- Is a common gynecologic malignancy that carries a high mortality because it is not usually diagnosed until well advanced.
- Its exact cause is unknown, about 10% of cases are associated with family history of breast, endometrial, colon, or ovarian cancer.
- High fat diet, smoking, alcohol, environmental toxins; patient history of breast, colon, or endometrial cancer, and low parity are additional risk factors.
- Ninety percent of ovarian tumors arise in epithelial tissue, with germ cell and stromal tissue making up the rest.
- Incidence peaks in women age 50 or older.
- Ovarian tumors spread intra-abdominally and through the lymph system.
- First manifestation includes vague abdominal discomfort, indigestion, flatulence, anorexia, pelvic pressure, weight loss or gain, and palpable ovarian enlargement.
- Late manifestations include abdominal pain, ascites, pleural effusion, and instestinal obstruction.
- Pelvic sonography (with transvaginal probe) and CT scan may be done. Unfortunately, these are not sensitive to early detection of ovarian cancer.
- Color Doppler imaging may be used to detect vascular changes within the ovaries.
- Paracentesis or thoracentesis are done if ascites or pleural effusion is present.
- Laparotomy is necessary to stage the disease and determine effectiveness of the treatment.
- CA 125 is a serum tumor marker that is not reliable for screening because its level may be elevated due to inflammation; however, an increase signifies progression of disease.
Therapeutic and Pharmacologic Interventions
- Chemotherapy is more effective if tumor is optimally bulked; usually follows surgery because of frequency of advanced disease; may be given I.V. or intraperitoneally.
- Immunotherapy with interferon or hormonal therapy with tamoxifen, an antiestrogen agent may be used.
- Total abdominal hysterectomy with bilateral salpingooophorectomy and omentectomy is usual treatment because of delayed diagnosis.
- Second-look laparotomy may be done after adjunct therapies to take multiple biopsy specimens and determine effectiveness of therapy.
- Administer anxiolytic and analgesic medications as prescribed and provide support throughout the diagnostic process.
- Administer or teach the patient or caregiver to administer antiemetics as needed for nausea and vomiting due to chemotherapy.
- Encourage small, frequent, bland meals or liquid nutritional supplements as able. Assess the need for I.V. fluids if patient is vomiting.
- Prepare the patient for body image changes resulting from chemotherapy.
- Encourage the patient to prepare ahead of time with turbans, wig, hats, and so forth.
- Stress the positive effects of the patient’s treatment plan.
- Prepare the patient for surgery as indicated.
- Postoperatively, reposition frequently and encourage early ambulation to promote comfort and prevent adverse effects.
- Explain to the patient that ovary removal will cause menopausal symptoms.
- Tell the patient that disease progression will be monitored closely by laboratory tests and that a second-look laparoscopy may be necessary.