1. Focus on Ovarian Cancer (Relates to Chapter 54, “Nursing Management: Female Reproductive Problems,” in the textbook) Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

2. Significance Malignant neoplasm of the ovaries 21,550 new cases and 16,210 deaths annually Occurs primarily in women of white descent, between the ages of 55 to 65 years Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 2

3. Etiology and Pathophysiology Women with mutations in BRCA genes have increased susceptibility. Greatest risk factor is family history. Also family history of Breast or colon cancers Hereditary nonpolyposis colorectal cancer Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 3

4. Etiology and Pathophysiology Women who have never been pregnant are at higher risk. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 4

5. Etiology and Pathophysiology Other risk factors include Age High-fat diet Greater number of ovulatory cycles Hormone replacement therapy Use of infertility drugs Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 5

6. Etiology and Pathophysiology Associated with lower risk Oral contraceptives Breast feeding Multiple pregnancies Early age at birth of first child Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 6

7. Etiology and Pathophysiology 90% of ovarian cancers are epithelial carcinomas from malignant transformation of surface epithelial cells. Germ cell tumors account for 10%. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 7

8. Etiology and Pathophysiology Histologic grading: important prognostic determinant Tumor grading according to level of differentiation (grades I to III) Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 8

9. Etiology and Pathophysiology Ovarian cancer can metastasize directly by shedding malignant cells. Frequently implant in uterus, bladder, bowel, and omentum Can metastasize by lymphatic spread Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 9

10. Clinical Manifestations General abdominal discomfort Pelvic pain Bloating Urinary urgency or frequency Difficulty eating or feeling full quickly Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 10

11. Clinical Manifestations Later signs include Increase in abdominal girth Unexplained weight loss or gain Menstrual irregularities Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 11

12. Diagnostic Studies No screening test exists. Yearly bimanual pelvic examination should be performed, as the early stages are usually asymptomatic. Postmenopausal women should not have palpable ovaries. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 12

13. Diagnostic Studies Abdominal or vaginal ultrasound can be used to detect ovarian masses. Exploratory laparotomy to diagnose and stage disease OVA1 uses blood sample to test for changes related to ovarian cancer. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 13

14. Diagnostic Studies Screening for high-risk women should include CA-125, ultrasound, and yearly pelvic examination. CA-125 is positive in 80% of women with ovarian cancer. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 14

15. Collaborative Care Counsel women at high risk regarding options (oophorectomy, oral contraceptives). Oophorectomy will reduce the risk but will not eliminate the possibility of disease. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 15

16. Collaborative Care Stage I: limited to ovaries Treatment includes Total hysterectomy Bilateral salpingo-oophorectomy Evaluation of remaining tissue in abdomen and pelvis Chemotherapy or intraperitoneal radioisotopes if poorly differentiated Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 16

17. Collaborative Care Stage II: limited to true pelvis Treatment includes External abdominal and pelvic radiation Intraperitoneal radiation Systemic combination chemotherapy after tumor-reducing surgery Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 17

18. Collaborative Care Chemotherapy agents Cisplatin (Platinol), carboplatin (Paraplatin) used for treatment of stages III and IV Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 18

19. Collaborative Care Chemotherapy agents Altretamine (Hexalen): palliative treatment of persistent, recurrent ovarian cancer Paclitaxel (Taxol), topotecan (Hycamtin): treat metastatic ovarian cancer Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 19

20. Collaborative Care Surgical debulking in addition to chemotherapy agents Intraperitoneal chemotherapy: used when minimum residual disease exists after surgery Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 20

21. Nursing Management Nursing Assessment Health history Family history of ovarian cancer Bladder or bowel dysfunction Pelvic or abdominal pain Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 21

22. Nursing Management Nursing Assessment Health history (cont’d) Pregnancies, breast feeding, menstrual irregularities Use of infertility drugs or HRT High-fat diet Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 22

23. Nursing Management Nursing Assessment Objective data Abnormal findings on pelvic and abdominal examination Abnormal ultrasound findings Increased abdominal girth, ascites Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 23

24. Nursing Management Nursing Diagnoses Anxiety Acute pain Disturbed body image Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 24

25. Nursing Management Nursing Diagnoses Ineffective sexuality patterns Ineffective breathing pattern Grieving Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 25

26. Nursing Management Planning Actively participate in treatment decisions. Achieve satisfactory pain and symptom management. Recognize and report problems promptly. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 26

27. Nursing ManagementPlanning Maintain preferred lifestyle for as long as possible. Continue to practice cancer detection strategies. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 27

28. Nursing Management Nursing Implementation Health promotion Teach women importance of routine screening. Educate about risk factors. Assist in identifying lifestyle changes. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 28

29. Nursing Management Nursing Implementation Acute intervention with surgery Provide psychological support. Preop preparation Douche or enema Catheter Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 29

30. Nursing Management Nursing Implementation Acute intervention with surgery (cont’d) Frequent position changes and avoidance of pressure under knees Leg exercises Abdominal binder Compression stockings to prevent deep venous thrombosis (DVT) Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 30

31. Nursing Management Nursing Implementation Acute intervention with surgery (cont’d) Discharge teaching Activity restrictions Garments Manifestations of infection Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 31

32. Nursing Management Nursing Implementation Acute intervention with radiation Efficient nursing, as nurses are limited to 30 minutes per day Tell patient to urinate immediately before treatment. Advise on side effects. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 32

33. Nursing Management Evaluation Participate actively in treatment decisions. Achieve satisfactory pain and symptom management. Recognize and report problems promptly. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 33

34. Nursing Management Evaluation Maintain preferred lifestyle for as long as possible. Continue to practice cancer detection strategies. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 34

35. Case Study Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 35

36. Case Study 45-year-old woman presents with abdominal bloating, gas, nausea, and constipation. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 36

37. Case Study She has never been pregnant despite not using any birth control methods. No abdominal pain, but feeling of pelvic fullness Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 37

38. Case Study Abdominal ultrasound results indicated need for transvaginal ultrasound. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 38

39. Case Study Results confirmed ovarian mass. Biopsy indicates stage II ovarian cancer. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 39

40. Discussion Questions 1. The patient feels surprised. What can you tell her about the disease? 2. What information can you provide to her about treatment? Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 40

41. Discussion Questions 3. What patient needs can you anticipate? 4. How might you best support her? Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 41