Endometrial

Cancer
Dolojol, Mary Anne Juliet C.
16-1-86903
•Cancer of the uterus
is usually
adenocarcinoma of
the endometrium of
the fundus or body of
the uterus.
Etiology
Cause is unknown but
associated with increased
estrogen exposure as in
tamoxifen use and
unopposed estrogen
replacement.
Risk Factors
Obesity
Nulliparity
Family history
Anovulation
Unopposed estrogen
Clinical Manifestations
• Irregular bleeding before menopause or
postmenopausal bleeding is the most
common complaint.
• Watery, usually malodorous vaginal
discharge.
• Pain, fever, and bowel and bladder
dysfunctions are late signs.
• Anemia secondary to bleeding.
Diagnostic Evaluation
• Pelvic and rectovaginal examination
Endometrial biopsy
Transvaginal ultrasound
Dilation and curettage
Cervical cytology
Management
Staging for endometrial cancer is based on
surgical aspects versus clinical staging.
• Emphasis is placed on histologic grade, depth of
myome-trial invasion, and cervical involvement.
• These parameters assist in prediction of lymph
node involve-ment and help determine need for
lymph node dissection.
• Early stage I requires total abdominal
hysterectomy with bilateral salpingo-
oophorectomy (TAH/BSO).
• Advanced stage I and stage II require
TAH/BSO and selective lymph node
dissection.
Radiation therapy (intracavitary or external) may be added after
surgery or chosen instead of surgery for more advanced stages
or for patients who are high-risk surgical candidates.
• Acute complications include hemorrhagic cystitis, vagini-tis,
enteritis, proctitis.
• Chronic complications include vaginal dryness, vaginal
stenosis, cystitis, bladder dysfunction, proctitis, small bowel
obstruction, fistulas, strictures, leg edema.
• Hormonal therapy—progestational agents may alter receptor
sites in endometrium for estrogen and thus decrease growth
(for metastatic disease); may provide stabilization of disease.

• Chemotherapy—for metastatic and recurrent disease; using

cisplatin, doxorubicin, and possibly paclitaxel.
Complications
• Spread throughout the pelvis; metastasis to
lungs, liver, bone, and brain.
Nursing Assessment
• Obtain history of menses, pregnancy, estrogen
replacement.
• Ask about irregular or postmenopausal bleeding
and other symptoms.
• Assess patient’s response to possible diagnosis
of cancer—fear, guilt, denial.
Nursing Diagnosis
•Acute Pain related to disease process
and surgical treatment.
•Fear related to cancer, treatment
options.
Nursing Interventions
Relieving Pain
• Administer pain medications, as prescribed,
and monitor patient’s response.
• Encourage use of relaxation techniques,
such as deep breath-ing, imagery, and
distraction, to help promote comfort.
Relieving Fear
• Support patient through the diagnostic process and reinforce
information given by health care provider about treatment
options.
• Prepare patient for radiation therapy, if indicated (see below).
• Prepare patient for hysterectomy, if indicated (see page 845).
• Provide complete and concise explanations for all care you
provide; emphasize the positive aspects of patient’s recovery.
Patient Education and Health Maintenance
• Explain importance of reporting postmenopausal bleeding.
• Encourage keeping follow-up visits.
• Explain that surgery or radiation treatment does not prevent
satisfying sexual activity.
Evaluation: Expected Outcomes
Verbalizes understanding of diagnosis and treatment chosen. ss
Verbalizes decreased pain.