Chapter 23: Gynecological cancers Flashcards
The HPV vaccine has reduced incidence of ______ cancer in women in the US, but remains a bigger threat in other countries
Cervical__
_______ cancer is the leading cause of gynecological cancer deaths in the US
Ovarian
Unlike _______ cancer, ovarian cancer presents with few symptoms making early detection difficult
Endometrial
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
Calcium/dairy and ovarian cancer
Some studies showed inverse relationship but very conflicting/inconclusive
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
Protective factors for endometrial cancer (4)
-Coffee
-Fruit & non-starchy vegetables
-Mediterranean diet
-physical activity
Risk factors for uterine sarcoma (3)
-Radiation to pelvis
-Family hx of retinoblastoma (abnormal copy of RB gene_
-Black women
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)
Factors that increase risk for ovarian cancer (4)
Age
Growth/height in adulthood
Obesity
Gene mutations (BRCA)
Factors that decrease risk for ovarian cancer (5)
Giving birth
Birth control
Breastfeeding
Increased hip circumference
Prophylactic oophrectomy
What is the word for removal of the ovaries?
Oophrectomy
Which 2 types of HPV are most linked to cervical cancer
HPV 16 & HPV 18
Endometrial cancer is the most common type of uterine cancer, while uterine _________ is rare
Sarcoma
The most common type of ovarian cancer is of the ________ cells
Epithelial
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)
- Psyllium - 2 teaspoons daily
- Probiotics - need more research on specifics
- Loperamide & diphenoxylate - standard of practice for mild symptoms
- 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
