Cancer of The Uterus

CANCER OF THE UTERUS
 Uterine cancer or endometrial cancer is the most common gynecologic cancer.

 It develops in the body of the uterus, which is a hollow organ located in the lower abdomen.
 Most endometrial cancers are adenocarcinomas.
 Endometrial cancer originates in the inner lining (endometrium) of the uterus, accounts for about
90% of uterine cancers.
 Uterine sarcoma originates in an outer layer of muscle tissue (myometrium) and accounts for less
than 10% of cases.
Causes and Risk Factors

 The cause of uterine cancer is unknown
 Age (more common after age 50)
 Family history of uterine cancer Personal history of breast, colorectal, or ovarian cancer
 Prior pelvic radiation therapy
 Early menarche (beginning menstruation before age 12)
 Hormone replacement therapy with exogenous estrogen
 Late menopause (after age 52) Nulliparity (having never given birth) or low parity
 Endometrial hyperplasia
 Obesity, diabetes or high blood pressure
 Use of tamoxifen
 A high-fat diet
Clinical Manifestations
Early uterine cancer usually is asymptomatic. Most cases of endometrial cancer develop in postmenopausal
women, whose periods have stopped. Abnormal vaginal bleeding, which is the most common symptom,
may also result from a condition called dysfunctional uterine bleeding (DUB).
Other symptoms of uterine cancer include the following:
 Any bleeding after menopause
 Prolonged periods or bleeding between periods An abnormal, non bloody discharge from vagina
 Painful or difficult urination
 Pelvic pain
 Pain during intercourse
 Advanced uterine cancer may cause weight loss, loss of appetite, and changes in bladder and bowel
habits.
Diagnostic Evaluations
 Pelvic exam
 Pap test
 Endometrial biopsy
 Dilation and Curettage
 Exploratory laparotomy
 MRI scan and CT scan,
 Transabdominal ultrasound and transvaginal ultrasound
Management
Treatment for uterine cancer depends on the stage of the disease and the overall health of the patient.
Removal of the tumor (surgical resection) is the primary treatment.
Radiation therapy, hormone therapy, and/or chemotherapy may be used as adjuvant treatment in patients
with metastatic or recurrent disease.
Surgical Treatment:
Surgery is the most common treatment for endometrial cancer. Most doctors recommend either the surgical
removal of the uterus alone (hysterectomy) or, more likely, the surgical removal of the uterus, fallopian
tubes and ovaries (hysterectomy with bilateral salpingo-oophorectomy). Lymph nodes in the area should
also be removed during surgery along with other tissue samples.
Radiation therapy:
Some women with Stage I, II, or III uterine cancer need both radiation therapy and surgery. They may have
radiation before surgery to shrink the tumor or after surgery to destroy any cancer cells that remain in the
area. Doctors use both external and internal radiation therapies to treat uterine cancer.
Hormone Therapy:
Hormone therapy may be used to treat endometrial cancer. If the cancer has spread to other parts of body,
synthetic progestin, a form of the hormone progesterone, may stop it from growing. Another hormone
therapy option is gonadotropin releasing hormone agonists. These drugs can lower estrogen levels in
premenopausal women.
Chemotherapy:
Chemotherapy may be used in addition to surgery to treat metastatic endometrial cancer and to prevent
recurrent disease. The following drugs are used to treat endometrial cancer: Carboplatin, Cisplatin,
Doxorubicin, Cyclophosphamide and Paclitaxel (Taxol).
NURSING MANAGEMENT: HYSTERECTOMY

Preoperative Nursing Interventions
1. Assist patient to seek information on stage of cancer and treatment options. Explain about side effects of
radiation and chemotherapy.
2. Give explanations to the patient about physical preparation and procedures that are performed pre and
postoperatively
3. Administer analgesics and tell the patient that heavy lifting, strenuous exercise, and sexual intercourse
may increase pain.
4. Encourage small, frequent, bland meals/liquid nutritional supplements as able.
5. Preparing Skin for Surgery: Skin preparation may include cleansing the lower abdomen, inguinal areas,
upper thighs, and vulva with a detergent germicide for several days before the surgical procedure.
Postoperative Nursing Interventions
1. Observe the patient for sign of shock. Check wound dressing regularly. If there is a wound drain checks
amount and type of drainage regularly.
2. Hemorrhage may occur within 24 hours, the nurse should observe for signs of internal and external
bleeding. Hemorrhage is more common after vaginal hysterectomy.
3. Give appropriate analgesic drugs as prescribed. Patient may have pain related to surgical procedure and
discomfort from abdominal distension.
4. Encourage frequent changes of position in bed. Activity decreases pain by increasing circulation and
reducing muscle tension.
5. Monitor stool characteristics and frequency. Restrict oral fluid and food until peristalsis resumes.
OVARIAN CANCER
Ovarian cancer is a disease produced by the rapid growth and division of cells within one or both ovaries.
The ovaries contain cells that, under normal circumstances, reproduce to maintain tissue health. When
growth control is lost and cells divide too much and too fast, a cellular mass or tumor is formed.
TYPES OF OVARIAN CANCER

The type of cell that originated the abnormal growth determines the class of the ovarian tumors. There are
actually more than 30 types and subtypes of ovarian malignancies.
1. Epithelial tumors:
About 70-80% of all ovarian cancers are epithelial. These are most common in women who have been
through menopause (aged 45-70 years).
2. Stromal tumors:
Stromal tumors develop from connective-tissue cells that help form the structure of the ovary and produce
hormones. Usually, only one ovary is involved. These account for 5-10% of ovarian cancers. These tumors
typically occur in women aged 40-60 years.
3. Germ cell tumors:
Tumors that arise from germ cells account for about 15% of all ovarian cancers. These tumors develop
most often in young women (including teenaged girls).
4. Metastatic tumors:
Only 5% of ovarian cancers have spread from other sites. The most common sites from which they spread
are the colon (52%), breast (17%), stomach (10%), and pancreas (5%).
Risk Factors
The biologic events that lead to ovarian cancer remain unknown. Several factors (e.g., hormonal,
environmental, and genetic variables) may play a role, although all women are at risk for developing this
disease. Studies have found the following risk factors for ovarian cancer:
 Age: Over 50% of all ovarian cancers occur in women older than age 65.
 Family history of ovarian cancer
 Use of Fertility drugs
 Personal history of cancer
 Menstruation before age 12 and/or menopause after age 50. women who have never been pregnant
(nulliparity)
 Menopausal hormone therapy
 Application of talcum powder to genital area or sanitary napkins
 Diets high in meat and animal fats
 Obesity also increases the risk
Clinical Manifestations of Ovarian Cancer

Early ovarian cancer may not cause obvious symptoms. But, as the cancer grows,
symptoms may include:
 Abnormalities in menstruation, puberty development, and abnormal hair growth
 Abdominal/pelvic discomfort or pressure
 Back or leg pain
 Abdominal swelling and bloating
 Urinary frequency
 Ascites - Collection of fluid in the abdomen, contributing to abdominal distension and shortness of
breath
 Loss of appetite
 Nausea and vomiting
 Gastrointestinal symptoms (e.g., gas, long-term stomach pain, indigestion)
 Feeling full after eating little
 Fatigue
 Gas and/or diarrhea
 Constipation
 Pain with intercourse
 Malnourished or wasted appearance
 Feeling very tired all the time
Less common symptoms include:
 Shortness of breath
 Pleural effusion
 Feeling the need to urinate often
 Unusual vaginal bleeding (heavy periods, or bleeding after menopause)
Diagnostic Evaluations
 Medical History
 Pelvic examination
 CA-125 Blood tests Ultrasound
 Transvaginal color flow Doppler
 Biopsy
 CT scan
 Chest x-ray
 Barium enema x-ray
 Colonoscopy
Management
1. Surgery:
Surgery is the usual first treatment for ovarian cancer. Once ovarian cancer is confirmed, a total
hysterectomy, bilateral salpingo-oophorectomy (removal of the fallopian tubes and ovaries on both sides),
omentectomy (removal of the fatty tissue that covers the bowels), lymphadenectomy (removal of one or
more lymph nodes) may be performed.
2. Chemotherapy:
Most women have chemotherapy for ovarian cancer after surgery. Some women have chemotherapy
before surgery. The best treatment at this time involves a platinum and taxane compounds (e.g., cisplatin,
carboplatin, paclitaxel); however, other drugs, such as "mustards" (e.g., melphalan) and anthracyclines
(e.g., doxorubicin) also show first-line activity in ovarian cancer.
3. Radiation Therapy:
Radiation therapy is rarely used in the initial treatment of ovarian cancer, but it may be used to relieve pain
and other problems caused by the disease. Each treatment takes only a few minutes.
4. Hormone Therapy:
Patient with ovarian cancer receives potential benefits of hormone treatments that do not respond to
conventional therapy. Progestins (medroxyprogesterone acetate and megestrol acetate), estrogens
(diethylstilbestroll, and antiestrogens (tamoxifen) are used.
Nursing Management
Encourage the use of oral contraceptives (birth control pills) which can reduce the risk of ovarian cancer by
40% to 50%. Instruct the women to eat a low-fat, high-fiber diet and reduce meat and alcohol consumption.
In addition, women are encouraged to exercise three times weekly to maintain a body fat percentage that is
within the accepted range. Genetic counseling may be advisable if a woman's family history suggests that
she may have a genetic mutation(s) associated with increased risk of ovarian cancer.

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CANCER OF THE UTERUS

 Uterine cancer or endometrial cancer is the most common gynecologic cancer.

Causes and Risk Factors

NURSING MANAGEMENT: HYSTERECTOMY

TYPES OF OVARIAN CANCER

Clinical Manifestations of Ovarian Cancer

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