Gynecologic Cancers and Oncology Nursing
Gynecologic cancers are malignancies that arise in the female reproductive system. The most common types include cervical, ovarian, uterine (endometrial), and breast cancer. Oncology nursing plays a critical role in early detection, treatment, and supportive care for patients with these cancers.
1. Cervical Cancer
Definition
Cervical cancer originates in the cervix, the lower part of the uterus that connects to the vagina. It is primarily caused by persistent infection with high-risk strains of Human Papillomavirus (HPV).
Causes and Predisposing Factors
- Persistent HPV infection (especially HPV-16 and HPV-18)
- Early onset of sexual activity
- Multiple sexual partners
- Smoking
- Weakened immune system (HIV/AIDS, immunosuppressive therapy)
- Long-term use of oral contraceptives
- Family history of cervical cancer
Signs and Symptoms
- Abnormal vaginal bleeding (between periods, postmenopausal, or post-intercourse)
- Unusual vaginal discharge (foul-smelling, watery, or bloody)
- Pelvic pain or pain during intercourse
- Advanced stages: Leg swelling, urinary/bowel issues, weight loss
Investigations
- Pap Smear (detects abnormal cervical cells)
- HPV DNA Testing (detects high-risk HPV strains)
- Colposcopy & Biopsy (examines cervix under magnification)
- Imaging (MRI, CT, PET scan) (for staging cancer spread)
Medical Treatment
- Early-stage: Cryotherapy, LEEP (Loop Electrosurgical Excision Procedure), Conization
- Advanced-stage:
- Surgery: Hysterectomy (removal of the uterus & cervix)
- Radiotherapy: External beam radiation & brachytherapy
- Chemotherapy: Cisplatin, Paclitaxel
- Targeted therapy: Bevacizumab (Avastin)
Nursing Management
- Pain management using prescribed analgesics
- Emotional support for coping with cancer diagnosis
- Postoperative care: Monitor for bleeding, infection, and wound healing
- Health education: Importance of HPV vaccination and regular Pap smears
Nursing Care Plan
| Nursing Diagnosis | Nursing Interventions | Expected Outcomes |
|---|---|---|
| Acute pain related to tissue damage | Administer pain medications, provide relaxation techniques | Pain relief reported by the patient |
| Anxiety related to cancer diagnosis | Provide psychological counseling, encourage family support | Reduced anxiety and better coping |
| Risk for infection post-surgery | Monitor temperature, educate on hygiene | No signs of infection |
2. Ovarian Cancer
Definition
Ovarian cancer affects the ovaries and is often detected at an advanced stage due to vague symptoms. It is one of the most lethal gynecologic cancers.
Causes and Predisposing Factors
- Family history of ovarian/breast cancer
- BRCA1 and BRCA2 gene mutations
- Early menstruation or late menopause
- Nulliparity (never having given birth)
- Hormone replacement therapy (HRT)
Signs and Symptoms
- Persistent bloating
- Abdominal or pelvic pain
- Loss of appetite or feeling full quickly
- Frequent urination
- Unexplained weight loss
Investigations
- Tumor markers: CA-125 (elevated in ovarian cancer)
- Ultrasound (Transvaginal USG)
- CT Scan / MRI
- Biopsy
Medical Treatment
- Surgery: Total abdominal hysterectomy with bilateral salpingo-oophorectomy (removal of ovaries, fallopian tubes, and uterus)
- Chemotherapy: Carboplatin & Paclitaxel
- Targeted therapy: PARP inhibitors (Olaparib)
Nursing Management
- Manage chemotherapy side effects (nausea, vomiting, hair loss)
- Psychological support (counseling for body image issues)
- Monitor for fluid accumulation (ascites)
Nursing Care Plan
| Nursing Diagnosis | Nursing Interventions | Expected Outcomes |
|---|---|---|
| Risk for fluid imbalance due to ascites | Monitor weight, administer diuretics if needed | Stabilized fluid levels |
| Body image disturbance | Encourage open discussions, provide wigs/scarves | Improved self-esteem |
3. Uterine (Endometrial) Cancer
Definition
Uterine cancer arises from the endometrium (lining of the uterus) and is most common in postmenopausal women.
Causes and Predisposing Factors
- Excess estrogen exposure (without progesterone)
- Obesity
- Polycystic ovary syndrome (PCOS)
- Diabetes
- Family history
Signs and Symptoms
- Postmenopausal bleeding
- Heavy or prolonged periods
- Pelvic pain
- Abdominal bloating
Investigations
- Endometrial biopsy
- Ultrasound (transvaginal)
- Hysteroscopy
Medical Treatment
- Surgery: Hysterectomy
- Hormonal therapy: Progesterone therapy
- Radiotherapy & Chemotherapy for advanced cases
Nursing Management
- Pre-op and post-op care (pain management, wound care)
- Educate about hormone therapy
Nursing Care Plan
| Nursing Diagnosis | Nursing Interventions | Expected Outcomes |
|---|---|---|
| Impaired comfort due to post-op pain | Provide analgesics, assist in mobility | Reduced pain |
| Deficient knowledge regarding treatment | Provide education on hormonal therapy | Improved patient compliance |
4. Breast Cancer
Definition
Breast cancer occurs in the cells of the breast tissue, ducts, or lobules. It is the most common cancer in women worldwide.
Causes and Predisposing Factors
- Family history
- BRCA1/BRCA2 gene mutations
- Early menstruation, late menopause
- Hormone replacement therapy
- Lifestyle factors (obesity, alcohol consumption)
Signs and Symptoms
- Lump in the breast or armpit
- Nipple discharge (bloody or clear)
- Changes in breast size or shape
- Skin dimpling
Investigations
- Mammography (screening test)
- Ultrasound & MRI
- Biopsy (Fine Needle Aspiration, Core Needle Biopsy)
- Tumor markers: HER2, ER/PR status
Medical Treatment
- Surgery: Lumpectomy, Mastectomy
- Chemotherapy & Radiotherapy
- Hormonal therapy: Tamoxifen, Letrozole
- Targeted therapy: Trastuzumab (Herceptin)
Nursing Management
- Pre-op and post-op care
- Manage side effects of chemo & radiation
- Breast self-examination education
Nursing Care Plan
| Nursing Diagnosis | Nursing Interventions | Expected Outcomes |
|---|---|---|
| Anxiety about mastectomy | Provide emotional support, involve support groups | Reduced anxiety |
| Risk for infection post-surgery | Educate on wound care, monitor for fever | No infection |
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