12. Uterine Cancer

Easy Description

1. Uterine cancer Presented by: Ms. Elizabeth M.Sc (N) Asst. Professor, Dept of MSN NNC, GNSU.

2. Uterine Cancer It may refers to any of several different types of cancer which occurs in uterus, namely: Endometrial cancer – originates from cells in the gland of endometrium Cervical cancer – arise from transformation zone of the cervix, lower portion of the uterus.

3. Risk factors Increased estrogen Hormone therapy Obesity Estrogen screening tumors Older age Infertility Genetics Endometrial Hyperplasia (the endometrium has an average thickness of 6.7 mm). Viral infection (HPV)

4. Symptoms Bleeding or watery discharge from vagina Difficult or painful urination Back Pain Swelling in Legs In later stages of the disease, women may feel pelvic pain and experience unexplained weight loss.

5. Pathophysiology Endometrial cancer forms when there are error in normal endometrial cell growth. Usually, when cell grow old or get damaged, they die, and new cell takes their place. Cancer starts when new cells form unneeded and old or damaged cells do not die as they should.

6. These abnormal cancer cells have many genetic abnormalities that cause them to grow excessively. Mutation are found in a tumor suppressor gene, commonly p53 or over expression of P13/ Akt kinase pathway, which promote cell growth in endometrial cancer

7. Diagnostic Parameters Transvaginal Ultrasound: An ultrasound uses sound waves to create a picture of internal organs. If the endometrium looks too thick, the doctor may decide to perform a biopsy. Hysteroscopy: It allows to do a visual examination of the endometrium of uterus.

8. Biopsy: Testing for endometrial cancer or endometrial hyperplasia. CT Scan and MRI: Both are used to measure the tumor’s size. CA 125 Blood Test: CA 125 is a substance released into the bloodstream. The normal value is less than 35 U/mL. A level above 35 U/mL is considered abnormal. In someone with endometrial cancer, a very high blood CA 125 level suggests that the cancer has probably spread beyond the uterus.

9. Treatment Once cancer has been diagnosed, treatment strategy depends on the extent (stage) of your cancer. Stages of endometrial cancer include: Stage I cancer is found only in uterus. Stage II cancer is present in both the uterus and cervix. Stage III cancer has spread beyond the uterus, but hasn't reached the rectum and bladder. The pelvic area lymph nodes may be involved. Stage IV cancer has spread past the pelvic region and can affect the bladder, rectum and more-distant parts of your body.

10. Surgery Hysterectomy: Removal of uterus Lymph node dissection: Removal of lymph nodes near the tumor if the cancer has spread beyond the uterus.

11. Radiation Therapy The radiation therapy is most often given after surgery to destroy any cancer cells remaining in the area but rarely given before surgery to shrink the tumor. Radiation therapy options for endometrial cancer may include radiation directed towards the whole pelvis externally or tiny radioactive seeds are placed in the body close to tumor which is termed as Brachytherapy.

12. Hormone Therapy Hormone therapy for uterine cancer often involves the hormone progesterone, given in a pill form. Other hormone therapies include the Aromatase inhibitors (AIs) often used for the treatment of women with breast cancer, such as Anastrozole and Letrozole. An AI is a drug that reduces the amount of the hormone estrogen in a woman's body by stopping tissues and organs other than the ovaries from producing it with other types of treatment.

13. Hormone therapy may also be used for women who cannot have surgery or radiation therapy or in combination.

14. Chemotherapy The chemo often includes the combination of Doxorubicin+ Cisplatin+ Paclitaxel. Bevacizumab (Avastin) blocks angiogenesis (the formation of new blood vessels) and is under evaluation in clinical trials. Pazopanib blocks angiogenesis and stop the growth of cancer cell.

15. Vaccination The World Health Organization (WHO), as well as public health officials in Australia, Canada, Europe, and the United States recommend this vaccination against HPV. Gardasil and Cervarix Both vaccines protect against the two HPV types (HPV-16 and HPV-18) that cause 70% of cervical cancers. Both Gardasil and Cervarix have been shown to prevent cervical hyperplasia due to viral infection.

16. Both vaccines are given as a series of three injections over a six-month period. The second dose is given one to two months after the first dose, and the third dose is given six months after the first dose

17. Nursing Management Monitor for adverse effects of radiation therapy such as fatigue, sore throat, dry cough, nausea, anorexia. Monitor for adverse effects of chemotherapy; bone marrow suppression, nausea and vomiting, alopecia, weight gain or loss, fatigue, stomatitis, anxiety, and depression. Realize that a diagnosis of breast cancer is a devastating emotional shock to the woman. Provide psychological support to the patient throughout the diagnostic and treatment process. Involve the patient in planning and treatment. Describe surgical procedures to alleviate fear.

18. Nursing Management Prepare the patient for the effects of chemotherapy, and plan ahead for alopecia, fatigue. Administer antiemetics prophylactically, as directed, for patients receiving chemotherapy. Administer I.V. fluids and hyperalimentation as indicated. Help patient identify and use support persons or family or community. Suggest to the patient the psychological interventions may be necessary for anxiety, depression, or sexual problems. Teach all women the recommended cancer-screening procedures