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51 Cards in this Set

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What is the leading cause of cancer death for women age 35-52?
Breast cancer
What is the risk of getting breast cancer assuming you live till 85?
1 in 8
Why have estrogen positive rates dropped since 2003?
Because women have stopped taking hormone replacement therapy.
What percentage of women have no other risk factors when diagnosed with breast cancer?
75% of women diagnosed have no other risk factors other than being a women
How do the odds increase as you age of getting breast cancer?
to age 39: 1/227
40-59: 1/25
60-79: 1/15
What are some other major predetermining risk factors?
-personal hx of breast cancer (having it in one breast increases chance of getting it in the other)
-family hx of breast cancer, mother or sister (2x risk)
-history of biopsy showing atypical changes
-5-10% of breast cancer patients carry BRCA 1 for 2 genes
Other risk factors for breast cancer:
-first pregnancy after age 30
-family history of more distant relative, grandmother or aunt
-early age of menarche
-menopause after age 50 (mean age in US is 52) and (no rest from period cycle)
-Weight gain
-family history of colon and prostate cancer
What are some of the risks for breast cancer that have conflicting opinions?
-high fat diet
-high use of alcohol
-obesity (later in life gain)
-exogenous hormones (HRT)
-breast trauma
-viral infection
-lactation - this is not really associated because we do not breastfeed enough in US to decrease risk
-higher socioeconomic at lower risk
What are some of the demographic risks of getting breast cancer?
-increased for women living in the US
-increased for white women in the US
-Black women have it less, but it is more lethal
-Increased for Jewish women living in NY
What are the incidences of breast cancer among different ethnicities?
Caucasian 137/100,000
African America 120.7/100,000
Asian 93.4/100,000
Latina 82.6/100,000
What is the mortality rate of breast cancer among different ethnicities?
African American 37.3/100,000
Caucasian 29.3/100,000
Latina 17.5/100,000
What are the screening recommendations for breast cancer?
-Breast self-exam: Every month after age 20
-Clinical breast exam: Every three years ages 20-39, yearly after 40
-Mammograms yearly after 40 because incidence increases
-Mammograms earlier
How do benign breast lumps feel?
-Discreet-feel around edges
-Regular shape
-Mobile-you can move them around
-Tender-fibrocystic
How do malignant breast lumps feel?
-Firm
-Irregular
-Attached
-Non-tender
What other findings might you see in the nipple with breast cancer?
-Nipple retraction or elevation
-Bloody discharge
-Spontaneous discharge
-Eczema of the nipple
What other findings might you see in the skin with breast cancer?
-Asymmetry between breasts
-Redness with edema
-Skin changes
You should encourage client to examine breast in mirror because?
They will notice differences much quicker than anyone else
Which women do breast cancer screening?
-Well educated
-Living in urban areas
-Have private health insurance
-
Who doesn't do breast cancer screening?
-Rural
-Not educated
-Uninsured
Why don't women follow mammogram recommendations?
-Less than 50% of women follow mammogram screening recommendations
-No family history of breast cancer
-Cost
-Time
-Lack of recommendation
-Fear
-Embarrassment
-Previous negative mammogram
Why do women say they don't do breast self-exam?
-I don't know how
-I don't think I can do it right
-I'm afraid I'll find something
-I think it is embarassing
What are the different ways to evaluate lumps?
-Mammogram
-Possibility of digital mammogram for younger women
-Ultrasound (is it cystic)
-Fine needle aspiration
-Excisional biopsy
-Sentinel node biopsy
How do they decide what surgery to perform for breast cancer?
-Depends on size of tumor
-How to control spread of cancer
-Satisfactory cosmetic results
-Psychological satisfaction of patient
-Conserve as much of the breast as possible, still works as well as radical mastectomy
What are the different types of surgery for breast cancer?
-Lumpectomy-just tumor is removed
-Lumpectomy w/lymph node dissection- tumor and lymph nodes removed
-Partial mastectomy-removal of the portion of the breast that contains the tumor
-Simple mastectomy- breast tissue and nipple are removed
-Modified radical mastectomy-breast tissue, nipple, lymph nodes are removed, but muscle is spared
-Radical mastectomy-breast, nipple, lymph nodes and pectoral muscle are removed
How does the number of nodes affect survival rates?
-No nodes (10yr survival) 80%
-1-3 nodes 40-50%
-4 or more nodes 25%
-Metastasis (5yr survival) 10%
What is the follow up after surgery for breast cancer?
-Follow breast conserving surgery with radiation.
-Chemotherapy for positive nodes
-Tamoxifen for 5 years
-Aromatase inhibitor
-Herceptin for HER2 expressing cancers
-Continue to be followed with mammograms
What is another management option for women that are at high risk?
Chemoprevention-this has been found to significantly reduce the incidence of breast cancer
-Tamoxifen (works well, but main side effect is endometrial cancer)
-Prophylactic mastectomy, should also have ovaries out as well, but usually women don't want to go through menopause
How can you improve women's health management?
-Teach all women BSE and screening guidelines
-Take good health histories
Use either the Gail or Claus model to screen for risk
Cervical cancer incidence statistics
-55,000 cases of carcinoma in the U.S.
-worldwide it is the leading cause of cancer death
-In US we use cheap screening the pap smear
What are the risk factors for cervical cancer?
-Young age at first intercourse (more likely to get HPV)
-Multiple partners (more likely to get HPV)
-High parity
-Lower socioeconomic status (less likely to get screened
-Smoking
-Non-barrier contraception
What are the screening guidelines for cervical cancer?
-All Women-yearly beginning at 21 or before if they are sexually active
-Once a woman has 3 sequential neg paps, chances are decreased
-A woman with 2 atypical paps should be referred to colposcopy
Connections between cervical cancer and HPV
-Strong association between HPV and cervical cancer
-Screening for cervical cancer in younger women with a history of HPV
HPV Vaccine
-Gardasil approved by the FDA last summer for use in HPV
-Incidence of HPV: highest 20-24
y/o
-Prevalence of high-risk types that vaccine protects against 0.5%-1.5%
How is cervical cancer managed?
-Once diagnosis is made if CIS, local removal of cancerous cells-LEEP procedure
-Hysterectomy is done for recurrent dysplasia
What is the primary prevention for cervical cancer?
-Health promotion and disease prevention
-Encourage young women to use condoms
-Encourage women to be screened annualy
-Get a good history from patients
Incidence of Endometrial Cancer
-Most common gynecologic cancer
-4th most common for women overall
-1 per 100 women
-Most common for women between 50-65
What are the risk for endometrial cancer?
-Older women
-Unopposed estrogen (HRT)
-Polycystic ovarian syndrome
-Obesity
-Prolonged reproductive years
-Diabetes
-Tamoxifen
What decreases the risk of endometrial cancer?
The use of oral contraceptives. The protection seems to last for 10 years.
What are the symptoms of endometrial cancer?
-Post menopausal bleeding, often spotting, 90% of endometrial cancers present this way
-In pre or peri menopausal women, see abnormal bleeding
(Not diagnosed by Pap smear)
When is screening done for endometrial cancer?
-Only done to symptomatic patients using endometrial biopsy or transvaginal ultrasound
-The older a woman is with unexplained bleeding, the more likely it is cancer
How endometrial cancer spread?
From the myometrium; through the ovary to abdomen; through lymphatic system
What is the treatment of endometrial cancer?
-TAH/BSO
- <50% invasion=radioactive implant
- >50% invasion=external pelvic radiation and pelvic nodes
-Chemo including progestin therapy is used for advanced disease
What are the survival rates for endometrial cancer?
-94% - early stage
-69% - regional stage
What is the primary prevention for endometrial cancer?
-Identify high risk women
-Place on oral contraceptives
-Do not give unopposed estrogen
-Teach peri-menopausal women signs and symptoms (bleeding & spotting)
-Make sure to question menopausal women about symptoms
-Screen for women on Tamoxifen
Incidence of Ovarian Cancer
-2nd most common gynecological cancer
-Leading cause of gyn cancer deaths
-26,000 cases per yr/15,000 deaths (higher ratio of death as opposed to breast cancer)
-75% are diagnosed in stage 3 or 4
-Very non-specific symptoms, spreads easily by lymph system
What are the risks for Ovarian Cancer?
-Age 50 or great
-Incessant ovulation (nulparity)
-Caucasian
-Family history of ovary, endometrium, breast or colon cancer
-Talc?
-Fertility drugs? (overstimulation of ovaries, could be the correlation)
What are some protective factors against ovarian cancer?
-Ovulation suppression
-Oral contraceptive pills
-Breast feeding (only if it is done for long long periods)
What is the screening process for ovarian cancer?
NONE AVAILABLE
-but you can use pelvic exam, transvaginal ultrasound or CA-125 (used to see if cancer has come back, not a good screener, lots of false positive)
What are the symptoms of ovarian cancer?
They are very non-specific: GI complaints-fullness, early satiety, bloating, constipation, urinary frequency
-Irregular bleeding is uncommon
What is the treatment for ovarian cancer?
-Referral to gynecologic oncologist
-Staging done with surgery
-TAH/BSO
-Omentectomy: Surgery to remove part or all of the omentum, a fold of the peritoneum (the thin tissue lining the abdomen) that surrounds the stomach and other organs in the abdomen.
-Explore upper abdomen for signs of cancer
What are th survival rates for ovarian cancer?
-5 year survival is 39%
-If found locally 88%
-Extremely deadly cancer