ovarian.ppt - Wikispaces by pengxiuhui

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									                                Diagnosis
                             Ovarian cancer- how it is diagnosed

  Lengthy medical history is obtained, particularly focusing on use of oral contraceptives,
pregnancy and breast feeding, family history of ovarian cancer, and previous cancer history,
                     as well as exposure to environmental substances.

 Physical exam to include palpating the abdomen for unusual growths, masses, or nodules. A
pelvic exam and Pap smear are also obtained, although the Pap is primarily used for screening
 in cervical cancer. The pelvic exam is used to palpate the ovaries, sides of the uterus, and
                                         pelvic floor.

A trans vaginal ultrasound may be ordered. This invasive test involves inserting a probe into
the vaginal allowing an immediate image to be generated on a computer screen. This method
                alone does not provide an accurate diagnosis of ovarian cancer.

  Blood tests include CA125, which is a blood protein known as a tumor marker. CA125 is a
substance found on the surface of ovarian cancer cells and on some normal tissue. This is not
a determining factor in diagnosis because the protein is also increased in the first trimester
 of pregnancy, during menstruation, in the presence of non cancerous illnesses, and cancers
   of other sites. BRCA1 and BRCA2 mutation screenings may be performed on women with
  strong family history of breast and/or ovarian cancer, as these are genes that may show
                      mutation in women with breast or ovarian cancer.
                                Diagnosis


   Surgery, usually a laparoscopy, is the preferred treatment and usually required for

  diagnosis. Biopsy is the primary method to confirm a diagnosis of ovarian cancer. This

involves the removal of tissue or fluid for analysis under a microscope. A pathologist then

grades the cells 1, 2, or 3. Grade 1 cancer cells are not as likely to grow and spread as are

                                       grade 3 cells
TYPES OF MALIGNANCY, INCIDENCE, RISK FACTORS


Type of Malignancy: Ovarian Cancer which is malignant neoplasm of the ovaries
Incidence: Ovarian cancer is the eighth most common cancer and the fifth leading cause of
cancer death.
Responsible for 32% of all cancers of female reproductive system and has a mortality rate
over 50%.
Occurs more frequently in women between 55 & 65 years of age.
Caucasian women of North America and European descent are @ greater risk for ovarian
cancer than African American women.
Risk Factors: Family history of ovarian cancer, breast, or colon cancer
Women who have never been pregnant
Increasing age
High fat diet
Increased # of ovarian cycles (associated with early menarche or late menopause)
Use of fertility drugs
Mutation of the BRCA-1 gene causes 60% higher risk
Having endometriosis (a condition where tissue from the lining of the uterus grows elsewhere
in the body).
Eastern European (Ashkenazi) Jewish background
                Symptoms of Ovarian Cancer



Ovarian cancer is called a “silent killer’ because symptoms were not thought to develop until
the disease had advanced and the chance of cure or remission poor. However, the following
symptoms are much more likely to occur in women with ovarian cancer than women in the
general population. These symptoms include: Bloating, pelvic or abdominal pain, difficulty
eating or feeling full quickly, and urinary symptoms (urgency or frequency).
Symptoms are persistent. The frequency and number of symptoms are a key factor in the
diagnosis of ovarian cancer. Sometimes even in early stages of ovarian cancer, these
symptoms can occur. Women who have these symptoms daily for more than a few weeks
should see their gynecologist. Prompt medical evaluation may lead to detection at the
earliest possible stage of the disease. Early stage diagnosis is associated with an improved
prognosis.
Other symptoms that have been commonly reported are fatigue, indigestion, back pain, pain
with intercourse, constipation and menstrual irregularities.
                               Treatment
Ovarian cancer can be cured if caught in time. However, cure rates vary and depend on the
extent of the cancer and the general health of the woman.

There are three main treatment types for ovarian cancer:
1) Surgery – Surgery to remove the cancerous growth is the most common method of
diagnosis and therapy for ovarian cancer. It is best performed by a qualified gynecologic
oncologist.
   Unilateral salpingo-oophorectomy: A surgical procedure to remove one ovary and one
fallopian tube.
   Bilateral salpingo-oophorectomy: A surgical procedure to remove both ovaries and both
fallopian tubes.
   Total hysterectomy and bilateral salpingo-oophorectomy: A surgical procedure to
remove the uterus, cervix, and both ovaries and fallopian tubes. If the uterus and cervix are
taken out through the vagina, the operation is called a vaginal hysterectomy. If the uterus
and cervix are taken out through a large incision (cut) in the abdomen, the operation is called
a total abdominal hysterectomy. If the uterus and cervix are taken out through a small
incision in the abdomen using a laparoscope, the operation is called a total laparoscopic
hysterectomy.
                              Treatment


 Partial oophorectomy: A surgical procedure to remove part of one ovary or part of both
ovaries.
  Omentectomy: A surgical procedure to remove the omentum (a piece of the tissue lining
the abdominal wall).
  Tumor debulking: A surgical procedure in which as much of the tumor as possible is
removed. Some tumors may not be able to be completely removed.
  Lymph node biopsy: Ovarian cancer staging during ovarian cancer surgery (to find out
whether the cancer has spread) generally involves removing lymph nodes
                              Treatment

2) Chemotherapy – Chemotherapy is the treatment of cancer using chemicals (medications)
that travel through the bloodstream to destroy cancer cells or stop them from growing both
in and outside the ovaries. Chemotherapy is used in the majority of cases as a follow-up
therapy to surgery.

Currently, the most common chemotherapy for patients with newly diagnosed ovarian cancer
is carboplatin(Paraplatin) or cisplatin (Platinol) plus paclitaxel (Taxol). Carboplatin and
cisplatin are chemicals that contain a platinum ion; therefore, these agents are called
“platinum agents.” Other treatment agents (some of which are not approved by the United
States Food and Drug Administration, but are used in clinical practice) include
                             Chemo


Chemotherapy agents commonly used for relapsed or recurrent ovarian cancer:

              Agents approved for use as single-agent therapies:

                           · Altretamine (Hexalen)

                           · Topotecan (Hycamtin)
                              Treatment



3) Radiation Therapy – Radiation therapy uses high-energy X-rays to kill cancer cells and

shrink tumors (only rarely used in the treatment of ovarian cancer in the United States).
                             Management


Nursing management must be individualized based upon the stage of illness, how the patient

is coping emotionally and physically, and the type of treatment the patient is receiving

(Christy & Nixon, 2004).
2 Types of Ovarian Cancer
       Treatment



Ovarian cancer is treated either by surgery or

                chemotherapy
                Nursing Management

                    Nursing management of the surgical patient includes:

1. .Preoperative education should include information about diagnostic tests, bowel
preparation, and the surgical procedure.
    A assess coping mechanisms encourage pt to verbalize concerns and feelings, assess for
support system.
2. Postoperative instructions should be introduced prior to surgery to encourage compliance.
3. Monitor pt closely post operatively for bleeding, pulmonary emboli, wound or urinary tract
infections, dehydration, and fluid/electrolyte imbalances, pain, anxiety, and compromised
nutrition. Postoperative nursing care often includes routine assessments, such as vital signs
and pain management, urethral catheters, nasogastric tubes, surgical incisions and drains,
hydration, use of antiembolic stockings, ambulation, and incentive spirometry. The nurse
should explain the role of incentive spirometry in preventing atelectasis and pneumonia, and
have the patient perform a return demonstration of spirometer use.
                Nursing Management


                  Chemotherapy usually is given in the outpatient setting.

 Nurses should be familiar with the specific chemotherapy agent, know how to administer it

safely, educate the patient about the chemotherapy, and manage effects and side effects of

the therapy. The patient and family should be provided with an after hours number to call in

                                    case problems arise.
   The basics of
    Nursing
    Management
    of Ovarian
    Cancer

								
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