Info

Experimental Therapy: The use of tamoxifen (N endometrial cancer is being investigated.

olvadex) to treat advanced or recurrent

Independent

The major emphasis is prevention, either primary by reduction of risk factors or secondary by early detection. Encourage women to seek regular medical checkups, which should include gynecologic examination. Discuss risk factors associated with the development of endometrial cancer, particularly as they apply or do not apply to the particular woman. Encourage the older menopausal woman to continue with regular examinations. If the woman is bleeding heavily, monitor her closely for signs of dehydration and shock (dry mucous membranes, rapid and thready pulses, delayed capillary refill, restlessness, and mental status changes). Encourage her to drink liberal amounts of fluids, and have the equipment available for intravenous hydration if necessary. A balanced diet promotes wound healing and maintains good skin integrity.

Patients require careful instruction before radiation therapy or surgery. Explain the procedures carefully, and notify the patient what to expect after the procedure. For surgical candidates, teach coughing and deep-breathing exercises. Fit the patient with antiembolism stockings. If the patient is premenopausal, explain that removal of her ovaries induces menopause. Unless she undergoes a total pelvic exenteration, her vagina is intact and sexual intercourse remains possible. During external radiation therapy, the patient needs to know the expected side effects (diarrhea, skin irritation) and the importance of adequate rest and nutrition. Explain that she should not remove ink markings on the skin because they direct the location for radiation. If a preloaded radiation implant is used, the patient has a preoperative hospital stay that includes bowel preparation, douches, an indwelling urinary catheter, and diet restrictions the day before surgery.

If the woman has pain from either the surgical procedure or the disease process, teach her pain-relief techniques such as imagery and deep breathing. Encourage her to express her anger and feelings without fear of being judged. Note that surgery and radiation may profoundly affect the patient's and partner's sexuality. Answer any questions honestly, provide information on alternatives to traditional sexual intercourse if appropriate, and encourage the couple to seek counseling if needed. If the woman's support systems and coping mechanisms are insufficient to meet her needs, help her find others. Provide a list of support groups that may be helpful.

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