Breast and Reproductive System PDF

THE BREAST, PROSTATE & REPRODUCTIV E SYSTEM Rebecca Cross Bodán  Cancer Stats Breast and Prostate Cancer Breast Subjective Outline Objective Common conditions Reproductive (male and female)...

THE BREAST, PROSTATE & REPRODUCTIV E SYSTEM Rebecca Cross Bodán  Cancer Stats Breast and Prostate Cancer Breast Subjective Outline Objective Common conditions Reproductive (male and female) Subjective Common conditions R. Bodan  STATISTICS FROM THE AMERICAN CANCER SOCIETY R. Bodan R. Bodan ACS, 2016 R. Bodan ACS, 2020 R. Bodan RACE – ETHNICITY – AND BCA R. Bodan R. Bodan RACE – ETHNICITY – PROSTATE CA R. Bodan  BREAS T CANCE R R. Bodan Breast Cancer Risk Factors (Non-Modifiable) Gender Age Signs & Symptoms Family and/or personal history Often asymptomatic Genetic (BRCA1/2) breast lump, pain Ethnicity Menarche before 12 Edema in affected arm Menopause after 55 Weight loss Bone pain Risk Factors (Modifiable) First pregnancy after 30 or nulliparity EtOH HRT (>4yrs combined HRT) Obesity Inactivity Radiation R. Bodan  Nurses Health Study Links EtOH Use to Breast Cancer Women who drink 3-6 drinks a week have a 15% higher risk of developing breast cancer Women who drink 2 drinks a day have a 50% increased risk of developing breast cancer What do we tell our patients?? R. Bodan  ACS BCS Screening Guidelines R. Bodan R. Bodan  CURRENT ACS CERVICAL CA GUIDELINE S R. Bodan Preventing Cervical CA HPVis the primary cause of cervical cancer (and can cause other cancers such as throat, vaginal, penile, and rectal). Thereare 3 FDA approved vaccines that prevent the most lethal forms of HPV which cause cervical cancers Recommended by CDC for kids at 11-12, up to age 26 R. Bodan  INTERVIEWING A PATIENT WITH A BREAST CONDITION R. Bodan Subjective HPI/ROS:breast discomfort, Menstrual history breast mass, nipple discharge, Pregnancies breast enlargement (men) FH:breast and other related PMH: previous breast dz, known genetic mutation, other cancers related cancers (e.g. ovarian), Health maintenance: breast surgeries cancer screening EtOH, caffeine R. Bodan  When? When a patient has a specific complaint What? When should you Breast and axillae do a breast exam and what Primarily for identification of masses, vascular or skin changes that might should you indicate malignancy examine? Tanner staging for children, abnormal breast development in males R. Bodan  THE BREAS T EXAM R. Bodan R. Bodan Documenting a Breast Mass Location Size Shape Consistency Tenderness Mobility Borders Retractions R. Bodan  Breast cancer Mastitis Common Fibrocystic breast changes Problems of the Fibroadeoma Breast Galactorrhea Gynecomastia R. Bodan  VISIBLE SIGNS OF INFECTION Erythema Peau d’ Orange AND CANCER OF BREAST Paget’s Dz R. Bodan Nipple Retraction and Dimpling R. Bodan Mastitis Infection of breast tissue Often bacterial (Staph aureus) Occur most frequently in women who are BF S/S:unilateral enlargement, pain, erythema, edema, warmth, fever and other systemic sxs, nipple d/c, enlarged axillary lymph nodes R. Bodan Supernumerary Nipples R. Bodan DISCHARGE R. Bodan Fibrocystic Breast Changes Multiple benign masses within the breast Etiology: ductal enlargement and cyst formation S & S: one or more palpable masses which often fluctuate with the menstrual cycle R. Bodan Fibroadenoma Benign breast mass Consists of both glandular and fibrous tissue Common in young women S& S: unilateral mass, no fluctuation with menstrual cycle R. Bodan  Milky nipple discharge, unrelated to breast feeding Can occur in men or women Galactorrhea Sign of an underlying problem Etiology: disorder of hypothalamus or pituitary (leading to increases in prolactin), medication SE, breast stimulation R. Bodan Gynecomastia Development of breast tissue in males Can occur in any age Often an indication of an underlying hormonal imbalance Psychosocial implications Treatment: ‘watchful waiting’, medication, surgery R. Bodan  PROSTA TE CANCER R. Bodan Prostate CA Symptoms & Risk Factors Signs/Symptoms Non-Modifiable RF Typically asymptomatic Age Urinary frequency Gender Dysuria Race/ethnicity (>common in Hematuria Black men, Asian men IN Asia Pain in low back, hips, or thighs lowest risk) Family/personal history Geography (sunlight) Modifiable Risk Factors Smoking, diet, sedentary lifestyle, BMI, occupation (farmer, tire plant, painter) R. Bodan  ACS PROSTATE CA SCREENING GUIDELINES R. Bodan Benign Prostatic Hypertrophy (BPH) NOT cancer NOT associated with cancer IS very common, and occurs to some degree to all men if they live long enough May cause urinary problems due to pressure placed on urethra Symptoms: difficulty with urination, ‘dribbling’, incomplete emptying of bladder, nocturia, weak stream, incontinence, etc. (sxs similar to cancer) R. Bodan REPRODUCTIVE SYSTEM R. Bodan R. Bodan Subjective HPI/ROS: abnormal bleeding, Health maintenance: previous pain, vaginal discharge, PMS pelvic exams/ paps, HPV sxs, menopausal sxs, testing fertility/infertility, urinary sxs, Sexual history and practices: menstrual history partners, barrier protection PMH EtOH, drugs, cleansing FH: DM, congenital problems, routines multiple pregnancies, related cancers Meds,include hormonal contraception R. Bodan  First menstruation Average age of onset is 12, normal age range is 9 – 15 years of age. Menarche before age 9, or after 15 should be evaluated. Childhood obesity thought to be r/t earlier Menarche age at menarche. Eating disorders, competitive athletes more likely to begin menstruation at an older age. In each case, endocrine abnormalities should be considered. Often irregular and unpredictable for the first 1-2 years following menarche. R. Bodan  Shedding of uterine lining Normal Menstrual Cycle every 21-35 days, most commonly every 28 days 3-7 days duration, moderate flow, mild PMS symptoms Should inquire about frequency, duration, Menstruation flow, associated symptoms. To quantify flow, ask about how often pt changes pad/tampon. Needing to change once an hour or more = heavy flow. Last menstrual period (LMP) refers to the first day of a woman’s last menstrual cycle. R. Bodan  Defined as no menses for 12 or more months (with no other biological or physiological explanation) Average age of menopause is 51 Increases in FSH Menopause Risks and benefits of HRT HRT can be used to alleviate peri- menopausal sxs such as hot flashes. Should be used at the lowest effective dose, for the shortest period of time possible in order not to ↑ one’s risk for BCA and cardiovascular dz. R. Bodan R. Bodan Subjective HPI/ROS: difficulty Health maintenance: testicular achieving/maintaining self exam, prostate cancer erection, penile discharge, screening dysuria, infertility, EtOH, drugs enlargement in inguinal area, testicular pain/masses, PMH:STIs, related cancers, DM, cardiac dz, hernias R. Bodan Signs of Sexually Transmitted Infections Ulcers Ulcers Penile discharge Purulent vaginal discharge Abdominal pain Abdominal/pelvic pain Systemic sxs (syphilis, HIV, Dyspareunia hepatitis) Infertility Systemic sxs (syphilis, HIV, hepatitis) R. Bodan Signs of Sexual Abuse Physical Complaints Behavioral Changes Evidence of general Problems in school abuse/neglect Change in appetite/weight Evidence of trauma/scarring Change in sleep Presence of STI Depression Anorectalpruritis, bleeding, Change in personality, pain, incontinence aggression Vaginalbleeding, discharge, Avoidance of people/places dysuria, UTIs R. Bodan