Benign tumor

Malignant tumor

Ms. Sneha Sehrawat

AIIMS Rishikesh
 Uterine myoma (fibroid)
• One of most common(80%) benign
gynecologic tumors(fibroid tumor); muscle
and connective fibrous tissue.
• Etiology: unknown
• Asymtomatic, uterus to enlarge depend
on size of tumor
• Fibroids are classified according to
location; subserosal, intramural,
submucosal
Uterine myoma(fibroid)
 Uterine myoma(fibroid)
• Signs & symptoms: menorrhagia(heavy prolonged
vaginal bleeding) and frequent bleeding anemia
(submucosal)
• Dysmenorrhea, dyspareunia, expansion of the low
abdomen(large tumor), pelvic pressure, abdominal
discomfort.
• Depend on ovarian hormones because they grow
during the reproductive years and atrophy during
menopause
• Tx: Depend on symptoms, supportive care,
laparoscopic myomectomy, hysterectomy
• Side effects of hysterectomy; depression, loss of
sexual pleasure, urinary tract injury or infection
 Endometrial hyperplasia
• Benign condition in which the cell lining the
uterus grow too much.
• Women old than 40 yrs some times
developed cancer
• Sign & symptoms: heavy menstrual period
• Dx: Physical & pelvic examination, D&C
endomaterial biopsy
• Tx: hormonal therapy(progesterone), D&C
hysterectomy to prevent developing
cancer
 Benign Cervical Polyps
• Growth and develop endocervical canal.
• Discovered during a speculum examination.
• Bright red, small single or multiple
• 30-40 age women common
• Asymptomatic, occasionally spotting,
leukorrhea(profuse thick vaginal discharge),
menorrhagia, postmenopausal bleeding
• Tx: surgical remove and cauterization biopsy
and endometrial sampling
• Avoid sexual intercourse at least 24hrs to prevent
irritation and bleeding
Benign cervical polyps
 Benign ovarian cyst
• Ovarian cysts are fluid-filled benign growth, various size, single and multiple.
• Many kind of cyst which include ,follicular, luteal, epithelial, dermoid
• Follicular cyst is most common, ovum does not release the egg
• Luteal(hemorrhagic)cyst: bleeding from the ovulation site enters the ovarian
capsule
• Epithelial cyst: from epithelium of the ovary
• Dermoid cyst: contain fat, hair, teeth, mature form
one of teratoma, easily change to malignant
• Post menopausal women with ovarian cyst are increased risk for ovarian
cancer.
• Sx & symptom: no symptoms if large, pelvic discomfort and pain
- Rupture of cyst; severe and sharp pain
- Torsion; Twisted and cut off the blood vessel supplying the cyst and ovary;
nausea, fever, severe abdominal pain
Benign ovarian cyst
 Benign ovarian cyst
• Tx: Wait and see; most of ovarian cyst
shrink and resolve on their own. Follow up
exam 2-3month
• Surgical remove by laparoscope
• Standard pre and postoperative nursing
care
 Uterine cancer
• Endometrial cancer is common, Malignant tumor
• Etiology & pathology: 55-70yrs of age at highest risk
• Risk factors: early menarche(before 12yrs)
- Older than 50 yrs
- Delayed menopause
- Endometrial hyperplasia
- Hormone replacement therapy
- Obesity
- Infertility or nulliparity
- White race
- Family history
 Uterine cancer
• Sign & symptoms: abnormal bleeding,
unusual discharge, painful urination, pelvic
pain
• Dx: D&C and endometrial biopsy
• TX: Depend on stage of the disease
Radical hysterectomy(TAH+BSO total
abdominal hysterectomy and both Salpingo
oopohrectomy)
NG care: Nurse can provide emotional support
and reassurance as well as education.
Preventive life style practices
 Uterine cancer
• 5yr survival rate
- Stage I: 90-95%
- Stage II: 75%
- Stage III: 60%
- Stage IV 15-26%
Prognosis is good because this cancer often
detected early(stage I and II)
 Cervical cancer
• Before cancer, cervical dysplasia
• If not treat dysplasia, develop cervical cancer
• Cervical cancer is third most common cancer in US
• Prevalence site; squamo-columminal junction(cell
lining the cervix); squamo-epitherial cell carcinoma
• Regular Pap smear through early detect and prevent
from invasive cervical cancer risk of death
• Cervical cancer is classified using stage system from
stage 0(carcinoma in situ) to stage IV(invasive cervical
cancer)
 Cervical cancer staging
• Stage 0; carcinoma in situ; cancer is found in
the first layer of cell lining the Cx only
• Stage I; cancer is found in the Cx only
• Stage II; cancer has spread beyond the Cx
upper vagina but not in to the pelvic wall
• Stage III; cancer has spread to the lower third
of vagina and have spread to the pelvic wall
and lymph nodes.
• Stage IV; cancer has spread to the bladder,
rectum, or other parts of body
 Etiology and pathophysiology
• Human papiloma virus(HPV type 16, 18)
• Risk factors: long term persistent HPV infection
and STI
• Smoking
• Weakened immune system
• Multiple sex partners
• First intercourse in an early age
• First childbirth before 20yrs
• Low socioeconomic status
• Diet lacking in Vit. A and C
• Oral contraceptive use
• Sx and symptoms: asymptomatic in the early
stage.
• Vaginal bleeding, Unusual vaginal discharge,
pelvic pain during intercourse
• Tx: Pap smear colposcopybiopsy,
endocervical curettage
• Cryosurgery, Loop Electrosurgical Excision
Procedure(LEEP)
• Invasive cervical cancer; radical
hysterectomy(remove TAH+BSO+lympnode)
• Radiation, chemotherapy depend on stage
Carcinoma of cervix survival at 5yrs
• Stage I 100% closed
100%
• Stage II 60%
• Stage III 25%
• Stage IV 5-10%
• All stage 60%
 Ovarian cancer
• Ovarian cancer is the fifth most common
cancer in U. S.
• Fourth leading cause of death. 78% of
women diagnosed with ovarian cancer
survive 1 yr after diagnosis
• 50% survive longer than 5yrs
• 29% of cases found during early stage
 Ovarian cancer staging
stage characteristics
• Stage I • Ovaries only
• Stage II • To pelvis
• Stafe III • Abdomen, inguinal node
• Stage IV • Distant metastasis, lung
liver etc
 Etiology and pathophysiology
• Risk Factors
- 55-65yrs age more likely than young women, after
menopause
- Family history( mother, sister, daughter)
- Obesity
- Reproductive history; menses before 12, no children,
first child after 30yrs, do not become pregnant.
- Infertility drug for long period
- Hormonal replacement and estrogen therapy more
than 10 yrs
- Breast cancer
 Sign & symptoms
• Asymtomatic, usually vague and similar to
other disorder, thus delaying accurate
identification
• Initial symptoms are abdominal swelling or
bloating, fatigue and abdominal pain,
constipation and urinary frequency.
• If torsion or tumor ruptures, sudden sharp
abdominal pain
• Dx: pelvic examination, ultrasound, Ca-
125(blood test), Laparoscopy with biopsy will
be done confirm diagnosis
 Ovarian cancer 5 yr survival
• Stage IA 82%
• Stage IB 75%
• Stage IC 68%
• Stage IIA 60%
• Stage IIB+c 54%
• Stage III 23%
Stage IV 8%
• Overall survival 32%
 Treatment & management
• Depend on stage and women’s general
health
• Surgery, chemotherapy, and radiation
• Nurse provide preoperative and
postoperative complication and side effects
from chemotherapy and radiation
• Nursing support and client to client
network(support group) can help improve
quality of life
• Nug care: teaching counseling, giving support,
physical care, hospice care if need.
 Vulva cancer
• Cancer of the vulva is rare
• Risk factor: vulvitis, vulvar dermatosis, STIS, cervical
cancer, Diabetes
• Sign & symptoms: vulva itching, burning, pain,
• Clinical exam, scaly lesion that present as red or white
irregular pigmentation
• Lesions can vary in size and shape and can be raised or flat
small or large
• Dx : biopsy and pathologic analysis
• Tx: surgery remove the tissue or tumor
• Complication from radical vulvactomy can include scarring
and wound breakdown skin graft required or
hemivulvactomy