Chapter 8: Cancers of the Female Reproductive Tract

A nurse is caring for a 30-year-old woman who was just diagnosed with cervical cancer. Which psychosocial need would be the priority for the nurse with her client?

A. offering words of hope to the client

B. remaining cheerful through all of the interactions

C. clear information on the disease, management, and treatment

D. touching the client's hand for comfort

C. clear information on the disease, management, and treatment

Explanation:

Women diagnosed with cancer of the reproduction tract need to understand their disease, prognosis, and what treatment options they have. The nurse's role is to educate with effective and clear communication techniques. The nurse should be sincere and may provide realistic hope, but her role as educator is primary.

Pg. 260

A middle-aged woman comes to the women's health clinic for a routine check-up. During the visit, the woman asks the nurse, "I've had a dear friend who was just diagnosed with ovarian cancer. Is there any way to screen for this disease?" Which response by the nurse would be most accurate?

A. "You can have a blood test to check for a genetic mutation that will tell if you will get it."

B. "Unfortunately, there is not any specific test that can be used to screen for this type of cancer."

C. "Just keep up with having your Papanicolaou tests and that should be enough to allow for early detection."

D. "You can be tested for a marker that if elevated will tell you have ovarian cancer."

B. "Unfortunately, there is not any specific test that can be used to screen for this type of cancer."

Explanation:

Women with ovarian cancer are typically diagnosed at a late stage, when the cancer has spread into the peritoneal cavity and complete surgical removal is challenging. Seventy-five percent of ovarian cancers are not diagnosed until the cancer has advanced to stage III or IV, primarily because there is still no adequate screening test. Papanicolaou tests detect cervical cell changes and are helpful in screening for cervical cancer but not ovarian cancer. Testing for the genetic mutation (BRCA), although linked to hereditary breast and ovarian cancer, does not predict whether a person will develop ovarian cancer. The tumor marker (CA-125) is associated with ovarian cancer but is it not specific for this cancer and elevated levels are associated with other types of malignancies.

Pg. 246

A nurse is reviewing the history, physical exam, and diagnostic test findings for a woman diagnosed with endometrial cancer. The findings reveal that the cancer has spread to the cervix and other parts of the uterus and to nearby lymph nodes. The nurse interprets these findings as suggestive of which stage?

A. II

B. I

C. III

D. IV

C. III

Explanation:

In stage I, the tumor is confined to the corpus uteri. In stage II, it has spread to the cervix, but not outside the uterus. In stage III, it has spread locally (to other parts of the uterus) and regionally (to nearby lymph nodes). In stage IV, it has invaded the bladder mucosa, bowel with distant metastases to the lungs, liver, and bone.

Pg. 250

An experienced nurse has just read that women have a one-in-three lifetime risk of developing cancer and becomes concerned that she has provided enough education. What should this nurse do to help prevent deaths from cancer? Select all that apply.

A. Tell women about early symptoms.

B. Provide education to all women.

C. There is nothing she can do.

D. Focus on screening.

E. Tell the health care providers to do a better job.

A. Tell women about early symptoms.

B. Provide education to all women.

D. Focus on screening.

Explanation:

Women do have a one-in-three lifetime risk of developing cancer, and one out of every four deaths is from cancer. Therefore, nurses must focus on screening and educating all women regardless of risk factors. The other options are not acceptable.

Pg. 240

A nurse is speaking to a local women's group about the various types of cancer affecting the female reproductive tract. The nurse explains that ovarian cancer is the leading cause of death from gynecologic malignancies based on the understanding that this type of cancer:

A. spreads more easily than other female reproductive cancers.

B. arises from extremely rare types of cells that are resistant to treatment.

C. is closely associated with highly resistant sexually transmitted infections.

D. typically manifests with vague symptoms resulting in late diagnosis.

D. typically manifests with vague symptoms resulting in late diagnosis.

Explanation:

Tumors of the ovary have been lethal largely because they present with nonspecific symptoms and therefore frequently are far advanced and inoperable by the time they are diagnosed. Ease of spread and types of cells involved are not reasons underlying the fatal nature of this type of cancer. Ovarian cancer is not associated with sexually transmitted infections. Cervical cancer is linked to human papillomavirus infection.

Pg. 246

A middle-aged woman is seen in the OB/GYN clinic and reports abdominal bloating, fatigue, abdominal pain, urinary frequency, and constipation. She also says that she had lost 24 pounds in the last month without trying to lose. For which disease should the primary care provider screen this client?

A. pelvic organ prolapse (POP)

B. fibroids (leiomyomas)

C. breast cancer

D. ovarian cancer

D. ovarian cancer

Explanation:

The most common early signs for ovarian cancer include abdominal bloating, early satiety, fatigue, vague abdominal pain, urinary frequency, diarrhea or constipation, and unexplained weight loss or gain. Fibroids do not have these same symptoms, nor does breast cancer or POP.

Pg. 248

A 55-year-old woman comes to the women's health clinic for an evaluation. The woman says, "Last week, I had a couple of episodes of bright red vaginal bleeding but no pain." The woman also tells the nurse that she has already gone through menopause. The nurse determines that additional information is needed from the woman based on the nurse's suspicion of which condition?

A. vulvar cancer

B. endometrial cancer

C. ovarian cancer

D. cervical cancer

B. endometrial cancer

Explanation:

The most common major initial symptom of endometrial cancer is abnormal and painless vaginal bleeding. Any episode of bright-red bleeding that occurs after menopause should be investigated with a high suspicion for endometrial cancer. Abnormal vaginal bleeding usually after intercourse is associated with cervical cancer. Vaginal bleeding is not associated with ovarian or vulvar cancer.

Pg. 252

A postmenopausal client is told at her routine gynecological exam that the primary care provider has found a cyst on her right ovary. The nurse notices that this does not cause worry for this client. What should the nurse and/or care provider tell this client?

A. "You may get a second opinion if you would like."

B. "After menopause a mass on an ovary is not a cyst and should be considered cancerous until proven otherwise."

C. "You are correct not to be concerned; after all, it is only a cyst."

D. "We will keep a eye on it and recheck it at your next yearly appointment."

B. "After menopause a mass on an ovary is not a cyst and should be considered cancerous until proven otherwise."

Explanation:

After menopause, a mass on an ovary is not a cyst; physiologic cysts can arise only from a follicle that has not ruptured or from the cystic degeneration of the corpus luteum. Brushing it off is not responsible, and waiting a full year would put the client at serious risk from dying from the cancer. Suggesting a second opinion instead of explaining the seriousness of it to the client would not be responsible or ethical.

Pg. 248

A nurse will be speaking at a local high school about women's health. The nurse is planning to talk about sexually transmitted infections (STIs) as well as routine checks, along with guidelines for Papanicolaou testing. What should the nurse include in the Papanicolaou test guidelines about when to have a first test?

A. at the age of 21 or within 3 years of first sexual intercourse

B. at the age of 18 or within 2 years of first sexual intercourse

C. at the age of 16

D. 2 years after first sexual intercourse

A. at the age of 21 or within 3 years of first sexual intercourse

Explanation:

American Cancer Society guidelines for Papanicolaou testing recommend that the first Papanicolaou test is done at age 21 or within 3 years of first sexual intercourse. Other guidelines state that the tests should be done yearly until age 30 using the glass slide method and every 2 years using liquid-based method. At age 30 to 70, the tests should be done every 2 to 3 years if the previous three Papanicolaou tests were normal. They may be discontinued after age 70 if the previous three Papanicolaou tests were normal and no Papanicolaou tests in the previous 10 years were abnormal.

Pg. 255

A nurse is assessing a 20-year-old female. Which data finding taken during the history would indicate endometrial cancer?

A. severe back pain

B. vaginal bleeding that is painless and abnormal

C. diagnosis of diabetes mellitus

D. diagnosis of liver disease

B. vaginal bleeding that is painless and abnormal

Explanation:

A finding of abnormal bleeding that is painless is a major sign of endometrial cancer. The diagnoses of liver disease and diabetes mellitus are risk factors for women. Back pain can be associated with many things, including ovarian cancer.

Pg. 252

A nurse working in the Family Birthing Center is answering the nurse hotline phone. A client calls in to schedule her annual Papanicolaou test. How could the nurse best educate the client before her procedure to make sure the results are not affected?

A. Refrain from sexual intercourse 48 hours before testing to ensure clear results.

B. It is safe to use tampons 72 hours before testing.

C. The client may douche at least 48 hours before testing.

D. Make sure the appointment is 5 days after the last menses.

A. Refrain from sexual intercourse 48 hours before testing to ensure clear results.

Explanation:

Nurses should use teaching guidelines with clients to optimize the Papanicolaou test results. Strategies to educate would include no douche, no tampons, no jellies, no spermicides, no intercourse. The optimal time for testing is 2 weeks after the first day of your last menses.

Pg. 259

The nurse reviews the medical record of a woman diagnosed with ovarian cancer, stage II. The nurse interprets this information, understanding that the disease:

A. has metastasized to distant sites.

B. is limited to the ovary.

C. involves one or both ovaries and extends into the pelvis.

D. has spread to the lymph nodes and other organs within the abdomen.

C. involves one or both ovaries and extends into the pelvis.

Explanation:

Stage II ovarian cancer involves one or both ovaries, with pelvic extension. Disease limited to the ovary characterizes stage I ovarian cancer. Stage III ovarian cancer has spread to the lymph nodes and other organs and structures inside the abdominal cavity. Stage IV disease typically involves metastasis to distant sites.

Pg. 245

A client presents for a routine checkup at a local health care center. One of the client's distant relatives died of ovarian cancer, and the client wants to know about measures that can reduce the risk of ovarian cancer. The nurse informs the client about which measure to reduce the risk of ovarian cancer?

A. not breastfeeding

B. maintaining a healthy weight

C. avoiding the use of oral contraceptive pills (OCPs)

D. using perineal talc or hygiene sprays

B. maintaining a healthy weight

Explanation:

The nurse should instruct the client about the importance of healthy lifestyles and stress the importance of maintaining a healthy weight to reduce the risk. Another factor associated with a reduced risk of ovarian cancer is the use of oral contraceptive pills. Breastfeeding should be encouraged as a risk-reducing strategy. The nurse should instruct the client to avoid using perineal talc or hygiene sprays.

Pg. 247

An elderly woman is seen in the clinic reporting a lesion on her labia majora and states that she has experienced some bleeding and itching as well. She states that this has been going on for approximately three months. She tells the nurse that she has not been to a health care provider in over 10 years. What diagnosis would the nurse expect the primary care provider to make?

A. polyps

B. cervical cancer

C. vulvar cancer

D. vaginal cancer

C. vulvar cancer

Explanation:

The correct diagnosis for this client would be vulvar cancer due to the placement of the lesion, the itching, and the bleeding. The other cancers would have different symptoms and not apply to this client.

Pg. 262

A client has just been diagnosed with ovarian cancer. The nurse understands that among women, this type of cancer ranks as:

A. fifth most common.

B. seventh most common.

C. ninth most common.

D. third most common.

A. fifth most common.

Explanation:

Ovarian cancer is the is the fifth most common cancer among women and the most common cause of cancer deaths for women in the United States.

Pg. 245

A middle-aged woman is seen in the OB/GYN clinic and reports abdominal bloating, fatigue, abdominal pain, urinary frequency, and constipation. She also says that she had lost 24 pounds in the last month without trying to lose. For which disease should the primary care provider screen this client?

A. fibroids (leiomyomas)

B. breast cancer

C. pelvic organ prolapse (POP)

D. ovarian cancer

D. ovarian cancer

Explanation:

The most common early signs for ovarian cancer include abdominal bloating, early satiety, fatigue, vague abdominal pain, urinary frequency, diarrhea or constipation, and unexplained weight loss or gain. Fibroids do not have these same symptoms, nor does breast cancer or POP.

Pg. 248

The nurse provides education to a client at 22 weeks' gestation who has been newly diagnosed with cervical cancer. Which statement is best for the nurse to include in the teaching?

A. "The preferred method of birth for your baby is by a cesarean. You will probably be scheduled for this procedure later. "

B. "The best treatment option for you is to terminate the pregnancy and have a radical hysterectomy."

C. "Your primary health care provider will repeat the colposcopy each month to track the progress of your cancer."

D. "The outlook is good for you as cervical cancer is one of the most common malignancies diagnosed during pregnancy."

A. "The preferred method of birth for your baby is by a cesarean. You will probably be scheduled for this procedure later. "

Explanation:

In women with early-stage disease and absence of nodal involvement, there is an increasing tendency to preserve the pregnancy. The birth (when the fetal maturity is attained) should be performed via cesarean. Discussion with the client and the family is essential, and treatment must be individualized. The client needs to be aware of the birth method to plan and prepare. The nurse would not recommend treatment for the client. This should be discussed at length with the primary health care provider to determine what is best for the client and the family. A colposcopy is typically repeated between 20 to 24 weeks' gestation or 4 weeks' postpartum, not monthly. The nurse would not provide false reassurance to the client by stating "the outlook is good."

Pg. 245

A 25-year-old woman is at the health care provider's office for her annual checkup. The nurse educated the woman on risks for cervical cancer. Which question would be important to ask as part of a risk screening?

A. "Have you had problems trying to get pregnant?"

B. "Were you sexually active at an early age?"

C. "How long have you been severely overweight?"

D. "Do you have a history of high blood pressure?"

B. "Were you sexually active at an early age?"

Explanation:

Women that have a history of sexual activity within the first year of getting their menstrual cycle are at increased risk for cervical cancer later in life. Infertility, obesity, and high blood pressure put women more at risk for endometrial cancer.

Pg. 256

A nurse assesses and suspects vulvar cancer based on which assessment finding?

A. dysuria

B. vulvar bleeding

C. vulvar itching that responds to creams

D. fleshy, ulcerated mass on the labia majora

D. fleshy, ulcerated mass on the labia majora

Explanation:

A vulvar lump or mass is most often noted, and it may be fleshy, ulcerated, leukoplakic, or warty. Vulvar itching that does not respond to creams or ointments is a common complaint associated with vulvar cancer. Vulvar bleeding and dysuria may be seen with vulvar cancer but would be uncommon findings.

Pg. 262

A client is waiting for the results of an endometrial biopsy for suspected endometrial cancer. She wants to know more about endometrial cancer and asks the nurse about the available treatment options. Which treatment information should the nurse give the client?

A. In advanced cancers, radiation and chemotherapy are used instead of surgery.

B. Surgery involves removal of the uterus only.

C. Follow-up care after the relevant treatment should last for at least 6 months after the treatment.

D. Surgery involves removal of the uterus, fallopian tubes, and ovaries; adjuvant therapy is used if relevant.

D. Surgery involves removal of the uterus, fallopian tubes, and ovaries; adjuvant therapy is used if relevant.

Explanation:

The nurse should inform the client that surgery most often involves removal of the uterus (hysterectomy) and the fallopian tubes and ovaries (salpingo-oophorectomy). Removal of the tubes and ovaries, not just the uterus, is recommended because tumor cells spread early to the ovaries, and any dormant cancer cells could be stimulated to grow by ovarian estrogen. In advanced cancers, radiation and chemotherapy are used as adjuvant therapies to surgery. Routine surveillance intervals for follow-up care are typically every 3 to 4 months for the first 2 years.

Pg. 251

Which risk factors have been linked to ovarian cancer? Select all that apply.

A. gene mutations BRCA-1 and BRCA-2

B. nulliparity

C. early menopause

D. very low body weight

A. gene mutations BRCA-1 and BRCA-2

B. nulliparity

Explanation:

An inherited gene mutation (BRCA-1, BRCA-2 ) is linked to ovarian cancer. Other risk factors include nulliparity, obesity, early menarche, late menopause, and a high-fat diet, as well as a history of breast and colon cancers.

Pg. 248

A nurse is preparing a presentation for a health fair at a local college. The nurse is creating a poster to emphasize the need for cervical cancer screening. The nurse would list which age to begin screening?

A. 18 years

B. 25 years

C. 21 years

D. 30 years

C. 21 years

The nurse is caring for a client being treated for vaginal cancer. Which finding will the nurse report immediately to the primary health care provider?

A. a feeling of heaviness in the vagina

B. watery vaginal discharge

C. vaginal bleeding after intercourse

D. foul-smelling urine

D. foul-smelling urine

Explanation:

The nurse would immediately report foul-smelling urine. This is an indication of a urinary tract infection, not vaginal cancer. Abnormal vaginal bleeding such as after intercourse or menopause, vaginal heaviness (from a lump or tumor), watery discharge, constipation, pelvic pain, vaginal mass, and urinary frequency are expected findings of vaginal cancer.

Pg. 241

A nurse is reviewing the medical history of a client just diagnosed with stage III ovarian cancer. Which findings would the nurse identify as placing this client at risk? Select all that apply.

A. menopause at age 50

B. positive BRCA1 and BRCA2 gene mutations

C. menarche at age 14

D. never been pregnant

E. use of perineal hygiene sprays

B. positive BRCA1 and BRCA2 gene mutations

D. never been pregnant

E. use of perineal hygiene sprays

Explanation:

Risk factors associated with ovarian cancer include nulliparity, early menarche (before age 12), late menopause (after age 55), positive BRCA1 and BRCA2 gene mutations, and use of perineal talcum powder or hygiene sprays.

Pg. 248

A young woman has been referred for a colposcopy by the health care provider. The nurse is educating the woman on the procedure. Which information about the colposcopy should the nurse provide?

A. The procedure may be painful.

B. The results of the Papanicolaou test were abnormal; therefore, this procedure must be done.

C. There may be some pain while urinating for up to 1 week after the test.

D. Sexual intercourse should be avoided for 2 weeks.

B. The results of the Papanicolaou test were abnormal; therefore, this procedure must be done.

Explanation:

A colposcopy is performed when results of a Papanicolaou test are abnormal. This is a painless procedure with no aftereffects, so urinating afterwards is not a problem, and sexual intercourse need not be avoided.

Pg. 255

A 55-year-old client presents to the clinic with persistent vulvar pruritus, burning, and a lump. She states she has had the symptoms for 5 months and has been trying to treat them with over-the-counter creams. She has a history of multiple sexual partners and HPV and is a smoker. What should the nurse do next?

A. Prepare the client for a biopsy of the lesion.

B. Determine what creams the client has used.

C. Assess how much the client smokes daily.

D. Schedule the client for cryosurgery.

A. Prepare the client for a biopsy of the lesion.

Explanation:

The client has classic symptoms of vulvar cancer. All clients with vulvar lumps should be biopsied even if they are asymptomatic. Cryosurgery may be scheduled if the biopsy confirms the diagnosis of vulvar cancer. It is not important to know what creams the client has used or how much she smokes at this time.

Pg. 262

A client newly diagnosed with cervical cancer states, "I cannot believe I am going to die so young. My mother and aunt died from cervical cancer and I am next." Which response by the nurse is most appropriate?

A. "Tell me about the treatments your mother and aunt received, so those can be avoided."

B. "I understand your concerns and fears. This is a scary diagnosis and genetics are a factor."

C. "There are several treatment options for you to consider including chemotherapy, radiation, and surgery."

D. "You sound worried. Let's talk about how you are feeling with this new diagnosis."

D. "You sound worried. Let's talk about how you are feeling with this new diagnosis."

Explanation:

The nurse would talk with the client about her feelings and concerns at the moment upon receiving this new diagnosis. Determining the treatment that the client's mother and aunt received is not appropriate. The best treatment for the client will be based on the client's condition, stage, and available options. The nurse should not state understanding of the client's feelings because this changes the conversation to focus on the nurse and not the client. While chemotherapy, radiation, and surgery are all options, this statement does not address the client's feelings.

Pg. 254

After teaching a local woman's community group about cervical cancer, the nurse understands that teaching has been successful when the group identifies which condition as a risk factor for cervical cancer?

A. obesity and menopause

B. genital herpes

C. chronic vulvitis

D. vulvar dermatosis

B. genital herpes

Explanation:

Genital herpes increases the risk for cervical cancer. Chronic vulvitis and vulvar dermatosis are risk factors for vulvar cancer. Obesity and menopause are risk factors for pelvic relaxation alteration.

Pg. 256

The results of a Papanicolaou test have been classified as atypical squamous cells with possible HSIL (ASC-H) as per the 2001 Bethesda system. Which interpretation of the result is correct?

A. No need for any further Papanicolaou tests.

B. Immediate colposcopy; follow-up is based on the results of findings.

C. Repeat the Papanicolaou test in 4 to 6 months, or refer for a colposcopy.

D. Refer for a colposcopy without human papillomavirus (HPV) testing.

D. Refer for a colposcopy without human papillomavirus (HPV) testing.

Explanation:

According to the 2001 Bethesda system for classifying Papanicolaou test results, a result of ASC-H means that the client is to be referred for colposcopy without HPV testing. Atypical squamous cells of undetermined significance (ASC-US) means that the test has to be repeated in 4 to 6 months or the client has to be referred for colposcopy. Atypical glandular cells (AGC) or adenocarcinoma in situ (AIS) results indicate immediate colposcopy, with the follow-up based on the results of findings.

Pg. 255

A young woman has been referred for a colposcopy by the health care provider. The nurse is educating the woman on the procedure. Which information about the colposcopy should the nurse provide?

A. The procedure may be painful.

B. The results of the Papanicolaou test were abnormal; therefore, this procedure must be done.

C. Sexual intercourse should be avoided for 2 weeks.

D. There may be some pain while urinating for up to 1 week after the test.

B. The results of the Papanicolaou test were abnormal; therefore, this procedure must be done.

Explanation:

A colposcopy is performed when results of a Papanicolaou test are abnormal. This is a painless procedure with no aftereffects, so urinating afterwards is not a problem, and sexual intercourse need not be avoided.

Pg. 255