Med-Surg Immune System, part 13: Endometrial, Cervical, Ovarian, & Breast Cancer
In this article, you'll learn the most important facts about endometrial, cervical, ovarian, and breast cancer. Learn about risk factors, signs and symptoms, prevention, screening, treatment, medication and surgeries for these cancers.
These cancers, their pathophysiology, treatment, and important patient teaching are covered in our Medical-Surgical flashcards (Immune system), and Cathy’s videos follow along with the cards.
Endometrial cancer is a cancer of the endometrium, which is the inner lining of the uterus.
Risk factors for endometrial cancer
A key risk factor for endometrial cancer is prolonged exposure to estrogen without progesterone.
Signs and symptoms of endometrial cancer
One of the key symptoms of endometrial cancer is postmenopausal bleeding. If your patient has gone through menopause, is no longer getting periods, and suddenly has a new onset of bleeding, that is considered a possible symptom of endometrial cancer.
Cervical cancer is cancer of the cervix.
Causes of cervical cancer
Cervical cancer is typically caused by human papilloma virus (HPV).
Signs and symptoms of cervical cancer
One key symptom of cervical cancer is painless vaginal bleeding (different than a normal menstrual period).
Preventing cervical cancer with the HPV vaccine
Fortunately, there is a vaccine for HPV. The HPV vaccine is given via three injections over a six-month period of time, and that helps to prevent contraction of HPV, which can help prevent cervical cancer from developing.
The way to screen for cervical cancer is via a pap smear. A pap smear is a routine screening procedure whereby cells from the cervix are collected and tested for abnormalities. Pap smears are performed every 1 to 3 years, depending on the risk profile of the patient. For example, younger patients may have their first pap smear, and if the cells are healthy, they might not need their next pap smear for another 3 years.
Pap smears usually start about three years after the patient begins sexual intercourse or by age 21.
Ovarian cancer is marked by an epithelial tumor that grows on the surface of the ovaries and spreads rapidly.
Signs and symptoms of ovarian cancer
Symptoms of ovarian cancer can be vague, like some GI disturbances. Unfortunately, this results in low survival rates because patients don't seek medical attention until it's too late.
Warning about ovarian cancer
It's important to note that pap smears screen for cervical cancer only, and will not catch ovarian cancer.
Treatment for cancers of the female reproductive system
There are different treatment options for endometrial, cervical, and ovarian cancer.
Chemotherapy and radiation are both options to treat endometrial, cervical, or ovarian cancers. Either internal or external radiation can be used. Internal radiation for this purpose is known as brachytherapy.
Ablation therapy is one treatment option available for these cancers. Endometrial ablation is a procedure to destroy the endometrium.
Surgeries: hysterectomy, salpingectomy, oophorectomy
Some of these cancers may require surgery to remove the affected organ. A hysterectomy is removal of the uterus. An oophorectomy is removal of the ovary. A salpingectomy is removal of the fallopian tube, which may be required if ovarian cancer travels to the fallopian tubes, or may be done proactively with an oophorectomy.
Breast cancer is a cancer that develops in breast tissue, usually as an adenocarcinoma in the glandular cells of the breast.
Screening for breast cancer
Screening for breast cancer is done through mammograms. It's usually recommended that patients start getting mammograms annually at age 40, in addition to monthly breast self-examinations. If a patient is at higher risk for breast cancer because of a family history, they may need to undergo a baseline mammogram starting at age 35.
There are several risk factors for breast cancer that are important to know about. Genetics play an important role in the development of breast cancer. Another risk factor is if a patient had an early menarche (first onset of their menstrual period), or late onset of menopause, because the longer the "reproductive years" of a patient, the greater exposure to hormones that have an effect on breast cancer. Other risk factors include long-term use of oral contraceptives, hormone replacement therapy, smoking, and obesity.
Signs and symptoms of breast cancer
There are some signs and symptoms of breast cancer that are important to look out for. This is why patients should perform monthly breast self-examinations; if there is a lump, it's better to catch it early.
A cancerous breast tumor is usually a lump that is firm, immobile, and non-tender. If a breast lump appears that hurts and that can move around, it's less likely to be breast cancer.
Other signs include:
- Dimpling over the skin of the breast, which is known as a peau d'orange appearance (French for "skin of an orange").
- Nipple retraction (a nipple that used to stick out becoming flat or inverted).
- Nipple ulceration (the nipple forming a scab or shallow wound).
- Nipple discharge
It's safe to say if a patient notices any change in the appearance of their breasts or nipples, then they should definitely notify their provider.
Treatment for breast cancer
There are several treatments for breast cancer depending on the type and severity of the cancer.
Chemotherapy or radiation can be used to treat breast cancer.
As part of the treatment for breast cancer, surgery may be required to remove the tumor, which is called a lumpectomy. A surgery to remove the whole breast is called a mastectomy, and it is referred to as a "double mastectomy" when both breasts are removed.
Some patients who get a mastectomy may opt for reconstructive breast surgery.
When you are caring for a patient with a mastectomy, there are some important tips to keep in mind.
Do not administer any injections, take blood, or take blood pressure on the affected side. It may be helpful to post a sign as a reminder.
If a patient has undergone a double mastectomy, blood pressure can be taken from the thigh. Injections or blood draws may need to be done in alternate sites, but the most important part is to NOT use a tourniquet if you are required to use the arm.
There are some important patient teaching points to provide to a patient post-mastectomy. After a mastectomy, a patient should wear a sling when they are ambulating, wear loose clothing so as not to constrict the healing area, and perform hand and arm exercises to help prevent edema and increase their range of motion.
Cathy’s teaching on these cancers is intended to help prepare you for Medical-Surgical nursing exams. The Medical-Surgical Nursing video series is intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI and NCLEX.
Hi, I'm Cathy. And in this video, I will be covering cancers of the female reproductive system. Specifically, I'll be talking about endometrial cancer, cervical cancer, ovarian cancer, and I also will be discussing breast cancer. If you are following along with our Medical-Surgical Nursing Edition 2 deck, I am on card 30 in the immune system.
Let's first talk about endometrial cancer which is cancer of the inner lining of the uterus.
A key risk factor with endometrial cancer is prolonged exposure to estrogen without progesterone, and a key symptom of endometrial cancer is postmenopausal bleeding. So if your patient has gone through menopause and she's not getting her periods anymore, and suddenly she has a new onset of bleeding, that would be suspect.
Okay, next we have cervical cancer which is cancer of the cervix and it is typically caused by HPV.
A key symptom of cervical cancer is painless vaginal bleeding.
The good news is is that we can prevent many occurrences of cervical cancer with use of the HPV vaccine. With this vaccine, you get three injections over a six-month period of time, and that helps to prevent HPV which in turn helps to prevent cervical cancer.
In terms of screening, we do this. We screen for cervical cancer with pap smears. Pap smears are performed every 1 to 3 years, depending on the risk profile of the patient. We usually start doing pap smears about three years after sexual intercourse or by age 21.
Then lastly, we have ovarian cancer. This is where we have an epithelial tumor that grows on the surface of the ovaries and spreads rapidly.
So symptoms of ovarian cancer are very vague, like some GI disturbances. So this results in low survival rates because patients don't seek medical attention until it's too late. So one thing I want to mention in this video is that about a year ago I had a patient with ovarian cancer. And one of the Patient Care Assistants, unbeknownst to me, asked her, "Well why didn't you get your pap smears? You know, your annual pap smears?"
Well, there's all sorts of things wrong with that question, right? It's completely un-therapeutic. First of all, she asks why which is always wrong, right? And then accusing her of not doing preventative care and that's how she ended up with ovarian cancer. And then lastly, it's completely inaccurate, right? Because pap smears test for cervical cancer only. They screen for cervical cancer. They have nothing to do with ovarian cancer. So just keep that in mind. Definitely don't make that mistake when you get out there and start your nursing career.
Okay, in terms of treatment for these different types of cancer we can use chemotherapy, we can use internal or external radiation. So, internal radiation is called brachytherapy.
We can also use ablation therapy, and then we can perform surgery to remove the affected organ. A hysterectomy is removal of the uterus. A salpingectomy is removal of the fallopian tube. And an oophorectomy is removal of an ovary.
Now let's talk about breast cancer.
Screening for breast cancer is done through mammograms, and it's recommended that women get mammograms annually starting at age 40, in addition to monthly breast self-examinations. Now, if a woman is at higher risk for breast cancer because of a family history, like I am, then they may want to do a an earlier baseline mammogram. Which is something I had. So I had like a baseline mammogram at age 35, and then I started having my annual mammograms at age 40.
In terms of risk factors, genetics definitely play a role. Also, if a woman had early menarche, which means she had early onset of periods or late onset of menopause, those are risk factors for breast cancer. So basically the longer she was bleeding through those reproductive years, that does place her at higher risk. Other risk factors include long-term use of oral contraceptives as well as hormone replacement therapy, and then smoking and obesity are other risk factors.
In terms of signs and symptoms. Signs and symptoms of a cancerous breast tumor are that it is a firm, immobile, non-tender lump. So if you have a lump that shows up that hurts and that you can move around, then chances are it's not breast cancer because breast cancer will be kind of immobile and painless. Okay? In addition, if the patient has some dimpling over the skin of the breast or this peau d'orange appearance which is a way of saying that really the breasts, the skin over the breast, looks like the outside surface of an orange. Or if you have nipple retraction, nipple ulceration, or discharge. Those are all warning signs of breast cancer.
So basically, if you notice any change in the appearance of your breasts or your nipples then that's definitely something you would want to notify your provider about.
In terms of treatment. Hormone therapy can be used for breast cancer. So this one such medication is Tamoxifen. Chemotherapy can be used, as well as radiation, and then surgery may be required to remove the tumor through a lumpectomy or remove the whole breast which is called a mastectomy.
So if you are caring for a patient with a mastectomy, there's some important considerations you definitely need to keep in mind and some patient teaching you need to do. So first of all, you do not want to administer any injections, take blood, or take blood pressure on the affected side with the mastectomy. So at our hospital we usually put a big sign behind the patient's bed to remind people no blood pressures, blood draws, et cetera, on the left side.
So you definitely want to avoid doing any of those things on the side that is affected.
In terms of patient teaching, we want the patient to wear a sling when they're ambulating. They should wear loose clothing, so nothing tight over there. And they should perform arm and hand exercises to help prevent edema and to increase their range of motion.
Okay, so that is it for this video. When we come back, we will go over the remaining cancers in this playlist. So thank you so much for watching and I'll see you soon!
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