Uterine cancer – Flashcards

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Overview
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Proliferation of cancer cells in the endometrium Most common gynecologic cancer Two classes: Type I: Occurs because of unopposed estrogen stimulation (most common) Type II: Occurs independent of estrogen Type I: Occurs because of unopposed estrogen stimulation (most common) Type II: Occurs independent of estrogen Also known as endometrial cancer
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Overview-Pathophysiology
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Uterine cancer is usually adenocarcinoma. Other possible cell types include adenosquamous, clear cell, and papillary serous carcinoma. Sarcomas may be mixed Müllerian, endometrial stromal, or leiomyosarcoma. Metastasis occurs late, usually from the endometrium to the cervix, ovaries, fallopian tubes, and other peritoneal structures. It may spread to distant organs, such as the lungs and the brain, by way of the blood or the lymphatic system; lymph node involvement can also occur.
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Overview-Causes
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Exact cause unknown
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Overview-Risk Factors
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Early menarche or late menopause Personal or family history of colon or reproductive tract cancer Metabolic syndrome Polycystic ovary syndrome History of breast cancer Prior pelvic irradiation Low fertility index and anovulation History of infertility or failure of ovulation Abnormal uterine bleeding Obesity Hypertension Diabetes Nulliparity Familial tendency History of uterine polyps or endometrial hyperplasia Prolonged estrogen therapy with exposure unopposed by progesterone Tamoxifen therapy Estrogen replacement therapy
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Overview-Incidence
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Uterine cancer is the fourth most common cancer in women and the most frequently occurring female gynecological cancer. Uterine cancer is most common in postmenopausal women between ages 60 and 70. It's uncommon between ages 30 and 40 and rare before age 30. Sarcomas are more common in women between ages 40 and 69. Most premenopausal patients have a history of anovulatory menstrual cycles or other hormonal imbalances.
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Overview-Complications
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Anemia Intestinal obstruction Ascites Increasing pain Hemorrhage Damage to urinary or intestinal systems after surgery Increased risk of breast and colon cancer
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Assessment-History
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Presence of risk factors Spotting and protracted, heavy menses (in young patients) In postmenopausal woman, possible bleeding beginning 12 or more months after menses stopped Vaginal discharge, initially watery and then increasingly blood streaked Weight loss Change in bowel or bladder habits
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Assessment-Physical Findings
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Palpable enlarged uterus (advanced disease) Abdominal tenderness
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Diagnostic Test Results-Laboratory
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Cancer antigen-125 (CA-125) level may be elevated when intra-abdominal disease is present.
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Diagnostic Test Results-Imaging
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Transvaginal ultrasonography shows increased endometrial thickness. Chest X-rays may reveal metastasis to the lungs.
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Diagnostic Test Results-Diagnostic Procedures
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Endometrial, cervical, or endocervical biopsy confirms the presence of cancer cells. Fractional dilatation and curettage are used to identify the problem when the disease is suspected but the endometrial biopsy result is negative. Multiple cervical biopsies and endocervical curettage pinpoint cervical involvement. A Papanicolaou test result may be normal or show abnormal cells.
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Treatment-General
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Radiation therapy, external or intravaginal
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Treatment-Diet
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Well-balanced diet Nothing by mouth before surgery
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Treatment-Medications
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Hormonal therapy: MedroxyPROGESTERone acetate for recurrence or metastasis; megestrol acetate for premalignant lesions, atypical complex hyperplasia, or well-differentiated endometrial cancer in patients desiring fertility; levonorgestrel-containing intrauterine system for patients desiring fertility Chemotherapy, such as DOXOrubicin hydrochloride, cisplatin and paclitaxel, or paclitaxel and carboplatin, for high-risk or metastatic disease Odansetron, dronabinol, or metoclopramide hydrochloride to control nausea due to chemotherapy
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Treatment-Surgery
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Total abdominal hysterectomy, bilateral salpingo-oophorectomy, or, possibly, omentectomy with or without pelvic or para-aortic lymphadenectomy Total pelvic exenteration (for recurrent endometrial cancer)
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Nursing Considerations-Nursing Diagnoses
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Acute pain Anxiety Disturbed body image Fear Impaired urinary elimination Ineffective coping Risk for infection Sexual dysfunction
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Nursing Considerations-Expected Outcomes
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report feeling increased comfort and decreased pain express feelings of decreased anxiety express positive feelings about herself discuss fears and concerns maintain adequate urine output demonstrate positive coping behaviors remain free from signs and symptoms of infection express feelings and perceptions about the change in sexual performance with her partner.
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Nursing Considerations-Nursing Interventions
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Allow the patient to verbalize feelings and concerns related to the diagnosis, prognosis, and treatment. Provide clear explanations, answer questions honestly, and offer empathetic support and guidance. Encourage the use of positive coping strategies. Encourage active patient participation in care and decision making to promote self-esteem and feelings of control. Assist with measures to address body image issues, such as hair loss, changes in sexual function, loss of reproductive organs, and feelings of femininity. Reinforce positive aspects about the patient's self and body. Assist with chemotherapy administration if appropriate. Institute measures to address adverse effects related to radiation therapy and chemotherapy, such as administering antiemetics before chemotherapy; providing small, frequent meals and snacks; and allowing for frequent rest periods. Prepare the patient for intravaginal radiation therapy as indicated. Explain the related safety precautions, movement limitations, and possible adverse effects, such as vaginal irritation or bleeding and abdominal discomfort. Prepare the patient physically and emotionally for surgery, if indicated. Explain preoperative and postoperative care measures and activities. Provide postoperative care, including surgical site care and dressing changes as indicated.
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Nursing Considerations-Monitoring
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Vital signs Surgical site Wound drainage system Cardiopulmonary status Bowel and bladder status, including bowel elimination, bowel sounds, and urinary output Nutritional status, including fluid balance Pain level and management Signs and symptoms of postoperative complications
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Nursing Considerations-After Surgery
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Vital signs Surgical site Wound drainage system Cardiopulmonary status Bowel and bladder status, including bowel elimination, bowel sounds, and urinary output Nutritional status, including fluid balance Pain level and management Signs and symptoms of postoperative complications
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Nursing Considerations-With Internal Radiation Therapy
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Safety precautions (time, distance, and shielding) Movement (limited while source is in place) Vital signs Bowel and bladder elimination Signs and symptoms of possible complications, such as infection, abnormal bleeding, skin reaction, vaginal bleeding, abdominal discomfort, and dehydration
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Nursing Considerations-Associated Nursing Procedures
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Blood pressure assessment Chemotherapeutic drug administration Chemotherapeutic drug preparation and handling Intake and output assessment IV bag preparation IV bolus injection IV catheter insertion IV pump use Nutritional screening Oral drug administration Pain management Papanicolaou (PAP) test (Advance practice) Postoperative care Preoperative care Preparing a patient for gynecologic surgery, OR Radiation implant therapy Radiation therapy, external Respiration assessment Transvaginal ultrasound Venipuncture
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Patient Teaching-General
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disorder, diagnosis, and treatment, including surgery as the main treatment and possible radiation therapy or chemotherapy as indicated by cancer stage proposed cycle for chemotherapy administration, if ordered possible adverse effects of radiation therapy and chemotherapy, such as nausea, vomiting, hair loss, and skin irritation, and measures to address these effects, such as antiemetics; small, frequent meals and snacks; scarves or wigs; and skin emollients signs and symptoms of infection and the need to notify a health care provider if any occur preoperative and postoperative care, including early ambulation, coughing and deep breathing, frequent turning, splinting the abdominal incision, and measures for pain management need to refrain from sexual intercourse and avoid lifting more than 10 lb for approximately 6 weeks after surgery and to avoid driving until pain-free fact that removal of the ovaries will induce menopause if the patient is premenopausal safety measures involved in internal radiation therapy, if indicated dietary modifications related to treatment therapies as appropriate, such as increased calorie and protein intake and the need to consume small, frequent meals importance of follow-up examinations with a gynecologist, including a Papanicolaou test every 4 months for 1 year, then every 6 months for 3 years, and then yearly thereafter need for possible periodic laboratory testing, such as a complete blood count, when receiving chemotherapy or radiation therapy.
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Patient Teaching-Discharge Planning
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Refer the patient to available resource and support services. Refer the patient to home health care services for follow-up as appropriate.
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