Cyndi - Week 9 - Exam 4 Flashcards
1
Q
what are the different cultural and ethnic disparities for women’s health?
A
- Access differences
- Insurance
- Money
- Quality of care
- Health knowledge/advocacy
- *Caucasian highest incidence - Hispanic/African American women increased death d/t Poverty level**
2
Q
what are the different types of breast cancer? (4)
A
• 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
3
Q
what are the risk factors for breast cancer?
A
• 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!
4
Q
what are the most common sxs for breast cancer?
A
• 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
5
Q
what are the uncommon sxs for breast cancer?
A
- 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)
6
Q
what are the diagnostic tests used for breast cancer?
A
• 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
7
Q
what are the radiologic tests done for BC?
A
- mammography (at 40; BRCA/hx at 25)
- MRI
- US
- PET scan (gold standard)
8
Q
what does a BC tissue biopsy consist of?
A
- grading and staging
- tissue specimen tests for type of cancer
9
Q
what does axillary lymph node status consist of?
A
- lymphatic mapping
- sentinel node dissection (the main node - most concentration of cancer)
- *tissue that has estrogen/progest. receptors have greater risk
10
Q
what is triple negative breast cancer?
A
don’t have HER2 marker, estrogen or progesterone; so it’s harder to tx
11
Q
what is differentiation in breast cancer?
A
the extent to which cancerous cells resemble normal cells
12
Q
how are tumors graded?
A
graded for how closely they resemble parent tissue
- grades 1 (better) to 3 (worse)
13
Q
what is TNM staging based on?
A
- 0 - 4 stages
- based on tumor size, node involvement, and metastasis
14
Q
what are the complications of differentiation?
A
- recurrence in local, regional, or distant sites
15
Q
what are the different tx for BC?
A
- meds
- surgery
- radiation
- pt education
- mastectomy post op care
16
Q
what are the meds used for BC?
A
- chemo (may have after surgery to clean up)
- hormone therapy - Tamoxifen
- biologic and targeted therapy - Herceptin
- bisphosphonates - new adjuvant tx?
17
Q
TEST: how does tamoxifen work?
A
its a estrogen receptor blocker
- estrogen helps produce breast tissue
- slows the process down
18
Q
what surgeries are used as tx for BC?
A
**primary tx** ◦ Lumpectomy ◦ Mastectomy -Radical vs modified radical ◦ Prophylactic ◦ Lymph node dissection
19
Q
TEST: what is the difference between a radical mast and a modified radical mast?
A
radial mast: whole breast, lymph and pectoral
modified: whole breast and lymph (NO pec)
20
Q
what is the pt education for BC tx?
A
- tx plan (monitoring and follow up)
- psychosocial issues
- body/sexual image
- health promotion
21
Q
what is the post op care for mastectomies?
A
- 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
22
Q
what is cervical cancer?
A
normal cells progress from dysplastic to cancerous
23
Q
what are the causes of cervical cancer?
A
- injury to cervix
- HPV virus (gardasil vaccine)
- *genetic link, mother/baby transmission
24
Q
what are the sxs of cervical cancer?
A
- Initially asymptomatic
- Bleeding between periods
- Pain
- Weight loss
25
what are the diagnostics for cervical cancer?
- pap test
| - biopsy or colposcopy
26
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
27
what is the tx for invasive cervical cancer?
* Conization - cut ouot a cone shape of the cervix
* Surgery – hysterectomy
* Radiation
* Chemotherapy
* Laser
28
what is endometrial cancer?
cancer of the lining of uterus
| **the most common female cancer
29
what are risk factors of endometrial cancer?
* Estrogen - long exposure
* Smoking
* Age
* Obesity
* Diabetes
* Familial history
* Late menopause or nulliparity
30
what are the sxs of endometrial cancer?
- abnormal uterine bleeding
| - pain
31
what are the diagnostic tests for endometrial cancer?
CA 125
Pelvic exam
Transvaginal ultrasound
Endometrial hysteroscopy+ biopsy
32
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
33
what is the tx for endometrial cancer?
- Hysterectomy with bilateral salpingo‐oophorectomy with
lymph node biopsies
- Radiation
- Chemo
34
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
```
35
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)
36
what is ovarian cancer?
Malignant tumor of the ovary
| • (Ovarian cysts are benign tumors)
37
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
38
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
39
what is BEAT?
```
Bloating
Eating less and feeling fuller
Abdominal pain
Trouble with bladder
**main sxs of ovarian cancer
```
40
what are the other sxs of ovarian cancer?
* Fluid accumulation‐enlarged abdomen
* Pelvic or abdominal pain
* Gas, indigestion, pressure, bloating, cramps
41
what are the late sxs of ovarian cancer
* Increased abdominal girth
* Pain
* Menstrual irregularities
* Ascites
42
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)
43
Test: treatment for ovarian cancer relies on _______ and ______ for staging
tumor biopsy and BRCA1-2 testing
44
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
45
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
```
46
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
47
what are the sxs of the post menopausal stage?
- Cessation of menses
- Vasomotor symptoms
- Atrophy of genitourinary tissue
- Stress/urge incontinence
- Breast tenderness
48
what is important to know regarding menopause?
determine if it really is menopause
- long distance runner?
- large weight loss?
49
what are tx for menopause?
- lifestyle changes
- HRT for symptom relief
- complimentary /alt therapy
* black cohosh and soy*** test
50
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
51
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"
