14.tumor of reproductive organs

Tumor of reproductive or-gans

Benign tumorMalignant tumor

Uterine myoma(fibroid)

• One of most common(80%) benign gynecologic tumors(fibroid tumor); muscle and connective fibrous tissue.

• Etiology: unknown• Asymtomatic, uterus to enlarge de-

pend on size of tumor• Fibroids are classified according to lo-

cation; subserosal, intramural, sub-mucosal

Uterine myoma(fibroid)

Uterine myoma(fibroid)

• Sx & symptoms: menorrhagia(heavy prolonged vaginal bleeding) and frequent bleeding anemia (submucosal)

• Dysmenorrhea, dyspareunia, expansion of the low ab-domen(large tumor), pelvic pressure, abdominal dis-comfort.

• Depend on ovarian hormones because they grow dur-ing the reproductive years and atrophy during menopause

• Tx: Depend on symptoms, supportive care, laparo-scopic myomectomy, hysterectomy

• Side effects of hysterectomy; depression, loss of sexual pleasure, urinary tract injury or infection

Endometrial hyperplasia

• Benign condition in which the cell lining the uterus grow too much.

• Women old than 40 yrs some times devel-oped cancer

• Sign & symptoms: heavy menstrual period• Dx: Physical & pelvic examination, D&C en-

domaterial biopsy• Tx: hormonal therapy(progesterone), D&C hysterectomy to prevent developing

cancer

Benign cervical polyps

• Growth and develop endocervical canal.• Discovered during a speculum examination.• Bright red, small single or multiple• 30-40 age women common• Asymptomatic, occasionally spotting,

leukorrhea(profuse thick vaginal discharge), menorrhagia, postmenopausal bleeding

• Tx: surgical remove and cauterization biopsy and endometrial sampling

• Avoid sexual intercourse at least 24hrs to prevent irritation and bleeding

Benign cervical polyps

Benign ovarian cyst• Ovarian cysts are fluid-filled benign growth, various size, single and

multiple.• Many kind of cyst which include ,follicular, luteal, epithelial, dermoid • Follicular cyst is most common, ovum does not release the egg• Luteal(hemorrhagic)cyst: bleeding from the ovulation site enters the

ovarian capsule• Epithelial cyst: from epithelium of the ovary• Dermoid cyst: contain fat, hair, teeth, mature form one of teratoma, easily change to malignant• Post menopausal women with ovarian cyst are increased risk for

ovarian cancer.• Sx & symptom: no symptoms if large, pelvic discomfort and pain - Rupture of cyst; severe and sharp pain - Torsion; Twisted and cut off the blood vessel supplying the cyst

and ovary; nausea, fever, severe abdominal pain

Benign ovarian cyst

Benign ovarian cyst

• Tx: Wait and see; most of ovarian cyst shrink and resolve on their own. Follow up exam 2-3month

• Surgical remove by laparoscope• Standard pre and postoperative nurs-

ing care

Uterine cancer

• Endometrial cancer is common, Malignant tumor• Etiology & pathology: 55-70yrs of age at highest risk• Risk factors: early menarche(before 12yrs)- Older than 50 yrs- Delayed menopause- Endometrial hyperplasia- Hormone replacement therapy- Obesity- Infertility or nulliparity- White race- Family history

Uterine cancer

• Sign & symptoms: abnormal bleeding, un-usual discharge, painful urination, pelvic pain

• Dx: D&C and endometrial biopsy• TX: Depend on stage of the disease Radical hysterectomy(TAH+BSO total ab-

dominal hysterectomy and both Salpingo oopohrectomy)

NG care: Nurse can provide emotional support and reassurance as well as education. Pre-ventive life style practices

Uterine cancer

• 5yr survival rate - Stage I: 90-95% - Stage II: 75% - Stage III: 60% - Stage IV 15-26%Prognosis is good because this cancer

often detected early(stage I and II)

Cervical cancer

• Before cancer, cervical dysplasia• If not treat dysplasia, develop cervical cancer• Cervical cancer is third most common cancer in US• Prevalence site; squamo-columminal junction(cell lin-

ing the cervix); squamo-epitherial cell carcinoma• Regular Pap smear through early detect and prevent

from invasive cervical cancer risk of death• Cervical cancer is classified using stage system from

stage 0(carcinoma in situ) to stage IV(invasive cervi-cal cancer)

Cervical cancer staging

• Stage 0; carcinoma in situ; cancer is found in the first layer of cell lining the Cx only

• Stage I; cancer is found in the Cx only• Stage II; cancer has spread beyond the Cx

upper vagina but not in to the pelvic wall• Stage III; cancer has spread to the lower

third of vagina and have spread to the pelvic wall and lymph nodes.

• Stage IV; cancer has spread to the bladder, rectum, or other parts of body

Etiology and pathophysiol-ogy

• Human papiloma virus(HPV type 16, 18)• Risk factors: long term persistent HPV infection

and STI• Smoking• Weakened immune system• Multiple sex partners• First intercourse in an early age• First childbirth before 20yrs• Low socioeconomic status• Diet lacking in Vit. A and C• Oral contraceptive use

• Sx and symptoms: asymptomatic in the early stage.

• Vaginal bleeding, Unusual vaginal dis-charge, pelvic pain during intercourse

• Tx: Pap smear colposcopybiopsy, endo-cervical curettage

• Cryosurgery, Loop Electrosurgical Excision Procedure(LEEP)

• Invasive cervical cancer; radical hysterec-tomy(remove TAH+BSO+lympnode)

• Radiation, chemotherapy depend on stage

Carcinoma of cervix survival at 5yrs

• Stage I 100% closed 100%

• Stage II 60%• Stage III 25%• Stage IV 5-10%• All stage 60%

Ovarian cancer

• Ovarian cancer is the fifth most common cancer in U. S.

• Fourth leading cause of death. 78% of women diagnosed with ovarian cancer survive 1 yr after diagnosis

• 50% survive longer than 5yrs• 29% of cases found during early

stage

Ovarian cancer staging

stage• Stage I• Stage II• Stafe III• Stage IV

characteristics• Ovaries only• To pelvis• Abdomen, inguinal

node• Distant metastasis,

lung liver etc

Etiology and pathophysiol-ogy

• Risk Factors - 55-65yrs age more likely than young women, after

menopause- Family history( mother, sister, daughter)- Obesity- Reproductive history; menses before 12, no chil-

dren, first child after 30yrs, do not become preg-nant.

- Infertility drug for long period- Hormonal replacement and estrogen therapy more

than 10 yrs- Breast cancer

Sign & symptoms

• Asymtomatic, usually vague and similar to other disorder, thus delaying accurate identi-fication

• Initial symptoms are abdominal swelling or bloating, fatigue and abdominal pain, consti-pation and urinary frequency.

• If torsion or tumor ruptures, sudden sharp abdominal pain

• Dx: pelvic examination, ultrasound, Ca- 125(blood test), Laparoscopy with biopsy will be done confirm diagnosis

Ovarian cancer 5 yr survival

• Stage IA 82%• Stage IB 75%• Stage IC 68%• Stage IIA 60%• Stage IIB+c 54%• Stage III 23%

Stage IV 8%• Overall survival

32%

Treatment & management

• Depend on stage and women’s general health• Surgery, chemotherapy, and radiation• Nurse provide preoperative and postoperative

complication and side effects from chemo-therapy and radiation

• Nursing support and client to client network(support group) can help improve quality of life

• Nug care: teaching counseling, giving sup-port, physical care, hospice care if need.

Vulva cancer

• Cancer of the vulva is rare• Risk factor: vulvitis, vulvar dermatosis, STIS, cervical

cancer, Diabetes• Sign & symptoms: vulva itching, burning, pain, • Clinical exam, scaly lesion that present as red or white

irregular pigmentation• Lesions can vary in size and shape and can be raised or

flat small or large• Dx : biopsy and pathologic analysis• Tx: surgery remove the tissue or tumor• Complication from radical vulvactomy can include scar-

ring and wound breakdown skin graft required or hemivulvactomy