1. Reproductive health

2. Cancer Definition Cancer Definition The abnormal growth of cells without normal control of body. Types of Cancer  Malignant Cancer 2. Benign Cancer

3. The Importance of Screening The Importance of Screening  Early screening maximizes the possibility of early diagnosis  Improves the treatment options available  Increases women's survival rates and decreases mortality  Decreases health services cost

4. Sites of Gynecological Cancer  Breast Cancer  Cervical Cancer  Endometrial Cancer  Ovarian Cancer  Vulvar cancer

6. Breast Cancer It is one of the common cancers among women including Jordanian women about 800 cases are diagnosed yearly (National Cancer Registery )

7. Risk Factors of Breast Cancer Women more than 40 years old Family history of breast cancer Previous history of breast cancer No history of pregnancy or first pregnancy after the age of thirty Never breast feeding a child Long term postmenopausal combined estrogen and progesterone hormonal therapy Being obese or overweight after menopause History of overdose of radiation to the chest

8. Signs and Symptoms of Breast Cancer  Presence of mass or lump  Change in the color or temperature of breast tissue  Change in breast size or shape  Abnormal secretions from the nipple  Inversion of the nipple or change in the direction of the nipple  Skin erosion or ulceration

9. Screening Tools of Breast Cancer 1. Monthly self breast examination 2. Clinical breast examination 3. Mammography 4. Magnetic Resonance Imaging (MRI)

10. Monthly Self Breast Examination  It is a method for detecting breast mass early through inspection and palpation  It is recommended to perform it monthly  Done after the onset of menstrual period one week  If the woman is pregnant or menopause it is performed on the same day each month

11. Nurses Role Educator Care provider Counselor Researcher Advocate

12. Procedure of Self Breast Examination

16. Clinical Breast Examination Examination of breasts by health care provider such as nurses or physicians

17. RememberRemember Self breast examination is not alone enough to detect breast cancer, it is associated with mammography

18. MammographyMammography It is an effective screening tool of breast cancer It detects about 90 % of breast cancer in women who are symptoms free It is more accurate in postmenopausal women It is a soft tissue X-ray image of the breasts taken with out the injection of contrast medium

19. When to Do Mammography When to Do Mammography Once to all women before the age of 40 Every 1 to 2 year for women age 40 and older

20. What Time To Do Mammography  After the menstrual period till the middle of the month  In menopause, at the same appointment every 1-2 years  It is not recommended to have mammography during pregnancy and lactation

21. Preparation for Mammography  To refrain from applying lotions powders, deodorants or cosmetics substances  Exposure of the upper part of the body

22. Procedure of Mammography

23. MammographyMammography

25. RememberRemember The risk of radiation exposure with mammography is low, therefore it doesn’t increase the risk of breast cancer.

26. Magnetic Resonance Imaging (MRI) It is recommended in younger women who are at high risk for breast cancer

27. Magnetic Resonance Imaging (MRI)

28. Cervical Cancer It is the second most common cancer in women, it is a preventable disease if it is diagnosed early because it is slow growing

29. Risk Factors of Cervical Cancer History of multiple sexual partners History of immunosuppressive therapy (chemotherapy ) or immunocompromised state (HIV) Coitus at an early age Long term oral contraceptive use Smoking

30. Screening of Cervical Cancer Pap smear It is used to screen for the presence of cellular abnormalities by obtaining a sample containing cells from the cervix It is the method f choice for cervical cancer screening

31. When to have Pap smear When the women reach the age of 21 ACOG recommended repeat Pap smear for women between the ages f 21 and 29 every two years. For women aged 30 years and older, who have had three consecutive negative Pap smears, may extend the interval to every three years

32. Procedure of Pap smear

35. RememberRemember The women should have avoiding any thing in her vagina for 24 hour in order not to interfere with the accuracy of the test

36. Endometrial Cancer o One of the most common female genital cancer o Has a high rate of cure, if it is detected early

37. Risk Factors of Endometrial Cancer Increased age Obesity Nulliparity History of infertility Menstrual irregularities History of diabetes Hpertension Early menarche or late menopause

38. RememberRemember  Majority of endometrial cancer occurs in postmenopausal women  Signs and symptoms Vaginal bleeding in postmenopausal women not treated with hormone therapy

39. Screening of Endometrial Cancer Pap smear Pelvic ultrasound to evaluate thickness of endometrium Endometrial biopsy

40. Ovarian Cancer It is the most fatal f all cancers, it is difficult to diagnose and often spread throughout the pelvis before it is detected

41. Risk Factors of Ovarian Cancer  Increased age  Nulliparity  History of breast cancer  Early menarche or late menopause

42. Signs and Symptoms of Ovarian Cancer Increased abdominal size Difficulty eating Abdominal or pelvic pain Dyspareunia Irregular bleeding Delayed menstruation

43. Screening of Ovarian Cancer o Have annual ultrasound examination o CA 125 blood test (a protein that may indicate the presence of certain gynecological cancer)

44. RememberRemember If a palpable mass is noted on routine pelvic examination radiography or ultrasonography is used to confirm diagnosis

45. Vulvar Cancer It makes up 3% to 5% of all female genital cancer.

46. Risk Factors of Vulvar Cancer Chronic vulvar inflammation Smoking Diabetes Immunosuppression History of lower genital cancer

47. Signs and Symptoms of Vulvar Cancer The woman may be presented with: Pruritus Lump Flat lesion which is itching, burning and painful

48. Screening of Vulvar Cancer A microscope is designed to look at the vulva and cervix to evaluate tissues

49. Coloscopy

50. Any Questions Thank you