focus on ovarian cancer (relates to chapter 54, “nursing management: female reproductive...

Focus onOvarian Cancer

(Relates to Chapter 54, “Nursing Management: Female

Reproductive Problems,” in the textbook)

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Significance

Malignant neoplasm of the ovaries

21,550 new cases and 16,210 deaths annually

Occurs primarily in women of white descent, between the ages of 55 to 65 years

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 2

Etiology and Pathophysiology

Women with mutations in BRCA genes have increased susceptibility.

Greatest risk factor is family history.•Also family history of •Breast or colon cancers •Hereditary nonpolyposis colorectal cancer



Women who have never been pregnant are at higher risk.



Other risk factors include •Age•High-fat diet•Greater number of ovulatory

cycles•Hormone replacement

therapy•Use of infertility drugs



Associated with lower risk•Oral contraceptives•Breast feeding•Multiple pregnancies•Early age at birth of first

child



90% of ovarian cancers are epithelial carcinomas from malignant transformation of surface epithelial cells.

Germ cell tumors account for 10%.



Histologic grading: important prognostic determinant

Tumor grading according to level of differentiation (grades I to III)



Ovarian cancer can metastasize directly by shedding malignant cells.•Frequently implant in uterus,

bladder, bowel, and omentumCan metastasize by

lymphatic spread


Clinical Manifestations

General abdominal discomfort

Pelvic painBloatingUrinary urgency or frequencyDifficulty eating or feeling

full quickly


Clinical Manifestations

Later signs include• Increase in abdominal girth•Unexplained weight loss or

gain•Menstrual irregularities


Diagnostic StudiesNo screening test exists.Yearly bimanual pelvic

examination should be performed, as the early stages are usually asymptomatic.

Postmenopausal women should not have palpable ovaries.


Diagnostic StudiesAbdominal or vaginal

ultrasound can be used to detect ovarian masses.

Exploratory laparotomy to diagnose and stage disease

OVA1 uses blood sample to test for changes related to ovarian cancer.


Diagnostic Studies

Screening for high-risk women should include CA-125, ultrasound, and yearly pelvic examination.

CA-125 is positive in 80% of women with ovarian cancer.


Collaborative Care

Counsel women at high risk regarding options (oophorectomy, oral contraceptives).

Oophorectomy will reduce the risk but will not eliminate the possibility of disease.


Collaborative Care

Stage I: limited to ovaries•Treatment includes•Total hysterectomy•Bilateral salpingo-oophorectomy •Evaluation of remaining tissue in abdomen and pelvis•Chemotherapy or intraperitoneal radioisotopes if poorly differentiated


Collaborative Care

Stage II: limited to true pelvis•Treatment includes•External abdominal and pelvic radiation•Intraperitoneal radiation •Systemic combination chemotherapy after tumor-reducing surgery


Collaborative Care

Chemotherapy agents •Cisplatin (Platinol),

carboplatin (Paraplatin) used for treatment of stages III and IV


Collaborative Care

Chemotherapy agents•Altretamine (Hexalen):

palliative treatment of persistent, recurrent ovarian cancer

•Paclitaxel (Taxol), topotecan (Hycamtin): treat metastatic ovarian cancer


Collaborative Care

Surgical debulking in addition to chemotherapy agents

Intraperitoneal chemotherapy: used when minimum residual disease exists after surgery


Nursing Management Nursing Assessment

Health history•Family history of ovarian

cancer•Bladder or bowel dysfunction•Pelvic or abdominal pain



Health history (cont’d) •Pregnancies, breast feeding,

menstrual irregularities•Use of infertility drugs or

HRT•High-fat diet



Objective data•Abnormal findings on pelvic

and abdominal examination•Abnormal ultrasound

findings• Increased abdominal girth,

ascites


Nursing Management Nursing Diagnoses

AnxietyAcute painDisturbed body image


Nursing Management Nursing Diagnoses

Ineffective sexuality patterns

Ineffective breathing pattern

Grieving


Nursing Management Planning

Actively participate in treatment decisions.

Achieve satisfactory pain and symptom management.

Recognize and report problems promptly.


Nursing ManagementPlanning

Maintain preferred lifestyle for as long as possible.

Continue to practice cancer detection strategies.


Nursing Management Nursing Implementation

Health promotion•Teach women importance of

routine screening.•Educate about risk factors.•Assist in identifying lifestyle

changes.



Acute intervention with surgery•Provide psychological

support.•Preop preparation•Douche or enema•Catheter



Acute intervention with surgery (cont’d)•Frequent position changes and

avoidance of pressure under knees•Leg exercises•Abdominal binder•Compression stockings to prevent

deep venous thrombosis (DVT)



Acute intervention with surgery (cont’d)•Discharge teaching•Activity restrictions•Garments•Manifestations of infection



Acute intervention with radiation •Efficient nursing, as nurses are

limited to 30 minutes per day•Tell patient to urinate

immediately before treatment.•Advise on side effects.


Nursing Management Evaluation

Participate actively in treatment decisions.

Achieve satisfactory pain and symptom management.

Recognize and report problems promptly.


Nursing Management Evaluation

Maintain preferred lifestyle for as long as possible.

Continue to practice cancer detection strategies.


Case Study


Case Study

45-year-old woman presents with abdominal bloating, gas, nausea, and constipation.


Case Study

She has never been pregnant despite not using any birth control methods.

No abdominal pain, but feeling of pelvic fullness


Case Study

Abdominal ultrasound results indicated need for transvaginal ultrasound.


Case Study

Results confirmed ovarian mass.

Biopsy indicates stage II ovarian cancer.


Discussion Questions

1. The patient feels surprised. What can you tell her about the disease?

2. What information can you provide to her about treatment?


Discussion Questions

3. What patient needs can you anticipate?

4. How might you best support her?


focus on ovarian cancer (relates to chapter 54, “nursing management: female reproductive...

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