Reproductive Cancer – Flashcards
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Cervical Cancer causes
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HPV 16 and HPV 18
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Cervical Cancer risks
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sex at early age multiple partners not being able to afford regular pap smears high risk sexual partners; HIV; weak immune system smoking; chlamydia diet low in fruits and vegetables; obesity long term oral contraceptive use multiple full term pregnancy; young age first pregnancy family history
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Cervical Cancer symptoms
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metrorrhagia (breakthrough bleeding/spotting) postcoital spotting cervical ulceration bladder or rectal dysfunction & lower abdominal pain- more advanced stage
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Cervical Cancer guidelines for screening
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should be screened via pap 3 years after onset of sexual activity but not past age 21
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Cervical Cancer guidelines for screening cont.
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screening can stop for women at age 70 who have 3 documented consecutive negative tests and no abnormal cytology within the past 10 years
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Cervical Cancer prevention
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Gardasil Vaccine reg pap smear limit # of partners use condoms follow up on abnormal screen
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Gardasil
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good for all 4 types of HPV; age 9-26; given IM in upper arm or thigh 1st dose- whenever pt. chooses; 2nd dose- 2 months later; 3rd 6 months after the first dose
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Pelvic exam
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"bimannual exam" (other name for pelvic exam) 2 fingers in utero and hand outside involves palpation by HCP thorough examination of reproductive organs detects cancers, infections, STI's, and repro issues
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Pap smear
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swab collected from the cervix that examines the cells for certain changes that could lead to cancer
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Pelvic exam vs Pap
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terms are NOT interchangeable Pelvic Exams: helps to detect cancer, infection, STI Pap Smears: examines cells that COULD lead to cancer
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Cervical Cancer treatment
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cryosurgical repair LEEP - cuts away abnormal tissue Total hysterectomy Radiation- external or internal Chemotherapy
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LEEP procedure
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Loop Electrosurgical Excision Procedure outpatient med is inserted in cervix (cervical block) can return to normal activities in 1-3 days after procedure mild cramping may occur spotting for about 3 weeks NOTHING in vagina for 3 weeks Call HCP for: fever, bleeding- heavier than period, increase in pelvic pain, bad smelling or yellow discharge
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hysterectomy
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abdomen or vaginal; done using general or spinal anesthesia a laproscope may be used on some types of hysterectomy procedure can last 1-3 hours and hospital stay about 2-3 days foley catheter to avoid urinary retention
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hysterectomy cont
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expect abdominal cramping; moderate drainage, perineal pad complications: wound infection, urinary retention, UTI, uteral fistural, thrombophlebitis
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hysterectomy recovery
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recovery will take 2 weeks to 2 months vaginal & laproscopic hysterectomy take less recovery time. abdominal hysterectomy takes longer recovery time. mild stool softeners no intercourse, douching, tub baths, tampons for 4-6 weeks until allowed
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da vinci hysterectomy- "robotic"
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3 d vision, magnified view, high definition and better control small incision and more precise CAN'T BE PROGRAMMED less pain, less blood loss, less amt of blood transfused, shorter hospital stay
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Endometrial cancer causes
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exact cause is unknown we know it is a genetic mutation in uterus lining & abnormal cells multiply beyond control; tumors may metastasize
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endometrial cancer risks
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50-70 years old is most common; obesity; diabetes nulliparity; polycystic ovary syndrome unopposed estrogen therapy (estrogen without progesterone) long use of Tamoxifen (for breast cancer tx) family hx
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Tamoxifen Use
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Tamoxifen - interferes with the action of estrogen and is used to treat breast cancer can cause endometrial cancer and uterine sarcoma in some women 2 per 1000 women may develop endometrial cancer via Tamoxifen use
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The presenting sign of endometrial cancer is
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abnormal bleeding
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endometrial cancer symptoms
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Abnormal bleeding is the presenting sign of endometrial cancer in 80% of cases vaginal bleeding after menopause (common in women 50-70) prolonged periods / bleeding between periods pyometra (collection of pus) hematmera (collection of blood) lower abdominal pain
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endometrial cancer screening
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report unexpected bleeding or spotting to doctors all women at menopause should be taught risks and symptoms of endometrial cancer
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endometrial cancer prevention
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prompt biopsy after bleeding young women with anovulation are at risk but can decrease with oral contraceptives of cyclic progestin therapy
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endometrial cancer treatment
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Stage 1 cancer total abdominal hysterectomy (TAH) / bilateral Salpingo-oophorectomy (BSO) Stage 2 cancer TAH/BSO/pelivic node dissection upper 1/3 vagina taken out radiation before and after surgery chemo (hair loss, anemia, bone marrow depression)
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endometrial cancer care
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patient needs to report fever, vaginal bleeding and discharge, sharp abdominal pain, distention share feelings, anxiety, fears ie. sexual function stress importance of regular follow up exams vaginal dryness; painful sex; may be upset about not able to have another child, etc
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Ovarian Cancer causes
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exact causes are unknown; women with a tubal ligation or hysterectomy have a LOWER risk of ovarian cancer! thought that androgens (male hormone) can cause ovarian cancer It is thought that the cancer agent enters through vagina and reaches ovaries through uterus and fallopian tubes
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Ovarian Cancer Risk Factors
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menopause (over 63); obesity, nulliparity, androgen use, estrogen use (w/o progesterone); Fertility drugs (Clomid); Family history of breast, ovarian, colorectal cancer genetic syndromes (Cowden's, PeutsJeghers syndrome)
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Ovarian Cancer Significant Risk Factors
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women with the BRCa1 gene mutation have 45% risk women with the BRCA2 mutation have a 25% risk of ovarian cancer women with BRCA 1 and 2 should have annual screening with transvaginal sonography prophylactic oophorectomy (ovary removal) is recommended by 35 or when childbearing is complete
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Ovarian Cancer Lab Findings
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CA 125 is elevated in 80% of women with epithelial ovarian cancer overall CA 125 is a protein antigen an elevated serum CA 125 > 35 units means a greater likelihood that an ovarian tumor is malignant
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Ovarian Cancer Symptoms
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abdominal pressure, fullness, swelling, bloating ( increased abdominal girth or tight clothes) unexplained change of bowel habits, diarrhea or constipation, frequent need to urinate, persistent indigestion, gas or nausea dyspareunia- pain in intercourse
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Ovarian Cancer Screening
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is not recommended because 98% with an abnormal screening will not have ovarian cancer women with higher risk should discuss with HCP
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Ovarian Cancer Risk Reduction
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pregnancy and breast feeding lowers risk of having ovarian cancer tubal ligation or hysterectomy reduces risk greatly
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Ovarian Cancer Staging: IA and IB
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IA and IB The cancer is limited to one or both ovaries and the capsule around the ovaries is in tact (has not been broken by the cancer)
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Ovarian Cancer Staging: IC
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IC Capsule of the ovary may have been ruptured or there may be signs of cancer cells in the pelvis
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Ovarian Cancer Staging: II
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II Pelvic organs ie the fallopian tubes, uterus are involved with the tumor and there may be early signs the cancer has spread beyond the pelvis
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Ovarian Cancer Staging: III
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III The cancer is confined to the abdomen and the abdominal lymph nodes.
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Ovarian Cancer Staging: IV
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IV The cancer has metastasized to distant sites like the lungs or liver.
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Treatment for benign neoplasms
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Tumor removal or unilateral oophorectomy
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Treatment for early stage ovarian cancer
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complete surgical staging followed by abdominal hysterectomy and bilateral salpingo-oophorectomy (removal of ovaries and fallopian tubes) with omentectomy and selective lymphadenectomy (removal of lymph nodes) Advanced cancer: aggressive removal of all visual tumors
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Treatment for advanced ovarian cancer
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Advanced cancer: aggressive removal of all visual tumors
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Who is post op chemotherapy recommended for?
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All women except those with low grade ovarian cancer in early stage (I)
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Chemotherapy treatment agents
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Carboplatin and Cisplatin are the two agents used
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Carboplatin
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alkylating agent agent for ovarian, lung and other cancers
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Carboplatin Side effects
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low white blood cell count; low platelet count, brittle hair, nausea; vomiting; loss of appetite; taste changes
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Cisplastin
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alkylating agent agent for ovarian, testicular, bladder cancers
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Cisplastin Side Effects
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low blood cells counts pins and needles in feet and hands fatigue; vomiting; kidney damage
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oviarian cancer care
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ovarian cancer is not curable ...chemo offered in palliative method common is development of bowel obstruction related to frequent abdominal surgeries debilitation due to prolonged chemo, multiple ab surgeries, poor renal function pain management, return to full ambulation and oral intake of food and fluids are main concerns
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Breast Cancer chances
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1 in 8 women will develop breast cancer in their lifetime age 60-69 is at most risk with 1 in 29 women
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Breast Cancer risks
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female gender; aging; heredity from BRAC1 and BRAC 2 genes family hx; dense breast tissue; early menses or delayed menopause previous chest radiation; nulliparity or first child after 30; recent contraceptive use; hormone therapy post menopause; alcohol; overweight; limited physical activity
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Breast Cancer Genetic Risk Factors
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maternal relative with breast cancer- sister, mom, aunt if relative was premenopausal - risk is 18.6% if relative was premenopausal and bilateral breast cancer- risk is 50%
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Breast Cancer Screenings
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mammograms starting at age 40 clinical breast exams every 3 years for women in 20-30's every year CBE for women 40 plus BSE for women in 20's optional
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Digital mammography benefits
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good for dense fibrocycstic tissue physician manipulation for accurate detection of breast cancer
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benign breast changes
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ropy or granular lumpiness: around upper outer quadrant, nipple and areolar cyclic breast change: swelling, tenderness, pain, lumps related to increase in fluid in breast tissue in pregnancy: milk glands are swollen, leads to tenderness
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benign breast changes cont
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Cysts- enlarged tender, bilateral fibrocystic disease- disappears after menopause ill defined
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needle biopsy
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small gauge needle- draws fluid from lumps thought to be cysts fine needle biopsy-uses a larger needle to draw out tissue and fluid from lump local anesthesia
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lumpectomy
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malignant tumor and surrounding tissue margin is removed, lymph nodes may be removed
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total mastectomy
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surgeon removes entire breast but does not take out axillary nodes
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radical mastectomy
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removal of entire breast, all underarm lymph nodes, chest wall muscles under the breast are removed
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Breast cancer Chemo agents
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Methotrexate Cyclophospamide Tamoxifen
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Lymphedema
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surgery and radiation cause this abnormal draining of lymph results in swelling
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Lymphedema treatment
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elastic sleeve, arm pump, arm massage, bandaging the arm, exercise and diet, aquatics
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reconstruction
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tissue form lower abdomen, back buttocks a flap of skin muscle and fat is moved to chest to create "breast"
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nipple reconstruction
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secondary to breast reconstruction done three to four months after breast reconstruction areolar is tattooed using permanent makeup this last step is crucial and completes the process
