Cyndi - Week 9 - Exam 4 Flashcards
what are the different cultural and ethnic disparities for women’s health?
- Access differences
- Insurance
- Money
- Quality of care
- Health knowledge/advocacy
- *Caucasian highest incidence - Hispanic/African American women increased death d/t Poverty level**
what are the different types of breast cancer? (4)
• Non‐invasive carcinoma
- DCIS‐ductal carcinoma in situ, LCIS‐lobular carcinoma in situ
• Invasive carcinoma
◦ Ductal – 80% -vascular - at risk for metastasis
◦ Lobular – 20%
• Inflammatory breast cancer
• Paget’s disease of the nipple - Hardening and thickening and sore; skin is dimpled/orange peeled
Misdiagnosed as mastitis
what are the risk factors for breast cancer?
• Age (50% - 65 years or older) • Ethnicity • Hormone status • Heredity • Familial - ↑ risk if first degree • DNA testing BRCA 1, 2 mutations - BRCA repair tissue in breast - too much production - mutation • Hormone status • Access • Other - Table 52‐2 *** Men’s risk factors • High estrogen levels - male with BRCA mutation • Obesity d/t higher level of estrogen • Teach breast self‐exam for early diagnosis!
what are the most common sxs for breast cancer?
• New lump or mass • Nontender lump • 50% in upper outer quadrant of breast - close to lymph so can go into blood stream • Nipple changes OR • Tender, soft, or rounded lump
what are the uncommon sxs for breast cancer?
- Swelling of all or part of breast OR arm (lymphedema)
- Skin irritation or dimpling
- Breast or nipple pain
- Nipple retraction (turning inward)
- Redness, scalyness, thickening of nipple or skin
- Nipple discharge (other than breast milk)
what are the diagnostic tests used for breast cancer?
• radiologic • biopsy • axillary lymph node status • initial detection vs monitoring • Tumor size • HER2 marker • Hormone receptor status - Estrogen - Progesterone • Cell proliferative indices • Cancer markers - Diagnosis and monitoring • DNA testing • Genomic assay
what are the radiologic tests done for BC?
- mammography (at 40; BRCA/hx at 25)
- MRI
- US
- PET scan (gold standard)
what does a BC tissue biopsy consist of?
- grading and staging
- tissue specimen tests for type of cancer
what does axillary lymph node status consist of?
- lymphatic mapping
- sentinel node dissection (the main node - most concentration of cancer)
- *tissue that has estrogen/progest. receptors have greater risk
what is triple negative breast cancer?
don’t have HER2 marker, estrogen or progesterone; so it’s harder to tx
what is differentiation in breast cancer?
the extent to which cancerous cells resemble normal cells
how are tumors graded?
graded for how closely they resemble parent tissue
- grades 1 (better) to 3 (worse)
what is TNM staging based on?
- 0 - 4 stages
- based on tumor size, node involvement, and metastasis
what are the complications of differentiation?
- recurrence in local, regional, or distant sites
what are the different tx for BC?
- meds
- surgery
- radiation
- pt education
- mastectomy post op care
what are the meds used for BC?
- chemo (may have after surgery to clean up)
- hormone therapy - Tamoxifen
- biologic and targeted therapy - Herceptin
- bisphosphonates - new adjuvant tx?
TEST: how does tamoxifen work?
its a estrogen receptor blocker
- estrogen helps produce breast tissue
- slows the process down
what surgeries are used as tx for BC?
**primary tx** ◦ Lumpectomy ◦ Mastectomy -Radical vs modified radical ◦ Prophylactic ◦ Lymph node dissection
TEST: what is the difference between a radical mast and a modified radical mast?
radial mast: whole breast, lymph and pectoral
modified: whole breast and lymph (NO pec)
what is the pt education for BC tx?
- tx plan (monitoring and follow up)
- psychosocial issues
- body/sexual image
- health promotion
what is the post op care for mastectomies?
- TEST site and arm care (prevent infection or lymphedema - no BP/IV blood draw on side - ues to arm on pillow and ROM exercises)
- physical mobility - may have limited ROM on affected side
- general post - op care TCDB
- pain management
- emotional support
- reconstructive surgery
what is cervical cancer?
normal cells progress from dysplastic to cancerous
what are the causes of cervical cancer?
- injury to cervix
- HPV virus (gardasil vaccine)
- *genetic link, mother/baby transmission
what are the sxs of cervical cancer?
- Initially asymptomatic
- Bleeding between periods
- Pain
- Weight loss
what are the diagnostics for cervical cancer?
- pap test
- biopsy or colposcopy
what are the characteristics of tx for cervical cancer?
- Up to 80% of dysplasia resoles spontaneously
- Cryotherapy can destroy abnormal tissue before it
becomes cancerous - Vaccines can prevent 70% of cervical cancer
what is the tx for invasive cervical cancer?
- Conization - cut ouot a cone shape of the cervix
- Surgery – hysterectomy
- Radiation
- Chemotherapy
- Laser
what is endometrial cancer?
cancer of the lining of uterus
**the most common female cancer
what are risk factors of endometrial cancer?
- Estrogen - long exposure
- Smoking
- Age
- Obesity
- Diabetes
- Familial history
- Late menopause or nulliparity
what are the sxs of endometrial cancer?
- abnormal uterine bleeding
- pain
what are the diagnostic tests for endometrial cancer?
CA 125
Pelvic exam
Transvaginal ultrasound
Endometrial hysteroscopy+ biopsy
what is the CA 125 gene?
antigen in blood with cancer; used for monitoring tx; precursor test for early sxs and for women with risk factors; used for women over 65
what is the tx for endometrial cancer?
- Hysterectomy with bilateral salpingo‐oophorectomy with
lymph node biopsies - Radiation
- Chemo
what is the post op care for a pt who had a hysterectomy?
Know which surgery pt had!! ◦ Abdominal ‐ abd dressing ◦ Vaginal – perineal pad ◦ How much was removed - Monitor urine output! - Regular post operative care - Grief response – body image - Pt education
what is the pt education for hysterectomies?
- bathing, no bath for vaginal
- pain
- stools (possible constipation)
- sexuality, depression (changes in libido common, may different about body; support group)
what is ovarian cancer?
Malignant tumor of the ovary
• (Ovarian cysts are benign tumors)
what are the risk factors for ovarian cancer?
- Family history highest risk
- Usually age over 40
- Nulliparity, infertility, heavy menses, HRT
- BRCA 1, 2 tumor suppressive gene mutations
- High fat diet
- Personal history of ovarian, breast, colorectal, or endometrial cancer
what are the characteristics of ovarian cancer?
- Poor survival
- Many types
- Historically a late diagnosis
• Potential for earlier dx with CA 125 - Intraperitoneal dissemination
• Uterus
• Bladder
• Bowel
• Omentum
• Other
what is BEAT?
Bloating Eating less and feeling fuller Abdominal pain Trouble with bladder **main sxs of ovarian cancer
what are the other sxs of ovarian cancer?
- Fluid accumulation‐enlarged abdomen
- Pelvic or abdominal pain
- Gas, indigestion, pressure, bloating, cramps
what are the late sxs of ovarian cancer
- Increased abdominal girth
- Pain
- Menstrual irregularities
- Ascites
how is ovarian cancer diagnosed?
New study shows CA 125 can screen for disease!!
• Lab test ‐ CA 125 level‐ cancer antigen 125
• Abdominal and transvaginal ultrasound
• Pelvic examination‐bimanual
• CT, MRI
• BRCA 1,2
• Tumor biopsy for staging – treatment determinant
• Laparotomy (diagnostic staging)
Test: treatment for ovarian cancer relies on _______ and ______ for staging
tumor biopsy and BRCA1-2 testing
what is the tx for ovarian cancer?
- Surgery
• Prophylactic oophorectomy for high risk
• TAH with BSO with omentectomy and tumor debulking
• Staging of tumor - Chemotherapy – intraperitoneal and systemic
- Radiation – intraperitoneal and external
- Palliative
• Various comfort treatments for metastatic disease
what is menopause?
physiologic cessation of menses • Considered complete at 1 year since menses • Gradual process • Can occur suddenly after hysterectomy/oopherectomy • vaginal tissue atrophy; dryness; can tear
what are the sxs of the perimenopausal stage?
- Irregular menses
- Vasomotor instability
“Hot Flashes” - Atrophy of genitourinary tissues
- Stress/urge incontinence
- Mood changes‐depression,
irritability, cognition - Osteoporosis
what are the sxs of the post menopausal stage?
- Cessation of menses
- Vasomotor symptoms
- Atrophy of genitourinary tissue
- Stress/urge incontinence
- Breast tenderness
what is important to know regarding menopause?
determine if it really is menopause
- long distance runner?
- large weight loss?
what are tx for menopause?
- lifestyle changes
- HRT for symptom relief
- complimentary /alt therapy
- black cohosh and soy*** test
what are the lifestyle changes for menopause?
- Avoid heat producing environment & food
- Wear loose clothes and light bedclothes
- Limit caffeine, alcohol
- Meditation and exercise help some
- Good nutrition
what is the difference between rectocele and cystocele?
RECTOCELE OR CYSTOCELE: RECTUM PUSHES THROUGH VAGINAL WALL; BLADDER HAS COME DOWN AND PUSHES INTO VAGINAL OPENING; “feels like I’m sitting on an egg”
