Reproductive

Breast Cancer: Risk Factors

• Family Hx
• Environment
• Genes
• BRCA 1 & 2
• Early menarche
• Late menopause
• Age 60 or older

Breast Cancer: Risk Factors Cont

• Most who develop breast cancer, no identifiable risk factors
• Hormonal regulation r/t cancer development
• 5-10% hereditary

BC Screening avg and increased risk

• Average Risk
- Mammogram 40-74 y/o every 2 years
• Increased Risk
- Discuss with Healthcare team on how often and what type of diagnostics to use
- Consistent BSE may facilitate breast self-awareness

Breast Cancer: Diagnostic Studies, Radiologic

• Mammography
• Digital mammography
• More accurate in younger women
- 3-D mammography (tomosynthesis)
• Ultrasonography
• MRI

Breast Cancer: Diagnostic Studies Biopsy

• Fine-needle aspiration (FNA)
• Core needle
• Vacuum-assisted
• Excisional

Breast Cancer: Clinical Manifestations

• Detected as lump, thickening, mammography abnormality
• Rate of growth varies
• Slow-growing lesions = lower mortality rates

Breast Cancer: Surgery

• Most common surgical procedures for breast cancer
Breast conservation surgery
• Lumpectomy
• Segmental mastectomy
Mastectomy
• With or without reconstruction

Breast Cancer Lymphedema

• Accumulated lymph in soft tissues
• Possible after node sampling or radiation Tx
• Axillary nodes can’t return lymph fluid to central circulation
• In arm, hand, breast
• Causes obstructive pressure on veins & venous return

Breast Cancer Goals

• Participate in decision-making
• Adhere to therapeutic plan
• Communicate about and manage side effects of adjuvant therapy
• Access and benefit from support
• Comply with recommended follow-up

Breast Cancer Care directed at treatment method

• Side effect management of chemo
• Post-Op care for surgical patients
• Psychosocial support, therapeutic communication

Breast Cancer: Patient Education

 Inform mastectomy patients
• Special garment choices
• Breast prosthesis
 Address implications of cancer diagnosis and breast surgery on
• Sexual identity
• Body image
• Interpersonal relationships

Cervical Cancer: Risk Factors

• Infection w/ high-risk strains of HPV
• Immunosuppression
• Low socioeconomic status
• Chlamydia
• Smoking

Cervical Cancer: Diagnostic Studies Pap and HPV

Pap (papanicolaou) test
• Identifies changes in cervical cells
• Obtained during pelvic exam
HPV test
• Identifies high-risk HPV 16,18
• Cervical scrapings tested for viral DNA or RNA

Cervical Cancer: Diagnostic Studies Co-testing

Co-testing

Abnormal Pap test should be followed with a colposcopy

Cervical Cancer: Interprofessional Care

• Vaccines against HPV
— Before 1st sexual contact
— Other Female Cancers
Ages 11-12; as early as 9 y/o
• Gardasil – types 6, 11, 16, 18
• Cervarix – types 16, 18
• Gardasil 9 – types 6, 11, 16, 18 plus 5 other types of HPV
• 3 IM doses over 6-month

Other Female Cancers

•Endometrial
•Ovarian
Rare:
•Vaginal
•Vulva
Hysterectomy
• Partial
• Complete
• Nursing considerations based on type

BPH

• Enlarged prostate leading to disrupted urine outflow from bladder - urethra
Almost 50% have lower urinary tract symptoms (LUTS)
• Difficulty starting urine
• Low urine
• Frequency

BPH is not

• Completely understood
• Hormonal changes from aging may contribute
• Excess accumulation of DHT in prostate cells, can stimulate overgrowth
• Increased proportion of estrogen over testosterone in blood

BPH: Risk Factors

• Age
• First degree relative
• Obesity
o Waist circumference
o Sedentary life
• Alcohol
• ED
• Smoking
• DM

BPH Irritative symptoms

• Associated with inflammation/infection
• Nocturia
• Frequency
• Urgency
• Dysuria
• Bladder pain
• Incontinence

BPH Obstructive symptoms

• From prostate enlargement
• Decrease in caliber and force of stream
• Difficulty starting stream
• Intermittency
— Starting, stopping stream several times while voiding
• Dribbling at end

BPH: 5α-Reductase inhibitors Treatment

• Blocks enzyme necessary for conversion of testosterone to DHT
• ↓ Size of prostate
• Finasteride (Proscar)

BPH: α-Adrenergic receptor blockers Treatment

• Smooth muscle relaxation, facilitate urinary flow through urethra
• Doesn’t decrease prostate size
• Tamsulosin (Flomax)
• Various less-invasive procedures available for Tx

BPH: TURP Complications Treatment

• Hemorrhage
• Bladder spasms
• Urinary incontinence
• Infection

BPH: Postoperative care for TURP Treatment

• Postoperative bladder irrigation
• Manually, intermittent basis
• Continuous bladder irrigation (CBI)
- Report large clots, bright red blood
- Ensure urine drainage
- Aseptic technique
- Record output subtracting total amount of solution

Prostate Cancer

• Most common among men, excluding skin cancer; second leading cause of cancer death
• Tumor of Prostate Gland
• Slow growing androgen- dependent cancer

Prostate Cancer Risk Factors:

• Age, ethnicity, family Hx
- age 50+
- Black men
• Diet
- Red meat
- High-fat dairy products
- Low in vegetables, fruits
• Obesity
• Environment
- Chemical pesticides

Prostate Cancer: Diagnostic

• PSA Screening
The American Cancer Society (ACS) recommends screening:

• Age 50 if avg risk, expected to live at least 10 years
• Age 45 if high risk; African-Americans and men w/ first-degree relative with prostate cancer less than 65 years
• Age 40 if higher risk; more than one first-degree relative has prostate cancer at early age