g besides C/S, general anesthesia may be
BIRTH CONTROL COMPARISONS
F. Common Benign Neoplasms 1 Types/Management
a. ovarian masses
-70-80% benign
-S & S-asymptomatic
-mass may be palpated on pelvic exam -may have a feeling of fullness, cramping -can lead to dyspareunia, irregular bleeding -may resolve on own
-use of OC’s
-diagnostic laparoscopy with possible laparotomy
b. uterine masses -fibroids-leiomyomas -minimal CA risk
-S & S-frequently asymptomatic -low abdominal pain, fullness, pressure -menorrhagia, dysmenorrhea
-metrorrhagia (intermenstrual bleeding) -may shrink with menopause
2. Total abdominal hysterectomy
a. removal of uterus and cervix thru abdominal incision
b. may include removal of fallopian tubes/ovaries BSO-bilateral salpingo-oophorectomy
castration in females c. 600,000+ are done yearly
d. questionable reasons for surgery e. may want to consider alternatives
LAVH-laparoscopic assisted vaginal hyster. f. pre-op: lab work, ECG, chest x-ray, informed
consent-must understand means sterility g. IV, shave, abdominal prep, Foley cath
h. post-op care similar to post-op C/section i. need to deal with psychosocial issues G. Reproductive cancers
1. Endometrial
a. most frequently occurring reproductive cancer
b. 5th most common after skin, lung, breast, and colorectal
c. asymptomatic in early development d. endometrial cancers are nearly all
adenocarcinomas (80%)
-cancer of glandular cells e. S &S-postmenopausal bleeding f. risk factors: obesity, advanced age,
unopposed ERT, nulliparity,
late menopause >age 52
Caucasians
g. found by endometrial biopsy
h. tests: CBC, liver function, renal function, BE, CT, liver and bone scan, CA-125 j. tx: radiation-intracavity (brachytherapy)
-external beam chemo
surgery-TAH/BSO 2. Cervical-
a. 3rd most common CA of reproductive tract
b. risk factors
-age (50-55) -early childbearing
-non-Caucasians -smoking
-multiple sexual partners -HPV→Gardasil vaccine c. testing
-Pap smear -colposcopy
-punch biopsy -ECC
d. staging:
Stage 0-carcinoma in situ-superficial
Stage 1-invaded the cervix without spreading Stage 2-CA has spread but remains in pelvis
Stage 3-CA spread to lower wall of vagina -5 year survival rate as low as 20-40% Stage 4-CA spread to distant organs
e. tx:
Stage 0-cryosurgery, laser surgery, LEEP/LEETZ,
cone biopsy, hysterectomy
(loop electrosurgical excision procedure)
Stage 1-simple hysterectomy
if cancer is more than 3mm-may want radical hysterectomy with removal of
lymph nodes in the pelvis
Stage 2-hysterectomy with high-dose radiation and chemo
Stage 3 & 4-treatment and predictive prognosis varies on severity of spread and response 3. Ovarian-
a. most often occurs in 5th decade (age 45-65)
b. most occur after menopause c. risk factors
-fertility drugs -early menstruation
-nulliparity -high fat diet
-smoking -alcohol
-1st child after age 30
-h/o breast, colon, or endometrial CA -family h/o breast or ovarian CA d. ↓ risk
-use of OC’s -h/o BTL
-BSO
e. 5 year survival rate-90% (Stage 1), 10% (Stage IV) -discovery of CA not until advanced stage f. S & S
-irregular menses -PM tension
-menorrhagia -breast tenderness
-early menopause -abdominal discomfort
-dyspepsia -pelvic pressure
-↑ abdominal girth -urinary frequency g. in 75% of cases, CA had metastasized before dx
-60% beyond the pelvis
h. dx: transvaginal U/S, laparoscopy, laparotomy i. tx:
-TAH/BSO -tamoxifen -chemo -radiation
j. CA 125-associated with various epithelial CA may be used to assess response to tx in women with known ovarian CA 4. Vulvar
a. 90% squamous cell carcinomas b. accounts for 4% of Gyn malignancies c. more than 50% of cases occur in
postmenopausal women (age 65-70)
by late metastasis to regional lymph nodes e. risk factors: HTN, obesity, DM
f. S & S: bleeding, malodorous D/C, pain, pruritus g. tx: excision, laser, radiation, vulvectomy
IV. Male Reproductive Disorders- A. Testicular Cancer
1. Leading cause of cancer deaths in men 15-35 yrs old a. highly treatable
b. usually curable-over 90% in all stages combined c. rarely bilateral
d. CA most commonly dx-solid tumor-age 15-40 e. most often in Caucasians, rare in African-Amer. 2. Pathophysiology
a. germinal-sperm-producing cells-95%of cases -2 types
seminomas- (40%)
-occur in men late 30’s to early 50’s -localized-grow slow
-metastasized later
-response well to radiation
-5 year survival rate-95% with
surgery and radiation
nonseminomas-not sensitive to radiation
-occur in men late teens to early 40’s
-need surgery or chemo
-embryonal carcinomas
common in men 19-26 yrs old may spread via bloodstream -teratomas
rarely occur
often mixed with other tumors -choriocarcinomas
lethal, fast spreading
initial dx often in metastatic
stage -25%-teratocarcinomas
b. stromal-hormone producing
-interstitial cell tumors(arise from Leydig cells) ↑ androgenic hormone secretions
rare, usually benign
-androblastomas
rare, usually benign
may secrete estrogen-feminization
3. Causes
a. mainly unknown
b. may be R/T cryptorchidism
-if develops CA, 75% will be in the undescended testis (assoc. with seminomas)
c. may be R/T trauma, infection 4. Testing
a. tumor marker study
-benign tumors never elevate marker proteins -AFP and HCG-for nonseminoma
-in seminomas-↑ hCG/LDH but not AFP if ↑ AFP, think mixed tumor-diff. Tx -if tx effective, markers should fall
b. CT scan, U/S
c. Chest x-ray to r/o metastasis
d. lymphangiography to ck retroperitoneal lymph nodes
5. Physical exam
a. palpate for lump
b. may see painless enlargement c. heaviness, dragging sensation d. dull ache in abdomen, inguinal 6. Nursing diagnosis
a. risk for sexual dysfunction R/T disease/surgery b. dysfunctional/anticipatory grieving
c. disturbance of body image R/T dx and tx d. acute/chronic pain
e. anxiety R/T dx of cancer
7. Management
a. sperm banking-before radiation and chemo
b. chemo
c. radiation-seminomas
-used after orchiectomy -external beam therapy
→nonseminomas-radical lymph node
dissection saves sympathetic ganglia
d. stem cell transplantation-used with chemo to help prevent infection/anemia
e. unilateral orchiectomy
f. radical retroperitoneal lymph node dissection
-helps to stage the disease and reduce tumor 8. Post-op teaching
a. watch for fever, chills, increasing tenderness, pain around the incision, drainage, or dehiscence of the incision
b. no stair climbing or heavy lifting (>20 lbs)
d. needs follow-up studies/TSE B. Other Reproductive Disorders
1. Hydrocele
a. cystic mass with straw-colored fluid forming around the testis
b. disorder of lymphatic drainage of scrotum c. no tx necessary unless compromises testis
circulation
d. aspirated or surgically removed
e. may need surgical drain and hospitalization f. directed to wear scrotal support
2. Spermatocele
a. sperm-containing cystic mass on the epididymus
alongside the testicle
b. usually small/asymptomatic-no intervention c. may be excised thru small incision in scrotum 3. Varicocele
a. cluster of dilated veins posterior/above testis b. uni or bilateral
c. usually asymptomatic-no tx d. if painful-surgically removed
-inguinal incision
-may need to elevate scrotum with towel when in bed to help with drainage
e. can cause infertility by ↑ scrotal temperature 4. Scrotal trauma
a. torsion of testes-twisting of spermatic cord -considered a surgical emergency
-S & S-pain, N & V
b. ice, elevate, avoid heavy lifting, scrotal support 5. Cryptorchidism
a. undescended testis
b. mainly a pediatric problem
-3% full term males
-20% male premies
c. 80% will spontaneously descend
d. orchidopexy-surgical placement of testis
into the scrotum 6. Cancer of the Penis
a. less than 1% of male malignancies
b. carcinoma is a painless, wartlike growth/ulcer c. small areas may be excised or cured with radiation d. penectomy-partial (glans only) or total
-with total-need a perineal urethrotomy for urinary drainage
7. Phimosis
a. prepuce constricted-can’t retract over glans b. tx-circumcision
8. Priapism
a. uncontrolled, prolonged erection
b. penis remains large, hard, and becomes painful c. causes
-neurological -vascular -pharmacological
d. urologic emergency
e. need to improve venous drainage to corpora cavernosa
f. tx: Demerol, warm enemas, catheter, aspiration of corpora cavernosa
9. Epididymitis
a. infection of the epididymis-tx with abx b. may come from infection of the prostate c. men under 35 yrs, chlamydia trachomatis d. c/o pain along inguinal canal and vas deferens e. may have pain and swelling of the scrotum f. if untreated, pyuria and bacteriuria may develop g. abscess may form necessitating an orchiectomy 10. Orchitis
a. acute testicular inflammation b. results from infection or trauma
c. caused by bacteria from urethra or other sources
d. may be uni or bilateral
e. risk for sterility R/T testicular atrophy
f. tx: bedrest, scrotal elevation, ice, analgesics,
and antibiotics
g. mumps orchitis-20% of males who have mumps after puberty-given gamma globulins
-childhood vaccination is a good preventative
measure 11. Prostatitis
a. may be bacterial or abacterial (more common) b. abacterial-after a viral illness or assoc. with STI
-also called prostatodynia
c. bacterial-assoc. with urethritis
-common bad guys-E. coli, Proteus, Enterobacter
and group D streptococci
-S & S-fever, chills, dysuria, urethral discharge,
and boggy, tender prostate
d. can lead to inflammation of the bladder and epididymus
e. sexual dysfunction may occur R/T pain f. tx: antimicrobials-Geocillin, Cipro
h. use analgesics prn
i. if UTI develops, may be put on Septra j. instructions on activities to drain prostate
-sexual activities -masturbation
-prostatic massage
Infertility and Genetics Lecture 13
I. The Couple Experiencing Infertility A. Incidence
1. Definition: Inability to conceive and carry a pregnancy to viability after at least one year of regular
sexual intercourse without contraceptive use a. Primary-never pregnant
b. Secondary-had been pregnant in the past 2. Problem for 10-15% of reproductive-aged couples 3. Women over age 35-21% chance of infertility B. Risk Factors
1. Females
a. abnormal external genitals
b. abnormal internal reproductive structures c. anovulation
-pituitary/hypothalamus hormone disorders -adrenal gland disorders
d. amenorrhea after stopping OCP e. early menopause
f. increased prolactin levels g. tubal motility reduced
h. inflammation within the tube i. tubal adhesions
j. endometrial/myometrial tumors
k. Asherman’s syndrome-uterine adhesions/scars 2. Males
a. undescended testes b. hypospadias
c. varicocele
d. low testosterone levels
e. testicular damage-trauma, mumps f. endocrine disorders
g. genetic disorders h. STI’s
i. exposure to hazardous substances j. change in sperm
-smoking, heroin, marijuana, amyl nitrate, butyl nitrate, methaqualone
k. decrease in sperm -hypopituitarism -chronic disease
-gonadotropic inadequacy
l. obstruction of the vas deferens or epididymis
m. decreased libido
n. impotency