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Women's health > What are the malignant disorders? > Flashcards

What are the malignant disorders? Flashcards

1
Q

What are malignant disorders?

A
  • Epidemiology
  • Cancer Screening
  • Breast Cancer
  • Endometrial Cancer
  • Ovarian Cancer
  • Cervical Cancer
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2
Q

What are top 5 leading cancer for female?

A
  1. Breast
  2. Colo-rectum
  3. Corpus uteri
  4. Lung
  5. Ovary
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3
Q

What are the guidelines for cancer screnning?

A 
> 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
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4
Q

What is the prognosis for breast cancer?

A

related to lymph nodes involved.

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5
Q

What are the risk factors for breast cancer?

A
  • 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) .
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6
Q

What is the pathophysiology for breast cancer?

A

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.

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7
Q

What are the manifestations for breast cancer?

A 
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
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8
Q

What are the Breast Cancer Tests:

Screening, Diagnosis and Monitoring

A

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.

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9
Q

What are the treatment methods?

A

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.

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10
Q

What are the nursing interventions?

A

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.

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11
Q

Breast inspection :

A
  1. Retraction or indentation of nipple
  2. Discharge from nipple
  3. Atypical fullness and / or puckering
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12
Q

What is endometrial cancer?

A

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.

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13
Q

What is the pathophysiology of endometrial cancer?

A

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.

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14
Q

What is the subjective manifestation of endometrial cancer?

A
  • Postmenopausal bleeding
  • Bleeding between cycles
  • Bleeding after intercourse
  • Watery vaginal discharge
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15
Q

What is the objective manifestation of endometrial cancer?

A
  • Uterine enlargement

* Suspicious Pap smear results

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16
Q

What are the diagnostic tests and methods for endometrial cancer?

A

Dilatation and Curettage (D & C)

Endometrial tissue biopsy examination using Pipelle

17
Q

What is the treatment?

A

 Surgical intervention: Pan hysterectomy (Radical hysterectomy),
oophorectomy, salpingectomy
 Chemotherapy
 Radiation

18
Q

What is the ovarian cancer?

A

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%.

19
Q

What is the pathophysiology of ovarian cancer?

A 
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.
20
Q

What are the manifestations for ovarian cancer?

A 
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
21
Q

What are the diagnostic test for ovarian cancer?

A

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

22
Q

What is the treatment of ovarian cancer

A

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.

23
Q

What is cervical cancer?

A

 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)

24
Q

Most preventable gynaecological cancer : cervical cancer

A 
 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
25
Q

What is the pathophysiology?

A 
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
26
Q

What is the manifestation?

A 
Subjective
Asymptomatic in early stage, “silent killer”
Menstrual disturbances
Postmenopausal bleeding
Bleeding after intercourse
Watery discharge

Objective:
Suspicious Pap smear result

27
Q

What are the diagnostic tests and methods?

A 
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

28
Q

What are the prevention and treatment?

A

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

29
Q

What is Nursing care for patients with Ovarian, Endometrial

and Cervical cancer

A

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

Women's health (9 decks)

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