OB Chapter 8: Cancers of the Female Reproductive Tract

A postmenopausal client is told at her routine gynecological exam that the primary care provider has found a cyst on her right ovary. The nurse notices that this does not cause worry for this client. What should the nurse and/or care provider tell this client?

"After menopause a mass on an ovary is not a cyst and should be considered cancerous until proven otherwise." After menopause, a mass on an ovary is not a cyst; physiologic cysts can arise only from a follicle that has not ruptured or from the cystic degeneration of the corpus luteum. Brushing it off is not responsible, and waiting a full year would put the client at serious risk from dying from the cancer. Suggesting a second opinion instead of explaining the seriousness of it to the client would not be responsible or ethical.

A client asks the nurse if she can recommend a screening test for ovarian cancer. Which response by the nurse would be most appropriate?

"Unfortunately, there aren't any routine screening methods currently." The United States Preventive Services Task Force [USPSTF] (2015), along with the American College of Obstetricians and Gynecologists (ACOG), and the American Medical Association (AMA) recently reviewed the evidence for ovarian cancer screening and did not recommend screening for women at average risk. Ovarian cancer is a silent disease that is often asymptomatic until it reaches stage III or IV and has metastasized to adjacent structures.

The nurse is caring for a woman who has dysplasia (disordered growth of abnormal cells). The nurse educates her on dysplasia progression that is high-grade. Which information is important for the nurse to include?

High-grade dysplasia progresses to invasive cervical cancer in about 2 years. With cervical cancer, lesions start as dysplasia and progress over a period of time. Progression of a high-grade dysplasia takes about 2 years to develop into an invasive cancer.

A nurse is teaching women at a senior center. Which type of cancer would the nurse explain is the most common type for women between 50 and 65 years of age?

endometrial cancer

When working in a local community health care center, a nurse is frequently asked about cervical cancer and ways to prevent it. Which information should the nurse provide? Select all that apply.

Encourage cessation of smoking and drinking. Encourage prevention of sexually-transmitted infections (STIs) to reduce risk factors. Counsel teenagers to avoid early sexual activity. To reduce the risk of cervical cancer, the nurse should encourage clients to avoid smoking and drinking. In addition, because STIs such as HPV increase the risk of cervical cancers, care should be taken to prevent STIs. Teenagers also should be counseled to avoid early sexual activity because it increases the risk of cervical cancer. The use of barrier methods of contraception, not IUDs, should be encouraged. Avoiding stress and high blood pressure will not have a significant impact on the risk of cervical cancer.

A nurse is reviewing the history, physical exam, and diagnostic test findings for a woman diagnosed with endometrial cancer. The findings reveal that the cancer has spread to the cervix and other parts of the uterus and to nearby lymph nodes. The nurse interprets these findings as suggestive of which stage?

III In stage I, the tumor is confined to the corpus uteri. In stage II, it has spread to the cervix, but not outside the uterus. In stage III, it has spread locally (to other parts of the uterus) and regionally (to nearby lymph nodes). In stage IV, it has invaded the bladder mucosa, bowel with distant metastases to the lungs, liver, and bone.

A client presents for a routine check-up at a local health care center. One of the client's distant relatives died of ovarian cancer, and the client wants to know about measures that can reduce the risk of ovarian cancer. The nurse informs the client about which measure to reduce the risk of ovarian cancer?

Provide genetic counseling and thorough assessment. Only 5% of ovarian cancers are genetic in origin. However, the nurse needs to tell the client to seek genetic counseling and thorough assessment to reduce her risk of ovarian cancer. Oral contraceptives reduce the risk of ovarian cancer and should be encouraged. Breastfeeding should be encouraged as a risk-reducing strategy. The nurse should instruct the client to avoid using perineal talc or hygiene sprays

A client is waiting for the results of an endometrial biopsy for suspected endometrial cancer. She wants to know more about endometrial cancer and asks the nurse about the available treatment options. Which treatment information should the nurse give the client?

Surgery involves removal of the uterus, fallopian tubes, and ovaries; adjuvant therapy is used if relevant. The nurse should inform the client that surgery most often involves removal of the uterus (hysterectomy) and the fallopian tubes and ovaries (salpingo-oophorectomy). Removal of the tubes and ovaries, not just the uterus, is recommended because tumor cells spread early to the ovaries, and any dormant cancer cells could be stimulated to grow by ovarian estrogen. In advanced cancers, radiation and chemotherapy are used as adjuvant therapies to surgery. Routine surveillance intervals for follow-up care are typically every 3 to 4 months for the first 2 years.

A woman with ovarian cancer has been told that she is in stage III of the cancer. The nurse is reviewing the information with her. Which statement would help in the woman's understanding of stage III ovarian cancer?

The growth has spread to the lymph nodes and other areas/organs in the abdominal cavity. The staging and diagnosis is performed by a laparoscopy. The staging is I to IV. Stage III means the cancer has spread to the lymph nodes and other areas in the abdominal cavity. A five-year survival rate for this stage is 30% to 60%.

Which risk factors are associated with vaginal cancer? Select all that apply.

advancing age HIV infection smoking Although direct risk factors for the initial development of vaginal cancer have not been identified, associated risk factors include advancing age (greater than 60 years old), human immunodeficiency virus (HIV) infection, smoking, previous pelvic radiation, exposure to diethylstilbestrol (DES) in utero, vaginal trauma, history of genital warts (human papilloma virus [HPV] infection), cervical cancer, chronic vaginal discharge, and low socioeconomic level. Persistent ovulation over time and hormone replacement therapy for more than 10 years are risk factors associated with ovarian cancer.

A nurse is preparing a presentation about vaginal cancer for a group of women at the local community clinic. The nurse plans to include information about metastatic forms of vaginal cancer. Which cancers would the nurse most likely include as commonly metastasizing to the vagina? Select all that apply.

breast cervical skin colon Malignant diseases of the vagina are either primary vaginal cancers or metastatic forms from adjacent or distant organs. About 80% of vaginal cancers are metastatic, primarily from the cervix and endometrium. These cancers invade the vagina directly. Cancers from distant sites that metastasize to the vagina through the blood or lymphatic system are typically from the colon, kidneys, skin (melanoma), or breast.

A nurse is conducting a class for a group of young women at a women's health center on risk reduction for ovarian cancer. Which information would the nurse most likely include as risk reduction strategies? Select all that apply.

breastfeeding avoidance of feminine hygiene spray use pregnancy before age 30 bilateral tubal ligation Factors associated with a reduced risk of ovarian cancer include the use of oral contraceptives for three years or longer, pregnancy and breastfeeding before the age of 30, bilateral tubal ligation, and removal of the ovaries. Women also should avoid the use of talc and hygiene sprays on their genitals.

A 30-year-old female is attending a health fair for women. The nurse at the fair is reviewing risk factors for cervical cancer. Which important risk factor should the nurse include at the fair?

exposure to diethylstilbestrol (DES) in utero Cervical cancer has several risk factors: early age of first intercourse (in first year of menarche), lower socioeconomic status, unprotected sex, family history of cervical cancer, exposure to DES in utero, HIV, use of oral contraceptives, HPV, and multiple male partners.

The nurse reviews the medical record of a woman diagnosed with ovarian cancer, stage II. The nurse interprets this information, understanding that the disease:

involves one or both ovaries and extends into the pelvis. Stage II ovarian cancer involves one or both ovaries, with pelvic extension. Disease limited to the ovary characterizes stage I ovarian cancer. Stage III ovarian cancer has spread to the lymph nodes and other organs and structures inside the abdominal cavity. Stage IV disease typically involves metastasis to distant sites.

Which risk factors have been linked to ovarian cancer? Select all that apply.

nulliparity gene mutations BRCA-1 and BRCA-2 An inherited gene mutation (BRAC-1, BRAC-2 ) is linked to ovarian cancer. Other risk factors include nulliparity, obesity, early menarche, late menopause, and a high fat diet, as well as a history of breast and colon cancers.

A middle-aged woman is seen in the OB/GYN clinic and reports abdominal bloating, fatigue, abdominal pain, urinary frequency, and constipation. She also says that she had lost 24 pounds in the last month without trying to lose. For which disease should the primary care provider screen this client?

ovarian cancer The most common early signs for ovarian cancer include abdominal bloating, early satiety, fatigue, vague abdominal pain, urinary frequency, diarrhea or constipation, and unexplained weight loss or gain. Fibroids do not have these same symptoms, nor does breat cancer or POP.

A nurse is speaking to a local women's group about the various types of cancer affecting the female reproductive tract. The nurse explains that ovarian cancer is the leading cause of death from gynecologic malignancies based on the understanding that this type of cancer:

typically manifests with vague symptoms resulting in late diagnosis. Tumors of the ovary have been lethal largely because they present with nonspecific symptoms and therefore frequently are far advanced and inoperable by the time they are diagnosed. Ease of spread and types of cells involved are not reasons underlying the fatal nature of this type of cancer. Ovarian cancer is not associated with sexually transmitted infections. Cervical cancer is linked to human papillomavirus infection.

While conducting an interview with a 38-year-old client, the nurse recognizes which factor as putting the client at the greatest risk for endometrial cancer?

use of estrogen without progestin for hormone replacement therapy One mechanism believed to be involved in the development of endometrial cancer is a history of exposure to unopposed estrogen, the cause in 75% of women. It is also uncommon before the age of 40.

A nurse explains to a client that although HPV infection is more commonly associated with cervical cancer, which cancer would the nurse identify as also a risk?

vulvar cancer Classic VIN vulvar cancer is associated with HPV infection (genital warts due to types 16, 18, 31, 33, 35, and 51). It typically occurs in women between 30 and 40 years old. Simplex VIN usually occurs in postmenopausal women and is not associated with HPV.

An elderly woman is seen in the clinic reporting a lesion on her labia majora and states that she has experienced some bleeding and itching as well. She states that this has been going on for approximately three months. She tells the nurse that she has not been to a health care provider in over 10 years. What diagnosis would the nurse expect the primary care provider to make?

vulvar cancer The correct diagnosis for this client would be vulvar cancer due to the placement of the lesion, the itching, and the bleeding. The other cancers would have different symptoms and not apply to this client.

A client presents at a community health care center for a routine check up. The client wants to know about any tests that can effectively detect ovarian cancer early. The nurse should inform the client about which test that aids in the detection of ovarian cancer?

yearly bimanual pelvic examinations