Female Malignancies Flashcards
(69 cards)
1
Q
Causes of Female Reproductive Cancers
A
- DNA damage/mutation (hereditary).
- Environmental factors.
- Hormonal factors
- Failure of apoptosis
2
Q
Cervical Cancer
Most common cause of Cervical Cancer
A
Human Papilloma Virus (HPV)
3
Q
Q: What are the risk factors for cervical cancer?
List 11
A
- HPV infection (most common cause)
- HIV infection / Immunosuppression
- Smoking
- Obesity
- Prolonged oral contraceptive use
- Family history of cervical cancer
- Multiparous (multiple pregnancies)
- Early childbearing
- First sexual intercourse < age 20
- Multiple sexual partners
- Lack of regular Pap smear screening
4
Q
What is a pap smear?
A
screening procedure used to check for abnormal cells in the cervix that may lead to cervical cancer.
AKA: papanicolaou (pap) smear
5
Q
When should women have their first pap smear
A
A: Age 21
6
Q
Women between the ages of 21-29 should get a pap smear every ___
A
3 years
7
Q
Women between the ages of 30-65 should get a pap smear every ___
A
5 years + HPV testing
8
Q
Women ages >65 can STOP pap smears if:
A
- Normal results with regular screenings
9
Q
Women >65 should continue pap smears if:
A
- If a history of cervical cancer or precancerous lesions
- Screen 20 more years, even if they are over age 65.
10
Q
What are the initial symptoms of cervical cancer ?
A
- No obvious symptoms
- Watery, thin vaginal discharge (often goes unnoticed)
- Painless vaginal bleeding (postmenstrual or post-coital (after sex))
Regular screenings (Pap smears) are important because early cervical cancer often shows no symptoms
11
Q
What are signs of MORE advanced cervical cancer?
A
- Abnormal vaginal discharge with a foul odor
- Pelvic pain (especially during intercourse)
12
Q
Dx Test for Cervical Cancer
A
- HPV Test: Done 1st, + test increses risk of cancer
- Pap Smear: Checks cervical cells for abnormality
- Colposcopy: Light magnification too visualize abnormal cervix. Done after Pap smear indicataes cancerous cells
- MRI, PET Scan, Barium Enema: used for staging.
13
Q
Cervical Cancer Staging
A
- Stage I: Confined to cervix.
- Stage II: Beyond cervix but not to pelvic wall.
- Stage III: Pelvic wall/vagina involvement.
- Stage IV: Spread to bladder, rectum, or distant organs.
14
Q
Medical Management:
LEEP (Loop Electrosurgical Excision Procedure)
A
- Thin wire loop with laser removes abnormal cells
- Outpatient, local anesthetic
15
Q
Test done PRIOR to LEEP procedure
A
Pregnancy test
16
Q
Patient Teaching for LEEP
A
- No douching, creams, or intercourse 24-48 hours before.
- Mild cramping for a few days.
- Discharge 1-3 weeks normal- due to meds.
- Avoid heavy activity/intercourse for 48 hours after.
- Report heavy bleeding, extreme pain, fever >100.8°F.
17
Q
Medical Management:
Laser Therapy
A
A laser used to ablate precancerous tissue
18
Q
Pt teaching for Laser Therapy
A
- Does not impact fertility.
- Some mild cramping normal.
- Contact HCP for increased pain, bleeding, fever
19
Q
Medical Management:
Conization
A
able to remove ‘cone shaped’ areas of cancerous tissue
20
Q
Q: Why is conization preferred over a hysterectomy for some patients?
A
Preserves fertility – Often chosen if the woman wants to have children.
21
Q
Patient teaching for Conization
A
- Same as with LEEP
- Risks include: hemorrhage, uterine perforation, pre-term labor if pregnant
22
Q
Medical Procedure:
Removal of female reproductive organs done laparoscopic or abdominally.
List 2 types of procedures that can be done this way.
A
Partial Hysterectomy OR Radical Hysterectomy
23
Q
What treatments are considered for Stage II cervical cancer and beyond?
A
- Chemotherapy
- External radiation
- Internal radiation (Brachytherapy)
24
Q
Surgical removal of ORGANS in the pelvic cavity for late-stage cervical cancer or recurrence.
A
pelvic exenteration
-includes: bladder, rectum, & reproductive organs
25
*Cervical Cancer Treatment:*
* Form of **internal radiation** therapy (Brachytherapy)
* Applicators inserted **into the endometrial cavity and vagina**
* **Radiation source loaded remotely** once pt in room.
Intracavitary Radiation
26
How long is the **Intracavitary Radiation** treatment?
24-72 hrs (high dose)
27
What **nursing interventions** are required for **Intracavitary Radiation** treatment?
* **Foley catheter inserted to keep bladder empty**
* **Vaginal packing to hold applicators in place and protect bladder/rectum**
* Administer enema: prevent straining
* Assess Pain & administer analgesia
* **Bedrest/Private room required**
28
Pts with **Intracavitary radiation** should have HOB ___
< 20 degrees.
29
Precautions for **Intracavitary radiation**
* Minimize exposure to radiation:
-Stand at foot of bed or doorway when possible.
* Wear dosimeter
* Visitors (if allowed) must stand at least 6 feet away
* Limit visits to 3 hrs.
30
*Intracavitary radiation:*
Q: What should you do if the **applicator or implant becomes dislodged**?
* **DO NOT TOUCH IT WITH BARE HANDS!**
* Use long-handled forceps & lead container (per facility policy).
* Call radiation safety officer immediately.
31
Malignancy called "silent killer"
Ovarian Cancer
32
Risk Factors for **Ovarian** Cancer
o BRCA-1, BRCA-2 mutations.
o **Age 55-65**
o Family history- 1st degree relative
o Breast/colon cancer history.
o Nulliparity
* use of infertility drugs (HRT >10yrs)
o Late Menopause (>55)
o Early menarche (<12)
o Obesity, high-fat diet.
33
**Late** signs of **Ovarian** Cancer
List 3
* Abdominal & back pain
* Abdominal swelling
* Lower extremity pain
34
**Early** signs of **Ovarian** Cancer
List 5
* Bloating
* constipation
* indigestion
* urinary urgency
* irregular menses.
-*Symptoms dont go away*
-*tumors press on surrounding intestines*
35
**Dx** test for **Ovarian** Cancer
List 5
* **No Screening Test Exists!!**
* **Pelvic Exam** (late stages reveal mass)
* **Confirmation with**: Transvaginal, pelvic, Ultrasound, CT/MRI.
* **Genetic Testing**: guides therapy
* **Surgery**
36
**Ovarian** Cancer Staging
* **I:** Confined to ovaries.
* **II**: cancer in ovarie(s), spread to pelvic organs but contained in pelvic region.
* **III**: Cancer in ovarie(s), spread beyond pelvis to abdomen lining or spread to lymph nodes.
* **IV**: Most advanced; Distant metastasis (liver lungs, other organs)
37
The only treatment for Ovarian Cancer
Hysterectomy + **Bilateral** Salpingo-Oophorectomy (BSO).
## Footnote
Hysterectomy + BSO = Removal of:
* Uterus (hysterectomy)
* Both fallopian tubes (biltateral salpingo)
* Both ovaries (oophorectomy)
38
Nursing Care **Ovarian** Cancer
* **Pre/Post-op**:
-Pain: gabapentin, baclofen
-hemodynamics: hemorrhage is important
-drain monitoring
-electrolytes: K+, Na+ (yachycardia starts to occur)
* **Diuretics, Antiemetic**
* **Electrolyte monitoring and replacement**
* **Nutrition**: Small, frequent meals; high protein; fluid restrictions if ascites.
* **Psychological Support**:
39
What is "Endometrium"
The **lining** of the **Uterus**
40
Endometrial Cancer:
Average **age** of onset
61 - AFTER menopause
41
Risk factors for **Endometrial** Cancer
o Unopposed estrogen (Hormone replacement therapy (estrogen only) **without** progesterone).
o Obesity (adipose tissue stores estrogen
o Diabetes.
o Nulliparity (never had pregnancy).
o Late menopause (>55).
o Early menarche (<12).
o Pelvic radiation history.
o PCOS, uterine fibroids.
42
**Early** signs of **Endometrial** Cancer
* Vague complaints of : intermittent bloating, nausea, fatigue
* Painless vaginal spotting AFTER meenopause
43
**Late** signs of **Endometrial** Cancer
* Low back, pelvic or abdominal pain **during urination &/or intercourse**
* **Enlarged Uterus** causes more persistent bloating and GI complaints
44
Is **postmenopausal** vaginal **bleeding** normal?
No, its never normal and should always be investigated.
45
Dx Studies for **Endometrial** cancer
* **Pelvic Exam, Pap Test**.
* Transvaginal Ultrasound.
* Endometrial Biopsy.
* **Estrogen/Progesterone Receptor Markers**.
46
What are the **2 types of Endometrial** Cancer?
* Type 1 (Estrogen-**Dependent**)
* Type 2 (Estrogen-**Independent**)
46
**Endometrial** Cancer Staging
* **I**: Uterus only.
* **II**: Spread to Cervix.
* **III**: Spread to lymph nodes/ovaries, vagina, fallopian tubes- has NOT spread to bladder, rectum or outside pelvis.
* **IV**: Spread to distant organs.
47
*Which Endometrial Cancer Type is this?*
* Not estrogen-related
* aggressive
* worse prognosis
Type 2
48
*Which Endometrial Cancer Type is this?*
* Estrogen-related
* slower
* better prognosis
TYPE 1
49
**Primary** treatment for **Endometrial** Cancer
Total hysterectomy & bilateral salpingo-oophorectomy **with lymph node biopsies**
50
What are **SECONDARY** treatments for **Endometrial** Cancer?
1. **Radiation Therapy**:
-*External Beam*: Pelvis/Abdomen
-*Intravaginal Brachytherapy*: Prevents local recurrence
2. **Hormone Therapy**
-Medroxyprogesterone (Depo-Provera)
-Megestrol Acetate (Megace)
-Tamoxifen (Nolvadex)
3. **Chemotherapy (Advanced Disease):**
-Carboplatin
-Cisplatin
-Paclitaxel (Taxol) (Same as Ovarian & Cervical)
51
Any vaginal spotting or bleeding must be ____ to a healthcare provider immediately.
reported
52
What **reduces** **Vulvar** Cancer
* HPV vaccine
53
S/S of vulvar cancer
* Pruritus
* soreness (most common)
* Bleeding
* dysuria
* discharge- foul smell
* pain- late disease
54
Q: What are the key **PRE-operative** nursing actions **before** a hysterectomy?
* Consent Signed?
* Pregnancy test negative?
* Patient Teaching on what comes next?
* Psychosocial Support
* Monitor Vitals, Circulation & Respiratory Status
* Administer Pain Meds/Prophylactic Antibiotics
* **Ensure that NSAIDS, anticoagulant, Vit E were stopped per MD Order.**
-Vit E can be a blood thinner
* Ensure standard pre-op prep for a hysterectomy completed (douche, enema, and a foley)
54
Post-Op teaching for Vulvectomy
* **Pain control: extensive invision/location make pain control a challenge**
* Skin integrity/Wound vac
* Infx control
* Drain management
* Risks: DVT, dehydration, anxiety, wound, dehiscence
55
Q: What are the key **POSToperative** nursing interventions **after** a **HYSTERECTOMY**?
**1. Monitor:**
-Vitals, Circulation, Respiratory Status
-I & O (Monitor Foley output, assess for bladder atony)
**2. Mobility:**
-ROM, Early Ambulation
-SCDs, TEDs, Incentive Spirometer → Prevent DVT & Atelectasis
**3. Pain Management**:
-Administer analgesics as ordered.
**4. Incision/Dressing:**
-Abdominal/Perineal Dressing
-Serosanguineous Drainage Expected
-Monitor for Excessive Bleeding (Saturation, Clots)
**5. Bladder Function:**
-Foley Catheter: Typically left 1-2 days
-Monitor for Atony: In-out cath may be needed if urine retention occurs after removal.
-Monitor I&Os: need to make sure pts making urine.
56
What does cancer do to blood?
**hyper**coagulates (increases clots)
56
**Post**-Operative complications with **HYSTERECTOMY**
* **Ureter ligation**-*Accidental occlusion of ureter intra-op*
* **Latrogenic hemorrhage**: *hemorrhage caused by medical treatment or intervention.*
* **DVT/PE**-sedentary and cancer creates hypercoagulability
* **Infection**
57
Q: What are **signs** of accidental **ureter ligation**?
* Low to zero urine output
* New-onset **back** pain refractory to treatment.
58
Q: What should the nurse do if **ureter ligation is suspected**?
A: Perform a **bladder scan** and **report immediately to the surgeon**.
59
Q: What are signs of **post-op hemorrhage**?
A: **Tachy**cardia & **hypo**tension → Indicate blood loss.
60
Q: What are the **nursing interventions** for **hemorrhage**?
* Report to the surgeon
* prepare for OR
* monitor Serial H&H
* telemetry
* administer blood products.
61
Q: Why is a patient **post**-**hysterectomy** at **risk for DVT/PE**?
A: Sedentary state & cancer increase hypercoagulability.
62
Q: What are **signs** of DVT/PE?
* Leg pain/swelling (DVT)
* sudden **increased** oxygen requirement (PE).
63
Q: What are the **nursing interventions** for suspected PE?
* Encourage Incentive Spirometry (I/S)
* **Report immediately**
* apply supplemental O2.
64
Signs of Infection
* increased WBC
* Fever
* tachycardia.
65
Q: How can the nurse help **prevent** infection?
* Aseptic technique
* early ambulation
* SCDs
* prophylactic antibiotics.
66
Post hysterectomy, patient should avoid
* **Intercourse**: 4-6 weeks or until fully healed.
* **Heavy lifting**: at least 2 months.
* **Strenous activity**: at least 2 months.
