POORLY

DIFFERENTIATED
ENDOMETRIAL
CANCER WITH
DERMOID CLEAR
CELL FEATURES
INTRODUCTION
• Poorly Differentiated Endometrial Cancer with Dermoid Clear Cell Features
represents a unique and concerning pathological entity within the spectrum of
endometrial malignancies.
• It represents a subtype of endometrial cancer that is characterized by
aggressive behavior and distinct histological features.
• Endometrial cancer is a type of cancer that begins as a growth of cells in the
uterus.
• It begins in the layer of cells that form the lining of the uterus, called the
endometrium.
• It is often found at an early stage because it causes symptoms.
INTRODUCTION
• Poorly differentiated is characterized by a lack of normal tissue
organization and cellular architecture, indicating a high grade of
malignancy.

• Dermoid features typically refer to tissues or cells that resemble skin

or other dermal elements.

• Clear cell features imply that the cancer cells contain clear cytoplasm
(the fluid inside the cell) due to the accumulation of glycogen or
lipids.
 CAUSES

01 GENETIC MUTATIONS

HISTOLOGICAL
02 TRANSFORMATION

03 HORMONAL FACTORS

INFLAMMATION AND IMMUNE

04 DYSREGULATION
 CAUSES

05 ENVIRONMENTAL FACTORS

06 HEREDITARY FACTORS

07 EPIGENETIC CHANGES

08 TUMOR MICROENVIRONMENT
 RISK FACTORS

01 Changes in the balance of hormones in the body

02 More years of menstruation

03 Never having been pregnant

 RISK FACTORS

04 Older age

05 Obesity

06 Hormone therapy for breast cancer

 NURSING MANAGEMENT

DIAGNOSTIC WORKUP
SYMPTOM MANAGEMENT
AND SUPPORTIVE CARE
TREATMENT PLANNING

SURGICAL MANAGEMENT MONITORING & FOLLOW-UP

ADJUVANT THERAPY PATIENT EDUCATION

 ANATOMY & PHYSIOLOGY
THE FEMALE REPRODUCTIVE SYSTEM
The female reproductive system is a complicated but fascinating
subject. It has the capability to function intimately with nearly every
other body system for the purpose of reproduction.

The female reproductive organs can be subdivided into the internal

and external genitalia (see the images below). The internal genitalia are
those organs that are within the true pelvis. These include the vagina,
uterus, cervix, uterine tubes (oviducts or fallopian tubes), and ovaries.
The external genitalia lie outside the true pelvis. These include the
perineum, mons pubis, clitoris, urethral (urinary) meatus, labia majora
and minora, vestibule, greater vestibular (Bartholin) glands, Skene
glands, and periurethral area.
 ANATOMY & PHYSIOLOGY
NORMAL ABNORMAL

The endometrium is the inner lining of the uterus that

undergoes dynamic changes during the menstrual cycle in
response to hormonal fluctuations.
The cyclic changes in the endometrium are essential for
supporting embryo implantation and subsequent pregnancy. If
fertilization occurs, the early embryo embeds into the rich,
secretory endometrial lining, establishing pregnancy. If not, the
endometrial lining is shed, and the cycle begins anew. These
hormonal interactions and structural changes within the
endometrium are crucial components of female reproductive
physiology.
It involves a complex interplay of genetic mutations,
altered signaling pathways, and changes in cellular
behavior within the endometrial tissue.
The endometrial tissue affected by this cancer may
show disrupted architecture, with the abnormal cells
infiltrating the surrounding tissue. The clear cell
features, indicative of glycogen-rich clear cytoplasm,
may reflect underlying metabolic abnormalities within
the tumor cells.
 DRUG STUDY
NAME OF CLASSIFI- MECHANISM OF ADVERSE NURSING
INDICATION
DRUG CATION ACTION REACTION MANAGEMENT

- Used to treat
- Osmotic Agent constipation Assessment & Drug Effects
GENERIC NAME:
Monobasic Dibasic An osmotic agents that when - Electrolyte
Lab tests:
these salts are ingested orally, Imbalance and
- Clean the bowel - Monitor serum electrolytes
BRAND NAME: dehydration
before a they are not absorbed
Sodium phosphate - Monitor urine output and check
colonoscopy efficiently in the - Kidney Injury
monobasic and sodium for signs of renal damage, such as
phosphate dibasic gastrointestinal tract due to
proteinuria or hematuria.
their high solubility and -Gastrointestinal
DOSAGE: osmotic effect. This leads to Effects - Check hemoglobin and
1.5 to 2.7 grams of
an increase in the osmotic hematocrit levels.
NaH2PO4 and 7 to 9 - Rectal Irritation
grams of Na2HPO4 OD pressure within the intestinal
- Keep an eye on magnesium
lumen, drawing water into the - Allergic Reactions levels.
ROUTE OF bowel from surrounding
ADMINISTRATION:
tissues via osmosis. - Metabolic Acidosis - Monitor serum osmolality and
Oral assess fluid balance
 DRUG STUDY
NAME OF CLASSIFI- MECHANISM OF ADVERSE NURSING
INDICATION
DRUG CATION ACTION REACTION MANAGEMENT

CNS:
GENERIC NAME: - Gastro- Headache
Omeprazole An antisecretory compound
intestinal - Treatment of active Dizziness Assessment & Drug Effects
duodenal ulcer in adults. that is a gastric acid pump Fatigue
Agent Lab tests:
BRAND NAME: - Proton Pump - Eradication of Helicobacter
inhibitor. Suppress gastric GI: Monitor urinalysis for hematuria
Prilosec pylori to reduce the risk of acid secretion by inhibiting Diarrhea and proteinuria. Periodic liver
Inhibitor duodenal ulcer recurrence in function tests with prolonged use.
adults.
the H+, K+-ATPase Abdominal pain
Nausea
DOSAGE: enzyme system and the Patient & Family Education
Mild transient
- Maintenance of healing of
Adult: 40mg OD acid proton H+ pump in the increases in liver - Report any changes in urinary
EE due to acid-mediated
GERD in patients 1 year of parietal cells. function tests elimination such as pain or
age and older. discomfort associated with
ROUTE OF Urogenital: urination, or blood in urine.
ADMINISTRATION: - Pathologic hypersecretory Hematuria
Oral conditions in adults Proteinuria - Report severe diarrhea; drugs
Gastroesophageal reflux. may need to be
Skin:
Rash
 DRUG STUDY
NAME OF CLASSIFI- MECHANISM OF ADVERSE NURSING
INDICATION
DRUG CATION ACTION REACTION MANAGEMENT

- Stimulant
Laxative
GENERIC NAME: - Constipation • Allergic
Bisacodyl Bisacodyl is deacetylated to the
reactions: Assessment:
active bis-(p-hydroxyphenyl)-
- Assess the patient's bowel
- Bowel Preparation pyridyl-2-methane (BHPM) by an - Skin rash
- Itching habits, current symptoms, and
intestinal deacetylase. BHPM can
BRAND NAME: response to previous laxative
stimulate parasympathetic nerves in - Hives
Dulcolax - Management of the colon directly to increase motility - Swelling of the face,
therapies.

Opioid-Induced and secretions. Bisacodyl stimulates lips, tongue, or throat

Monitoring:
Constipation adenylate cyclase, increasing cyclic
DOSAGE: - Monitor the patient's response to
AMP, leading to active transport of • Bloating
Adult: 5mg OD bisacodyl therapy, including
chloride and bicarbonate out of cells.
bowel movements and relief of
- Neurogenic Bowel Sodium ions, potassium ions, and • Nausea constipation symptoms.
water passively leave the cell; while
ROUTE OF
Dysfunction
sodium and chloride ions are unable • Stomach
ADMINISTRATION: to be reabsorbed.
cramping
Oral
 NURSING CARE PLANS
NURSING
ASSESSMENT PLANNING IMPLEMENTATION RATIONALE EVALUATION
DIAGNOSIS

INDEPENDENT:
Examine the entire abdomen and Perceived pain is not limited to
gastritis patients and may or may
SHORT TERM:
record the type, intensity, and
SUBJECTIVE DATA: not be associated with other Goal met
SHORT TERM: location of the pain.
“Masakit ang tiyan ko, After 3 hours of nursing medical conditions.
parang mayroon pong intervention, perceived Inquire with the patient about the
mabigat na pakiramdam Excess cholesterol in Finding out about the aggravating
pain scaled at 7/10 will be things that make them worse and
sa ilalim" as verbalized. bile can cause acute factors can help identify potential
reduced to 5/1. better.
pain. Symptoms triggers that exacerbate stomach
Pain Scale: 7/10 include guarding pain.
LONG TERM:
behavior and a weak LONG TERM:
OBJECTIVE DATA: After 3 days of nursing Help to a comfortable position. There is a position that can help
appearance. Goal met
• Guarding behavior intervention, the patient relieve abdominal pain and
• Weak in will experience relief improve comfort. It is generally
Appearance from pain. less painful to lie sideways or in a
knee-chest position when
experiencing abdominal pain.
 NURSING CARE PLANS
NURSING
ASSESSMENT PLANNING IMPLEMENTATION RATIONALE EVALUATION
DIAGNOSIS

As needed, apply a hot compress to

By allowing blood vessels to
the abdominal region that is hurting.
dilate and contracted muscles to
relax, hot compresses help reduce
Offer non-pharmacological pain
pain.
management techniques, like using
distraction techniques, guided
These techniques change how the
imagery, and inducing a relaxation
mind reacts to pain in order to
response.
bring comfort.

DEPENDENT:
Making sure the dosage is right
As directed, administer the
and keeping an eye out for any
prescribed painkillers.
negative effects.

HEALTH TEACHING:
Providing patients with
Inform the patient of the
information regarding the proper
significance of adhering to the
and safe use of medications helps
medication's recommended
them manage their pain.
instructions.
 NURSING CARE PLANS
NURSING
ASSESSMENT PLANNING IMPLEMENTATION RATIONALE EVALUATION
DIAGNOSIS

SUBJECTIVE DATA:
SHORT TERM: INDEPENDENT: Administering analgesics as
SHORT TERM:
“Masakit ang aking Within 24 hours of Administer prescribed analgesics prescribed helps alleviate pain
Goal met
puson at madalas akong nursing intervention, the as ordered and reassess pain level and discomfort, promoting
napapagod ngayon" as Acute Pain related to patient will report a pain 30 minutes after administration. patient comfort.
LONG TERM:
verbalized tissue invasion level of 4/10 or less
Goal partially met.
secondary to within 24 hours. Apply a heating pad to the Heat therapy promotes
Patient demonstrates
Pain scale: 6/10 endometrial cancer as abdomen for 15-20 minutes every vasodilation, increases blood
improved pain
evidenced by patient's LONG TERM: 2-3 hours to promote muscle flow to the affected area, and
management strategies
verbalization of Within 1 week of nursing relaxation and reduce pain. reduces muscle tension,
OBJECTIVE DATA: but still experiences
abdominal pain and intervention, the patient resulting in pain relief.
• Fatigue occasional discomfort
discomfort. will demonstrate effective Assist the patient in finding a
• Patient appears pale beyond 1 week. Further
pain management comfortable position, such as Proper positioning reduces
• Reports vaginal interventions and
strategies to alleviate lying on their side with a pillow pressure on sensitive areas and
bleeding follow-up are required.
discomfort. between their knees. may alleviate discomfort.
 NURSING CARE PLANS
NURSING
ASSESSMENT PLANNING IMPLEMENTATION RATIONALE EVALUATION
DIAGNOSIS

DEPENDENT: Collaboration with the

Coordinate with the physician to
adjust pain medications as needed
based on patient response.
HEALTH TEACHING:
Instruct patient on the importance
of adhering to prescribed pain
medication regimen and reporting
any unrelieved pain promptly.
healthcare team ensures
comprehensive pain
management tailored to the
patient's needs and preferences.
Adherence to medication
regimen is crucial for effective
pain management, and prompt
reporting of unrelieved pain
ensures timely intervention.
 NURSING CARE PLANS
NURSING
ASSESSMENT PLANNING IMPLEMENTATION RATIONALE EVALUATION
DIAGNOSIS

SUBJECTIVE DATA:
“Napapansin ko na
palaging may pagbabago
sa aking timbang at
pakiramdam ko na lagi
akong pagod" as
verbalized
Nutrition: Less
OBJECTIVE DATA:
Decreased level of the ff:
- Hgb: 10 g/dL (12-16
Requirements
g/dL)
- Hct: 30% (36-48%)
- Serum Fe: 50 mcg/dL
(60-160 mcg/dL)
- Fatigue
- Pale appearance
SHORT TERM:
Within weeks of nursing
intervention, the patient will
maintain stable weight and
Risk for will report decreased fatigue
Imbalanced within 1 week.
LONG TERM:
than Body Within 1 month of nursing
intervention, the patient will
related to demonstrate improved
anorexia. nutritional status and will
verbalize understanding of
the importance of nutrition in
managing cancer within 2
weeks.
INDEPENDENT:
Monitor patient's weight and
nutritional intake regularly.
Encourage patient to eat small,
nutrient-dense meals.
Provide emotional support and
reassurance.
Regular monitoring of weight and
nutritional intake helps track
progress and identify areas for
intervention.
Providing small, frequent meals
helps prevent overwhelming the
patient and promotes better
nutrient absorption.
Offering emotional support
acknowledges the psychological
impact of the illness and validates
the patient's feelings, fostering a
sense of understanding and
empathy.
SHORT TERM:
Goal met
LONG TERM:
Goal partially met.
Patient demonstrated
understanding of the
importance of nutrition
in managing cancer
through verbal
communication or other
means and made
progress in nutrition but
not enough to reach a
healthy nutritional
status.
 NURSING CARE PLANS
NURSING
ASSESSMENT PLANNING IMPLEMENTATION RATIONALE EVALUATION
DIAGNOSIS

DEPENDENT:
Iron supplements are essential
Administer iron supplements as
in addressing anemia caused by
prescribed by the physician.
chronic blood loss.

Collaborate with dietitian to

Collaboration with a dietitian
develop a meal plan tailored to
ensures that the patient receives
patient's preferences and
individualized nutritional
nutritional needs.
support.

HEALTH TEACHING:
Education empowers the patient
Teach patient about the
to take an active role in
importance of maintaining
managing their nutritional needs
adequate nutrition during cancer
and overall health.
treatment.
 REFERENCES
Facog, A. M. M. M. (n.d.). Female Reproductive Organ Anatomy: Overview, Gross Anatomy, Microscopic Anatomy.
https://emedicine.medscape.com/article/1898919-overview?form=fpf#a2

Bisacodyl tablets and capsules. (n.d.). Cleveland Clinic. https://my.clevelandclinic.org/health/drugs/20717-bisacodyl-tablets-and-capsules

Bisacodyl: Uses, Interactions, Mechanism of Action | DrugBank Online. (n.d.). DrugBank. https://go.drugbank.com/drugs/DB09020

Shah, N., & Gossman, W. (2023, February 7). Omeprazole. StatPearls - NCBI Bookshelf.
https://www.ncbi.nlm.nih.gov/books/NBK539786/#:~:text=Omeprazole%20is%20a%20proton%2Dpump,gastric%20ulcers%2C%20and
%20helicobacter%20pylori

Mahdy, H., Casey, M. J., & Crotzer, D. (2022, September 26). Endometrial Cancer. StatPearls - NCBI Bookshelf.
https://www.ncbi.nlm.nih.gov/books/NBK525981/

Endometrial cancer - Symptoms and causes - Mayo Clinic. (2023, August 11). Mayo Clinic.
https://www.mayoclinic.org/diseases-conditions/endometrial-cancer/symptoms-causes/syc-20352461