OVARIAN CANCER

INTRODUCTION: Cancer of the ovaries (ovarian carcinoma)

develops most often in women aged 50 to 40. This cancer eventually develops in about 1 of 70 women. It is the second most common gynecological cancer. However, more women die of ovarian cancer than of any other gynecological cancer.

The risk of this cancer is higher in industrialized countries because the diet tends to be high in fat. Risk is increased for women who were unable to become pregnant, who had their first child late in life,

who started menstruating early or who reached menopause late. Risk is also increased for women who have a family history of cancer of the uterus, breast or large intestine (colon).

Ovarian cancer causes the affected ovary to enlarge. In young women, enlargement of an ovary is likely to be caused by a non-cancerous fluid-filled sac (cyst). However, after menopause, an enlarged ovary is often a sign of ovarian cancer. Many women have no symptoms until the cancer is advanced.

If ovarian cancer is suspected or confirmed, surgery is performed to remove the mass and to determine how far the cancer has spread.

Diagnosis of ovarian cancer starts with a physical examination (including pelvic examination) a blood test (for CA-125) and transvaginal UTZ. The Diagnosis must be confirmed with surgery to inspect the abdominal fluid.

PROFILE: Name: Ms. E.P Address: Pob. Ward 1 Minglanilla,

Cebu Sex: Female Birth Date: July 10, 1966 Age: 45

Status: Single Religion: Roman Catholic

Occupation: Self-employed

HISTORY OF PRESENT ILLNESS

2 years PTA patient noted to have abdominal enlargement with no associated symptoms. No consult done. Condition tolerated until 1 month PTA when patient was told to have check-up regarding her abdominal enlargement. Transrectal ultrasound was done which showed multiple, solid heterogenous masses within the myometrium.

Menarche at 13 years old, subsequent cycle are regular, 3-6 day duration, soaking 2-3 pads/day, negative dysmenorrhea.

She was diagnosed with papillary serous cystadenocarcinoma of the ovary stage IIIC with metastasis to the uterine serosa, both fallopian tubes or ovaries, omentum and peritoneal fluid, had surgery in November 2010.

LAB FINDINGSDate: 08-02-10TEST RESULT REFERENCE

RANGE

White Blood CellsRed Blood CellsHemoglobinHematocritMean Corpuscular HbRBC Distribution WidthSegmentersLymphocytes

L 3.1L 3.14L 103L 0.30H 32.84H 16.5L 0.43 H 0.48

4.0-10.504.20-5.40125-1600.37-0.4727-3111.0-16.00.50-0.700.18-0.42

TEST REFERENCE RANGE

06-19-10

White Blood CellsRed Blood CellsHemoglobinHematocritRBC Distribution WidthSegmenters

4.00-11.304.00-5.40120-1600.37-0.470.32-0.360.50-0.70

L 3.8L 3.99L 114L 0.33H 17.6L 0.43

SIGNS AND SYMPTOMS

DATA FROM THE TEXTBOOK

S/S PRESENTED BY THE PATIENT

RATIONALE

Indigestion X

Urinary Frequency Due to increased tumor size

Abdominal bloating X

Constipation X

Abdominal Vaginal Bleeding

Due to vaginal atrophy

Pelvic Pain Due to increasing size of tumor

Ascites X

DRUG STUDY

NAME OF DRUG: DexamethasoneCLASSIFICATION: Glucocorticoid, anti-

inflammatoryINDICATION: can be used for all

conventional indications for glucocorticoids. Dexamethasone produces considerable pressure relief in the event of cerebral edema or raised intracranial pressure of a different origin. It is also very efficient as an antiemetic agent in strongly emetogenic chemotherapy.

ADVERSE EFFECT:-malaise-headache-vertigo-hypotension-thromboembolism-n/v-abdominal distention-muscle pain-osteoporosis-facial edema-wait gain

CONTRAINDICATION:-Existing gastrointestinal ulceration-Cushing’s syndrome-Severe forms of heart insufficiency-Severe Hypertension-Uncontrolled DM-Systemic Tuberculosis-Severe Systemic viral, bacterial and fungal

infection-Pre-existing angle glaucoma-Osteoporosis

DRUG INTERACTION:-NSAIDs and alcohol: increase risk of G.I

ulceration-Mineralocorticoids: increase risk of

hypertension-Oral anti diabetic drugs and insulin: anti

diabetic therapy may have to be adjusted

NURSING RESPONSIBILITIES:-Monitor I&O of patient-observe the patient or peripheral edema,

steady weight gain, rales or cracles or dyspnea

-Administer with meals, to minimize GI irritation

-Educate patient to take missed doses as soon as remembered, unless almost time for the next dose skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed dose.

-Instruct patient to avoid people with known infection and contagious illnesses as corticosteroids causes immunosuppression.

NAME OF DRUG: PaclitaxelDOSE, ROUTE, FREQUENCY: 241 mg in PNSS

x 3 hr.CLASSIFICATION: AntineoplasticACTION: is part of a group of anti-cancer

drugs that works by killing the tumor cells as they grow and multiply.

INDICATION: For the treatment of carcinoma of the ovary or breast alone or in combination.

ADVERSE EFFECT:-light headed, dizzy-anemia

-neutropenia-high levels of some liver enzymes-rash/flushing-Nausea an vomiting-diarrhea-hair loss-muscle aches-heart attack-liver damage-pain/swelling at the site of injection

CONTRAINDICATION: Patients who have a history of severe

hypersensitivity reactions to paclitaxel or other drugs formulated in cremorphor EL (polyethoxylated castor oil).

DRUG INTERACTION:Can potentially interact with other

medications some of the medicines that may lead to paclitaxel interactions include:

-certain antibiotics/antifungal-certain anticonvulsant-Doxorubicin

-Gemfibrozil-Live vaccinations-Protease inhibitors

NURSING RESPONSIBILITIES:-Tell patient to promptly report pain or

burning at injecton site-Explain that temporary hair loss may ocuur-Tell thrombocytopenic patient to avoid

activities that can cause injury-instruct neutropenic patient to minimize in

function risk by by avoiding crowds , plants and vegetables.

NAME OF DRUG: CarboplatinDose, Route, Frequency:854 inD5W 250cc x 30

mins.CLASSIFICATION: Platinum- containing

antineoplastic agent.ACTION: Is an alkylating agent which binds

covalently to DNA. It modifies the cell cycle by interfering with DNA structure and function.

ADVERSE EFFECT:-thrombocytopenia -central neurotoxicity-leukopenia -peripheral

neuropathies-anemia -ototoxicity-nausea -alopecia-vomiting -cardiac failure

SIDE EFFECTS:-difficulty of breathing-swelling of the lips, tongue-kidney damage-decreased bone marrow function-blood problems-extreme fatigue-fever-chills-bloody stools

CONTRAINDICATION:-pregnancy-lactation-allergy to other platinum compounds-severe bone marrow depression

DRUG INTERACTION:-Increased risk of ototoxicity when used

with aminoglycosides.-Instruct patient to report s/s of allergic

response and other adverse reactions.-advise pt. to report unusual bleeding or

bruising

-Urge patient to avoid activities that can cause injury.

-provide dietary counselling and refer patient to dietitian as needed.

NURSING DIAGNOSIS:High risk for infection related t inadequate

secondary defense immunosuppression

NURSING GOAL:After 1 day of rendering nursing intervention

patient will remain free from infection as would manifest normal vital signs.

NURSING INTERVENTION/RATIONALE-Observe and report signs of infection such as

redness, warmth, discharge and increased body temperature. With the onset of infection the immune system is activated an signs of infection appear.

-Carefully wash and pat dry skin, including skinfold areas. Use hydration and moisturization. Dry skin can lead to inflammation, excoriations and possible infection episodes.

-Encourage a balanced diet, emphasizing proteins to feed the immune system. Immune function is affected by protein intake; the balance between omega 6 and omega-3 fatty acid intake and adequate amounts of vitamins A,C and E the minerals zinc and iron. A deficiency of these nutrients puts the client at an increased risk of infection.

-Encourage adequate rest. To booster the immune system.

-Encourage fluid intake. Fluid intake helps thin secretion and replace fluid lost during fever.

NURSING EVALUATION:After 1 day of rendering nursing

intervention patient remains free from infection as would manifest normal vital signs.

-Goal met

NURSING ASSESSMENT:Subjective: “Hindi na ako masyadong nag

eexercise kasi mabilis akong mapagod lalo na pag nagchechemotherapy ako.” verbalized by the patient.

Objectives:-inability to maintain usual routines.-lack of energy-decrease performance

NURSING DIAGNOSIS:Fatigue related to altered body

chemistry (side effects of chemotheray) as manifested by inability to maintain usual routines, lack of energy, decrease performance and verbalization of “Hindi na ako masyadong nag eexercise kasi mabilis akong mapagod lalo na pag nagchechemotherapy ako.”

NURSING GOAL:After 8 hrs. of rendering nursing intervention

patient will report improved sense of energy, perform ADLs with assistance as necessary and participate in desired activities at level of ability.

NURSING INTERVENTION:-Recommend scheduling activities for periods

when client has most energy. Plan care to allow for rest periods. Planning allows client to be active during times when energy level is higher, which may restore a feeling of well being and a sense of control.

-Encourage patient to do whatever possible, such as take short walks. Prevents severe deconditioning and may conserve strength increase stamina and enable patient to become more active.

-Monitor physiological response to activity such as changes in BP. Respiratory rate or heart rate. Tolerance varies greatly, depending on the stage of the disease process, nutrition state, fluid balance

-Encourage nutritional intake. Adequate intake of nutrients is necessary to meet and build energy.

NURSING EVALUATION:After 8 hrs. of rendering nursing

intervention patient reports improved sense of energy, perform ADLs with assistance as necessary and participate in desired activities at level of ability.

-Goal met

NURSING ASSESSMENT:Subjective:“Wala na akong buhok, kalbo na ako.”Verbalized by the patient

Objective:-alopecia-wearing of wig

NURSING DIAGNOSIS:Body image disturbance may

be related to structural changes(loss of hair) as manifested by alopecia and wearing of wig.

NURSING GOAL:After 1 day of rendering nursing

intervention patient will verbalize understanding of body changes.

NURSING INTERVENTION:-Encourage verbalization of feelings. Listen

concerns to alleviate anxiety.-Explain patient that loss of hair is side

effect of chemotherapy. So that patient will be educated about the side effect.

-Convey feelings of acceptance. Provide emotional feelings.

-Encourage patient to look and touch affected body part. To begin to incorporate changes into body image..

NURSING EVALUATION:After 1 day of rendering nursing

intervention patient will verbalize understanding of body changes.

PATHOPHYSIOLOGY

Hyperstimulation of ovariesRisk Factors:-celibacy -lifestyle -dysmenorrhea -exposure to asbestos-stress -diet high in saturated fat

Hyperstimulation of ovaries

Hyperstimulation of ovaries

Increased estrogen

Abnormal proliferation of follicle

Lower quadrant

pain

Cyst grow in size

Follicles fails to ovulate

Increased pelvic pressure

Increased cell division

Urinary frequency

Fatigue & sense of

heaviness in the pelvis

Mutation occurs from the center surface

of ovary

Spreads rapidly

intraperitoneally

Peritoneal carcinoma

MEDICAL MANAGEMENT:Surgery – to remove the tumor

Chemotherapy- To kill cancer cells and to control recurrence of tumor growth after surgery.

Zofran- used to prevent nausea and vomiting associated with chemotherapy

Carboplatin- initial treatment of advance ovarian carcinoma.