Uterine Cancer Pathophysiology:

Excessive increase estrogen

Suppress LH & FSH

Slows ovarian cycle

Increase reformation of endometrial lining and regeneration

Normal cells continuously growing and old cells do not die

Extra cell form together

Tumor

Endometrial cancer

Precipitating factors: Hormone replacement therapy (HRT):

estrogen Obesity (increase estrogen) Lifestyle: exposure to carcinogens Sexual activity: nulliparity

Predisposing Factors”: Age: over 50 years old Race: black Americans Genetic Disease: endometrial hyperplasia,

colorectal menstruation Physiological changes: early menstruation,

late menopausal stage, amenorrhea

Unusual vaginal bleeding

Watery malodorous vaginal discharge

Pain Bladder dysfunction

Pathophysiology of Breast Cancer

Changes in the structure & function of the cellat the genetic or molecular level

Genetic mutation (BRCA1, BRCA2, PS3)

Additional assaults to the cell

Further genetic damage

Malignant conversion of cells

Malignant cells continue to grow relentlessly

Malignant tumors confined in the ductal-lobular Epithelial cells of the breast (carcinoma in situ)

Tumor size increased

Non-Modifiable: Age(after age 50) Sex (women) Family history Ovarian & hormonal changes( early

menarche, nulliparity, late menopause

Modifiable: Environmental pollutants (ionizing

radiation) Obesity Alcohol intake

Tissue pressure & mechanical expansionCells at the center becomes hypoxic

Painless, non-tender, irregularly shaped, non-mobile masses

Nipple discharges Indurations Dimpling and

orange appearance of the skin

Cells begin to seek it’s own blood supply

Establishment of cancer cells at the secondary site (metastasis)

Development of new blood supply (Angiogenesis)

Increase in tumor size

Another metastasis

Invades surrounding tissuePenetrates blood or lymph vessels

Pathophysiology of LUNG CANCER:

Changes in genome or somatic cell(Airway epithelial cell)

Expression of altered gene products

Loss of regulatory gene products

Malignant neoplasm (TUMOR)

Tumor will continually grow

Risk Factors: Cigarette smoke Second-hand smoke Environmental and occupational

exposure(asbestos & radiation ) Genetics Dietary factors (diet low in fruit & veg.)

Activation of growth promoting gene(Oncogene)

Inactivation of growth inhibiting gene(Cancer suppressing gene)

Partially obstruct the airway lumen or grow to an extent that it

completely blocks the airway

Hemorrhage

Hemoptysis

Irritates the airway

Stimulates goblet cells and mucus secreting glands

Excessive mucus production

Cough

Sputum production

Metastasis to other thoracic structures, brain, liver, bone, & renal

Post-obstructive lobular collapse

Impaired gas exchange

BRAIN

RESPI

CARDIO

KINDEY

CELL

Decrease O₂ Increase CO₂

Respiratory acidosis

Increase unoxygenated blood

Cyanosis

Lethargy & confusion

RR (tachypnea)

HR (tachycardia)

Release of erythropoietin

Stimulates bone marrow

RBC production

Polcythemia

Anaerobic respiration

Lactic acid

Fatigue

Pain

Weight Loss

Lung CancerStatistics • The leading cancerous death• Second most common cancer• About 200,000 cases annually• An estimated 159,390 people will

die from lung cancer this year. Risk Factors • Tobacco (cigarette smoke) is the

#1 cause− Accounts for 90% of all

cases− 25% is from second-

hand smoke• Radon• Asbestos exposure • Pollution• Family history• Age

Types of Lung Cancer • Non-Small Cell Lung Cancer

(NSCLC)− Most common type − About 80-85% are NSCLC− Grows more slowly

• Small Cell Lung Cancer

Types of NSCLC:SQUAMOUS CELL/ EPIDERMOID• 30-35% of lung cancer• Arise from bronchial epithelium• Cavitation may also occur• Slow growth, metastasis not

common• Secondary infections distal to

obstructive tumor in bronchioles frequently occur

ADENOCARCINOMA• 25-30% of lung cancer• Arise from bronchiole mucus gland• Slow growth, may metastasize• Rarely cavity• Strongly linked to cigarette

smoking• Bronchiolo alveolar cell carcinoma

is a subtype • NON SMALL CELL LUNG

CARCINOMALARGE CELL CARCINOMA• 10-20% of lung cancer

• Cavitation common• Slow, metastasis may occur to

kidney, liver and adrenals• May be located centrally, mid lung

or peripherallyCAUSES AND RISK FACTOR• Smoking (heavy smoking?)• Exposure to secondhand smoke • Family history of lung cancer • Exposure to asbestos and other

chemicals • Air pollution (urban vs rural)

Symptoms • Chest pain ,shoulder, or back pain

that does not go away and often gets worse with deep breathing

• SOB, dyspnea and wheezing • Repeated bouts of pneumonia or

bronchitis • Hoarseness that lasts more than

two weeks • Increasing fatigue and weakness. • Clubbing of the fingers and toes

Diagnostic Tests Chest X-ray

is usually the first test performed to evaluate any concerns based on a careful history and physical. This may show a mass in the lungs or enlarged lymph nodes. Sometimes the chest x-ray is normal, and further tests are needed look for a suspected lung cancer. Even if a mass is found, these are not always cancerous and further studies are needed.

CT Scan (computerized tomography) is frequently the second step either

to follow up on an abnormal chest x-ray finding, or to evaluate troublesome symptoms in those with a normal chest x-ray. CT scanning involves a series of x-rays that create a 3-dimensional view of the lungs. If the CT is abnormal, the diagnosis of lung cancer still needs confirmation through a sample of tissue by one of the procedures below.

MRI (magnetic resonance imaging) used to evaluate the possibility of

lung cancer. This procedure uses

magnetism and does not involve radiation. Certain individuals, such as those with metal implants (pacemakers, etc) should not have MRI scans. The technician will ask questions to make sure these are not present.• Diagnostic Tests: Sputum Cytology

After a lung cancer is suspected based on imaging, a sample of tissue is required to confirm the diagnosis and determine the type of cancer. Sputum cytology is the easiest way to do this, but its use is limited to those tumors that extend into the airways. Sputum cytology is not always accurate and can miss some cancer cells.

Bronchoscopy In a bronchoscopy, a lung specialist

inserts a tube into the airways to visualize and take a sample of the tumor. This procedure is used when the tumor is found in the large airways and can be reached by the scope. Patients are given anesthesia during this procedure to minimize discomfort.

Needle Biopsy (fine needle aspiration) With this procedure, a hollow

needle is inserted through the chest wall, usually guided by CT visualization, to take a sample of the tumor. This can be performed for tumors that cannot be reached by bronchoscopy.

Thoracentesis When lung cancer affects the

periphery of the lungs, it can create a fluid build up between the lungs and the lung lining (pleural effusion). With local anesthesia, a larger needle is inserted into the pleural space from which either a diagnostic amount of fluid (small amount to test for cancer cells) or a therapeutic amount of fluid (large amount to improve pain/shortness of breath) is removed.

Mediastinoscopy This procedure is done in the

operating room under general anesthesia. A scope is inserted just above the sternum (the breast bone) into

the region between the lungs to take tissue samples from lymph nodes.

SURGICAL MANAGEMENT• Wedge Resection : Involves the

removal of a small localized area of diseased tissue near the surface of the lung. Pulmonary functions & structures remain unchanged.

• Segmental Resection: involves the removal of one or more lung segments (a bronchiole and its alveoli) the remaining lung tissue over expands to fill the space.

• Lobectomy: lobectomy involves removing an entire lobe of one lung.

• Pneumonectomy: an entire lung is removed.

MEDICAL MANAGEMENT1. RADIATION THERAPY- is the delivery

of high-energy radiation to kill cancer cells and shrink tumors. Depending upon the type and stage of your lung cancer, radiation therapy may be used:

After surgery – To treat any cancer cells that might remain in the area after surgeryBefore surgery – To decrease the size of a tumor and make surgery more effectiveTo cure cancer – With small tumors, and in patients that are unable to have surgery due to age, location of atumor or other medical conditions, radiation therapy can sometimes offer the chance for a cure.To treat lung cancer – Both locally, such as nearby lymph nodes, and to other parts of the body, such as theBrainTo treat symptoms – When a tumor is causing symptoms such as shortness of breath and pain, sometimesradiation therapy is used to reduce tumor size to decrease symptoms.

For prevention – In small-cell lung cancer, radiation therapy to the brain is sometimes given to kill any cellsthat have spread to the brain but are not detected by scans. This is called Prophylactic Cranial Irradiation(PCI)

2. CHEMOTHERAPY - chemotherapy essentially means the use of cytotoxic (cell-killing) medications to kill cancer cells or make them less active. It is a “systemic treatment,” meaning that it works to kill cancer cells anywhere in the body. This can be particularly helpful if cancer cells may have spread beyond the regions treated by surgery and radiation. Chemotherapy may be considered for several reasons:

– As an adjunct (in addition) to surgery – In this case, chemotherapy is given to kill any cancer cells that may have spread beyond the cancer but are undetectable by scans.

– To shrink a tumor before surgery – In some cases, chemotherapy is used before surgery to shrink a tumor and improve the chances that surgery will be effective.

– To cure cancer – Rarely, lung cancer may be cured by chemotherapy but this is more common with cancers such as leukemia.

– To prolong life in those with advanced cancer – Often chemotherapy can extend life when a cure is not possible.

– To help with symptoms of cancer – When a tumor is causing symptoms such as pain or shortness of breath, sometimes chemotherapy can reduce the size of the

tumor to decrease symptoms.

Paraplatin ( carboplatin ) Platinol ( cisplatin ) Taxotere ( docetaxel ) Adriamycin (doxorubicin) VePesid ( etoposide ) Gemzar ( gemcitabine ) Ifex ( ifosfamide )

NURSING MANAGEMENT:Assessment:

Respiratory assessment Lab investigations and other

diagnostic tests Patient’s knowledge and

understanding of diagnosis and treatment,

Patient’s anxiety level and support system,

Exposure to carcinogen• NURSING DIAGNOSIS: Impaired gas exchange related

to Decreased oxygen-carrying capacity of blood (blood loss).

Ineffective Airway Clearance related to Increased amount or viscosity of secretions

Acute Pain related to Cancer invasion to pleura or chest wall

Anxiety related to Perceived threat of death

Deficient Knowledge Learning Need regarding condition, treatment, prognosis, self-care, and discharge needs Related to Lack of exposure, unfamiliarity with information or resources

Impaired gas exchange related to Decreased oxygen-carrying capacity of blood (blood loss) Respiratory Management:

1. Note respiratory rate, depth, and ease of respirations. Observe for use of accessory muscles, pursed-lip breathing, or changes in skin or mucous membrane .

2. Auscultate lungs for air movement and abnormal breath sounds. 

3. Investigate restlessness and changes in mentation and level of consciousness

4. Assess client response to activity. Encourage rest periods, limiting activities to client tolerance

5. Maintain patent airway by positioning, suctioning, and use of airway adjuncts. 

6. Reposition frequently, placing client in sitting and supine to side positions.

7. Avoid positioning client with a pneumonectomy on the operative side. 

8. Encourage and assist with deep-breathing exercises and pursed lip breathing, as appropriate

9. Administer supplemental oxygen via nasal cannula, partial rebreathing mask, or high-humidity face mask, as indicated

10. Assist with and encourage use of incentive spirometer.

11. Monitor and graph ABGs and pulse oximetry readings. Note hemoglobin (Hgb) levels. 

12. Maintain patency of chest drainage system following lobectomy and segmental wedge resection procedures.

Ineffective Airway Clearance related to Increased amount or viscosity of secretions

1. Auscultate chest for character of breath sounds and presence of secretions. 

2. Assist client with and provide instruction in effective deep breathing, coughing in upright position (sitting), and splinting of incision

3. Observe amount and character of sputum and aspirated secretions. Investigate changes, as indicated.

4. Suction if cough is weak or breathe sounds not cleared by cough effort. Avoid deep endotracheal and nasotracheal suctioning in client who has had pneumonectomy if possible

5. Encourage oral fluid intake, within cardiac tolerance.

6. Assess for pain and discomfort and medicate on a routine basis and before breathing exercises.

7. Provide and assist client with incentive spirometer and postural drainage and percussion, as indicated.

8. Administer bronchodilators, expectorants, and analgesics, as indicated.

Acute Pain related to Cancer invasion to pleura or chest wall

1. Ask client about pain. Determine pain location and characteristics. Have client rate intensity on a scale of 0 to 10. 

2. Assess client verbal and nonverbal pain cues

3. Note possible pathophysiological and psychological causes of pain. 

4. Evaluate effectiveness of pain control. Encourage sufficient medication to manage pain; change medication or time span as appropriate

5. Encourage verbalization of feelings about the pain

6. Provide comfort measures such as frequent changes of position, back rubs, and support with pillows. Encourage use of relaxation techniques including visualization, guided imagery, and appropriate Diversional activities.

7. Schedule rest periods, provide quiet environment. 

8. Assist with self care activities, breathing, arm exercises, and ambulation

9. Assist with patient-controlled analgesia PCA or analgesia through epidural catheter. Administer intermittent analgesics routinely, as indicated, especially 45 to 60 minutes before respiratory treatments, and deep-breathing and coughing exercises.

Anxiety related to Perceived threat of death1. Evaluate client and significant

other (SO) level of understanding of diagnosis. 

2. Acknowledge reality of client’s fears and concerns and encourage expression of feelings

3. Provide opportunity for questions and answer them honestly. Be sure that client and care providers have the same understanding of terms used.

4. Accept, but do not reinforce, client’s denial of the situation. 

5. Note comments and behaviors indicative of beginning acceptance or use of effective strategies to deal with situation. 

6. Involve client and SO in care planning. Provide time to prepare for events and treatments

7. Provide for client’s physical comfort. 

Deficient Knowledge Learning Need regarding condition, treatment, prognosis, self-care, and discharge needs Related to Lack of exposure, unfamiliarity with information or resources

1. Discuss diagnosis, current and planned therapies, and expected outcomes. 

2. Discuss necessity of planning for follow-up care before discharge.

3. Identify signs and symptoms requiring medical evaluations, such as changes in appearance of incision, development of respiratory difficulty, fever, increased chest pain, and changes in appearance of sputum.

4. Review nutritional and fluid needs. Suggest increasing protein and use of high-calorie snacks as appropriate. 

5. Help client determine activity tolerance and set goals. 

6. Evaluate availability and adequacy of support system(s) and necessity

for assistance in self-care and home management.

7. Encourage alternating rest periods with activity and light tasks with heavy tasks. Stress avoidance of heavy lifting and isometric or strenuous upper body exercise. Reinforce physician’s time limitations about lifting.

8. Suggest wearing soft cotton shirts and loose fitting clothing, cover portion of incision with pad, as indicated, and leave incision open to air as much as possible

9. Shower in warm water, washing incision gently. Avoid tub baths until approved by physician

Prognosis: The prognosis of lung cancer refers

to the chance for cure or prolongation of life (survival) and is dependent upon where the cancer is located, the size of the cancer, the presence of symptoms, the type of lung cancer, and the overall health status of the patient.

The overall prognosis for lung cancer is poor when compared with some other cancers. Survival rates for lung cancer are generally lower than those for most cancers, with an overall five-year survival rate for lung cancer of about 16% compared to 65% for colon cancer, 89% for breast cancer, and over 99% for prostate cancer.

Breast CancerCancer involves the abnormal multiplication and spread of cells in the body.

It is usually caused by mutations in somatic cell genes that regulate cell growth.Almost every tissue in the body can produce cancer; some even generate many different types of cancer.However, cancer mostly occurs in cells that divide and reproduce more than other cells.

Breast CancerBreast Cancer occurs when a mutation takes place in the cells that line the lobules that manufacture milk or more commonly in the ducts that carry it to the nipple.The area around the center of the breast is where most cancers occur.It is fairly rare for cancers to form in the fat or non-glandular tissues of the breast.

Risk Factors that cause Breast Cancer:Factors that Cannot be Prevented

GenderAgingGenetic Risk Factors (inherited)Family HistoryPersonal HistoryRaceMenstrual CycleEstrogen

Lifestyle RisksOral Contraceptive UseNot Having ChildrenHormone Replacement TherapyNot Breast FeedingAlcohol UseObesityHigh Fat DietsPhysical InactivitySmoking

Environmental FactorsExposure to EstrogenRadiationElectromagnetic FieldsXenoestrogensExposure to Chemicals

BRCA 1 and BRCA 2Both of these genes code for DNA repair.

If a woman has a mutation on either one of these genes, the risk of her getting breast cancer increases from 10% to 80% in her lifetime.Mutations in BRCA1 or BRCA2 account for 40-50% of all cases of inherited breast cancer. These genes are also associated with ovarian cancer in women and prostate cancer in men.These genes can be inherited either from the mother or the father.

Types of Breast CancerDuctal Carcinoma in situ (DCIS)Invasive Ductal Carcinoma (IDC – 80% of breast cancer)The cancer has spread to the surrounding tissuesCarcinoma refers to any cancer that begins in the skin or other tissues that cover internal organsInvasive Lobular Carcinoma (ILC)Cancer Can also Invade Lymph or Blood VesselsStaging of Breast Cancer

The American Joint Committee on Cancer (AJCC) has designated staging by TNMT= tumor sizeN = lymph node involvementM = metastasisStage 1

Tumor < 2.0 cm in greatest dimensionNo nodal involvement (N0)No metastases (M0)

Stage IITumor > 2.0 < 5 cm orIpsilateral axillary lymph node (N1)No Metastasis (M0)

Stage IIITumor > 5 cm (T3)or ipsilateral axillary lymph nodes fixed to each other or other structures (N2)involvement of ipsilateral internal mammary nodes (N3)Inflammatory carcinoma (T4d)

Stage IV (Metastatic breast cancer)

How do you detect Breast Cancer?Breast Self Examination

Opportunity for woman to become familiar with her breastsMonthly exam of the breasts and underarm areaMay discover any changes earlyBegin at age 20, continue monthlyWhen to do BSE Menstruating women- 5 to 7 days after the beginning of their periodMenopausal women - same date each monthPregnant women – same date each monthTakes about 20 minutesPerform BSE at least once a monthExamine all breast tissueBreast ExamBreast exam. The doctor will check both of your breasts, feeling for any lumps or other abnormalities. Your doctor will likely check your breasts in varying positions, such as with your arms above your head and at your side.Mammogram

A Mammogram is a X-ray of the breast that takes pictures of the fat, fibrous tissues, ducts, lobes, and blood vessels.When should a mammogram be performed?

If a lump has been found during self-examination or by a physicianYounger women who have a strong history of breast cancer in their familyAll women over fortyWomen who have had previous diagnosis of breast cancer.

Breast UltrasoudBreast ultrasound. Ultrasound uses sound waves to produce images of structures deep within the body. Your doctor may recommend an ultrasound to help determine whether a breast abnormality is likely to be a fluid-filled cyst or a solid mass, which may be either benign or cancerous. Breast ultrasound is helpful to guide radiologic biopsy to get a sample of breast tissue if a solid mass is found.

Breast BiopsyAbnormal Results:

Benign tumors may suggest fibrocystic disease, adenofibroma, intraductal papilloma, mammary fat necrosis, or plasma cell mastitis.Malignant tumors may suggest adenocarcinoma, cystosarcoma, intraductal and infiltrating carcinoma, inflammatory carcinoma, medullary or circumscribed carcinoma, colloid carcinoma, lobular carcinoma, sarcoma, or Paget’s disease.Breast magnetic resonance imaging (MRI). Breast magnetic resonance imaging (MRI). An MRI machine uses a magnet and radio waves to create pictures of the interior of your breast. Before a breast MRI, you receive an injection of dye. This test may be ordered after a breast biopsy confirms cancer, but before surgery to give your doctor an idea of the extent of the cancer and to see if there's any evidence of cancer in the other breast.Different ViewsTreatments of Breast CancerTreatment of Breast Cancer

ChemotherapyRadiation TherapyDrugsSurgery

ChemotherapyChemotherapy works by destroying cells that are dividing and multiplying all the time.Chemotherapy is used for treatment of breast cancer because there is a possibility of the cancer to spread to other parts of the body.Chemotherapy works better for premenopausal women.Systemic chemotherapy can prevent the spread of cancer.Chemotherapy drugs are administered intravenously.

RadiationRadiation, at high energy levels, has the ability to destroy what is in its path, including normal and abnormal cells

Fortunately new technologies have found a way to battle cancer with radiation.

Radiation usually destroys rapidly dividing cancerous cells.

Normal cells have the ability to repair themselves.

DrugsUsually drugs used to battle cancer are taken while receiving some other type of treatment.Most of the time as well, three or four drugs are used at the same time, so there is an overlapping effectiveness.There are four drugs that are commonly used to battle breast cancer.

Types of Drugs used to Treat Breast CancerAlkylating Agents

CytoxanThese types of drugs usually damage the programs that control the growth in tumor cells.

AntimetabolitesMethotrexate & 5-fluorouracilThis type of drug interferes with the making of nucleotides, which are the substances that make up DNA.

Natural ProductsVincristine (Oncovin and vinblastine (Velban) come from the periwinkle plant.These drugs interfere with cell structure as well as cell division.

HormonesPrednisoneHormones affect the growth of hormones and usually enhances the effects of other cytotoxic drugs.

Surgical Management:Lumpectomy: Surgery to remove a tumor (lump) and a small amount of normal tissue around it.Partial mastectomy: Surgery to remove the part of the breast that has cancer and some normal tissue around it. This procedure is also called a segmental mastectomy. Total mastectomy: Surgery to remove the whole breast that has cancer. This procedure is also called a simple mastectomy. Some of the lymph nodes under the arm may be removed for biopsy at the same time as the breast surgery or after. This is done through a separate incision.Surgical Management:

Modified radical mastectomy: Surgery to remove the whole breast that has cancer, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of the chest wall muscles.Radical mastectomy: Surgery to remove the breast that has cancer, chest wall muscles under the breast, and all of the lymph nodes under the arm. This procedure is sometimes called a Halsted radical mastectomy.Preoperative Nursing Diagnoses:

Knowledge deficit about breast cancer and treatment option.

Anxiety related to breast cancer diagnosis. Fear related to specific treatments, body image

changes or possible death. Risk for ineffective coping (individual or family

coping)related to the diagnosis of breast cancer and related treatment options.

Decisional conflict related to treatment options.Nursing interventions:

1. Explain breast cancer and treatment options The patient confronting the diagnosis of breast

cancer reacts with feelings of fear, dread, and anxiety. The patient must be given time to absorb significance of diagnosis and in any formation that will help her to evaluate available treatment options.

The nurse caring for the patient with breast cancer should be knowledgeable enough to inform her patient about the things she should learn .

Methods to compensate for physical changes related to mastectomy are also discussed.

2. Reducing fear and anxiety and improving coping ability

Fears and concerns are common and are discussed with the patient

The nurse provides anticipatory teaching and counseling at each stage of the process and identifies sensations that can be expected during additional diagnostic procedures.

The nurse also discusses the implications of treatment course and lifestyle.

Promoting decision making ability Careful guidance and supportive counseling are

the interventions the nurse can use to help such patients.

Encouraging one step of the treatment process at a time can be helpful.

Postoperative Nursing Diagnoses Pain related to surgical procedure Impaired skin integrity related to surgical

incision Risk for infection related to surgical incision and

presence of surgical drain. Body image disturbance related to loss or

alteration of the breast related to the surgical procedure

Self-care deficit related to partial immobility of upper extremity on operative side.

Risk for sexual dysfunction related to loss of body part, change in self-image , and fear of partners responses.

Nursing Interventions1. Relieving pain and discomfort Assess pain and discomfort Moderately elevate the involved extremity to

relieve pain because it decreases tension on the surgical incision, promotes circulation, and prevents venous congestion on the affected extremity.

Give intravenous or intramuscular opioid analgesics to manage pain.

by the following day after surgery after the patient takes in food and fluid and anesthesia has cleared sufficiently oral analgesics can be effective in relieving pain.

patient teaching before discharge is important in managing discomfort after surgery.

Patients should be encourage to take analgesic like Acethaminophen before exercise or at bedtime.

Take warm shower twice daily (2nd

postoperative day) to alleviate discomfort that comes from referred muscle pain.

Maintaining skin integrity and preventing infection

Maintain the patency of the surgical drain. The dressing and drain should be inspected for

bleeding and the extent of drainage monitored regularly.

initially, the fluid in the surgical drain appears bloody , but it gradually change into

serosanguinos and then serous fluid during the next several days.

the 2nd day the patient may shower and wash the incision and drain site with soap and water to prevent infection.

Dry dressing should be applied to the incision each day for 7 days.

After incision is completely healed (usually 4-6 weeks) , lotions or creams may be applied to the area to increase skin elasticity.

Reducing stress and improving coping skills Privacy is a consideration when assisting the

woman to view her incision for the first time. Allowing her to express what she perceives,

acknowledging her feelings and allowing her to express her emotions.

Patients support system is important and the patients spouse or partner may need guidance, support and education as well.

Answering questions and addressing the patients concerns about treatment options that may follow surgery.

4. Promoting participation in care. ambulation is encourage when client is free of

post anesthesia nausea and can tolerate fluid. Exercise are initiated on the 2nd day to increase

circulation and muscle strength, prevent joint stiffness, contractures, and restore full range of motion.

exercise is performed 3 times daily for 20 mins. Showering before exercising loosens stiff

muscle encourage self care activities such as brushing, combing etc.

Heavy lifting is avoided Driving may begin after the drain is removed

and patient has full ROM women are encourage to elevate the arm

above the level of the heart on a pillow for 45 minutes at a time.( 3 times daily)

Managing postoperative sensation Common sensations are tightness, pulling,

burning, and tingling along the chest wall in the axilla and along the inside aspect of the upper arm are normal part of the healing process.

Performing the exercises may decrease the sensations.

Acetaminophen assist in managing this discomfort.

Prevention:Fat

Research shows that dietary fat should be 20% or less in order to gain meaningful protection against cancer.Fat cells make estrogen, which promotes breast cancer.Diets high in fat are associated with the increasing breast density in mammograms, which makes interpretation more difficult.

FiberFiber provides protection against breast cancer because it has a mechanism that decreases the amount of estrogen in the body.The amount of fiber in the diet affects the activities of intestinal bacteria, which affects the amount of reabsorbed estrogens.

Antioxidant NutrientsAntioxidants are important in fighting breast cancer because they can disarm cancer-causing substances called free radicals.Vitamin CVitamin EBeta-caroteneVitamin ASelenium

Other Preventative Measures10 Super Foods to Fight Breast Cancer1. Crunchy VegetablesGrouped with cauliflower, brussel sprouts and mustard greens, all contain antioxidants and help to covert unhealthy estrogens into healthy ones.2. CherriesPretty and perfect for popping into your mouth as a treat, cherries contain an alcohol that fights many kinds of cancer, including breast cancer. They also have a natural anti-inflammatory agent and antioxidants.3. TomatoesWhether diced, sliced, pureed, pasted or sundried, tomatoes are well-known for containing lycopene, a powerful, cancer-fighting antioxidant and anti-inflammatory. 4. GarlicStrong in smell but wonderful as a seasoning for soups

and sauces, garlic contains a group of compounds that work to kill bacteria and fungus, and stimulate the immune system. Research shows that breast cancer cells die when exposed to garlic in test tubes.5. SalmonRich with fish oil, this super food contains essential omega-3 fatty acids, which research shows lowers the risk of breast cancer, reduces inflammation, improves blood flow characteristics, and may improve response to chemotherapy.6. TurmericVery popular in East Indian dishes, this ginger-based herb, often ground into a yellow-orange powder, is mainly used for adding flavor and color to foods. Think curry-based dishes. As a health benefit, turmeric contains aromatic oils that demonstrate anti-inflammatory and anti-cancer activity. It also protects against free radicals.7. SoyVegetarians dig soy for its versatility and its usefulness as a protein source in place of red meat. But there’s more to soy than meets the eye. Soy also contains phytochemicals that are known to greatly reduce your risk of developing breast cancer.8. Green TeaIts potent antioxidants also discourage cancer cells from growing. Studies show that people who regularly drink green tea reduce their risk of many cancers, including breast cancer.9. FlaxseedThis tiny wonder food contains cancer-fighting compounds that protect because of their ability to reduce the chances of cancer cells spreading. Flaxseeds are packed with fiber and omega-3 fatty acids that fight inflammation in the body.10. BerriesBlueberries, raspberries and blackberries especially contain an abundance of antioxidants that can help reduce the risk of a number of cancers.

Endometrium CancerEndometrium Lining for the uterusPreventing adhesions between the opposed walls of the myometrium.Soft and spongy.

Each month endometrium change as part of menstrual cycle. CauseRisk FactorsEndometrial stromal sarcoma grossSigns and symptoms

• Vaginal bleeding and/or spotting in postmenopausal women. It may start as a watery, blood-streaked flow that gradually contains more blood. After menopause, any vaginal bleeding is abnormal.

• Abnormal uterine bleeding, abnormal menstrual periods.

Bleeding between normal periods in premenopausal women in women older than 40: extremely long, heavy, or frequent episodes of bleeding (may indicate premalignant changes).Anemia, caused by chronic loss of blood. (This may occur if the woman has ignored symptoms of prolonged or frequent abnormal menstrual bleeding.)Lower abdominal pain or pelvic cramping.Thin white or clear vaginal discharge in postmenopausal women.Weight loss. TYPE OF ENDOMETRIAL CANCER Type 1

caused by excess estrogenType 2

experts aren't sure what causes type 2 cancers, but they don't seem to be caused by too much estrogen

TYPE I not very aggressive slow to spread to other tissuesgrades 1 and 2 endometrial cancers are "type 1" endometrial cancer occur most commonly in pre- and peri-menopausal womenhistory of unopposed estrogen exposure and/or endometrial hyperplasiacarry a good prognosis.TYPE II occur in older, post-menopausal womenmore common in African-Americansmore likely to grow and spread outside of the uteruscarry a poorer prognosis

Example of type I cancer Endometrial adenocarcinoma

most common type of uterine cancer it arises from the glands of the endometrium About 80% of uterine cancers are

adenocarcinomas, and they have varying aggressiveness.

The pathologist assigns a "grade" to this cancer, which basically says how cancerous it looks under the microscope.

While "Grade I" looks a lot like normal uterine

tissue and can be very indolent, "Grade III" looks very cancerous and will probably be aggressive. "Grade II" is intermediate in looks and behavior.

About 40% of adenocarcinomas are "Grade I," 20% are "Grade II," and 40% are "Grade III

Example of type II cancer UTERINE PAPILLARY SEROUS CARCINOMAuterine papillary serous carcinoma (UPSC) is an uncommon form of endometrial cancer that typically arises in postmenopausal women.is the worst type since it is very aggressive and tends to come back even when caught early. It represents 5% of uterine cancers.It is typically diagnosed on endometrial biopsy, prompted by post-menopausal bleeding. It arises in the setting of endometrial atrophy and is classified as a type II endometrial cancer.

Uterine clear cell carcinoma (CC) is a rare form of endometrial cancer with distinct morphological features on pathology; it is aggressive and has high recurrence rate.is an aggressive cancer accounting for about 2% of uterine cancers. It is associated with a woman's mother having used a hormone called DES while pregnant, and is getting less common with DES no longer used. Like uterine papillary serous carcinoma CC does not develop from endometrial hyperplasia and is not hormone sensitive, rather it arises from an atrophic endometrium.

Treatment for endometrial cancer

Depends on the stage of the disease and the overall health of the patient. Primary treatment is the surgery (removal of the tumor ). Radiation therapy, hormone therapy, and/or chemotherapy may be used as adjuvant treatment (i.e., in addition to surgery) in patients with metastatic or recurrent disease.Surgery Surgery (removing the tumor in an operation) for endometrial cancer is also known as hysterectomy which the uterus is surgically removed with or without other organs or tissues. Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing.Treatment usually involves a combination of two or three chemotherapy drugs. This treatment may be considered in some cases, especially for those with stage 3 and 4 disease.Chemotherapy also may be used in addition to surgery (called adjuvant therapy) to treat metastatic endometrial cancer and to prevent recurrent disease. Adjuvant chemotherapy for endometrial cancer is usually given for a total of six to eight 21-day cycles (the treatment is given once every 21 days for a total of six to eight treatments).

The following drugs are used to treat endometrial cancer:Carboplatin (Paraplatin®)Cisplatin (Platinol®)Doxorubicin (Doxil®)Cyclophosphamide (Cytoxin®)Paclitaxel (Taxol®, Paxene®)RADIATION THERAPY Compared with low-risk endometrial cancer, intermediate-risk cancers have a higher chance of coming back after surgery. Intermediate-risk endometrial cancer has invaded more deeply into the lining of the uterus, or evidence of cancer invasion into the cervix when the hysterectomy specimen is examined under a microscope.

Radiation therapy is recommended for some women after surgery. This practice is called "adjuvant" radiation therapy. The purpose is to get rid of any tumor cells that might be left in the body after surgery.Adjuvant radiation therapy (RT)Vaginal brachytherapyLow-dose rate brachytherapy uses a device that delivers radiation through the vagina continuously for two or three days, 24 hours per day.High-dose rate brachytherapy uses a device that delivers radiation in the vagina for only a few minutes at a time once a day, and treatment is generally repeated three to five times. This treatment is generally given as an outpatient and do not have to stay in the hospital overnight.External beam RTDuring EBRT, your body is positioned beneath the X-ray machine in the same way every day, and the radiation field is exposed to the radiation beam for a few seconds once per day, five days per week, for five to six weeks. The choice between external beam RT and vaginal brachytherapy depends on a number of factors. However, for most women with intermediate-risk disease, vaginal brachytherapy seems to be as effective as external beam RT. Hormone therapy Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances made by glands in the body and circulated in the bloodstream. Some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy is used to reduce the production of hormones or block them from working.Progestins The main hormone treatment for endometrial

cancer Eg - medroxyprogesterone acetate (Provera®) and

megestrol acetate (Megace®). Slowing the growth of endometrial cancer cells.

Side effects can include increased blood sugar levels in patients with diabetes.

Tamoxifen

An anti-estrogen drug often used to treat breast cancer, may also be used to treat advanced or recurrent endometrial cancer.

Prevent any estrogens circulating in the woman's body from stimulating growth of the cancer cells and nourishing the cancer cells.

It does not cause bone loss, but can cause hot flashes, vaginal dryness and increased risk of serious blood clots in the leg.

Gonadotropin-releasing hormone agonists These drugs switch off estrogen production by the

ovaries in women who are premenopausal. Eg- goserelin (Zoladex) and leuprolide (Lupron).

These drugs are injected every 1 to 3 months. Side effects can include hot flashes and vaginal

dryness. If they are taken for a long time (years), these drugs can weaken bones (leading to osteoporosis).

Aromatase inhibitors After the ovaries are removed estrogen is still made

in fat tissue. Stop this estrogen from being formed and lower

estrogen levels even further. Eg - letrozole (Femara), anastrozole (Arimidex), and

exemestane (Aromasin). These drugs are most often used to treat breast

cancer, but may be helpful in the treatment of endometrial cancer.

Side effects can include joint and muscle pain and hot flashes. If they are taken for a long time (years), these drugs can weaken bones (leading to osteoporosis).

These drugs are still being studied for use in treating endometrial cancer