1. Disorders of the Female Reproductive Tract Cancer

2. I.Cancer in Situ A pre-invasive, asymptomatic CA Can only be diagnosed by examination of cervical cells via microscope Can be treated without radical surgery Is 100% curable

3. II.Management of CA in Situ Electrocautery Cryosurgery Laser Conization Hysterectomy

4. III.Cancers of the Reproductive Tract – Cervix Those @ risk: –Sexually active as teens –Multiple births –  socioeconomic levels –STDs

5. Cervix – etiology (con’t) –HPV (human papilloma virus) –Smoking –Whose mothers took DES –Infections & erosion of the cervix

6. Cervix – S/sx Silent in early stages w/ few sx Leukorrhea Irregular vaginal bleeding/spotting between menses Bleeding after coitus or after menopause –Bleeding slight @ 1 st, then increases w/ progression of disease

7. Cervix – S/sx (con’t) Vaginal exudate –Becomes watery –  & becomes dark bloody & odiferous d/t necrosis & infection Severe pain in back, legs & upper thighs w/ advanced stages

8. Cervix – Dx Tests Pap Smear Schiller’s test Cervical biopsy CT, etc as needed Cervical screening – 3 yrs after having sex but no later than age 21 & prn

9. Cervix – Med Mgmt Early CA of cervix treated with hysterectomy or intracavity radiation Radical hysterectomy includes pelvic lymph node dissection; then chemo & radiation Internal radiation done on in-patient status

10. Cervix – NI Reassurance Hospice care if CA well advanced Change dressings & peri-pads often Monitor skin integrity closely

11. B.Endometrium – Etiology Usually affects post-menopausal women Either localized or may metastasize @ risk –Irregular periods –Menopause difficulties

12. Endometrium – Etiology (con’t) @ risk (con’t) –Obesity –HTN –DM –HRT –On Tamoxifen (anti-neoplastic)

13. Endometrium – S/sx Dx Tests Post-menopausal bleeding (50% have CA) Report any type of abnormal bleeding, regardless of age Pelvic exam Rectal exam D&C

14. Endometrium – Med Mgmt Depends on tumor stage & health status Surgery, radiation, chemotherapy TAH-BSO Intracavity radiation All tx tailored individually

15. Endometrium – NI Regular exams after interventions (surgery, chemo, radiation) Compliance with treatment plan Primarily an adenocarcinoma & slow growing giving adequate time for appropriate intervention

16. C.Ovary – Etiology Tumors asymptomatic in early stages Has become metastatic when diagnosed Those @  risk: –Oral contraceptives –heredity

17. Ovary – Etiology (con’t) Those @  risk: –Infertile, anovulatory, nulliparous, habitual aborters –Oral contraceptive use > 5 yrs –  fat diet –Industrial chemical exposure (asbestos & talc)

18. Ovary – S/sx Early stage Later stage Vague sx : abd pain, flatulence, mild gastric c/o Abdominal girth enlarges Flatulence with distention Other sx: Frequency, N/V, constipation, wt loss

19. Ovary – Dx Tests Bi-manual exam CT of the pelvis Tumor bx Exploratory laparoscopy CA-125Is it a positive test? Aspiration of ascitic fluid

20. Ovary – Med Mgmt TAH-BSO & omentectomy (excision of part of peritoneal folds) Chemo Radiation

21. Ovary – NI Same as w/ TAH-BSO, radiation & chemo All for venting/verbalizing Possibly palliative care

22. IV.Epidemiology of Ovarian CA Risk increases with age Peaks in late 70’s Hereditary accounts for 5% - 10% of all ovarian CA 2004: of 25,580 diagnosed, 16,090 would die  63%

23. V.Therapies for CA Surgery Radiation therapy –Internal –External chemotherapy

24. VI.Hysterectomy – Vaginal Done more often than abd approach No incision Lithotomy position Shorter in-hospital stay Fewer complications 10 yrs after surgery stress incontinence may occur

25. Hysterectomy – Abdominal Sub-total:removes only midsection of the uterus Total:removes uterus & cervix, leaving tubes & ovaries TAH-BSO:removes everything What is concern with a sub-total?

26. Hysterectomy – Abdominal Pre-op Low residue diet Fleets enema @ HS Antiseptic vaginal douche (betadine)

27. VII.Post-op NI for Hysterectomy Monitoring VS Preventing UA retention, intestinal distention & venous thrombosis Early ambulating Harris flush, prn TEDS or SCDs Pain control, often w/ PCA

28. Post-op NI for Hysterectomy (con’t) No sex X 4-6 weeks post-op No heavy lifting, long car rides Vaginal discharge X 2-4 weeks Report any s/sx of infection –Malodorous vaginal exudate –Hyperthermic @ 101 F –S/sx of UTI