reproductive tract malignancy

1. NURSING CARE OF
WOMEN WITH
REPRODUCTIVE TRACT
MALIGNANCY
Presented By:
Ms. Lisa Chadha
S.Y.Msc Nursing
B.V.CON, Pune

2. FEMALE REPRODUCTIVE
TRACT

3. DEFINITION
• Female Reproductive Tract
Malignancies is also known
as Gynaecological cancers
of the female genital tract
that occur when abnormal
cells starts dividing in an
uncontrolled way.

4. CERVICAL CANCER
• Cervical cancer is a malignant
tumour deriving from cells of
the "cervix uteri", which is the
lower part, the "neck" of the
womb, the Female reproductive
organ.
• Cervical cancer is the third most
common cancer in women
worldwide

5. RISK FACTORS
• Human papilloma virus(HPV)
• Multiple sexual partners.
• Smoking
• Weakened immune system
• Multiple pregnancies
• Giving birth at a very young age
• Long-term use of the
contraceptive pill
• Family history

6. SIGN AND SYMPTOMS
• Bleeding that occurs between regular
menstrual periods.
• Bleeding after sexual intercourse,
douching, or a pelvic exam.
• Menstrual periods that last longer and are
heavier than before.
• Bleeding after going through menopause.
• Increased vaginal discharge.
• Pelvic pain

7. DIAGNOSTIC TEST
• PAP smear test
• HPV DNA test
• Colposcopy
• Cone biopsy
• CT (computerized
tomography) scan
• MRI (magnetic resonance
imaging scan
• Pelvic ultrasound

8. PAP SMEAR TEST

9. COLPOSCOPY

10. CONE BIOPSY

11. STAGES OF CERVICAL CANCER
• Stage I- Cancer is confined to the cervix.
• Stage II- Cancer at this stage includes the
cervix and uterus, but has not spread to
the pelvic wall or the lower portion of the
vagina.
• Stage III- Cancer at this stage has moved
beyond the cervix and uterus to the pelvic
wall or the lower portion of the vagina.
• Stage IV- At this stage, cancer has spread
to nearby organs, such as the bladder or
rectum, or it has spread to other areas of
the body, such as the lungs, liver or bones.

12. MANAGEMENT
• Chemotherapy
• Radiotherapy
• Combined therapy
• Surgical treatment
Laser surgery
LEEP (loop electrosurgical excision procedure)
Hysterectomy

13. NURSING MANAGEMENT
• Encourage to take Folate (a water-soluble
B vitamin)which helps in reducing the risk
of cervical cancer in people with HPV.
• Educate women regarding HPV (human
papilloma virus) vaccine.
• Advise couple to practice safe sexual
practice and avoid multiple sexual
partners.
• Regular Cervical screening to be done.
• Advise to quit smoking.

14. OVARIAN CANCER
• It is an abnormal cells that forms in
an ovary.
• Most of these tumors are benign and
never spread beyond the ovary.
• It can be treated by removing the
ovary or the part of the ovary that
contains the tumor.
• It is the 5th most common cause of
cancer deaths in women,

15. Types of ovarian cancer
• The ovaries are made up of 3 main kinds of
cells. Each type of cell can develop into a
different type of tumor:
• Epithelial tumors start from the cells that cover
the outer surface of the ovary. Most ovarian
tumors are epithelial cell tumors.
• Germ cell tumors start from the cells that
produce the eggs (ova).
• Stromal tumors start from structural tissue cells
that hold the ovary together and produce the
female hormones estrogen and progesterone.

16. Signs and symptoms:
• Abdominal bloating, pressure
• Dull abdominal pain
• Sudden loss of weight
• Abdominal distention
• Dyspepsia
• Difficulty Eating
• An Increased Urge to urinate
• Fatigue
• Indigestion
• Heartburn
• Constipation
• Back Pain
• Menstrual Irregularities
• Painful Intercourse

17. Risk factors
• Age- beyond 45years of age.
• Inherited gene mutation
• Estrogen hormone replacement therapy,
especially with long- term use and in large
doses
• Nulligravida
• Fertility treatment.
• Smoking.
• Use of an intrauterine device.

18. Diagnosis:
• It starts with a pelvic
examination- enlarged pelvic
mass.
• ultrasound
• CT scans,
• Blood test, which can detect a
protein (CA 125) found on the
surface of ovarian cancer cells
• Abdominal fluid cytology
• Pet scan

19. Treatment
• Radiation therapy
• Chemotherapy
• Combination of surgery and chemotherapy.
• Surgery
• Treatment generally involves removal of
both ovaries, the fallopian tubes, the uterus
as well as nearby lymph nodes and a fold of
fatty abdominal tissue (omentum)
• Less extensive surgery involve removal of
one ovary and fallopian tube.

20. STAGING OF OVARIAN CANCER
• Stage I. Cancer is found in
one or both ovaries.
• Stage II. Cancer has spread to
other parts of the pelvis.
• Stage III. Cancer has spread
to the abdomen.
• Stage IV. Cancer is found
outside the abdomen.

21. NURSES RESPONSIBILITIES
• Teach women the importance of having routine screenings
for cancer of the reproductive system. (pap smear, and pelvic
exam)
• Teach women about the risk factors of the reproductive
system.
• Teach women about menopause signs and symptoms after
bilateral oophorectomy.
• Teach women about hormone replacement therapy and the
side effects.
• Manage client's pain related to chemotherapy
• Monitor for infection .
• Teach client how to prevent DVTs after surgery, i.e. frequent
changes in positions, leg exercises to promote circulation.
• Explain the need for increased intake of fruits, vegetables,
and whole grains. Also, a decreased fat intake of <30% of
calories.

22. ENDOMETRIAL CANCER
• Endometrial cancer is a cancer
that arises from the endometrium
(the lining of the uterus or
womb).
• It is the result of the abnormal
growth of cells that have the
ability to invade or spread to
other parts of the body.
• It account for 7.0% of all cancers
in women
• Peak incidence is in the age
group of 55 to 69 years

23. RISK FACTORS
• Early menarche < 12 Years of age.
• Late menopause > 52 Years of age.
• Estrogen given alone as postmenopausal hormone
replacement therapy
• Nulliparity
• PCOD syndrome
• Obesity
• Diabetic and hypertensive women develop
endometrial cancer
• Previous history of breast, ovarian) & colorectal Ca.
• Family History of endometrial Cancer
• Tamoxifen
• Long term use of Oral contraceptives.

24. SIGN AND SYMPTOMS
• Postmenopausal bleeding
• Premenopausal irregular or
excessive bleeding
• Watery and offensive
discharge
• Colicky pain due to uterine
contraction

25. DIAGNOSIS
• Hysteroscopy with
endometrial curettage
• Endometrial curettage
• Endometrial biopsy
• Ultrasound and colour
Doppler
• Hysteroscopy
• Histopathological
examination
• CT/MRI

26. STAGES OF ENDOMETRIAL CANCER
• Stage1- Growth of tumor is
confined to endometrium.
• Stage 2- Growth extend to
cervix.
• Stage 3- Growth extends to
vagina including lymph nodes.
• Stage 4- Growth invades
rectum or bladder and
structure beyond pelvis.

27. TREATMENT
• Surgery- Hysterectomy,
Laparotomy
• Chemotherapy
• Radiation therapy
• Combined therapy

28. NURSES RESPONSIBILITIES
• Advise women for routine screening of
all asymptomatic women on HRT and
Tamoxifen therapy
• All women with postmenopausal
bleeding should be screened by Pv
examination,
• Educate women to regarding reduction
of weight if they are obese.
• Advise the mother to restrict use of
estrogen after menopause for non
hystrectomized women

29. CONCLUSION
Cancers can occur in any part of the female
reproductive system—the vulva, vagina,
cervix, uterus, fallopian tubes, or ovaries.
These cancers are called gynecologic
cancers and their treatment modalities
include –radiation, chemotherapy, combined
therapy and surgery.

30. BIBLIOGRAPHY
• Myers, JS. (2001). Oncologic complications. In SE Otto (Ed.),
Oncology Nursing, 4th Ed. (pp. 544-548). St. Louis, Missouri:
Mosby.
• Otto, SE. (2001). Gynecologic cancers. In SE Otto ((Ed.).
Oncology Nursing, 4th Ed. (pp. 257-260). St. Louis, Missouri:
Mosby.
• Penson, R., & Powell, M. (2014). Clinical features, diagnosis,
staging, and treatment of uterine carcinosarcoma. Retrieved
November 2, 2015.
• http://www.uptodate.com/contents/clinical-features-diagnosis-
staging-and- treatment-of-uterine