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147 Cards in this Set
- Front
- Back
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A Condition of failure of one or both testes to decend into the scrotal sac is known as?
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Cryptorchidism
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A normal retraction of the testes when stimulated by stroking the thigh on affected side downward?
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Cremasteric Reflex
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At what age does testicular cancer usually occur?
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Between Ages 15-35
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A condition that occurs in men who have an extra X chromosome in most of their cells
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Klinefelters syndrome
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Characteristics of Klinefelters syndrome?
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Infertility
Decreased testosterone less body hair not muscular atrophy testicles (smaller) |
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Risk Factors for Testicular cancer?
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- Family hx of Testicular Ca
- Abnormal testicular development - Klinefelters Syndrome - Crytoporchism - HIV + |
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4 Signs and symptoms of testicular Cancer
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1. Mass within Scrotum
2.Painless swelling or nodule in one testicle 3. Heavy,dull ache or pain, discomfort in scrotum or lower abdomen 4. back pain - Mets to retropertoneal lymph nodes. |
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is an area at the back of the abdomen behind the intestines
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retroperitoneum
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Lymph nodes located in the area at the back of the abdomen behind the intestines
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Retropertinoneal lymph nodes
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5 ways to Dx testicular Cancer
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1. Palpation of the testicle
2. Testicular sonogram & MRI 3.Elevated levels of Blood 4.Elevated LDH 5. Transillumination |
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a procedure where the room light is dimmed or turned off and a bright light is pointed at a locationon the body
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Transillumination
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Tumor markers that are elevated when patient has testicular cancer
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AFP : Alpha -fetoprotein
HCG : Human Chronic Gonadotropin |
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Classifications of Testicular tumors?
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Germinal Tumors & Non Germinal Tumors
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Two types of germinal tumors
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Seminomas and Nonseminomas
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A slow growing form of testicular cancer, usually found in men 30's & 40's. This type can spread to lymph nodes but is mostly localized in testes?
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Seminomas
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Most common form of testicular Cancer which spreads quickly and made up of different cell types.
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Non Seminomas
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Different types of cell types of non seminomas?
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-Embroyonal carcinomas
-Teratomas -Yok Sac Tumors |
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When is testicular Self examination education started ?
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Adolescence
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What is the best time to do a Testicular Self Examination?
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After a warm bath or shower
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How often should a male do a Self exam of his testicles?
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Once a month
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When should the patient notify the HCP in regards to (TSE)?
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Signs of:
- Induration (Hardness) - Enlarged - Atrophied (Shriveled) - Painful |
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Removal of the Testes used to diagnose and treat
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Orchiectomy
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commonly referred to as RPLND
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Retroperitoneal lymph node dissection
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is a procedure to remove abdominal lymph nodes to treat testicular cancer, as well as help establish its exact stage and type.
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Retroperitoneal lymph node dissection
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High impotence & infertility due to retrograde ejaculation is involved in this procedure
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Retroperitoneal lymph node dissection
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Teatments of testicular cancers is followed by what?
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Chemo and Radiation
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A newer procedure for testicular cancer is known as
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laparoscope node dissection.
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Medication used as preventative for 18-24 months after last cycle of chemo for testicular cancer
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Birth control
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types of chemotherapy medications used in testicular cancer
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(Taxol) Paclitaxel
(Toposar) Etopside (platinol AQ) Cisplatin |
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Complications that can occur due to radiation?
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Irritable Bowel
Skin reactions Fatigue Nausea Temporary/Perminant infertility |
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If early diagnosed what is the percent of survival of testicular cancer?
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80-90%
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How is testicular cancer staged?
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With an MRI and CT
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What is the follow-up care for the patient with Testicular Cancer
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F/U:
- Self Testicular Exam - CT Scans - Tumor Markers |
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Most common malignancy of female genital tract?
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Endometrial Cancer
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Related to overstimulation of endometrium by excessive circulation estrogen is known as
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Endometrial cancer
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What is the highest risk factor for endometrial cancer
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High cumulative exposure to estrogen
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clinical manifestations of endometrial cancer?
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Postmenapausal bleeding
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Annual screening with a biopsy should be done for high risk cases of what type of condition?
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Endometrial Cancer
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What is a precursor of endometrial cancer?
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endometrial hyperplasia
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the build up of extra cells is known as
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hyperplasia
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This type of cancer is developed in the grandular cells or the endometrial lining of the uterus
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Endometrial Cancer
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Most Endometrial cancers are catogorized by?
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Adenocarcinomas which are slow growing cancer cells
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Treatments for endometrial cancers
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-Internal radiation therapy
- External radiation - hysterectomy: total & bilateral salpingoophorectomy -Meds: progesterone |
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Medications given to patient for treatment of endometrial cancer
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Progesterone for recjrrent diease.
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types of surgical treatment for endometrial cancer
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Total hysterectomy & Bilateral salpingoophorectomy
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Radioisotope placed in the vagina for 1-3 days. Bed rest is encouraged with HOB at 20 degree elevation
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Internal Radiation therapy (IRT)
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This method of delivering radiation destroys cancerous cells at the skin surface or deeper in the body
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External Radiation Therapy
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Risk factors/Etiology of cervical cancer?
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- multiple sex partners
- early intercourse -hx STD's HSV-2, HPV -untreated Cervicitis - Low socioeconomic status |
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Early symptoms of Cervical Cancer
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-Thin Watery DIscharge
- Bloody spotting after coitus or douching - Metrorrhagia -Polymenorrhea -Post menopausal bleeding |
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Late symptoms of cervical cancer
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-Dark foul-smelling discharge
-Flank Pain -Weight Loss -Anorexia -Leg Edema -Dysuria -Rectal bleeding |
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5 types of Cervical Cancer Management
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-Pap Smear
-Thin Prep -Colposcopy -Cryotherapy -Loop Electrocaudery |
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Primary Diagnostic tool for Dx of cervical Cancer
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Pap Smear
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Newer pap test that collects cells from the cervix and smears them on a glass slide
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Thin Prep
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Provides an in SITU macroscopic exam of vagina and cervix. Performed after abnormal Pap Test. Useful in identifying suspecious lesions
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Colposcopy
Definitive Dx = Biopsy |
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Freezing with nitrous Oxide. Destruction of cells by extreme cold
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Cryotherapy
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Removal of abnormal cells. Excision of cervical areas affected.
This procedure allows the pathologist to examine the removed tissue sample to determine the borders of the tissue that are dieased free. |
LEEP Procedure
Loop Electrocaudery |
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LEEP procedure is ..
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An Outpatient Procedure which only takes a few minutes.
Analgesics given before procedure. Anesthetic agent is injected into the area or removal. |
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When should an inital pap smear be done?
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at the age of 21 or after first sexual intercourse
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A patient with cervical cancer can discontinue yearly pap smears true or false?
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False.
Pap Smears are continued after menopause and hysterectomies |
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What is Bethesda Classification System for?
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Classification for Pap test Results
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Bethesda Classification system (pap test) , Findings are described as
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Negitive or having epithelial cell abnormalities
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Pap test abnormalities are classified as what two types
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squamous cell or glandular cell
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After a cervical biopsy what information should the nurse tell the patient
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-Avoid strenous activity for 24 hours.
-Leave vaginal packing in for 24 hours. -Abstain from intercourse for 24 hours. -Avoid tampons and douching |
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Treatment : Either Internal (radium implant) or External for invasive cancer
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Radiation
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Treatment is used for early cervical cancer.
-Curative -Induces menopause -Not given to the pelvic wall |
Radiation
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3 Types of treatment used in Cervical Cancer
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-Radiation
- Radial hysterectomy with Pelvic Lymphadectomy -Chemotherapy |
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Treatment for cervical cancer that is given for unresectable tumors and has a poor effect
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Chemotherapy
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Leading cause of death from genital reproductive malignancies
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Ovarian Cancer
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Most Ovarian cancers are known as
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Epithelial tumors or some adenocarcimomas
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Ovarian Cancer 5 Manifestations
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-Pelvic Pressure
-abdominal Distention, Constipation and indigestion -Spreads to ovaries and other structures -Involves Pelvic and Para Aortic lymphnodes -Abnormal Bleeding if endometrium is stimulated |
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Ovarian Cancer Test to Dx
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-Ca 125
-Ultrasound -Laparoscope -CT Scan |
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Tumor marker for Ovarian Cancer. Highly specific to epitheal ovarian cancer
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Ca 125
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Used to detect ovarian size and detect mass
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Transvaginal or transabdominal ultrasound
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Test used in Ovarian cancer to determine definitive dx and organ involvement. Maybe unable to determine benign or malignant
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Laparoscope
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Test used in ovarian cancer to reveal areas of METS is any.
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CT Scan
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3 Treatments used in Ovarian Cancer
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-Surgery
-Chemotherapy -Radiation therapy |
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Uterus is removed through vagina, there isno adbominal incision
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Vaginal Hysterectomy
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uterus is removed through abdominal incision
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abdominal hysterectomy
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Includes Uterus, Ovaries and Possible Lymph nodes.
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Total Abdominal hysterectomy
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Post- Op Hysterectomy Management
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-Fluid Volume evaluation
-Prevention of Pulmonary complications -Prevention of DVT -Assessement of Bleeding |
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Assessment of bleeding for Hysterectomy can be evaluated by
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-Quality of bleeding
Frank vs. Seriousangious -# of Pads per shift -Assess for blood pooling under client |
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Usually left in place for 24-72 hours in the endometrial cavity and vagina
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intra cavity implants
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May stimulate severe uterine contractions
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Internal Radiation
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Not Curative but hope to achieve remission of disease
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Chemotherapy
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What can the nurse do to prevent dislodgement of the intra cavity implant
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position body flat to a 20 degree angle in bed
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does the patient have restrictions with visitors when they have the intra cavity implant?
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Yes, Patient is isolated in a private room until application is complete. Adjacent rooms may need to be evacuated and a lead sheild placed at the door way
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What may the patent develop from the intra cavity radiation treatment
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Patient may develop foul smelling discharge from destruction and floughing of cells.
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a women who has never given birth
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Nullipara
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indicates the number of times the patient has been pregnant, regardless of whether these pregnancies were carried to term.
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Gravida
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women in their 20-30's should go get a breast exam?
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At least every 3 years then preferably annually after 40
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Annual Mammogram usually begins at what age
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40
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When is the best time to perform BSE
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days 5-7 after first day of menses
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When is a good time for a menopausal women to do a BSE
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Same time Monthly
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Where is the best place to perform BSE
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in the shower with soapy hands to glide over the breast and focus on underlying tissue
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What important area should the nurse include about BSE to the patient
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The area between the breast and the underarm as well as the underarm itself
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a modality used for early detection of breast cancer?
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Breast self Examination
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A Breast imaging technique that has been shown to reduce breast cancer Mortality rates
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Mammography
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This type of test can detect nonpalable leasons and assists in diagnosing palable masses
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Mamography
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Individuals that are at increased risk because of strong family hx should begin screening when?
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10 years earlier than age at which family member developed
*not before age 25 |
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A procedure that involves injecting of less than 1ml of radiopaque material through a cannula inserted into the ductal area of the areola which is then followed by Mammogram
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Galactography
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Why is an Galactography performed?
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to evaluate an abnormality with in the duct when the patient has bloody nipple discharge
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Test used to help distinguish fluid filled cysts from other lesions . Lubricated jelly is spread over the area to be imaged by a transducer
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Ultrasonography
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Ultrasonography can diagnosis ? Rule out?
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diagnose Cysts but CAN'T rule out malignant leasions
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Contrast Dye with a coil placed around the breast. Patient is placed inside for 30-40 minutes.
Most useful with patients that have breast cancer or undetected |
MRI
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Performed on an outpatient basis to sample palpable and nonpalpable lesions
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Percutaneous Biopsy
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Noninvasive biopsy technique that is generally well tolerated.
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Fine Needle Aspiration
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Fine needle Aspiration
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Local Anesthetics-Maybe
Small gauge Needle 25-22 Needle is attached to suction, which is applied to syringe and passed through mass. Simple cyst- aspirated and discarded no fluids obtained-hub of needle is spread on glass slide and sent to lab |
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Core Needle Biopsy
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similar to FNB
larger gauge needle -14 gauge local anesthetics tissue core is removed actual tissue removed |
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preparing the client for a mamogram advise the patient ...
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not to use talcum powder or deoderant before procedure..
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When is a mammogram best performed
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The first 2 weeks of the menstrual cycle so minimal cystic changes are present
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Surgical removal of tissue from the breast mass
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Incisional biopsy
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Removes the mass itself for histologic exam
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Excisional biopsy
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Removal of tissue or fluid from the breast mass through a large bore needle
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Aspiration therapy
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Breast conserving is also known as
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Lumpectomy
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Skin coloring and thickening, large pores with an orange peal appearance.
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Peau d' orange
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Clinical Manifestations of breast Cancer
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-Asymmetry of the breast
-Skin dimpling or flattening -Nipple deviation, Discharge -Mass is painless, nontender, hard and irregular in shape, nonmobile |
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Majority of malignant lesions are found
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in the upper outer quadrant of the breast (tail of spence)
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Pathophysiology of breast cancer
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Tumor which begin in the ductal lobular epithelial cells of the breast and spread via lymphatic system to axillary nodes.
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Types of Breast Cancer
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Ductal or Lobular Carcinomas
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Common areas that majority of breast tumors occur in
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the left breast and in the upper outer quadrant
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Lesion detected by a mammography and needle used to identify non palpable lesionin breast
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sterotactic needle guided biopsy
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Staging Tumors
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T-Tumor
N-Regional Nodes M-Metastasis |
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Serum Tumor markers for breast cancer
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Ca 125
CEA CA 15-3 |
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Supports breast tissue but becomes contracted in breast cancer causing pitting and dimples
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coopers ligaments
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accommodates an implant, skin that remains after the mastectomy is gradually stretched by this process
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Breast reconstruction with tissue expander
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Tissue expander procedure
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Surgeon placess a balloon like device through incision and injects a small amount of saline in 6-8 week intervals
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Autologous reconstruction is the use of the patients own tissue to create a breast mound. A Flap of skin , fat and muscle with attached blood supply is rotated to mastectomy site.
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Breast reconstruction with TRAM
Transverse rectus abdominis myocutaneous |
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Back muscle is rotated from to the mastectomy site
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Breast reconstruction latissimus dorsi flap
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MOST COMMON
removal of all breast tissue and axillary lymph nodes, Pectoralis muscle stays intact. |
Modified Radical Mastectomy
Preservation of the muscle helps reduce edema |
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destroys malignant cells with minimal exposure of normal cells
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Radiation
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Damage DNA and interfere with cell division
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Chemotherapy
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Competitors for hormones at receptor site slow down tumor growth
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Hormonal manipulation
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interleukins/Interferon
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Immunotherapy
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Used as adjunctive therapy for stage 1 & 2 breast Ca
Reduces the rate of recurrence May be given with Chemo May be External Beam or Iridum Implant |
Radiation therapy
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Given as Adjuvant systemic treatment for stage 1 & 2 Breast CA following surgical intervention
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Chemotherapy
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Chemotherapy medications
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5FU
Taxol Methotrexate Adriamycin Cytoxan |
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Adjuvent Systemic Therapy is not given to women with
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0.5cm or less in diameter mass without node involvement
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Widely used to treat recurrent or metatastic Ca
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Hormornal Therapy
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Adjunctive Medication is indicated for ductal cancer in situ. Reduction of breast cancer risk is higher risk patients
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Tamoxifen Citrate
(Nolvadex, Tamofen) Nonsteroidal Anti-Estrogen |
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Tamoxifen Citrate action:
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Antineoplastic Action: cytoxin action. Blocks Estrogen receptors within tumor cells which require estrogen to survive.
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Use caution when on tamoxifen because
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Pregnancy Class D- Use BC
Can increase Gyn Ca - Pap Smear |
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Adverse reactions to Tamoxifen
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N & V
diarrhea Vaginal Discharge Bleeding Amenorrhea Leukopenia Thrombocytopenia PE Hot flashes |
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WHile taking Tamoxifen the patient has iniial bone pain why?
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May mean a good response to medication shortly after therapy
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What should the nurse monitor with a patient on Tamoxifen?WHy?
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Serum Calicum levels
BC bone mets may increase levels |
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After wound has heal what ROM exercises should the patient perform?
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Abduction and external rotation arm excercises
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What ROM excercises can the patient perform while in recovery from a mastectomy
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FLexion and Extension
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What can occur to the patient post op of a mastectomy or even years later?
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Edema
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