Management of Hyperplasia and Malignancy

Study Notes

Hyperplasia without atypia treated with progestogens.
Atypical hyperplasia carries the highest risk of malignancy, requiring total abdominal hysterectomy and bilateral salpingo-oophorectomy.
Stage I/II endometrial cancer: radical hysterectomy, which includes removal of surrounding vaginal tissue and ligaments, possibly with lymphadenectomy.
Stage III/IV endometrial cancer management: maximal de-bulking surgery when feasible, supplemented by palliative care options like low-dose radiotherapy, chemotherapy, and high-dose oral progestogens.

Obtain History: Consider menstrual patterns, STIs, obstetric history (including parity and infertility), contraceptive use, and any hormone replacement medications.
Client Examination: Assess past investigations, psychological responses to diagnosis, and any social stigma impacts.
Addressing Emotional Needs: Relieve fear and anxiety, provide treatment options information, and prepare clients for upcoming medical procedures while encouraging family support.
Pain Management: Administer prescribed pain medications and monitor the client's response.
Patient Education: Stress the importance of lifelong follow-up, avoiding heavy lifting (more than 3-4 kg) for 4-6 weeks, preventing straining during bowel movements, managing constipation, and maintaining a well-balanced diet.

Understanding cancer of the cervix and endometrium, uterine myomas, and endometriosis is crucial in nursing assessments and care.

Abnormal cell growth in the cervix; it ranks as the third most common female malignancy globally.
Squamous cell carcinoma is the predominant type, affecting women aged 35 to 55.

History of STDs, particularly high-risk HPV strains.
Conditions that compromise immunity, such as poor nutrition and HIV.
Behaviors and experiences including smoking, vitamin deficiencies, early sexual activity, and multiple partners.

Often asymptomatic in early stages; abnormal Papanicolaou (Pap) test results may be the first indication.
Possible symptoms: abnormal vaginal bleeding, discomfort, malodorous discharge, dysuria, and in advanced cases, constant bleeding and pain radiating to the back and legs.

Stage 0: Carcinoma in situ.
Stage 1: Cancer confined to cervix (with subdivisions based on microscopic identification).
Stage 2: Beyond cervix but not pelvic sidewall, involves vagina but not lower third (with subdivisions).
Stage 3: Extends to pelvic sidewall or lower third of vagina, with potential hydronephrosis (with subdivisions).
Stage 4: Extends to bladder or rectum, or distant metastases (with subdivisions).

Stage-based therapy with a focus on preserving fertility; early invasive cancer ideally treated with surgery.
Advanced cases require a combination of radiation and chemotherapy. In cases of dissemination, palliative treatments are pursued.

Cryosurgery: Destroys abnormal cells by freezing, using liquid nitrous oxide, with 90% efficacy; post-procedure may cause cramping, watery discharge, or bleeding.
LEEP (Loop Electrosurgical Excision Procedure): Removes abnormal tissue using electrical current; applicable for microinvasive cancer.
Conization: Excision of a cone-shaped tissue from the cervix.
Radical Vaginal Trachelectomy: Removal of most of the cervix and surrounding tissues along with pelvic lymph nodes.
Hysterectomies: Types include total hysterectomy (removes uterus and cervix) and radical hysterectomy (removal of uterus, cervix, upper vagina, and surrounding tissus), with bilateral salpingo-oophorectomy involving the removal of both ovaries and fallopian tubes.