Week 11 Neoplasm Female-AFAB Reproductive Cancers PDF 2024-2025

Cancers Cervical Uterine Ovarian NURS 1028 Week 11 Chapter 56 Note. "Please note that in an effort for more inclusive language, the content covered r...

Cancers Cervical Uterine Ovarian NURS 1028 Week 11 Chapter 56 Note. "Please note that in an effort for more inclusive language, the content covered refers to individuals assigned female at birth (AFAB) even though we may use the term 1 "female" when NURS 1028 / 2024-2025 discussing these reproductive cancers“.  *Cervical Cancer *The progression from normal cervical cells to dysplasia (precancerous cells) and then to cervical cancer appears to be related to repeated injuries to the cervix *Progression occurs slowly over years *Peak incidence of non-invasive cervical cancer is in people in their early 30s *Average age for people with invasive cervical cancer is 50 *Causes: *A strong relationship exists between dysplasia Human papillomavirus (HPV) infection *Sexual history (multiple partners, sex before age 18) NURS 1028 / 2024-2025 2  *Risk Factors * Smoking: Women who smoke are about twice as likely as non- smokers to get cervical cancer. Tobacco by-products have been found in the cervical mucus of women who smoke. Researchers believe that these by-products damage the DNA of cervix cells and may contribute to the development of cervical cancer * Weakened Immune System: Increases the risk of getting other infections, including HPV * Multiparous: Multiple Births (defined as > 3 or more full-term pregnancies ). It may be because of changes in hormones during pregnancy, or the trauma to the cervix during birth * Long-Term Contraceptive Use: Oral contraceptives contain synthetic estrogen and progesterone, which can be a catalyst in the development of cervical cancer. The risk goes down when stopping taking them. And if individuals in their 20s, 30s, or early 40s, the risk lowers * The longer a person uses oral contraceptives, the higher the risk of cervical cancer. One study found the risk rose by 10% with less than 5NURS years 1028of use, 60% with 5-9 years of3 use, and double with 10 or / 2024-2025 more years of use  *Risk Factors * Giving Birth at Young Age: Associated with riskier sexual behaviour, such as having unprotected sex, having multiple sexual partners, as well as a woman's partner having multiple partners * It has also been speculated that the increased risk of HPV is because of a biological predisposition of the immature cervix during adolescence that may be more susceptible to persistent HPV infections and therefore have a greater risk of cancer development * Genital Herpes: Defined as an STD, which confirms even once no protection was used during sexual intercourse * Overweight: This risk factor remains to be debatable. Obesity has been inconsistently linked to increased cervical cancer incidence and mortality. A research study found, “It is plausible that obesity may similarly be a risk factor for cervical cancer because of decreased efficacy of cervical visualization and sampling during routine screening” The Journal of Oncology, 2018, para. 6). NURS 1028 / 2024-2025 4  *Cervical Cancer *Manifestations *Early Cervical Cancer *Rarely produces symptoms, if symptoms are present: * Vaginal discharge (i.e., bleeding that occurs between regular menstrual cycles) * Bleeding after sexual intercourse * Menstrual periods that last longer and are heavy * Bleeding after menopause * Pelvic pain *Advanced Cervical Cancer * Increased vaginal discharge gradually increases and comes watery and finally, dark and foul-smelling from necrosis and infection from the tumour * Pain is a late symptom and is followed by weight loss, anemia, and cachexia NURS 1028 / 2024-2025 5  *Cervical Cancer * Diagnostic Tests * Early Stages * Pap Smear * HPV DNA test (done during a Pap Smear test) * A laboratory test in which cells are scraped from the cervix to look for DNA of human papillomaviruses (HPV) * Cervical Screening for Trans Women: * https://cancer.ca/en/cancer-information/find-cancer-early/screening-in-lgbtq-communities/as-a-trans-w oman-do-i-need-to-get-screened-for-cervical-cancer * Later Stages * Pelvic examination and cervical biopsy * Colposcopy * Cone biopsy * MRI, CT Scan, Pelvic Ultrasound * Prevention: * HPV vaccine (Gardasil) * Specifically HPV types 6, 11, 16 and 18 * Safe sex * Regular Pap smear NURS 1028 / 2024-2025 6  *Diagnostic Studies * Cervical cancer screening is recommended in Canada for sexually active people between the ages of 21 and 69 * Pap Smear: Cervix is viewed through a speculum with the client in the lithotomy position. Cells are scraped from the cervix and spread on a microscope slide for examination to check for disease and other problems * Pap test every 1 to 3 years, depending on the screening guidelines in their province or territory and depending on their previous test results * People with previous abnormal Pap tests may be screened more often * People who have had a total hysterectomy do not need to be screened for cervical cancer, unless the surgery was done for cervical precancer or cancer * Cervical Biopsy: Small tissue samples are taken from the cervix and examined * Cone Biopsy: A large area of tissue around the cervix is excised for examination * Colposcopy: Illuminates the cervix for biopsy. Biopsy forceps are used to sample the cervix * Note. Clients who are female-to-male transgender should be considered for cervical cancer screening if they have a cervix, including those who have undergone subtotal hysterectomy or hormonal gender confirmation NURS 1028 / 2024-2025 7  * Nursing Interventions for Cervical Biopsy *Client to empty bladder prior to test *Explain to client that bleeding and vaginal discharge are expected following procedure *Avoid tampon use for 3 to 4 weeks *Caution the client to avoid sexual intercourse until vaginal discharge stops or 3 to 4 weeks *Instruct client to inform physician if heavy bleeding or foul-smelling discharge present NURS 1028 / 2024-2025 8  *Collaborative Care * Vaccines against HPV (e.g., Gardasil, Cervarix) reduce the incidence of both cervical-related neoplasia and cervical cancer caused by infection from HPV types 16 and 18 (high risk strains) * Primary group recommended for vaccination is females aged 9 to 13. Gardasil is also recommended in males between 9 and 26 years of age, and in males ≥9 years of age who have sex with males As of September 2022, Ontario students can get the HPV vaccine (GARDASIL®9) free of charge in Grade 7 Boys or girls who are unable to begin or complete the HPV vaccine series in Grade 7 are eligible to catch-up missed doses through their local public health unit, free of charge, until the end of Grade 12 NURS 1028 / 2024-2025 9  *Collaborative Care * The treatment of cancer of the cervix is guided by the stage of the tumour and the client's age and general state of health: Stag Extent Treatment e 0 In situ Cervical conization Hysterectomy Cryosurgery Laser surgery I Confinement to cervix Radiation Radical hysterectomy II Spread beyond cervix to upper two thirds of Radiation the vagina but not to tissues around uterus Cisplatin-based chemotherapy Radical hysterectomy III Spread to pelvic wall, involvement of lower Surgery (laparotomy) third of vagina or has caused kidney Radiation conditions for both of the latter two) Cisplatin-based chemotherapy IV Spread to other parts of the body, such as Radiation bladder, rectum, liver, lungs, and bones Surgery (debulking, pelvic Cisplatin is a chemotherapy medication used to treat a number exenteration) of cancers. It is a platinum- Cisplatin-based based antineoplastic family of medications. It works in part by binding to DNA and inhibiting its replication NURS 1028 / 2024-2025 10 chemotherapy *Endometrial or Uterine Cancer *Uterine cancer is the most common gynecological cancer among females and AFAB and its cause is unknown other than consideration of hormonal imbalance between This Photo by Unknown Author is licensed under CC BY-NC-ND estrogen and progesterone *Abnormal growth of tumour in the uterine lining (endometrium) *Usually called endometrial cancer NURS 1028 / 2024-2025 11 *Endometrial or Uterine * HRT: Estrogen Cancer * Obesity * Obesity is a risk factor because adipose cells store estrogen, thus increasing endogenous estrogen * Nulliparity * Pregnancy and oral contraceptives are protective factors * Over 50 years (most diagnosed between 55 and 64 years of age) * Endometrial hyperplasia * Early menstruation * Late menopause * Family history of hereditary nonpolyposis colorectal cancer NURS 1028 / 2024-2025 12  *Endometrial or Uterine * Manifestations: Cancer * Abnormal uterine bleeding, usually in postmenopausal people * Note. Perimenopausal have sporadic periods for a time, it is important that this sign not be ignored or attributed to menopause * Pain occurs late in the disease process * Metastases are the lung, bones, the liver, and eventually, the brain * Diagnostic Tests: * History and physical * Irregular vaginal bleeding should be evaluated promptly * Pelvic or transvaginal ultrasound * Endometrial biopsy * Hysteroscopy * Dilation and curettage (D&C) NURS 1028 / 2024-2025 13 * CT, MRI, PET  *Diagnostic Studies * Pelvic Ultrasound: Ultrasound imaging of the pelvis uses sound waves to produce pictures of the structures and organs in the lower abdomen and pelvis. Types of pelvic ultrasound: abdominal and vaginal. These exams are frequently used to evaluate the reproductive and urinary systems. Ultrasound is safe, non-invasive and does not use ionizing radiation. * Endometrial Biopsy: A catheter is inserted into the uterus through the vagina to remove cells from the uterine lining for examination * Hysteroscopy: The inspection of the uterine cavity by endoscopy with access through the cervix. It allows for the diagnosis of intrauterine pathology and serves as a method for surgical intervention (operative hysteroscopy) * Dilation and Curettage (D&C): Refers to the dilation (widening/opening) of the cervix and surgical removal of part of the lining of the uterus and/or contents of the uterus by scraping and scooping (curettage). It is a therapeutic gynecological procedure as well as the most often used method of first trimester miscarriage or abortion NURS 1028 / 2024-2025 14  *Collaborative Care * Treatment Options: * Total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO) with lymph node biopsies * Surgery may be followed by radiation, either to the pelvis or abdomen, externally or intravaginally, to decrease local recurrence * Increased CA-125 values pre-treatment might prove useful in post-treatment surveillance * Progesterone HT (e.g., megestrol [Megace OS]) is the treatment of choice when the progesterone receptor status is positive and the tumour is well differentiated * Tamoxifen (Nolvadex-D), either alone or in combination with progesterone therapy, is also effective in women with advanced or recurrent endometrial cancer * Chemotherapy is considered when progesterone therapy is unsuccessful * Prevention: * Encouraged to have annual checkups, including gynecologic examination * Healthy weight * Physically active NURS 1028 / 2024-2025 15  *Ovarian Cancer * Ovarian cancer is a malignant neoplasm of the ovaries. Ovarian tumours are often difficult to detect because the are usually deep in the pelvis * People who have mutations of the BRCA genes have increased susceptibility for ovarian and breast cancer * Ovarian tumours that are malignant (cancerous) can spread (metastasize) to other parts of the body and can be serious * Metastasizes to the uterus, bladder, bowel, and omentum. In advanced disease, it can spread to the stomach, colon, liver, and other parts of the body * Stage IV lesions carry a poorer prognosis than the other grades NURS 1028 / 2024-2025 16  *Ovarian Cancer NURS 1028 / 2024-2025 17  *Risk Factors * Breast cancer gene 1 (BRCA1) or 2 (BRCA2) * Family history (one or more first-degree relatives with ovarian cancer) * 55-65 years of age * Early menstruation (before age 12) * Nulliparity * First child after 30 years of age * Menopause after 50 years of age * HRT * Infertility drugs * Obesity NURS 1028 / 2024-2025 18 * Manifestations *Ovarian Cancer 1. Enlargement (swelling) of abdominal girth 2. Pelvic pressure 3. Pain during intercourse 4. Bloating 5. Constipation 6. Urinary urgency/frequency 7. Indigestion or early satiety 8. Flatulence 9. Bleeding from the vagina that isn’t normal (such as heavy or irregular bleeding, bleeding between periods), especially after menopause 10. Pain * Back * Aching, stabbing, shooting, or burning pain anywhere along the spine and the back * Abdomen * Legs * Pelvic Note. A palpable ovary in a post menopausal person should be investigated immediately because ovaries become smaller and less palpable Note. Symptoms are often vague, so many females and AFAB tend to ignore them. Ovarian NURS cancer is silent, the silent 19 1028 / 2024-2025 killer…  *Diagnostic * Only 20% of ovarian cancers are diagnosed at an early stage Studies * History and physical examination * Abdominal and transvaginal ultrasonography * Individuals who are postmenopausal should not have palpable ovaries, so a mass of any size should be suspected as possible ovarian cancer. An abdominal or transvaginal ultrasonography can be used to detect ovarian masses * CA 125 levels * Laparotomy for diagnostic staging * An exploratory laparotomy may be used to establish the diagnosis and stage the disease * Yearly bimanual pelvic examinations NURS 1028 / 2024-2025 20  *Collaborative *Surgery Care *Abdominal hysterectomy and bilateral salpingo- oophorectomy with pelvic lymph node biopsies *Debulking for advanced disease *Removal of as much of the tumour as possible *Chemotherapy *Adjuvant and palliative *Radiation therapy *Adjuvant and palliative NURS 1028 / 2024-2025 21  *Ovarian Cancer *Prevention *For people with a high risk for ovarian cancer: *Screening using a combination of the tumour marker (carbohydrate antigen- 125 [CA-125]) *Ultrasonography *Yearly pelvic examination NURS 1028 / 2024-2025 22  * Female Reproductive System Cancers * Anxiety related toNursing Diagnosis the diagnosis of cancer, fear of pain, loss of femininity, threat of death * Disturbed body image related to altered fertility and fears about sexuality and relationships * Acute pain related to enlarging tumour, surgery and other therapies * Deficient knowledge related to postoperative self-care * Grieving related to (poor prognosis of advanced disease) * Dysfunctional family processes related to the effect of illness on family member(s). * Example: Dysfunctional family processes related to the effect of illness on family member(s) as evidenced by the significant other reporting, “She tells me I’m not supportive enough, Its just that I never know what to say to help my wife without upsetting her even more. Even just saying the word cancer, she breaks down uncontrollably, and I feel I caused that. So I figured it is better to not say anything, but that’s wrong too”. NURS 1028 / 2024-2025 23  * Female Reproductive System Cancers Planning *The overall goals are that the client with cancer of the female reproductive system will: * actively participate in treatment decisions * achieve satisfactory pain and symptom management * recognize and report problems promptly * maintain preferred lifestyle as long as possible * continue to practise cancer detection strategies * Example: The client will demonstrate how to properly change wound dressing using clean technique by discharge. * The client will identify two individuals of support they can talk to about their feelings of grief related to the hysterectomy by discharge. NURS 1028 / 2024-2025 24  *Hysterectomy * Surgical removal of the uterus to treat cancer, dysfunctional uterine bleeding, endometriosis, nonmalignant growths, persistent pain, pelvic relaxation and prolapse, and previous injury to the uterus * Partial (Subtotal) Hysterectomy * Subtotal Hysterectomy * Surgeon removes only the upper part of the uterus, keeping the cervix in place. * Total Hysterectomy * A total hysterectomy removes the whole uterus and cervix * Radical Hysterectomy * Surgeon removes the whole uterus, tissue on the sides of the uterus, the cervix, and the top part of the vagina. Radical hysterectomy is generally only done when cancer is present * Types of Approaches: * Laparoscopic * Vaginal * Abdominal * If ovaries and fallopian tubes are also removed, it is called a hysterectomy with bilateral salpingectomy-oophorectomy NURS 1028 / 2024-2025 25  *Hysterectomy *Postoperative Care * Dressing should be observed frequently for any sign of bleeding during the first 8 hours after surgery * Laparoscopic sites (e.g., Steri Strips, Band-Aids or 2 x 2 gauze pads) * An abdominal dressing (abdominal hysterectomy) * Horizontal Incision (e.g., most common) * Vertical Incision (e.g., emergency situations) * A sterile perineal pad (vaginal hysterectomy) * Assess for urinary retention (temporary bladder atony resulting from edema or nerve trauma) * Note. Catheterization may be necessary if the client has not urinated for 8 hours postoperatively * Indwelling catheter is used for 1 to 2 days (to maintain constant drainage of the bladder and prevent strain on the suture line) NURS 1028 / 2024-2025 26  *Hysterectomy NURS 1028 / 2024-2025 27  *Hysterectomy *Postoperative Care *Assess for abdominal distension (sudden release of pressure on the intestines when a large tumour is removed) *Paralytic ileus secondary to anaesthesia and manipulation of the bowel *Food and fluids may be restricted if the client is nauseated *Early ambulation is encouraged (relieve abdominal pain related to flatus and to prevent abdominal distension) *Prevention of DVT *Frequent changes of position, avoidance of the high Fowler's position, and avoidance of pressure under the knees minimize stasis and pooling of blood *Leg exercises should be encouraged to promote circulation NURS 1028 / 2024-2025 28  *Hysterectomy * Psychosocial Care * Loss of the uterus may bring about a grief response in some people, similar to any significant personal loss * Ability to bear children may be associated with their perception of womanhood * Loss of ovaries, women experience surgical menopause * Estrogen is no longer available from the ovaries * HT may be initiated in the early postoperative period to counteract symptoms of estrogen deficiency * Discharge Teaching * Will no longer menstruate * Intercourse should be avoided until the wound is healed (4 to 6 weeks) * If a vaginal hysterectomy is performed, the woman needs to know that there may be a temporary loss of vaginal sensation * Heavy lifting should be avoided for 6 to 8 weeks NURS 1028 / 2024-2025 29  *Radiation Therapy * External Radiation Therapy * External beam therapy (EBT) is a method for delivering high- energy x-ray or electron beams to a patient’s tumor. Beams are usually generated by a linear accelerator and targeted to destroy cancer cells while sparing surrounding normal tissues. EBT also may be used to relieve symptoms in patients with advanced cancer or cancer that has metastasized * Internal (Intracavity) Irradiation * A radioactive implant is put inside the body in or near the tumor. Internal radiation therapy (brachytherapy) allows a higher dose of radiation in a smaller area than might be possible with external radiation treatment. It uses a radiation source that’s usually sealed in a small holder called an implant. Different types of implants may be called pellets, seeds, ribbons, wires, needles, capsules, balloons, or tubes NURS 1028 / 2024-2025 30  * Placement of Tandem and Ovoids for Internal Radiation Therapy NURS 1028 / 2024-2025 31  * Internal Radiation Therapy Nursing Interventions * Pre-Procedure * To prepare the patient for the treatment, the nurse gives a cleansing enema to prevent straining at stool, which could cause displacement of the isotope * An indwelling catheter is inserted to prevent a distended bladder from coming into contact with the radioactive source * Post-Procedure * Vaginal packing is inserted to keep the applicator in place and keep other organs such as the bladder and rectum, as far away from the radioactive source as possible * Absolute bed rest (24 to 72 hours) * Client is placed in a lead-lined private room, on absolute bed rest with positioning restrictions * May be turned from side to side * Administer analgesics (intrauterine applicator produces uterine contractions) * Room deodorizer is helpful (destruction of cells results in a foul-smelling vaginal discharge) * Monitor for nausea, vomiting, diarrhea, and malaise that may develop as a systemic reaction to the radiation NURS 1028 / 2024-2025 32 * (Intracavity Radiation Safety) Nursing Interventions * Follow specific precautions related to time, distance, and use of shielding * No individual nurse should attend the patient for more than 30 minutes per day * Nurse should stay at the foot of the bed or at the entrance to the room to minimize radiation exposure * Methods to monitor staff exposure (film badges) * No pregnant caregivers, and no pregnant visitors or visitors younger than 18 years of age * Teaching for family and others in contact with patient * Visitors need to be told to stay about 2 m away from the bed and limit visits to less than 3 hours a day * Monitor that device is not dislodged. If it is dislodged, do not touch the radioactive object, and notify radiation safety NURS 1028 / 2024-2025 33 *References *Tyerman, J., Cobbett, S., Harding, M., Kwong, J., Roberts, D., Hagler, D., & Reinisch, C. (2022). Lewis’s medical- surgical nursing in Canada: Assessment and management of clinical problems (5th Canadian ed.). Elsevier Canada. NURS 1028 / 2024-2025 34 34