Assessment

HISTORY. Establish a history of risk factors. The major initial symptom of endometrial cancer occurring in 85% of women is abnormal, painless vaginal bleeding, either menometror-rhagia or postmenopausal. A mucoid and watery discharge may be noted several weeks to months before this bleeding. Postmenopausal women may report bleeding that began a year or more after menses stopped. A mucosanguineous, odorous vaginal discharge is noted if metastases to the vagina has occurred. Younger women may have spotting and prolonged, heavy menses.

Inquire about pain, fever, and bowel/bladder dysfunction, which are late symptoms of uterine cancer. Assess the use and effectiveness of any analgesics for pain relief and also the location, onset, duration, and intensity of the pain.

PHYSICAL EXAMINATION. Conduct a general physical and gynecologic examination. The woman should be directed to not douche or bathe for 24 hours before the examination so that tissue is not washed away. Inspection of any bleeding or vaginal discharge is imperative. The characteristics and amount of bleeding should be noted. Upon palpation, the uterus will feel enlarged and may reveal masses.

PSYCHOSOCIAL. Women with the disease often exhibit depression and anger, especially if they are a nulligravida. Therefore, a thorough assessment of the woman's perception of the disease process and her coping mechanisms is required. The family should also be included in the assessment to examine the extent of support they can provide for the patient. Family anger, ineffective coping, and role disturbances may interfere with family functioning and need careful monitoring.

Diagnostic Highlights

General Comments: Several diagnostic tests may be done to confirm the diagnosis and to check for metastases.

Test

Normal Result

Abnormality with Condition

Explanation

Fractional dilation and curettage of the uterus

Papanicolaou examination (Pap smear)

No malignant cells found

No abnormality or atypical cells noted

Malignant cells found

High-class/grade cytologic results

Obtain specimen of endometrium and endocervix for pathological examination

Initial screening; can detect 50% of cases of uterine cancer

Other Tests: Sonography, sonohysterography, hysteroscopy, chest x-ray, intravenous pyelography, cystoscopy, proctoscopy, computed tomography (CT) scan, magnetic resonance imaging (MRI)

From PMS To PPD

From PMS To PPD

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