1. Human Reproductive Health NURS 330
June 4, 2012
Human Reproductive Health
NURS 330

2. Abortion Spontaneous abortion Induced abortion aka miscarriage
Loss of baby before 20 weeks of pregnancy
Induced abortion
Surgical
Drug-based

3. Surgical Method Vacuum Aspiration Dilation and Extraction (D & X)
First trimester method
Dilation and Extraction (D & X)
Late surgical method

4. 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

5. 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.

6. 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?

7. 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 From 1973 through 2005, more than 45 million legal abortions occurred.
Each year, about two percent of women aged have an abortion; 47% of them have had at least one previous abortion.
Source: Perspectives on Sexual and Reproductive Health

8. When women have abortions
Source: Guttmacher Institute

9. Cost Surgical Drug-based
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

10. 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

11. 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.
Source: Alan Guttmacher Institute

12. The Pro-Life and Pro-Choice Controversy
Anti-abortion (Pro-life) position
Pro-choice position

13. Instructor Evaluation
Volunteer Needed, Please

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

15. 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.

16. 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.

17. Survival 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.

18. 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.

19. 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

20. 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

21. 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.

22. 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.

23. 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

24. 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. Age
Approximately 77% of women with breast cancer are age 50 or older at the time of diagnosis.

25. 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

26. Other Risk Factors Family history of breast cancer
Having a first-degree relative (mother, sister, or daughter) with breast cancer approximately doubles a 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

27. Other 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

28. Reducing 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.

29. 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

30. Symptoms – other signs (cont)
Nipple pain or retraction (turning inward)
Redness or scaliness of the nipple or breast skin
Discharge other than breast milk

31. 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.

32. 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.

33. 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.

34. 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.

35. Treatment
Treatment is most successful when breast cancer is detected early.
Often two or more treatment methods are used.
Patients should thoroughly discuss treatment options with their doctors.

36. Treatment Options Breast conservation surgery* Mastectomy*
* In both cases, the lymph nodes under the arm may also be removed.

37. Treatment Options Chemotherapy Hormone therapy
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.

38. Treatment Options Monoclonal antibody therapy Radiation 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.

39. Survival Rates 5-year Survival Rate 93% I 88% IIA 81% IIB 74% IIIA
93% I
88%
IIA
81%
IIB
74%
IIIA
Stage
IIIB
41%*
IIIC
49%* IV
15%

40. Hope 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.

41. Hope 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.

42. The 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.

43. 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 years.

44. Testicular Cancer

45. 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

46. 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.

47. 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.

48. 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.

49. 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.

50. 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 developing the disease.

51. 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.

52. 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)

53. 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.
American Cancer Society. 2006

55. Symptoms Lump or swelling in either testicle Enlargement of a 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

56. 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.

57. Diagnosis
Medical History and Physical Exam
Ultrasound
Blood Tests

58. Treatment
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.

59. 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.

60. 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.

61. Prostate Cancer

62. 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.

63. The American Cancer Society’s Estimates
In the United States during 2011:
240,890 new cases of prostate cancer
Deaths per year: 33,720

64. The Prostate Gland
Urinary Bladder
Prostate Gland

65. 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.

66. 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.

67. Symptoms
Most early cases of prostate cancer cause no symptoms, but some early signs may be:
Frequent urination, especially at night.
Difficulty starting urination or inability to urinate.
Weak or painful urination.

68. Diagnosis Prostate-Specific Antigen (PSA) Digital Rectal Exam (DRE)
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

69. Treatment
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.

70. 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.

71. 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.

72. 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.

73. Source: American Cancer Society
2011 Survival Rates
Stage
5-year relative survival
Local
100%
Regional
Distant
31%
Source: American Cancer Society

74. 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.

75. In-Class Assignment

76. June 11, 2012 Final Exam Scantron 882 needed 100 Questions
7:00PM – 10:00PM
Scantron 882 needed
100 Questions
Cumulative
Study guide will be ed or posted on course website by June 5, 2012.