stress urinary incontinence
who is this common in?
why does it occur?
explain the pressure differences?
what actions might bring this on?
what are 3 things that could cause this in a person?
common problem in women of all ages and results from weakness or disruption in the pelvic floor muscles leading to poor support of the vesicourethral sphincters
usually: the intraurethral pressure is greater than the intravesicular pressure which is called the urethral closure pressure
if intra-abdominal pressure increases from things like coughing, laughing, or sneezing and the pressure isn’t equally distributed to the urethra then incontinence occurs
causes of decreased muscle tone: aging, child birth, surgical procedures
urge urinary incontinence
what does the pt feel?
what is this associated with?
what is the definition of this?
what are 2 contributing factors?
overactive, nocturia, urinary frequency, detrusor overactivity
loss of urine associated with strong desire to void URGENCY, often associated with overactive bladder
definition: urgency, frequency with or without incontinence in the absence of UTI or obvious pathology
Two contributing factors to overactive bladder:
1. CNS and neural control of bladder sensation and emptying, ex: stroke, Parkinsons, MS
2. smooth muscle of the bladder itself (myogenic)
incomplete emptying "overflow" urinary incontinence
what are 7 signs of this?
what are two causes?
what are 2 causes in women?
what are 2 causes in men?
intravesical pressure exceeds the maximal urethral pressure because of bladder distension
dribbling, weak urinary stream, frequency, and nocturia, hesitancy, frequency, nocturia, nocturnal enuresis (bedwetting), detrusor underactivity or bladder outlet obstruction
women causes: uterine prolapse, previous incontinence surgery
men: most common is enlarged prostate gland
what are the 3 PE tests you want to do with someone with urinary incontinence?
what are the 4 workup tests you would do?
1. pelvic exam
2. digital rectal exam (masses, prostate)
3. neuro exam if sudden loss (think cauda equina)
2. prostate specific antigen
3. post void bladder scan
4. urology consult
although urinary incontince tx is dependent on the type, what are 5 tx options you could consider?
1. fluid management
2. timed voiding
3. bladder retraining
4. keagle/pelvic floor exercises
5. surgical intervention
6. pessaries to hold uterus up
7. decrease caffine/alchohol
7. (urge) anticholinergics
(oxybutynin, possibly tricyclic antidepressant)
calcium oxalate stones
can you see it on a xray?
what is it usually associated with?
what are 4 associated factors?
3 tx options in general?
MOST COMMON TYPE OF STONE
2. usually associated with high calcium levels in the blood and urine
3. contributing factors: excessive bone reabsorption, bone disease, hyperparathyroidism and renal tubular acidosis predispose for these stones
treat underlying conditions
increased fluid intake
uric acid stone
what is this caused by?
can you see on xray?
what are 2 RF?
2 tx options?
caused by low Ph (acidic) urine
1. radiolucent cant be seen on xray
2. caused by high levels of uric acid in the urine or gout
3. RF: obesity/diabetic or both
1. decrease uring PH below 6 (more alkaline) using potassium citrate
2. allopurinol with decrease purine diet (fish, shellfish, and meats)
what type of disorder is this and who is it common in?
what is the appearance of the stones?
what are the two treatement options?
autosomally recessive inherited abnormalities CYSTINURIA
1.smooth-edged ground glass appearence
1. increase urine volumes to 3 L a day and increase urine pH to greater than 7
2. occasionally chelating agents
what are 6 RF for nephrolithiasis in general?
high animal protein and high salt
FH for calcium stones
what are the 4 most common symptoms with nephrolithiasis? and less common symtpoms? (4)
1. unilateral flank pain
2. sudden onset
3. renal colic
1. vague abdominal pain
2. acute abdominal/flank pain
3. difficulty urinating
4. penile or testicular pain
what is the most common cause of recurrent calcium stones?
most common abnormality elevated Ca excretion, decreased serum Ca
1. explain how size and location effect the ability to pass the stone?
2. what are two meds you can give to help during the passage?
5-10 mm less likely to pass on their own
>10 mm won’t pass on their own
stones in proximal ureter less likely to pass
ureterovesicular junction more likely to pass
Meds to help pass:
alpha blocker (tramsulosin)
if you txing a pt with nephrolithiasis what are 3 things you want to do to help manage the pt?
when do you consider hospitalization (2)?
1. most managed conservatively with pain management Nsaids and Opoids (BETTER USED TOGETHER!!)
3. strain urine
can’t tolerate oral intake
why is it important to educate your patient on recurrence for nephrolithiasis?
⅓ will experience stone recurrence within 5 years
½ experience stone reccurence within 10 years
what are the two things you need for the formation of crystals?
what are four risk factors that allows this to happen?
what are the four types of stones?
formation is dependent on supersaturation and an environment that allows the stone to grow!
heredity- cystinuria SLC3A1/SLC7A9
four types of stones:
1. calcium oxalate
3. uric acid
what 2 things is this associated with?
can you pass them?
when do they get bigger?
3 tx options?
"staghorn" stones that always associated with UTI and alkaline urine
1. produced by UTI with urease producing bacteria
2. proteus, klebsiella, pseudomonas, enterobacter
3. made of magnesium ammonium
4. usually too large to pass and require lithotripsy or surgical removal
5. they enlarge as the bacterial count increases
1. prevent UTIs
3. surgical removal
what is the most important test when suspecting nephrolithiasis? what do you expect to see for each of the stones? 4 types of labs you should consider ordering?
1. non-contrast CT (gold standard)
used to identify the size, location and type of stone
-low density (aka can't see): uric acid, cystine
-high density: calcium oxalate, struvite
-struvite: laminar, rugged apperance, full of casts with "stag horn apperance"
*****do renal US for pregnant people who can't have the CT****
1. urinalysis (stone type/blood)
2. BMP (calcium and creatinine if worried about kidney function)
3. 24 hour urine for the amount excreted
4. thyroid function test
what are the 5 tx options for nephrolithiasis?
1. NSAIDS and opoids!!
1.5. increased fluid intake key!
2. shock wave lithotripsy (small renal caliculi)
3. precutaneous nephrolithotomy
4. rigid and flexible ureterscopy +/- stent placement
(tx of choice for maority of middle and distal urethral stones or those who failed shock wave lithrotripsy)
5. diet changes for Ca oxalate stones (decrease spinach, animal protein, Na intake)
what are 3 things its assocaited with?
do you screen?
if positive what must you do (2)?
what is one really key thing to remember about UTI and pregnant women?
associated with preterm birth, low birth weight, prenatal mortality
screen in 1st trimester with UC
admit them since dangerous with baby
always check urine culture if asymptomatic because the bacteria in the urine can cause the things under A, if + treat with abx
if they get 2+ positive tests with greater than 100,000 positive tests they they will be on suppressive abx for the remainder of the pregnancy
what are two groups of peopel that are esp susceptible?
what are three things that contribute to the first?
1. bladder/uterine prolapse
2. loss of lactobacilli in vaginal flor allos for E. coli to take over
3. diabetes (sugar)
benign prostatic hypertrophy
who is this more common in?
what is the DOC?
how long do you treat for, two options?
white children more common than black children
fever, hematuria, abdominal pain
DOC: 2nd-3rd line cephalosporin
7-14 days if febrile
5 days if immune competent and afebrile
what are two risk factors?
unusual for men 15-50
RF: uncircumcised, anal intercourse
antibacterial material in prostatic fluid
18-20 cm urethra
who are UTIs most common in?
what is the most common route of infection?
what are most from?
what isthe pathogenisis of this and what does it RARELY come from?
30:1 ratio women to men because women have a significantly short urethra
route of infection: ascending from the urethra
UTI most commonly from uncomplifcated acute cystitis
1. colonization of vaginal introitus by uropathogens from fecal flora ascend from urethra into bladder CYSTITIS
2. uropathogens ascend from bladder to kidney via ureters
RARELY CAUSED BY SEEDING OF BACTERIA
what are 5 RF for UTI?
frequent sexual intercourse
delayed post-coital micturition (not urinating after intercourse)
hx of UTI
what are four bacteria that cause UTI and which is by far the most common? what percent?
e.coli most common 75-95%
what are the difference in symptoms for
1. dysuria or burning while urination
2. increased frequency/urgency
3. suprapubic pain/discomfort
5. voiding small amounts
3. flank pain
4. costovertebral tenderness
5. CBC with left shift
what 3 lab tests are important to do when diagnosiing a UTI?
what do you find on each?
+ leukocyte esterase (product of baceteria)
+ nitrites (conversion of nitrates to nitrites via bacteria)
+WBC casts (INDICATES KIDNEY ORIGIN!***)
3. culture greater than 100,000
what are the DOC fo acute cystitis (4) vs pyelonephritits (2)?
what do you need to note?
DOC3 if pregnant/allergic: Nitrofurantoin
*****NOTE THE DOC FOR FOR THESE TWO ARE DIFFERENT!!!*****
what is the DOC for an inpatient with UTI/pyelonphritis?
fluoroquinolone, amp+gentamycin, ceftriaxone
what is the most common nosocomial infection in the US? what is the tx protocol with this?
cathertized associated UTI
if asymptomatic don’t need to treat with abx
screen urine 48 hours after removing catheter
what are the two definitions of this?
what should you consider?
what about in women with decrease in lactobacillis?
3 or more episodes per year confirmed UC OR 2 UTIs in last 6 months
consider self treatment at first sign (urine cup for UC)
vaginal estrogen in women since they have a decrease in lactobacillus
in asymptomatic bacteremia who do you treat (3) and who do you not treat (3)? *key!*
2. before urologic procedures
3. after renal transplant
3. patients with spinal cord injury or indwelling urethral catheter
do you tx UTI empirically while waiting for culture?
YES! then adjust abx as appropriate! :)
benign prostatic hyperplasia
who does this happen in?
where does it start in response to what?
what does it cause?
increased incidence in nearly ALL MEN!!
80 and up 90% incidence!!!
begins around the urethra in response to increase dihydrotestosterone production and estrogen causing
urinary obstruction leading to SXS
1. decrease in stream quality
c. takes longer to pee, don't pee as far
2. incomplete emptying/frequency
how are symptoms for BPH scored? 2
international prostate symptom score (IPSS)
American system (AUA)
what are the 3 general tx options for BPH?
1. watchful waiting
**depends on severtiy of sxs!!***
what are 3 tx options for BPH?
how do they work?
1. alpha 1 adrenergic blockers "flow"
relax bladder to improve sxs
***watch for decreased libido, dizziness, floppy iris syndrome***
2. 5 alpha reductase inhibitors "shrink"
inhibit enzyme that convert testosterone to 5 alpha dihydrotestosterone (DHT) which decreases testosterone stimulation of the gland
3. combination-increase flow and shrink
what are the 4 surigcal options for BPH?
1. transurethral resection of prostate (TURP)
2. transurethral microwave therapy (TUMT)
3. transurethral needle ablation (TUNA)
4. transurethral US guided laser induced prostaectomy (TULIP)
do you always tx BPH?
no! only if pt is symptomatic
where does this occur?
sizes of prostate?
occurs in the secretory gland below the bladder that contributes to seminal fluid
common, slow growing cancer that leads to urinary obstruction "you die with it not from it!!
usually 20 ml (chesetnut or walnut)
prostate cancer: 40 ml enlarged golf ball
Need to make sure to screeen since hereditary!!!!
prostate cancer staging!**
what do you use to stage?
explain the rating system
1= well differentiated (favorable)
5=poorly differentiated (unfavorable)
add the two bx together for a score between 2-10, 10 is the worst oucome
what are the sxs with prostate cancer? 2
how do you dx? 3
usually asymptomatic untill metastsizes to bone causing bone pain
might cause urinary sxs if gotten into uretha and cause
1. DRE: hard irregularity/nodule, usually posterior
2. transrectal bx or US guided bx
3. if positive get erdionucleotide bone scane to look for metastasis
where are the 4 places prostate cancer likes to metastasize?
how can you screen for prostate cancer? 3
3. prostate cancer antigen 3
who has the highest incidence for prostate cancer? general lifetime risk?
general lifetime risk: 16%
what are the 4 tx options for prostate cancer? what is the gold standard?
1. surgery-radical prostatectomy or robotically
a. can cure
b. high incidence of impotence and incontinence
2. radiation with external beam or implantable seeds
a. not curative
b. palliation of bone mets
c. less impotence and incontinence than surgery
3. hormone-androgen deprevation
a. suppressive, not curative
4. chemo? not effective as much
what are you options when using hormone therapy for prostate cancer and androgen deprivation? what drugs can you use for each method?
1. remove testosterone production via orchiectomy (remove teste)
2. inhibit ACTH and estrogen (leuprolide)
3. inhibit testicular synthesis of testosterone (aminoglutethimide)
4. inhibit binding of androgen (flutamide)
prostate specific antigen
what is this?
serine protease that is involved in liquefaction
elevated in 65% of cases
35% false negative rate
non specific since also raised in prostate enlargement and prostatis
leads to more dx but doesn't decrease mortality so controversial...why look for a problem?
what is the difference between acute and chronic?
often in young, with sudden onset
often e.coli, klebsiella (poop bugs)
prostate normal on exam
can be from reccurent infection or inflammation
1. FEVER CHILLS
2. PROSTATE TENDERNESS
3. DYSURIA (SINCE INFECTION!)
4. URINARY FREQUENCY
5. LOW BACK PAIN!
1. consider prostate massage if first culture negative
2. clinical and UA
2. alpha blockers
psychogenic causes of erectile dysfunction
what percent of cases?
what is this?
2 common causes?
3 problems seen
20% of cases
common cause and occurs because the mood must br right, commonly effected by depression and anxiety
1. can't initiate
2. can't fill (encgorge) usually arterial proble
3. can't store veno occlusive dysfunction
organic causes of erectile dysfunction
what perecent of cases is this?
80% of cases
-loss of testosterone in testicular failure
-pituitary tumor producing prolactin
3. vascular disease
4. peyronies disease
what is it what do you do?
persistent painful erection
emergent urology consult
what is the difference between primary and secondary hypogonadism?
low testosterone, high LH or FSH (north works, south doesn't
low testosterone, low to normal LH/FSH, so therefor north not working well too
what testing sequence should you do to evaluate for hypogonadism?
1. AM total testosterone level
2. if low, repeat morning testosterone x2
A. if low testosterone, with LH and FSH not elevated then it is secondary hypogonadism
B. if low testosterone, with increased LH and FSH than primary hypogonadism
what are 5 test you want to do for erectile dysfunction?
1. testosterone level
2. prolactin levels **if this is high, it causes low levels of testosterone**
5. nocturnal penile tumescence testing "tape testing"
if prolactin levels are high what do you want to do?
get MRI because it likely has CNS origin, possibly tumor
what are 5 tx options for erectile dysfunction?
what does the medication do?
what can it cause?
1. replace testosterone if low
2. phosphodiesterase 5 inhibitor
-relaxes SM allowing for filling
-can cause headaches and flushing and when combined with nitrates can cause massive dip in BP
-effected by high fat meanls
3. prostaglandin E1
-intra-penile injection or intraurethral
4. vaccum device
5. surgery-penile prosthesis
what is hypogonadism caused by? how to you give testosterone?
1. testicular failure
2. problems from hypothalamic/pituary axis
**give depo-testosterone IM 1-2x a month!!**
what is it?
what 4 things most commonly cause it?
IT IS A STI!!!!
HPV in 99.7% of cases
HPV: 16, 18, 31, and 33
what are two important stats on this?
where does this likely occur?
what are the two most common histological types?
3rd most common GYN cancer in US and #2 of ALL CANCERS in women worldwide
usually occurs at the transformation zone (at SJC junction between squamous epithelium and glandular epitelium)
squamous cell 69%
explain the progesson of cervical cancer and why this is considered a cancer that effects 40-50s and why we screen in younger women?
cervical dysplasia is a precursor for cervical cancer
Cervical intraepithelial neoplasia CIN is the preinvasive phases of cervical cancer (it isn't cancer yet!)
carcinoma in situ CIS is the first cell change to cancer
20s: common occurance of CIN
25-35: CIS becomes more common in addition to continuation of CIN
40-50: Cervical cancer
explain the ranking of cervical intraepithelial neoplasia (CIN)?
CIN1: mild dysplasia
CIN2: modterate dysplasia
CIN3: severe dysplasia
**1/3 of patients will progress to carcinoma**
CIS: carcinoma in situ
how do you prevent cervical cancer?
protects: 6, 11, 16, 18
reccomended ages for bots and girls 11-26 years old
why was the pap smear considered a epidemology succes?
decreased the insicidence and mortality from cervical cancer 75% in the last 50 years in developed countries, 95% according to hoffmans lecture?
explain the process of performing a colposcopy? what is it used for? what are 2 management tecnniques?
used to follow up abnormal pap results
cervix stainged with acetic acid (vinegar) or iodine to identify the areas that need to be bxed
1. loop-electrosurgical excision procedure (LEEP)
2. ablation of T-zone with cryrotherapy or laser
what are you intervention options based on the possible cervical bx results?
1. mild lesions may resolve spontaneously
2. preinvasive neoplasia can be txed with electrocautery, cryocautery, laser surgery, conization, large loop excesion of transitional zone, or LEEP procedure (Green book)
what symptom and PE findings are found with cervical cancer?
what do you use to dx?
what are the tx options?
early cervical CA is asymptomatic
irregular or heavy vaginal bleeding
post coital bleeding and spotting MC sxs
PE: possible lesions that are raised and friable
DX: colpscopy with bx
if early stage
1. radical hysterectomy
2. fertility-sparing surgery
3. radiation and chemo
if metastic of reccurent, media survival is less than 2 years
explain HPV 16 and 18 and what they are likely to cause?
responsible for 70% of cervical cancers
16: higher rates of squamous cell cancers CIN3
18: higher rates of adenocarcinomas
what percent of woman who get cervical cancer never got a pap?!
what are the screening guidelines for a pap smear?
1. start at age 21 until 65 (don't check if under 21 and sexually active)
2. screen every 3 years from 21-29
3. pap + HPV "co-test" every 5 years if between 30-65
**notice you don't screen for the actualy HPV virus if you are under 30
who is this most common in?
what are the two types?
2 main presentations?
typically in younger men 20-40 years old
1. seminoma tumors
a. less aggressive
b. radiosensitive (get radiation tx)
c. normal levels
******seminoma are Simple and Sensitive*****
2 non-seminomatous tumors
a. screte AFP but not HCG (green book says both
painless testicular nodule, solid mass, or enlargement "heavy testicle"
what puts a person at higher risk for testicular cancer?
what is the cure rate for testicular cancer?
2. Self exam/physical exam
3. tumor markers
beta human gonadotrophic hormone (beta HCG)
alpha feto protein (AFP)
1. orchioplexy-CUT IT OUT
3. fix cryptochidism before puberty
if someone is dx with testicular cancer, what MUST you do?!
you must get a chest xray because testicular cancer metastasizes here!
what must you do for ANY breast lump?
this is 2nd most common breast complain in primary care, 90% are benign but still need to rule out cancer!!!
what is the triple test used when a breast lump is identified?
1. breast exam
2. mammorgram (often with US)
3. needle BX
A. fine need aspiration (FNA)
B. core needle Bx (CNB)
how do you make a definitive dx of breast cancer? (3)
1. fine needle aspiration
2. core needle bx
3. open bx
what is the most common cancer in women?
where are the 7 MC mestastasis placed for breast cancer?
what are 7 potenital sxs of breast cancer?
3. skin changes
5. red, hot
6. pain/no pain
7. regional node enlargement
what predominates in premenopausal women with bumps/lumps
benign conditions predominate
what predominates in post menopausal women with lumps and bumps? what do you need to remeber?
in postmenopausal women, any dominant mass or assymetry should be presumed cancerous until proven otherwise
how do you determine between a mass and a cyst?
sometimes simplest is to aspirate the mass
what should any solid mass, wheter or not it is imageable, warrants...
a definitive dx...bx it!!!
what is the GOLD STANDARD for dx breast cancer?
Biopsy!!! superior to even the most advanced imaging
when in doubt when it comes to a mass...
aspirate or refer to surgeon
what is this?
what are two other things to look for?
cells collect around the nipple causing eczematous appearance
97% also have ductal carcinoma in situ OR invasiver cancer elsewhere in the breast
scaling and thickening of the skin
yellow or bloody discharge from the nipple
non-invasive breast cancer:
ductal carinoma in situ
what is this?
how are they found?
2 tx options?
MOST COMMON TYPE OF NON-INSIVE BREAST CANCER
1 in 5, 25% of all BC is this
non-lifethreatening, typically without signs and symptoms
increases risk of developing invasive BC
80% found on mammorgram
1. lumpectomy alone 25-30% recurrence
2. lumpectomy and radiation 15% recurreny
non-invasive breast cancer:
lobular carcinoma in situ
what is this?
what does it increase risk of?
when/how is it dxed?
collection of abnormal cells, not true cancer
increases risk of invasive cancer later in life
dxed before menopause, usually dxed becuase bx performed for some other reason
hormonal receptor positive
invasive ductal carcinoma
what is this?
5 tx options?
most common invasive breast cancer!!!
70-80% of BC
1. swelling of all or part of the breast
2. skin irritation or dippling
3. breast pain
4. nipple pain/nipple turing inwards
5. nipple discharge other than milk
6. enlarged lymph nodes in the axilla
1. lumpectomy less than 2 cm
2. mastectomy (partial, total, radical)
3. sentinel lymph node bx
4. axillary lymph node bx
5. post surgical radiation
what is involved in pt follow up for invasive ductal carinoma breast cancer?
1. provider visit with exam every 3-6 months for first 3 years
2. every 6-12 months for 4-5 years
3. every year post 5 years
4. yearly mammogram
invasive lobular carcinoma
where does it occur?
2ND MOST COMMON TYPE 10% OF CA
BEGINS IN THE MILK PRODUCING LOBULES
occurs later in life around 60s
what are 5 additional tx options for a patient with with invasive ductal carcinoma post lumpectomy?
2. hormonal therapy
3. estrogen receptor down regulatiors-tamoxifen
4. oviaran shut down or removal
5. HER2 therapies-block HER2 that allows for rapid cancer growth
invasive breast cancer:
inflammatory breast cancer
what does this look like?
how to dx?
4 staging options?
2 tx options?
rare, average age in 55s
looks like eczema on the breast (not confined to nipple), breast enlarged
1. skin punch bx
2. CT of chest/abdomen
3. bone scan
1. chemotherapy prior to surgery
2. targeted therapy: if HER2 receptor postivie also treat prior to surgery HECEPTIN
invasive breast cancer:
inflammatory breast cancer
how does your response to pre-surgical chemo effect the next step in tx?
if cancer response to first dose chemo before surgery: modified radical mastectomy
if no response to first dose chemo before surgery: another round chemo + radiation and likely radiation AFTER surgery
what are 7 RF in developing breast cancer?
2. greater to 55
3. no children, no breastfeeding
4. exogenous exposure to estroen
5. family hx postive for BC 1st degree relative
6. BRCA1 and 2
BRCA1 and BRCA2
60% increase in risk of BC
1.develope breast cancer earlier
2. have bilaterally breast more often
do malignant breast conditions tend to have more or less discharge?
how do you dx breast cancer?
1. yearly breast exam by provider
3. aspiration/bx=gold standard
4.mammogram-controversial time frame
(2 main guidelines)
-start at 40, Q 1 or 2 years
-start at 50, Q1 or 2 years
how is Breast cancer staged?
2. spread to lymph node
when are 6 instances it is appropriate to test a patient for BRCA1 and BRCA2?
1. eastern european
2. AA before dx before 35
3. in all family of man dx
4. women with BC in both breasts
5.multiple family with breast or ovarian cancer
6. blood relative before 50
what is the most LETHAL GYN cancer? what the nickname?
by the time we dx it it is already really progressed and metastisizes!
if you find an enlarging ovarian mass with a solid component or change in character esp in post menopausal woman, what should you do?
REMOVE IT!! ASAP!!!
is it reccomended to screen for ovarian cancer?
no because it does not appeare to reduce mortality
what are the genetic markers associated with ovarian cancer?
BRCA1 and 2
what is the most common type of ovarian cancer?
85-90% of all ovarian cancers
what are the 3 types of ovariance cancer classifications?
include caracteristics of each
most are benign
-epithelial carcinomas 85-90% of all ovarian cancers
-clear cell-rarely benign
2. germ cell
occurs in cells that produce eggs
young women teenage-20s
teratomes or dermoid cysts are in 40-50% and can contian hair and teeth
3. stomal carcinoma
in connective tissues of the ovaries that produce estrogen and progesterone
what are 4 protective factors of ovarian cancer?
more than 1 full term pregnancy before age 35
how much does have the BRCA1 and BRCA2 genes increase womens chance of ovarian cancer? what should they consider?
increase lifetime risk by 25-50%
***consider prophylactic billateral salpino-oophorectomy (BSO) by age 35 or as SOON as childbearing is complete for familial ovariance cancer syndrome!!!!!****
what are the 3 sxs that are likely to present in late dxs?
what do you need to keep in mind?
usually asymptomatic until late disease
late stage sxs usually when person presents
1. abdominal pain/bloating
2. early satiety (feeling full)
3. urinary urgency/frequency
palpable ovary needs evaluation!!!
1. transvaginal US
2. laparoscopic evaluation
what is the 4 tx options for ovarian cancer?
1. surgery-removal of tumor (may be total hysterectomy)
4. sometimes radiation