Week 10: oncological disorders

● Testicular cancer
○ Often occurs in males between the ages of 15-40 years old
○ Cause is unknown but a history of undescended testicle & genetic predisposition
have been associated to the development of testicular tumor
○ Metastasis occurs to the lung, live,r bone, and adrenal glands via the blood and to
retroperitoneal lymph nodes via lymphatic channels
○ Early detection:
■ Performing a testicular self-examination; perform monthly
○ Assessment
■ Painless testicular swelling, dragging or pulling sensation in scrotum,
palpable lymphadenopathy, abdominal masses, and gynecomastia may
indicate metastasis
■ Late signs including back or bone pain along with respiratory symptoms
○ Interventions
■ Administer chemotherapy if prescribed
■ Radiation therapy if prescribed
■ Unilateral orchiectomy if prescribed
■ Retroperitoneal lymph node dissection if prescribed
■ Discuss reproduction, sexuality, and fertility info and options with patient
● Cervical cancer
○ Preinvasive cancer is limited to the cervix
○ Invasive cancer is in the cervix and other pelvic structures
○ Metastasis usually is confined to the pelvis but distant metastasis occurs through
lymphatic spread
○ Risk factors
■ HPV infection
■ Cigarette smoking, early intercourse (before age 17), multiple sex partners
○ Assessment
■ Painless vaginal postmenstrual and postcoital bleeding
■ Foul smelling or serosanguineous vaginal discharge
■ Pelvic, lower back, leg or groin pain
■ Leakage of urine and feces from the vagina
■ Dysuria, hematuria, cytological changes on pap test
○ Interventions
■ Chemotherapy, cryosurgery, radiation, laser therapy, conization,
hysterectomy, pelvic exenteration
■ Postoperative
 ● Do not lift more than 20 pounds; assist with coughing and
deep-breathing
● Assist with ROM exercises and early ambulation, stockings,
monitor bowel sounds
● Ovarian cancer
○ Grows rapidly, spreads fast and is often bilateral
○ Metastasis occurs by direct spread to the organs in the pelvis, by distal spread
through lymphatic drainage or by peritoneal seeding
○ Assessment
■ Early stages - often asymptomatic
■ Later
● Abdominal discomfort or swelling, gastrointestinal disturbances,
dysfunctional vaginal bleeding, abdominal mass, elevated tumor
marker
○ Interventions
■ External radiation - if tumor has invaded other organs
■ Chemotherapy - postoperatively
■ Total abdominal hysterectomy and bilateral salpingo-oophorectomy with
tumor debulking may be necessary
● Endometrial (Uterine) cancer
○ Slow-growing tumor of the uterus; associated with the menopausal years
○ Metastasis occurs through the lymphatic system to the ovaries and pelvis; via the
blood to the lungs, liver, and bone, or intra abdominally to the peritoneal cavity
○ Risk factors
■ Use of estrogen replacement therapy, nulliparity, polycystic ovary disease,
increased age, late menopause, family history, obesity, HTN, DM
○ Assessment
■ Abnormal bleeding - especially in postmenopausal women, vaginal
discharge, low back, pelvic, or abdominal pain, enlargened uterus
○ Interventions
■ Radiation, chemotherapy, progesterone therapy, antiestrogen medications,
total abdominal hysterectomy and bilateral salpingo-oophorectomy
● Breast cancer
○ Invasive when it penetrates the tissue surrounding the mammary duct and grows
in an irregular pattern
○ Metastasis occurs via lymph nodes
○ Common sites of metastasis are the bone and lungs, it may also occur in the brain
and liver
○ Risk factors
■ Age, family history, early menarche and late menopause
 ■ Previous cancer of the breast, uterus, or ovaries, nulliparity, late first birth,
obesity, high-dose radiation exposure to chest
○ Assessment
■ Mass felt during BSE
■ Presence of the lesion on mammography
■ Fixed, irregular nonencapsulated mass
■ Asymmetry, bloody or clear nipple discharge, nipple retraction or
elevation, skin dimpling, retraction or ulceration, skin edema or peau
d’orange skin
■ Axillary lymphadenopathy, lymphedema of the affected arm, symptoms of
bone or lung metastasis in late stage
○ Interventions
■ Early detection: regular BSE; perform regularly 7-10 days after menses
and for those post-menopausal should do it as well
■ Chemotherapy, radiation
■ Hormonal manipulation, monoclonal antibodies
■ Surgical interventions
● Lumpectomy, simple mastectomy, modified radical mastectomy