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19 Cards in this Set

  • Front
  • Back
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
Risk Factors/Causes
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
Risk Factors
Family history of ovarian, breast, colorectal or endometrial cancer
HRT use over 10 years
Genetic mutations
Genetic Mutations
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
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
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
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
Manifestations cont.
-Dyspepsia (upper abdominal discomfort, often chronic or persistent, colloquially referred to as "indigestion.")
Manifestations cont.
Symptoms from tumor spread:
-Pleural effusion
-Constitutional (vague, nonspecific symptoms i.e. fatigue, bloating
*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
Treatment-Based on Staging
*Stage I - limited to ovaries
*Stage II - limited to true pelvis
*Stage III - limited to abdominal cavity
*Stage IV - distant metastasis - peritoneum and beyond
*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
Post Op Course
Monitor vaginal drainage (pad count) determines hemorrhage
Assess abdominal incision
Monitor JP drainage output
Foley catheter
Assess pain
Hormone replacement unless contraindicated
Postoperative Complications
Thrombophlebitis (inflammation of a vein in conjunction with the formation of a thrombus.)
**Femoral nerve injury**
Pulmonary/bowel/bladder problems
Other treatment
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
Other treatment, cont.
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
Nursing Diagnoses
Actual: Acute pain, alteration in skin integrity
Risk for:
-Fluid/electrolyte imbalance
-Nutrition: less than body requirements
-Altered urinary elimination
Nursing Diagnoses, cont.
Actual: Grieving r/t loss of body part and childbearing ability
-Fear r/t diagnosis of cancer
-Self-concept disturbance
-Ineffective coping
-Ineffective management of therapeutic regimen r/t insufficient knowledge
*American College of Obstetricians and gynecologists:
*Hysterectomy Educational Resources and Services Foundation: