
• To found a precancerous condition in the cervix.
• Cervical conization also may be performed if
  there is an abnormal cervical smear test A
  biopsy is a diagnostic test in which tissue or
  cells are removed from the body and examined
Precautions

• As with any operation that is
  performed under general
  anesthesia, the patient must
  not eat or drink anything for
  six to eight hours before
  surgery
Presentation of diagnosis related to cancer by heena
Procedure
• The patient lies on the table with her legs raised
  in stirrups, similar to the position when having a
  Pap test.
• The patient is given general anesthesia, and
  the vagina is held open with an instrument
  called a speculum.
• Using a scalpel or laser the doctor removes a
  cone-shaped piece of the cervix containing the
  area with abnormal cells.
• The resulting crater is repaired by stitching flaps
  of tissue over the wound.
• Aftercare
• An overnight stay in the hospital may be
  required. After the test, the patient may
  feel some cramps or discomfort for about
  a week. Women should not have sex, use
  tampons, or douche until after seeing their
  physician for a follow up appointment (a
  week or more after the procedure).
RADIOLOGICAL
           ASSESSMENT
• What are the different types of
  diagnostic imaging?
• There are three types of imaging used for
  diagnosing cancer: transmission
  imaging, reflection imaging, and emission
  imaging. Each uses a different process.
transmission imaging
• X-rays, computed tomography scans (CT
  scans), and fluoroscopy are radiological
  examinations whose images are produced by
  transmission. In transmission imaging, a beam
  of high-energy photons is produced and passed
  through the body structure being examined.
  The beam passes very quickly through less
  dense types of tissue such as watery
  secretions, blood, and fat, leaving a darkened
  area on the x-ray film.
1- x-ray
• X-rays are diagnostic
  tests that use invisible
  electromagnetic
  energy beams to
  produce images of
  internal
  tissues, bones, and
  organs on film. X-rays
  may be taken of any
  part of the body to
  detect a tumor (or
  cancer).
How do we "see" using X-ray
             light?
• when X-ray light
  shines on us, it goes
  through our skin, but
  allows shadows of
  our bones to be
  projected onto and
  captured by film
Presentation of diagnosis related to cancer by heena
2-computed tomography scan
    (Also called a CT scan)
• A CT scan is a diagnostic imaging
  procedure that uses a combination of x-
  rays and computer technology to produce
  cross-sectional images (often called
  slices), both horizontally and vertically, of
  the body. A CT scan shows detailed
  images of any part of the body, including
  the bones, muscles, fat, and organs. CT
  scans are more detailed than general x-
  rays.
How a CT scanner works
• CT scan (or CAT scan) stands
  for Computerised (Axial) Tomography
  scan. This means a scan that takes a
  series of X-rays and uses a computer
  to put them together. The scan is is
  painless. The CT machine takes
  pictures of your body from different
  angles and gives a series of cross
  sections or 'slices' through the part of
  the body being scanned.
CT scan of the pelvis
Preparation
• Change own cloth and wear hospital dress.
• Remove jwellery,pin and metal from the body.
• Remove artificial denture.
• Some CT scans need special preparation
  beforehand. This is explained below for scans
  of different parts of the body.
• For some scans, you will have a drink or
  injection of 'contrast medium'. This is a dye that
  shows up body tissues more clearly on the
  scan. Before you have this, ask you about
  allergies or asthma as some people can be
  allergic to it. The injection may make you feel
Abdominal CT scans
• Not to eat or drink
  after midnight the
  night before the scan
• To drink a liquid
  contrast medium
  some time before the
  scan
• To drink more of the
  liquid in the X-ray
  department
CT scans of the head
• For some brain
  scans, you may
  be given an
  injection of the
  'contrast
  medium' dye
  beforehand to
  make the scan
  clearer
CT scans of the chest
• For some chest
  (thoracic) scans, you
  may be given an
  injection of the
  'contrast medium' dye
  beforehand. This is to
  help show up the
  tissues close to the
  area containing the
  cancer, for example
  blood vessels
Pelvic CT scans
• Not to eat or drink for some time before the
  scan
• To have an injection of 'contrast medium' just
  beforehand
• Depending on the part of your pelvis being
  scanned, you may have an injection of a drug to
  slow down the normal movement of your bowel.
  This movement (called 'peristalsis') can distort
  the scan and make it more difficult to read.
• There is a very
  detailed scan of the
  bowel called a 'virtual
  colonoscopy' (also
  called a CT
  colonography).
  Instead of having a
  tube and a camera
  put into your bowel to
  look inside (a
  colonoscopy).
3---- Bone scan
• How the Test is Performed
• A bone scan involves injecting a radioactive
  material (radiotracer) into a vein. The
  substance travels through your blood to the
  bones and organs. As it wears off, it gives off
  a little bit of radiation. This radiation is
  detected by a camera that slowly scans your
  body. The camera takes pictures of how
  much radiotracer collects in the bones.
Presentation of diagnosis related to cancer by heena
How to Prepare for the Test
• You must remove jewelry and other metal
  objects. You may be asked to wear a hospital
  gown.
• Tell your doctor if you are or may be pregnant.
• Do not take any medicine with bismuth in it,
  such as Pepto-Bismol, for 4 days before the
  test.
Why the Test is needed
• Diagnose a bone tumor or cancer
• Determine if a cancer that began elsewhere
  in your body has spread to the bones;
  common cancers that spread to the bones
  include breast, lung, prostate, thyroid, and
  kidney.
• Diagnose a fracture, when it cannot be seen
  on a regular x-ray (most commonly hip
  fractures, stress fractures in the feet or legs,
  or spine fractures)
• Diagnose a bone infection
  (osteomyelitis)
• Diagnose or determine the cause of
  bone pain, when no other cause has
  been identified
• Evaluate metabolic disorders, such as
  osteomalacia, renal
  osteodystrophy, primary
  hyperparathyroidism, osteoporosis, co
  mplex regional pain syndrome, and
PROCEDURE OF BONE SCAN
• First part – 20 to 30 minutes including time
  taken to get ready. This will
• include injection of the radioactive liquid and
  may include having some
• pictures taken straight after the injection.
• • 3 – 6 hours waiting time between
• • Second part – 30 to 60 minutes including time
  taken to get ready.
• (Total 4 – 7 hours altogether)
• Injection of radioactive liquid
• After the Bone Scan
• You will be able to go soon after the bone scan
  has finished and can continue with normal
  activities.
• Staff will need to take out the needle if it is still
  in your arm.
• Staff will give you any special instructions
• The radioactive liquid will pass out of your body
  in your urine within 2 days. You will not notice it
  as it is colourless.
• Drink plenty of fluid to help get rid of the
  radioactive liquid
Presentation of diagnosis related to cancer by heena
4- lymphangiogram (LAG)
• Lymphangiography
• radiographic examination of the lymphatic
  system by injection of contrast medium. The
  procedure serves to visualize lymph vessels in
  the upper and
  lower extremities, thethoracic duct and
  regional lymph nodes, particularly the
  axillary, inguinal, external and common iliac and
  para-aortic (lumbar) groups.
Indications
• 1. Oily lymphangiography has been performed
  for a) detection of regional lymph node
  metastases (pelvic tumours
  and malignant melanomas) and in staging
  of malignantlymphomas, and b) chylothorax
  and pathologies of the thoracic duct (injuries,
  infectious diseases, tumour invasion).
• 2. Water-soluble lymphangiography is indicated
  for investigation of primary and secondary
  lymphoedema.
5- Mammogram
• A mammogram is an x-ray examination of the
  breast. It is used to detect and diagnose breast
  disease in women who either have breast
  problems such as a lump, pain, or nipple
  discharge, as well as for women who have no
  breast complaints.
Presentation of diagnosis related to cancer by heena
Types of memmography
• Digital mammography, also called full-field
  digital mammography (FFDM), is a
  mammography system in which the x-ray film
  is replaced by solid-state detectors that
  convert x-rays into electrical signals.
• Computer-aided detection (CAD) systems
  use a digitized mammographic image that can
  be obtained from either a conventional film
  mammogram or a digitally acquired
  mammogram. The computer software then
  searches for abnormal areas of density, mass,
  or calcification that may indicate the presence
• common uses of the procedure
• Mammograms are used as a
  screening tool to detect early
  breast cancer in women
  experiencing no symptoms and to
  detect and diagnose breast
  disease in women experiencing
  symptoms such as a lump, pain or
  nipple discharge.
• Screening Mammography
  Mammography plays a central part in early
  detection of breast cancers because it can
  show changes in the breast up to two years
  before a patient or physician can feel them.
• Diagnostic Mammography
  Diagnostic mammography is used to evaluate a
  patient with abnormal clinical findings—such as
  a breast lump or lumps.
Preparation of patient
• Do not wear deodorant, talcum
  powder or lotion under your arms or
  on your breasts on the day of the
  exam. These can appear on the
  mammogram as calcium spots.
• Describe any breast symptoms or
  problems to the technologist
  performing the exam.
•
How does the procedure
              work?
• X-rays are a form of radiation like light or radio
  waves. X-rays pass through most objects,
  including the body. Once it is carefully aimed at
  the part of the body being examined, an x-ray
  machine produces a small burst of radiation
  that passes through the body, recording an
  image on photographic film or a special digital
  image recording plate.
Benefits
• to detect small tumors. When cancers are
  small, the woman has more treatment options
  and a cure is more likely.
• The use of screening mammography increases
  the detection of small abnormal tissue growths..
  It is also useful for detecting all types of breast
  cancer, including invasive ductal and invasive
  lobular cancer.
• No radiation remains in a patient's body after an
  x-ray examination.
• X-rays usually have no side effects in the
Reflection imaging
Reflection imaging refers to the type of
imaging produced by sending high-
frequency sounds to the body part or
organ being studied. These sound
waves "bounce" off of the various types
of body tissues and structures at
varying speeds, depending on the
density of the tissues present.
6- Ultrasound
• Ultrasound, or sonography, is the most
  commonly used type of reflection imaging.
  This technique uses high-frequency sound
  waves and a computer to create images,
  called sonograms, of blood vessels,
  tissues, and organs. Sonograms are used
  to view internal organs as they function
  and to assess blood flow through various
  vessels. Tumors in the abdomen, liver,
  and kidneys can often be seen with an
  ultrasound.
• Ultrasound Uses
• Ultrasound can be used as a
  diagnostic or screening tool to
  confirm medical disorders or to
  assist in performing medical
  procedures. It is also used as a
  therapeutic tool in treating
  musculoskeletal problems, renal
  stones (kidney
  stones), and gallstones
• Diagnostic or Screening Uses
• Obstetrics and gynecology: Pregnancy
 ultrasound (or fetal ultrasound) is used to assess
 the progression of the fetus. Vaginal ultrasound,
 pelvic ultrasound, or transvaginal ultrasound is
 used to diagnose growths or tumors of the ovary,
 uterus, and Fallopian tubes. It can be used to
 assess non-pregnancy related issues as well:
  – lower abdominal pain
  – ovarian cysts
  – uterine fibroids
  – uterine growths
  – endometriosis
• Cardiology: . It is used to evaluate the flow
 of blood through the chambers and valves of
 the heart. It also assesses the strength of the
 heart beat and the volume of blood pumped
 through. Echocardiography is often used for the
 following:
  – heart valve problems, such as mitral valve
    prolapse or aortic stenosis;
  – congestive heart failure;
  – blood clots due to irregular heart beats such as
    in atrial fibrillation;
  – abnormal fluid collections around the heart, such as
    pericardial effusions; and
  – pulmonary artery hypertension.
• Blood vessels: . Using Doppler ultrasound
 technology, the flow of blood through the
 vessels can be observed and measured.
 Narrowing of vessels (stenosis) or widening of
 vessels (dilatation, also referred to as
 aneurysms) can be detected. Ultrasound testing
 of blood vessels includes:
  – carotid ultrasound,
  – abdominal aorta ultrasound for
    abdominal aortic aneurysm, and
  – blood clots in veins (superficial or deep
    venous thrombosis, or DVT).
• Abdominal structures: Abdominal
 ultrasound is used to evaluate the solid organs
 within the abdominal cavity, including the liver,
 gallbladder, pancreas, kidneys, and bladder.
 –Renal ultrasound is used to evaluate the
  function and structure of the kidneys.
  Swelling around the kidney with
  blockage in the urinary tract can be
  seen with ultrasound, making abdominal
  ultrasound useful in detecting kidney
  stones.
• Testicular ultrasound: Used to
  diagnose testicular
  torsion, epididymitis(testicle infection),
  and testicular masses.
• Neck ultrasound: The thyroid and
  parathyroid glands can be imaged to
  detect nodules, growths, and tumors.
• Breast ultrasound: Used to image
  the breasts and to guide biopsy of
  breast masses to evaluate for breast
• Knee ultrasound: Ultrasound can be used to
  evaluate the structures in the back of the knee
  to determine if a Baker's Cyst is present.
• Eye ultrasound: An eye ultrasound is used to
  look at the back of the eye (retina). It is often
  used when a patient has cataracts that make
  looking into the eye difficult. The test may help
  diagnose retinal detachmentSkin
  ultrasound: Ultrasound can be used to help
  find certain types of foreign bodies that may
  become lodged in the skin.
–Liver ultrasound is used to find
 abnormalities in the liver tissue and
 ducts.
–Gallbladder ultrasound can screen
 for gallstones or an infected
 gallbladder.
–Appendix ultrasound is used in
 children or pregnant women, where
 it is necessary to avoid radiation
 from a CT scan (computerized
Emission imaging
• Emission imaging occurs when
  tiny nuclear particles or magnetic
  energy are detected by a scanner
  and analyzed by computer to
  produce an image of the body
  structure or organ being
  examined.
8- Magnetic resonance
            imaging (MRI)
• Definition
• Magnetic resonance imaging
  (MRI) is the newest, and perhaps
  most versatile, medical imaging
  technology available. Doctors can
  get highly refined images of the
  body's interior without surgery,
  using MRI.
Presentation of diagnosis related to cancer by heena
• Purpose
• MRI was developed in the 1980s. The
  latest additions to MRI technology
  are angiography (MRA) and
  spectroscopy (MRS). MRA was
  developed to study blood flow, while
  MRS can identify the chemical
  composition of diseased tissue and
  produce color images of brain
  function.
Prescribe an MRI scan of
    different areas of the body.
• Brain and head. -MRI may be needed for
  patients with symptoms of a brain
  tumor, stroke, or infection (like meningitis).
  MRI also may be needed when cognitive
  and/or psychological symptoms suggest
  brain disease (like Alzheimer's or
  Huntington's diseases, or multiple
  sclerosis), or when developmental
  retardation suggests a birth defect.
• Spine-MRI is particularly useful for
  identifying and evaluating
  degenerated or herniated spinal discs.
• Joint. -MRI scanning is most
  commonly used to diagnose and
  assess joint problems. MRI can
  provide clear images of the bone,
  cartilage, ligament, and tendon that
  comprise a joint.
• Skeleton-The properties of MRI that allow it to
  see through the skull also allow it to view the
  inside of bones.
• Preparation
• In some cases (such as for MRI brain scanning
  or an MRA), a chemical designed to increase
  image contrast may be given by the radiologist
  immediately before the exam. If a patient
  suffers from anxiety or claustrophobia, drugs
  may be given to help the patient relax.
• The patient may be asked to wear
  clothing without metal snaps,
  buckles, or zippers, unless a
  medical gown is worn during the
  procedure. The patient may be
  asked to remove any hair spray,
  hair gel, or cosmetics that may
  interfere with the scan.
Positron emission tomography
             (PET)
• PET is a specialized radiology procedure
  used to examine various body tissues to
  identify certain conditions. PET may also
  be used to follow the progress of the
  treatment of certain conditions. PET is a
  type of nuclear medicine procedure. This
  means that a tiny amount of a radioactive
  substance, called a radionuclide
  (radiopharmaceutical or radioactive
  tracer), is used during the procedure to
  assist in the examination of the tissue
What is PET?
• The name "PET" comes
  from Positron Emission Tomograp
  hy. It is a new scanning technique
  in medical research. PET allows
  us, for the first time, to measure in
  detail the functioning of distinct
  areas of the human brain while the
  patient is comfortable, conscious
How does it work?
• A conventional "X-
  ray" is taken by firing
  X-rays through a
  person and onto a
  film. This "shadow"
  image shows some
  structures in the
  body, such as
  cartilage and bone.
What does a PET scan
             show?
• Oxygen-15 can be used to label
  oxygen gas for the study of oxygen
  metabolism, carbon monoxide for the
  study of blood volume, or water for
  the study of blood flow in the brain.
  Similarly, fluorine-18 is attached to a
  glucose molecule to produce FDG for
  use in the observation of the brain�s
  sugar metabolism.
Presentation of diagnosis related to cancer by heena
How much radiation does a
        patient get?
• PET scans using radioactive fluorine
  in FDG would result in patients
  receiving exposures comparable to
  (or less than) those from other
  medical procedures, such as the
  taking of X-rays. Other scanning
  agents - for instance, 6-F-dopa or
  radioactive water - normally cause
  even less exposure.
Presentation of diagnosis related to cancer by heena
DIAGNOSTIC TESTS
• Barium Enema An x-ray examination of the
  colon using barium sulfate. Laxatives or
  enemas may be required beforehand.
• What is Lower GI Tract X-ray Radiography
  (Barium Enema)?
• Lower gastrointestinal (GI) tract radiography,
  also called a lower GI or barium enema, is
  an x-ray examination of the large intestine,
  also known as the colon. This examination
  evaluates the right or ascending colon, the
  transverse colon, the left or descending colon,
Presentation of diagnosis related to cancer by heena
• common uses of the
  procedure-
• A physician may order a lower
  GI examination to detect:
• benign tumors (such
  as polyps).
• cancer.
• causes of other intestinal
  illnesses
• The procedure is frequently performed to help
  diagnose symptoms such as:
• chronic diarrhea.
• blood in stools.
• constipation.
• irritable bowel syndrome.
• unexplained weight loss.
• a change in bowel habits.
• suspected blood loss.
• abdominal pain.
• to diagnose inflammatory bowel disease, a
  group of disorders that includes Crohn's
prepare for the procedure
• On the day before the procedure ,asked not
  to eat, and to drink only clear liquids like
  juice, tea, black coffee, cola or broth, and to
  avoid dairy products. After midnight, you
  should not eat or drink anything.
• Instructed to take a laxative and to use an
  over-the-counter enema preparation the
  night before the examination and possibly a
  few hours before the procedure.
•  take your usual prescribed oral
  medications with limited amounts
  of water.
• to remove some or all of your
  clothes and to wear a gown during
  the exam.
• to remove jewelry, removable
  dental appliances, eye glasses and
  any metal objects or clothing that
  might interfere with the x-ray
• Women should always inform
  their physician and x-
  ray technologist if there is any
  possibility that they are
  pregnant. Many imaging tests
  are not performed during
  pregnancy so as not to expose
  the fetus to radiation.
• Infants and children may
  undergo lower GI radiography.
  Usually, there is no special
  preparation, but your doctor will
  give you detailed instructions to
  prepare your child for the
  examination. The use of barium
  and the taking of x-ray images
  is similar to that described for
  adults.
• How does the procedure work?
• X-rays are a form of radiation like light
  or radio waves. X-rays pass through
  most objects, including the body.
  Once it is carefully aimed at the part
  of the body being examined, an x-ray
  machine produces a small burst of
  radiation that passes through the
  body, recording an image on
  photographic film or a special digital
  image recording plate.
What will I experience during
   and after the procedure?
• feel abdominal pressure or even
  minor cramping. Most people tolerate
  the mild discomfort easily. The tip of
  the enema tube is specially designed
  to help you hold in the barium.
• several different positions. At
  times, pressure may be applied to
  your abdomen. With air contrast
  studies of the bowel the table may
  be moved to an upright position.
• After the examination, you may be
  given a laxative or enema to wash
  the barium out of your system.
• regular diet and take orally
  administered medications unless
  told otherwise by your doctor.
• to return to a normal diet and
  activities immediately after the
  examination.
• to drink additional water for 24
  hours after the examination.
• Your stools may appear white for a
  day or so as your body clears the
  barium liquid from your system.
• Some people experience constipation
  after a barium enema. If you do not
  have a bowel movement for more
  than two days after your exam or are
  unable to pass gas rectally, call your
  physician promptly.
Barium Swallow
• IT IS THE SAME PROCEDURE
  AS BARIUM ENEMA BUT THE
  PROCEDURE DONE FOR
  UPPER GI TRACT DISEASE
• SAME PREPARATION ,SAME
  METHOD AND SAME TYPE X-
  RAY DONE FOR UPPER GI
  TRACT.
ERCP (Endoscopic
      Retrograde Cholangio-
        pancreatography)
• An examination of the pancreas
  where a tube is inserted down the
  throat, through the stomach and into
  the pancreas. A dye is injected and x-
  rays are taken to show abnormalities.
  The ERCP can also be used to obtain
  tissue samples for biopsy.
• Upper gastrointestinal
  (GI) endoscopy
• Upper GI endoscopy is
  a procedure that uses a
  lighted, flexible
  endoscope to see and
  perform procedures
  inside the upper GI
  tract. The upper GI tract
  includes the
  esophagus, stomach,
  and duodenum—the
  first part of the small
• The bile and pancreatic ducts
• Ducts are tubelike structures in the
  body that carry fluids. The bile
  ducts carry bile, a liquid the liver
  makes to help break down food. A
  group of small bile ducts—called
  the biliary tree—in the liver
  empties bile into the larger
  common bile duct.
Presentation of diagnosis related to cancer by heena
INDICATION FOR ERCP
• tumors
• gallstones that form in the gallbladder and
  become stuck in the ducts
• inflammation due to trauma or illness, such as
  pancreatitis—inflammation of the pancreas
• infection
• valves in the ducts, called sphincters, that won‘t
  open properly
• scarring of the ducts, called sclerosis
• pseudocysts—accumulations of fluid and tissue
Person prepare for ERCP
• The health care provider usually
  provides written instructions about
  how to prepare for ERCP.
• The upper GI tract must be empty.
  Generally, no eating or drinking is
  allowed 8 hours before ERCP.
• Smoking and chewing gum are also
  prohibited during this time.
Medications and vitamins that
  may be restricted before and
       after ERCP include
• nonsteroidal anti-inflammatory drugs, such
  as aspirin, ibuprofen (Advil), and naproxen
  (Aleve)
• blood thinners
• high blood pressure medication
• diabetes medications
• antidepressants
• dietary supplements.
• Patients should tell their health care provider
  about all health conditions they have, especially
  heart and lung problems, diabetes, and
  allergies.
• Patients should also tell their health care
  provider about all medications they take.
• Patients may be asked to temporarily stop
  taking medications that affect blood clotting or
  interact with sedatives, which are usually given
  during ERCP to help patients relax and stay
  comfortable.
PROCEDURE
• . Patients receive a local anesthetic
  that is gargled or sprayed on the back
  of the throat. The anesthetic numbs
  the throat and calms the gag reflex.
• An intravenous needle is inserted into
  a vein in the arm if sedatives will be
  given. Doctors and other medical staff
  monitor vital signs while patients are
  sedated.
• Recovery from ERCP
• After ERCP, patients are moved to a recovery
  room where they wait for about an hour for the
  sedatives to wear off.. During this time, patients
  may feel bloated or nauseous. Patients may
  also have a sore throat, which can last a day or
  two.
• Patients can go home after the sedatives wear
  off. Patients will likely feel tired and should plan
  to rest for the remainder of the day.
• Eating, Diet, and Nutrition
• Unless otherwise
  directed, patients may
  immediately resume their
  normal diet and medications
  after having an ERCP. The
  health care provider can
  answer any specific questions
  about eating, diet, and nutrition.
• Risks associated with ERCP
• Significant risks associated with ERCP
  include
• infection
• pancreatitis
• allergic reaction to sedatives
• excessive bleeding, called hemorrhage
• puncture of the GI tract or ducts
• tissue damage from radiation exposure
• death, in rare circumstances.
Estrogen Receptor Assay
• A test that determines if breast
  cancer is stimulated by the
  hormone estrogen.
• a microscopic examination of
  breast tumor tissue used to
  determine the probable response
  of a tumor to endocrine therapy.
Frozen Section
• A diagnostic technique done by
  a pathologist on a piece of
  tissue removed by a surgeon.
  The tissue is quick frozen,
  stained, and then examined
  under a microscope to
  determine if it is benign or
  malignant.
The Brush
Use brush for
making sample for
examination.
Holding the brush
    Hold the brush like a pen in the
    left hand and stabilize the hand
    by gently resting the side of the
 fifth finger on the stage (or where
            ever you can find a place
 depending on your hand size and
   cryostatwhich approximates the
angle I hold the brush in my hand.
 This results in the brush meeting
          the tissue flat over its 1/4 ''
                               length.
• Turning the wheel
• Turn the wheel in a continuous
  uniform motion without
  hesitation. I have seen many
  frozen sectionists using a brush
  stop at the beginning of the
  section, slowly grab the tissue
  and then start to turn the wheel.
• Movement of the brush
•
  As the block begins to move toward the knife
  the brush moves downward in pace with the
  block. The brush can gently rest on the bottom
  2mm of the block and "ride the block" pulling
  away just as the block meets the knife. It is the
  downward movement of the brush that allows
  you to keep a continuous motion as you grab
  the section.
As the block
descends toward the
brush the brush
keeps pace with the
block by gently
resting on the bottom
2-3 mm of the block
and ―Riding the
As the block
meets the blade
and the sections
begins it‘s curl
the brush leaves
the block while
catching the
curling edge of
the
section. "Catchin
g the curl"
• The brush
  jumps off
  the block
  with the
  curl. "The
  brush
  jumps over
  the blade"
• The brush holding
  the curl pulls the
  section
  horizontally over
  the stage like a
  pulling the covers
  over you in bed
  without pressing
  the tissue to the
  stage. "Pull over
  the blanket"
• Retrieving from stage
• Slide levers down to
  gently touch the section
  which will float onto the
  slide with static or
  cohesive attraction. Try
  avoid stretching or
  folding the section
  during this process by
  keeping the a steady
  hand and the transverse
  axis of the slide parallel
  to the section.
• Retrieving
  from the block
• 1) A section
  is cut leaving
  an attachment
  of medium at
  the top
• 2) The
 wheel is
 turned in
 opposite
 direction
 bring the
 section
 back to the
 face of the
 block.
• 3) Section
  is retrieved
  by placing
  the slide
  over the
  tissue on
  the face of
  the block.
• 1) Bronchiolo-
  alveolar
  Carcinoma - 15
  seconds drying
• 2) Same tissue
  immediately
  fixed 95% ETOH
• 1) Kidney
  tubules -15
  seconds
  drying
• 2) Same
  tissue
  immediately
  fixed in 95%
  ETOH
Gallium Scan
• Radiographic imaging of the body
  which measures the amount of the
  radioisotope gallium that is
  concentrated in a specific part of the
  body. It is most useful in detecting
  nodal disease above the diaphragm.
  Also called: Gallium-67 scintigraphy,
  Ga67 scan, high dose (8-11 mCi)
  gallium scan.
Presentation of diagnosis related to cancer by heena
• Preparation
• • Before you receive the
  injection, there is no
  preparation. You may eat and
  drink
• whatever you like.
• Procedure
• • After you receive the injection and
  before the pictures are taken, be sure
  to have
• a good bowel movement. If you need
  a laxative to do this, please ask for
  one.
• • A small amount of the radioisotope
  will be injected into a vein. You will
  feel a
• Depending on the purpose of the scan,
  it may be done 24 or 48 hours after the
• injection. Sometimes the scan is
  repeated daily, over 3 to 4 days, but
  no additional
• injection will be given.
• • During the scan, lie on your back on
  a firm table with your head flat.
• very sensitive machine
  (scanner) that receives and
  records radiation, will move
• over your body from your
  head to your toes. Many
  pictures will be taken as the
• scanner moves.
• After the procedure
• There are no side effects, but a small amount
  of radioisotope may still be present in your body
  for up to 4 weeks.
• You may urinate in the toilet as usual. Your
  urine and blood will be labeled
• ―Radioactive‖ if sent to the laboratory during the
  first 4 weeks after the injection.
• Your body rids itself of the compound as it does
  the food you eat..
Nuclear Scan
• A diagnostic procedure in
  which a weak radioactive
  substance is injected into the
  blood stream. The body then
  absorbs the substance. A
  machine, like a giant Geiger
  counter, moves over the area
  being tested and takes
  pictures.
• Nuclear Medicine Scan
• This is a test in which a small
  amount of radioactivity is used
  to obtain pictures of your body
  with a gamma camera. These
  pictures will help your doctor
  make a diagnose.
• A small
  amount of
  radioactive
  tracer is
  injected into a
  vein, usually
  in your arm.
  The injection
  is no more
  painful than a
  blood test.
• Is the radiation dangerous?
• The amount of radiation you receive is
  small; it is comparable to that of an X-
  ray examination. The substances we
  inject are non-toxic and will not make
  you feel sick or drowsy. However, for
  radiation safety reasons
  children should not be brought to the
  Nuclear Medicine Department.
• Pap Smear A microscopic examination of
  cells of the cervix. This test can detect
  cancer of the cervix in the early stages.
• Progesterone Receptor Assay
• A test done of a breast cancer tissue
  specimen to determine if it is dependent
  on female hormones for growth.
• IT IS SAME AS EOSTROGEN
  RECEPTOR ASSAY PROCEDURE.
•SUMMARY
•CONCLUSION
BIBLIOGRAPHY
• 1-ANSARI&KAUR,T/B OF
  MEDICAL SURGICAL NURSING-
  2(SPECIALITIES)2011EDITION,S.VI
  KAS & COMPANY.PAGE NO-
  7,14,15,16.
• 2-BLACK (VOL-
  1),MED.SUR.NSG,8TH ED.
  ,ELSIVIER PUBLISHER,PAGE NO
  268 TO 269, 2131.
• 3-           NURSING PROCEDURE&
  DIAGNOSTIC TEST, J P BROTHER, PAGE
  NO-223,321,178,333.
• Website
• www.wikipedia.com
• www.cancerdiagnosis.com
• www.pubmed.com
• www.nursingdepartment.com
Thank you all of and have a
        nice day

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Presentation of diagnosis related to cancer by heena

  • 1. MEDICAL SURGICAL NURSING TOPIC-DIAGNOSIS RELATED TO THE CANCER PRESENTED BY MRS HEENA MEHTA IVALUTOR MR.P.YONATANSIR
  • 2. VARIOS DIAGNOSTIC INVESTIGATION USED FOR DETECTION OF CANCER • For the assessment of the cancer, first step is to obtain complete history and physical examination • HISTORY
  • 3. -TIME OF ONSET OF THE DIEASE -HOW LONG IT OCCURE? -WHAT IS THE PROGRESS ,EITHER SLOW OR FAST? -SEVIARITY OF THE SYSMPTOMS EITHER IT RECOVER WITH TREATMENT NOR NON EFFECTIVE -ANY TREATMENT TAKEN FOR DISEASE? -ANY DIAGNOSTIC PROCEDURE DONE OR NOT? -HOW MANY TIMES FOLLOWUP DONE ?
  • 4. • ANY FAMILY HISTORY OF THE CANCER -ANY ABNORMAL HABITS FOR LONG TIME? -WHAT IS THE OCCUPATION? - WHAT IS THE FAMILY BACK GROUND? -ANY DRUG ADICTION OR NOT? -ANY COMMUNICABLE DISEASE OCCURE OR NOT,IF OCCUR IT IS CURABLE OR HARMFUL? -ANY GENETIC ABNORMALITY IN
  • 5. OTHER STEP IS PHYSICAL EXAMINATION
  • 6. • SIZE OF THE TUMOR OR ABNOMAL SYMPTOMS • SIZE OF THE NODULES • SKIN CHANGES • COLOUR CHANGES • OEDEMA • PRESSURE SYMPTOMS
  • 7. • SIZE OF THE BONE • WEIGHT • HEAD TO TOE EXAMINATION NURSE CAN FIND SOMANY ABNORMAL SYMPTOMS • OBSTRUCTION • PAIN • CNS DISTURBANCE •
  • 10. Grade level Cellular characteristics Grade -1 Low grade malignancy. Cells are similar to normal parent tissue and have a slow growth rate. Well differentiated in appearance and function. Grade -2 Low to moderate grade malignancy. Cells have some normal and some malignant cell features. The tissue of origin is apparent.
  • 11. Grade-3 Moderate to high grade malignancy. Cells have more malignant feature than normal cell features. Grade-4 High grade malignancy. Cells have no normal cell features in appearance and function. Poorly differentiated or undifferentiated. Tissue of origin may be unknown.
  • 13. STAGE 0 or CARCINOMA IN SITU; • Carcinoma in situ is very early cancer. The abnormal cells are found only in the first layer of cells of the primary site and do not invade the deeper tissues. • STAGE-1: • Cancer involves the primary site, but has not spread to nearby tissues. • STAGE- 1A: • A very small amount of cancer – visible uncer a microscope is found deeper in the tissues.
  • 14. • STAGE-1B: • A larger amount of cancer is found in the tissues. • STAGE-2: • Cancer has spread to nearby areas but is still inside the primary site. • STAGE-2A: • Cancer has spread beyond the primary site. • STAGE-2B: • Cancer has spread to other tissue around the primary site.
  • 15. • STAGE-3: • Cancer has spread throughout the nearby area. • STAGE-4: • Cancer has spread to other parts of the body. • STAGE-4A • Cancer has spread to organs close to the pelvic area. • STAGE-4B • Cancer has spread to distant organs, such as the lungs.
  • 16. TNM CLASSIFICATION • The American joint committee of cancer(AJCC) has developed a simple classification solid tumors. T refers to lthe extent primary tumor (tumors size), N represents regional lymph node involvement and extent of metastasis is represented by the letter M.
  • 18. Mandatory parameters ("T", "N", and "M") • T: size or direct extent of the primary tumor –Tx: tumor cannot be evaluated –Tis: carcinoma in situ –T0: no signs of tumor • T1, T2, T3, T4: size and/or extension of the primary tumor
  • 19. • N: degree of spread to regional lymph nodes – Nx: lymph nodes cannot be evaluated – N0: tumor cells absent from regional lymph nodes – N1: regional lymph node metastasis present; (at some sites: tumor spread to closest or small number of regional lymph nodes) – N2: tumor spread to an extent between N1 and N3 (N2 is not used at all sites) – N3: tumor spread to more distant or numerous regional lymph nodes (N3 is not used at all sites)
  • 20. • M: presence of metastasis –Mx: distant metastasis cannot be evaluated –M0: no distant metastasis –M1: metastasis to distant organs (beyond regional lymph node
  • 22. How is cancer diagnosed? • There is no single test that can accurately diagnose cancer. The complete evaluation of a patient usually requires a thorough history and physical examination along with diagnostic testing. Many tests are needed to determine whether a person has cancer, or if another condition (such as an infection) is mimicking the symptoms of cancer.
  • 24. • Absolute Neutrophil Count (ANC) The ANC is calculated by multiplying the percent of neutrophils (plus bands) by the total number of white blood cells. This count is used to determine if chemotherapy can be given. • Acid Phosphatase Also called: acid phos, acid f, acid p‘tase. A test of blood serum to detect a specific enzyme produced by several tissues, particularly the prostate.
  • 25. • Blood Count -A blood test used to determine the number of the various types of blood cells. • BUN (Blood Urea Nitrogen)- Chemistry study of blood serum to measure the level of urea in the blood, a sign of impaired kidney function or urinary obstruction. Normal range: 10-15 mg/100 ml. • CA-125 -Tumor marker that may be elevated in cancers of the ovary, breast, and colon. • CA-19-9 -A tumor marker that may be elevated in cancers of the colon and pancreas. • CA15-3 -A tumor marker that may be elevated in breast cancer.
  • 26. • Calcium Elevated in cancer that has spread to the bone, with tumors that produce parathyroid hormone-like protein and in multiple myeloma, as well as in some non-malignant diseases. • CEA (Carcinogenic Embryonic Antigen) A tumor marker found in the blood that may indicate the presence of certain types of cancer cells. Tumor marker substances may be produced by the tumor itself or by the body in response to a cancer. • Creatinine Waste product in blood; is a measure of kidney function; if elevated may signify kidney disease..
  • 27. • Ferritin Measures iron storage protein in sialic acid; low levels suggest good prognosis in head and neck malignancies. • Leukocyte Another name for white blood cells. A type of cell in the blood which helps defend the body against diseases caused by bacteria, virus, or parasites. There are three types of leukocytes: monocyte, granuloctye, and lymphocytes.
  • 28. • Platelet Count Measures the number of platelets in a drop of blood. Platelet counts increase during strenuous activity and certain conditions called myeloproliferative disorders: infections, inflammations, malignancies, and when the spleen has been removed • Ploidy Analysis A test to measure the amount of DNA contained in a cell. Most cancer cells are aneuploid, which means they contain an abnormal amount of DNA.
  • 29. • Proliferation Index High rates indicate actively growing tumors and a greater risk of relapse. • PSA (Prostate Specific Antigen) A substance (tumor marker) in the blood derived from the prostate gland. Its level may rise in prostatic cancer and is useful as a marker to monitor the effects of treatment. • S-Phase (Cell Cycle Analysis) Percentage of tumor cells synthesizing DNA; patients with high S-phase fraction have less favorable prognosis.
  • 30. • Thyroid Hormones T3 Thyroxine (T4). The other 20% is triiodothyronine measures as T3. Sometimes the diseased thyroid gland will start producing very high levels of T3 but still produce normal levels of T4. And TSH. • Thyroblobulin Elevated levels of this serum hormone are found in follicular carcinoma and return to normal following treatment if all tumor is removed; useful for monitoring residual disease and recurrence of follicular carcinoma.
  • 31. • Tumor Markers Chemicals in the blood that are produced by certain cancers. Measuring the markers is useful for diagnosis, but especially useful for following the course of treatment. • White Blood Count (WBC) Measures the number of white cells; WBC elevated during infection, inflammation, burns, leukemia, low WBC indicates bone marrow depression–may be present with some viruses, toxic reactions, German measles, infectious hepatitis, and other diseases.
  • 33. • Tumor Marker is a molecule or process or a substance that can be measured with an examination (assay) both qualitatively and quantitatively in precancerous condition and cancer. Changes in these levels can be caused by tumors and normal tissue in response to the tumor. Tumor markers can be DNA, mRNA, protein o parts of proteins ( such as te process o proliferation, angiogenesis, apoptosis,
  • 34. • Tumor markers can be found in significant amounts in the blood or urine of patients with cancer and can also be found in the blood and urine of patients with no cancer. Beside that Tissue, saliva, body fluids, and the cell itself can be used as a specimen for the tumor marker test
  • 36. • Growth hormone (GH), which is produced in the pituitary gland under control of the hypothalamic factors growth-hormone-releasing hormone (GHRH) and somatostatin (SMS), is a key stimulator of IGF-1 production. Various IGF-binding proteins (IGFBPs) are also produced in the liver. In IGF-responsive tissues, the ligands IGF-1 and IGF-2 as well as IGFBPs can be delivered through the circulation from the liver (an 'endocrine' source), but IGFs and IGFBPs can also be locally produced through autocrine or paracrine mechanisms
  • 37. CYTOLOGY: FINE NEEDLE ASPIRATION
  • 38. Bone Marrow Biopsy and Aspiration • A needle is inserted into the bone of the hip or breast bone to obtain a sample of bone marrow for study under a microscope. • Bone Marrow Tests • Bone marrow tests check whether your bone marrow is healthy. Bone marrow is a sponge- like tissue inside the bones. It contains stem cells that develop into the three types of blood cells that the body needs:
  • 39. Stereotactic Needle Biopsy • A procedure used in the diagnosis of brain tumors. A special frame is used to hold the patients head stationary while the biopsy needle is directed to exactly the right spot. A CT scanner is used to find the correct position. This method has also been applied to very small breast cancers
  • 40. Different Types Of Biopsy Procedures • Some of the more common types of breast biopsy procedures include Fine Needle Aspiration Biopsy, Core Needle Biopsy, Stereotactic Core Needle Biopsy, Vacuum Assisted Core Biopsy, Circular Rotating ‗Cookie Cutter‘ Knife, MRI (Magnetic Resonance Imaging) guidance, Ultrasound Guided Biopsy and Excisional Biopsy.
  • 41. HISTOPATHOLOGY Biopsy • The surgical removal of a small piece of tissue to determine if the area is cancerous. • A biopsy is the removal of a small piece of tissue for laboratory examination. • There are several different types of biopsies.
  • 42. • Basically, biopsies can be divided in to 07 groups on the basis of method of removal of tissue form the body . • Needle biopsy • Punch biopsy • Incisional biopsy • Excisional biopsy • Currettage biopsy • Extracting tissue piece by piece • Endoscopic biopsy
  • 43. • Prior to removal of tissue, the most appropriate type of biopsy going to be made should be determined. This depends on varieties of factors. • Tissue to be sampled. • how suspicious the abnormality appears. • Size, shape and other characteristic of abnormalities • The location of abnormalities • Number of abnormalities •
  • 44. 1. Needle Biopsy • A needle is inserted through the skin to the suspicious area and cells are extracted. The needle biopsy includes Fine Needle Aspiration (FNA), vacuum assist biopsy and core needle biopsy.
  • 45. • Fine Needle Biopsy • A long thin needle is inserted to the suspicious area and fluid collected into a syringe. This fluid is sent to the cytology laboratory for cellular studies. (FNA Thyroid
  • 46. Vacuum Assist Biopsy • A vacuum pressure is used to collect tissue through a specially designed hollow needle. This procedure facilitates to collect multiple or large samples from the same biopsy site without having to insert the needle more than once. (Example : Breast
  • 47. Core Needle Biopsy • Core needle biopsy is performed by inserting a hollow core needle through the skin to the lesion. This needle is larger than the one used in fine needle biopsy (gauge 16,14 or 11) and it has been designed with a cutting tip to extract a column or cylinder shaped of tissue from the abnormality. The core needle biopsy is performed when the fine needle biopsy didn‘t provide a definitive diagnosis. (Example : Trephine biopsy)
  • 49. . Punch Biopsy • A punch or circular tool is used to extract about 6 mm deep skin layers. This technique is usually used by dermatologists. The punch biopsy is made on exposed areas especially oral mucosa. (Example : Skin biopsy, Rectum biopsy and Oral biopsy)
  • 50. Incisional Biopsy • A scalpel is used to remove a small piece of tissue from large lesion. Incisional biopsy may be used for soft tissues. (Example : Biopsy from Tumors).
  • 51. Excisional Biopsy • The entire lesion is removed from the body.
  • 52. 5. Currettage Biopsy • Removal of piece of tissue by scraping. (endometrial curretings)
  • 53. 6. Extracting Tissue piece by piece • Example : Transurethral Reaction of the Prostate (TURP
  • 54. Endoscopic Biopsy • Endoscope is a fine flexible tube with a camera used to view the inside of the body either through a natural body orifice or a small surgical incision. The endoscope used to visualize the different parts of body is named in different names.
  • 56. • gastrointestinal tract – Alimentary tract endoscope • Urinary bladder – Cystoscope • Abdominal cavity – Laparoscope • Joint cavity – Arthroscope • Mid point of chest – Mediastinoscope • Respiratory Tract – laryngoscope or Bronchoscope
  • 57. • The endoscope can visualize the abnormal area on the lining of the organ and pinch off a tiny piece of tissue with forceps attached to a long cable that runs inside the endoscope.
  • 58. Other various type of biopsy
  • 59. Conization • A small wedge shaped tissue sample is surgically removed from the cervix and examined for the detection of cancer cells.
  • 60. Cervical Conization • Definition • Cervical conization is both a diagnostic and treatment tool used to detect and treat abnormalities of the cervix. It is also known as a cone biopsy or cold knife cone biopsy. • Purpose • To found a precancerous condition in the cervix. • Cervical conization also may be performed if there is an abnormal cervical smear test A biopsy is a diagnostic test in which tissue or cells are removed from the body and examined
  • 61. Precautions • As with any operation that is performed under general anesthesia, the patient must not eat or drink anything for six to eight hours before surgery
  • 63. Procedure • The patient lies on the table with her legs raised in stirrups, similar to the position when having a Pap test. • The patient is given general anesthesia, and the vagina is held open with an instrument called a speculum. • Using a scalpel or laser the doctor removes a cone-shaped piece of the cervix containing the area with abnormal cells. • The resulting crater is repaired by stitching flaps of tissue over the wound.
  • 64. • Aftercare • An overnight stay in the hospital may be required. After the test, the patient may feel some cramps or discomfort for about a week. Women should not have sex, use tampons, or douche until after seeing their physician for a follow up appointment (a week or more after the procedure).
  • 65. RADIOLOGICAL ASSESSMENT • What are the different types of diagnostic imaging? • There are three types of imaging used for diagnosing cancer: transmission imaging, reflection imaging, and emission imaging. Each uses a different process.
  • 66. transmission imaging • X-rays, computed tomography scans (CT scans), and fluoroscopy are radiological examinations whose images are produced by transmission. In transmission imaging, a beam of high-energy photons is produced and passed through the body structure being examined. The beam passes very quickly through less dense types of tissue such as watery secretions, blood, and fat, leaving a darkened area on the x-ray film.
  • 67. 1- x-ray • X-rays are diagnostic tests that use invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs on film. X-rays may be taken of any part of the body to detect a tumor (or cancer).
  • 68. How do we "see" using X-ray light? • when X-ray light shines on us, it goes through our skin, but allows shadows of our bones to be projected onto and captured by film
  • 70. 2-computed tomography scan (Also called a CT scan) • A CT scan is a diagnostic imaging procedure that uses a combination of x- rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x- rays.
  • 71. How a CT scanner works • CT scan (or CAT scan) stands for Computerised (Axial) Tomography scan. This means a scan that takes a series of X-rays and uses a computer to put them together. The scan is is painless. The CT machine takes pictures of your body from different angles and gives a series of cross sections or 'slices' through the part of the body being scanned.
  • 72. CT scan of the pelvis
  • 73. Preparation • Change own cloth and wear hospital dress. • Remove jwellery,pin and metal from the body. • Remove artificial denture. • Some CT scans need special preparation beforehand. This is explained below for scans of different parts of the body. • For some scans, you will have a drink or injection of 'contrast medium'. This is a dye that shows up body tissues more clearly on the scan. Before you have this, ask you about allergies or asthma as some people can be allergic to it. The injection may make you feel
  • 74. Abdominal CT scans • Not to eat or drink after midnight the night before the scan • To drink a liquid contrast medium some time before the scan • To drink more of the liquid in the X-ray department
  • 75. CT scans of the head • For some brain scans, you may be given an injection of the 'contrast medium' dye beforehand to make the scan clearer
  • 76. CT scans of the chest • For some chest (thoracic) scans, you may be given an injection of the 'contrast medium' dye beforehand. This is to help show up the tissues close to the area containing the cancer, for example blood vessels
  • 77. Pelvic CT scans • Not to eat or drink for some time before the scan • To have an injection of 'contrast medium' just beforehand • Depending on the part of your pelvis being scanned, you may have an injection of a drug to slow down the normal movement of your bowel. This movement (called 'peristalsis') can distort the scan and make it more difficult to read.
  • 78. • There is a very detailed scan of the bowel called a 'virtual colonoscopy' (also called a CT colonography). Instead of having a tube and a camera put into your bowel to look inside (a colonoscopy).
  • 79. 3---- Bone scan • How the Test is Performed • A bone scan involves injecting a radioactive material (radiotracer) into a vein. The substance travels through your blood to the bones and organs. As it wears off, it gives off a little bit of radiation. This radiation is detected by a camera that slowly scans your body. The camera takes pictures of how much radiotracer collects in the bones.
  • 81. How to Prepare for the Test • You must remove jewelry and other metal objects. You may be asked to wear a hospital gown. • Tell your doctor if you are or may be pregnant. • Do not take any medicine with bismuth in it, such as Pepto-Bismol, for 4 days before the test.
  • 82. Why the Test is needed • Diagnose a bone tumor or cancer • Determine if a cancer that began elsewhere in your body has spread to the bones; common cancers that spread to the bones include breast, lung, prostate, thyroid, and kidney. • Diagnose a fracture, when it cannot be seen on a regular x-ray (most commonly hip fractures, stress fractures in the feet or legs, or spine fractures)
  • 83. • Diagnose a bone infection (osteomyelitis) • Diagnose or determine the cause of bone pain, when no other cause has been identified • Evaluate metabolic disorders, such as osteomalacia, renal osteodystrophy, primary hyperparathyroidism, osteoporosis, co mplex regional pain syndrome, and
  • 84. PROCEDURE OF BONE SCAN • First part – 20 to 30 minutes including time taken to get ready. This will • include injection of the radioactive liquid and may include having some • pictures taken straight after the injection. • • 3 – 6 hours waiting time between • • Second part – 30 to 60 minutes including time taken to get ready. • (Total 4 – 7 hours altogether) • Injection of radioactive liquid
  • 85. • After the Bone Scan • You will be able to go soon after the bone scan has finished and can continue with normal activities. • Staff will need to take out the needle if it is still in your arm. • Staff will give you any special instructions • The radioactive liquid will pass out of your body in your urine within 2 days. You will not notice it as it is colourless. • Drink plenty of fluid to help get rid of the radioactive liquid
  • 87. 4- lymphangiogram (LAG) • Lymphangiography • radiographic examination of the lymphatic system by injection of contrast medium. The procedure serves to visualize lymph vessels in the upper and lower extremities, thethoracic duct and regional lymph nodes, particularly the axillary, inguinal, external and common iliac and para-aortic (lumbar) groups.
  • 88. Indications • 1. Oily lymphangiography has been performed for a) detection of regional lymph node metastases (pelvic tumours and malignant melanomas) and in staging of malignantlymphomas, and b) chylothorax and pathologies of the thoracic duct (injuries, infectious diseases, tumour invasion). • 2. Water-soluble lymphangiography is indicated for investigation of primary and secondary lymphoedema.
  • 89. 5- Mammogram • A mammogram is an x-ray examination of the breast. It is used to detect and diagnose breast disease in women who either have breast problems such as a lump, pain, or nipple discharge, as well as for women who have no breast complaints.
  • 91. Types of memmography • Digital mammography, also called full-field digital mammography (FFDM), is a mammography system in which the x-ray film is replaced by solid-state detectors that convert x-rays into electrical signals. • Computer-aided detection (CAD) systems use a digitized mammographic image that can be obtained from either a conventional film mammogram or a digitally acquired mammogram. The computer software then searches for abnormal areas of density, mass, or calcification that may indicate the presence
  • 92. • common uses of the procedure • Mammograms are used as a screening tool to detect early breast cancer in women experiencing no symptoms and to detect and diagnose breast disease in women experiencing symptoms such as a lump, pain or nipple discharge.
  • 93. • Screening Mammography Mammography plays a central part in early detection of breast cancers because it can show changes in the breast up to two years before a patient or physician can feel them. • Diagnostic Mammography Diagnostic mammography is used to evaluate a patient with abnormal clinical findings—such as a breast lump or lumps.
  • 94. Preparation of patient • Do not wear deodorant, talcum powder or lotion under your arms or on your breasts on the day of the exam. These can appear on the mammogram as calcium spots. • Describe any breast symptoms or problems to the technologist performing the exam. •
  • 95. How does the procedure work? • X-rays are a form of radiation like light or radio waves. X-rays pass through most objects, including the body. Once it is carefully aimed at the part of the body being examined, an x-ray machine produces a small burst of radiation that passes through the body, recording an image on photographic film or a special digital image recording plate.
  • 96. Benefits • to detect small tumors. When cancers are small, the woman has more treatment options and a cure is more likely. • The use of screening mammography increases the detection of small abnormal tissue growths.. It is also useful for detecting all types of breast cancer, including invasive ductal and invasive lobular cancer. • No radiation remains in a patient's body after an x-ray examination. • X-rays usually have no side effects in the
  • 97. Reflection imaging Reflection imaging refers to the type of imaging produced by sending high- frequency sounds to the body part or organ being studied. These sound waves "bounce" off of the various types of body tissues and structures at varying speeds, depending on the density of the tissues present.
  • 99. • Ultrasound, or sonography, is the most commonly used type of reflection imaging. This technique uses high-frequency sound waves and a computer to create images, called sonograms, of blood vessels, tissues, and organs. Sonograms are used to view internal organs as they function and to assess blood flow through various vessels. Tumors in the abdomen, liver, and kidneys can often be seen with an ultrasound.
  • 100. • Ultrasound Uses • Ultrasound can be used as a diagnostic or screening tool to confirm medical disorders or to assist in performing medical procedures. It is also used as a therapeutic tool in treating musculoskeletal problems, renal stones (kidney stones), and gallstones
  • 101. • Diagnostic or Screening Uses • Obstetrics and gynecology: Pregnancy ultrasound (or fetal ultrasound) is used to assess the progression of the fetus. Vaginal ultrasound, pelvic ultrasound, or transvaginal ultrasound is used to diagnose growths or tumors of the ovary, uterus, and Fallopian tubes. It can be used to assess non-pregnancy related issues as well: – lower abdominal pain – ovarian cysts – uterine fibroids – uterine growths – endometriosis
  • 102. • Cardiology: . It is used to evaluate the flow of blood through the chambers and valves of the heart. It also assesses the strength of the heart beat and the volume of blood pumped through. Echocardiography is often used for the following: – heart valve problems, such as mitral valve prolapse or aortic stenosis; – congestive heart failure; – blood clots due to irregular heart beats such as in atrial fibrillation; – abnormal fluid collections around the heart, such as pericardial effusions; and – pulmonary artery hypertension.
  • 103. • Blood vessels: . Using Doppler ultrasound technology, the flow of blood through the vessels can be observed and measured. Narrowing of vessels (stenosis) or widening of vessels (dilatation, also referred to as aneurysms) can be detected. Ultrasound testing of blood vessels includes: – carotid ultrasound, – abdominal aorta ultrasound for abdominal aortic aneurysm, and – blood clots in veins (superficial or deep venous thrombosis, or DVT).
  • 104. • Abdominal structures: Abdominal ultrasound is used to evaluate the solid organs within the abdominal cavity, including the liver, gallbladder, pancreas, kidneys, and bladder. –Renal ultrasound is used to evaluate the function and structure of the kidneys. Swelling around the kidney with blockage in the urinary tract can be seen with ultrasound, making abdominal ultrasound useful in detecting kidney stones.
  • 105. • Testicular ultrasound: Used to diagnose testicular torsion, epididymitis(testicle infection), and testicular masses. • Neck ultrasound: The thyroid and parathyroid glands can be imaged to detect nodules, growths, and tumors. • Breast ultrasound: Used to image the breasts and to guide biopsy of breast masses to evaluate for breast
  • 106. • Knee ultrasound: Ultrasound can be used to evaluate the structures in the back of the knee to determine if a Baker's Cyst is present. • Eye ultrasound: An eye ultrasound is used to look at the back of the eye (retina). It is often used when a patient has cataracts that make looking into the eye difficult. The test may help diagnose retinal detachmentSkin ultrasound: Ultrasound can be used to help find certain types of foreign bodies that may become lodged in the skin.
  • 107. –Liver ultrasound is used to find abnormalities in the liver tissue and ducts. –Gallbladder ultrasound can screen for gallstones or an infected gallbladder. –Appendix ultrasound is used in children or pregnant women, where it is necessary to avoid radiation from a CT scan (computerized
  • 108. Emission imaging • Emission imaging occurs when tiny nuclear particles or magnetic energy are detected by a scanner and analyzed by computer to produce an image of the body structure or organ being examined.
  • 109. 8- Magnetic resonance imaging (MRI) • Definition • Magnetic resonance imaging (MRI) is the newest, and perhaps most versatile, medical imaging technology available. Doctors can get highly refined images of the body's interior without surgery, using MRI.
  • 111. • Purpose • MRI was developed in the 1980s. The latest additions to MRI technology are angiography (MRA) and spectroscopy (MRS). MRA was developed to study blood flow, while MRS can identify the chemical composition of diseased tissue and produce color images of brain function.
  • 112. Prescribe an MRI scan of different areas of the body. • Brain and head. -MRI may be needed for patients with symptoms of a brain tumor, stroke, or infection (like meningitis). MRI also may be needed when cognitive and/or psychological symptoms suggest brain disease (like Alzheimer's or Huntington's diseases, or multiple sclerosis), or when developmental retardation suggests a birth defect.
  • 113. • Spine-MRI is particularly useful for identifying and evaluating degenerated or herniated spinal discs. • Joint. -MRI scanning is most commonly used to diagnose and assess joint problems. MRI can provide clear images of the bone, cartilage, ligament, and tendon that comprise a joint.
  • 114. • Skeleton-The properties of MRI that allow it to see through the skull also allow it to view the inside of bones. • Preparation • In some cases (such as for MRI brain scanning or an MRA), a chemical designed to increase image contrast may be given by the radiologist immediately before the exam. If a patient suffers from anxiety or claustrophobia, drugs may be given to help the patient relax.
  • 115. • The patient may be asked to wear clothing without metal snaps, buckles, or zippers, unless a medical gown is worn during the procedure. The patient may be asked to remove any hair spray, hair gel, or cosmetics that may interfere with the scan.
  • 116. Positron emission tomography (PET) • PET is a specialized radiology procedure used to examine various body tissues to identify certain conditions. PET may also be used to follow the progress of the treatment of certain conditions. PET is a type of nuclear medicine procedure. This means that a tiny amount of a radioactive substance, called a radionuclide (radiopharmaceutical or radioactive tracer), is used during the procedure to assist in the examination of the tissue
  • 117. What is PET? • The name "PET" comes from Positron Emission Tomograp hy. It is a new scanning technique in medical research. PET allows us, for the first time, to measure in detail the functioning of distinct areas of the human brain while the patient is comfortable, conscious
  • 118. How does it work? • A conventional "X- ray" is taken by firing X-rays through a person and onto a film. This "shadow" image shows some structures in the body, such as cartilage and bone.
  • 119. What does a PET scan show? • Oxygen-15 can be used to label oxygen gas for the study of oxygen metabolism, carbon monoxide for the study of blood volume, or water for the study of blood flow in the brain. Similarly, fluorine-18 is attached to a glucose molecule to produce FDG for use in the observation of the brain�s sugar metabolism.
  • 121. How much radiation does a patient get? • PET scans using radioactive fluorine in FDG would result in patients receiving exposures comparable to (or less than) those from other medical procedures, such as the taking of X-rays. Other scanning agents - for instance, 6-F-dopa or radioactive water - normally cause even less exposure.
  • 123. DIAGNOSTIC TESTS • Barium Enema An x-ray examination of the colon using barium sulfate. Laxatives or enemas may be required beforehand. • What is Lower GI Tract X-ray Radiography (Barium Enema)? • Lower gastrointestinal (GI) tract radiography, also called a lower GI or barium enema, is an x-ray examination of the large intestine, also known as the colon. This examination evaluates the right or ascending colon, the transverse colon, the left or descending colon,
  • 125. • common uses of the procedure- • A physician may order a lower GI examination to detect: • benign tumors (such as polyps). • cancer. • causes of other intestinal illnesses
  • 126. • The procedure is frequently performed to help diagnose symptoms such as: • chronic diarrhea. • blood in stools. • constipation. • irritable bowel syndrome. • unexplained weight loss. • a change in bowel habits. • suspected blood loss. • abdominal pain. • to diagnose inflammatory bowel disease, a group of disorders that includes Crohn's
  • 127. prepare for the procedure • On the day before the procedure ,asked not to eat, and to drink only clear liquids like juice, tea, black coffee, cola or broth, and to avoid dairy products. After midnight, you should not eat or drink anything. • Instructed to take a laxative and to use an over-the-counter enema preparation the night before the examination and possibly a few hours before the procedure.
  • 128. • take your usual prescribed oral medications with limited amounts of water. • to remove some or all of your clothes and to wear a gown during the exam. • to remove jewelry, removable dental appliances, eye glasses and any metal objects or clothing that might interfere with the x-ray
  • 129. • Women should always inform their physician and x- ray technologist if there is any possibility that they are pregnant. Many imaging tests are not performed during pregnancy so as not to expose the fetus to radiation.
  • 130. • Infants and children may undergo lower GI radiography. Usually, there is no special preparation, but your doctor will give you detailed instructions to prepare your child for the examination. The use of barium and the taking of x-ray images is similar to that described for adults.
  • 131. • How does the procedure work? • X-rays are a form of radiation like light or radio waves. X-rays pass through most objects, including the body. Once it is carefully aimed at the part of the body being examined, an x-ray machine produces a small burst of radiation that passes through the body, recording an image on photographic film or a special digital image recording plate.
  • 132. What will I experience during and after the procedure? • feel abdominal pressure or even minor cramping. Most people tolerate the mild discomfort easily. The tip of the enema tube is specially designed to help you hold in the barium.
  • 133. • several different positions. At times, pressure may be applied to your abdomen. With air contrast studies of the bowel the table may be moved to an upright position. • After the examination, you may be given a laxative or enema to wash the barium out of your system.
  • 134. • regular diet and take orally administered medications unless told otherwise by your doctor. • to return to a normal diet and activities immediately after the examination. • to drink additional water for 24 hours after the examination.
  • 135. • Your stools may appear white for a day or so as your body clears the barium liquid from your system. • Some people experience constipation after a barium enema. If you do not have a bowel movement for more than two days after your exam or are unable to pass gas rectally, call your physician promptly.
  • 136. Barium Swallow • IT IS THE SAME PROCEDURE AS BARIUM ENEMA BUT THE PROCEDURE DONE FOR UPPER GI TRACT DISEASE • SAME PREPARATION ,SAME METHOD AND SAME TYPE X- RAY DONE FOR UPPER GI TRACT.
  • 137. ERCP (Endoscopic Retrograde Cholangio- pancreatography) • An examination of the pancreas where a tube is inserted down the throat, through the stomach and into the pancreas. A dye is injected and x- rays are taken to show abnormalities. The ERCP can also be used to obtain tissue samples for biopsy.
  • 138. • Upper gastrointestinal (GI) endoscopy • Upper GI endoscopy is a procedure that uses a lighted, flexible endoscope to see and perform procedures inside the upper GI tract. The upper GI tract includes the esophagus, stomach, and duodenum—the first part of the small
  • 139. • The bile and pancreatic ducts • Ducts are tubelike structures in the body that carry fluids. The bile ducts carry bile, a liquid the liver makes to help break down food. A group of small bile ducts—called the biliary tree—in the liver empties bile into the larger common bile duct.
  • 141. INDICATION FOR ERCP • tumors • gallstones that form in the gallbladder and become stuck in the ducts • inflammation due to trauma or illness, such as pancreatitis—inflammation of the pancreas • infection • valves in the ducts, called sphincters, that won‘t open properly • scarring of the ducts, called sclerosis • pseudocysts—accumulations of fluid and tissue
  • 142. Person prepare for ERCP • The health care provider usually provides written instructions about how to prepare for ERCP. • The upper GI tract must be empty. Generally, no eating or drinking is allowed 8 hours before ERCP. • Smoking and chewing gum are also prohibited during this time.
  • 143. Medications and vitamins that may be restricted before and after ERCP include • nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen (Advil), and naproxen (Aleve) • blood thinners • high blood pressure medication • diabetes medications • antidepressants • dietary supplements.
  • 144. • Patients should tell their health care provider about all health conditions they have, especially heart and lung problems, diabetes, and allergies. • Patients should also tell their health care provider about all medications they take. • Patients may be asked to temporarily stop taking medications that affect blood clotting or interact with sedatives, which are usually given during ERCP to help patients relax and stay comfortable.
  • 145. PROCEDURE • . Patients receive a local anesthetic that is gargled or sprayed on the back of the throat. The anesthetic numbs the throat and calms the gag reflex. • An intravenous needle is inserted into a vein in the arm if sedatives will be given. Doctors and other medical staff monitor vital signs while patients are sedated.
  • 146. • Recovery from ERCP • After ERCP, patients are moved to a recovery room where they wait for about an hour for the sedatives to wear off.. During this time, patients may feel bloated or nauseous. Patients may also have a sore throat, which can last a day or two. • Patients can go home after the sedatives wear off. Patients will likely feel tired and should plan to rest for the remainder of the day.
  • 147. • Eating, Diet, and Nutrition • Unless otherwise directed, patients may immediately resume their normal diet and medications after having an ERCP. The health care provider can answer any specific questions about eating, diet, and nutrition.
  • 148. • Risks associated with ERCP • Significant risks associated with ERCP include • infection • pancreatitis • allergic reaction to sedatives • excessive bleeding, called hemorrhage • puncture of the GI tract or ducts • tissue damage from radiation exposure • death, in rare circumstances.
  • 149. Estrogen Receptor Assay • A test that determines if breast cancer is stimulated by the hormone estrogen. • a microscopic examination of breast tumor tissue used to determine the probable response of a tumor to endocrine therapy.
  • 150. Frozen Section • A diagnostic technique done by a pathologist on a piece of tissue removed by a surgeon. The tissue is quick frozen, stained, and then examined under a microscope to determine if it is benign or malignant.
  • 151. The Brush Use brush for making sample for examination.
  • 152. Holding the brush Hold the brush like a pen in the left hand and stabilize the hand by gently resting the side of the fifth finger on the stage (or where ever you can find a place depending on your hand size and cryostatwhich approximates the angle I hold the brush in my hand. This results in the brush meeting the tissue flat over its 1/4 '' length.
  • 153. • Turning the wheel • Turn the wheel in a continuous uniform motion without hesitation. I have seen many frozen sectionists using a brush stop at the beginning of the section, slowly grab the tissue and then start to turn the wheel.
  • 154. • Movement of the brush • As the block begins to move toward the knife the brush moves downward in pace with the block. The brush can gently rest on the bottom 2mm of the block and "ride the block" pulling away just as the block meets the knife. It is the downward movement of the brush that allows you to keep a continuous motion as you grab the section.
  • 155. As the block descends toward the brush the brush keeps pace with the block by gently resting on the bottom 2-3 mm of the block and ―Riding the
  • 156. As the block meets the blade and the sections begins it‘s curl the brush leaves the block while catching the curling edge of the section. "Catchin g the curl"
  • 157. • The brush jumps off the block with the curl. "The brush jumps over the blade"
  • 158. • The brush holding the curl pulls the section horizontally over the stage like a pulling the covers over you in bed without pressing the tissue to the stage. "Pull over the blanket"
  • 159. • Retrieving from stage • Slide levers down to gently touch the section which will float onto the slide with static or cohesive attraction. Try avoid stretching or folding the section during this process by keeping the a steady hand and the transverse axis of the slide parallel to the section.
  • 160. • Retrieving from the block • 1) A section is cut leaving an attachment of medium at the top
  • 161. • 2) The wheel is turned in opposite direction bring the section back to the face of the block.
  • 162. • 3) Section is retrieved by placing the slide over the tissue on the face of the block.
  • 163. • 1) Bronchiolo- alveolar Carcinoma - 15 seconds drying • 2) Same tissue immediately fixed 95% ETOH
  • 164. • 1) Kidney tubules -15 seconds drying • 2) Same tissue immediately fixed in 95% ETOH
  • 165. Gallium Scan • Radiographic imaging of the body which measures the amount of the radioisotope gallium that is concentrated in a specific part of the body. It is most useful in detecting nodal disease above the diaphragm. Also called: Gallium-67 scintigraphy, Ga67 scan, high dose (8-11 mCi) gallium scan.
  • 167. • Preparation • • Before you receive the injection, there is no preparation. You may eat and drink • whatever you like.
  • 168. • Procedure • • After you receive the injection and before the pictures are taken, be sure to have • a good bowel movement. If you need a laxative to do this, please ask for one. • • A small amount of the radioisotope will be injected into a vein. You will feel a
  • 169. • Depending on the purpose of the scan, it may be done 24 or 48 hours after the • injection. Sometimes the scan is repeated daily, over 3 to 4 days, but no additional • injection will be given. • • During the scan, lie on your back on a firm table with your head flat.
  • 170. • very sensitive machine (scanner) that receives and records radiation, will move • over your body from your head to your toes. Many pictures will be taken as the • scanner moves.
  • 171. • After the procedure • There are no side effects, but a small amount of radioisotope may still be present in your body for up to 4 weeks. • You may urinate in the toilet as usual. Your urine and blood will be labeled • ―Radioactive‖ if sent to the laboratory during the first 4 weeks after the injection. • Your body rids itself of the compound as it does the food you eat..
  • 172. Nuclear Scan • A diagnostic procedure in which a weak radioactive substance is injected into the blood stream. The body then absorbs the substance. A machine, like a giant Geiger counter, moves over the area being tested and takes pictures.
  • 173. • Nuclear Medicine Scan • This is a test in which a small amount of radioactivity is used to obtain pictures of your body with a gamma camera. These pictures will help your doctor make a diagnose.
  • 174. • A small amount of radioactive tracer is injected into a vein, usually in your arm. The injection is no more painful than a blood test.
  • 175. • Is the radiation dangerous? • The amount of radiation you receive is small; it is comparable to that of an X- ray examination. The substances we inject are non-toxic and will not make you feel sick or drowsy. However, for radiation safety reasons children should not be brought to the Nuclear Medicine Department.
  • 176. • Pap Smear A microscopic examination of cells of the cervix. This test can detect cancer of the cervix in the early stages. • Progesterone Receptor Assay • A test done of a breast cancer tissue specimen to determine if it is dependent on female hormones for growth. • IT IS SAME AS EOSTROGEN RECEPTOR ASSAY PROCEDURE.
  • 178. BIBLIOGRAPHY • 1-ANSARI&KAUR,T/B OF MEDICAL SURGICAL NURSING- 2(SPECIALITIES)2011EDITION,S.VI KAS & COMPANY.PAGE NO- 7,14,15,16. • 2-BLACK (VOL- 1),MED.SUR.NSG,8TH ED. ,ELSIVIER PUBLISHER,PAGE NO 268 TO 269, 2131.
  • 179. • 3- NURSING PROCEDURE& DIAGNOSTIC TEST, J P BROTHER, PAGE NO-223,321,178,333. • Website • www.wikipedia.com • www.cancerdiagnosis.com • www.pubmed.com • www.nursingdepartment.com
  • 180. Thank you all of and have a nice day