4. Leiomyomas
• Signs and Symptoms
– Most do NOT have symptoms
If they do:
– Abnormal uterine bleeding- menorrhagia and
metrorrhagia
– Pain, pelvic pressure
5. Uterine Fibroids (Leiomyomas)
• Diagnosis
– Enlarged uterus distorted with nodular masses
• Treatment and Nursing Care
– Myeomectomy, Myeolysis
– hysterectomy
– Cryosurgery
– ExAblate 2000 system
6. Answer this!
• A 26 y/o woman who wishes to have
children is diagnosed with uterine fibroids
(leiomyoma). Which of the following is
likely to be the treatment of choice?
a. A hysterectomy will be necessary to remove the
tumor
b. A myomectomy may be performed
c. Aspirin and NSAID’s will be used to control the pain
d. Hormonal therapy will be used to shrink the tumor
and maintain sterility
8. Polycystic ovaries
LH, FSH
No egg
released from
ovary
Small cysts
develop in
ovaries r/t
failure to
release egg
Diagnosed – Pelvic Ultrasound
Estrogen/ testosterone
progesterone
9.
10.
11. Polycystic Ovaries
• Signs and Symptoms
– Irregular menstrual periods – infrequent or absent
– Hirsutism
– Obesity
– Acne
– No ovulation
12. Polycystic ovaries
Treatment:
a. oral contraceptives –
b. spironolactone (Aldactone) -
c. leuprolide (Lupron) -
d. Metformin (glucophage) -
e. clomiphene (Clomid) –
Surgery
• Oophorectomy
25. Endometrial Cancer
• Major Risk factor
– Prolonged exposure to Estrogen
• Other Risk factors
– Age - >60
– Infertility
– Diabetes
– Family history, other cancers
– Lifestyle – obesity, smoking
26. Endometrial Cancer
Treatment and Nursing Care
• Diagnosed
– Endometrial biopsy
Treatment:
• Surgical Therapy
– Hysterectomy – first choice of treatment
• Chemotherapy
• Radiation - brachytherapy
27. Brachytherapy
• Internal radiation implantation which
delivers a high dose of radiation to a
localized area.
• The radiation device is placed
near the tumor (in vagina)
seeds, needles, catheters
• Radioisotopes are loaded into
the device after correct placement.
30. Ovarian Cancer
• Greatest risk factor is family history
• Other risk factors include
– Age
– High-fat diet
– Greater number of ovulatory cycles
– Hormone replacement therapy
– Use of infertility drugs
• 90% of ovarian cancers are epithelial carcinomas from
malignant transformation of surface epithelial cells
31. Clinical Manifestations
– Increase in abdominal girth
– Bowel and bladder dysfunctions
– Persistent pelvic or abdominal pain
– Menstrual irregularities
– Ascites
32. Ovarian Cancer
Diagnosis
• Screening for high risk women should
include CA-125, ultrasound, and yearly
pelvic examination
• CA-125 is positive in 80% of women with
ovarian cancer
33. Tutorial on ovarian cancer
• http://www.nlm.nih.gov/medlineplus/tutorial
s/ovariancancer/htm/index.htm
• Treatment of Ovarian Cancer
– Surgery – most common
– Chemotherapy
34. Treatment options for all Caners
• Surgery
– Oophorectomy, Panhysterectomy
– Pelvic Exenteration
• Chemotherapy
• Radiation
– External
– Brachytherapy
36. Uterine Prolapse
• Downward displacement of uterus into vagina
Stage I Stage II
Stage III
•Stage I – the uterus is in the upper half of the vagina.
•Stage II – the uterus has descended nearly to the opening of the vagina.
•Stage III – the uterus protrudes out of the vagina.
37. Uterine Prolapse
• Signs and symptoms
– Stress incontinence
– Dyspareunia
– Heavy feeling in pelvis
• Treatment and Nursing Care
– Pessary
– Hysterectomy with A&P repair
38. Cystocele and Rectocele
• Cystocele – support is
lost and bladder
protrudes into the
vagina
• Rectocele – support is
lost and rectum
protrudes into the
vagina
39. Treatment and Nursing Care
• Patient teaching – Kegels exercises
• Surgery
– Anterior or Posterior colporrhaphy
– Post-op nursing care
• Patient teaching
– Prevent straining at Bowel Movement by using a Low residue
diet
– Restriction of heavy lifting and prolonged standing, walking or
sitting
– Prevention of urinary retention
40. Infertility
• May be related to anatomic or endocrine
problems.
• Diagnostic tests may include:
–Endometrial biopsy to detect tissue
responses during both phases of menstrual
cycle.
–Endocrine imbalance testing.
–Laparoscopy to discover conditions such as
endometriosis, adhesions, or scar tissue.
42. Signs and Symptoms
• Pink or brown discharge may precede onset of
cramping and increased vaginal bleeding
• Clotty menstrual flow
• Pulse rate increased
• Blood pressure is lowered
43. Ectopic Pregnancy
• Occurs when the fertilized ovum implants and
grows somewhere other than the uterine
cavity
• Most common in fallopian tubes
44.
45. Ectopic Pregnancy
• Etiology
• Scarring or inflammation of the fallopian tubes as
result of infection or congenital malformations
• Signs and Symptoms
• Abdominal pain and tenderness
• If life threatening, severe abdominal pain
• Treatment
• Laparotomy
• Transfusions of blood in the event of severe intra-
abdominal bleeding or hypovolemic shock
46. Hydatidiform mole
• Hydatidiform mole, also called molar
pregnancy, is a rare mass or growth that
forms inside the uterus at the beginning of a
pregnancy. It is a type of gestational
trophoblastic disease (GTD).
47. • Hydatidiform mole, or molar pregnancy, results from over-
production of the tissue that is supposed to develop into the
placenta. The placenta feeds the fetus during pregnancy. With a
molar pregnancy, the tissues develop into an abnormal growth,
called a mass.
• There are two types:
• Partial molar pregnancy: There is an abnormal placenta and some
fetal development.
• Complete molar pregnancy: There is an abnormal placenta but no
fetus.
• Both forms are due to problems during fertilization. The exact cause
of fertilization problems is unknown. A diet low in protein, animal
fat, and vitamin A may play a role.
49. Fistulas
• A fistula is a passage or hole that has formed
between:
Two organs in the body.
An organ in the body and skin.
50. • Vesicovaginal fistula: between the bladder and
the vagina
• Cervical fistula: abnormal opening in the
cervix
• Enterovaginal fistula: between the intestine
and the vagina
• Rectovaginal: between the rectum and the
vagina
51. Breast Cancer
• Second major cause of cancer death among
women. Statistics indicate that 1 in 10 will
develop cancer sometime during her life.
• The key to cure is early detection by physical
examination, mammography, and breast self-
examination.
• Five year survival rate is 97% for localized
cancer, 76% for cancer that has spread
regionally, and 21% for cancers having distant
metastases.
52. Highest At-Risk for Breast Cancer
• Had a mother or sibling with breast cancer.
• Never had children or had first child after 30.
• Never breast fed.
• Has a history of fibrocystic breast disease.
• Started menstruating before age 10.
• Is obese.
• Consumes high-fat diet and moderate amount of
alcohol.
• Smokes.
• Experienced a late menopause.
