W - Gynaecology

Question 1

Breast cancer - Nursing Process

Whats breast cancer?

Answer 1

uncontrolled growth of epithelial cells within the breast tissue

most breast cancers are adenocarcinomas originating from the ducts or lobules, and can be categorized by whether or not they have invaded surrounding tissue.

Non-invasive, also called in situ, breast cancers are confined to the ducts, called ductal carcinoma in situ, or DCIS for short, or lobules, called lobular carcinoma in situ, or LCIS for short.

Some non-invasive breast cancers can become invasive breast cancers, which infiltrate the basement membrane and spread to surrounding tissue where they can reach the blood and lymphatic vessels, ultimately leading to metastasis.

The most common invasive breast cancers include invasive ductal carcinoma, which starts from the ducts, and invasive lobular carcinoma, which starts from the lobules.

Question 2

Risk factors of breast cancer? (12)

Answer 2

1. age over 50
2. family history of breast / ovarian cancer
3. hereditary genetic mutations in tumor suppressor genes
   - like BRCA1, BRCA2, and less frequently TP53 or CHEK2 -> controls cell proliferation
4. increased estrogen exposure like nulliparity,
5. first pregnancy after 30,
6. early menarche period <12yrs old,
   - affects level of estrogen in the body -> development and regulation of the female reproductive system.
   - High levels of estrogen increase risk of breast cancer.
7. late menopause > 55
   - hormones play an active role
8. No breastfeeding,
9. obesity
10. smoking, heavy alcohol consumption
11. exposure to radiation
12. Caucasian

Question 3

Symptoms of breast cancer?

Answer 3

1. hard, irregular, fixed painless lump or swelling, most often located in the upper outer quadrant of the breast.
2. Skin reddened, swollen, warm to touch, or ulceration. If the cancer cells obstruct the lymphatics, they can cause swelling and thickened skin around exaggerated hair follicles, giving the skin the appearance of an orange peel

Paget disease
- cancer cells migrate along the lactiferous duct and through the pore, onto the skin over the nipple,
- cause itching, redness, crusting,
- clear or bloody discharge from nipple.

If not promptly treated, breast cancer can lead to complications like metastasis. Metastases often occur through the axillary lymph nodes, so clients may present with swelling and palpable nodes under the armpit.

Other common sites for metastasis include bones, lungs, brain, and liver. Unfortunately, most cases of metastatic breast cancer can’t be cured, so they eventually lead to death.

Question 4

How to diagnose breast cancer? (5)

Answer 4

1. history and physical examination
2. mammogram
   - uses X-ray images to detect abnormalities in breast tissue
   - can detect cancer early
3. ultrasound and MRI
   - detect tumor detect nodules or masses in the breast using magnets and radio waves to produce images of structures.
   - determine TNM = tumor size, nodal involvement, & metastasis.
4. biopsy of suspicious tissues or lymph nodes
   - microscopically looking at cells to identify if a mass is cancerous or not
   - confirm the diagnosis & testing for the expression of hormone receptors: like estrogen and progesterone receptors
   - human epidermal growth factor 2 or HER2 receptors.
5. According to American Cancer Society guidelines, females aged 45 -54 yrs of age do mammography every year!!!

Question 5

Treatment of breast cancer? (5)

Answer 5

• based on the type and TNM stage

1. Surgery
   - depending on size, non-invasive tumors are removed surgically by lumpectomy, or partial or total mastectomy.
   - nearby structures like lymph nodes may also be removed if the cancer has metastasized there
2. followed by radiotherapy & systemic therapy with chemotherapy or immunotherapy.
3. hormonal therapy with tamoxifen, exemestane, or an aromatase inhibitor,
   - if positive for ER or PR & targeted therapy with trastuzumab for HER2 positive clients.
4. most cases of metastatic breast cancer can’t be cured
   - benefit from local or systemic therapy
   - supportive care
   - help prevent or treat symptoms

Question 11

Uterus (lect notes on canvas)

Question 15

Cervical cancer:
Whats CC?

Answer 15

malignant tumor that originates in the cervix

Question 16

Signs & symptoms for early and metastatic cervical cancer? (8)

Answer 16

1. Early cervical cancer doesn’t typically cause any symptoms
2. painless vaginal bleeding, especially after sexual intercourse
3. menorrhagia or abnormally heavy or prolonged menstrual periods
4. spotting between periods,
   foul-smelling vaginal discharge,
5. vaginal discomfort, &
   dyspareunia/painful intercourse

For metastatic cancer that has spread beyond the cervix:
6. pelvic pain, constipation
7. frequent, painful, or bloody urination
8. weight loss.

Question 17

Causes & risk factors of cervical cancer (8)?

Answer 17

• Most cervical cancers are caused by human papillomavirus / HPV
• high-risk HPV strains such as 16 and 18 are responsible for more than half of all cervical cancers

Risk factors:
- unprotected sex
- multiple sexual partners
- early age at first sexual intercourse
- smoking
- compromised immune system
- obesity
- long-term use of oral contraceptive pills
- family history of cervical cancer

Question 18

How to diagnose cervical cancer? (5)

Answer 18

1. screening with HPV DNA testing
2. Pap smear
   - sample of cells from the transformation zone examined under a microscope
   - evidence of abnormal cell changes like dysplasia
3. will be followed up with colposcopy
   - magnifying device used to examine the cervix -> obtain biopsies to confirm the diagnosis.
4. CT scan or MRI & endoscopic tests like cystoscopy or rectosigmoidoscopy,
   - look for metastasis
5. Once diagnosis is confirmed
   - cervical cancer can be staged using the FIGO system

Question 19

Treatment for cervical cancer? (5)

Answer 19

• depends on aggressiveness and extension of tumor

1. Precancerous lesions can be destroyed with:
   - cryosurgery (liquid nitrogen)
   - laser surgery
2. Small, localized tumors:
   - conization = transformation zone and part of the endocervix are removed surgically
   - using a scalpel / cold-knife conization
   - or heating a loop of thin wire with electricity, = loop electrosurgical excision procedure LEEP
3. treatment of larger tumors
   - hysterectomy
   - surgical removal of the uterus
   - removal of associated lymph nodes
4. For metastatic cancer
   - extensive surgeries, with chemotherapy and radiotherapy.
5. most effective way to prevent cervical cancer: HPV vaccination & regular screening.

Question 20

Nursing care for patient with cervical cancer?

Answer 20

1. pain assessment
   - onset, quality, severity, location, aggravating or relieving factors
   - how frequently they experience pain.
2. assist into comfortable position
   - provide comfort measures,
   - administer analgesics as prescribed
   - if pain is unrelieved with medication, report to HCP

after a hysterectomy:
- implement routine post-operative interventions
- monitor closely for complications related to procedure
- radical hysterectomy: nerves supplying the bladder and rectum could be disrupted.

chemoradiotherapy
- administer prescribed chemotherapy medications, assess for side effects, and intervene as needed.
- If external beam radiation/EBRT is used, assess your client for radiation-induced skin changes, and report worsening skin integrity to the radiation oncologist.

Assess for common side effects of pelvic radiation:
- fatigue, nausea, and impaired bowel and bladder function
- ask your client about any impacts to their sexual health, such as dyspareunia, which could be the result of vaginal stenosis.

• ensure your client has referral for oncology radiation nurse to coordinate their care needs during the course of treatment.
• assess their psychosocial status and anxiety level regularly
• actively listen to concerns regarding issues like loss of independence, body image changes, infertility, and fear of death
• provide emotional support & promote coping strategies
• refer client to support resources as needed.

Question 21

Client & fam teaching for cervical cancer?

Answer 21

1. provide information about disease process, available treatments, and plan of care.
2. Emphasize importance of hydration and maintaining optimal nutrition during treatment
3. encourage client to work with the registered dietitian to help them develop an individualized plan to get the calories, protein and nutrients they need.

Teach them to manage symptoms like nausea and vomiting
- take antiemetics
- eating smaller, more frequent meals + slowly
- contact their HCP if vomiting prevents them from keeping food, drinks, or medicines in their stomach.

• Give suggestions to help them manage pain and fatigue
• take their prescribed analgesics, as directed, and plan their daily activities so they can space tasks that take a lot of energy throughout the day.
• take rest periods between tasks as needed, and to get enough sleep each night
• contact their HCP if amount of fatigue or pain they are experiencing prevents them from doing ADLs

Radiotherapy patients:
- use unscented soaps when bathing
- gently cleanse affected areas of the skin
- pat area dry without rubbing
- apply prescribed moisturizers.

If your client has also had a hysterectomy, teach them how to care for their incision site. Explain that a small amount of drainage is normal, but they should contact their healthcare provider if there’s redness, swelling, bleeding, bad-smelling drainage, or increased pain around their surgical incisions.

In addition, remind your client that surgery and radiation can cause problems with their bowel and bladder function, so stress the importance of contacting their healthcare provider if they experience urinary or fecal urgency, diarrhea, or constipation; as well as symptoms of a urinary tract infection, such as pain or burning during urination, or if they notice blood in the urine.

Finally, provide your client with resources for local support groups, and reassure them that there are additional resources available to them, including home health care, nutrition counseling, physical therapy, and psychosocial care.