Pathophysiology
- Breast cancer: Typically presents as a painless lump or skin texture changes. Commonly metastasizes to spine, pelvis, and long bones
- Cervical cancer: Strongly linked to HPV. Most curable if detected early via Pap tests
- Uterine (endometrial) cancer: Most common pelvic cancer in females. Triggered by excessive estrogen exposure
- Ovarian cancer: "Silent killer" — symptoms are vague and nonspecific until peritoneal metastasis
- Tamoxifen paradox: Blocks estrogen receptors in breast tissue but acts as a weak estrogen in the uterus, potentially increasing endometrial cancer risk
- Hormonal risk factors include early menarche, late menopause, nulliparity, first child after age 30, HRT, and obesity (fat cells produce estrogen)
Signs and Symptoms
Hallmark Indicators
- Breast: Painless lump. "orange peel" skin (peau d'orange). Inverted nipples. Redness or scaling
- Cervical: Often asymptomatic early. Abnormal bleeding or discharge
- Uterine: Postmenopausal bleeding (most dependable early sign). Spotting between periods
- Ovarian: Persistent bloating or abdominal swelling (ascites). Pelvic heaviness. Bowel/bladder habit changes
- General: Unexplained weight loss, persistent fatigue, drenching night sweats
Red Flags and Rule-Outs
- Postmenopausal bleeding: Most dependable early sign of uterine cancer — immediate referral
- Painless breast lump with skin changes: Refer for mammography/biopsy
- Persistent bloating + pelvic heaviness: Often mistaken for GI distress or perimenopause. Ovarian cancer must be ruled out
- Any unexplained lump >5 cm or deep bone pain worse at night: Immediate medical referral
- Axillary lymph node fixed and nontender: Suggests breast cancer metastasis to sentinel node
MT Considerations
- Goal: Palliative support to alleviate pain, anxiety, nausea, fatigue, and depression
- Bone fragility: Breast cancer commonly metastasizes to spine, pelvis, and long bones. Extreme caution with pressure
- Lymphedema: Axillary node dissection or radiation creates lifelong upper extremity lymphedema risk. Conservative massage or specialized MLD required (see mastectomy)
- Psychosocial impact: Disfiguring surgeries (mastectomy, hysterectomy) often cause altered body image, anxiety, and depression. Nurturing touch is essential
- Positioning: Clients with ascites may not tolerate prone or supine. Side-lying or semi-reclined preferred
- Treatment side effects: See chemotherapy and radiation-therapy
CMTO Exam Relevance
- Postmenopausal bleeding is the most dependable early sign of uterine cancer
- Ovarian cancer symptoms are often mistaken for GI distress or perimenopause
- BRCA1/2 mutations increase risk for both breast and ovarian cancers
- Sentinel node biopsy status determines extent of surgical resection
- Breast cancer commonly metastasizes to bone — always assess for deep bone pain
Key Takeaways
- Female reproductive cancers include breast, cervical, uterine, and ovarian malignancies with distinct presentations
- Postmenopausal bleeding is the most reliable early sign of uterine cancer. Ovarian cancer is a "silent killer"
- BRCA1/2 mutations significantly increase risk for both breast and ovarian cancers
- Breast cancer commonly metastasizes to spine, pelvis, and long bones, creating high fracture risk
- Lymphedema is a lifelong risk following axillary lymph node surgery or radiation