(and it may occur with intercourse), leg pain along sciatic nerve, and flank/back pain 100% cure if detected early Diagnosis What is the test that helps diagnose this? __pap_________ _smear___________ Abnormal? Repeat test 7
Treatment Electrosurgical excision Laser Cryosurgery _radiation_____________________ and chemo for late stages Conization – remove part of __cervix___________ Hysterectomy B. Uterine (Endometrial Cancer) Risk Factors Greater than _50_____ years of age Taking estrogen therapy without progesterone Positive family history __late__________ menopause No pregnancy (null parity) Signs / Symptoms Major symptom: post ____menopausal____________________ bleeding Other S/S: watery/bloody vaginal discharge, low back/abd pain, pelvic pain Diagnosis CA-125 (blood test to R/O __ovarian involvement____________________ Tests to evaluate for metastasis: CXR (chest x-ray) CT IVP (Intravenous pyelogram) Liver and bone scan BE (barium enema) The most definitive diagnostic test is a D & C (dilatation & curettage) and endometrial biopsy C. Ovarian Cancer 8
Leading cause of gynecologic cancer deaths in the U.S. Incidence increases after _40____ years of age, and half of women at diagnosis are older than __60__ years. Most cases are random, but 5% to 10% are mutations in the _BRAC____ 1 and 2 genes (same risk factors as breast cancer w 1 st degree relative and family history) Symptoms are often vague. Many women tend to __ignore________ these symptoms. A ___palpable________________ ovary in a woman who has gone through menopause is investigated immediately. Most likely treatment: total_______ _abdominal____________ _hysterectomy___________ (TAH) with removal of fallopian tubes and ovaries and possibly the omentum (bilateral salpingo-oophorectomy and omentectomy), tumor debulking, para-aortic and pelvic lymph node sampling, diaphragmatic biopsies, random peritoneal biopsies, and cytologic washings. Postoperative management may include taxanes or platinum-based chemotherapy. D. Vaginal Cancer (rare) Rare and usually takes years to develop. Risk Factors: previous cervical cancer, in utero exposure to diethylstilbestrol (DES), previous radiation therapy, history of HPV or pessary use. Treatment is similar to cervical cancer treatment E. Surgery ( hysterectomy) TAH (total abdominal hysterectomy) or TVH (total vaginal hysterectomy (uterus and cervix only) Tubes & ovaries removed? -Bilateral oophorectomy (ovaries) 9
-Bilateral salpingectomy (tubes) Laparoscopic hysterectomy may be possible Supracervical or subtotal (uterus is removed but cervix is spared) Radical Hysterectomy: Removal of the uterus as well as the surrounding tissue, including the upper third of the vagina, pelvic lymph nodes. (removal of ALL the pelvic organs, including bladder or rectum is called a pelvic exenteration patient may have colostomy or ileal conduit) Preoperative Management Discontinue anticoagulant medications, NSAIDS, such as aspirin, and vitamin E prior to surgery to reduce the risk of __bleeding___________ Pregnancy is ruled out on day of surgery Prophylactic antibiotics DVT prophylaxis critical Postoperative Management
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- Fall '16
- Denise Cauble