10/12/20
Genitourinary Cancers
Part 2
1
Outcomes Related to this Lesson
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Correlate the epidemiological factors, pathophysiology, clinical manifestations, and nursing
management of clients experience the following genitourinary cancers:
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Differentiate pertinent diagnostic studies and lab findings used to confirm the diagnosis of
genitourinary cancers
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Compare collaborative treatments used for the management of genitourinary cancers
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Prioritize nursing interventions for managing genitourinary cancers
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Design a discharge teaching plan that includes dietary and lifestyle considerations for clients with
genitourinary cancers
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Formulate a comprehensive teaching plan for clients experiencing or recovering from specified genitourinary
cancers
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Perform and document in the EHR a physical examination of clients affected by genitourinary cancers
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Utilize SBAR to communicate client information to the supervising nurse
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Breast Cancer
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Uterine/Endometrial Cancer
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Breast Cancer
3
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Definition of Disease process
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Pathophysiology/Etiology
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Review this information in the Lewis text and your pathopharm text.
Tumors of the breast
Can effect both men & women
2nd most common cause of cancer
2nd most common cause of death
Incidence is slowly decreasing
Breast cancer survivors are largest group
Etiology & risk factors for women - family hx,
environmental factors, genetics, early menarche,
late menopause, 60 or older
Most who develop have no identifiable risk factors
Hormonal regulation is related to breast cancer
development - poorly understand
Combined hormone therapy - can increase risk of breast
cancer - small increase risk (larger tumor size at diagnosis)
High tumor stage as diagnosis
Estrogen alone may increase risk after 15 years of taking it
Modifiable - excess weight gain during adulthood,
sedentary lifestyle, smoking, excess dietary fat intake,
obesity, excess alcohol intake, environmental factors,
radiation exposure, 10% genetic
Genetic link is stronger - family member had a hx of
ovarian cancer was premeno - bilateral breast cancer
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First degree family member of breast cancer - risk doubles
10/12/20
Breast Cancer
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CLINICAL MANIFESTATIONS
Lump that has not been present before
Thickening or mammographic abnormality in the breast
Rate of lesion growth varies
Palpable - feels hard, irregular, borders are indistinct
Not going to move, painless
Nipple discharge or retraction of nipple
Dippling of the tissue - or tissue may be red or swollen
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Breast Cancer
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Diagnostics
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Breast Cancer
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Interprofessional Care
Radiologic studies
Mammogram
Digitial mammography - more accurate in younger women
3d mammography
Ultrasound in conjuction with mammogram
if abnormality is found
MRI
Biopsy - high risk - fine needle aspiration of lung
Vacuum assisted biopsy - very large needle introduced
tissue is vacummed
Exigency biopsy - remove mass itself
Wide range of treatment options
Critical pt & HCP work together to make decisions
Treatment plan depends on prognostic
Stage & biology of cancer
Surgical intervention, radiation, drug, hormone,
immunotherapy, targeted therapy
Surgical procedures for operable breast cancer:
Breast conservation therapy (lumpectomy)
MUST HAVE Radiation following to entire breast
Segmental mastectomy
Mastectomy with or without reconstruction
Lumpectomy - removing tumor with a margin
of normal tissue around it
If chemo - prior to radiation therapy
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10/12/20
Breast Cancer
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Nursing Interventions
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Reducing risk factors
Healthy weight, exercise, limiting alcohol,
eating nutritious foods, low fat diet, no smoking,
complying with screening guidelines
Risk reduction options for high risk pts:
Genetic testing- consider prophylactic ovary and tube removal
& breast surgery
Assist to be able to cope with the diagnosis
Pre and post op pain control and care
Mobility restrictions and post op exercises
Recovery period - follow up
Premedicate prior to exercises
Drain care is needed and taught
Restoring arm function on affected side is a key
nursing goal - reach for recovery - support group
Report symptoms post op - fever, inflammation,
eryhtema, unusual swelling
Garment that have foam breasts within them
Psychosocial support is a must
Offer coping skills
Breast Cancer
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Nursing Interventions
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Breast Cancer
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Complications
Recurrence and metastasis
Local - skin
Regional - lymph nodes
Distance - bones, brain, lungs, liver,
bone marrow, spinal cord
Lymphedema - accumulation of the lymph
in the soft tissue of the affected mode
Lymph node sampling or radiation therapy
Axillary nodes cannot return lymph fluid to the central
circulation because they have been removed
or damaged - obstructive pressure on veins
Post breast therapy pain syndrome - nerve injury
to chest wall during surgery
Chemo complications - can be mild to debilitating
pain tingling aching numbness edema itching
Treatment - NSAIDS, low dose antidepressents,
antiseizure drugs
Phantom breast pain
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10/12/20
Breast Cancer
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Patient Education
10
Breast Cancer
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Patient Education
11
Uterine/Endometrial Cancer
12
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Definition of Disease process
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Pathophysiology/Etiology
Yearly mammograms
Start age 45
45-54 YEARLY
55 - start to get every 2 years
Continue screening as long as overall
health is good
Clinical breast exams annually
Increased risk - earlier 3d screening
Family hx - breast MRI, more frequent
clinical breast exams
Self breast exams - self awareness
Normal look & feel of breast
Return demonstration with pt
Drain care, report symptoms fever,
inflammation, swelling
Continue with follow up routine
Ongoing monitoring and self care
Prevent and reduce lymphedema
No BP, vein, injections on that side
Arm should not be dependent for long periods
Preventing infections, burns, compromised
circulation of that arm
Exercise - normal weight
Special garment choices, breast prosthesis
Breast cancer survivorship care - 1-4x a year HCP for first 5 years
Annually after that
Reccurence is usually at surgical site
Do mammograms
Breast cancer is men is rare but does occur
Same treatments - may have body image issue
Uterine lining or the endometrial lining
where cancer arises
Most common gyne cancer
Low mortality rate when diagnosed early
88% survival rate
Reduced riisk - pregnancy, BC pills, IUD,
physical exercise
Most tumors are adenocarcinomas - can invade the myometrium
and regional lymph nodes if not diagnosed early
Metastatic sites - lung, liver, brain & bone
Prognosis depends on tumor size, cell type,
degree of invasion, and metastasis
Risk factors - exposure to estrogen - estrogen therapy
without progesterone therapy, obesity, adipose cells
store estrogen, age, early menarche, late menopause,
smoking, diabetes, family hx of hereditary
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10/12/20
Uterine/Endometrial Cancer
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Clinical Manifestations
Early - abnormal uterine bleeding
Any women over 35 - bleeding inbetween periods
with uterine cancer until proven otherwise
NEEDS TO BE EVALUATED
Bleeding after menopause - likely cancer
Dysuria, dyspareunia (painful intercourse),
weight loss, pelvic pain
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Uterine/Endometrial Cancer
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No routine tests
Diagnosed early due to post menopausal bleeding
Endrometrial biopsy - main test
Diagnostics
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Uterine/Endometrial Cancer
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Interprofessional Care
Total hysterectomy
Bilateral salpingo-oophorectomy
lymph node biopsies
radiation can be done for local or distanced
Chemotherapy, hormonal therapy - for advanced
or recurrent
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5
10/12/20
Uterine/Endometrial Cancer
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Nursing Interventions
Family hx of cancers of uterine, stomach, liver,
kidney, brain, skin,
ovarian, colorectal
Hx of 2 of these cancers means a referral for
genetic testing - can indicate lynch syndrome
Assess for pain & provide meds as ordered
Infection at surgical site
Fever, wound care
Early ambulation
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Uterine/Endometrial Cancer
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Patient Education
Report signs and symptoms of infections
Excessive bleeding
Scant bleeding after surgery - expected
Not recommended to drive 4 weeks after surgery
Post op appointments
Pain management - no opiods after 3 days
NSAIDS should be ok
Stool soft - to prevent straining
Will be infertile - pt needs to know
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