Prepared by: Bunda, Klarriza Joie Calma, Joannalae

Ovarian Cancer -a disease characterized by the abnormal growth of cells in the ovaries, the internal reproductive organs that produce the ova, or egg cells, in women. Ovarian cancer seems to be disordered growth in response to excessive estrogen exposure Most theories of the pathophysiology of ovarian cancer include the concept that it begins with the dedifferentiation of the cells overlying the ovary. During ovulation, these cells can be incorporated into the ovary, where they then proliferate. Ovarian cancer typically spreads to the peritoneal surfaces and omentum.

Epithelial ovarian tumors are derived from the cells on the surface of the ovary the most common form of ovarian cancer and occurs primarily in adults Classified as either serous or mucinous Germ cell tumors ovarian tumors are derived from the egg producing cells within the body of the ovary occurs primarily in children and teens and is rare by comparison to epithelial ovarian tumors.

Sex cord stromal tumors ovarian tumors are also rare in comparison to epithelial tumors and this class of tumors often produces steroid hormones. Associated with favorable long term prognosis Usually diagnosed in patients before they reach the age of 40 Metastatic tumors- cancers derived from other organs that spreads in ovary

Etiology remains unknown

Risk Factors: Non modifiable (Predisposing Factors) Age (40 years old and above) Hx. of PID Low serum gonadotropin Ashkenazi Jews descendants (BRCA1 or BRCA 2 gene mutations) Family history of breast and ovarian cancer Early menarche or late menopause

Modifiable (Precipitating Factors): Obesity/ high fat diet Living in industrialized countries Diabetes Mellitus

Early Stage: Often asymptomatic Difficult to detect

Palpation of a pelvic mass or a palpable ovary in a postmenopausal woman should be cause for further investigation
Chest x-ray and CT scans-evaluate metastatic disease

Use of oral contraceptives decrease the risk for ovarian CA by 30%-60% depending on the length of use Breastfeeding appears to have protective effect Women who have experienced the birth of at least one child have a risk reduction of 0.3 or 0.4%

Prophylactic oophorectomy- will reduce but not eliminate the risk of having ovarian CA

Screening Methods: Pelvic examination Measuring the level of tumor markers (increased CA-125)- confirm and monitor the disease relapse Pelvic ultrasonography- for high risk women Transvaginal utz Proteomics-the study of human proteins

Exploratory laparotomy - Goal: leave no tumor greater than 1 cm. Cytoreductive surgery or debulking during exploratory laparotomy - remove the primary tumor and all the associated disease - provides basis of treatment decisions -alleviates ascites, nausea and vomiting, and restore adequate intestinal functioning when metastasis are found - helpful in eliminating tumors that are resistant to treatment

I- cancer is contained within the ovary (or ovaries) II- cancer is in one or both ovaries and has involved other organs (i.e. Uterus, fallopian tubes, bladder, the sigmoid colon, or the rectum) within the pelvis

III- Cancer involves one or both ovaries, and one or both of the following are present: (1) cancer has spread beyond the pelvis to the lining of the abdomen; (2) cancer has spread to lymph nodes.

IV- the most advanced stage of cancer. Cancer is in one or both ovaries. There is distant metastasis to the liver, lungs, and other organs outside the peritoneal cavity; ovarian cancer cells in the pleural cavity are evidence of stage IV disease.

Metastasized ovarian CA

Right ovarian CA

The woman with ovarian cancer has concerns similar to those described for the patient with endometrial cancer. Because the cancer is often diagnosed in an advanced stage, thoughts of death and dying, menopause, and loss of fertility come as a shock.

Early Symptoms: GI distress, dyspepsia, abdominal discomfort, back pain, loss of appetite, changes in bowel habits, bloating, eructation, increase in pelvic pressure, and vaginal bleeding

Genitourinary Sx- burning, urgency, and frequency

Late Symptoms: Palpable abdominal mass Ascites-occurs when lymphatic channels are blocked or when tumor produces excessive fluid Increase abdominal girth Pleural effusion Shortness of breath Weight loss Nausea and vomiting Intestinal obstruction Vaginal bleeding

Chemotherapy: Carboplatin(Paraplatin)+Paclitaxel(Taxol) - most commonly preferred agents - combination is equally effective, less toxic, and easy to administer in an outpatient setting

Cisplatin- antineoplastic agent used intraperitoneally to treat metastatic disease within peritoneal cavity These drugs are usually given every 3 to 4 weeks for 6 cycles in an in-patient or ambulatory setting

Radiation Therapy: Specific criteria in selecting patients for abdominal pelvic radiation: 1. patients who have residual disease or tumor of less than or equal to 2 cm, cell type and grade, and whether the tumoris located within the radiation field
2.

patients physical status and tolerance to radiation

Complications: Lung fibrosis Bone necrosis Secondary malignancies such as leukemia, melanoma, and breast cancer

SURGERY: TAHBSO- primary treatment for early stage epithelial ovarian cancer

Unilateral oophorectomy (Conservative treatment)- for young patients with boarderline tumors who wish to preserve their fertility

Patients over 69 years of age have poorer survival rates compared to those under the age of 50 Histological type, grade, and tumor stage are significant Volume of the disease remaining after surgery- greater tumor burden remaining, the poorer the prognosis 5 year survival for ovarian cancer is 53%

Emotional support, comfort measures, and information, plus attentiveness and caring, are important components of nursing care

For patients with advanced ovarian cancer: Administer IV fluids as prescribed Administer parenteral nutrition Provide post-op care after intestinal by pass

Comfort measures for women with ascites: Provide small frequent meals:high protein meals Decrease fluid intake Administer diuretic agents as prescribed Provide rest Position the patient in left side. For patients with pleural effusion: Position patient on semi or high fowlers Administer oxygen therapy as ordered

Fear/Anxiety related to diagnosis of cancer Hopelessness related to infertility Anticipatory grieving related to impending death Pain related to increase in tumor growth Ineffective breathing pattern related to increased pressure on pleural area Nutritional imbalance:less than body requirements related to gastrointestinal disturbances Fluid and electrolyte imbalance related to vaginal bleeding Disturbed body image related to post surgical procedure