Reproductive: Male and Female

Question 1

What are important nursing considerations after breast biopsy (specific to type of biopsy done if possible)

Answer 1

Avoid NSAID’s afterwards (to prevent bleeding) except for fine-needle aspiration biopsy (FNAB)
Wear sports bra/tight bra 24hr for 2 weeks after biopsy
Continue with yearly mammograms after biopsy
Avoid strenuous activity/heavy lifting after biopsy for 2 weeks (ABBI and surgical biopsies)

Question 2

3 main risk factors (non-modifiable) for prostate cancer

Answer 2

African-American
Family history
> 65 years

Question 3

Modifiable risk factors for prostate cancer

Answer 3

diet high in red meat and low in fruits/vegetables
diet low in selenium, vitamin D, E. lycopene
exposure to cadmium

Question 4

Differentiate between early and late signs and symptoms of prostate cancer

Answer 4

Early: asymptomatic because cancer usually in peripheral zone of prostate
As tumor grows, may have similar manifestations as BPH: urinary frequency, urgency, decreased strength of stream, incomplete emptying, straining to urinate, PLUS blood in urine or ejaculate, and pain in hips, back if mets

Question 5

Screening for prostate cancer

Answer 5

DRE + PSA annually after 50 yrs old

both important because DRE may not find tumor and PSA levels may indicate more accurately

Question 6

Normal PSA levels and levels of risk

Answer 6

Normal = 0-4 ng/mL
15% risk if under 4 ng/mL
25% risk if 4-10 ng/mL
50% risk if > 10 ng/mL

Question 7

There is a positive link between BPH and prostate cancer: true or false?

Answer 7

False

Question 8

High PSA level is always an indicator of prostate cancer

Answer 8

False: PSA level may be elevated with prostatitis or BPH

Question 9

Explain the percent free PSA test and how it compares in patients with or without prostate cancer

Answer 9

Percent free PSA test compares free PSA (in blood) with total PSA
Men WITH prostate cancer will have lower percent of free PSA (because more is at prostate (?)

Question 10

What is the only reliable/definitive diagnosis for prostate cancer

Answer 10

Biopsy with transrectal ultrasound

Question 11

Explain the staging system for prostate cancer

Answer 11

1-4

1: microscopic
2: prostate only
3: spread beyond capsule of prostate
4: spread to local organs and possible distant mets

Question 12

Explain the grading for prostate cancer

Answer 12

Gleason scale (1-5) taken twice –> total score 2-10
2 indicates well differentiated cells
10 indicates poorly/undifferentiated cells

Question 13

What factors are considered when choosing treatment for a patient with prostate cancer?

Answer 13

life expectancy
presence of comorbidities
grade/stage of tumor

patients with >10 yrs life expectancy, no comorbidities, and low grade/stage of tumor will have more options: cryosurgery, TUPR, or prostatectomy

palliative patients may receive TUPR to relieve symptoms and chemotherapy for mets

Question 14

Explain the difference between alkaline phosphatase and acid phosphatase in relation to diagnostics for prostate cancer

Answer 14

Alkaline Phosphatase is a serum enzyme that is elevated in advanced prostate cancer, due to metastasis to bone
Acid Phosphatase: is a serum enzyme that is another indication of prostate cancer, expecially if there is extracapsular spread

Question 15

Explain the differences between radical prostatectomy that is done retropubic route vs. perineal route

Answer 15

Perineal prostatectomy incision is made between scrotum and anus - unable to remove regional lymph nodes
Retropubic prostatectomy: horizonal incision is made above pubic bone - able to remove lymph nodes

Question 16

What is the purpose of androgen deprivation therapy in prostate cancer?

Answer 16

Prostate cancer growth is dependent on the presence of androgens; therefore, androgen deprivation helps to reduce tumor growth so that it can be surgically removed easily

Question 17

What are the 2 major complications of radical prostatectomy?

Answer 17

Erectile dysfunction (ED)/impotence and incontinence

Question 18

Briefly describe the procedure and explain the rationale for cryosurgery in prostate cancer

Answer 18

Used as initial treatment and second-line treatment after radiation failures
TRUS probe to visualize prostate and probe inserted into prostate to freeze cancer cells with liquid nitrogen: no abdominal incision

Question 19

Briefly describe the procedure and explain the rationale for external beam radiation in prostate cancer

Answer 19

Most widely used method of delivery of radiation therapy
Outpatient basis 5d/wk for 6-8 weeks
Each treatment lasts a few minutes (because cumulative effects of radiation more effective and fewer side effects)

Question 20

Briefly describe the procedure and explain the rationale for brachytherapy in prostate cancer

Answer 20

Implantatin of radioactive seeds via TRUS - permanent or temporary and allows sparing of surrounding tissue
Used for patients that are not candidates for other apporaches, with localized disease, older patients, and those that refuse other treatments

Question 21

Briefly describe the procedure and explain the rationale for hormone therapy in prostate cancer

Answer 21

Includes androgen deprivation therapy, LHRH agonists, and orchiectomy
LHRH agonists suppress feedback with pituitary and testes to decrease testosterone
Orchiectomy removes both testes so testosterone suppressed
Decreased testosterone levels will help decrease size of prostate - hormone therapy is used in combination with radiation for locally advanced, advanced, or metastatic disease

Question 22

Briefly describe the procedure and explain the rationale for chemotherapy in prostate cancer

Answer 22

Chemotherapy is used palliatively for patients with metastases

Question 23

What are the clnical manifestations of BPH?

Answer 23

Decresed force of urine stream, abdominal straining, increased frequency, urgency, urinary retention, feeling of incomplete emptying of bladder

Question 24

What diagnostic tests indicate BPH?

Answer 24

DRE + symptoms of urethral obstruction

PSA and biopsy to rule out prostate cancer

Question 25

What drug therapy is commonly used to treat BPH?

Answer 25

Finasteride - may reduce PSA levels by 50% | Alpha 1 adrenergic receptor blockers (doxazosin, prazosin, terazosin) may decrease symptoms

Question 26

What are the most common surgical procedures to treat BPH?

Answer 26

Transurethral Prostate Resection | Abdominal approach to resection if extent of prostate enlargement is too much to treat trans-urethrally

Question 27

What are some risk factors for breast cancer?

Answer 27

Female, 50 years and older (especially post-menopausal) Family history Genetics especially with BRCA1 and BRCA2 gene mutations Personal hx of breast, colon, endometrial, ovarian cancers Early menarche and late menopause (55 yrs) First full-term pregnancy after age 30; nullparity Benign breast disorder Weight gain and obesity after menopause (because fat cells store estrogen) Exposure to radiation

Question 28

What is the gold standard for breast cancer treatment?

Answer 28

Surgical removal (lumpectomy/mastectomy), radiation, chemotherapy

Question 29

How is breast cancer diagnosed?

Answer 29

SBE or medical practitioner exam Mammography BIRADS (breast imaging reporting and data system): 0-2 benign 3-5 score must have follow-up: low, moderate, or high probability of being malignant 6 is know biopsy proven malignancy - done to assure treatment has been effective Biopsy

Question 30

What are some clinical manifestations of breast cancer?

Answer 30

Unilateral lump - often occurs in upper outer quadrant (high amounts of glandular tissue) Palpable lump is hard, irregularly shaped, poorly delineated, nonmobile, nontender May be nipple discharge or retraction

Question 31

Possible complications of cryotherapy for prostate cancer?

Answer 31

``` damage to the urethra urethrorectal fistula (urethra to rectum) - rare urethrocutaneous fistula (urethra to skin) - rare ```

Question 32

Side effects and complications of external beam radiation for prostate cancer?

Answer 32

``` Skin irritation (dryness, redness, pain), GIT disurbances (diarrhea**, abdominal cramping, bleeding) and genitourinary tract dysfunction (dysuria, frequency, hesitancy, urgency, nocturia, ED, sexual fatigue), and bone marrow suppression Risk for infection from skin breakdown; therefore teach patient to recognize s/s Low-residue diet to manage diarrhea Avoid alcohol, caffeine, spices, and smoking because it can irritate the bladder mucosa and aggravate urinary tract symptoms ```

Question 33

Explain the phrase "watchful waiting"

Answer 33

Frequent periodic monitoring of the patient (DRE and PSA) and not starting treatment unless symptoms progress or changes Suitable "treatment" for prostate cancer or BPH if short life expectancy, multiple medical problems, or clinically insignificant disease

Question 34

Possible complications of brachy therapy for prostate cancer

Answer 34

must adhere to radiation precautions, including restricting sexual activity for 2 weeks + condom use following those 2 weeks to catch lost seeds Perineal care because of discomfort from procedure Hematuria and semen that may be red, brown, or black from blood Rectal bleeding or irritation, gassy bowel movements or diarrhea --> contact physician immediately

Question 35

What are some complications of hormone therapy for prostate cancer?

Answer 35

``` Gynecomastia Breast tenderness Impotence Osteoporosis Hot flashes Fatigue Hepatic dysfunction Anemia (when LHRH agonists given with radiation therapy)) ```

Question 36

What are some common complications of chemotherapy for prostate cancer?

Answer 36

``` Bone marrow depression Fatigue Nausea and vomiting Hair loss Renal, liver, cardiac toxicity ```

Question 37

Describe and explain the rationale for radical prostatectomy

Answer 37

Candidates whuld be 70 or younger, without mets, and 10-20 years life expectancy Involves abdominal or perineal incision and complete removal of prostate, (regional lymph nodes - retropubic only), seminal vesicles, and part of the bladder neck

Question 38

Common complications of radical prostatectomy

Answer 38

``` Incontinence Impotence Urethral strictures Bladder neck contractures Post-op complications: DVT, PE, infection, bleeding, UTE, paralytic ileus ```

Question 39

Common complications of BPH?

Answer 39

Diverticula Urinary stasis Calculus development Thickening of bladder wall that may compress ureters --> backing up urine flow and causing kidney distention --> renal insufficiency

Question 40

What are the different mastectomies for breast cancer?

Answer 40

Lumpectomy (breast conservation sx): remove tumor + margin of normal tissue + radiation and/or chemo Modified radical mastectomy: removal of breast + axillary lymph nodes with preservation of pectoralis major muscle Radical mastectomy: remove breast + axillary lymph nodes, pectoralis muscles