endometrial, cervical and ovarian cancer

endometrial cancer

cancer of the lining of the uterus

most common gynecologic cancer

slow growing cancer

abnormal vaginal bleeding is the most common symptoms

strongly associated with estrogen the protective effects of progesterone therapy without

endometrial cancer risk factors

middle age or older

high fat diet, low in fruits/veggies

early menarche or late menopause; high exposure to estrogen

use of estrogen without progesterone

radiation treatment to the pelvis

personal history of diabetes, ovarian tumors, polycystic ovary syndrome, breast or ovarian cancer or endometrial hyperplasia (abundance of abnormal cells)

family history of colon cancer or lynch syndrome(genetic disorder that can lead to cancer)

obesity

have never been pregnant, especially due to infertility. not being pregnant = have increased amount of ovulations (you don’t ovulate during pregnancy)

tamoxifen use

endometrial history assessment

main symptoms is abnormal uterine bleeding, especially if postmenopausal

ask about number of pads or tampons used each day

watery, blood vaginal discharge, low back or pelvic pain, abdominal pain. location and intensity of the discomfort

endometrial physical exam and diagnostics assessment

pelvic exam

lab tests: CBC, tumor markers, transvaginal US, endometrial biopsy, dilation and curettage, hysteroscopy, CXR CT MRI PET, liver and bone scans can check for metastasis

endometrial biopsy

used to diagnose dysfunctional uterine bleeding or endometrial cancer

performed by an obstetrician or gynecologist in 10-15 mins

contraindication: infection, cervix cannot be visualized, pregnancy

complications: perforation of the uterus, uterine bleeding, interference with pregnancy, infection

post procedure instructions: normal for spotting to occur. wear a pad, avoid sex and douching for 72 hours, avoid heavy lifting, report excessive bleeding, fever(infection; draw for UA or urine culture)

endometrial cancer interventions

surgery: removal of tumor and lymph nodes, total hysterectomy and bilateral salpingo-oophorectomy

nonsurgical management: radiation, chemo, palliative treatment, complementary and integrative therapy, care coordination(psychologist, dietitian/nutritionist, social worker)

total hysterectomy

removes uterus and cervix

bilateral salpingo-oophorectomy

removes fallopian tubes and ovaries

radical hysterectomy

removes everything and some surrounding lymph nodes

post op care

management of airway/breathing, circulation

cough and deep breathe, IS; prevents postop pneumonia

TEDs, SCDs for DVTs

I&Os, UTI prevention

managment of urinary catheter

monitor vaginal bleeding; less than one saturated pad/4hrs

altered GI peristalsis; stool softeners

impaired skin integrity; abdominal incision

assisting with grief and loss, altered sexuality; especially with childbearing aged

teaching when to call for help

ovarian cancer

leading cause of gynecological cancer death and second most common gynecologic cancer

when caught early, 90% curable

risk factors: older age, overweight, nulliparity or pregnancy late in life, use of estrogen after menopause, family history of ovarian, breast or colorectal cancer, genetics

symptoms: bloating, urinary urgency and frequency, eating difficulty, anorexia, feeling full after a few bites, abdominal or pelvic pain

ovarian cancer assessment

vague abdominal and GI symptoms; pain, swelling, indigestion, or gas

urinary frequency, incontinence, unexpected weight loss, vaginal bleeding

advanced disease: ascites, pleural effusion(fluid in pleural space in lungs), bowel obstruction, venous thromboembolism(later stage)

pelvic mass palpable when > 4-6 inches

CA-125 (cancer antigen test); tumor marker that can help with diagnoses, not confirm

chest x-ray, CT scans

staging of ovarian cancer

stage I: limited to the ovary or ovaries

stage II: involves 1 or both ovaries with pelvic extension

stage III: involves 1 or both ovaries; spread beyond to lining of the abdomen; and/or spread to lymph nodes

stage IV: involves 1 or both ovaries and distant metastases have occurred

interventions of ovarian cancer

surgery: total abdominal hysterectomy and bilateral salpingo-oophorectomy and pelvic and paraaortic lymph node dissection (removes lymph nodes bc cancer can travel through)

chemo: combo to prevent drug resistance

niraparib (zejula) once daily pill to treat BRCA mutated ovarian cancer

routine post-op nursing care

care coordination: avoid use of tampons, douches, and sexual intercourse for 6 weeks; high recurrence rate bc its caught later, palliative and hospice care

cervical cancer

uterine cancer has squamous cells on the outside and columnar cells that line the endocervical canal

the squamocolumnar junction is where most cellular abnormalities occur

Papanicolaou (pap) test samples cells from the cervix

continuum of abnormality: cervical intraepithelial neoplasia (dysplasia) to cervical carcinoma in situ to invasive carcinoma

high risk human papillomavirus (HPV) type 16 and 18 are responsible for 50% of cervical cancers

cervical cancer risk factors

immunocompromised women

daughters of women who took diethylstilbestrol (DES) between 1940-1971 (a hormone to prevent miscarrage)

sexually active at a young age

do not eat a diet high in fruits and vegetables

tobacco use

FH of cervical cancer

infection with HPV or chlamydia

obesity

multiple sexual partners

lengthy use of oral contraceptives

multiple full term pregnancies

first full term pregnancy before age 20

health promotion/disease prevention for cervical cancer

immunization with HPV vaccines: gardasil age 9-26, up to age 45

pap and HPV testing: age 21-29, pap every 3 years, age 30-65 pap every 3 years, HPV every 5 years or pap and HPV every 5 years. over 65 may discontinue

HPV testing

there are more than 100 distinct types of human papillomavirus, most are benign; body kills off

HPV is spread through skin-to-skin contact and si asymptomatic

high risk strains associated with cervical cancers are type 16 and 18

most women can clear an active HPV infection with treatment. persistent high risk HPV infection peaks in women over 30

HPV can activate oncogenesis and suppression of host immune response. prevents DNA repair and programmed cell death

men are carriers; can develop into genital warts

pap tested

used to screen for cancer of the vagina, cervix, and uterus

microscopically examining vaginal secretions for abnormal cells

95% accurate in detecting cervical cancer

Bethesda system for reporting results

conventional pap test vs thin prep testing; less chance of false negative

contraindications: menses, vaginal infections; can give false negative

cervical cancer assessment

initially asymptomatic

painless vaginal bleeding, bleeding after intercourse

pelvic and back pain, hematuria, hematochezia(bright red blood in stool), vaginal passage of stool or urine

cervical cancer diagnostics

colposcopy; open cervix and perform intervention to kill bacteria or cells

punch biopsy, cone biopsy, endocervical curettage(small spoon to remove)

post procedure: no tampons, douche or intercourse for 1 week

colposcopy

provides an in situ macroscopic exam of the vagina and cervix for clients with abnormal vaginal epithelial patterns, cervical lesions, abnormal pap test, positive HPV and exposure to DES

biopsy can be performed during the procedure

procedure is performed by physicians, nurse practitioners and physician assistants

procedure performed in 5-10 minutes

client may feel pressure during the procedure

contraindication: heavy menstural flow

complications: infection, hemorrhage, vasovagal reaction (drop in BP)

cervical biopsy

used to identify premalignant and superficial malignant lesions of the cervix when the client has an abnormal pap test. often performed during colposcopy

punch biopsy, endocervical curettage, LEEP, cone biopsy

contraindications: active menstrual bleeding, pregnancy (don’t want to open cervix, can disrupt)

complications: significant bleeding, infection, cervical stenosis (narrowing of cervix)

client education: vaginal bleeding, use sanitary napkins. avoid tampons, sexual intercourse, douching for 3-4 weeks. mild cramping. brown-black vaginal discharge for 1 week, vaginal discharge or spotting for 1-3 weeks

cervical cancer interventions

surgery: loop electrosurgical excision procedure (LEEP), laser surgery, cryosurgery, conization, radical trachelectomy, hysterectomy, post op: no tampons, intercourse, douching, tub baths, heavy lifting. report heavy vaginal bleeding, foul smelling drainage, fever

chemotherapy; similar to cancer chemo

radiation; ensure all cells are killed