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Ovarian Cancer


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									Ovarian Cancer

  The silent killer
What is it?

       Ovarian Cancer is a
        malignant neoplasm of
        the ovaries
       Most ovarian cancers are
        either ovarian epithelial
        carcinomas (cancer that
        begins in the cells on the
        surface of the ovary) or
        malignant germ cell
        tumors (cancer that
        begins in egg cells).
               How is it 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 transvaginal 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 protien 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.
   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
 Ovarian cancer is the eighth most common
  cancer and the fifth leading cause of cancer
 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
            Clinical Manifestations
   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 was poor.
    However, the following
    symptoms are much
    more likely to occur in
    women with ovarian
    cancer than women in
    the general population.
 Bloating
 Pelvic or abdominal
 Difficulty eating or
  feeling full quickly
 urinary symptoms
  (urgency or
    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:

   Fatigue
   Indigestion
   Back pain
   Pain with intercourse
   Constipation
   Menstrual
        Medical 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 Treatments
 1) Radiation Therapy – Radiation
  therapy uses high-energy X-rays to kill
  cancer cells and shrink tumors.
 2) 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.
                   Types Of Surgery
   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
   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
   Lymph node biopsy: Ovarian cancer staging during ovarian cancer
    surgery (to find out whether the cancer has spread) generally involves
    removing lymph nodes
   3) Chemotherapy – Chemotherapy is the
    treatment of cancer using chemicals 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.
              Nursing Management
   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

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