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Cervical Cancer - a malignant neoplasm arising from cells originating in the cervix uteri.

One of the most common symptoms of cervical cancer is abnormal vaginal bleeding, but in some cases there may be no obvious symptoms until the cancer has progressed to an advanced stage Signs and Symptoms: The early stages of cervical cancer may be completely asymptomatic.[1][2] Vaginal bleeding, contact bleeding, or (rarely) a vaginal mass may indicate the presence of malignancy. Also, moderate pain during sexual intercourse and vaginal discharge are symptoms of cervical cancer. In advanced disease, metastases may be present in the abdomen, lungs or elsewhere. Symptoms of advanced cervical cancer may include: loss of appetite, weight loss, fatigue, pelvic pain, back pain, leg pain, swollen legs, heavy bleeding from the vagina, bone fractures, and/or (rarely) leakage of urine or feces from the vagina (rarely). Management: Three treatments methods are commonly used to treat cervical cancer: surgery, chemotherapy, and radiation therapy. Sometimes they are used alone, and there are times when they are used in conjunction with one another. Surgical Methods: Lymphadenectomy Surgical removal of the lymph nodes. It is common in treating women with cervical cancer. Radical Trachelectom - removal of the cervix and its surrounding tissue while leaving the body of the uterus intact. A radical trachelectomy with lymphadenectomy is an option for young women with early stage disease who wish to maintain fertility. Radical Hysterectomy Surgical - removal of the uterus, cervix, and part of the vagina. In some cases, the ovaries, fallopian tubes, and lymph nodes are removed. A radical hysterectomy may be combine with chemotherapy or radiation therapy. Bilateral Salpingo-Oophorectomy - surgical removal of both ovaries and the fallopian tubes. This type of surgery accompanies a hysterectomy is some cases. Chemotherapy Chemotherapy is prescribed to treat cervical cancer and also to help radiation therapy be more effective. Chemotherapy drugs work by killing cancer cells or preventing them from multiplying. Several chemotherapy drugs are available to treat cervical cancer and will be prescribed according to the stage of cancer, type of cervical cancer, and other health factors. Radiation Therapy Radiation therapy uses high energy beams to reduce the size of a tumor or to kill cancer cells. This type of treatment can be done internally with radioactive materials that are implanted in the uterus or externally with the use of a radiation therapy machines. Often prescribed with chemotherapy, radiation therapy is an effective method of treating cervical cancer. It can however, be prescribed alone or before or after chemotherapy. Radiation treatment plans depend on stage of cervical cancer, other treatment methods used, and the general health of the patient.
Pathophysiology of Cervical CancerOrigins and growth patterns-

Cancer of the cervix typically originates from a dysplastic or premalignant lesion previously present at the active squamocolumnar fork. The transformation from mild dysplastic to invasive carcinoma generally occurs slowly inside several years, although the rate of this process varies widely. Carcinoma in situ is more than ever known to precedeinvasive cervical cancer in most cases. In different reported series of patients beside untreated carcinomain situ who were followed up for copious years, invasivecarcinoma developed in about 30% of patients at 10 years and contained by about 80% of patients at 30 years. However, thecarcinoma-in-situ lesion may regress after the initial diagnosis; such an occurrence be reported in 17 (25%) of 67 patients who were followed up for at tiniest 3 years. Progression to invasive carcinomabecomes established and is considered irreversible once the malignant process extends through the basement membrane and invasion of the cervical stroma occur. Multiple local growth patterns of invasive cervical cancer have be described, with combination growth patterns self common. The patterns include the following: exophytic, nodular, infiltrative, and ulcerative. The exophytic range is the most common growth pattern. It usually arises from the exocervix and is commonly polypoid or papillary in form. Exophytic cervical cancer may result in a considerable, friable, bulky mass that involves only the superficial aspect of the cervix and has the predisposition for excessive bleeding. The nodular variety typically arises in the endocervix and grows through the cervical stroma into confluent, firm common herd that cause the cervix and isthmus to expand. Large, nodular-type tumors that circumferentially involve the endocervical region and large, exophytic-type tumors that come from the endocervix and extend into the endocervical canal result in what have been referred to as a barrel-shaped cervix. The infiltrative growth pattern lead to a stone-hard cervix that may be predicated to have minimal visible ulcerations or an exophytic mass. Infiltrative exocervical lesion tend to invade the vaginal fornices and the upper part of the vagina. On the other hand, infiltrative endocervical lesion tend to extend into the corpus and the lateral parametrium. The ulcerative growth pattern is associated with tumor necrosis and sloughing, near the formation of acavity that is marginated by the invasive tumor. This process is usually complicated by infection that causes seropurulent discharge.-

1. 2. 3. 4. 5. 6. 7. 8.

Nursing Interventions: Cervical Cancer Listen to the patients fears and concerns, and offer reassurance when appropriate. Encourage the patient to use relaxation techniques to promote comfort during the diagnostic procedures. Monitor the patients response to therapy through frequent Pap tests and cone biopsies as ordered. Watch for complications related to therapy by listening to and observing the patient. Monitor laboratory studies and obtain frequent vital signs. Understand the treatment regimen and verbalize the need for adequate fluid and nutritional intake to promote tissue healing. Explain any surgical or therapeutic procedure to the patient, including what to expect both before and after the procedure. Review the possible complications of the type therapy ordered.

9. Remind the patient to watch for and report uncomfortable adverse reactions. 10. Reassure the patient that this disease and its treatment shouldnt radically alter her lifestyle or prohibit sexual intimacy. 11. Explain the importance of complying with follow up visits to the gynecologist and oncologist. How to Reduce Your Risk of Cervical Cancer 1. Get a regular Pap smear. The Pap smear can be the greatest defenses for cervical cancer. The Pap smear can detect cervical changes early before they turn into cancer. Check cervical cancer screeningguidelines to find out how often you should have a Pap smear, or check with your doctor. 2. Limit the amount of sexual partners you have.Studies have shown women who have many sexual partners increase their risk for cervical cancer. They also are increasing their risk of developing HPV, a known cause for cervical cancer. 3. Quit smoking or avoid secondhand smoke. Smoking cigarettes increases your risk of developing many cancers, including cervical cancer. Smoking combined with an HPV infection can actually accelerate cervical dysplasia. Your best bet is to kick the habit. 4. If you are sexually active, use a condom. Having unprotected sex puts you at risk for HIV and other STD's which can increase your risk factor for developing cervical cancer. 5. Follow up on abnormal Pap smears. If you have had an abnormal Pap smear, it is important to follow up with regular Pap smears or colposcopies, whatever your doctor has decided for you. If you have been treated for cervical dysplasia, you still need to follow up with Pap smears or colposcopies. Dysplasia can return and when undetected, can turn into cervical cancer. 6. Get the HPV vaccine. If you are under 27, you may be eligible to receive the HPV vaccine, which prevents high risk strains of HPV in women. The HPV vaccine, Gardasil, was approved by the FDA to give to young girls as young as 9. The vaccine is most effective when given to young women before they become sexually active.
Breast Cancer Breast cancer is a type of cancer originating from breast tissue, most commonly from the inner lining [1] of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas, while those originating from lobules are known as lobular carcinomas. Breast cancer occurs in humans and other mammals. While the overwhelming majority of human cases occur in [2] women, male breast cancer can also occur.

symptom of breast cancer:


swelling of all or part of the breast skin irritation or dimpling breast pain nipple pain or the nipple turning inward redness, scaliness, or thickening of the nipple or breast skin

a nipple discharge other than breast milk a lump in the underarm area

These changes also can be signs of less serious conditions that are not cancerous, such as an infection or a cyst. Its important to get any breast changes checked out promptly by a doctor.

management Breast cancer treatments are local or systemic. Local treatments are used to remove or destroy the disease within the breast and surrounding regions, such as lymph nodes. These include: Surgery, either mastectomy or lumpectomy -- also called breast-conserving therapy. There are different types of mastectomies and lumpectomies. Radiation therapy Systemic treatments are used to destroy or control cancer cells all over the body and include: Chemotherapy uses drugs to kill cancer cells. Side effects can include nausea,hair loss, early menopause, hot flashes, fatigue, and temporarily lowered blood counts. Hormone therapy (endocrine therapy) such as tamoxifen in premenopausal and postmenopausal women and the aromatase inhibitors Arimidex, Aromasin, andFemara in postmenopausal women. Hormone therapy uses drugs to prevent hormones, especially estrogen, from promoting the growth of breast cancer cells that may remain after breast cancer surgery. Side effects can include hot flashes and vaginal dryness. Biological Therapy such as Herceptin, Perjeta, or Tykerb, which work by using the body's immune system to destroy cancer cells. These drugs target breast cancer cells that have high levels of a protein called HER2. Systemic therapy may be given after local treatment (adjuvant therapy) or before (neoadjuvant therapy). Adjuvant therapy is used after local treatments to kill any cancer cells that may remain in the body, but are undetectable.
What is Pathophysiology? The field of pathophysiology is normally described as a combination of two separate specialties pathology and physiology. Physiology involves the study of the body and its various functions, while pathology is the study of disease and the way it effects the body. Putting these two together, what we are left with is a practice that describes the specific changes that occur in the functions and processes of the body as a result of the presence of disease. While this description is certainly accurate, it actually leaves out another field of study which is relevant to pathophysiology, and that is history. Ultimately, pathophysiological study looks closely at and describes the history of what happens in the human body when disease agents are present. It may not be the normal custom to think of a medical science practice as involving history, but research into breast cancer is all dedicated to uncovering more details about the historical development of this disease in the human body, in order to develop treatments and prevention strategies that will work better because they can be precisely and appropriately applied based on newfound knowledge about what is really going on in the body of a woman afflicted by breast cancer.

NURSING INTERVENTIONS 1. 2. Monitor for adverse effects of radiation therapy such as fatigue, sore throat, dry cough, nausea, anorexia. Monitor for adverse effects of chemotherapy; bone marrow suppression, nausea and vomiting, alopecia, weight gain or loss, fatigue, stomatitis, anxiety, and depression.

3. 4. 5. 6. 7. 8.

Realize that a diagnosis of breast cancer is a devastating emotional shock to the woman. Provide psychological support to the patient throughout the diagnostic and treatment process. Involve the patient in planning and treatment. Describe surgical procedures to alleviate fear. Prepare the patient for the effects of chemotherapy, and plan ahead for alopecia, fatigue. Administer antiemetics prophylactically, as directed, for patients receiving chemotherapy. Administer I.V. fluids and hyperalimentation as indicated.

9. Help patient identify and use support persons or family or community. 10. Suggest to the patient the psychological interventions may be necessary for anxiety, depression, or sexual problems. 11. Teach all women the recommended cancer-screening procedures.

Prevention
Tamoxifen is approved for breast cancer prevention in women aged 35 and older who are at high risk. Discuss this with your doctor. Women at very high risk for breast cancer may consider preventive (prophylactic) mastectomy. This is the surgical removal of the breasts before breast cancer is ever diagnosed. Possible candidates include:

Women who have already had one breast removed due to cancer Women with a strong family history of breast cancer Women with genes or genetic mutations that raise their risk of breast cancer (such as BRCA1 or BRCA2) Your doctor may do a total mastectomy to reduce your risk of breast cancer. This may reduce, but does not eliminate the risk of breast cancer. Many risk factors, such as your genes and family history, cannot be controlled. However, eating a healthy diet and making a few lifestyle changes may reduce your overall chance of getting cancer. There is still little agreement about whether lifestyle changes can prevent breast cancer. The best advice is to eat a well-balanced diet and avoid focusing on one "cancer-fighting" food. The American Cancer Society's dietary guidelines for cancer prevention recommend that people:

Choose foods and portion sizes that promote a healthy weight Choose whole grains instead of refined grain products Eat 5 or more servings of fruits and vegetables each day Limit processed and red meat in the diet Limit alcohol consumption to one drink per day (women who are at high risk for breast cancer should consider not drinking alcohol at all)

Endometrial cancer refers to several types of malignancies that arise from the endometrium, or lining, of the uterus. Endometrial cancers are the most common gynecologic cancers in the United States, with over 35,000 women diagnosed each year. The incidence is on a slow rise secondary to the obesity epidemic. The most common subtype, endometrioid adenocarcinoma, typically occurs within a few decades of menopause, is associated with obesity, excessive estrogen exposure, often develops in the setting of endometrial hyperplasia, and presents most often with vaginal bleeding. Endometrial carcinoma is the third most common cause of gynecologic cancer death (behind ovarian and cervical cancer). Signs and symptoms

Vaginal bleeding and/or spotting in postmenopausal women. Abnormal uterine bleeding, abnormal menstrual periods. Bleeding between normal periods in premenopausal women in women older than 40: extremely long, heavy, or frequent episodes of bleeding (may indicate premalignant changes). Anemia, caused by chronic loss of blood. (This may occur if the woman has ignored symptoms of prolonged or frequent abnormal menstrual bleeding.) Lower abdominal pain or pelvic cramping.

Thin white or clear vaginal discharge in postmenopausal women. Management 1. Surgical staging (pelvic washing, bilateral pelvic and paraaortic lymphadenectomy, retroperitoneal lymph node assessment) 2. Laparoscopic surgical restaging 3. Post-operative imaging (computed tomography, positron emission tomography) 4. Individualized care for comorbid conditions (e.g., long instrumentation, thromboembolic prophylaxis, postoperative pulmonary function care, panniculectomy, surgical procedure) 5. Frequency of post-treatment follow-up 6. Referral to or consultation with a gynecologic oncologist Treatment 1. Surgery (complete resection of disease, hysterectomy, bilateral salphingo-oophorectomy, bilateral pelvic and paraaortic lymphandenectomy) 2. Preoperative radiation therapy 3. Adjuvant radiation therapy (whole pelvic radiation therapy, vaginal brachytherapy) 4. Systemic cytotoxic therapy may be used alone or in combination 5. Hormonal therapy (oral, parenteral, or intrauterine progestational agents; continuous versus cyclical therapy) 6. Concomitant versus sequential systemic therapy 7. Primary therapeutic radiation therapy (for poor surgical candidates) Precipitating Factors: Hormone Replacement Therapy (HRT):ESTROGEN-Obesity: increase ESTROGEN-Lifestyle: exposure to carcinogens-Sexual Activity: nulliparity P redisposing Factors: -Age: over 50 yrs old-Race: black Americans-Genetic-Disease: Endometrial hyperplasia,colorectal menstruation-Physiologic changes:Early menstruation,Late menopausal Excessive increase estrogen Suppress LH and FSH Slows ovarian cycle Increase reformationof endometrial lining and slow regeneration Normal cell continously growing and old cells do not die Extra cell form together Tumor Endometrial cancer Unusuyal vaginal bleeding , Watery,malodorous vaginal discharge Pain Bladder dysfunction Nursing Intervention:1 . R e l i e v i n g P

ain 1.1 Administer pain medications as prescribed and monitor patient 1. 2 Encourage use of relaxation techniques to help promote comfort. 2 . Relieving Fear 1.1 Support patient through the disease process and reinforceinformation given by health care provider about treatment options.1. 2 Prepare for radiation therapy and surgery

. Nutrition 1.1 Encourage intake of calories and protein to promote healing,maintain strength, and keep a healthy weight. 4 . Support client on side effects of chemo therapeutic drugs.5. Follow up care
To reduce your risk of endometrial cancer, you may wish to: Talk to your doctor about the risks of hormone therapy after menopause. If you're considering hormone replacement therapy to help control menopause symptoms, talk to your doctor about the risks and benefits. Unless you've undergone a hysterectomy, replacing estrogen alone after menopause may increase your risk of endometrial cancer. Taking a combination of estrogen and progestin can reduce this risk. Hormone therapy carries other risks, such as a possible increase in the risk of breast cancer, so weigh the benefits and risks with your doctor. Consider taking birth control pills. Using oral contraceptives for at least one year may reduce endometrial cancer risk. The risk reduction is thought to last for several years after you stop taking oral contraceptives. Oral contraceptives have side effects, though, so discuss the benefits and risks with your doctor. Maintain a healthy weight. Obesity increases the risk of endometrial cancer, so work to achieve and maintain a healthy weight. If you need to lose weight, increase your physical activity and reduce the number of calories you eat each day. Exercise most days of the week. Work physical activity into your daily routine. Try to exercise 30 minutes most days of the week. If you can exercise more, that's even better.