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19 Cards in this Set
- Front
- Back
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Incidence
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5th cause of female cancer deaths in U.S.
2006-Est-20,180 new cases; 15,310 deaths Occurs most during 55-66 years More common in Scandinavian countries 5 year survival rate 29% for advanced, 95% for confined disease |
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Risk Factors/Causes
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Cause: unknown
Increase risk: Age over 40 Nulliparity, infertility or few pregnancies Race: increased in white, Ashkenazu Jewish or Eastern European descent Diet: high in fat, low in fiber |
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Risk Factors
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Family history of ovarian, breast, colorectal or endometrial cancer
HRT use over 10 years Genetic mutations |
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Genetic Mutations
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BRCA1 gene has 25-40% chance of ovarian cancer
BRCA2 gene has 10-20% chance of ovarian cancer BRCA mutations occur in 10-20% of patients with ovarian cancer w/o history of breast or ovarian cancer |
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Pathophysiology
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90% are surface epithelial in origin
10% are germ cell, from egg making cells -most common in children and teens Graded based on differentiation I-IV Grading is important in prognosis |
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Metastasis
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Spreads by shedding cells-implant on bladder, uterus, bowel, omentum
Can spread via lymph system through retroperitoneal, inguinal or iliac nodes Rare to spread outside abdomen |
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Manifestations
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Usually none till advanced disease
Mimics GI disorders: -Pevic pressure, discomfort -Abdominal distention/bloating -Dyspareunia (pain in the labia, vagina, or pelvis during or after sexual intercourse) -Dysmenorrhea (pain in association with menstruation) -Vaginal bleeding |
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Manifestations cont.
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-Dyspepsia (upper abdominal discomfort, often chronic or persistent, colloquially referred to as "indigestion.")
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Manifestations cont.
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Symptoms from tumor spread:
-Ascites -Dyspnea -Pleural effusion -Constitutional (vague, nonspecific symptoms i.e. fatigue, bloating |
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Diagnosis
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*No specific sensitive screening test exists
*Bimanual and rectovaginal exam - ineffective for early disease *Serum tumor marker CA-125 false positives and false negatives *Ultrasound-high false positive results because of cysts |
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Treatment-Based on Staging
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*Stage I - limited to ovaries
*Stage II - limited to true pelvis *Stage III - limited to abdominal cavity *Stage IV - distant metastasis - peritoneum and beyond |
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Treatment
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*TAH: Total abdominal hysterectomy-removal of uterus and cervix
**BSO: Bilateral Salpingo-oophorectomy-removal of ovaries and fallopian tubes** *Radical hysterectomy: removal of uterus, supporting tissues, upper part of vagina and pelvic lymph nodes |
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Post Op Course
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Monitor vaginal drainage (pad count) determines hemorrhage
Assess abdominal incision Monitor JP drainage output Foley catheter Assess pain Hormone replacement unless contraindicated |
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Postoperative Complications
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Hemorrhage
Hematoma Infection Thrombophlebitis (inflammation of a vein in conjunction with the formation of a thrombus.) **Femoral nerve injury** Fistula Pulmonary/bowel/bladder problems |
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Other treatment
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Lack of standard approach to treatment; need for more clinical trials
Chemotherapy: standard is carboplatin -review side effects of chemotherapy: anemia, thrombocytopenia, neutropenia, nausea, vomiting, fatigue |
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Other treatment, cont.
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Radiation therapy - whole abdomen radiation for Stages II-IV
-Review side effects: nausea, vomiting, diarrhea, fluid/electrolyte imbalances, small bowel obstruction, skin breakdown and bone marrow suppression **Intraperitoneal radioisotopes-Stage I and II (implanted into abdomen Nursing Care: Bedrest, Turn side to side for 30 minutes/8 hr. shift -Side effects: small bowel obstruction |
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Nursing Diagnoses
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Actual: Acute pain, alteration in skin integrity
Risk for: -Fluid/electrolyte imbalance -Infection -Bleeding -Nutrition: less than body requirements -Altered urinary elimination |
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Nursing Diagnoses, cont.
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Actual: Grieving r/t loss of body part and childbearing ability
Risk: -Fear r/t diagnosis of cancer -Self-concept disturbance -Ineffective coping -Ineffective management of therapeutic regimen r/t insufficient knowledge |
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Resources
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*American College of Obstetricians and gynecologists: www.acog.org
*Hysterectomy Educational Resources and Services Foundation: www.hersfoundation.com www.ovariancancer.org www.cancer.org |
