MDC 3 – EXAM 1 BLUEPRINT
Breast Cancer
Patho:
- Impaired cellular regulation in the breast tissue. One single cell that grows and multiplies in epithelial cells in one or
more of the mammary ducts or lobules
Risk Factors:
- Increased age
- family history
- early menarche
- nulliparity
- late menopause
- lack of breastfeeding
- postmenopausal obesity
- smoking/alcohol consumption
- positive BRCA 1 or 2
Assessment:
- Lump in the breast, changes in the size, shape or appearance of a breast, changes to the skin over the breast such as
dimpling, a newly inverted nipple, peeling, scaling, crusting, or flaking of areola or breast skin, peau d’ orange,
tender, firm, enlarged or itchy breast.
Diagnosis:
- Mammogram, tomosynthesis, ultrasound, MRI, chest x-ray, CT scan, liver enzymes, serum calcium, alkaline
phosphate
Treatment:
- Non-surgical: vitamins, diets, and herbal therapy
- Surgical: lumpectomy, mastectomy (partial, total, or radical)
- Adjuvant: radiation, chemo or combo, drug therapy, stem cell transplant therapy
Self-screening and mammogram recommendations:
- Self-breast exam MONTHLY for all women 7-10 days after menstruation starts
- 45-54 mammograms every year
- Screening should continue as long as a woman is in good health
- Those with risk factors start screening earlier
Fibrocystic Breast Disorder
Patho:
- Non-cancerous, lumpy breast texture
Risk Factors:
- Hormone replacement therapy
- 20-50 years old
Assessment:
- breast pain/tenderness/lumps
Diagnosis:
- Clinical breast exam
- Mammogram
- Ultrasound
- Fine-needle aspiration
- Breast biopsy
Treatment:
- Analgesics
- Limit salt intake before menses
- Wear supportive bra at all times
- Ice or heat may help
- Reduce or eliminate caffeine, dairy product
- Needle aspiration may be necessary
- Oral contraceptives or selective estrogen receptor modulators may be prescribed to help with hormonal imbalance
Endometrial Cancer
Patho:
- Most common reproductive cancer of the inner uterine lining. Adenocarcinoma is the most common tumor type. It
arises from the glandular part of the endometrium and usually follows endometrial hyperplasia (overgrowth)
- Stages of Endometrial Cancer:
Stage 1: endometrium only
Stage 2: endometrium, cervix
Stage 3: endometrium, cervix, vagina, lymph nodes
, Stage 4: endometrium, cervix, vagina, lymph nodes, bowel and bladder
Risk Factors:
- women in reproductive years
- family history
- diabetes mellitus
- hypertension
- obesity
- uterine polyps
- late menopause
- nulliparity
- smoking
Assessment:
- The main symptom of endometrial cancer is postmenopausal bleeding. Ask the patient how many tampons or pads
they use each day.
- Other symptoms include low pelvic pain, watery and bloody vaginal discharge, low back/abdominal pain. Ask the
patient to describe where the pain is and perform a pelvic examination.
Diagnosis:
- CBC’s because of blood loss and serum tumor markers CA-125
- -transvaginal ultrasound and endometrial biopsy **GOLD STANDARD**
- Chest x-ray, abdominal US, CT of pelvis, MRI of the abdomen and pelvis.
Treatment:
- Surgical: total hysterectomy and bilateral salpingo-oophorectomy
- Nonsurgical: radiation, chemotherapy, drug therapy.
Cervical Cancer
Patho:
- The uterine cervix is covered with squamous cells on the outer cervix and columnar (glandular) cells that line the
endocervical canal. Most cervical cancers arise from the squamous cells on the outside of the cervix. The other
cancers arise from the mucus-secreting glandular cells (adenocarcinoma) in the endocervical canal.
Risk Factors:
- HPV or STI
- smoking
- having multiple full-term pregnancies
- age (late-teens-early 30’s most at risk)
- no access for screening
- oral contraceptives
Assessment:
- (hematuria) painless vaginal bleeding, unexplained weight loss, dysuria (painful urination), pelvic pain, chest pain,
rectal bleeding.
- Pap smear will be performed to visualize the tumor if it is visible.
Diagnosis:
- Pap smear
- colposcopy-visualizing the characteristics of cells by using a light.
- endocervical curettage (scraping of the uterine lining-may cause bleeding)
Treatment:
- LEEP (loop electrosurgical excision procedure)- a thin loop wire electrode that transmits a painless electrical current
is used to cut away affected tissue.
- Chemotherapy, radiation, cryotherapy, laser therapy, total hysterectomy, conization
Cervical ablation- post op care:
- No sexual intercourse
- No tampons / douche
- No baths (showers only)
- No fragrant soaps on vagina
- Avoid lifting heavy objects
- report vaginal bleeding
Uterine Leiomyoma/Fibroid
Patho:
- benign, slow-growing solid tumors of the uterine myometrium. Classified by the location. Intramural leiomyomas
are contained in the uterine wall. Submucosal leiomyomas protrude into the cavity of the uterus and can cause
bleeding and disrupt pregnancy. Subserosal leiomyomas protrude through the outer surface of the uterine wall and
may extend to the broad ligament pressing other organs.
Risk Factors:
- Cause is unknown but they think leiomyomas develop from excessive local growth of smooth muscle cells.
Breast Cancer
Patho:
- Impaired cellular regulation in the breast tissue. One single cell that grows and multiplies in epithelial cells in one or
more of the mammary ducts or lobules
Risk Factors:
- Increased age
- family history
- early menarche
- nulliparity
- late menopause
- lack of breastfeeding
- postmenopausal obesity
- smoking/alcohol consumption
- positive BRCA 1 or 2
Assessment:
- Lump in the breast, changes in the size, shape or appearance of a breast, changes to the skin over the breast such as
dimpling, a newly inverted nipple, peeling, scaling, crusting, or flaking of areola or breast skin, peau d’ orange,
tender, firm, enlarged or itchy breast.
Diagnosis:
- Mammogram, tomosynthesis, ultrasound, MRI, chest x-ray, CT scan, liver enzymes, serum calcium, alkaline
phosphate
Treatment:
- Non-surgical: vitamins, diets, and herbal therapy
- Surgical: lumpectomy, mastectomy (partial, total, or radical)
- Adjuvant: radiation, chemo or combo, drug therapy, stem cell transplant therapy
Self-screening and mammogram recommendations:
- Self-breast exam MONTHLY for all women 7-10 days after menstruation starts
- 45-54 mammograms every year
- Screening should continue as long as a woman is in good health
- Those with risk factors start screening earlier
Fibrocystic Breast Disorder
Patho:
- Non-cancerous, lumpy breast texture
Risk Factors:
- Hormone replacement therapy
- 20-50 years old
Assessment:
- breast pain/tenderness/lumps
Diagnosis:
- Clinical breast exam
- Mammogram
- Ultrasound
- Fine-needle aspiration
- Breast biopsy
Treatment:
- Analgesics
- Limit salt intake before menses
- Wear supportive bra at all times
- Ice or heat may help
- Reduce or eliminate caffeine, dairy product
- Needle aspiration may be necessary
- Oral contraceptives or selective estrogen receptor modulators may be prescribed to help with hormonal imbalance
Endometrial Cancer
Patho:
- Most common reproductive cancer of the inner uterine lining. Adenocarcinoma is the most common tumor type. It
arises from the glandular part of the endometrium and usually follows endometrial hyperplasia (overgrowth)
- Stages of Endometrial Cancer:
Stage 1: endometrium only
Stage 2: endometrium, cervix
Stage 3: endometrium, cervix, vagina, lymph nodes
, Stage 4: endometrium, cervix, vagina, lymph nodes, bowel and bladder
Risk Factors:
- women in reproductive years
- family history
- diabetes mellitus
- hypertension
- obesity
- uterine polyps
- late menopause
- nulliparity
- smoking
Assessment:
- The main symptom of endometrial cancer is postmenopausal bleeding. Ask the patient how many tampons or pads
they use each day.
- Other symptoms include low pelvic pain, watery and bloody vaginal discharge, low back/abdominal pain. Ask the
patient to describe where the pain is and perform a pelvic examination.
Diagnosis:
- CBC’s because of blood loss and serum tumor markers CA-125
- -transvaginal ultrasound and endometrial biopsy **GOLD STANDARD**
- Chest x-ray, abdominal US, CT of pelvis, MRI of the abdomen and pelvis.
Treatment:
- Surgical: total hysterectomy and bilateral salpingo-oophorectomy
- Nonsurgical: radiation, chemotherapy, drug therapy.
Cervical Cancer
Patho:
- The uterine cervix is covered with squamous cells on the outer cervix and columnar (glandular) cells that line the
endocervical canal. Most cervical cancers arise from the squamous cells on the outside of the cervix. The other
cancers arise from the mucus-secreting glandular cells (adenocarcinoma) in the endocervical canal.
Risk Factors:
- HPV or STI
- smoking
- having multiple full-term pregnancies
- age (late-teens-early 30’s most at risk)
- no access for screening
- oral contraceptives
Assessment:
- (hematuria) painless vaginal bleeding, unexplained weight loss, dysuria (painful urination), pelvic pain, chest pain,
rectal bleeding.
- Pap smear will be performed to visualize the tumor if it is visible.
Diagnosis:
- Pap smear
- colposcopy-visualizing the characteristics of cells by using a light.
- endocervical curettage (scraping of the uterine lining-may cause bleeding)
Treatment:
- LEEP (loop electrosurgical excision procedure)- a thin loop wire electrode that transmits a painless electrical current
is used to cut away affected tissue.
- Chemotherapy, radiation, cryotherapy, laser therapy, total hysterectomy, conization
Cervical ablation- post op care:
- No sexual intercourse
- No tampons / douche
- No baths (showers only)
- No fragrant soaps on vagina
- Avoid lifting heavy objects
- report vaginal bleeding
Uterine Leiomyoma/Fibroid
Patho:
- benign, slow-growing solid tumors of the uterine myometrium. Classified by the location. Intramural leiomyomas
are contained in the uterine wall. Submucosal leiomyomas protrude into the cavity of the uterus and can cause
bleeding and disrupt pregnancy. Subserosal leiomyomas protrude through the outer surface of the uterine wall and
may extend to the broad ligament pressing other organs.
Risk Factors:
- Cause is unknown but they think leiomyomas develop from excessive local growth of smooth muscle cells.
