Oncology

The transformation of normal cells into cancerous cells involves a series of steps known as carcinogenesis. This process can be broken down into three main stages:
1. Initiation: The alteration of the genetic material of a cell due to carcinogenic agents (e.g., chemicals, radiation).
2. Promotion: The proliferation of initiated cells due to factors such as hormones or inflammation, leading to a pre-cancerous state.
3. Progression: Further genetic changes and the accumulation of mutations that result in malignant transformation and the ability of the cells to invade surrounding tissues.

Screening aims to detect cancer at an early stage when it is most treatable. The rationale behind screening includes early diagnosis, improved outcomes, and subsequently reduced mortality rates from cancer.

Primary Prevention: Actions taken to avoid disease (e.g., vaccination, lifestyle modifications).
Secondary Prevention: Early detection through screenings (e.g., mammograms for breast cancer).
Tertiary Prevention: Rehabilitation and palliative care for those already diagnosed with cancer to improve quality of life and manage symptoms.

The TNM system stands for Tumor, Nodes, Metastasis:
- Tumor (T): Size and extent of the primary tumor.
- Nodes (N): Indicates if there is regional lymph node involvement.
- Metastasis (M): Presence or absence of distant metastasis.
This staging provides crucial information about the extent of cancer and aids in determining the most appropriate treatment options.

Common diagnostic methods for cancer include:
- CT (Computed Tomography): Provides cross-sectional imaging for detailed views of the body.
- PET CT (Positron Emission Tomography): Helps visualize metabolic activity and cancer spread.
- MRI (Magnetic Resonance Imaging): Offers high-resolution images of soft tissues, useful in brain, breast, and pelvic cancers.

Ovarian Cancer: Notable mostly for late detection, which is a major issue hindering effective treatment.
Hormone Receptor Status: Key subtypes include:
- Hormone Receptor Positive: Cancer cells depend on hormones to grow.
- HER2 Positive: Increased levels of HER2 protein, indicating aggressive cancer traits.
- Triple Negative: Lacks estrogen, progesterone, and HER2 receptors, usually more difficult to treat.

Surgical options may include lumpectomy, mastectomy, or sentinel lymph node biopsy.
Risk Factors: Include family history, genetic mutations, and lifestyle factors (e.g., obesity, alcohol consumption).
Hormone Therapy: Can reduce the risk of cancer recurrence; however, it may have side effects like lymphedema, especially post-surgery.

Smoking: The leading risk factor associated with lung cancer development.
Symptoms: Persistent cough, coughing up blood, chest pain, and shortness of breath.
Calculation of Pack Years: A way to quantify exposure to smoking; calculated by multiplying the number of packs smoked per day by the number of years smoked (e.g., 1 pack/day for 20 years equals 20 pack years).
Red Flags: Include unexplained weight loss, fatigue, and recurring respiratory infections.

Locally Extensive: Refers to the spread of cancer to surrounding tissues and structures, affecting treatment decisions significantly by potentially precluding surgical options.

Surgeries may be conducted for curative purposes or palliative care, addressing specific symptoms associated with the disease, such as obstruction or discomfort.

TLS can occur when large numbers of cancer cells die quickly, releasing their contents into the bloodstream, leading to metabolic complications.
Management: Helps prevent TLS through hydration before treatment.

Recognized as a medical emergency requiring immediate intervention to prevent loss of function and mitigate severe symptoms.

Tunneled vs. Untunneled Central Lines:
- Tunneled: Inserted through the skin, providing a long-term access point; less visible.
- Untunneled: Directly inserted into a vein; visible and used for shorter durations.

Long-term side effects may include fatigue, necessitating strategies for improved quality of life. Fatigue can stem from:
- Metabolic Factors: Such as anemia.
- Cytokine Release: Resulting from the cancer itself.
- Psychosocial Factors: Including stress and anxiety.
Fatigue Management: Strategies include lifestyle changes such as maintaining a proper rest/work balance, sleep hygiene, and exercises, which have been clinically proven to improve fatigue levels.

Defined as the leakage of IV-administered medications into surrounding tissue, posing risks such as necrosis and chemical burns.
Management Steps:
1. Step 1: Stop administration immediately.
2. Step 2: Call the doctor and follow established protocols for treatment, including photographing the area for documentation.
- Note: Do not attempt to remove the IV if extravasation occurs, as this may exacerbate the situation. Always check for blood return when administering vesicant chemotherapy to ensure proper placement in the vein.
To prevent extravasation, it is recommended to utilize a central line for chemotherapy administration to minimize risk.