Nursing 203 Ovarian Cancer Exam 2 – Flashcards
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ovarian cancer facts
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Malignant tumor of the ovaries 22,280 new cases yearly, 15,000 deaths annually(?) 5th leading cause of cancer deaths in US -Most have advanced disease at time of diagnosis -Difficult to detect, deep in the pelvis. -No early screening mechanisms exists at this time Women between 55 and 65, Caucasian women> African American
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risk factors for ovarian cancer
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Genetics: gene mutation BRCA1/BRCA2 genes -1st degree relative: hx of ovarian, breast/colon cancer. Age: > 50 yrs, more common after menopause Hormone Replacement Therapy (HRT): (estrogen without progesterone for at least 5-10yrs) Obesity (higher death rates) Infertility(nullparity), endometriosis, Early menarche and late menopause Ethnicity: Caucasian >African-American women
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decrease risk for ovarian cancer
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Pregnancy: younger age with first birth, multiple pregnancies Breast feeding Oral contraceptives: BCP> than 5 years. -recent Harvard study:10-12% decrease after 1 year of use, approximately 50 % decrease after 5 years of use. (Cancer and Steroid Hormone Study or CASH): OC formulations with high levels of progestin reduced ovarian cancer risk more than preparations with low progestin levels. Prophylactic oophorectomy in women with genetic mutation BMI<30
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patho of ovarian cancer
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90% :epithelial. (outer surface of ovary) 10% : germ cell tumors (cells that produce eggs) Histological grading:Grade I- III (according to cell differentiation) - Grade I: well differentiated, good prognosis. -Grade II: moderately well differentiated - Grade III, poorly differentiated, poor prognosis. Metastasis: Uterus, bladder, bowel ,omentum. Advanced spread to stomach, colon, liver and other parts.... Symptoms?
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ovarian cancer grading
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Histological grading:Grade I- III (according to cell differentiation) - Grade I: well differentiated, good prognosis. -Grade II: moderately well differentiated - Grade III, poorly differentiated, poor prognosis. Metastasis: Uterus, bladder, bowel ,omentum. Advanced spread to stomach, colon, liver and other parts.... Symptoms?
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why is ovarian cancer difficult to diagnose
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diff to diagnose until it has spread to lymph system or by direct extension to other organs or tissues
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clinical manifestations of ovarian cancer
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Non specific, vague symptoms in early stages in abdominal/pelvic region: Easily ignored -abdominal pain, bloating, urinary urgency or frequency and difficulty eating or feeling full quickly. Need to educate that if women have one or more of these symptoms, especially if new or persistent or worsening: need MD follow up. Early identification impacts treatment and prognosis
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ovarian cancer diagnostics
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NO screening tests available Pelvic exams recommended yearly. (ID presence of ovarian mass) -Abdominal and transvaginal ultrasound, exploratory laparotomy (dx & stage) Serum OVA-1(detects biomarker levels of ovarian involvement; differentiates benign or malignant status prior to surgical removal) High Risk women: -Serum levels of protein; CA-125 (tumor marker, can be + with other malignancies or fibroids, endometriosis) -Ultrasound of the ovaries Clinical trial results: Neither resulted in fewer deaths
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serum OVA1
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Serum OVA-1(detects biomarker levels of ovarian involvement; differentiates benign or malignant status prior to surgical removal)
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high risk women ovarian cancer diagnostics
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High Risk women: -Serum levels of protein; CA-125 (tumor marker, can be + with other malignancies or fibroids, endometriosis) -Ultrasound of the ovaries Clinical trial results: Neither resulted in fewer deaths
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american cancer society ovarian recommendations
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ACS recommends that if any of these symptoms occur almost daily or last a few weeks and are new, the woman should seek the attention of her physician. In many cases, symptoms do not occur until the ovarian cancer is in an advanced stage. The symptoms of ovarian cancer may resemble other medical conditions or problems. Always consult your physician for a diagnosis
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nurses educate on ovarian cancer
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Identify high risk females -family and health history Counseling: for high risk population. Options include: - prophylactic oophorectomy (reduces risk of ovarian cancer but does not eliminate possibility) -use of oral contraceptives
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stage 1 ovarian cancer
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limited to ovaries
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stage 1 ovarian cancer treatment
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TX: surgery:total hysterectomy and bilateral salpingo-oophorectomy May do tumor debulking. Chemo: Intra-peritoneal radiation if poorly differentiated 90% survival
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stage 2 ovarian cancer
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disease limited to pelvis
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stage 2 ovarian cancer treatment
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TX: surgery hysterectomy AND external abdominal/ pelvic radiation, intraperitoneal radiation OR systemic combined chemo.after tumor debulking surgery monitor for recurrent disease
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stage 3 ovarian cancer
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disease limited to abdominal cavity
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stage 3 ovarian cancer treatment
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Surgery: Debulking and chemotherapy: cisplatin(Platinol), Carboplatin (parplatin) survival rate 36%
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stage 4 ovarian cancer
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distant metastic disease
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stage 4 ovarian cancer treatment
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Surgery: Debulking and chemotherapy; cisplatin(Platinol), Carboplatin (parplatin) Paclitaxel(Taxol) Topotecan (Hycamtin) survival rate 20%
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ovarian cancer treatment and Nursing responsibility
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Most patients with ovarian cancer have widespread disease at time of diagnosis Surgery: total abdominal hysterectomy and bilateral salpingo-oophorectomy, with omentectomy with tumor debulking (removal of as much of the tumor as possible) Patient problems? Complications of surgery? Nursing interventions?
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ovarian cancer radiation
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Radiation: Nursing interventions? intra peritoneal instillation of radioisotopes (intracavity):placing an isotope into the area of the cancer or in the area where micrometastasis (unseen cancer) is suspected(abdominal, small and large bowel lining) -allows uniform spread throughout abdominal cavity Side effects: N/V/D, fleeting abdominal pain, low grade fever(22%) External abdominal radiation Pelvic radiation therapy
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side effects of ovarian cancer radiation
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Side effects: N/V/D, fleeting abdominal pain, low grade fever(22%) External abdominal radiation Pelvic radiation therapy
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internal radiation therapy
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sealed radiation: intracavity, interstitial clients excretion is not radioactive. bodily fluids not contaminated private room properly labeled no kids under 18 no pregnant women wear film badge prevent dislodgemnt monitor VS q4hrs accurate I/O's Time, distance, shield Dosimeter Hospital policy
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ovarian cancer chemo nursing responsibilities
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Type and amount of chemotherapy dictated by cell differentiation and stage of ovarian cancer Intra-peritoneal chemotherapy Systemic chemotherapy:Combination medications Platinum compound (Cisplatin,Carboplatin) combined with taxane (paclitaxel,or docetaxel:taxotere) 3-6 cycles Monitor and treat side effects of chemotherapy Chemo: treat recurrent disease or palliation
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purpose of chemotherapy
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Chemo: treat recurrent disease or palliation Monitor and treat side effects of chemotherapy
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nursing diagnosis: patient problems with ovarian cancer
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Anticipated grieving, anxiety, fear of cancer, loss of child bearing capacity : active listening Tissue integrity(radiation): Fatigue, weakness, lack of appetite (chemotherapy): gentile exercise program Early menopause: risk of osteoporosis Body image, sexuality(surgical hysterectomy, hair loss) Knowledge deficit(treatment side effects, complications )
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after ovarian cancer treatment
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If patient is clinically clear after completing treatment: -repeat exploratory laporoscopy.. "second look" for evidence of disease...if no evidence Monitor for recurrent disease -recommendation: pelvic exam every 2-4 months x 2 years following treatment, every 6 months for next 3 years -Other tests may include: CXR, CT scan, urinalysis, serum CA-125. Fear of recurrence is common
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ovarian cancer after treatment tests
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-Other tests may include: CXR, CT scan, urinalysis, serum CA-125. Fear of recurrence is common
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how to monitor for recurrent pelvic disease
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Monitor for recurrent disease -recommendation: pelvic exam every 2-4 months x 2 years following treatment, every 6 months for next 3 years
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how nurses can help with ovarian cancer
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Educate women not to ignore any symptoms Awareness Active listening Good history Support Coping Hope
