AMS Reproductive Cancers (Intro + Breast) 1

1. Breast

2. Gynocologic

   1. Uterine/endometrial

   2. Cervical

   3. Ovarian

3. Testicular

4. Prostate

What are all the reproductive cancers?

• General overall health?

• Chronic problems?

• Family history/genetics?

• Med use?

• Nutrition status?

• What is their current complaint?

• Onset of puberty?

• SEXUAL ACTIVITY DATA?

What are the assessment questions to ask a patient about reproductive system?

Increased sexual activity = more trauma to the cervix which can lead to abnormal cell growth (dysplasia)

Why is sexual activity an important assessment question to ask for reproductive cancers?

• Menstruation hx (onset)

• Obstetrical hx (pregnancies, abortions, procedures)

• STDs

• GYN visits

• Self-exams (breast)

What are the specific reproductive hx questions to consider for females?

• Menarche: before period

• Menses: during

• Menopause: after period

What is menarche, menses, menopause?

• Early menarche

• Late menopause

• Less children (low amount of times pregnant)

• Birth control

What are specific risk factors that increase cancer due to hormones in women?

Exposed to hormones for a longer amount of time

Why does early menarche and late menopause increase the risk for cancer in women?

• STDs

• ED issues

• Self-exams (testicular)

What are the specific reproductive hx questions to consider for males?

• PAP smear

• Blood studies

• Microscopic studies

• Radiology

• Mammogram

• Endoscopic studies

• Biopsy

What are general dx tests for reproductive cancer?

Papanicolaou test (PAP smear)

A method to collect cervical cells by swabbing the cervix to identify early cellular changes before they progress to cervical cancer

• No douching, tampons, vaginal creams/meds 24-48hrs before

• No sexual intercourse 24-48hrs before

• Wait until 1 week AFTER period is over

• Empty bladder before

What is the patient prep for PAP smear?

• Start at 21

• Done every 3 years

When should a PAP smear be done?

Human Papillomavirus (HPV)

The most common type of STI that is spread by sexual contact (skin-to-skin)

• It can be non-oncogenic (not cancerous), genital warts

• Or oncongenic (cancerous), cervical, oropharyngeal, vaginal, vulvular, anal, penile

• Can affect both male and female

• Detection: PAP smear (separate test is done for HPV)

• HPV vaccine: given at a young age, older than 26 not as effective

• Use of condoms

How do you prevent HPV?

• Pituitary Gonadotropin

• Steroid hormones

• Serologic tests

• STS or VDRL (syphillis)

• PSA

• HIV testing

• Antibody or antigen test

What are the blood studies done for dx reproducive cancer?

• Microscopic studies (samples from cells) (ex. biopsy from pap smear)

• Radiology (US, CT/MRI)

• Mammogram (X-ray of soft tissue of breast)

What are the dx imaging tests for reproductive cancer?

• Density

• Lumps

• Cancers not detectable my human hand

What does a mammogram look for?

40 because younger people have denser breast tissue which makes the cancer hard to see (could have false +) and tissue becomes less dense with age

What age are mammograms done and why?

• No deodorant, powder, lotion, perfumes (false calcifications)

• Best done after period (breasts are less tender)

What is the patient prep before a mammogram?

• Colposcopy (microscope to magnify cervix, vagina, vulva)

• Laparoscopy (use endoscope to look at or remove tissue from pelvic cavity)

• Hysteroscopy (use scope through cervix into uterus)

What are the endoscopic studies for dx reproductive cancer?

• Cervical

• Endometrial

• Breast (sentinal)

• Prostate

What are the biopsy studies for dx reproductive cancer?

BRCA1 and BRCA2

What genes are looked for in breast cancer?

Protect cells from becoming cancerous; lack of these in breast cancer

What do BRCA1 and BRCA2 genes do?

• Lack for BRCA genes

• Fam hx

• Older age

• Hx radiation or hormone therapy

• Obesity

• Conditions with testicles or liver

What are the risk factors for men getting breast cancer?

1. Noninvasive (stay inside mammory duct)

2. Invasive (into surrounding breast tissues)

What are the two types of breast cancer?

Brain, bones, liver, lungs, etc.

Where does breast cancer typically metastasis to?

1. Ductal carcinoma in situ (DCIS)

2. Lobular carcinoma in situ (LCIS)

What are the types of noninvasive breast cancer?

Ductal carcinoma in situ (DCIS)

Early form of non-invasive breast cancer that are confined to the MILK DUCTS of the breast and have not invaded surrounding breast tissues

• No lump typically felt

• Early detection (mammogram)

• Lumpectomy

What is the tx for DCIS?

Lobular carcinoma in situ (LCIS)

Cells that look like cancer cells, found in the LOBULES of breast but have not invaded surround tissue

• Typically, no lump felt

• Not technically cancer but shows a RISK

• Doesn’t show on mammogram

Continue to watch for changes

What is the tx for LCIS?

1. Infiltrating ductal carcinoma

2. Inflammatory

What are the types of invasive breast carcinoma?

Infiltrating ductal carcinoma

A type of breast cancer that originates the MAMMARY DUCTS and grows into surrounding tissues in an IRREGULAR PATTERN and can spread to LYMPH NODES

• Palpable lump (irregular, poorly defined edges)

• Skin dimpling (fibrosis around cancer that shortens cooper’s ligaments; pulls in skin around breast)

• Peau d’ orange (edematous dimpling and pitting, orangish skin; looks like surface of orange)

What are the sx of infiltrating ductal carcinoma?

Inflammatory breast cancer

The most malignant of all breast cancer that is rare but aggressive

• Usually dx late stage where it already metastasized

• Hard to tx, low survival

• Peau d’ orange

• Breast pain

• Rapid growing lump

• Breast tenderness, firm

• Breast itching

What are the sx of inflammatory breast cancer?

• Stage I: only in milk ducts, no lymph involvement

• Stage II: some lymph involvement (1-3) near breast bone, 2-5 cm in size

• Stage III: spread to other areas around breast (skin, chest, muscle), multiple lymph nodes, past ductal tissue

• Stage IV: spread to distant organs

What are the stages of breast cancer?

• Educate on risk factors

• Mammography

• Breast self-examination (BSE)

• Clinical breast examination (CBE)

• Prophylatic masectomy (if pt. high risk for breast cancer)

• CHEMOPREVENTION: TAMOXIFEN

What are the methods of prevention for breast cancer?

tamoxifen (Nolvadex) (SERM)

Not a chemo drug, but a hormone agonist that blocks the receptor estrogen is attracted to (hormone therapy)

• Lowers the risk of breast cancer but increase the risk for uterine cancer

• AR: DVT, PE (blood clots), increase uterine cancer, hot flashes, vaginal dryness, weight gain

• FEMALE

• AGE (>40)

• HX BREAST CA

• FAMILY HX

• Reproductive hx (low # of pregnancies)

• Menstrual hx (early menarche, late menopause)

• Diet

• ETOH (ethanol)

• Obesity

• Radiation exposure

• Oral contraceptives

What are the risk factors of breast cancer?

• Prevention

• Sx

• Dx

• Tx

• Pre and post op care

What is the health teaching for breast cancer?

BSE

• Women should know how their breasts normally look and feel and report breast changes promptly to HCP

• Start in 20s

CBE

Breast exam done by clinical provider

Nonsurgical

• Chemo systemically

• Radiation

• Hormone therapy (tamoxifen)

• Targeted therapy

Surgical

• Masectomy

• Lumpectomy

• Reconstruction

What is the tx for breast cancer?

Reduce size of tumor

Why can chemo be given prior to surgery?

• Cytoxan

• Adriamycin

• 5FU

What are the common chemo agents given in breast cancer?

doxorubicin (Adriamycin)

Antitumor AB

• Damages DNA of cancer cells and stops cell replication

• Typically given along with other types of chemo

• Route: IV

• AR: bone marrow suppression, cardiotoxic, HF, cardiomyopathy, n/v, GI upset

• Monitor CBC, cardiac, tele/arrhythmias

Targeted therapy

Chemo agents that target specific characteristics of cancer cells; decrease harm to normal cells; fewer side effects

• trastuzumab (Herceptin)

• bevacizumab (Avastin)

What are the examples of targeted therapy meds for reproductive cancer?

bevacizumab (Avastin)

Angiogenesis inhibitor

• blocks the development of new blood vessels, depriving tumors of needed blood supply. Does not kill tumor cells

• AVOID pregnancy or 28 days before surgery

• Indication: NSCLC, colorectal, renal, glioblastoma, cervical and ovarian cancer

• AR: GI perforation, bleeding, HTN crisis

Hormonal therapy

Reduces estrogen available to stop or reduce growth of tumor

1. Dye injected near tumor

2. Identify first draining lymph node

3. Node is removed and examined for cancer

What is a sentinal biopsy?

1. Total/simple: entire breast and axillary lymph nodes

2. Modified radial: entire breast, lymph nodes, some chest wall

What are the types of masectomies?

Lumpectomy (partial masectomy)

Tumor (lump) and some surrounding lymph and tissue

• Removes cancer while keeping breast intact (can also have reconstruction after)

• Same day surgery

• Often combined with radiation to prevent recurrence

• Body image/sexuality (psychosocial)

• Pain

• Wound care (JP drain, infection)

• Position

• Exercise

• Home care

What are the nursing interventions for breast cancer surgery?

Focus on relieving anxiety and on pt. edu

What is the nursing goal for pre op breast surgery?

• Type of drain

• Location of incision

• Mobility restrictions

• Length of stay

What information should you provide the patient pre op for post op breast surgery?

• Discharge teaching

• Arm restrictions

• Incisional site care

• JP drain (d/c with drain)

• Positioning

• Post-mastectomy exercises

What are nursing interventions for post op breast surgery?

• Hand wall climbing

• Wand exercises

• Side bends

• Shoulder blade squeeze

Types of post masectomy exercises?

• Dry gauze on incision (change when soiled)

• Dry gauze on JP drain (change when soiled but if more than once a day call HCP)

• Empty JP drain 2x day

• Drain and incision should stay dry when bathing

• Can use arm for normal activities, but only resume strenous activity until drains removed or surgeon clears.

• Mild pain expected 4-5 days after surgery

• Numbness expected in that area after surgery (should lessen over time)

• Pamphlets on exercise

What are some d/c teaching points for a patient post op breast surgery?

Usually 2 placed on each side after surgery

• Color and amount

• Infection

• Drainage around site

What should you monitor for JP drains?