June 4, 2012

Human Reproductive HealthNURS 330

Abortion

• Spontaneous abortion– aka miscarriage– Loss of baby before 20 weeks of pregnancy

• Induced abortion– Surgical– Drug-based

Surgical Method

• Vacuum Aspiration– First trimester method

• Dilation and Extraction (D & X)– Late surgical method

Drug-Based Methods

• Mifepristone (RU 486) –Injection, 0rally– An anti-progesterone

• prevents progesterone from making uterine lining hospitable for implantation

• If fetus is already implanted, causes the uterus to shed its lining and, along with it, the fertilized fetus

– Approved by FDA in September 2000 for abortion• As an alternative to surgical procedure

– Effectiveness is increased if used with another drug, Misoprostol (95-98%)

– Most effective within 7 weeks of fertilization

Drug-Based Methods (cont)• Methotrexate –Injection; orally (rarely)

– Prevents cell division and multiplication– Can be used to induce an abortion

• Effectiveness is increased if used with another drug, Misoprostol (95%)– Approved by FDA for treatment of cancer, arthritis and psoriasis– Most effective within 7 weeks of fertilization

• Misoprostol – orally or vaginally– Legal Drug used in conjunction with above drugs– The second drug used to complete the abortion procedure

• Taken a day or two after administration of the first drug– Causes the uterus to contract and expel its contents– Approved in the US for coating the stomach of people who take stomach-

irritating anti-inflammatory drugs.

Abortifacient

• A method or substance that causes a fertilized egg that has implanted in the uterine wall or fetus to be expelled.

• Which of the drug-based methods is an abortifacient?

Source: Perspectives on Sexual and Reproductive Health

Incidence of Abortions

• Nearly half of pregnancies among American women are unintended, and four in 10 of these are terminated by abortion.

• Twenty-two percent of all pregnancies (excluding miscarriages) end in abortion.

• In 2005, 1.21 million abortions were performed, down from 1.31 million in 2000. From 1973 through 2005, more than 45 million legal abortions occurred.

• Each year, about two percent of women aged 15-44 have an abortion; 47% of them have had at least one previous abortion.

Source: Guttmacher Institute

When women have abortions

Cost

• Surgical – In 2005, the cost of a non-hospital abortion with

local anesthesia at 10 weeks’ gestation ranged from $90 to $1,800; the average amount paid was $413

(Source: Perspectives on Sexual and Reproductive Health)

• Drug-based– most providers do charge more for this method

Abortion and the Law

• Roe v. Wade– 1973 Supreme Court decision stating • 1st trimester abortions cannot be regulated by states

and the decision to abort is between woman and physician• 2nd trimester abortions permitted when mental or

physical health of mother at risk• 3rd trimester abortions allowed when life of mother at

risk

Source: Alan Guttmacher Institute

California Law

• California does not have any of the major types of abortion restrictions – such as waiting period, mandated parental involvement or limitations on publicly funded abortions – often found in other states.

The Pro-Life and Pro-Choice Controversy

• Anti-abortion (Pro-life) position• Pro-choice position

Instructor Evaluation

Volunteer Needed, Please

The following presentation on Cancer is from the American Cancer Society. It has been authorized for use by Chrissy Kim, Manager, Healthcare/Corporate Initiatives

What is Cancer?

• Cancer occurs when cells in a part of the body begin to grow out of control. Normal cells divide and grow in an orderly fashion, but cancer cells do not. They continue to grow and crowd out normal cells.

• Although there are many kinds of cancer, they all have in common this out-of-control growth of cells.

Cancer (cont)

• Sometimes cancer cells break away from a tumor and spread to other parts of the body through the blood or lymph system. They can settle in new places and form new tumors. When this happens, it is called metastasis. Cancer that has spread in this way is called metastatic cancer.

• Even when cancer has spread to a new place in the body, it is still named after the part of the body where it started. For example, if prostate cancer spreads to the bones, it is still called prostate cancer. If breast cancer spreads to the lungs, it is still breast cancer. When cancer comes back in a person who appeared to be free of the disease after treatment, it is called a recurrence.

Survival RatesSurvival Rates

• 5-year localized survival rate – Localized cancer is cancer that, at the time of

diagnosis, had not spread to additional sites within the body. Typically, the earlier a cancer is detected and diagnosed, the more successful the treatment, thus enhancing the survival rate.

Survival Rates

• 5-year overall survival rate– The 5-year survival rates represent persons who are

living 5 years after diagnosis, whether disease-free, in remission, or under treatment. They do not imply that 5-year survivors have been permanently cured of cancer.

The Breast

• Main function is to produce milk for breastfeeding

• 2 main types of tissues: – glandular tissues • Lobules – milk production• Ducts – milk passages to the nipples

– supporting (stromal) tissues • Fatty & Fibrous connective tissue• Give breast their size, shape and support

Breast Changes

• Changes in the breasts may be caused either by benign conditions or cancer – Benign Breast Conditions• Never life threatening; very common• Some may increase the risk of developing breast cancer

– fibrocystic changes– benign breast tumors– breast inflammation

– Breast Cancer - Life threatening

Breast Changes

• It is often not possible to tell the difference between benign and cancerous conditions based on symptoms alone – More tests will be needed

• Some benign breast conditions may not cause any symptoms and may be found during a mammogram or a breast biopsy.

What Is Breast Cancer?What Is Breast Cancer?

• Breast cancer is a malignant (cancerous) tumor that develops from cells in the breast.

• Most breast lumps are benign (not cancerous).

• Early detection is very important because the cancer can spread if not treated at its earliest stages.

The American Cancer Society’s Estimates

The American Cancer Society’s Estimates

•The American Cancer Society's most recent estimates for breast cancer in the United States are for 2011: •About 230,480 new cases of invasive breast cancer will be diagnosed in women. •About 57,650 new cases of carcinoma in situ (CIS) will be diagnosed (CIS is non-invasive and is the earliest form of breast cancer). •About 39,520 women will die from breast cancer

Who Is At Risk?Who Is At Risk?

• Two factors greatly influence the risk of developing breast cancer:

• 1. Being a woman The disease is over 100 times more common in women than in men.

• 2. AgeApproximately 77% of women with breast cancer are age 50 or older at the time of diagnosis.

Why Are Older Women More At Risk?

Why Are Older Women More At Risk?

• Exposure to reproductive hormones, like estrogen, over a lifetime may increase the risk. This is influenced by:– Age– Age of first menstrual period– Number of pregnancies– Age at menopause– History of taking medication

that contains estrogen

Other Risk FactorsOther Risk Factors

• Family history of breast cancer

–Having a first-degree relative (mother, sister, or daughter) with breast cancer approximately doublesa woman’s risk. –Most women with breast cancer do not have a

first-degree relative with the disease.

• History of noncancerous breast disease

• Never having children or having first live birth after age 30

Other Risk FactorsOther Risk Factors

• Starting monthly periods before age 12• Starting menopause after age 55 • More than 5 years of postmenopausal estrogen

replacement therapy • Use of alcohol, especially two or more drinks daily• Obesity, especially excessive weight gain • Physical inactivity

Reducing Your RiskReducing Your Risk

• Limit alcohol use.

• Engage in regular physical activity.

• Maintain a healthy weight.

• Eat a healthy, balanced diet that includes at least five servings of fruits and vegetables every day.

Symptoms

• The most common sign of breast cancer is a new lump or mass.

• Other signs include:

– Generalized swelling of part of a breast (even if no distinct lump is felt)

– Skin irritation or dimpling

Symptoms – other signs (cont)

– Nipple pain or retraction (turning inward)

– Redness or scaliness of the nipple or breast skin

– Discharge other than breast milk

Detection Methods

• Nearly all breast cancers can be successfully treated if detected early.

• A mammogram is the best method for detecting breast cancer because often it can identify cancer before physical symptoms develop.

• All women should have regular breast examinations by a health provider.

The American Cancer Society’s Screening Recommendations

• Clinical Breast Exam should be part of a periodic health exam, about every three years for women in their 20s and 30s, and every year for women 40 and older.

• Women should know how their breasts normally feel and report any breast change promptly to their health care provider. Breast Self Examination is an option for women starting in their 20s.

The American Cancer Society’s Screening Recommendations

• Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health.

• Women at increased risk (e.g., family history, genetic tendency, past breast cancer) should talk with their doctors about the benefits and limitations of starting mammography screening earlier, having additional tests (i.e., breast ultrasound and MRI), or having more frequent exams.

Breast Self Exam

• Beginning in their 20s, women should be told about the benefits and limitations of BSE. Women should be aware of how their breasts normally feel and report any new breast changes to a health professional as soon as they are found. Finding a breast change does not mean that a cancer is present.

TreatmentTreatment

• Treatment is most successful when breast cancer is detected early.

• Often two or more treatment methods are used.

• Patients should thoroughlydiscuss treatment optionswith their doctors.

Treatment OptionsTreatment Options

• Breast conservation surgery*• Mastectomy*

* In both cases, the lymph nodes under the arm may alsobe removed.

Treatment Options

• Chemotherapy – Uses anticancer drugs that attack cancer cells and normal

cells.

– These drugs usually are given by injection or by mouth.

• Hormone therapy

– Uses hormones (chemicals made in the body that affect cell activity) or drugs that interfere with hormone production.

Treatment OptionsTreatment Options

• Monoclonal antibody therapy

– Uses substances that locate and bind to cancer cells.

– Can be used alone or to deliver drugs, toxins, or radioactive material directly to tumor cells.

• Radiation therapy

– Uses high-energy rays to shrink or kill cancer cells.

Survival Rates

5-yearSurvival Rate

0 93%

I 88%

IIA 81%

IIB 74%

IIIA Stage

IIIB 41%*

IIIC 49%*

IV 15%

Hope For The FutureHope For The Future

• Scientists are continually learning more about breast cancer, including how lifestyle, environment, and other factors affect risk.– Examining the role of physical activity, weight gain or

loss, diet, hormone replacement therapy, and environment on breast cancer risks.

– Determining the best use of genetic testing to find gene mutations (BRCA1 and BRCA2) that may increase breast cancer risks.

Hope For The FutureHope For The Future

• Scientists are also finding better ways to detect and treat breast cancer, such as:

– Developing new screening methods and improving existing ones.

– Testing chemotherapy drugs and drug combinations to find those that attack breast cancer cells but cause less damage to normal cells.

– Testing hormone therapies, such as raloxifene and tamoxifen, that have been shown to greatly reduce the risks among women at high risk for this disease.

The Bottom LineThe Bottom Line

• Nearly all breast cancers can be treated successfully if found early.

• The key is early detection!

• Breast cancer risk may be reduced by being physically active, maintaining a healthy weight, and reducing alcohol use.

Conditions of the Scrotum

• Epididymitis– an inflammation or infection of the epididymis

– Caused by bacterial infections• Sometimes caused by gonorrhea and chlamydia

– Incidence is less than 1 in 1,000 males per year

– Epididymitis is primarily a disease of adults, most commonly affecting males aged 19-40 years.

Testicular Cancer

What Is Testicular Cancer?

•Testicular cancer can develop in one or both testicles in men and boys.

•Contained in a sac of skin called the scrotum, the testicles are the part of the male reproductive system that produces sperm and male hormones (like testosterone).

•Very rare cancer but is the most common cancer found in men ages 15 - 35

The American Cancer Society’s Estimates

• In the United States during 2011:

–8,920 new cases of testicular cancer

–Deaths per year: 350 men

–Testicular cancer is not common; about 1 in 270 men will develop testicular cancer in their lifetime.

Risk Factors

•The main risk factors for testicular cancer include:–Race–Family history–Being born with an undescended testicle

• Cryptorchidism

•Because these risks cannot be avoided, it is not currently known how to prevent most cases of testicular cancer.

Risk Factors (cont)

•Although testicular cancers usually occur in patients between the ages of 15 and 40, they can affect males of any age, including infants and elderly men.

•The risk among White men is about five times higher than among African American men.

•Men who have had cancer in one testicle are at increased risk for developing cancer in the other testicle.

What Are Other Risk Factors?

•If a man’s close family members have had testicular cancer, he is at greater risk.•Men who had an undescended testicle as a baby are at increased risk (3 out of every 100 male infants).•Men who have had cancer in one testicle are at increased risk for developing cancer in the other testicle.

Other Risk Factors

•Some jobs may put men at increased risk for testicular cancer. Examples include being one of the following:–Miner –Oil or gas worker– Janitor– Leather worker•Recent studies found no evidence that having a vasectomy increases a man’s risk of developingthe disease.

Reducing Your Risk

•The main risk factors for testicular cancer include:–Race–Family history–Being born with an undescended testicle

•Because these risks cannot be avoided, it is not currently known how to prevent most cases of testicular cancer.

Risk Factors (cont)

• Since none of these risks can be prevented, the best protection is awareness of risks and symptoms, early detection, and prompt treatment.

• Men at risk may want to perform a monthly self-exam – Testicular Self Exam (TSE)

American Cancer Society. 2006

Testicular Self Exam (TSE)

The best time to perform the self-exam is during or after a bath or shower, when the skin of the scrotum is relaxed. To perform a testicular self exam: • Hold the penis out of the way and examine each testicle

separately.

• Hold the testicle between the thumbs and fingers with both hands and roll it gently between the fingers.

• Look and feel for any hard lumps or nodules (smooth rounded masses) or any change in the size, shape, or consistency of the testes.

http://www.webmd.com/video/marks-testicular-self-exam

Symptoms

•Lump or swelling in either testicle–90% of cases–Often painless or slightly uncomfortable

•Enlargement of a testicle•Feeling of heaviness in the scrotum•Dull ache in the lower abdomen or groin•Sudden collection of fluid in the scrotum•Enlargement or tenderness of the breasts

Detection Methods

•In 90% of cases, men have a lump or swelling in a testicle. •Any swelling or aching in the testicles should be examined by a doctor without delay.•Men at risk may want to perform a monthly self-exam.

Diagnosis

• Medical History and Physical Exam • Ultrasound• Blood Tests

TreatmentTreatment

Testicular cancer is highly treatable, usually curable, and relatively rare.•Treatment is most successful when cancer is detected early.•Often two or more treatment methods are used. •Patients should thoroughly discuss treatment options with their doctors.

Treatment Options

There are three main treatment options:– Surgery

• An operation to remove cancer cells.

– Radiation therapy • Uses high-energy rays to shrink or kill cancer cells.

– Chemotherapy • Uses anticancer drugs that attack cancer cells and

normal cells. The drugs are usually given by injection or by mouth.

Survival Rates

•5-year localized survival rate is 99%–Even if the cancer has spread to nearby lymph nodes, the rate is 96%

•5-year overall survival rate is 95%

•5-year survival rates drop to 71% when cancer has spread to distant organs, which underlines the need for early action.

Prostate Cancer

What Is Prostate Cancer?

•In American men, prostate cancer is the most common cancer and the second leading cause of cancer death.

•The prostate gland is walnut-sized and is located in front of the rectum, behind the penis, and under the bladder.

•Most prostate cancers grow very slowly, but when they spread, they can do so quickly.

The American Cancer Society’s Estimates

• In the United States during 2011:

–240,890 new cases of prostate cancer

–Deaths per year: 33,720

The Prostate Gland

Prostate Gland

Urinary Bladder

Three Greatest Risk Factors Three Greatest Risk Factors

• Being a man –Only men develop prostate cancer, typically those ages 50 and

older.

• Age–More than 70% of prostate cancers are diagnosed in men over

65.

• Race: African American men have the highest prostate cancer incidence rates in the world. The rates of prostate cancer death for African American men are more than twice the rates for White men.

Other Risk Factors

•About 5 to 10% of prostate cancers may be inherited.

•Eating a high-fat diet–especially a diet high in saturated fat, found primarily in

animal sources, such as red meat and dairy products—may play a part in causing prostate cancer.

Symptoms

•Most early cases of prostate cancer cause no symptoms, but some early signs may be:

–Frequent urination, especially at night.

–Difficulty starting urinationor inability to urinate.

–Weak or painful urination.

Diagnosis

• Prostate-Specific Antigen (PSA) – blood test

• Digital Rectal Exam (DRE)– rectal exam

• All men 50 years of age and older should ask their physicians about having the PSA test and a DRE every year. – At a younger age if at high risk

TreatmentTreatment

•Treatment is most successful when prostate cancer is detected early.

•Often two or more treatment methods are used.

•Patients should thoroughly discuss treatment options with their doctors.

Treatment

•If prostate cancer is detected early, is slow growing, and is not causing symptoms, “watchful waiting” may be chosen initially, especially for older men.

•Active treatment is started if the cancer begins to grow more quickly or symptoms appear.

Treatment (active) Options

•Surgery

–Removal of the prostate, called prostatectomy, is

the most commonly chosen surgical treatment.

•Radiation therapy

–Uses high-energy rays to shrink or kill cancer cells.

Treatment Options (cont)

• Chemotherapy

– Uses anticancer drugs that attack cancer cells and normal cells. The drugs are usually given by injection or by mouth.

• Hormone therapy

– Treatment with hormones or drugs that interfere with hormone production or action, or the surgical removal of hormone producing glands.

2011 Survival Rates

Stage 5-year relative survival

Local 100%

Regional 100%

Distant 31%

Source: American Cancer Society

Prevention

•All men 50 and older should talk to their doctors about having annual DRE and PSA tests to help find prostate cancer early.

•Men who are at high risk for prostate cancer (African Americans or men with a first-degree relative diagnosed with prostate cancer at a young age) should begin testing at age 45.

•Prostate cancer is less likely to be curable once it has spread; however, with annual screening, prostate cancer can be detected before this occurs.

In-Class Assignment

June 11, 2012

• Final Exam– 7:00PM – 10:00PM

• Scantron 882 needed

• 100 Questions– Cumulative– Study guide will be e-mailed or posted on course

website by June 5, 2012.