GYNAECOLOGY

ASSIGNMENT
GROUP 7
MEMBERS
• 1. FARAJ ABDULKARIM BSCN/2020/45784
• 2. HUSSEIN HUSNA DAGANE BSCN/2020/45781
• 3. EBRAHIM YUSRA ABDUL BSCN/2020/45797
• 4. GUYO ABDUBA GEORGE BSCN/2020/45798
• 5. MWAMBEGA BINTI JUMA BSCN/2020/45809
• 6. PTOO GEOFRY BSCN/2020/45824
• 7. ALI, HALIMASAADIA BSCN/2020/45867
• 8. MUTWIRI NTONGAI BSCN/2020/45876
• 9. WAITHERA KABIRURI BSCN/2020/45889
• 10. JANET ATIENO BSCN/2020/45747
CANCER OF THE BREAST
• The breast is the common site of carcinoma in women aged 44 years
• It is a leading cause of death in women.
CAUSES / RISK FACTORS
• Heredity – women whose mothers or sisters have had cancer are two
or three times more likely to develop the disease
• Marital status and parity- Single and nulliparous wpmen have a
slightly higher incidence of breast cancer than married and parous
women
• Mammary dysplacia or cystic disease of the breast
• Women with cancer of the uterus and/or the ovary face an almost
doubled risk of developing CA breast
• Oral contraceptives and menopausal estrogen may produce
proliferation of epithelial elements within the breast
CLINICAL EVALUATION
• Take a thorough medical history
• Examine breast size and contour, minimal nipple retraction, slight
oedema, redness and retraction of skin
• Slight nipple or skin retraction is an important sign
BREAST CANCER STAGING
• STAGE 1 ; The growth is confined to the breast
• Stage 2; The growth is confined to the breast, but palpable, mobile
lymph nodes are present in the axilla
• Stage 3; The growth extends beyond the mammary parenchyma:
• (a) Skin invasion or fixation over an area large in relation to the size of
the breast or skin ulceration
• (b) tumor fixation to the underlying muscle or fascia, axillary nodes, if
present ,are mobile
• Stage 4 ; The growth extends beyond the breast are as shown by
fixation or matting of the axillary nodes
DIAGNOSIS
• Blood test for sedimentation rate will be raised as a result of
disseminated cancer
• Urinalysis
• X-ray to determine the frequency of metastasis to the lungs
• Biopsy for tissue examination
• Mammogram – soft tissue radiological examination of the breast
MANAGEMENT
• The treatment may be curative or palliative according to clinical stage
I, II , III disease
• Palliative treatment is by radiation, hormones, chemotherapy
• Radical mastectomy: This involves en bloc removal of the breast,
pectoral muscles and axillary nodes.
• Extended Radical Mastectomy ; This involves en bloc removal of the
breast and preservation of the pectoralis major muscles
• Simple mastectomy ; This is done if the malignancy is confined to the
breast without spread to adjascent muscles or to the regional nodes
or beyond
Management cont’d
• Local Excision/lumpectomy ; This is also known as a partial
mastectomy and provides definitive treatment for early breast cancer,
especially for a small stage I lesion
• Radiotherapy ; This method is used for the treatment of certain
breast cancers, particularly those that are locally advanced or in cases
where the patient refuses a mastectomy
• Chemotherapy; This process can be used in conjuction with radical
mastectomy, especially in patients found to have positive axillary
nodes
CANCER OF THE UTERUS
• It most cases , it arises from inside the lining of the uterus
• Mostly develops in women aged above 50
• 4th most common cancer in women
RISK FACTORS/ CAUSES
• Age- women above 50 years
• Increased exposure to estrogens with no progesterone
• Null parity
• Obesity – fatty tissue produce large amount of estrogen
• Late menopause or early onset of menarche
• Family history
• Endometrial hyperplasia
RISK FACTORS/ CAUSES
• Tomoxifen – drug used used in treatment of breast cancer, causes
proliferation of the uterine lining
• Polycystic ovary syndrome
• History of radiation therapy to the pelvis
• Hypertension, gallbladder disease
SIGNS AND SYMPTOMS
• Abnormal vaginal bleeding past menopause, after intercourse
• Intramenstrual bleeding
• Lower abdominal pain
• Abnormal blood tinged discharge
• Vaginal pain
• Weight loss anaemia
ENDOMETRIAL CANCER STAGING
Stage I; Cancer that is confined to the uterus
Stage II; Cancer that has spread to the cervix
Stage III; Cancer that has spread to the vagina, ovaries and/or lymph
nodes
Stage IV; Cancer that has spread to the urinary bladder, rectum , or
organs located far from the uterus, such as the lungs or bones
DIAGNOSIS
• Vaginal examination feel enlarged uterus
• Ultrasound scan of uterus
• Hysteroscopy
• Endometrial biopsy
• Chest X-ray
MANAGEMENT
• Surgery is the main treatment
• Total hysterectomy or subtotal hysterectomy
• Radiotherapy
• Chemotherapy
• Hormonal treatment with progesterone
• Palliative care
SEXUAL DYSFUNCTION
• It is the inability of a patient to experience sexual arousal or to
achieve sexual satisfaction under appropriate circumstances as result
of either physical disorder pr psychological problems
SIGNS AND SYMPTOMS
1) In both men and women
• Lack of interest or desire for intercourse
• Inability to become aroused
• Pain with intercourse
2) In women
• Inability to achieve orgasm
• Inadequate vaginal lubrication before and during intercourse
• Dyspaneuria
SIGNS AND SYMPTOMS CONTD
3) In men
• Inability to achieve or maintain an erection
• Absent or delayed ejaculation despite enough sexual stimulation
• Premature ejaculation
CAUSES/ PREDISPOSING FACTORS
1) EMOTIONAL FACTORS
• Depression
• Sexual fear or guilt
• Past sexual trauma
• Anxiety
CAUSES/ PREDISPOSING FACTORS
2) Physical factors
• Pain and discomfort during sex
3) Other causes
• Pregnancy
• Postpartum period
• Menopause
• Alcohol use
• Smoking
• Diabetes mellitus
MANAGEMENT
• 1. Psychological treatment includes
Education – replace myths and misconceptions with facts
Anxiety reduction
Structured behavioural exercises that increase amount of sexual interaction
Teaching appropriate ways of communicating sexual wishes
For female orgasmic dysfunction, masturbation most effective for women
Early ejaculation – petting and stopping and squeeze technique are used
 For Vaginismus-training of vaginal muscles is encouraged
MANAGEMENT CONT’D
2. Biological interventions;
Hormone replacement e.g testosterone. estrogen
Special medications or mechanical means such as vacuum pumps,
suppositories and penile implants
Oral medications such as Viagra, Levitra
For Ed, injection of substances into penis
ANDROPAUSE.
Definition
• Andropause is male related menopause that is marked by
age related changes in the male hormone.
• It is a syndrome associated with decrease in sexual
satisfaction or a decline in a feeling of general well being
with low levels of testosterone in older men.
• 'Andras’ in Greek which means human male and 'pause’
meaning cessation.
Signs and symptoms .
Symptoms vary from person to person.
common symptoms include;
• Low sex drive
• Difficulties getting erections or erections that are not
strong as usual.
• Erectile dysfunction
• Hot flashes
• Lack of energy
• Depression
• Increased body fat
• Dry and thin
Causes.
1. Gradual decrease in testosterone.-is an important factor in
men suspected of having andropause.
2. Testicular cancer
3. Surgical removal of testes
4. Prostate cancer- as seen in patients who receive anti-
testosterone therapy to maintain very low testosterone
levels.
Risk factors.
• Obesity
• Smoking
• Increase in age-testes produce less testosterone as
men age.
• Hypertension
• Diabetes mellitus
• Cardiovascular disease
• Stress
Diagnosis.
• Blood test- to measure level of testosterone in blood.
Management and treatment.
• Eating a healthy diet.
• Regular exercise
• Reduce stress.
• Antidepressants –behavioural therapy if experiencing
depression.
• Hormonal replacement therapy -replacing testosterone in
blood .it can either be done through;
Skin patches
Capsules
Gels
Injections.
Differences between menopause and andropause.
1. Menopause causes infertility while andropause does not limit a
man’s ability to be fertile.
2. In menopause hormones decrease and change rapidly e.g
estrogen, while in andropause hormones decrease gradually but
are persistent.
3. Menopause affects all women while andropause only affects men
with low testosterone levels.
4. Menopause starts at around age 40 while andropause starts at
around age 30.