Jinekolojik Kanserlerde Cerrahi Tedavi ve Hemşirelik Bakımı
Özet
Jinekolojik kanserlerde cerrahi tedavi; tümörün evresi, hastanın yaşı, genel durumu ve fertilite isteğine göre değişiklik gösteren temel bir yöntemdir. Serviks kanserinde kriyoterapi, LEEP ve radikal histerektomi gibi ablatif, eksizyonel veya anatomik yayılıma göre sınıflandırılan cerrahi seçenekler uygulanır. Endometrium kanserinde erken evrede histerektomi ve salpingooferektomi tercih edilirken, ileri evrelerde lenf nodu diseksiyonu ve omentektomi içeren evreleme cerrahisi uygulanmaktadır. Sıklıkla ileri evrede teşhis edilen over kanserinde ise tümör yükünü minimuma indirmek amacıyla primer evreleme ve sitoredüktif (debulking) cerrahiler ön plana çıkar. Yaşlı popülasyonda daha sık görülen vulva kanserinde ise tedavi lezyonun büyüklüğüne ve yayılımına göre bireyselleştirilerek radikal veya lokal eksizyonlar şeklinde yürütülür. Bu süreçte bütüncül hemşirelik bakımı, cerrahi öncesi ve sonrası olmak üzere iki kritik aşamadan oluşur. Cerrahi öncesinde anemi tedavisi, kan şekeri takibi, beslenme düzeni, solunum egzersizleri ve tromboemboli profilaksisine yönelik eğitimler verilir. Cerrahi sonrasında ise hastanın yaşam bulgularının takibi, erken mobilizasyon, sıvı replasmanı, sakız çiğneme gibi yöntemlerle barsak fonksiyonlarının hızlandırılması, ağrı yönetimi, kateter bakımı ve taburculuk eğitimleri ile komplikasyonların önlenmesi ve iyileşme sürecinin optimize edilmesi hedeflenir.
Surgical treatment in gynecologic cancers is a primary method that varies according to the stage of the tumor, patient's age, general health status, and fertility desires. In cervical cancer, ablatif, excisional, or surgical options classified by anatomical spread, such as cryotherapy, LEEP, and radical hysterectomy, are performed. While hysterectomy and salpingo-oophorectomy are preferred in the early stages of endometrial cancer, staging surgery including lymph node dissection and omentectomy is applied in advanced stages. In ovarian cancer, which is frequently diagnosed at an advanced stage, primary staging and cytoreductive (debulking) surgeries come to the fore to minimize the tumor load. In vulvar cancer, which is more common in the elderly population, treatment is individualized based on the size and spread of the lesion, utilizing radical or local excisions. Throughout this process, holistic nursing care consists of two critical phases: preoperative and postoperative care. Preoperatively, training is provided on anemia treatment, blood glucose monitoring, nutritional regulation, breathing exercises, and thromboembolism prophylaxis. Postoperatively, it aims to prevent complications and optimize the healing process through vital signs monitoring, early mobilization, fluid replacement, accelerating bowel functions with methods like chewing gum, pain management, catheter care, and discharge education.
Referanslar
Akyolcu N. (2015). Onkoloji hastasında cerrahi tedavi ve bakım. Gülbeyaz. Can (Ed), Onkoloji Hemşireliği (s.126). İstanbul: Nobel Tıp Kitabevleri.
Miseon Kim , Dong Hoon Suh , Kyung-Hun Lee, et al. Major clinical research advances in gynecologic cancer in 2018. J Gynecol Oncol. 2019 Mar; 30(2): e18.
Nelson G, Altman AD, Nick A, et al. Guidelines for pre- and intra-operative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations--Part I. Gynecol Oncol. 2016;140: 313-22.
Kimmig R, Ind T. Minimally invasive surgery for cervical cancer: consequences for treatment after LACC Study. J Gynecol Oncol. 2018;29:e75.
Martin-Hirsch PP, Paraskevaidis E, Bryant A, et al. Surgery for cervical intraepithelial neoplasia. Cochrane Database Syst Rev. 2010 Jun 16;(6):CD001318.
Ramirez PT, Frumovitz M, Pareja R, et al. Minimally invasive versus abdominal radical hysterectomy for cervical cancer. N Engl J Med. 2018;379:1895–1904.
Al-Mandeel HM, Sagr E, Sait K, et al. Clinical practice guidelines on the screening and treatment of precancerous lesions for cervical cancer prevention in saudi arabia. Ann Saudi Med. 2016; 36(5):313-20.
Castle PE, Murokora D, Perez C, et al. Servikal intraepitelyal lezyonların tedavisi. Int J Gynaecol Obstet. 2017 Temmuz; 138 Ek 1:20-25
Cremer ML, Conzuelo-Rodriguez G, Cherniak W, et al. Ablative therapies for cervical ıntraepithelial neoplasia in low-resource settings: findings and key questions. J Glob Oncol. 2018 Oct;4:1-10.
Moore MA, Tajima K. Cervical cancer in the asian pacific-epidemiology, screening and treatment. Asian Pac J Cancer Prev. 2004; 5(4):349-61.
Ayhan A, Esinler İ. (2008). Servikal İntraepitelyal Neoplaziler (CIN). Ali Ayhan, Tekin Durukan, Serdal Günalp, Timur Gürgan, Lütfü S. Önderoğlu, Hakan Yaralı, Kunter Yüce (ed). Temel Kadın Hastalıkları ve Doğum Bilgisi (s. 1171-1192). Ankara: Güneş Tıp Kitabevi.
Taşkın L. (2016). Jinekolojik kanserler ve bakım. Lale Taşkın (ed). Doğum ve Kadın Sağlığı Hemşireliği (s. 671-681). Ankara: Akademisyen Tıp Kitabevi.
Arbyn M, Redman CWE, Verdoodt F, et al. Incomplete excision of cervical precancer as a predictor of treatment failure: a systematic review and meta-analysis. Lancet Oncol. 2017 Dec;18(12):1665-79.
Cooper DB, Carugno J, Menefee GW. (2021). Conization of cervix In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan. 2021 Mar 30. (21.05.2021 tarihinde https://pubmed.ncbi.nlm.nih.gov/28722875/ adresinden ulaşılmıştır).
Cohen PA, Brand A, Sykes P, et al. Excisional treatment in women with cervical adenocarcinoma in situ (AIS): a prospective randomised controlled non-inferiority trial to compare AIS persistence/recurrence after loop electrosurgical excision procedure with cold knife cone biopsy: protocol for a pilot study. BMJ Open. 2017 Aug 28;7(8):e017576.
Latif NA, Neubauer NL, Helenowski IB, et al. Management of adenocarcinoma insitu of the uterine cervix: a comparison of loop electrosurgical excision procedure and cold knife conization. J Low Genit Tract Dis. 2015 Apr;19(2):97-102.
Baldauf JJ, Baulon E, Thoma V, et al. Prevention of obstetrical complications following LEEP, is it possible? J Gynecol Obstet Biol Reprod (Paris). 2014 Jan;43(1):19-25.
Chen JY, Wang ZL, Wang ZY, et al. The risk factors of residual lesions and recurrence of the high-grade cervical intraepithelial lesions (HSIL) patients with positive-margin after conization. Medicine (Baltimore). 2018; ct;97(41):e12792.
Mota F, Vergote I, Trimbos JB, et al. Classification of radical hysterectomy adopted by the Gynecological Cancer Group of the European Organization for Research and Treatment of Cancer. Int J Gynecol Cancer 2008;18:1136–38.
Piver MS, Rutledge F, Smith JP. Five classes of extended hysterectomy for women with cervical canser. Obstet. Gynecol. 1974; 44 (2):262-72.
Beyatlı F. Serviks Kanseri tanısıyla radikal histerektomi ve pelvik paraaortik lenf nodu diseksiyonu yapılan ve 2018 FIGO Evre IIIC hastalık saptanan olgularda “Lenf Nodu Oranı”nın prognostik değeri. T. C. Sağlık Bakanlığı Ankara İl Sağlık Müdürlüğü Ankara Şehir Hastanesi Tıpta Uzmanlık Tezi, Ankara, 2020.
Colombo N, Creutzberg C, Amant F, et al. ESMO-ESGO-ESTRO Consensus Conference on endometrial cancer: diagnosis, treatment and follow-up. International Journal of Gynecological Cancer. 2016; 27(1): 2-30.
Narducci F, Jean-Laurent M, Lambaudie E, et al. Surgical approaches for endometrial cancer? Bull Cancer. 2012; 99(1):29-34.
Frederick PJ, Straughn JM Jr. The role of comprehensive surgical staging in patients with endometrial cancer. Cancer Control. 2009 Jan;16(1):23-9.
Kirby TO, Leath CA 3rd, Kilgore LC. Surgical staging in endometrial cancer. Oncology (Williston Park). 2006 Jan;20(1):45-50.
Mingels MJ, van Ham MA, de Kievit IM, et al. Müllerian precursor lesions in serous ovarian cancer patients: using the SEE-Fim and SEE-End protocol. Mod Pathol. 2014;27(7): 1002-13.
Özdeş EK, Çelik H, Kökçü A. Over kanserinde cerrahi tedavi. Turkiye Klinikleri J Med Oncol-Special Topics 2016; 9(1).
Ghezzi F, Cromi A, Uccella S, et al. Laparoscopy versus laparotomy for the surgical management of apparent early stage ovarian cancer. Gynecol Oncol 2007;105(2):409-13.
Zhai LR, Zhang XW, Yu T, et al. Primary ovarian carcinoid: Two cases report and review of literature. Medicine (Baltimore). 2020; (40):e21109.
Inada Y, Nakai G, Yamamoto K, et al. Rapidly growing juvenile granulosa cell tumor of the ovary arising in adult: a case report and review of the literature. J Ovarian Res. 2018;11(1):100.
Ratnavelu ND, Brown AP, Mallett S, et al. Intraoperative frozen section analysis for the diagnosis of early stage ovarian cancer in suspicious pelvic masses. Cochrane Database Syst Rev. 2016; 3(3):CD010360.
Bentivegna E, Gouy S, Maulard A, Pautier P, Leary A, Colombo N, Morice P. Fertility-sparing surgery in epithelial ovarian cancer: a systematic review of oncological issues. Ann Oncol. 2016 Nov;27(11):1994-2004.
Pérez-Quintanilla M, Del Real-Ordoñez S, Gallardo-Alvarado L, et al. Fertility-sparing treatment for epithelial ovarian cancer: a literature review. Chin Clin Oncol. 2020;9(4):48.
Bois A du, Trillsch F, Mahner S, et al. Management of borderline ovarian tumors. Ann Oncol. 2016 Apr;27 Suppl 1:i20-i22.
Uccello M, Boussios S, Samartzis EP, et al. Systemic anti-cancer treatment in malignant ovarian germ cell tumours (MOGCTs): current management and promising approaches. Ann Transl Med. 2020 Dec;8(24):1713.
Schultz KAP, Williams GM, Kamihara J, et al. DICER1 and associated conditions: ıdentification of at-risk ındividuals and recommended surveillance strategies. Clin Cancer Res. 2018; 24(10):2251-61.
Young RH. Ovarian Sex Cord-Stromal Tumors: Reflections on a 40-Year Experience With a Fascinating Group of Tumors, Including Comments on the Seminal Observations of Robert E. Scully, MD. Arch Pathol Lab Med. 2018;142(12):1459-84.
Akazawa M, Hashimota K. Early Recurrence of Ovarian Cancer during Pregnancy after Primary Staging Surgery in the First Trimester. Case Rep Obstet Gynecol. 2020 Mar 3;2020:1737061.
Franciszek DD, Mierzyński R, Poniedziałek-Czajkowska E, et al. Ovarian cancer and pregnancy-a current problem in perinatal medicine: a comprehensive review. Cancers (Basel). 2020; 12(12):3795.
Makar AP, Tropé CG, Tummers P, et al. Advanced ovarian cancer: primary or ınterval debulking? Five categories of patients in view of the results of randomized trials and tumor biology: primary debulking surgery and ınterval debulking surgery for advanced ovarian cancer. Oncologist. 2016 Jun;21(6):745-54.
Tatiana V Gorodnova , Anna P Sokolenko, Ekatherina Kuligina, et al. Principles of clinical management of ovarian cancer. Chin Clin Oncol. 2018;7(6):56.
Şenol T, Karatepe A. Primer veya nüks jinekolojik kanserlerde sitoredüktif cerrahinin yeri. Turkiye Klinikleri J Gynecol Obst-Special Topics. 2015;8(2):108-13.
Kaban A, Kaban I, Afşar S. Surgical management of squamous cell vulvar cancer without clitoris, urethra or anus involvement. Gynecol Oncol Rep. 2017;10(20):41-46.
Singh N, Negi N, Srivastava K, et al. A cohort study of vulvar cancer over a period of 10 years and review of literature. Indian J Cancer. 2016 Jul-Sep;53(3):412-15.
Şenel N, Akyüz A. (2012). Üreme organlarının iyi ve kötü huylu oluşumları. Anahit M. Coşkun (Ed), Kadın Sağlığı ve Hastalıkları Hemşireliği El Kitabı (s. 495-538). İstanbul: Koç Üniversitesi Yayınları.
Ayhan A, Gultekin M. Dursun P. 2010. Textbook of gynaecological oncology. Güneş Publishing. Second edition. 219.
Şahin NH, Bal MD. (2015). Üreme Organı Tümörleri. Nezihe Kızılkaya Beji (Ed), Hemşire ve Ebelere Yönelik Kadın Sağlığı ve Hastalıkları (s.157-159). İstanbul: Nobel Tıp Kitabevleri.
Huang F, Chia YY, Eng CL, et al. Evaluation of a preoperative clinic for women with gynecologic cancer, Clinical Journal of Oncology Nursing. 2015;19 (6): 9-72.
Bilgiç D, Yağcan H, Güler B, ve ark. Jinekolojik cerrahide ameliyat öncesi ve sonrası kanıta dayalı bakım uygulamaları. Sağ Aka Derg. 2019; 6(2): 114-21.
Grønkjær M, Eliasen M, Skov-Ettrup LS, et al. Preoperative smoking status and postoperative complications: a systematic review and meta-analysis. Ann Surg. 2014;259(1):52-71.
Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. National Guideline Clearinghouse. 2013;70(3):195-283.
Eltorai AEM, Szabo AL, Antoci V J, et al. Clinical effectiveness of ıncentive spirometry for the prevention of postoperative pulmonary complications. Respir Care. 2018;63(3): 347-52.
Beji KN. (2015). Over kanseri. Gülbeyaz Can (Ed), Onkoloji Hemşireliği (s. 807-838). İstanbul: Nobel Tıp Kitapevleri.
