Ovarian cancer

nursing

1. OVARIAN CANCER
INTRODUCTION
Ovarian cancer is when abnormal cells in the ovary begin to multiply out of
control and form a tumor. If left untreated, the tumor can spread to other parts of
the body. This is called metastatic ovarian cancer.

RISK FACTORS FOR OVARIAN CANCER
The exact cause of ovarian cancer is unknown. These factors can increase your
risk:
 A Family History Of Ovarian Cancer
 Genetic Mutations Of Genes Associated With Ovarian Cancer, Such As
Brca1 Or Brca2
 A Personal History Of Breast, Uterine, Or Colon Cancer
 Obesity
 The Use Of Certain Fertility Drugs Or Hormone Therapies
 No History Of Pregnancy
 Endometriosis
TYPES OF OVARIAN CANCER
The ovaries are made up of three types of cells. Each cell can develop into a
different type of tumor:
 Epithelial tumors form in the layer of tissue on the outside of the
ovaries. About 90 percent of ovarian cancers are epithelial tumors
 Stromal tumors grow in the hormone-producing cells. Seven percent of
ovarian cancers are stromal tumors.
 Germ cell tumors develop in the egg-producing cells. Germ cell tumors
are rare.
STAGES
Stage I: The cancer is limited to the ovary/ovaries or fallopian tubes and has not
spread.

2. Stage IA : Only one ovary (or fallopian tube) is affected by the cancer, and the
tumour is confined to the inside of the affected ovary or fallopian tube. No cancer
is detected on the surface of the ovary or fallopian tube and there are no
malignant (cancerous) cells detected in the washing fluid from the tummy
(abdomen) and pelvis.
Stage IB : Both ovaries (or fallopian tubes) are affected by the cancer but no
cancer is detected in either the surface of the ovaries (or fallopian tubes) or in
fluid taken from the tummy (abdomen) and pelvis.
Stage IC :The cancer is limited to one or both ovaries or fallopian tubes,
Stage II : The cancer is in one or both ovaries or fallopian tubes and has spread
into the pelvis eg onto the uterus or bladder. The pelvis is the area circled by your
hip bones. There is no spread of the tumour outside of the pelvis.
 Stage IIA : The cancer has spread into the uterus (womb) and/or fallopian
tubes.
 Stage IIB : The cancer is affecting other organs in your pelvis (eg bladder or
rectum.)
Stage III: The cancer has spread outside of the pelvis into the tummy area
(abdomen) and/or the lymph nodes at the back of the abdomen (called
retroperitoneal lymph nodes).
 Stage IIIA :The cancer is in one or both ovaries or fallopian tubes. During
surgery no cancer is visible outside the pelvis within the abdomen to the
naked eye but tiny deposits of cancer are detected in the lining of the
abdomen (peritoneum) or in the fatty apron (omentum) under a
microscope. The cancer might or might not have spread to nearby lymph
nodes.
 Stage IIIB: Tumours less than 2cm in diameter are visible outside the
pelvis within the abdomen and nearby lymph nodes may or may not
contain cancerous cells.
 Stage IIIC: Tumours more than 2cm in diameter are detected outside the
pelvis within the abdomen and may be on the outside of the liver or
spleen.

3. Stage IV: The cancer has spread outside of the abdomen and pelvis to more
distant organs.
 Stage IVA: The cancer cells are found in the fluid around the lungs.
 Stage IVB: The cancer has spread to the inside of the spleen or liver or to
distant lymph nodes or to other organs such as the lungs and bones.

CLINICAL FEATURES
Abdominal Bloating, Pressure, And Pain
Abnormal Fullness After Eating
Difficulty Eating
An Increase In Urination
An Increased Urge To Urinate
Fatigue
Indigestion
Heartburn
Constipation
Back Pain
Menstrual Irregularities
Painful Intercourse
Dermatomyositis (A Rare Inflammatory Disease That Can Cause Skin Rash,
Muscle Weakness, And Inflamed Muscles)

DIAGNOSIS
Blood test:Tests that may be used to diagnose ovarian cancer include:
A complete blood count
A test for cancer antigen 125 levels, which may be elevated if you have
ovarian cancer
A test for hcg levels, which may be elevated if you have a germ cell tumor
A test for alpha-fetoprotein, which may be produced by germ cell tumors

4. A test for lactate dehydrogenase levels, which may be elevated if you have
a germ cell tumor
A test for inhibin, estrogen, and testosterone levels, which may be elevated
if you have a stromal cell tumor
Liver function tests to determine if the cancer has spread
Kidney function tests to determine if the cancer has obstructed your urine
flow or spread to the bladder and kidneys

Pelvic ultrasound: uses sound waves to produce pictures of the structures
and organs in the pelvis and can help identify ovarian or uterine cancers.
In transvaginal ultrasound, a probe is inserted into the vagina for a better
view of the uterus and ovaries.

Abdominal and pelvic CT: takes images of the entire belly cavity and is used
to help diagnose the cause of abdominal or pelvic pain and detect cancers of
the ovaries. An injection of contrast material, as well as oral contrast, is
commonly used to enhance the visibility of the lymph nodes and other tissues
during the exam.

Laparotomy requires an incision by a surgeon in the abdominal wall to
examine the organs in the abdomen and pelvis for signs of cancer. If cancer is
found, this surgery will generally include a removal of the ovaries, uterus and
as much tumor tissue as possible from the abdomen.

Laparoscopy is performed with the use of a thin, lighted tube called a
laparoscope that is inserted through a small incision in the abdomen to look
for signs of cancer.

body MRI can be used to produce detailed pictures of the uterus, lymph
nodes and other tissues in the abdomen and pelvis. An injection of contrast
material may also be used to enhance the visibility of the lymph nodes and
other tissues during the exam.

5. PET is a nuclear medicine imaging exam that uses a small amount of
radioactive material to help determine the extent of or treat a variety of
diseases, including cancer. PET scans can be superimposed with CT or MRI to
produce special views that can lead to more precise or accurate diagnoses.
PET/CT may be used to evaluate the response of ovarian cancer to therapy,
such as chemotherapy.

Radiography is an x-ray examination of the large intestine (colon). The
lower gastrointestinal tract is filled with barium with the use of a flexible tube
inserted in the rectum for better visualization of possible cancer spread in the
digestive tract.
TREATMENT
1. SURGICAL MANAGMENT
a. Salpingo-oophorectomy This surgery involves removal of the ovaries
and fallopian tubes. If both ovaries and both fallopian tubes are
removed, it is called a bilateral salpingo-oophorectomy. If the woman
wants to become pregnant in the future and has early-stage cancer, it
may be possible to remove only 1 ovary and 1 fallopian tube if the
cancer is located in only 1 ovary. That surgery is called a unilateral
salpingo-oophorectomy. For women with a germ cell type of ovarian
tumor, often only the ovary with the tumor needs to be removed, which
preserves the woman’s ability to become pregnant.
b. Hysterectomy. .
c. Lymphadenectomy/lymph node dissection. During this procedure, the
surgeon may remove lymph nodes in the pelvis and paraortic areas.
d. Omentectomy. This is surgery to remove the thin tissue that covers the
stomach and intestines.
e. Cytoreductive/debulking surgery.
2. Chemotherapy
3. Targeted therapy
4. Hormone therapy
5. Radiation therapy