The document discusses several types of benign and malignant gynecological conditions including uterine fibroids, endometrial hyperplasia, benign cervical polyps, benign ovarian cysts, uterine cancer, cervical cancer, ovarian cancer, and vulva cancer. It covers the etiology, risk factors, signs and symptoms, diagnosis, staging, treatment options, survival rates, and nursing care considerations for each condition. Many of the benign conditions can develop into cancers if left untreated.
The document discusses several types of benign and malignant gynecological conditions including uterine fibroids, endometrial hyperplasia, benign cervical polyps, benign ovarian cysts, uterine cancer, cervical cancer, ovarian cancer, and vulva cancer. It covers the etiology, risk factors, signs and symptoms, diagnosis, staging, treatment options, survival rates, and nursing care considerations for each condition. Many of the benign conditions can develop into cancers if left untreated.
The document discusses several types of benign and malignant gynecological conditions including uterine fibroids, endometrial hyperplasia, benign cervical polyps, benign ovarian cysts, uterine cancer, cervical cancer, ovarian cancer, and vulva cancer. It covers the etiology, risk factors, signs and symptoms, diagnosis, staging, treatment options, survival rates, and nursing care considerations for each condition. Many of the benign conditions can develop into cancers if left untreated.
AIIMS Rishikesh Uterine myoma (fibroid) • One of most common(80%) benign gynecologic tumors(fibroid tumor); muscle and connective fibrous tissue. • Etiology: unknown • Asymtomatic, uterus to enlarge depend on size of tumor • Fibroids are classified according to location; subserosal, intramural, submucosal Uterine myoma(fibroid) Uterine myoma(fibroid) • Signs & symptoms: menorrhagia(heavy prolonged vaginal bleeding) and frequent bleeding anemia (submucosal) • Dysmenorrhea, dyspareunia, expansion of the low abdomen(large tumor), pelvic pressure, abdominal discomfort. • Depend on ovarian hormones because they grow during the reproductive years and atrophy during menopause • Tx: Depend on symptoms, supportive care, laparoscopic 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 developed cancer • Sign & symptoms: heavy menstrual period • Dx: Physical & pelvic examination, D&C endomaterial 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 nursing 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, unusual discharge, painful urination, pelvic pain • Dx: D&C and endometrial biopsy • TX: Depend on stage of the disease Radical hysterectomy(TAH+BSO total abdominal hysterectomy and both Salpingo oopohrectomy) NG care: Nurse can provide emotional support and reassurance as well as education. Preventive 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 lining 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 cervical 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 pathophysiology • 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 discharge, pelvic pain during intercourse • Tx: Pap smear colposcopybiopsy, endocervical curettage • Cryosurgery, Loop Electrosurgical Excision Procedure(LEEP) • Invasive cervical cancer; radical hysterectomy(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 characteristics • Stage I • Ovaries only • Stage II • To pelvis • Stafe III • Abdomen, inguinal node • Stage IV • Distant metastasis, lung liver etc Etiology and pathophysiology • Risk Factors - 55-65yrs age more likely than young women, after menopause - Family history( mother, sister, daughter) - Obesity - Reproductive history; menses before 12, no children, first child after 30yrs, do not become pregnant. - 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 identification • Initial symptoms are abdominal swelling or bloating, fatigue and abdominal pain, constipation 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 chemotherapy and radiation • Nursing support and client to client network(support group) can help improve quality of life • Nug care: teaching counseling, giving support, 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 scarring and wound breakdown skin graft required or hemivulvactomy
College of Nursing All India Instutite of Medical Sciences, Rishikesh (Uttarakhand) B.Sc. (Hons) Nursing 3 Year Batch - 2016 End Term Examination - 2019 Subject - Maternal Health Nursing