Breast Disorders and Gynecologic Problems

Question 1

breast cancer

Answer 1

most common diagnosis in women, second to lung cancer in causing death, early detection is key to effective treatment and survival.

Question 2

categories of breast cancer

Answer 2

noninvasive (20%) and invasive (80%)

Question 3

noninvasive breast cancer

Answer 3

ductal carcinoma in situ (DCIS)
lobular carcinoma in situ (LCIS)

Question 4

ductal carcinoma in situ (DCIS)

Answer 4

cancer cells are located within the duct and have not invaded the surrounding fatty breast tissue. 14% to 53% become invasive and spread into the breast tissue surrounding the ducts over a period of 10 yrs if not treated.

Question 5

lobular carcinoma in situ (LCIS)

Answer 5

rare. occurs as an abnormal cell growth in the lobules (milk producing glands) of the breast. treated with close observation only but women with breast cancer risk factors may consider prophylactic treatment.

Question 6

invasive breast cancer

Answer 6

infiltrating ductal carcinoma
inflammatory breast cancer (IBC)

Question 7

infiltrating ductal carcinoma

Answer 7

most common type, originates in the mammary ducts and grows in the epithelial cells lining these ducts. dimpling and an edematous thickening and pitting of breast skin called peau’d orange may be seen as the tumor continues to grow.

Question 8

inflammatory breast cancer (IBC)

Answer 8

rare but highly aggressive
symptoms including swelling, skin redness, pain in the breasts
usually diagnosed at a later stage than other types of cancer so it is harder to treat successfully.

Question 9

Breast cancer in young women

Answer 9

4.6% occur in women younger than 40
genetic predisposition is a stronger risk factor for younger women than older women
frequently present with more aggressive forms of the disease, and the number of cases is increasing
screening tools are less effective because breasts are denser

Question 10

Breast cancer in men

Answer 10

rare, occuring in fewer than 1% of all cases
average onset 68
symptoms: hard, painless, subareolar mass
gynecomastia may be present
diagnosis frequently delayed

Question 11

etiology of breast cancer

Answer 11

no known single cause

Question 12

risk factors that increase the risk of breast cancer

Answer 12

females, older than 65, genetic factors (inherited mutations or BRCA1 and or BRCA2), history of a previous breast cancer, dense breasts (more glandular than connective tissue), atypical hyperplasia, exposure to radiation, first born child after age 30 or nulliparity, recent oral contraceptive use or hormonal replacement therapy.

Question 13

modifiable risk factors for breast cancer

Answer 13

avoid weight gain and obesity, engage in regular physical activity, minimize alcohol intake

Question 14

health promotion and maintenance of breast cancer

Answer 14

mammography, breast self awareness/ self examination, clinical breast examination

Question 15

mammography

Answer 15

annually for women ages 40 and older. MRI should be done in women who have known genetic mutations and or other high risk factors. ultrasound sometimes is used.

Question 16

breast self awareness/self examination

Answer 16

should be done in premenopausal women 1 week after their period. For others, should be done the same day each month.

Question 17

Clinical breast exam

Answer 17

performed by advanced practice nurses and other health care providers annually.

Question 18

additional health promotion and maintenance for high risk women

Answer 18

prophylactic mastectomy- preventative surgical removal of one or both breasts
prophylactic oophorectomy- removal of the ovaries
anti-estrogen chemo-preventative drugs

Question 19

assessment for breast cancer

Answer 19

history, physical assessment, clinical manifestations, psychosocial, lab assessments, imaging assessments,

Question 20

physical assessment/clinical manifestations of breast cancer

Answer 20

breast mass- identify location by using the “face of the clock” method. describe shape, size, and consistency, mass will be hard and fixed versus mobile.
note any skin changes around the mass- dimpling, redness and warmth
nipple retraction or ulceration
assess adjacent lymph nodes for swelling
pain or soreness

Question 21

lab assessments for breast cancer

Answer 21

biopsies- pathalogic examination of tissue from the breast mass, pathologic study of the lymph nodes

Question 22

imaging studies for breast cancer

Answer 22

mammography, ultrasonography, MRI, chest x-ray (screen for lung metastasis), CT scans (screen for bone, liver, and brain metastases), breast tissue biopsy is the only definitive way to diagnose breast cancer

Question 23

priority nursing diagnosis and collaborative problems

Answer 23

ineffective coping related to unanticipated breast cancer diagnosis. potential for metastasis of cancer to other parts of the body

Question 24

Interventions for breast cancer

Answer 24

developing coping strategies, decrease the risk for metastasis, surgical management, breast reconstruction,

Question 25

developing coping strategies

Answer 25

decrease anxiety, offer outside resources, assess need for knowledge

Question 26

decrease the risk for metastasis

Answer 26

nonsurgical management- follow up with adjuvant radiation, chemotherapy, hormone therapy, or targeted therapy. Promote comfort for those who cannot have surgery or whose cancer is too advanced. CAM: vitamins, special diets, herbal therapy, prayer, guided imagery, massage etc. 80% of women use some form during breast cancer treatment, should not be used in place of standard treatment. check with HCP before using

Question 27

surgical management for breast cancer

Answer 27

preoperative: relieve anxiety and provide information to increase patient knowledge, include the spouse or partner, address body image issues before surgery. Operative procedures: lumpectomy, partial mastectomy, total simple mastectomy, modified radical mastectomy post operative: avoid using the affected arm for measuring blood pressure, giving injections, or drawing blood, observe for signs of swelling and infection, wound care, drainage tube care, HOB elevated 30 degrees, elevate arm of affected side on a pillow while awake, repositioning, analgesics breast reconstruction Adjuvant therapy

Question 28

lumpectomy

Answer 28

tumor and small amount of tissue removed

Question 29

partial mastectomy

Answer 29

part of the breast and some normal tissue around it removed

Question 30

total simple mastectomy

Answer 30

removal of the entire breast

Question 31

modified radical mastectomy

Answer 31

breast and some lymph nodes removed, part of the chest wall muscle may also be removed

Question 32

adjuvant therapy

Answer 32

radiation therapy drug therapy: chemotherapy, targeted therapy, and hormonal therapy

Question 33

interventions for breast cancer depend on

Answer 33

the stage of the disease, patient's age menopausal status, patient preferences, pathologic examination, hormone receptor status, presence of known genetic predisposition

Question 34

patient/family teaching for post operative mastectomy

Answer 34

wound care care of drains no lotions or ointments no use of deodorant under the affected arm until healing is complete observe for infection (swelling, redness, increased heat, and tenderness) Elevate affected arm on a pillow 30 min a day for the first 6 months Sponge baths or tub baths only until stitches, staples, or drains are removed numbness in the area of the surgery and along the inner side of the armpit to the elbow occurs in almost all women wear loose fitting clothes active range of motion exercises should begin 1 week after surgery or when sutures and drains are removed.

Question 35

patient teaching lymphedema

Answer 35

abnormal accumulation of protein fluid in the subQ tissue of the affected limb after mastectomy once it develops, can be difficult to manage, and lifelong measures must be taken to prevent it

Question 36

symptoms of lymphedema

Answer 36

sensation of heaviness, aching, fatigue, numbness, tingling and or swelling in the affected arm, as well as swelling in the upper chest

Question 37

prevention of lymphedema

Answer 37

avoid blood pressure measurements, injections in, or drawing blood from the effected side, wear a mitt when using an oven, wear gloves when gardening, treats cuts and scrapes, elevate arm when possible, measures are lifelong, referral to a specialist may be necessary.

Question 38

endometrial (uterine) cancer

Answer 38

cancer of the inner uterine lining, most common gynecologic malignancy, good prognosis, grows slowly in most cases, adenocarcinoma most common type of tumor

Question 39

stage 1 of endometrial cancer

Answer 39

confined to the endometrium

Question 40

stage 2 of endometrial cancer

Answer 40

also involves the cervix

Question 41

stage 3 of endometrial cancer

Answer 41

reaches the vagina or lymph nodes

Question 42

stage 4 of endometrial cancer

Answer 42

spread to the bowel or bladder mucosa and or beyond the pelvis

Question 43

etiology for endometrial cancer

Answer 43

strongly associated with prolonged exposure to estrogen without the protective effects of progesterone

Question 44

risk factors of endometrial cancer

Answer 44

women in reproductive years, nulliparity, family history, DM, HTN, obesity, uterine polyps, late menopause, smoking, tamoxifen given breast cancer

Question 45

symptoms of endometrial cancer

Answer 45

postmenopausal vaginal bleeding- main symptom watery bloody vaginal discharge low back or abdominal pain low pelvic pain uterus is enlarged if the cancer is advanced

Question 46

Lab assessment for endometrial cancer

Answer 46

CBC, cancer antigen 125, alpha fetoprotein, HCG

Question 47

diagnostic assessment of endometrial cancer

Answer 47

transvaginal ultrasound, endometrial biopsy, other diagnostic tests may be done to determine the patients overall health status and the presence of metastasis.

Question 48

stage one of surgical management of endometrial cancer

Answer 48

removal of the uterus, fallopian tubes, and ovaries (total hysterectomy and bilateral salpingectomy) as well as peritoneum fluid or washings for cytologic examination.

Question 49

stage two of surgical management of endometrial cancer

Answer 49

radical hysterectomy with bilateral pelvic lymph node dissection and removal of the upper third of the vagina

Question 50

nonsurgical management of endometrial cancer

Answer 50

used postoperatively and depends on the surgical staging.

Question 51

radiation therapy for endometrial cancer

Answer 51

brachytherapy internal radiation placed by the radiologist. Radioactive implant remains in place for several minutes. procedure may be repeated between 2 and 5 times once or twice a week. Patient is not radioactive between treatments and there is no restrictions on her interactions with others. restricted to bedrest during treatment session. External beam radiation therapy: 4-6 weeks

Question 52

Drug therapy

Answer 52

chemotherapy

Question 53

psychosocial inteventions

Answer 53

coping mechanisms

Question 54

Cervical cancer

Answer 54

progressive cancer: normal cervical cells, atypia, cervical intraepithelial neoplasia, carcinoma in situ (which is most advanced premalignant change) generally takes years for the cervical cells to transform from normal to premalignant to invasive cancer.

Question 55

cervical cancer etiology

Answer 55

most causes are caused by certain types of HPV (most common types of STD in US)

Question 56

risk factors for cervical cancer

Answer 56

multi parity, smoking, African American, oral contraceptive, history of STI, obesity, family history, HIV/AIDS, younger than 18 at first intercourse.

Question 57

health promotion and maintenance for cervical cancer

Answer 57

Gardasil and cervix: ideally given before sexual contact for girls and younger women, also given for boys and young men to precent genital warts, transmission, and certain types of cancer. Protection against the highest risk HPV types that are responsible for most cervical cancers  Periodic pelvic examinations and pap tests at age 21 for women.

Question 58

assessment for cervical cancer

Answer 58

asymptomatic in pre-invasive cancer clinical manifestations for invasive cancers

Question 59

Clinical manifestations for invasive cancer

Answer 59

painless vaginal bleeding- classic symptoms late: watery, blood tinged vaginal discharge that becomes dark and foul smelling, leg pain (along sciatic nerve) or swelling of one leg, flank pain (symptom of hydro-nephrosis) cancer may be pressing on the ureters, backing up the urine into the kidneys.

Question 60

Diagnostic assessment for cervical cancer

Answer 60

HPV-typing DNA test if pap results are abnormal colposcopy.

Question 61

interventions for cervical cancer

Answer 61

early surgical procedures, surgical procedure, nonsurgical management

Question 62

early surgical procedures for cervical cancer

Answer 62

loop electrosurgical excision procedure, laser therapy, cryotherapy

Question 63

surgical procedure for cervical cancer

Answer 63

hysterectomy

Question 64

non surgical management for cervical cancer

Answer 64

radiation or chemotherapy

Question 65

Ovarian cancer

Answer 65

most ovarian cancers are epithelial tumors that grow on the surface of the ovaries. tumors grow rapidly, spread quickly, and are often bilateral. leading cause of death from female reproductive cancers. survival rates are low because because of ovarian cancer is often not detected until its late stages. second most common type. Incidence increases in women older than 50 and most are diagnosed after menopause. Teach women to "think ovarian" if they have vague abdominal and GI symptoms.

Question 66

risk factors for ovarian cancer

Answer 66

older than 40, family history of ovarian or breast cancer or heredity nonpolyposis colon cancer, DM, nulliparity, older than 30 with first pregnancy, breast cancer, colorectal cancer, infertility, BRCA 1 and BRCA 2 gene mutations, early menarche/late menopause, endometriosis, obesity and high fat diet.

Question 67

clinical manifestations for ovarian cancer

Answer 67

mild symptoms for several months but may have thoughts they were due to normal perimenopausal changes or stress, abdominal pain and swelling, vague GI disturbances such as dyspepsia (indigestion) and gas, any enlarged ovary found after menopause should be evaluated as though it were malignant.

Question 68

Diagnostic assessment for ovarian cancer

Answer 68

CA125 may be elevated in ovarian cancer but for other reasons too; transvaginal ultrasonography, CXR and CT

Question 69

surgical management of ovarian cancer

Answer 69

exploratory laparotomy, total abdominal hysterectomy, bilateral salpingoophorectomy and pelvic and para-aortic lymph node dissection usually performed, very large tumors that cannot be removed are debulked (cyto-reduction)

Question 70

non surgical management for ovarian cancer

Answer 70

chemotherapy after surgery

Question 71

interventions for ovarian cancer at advanced metastasis

Answer 71

palliative and end of life care, difficult cancer to diagnose before metastasis occurs.