Female Malignancies Flashcards
Causes of Female Reproductive Cancers
- DNA damage/mutation (hereditary).
- Environmental factors.
- Hormonal factors
- Failure of apoptosis
Cervical Cancer
Most common cause of Cervical Cancer
Human Papilloma Virus (HPV)
Q: What are the risk factors for cervical cancer?
List 11
- HPV infection (most common cause)
- HIV infection / Immunosuppression
- Smoking
- Obesity
- Prolonged oral contraceptive use
- Family history of cervical cancer
- Multiparous (multiple pregnancies)
- Early childbearing
- First sexual intercourse < age 20
- Multiple sexual partners
- Lack of regular Pap smear screening
What is a pap smear?
screening procedure used to check for abnormal cells in the cervix that may lead to cervical cancer.
AKA: papanicolaou (pap) smear
When should women have their first pap smear
A: Age 21
Women between the ages of 21-29 should get a pap smear every ___
3 years
Women between the ages of 30-65 should get a pap smear every ___
5 years + HPV testing
Women ages >65 can STOP pap smears if:
- Normal results with regular screenings
Women >65 should continue pap smears if:
- If a history of cervical cancer or precancerous lesions
- Screen 20 more years, even if they are over age 65.
What are the initial symptoms of cervical cancer ?
- No obvious symptoms
- Watery, thin vaginal discharge (often goes unnoticed)
- Painless vaginal bleeding (postmenstrual or post-coital (after sex))
Regular screenings (Pap smears) are important because early cervical cancer often shows no symptoms
What are signs of MORE advanced cervical cancer?
- Abnormal vaginal discharge with a foul odor
- Pelvic pain (especially during intercourse)
Dx Test for Cervical Cancer
- HPV Test: Done 1st, + test increses risk of cancer
- Pap Smear: Checks cervical cells for abnormality
- Colposcopy: Light magnification too visualize abnormal cervix. Done after Pap smear indicataes cancerous cells
- MRI, PET Scan, Barium Enema: used for staging.
Cervical Cancer Staging
- Stage I: Confined to cervix.
- Stage II: Beyond cervix but not to pelvic wall.
- Stage III: Pelvic wall/vagina involvement.
- Stage IV: Spread to bladder, rectum, or distant organs.
Medical Management:
LEEP (Loop Electrosurgical Excision Procedure)
- Thin wire loop with laser removes abnormal cells
- Outpatient, local anesthetic
Test done PRIOR to LEEP procedure
Pregnancy test
Patient Teaching for LEEP
- No douching, creams, or intercourse 24-48 hours before.
- Mild cramping for a few days.
- Discharge 1-3 weeks normal- due to meds.
- Avoid heavy activity/intercourse for 48 hours after.
- Report heavy bleeding, extreme pain, fever >100.8°F.
Medical Management:
Laser Therapy
A laser used to ablate precancerous tissue
Pt teaching for Laser Therapy
- Does not impact fertility.
- Some mild cramping normal.
- Contact HCP for increased pain, bleeding, fever
Medical Management:
Conization
able to remove ‘cone shaped’ areas of cancerous tissue
Q: Why is conization preferred over a hysterectomy for some patients?
Preserves fertility – Often chosen if the woman wants to have children.
Patient teaching for Conization
- Same as with LEEP
- Risks include: hemorrhage, uterine perforation, pre-term labor if pregnant
Medical Procedure:
Removal of female reproductive organs done laparoscopic or abdominally.
List 2 types of procedures that can be done this way.
Partial Hysterectomy OR Radical Hysterectomy
What treatments are considered for Stage II cervical cancer and beyond?
- Chemotherapy
- External radiation
- Internal radiation (Brachytherapy)
Surgical removal of ORGANS in the pelvic cavity for late-stage cervical cancer or recurrence.
pelvic exenteration
-includes: bladder, rectum, & reproductive organs
Cervical Cancer Treatment:
- Form of internal radiation therapy (Brachytherapy)
- Applicators inserted into the endometrial cavity and vagina
- Radiation source loaded remotely once pt in room.
Intracavitary Radiation
How long is the Intracavitary Radiation treatment?
24-72 hrs (high dose)
What nursing interventions are required for Intracavitary Radiation treatment?
- Foley catheter inserted to keep bladder empty
- Vaginal packing to hold applicators in place and protect bladder/rectum
- Administer enema: prevent straining
- Assess Pain & administer analgesia
- Bedrest/Private room required
Pts with Intracavitary radiation should have HOB ___
< 20 degrees.
Precautions for Intracavitary radiation
- Minimize exposure to radiation:
-Stand at foot of bed or doorway when possible. - Wear dosimeter
- Visitors (if allowed) must stand at least 6 feet away
- Limit visits to 3 hrs.
Intracavitary radiation:
Q: What should you do if the applicator or implant becomes dislodged?
- DO NOT TOUCH IT WITH BARE HANDS!
- Use long-handled forceps & lead container (per facility policy).
- Call radiation safety officer immediately.
Malignancy called “silent killer”
Ovarian Cancer
Risk Factors for Ovarian Cancer
o BRCA-1, BRCA-2 mutations.
o Age 55-65
o Family history- 1st degree relative
o Breast/colon cancer history.
o Nulliparity
* use of infertility drugs (HRT >10yrs)
o Late Menopause (>55)
o Early menarche (<12)
o Obesity, high-fat diet.
Late signs of Ovarian Cancer
List 3
- Abdominal & back pain
- Abdominal swelling
- Lower extremity pain
Early signs of Ovarian Cancer
List 5
- Bloating
- constipation
- indigestion
- urinary urgency
- irregular menses.
-Symptoms dont go away
-tumors press on surrounding intestines
Dx test for Ovarian Cancer
List 5
- No Screening Test Exists!!
- Pelvic Exam (late stages reveal mass)
- Confirmation with: Transvaginal, pelvic, Ultrasound, CT/MRI.
- Genetic Testing: guides therapy
- Surgery
Ovarian Cancer Staging
- I: Confined to ovaries.
- II: cancer in ovarie(s), spread to pelvic organs but contained in pelvic region.
- III: Cancer in ovarie(s), spread beyond pelvis to abdomen lining or spread to lymph nodes.
- IV: Most advanced; Distant metastasis (liver lungs, other organs)
The only treatment for Ovarian Cancer
Hysterectomy + Bilateral Salpingo-Oophorectomy (BSO).
Hysterectomy + BSO = Removal of:
* Uterus (hysterectomy)
* Both fallopian tubes (biltateral salpingo)
* Both ovaries (oophorectomy)
Nursing Care Ovarian Cancer
-
Pre/Post-op:
-Pain: gabapentin, baclofen
-hemodynamics: hemorrhage is important
-drain monitoring
-electrolytes: K+, Na+ (yachycardia starts to occur) - Diuretics, Antiemetic
- Electrolyte monitoring and replacement
- Nutrition: Small, frequent meals; high protein; fluid restrictions if ascites.
- Psychological Support:
What is “Endometrium”
The lining of the Uterus
Endometrial Cancer:
Average age of onset
61 - AFTER menopause
Risk factors for Endometrial Cancer
o Unopposed estrogen (Hormone replacement therapy (estrogen only) without progesterone).
o Obesity (adipose tissue stores estrogen
o Diabetes.
o Nulliparity (never had pregnancy).
o Late menopause (>55).
o Early menarche (<12).
o Pelvic radiation history.
o PCOS, uterine fibroids.
Early signs of Endometrial Cancer
- Vague complaints of : intermittent bloating, nausea, fatigue
- Painless vaginal spotting AFTER meenopause
Late signs of Endometrial Cancer
- Low back, pelvic or abdominal pain during urination &/or intercourse
- Enlarged Uterus causes more persistent bloating and GI complaints
Is postmenopausal vaginal bleeding normal?
No, its never normal and should always be investigated.
Dx Studies for Endometrial cancer
- Pelvic Exam, Pap Test.
- Transvaginal Ultrasound.
- Endometrial Biopsy.
- Estrogen/Progesterone Receptor Markers.
What are the 2 types of Endometrial Cancer?
- Type 1 (Estrogen-Dependent)
- Type 2 (Estrogen-Independent)
Endometrial Cancer Staging
- I: Uterus only.
- II: Spread to Cervix.
- III: Spread to lymph nodes/ovaries, vagina, fallopian tubes- has NOT spread to bladder, rectum or outside pelvis.
- IV: Spread to distant organs.
Which Endometrial Cancer Type is this?
- Not estrogen-related
- aggressive
- worse prognosis
Type 2
Which Endometrial Cancer Type is this?
- Estrogen-related
- slower
- better prognosis
TYPE 1
Primary treatment for Endometrial Cancer
Total hysterectomy & bilateral salpingo-oophorectomy with lymph node biopsies
What are SECONDARY treatments for Endometrial Cancer?
-
Radiation Therapy:
-External Beam: Pelvis/Abdomen
-Intravaginal Brachytherapy: Prevents local recurrence -
Hormone Therapy
-Medroxyprogesterone (Depo-Provera)
-Megestrol Acetate (Megace)
-Tamoxifen (Nolvadex) -
Chemotherapy (Advanced Disease):
-Carboplatin
-Cisplatin
-Paclitaxel (Taxol) (Same as Ovarian & Cervical)
Any vaginal spotting or bleeding must be ____ to a healthcare provider immediately.
reported
What reduces Vulvar Cancer
- HPV vaccine
S/S of vulvar cancer
- Pruritus
- soreness (most common)
- Bleeding
- dysuria
- discharge- foul smell
- pain- late disease
Q: What are the key PRE-operative nursing actions before a hysterectomy?
- Consent Signed?
- Pregnancy test negative?
- Patient Teaching on what comes next?
- Psychosocial Support
- Monitor Vitals, Circulation & Respiratory Status
- Administer Pain Meds/Prophylactic Antibiotics
-
Ensure that NSAIDS, anticoagulant, Vit E were stopped per MD Order.
-Vit E can be a blood thinner - Ensure standard pre-op prep for a hysterectomy completed (douche, enema, and a foley)
Post-Op teaching for Vulvectomy
- Pain control: extensive invision/location make pain control a challenge
- Skin integrity/Wound vac
- Infx control
- Drain management
- Risks: DVT, dehydration, anxiety, wound, dehiscence
Q: What are the key POSToperative nursing interventions after a HYSTERECTOMY?
1. Monitor:
-Vitals, Circulation, Respiratory Status
-I & O (Monitor Foley output, assess for bladder atony)
2. Mobility:
-ROM, Early Ambulation
-SCDs, TEDs, Incentive Spirometer → Prevent DVT & Atelectasis
3. Pain Management:
-Administer analgesics as ordered.
4. Incision/Dressing:
-Abdominal/Perineal Dressing
-Serosanguineous Drainage Expected
-Monitor for Excessive Bleeding (Saturation, Clots)
5. Bladder Function:
-Foley Catheter: Typically left 1-2 days
-Monitor for Atony: In-out cath may be needed if urine retention occurs after removal.
-Monitor I&Os: need to make sure pts making urine.
What does cancer do to blood?
hypercoagulates (increases clots)
Post-Operative complications with HYSTERECTOMY
- Ureter ligation-Accidental occlusion of ureter intra-op
- Latrogenic hemorrhage: hemorrhage caused by medical treatment or intervention.
- DVT/PE-sedentary and cancer creates hypercoagulability
- Infection
Q: What are signs of accidental ureter ligation?
- Low to zero urine output
- New-onset back pain refractory to treatment.
Q: What should the nurse do if ureter ligation is suspected?
A: Perform a bladder scan and report immediately to the surgeon.
Q: What are signs of post-op hemorrhage?
A: Tachycardia & hypotension → Indicate blood loss.
Q: What are the nursing interventions for hemorrhage?
- Report to the surgeon
- prepare for OR
- monitor Serial H&H
- telemetry
- administer blood products.
Q: Why is a patient post-hysterectomy at risk for DVT/PE?
A: Sedentary state & cancer increase hypercoagulability.
Q: What are signs of DVT/PE?
- Leg pain/swelling (DVT)
- sudden increased oxygen requirement (PE).
Q: What are the nursing interventions for suspected PE?
- Encourage Incentive Spirometry (I/S)
- Report immediately
- apply supplemental O2.
Signs of Infection
- increased WBC
- Fever
- tachycardia.
Q: How can the nurse help prevent infection?
- Aseptic technique
- early ambulation
- SCDs
- prophylactic antibiotics.
Post hysterectomy, patient should avoid
- Intercourse: 4-6 weeks or until fully healed.
- Heavy lifting: at least 2 months.
- Strenous activity: at least 2 months.
