1. assessment
1) grading
- Classifies the cellular aspects of cancer.
| grade 1 | Cells differ slightly from normal cells and are well differentiated. (mild dysplasia) |
| grade 2 | Cells are more abnormal and are moderately differentiated. (moderate dysplasia) |
| grade 3 | Cells are very abnormal and are poorly differentiated. (severe dysplasia) |
| grade 4 | Cells are immature (anaplasia) and undifferentiated. A cell of origin is difficult to determine. |
2) staging
- Classifies the clinical aspects of cancer and the degree of metastasis at diagnosis.
| stage 0 | carcinoma in situ |
| stage 1 | tumor limited to the tissue of origin, localized tumor growth |
| stage 2 | limited local spread |
| stage 3 | extensive local and regional spread |
| stage 4 | distant metastasis |
3) ★ factors that influence cancer development → primary prevention
- chemical carcinogen: drugs, tobacco, industrial chemicals
- physical carcinogen: ionizing radiation, ultraviolet radiation, chronic irritation, tissue trauma
- viral carcinogen (oncoviruses): Epstein-Barr virus, hepatitis B virus, human papillomavirus
- helicobacter pylori infection
- obesity
- dietary factors: preservatives, contaminants, additives, nitrates
- immune function: AIDS, organ transplant recipients
- genetic predisposition
- age
2. diagnostic test
1) early detection → secondary prevention
(Cf.) tertiary prevention: to prevent long term complication)
- skin inspection
- breast self-examination and clinical breast examination
- mammography
- Pap (Papanicolaou’s) test
- testicular self-examination
- rectal exams and stools for occult blood
- sigmoidoscopy, colonoscopy
2) warning signs of cancer
- any sore that does not heal
- obvious change in wart or mole
- thickening or lump in the breast or elsewhere
- unusual bleeding or discharge
- change in bowel or bladder habits
- indigestion
- nagging cough or hoarseness
3) biopsy
- The biopsy is the definitive means of diagnosing cancer and provides histological proof of malignancy.
- needle (aspiration of cells) / incisional (removal of a wedge of suspected tissue from a larger mass) / excisional (complete removal)
→ frozen section / permanent paraffin section - Ensure that informed consent has been obtained. Assess the results of coagulation tests.
- The procedure usually is performed in an outpatient surgical setting. 국소마취. 5∼15분 소요. Prone or side-lying position.
- Prepare the client for the diagnostic procedure and provide postprocedural instructions. 24hr 동안 bleeding 관찰. 48hr 동안 contact sports 피할 것.