Female

Reproductive cell
cancers
REPRODUCTIVE CELL CANCER
CERVICAL CANCER—TEAL AND WHITE
CERVICAL CANCER
DEFINITION
 Cervical cancer is a malignant tumour deriving from
cells of the Cervix
 Various strains of the human papillomavirus(HPV) a
sexually transmitted infection play a role in causing
most cervical cancer.
INCIDENCE
 Cervical cancer is the fourth most common cancer in women world
wide
 It is the disease that develops quite slowly and begins with a
precancerous condition known as dysplasia..
CONT…..
RISK FACTORS
Family History/ Hereditary
Age: 30- 39 and 60 – 69 year
Smoking in women
Menstrual irregularities
Low socio economic status.
Oral contraceptive pills
Unprotected sex
Weakened immune system
TYPES OF CERVICAL CANCER

Ecto-cervix squamous Endo-cervix

cell carcinoma Adenocarcinoma

Types of cervical cancer

 CONT….
 Ecto -Cervical Squamous Cell Carcinoma( outer):
• This type of cervical cancer begins in the thin squamous cells lining the
outer part of the cervix which projects into the vagina. Most
cervical cancers are squamous cell carcinoma.

 Endo-Cervical Adenocarcinoma (inner): This type of cervical

cancer begins in the column- shaped cells that line the inner part of
cervical .
PATHOPHYSIOLOGY
Etiological interference esp involvement
of HPV

Cervical cell differentiation or cellular

infection

Cervical epithelial changes

Normal cervical cell changes to

Dysplasia and then to malignant changes
 CLINICAL MANIFESTATIONS
Early detection is difficult

Abnormal PAP smear result

Excessive Leukorrhoea---vaginal discharge, Discharge: thin and watery;

becomes dark and foul smelling.
Intermenstrual bleeding

Pain is the late symptom.

Metrorrhagia---Abnormal excessive vaginal bleeding

CONT….
Weight loss

Anemia

Cachexia.: a wasting syndrome that leads to loss of

skeletal muscle and fat
Cervix is usually hard to feel .
 CLINICAL MANIFESTATION
Other Manifestations:

Pressure on the bowel/bladder/ both

Bladder irritation
Rectal discharge
Ureteral obstruction
Abdominal pain

Fistulae may form

DIAGNOSIS
 History collection
 Physical examination
PAP Smear
 Blood Test
 Biopsy
 Radiologic Examination

Pap smear and biopsy----gold standard test

 PAP SMEAR TEST –PAPANICOLAOU
TEST

A Pap smear is a procedure to test for cervical

cancer in women.
A Pap smear involves collecting cells from the
cervix
PURPOSE

To detect cervical To detect

cancer abnormal
estrogenic activity
WHEN TO DO……

Can be done after 21 years

Usually done 2 weeks after the

menstruation
 PROCEDURE
Patient will lie in lithotomy position
Doctor will gently insert an instrument called a
vaginal speculum into the vagina.
The speculum holds the walls of the vagina apart so
that doctor can easily access the cervix.
After that doctor will collect samples of cervical
cells using a spatula brush called cervix brush
LITHOTOMY POSITION
VAGINAL SPECULUM
CERVIX BRUSH
CERVIX BRUSH
NURSING CARE ---BEFORE PROCEDURE
Ensure the correct date of doing the test–2 weeks
after menstruation
Advice the patient to avoid sexual intercourse for
2 days—may interfere with the normal results
Refrain from the use of birth control measures
Avoid vaginal lubricants or medications for at
least 48 hrs.
CONT…
Advice the patient to void before test
Provide privacy
Assist in Lithotomy position
Drape the patient with minimal exposure
DURING THE PROCEDURE
Explain the steps in the procedure
Encourage the patient to do deep breathing while
inserting the vaginal speculum so as to help the
pelvic muscle to relax
Focus the light properly to obtain the required
cellular specimen
POST PROCEDURE
Observe the patient for any abnormal bleeding/
vaginal discharge
Perineal care with normal saline
Assist the patient to be in supine position
Documentation
Sent the specimen to lab with correct
LABELLING
RESULT
Normal/ Negative---No identifiable cellular
abnormality

Positive result—Presence of HPV infection,

presence of atypical cells, presence of squamous
cells/ adenocarcinoma
MANAGEMENT
Chemo- Surgery
therapy

Radiation Immuno
therapy therapy
 SURGICAL MANAGEMENT
 Conization---Cone shaped excission
 Cryosurgery
 Laser therapy
 LEEP- Loop Electrocautery Excision Procedure
 Hysterectomy
CONIZATION—CONE SHAPED EXCISION
A procedure in which a cone-shaped piece of abnormal
tissue is removed from the cervix using a scalpel or laser
knife.
LOOP ELECTROCAUTERY EXCISION PROCEDURE

Loop electrocautery excision procedure (LEEP) uses a wire loop heated by electric
current to remove abnormal cervical cells
 CRYOSURGERY
• A procedure in which an extremely
cold liquid or an instrument
called a cryo-probe is used to freeze
and destroy abnormal tissue.
• Cryo- probe consist of Volatile gases
such as nitrous oxide or carbon
dioxide (frozen) is commonly used.
LASER THERAPY
Cervical malignant tissues are destroyed by
the usage of LASER energy
TOTAL ABDOMINAL HYSTERECTOMY
An abdominal
hysterectomy is a
surgical procedure
that completely
removes the uterus
through an incision in
the lower abdomen.
TAH
CHEMOTHERAPY REGIMEN

Vincristine
Bevacizumab
Bleomycin
Cisplatin
Paclitaxel
PREVENTION -----HUMAN
PAPILLOMA VACCINES
 NURSING DIAGNOSIS
 Acute/ Chronic Pain related to cancer and treatment effects as evidenced by pain
scale score and facial expression.
 Imbalanced nutrition less than body requirement related to anorexia vomiting as
evidenced by weight loss.
 Impaired skin integrity related to treatment regimen as evidenced by mucocitis.
 Anxiety related to diagnosis of cancer as evidenced by talking with family
members.
 Risk for infection related to immune suppression
 Impaired urinary elimination retaled to surgical incision
CA OVARY
Definition

Ovarian cancer is a growth of cells that forms in

the ovaries esp epithelial cells, germ cells or
stromal cells .
ETIOLOGY
Family history
Age
Nulliparous women—Women who hasn’t given birth to
a child
Early start of menstruation and late start of menopause
Hormone therapy
Obesity
Other cancers
TYPES
Epithelial cell tumors---affecting the epithelial
lining of the ovary
Germ cell tumor----tumor growth in the germ
cells (Ovum)
Stromal cell tumor----Tumor growth in the
stromal cells(connective tissue in the ovary)
PATHOPHYSIOLOGY
Stimulate the
Rapid
Estrogenic genetic oncogenes
proliferation and
changes in the in the epithelial/
lack of
ovary germ cell/
differentiation
stromal cells

Metastasis to
near by
structures
Malignancy in
uterus, vagina,
the ovary
cervix, vertebra,
liver and then
lungs
CLINICAL FEATURES
Early symptoms
Pain in the pelvis
Pain in the lower side of the body
Severe back pain
Pain during sexual intercourse
More frequent and urgent urination
DIAGNOSIS
CBC
USG
Laparoscopy
CT/ MRI
PET scan
Trans vaginal USG and Biopsy---confirmatory
test
TREATMENT
Chemotherapy—Combinations:
PEB: Platinol + Etoposide+ Bleomycin
Other drugs
TIP: Topotecan + Ifosfamide+ Paclitaxel
Radiation therapy---Usually Brachytherapy
PREVENTION AND EARLY DETECTION
Regular blood check ups---ca ovary tumor
markers—CA 125
Transvaginal USG and Biopsy in case of
symptoms
Pelvic Exam---To assess any abnormal growth
NURSING MANAGEMENT
Correlation of clinical symptoms and prompt
diagnosis
Pain medications __Opioid injections
Perineal care ---instruct to wash perineum with soap
and clean water or normal saline
In case of fertile women---Instruct the patient to
refrain from sexual activities and to adopt birth
control measures(avoid pregnancy)
Advice the patient to perform KEGAL exercises to
obtain proper Bladder control
CA UTERUS
UTERUS
The uterus is a hollow muscular organ located in the female
pelvis between the bladder and rectum.
 It accommodates the embryonic and fetal development of one
or more embryos until birth.
The uterus is a hormone-responsive sex organ
The uterus has three layers, which together form the uterine
wall.
 Endometrium, myometrium, and perimetrium
 DEFINITION AND INCIDENCE
Carcinoma affecting the lining of the uterus,
commonly in endometrium
Abnormal Adenomatous growth in the endometrial
lining
Incidence
Most common in post menopausal women
Commonly occur after 40 years
RISK FACTORS
Family history
Old age
Early menarche
Late menopause
Nulliparous
Imbalance in estrogen(Obesity, PCOS, HRT)
Long term Tamoxifen use
Chronic DM
PATHOPHYSIOLOGY

Stimulate the Rapid

Estrogenic/
genetic oncogenes proliferation and
Atrophic changes
in the lack of
in endometrium
endometrium differentiation

Metastasis to
near by Malignancy in
structures vagina, the endometrial
vertebra, liver lining
and then lungs
CLINICAL FEATURES

Asymptomatic
ABNORMAL BLEEDING
POST MENOPAUSAL BLEEDING
Menorrhagia—heavy or prolonged
vaginal bleeding with menstrual cycle
CONT…
Post Coital heavy bleeding
Blood stained vaginal discharge
Hematometra---Abnormal collection and retention
of blood in the uterus
Pyometra---Abnormal collection and retention of
pus in the uterus
DIAGNOSIS
1. H/PE
2. Pelvic examination
Speculum examination---to assess any vaginal/ cervical
obstruction
Bimanual examination---To assess any enlarged or
atrophic uterus
Transvaginal endoscopy—to assess endometrial thickness
Hysteroscopy and endometrial biopsy(gold standard
test)---FIGO staging
FIGO STAGING
Stage 0—Hyperplasia of uterus
Stage I—Tumor limiting to uterus
Stage II--- Tumor extension to cervix
Stage III---Tumor extension to vagina
Stage IV---Tumor extension to other
organs(Distant mets)
TREATMENT
1. Surgery---Hystrectomy( Removal of Uterus)
2. Chemotherapy
Hormonal replacement --- Progestin 2-10mg
daily Injection
Carboplatin, Paclitaxel, 5FU,
Cyclophosphamide
3. Radiation
Usually Brachytherapy
 NURSING MANAGEMENT
Health education regarding --Regular
screening after menopause
Identification and correlation of clinical signs
of uterine cancer
Preparation to diagnostic test
Chemo and Radiation care
General care after surgery
 CONT.….
Hydration of patient with IV fluids
BLOOD TRANSFUSION in case of severe bleeding
Maintenance of perineal care using saline or clean
water
Prevention of perineal infection
Prophylactic antibiotics