Care of Patients with Gynecologic Problems

Question 1

Cancer of the inner uterine lining
Is Most common female gynecologic malignancy
Relatively Good prognosis - depends on staging
Grows slowly in most cases compared to other female cancers
Adenocarcinoma most common type of tumor
Etiology/Risk Factors

Answer 1

Endometrial (Uterine) Cancer

Question 2

Stage 1 – confined to the endometrium; not metastasis
Stage 2 – also involves the cervix
Stage 3 – reaches the vagina or lymph nodes
Stage 4 – spread to the bowel or bladder mucosa and/or beyond the pelvis; spreading to distant area
Determines treatment options

Answer 2

Grows slowly in most cases compared to other female cancers

Question 3

Imp - gen health for clients and so are aware
#1: Strongly associated with prolonged exposure to estrogen without the protective effects of progesterone - estrogen supplements without progesterone
Women in reproductive years
Nulliparity - no children
Family history
DM
HTN
Obesity
Uterine polyps - BIG RISK FACTOR; precursor to cancer cells
Late menopause
Smoking
Tamoxifen given for breast cancer - treatment sometimes use for breast cancer

Answer 3

Etiology/Risk Factors

Question 4

Symptoms
Lab assessment
Diagnostic assessment

Answer 4

Assessment

Question 5

Postmenopausal and has vaginal bleeding – one of the big warning signings; main symptom
Watery, bloody vaginal discharge
Low back or abdominal pain - when advances - cancer growing in uterus
Low pelvic pain (caused by pressure of the enlarged uterus)

Answer 5

Symptoms

Question 6

Early symptoms of vaginal bleeding generally lead to prompt evaluation and treatment

Answer 6

Postmenopausal and has vaginal bleeding – one of the big warning signings; main symptom

Question 7

Uterus is enlarged if the cancer is advanced

Answer 7

Low pelvic pain (caused by pressure of the enlarged uterus)

Question 8

CBC (may show anemia)
Cancer antigen 125 (CA-125) – elevated in ovarian cancer; big one for endometrial cancer; warrants further eval
Alpha-fetoprotein (AFP) – elevated in ovarian cancer; big one for endometrial cancer; warrants further eval
Human chorionic gonadotropin (hCG) – elevated level may indicate pregnancy, pregnancy should be ruled out before treatment begins

Answer 8

Lab assessment

Question 9

Transvaginal ultrasound
Endometrial biopsy in order to confirm diagnosis
Other diagnostic tests may be done to determine the patient’s overall health status and the presence of metastasis

Answer 9

Diagnostic assessment

Question 10

Surgical management
Nonsurgical management
Psychosocial Interventions

Answer 10

Interventions

Question 11

Stage 1
Stage 2
Stage 3/4 may or may not do surgery but once metastasized diff places have do chemo and radiation; might with 1 and 2 do chemo and radiation but typ with those do surgical

Answer 11

Surgical management

Question 12

Removal of the uterus, fallopian tubes, and ovaries (total hysterectomy and bilateral salpingectomy (BSO) as well as peritoneum fluid or washings for cytologic examination - check peritoneal area for metastasis and check for cancer cells in fluid/washings

Answer 12

Stage 1

Question 13

Radical hysterectomy with bilateral salpingectomy with radical pelvic lymph node dissection and removal of the upper third of the vagina
Depends

Answer 13

Stage 2

Question 14

Used postoperatively and depends on the surgical staging
Radiation therapy
Drug therapy

Answer 14

Nonsurgical management

Question 15

More common interventions for cervical and endometrium cancer
Brachytherapy internal radiation placed by the radiologist
External beam radiation therapy (EBRT)

Answer 15

Radiation therapy

Question 16

Put the radioactive implant remains in place for several minutes then take it out; not radioactive in between treatments
procedure may be repeated between 2 and 5 times once or twice a week - or however often need
patient is not radioactive between treatments and there is no restrictions on her interactions with others
restricted to bedrest during the treatment session

Answer 16

Brachytherapy internal radiation placed by the radiologist

Question 17

4-6 weeks; 5x/week
Not radioactive between treatments; never internal

Answer 17

External beam radiation therapy (EBRT)

Question 18

Chemotherapy - used if need postop or in addition to radiation

Answer 18

Drug therapy

Question 19

Coping mechanisms

Answer 19

Psychosocial Interventions

Question 20

Is a Progressive cancer: - cervical cells have long-time - years for cervical cells to transform from normal to premalignant to cancer cells
Generally takes years for the cervical cells to transform from normal to premalignant to invasive cancer
Etiology/Risk Factors
Health promotion and maintenance

Answer 20

Cervical cancer

Question 21

Pap smear and pelvic exams imp before progress to CIS
Normal cervical cells
Atypia (suspicious) - cervical cells started to change so need keep eye
Cervical intraepitheilial neoplasia (CIN)
Carcinoma in situ (CIS)

Answer 21

Is a Progressive cancer: - cervical cells have long-time - years for cervical cells to transform from normal to premalignant to cancer cells

Question 22

which is the most advanced premalignant change

Answer 22

Carcinoma in situ (CIS)

Question 23

Most cases are caused by certain types of HPV (most common type of STD in the US) - #1 risk factor; imp for health promotion related to this
Multiparity - multiple children
Smoking
African American
Oral contraceptive use
History of STI - not just HPV
Obesity
Family history
HIV/AIDS
Younger than 18 at first intercourse

Answer 23

Etiology/Risk Factors

Question 24

Gardasil and Cervarix
Periodic pelvic examinations and Pap tests at age 21 for women annually - very imp to catch changes in cervical cells

Answer 24

Health promotion and maintenance

Question 25

HPV vaccines Ideally given before onset of first sexual contact for girls and young women (ages 9-26); primarily prevent cervical cancer Also given for boys and young men to prevent genital warts, transmission and protection against certain types of cancer (HPV transmission) Protection against the highest-risk HPV types that are responsible for most cervical cancers

Answer 25

Gardasil and Cervarix

Question 26

Asymptomatic in preinvasive cancer early on - why screening imp Clinical manifestations for invasive cancer: Diagnostic assessment:

Answer 26

Assessment

Question 27

Painless vaginal bleeding – classic symptom; first; bleeding continually Late symptoms: - not want get here

Answer 27

Clinical manifestations for invasive cancer:

Question 28

Watery, blood-tinged vaginal discharge that becomes dark and foul-smelling Leg pain (along the sciatic nerve) or swelling of one leg - increase of tumor size and potential compression on nerve Flank plain (symptom of hydronephrosis) - compression on ureters which can then impact kidneys

Answer 28

Late symptoms: - not want get here

Question 29

cancer may be pressing on the ureters, backing up the urine into the kidneys

Answer 29

Flank plain (symptom of hydronephrosis) - compression on ureters which can then impact kidneys

Question 30

HPV-typing DNA test if pap results are abnormal - increased risk for cervical cancer from HPV virus Colposcopy - abnormal cells: more biopsy and able diagnose

Answer 30

Diagnostic assessment:

Question 31

Early surgical procedures - catch early Surgical procedure - stage 1: not metastasized but is cancer Nonsurgical management - stage 2/3/4 surgery not good option Staging time diagnosis directs interventions do for client

Answer 31

Interventions:

Question 32

Loop electrosurgical excision procedure (LEEP) - get premalignant cells out Laser therapy Cryotherapy - cold therapy

Answer 32

Early surgical procedures - catch early

Question 33

Hysterectomy

Answer 33

Surgical procedure - stage 1: not metastasized but is cancer

Question 34

Radiation therapy - external, brachytherapy at end of external Chemotherapy - also with radiation

Answer 34

Nonsurgical management - stage 2/3/4 surgery not good option

Question 35

Most ovarian cancers are epithelial tumors that grow on the surface of the ovaries Tumors grow very rapidly, spread very quickly, and are often bilateral Second most common type Leading cause of death from female reproductive cancers Incidence increases in women older than 50 years, and most are diagnosed after menopause - greater risk here Teach women to “think ovarian” if they have vague abdominal and GI symptoms

Answer 35

Ovarian cancer

Question 36

Survival rates are low because ovarian cancer is often not detected until its late stages - not caught early Second most common type

Answer 36

Leading cause of death from female reproductive cancers

Question 37

Older than 40-50 years Family history of ovarian or breast cancer or hereditary nonpolyposis colon cancer Diabetes mellitus Nulliparity Older than 30 at first pregnancy Breast cancer Colorectal cancer Infertility BRCA 1 or BRCA 2 gene mutations Early or late menarche/late menopause Endometriosis Obesity/high-fat diet

Answer 37

Risk factors

Question 38

Clinical manifestations: Diagnostic assessment:

Answer 38

Assessment

Question 39

Typ have very Mild symptoms for several months and may not notice but may have thought they were due to normal perimenopausal changes or stress Abdominal pain or swelling - when growing Vague GI disturbances such as dyspepsia (indigestion) and gas Any enlarged ovary found after menopause should be evaluated as though it were malignant

Answer 39

Clinical manifestations:

Question 40

“Think ovarian” so eval for that

Answer 40

Vague GI disturbances such as dyspepsia (indigestion) and gas

Question 41

CA-125 – may be elevated in ovarian cancer, but for other reasons too Transvaginal ultrasonography, CXR, CT; biopsies if needed

Answer 41

Diagnostic assessment:

Question 42

Surgical management: Nonsurgical management: In advanced metastatic disease: - metastasized sig

Answer 42

Interventions

Question 43

Exploratory laparotomy - cancer staged during surgery and definitive diagnosis Total abdominal hysterectomy, bilateral salpingo-oophorectomy (remove everything) and pelvic and para-aortic lymph node dissection usually performed if necessary Very large tumors that cannot be removed/remove all cancer are debulked (cytoreduction) - cut it down smaller to manage symptoms and if do chemo easier for chemo to work

Answer 43

Surgical management:

Question 44

Chemotherapy after surgery

Answer 44

Nonsurgical management:

Question 45

Palliative and End of life care quickly; hopefully catch quickly so can do interventions Difficult cancer to diagnose before metastasis occurs

Answer 45

In advanced metastatic disease: - metastasized sig