Disorders of the Disorders of the Female Reproductive Female Reproductive

TractTract

Disorders of the Disorders of the Female Reproductive Female Reproductive

TractTract

Cancer Cancer

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

II. Management of CA in Situ

• Electrocautery• Cryosurgery• Laser• Conization• Hysterectomy

III. Cancers of the Reproductive Tract –

Cervix • Those @ risk:

– Sexually active as teens– Multiple births socioeconomic levels– STDs

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

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 @ 1st, then increases w/

progression of disease

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

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

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

Cervix – NI• Reassurance• Hospice care if CA well advanced• Change dressings & peri-pads

often• Monitor skin integrity closely

B. Endometrium – Etiology

• Usually affects post-menopausal women

• Either localized or may metastasize

• @ risk– Irregular periods– Menopause difficulties

Endometrium – Etiology (con’t)

• @ risk (con’t)– Obesity– HTN– DM– HRT– On Tamoxifen (anti-neoplastic)

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

Endometrium – Med Mgmt

• Depends on tumor stage & health status

• Surgery, radiation, chemotherapy• TAH-BSO• Intracavity radiation• All tx tailored individually

Endometrium – NI• Regular exams after interventions

(surgery, chemo, radiation)• Compliance with treatment plan• Primarily an adenocarcinoma &

slow growing giving adequate time for appropriate intervention

C. Ovary – Etiology • Tumors asymptomatic in early

stages• Has become metastatic when

diagnosed• Those @ risk:

– Oral contraceptives– heredity

Ovary – Etiology (con’t)• Those @ risk:

– Infertile, anovulatory, nulliparous, habitual aborters

– Oral contraceptive use > 5 yrs fat diet– Industrial chemical exposure

(asbestos & talc)

Ovary – S/sxEarly 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

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

Ovary – Med Mgmt• TAH-BSO & omentectomy

(excision of part of peritoneal folds)

• Chemo• Radiation

Ovary – NI• Same as w/ TAH-BSO, radiation &

chemo• All for venting/verbalizing• Possibly palliative care

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%

V. Therapies for CA• Surgery• Radiation therapy

– Internal– External

• chemotherapy

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

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?

Hysterectomy – Abdominal

Pre-op• Low residue diet• Fleets enema @ HS• Antiseptic vaginal douche

(betadine)

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

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