Sample Answer for NUR-631 Topic 15 DQ 2 Included After Question
Select two of the following questions for your discussion response. Indicate which questions you have chosen using the format displayed in the “Discussion Forum Sample.”
Explain the pathophysiological development of breast cancer. Detail the varying types and oncogenic influences for each type.
Menopause comes at different ages for women. What are the changes causing menopause and what are the changes experienced after menopause?
Testicular cancer is common in younger men. Upon examination, you discover a hard nodule of the right testes. What are the oncogenic influences associated with testicular cancer?
A Sample Answer For the Assignment: NUR-631 Topic 15 DQ 2
Title: NUR-631 Topic 15 DQ 2
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MH
Explain the pathophysiological development of breast cancer. Detail the varying types and oncogenic influences for each type.
Breast cancer is one of the most dominant in American women and numbers demonstrate that early detection is a key factor for treatment specially for women with hx of familial and are in early 30’s can have a major impact on fighting this cause. Factors that are considered is race- AAW have higher incidence up to 40 y/o. WW have higher incidence after age 40 Relative risk 1.1-1.9, familial- BCA 1st degree relative before age of 60 y/o is 2-3 Risk
Histologic Type BCAs
DUCTS
Papillary- Is well delineated cystic mass varying in different areas of the breast, hemorrhage (+), age 40-60 y/o and skin is often involved.
Intraductal- (+) inflammation, well circular tumor within duct, differentiated tumor cells, rare ulceration is seen.
INFILTRATING CARCINOMA-
Ductal -NST- Fibrous, firm, glistening, and gray-tan mass and chalky streaks, a pattern demonstrates a mixture; client will express a discharge from nipple area- approx. 70-80 % of all breast CA’s will be in this category.
Mucinous- Demonstrates a large usually >3cm, encapsulate, glistening in appearance, variables in color and two type pre and mixed- pure surrounded by mucin- infrequent and usually found in lateral half of breast and usually seen in women after age 70 y/o
Medullary- Capsulated, growth seen on tumor large 7-8 cm diameter, found in lymphocytic inflammatory infiltrate: usually seen after age 50.
Tubular- well differentiated, orderly tubules in center (stroma) of tumor, can be associated in non-infiltrating ductal carcinoma.
Adenoid cystic Very rare; well-circumscribed, painless mass arising from nipple and areola.
Metaplastic-Involves cartilage or bone, mixed tumors or osteogenic sarcoma.
Squamous cell Frequent in blacks; originates in ductal epithelium.
Carcinoma of Mammary lobules- Lobular carcinoma in situ Found in individuals with fibrocystic disease; localized to upper breast quadrants; 15%–35% risk of becoming invasive; occurs frequently in mid-40s; infiltrating variety occurs in early 50s Infiltrating lobular.
Infiltrates from duct; firm mass with chalky streaks Paget disease
Eczema of nipple that extends to areola; cancer usually found underneath nipple; poorly circumscribed; large Paget cells arise from duct and directly invade nipple; history of scaly (McCance & Huether, 2018).
Testicular cancer is common in younger men. Upon examination, you discover a hard nodule of the right testes. What are the oncogenic influences associated with testicular cancer?
Testicular cancer is considered highly treatable and even the most aggressive forms of TC, the seminoma all stages combined has a cure of 90%, seminomas low stage non seminoma has a cure of almost 100% (McCance & Huether, 2018). In addition, 90 % of TC are from germ cell tumor gametes and other testicular cancers ate based on seminomas which are least aggressive and consist of 30-35% of cancers, non-seminomas are divided into 3, embryonal canrcinomas, teratomas, and choriocarcinomas- tested by embryo hCG/ AFP, teratomas- hCG, ChorioCa- No increase in hCG/AFP and they are the most aggressive but are less then 1% of all TC. In addition, the neoplasm is unknown but what is known is that increase chances are with brothers, identical twins, and other close familial relatives. Moreover, testicular tumors may be classified by the location in which they are ex. Leydig cell, Sertoli Cell, Granulosa cell, Theca cell, in which they form < 10% of TC. Furthermore, literature study demonstrates that there is familial germ cell tumors that are associated with transgenerational inheritance of epigenetic events in environment, work, and drugs or ETOH use or abuse. Additionally, risk factor are hx of cryptorchidism, prior hx of TC/ and or Cryptorchidism 2’ studies show that 50% of the 1-2% with both TCA’s and Cryptorchid are from treated and untreated cryptorchidism (McCance & Huether, 2018).
McCance, K. L., & Huether, S. E. (2018). Pathophysiology – e-book (8th ed.). Elsevier Health Sciences.
REPLY
DS
Menopause comes at different ages for women. What are the changes causing menopause and what are the changes experienced after menopause?
Menopause is essentially the cessation of ovulation and menstruation due to ovarian failure, the age at which it stops is dependent on individual factors and lifestyles. The average age range for menopause is between 40 and 60 years of age. Depending on weight, genetics, and tobacco use, premature menopause can occur before the age of 40 (McCance et.al, 2019). In the years prior to menopause, it is known as the transitional period between reproductive and non-reproductive years, in this phase the menstrual cycle is longer and correlates to anovulatory cycles (McCance et.al, 2019). Changes in hormones such as higher estradiol levels, lower progesterone, and a disturbance in the ovarian-pituitary-hypothalamic system contribute to the years leading up to menopause. One of the first signs is irregular or unpredictable ovulation and/or periods. Some changes that women often experience after menopause include changes in breast tissue, changes to the GI tract such as uterus atrophy, reduced bone mass, increased risk of cardiovascular diseases, vasomotor flushes (hot flashes), lower estrogen levels, and unpredictable changes in mood (McCance et.al, 2019). Management for women with menopause includes support, estrogen supplements, calcium intake, and heart health.
Testicular cancer is common in younger men. Upon examination, you discover a hard nodule of the right testes. What are the oncogenic influences associated with testicular cancer?
Testicular cancer is common among younger men. This type of cancer affects over 90% of young men and comprises of different neoplasms depending on the cell of origin and the age of presentation (Rjpert-DeMeyts et.al, 2023). Testicular germ cell tumors (TGCT) comprise of seminoma and no seminoma, they are typically derived from germ cell neoplasia in situ (GCNIS). Testicular cancers represent developmental, endocrine, and reproductive problems in young adult men, so it is important to identify the several different oncogenic influences associated with testicular cancer. Studies suggest that individuals with developmental abnormalities of the gonads and sex differentiation (DSD) are at one of the higher risk categories for developing a germ cell neoplasia (Rajpert-DeMeyts et.al, 2023). Other oncogenic influences include low birth weight, Down syndrome, premature birth, high maternal age, late age puberty, and high levels of maternal estrogens (Rajpert-DeMeyts et.al, 2023). The first sign of testicular cancer is usually a scrotal mass with presenting tenderness in very few patients, in a few cases with the same symptoms it can be metastatic, but other symptoms such as lumbar pain and supra-clavicular lymph-node enlargement can also be found with testicular cancer. Management of a patient with testicular cancer includes supportive treatment for early diagnosis, testosterone deficiency, fertility issues, and the impact of the treatment on quality of life and changes to family planning (Rajpert-DeMeyts et.al, 2023). Treatments for testicular cancer include chemotherapy, radiation therapy, and continuous monitoring of reproductive hormone profiles.
References:
McCance, K. L., Huether, S. E., Brashers, V. L., Rote, N. S. (2019). Pathophysiology: The biologic basis for disease in adults and children (Eighth ed.). Elsevier.
Rajpert-De Meyts E, Aksglaede L, Bandak M, et al. Testicular Cancer: Pathogenesis, Diagnosis and Management with Focus on Endocrine Aspects. [Updated 2023 Mar 29]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-.Available from: https://www.ncbi.nlm.nih.gov/books/NBK278992/
REPLY
TG
Testicular cancer is highly treatable (McCance & Huether, 2018). To prevent the disease from metastasizing before diagnosis, providers should strongly educate on self exams and signs that should be brought to a providers attention. These include even minor symptoms such as a change in size of one testicle.
References
McCance, K. L., & Huether, S. E. (2018). Pathophysiology – e-book (8th ed.). Elsevier Health Sciences.
REPLY
KM
Hormone therapy can provide relief of menopausal symptoms caused by the decrease in estrogen at menopause. These symptoms include hot flashes, sleep disturbances, and vaginal dryness. Hormone therapy is also approved in the treatment of osteoporosis. There are two types of hormone therapy, estrogen-only therapy and estrogen plus progestogen therapy. Progestogen is added to estrogen-only therapy to protect women with a uterus against uterine cancer from estrogen alone. Hormone therapy can be provided systemically where products circulate throughout the bloodstream and local where the products are only applied to a specific or localized part of the body. Studies have shown that hormone therapy (estrogen with or without progestogen) help relieve symptoms of menopause as well as preventing bone loss as well improved quality of life. The risks associated with hormone therapy are associated with mostly estrogen progestogen therapy as both estrogen and progestogen are associated with stroke and an increase in blood clots. For women with a uterus, progestogen must be used with estrogen to protect against uterine cancer. To minimize risks, hormone therapy should be used at the lowest effective dose for the shortest time period.
The North American Menopause Society. (n.d.) Hormone Therapy:: Benefits and Risks. Retrieved on August 16, 2023, from https://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/hormone-therapy-benefits-risks
