What are the malignant disorders? Flashcards
What are malignant disorders?
- Epidemiology
- Cancer Screening
- Breast Cancer
- Endometrial Cancer
- Ovarian Cancer
- Cervical Cancer
What are top 5 leading cancer for female?
- Breast
- Colo-rectum
- Corpus uteri
- Lung
- Ovary
What are the guidelines for cancer screnning?
> 50 : faecal occult ( blood test ) > 25 : pap smear once every 3 years ( if have sexual intercourse ) > 30 : Breast self examination monthly > 40 : Mammogram yearly > 50 : mammogram once every 2 years
What is the prognosis for breast cancer?
related to lymph nodes involved.
What are the risk factors for breast cancer?
- Family history: mother or sibling, specific genes
- Menstrual and Obstetric history: Reproductive factors associated with
prolonged exposure to endogenous oestrogens, such as long period of
regular menstrual cycles (early menarche, late menopause), late age at
first childbirth are among the most important risk factors for breast cancer;
nulliparity; Never breast fed; Exogenous hormones. - Medical history: breast cancer, fibrocystic breast disease, previous breast
irradiation. - Personal history: 21% of all breast cancer deaths worldwide are
attributable to alcohol use, overweight and obesity, and physical inactivity
(Danaei et al., 2005) .
What is the pathophysiology for breast cancer?
Location: upper outer quadrant of breast in 1⁄2 of the
cases, and central portion; unilateral.
Types: adenocarcinomas arising from breast ductal
tissue
Infiltrates surrounding tissue
dimpling if adheres to skin
fixed if adheres to muscle or fascia of chest wall
Metastases: at early stage, 1st to axillary nodes;
quickly to other organs
Presence of oestrogen and progesterone receptors:
in the cancer cells.
What are the manifestations for breast cancer?
Initial sign: single, hard, non-tender nodule, freely movable Advanced signs: Fixed nodule Skin dimpling, pulling Nipple discharge, retraction or elevation Change in breast contour Enlarged axillary nodes
What are the Breast Cancer Tests:
Screening, Diagnosis and Monitoring
Screening tests: mammography(50-69 years, 40-49
years, <40 years with normal risk? 70-75 years)
Diagnostic tests: e.g. biopsy (aspiration, excisional, or
stereotactic biopsy). For those who are suspected of
having breast cancer.
Monitoring tests: used during and after treatment to
monitor how well therapies are working.
Including: Biopsy, Breast MRI (Magnetic Resonance
Imaging), Breast Physical Exam, BSE, CT scan, Chest
X-Rays, Thermography, Ultrasound, Mammograms.
What are the treatment methods?
Medications: Chemotherapy; Hormonal therapy (e.g. anti-oestrogens,
corticosteroids)
Surgery
– Lumpectomy: indicated for early detection
– Mastectomy: simple, modified radical, radical
– Oophorectomy, adrenalectomy, hypophysectomy
Radiation therapy: undetected micrometastases
High frequency electricity: in 2007, in Sweden to insert a metal rod into the
breast which will send “electric heat at a high frequency” killing the cancer.
What are the nursing interventions?
Emotional support: acceptance, reassurance, and encouragement in illness
adjustment; psychosocial intervention
Managing side effects: radiation or chemotherapy
Postoperative care:
Elevate affected arm above level of right atrium to prevent oedema;
Measure upper arm and forearm twice daily to monitor oedema;
Monitor dressing for haemorrhage;
Empty Haemovac drainage tube and measure drainage;
Assess circulatory status of affected arm;
Encourage exercises of the affected arm when approved by a physician; avoid
abduction;
Drawing blood or administering parenteral fluids or taking blood pressure on
affected arm is contraindicated.
Breast inspection :
- Retraction or indentation of nipple
- Discharge from nipple
- Atypical fullness and / or puckering
What is endometrial cancer?
Incidence: Common in women > 40 years old
Risk factors:
Increased oestrogen levels (HRT for postmenopausal women for more than
five years.)
Infertility
Obesity, diabetes, hypertension increase risk
Simple screening: not available
Usually no symptoms until it becomes relatively advanced.
Five-year survival rate: 90% if cancer well localized.
What is the pathophysiology of endometrial cancer?
Types: mostly adenocarcinomas arising from glandular epithelium.
Endometrial hyperplasia: due to excessive oestrogen stimulation
Eventually tumour mass fills interior of uterus
May infiltrate uterine wall and spread out to endometrial cavity.
Cancer is slow-growing.
What is the subjective manifestation of endometrial cancer?
- Postmenopausal bleeding
- Bleeding between cycles
- Bleeding after intercourse
- Watery vaginal discharge
What is the objective manifestation of endometrial cancer?
- Uterine enlargement
* Suspicious Pap smear results
What are the diagnostic tests and methods for endometrial cancer?
Dilatation and Curettage (D & C)
Endometrial tissue biopsy examination using Pipelle
What is the treatment?
Surgical intervention: Pan hysterectomy (Radical hysterectomy),
oophorectomy, salpingectomy
Chemotherapy
Radiation
What is the ovarian cancer?
Incidence: USA-7.3 to 15.4 per 100,000 women (U.S.Cancer
Statistics Working Group, 2010); About 300 new cases per year in
Singapore.
Risk factors: family and personal history of cancer, age over
55, nulliparity, infertility and taking certain fertility drugs,
menopausal hormone therapy, and using talcum powder,
or being obese.
Severity: causes more deaths than any other
gynaecological cancer.
Five year survival rate: 46%.
What is the pathophysiology of ovarian cancer?
Type: mostly epithelial tumours that attach to the surface of organs Metastases: by direct spread or lymphatic drainage. Tumour cells implant along the lining of the peritoneal cavity (local advancement), omentum, bowel mesentery, liver capsule etc.
What are the manifestations for ovarian cancer?
Pressure or pain in the abdomen, pelvis, back, legs A swollen or bloated abdomen Nausea, indigestion, gas Constipation, or diarrhoea Feeling very tired all the time Shortness of breath Feeling the need to urinate often Unusual vaginal bleeding (heavy periods, or bleeding after menopause
What are the diagnostic test for ovarian cancer?
Blood test: CA125 antigen level, AFP, CEA
Pap smear: abnormal in 30% of patients
Ultrasound: transabdominal or transvaginal
Biopsy: through laparotomy
Laparoscopy: to determine definite diagnosis and remove early
ovarian cancer.
CT scans, MRI scans, chest X-rays, colonoscopy: to detect
metastases to other organs
What is the treatment of ovarian cancer
Surgery: to remove
both ovaries and fallopian tubes (salpingo-oophorectomy)
the uterus (hysterectomy)
the 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.
What is cervical cancer?
Countries that do not have access to cervical cancer screening and
prevention programs: the second most common type of cancer (17.8 per
100,000 women) and cause of cancer deaths (9.8 per 100,000) among all
types of cancer in women
Developed countries: Cervical cancer has lower rates than corpus uteri
and ovarian cancer
Mortality rate: decreased due to Pap smear screening (and HPV
vaccinations?).
(AsiaOne Health, 2011; Health Promotion Board, 2011)
Most preventable gynaecological cancer : cervical cancer
HPV Vaccination rate in Singapore: 3% in 2010, can be covered by Medisave300. Strongly linked to STDs: Human papilloma virus (HPV) Herpes simplex virus type 2 (HSV-2) High risk factors: o Multiple sex partners o Sexual activity at an early age o Weakened immune system o Long term consumption of contraceptive pills o Patient history of STDs o Cigarette smoking Five year survival rate: 100% if carcinoma still in situ. 69% if advanced stage
What is the pathophysiology?
Types: dysplasia of cervical epithelial tissue. Location: at the junction of columnar cells and squamous cells of external cervical os. - Spreads in all directions and affect adjacent tissues (uterus and vagina), bladder, rectum, ligaments Metastases to lymph nodes: rarely or in late stage
What is the manifestation?
Subjective Asymptomatic in early stage, “silent killer” Menstrual disturbances Postmenopausal bleeding Bleeding after intercourse Watery discharge
Objective:
Suspicious Pap smear result
What are the diagnostic tests and methods?
Pelvic examination Pap smear – cells obtained from ectocervix, endocervix and transformation zone of the cervix using cervix brush HPV typing Schiller’s test
Cervical biopsy examination
Colposcopy
MRI, CT, Laparoscopy
What are the prevention and treatment?
Prevention: reduce risk, diagnose early, Vaccination
Treatment:
Surgery:
Conization, LEEP (Loop Electrosurgical excision procedure): for micro-invasive cancer
Hysterectomy (Stage I and IIA):
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.
Radiation: in advance case (Stage IIB and above)
Chemotherapy
What is Nursing care for patients with Ovarian, Endometrial
and Cervical cancer
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
