Ovarian Cancer

  • ovarian cancer 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.

Assessment

  1. First manifestation includes vague abdominal discomfort, indigestion, flatulence, anorexia, pelvic pressure, weight loss or gain, and palpable ovarian enlargement.
  2. Late manifestations include abdominal pain, ascites, pleural effusion, and instestinal obstruction.

Diagnostic Evaluation

  1. Pelvic sonography (with transvaginal probe) and CT scan may be done. Unfortunately, these are not sensitive to early detection of ovarian cancer.
  2. Color Doppler imaging may be used to detect vascular changes within the ovaries.
  3. Paracentesis or thoracentesis are done if ascites or pleural effusion is present.
  4. Laparotomy is necessary to stage the disease and determine effectiveness of the treatment.
  5. 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

  1. 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.
  2. Immunotherapy with interferon or hormonal therapy with tamoxifen, an antiestrogen agent may be used.

Surgical Interventions

  1. Total abdominal hysterectomy with bilateral salpingooophorectomy and omentectomy is usual treatment because of delayed diagnosis.
  2. Second-look laparotomy may be done after adjunct therapies to take multiple biopsy specimens and determine effectiveness of therapy.

Nursing Interventions

  1. Administer anxiolytic and analgesic medications as prescribed and provide support throughout the diagnostic process.
  2. Administer or teach the patient or caregiver to administer antiemetics as needed for nausea and vomiting due to chemotherapy.
  3. Encourage small, frequent, bland meals or liquid nutritional supplements as able. Assess the need for I.V. fluids if patient is vomiting.
  4. Prepare the patient for body image changes resulting from chemotherapy.
  5. Encourage the patient to prepare ahead of time with turbans, wig, hats, and so forth.
  6. Stress the positive effects of the patient’s treatment plan.
  7. Prepare the patient for surgery as indicated.
  8. Postoperatively, reposition frequently and encourage early ambulation to promote comfort and prevent adverse effects.
  9. Explain to the patient that ovary removal will cause menopausal symptoms.
  10. Tell the patient that disease progression will be monitored closely by laboratory tests and that a second-look laparoscopy may be necessary.

Daisy Jane Antipuesto RN MN

Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing. Previous work experiences include: Clinical instructor/lecturer, clinical coordinator (Level II), caregiver instructor/lecturer, NC2 examination reviewer and staff/clinic nurse. Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Also an IELTS passer.

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