WOMENSHEALTH

Vocabulary:
Cytology:Structureandfunctionofcells.
Dyspareunia:painfulsex
Dysmenorrhea:painfulmenstruation
Dysuria:painfulurination
Fistula:tunnel,abnormalconnectionbtworgans
Lisothomy:positionforsurgicalproceduresandmedicalexaminationsinvolvingthepelvisand
lowerabdomen.
Menopause:Cessationofmensesandfertility
Oligo:decrease
Femalereproductivestructures
Ovaries:
Produceestrogenandprogesterone
Estrogen:Estradiol
Mainsecretoryproductofovaries
RegulationofFSH&LH
Developmentofsexcharacteristics
Growthoftheductalsystemofthe
breasts
Monthlyendometrialgrowth
Thickeningofvaginalmucosa
Thinningofcervicalmucus:usedinfertilityclinics
toindicateovulationwilloccursoon
Stimulatedevelopmentofsecondarysex
characteristics(Breasts,skin,bonedevelopment,
distributionofhairandbodyfat)
Proliferativeendometrium(topreparetheliningof
theuterusforimplantationwiththefertilizedegg)

Progestin:Progesterone
Promoteoptimalconditionsforpregnancy
Endometriumafterovulation
Startofmensesinabsenceoffertilizedovum
Mainsecretoryproductofthecorpusluteum
Responsiblefortissuegrowth&secretoryactivity
intheendometriumfollowingtheproliferative
phaseofmenstrualcycle
Maintenanceofpregnancy
Inductionofmenstruationwhenunfertilizedegg
Increasetemperaturewhichismonitoredinthe
RhythmMethodofbirthcontroltoindicatethat
ovulationhasoccurred

Antiinsulineffectwithincreasedglucoselevels(to
allowincreaseddiffusionofglucosetothedeveloping
fetus)
Hormonessecretedbypituitaryglandsplayamajorroleintheregulationofthemenstrual
cycleandfertility.

PituitaryGland:
Anteriorpituitary:
ThyroidStimulatingHormone(TSH)
FollicleStimulatingHormone(FSH)
SynthesisandreleaseofFSHistriggeredbythearrival
from the hypothalamus of gonadotropinreleasing
hormone (GnRH). FSH (assisted by LH) acts on the
follicletostimulateittoreleaseestrogens.
LuteinizingHormone(LH)
AsurgeofLHtriggerseggrelease(ovulation)inthe
middleofthemenstrualcycle;stimulatesthenow
emptyfollicletodevelopintothecorpusluteum,which
secretesprogesteroneduringthelatterhalfofthe
menstrualcycle.
Prolactin(PRL)
GrowthHormone(GH)
ACTHtheadrenocorticotropichormone
AlphaMelanocyteStimulatingHormone(MSH)

Posteriorpituitary:
Vasopressin (ADH): Reabsortion of H2O by
blood.
Oxytocin
Stimulatingcontractionsoftheuterusatthetime
of birth; stimulating release of milk when the
babybeginstosuckle.

Pelvicexamination:
Lisothomyposition:positionforsurgicalproceduresandmedicalexaminationsinvolvingthe
pelvisandlowerabdomen.
Relaxationtechniques:breathingexercises,adjusttemperature,andexplaintheprocedure,calm
environment.
Explainprocedure

Equipment:
Perinealdrape
VaginalSpecula
Watersolublelubricant

 Sterilegloves
Longswabsticks
Adequatelighting
Diagnostictests:
CA125tumorantigen(markerforovariancancer)CAstandsforcancerantigen.CA125isa
proteinthatisatumormarkerorbiomarker,whichisasubstancethatisfoundingreater
concentrationintumorcellsthaninothercellsofthebody.
ThenormalvaluesforCA125is035units/ml.CA125isusuallymeasuredfromavenousblood
sample.CA125ispresentingreaterconcentrationinovariancancercellsthaninothercells.
Cytology:
BethesdaSystem2001????
Papanicolau:methodofcervicalscreeningusedtodetectpotentiallyprecancerousandcancerous
processesinthecervix(openingoftheuterusorwomb).Scrapeofthecervixtogetthecells.
TestforGonorrhea/Chlamydia
DNAProbe/Antigendetectiontest

a.
b.
c.

d.
e.
f.
g.
h.

i.

RadiologicandImaging
Hysterosalpinogram:isanXraytestthatlooksattheinsideoftheuterusandfallopiantubes
andtheareaaroundthem
Pelvicultrasound:lookingformasses,tumors,typeofgrowth,fibroids.
Colposcopy:useofamagnifyingdevicetolookatthevulva,vagina,andcervix.Ifaproblemis
seenduringcolposcopy,asmallsampleoftissue(biopsy)maybetakenfromthecervixorfrom
insidetheopeningofthecervix(endocervicalcanal)
Conization:excisionofaconeshapedsampleoftissuefromthemucousmembraneofthecervix
Culdoscopy:Examinationoftherectovaginalpouch
Hysteroscopy:usesathintubeliketelescopetoseeinsidethewomb(uterus).Itcanalsoallow
doctorstodosomeminoroperationstotheuterus.
Endometrialbiopsy:Takeapieceoftheendometrium
DilationandCurettage:DilationwithdifferentrodsizestoaccesstheuterusandthenCurettage,
whichisremovalorpartoftheendometriumfortesting.(isnotadiagnostictest,isinvasiveis
doneafterbiopsy,oranyotherdiagnostictest.Takingawaypiecesofendometrium)
Laparascopy:openingasmallincisionandputscopeandlookaround.Thehealingtimeis
shorterthandoingthewholeincisionoperation

Perimenopause:istheperiodextendingfromthefirstsignsofmenopauseusuallyhotflashes,
vaginaldryness,orirregularmensestothecompletecessationofmenses.
Decline(notcompletecessation)ofhormones(estrogenprogesterone)
Cycleirregularity
Thermalissues
Duration28yrs(avg5yrs)
HowisDiagnosed
ByrulingoutotherdiseasesthatmaymimictheS/Sofperimenopause
Ex:Hypothyroidism(weightgain,fatigue,thindryhair,goiter,coldintolerance,thickbrittle
nails.)
InthiscasetestforTSH,T3&T4

S/S
Irregularmenstruation.
Vasomotorinstability(85%)
Basicallythebloodvesselsaren'tquiteuptospeedonkeepingthecorrectbloodpressure.ANS
related.AffectsbothSNSandPNS.
Sleep/Mooddisturbances
Oligo(anovulation)oligomeansdecrease,sothereisadecreaseinovulation.
SomaticSymptoms(Fatigue,palpitations,headache,increasedmigraine,breastpainand
enlargement.)
ManagingPerimenopause
HRT:replacementofhormonesisnotwidelyusedanymore.Itcausesthromboembolicevents
(Stroke,Heartattack,DVT,MI,PE).Italsoincreasestheriskofbreastandendometrial
cancer.Somephysiciansstillrecommendedbutatverylowdoses.

Smokingandtakinghormonesiscontraindicatedtoo.Smokingcausesvasoconstriction,closes
thevessels,addingHRTincreasestheriskforthromboembolicevents.Ptover35whosmoke
shouldnotbeonHRT.
Menopause:Cessationofmensesandreproduction
Permanentphysiologiccessationofmensesassociatedwithdecliningovarianfunction;during
thistime,reproductivefunctiondiminishesandends
S/S

Vasomotorinstability(85%)
Irregularmenses
Breasttenderness
Moodswings
Hotflashes
#1complaintophysicians
Moresevereatnightandduringtimesofstress
Lastfewsecstomins
Morecommoninoverweightwomen
Usuallylast12yrs(25%willlastformorethan5yrs)
Nightsweats
Weightgain
Fatigue
Forgetfulness

Factorsimpactingmenopause
Age(Average51)
Tobacco
Alcohol
BMI
Startofmenarche
Genetics

FactorsNOTimpactingmenopause
Oralcontraceptivepill(OCP)use

Parity
Multiparity(givingbirthto2ormorechildren)
Primiparity(givingbirthto1children)
Nulliparity(nevergivingbirth)
Race
Height
Managinghotflushes/flashes
Lowerambienttemp
ReducedEstrogen(8095%reduction)
UseHRTbutconsidertheS/Elikethromboemboliticevents(DVT,Stroke,MI,Pulmonary
EmbolismPE)
Italsoincreasestheriskofbreastandendometrialcancer
Medications
Highdosesofprogestin
Tibolone(isareplacementforestrogen)
SelectiveserotoninreuptakeinhibitorsSSRIs(Antidepressants)
Paroxetine(Paxil)
Fluoxetine(Prozac)
SerotoninNorepinephrineReuptakeInhibitorsSNRI(Antidepressants)
SNRIsblocktheabsorption(reuptake)oftheneurotransmittersserotoninandnorepinephrinein
thebrain
Venlafaxine(Effexor)
Gabapentin(neurontin)worksinANS,helpsw/thermoregulation
Clonidine(alphaadrenergic,BP,vasodilates,thereforecausestachycardia,dizziness,fatigue)
Osteoporosis:Decreasebonedensity
Osteoclast:increasesboneresorption(breakdown)thereforetheCagoesintotheblood,and
hypercalcemia(neuromuscular,coagulationproblems,putEKGtopt)
Osteoblast:Boneformation.
Forosteoporosistooccurthereismoreosteoclastthanosteoblast.
Calcitonin(producebythyroidgland)inhibitsosteoclasticboneresorption.Thereforedecreases
boneresorptionandincreasesdepositsofCaandPinbones.
Note:CaandPareinverselyrelatedCaP
Abonedensitytestisusedtodeterminetheconditionofthebones(DEXA)isnoninvasive

Interventionsforpostmenopausalosteoporosis
CaSupplementandVitD
Camustbetakenwithmealsandforpostmenopausalwomen(12001500mgdaily)
Watchforconstipation,renalcalculi,hypercalcemia
Mobility/Exercise(weightbearing)
Estrogentherapy
Watchforthromboemboliticevents
Ex:DVT(Tenderness,warmthincalf,unilateralcalfswelling)
PE(Suddenintensechestpainw/shortnessofbreath)
MI(Chestpressure,sweating,painradiatestoback)

Nutrition
Highinfiber
HighinCa(darkgreenvegetables,soy,legumes)

WhoGetsOsteoporosis?Why??
Age
Gender
Race(White)
Estrogendeficiency
Testosteronedeficiency
Familyhistory/genetics
LowCa/VitDintake
Poorexercise
Smoking/alcohol
Lowbodyweight/anorexia:Womenwithlowbodyfatoftendonotproducesufficientamounts
ofestrogen,progesterone,andtestosterone.Thiscanbeaproblemforwomensuchasathletes,
models,andgymnasts.Itcanalsobeaproblemforwomenwitheatingdisorders
Hyperthyroidism
Hyperparathyroidism
Prednisoneuse
Liverandrenaldisease(thinkaboutVitDsynthesis)
Lowsunexposure
Medications(antiepilectics,heparin,glucocotticoidstakenforprolonguedperiodsoftime)
Malignancies(metastaticdisease,multiplemyelomacanpresentasosteopenia)
Hemiplegias/pCVA/immobility
MethodtoevaluateOsteoporosis?
DualenergyXrayAbsorptiometry(DEXA)
MajordiagnostictooltoutilizeandanticipatethephysicianwillorderDEXAtoruleout
osteoporosis.Itmeasurestheheel,theforearmandthedensityofthebone.

OsteoporosisTreatment
Ca&VitD
Calcitonin(Miacalcin):asanasalspraycanbeusedalso.Thereforedecreasesboneresorption
andincreasesdepositsofCaandPinbones.
Biphosphates(dronate)
Alendronate(Fosamax):takeitonanemptystomach,fullglassofwatertoincreaseabsorption.
Stayuprightfor30mintoavoidesophagealerosion.
Risodronate(Actonel,Atelvia)
Ibandronate(Boniva)
WithBisphosphonatesptneedstodrink8ozofH2Oandstayuprightfor30minafter
takingthemedtoavoidesophagealerosion.
IVform(Pamidronate,zolendronate)givenforacutesituationsinthehospitalsetting.
Selectiveestrogenreceptormodulators(SERMS)
Raloxifene(Evista)
PTH(Parathyroid)
terapartide
Endometriosis

Isintheuterus,butwhenitbecomeshyperproliferative(overgrowth)goesthroughlymphatic
systemandtothevesselsandgooutsideoftheuterus(ovaries,fallopiantubes).Whentheuterine
liningisabouttoshed,causecramping(duetoprostaglandins).Theendometriumthatisoutof
theuteruscauseevenmorepainbctheendometriumisalsogoingthroughthatinflammatory
process.

S/S
Dysmenorrhea
DeepPelvicDyspareunia
Pelvicheaviness(Pelvicorlowerabdominalpain;theareamayfeel"heavy")
Painradiatingtothethighs(radiatestothethighandbackbcuterusandlegareconnectedand
havethesamedermatones(areaofskinthatismainlysuppliedbyasinglespinalnerve)
Diarrhea(bcGIistheneighbor)
Painondefecation(GIistheneighbor)
Management/Medication(isbasedonseverityofsymptoms)
MildpainistreatedwithNSAIDs(decreaseprostaglandinsproductionandtherefore
inflammation)
Txwith:
Lupron
Synarel
Botharehormonesthatdecreaseproductionofestrogen(bcestrogenhelpw/proliferationof
endometrialtissue)Reducepain/lesionsofendometriosis.
Txwith:
Testosterone
Leuprolide
Nafarelin
Danazol
Toreduceendometriallesionsandpelvicpain.
Treatment
Islimitedto6monthstominimizeboneloss
S/E:masculinizingtraitsinwomen(hirsutism:facialhair,deepvoice)
Surgical:Totalabdominalhysterectomyifnonchildbearing
Surgical:Carefulremovalbysurgeryorlasertherapyforchildbearingwomen.
Itisdifficulttogetpregnant
STIs
Areprimarilytransmittedbyclose,intimatecontact.
Mostcommoninwomen:
Chlamydia(Bacteria)
Gonorrhea(Bacteria)
HumanPapillomavirus(virus)
HerpesSimplexVirustype2(virus)locatedinthegenitals
Syphilis(Primary,SecondaryandTertiary)
HIV
ChlamydiaandGonorrheaarebestfriends.IfthereisChlamydia,testingneedstobedonefor
Gonorrheaandvice.

1.
ChlamydiaTrachomatis

(causedbybacteria)

Silentbutdestructive.Transmittedbyoral,vaginalandanalsex
Difficulttodiagnose/symptomsarenonspecific
Mayexperiencespotting
Postcoitalbleeding/strongvaginalodor
Muccoidorpurulentdischarge
Dysuria(painonurination)
Complications
PelvicInflammatorydisease(PID)
Increasechanceofectopicpregnancy
medicationforectopicpregnancy:
methotrexate
Action:interfereswithfolicacidmetabolism,inhibitcellreproduction.Theeggwontgrowis
goingtodestroy.Ectopicpregnancyisamedicalemergencybcitcanrupturethefallopiantube.
Tubalfactorinfertility(lotsofscarringdoesntlettheegggothroughthefallopiantubes)
Management/Medication
Pregnantwomenshouldhavecervicalculturesatfirstprenatalvisitandlateinthethirds
semester.
Treatmentforpregnantwomen
Erythromycinx7days
Erythromycinisanantibioticmicrolide(mycin)
Amoxicillinx7days
Amoxicillinisapenicillin(cillin)
Treatmentforurethral,cervicalandrectalinfections(Tetracyclineantibiotics)(cycline)
Doxycyclinex7days
S/E:inchildrenandpregnantwomencausesdiscolorationanddamagetheteeth
Azithromycinx1dose(AntibMicrolide)(whenpatientsarenoncompliantwiththetreatment)

2. Gonorrhea(causedbybacteria)
Transmissiongenitaltogenitalcontact
Mayspreadfromvaginatorectuminfemales
Majoritycontractinginfectionisunder20yearsofage
Causessterility(bothmale/female)
Incubationperiodis35days

S/S
OftenAsymptomaticinfemales
Purulentdischarge
ChronicAcuteAbdominal/Lowbackpain
Rectal
Pain
Itching
Bloodinstool
Interventionsforantibiotictherapy
Takeitforfulltime
Drinkalotofwater(toflush)

Labtestbeforeadminantibiotics(liverenzymes,BUN/Creatinine)

Management/Medication
EIAtesting
Ceftriaxone(Rocephin)
AntibiotictherapysimilartoChlamydia

3. Syphilis
CausedbyTreponemaPallidum(bacteria)
Transmission:
Subcutaneouslythroughmicroscopicabrasionsthatcanoccurduringintercourse
Kissing
Biting
OralSEX
Transplacental

S/S
Primarylesion(590days=painlesschancresores)
Secondarylesion(6weeks6months=widespreadsymmetricmacopapularrash,spotsonhands
andfeet)
Pinkgraywartlikelesions.
Tertiary(untreated=neurologicalandmultisystemcomplications)GUMMAS
Thetertiarystageisnoncontagious
Gummas:isasoft,noncancerousgrowthresultingfromthetertiarystageofsyphilis.Big
ulceration.
Aortitisandneurosyphilis(valvularinsufficiency,gummas,andchangesinmentationareother
clinicalmanifestationsofthisstage.dementia,psychosis,stroke,paresis,andmeningitis)arethe
mostcommonmanifestationsoftertiarysyphilis.

Diagnosis
Rapidplasmareagincardtest(RPRCT)

Management/Medication
Penicillin
Doxycycline(classtetracycline)
Erythromycin(oto/earandnephrotoxicity)
Monthlyfollowup

4. Pelvicinflammatorydisease
Chlamydia,ghonorrheaandendometryosiscanleadtoPID
Etiology:
Associatedwithmorethatoneorganism
Ascendingorganismfromvaginatouppergenitaltract
Spreadhappensattheendorjustaftermenses

Organsinvolved
Uterinetubes

Uterus
Ovaries

RiskFactors:
Youngage
MultipleSexualPartners/Highrateofnewpartners
HistoryofSTIs

S/S
Pain
Intermenstrualbleeding
Bilateralpelvictenderness
Fever!!!
AlsocanhaveGIandGUsymptoms

Complications:
Ectopicpregnancy,infertility
Management/Medication
BroadSpectrumABT(penicillin,cephalosporin)
Education
Routinescreening
Bedrest
Nutritionallysounddiet

Viralinfections
5.

Humanpapillomavirus(HPV)
Previouslyknownasgenitalwarts(Chomdilamadaisthestrainthatcreatesthewarts)
Verylonglatencyperiod
Transmittedbysexualcontact

Diagnosedby:
colposcopyanddirectvisualization
Biopsy
Maybemistakenforsecondarysyphilis(bcitmayhavethecherryspotsonit)

S/S
Lesionsonbuttocks,vulva,vagina,anusandcervix
Small,soft,papillaryswellingsinclusters
Vaginallesionsaremultiple
CANCAUSECHANGESINCERVICALCELLSTOCERVICALCANCER

Management/Medication
Cannotbeeradicated(ITSFORLIFE!!)
Treatthesymptoms
Goalistoremovethewartsandrelievepain
Bathinginoatmealsolutions
Usinghairdryertodryarea
Decreasefriction

Podofillin(topicaltreatmentforwarts)

6. HerpesSimplexVirus
Liveswhenevertherearemucusmembranes(eyes,ears,nose,mouthetc).Thereiscellcross
contamination
Thereisnosafetimetohavesexwithouttheriskofbeingtransmitted.Alwaysatrisk(viral
shedding)
HerpessimplexandHPVareunderviralcategorybuttheyhavedifferentstrains

Etiology
Transmittedsexually
Resultsinpainfulrecurrentgenitalulcers
HSV1Oralfeverblisters
HSV2Genital

S/S
Thefirsttimew/theoutbreaktheycanfeelverysickandthenthechancressorecomeout.After
thattheycangetsickbutnotassick
Genitallesions
Fever
Chills
Malaise
Severedysuria
Maylast23weeks
Severevulvarswelling
Itching/Tinglingsensationindicatinganoutbreakisimminent.
Inguinaltenderness
Management/Medication

ChronicandrecurrentwithNoCure
Donthavesexuntillesionsaregone.
Systemicantiviralmedications
Acyclovir,Valacyclovirandfamciclovir
CleaninglesionsBIDwithNSwillhelppreventsecondaryinfection
Warmsitzbathwithbakingsoda
Keeplesionsdry
Looseclothing
HydrogenPeroxide
OatmealBaths

VaginalInfections

7. Candidiasis
YeastInfection(isafungus)
OrganismCandidaAlbicans
Anodorless,white,curdlikevaginaldischarge.(likecottagecheese)
Mostcommonsign=vaginalitching
Note:antibioticsandcorticorteroidscausecandidabckillthegoodandbadflorainvagina

Management/Medication
Antifungals,Monistat,Fluconazole,Gynelotrimin(azole)

Predisposingfactors:
ABT
Pregnancy
Obesity
DietHighinrefinedsugars
Corticosteroids(increasetheinflammatoryresponseanddecreasetheimmunesystem)

8. Trichomoniasis(causedbyaparasite/protozoa)
Almostalwaysasexuallytransmittedinfection
Maybeasymptomatic

S/S
Yellowishgreenishfrothydischarge
Mucopurulent,copiousmalodorousDC
Dysuria,dyspareunia
Vulvainflammation
Strawberryspotsoncervixandvaginalwall

Diagnosis
PelvicExam,PAP
Management/Medication

Metronidazole2Gsingledose
or1week3timesaday.
akaflagyl
S/E:metallictasteinmouth(tellthepatientislikesuckingonapenny)

GynecologicalCancer
Ovarian
Mostmalignant
Mostdeathsfromthiscancer
Riskfactors:
Age(>40)
Familyhistoryofovarian/breastcancer
Havingnochildren(nulliparity)orHavingchildrenlateinlife
NativeAmericanwomenhavethehighestincidence
Noearlywarningsigns

Endometrial/Uterine
Mostcommonmalignancyofreproductivesystem
Birthcontrolpillsprovidesomeprotection
MostcommoninCaucasianwomenandaftermenopause
Cardinalsign:Abnormaluterinebleeding

Riskfactors:
Estrogentx,
Nulliparity/infertility
Early/latemenopause
Obesity,HTN,DM
FamilyHx

Cervical(cardinalsignisabnormalbleeding)
Riskfactors:
Earlyageoffirstsexualintercourse
Cigarettesmoking
HumanPapillomavirus(HPV)
Multiplesexualpartners
VaginalCancer
Notasfrequent,isverypainful,bleedinganddevelopsfistulaintotherectum
Hysterectomy

Usuallyperformedbyagynecologist
Uterusisremoved
Otherreproductiveorgansmayberemoved
Nolongerabletohaveababy
Periodswillstop

Indications(knowtheindications!!!)

Fibroids
Endometriosis
Uterineprolapse
Canceroftheuterus,cervix,orovaries
Vaginalbleeding
Uncontrollablepostpartumobstetricalhemorrhage
Transgenderman

Risksandsideeffects

Earlieronsetofmenopause
Greaterriskofcardiovasculardisease
Increasedchanceofosteoporosisandbonefractures

Uncontrolledurination
Reducedlibido
Vaginaldryness

ProvideHRTafterHysterectomy,lowdoses,bchighdosesincreaseriskfor
thromboemboliticevents
TypesofHysterectomy(notimportantforthetest)
PartialHysterectomy
Removes2/3ofuterus
TotalHysterectomy
Removesuterusandcervix
RadicalHysterecomty
Removesuterus,cervix,andvagina
AbdominalHysterectomy
Theuterusisremovedthroughanincisioninthewomansabdomen.
Mostinvasivemethod(longertimeofrecovery)
Incisionsiteatabdomen
Hospitalstayof56days
Recoverytime6weeks
Possibleretentionofcervix
Requiredforendometriosisandlargefibroids
Interventionspostoperatively(RecoveryinPACU)
Assess
Respiration
LOC
Pain
VS
EKG
Reviewmeds
Keepeyeofmalignanthyperthermia(maincomplicationoutofOR)(give
Dantrolene)
NOobservationofincisionbyRN.
Circleiftherewasbleedingondressing,toseeifthereismorebleeding
later.
BPisgoingbelowduetoanesthesiaandbloodloss.
I&O
VaginalHysterectomy
Theuterusisremovedthroughthevagina.
Lessinvasivethanabdominalhysterectomy
Incisionsiteatinnervagina
Hospitalstay13days
Recoverytime46weeks
Cervixcannotbepreservedinavaginalhysterectomy
LaparoscopicHysterectomy(smallincision,lesscomplications,fasterrecovery)
Theuterusisremovedinsectionsthroughsmallincisionsusinga

laparoscope
Hospitalstay13days
Recovertimeis46weeks
Longerdurationofprocedure
Requiresgreatersurgicalexpertise
Urinarytractinjuriesaremorelikely
Fewerabdominalwallinfectionsorfebrileepisodes
Lessbloodloss
TherecoveryoftheoperationinPACUdespitebeingalittleincisionis
thesameasanyotherprocedure

RoboticHysterectomy
3dimensionalimage
Greaterarticulation
Eliminatehandtremors
Increasedaccuracyandprecision
MalignantConditionsoftheBreast
Etiology
Unknown
Riskfactors
Age
FamilyHx(mother,sisterordaughter)
EarlyMenarche(12oryounger)
LateMenopause(55orolder)
Nulliparityorfirstpregnancyafter30years
EstrogenTx
DailyAlcoholuse
Obesityaftermenopause
S/S

Lumpofthickeningofbreast,dimpling
Acancerousbreastmassishard,irregularshape,poorlydelineated,non
tenderandnonmobile.Mostpalpablemassesoccurintheupperquadrant
ofthebreast.

Diagnosis
Mammogram
FNA(Fineneedleaspiration)
Localizedbiopsy
Treatment
Surgery(Mastectomy/Lumpectomy)
Breastreconstruction
RadiationTherapy
Hormonetherapy

Chemotherapy

Breastcancerriskfactorsthatcanbecontrolled
Allwomenareatrisk.
Obesity
Exercise
Breastfeeding
Alcohol
HRT
Birthcontrolpills
Nothavingchildren

PotentialApplicationsforBreastCancerBiology
Predictriskofcancerdevelopment
Estimateprognosisforestablishedcancer
Predictresponsetotherapy
(NADIR(lowestpoint)
Ex:WBClevelsislowerthan3000
Whenthechemotherapygetstothenadirthechemoisstopped,untilthevaluesgoesupagainand
restartchemo.
Identifytherapeutictargets
Identifyearlydetectionmarkers
FamilyhistoryasariskfactorHereditaryBreastandOvarianCancer
CausesofHereditarySusceptibilitytoBreastCancer
Sedicebracaisagene.(Isanindicatorofbreastcancer(AngelinaJolie)
BRCA1Associated Cancers:LifetimeRisk.Contributiontohereditarybreastcancer20
40%
BRCA2AssociatedCancers:LifetimeRisk.Contributiontohereditarybreastcancer1030%

BreastsandAxillaeAssessment
Patientistobesittingandfacingnurse
Inspectbreasts,areolarareas,nipplesandaxillae
Raisearmsandassesssymmetry
Placehandsonhipsandassesssymmetry
Leanforwardandassesssymmetry

BreastsandAxillae
Palpateinasequentialmanner(sittingandlying)
Beginatouterquadrantofbreast
Palpatedownwardfromoutertosternalborderofbreast
Compressnipplefordischarge
Palpatechestwall
Palpateaxillarylymphnodes
GuidelinesforBreastSelfExamination

20yearoldandolder=monthly
2040exambypractitionerevery3years
RegardlessofageiffamilyHxshouldseepractitioneryearly
Baselinemammogram3539
Yearlymammogramforwomen35withfamilyhistory
Yearlymammogramforwomenover40
Sametimeeverymonth.Afterperiodduetofybrocisticchangesandbreast
tenderness.Dischargeisabnormal,sotheRNneedstoassessfurther

Mammography(notinvasive,tolookatthedensityofthetissue)
Usealowdosexraysystemtoexaminebreasts
Digitalmammographyreplacesxrayfilmbysolidstatedetectorsthatconvertx
raysintoelectricalsignals.Thesesignalsareusedtoproduceimagesthatcanbe
displayedonacomputerscreen(similartodigitalcameras)
Mammographycanshowchangesinthebreastuptotwoyearsbeforeaphysician
canfeelthem
MammographyEquipment

ComputerAidedDiagnosis
Mammographyallowsforefficientdiagnosisofbreastcancersatanearlierstage
Radiologistsmisdiagnose1030%ofthemalignantcases
Ofthecasessentforsurgicalbiopsy,only1020%areactuallymalignant
CADsystemscanassistradiologiststoreducetheaboveproblems
WhatMammogramsShow
Twoofthemostimportantmammographicindicatorsofbreastcancers
Masses
Microcalcifications:Tinyflecksofcalciumlikegrainsofsaltinthesofttissue
ofthebreastthatcansometimesindicateanearlycancer.
DetectionofMalignantMasses
Malignantmasseshaveamorespiculatedappearance
Complications

Infection
Lymphedema
Hematoma/SeromaFormation
AllergicReaction