Reproductive

Question 1

Identify changes in the reproductive system related to aging

Answer 1

Female:
— graying and thinning of pubic hair
— decreased size of labia majora and clitoris
—drying, smoothing, and thinning of vaginal walls
— decreased size of uterus
— loss of tone and elasticity of pelvic ligaments and connective tissues
— increased flabbiness and fibrosis of breasts; hang lower than chest wall; decreases erection of nipples

Male:
— graying and thinning of pubic hair
— increases drooping of scrotum
— prostate enlargement, increased likelihood of urethral obstruction

Question 2

Nutritional history:

Answer 2

— high alcohol intake increases risk of ovarian cancer
— diet high in fat and low in fruits and vegetables increases risk of reproductive cancers

Question 3

Family hx and genetic risk:

Answer 3

— daughters of women given DES to control bleeding during pregnancy are at increased risk for infertility and reproductive tract cancer
— specific BRCA1 and BRCA2 gene mutations increase overall risk for breast and ovarian cancer
— men with first degree relatives (father, brother) with prostate cancer are at greater risk

Question 4

What are current health problems to assess?

Answer 4

— pain
— bleeding
— discharge
— masses

Question 5

What is a Pap smear and at what age do women need to begin annual Pap smears?

Answer 5

Detects precancerous and cancerous cells from the cervix
Annual Pap test starting at age 21

Question 6

What do vaginal cultures help detect?

Answer 6

Used to detect bacterial, viral, fungal, and parasitic disorders

Question 7

What is alpha fetoprotein (AFP)
What is cancer antigen 125 (CA 125)

Answer 7

Elevated with ovarian cancer

Question 8

Prostate specific antigen (PSA) test

Answer 8

Normal <2.5 for age <50 and increases with age
— used as screening lab for prostate cancer; other prostate problems can increase the level

Question 9

What lab is an indicative for prostate cancer?

Answer 9

Early prostate cancer antigen (EPCA-2) and Serum acid phosphate

Question 10

Describe the uses for CT, MRI, and ultrasonography

Answer 10

CT:
— evaluate for metastasis with different reproductive cancers
— evaluates for ovarian cancer

MRI:
— evaluation for breast cancer for women with high risk factors

Ultrasonography:
— transvaginal: ovarian and endometrial cancer
— transrectal: prostate cancer
— ultrasound: testicular masses; breast cancer evaluation

Question 11

What is a hysterosalpingography?

Answer 11

X-ray that uses contrast dye to visualize the cervix, uterus, and Fallopian tubes
* uterine problems such as fibroids, tumors, fistulas

Pre: assess for contrast dye allergies
Post: pelvic and shoulder pain expected

Question 12

What is a mammography?

Answer 12

X-ray of soft tissue of the breast
Annually for women 40+

Pre: no creams, lotions, powders, or deodorant on breast or under arms
*may experience discomfort during procedure

Post: reinforce continued self breast exams and clinical breast exams

Question 13

What is a colposcopy?

Answer 13

Examines cervix and vagina using colposcope
Locates exact site of precancerous and malignant lesions for biopsy

Question 14

What is a laparoscopy?

Answer 14

Direct examination of pelvic cavity through endocope
PERFORMED UNDER ANESTHESIA

Pre: NPO
Post: pelvic and shoulder pain; observe incision sites for infection

Question 15

What is a hysteroscopy?

Answer 15

fibrotic camera inserted into the vagina
— examines cervix and uterus
— performed with regional nerve block
Post: pelvic and shoulder pain

Question 16

Cervical biopsy study:

Answer 16

Cervical tissue removed for study
Early in menstrual cycle so less vascular

Pre: address anxiety; anesthesia
Post: monitor for bleeding and infections, nothing in vagina for 2 weeks, no heavy lifting

Question 17

What is an endometrial biopsy?

Answer 17

Used to obtain cells directly from the lining of uterus to assess for cancer of endometrium
— assess menstrual disturbances infertility

Post:
— cramping
— monitor bleeding and infections
— spotting for 1-2 days
— nothing in vagina for 1-2 days

Question 18

What is a breast biopsy study?

Answer 18

— tissue aspirated through large bore needle or small incision
— local anesthetic
— aspirated fluid from benign cysts may appear dark green-brown
— bloody fluid suggest cancer

Pre: address anxiety, anesthesia
Post:
— mild pain alleviated with analgesics, ice or heat
— monitor for bleeding and infection around incision
— numbness may occur around biopsy site
— wear supportive bra for 1 week

Question 19

Prostate biopsy:

Answer 19

Diagnostic tool for prostate cancer

Pre: discuss positioning and discomfort; address anxiety

Post:
— educate regarding soreness and light rectal bleeding
— blood in urine and stool for a few days in addition to rust colored semen for several weeks
— monitor for excessive bleeding, infection, urinary retention
— post biopsy antibiotic

Question 20

What are the CM of prostate cancer?

Answer 20

Early symptoms:
— urinary retention
— bladder infections
— difficulty starting urination

Advanced:
— hematuria
— swollen lymph nodes in groin
— pain
— unexpected weight loss

Question 21

What are labs to evaluate prostate cancer?

Answer 21

Prostate specific agent (PSA)
— normal <2.5 with age <50 and increases with age
— used as screening lab; other prostate problems can increase level

Early prostate cancer antigen (EPCA-2)
— detects changes in prostate gland early

Question 22

What are interventions for prostate cancer?

Answer 22

Active surveillance
*slow growing cancer

Surgery:
— laparoscopic radical prostatectomy (LRP): entire prostate removal
— open radical prostatectomy: entire prostate removal
— bilateral orchiectomy: removal of both testicles

Nonsurgical:
— radiation
— drug therapy: hormone, chemotherapy

Question 23

What do you need to assess with prostatitis?

Answer 23

Inflammation of prostate gland
— occurs with urethritis or an infection of lower urinary tract
* organisms reach via bloodstream/urethra

CM:
— fever
— chills
— dysuria
— urethral discharge
— boggy and tender prostate

Question 24

Chronic bacterial prostatitis:

Answer 24

— occurs in older men
— symptoms less dramatic

Question 25

What are some interventions with prostatitis?

Answer 25

Tx:
— antibiotics
— hospitalization with aggressive IV antibiotics

Complications:
Inflammation of epididymis
Cystitis: inflammation of bladder

Question 26

Testicular cancer assessments:

Answer 26

Rare cancer; affecting men 20-35 years of age

CM:
— painless
— hard swelling or enlargement of testicle

Question 27

What are lab assessments with testicular cancer?

Answer 27

— alpha-fetoprotein AFP
— beta human chorionic gonadotropin (hCG)
— lactate dehydrogenase (LDH)

Ultrasounds to identify masses
CT + MRI to check for metastasis

Question 28

Testicular cancer interventions:

Answer 28

Surgical management:
— radical unilateral orchiectomy
— radical retroperitoneal lymph node dissection

Nonsurgical:
— chemotherapy
— external beam radiation therapy

Question 29

What is endometrial cancer? What are risk factors?

Answer 29

Cancer of the inner uterine lining
— grows slowly
— most common

Risk factors:
— prolonged exposure to estrogen without protective effect of progesterone
— women in reproductive years
— family hx
— DM
— HTN
— obesity
— smoking

Question 30

What do you assess with patients with endometrial cancer?

Answer 30

Postmenopausal vag bleeding — main symptom
— watery, bloody vag discharge
— low back or abdominal pain
— low pelvic pain (enlarged uterus)

Question 31

Endometrial cancer lab assessments:

Answer 31

CBC: anemia
Cancer antigen 125: elevated in ovarian cancer
Alpha fetoprotein: elevated
Human chorionic gonadotropin (hCG): elevated

Question 32

Diagnostic assessment with endometrial cancer

Answer 32

Transvaginal ultrasounds
Endometrial biopsy

Question 33

What are the stage 1 and stage 2 interventions with endometrial cancer?

Answer 33

Surgical management:
Stage 1:
— removal of uterus, Fallopian tubes, and ovaries TOTAL HYSTERCTOMY

Stage 2:
Radical hysterectomy; bilateral pelvic lymph node dissection and removal of upper third of vagina

Question 34

Nonsurgical management of endometrial cancer:

Answer 34

Radiation therapy 1x to 2x a week
— bed rest during tx
— brachytherapy: internal radiation placed by radiologist; radioactive implant stays in place for several minutes

Drug therapy:
Chemotherapy

— coping mechanisms

Question 35

What is cervical cancer and how would you treat it?
What are some health promotion tips?

Answer 35

Progressive cancer
— generally takes years for cervical cells to transform from normal to premalignant to invasive cancer
1. Normal cervical cells
2. Atypia (suspicious)
3. Cervical intraepithelial neoplasia
4. Carcinoma in situ

Health promotion:
Gardasil and Cervarix:
— given before sexual contract for girls and young women ages 9-26; also given to boys/men with genital warts + transmission of cancers
— protection against high risk HPV
— periodic pelvic exams; Pap smears age 21

TREATMENT:
Early surgical procedures:
— loop electro surgical excision procedure
— laser therapy
— cryotherapy
Surgical:
— hysterectomy
Nonsurgical:
— radiation therapy
— chemotherapy

Question 36

What is ovarian cancer and what are some risk factors?

Answer 36

Epithelial tumors that grow on the surface of the ovaries
* tumors grow rapidly, spread quickly, often bilateral

LEADING CAUSE OF DEATH FROM FEMALE REPRODUCTIVE CANCERS
— survival rate is low; often not detected until late stages
*vague abdominal and GI symptoms

Risk factors:
— older than 40
— family hx of ovarian or breast cancer
— DM
— older than 30 at first pregnancy
— breast cancer
— infertility
— endometriosis
— obesity/high fat diet
— BRCA 1 or BRCA 2 gene mutations

Question 37

What are CM and interventions for cervical cancer?

Answer 37

CM:
— mild symptoms for several months
— abdominal pain or swelling
— vague GI disturbances: dyspepsia + gas
— any enlarged ovary found after menopause should be evaluated as though if malignant

Interventions:
Diagnostic:
— CA-125 may be elevated
— transvaginal ultrasound, CXR, CT
Surgical:
— exploratory laparotomy (cancer is staged)
— total abdominal hysterectomy
— bilateral salpingo-oophorectomy
— pelvic and paraaortic lymph node dissection
— cytoreducation
Nonsurgical:
— chemo after surgery
ADVANCED
— palliative end of life care
— difficult cancer to dx before metastasis occurs