Endometrial

&
Pancreatic Cancer

Prepared by: Miss Sarah M. Kadato BSN IV

What is cancer?

Cancer
a disease process whereby cells
proliferate abnormally, ignoring growthregulating signals in the environment
surrounding the cells.

Anatomy
&
Physiology of Endometrium

Endometrium
The tissue lining the uterus (or womb).
Soft and spongy.
Muscular, pear-shaped cavity in which the
fetus develops.
Found in a woman's pelvic region and is
the organ where the fetus grows until birth.
Cavity from which menstruation occurs.

 The upper part of the uterus is called the

corpus.
The lower, narrower part of the uterus is
called the cervix (the opening between
the uterus and the vagina).
The outer layer of the uterus is called the
myometrium (thick and composed of
strong muscles. These muscles contract
during labor to push out the baby).

 Early in the cycle, the ovaries secrete a hormone

called estrogen that causes the endometrium to
thicken.
In the middle of the cycle, the ovaries start
secreting another hormone
called progesterone. Progesterone prepares
the innermost layer of the endometrium to
support an embryo should conception
(pregnancy) occur. If conception does not occur,
the hormone levels decrease dramatically.
The innermost layer of the endometrium is then
shed as menstrual fluid. This leads to the
cyclical nature of the menstrual cycle.

Cancer of the uterus (Endometrium)

Cancer of the uterus (Endometrium)

Cancer of the uterus (Endometrium)

A slow-growing tumor arising from the endometrial
mucosa of the uterus, associated with the menopausal
years.
Metastasis occurs through the lymphatic system to the
ovaries and pelvis, via the blood to the lungs, liver, and
bone, or intraabdominally to the peritoneal cavity.
The most frequently occurring gynecological cancer in
the U.S.
Fourth most common cancer in women after the breast,
colorectal, and lung cancer.
Most women are diagnosed between 55 and 64 years of
age.

Two main types of endometrial cancers

Endometrial adenocarcinomas, meaning
they originate from glandular (secreting)
tissue.
Adenosquamous carcinoma
Papillary serous adenocarcinomas
Clear cell carcinomas

Uterine sarcomas, originates in the

connective tissue or muscle of the uterus.

Endometrial adenocarcinoma

Pathology

Risk factors:

Cumulative exposure to estrogen

Truncal Obesity
Infertility (nulliparity)
Late menopause (after 52 years of
age)
Diabetes Mellitus
Use of Tamoxifen
Polycystic ovary disease
Increased age
Family history of uterine cancer or
hereditary nonpolyposis colorectal
cancer
Hypertension

Obesity

Polycystic ovarian disease

Signs & Symptoms:

Abnormal
bleeding
(after
menopau
sal in
older
women)

Endometrial Cancer Diagnosis

Lab tests
Routine blood tests: Tests of
blood chemistry, liver and
kidney functions, and blood
cell counts are done to check
a woman's overall health and
her ability to tolerate surgery
and other therapy.

Imaging studies
Vaginal
(transvaginal) ultrasound:
Ultrasound is a technique that uses
sound waves to take a picture of the
internal organs. Ultrasound is the
same technique used to look at a
fetus in the uterus. To perform a
vaginal (transvaginal) ultrasound, a
small device called a transducer is
inserted into the vagina. The device
emits sound waves, which bounce
off the pelvic organs and transmit a
picture to a video monitor. Often, the
examiner moves the transducer
around slightly to get a better
picture. A vaginal (transvaginal)
ultrasound is safe and painless.

 Hysterosonogram is
similar to vaginal
(transvaginal) ultrasound,
but a saline (saltwater)
solution is first injected
into the uterus to extend
the uterine walls. This
procedure can improve
the picture in some cases
and show the uterus in
greater detail.

 A CT scan of the
pelvis would be the
usual choice of a
follow-up imaging
test. A CT scan is
like an X-ray film
but shows greater
detail in two
dimensions.

 An MRI of the
pelvis is another
choice of a
follow-up imaging
test. An MRI
shows great
detail in three
dimensions.

 A chest Xray may be

needed if
metastasis to
the lungs is
suspected.

 A bone scan may

be needed if
metastasis to the
bones is suspected.

Diagnostic Test
or
Laboratory Test:

Annual Check-ups

Gynecologic
examination

Dilatation and Curettage

Hysteroscopy

Ultrasonography

Staging

A system for classifying cancers based on the extent of

the disease. In general, the lower the cancer stage, the
better the outlook for remission and survival.
In endometrial cancer, staging is based on how far the
primary tumor has spread, if at all. The staging system
used for endometrial cancer was developed by the
International Federation of Gynecology and Obstetrics
(FIGO). The staging system for endometrial cancer is a
surgical staging system, meaning that staging is based
on the pathologist's findings on examining organs
removed during surgery. The FIGO system uses four
stages.

 Stage I: The tumor is limited to the corpus (upper part)

of the uterus and has not spread to the surrounding
lymph nodes or other organs.
Stage IA: Tumor limited to the endometrium or less
than one half the myometrium
Stage IB: Invasion equal to or more than one half the
myometrium (middle layer of the uterine wall)
Stage II: Invasion of the cervical stroma but does not
extend beyond the uterus (strong supportive
connective tissue of the cervix)

 Stage IIIA: Invasion of the serosa (outermost layer of the

myometrium) and/or the adnexa (the ovaries or fallopian tubes)
Stage IIIB: Invasion of the vagina and/or parametrial involvement
Stage IIIC1: Cancer has spread to the pelvic lymph nodes but not
to distant organs
Stage IIIC2: Cancer has spread to the paraaortic lymph nodes
with or without positive pelvic lymph nodes but not to distant
organs
Stage IV: The cancer has spread to the inside (mucosa) of the
bladder or the rectum (lower part of the large intestine) and/or to
the inguinal lymph nodes and/or to the bones or distant organs
outside the pelvis, such as the lungs.
Stage IVA: Tumor invasion of the bladder, the bowel mucosa, or
both
Stage IVB: Metastasis to distant organs, including intraabdominal metastasis, and/or inguinal lymph nodes.

Assesment:
Irregular bleeding especially in
postmenopausal women.
Vaginal discharge
Low back, pelvic, or abdominal pain (pain
occurs late in the disease process).

TREATMENT

Nonsurgical intervention:
External or internal radiation is used alone
or in combination with surgery, depending
on the stage of cancer.
Progestational therapy with medication such
as medroxyprogesterone (Depo-provera) or
megestrol acetate (Megace) is used for
estrogen dependent tumors.
Tamoxifen (Nolvadex), an antiestrogen, also
may be prescribed.

Medical Management:

Total or radical hysterectomy

Bilateral salpingo-oophorectomy
Node sampling
Adjuvant radiation
Vaginal brachytherapy
Whole pelvis radiotherapy
Hormonal therapy or chemotherapy
Progestin therapy

Vaginal Brachytherapy

Whole pelvis radiotherapy

Anatomy
&
Physiology of Pancreas

PANCREAS
An organ in the abdomen that sits in front
of the spine above the level of the belly
button.
Sits deep in the belly and is in close
proximity to many important structures
such as the small intestine (the
duodenum) and the bile ducts, as well as
important blood vessels and nerves.

Exocrine gland
Secretes sodium bicarbonate to neutralize the acidity of the
stomach contents that enter the duodenum.
Pancreatic juices contain enzymes for digesting
carbohydrates, fats, and proteins.
Endocrine gland
Secretes glucagon to raise blood glucose levels and
secretes somatostatin to exert a hypoglycemic effect.
The islets of langerhans secrete insulin.
Insulin is secreted into the bloodstream and is important for
carbohydrate metabolism.

Two major functions:

It makes insulin, a hormone that regulates
blood sugar levels.
It makes enzymes which help break down
proteins. The enzymes help digestion by
chopping proteins into smaller parts so that
they can be more easily absorbed by the body
and used for energy. Enzymes leave the
pancreas via a system of tubes called "ducts"
that connect the pancreas to the intestines.

Cancer of the Pancreas or

Pancreatic Cancer

Cancer of the Pancreas or

Pancreatic Cancer
Most pancreatic tumors are highly malignant, rapidly growing
adenocarcinomas originating from the epithelium of the
ductal system.
Symptoms do not occur until the tumor is large; therefore,
the prognosis is poor.
Endoscopic retrograde cholangiopancreatography for
visualization of the pancreatic duct and biliary system and
collection of tissue and secretions may be done.
The fourth leading cause of cancer death in men in the U.S.
and fifth leading cause cancer death in women.
It is very rare before the age of 45 years.
It may develop in the head, body, or tail of the pancreas.

Risk Factors:

tobacco use or cigarette smoking

alcohol use
obesity
sedentary lifestyle or exposure to industrial
chemicals or toxins in the environment
history of diabetes
chronic pancreatic inflammation
(pancreatitis)
fatty (or Western) diet

Obesity

Clinical Manifestations:

Vague or midabdominal pain or discomfort

Boring pain in the midback
Jaundice
Rapid, profound, and progressive weight loss
Insulin deficiency: glucosuria, hyperglycemia,
and abnormal glucose tolerance.
Biabetes (early sign)
Nausea and vomiting
Clay-colored stools

Jaundice

Clay-colored stools

Diagnostic test/Laboratory test

Spiral (helical) CT
MRI
ERCP
Endoscopic Ultrasound (EUS)
GI x-ray
Percutaneous fine-needle aspiration biopsy of the pancreas
Percutaneous traanshepatic cholangioraphy
Tumor markers
Angiography
CT Scan
Laparoscopy
Intraoperative ultrasonography

MRI

CT Scan

Laparoscopy

Intraoperative ultrasonography

Pancreatic cancer are typically grouped

into three categories:
Those with local disease. Patients with stage I and
stage II cancers are thought to have local or
"resectable" cancer (cancer that can be completely
removed with an operation).
Those with locally advanced disease. Patients with
stage III cancers have "locally advanced,
unresectable" disease. In this situation, the opportunity
for cure has been lost but local treatments such as
radiation remain options.

Pancreatic cancer are typically

grouped into three categories:
Those with metastatic disease. Patients
with stage IV pancreatic cancer,
chemotherapy is most commonly
recommended as a means of controlling
the symptoms related to the cancer and
extending life.

Medical Management:

Total excision of the lesion

Radiation and chemotherapy
Interstitial implantation of radioactive sources
Large biliary stent inserted percutaneously or by
endoscopy
Whipple procedure, which involves a
pancreaticoduodenectomy with removal of the
distal third of the stomach, pancreaticojejunostomy,
gastrojejunostomy, and choledochojejunostomy.

Surgery

Whipple Procedure

Nursing Management:
Improve patient level of comfort (pain management and
attention to nutritional requirements)
Nursing measures and skin care
Specialty mattresses re beneficial and protect bony
prominences from pressure
Administering opioids as ordered by the physician
If the patient elects to receive chemotherapy, the nurse focuses
teaching on prevention of side effects and complications of the
agents used
The nurse instructs the family about changes in the patients
status that should be reported to the physician
The nurse teaches the patient and family strategies to prevent
skin breakdown and relieve pain, pruritus, and anorexia.

Dont stop when you tired,

stop WHEN you DONE

Thank You for

NOT
Listening :-P