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INTRODUCTION PATHOPHYSIOLOGY OF CANCERS SECTION A BREAST CANCER SECTION B CERVICAL CANCER
CANCERS
Cancers are abnormal growth that can occur in any part of the body which can be benign or malignant Cancers can affect female breast Cancers can also occur in any part of the female reproductive systemthe vulva, vagina, cervix, uterus, fallopian tubes, or ovaries. These cancers are called gynecologic cancers.
PATHOPHYSIOLOGY
It is a disease process that begins with abnormal cells transformed by the genetic mutation of cellular DNA The cells may acquire invasive characteristics and infiltrate tissues and other organs or structures surrounding it or far away from it Factors implicated in carcinogenesis include viruses and bacteria, physical agents
Review of anatomy and physiology Diagostic assesment of cancer of the breast Management of cancer of breast Nursing management of cancer of the breast
Lactiferous ducts
Narrow tubular structures of the breast that transport milk to the nipple for breastfeeding
Areola
Darker pigmented area surrounding the nipple Montgomerys tubercles
Breast Cancer
Breast cancer is second only to lung cancer in its rate of occurrence in women. There are about 150,000 to 175,000 cases yearly and about 45,000 deaths. The rate increases with age; a woman who lives to age 85 has about a 1 in 9 chance of developing breast cancer. Overall the cumulative risk of developing breast cancer is 10.2%; the risk of dying from the disease is about 3.6%. Much of the risk is after age 75.
Breast cancer 2
Breast cancer is usually classified by the extent of its spread and by the kind of tissue in which the cancer starts. Carcinoma in situ means cancer in place. It is the earliest stage of breast cancer. Carcinoma in situ may be large and may even affect a substantial area of the breast, but it has not invaded the surrounding tissues or spread to other parts of the body. More than 15% of all breast cancers diagnosed in the United States are carcinoma in situ. It is usually detected during mammography.
Breast cancer 3
Invasive cancer is further classified as follows. -Localized: The cancer has invaded surrounding tissues but is confined to the breast. -Regional: The cancer has invaded tissues near the breasts, such as the chest wall or lymph nodes. -Distant (metastatic): The cancer has spread from the breast to other parts of the body
Diagnostic asesment
History and physical examination Screening Histological examination of cancer cells Radiological examinations
Screening
Because breast cancer rarely causes symptoms in its early stages and because early treatment is more likely to be successful, screening is important. Screening is the hunt for a disorder before any symptoms occur.
2
Watching closely in the mirror, clasp the hands behind the head and press them against the head. This position helps make subtle changes caused by cancer more noticeable. Look for changes in the shape and contour of the breasts, especially in the lower part of the breasts.
3
Place the hands firmly on the hips and bend slightly toward the mirror, pressing the shoulders and elbows forward. Again, look for changes in shape and contour.
Many women do the next part of the examination in the shower because the hand moves easily over wet, slippery skin.
Raise the left arm. Using three or four fingers of the right hand, probe the left breast thoroughly with the flat part of the fingers. Moving the fingers in small circles around the breast, begin at the nipple and gradually move outward. Press gently but firmly, feeling for any unusual lump or mass under the skin. Be sure to check the whole breast. Also, carefully probe the armpit and the area between the breast and armpit for lumps.
5
5. Squeeze the left nipple gently and look for a discharge. (See a doctor if a discharge appears at any time of the month, regardless of whether it happens during breast self-examination.)
Repeat steps 4 and 5 for the right breast, raising the right arm and using the left hand.
6
Lie flat on the back with a pillow or folded towel under the left shoulder and with the left arm overhead. This position flattens the breast and makes it easier to examine. Examine the breast as in steps 4 and 5. Repeat for the right breast.
Routine self-examination enables women to detect lumps at an early stage. However, self-examination alone does not reduce the death rate from breast cancer, and it does not detect as many early cancers as routine screening with mammography.
Mammography Process of examining with x-ray the soft tissue of the breast to detect various benign and/or malignant growths before they can be felt
A breast examination is a routine part of a physical examination. A nurse inspects the breasts for irregularities, dimpling, tightened skin, lumps, and a discharge.
Nursing management
Assessment Assess patients needs for Acceptance of diagnosis Development of coping mechanisms Emotional support from family members and health workers etc
Pain (Acute ) Risk for infection Risk of impaired adjustment Disturbed body image Self care deficit etc
planning
Draw a nursing care plan on identified problem
Implementation
Implement care based on identifeid problems
Pre-op Explain breast cancer and treatment options Reduce anxiety and fear Improve coping ability Promoting decision making ability
Post op Relieve pain and discomfort Prevent infection Promote participation in care Promote positive body image
Evaluation
Pre-op Expected patient outcome may include Exhibits knowlegde about diagnosis and traetmnet optiions Verbalizes willingness to deal with anxiety and fears Demonstrtaes ability to cope Demonstrates ability to make decisions
Section b
Cervical cancer Review of anatomy and physiology Overview of cervical cancer Staging of cervical cancer Management
External Genitalia
Mons pubis
Fatty tissue that covers and cushions symphysis pubis
Labia majora
Two folds of skin containing fatty tissue and covered with hair
Located on either side of the vaginal opening, extending from the mons pubis to the perineum
External Genitalia
Labia minora
Two thin folds of tissue located within the folds of the labia majora
Extends from the clitoris downward toward the perineum
Bartholins glands
Located on either side of the vaginal orifice
Secrete a mucous substance that lubricates the vagina
External Genitalia
Clitoris
Short, elongated organ composed of erectile tissue Located just behind the upper junction of the labia minora Homologous to the penis
Urinary orifice
Not true part of female reproductive system, but part of the vulva
External Genitalia
Vaginal orifice
Located in lower portion of the vestibule, below the urinary meatus Also known as the vaginal introitus
Perineum
Area between vaginal orifice and anus Consists of muscular and fibrous tissue and serves as support for pelvic structures
Internal Genitalia
Vagina
Muscular tube that connects the uterus with the vulva
Rests between bladder (anteriorly) and rectum (posteriorly)
Internal Genitalia
Uterus
Pear-shaped, hollow, muscular organ that houses the fertilized implanted ovum as it develops throughout pregnancy
Source of monthly menstrual flow if pregnancy does not occur
Internal Genitalia
Uterus
Three identifiable portions
Fundus
Small dome-shaped upper portion
Body
Central portion
Cervix
Narrower, necklike portion at lower end
Internal Genitalia
Wall of uterus contains three layers
Perimetrium
Outermost serous membrane layer
Myometrium
Middle, muscular layer
Endometrium
Innermost layer, highly vascular
Internal Genitalia
Fallopian tubes
Also known as uterine tubes or oviducts Serve as passageway for the ova as they exit the ovary enroute to the uterus Free end of each tube ends in fingerlike projections called fimbriae
Fimbriated ends draw ovum into tube through wavelike motions when ovum is released from ovary
Internal Genitalia
Ovaries
Female sex cells = female gonads Almond-shaped pair of ovaries, held in place by ligaments Responsible for:
Producing mature ova and releasing them at monthly intervals Producing hormones necessary for normal growth and development of female Producing hormones necessary for maintaining pregnancy should it occur
Cervical Cancer
Cervical cancer is the second most common malignancy of the female reproductive tract. The Pap test can detect 90% or more of early cervical neoplasia (pre-invasive changes in cervical cells) and its use has reduced deaths from cervical cancer by more than 50%. Cervical cancer could be eliminated as a cause of death in all women if they had annual Pap tests (beginning no later than age 20); however, fewer than 40% of women do.
Cervical cancer 2
Most risk factors for cervical neoplasia are related to sexual activity. The sexually active are at higher risk; cervical neoplasia is virtually unknown among nuns. Women who are sexually active early (mid-teens or earlier) and those with three or more sexual partners before the age of 35 (or with sexual partners with three or more partners) are at increased risk. Recently several subtypes of the human papilloma virus have been implicated as causative in cervical neoplasia. Genital herpes infection is also a risk factor.
Diagnostic assessment
History taking and physical examination Biopsy Pelvic examination Papanicolaou smear
Microscopic examination of cells scraped from within the cervix, from around the cervix, and from the posterior part of the vagina to test for cervical cancer
Radiological examinations
Management
Medical At the pre-invasive stage , medical treatment is conservative consisiting of Monitoring
Cryotherapy (Destruction of tissue by rapid freezing with substances such as liquid nitrogen)
Laser therapy
Management 2
At the invasive stage, treatment depends on stage of lesion, patient s age and genearl health. This may include Radition surgery
Nursing management
Assesment Asess client needs for Knowledge about regular pap smears for early detection Emotional support before, during and after diagnostic procedures and treatment Relief of pain and discomfort Sexual dysfunction
planning
Draw a nursing care plan on identified problem
implementation
Provide information on ned for regular medical tests for early detection Provide information on possible causes of condition nd preferred treatment modality Acknowlegd need for emotional support Assist with perineal care etc
Evaluation
Expected patient outcome Demonstration of understanding of treatment modality Verbalizing curent situational improvement in self worth Feeling comfortable with proceduree etc
conclusion
The unit has specifically covered the malignancies of female reproductive system with special reference to cancer of breast and cervix.