Cancer of the Ovary
Introduction
Silent onset
usually detected late in the advanced stage
ovary is a common site for primary as well as metastatic lesions from other cancers
A woman with ovarian cancer has a threefold increased risk for breast cancer and a woman with beast cancer has an increased risk of ovarian cancer
Oral contraceptives appear to have a protective effect
Genetic mutation BRCA-2 & BRCA -1 result in an increased risk of ovarian and breast cancer
risk factors include nulliparity, infertility an anovulation
older age - incidence peaks in the eighth decade of life
Clinical Manifestations
Symptoms are non specific and vague
increased abdominal girth
Pelvic pressure
Pelvic pain
enlargement of the abdomen due to accumulation of fluid is the most common sign
abdominal pain, abdominal discomfort
ascites
change inbowel habits,
back pain
bladder changes - stress urinary incotinence, urinary frequency, dyspareunia,
gastroesophageal reflux,
irregular menses, increasing prenenstrual tension, heavy menstrual flow (menorrhagia) , early menopause, pelvic pressure
breast tenderness
dyspepsia
Flatulence, fullness after a light meal , and increasing abdominal girth are significant symptoms
the combination of two major clues- a long history of ovarian dysfunctions and vague, undiagnosed, persistent gastrointestinal symproms - should alert to the possibility of early ovarian malignancy.
a palpable ovary in a woman who has gone through menopause is investigated because ovaries normally become smaller and less palpable after menopause
types of tumours : - epithelian - 90%
Germ cell tumours and stromal tumours - 10%
Medical Management
Chemotherapy often follows surgery, usually with
cyclophosphamide
Cisplatin
Carboplatin
Paclitaxel
Hexamethylmelamine,
ifosfamide,
bone marrow transplantation and stem cell support may also be used
Paclitaxel and cisplatin are most often used because of their excellent clinical benefits and manageable toxicity.
cisplatin may be used in intraperioneal applications
other new drugs include topotecan, irinotecan, gemcitabine, vinorelbine, liposomal doxorubicin, and docetaxel
Liposomal therapy
Delivery of chemotherapy in a liposome allows the highest possible dose of chemotherapy to the tumor target with a reduction in adverse effects - liposomes are used as drug carriers
patient must be monitored for myelosuppression
These medications are administered as a slow intravenous infusion over 60 or 90 minutes
gene therapy is a future possibility
Surgical Treatment
Total hysterectomy, bilateral salphingo-oophorectomy, with removal of the mass or tumour
Nursing management
Emotional support
Comfort measures
Information
Attentiveness and caring
Young woman unilateral ovarian cancer - occurs the tumour is excised, child bearing is encouraged. After chldbirth surgical reexploration may be performed and the remaining ovary may be removed
If both ovaries are involved surgery is performed, and chemotherapy follows
Patients with advanced ovarian cancer may develpp ascites and pleural effusion.
Nurse adminsters intravenous therapy to alleviate fluid and electrolyte imbalances
Initiates total parenteral nutrition(TPN) to provide adequatete nutrition if needed
Provides post operative care after intestinal bypass to alleviate an obstruction
Provides pain relief
