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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