UTERINE CANCER case analysis presentation.pptx

UTERINE-CANCER

1. CASE ANALYSIS Prepared by: APRIL 14, 2025 Agnes, Chelxia Ricci O. Balimbingan , Meshael E. Buhay, Zyrianne Dimalutang , Rohaya M. Jamoner , Jhazie G. Labandero , Rolygie M. GROUP 2 BSN-2C Minalang , Mariel-Ann S. Pantaran , Hamiemay Polo, Princess Lean M. Rallos , Nel Angeli S. Silva, Charolize NCM 109 A UTERINE CANCER

2. INTRODUCTION NEXT PAGE Uterine cancer is a general term that describes cancer in your uterus: Endometrial cancer develops in the endometrium, the inner lining of your uterus. It’s one of the most common gynecologic cancers — cancers affecting your reproductive system . Endometrial carcinomas originate from cells in the glands of the endometrium (uterine lining). These include the common and readily treatable well-differentiated endometrioid adenocarcinoma, as well as the more aggressive uterine papillary serous carcinoma and uterine clear-cell carcinoma .   Malignant mixed Müllerian tumors (also known as uterine carcinosarcomas) are rare endometrial tumors which show both glandular ( carcinomatous ) and stromal ( sarcomatous ) differentiation. Uterine sarcoma develops in the myometrium, the muscle wall of your uterus. Uterine sarcomas are very rare. Leiomyosarcomas originate from the muscular layer of the uterus (or myometrium ). Of note, leiomyosarcomas are distinct from uterine leiomyomas , which are benign tumors of the uterus. Endometrial stromal sarcomas originate from the connective tissues of the endometrium , and are far less common than endometrial carcinomas.

3. PATHOPHYSIOLOGY

4. PATHOPHYSIOLOGY

5. MEDICAL MANAGEMENT Uterine Cancer Diagnosis and Initial Assessment Methods Physical examination The doctor may check your abdomen for swelling. To check your uterus, the doctor will place two fingers inside your vagina while pressing on your abdomen, or they may use an instrument (a speculum) that separates the walls of the vagina (similar to a cervical screening test). Pelvic ultrasound A pelvic ultrasound will use soundwaves to make a picture of your uterus and ovaries. The soundwaves echo when they meet something dense such as a tumour or organ. A computer then makes a picture from these echoes. A pelvic ultrasound can be done in two ways and you often have both types at the same appointment. A pelvic ultrasound usually takes between 15 and 30 minutes. If anything appears unusual, the doctor may suggest a biopsy. Abdominal ultrasound In order to get good pictures of the ovaries and uterus in an abdominal ultrasound you will need to have a full bladder so you will be asked to drink water before your appointment. A technician called a sonographer will move a small device called a transducer over your abdomen. Transvaginal ultrasound For a transvaginal ultrasound you do not need a full bladder. The sonographer will insert a transducer wand into your vagina. You may find the ultrasound uncomfortable, but it should not be painful. If you feel uncomfortable or embarrassed about having the ultrasound, talk to the technician beforehand. You can ask to have a female sonographer or have someone else in the room with you .

6. MEDICAL MANAGEMENT Endometrial biopsy An endometrial biopsy is done in the specialist’s office. A long, thin tube ( pipelle ) is inserted into your vagina to gently suck cells from the uterine lining. The cells are sent to a pathologist who examines them under a microscope. There may be some discomfort similar to period cramps so your doctor may suggest taking non-steroidal anti-inflammatory drugs such as ibuprofen, before the procedure. Hysteroscopy and biopsy A hysteroscope is a telescope-like device which is inserted through your vagina into your uterus and allows a gynaecologist or gynaecological oncologist to see inside your uterus. During this procedure, tissue can also be removed (biopsy) and sent for further testing in a laboratory. Blood and urine tests Blood and urine tests may be used to assess your general health and inform treatment decisions. Other tests If cancer is detected in your uterus, you may have other scans to see if the cancer has spread to other parts of your body, such as an x-ray, CT scan or MRI scan . For particular types of uterine cancer, such as sarcoma, a PET scan may be used

7. DRUG STUDY

8. PHARMACOLOGICAL MANAGEMENT 1. HORMONAL THERAPY Hormonal therapy is often used for uterine cancer that is hormone receptor-positive, such as some types of endometrial cancer. These cancers may respond to medications that block estrogen or reduce its levels. Progestins (e.g., Medroxyprogesterone acetate , Megestrol acetate ): Used in cases of endometrial cancer where the tumor cells have progesterone receptors. They work by inhibiting the growth of estrogen-driven cancer cells. Indication : Often used for early-stage, low-grade, or well-differentiated endometrial cancers, especially in patients who wish to preserve fertility. Aromatase inhibitors (e.g., Letrozole , Anastrozole , Exemestane ): These drugs block the production of estrogen from other tissues in the body, potentially reducing the growth of estrogen-dependent cancer cells. Indication : Used less frequently but may be considered in hormone-sensitive tumors, especially if progestins are ineffective.

9. PHARMACOLOGICAL MANAGEMENT 2. CHEMOTHERAPY Chemotherapy is often used for more advanced uterine cancers, particularly when the cancer has spread or is at high risk of recurrence. Carboplatin and Paclitaxel (commonly used in endometrial cancer): This combination is considered standard treatment for advanced or recurrent uterine cancer. Carboplatin is a platinum-based drug that damages cancer cells' DNA, preventing their replication. Paclitaxel is a chemotherapy drug that interferes with cell division. Cisplatin : Another platinum-based chemotherapy that may be used, particularly for more aggressive types of uterine cancer. Doxorubicin (Adriamycin): A chemotherapy drug that may be used alone or in combination with other chemotherapy agents for advanced uterine cancer. Docetaxel (Taxotere): Similar to paclitaxel, docetaxel is used in combination chemotherapy regimens for uterine cancer. Topotecan : An option for recurrent or metastatic uterine cancer, particularly if other treatments have failed.

10. PHARMACOLOGICAL MANAGEMENT 3. TARGETED THERAPY Targeted therapy drugs are designed to target specific molecules involved in the growth and spread of cancer cells. Lenvatinib ( Lenvima ) : A tyrosine kinase inhibitor that targets the blood supply to the tumor and helps to slow the growth of cancer cells. Indication : Used in combination with pembrolizumab for advanced or recurrent endometrial carcinoma that is mismatch repair-deficient or microsatellite instability-high (MSI-H). Pembrolizumab (Keytruda) : A PD-1 inhibitor, which is an immune checkpoint inhibitor that boosts the body's immune response against cancer cells. Indication : Used in advanced or recurrent endometrial cancer, especially for tumors that are mismatch repair-deficient ( dMMR ) or microsatellite instability-high (MSI-H). Bevacizumab (Avastin) : An anti-angiogenesis drug that prevents the formation of blood vessels that tumors need to grow. Indication : Can be used for advanced or recurrent uterine cancer, often in combination with chemotherapy.

11. PHARMACOLOGICAL MANAGEMENT 4. RADIATION THERAPY While not a medication, radiation therapy can be used in combination with medications to treat uterine cancer. It is typically used after surgery to treat any remaining cancer cells, or in advanced cases where surgery is not an option. 5. Immunotherapy Pembrolizumab (Keytruda) : As mentioned earlier, immunotherapy is used to help the immune system recognize and attack cancer cells, particularly in cancers with certain genetic features (like MMR deficiency or MSI-H). Nivolumab ( Opdivo ) : Another PD-1 inhibitor used in some cases of uterine cancer, particularly in clinical trial settings.   6. Other Medications for Symptom Management Pain management : For advanced disease, medications such as opioids (e.g., Morphine , Oxycodone ) may be prescribed to control pain. Antiemetics : Drugs like Ondansetron or Granisetron may be used to prevent nausea and vomiting associated with chemotherapy. Growth factors : Medications like Filgrastim or Pegfilgrastim may be prescribed to stimulate white blood cell production, especially if chemotherapy leads to neutropenia (low white blood cells).

12. MONITORING AND FOLLOW-UP Physical Examinations: Every 3 to 6 months for the first 2–3 years. Every 6 to 12 months up to 5 years. Annually thereafter. Pelvic Exams: To assess the vaginal cuff, lymph nodes, and any signs of recurrence. Imaging Tests: CT scan, MRI, or PET scan if recurrence is suspected. Used selectively based on symptoms or findings. Laboratory Tests: CA-125 levels may be monitored in patients with high-risk or advanced-stage cancer. Other tumor markers depending on histologic type. Surveillance for Symptoms: Bleeding, pelvic pain, bloating, or weight loss should be reported immediately. Psychosocial Support: Counseling, support groups, and mental health care for emotional well-being. Management of Side Effects: Address menopausal symptoms, fatigue, neuropathy, or lymphedema from treatment .

13. COMPLICATIONS IF LEFT UNTREATED If uterine cancer is not treated promptly, several serious and potentially fatal complications may occur: Local Invasion: Tumor may grow and invade nearby organs such as the bladder , rectum , or pelvic wall , leading to urinary or bowel obstruction, hematuria, and pain. Metastasis: Cancer cells may spread to distant sites: Lungs (most common) Liver Bones Brain (rare) Severe Anemia: From chronic vaginal bleeding, leading to fatigue, dizziness, and cardiovascular strain. Infections and Sepsis: From necrotic tumor tissue or fistula formation (e.g., between uterus and bladder or rectum). Pain and Immobility: From nerve compression, pelvic mass effects, or bone metastases. Psychological Distress: Anxiety, depression, and a diminished quality of life. Death: Advanced untreated uterine cancer can ultimately lead to death from organ failure, sepsis, or systemic metastasis.

14. POSSIBLE COMPLICATIONS 1. Metastasis Spread of cancer to distant organs such as the lungs , liver , bones , or brain . Leads to severe symptoms like chronic cough, bone pain, neurological issues, or liver dysfunction. 2. Local Invasion Tumor may grow into nearby structures like the bladder , rectum , or pelvic wall , causing: Urinary retention or incontinence Bowel obstruction Severe pelvic pain or pressure 3. Abnormal Uterine Bleeding and Anemia Ongoing bleeding can result in iron-deficiency anemia , causing fatigue, weakness, and dizziness. 4. Lymphedema Swelling of the lower limbs due to lymph node dissection or radiation , leading to discomfort and limited mobility. 5. Infection Post-surgical infections (especially in the pelvic area) Immunosuppression from chemotherapy may increase the risk of systemic infections.

15. POSSIBLE COMPLICATIONS 6. Bowel and Bladder Dysfunction Nerve damage or scarring from surgery/radiation may lead to: Fecal or urinary incontinence Chronic constipation or retention 7. Sexual Dysfunction Vaginal dryness, pain during intercourse (dyspareunia), or loss of libido after treatment. 8. Early Menopause Resulting from oophorectomy (removal of ovaries), causing hot flashes, mood swings, and vaginal dryness. 9. Blood Clots (Deep Vein Thrombosis / Pulmonary Embolism) Higher risk due to immobility, cancer status, or surgery, which can be life-threatening. 10. Psychological and Emotional Impact Anxiety, depression, fear of recurrence, and altered body image can significantly affect quality of life.

16. SURGICAL MANAGEMENT Total Hysterectomy Definition : Removal of the uterus and cervix. Indication : This is the most common surgical procedure for uterine cancer, particularly for endometrial cancer, which is the most common type of uterine cancer. Procedure : The surgeon removes the uterus, and in some cases, also removes the cervix, ovaries, and fallopian tubes (bilateral salpingo -oophorectomy). 2. Radical Hysterectomy Definition : A more extensive surgery where the uterus, cervix, the upper part of the vagina, and the surrounding tissue, including lymph nodes, are removed. Indication : This is typically done for more advanced stages of uterine cancer or when the cancer has spread beyond the uterus. Procedure : The removal may include nearby lymph nodes to check for metastasis, as well as any surrounding tissues or structures that might be affected. 3. Lymphadenectomy Definition : Removal of the lymph nodes near the uterus (pelvic and para-aortic lymph nodes). Indication : Performed when there is a suspicion that cancer has spread to the lymph nodes. It helps determine the stage of the disease and may guide further treatment. Procedure : Lymph nodes are removed for pathological examination to check for cancer spread.

17. SURGICAL MANAGEMENT 4. Oophorectomy (Bilateral Salpingo-Oophorectomy) Definition : Removal of both ovaries and fallopian tubes. Indication : Often performed in cases of endometrial cancer, especially if the cancer is in an advanced stage or if the patient is postmenopausal. It may also be done in patients who are at higher risk for ovarian cancer or in cases of hereditary cancer syndromes (e.g., Lynch syndrome). 5. Vaginal or Abdominal Approaches Vaginal Hysterectomy : This is often used in early-stage uterine cancer if the tumor is confined to the uterus and the cervix. Abdominal Hysterectomy : In more advanced or high-risk cases, a larger incision is made in the abdomen to access and remove the uterus and surrounding tissues. Laparoscopic (Minimally Invasive) Surgery : For some patients, a minimally invasive approach using small incisions and a camera (laparoscopy) may be used. This approach can result in less pain and quicker recovery. 6. Surgical Staging Importance : After the removal of the uterus, surgical staging involves determining how far the cancer has spread. The staging helps determine the prognosis and guides further treatment decisions. Procedure : This may involve removal and examination of lymph nodes, tissues, and other areas around the uterus.

18. NURSING MANAGEMENT Preoperative Care Health Education: Explain the surgical procedure (e.g., hysterectomy), anesthesia, and expected recovery. Informed Consent: Ensure patient understands the procedure and has signed the consent form. Physical Preparation: Bowel prep (if ordered) NPO status before surgery Skin cleansing or shaving as indicated Emotional Support: Address anxiety and fears related to cancer diagnosis and surgery. Offer spiritual or psychological support as needed. . Postoperative Care Monitoring: Vital signs, intake/output, and surgical site for bleeding or infection. Monitor pain level and manage with prescribed analgesics.

19. NURSING MANAGEMENT Monitor pain level and manage with prescribed analgesics. Promote Recovery: Encourage early ambulation to prevent deep vein thrombosis (DVT) and pneumonia. Assist with turning, coughing, and deep breathing exercises. Wound Care: Maintain cleanliness and dryness of surgical site. Monitor for signs of infection (redness, swelling, discharge). Chemotherapy/Radiation Support Monitor for Side Effects: Nausea, vomiting, hair loss, fatigue, bone marrow suppression. Provide antiemetics and comfort measures. Infection Prevention: Educate about hand hygiene, avoiding crowds, and monitoring for fever. Skin Care: For radiation therapy, protect skin from irritation and sun exposure.

20. NURSING MANAGEMENT Emotional and Psychosocial Care Support Coping: Provide a safe space for expression of emotions. Refer to counseling, support groups, or a mental health specialist. Body Image and Sexual Health: Address concerns related to sexuality and self-esteem post-surgery. Discharge Planning and Health Teaching Activity Restrictions: Avoid heavy lifting, strenuous exercise, and driving for a few weeks. Follow-Up Appointments: Stress the importance of regular follow-up for monitoring recurrence. Medication Adherence: Educate about prescribed medications and managing side effects. Lifestyle Modifications: Promote a healthy diet, regular exercise, and smoking cessation.

21. PATIENT TEACHING 1. Understanding the Disease Educate the patient about uterine cancer , its causes , risk factors , and prognosis . Explain the type of cancer (e.g., endometrial adenocarcinoma) and the stage , if known. 2. Treatment Plan Discuss the chosen treatment(s) such as: Surgery (e.g., hysterectomy) Radiation therapy Chemotherapy Hormonal therapy Emphasize the purpose of each and possible side effects . 3. Postoperative Instructions Activity limitations: Avoid lifting, driving, or heavy household work for several weeks. Wound care: Keep the surgical area clean and dry; report signs of infection. Pain management: Take prescribed analgesics as directed.

22. PATIENT TEACHING 4. Management of Side Effects Educate on how to deal with: Nausea and vomiting (antiemetic use, bland diet) Fatigue (rest periods, balanced activity) Hair loss (temporary, options like wigs or scarves) Vaginal dryness or pain during intercourse 5. Nutrition and Lifestyle Encourage: A balanced diet rich in iron and vitamins to prevent anemia. Adequate fluid intake and fiber to prevent constipation. Smoking cessation and limiting alcohol intake. Regular physical activity (light walking, stretching). 6. Emotional and Psychological Support Discuss the emotional effects of a cancer diagnosis. Encourage joining support groups or talking to a mental health professional . Discuss potential impacts on fertility and sexual health and provide counseling if needed .

23. PATIENT TEACHING 5. Nutrition and Lifestyle Encourage: A balanced diet rich in iron and vitamins to prevent anemia. Adequate fluid intake and fiber to prevent constipation. Smoking cessation and limiting alcohol intake. Regular physical activity (light walking, stretching). 6. Emotional and Psychological Support Discuss the emotional effects of a cancer diagnosis. Encourage joining support groups or talking to a mental health professional . Discuss potential impacts on fertility and sexual health and provide counseling if needed. up appointments . Educate about routine surveillance , including pelvic exams and imaging as ordered. 9. Medication Adherence Stress the importance of taking medications on schedule . Review drug interactions , side effects, and when to call the doctor.  

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