Breast Disorders and Gynecologic Problems Flashcards
breast cancer
most common diagnosis in women, second to lung cancer in causing death, early detection is key to effective treatment and survival.
categories of breast cancer
noninvasive (20%) and invasive (80%)
noninvasive breast cancer
ductal carcinoma in situ (DCIS)
lobular carcinoma in situ (LCIS)
ductal carcinoma in situ (DCIS)
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.
lobular carcinoma in situ (LCIS)
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.
invasive breast cancer
infiltrating ductal carcinoma
inflammatory breast cancer (IBC)
infiltrating ductal carcinoma
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.
inflammatory breast cancer (IBC)
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.
Breast cancer in young women
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
Breast cancer in men
rare, occuring in fewer than 1% of all cases
average onset 68
symptoms: hard, painless, subareolar mass
gynecomastia may be present
diagnosis frequently delayed
etiology of breast cancer
no known single cause
risk factors that increase the risk of breast cancer
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.
modifiable risk factors for breast cancer
avoid weight gain and obesity, engage in regular physical activity, minimize alcohol intake
health promotion and maintenance of breast cancer
mammography, breast self awareness/ self examination, clinical breast examination
mammography
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.
breast self awareness/self examination
should be done in premenopausal women 1 week after their period. For others, should be done the same day each month.
Clinical breast exam
performed by advanced practice nurses and other health care providers annually.
additional health promotion and maintenance for high risk women
prophylactic mastectomy- preventative surgical removal of one or both breasts
prophylactic oophorectomy- removal of the ovaries
anti-estrogen chemo-preventative drugs
assessment for breast cancer
history, physical assessment, clinical manifestations, psychosocial, lab assessments, imaging assessments,
physical assessment/clinical manifestations of breast cancer
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
lab assessments for breast cancer
biopsies- pathalogic examination of tissue from the breast mass, pathologic study of the lymph nodes
imaging studies for breast cancer
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
priority nursing diagnosis and collaborative problems
ineffective coping related to unanticipated breast cancer diagnosis. potential for metastasis of cancer to other parts of the body
Interventions for breast cancer
developing coping strategies, decrease the risk for metastasis, surgical management, breast reconstruction,
developing coping strategies
decrease anxiety, offer outside resources, assess need for knowledge
decrease the risk for metastasis
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
surgical management for breast cancer
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
lumpectomy
tumor and small amount of tissue removed
partial mastectomy
part of the breast and some normal tissue around it removed
total simple mastectomy
removal of the entire breast
modified radical mastectomy
breast and some lymph nodes removed, part of the chest wall muscle may also be removed
adjuvant therapy
radiation therapy
drug therapy: chemotherapy, targeted therapy, and hormonal therapy
interventions for breast cancer depend on
the stage of the disease, patient’s age menopausal status, patient preferences, pathologic examination, hormone receptor status, presence of known genetic predisposition
patient/family teaching for post operative mastectomy
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.
patient teaching lymphedema
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
symptoms of lymphedema
sensation of heaviness, aching, fatigue, numbness, tingling and or swelling in the affected arm, as well as swelling in the upper chest
prevention of lymphedema
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.
endometrial (uterine) cancer
cancer of the inner uterine lining, most common gynecologic malignancy, good prognosis, grows slowly in most cases, adenocarcinoma most common type of tumor
stage 1 of endometrial cancer
confined to the endometrium
stage 2 of endometrial cancer
also involves the cervix
stage 3 of endometrial cancer
reaches the vagina or lymph nodes
stage 4 of endometrial cancer
spread to the bowel or bladder mucosa and or beyond the pelvis
etiology for endometrial cancer
strongly associated with prolonged exposure to estrogen without the protective effects of progesterone
risk factors of endometrial cancer
women in reproductive years, nulliparity, family history, DM, HTN, obesity, uterine polyps, late menopause, smoking, tamoxifen given breast cancer
symptoms of endometrial cancer
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
Lab assessment for endometrial cancer
CBC, cancer antigen 125, alpha fetoprotein, HCG
diagnostic assessment of endometrial cancer
transvaginal ultrasound, endometrial biopsy, other diagnostic tests may be done to determine the patients overall health status and the presence of metastasis.
stage one of surgical management of endometrial cancer
removal of the uterus, fallopian tubes, and ovaries (total hysterectomy and bilateral salpingectomy) as well as peritoneum fluid or washings for cytologic examination.
stage two of surgical management of endometrial cancer
radical hysterectomy with bilateral pelvic lymph node dissection and removal of the upper third of the vagina
nonsurgical management of endometrial cancer
used postoperatively and depends on the surgical staging.
radiation therapy for endometrial cancer
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
Drug therapy
chemotherapy
psychosocial inteventions
coping mechanisms
Cervical cancer
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.
cervical cancer etiology
most causes are caused by certain types of HPV (most common types of STD in US)
risk factors for cervical cancer
multi parity, smoking, African American, oral contraceptive, history of STI, obesity, family history, HIV/AIDS, younger than 18 at first intercourse.
health promotion and maintenance for cervical cancer
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.
assessment for cervical cancer
asymptomatic in pre-invasive cancer
clinical manifestations for invasive cancers
Clinical manifestations for invasive cancer
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.
Diagnostic assessment for cervical cancer
HPV-typing DNA test if pap results are abnormal
colposcopy.
interventions for cervical cancer
early surgical procedures, surgical procedure, nonsurgical management
early surgical procedures for cervical cancer
loop electrosurgical excision procedure, laser therapy, cryotherapy
surgical procedure for cervical cancer
hysterectomy
non surgical management for cervical cancer
radiation or chemotherapy
Ovarian cancer
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.
risk factors for ovarian cancer
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.
clinical manifestations for ovarian cancer
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.
Diagnostic assessment for ovarian cancer
CA125 may be elevated in ovarian cancer but for other reasons too; transvaginal ultrasonography, CXR and CT
surgical management of ovarian cancer
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)
non surgical management for ovarian cancer
chemotherapy after surgery
interventions for ovarian cancer at advanced metastasis
palliative and end of life care, difficult cancer to diagnose before metastasis occurs.
