Chapter 23: Gynecological cancers Flashcards by Lisa Conticello

The HPV vaccine has reduced incidence of ______ cancer in women in the US, but remains a bigger threat in other countries

Cervical__

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_______ cancer is the leading cause of gynecological cancer deaths in the US

Ovarian

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Unlike _______ cancer, ovarian cancer presents with few symptoms making early detection difficult

Endometrial

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Risk for _______ gyn cancer is increased w/ obesity & Mediterranean diet, while there is little evidence to support metabolic syndrome or diet quality to _________ gyn cancer

Endometrial
Ovarian

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Calcium/dairy and ovarian cancer

Some studies showed inverse relationship but very conflicting/inconclusive

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Factors increasing risk for endometrial cancer (6)

-Exposure to estrogen (birth control pills, total number of menstrual cycles)
-Tamoxifen
-PCOS
-Obesity
-Older age
-Hyperglycemia/DM/metabolic syndrome

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Protective factors for endometrial cancer (4)

-Coffee
-Fruit & non-starchy vegetables
-Mediterranean diet
-physical activity

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Risk factors for uterine sarcoma (3)

-Radiation to pelvis
-Family hx of retinoblastoma (abnormal copy of RB gene_
-Black women

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Oral contraceptives increase risk for ________ gyn cancer, but decrease risk for _______ gyn cancer

Endometrial
Ovarian
(think that the ovaries produce estrogen so they like it)

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Factors that increase risk for ovarian cancer (4)

Age
Growth/height in adulthood
Obesity
Gene mutations (BRCA)

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Factors that decrease risk for ovarian cancer (5)

Giving birth
Birth control
Breastfeeding
Increased hip circumference
Prophylactic oophrectomy

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What is the word for removal of the ovaries?

Oophrectomy

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Which 2 types of HPV are most linked to cervical cancer

HPV 16 & HPV 18

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Endometrial cancer is the most common type of uterine cancer, while uterine _________ is rare

Sarcoma

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The most common type of ovarian cancer is of the ________ cells

Epithelial

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These are the 2 types of cervical cancer, based on the type of cell they originate from

squamous cell
adenocarcinoma

Signs of endometrial cancer

Unusual bleeding/pelvic pain after menopause, unintentional weight loss

Signs of late ovarian cancer

GI issues (gas, bloating, constipation)
Early satiety
Abdominal pain/swelling/bloating

_______ cancer is usual detected by regular exams or pain during sex

Cervical

Treatment of endometrial cancer

Surgery + observation

Vaginal brachytherapy, EBRT, systemic chemo, or hormone therapy may be considered

Surgery for ovarian cancer is the primary treatment and involves removal of (4)

Ovaries
Uterus (hysterectomy)
Lymph nodes
Omentum

“hysterectomy with bilateral salpingo-oophrectomy with lymph node dissection and omentectomy”

*fertility sparing surgery may be an option

*Instestinal surgery may also be needed

________ > is preferred to _______ when ovarian cancer is detected to reduce the risk for mets

Tissue removal
Biopsy

Intestinal surgery is needed in ______ - _____% cases of advanced ovarian cancer

30-50%

Adjuvant recommendations for ovarian cancer

Platinum-based chemotherapy, may include intraperitoneal. Targeted therapy may also be an option.

Radiation is NOT standard, this was done historically

Treatment for cervical cancer

Varies on the stage - advanced will require hysterectomy while cryotherapy or laser surgery may be used for early stages EBRT, brachytherapy, and chemotherapy are also options

Mets to the ________ or ______ systems are possible with GYN cancers d/t close proximity

GI Urinary

_________ during gyn surgery can contribute to ascites and mask true wt loss

Lypmh node removal

The prognostic nutritional index may be used as a screening tool, often for breast & gyn cancers. It is calculated by ___________ + __________

Albumin + total lymphocytes

Malnutrition is approximately ____________% in ovarian cancer

70%

4 supplements/medical management for radiation-induced diarrhea (gyn cancer category)

1. Psyllium - 2 teaspoons daily 2. Probiotics - need more research on specifics 3. Loperamide & diphenoxylate - standard of practice for mild symptoms 4. Octreotide - studied specifically w/ rectal cancer (may be difficult to get insurance coverage d/t newer research)

Traditional versus non-traditional nutrition progression post-op of GYN cancers

Witholding intake until bowel sounds, flatus, or stool or noted ERAS - early PO, enteral, or immune-enhanced formulas. Associated with fewer complications and LOS **may contribute to more nausea

________ is a preterminal event to ovarian cancer and make it very difficult to tolerate oral intake d/t pain, N/V, ascites

Malignant bowel obstruction

Survival length of surgical versus non-surgical malignant bowel obstruction

Non-surgical: 4-5 weeks Surgical: 6 months but most of the time spent in the hospital d/t various complications

T/F: PN is recommended for inoperable cases of MBO

False. Use palliative measures

_______ & ______ are tools used to relieve symptoms of MBO for non-surgical candidates

Venting G tubes Stents Reduce nausea, vomiting, improves PO intake thus QOL

Some RDs recommend a __________ diet for MBO, but need clinical judgement

low fiber

Factors to consider w/ PN in advanced gynelogical cancers w/ MBO d/t discomfort w/ PN and only mild increase on life span

Performance status (karnofsky >/= 50), if you'll die from malnutrition before the cancer

Long-term survivors of ovarian cancer will experience early menopause, thus risks for ______ & ______ increase

Osteoporosis Heart disease