Week 8 Flashcards
1
Q
What is the acute infection of the upper genital tract that can involve the uterus, fallopian tubes, and ovaries, and can spread to the peritoneum?
A
Pelvic Inflammatory Disease (PID)
2
Q
what are the two most causitive agents of pelvic inflammatory disease?
A
Chlamydia and gonorrhea
3
Q
what are long term consequences of acute pelvic inflammatory disease?
A
Infertility, ectopic pregnancy, chronic pelvic pain
4
Q
____ is ____ greater in women with a history of PID due to____ and ____.
A
ectopic pregnancy
10 times
Scarring
Adhesion
4
Q
what are the risk factors to PID?
A
Hx of STI
Multiple partners
Under 25 and sexually active
Douching- can push bacteria upwards into uterus and fallopian tubes
IUD (increased risk of PID at the time of placement and three weeks following placement of an IUD)
4
Q
signs and symptoms of PID?
A
Asymptomatic
severe abdominal, uterine, and ovarian pain tenderness
Irregular menses
Abnormal vaginal discharge with foul order
Painful sexual intercourse
Fever (100.4°F or 38°C)
elevated white blood cell count and erythrocyte sedimentation rate
4
Q
what are three definitive criteria for diagnosing PID?
A
evidence of metritis on endometrial biopsy
Thickened fluid filled fallopian tubes noted on transvaginal sonogram or MRI
abnormalities noted during laparoscopic examination
4
Q
what is the medical management for those who have PID?
A
Treatment in outpatient
Test for STI and treat
oral antibiotic therapy
treatment of sexual partner to decrease risk of reinfection
analgesia for pain management
Hospitalization with IV antibiotic therapy
4
Q
When would a woman with PID have an IV antibiotic therapy?
A
Pregnancy
Not responding to oral antibiotic treatment
Unable to follow or tolerate outpatient treatment plan
Severely ill
Have an Abscess in the fallopian tubes or ovaries
5
Q
what are some considerations for those with PID undergoing oral antibiotic therapy? (2)
A
Women is reevaluated after 48 to 72 hours of therapy
when PID responds to treatment the woman should be examined in four to the six weeks after for reevaluation.
5
Q
What are some ways to reduce risk of PID?
A
Be in a monogamous sexual relationship with a partner who has been screened for STI and not affected
Avoid douching
Use condoms correctly and each time engaged in sexual activity
5
Q
What is another name for Stein leventhal syndrome?
A
Polycystic ovary syndrome
5
Q
how many people are affected with PCOS?
A
5 to 10% of women of childbearing age.
5
Q
What is the etiology of polycystic ovary syndrome?
A
Etiology is not fully understood but there might be a genetic component because it runs in families.
5
Q
What are some general homonal commonalities of people with PCOS?
A
An elevated levels of estrogen, testosterone and luteinizing hormone
A decrease in the secretion of follicular stimulating hormone
Multiple follicular cysts on one or both ovaries producing excess estrogen
6
Q
Women with PCOS are at a higher risk for what?
A
Type 2 diabetesObesity
Cardiovascular disease
Hypertension
Cancers such as endometrial, ovarian, and breast
Dyslipidemia
Infertility
Sleep apnea
Metabolic syndrome
6
Q
How does insulin resistance in patients with PCOS affect their cardiovascular health?
A
Insulin resistance and obesity increases a woman’s risk of carotid and coronary atherosclerosis
endocrine changes also increase the risk for high low density lipoprotein cholesterol and lowered high density lipoprotein
6
Q
Why might women with PCOS have a higher risk of obesity?
A
The body produces insulin but does not use it properly and it eventually leads to hyperinsulinemia and hyperglycemia and obesity
6
Q
How does PCOS increase the rate of cancer?
A
It increases the levels of continuous estrogen
6
Q
how does PCOS increase the rate of infertility?
A
Anovulation is related to increased androgen levels and increased LH and lowered FSH
6
Q
what are some signs and symptoms of PCOS?
A
Infertility
Menstrual disorders
Hirsutism
Ovarian cyst
Obesity
Oily skin and acne
Pelvic pain
Male pattern baldness
6
Q
What are some primary characteristics of PCOS that relate to ovulatory and menstrual dysfunction? (3)
A
Anovulation
Amenorrhea or decrease frequency
Menorrhagia
6
Q
what are some primary characteristics of PCOS that relate to hyperandrogenemia?
A
Increased hair growth on the face, chest, stomach, and back
Severe acne
Male pattern baldness
7
Q
what are some specific nursing actions related to PCOS?
A
Educate on weight reduction through diet and exercise treatment options for hirsutism such as electrolysis or laser hair removal
Treatment options for acne and oily skin
Infertility issues
Psychological effects on the body changes
7
what are four ways to manage PCOS?
Lifestyle modifications such as diet and exercise
Hormone therapy
Fertility therapy
Diabetic medications
7
how does diet and exercise affect PCOS?
Reduces the risk for type 2 diabetes
Decreases levels of androgen
Improves frequency of ovulation and menstruation
Reduces risk of cardiovascular disease
8
what are some hormone therapy options for those with PCOS?
Low dose hormonal contraceptives for those who do not wish to conceive
They inhibit LH production, decrease testosterone levels, and reduce degree of acne and hirsutism
8
what are some fertility therapy options for those with PCOS?
Medications that induce ovulation such as clomid
Assisted reproductive technology such as in vitro fertilization
9
what are two benefits of anti diabetic medication on PCOS?
They can lower testosterone levels which reduces the degree of acne, hirsutism and abdominal obesity and regulate the menstrual cycle and treat infertility
Manage blood glucose levels
9
What is the name for a group of conditions that increase in individuals risk for heart disease, stroke, and diabetes?
Metabolic syndrome
9
What are the five conditions that needs to be in order for someone to have metabolic syndrome?
Abdominal obesity with a waist circumference in women greater than 35 inches
High triglyceride level greater than 150 mg/dL
Low HDL cholesterol lower than 50 mg/dL
increase blood pressure with systolic greater than 130 and/or diastolic greater than 85
elevated fasting blood glucose greater than 110 mg/dL
9
What is a chronic inflammatory disease in which the presence and growth of endometrial tissue is found outside the uterine cavity?
Endometriosis
10
How does endometrial tissue respond to hormones within the body?
It responds to changes in estrogen and progesterone levels within the body
the tissue is estrogen dependent so it is most common during the reproductive years
10
where is endometrial tissue found in endometriosis?
Peritoneal services of reproductive organs an adjacent structures of the pelvis such as ovaries, fallopian tubes, bladder, bowel, and intestines
10
where is the most common site of endometriosis tissue?
Ovaries
10
What are some signs and symptoms of endometriosis?
pelvic pain and dysmenorrhea
Lower back pain
Pelvic pressure
Dispareunia
Infertility
Premenstrual spotting and Menorrhagia
diarrhea, pain with defecation, Constipation (bowel lesions)
bloody urine with bladder involvement
Fixed retroverted uterus
Enlarged and tender ovaries
11
what are some common medications for endometriosis?
Danazol
GnRH agonists (Lupron, Zoladex, and nafarelin)
Oral Contraceptic pills
Progestins
NSAIDS
12
what would you say to a patient who is on medications for Endometriosis?
Symptoms will usually return within 1-5 yrs after medications are stopped
12
what are some long term effects of endometriosis?
Scarring, fibrosis, and adhesions can form from continued inflammation
13
what are some SE of nafarelin?
Emotional instability, headaches, vaginal dryness, acne, cessation of menses, impaired fertility, decreased libido, and hot flashes
14
what is the goal of hormone therapy of endometriosis?
Surprise menstruation and further growth of tissue
15
how does the surgical intervention for endometriosis work for those who desire pregnancy and those who do not?
There is a surgical removal of lesions via laparoscopy procedure and laser treatment for women with severe symptoms who are infertile and desire pregnancy
Hysterectomy with bilateral salpingo-oopherectomy and removal of adhesions and lesions for those who do not desire pregnancy
15
How often should women older than age 65 get the influenza vaccine?
Every fall or winter
15
how often should women older than age 65 get the pneumococcal vaccine?
One dose at age 65
15
how often should women older than 65 get the Tdap vaccine?
Td Every 10 years
Tdap needed if booster for whooping cough
16
What is the loss of bone mass that occurs when more bone mass is absorbed than new body mass is laid down?
Osteoporosis
16
after age 35 bone mass usually occurs at a rate of what?
0.3% to 0.5%
17
How is osteoporosis diagnosed?
With a dual energy X-ray absorptiometry scan,
17
Which bones does the DXA scan?
Hip, spine, forearm
17
A T score is determined by comparing the women's bone density to that of the average __ ___ of the same___ and ___
bone density
sex and race
18
What A T score is indicative of osteoporosis and osteopenia?
-2.5 (osteoporosis)
-1 to -2.5 (osteopenia)
19
what are some signs and symptoms of osteoporosis?
Back pain related to fracture or collapsed vertebra
loss of height related to collapsed vertebra
Stoop posture related to collapsed vertebra
Bone fractures related to bone weakness
19
What are some risk factors for osteoporosis?
Caucasian women
Then small boned women
Family history of osteoporosis
History of a smoking
Inactivity
Low calcium so vitamin F and calcium
Excessive alcohol consumption
Decrease levels of estrogen
Long term use of steroids
Eating disorders such as anorexia
Weight loss surgery
19
how would you reduce the risk of osteoporosis in women?
Maintain a diet high in calcium and vitamin D starting from the age of 9
Engage in weight bearing exercises
avoid smoking
limit alcohol use
19
how much calcium should a girl from ages 9 to 18 have? What about women 19 to 15 years old? 51+?
1,300 mg 9-18 y.o.
1000 mg for those 19-50
1,200 mg for those 51+
19
what are some foods high in calcium?
Plain low fat yogurt
Fortified orange juice
Can sardines
Cheddar cheese
Milk and 2% milk fat
Salmon
19
What are some pharmacotherapies for women with a DXA T score less than or equal to -2.5 or someone with risk factors and a DXA T score of less than -1.5?
Biphosphonates
estrogen receptor modulators
Hormone therapy
20
What is The criteria for getting pharmacotherapy for osteoporosis?
DXA T score less than or equal to -2.5 or someone with risk factors and a DXA T score of less than -1.5?
20
How do biphosphonates work?
They inhibit the resorption of bone
20
What are some adverse effects of bisphosphonates?
Muscular skeletal aches and pains, gastrointestinal irritation, and esophageal ulcerations
20
What would be some education to tell people on how to enhance absorption of oral medication of biphosphonates and reduce side effects?
Take the medication in the morning on an empty stomach at least 30 minutes before breakfast
Take the medication with at least 8 ounces of water but not juice coffee or tea
Take the medication in a sitting or standing position
Remain upright for 30 minutes to prevent reflux of the pill
20
how do estrogen receptor modulators help prevent or reduce osteoporosis?
Binds with estrogen receptors, producing estrogen like effects on the bone, and reduces resorption of bone
21
What years does menopause usually occur between?
35-58
21
What are the three stages of menopause?
Perimenopause
Menopause
Post menopause
21
How would you characterize perimenopause?
Begins when the woman experiences menopausal signs and symptoms and ends after the first year following the last menstrual period this stage can last several years, and the woman can become pregnant during this stage
22
When does a woman stop producing eggs? Why?
In her late thirties as there is a decline in production of estrogen and progesterone
23
What are the signs of menopause?
Irregular periods
Hot flashes
Night sweats
Sleep disturbances
Vaginal dryness
Mood changes and trouble focusing
Decreased interest in sex
Fatigue
Hair loss
Incontinence
Irregular heartbeat/palpitations
23
What are Signs and symptoms of menopause in regards to irregular periods?
Menstrual cycle may become irregular
The time between cycles may become longer or shorter
Menstrual flow may become lighter or heavier
Cycles become anovulatory
23
What are signs and symptoms of menopause caused by in regards to hot flashes?
Basal motor responses to changes in hormone levels triggers blood vessels near the skin to dilate causing an increase in blood supply
23
What are the most common signs and symptoms of menopause?
Hot flashes
23
What causes vaginal dryness in menopause?
A decrease in estrogen
23
What are three approaches for treatment of menopausal symptoms?
Lifestyle changes, alternative medicine, menopause hormone therapy
23
what are some lifestyle changes that can help with treating menopausal symptoms?
Get enough sleep per night
Eat a balanced diet
Exercise
Avoid caffeine and alcohol
Avoid cigarette smoking and second hand smoke
23
what are some alternative medicine that can help with treating menopausal symptoms?
Herbal supplements such as black cohosh
Acupuncture
Biofeedback
Hypnosis
24
What kinds of hormone therapy can be used for menopause?
Estrogen for those who do not have a uterus
estrogen and progesterone for those who have a uterus
24
what is the benefit of using progesterone as a menopausal treatment?
It can reduce the risk of endometrial cancers
24
what is some treatment for hot flashes? Pharm and non pharm
Avoid alcohol, hot beverages, spicy foods, warm rooms, and smoking
dress in layers
avoid wearing clothes from wool or synthetics
Use fans
low dose antidepressants called fluoxetine
anti seizure medications gabapentin
antihypertensive Clonidine
24
what are some medications to treat hot flashes?
low dose antidepressants called fluoxetine
anti seizure medications gabapentin
antihypertensive Clonidine
24
What is some treatment for night sweats?
Sleep in cotton night wear
use cotton bed linens
Sleep in a cold room
Sleep with a fan blowing over the body
Take a cool shower before bedtime
24
what are some treatments for vaginal dryness?
Use water based lubricants
Vaginal moisturizers
Estrogen vaginal cream
Soy flower and flaxeeds in diet
24
What percentage of adolescents who use alcohol, tobacco,and drugs smoke cigarettes?
16.1%
25
Physical activity can lower the woman’s risk for:
■ Heart disease
■ Type 2 diabetes
■ Colon cancer
■ Breast cancer
■ Falls
■ Depression
25
Excessive drinking increases a woman’s risk for
alcoholism, elevated blood pressure, obesity, diabetes, stroke, breast cancer, suicide, and accidents
25
What is the most common cancer for women in the United states?
Breast cancer
25
what are major risk factors for breast cancer?
age
25
what are some extra factors that can affect breast cancer rates?
High endogenous estrogen or testosterone levels
High bone density
Family history of breast cancer
Exposure to chest radiation
Excess weight
Exposure to estrogen such as early onset of menarche, late menopause, or use of hormone therapy
Smoking
Exposure to carcinogens alcohol and diethylstilbestrol
26
What are some ways to diagnose breast cancer?
Mammograms
Ultrasounds
MRI's
Biopsy
26
what are indications of breast cancer disease prognosis?
Presence of hormone receptor levels
Stage of cancer such as type and tumor size and presence of lymph node involvement
Presence of HER2/neu in the tumor tissue
26
What is the order of BSE?
Examine breasts in shower
Arms up , down, and hips
Stand and press fingers into breast, working around the breast in a circular motion
Lie down and repeat previous step
Squeeze your nipples for discharge
26
STAGE IV meaning
cancer has spread to distant organs or lymph nodes distant from the breast.
26
Surgical interventions for breast cancer
lumpectomy
Partial or segmental mastectomy
Simple mastectomy
Modified radical mastectomy
Possible reconstruction
26
what are some types of radiation therapy?
External radiation and internal radiation with needles, seeds, and wires
26
what are some visual signs of breast cancer?
Lump
skin dimpling
change in skin color or texture
inversion of the nipple
clear or bloody discharge from the nipple
26
how are mammograms done?
Each breast (one at a time) is placed between the x-ray plate and plastic plate. Pressure is gradually placed on the breast to flatten the breast. A clearer picture of the breast is obtained by flattening the breast.
26
Women should not wear what on the day of their mammogram appointment? Why?
Women should not wear any deodorants, perfume, lotion, or powder under their arms or on their breasts on the day of the appointment. These substances can make shadows on the x-ray.
27
When should women start having mammograms, and how frequently?
From 40+, Every 1–2 years
27
When should women start having pelvic exams, and how frequently?
Yearly from age 21 if sexually active
28
When should a woman get a pneumococcal vaccine?
Starting from age 19, if smoker or has chronic health issues, and definitely one dose at age 65
29
how to prevent women's heart disease?
Weight loss
Manage stress
Sufficient sleep
Exercise
Smoking cessation
Lower cholesterol
Healthy diet
29
What is the number one cause of death of women?
heart disease
29
Annual physicals in your 20s will include what three things?
Clinical breast exam
Blood pressure check
Blood test
STD screening
Vision screening
29
Common health topics during 20’s
Menstrual issues
STI
Contraception
pregnancy
29
health promotion and screening in the 30s
Clinical breast exam
Blood pressure check
Blood test
29
health promotion and screening in the 40s
Clinical breast exam
Blood pressure check
Blood test
Cholesterol
Mammogram
Eye disease
29
health promotion and screening in the 50s
Clinical breast exam
Blood pressure check
Blood test
Cholesterol
Mammogram
Skin check
29
What are the leading health problems and issues for female adolescents?
Unintentional injuries, suicide and homicides
eating disorders
STI
Pregnancies
Issues related to self esteem
Menstrual disorders
Acne
29
what is the leading cause of death for females ages 15 to 19?
Unintentional injuries, suicide and homicides
29
what are the risk factors for health problems for female adolescents?
Risky behavior that contributes to unintentional injury of violence
Alcohol, tobacco, and drug use
Unhealthy sex behaviors
unhealthy dietary behaviors
Inadequate physical activity
29
What are some common types of menstrual disorders?
These include amenorrhea, dysfunctional uterine bleeding, dysmenorrhea, and premenstrual syndrome
29
The _____, ___, and ______ are the main sites of regulation of the menstrual cycle.
Hypothalamus, pituitary, and ovaries
30
What is the role of the hypothalamus in menstruation? What does it secrete?
Secretes gonadotropin-releasing hormone (GnRH), also called luteinizing-hormone-releasing hormone (LHRH), which simulates the anterior pituitary.
30
What is the role of the Anterior pituitary in menstruation?
Secretes follicle-stimulating hormone (FSH) and luteinizing hormone (LH) that stimulates the ovaries.
30
What is the role of ovaries in the menstrual cycle?
The ovarian follicles respond to the increase in FSH by producing increasing amounts of estrogen. LH stimulates the ovaries to release the ova and secrete progesterone. Estrogen and progesterone influence the menstrual cycle
30
What can cause primary amenorrhea?
* Body build (i.e., minimal levels of body fat)
* Heredity (family history of delayed menses)
* Pituitary function (lack of secretion of FSH and LH)
* Congenital absence of the vagina
* 90% of cases have no identifiable cause.
30
Secondary amenorrhea s/s
No menses in 6 months in a woman who has had normal menstrual cycles
30
Causes of secondary amenorrhea
* Lack of ovarian production
* Pregnancy
* Polycystic ovary syndrome
* Nutritional disturbances
* Endocrine disturbances
* Uncontrolled diabetes
* Heavy athletic activity
* Emotional distress
31
What is menorrhagia?
Menstrual bleeding that is excessive in number of days and amount of blood
31
Causes/pathophysiology of menorrhagia
* Anovulatory cycle with continued estrogen production
* Fibroids are most common anatomic cause.
* Inflammatory or infectious cause (e.g., metritis, salpingitis)
* Endometrial cause (e.g., hyperplasia, polyps, cancer)
* Intrauterine device (IUD)
32
Management of menorrhagia
Depends on cause
Biopsy
Abx
Contraceptives
D&C
32
S/s of metrorrhagia
Bleeding between periods or after menopause
32
What is the most significant form of menstrual disorder and warrants immediate investigation
* Occurs with cancerous or benign tumors of the uterus
* Associated with IUD and use of oral contraceptives
* May be associated with trauma, cervicitis, vaginitis, polyps, ovarian cysts, cervical dysplasia
32
What is painful menstruation with severe cramping, chills, nausea, vomiting, and headaches
Primary dysmenorrhea
32
Causes and pathophys of primary dysmenorrhea
Excessive endometrial production of prostaglandin; women with primary dysmenorrhea produce 10 times the amount of prostaglandin. Prostaglandin is a myometrial stimulant and vasoconstrictor.
32
Difference between primary and secondary dysmenorrhea
Secondary has known anatomic factors or pelvic pathology. Pain can be present at any point of the menstrual cycle.
33
Causes and pathophysiology of secondary dysmenorrhea
* Endometriosis
* Pelvic adhesions
* Inflammatory disease
* Cervical stenosis
* Uterine fibroids
* Adenomyoma
33
Explain Premenstrual syndrome (PMS)
A combination of emotional and physical symptoms that begin during the luteal phase and diminish after menstruation begins.
Symptoms include (but are not limited to) lower abdominal and back pain, bloating, weight gain, breast tenderness, joint and muscle pain, oliguria, diaphoresis, diarrhea,
33
Possible causes of PMS
* Hormonal changes related to the menstrual cycle
* Estrogen-progesterone imbalance
* Chemical changes in the brain
33
Hemorrhage can lead to a removal of what?
The uterus
34
The top three reasons for hysterectomy are:
■ Leiomyomas—benign fibrous tumor of the uterine wall
■ Endometriosis—abnormal growth of tissue resembling the endometrium that is present outside of uterine cavity
■ Uterine prolapse
35
other reasons for hysterectomy are:
■ Cancer—cervical, ovarian, endometrial
■ Abnormal uterine bleeding
■ Chronic pelvic pain
■ Pelvic inflammatory disease
35
Leiomyomas?
benign fibrous tumor of the uterine wall
35
Types of Hysterectomies
■ Total hysterectomy: Removal of the uterus and the cervix
■ Hysterectomy with salpingo-oophorectomy: Removal of the uterus, cervix, fallopian tubes, and ovaries
■ Radical hysterectomy: Removal of the uterus, cervix, fallopian tubes, ovaries, upper portion of the vagina, and lymph nodes. This is done for some cases of reproductive cancer.
■ Supracervical hysterectomy: Removal of the uterus
35
What determines the type of hysterectomy?
determined by the reason for hysterectomy and the age and health status of the woman.
36
Surgical and Anesthetic Techniques for hysterectomy
Abdominal hysterectomy: Removal of the uterus and other structures through an abdominal incision.
Vaginal hysterectomy: The uterus is removed through the vagina.
Laparoscope-assisted vaginal hysterectomy (LAVH): The woman is placed in a steep Trendelenburg position. Laparoscope and instruments are inserted through small incisions in the abdomen
General anesthesia
36
Risks Related to Surgical Procedure of hysterectomy (complications)
■ Complication related to anesthesia
■ Injury to ureters, bladder, and/or bowel
■ Hemorrhage
■ Infection
■ Deep vein thrombosis
37
Medical Management- Preoperative Care for Abdominal Hysterectomy
■ Physical assessment and health history
■ Laboratory tests—complete blood count, type and crossmatch, urinalysis
■ Electrocardiogram
■ NPO 8 hours prior to surgery
37
Postoperative Medical Management for Abdominal Hysterectomy
■ IV therapy
■ Medications for pain management
■ Antibiotic therapy if at risk for infection
■ Hormone replacement therapy if ovaries were removed
■ Progression of diet
■ Foley catheter for 24–48 hours post-surgery
■ Ambulate once recovered from anesthesia
37
Postoperative Nursing Actions for Abdominal Hysterectomy regarding bleeding
assess for blood on abdominal dressing and perineal pad. The woman will experience small to moderate amounts of vaginal bleeding for several days.
37
Postoperative Nursing Actions for Abdominal Hysterectomy regarding fertility questions
The woman may experience emotional symptoms following surgery related to hormonal changes and loss of fertility.
38
Postoperative Nursing Actions for Abdominal Hysterectomy regarding discharge
■ Keep the incision area dry, following the surgeon’s instructions for bathing and dressing care.
■ Explain that walking is important in helping her to gradually return to her pre-surgery activity level.
■ Instruct the woman to follow her surgeon’s orders
regarding level of activity and heavy lifting.
■ Explain that she may experience light vaginal bleeding for
several days.
■ Provide nutritional information
■ Instruct the woman not to put anything in the vagina (e.g., do not douche, use tampons, or engage in sexual intercourse)
38
What marker in the blood is elevated in women with ovarian cancer?
OVA1: A multivariate index that examines 5 serum biomarkers: CA-125, A-1
38
____ ____ ____ is the most common type of ovarian cancer and the ____ leading cause of cancer related deaths in women
Ovarian epithelial tumor
third
39
What are the risk factors of ovarian epithelial cancer?
■ Family history of a first-degree relative with the disease; the most important risk factor
■ Personal history of cancer
■ Age over 55
■ Eastern European Jewish background
■ Never given birth
■ Have endometriosis
■ Tested positive for BRCA1 or BRCA2
39
General signs and symptoms of ovarian cancer?
■ Pressure or pain in the abdomen, pelvis, back, or leg
■ Swollen or bloated abdomen
■ Urinary urgency and frequency
■ Difficulty eating or feeling full quickly
39
Early signs and symptoms of ovarian cancer?
vague abdominal, genitourinary, or reproductive symptoms
39
how would you describe the four stages of ovarian epithelial cancer?
■ Stage I: Cancer cells are found in one or both ovaries.
■ Stage II Cancer cells have spread to other tissue in the pelvis.
■ Stage III: Cancer cells have spread outside the pelvis or
to the regional lymph nodes.
■ Stage IV: Cancer cells have spread to tissue outside the
abdomen and pelvis
39
What is the medical management of ovarian epithelial cancer Regarding tests and procedures??
■ Transvaginal ultrasound to identify changes in ovaries
■ CT scan and MRI to confirm presence of pelvic mass
■ PET scan to assess for metastasis to other body organs
■ Barium enema x-ray to determine if there is colon and/or
rectal involvement
■ OVA1: A multivariate index that examines 5 serum biomarkers: CA-125, A-1
■ Risk of ovarian malignancy algorithm (ROMA) classifies patients into high-risk and low-risk groups for having epithelial ovarian cancer
39
What is an OVA 1 score that indicates the probability of ovarian cancer in a premenopausal and postmenopausal woman?
■ Premenopausal women: Score of 5.0 or higher—strong probability of ovarian cancer
■ Postmenopausal women: Score of 4.4 or higher—strong probability of ovarian cancer
40
what does a ROMA score do?
classifies patients into high-risk and low-risk groups for having epithelial ovarian cancer. HE4, human epididymis protein 4, in combination with CA-125 are used in the algorithm.
40
What is a ROMA score that is considered high risk for pre menopausal and postmenopausal women?
■ A ROMA score of ≥12.5% is considered high risk for premenopausal women.
■ A ROMA score of ≥14.4% is considered high risk for postmenopausal women
41
The four most common occurring early warning signs of ovarian cancer are:
■ Bloating
■ Pelvic/abdominal pain
■ Difficulty eating or feeling full quickly
■ Urinary symptoms
41
What should women do to see if they can get screened for ovarian cancer?
Keep a log of their symptoms for one month of any of the four common symptoms
If they experience any of these symptoms more than
12 times in one month and these symptoms first appeared within the past 12 months should be evaluated for possible ovarian cancer
41
What surgery would be recommended treatment for Stage I ovarian cancer?
Total abdominal hysterectomy and bilateral salpingo-oophorectomy, omentectomy, and biopsy of lymph nodes and other pelvic and abdominal tissues and chemotherapy when high grade tumors are present
41
Total abdominal hysterectomy and bilateral salpingo-oophorectomy, omentectomy, and biopsy of lymph nodes and other pelvic and abdominal tissues and chemotherapy with or without radiation therapy
Total abdominal hysterectomy and bilateral salpingo-oophorectomy, omentectomy, and biopsy of lymph nodes and other pelvic and abdominal tissues and chemotherapy with or without radiation therapy
41
What surgery would be recommended treatment for Stage IV ovarian cancer?
Stage IV—Surgery to remove as much of tumor as possible followed by chemotherapy
