Care of Patients with Gynecologic Problems Flashcards
Cancer of the inner uterine lining
Is Most common female gynecologic malignancy
Relatively Good prognosis - depends on staging
Grows slowly in most cases compared to other female cancers
Adenocarcinoma most common type of tumor
Etiology/Risk Factors
Endometrial (Uterine) Cancer
Stage 1 – confined to the endometrium; not metastasis
Stage 2 – also involves the cervix
Stage 3 – reaches the vagina or lymph nodes
Stage 4 – spread to the bowel or bladder mucosa and/or beyond the pelvis; spreading to distant area
Determines treatment options
Grows slowly in most cases compared to other female cancers
Imp - gen health for clients and so are aware
#1: Strongly associated with prolonged exposure to estrogen without the protective effects of progesterone - estrogen supplements without progesterone
Women in reproductive years
Nulliparity - no children
Family history
DM
HTN
Obesity
Uterine polyps - BIG RISK FACTOR; precursor to cancer cells
Late menopause
Smoking
Tamoxifen given for breast cancer - treatment sometimes use for breast cancer
Etiology/Risk Factors
Symptoms
Lab assessment
Diagnostic assessment
Assessment
Postmenopausal and has vaginal bleeding – one of the big warning signings; main symptom
Watery, bloody vaginal discharge
Low back or abdominal pain - when advances - cancer growing in uterus
Low pelvic pain (caused by pressure of the enlarged uterus)
Symptoms
Early symptoms of vaginal bleeding generally lead to prompt evaluation and treatment
Postmenopausal and has vaginal bleeding – one of the big warning signings; main symptom
Uterus is enlarged if the cancer is advanced
Low pelvic pain (caused by pressure of the enlarged uterus)
CBC (may show anemia)
Cancer antigen 125 (CA-125) – elevated in ovarian cancer; big one for endometrial cancer; warrants further eval
Alpha-fetoprotein (AFP) – elevated in ovarian cancer; big one for endometrial cancer; warrants further eval
Human chorionic gonadotropin (hCG) – elevated level may indicate pregnancy, pregnancy should be ruled out before treatment begins
Lab assessment
Transvaginal ultrasound
Endometrial biopsy in order to confirm diagnosis
Other diagnostic tests may be done to determine the patient’s overall health status and the presence of metastasis
Diagnostic assessment
Surgical management
Nonsurgical management
Psychosocial Interventions
Interventions
Stage 1
Stage 2
Stage 3/4 may or may not do surgery but once metastasized diff places have do chemo and radiation; might with 1 and 2 do chemo and radiation but typ with those do surgical
Surgical management
Removal of the uterus, fallopian tubes, and ovaries (total hysterectomy and bilateral salpingectomy (BSO) as well as peritoneum fluid or washings for cytologic examination - check peritoneal area for metastasis and check for cancer cells in fluid/washings
Stage 1
Radical hysterectomy with bilateral salpingectomy with radical pelvic lymph node dissection and removal of the upper third of the vagina
Depends
Stage 2
Used postoperatively and depends on the surgical staging
Radiation therapy
Drug therapy
Nonsurgical management
More common interventions for cervical and endometrium cancer
Brachytherapy internal radiation placed by the radiologist
External beam radiation therapy (EBRT)
Radiation therapy
Put the radioactive implant remains in place for several minutes then take it out; not radioactive in between treatments
procedure may be repeated between 2 and 5 times once or twice a week - or however often need
patient is not radioactive between treatments and there is no restrictions on her interactions with others
restricted to bedrest during the treatment session
Brachytherapy internal radiation placed by the radiologist
4-6 weeks; 5x/week
Not radioactive between treatments; never internal
External beam radiation therapy (EBRT)
Chemotherapy - used if need postop or in addition to radiation
Drug therapy
Coping mechanisms
Psychosocial Interventions
Is a Progressive cancer: - cervical cells have long-time - years for cervical cells to transform from normal to premalignant to cancer cells
Generally takes years for the cervical cells to transform from normal to premalignant to invasive cancer
Etiology/Risk Factors
Health promotion and maintenance
Cervical cancer
Pap smear and pelvic exams imp before progress to CIS
Normal cervical cells
Atypia (suspicious) - cervical cells started to change so need keep eye
Cervical intraepitheilial neoplasia (CIN)
Carcinoma in situ (CIS)
Is a Progressive cancer: - cervical cells have long-time - years for cervical cells to transform from normal to premalignant to cancer cells
which is the most advanced premalignant change
Carcinoma in situ (CIS)
Most cases are caused by certain types of HPV (most common type of STD in the US) - #1 risk factor; imp for health promotion related to this
Multiparity - multiple children
Smoking
African American
Oral contraceptive use
History of STI - not just HPV
Obesity
Family history
HIV/AIDS
Younger than 18 at first intercourse
Etiology/Risk Factors
Gardasil and Cervarix
Periodic pelvic examinations and Pap tests at age 21 for women annually - very imp to catch changes in cervical cells
Health promotion and maintenance
HPV vaccines
Ideally given before onset of first sexual contact for girls and young women (ages 9-26); primarily prevent cervical cancer
Also given for boys and young men to prevent genital warts, transmission and protection against certain types of cancer (HPV transmission)
Protection against the highest-risk HPV types that are responsible for most cervical cancers
Gardasil and Cervarix
Asymptomatic in preinvasive cancer early on - why screening imp
Clinical manifestations for invasive cancer:
Diagnostic assessment:
Assessment
Painless vaginal bleeding – classic symptom; first; bleeding continually
Late symptoms: - not want get here
Clinical manifestations for invasive cancer:
Watery, blood-tinged vaginal discharge that becomes dark and foul-smelling
Leg pain (along the sciatic nerve) or swelling of one leg - increase of tumor size and potential compression on nerve
Flank plain (symptom of hydronephrosis) - compression on ureters which can then impact kidneys
Late symptoms: - not want get here
cancer may be pressing on the ureters, backing up the urine into the kidneys
Flank plain (symptom of hydronephrosis) - compression on ureters which can then impact kidneys
HPV-typing DNA test if pap results are abnormal - increased risk for cervical cancer from HPV virus
Colposcopy - abnormal cells: more biopsy and able diagnose
Diagnostic assessment:
Early surgical procedures - catch early
Surgical procedure - stage 1: not metastasized but is cancer
Nonsurgical management - stage 2/3/4 surgery not good option
Staging time diagnosis directs interventions do for client
Interventions:
Loop electrosurgical excision procedure (LEEP) - get premalignant cells out
Laser therapy
Cryotherapy - cold therapy
Early surgical procedures - catch early
Hysterectomy
Surgical procedure - stage 1: not metastasized but is cancer
Radiation therapy - external, brachytherapy at end of external
Chemotherapy - also with radiation
Nonsurgical management - stage 2/3/4 surgery not good option
Most ovarian cancers are epithelial tumors that grow on the surface of the ovaries
Tumors grow very rapidly, spread very quickly, and are often bilateral
Second most common type
Leading cause of death from female reproductive cancers
Incidence increases in women older than 50 years, and most are diagnosed after menopause - greater risk here
Teach women to “think ovarian” if they have vague abdominal and GI symptoms
Ovarian cancer
Survival rates are low because ovarian cancer is often not detected until its late stages - not caught early
Second most common type
Leading cause of death from female reproductive cancers
Older than 40-50 years
Family history of ovarian or breast cancer or hereditary nonpolyposis colon cancer
Diabetes mellitus
Nulliparity
Older than 30 at first pregnancy
Breast cancer
Colorectal cancer
Infertility
BRCA 1 or BRCA 2 gene mutations
Early or late menarche/late menopause
Endometriosis
Obesity/high-fat diet
Risk factors
Clinical manifestations:
Diagnostic assessment:
Assessment
Typ have very Mild symptoms for several months and may not notice but may have thought they were due to normal perimenopausal changes or stress
Abdominal pain or swelling - when growing
Vague GI disturbances such as dyspepsia (indigestion) and gas
Any enlarged ovary found after menopause should be evaluated as though it were malignant
Clinical manifestations:
“Think ovarian” so eval for that
Vague GI disturbances such as dyspepsia (indigestion) and gas
CA-125 – may be elevated in ovarian cancer, but for other reasons too
Transvaginal ultrasonography, CXR, CT; biopsies if needed
Diagnostic assessment:
Surgical management:
Nonsurgical management:
In advanced metastatic disease: - metastasized sig
Interventions
Exploratory laparotomy - cancer staged during surgery and definitive diagnosis
Total abdominal hysterectomy, bilateral salpingo-oophorectomy (remove everything) and pelvic and para-aortic lymph node dissection usually performed if necessary
Very large tumors that cannot be removed/remove all cancer are debulked (cytoreduction) - cut it down smaller to manage symptoms and if do chemo easier for chemo to work
Surgical management:
Chemotherapy after surgery
Nonsurgical management:
Palliative and End of life care quickly; hopefully catch quickly so can do interventions
Difficult cancer to diagnose before metastasis occurs
In advanced metastatic disease: - metastasized sig
