23: GYN Flashcards
What type of GYN cancer is the most lethal?
Ovarian Cancer - has few symptoms and early detection is difficult
What two GYN cancers are often interchangable?
Endometrial (endometrial adenocarcinoma) – the most common form of Uterine Cancer (80%)
Uterine sarcoma, the other main form for uterine cancer , develops in the myometrium and is rare
What are the risk factors for uterine/endometrial?
What are protective factors?
Risk Factors:
Hormonal changes (the pill, # of cycles, obesity, pregnancy, PCOS, ovarian tumors, taxomifen use)
Age: increases as we age
Diet/Exercise: increased with body fat increase, probably increase with increased glycemic load
family hx: hereditary nonpolyposis colon CA or Lynch Syndrome
Med hx: metabolic syndrome, PCOS, DM, HTN, High TG, previous pelvic radiation, endometrial hyperplasia, breast or ovarian CA
Protective:
coffee, veggies (particularly nonstarchy), fruit, Mediterranean diet, physical activity
What are the risk factors for uterine sarcoma?
med hx: radiotherapy to pelvis
Family hx: hx of retinoblastoma due to abd copy of RB gene
Race: black women are 2x more likely than white/asian
What are the risk factors for Ovarian?
What are protective factors?
Increase:
age: increases with age
HT/BMI: greater linear growth (adult-attained ht) and BMI > 30
Family hx: family hx – 5-15% are geneticly determined
Genetic mutations: BRCA1, BRCA2, RAD51C
Decrease:
reproductive: giving birth, the pill for more than 5 years, breastfeeding, tubal ligation
Body Comp: increasing hip circumference (postmeno)
Med hx: prophylactic bilateral salpingo-oophorectomy (may reduce risk by 80% in carriers of genetic mutations)
What are the risk factors for Cervical?
What are protective factors?
Increase:
Med hx: HPV, immunosuppression from HIV meds (increased risk of HPV, thus cancer), in utero exposure to diethylstilbestrol
Decrease:
vaccine against HPV
What are symptoms of advanced ovarian CA?
pelvic and abd pain, swelling/pressure, early satiety, GI problems like gas, bloating or constipation
What is the primary part of ovarian CA treatment? What is a nutrition related side effect?
Surgery
Intestinal surgery is needed in 30-50% of advanced cases
What is the reasons a GYN cancer would have nutrition concerns?
the location in the body–close to the GI and Urinary systems–can cause mets to these areas and cause nutrition-related problems.
They are also more prone to ascites and lymphedema, which can mask wt loss/malnutrition
Surgery admits are often 7-10 days and can cause malnutrition on their own
What are the nutrition requirements for GYN cancers?
malnourished pts – 30-35 kcal/kg, if cachaxic may need up to 1.5-2.5 g/day of protein
typical/well-nourished would be more like 25-30 kcal/kg and 1-1.5 g/day or protein
What are some ways to treat radiation-induced diarrhea for GYN patients?
EBRT can cause GI issues in 70% of patients
Fiber supplementation–two tsp daily
probiotics–general recs have been used but too early for specific dosage/strains
Loperamid and diphenoxylate
Octreotide
What is a MAJOR GI side effect/complication from GYN CA–particularly ovarian? Why does it occur? How is it treated?
Malignant Bowel Obstructions
20-50% of ovarian CA
Often results from peritoneal carcinomatosis and may involve small or large intestine or both. Might be from location of tumor, radiation enteritis, disease progression or postop issues.
Interventions include surgery, PEGs for drainage/venting, palliative surgery. Or NGT to suction, bowel rest, meds to help with symptoms, IV fluids or PN
What is a concern for long-term survivors of ovarian CA?
will experience premature menopause and therefore higher risk for Heart disease and osteoporosis — key in survivorship education
