W - Management of women with reproductive system cancer

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
• categorized by whether or not they have invaded surrounding tissue.

Question 2

Symptoms of breast cancer? (6)

Answer 2

Initial signs:
1. single, hard, non-tender (not pain), movable nodule

Advanced signs:
2. Fixed nodule
3, Skin dimpling, pulling
4. Nipple discharge, retraction or elevation
5. Change in breast contour
6. Enlarged axillary nodes

Question 3

How to screen & diagnose breast cancer? (4)

Answer 3

1. screening: mammogram
   - uses X-ray images to detect abnormalities in breast tissue
   - can detect cancer early
2. diagnostic test: biopsy of suspicious tissues or lymph nodes
   - microscopically looking at cells to identify if a mass is cancerous or not
   - confirm diagnosis
3. Monitor how well therapy is working: ultrasound, 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.
   - self breast exam
4. SCREENING
   - normal risk, asymptomatic women 50-69: mammography every 2 years.
   - 40-49 yrs mammography can go every year!!!
   - Normal risk, asymptomatic women under 40 years should not undergo breast screening

Question 4

Treatment of breast cancer? (4)

Answer 4

• main goals: cure or prolong life
  of patients and ensure the best possible QOL to cancer survivors.

1. Medications:
   - Chemotherapy; medications that kill or shrink growing cancer cells.
   - Hormonal therapy (e.g. anti-oestrogens, corticosteroids)
2. Surgery
   – Lumpectomy: remove a breast lump, early detection
   – Mastectomy: entire breast simple, modified radical, radical
   – Oophorectomy: one or both ovaries
   - adrenalectomy: one or both adrenal glands, located above the kidneys.
   - reduce hormone levels that fuel cancer growth
   - in patients with inoperable or recurrent breast cancer
3. Radiation therapy:
   - undetected micro-metastases
   - kills cancer cells by using beams of high energy, for example, x-rays or protons.
4. most cases of metastatic breast cancer can’t be cured
   - local or systemic therapy
   - support & help prevent or treat symptoms: manages side effects of cancer & improve QOL

Question 5

WHATS Endometrial cancer?

Answer 5

develops from the lining of the uterus/endometrium

down up:
vagina -> cervix -> uterus

Question 6

Signs & symptoms of endometrial/uterine cancer?

Answer 6

OCCURS IN THE UTERUS

Subjective:
* Postmenopausal bleeding
- period bleeding comes from endometrium/lining of the uterus

• Bleeding between cycles
• cancer causes irregular shedding of endometrium
• Bleeding after intercourse - Cancer causes endometrium to be fragile -> damaged easily
• Watery vaginal discharge
• Tumor cells -> increased production of fluid or mucus -> mix with blood -> watery pinkish

Objective:
* Uterine enlargement
- mass formed in uterus

• Suspicious Pap smear results
• although Pap smears usually detects cervical cancer -> can sometimes detect abnormal endometrial cells that have shed into the cervix or vagina.

Question 7

How to screen & diagnose endometrial cancer? (2)

Answer 7

1. Dilation and Curettage (D & C)
   - open/dilate cervix, then use small knife/curettage -> remove tissue from uterus
2. Endometrial tissue biopsy examination using Pipelle swab (same as COVID)

Question 8

Treatment of endometrial cancer? (3)

Answer 8

1. Surgical intervention:
   - Pan/TOTAL hysterectomy: uterus, cervix, (ovaries & fallopian tubes depending on pt)
   - oophorectomy - 1/2 ovaries
   - salpingectomy - 1/2 fallopian tubes
2. Chemotherapy
3. Radiation

Question 9

Signs & symptoms for ovarian cancer? (6)

Answer 9

** Vague and mild, often presents as
digestive and bladder problems**

1. Very tired all the time & SOB - energy demands of the tumor,
2. need to urinate often - exerts pressure on the bladder
3. Unusual vaginal bleeding (heavy periods, or bleeding after menopause - stimulate shedding of uterine lining
4. Pressure or pain in the abdomen, pelvis, back, legs - press on nerves
5. swollen or bloated abdomen - fluid buildup
6. Nausea, indigestion, gas, constipation, diarrhoea - compress the stomach

Question 10

How to screen & diagnose OC? (6)

Answer 10

1. Ultrasound
2. Biopsy: through laparotomy
3. CT scans, MRI scans, chest X-rays, colonoscopy: to detect metastases to other organs
4. Laparoscopy:
   - thin lighted tube with video camera, poke through abdomen
   - definite diagnosis and remove early ovarian cancer.
5. Blood test: CA125 antigen level, AFP, CEA
6. Pap smear: abnormal in 30% of patients

Question 11

Treatment of OC?

Answer 11

Surgery: to remove
 both ovaries and fallopian tubes (salpingo-oophorectomy)
 uterus & cervix total hysterectomy
- partial hysterectomy = uterus only
 omentum
 nearby lymph nodes
 samples of tissue from the pelvis and abdomen

Chemotherapy:
 Intraperitoneal chemotherapy: directly into the abdomen and pelvis through a thin tube.
 Systemic chemotherapy: by mouth or vein.

Radiotherapy: not common.

Question 12

Cervical cancer:
Whats CC?

Answer 12

malignant tumor that originates in the cervix

Question 13

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

Answer 13

SUBJECTIVE
1. Early cervical cancer doesn’t cause any symptoms
2. vaginal bleeding after intercourse
3. menstrual disturbances
4. watery discharge
5. postmenopausal bleeding

OBJECTIVE
6. sus PAP smear results

Question 14

How to diagnose cervical cancer? (6)

Answer 14

1. 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. followed up with colposcopy
   - magnifying device used to examine the cervix -> cervical biopsy to confirm diagnosis.
4. CT scan or MRI & laproscopy
   - look for metastasis
5. Pelvic examination
6. Schiller’s test
   - Iodine applied to cervix
   - colors healthy cells brown;
   - abnormal cells remain unstained, usually white or yellow.

Question 15

Prevention & Treatment for cervical cancer? (5)

Answer 15

Prevention: reduce risk, screening, HPV vaccination

Treatment:
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
   - Simple: removal of uterus and cervix
   - Radical: uterus, cervix, upper vagina, and the tissue around the cervix, and the lymph nodes; lower colon, rectum or bladder may also be removed if affected.
4. For metastatic cancer
   - extensive surgeries, with chemotherapy -removal of associated lymph nodes and radiotherapy.

Question 16

Nursing care for patients with Ovarian, Endometrial & Cervical cancer?

Answer 16

Emotional support: Reassure the patient and family that adjustment illness
can be slow.

Managing side effects: radiation or chemotherapy

Provide general pre- and post- operative care: if undergo surgery.

Provide care for those receiving an internal radium implant:
 Provide isolation and limit visiting time.
 Maintain supine or side-lying position
 Diet: high-protein, low residue diet
 Maintain high fluid intake: 2000 to 3000 ml daily
 Insert Foley catheter to prevent bladder distension

Question 17

DN TO KNOW JS READ
Client & fam teaching for cervical cancer?

Answer 17

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.

Question 18

JS READ DN TO KNOW
Risk factors of breast cancer? (12)

Answer 18

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 19

DN TO KNOW JS READ
Causes & risk factors of cervical cancer (8)?

Answer 19

• 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