Nursing Diagnosis Plan

 When women are diagnosed with Ovarian Cancer, there are many nursing diagnoses to think about. Some of the most significant ones are:

1. Disturbed body image r/t removal of reproductive organs, or hair loss
2. Acute pain r/t gynecologic surgery 
3. Ineffective sexuality pattern r/t physiologic limitations and mood 
4. Risk for infection r/t immuno-suppressed status in chemo

Scars from traditional "bikini-cut" hysterectomy surgery.  Women may have concerns about body image after a surgery.

Here, I address the different elements of nursing care for a woman with disturbed body image r/t surgery scars and removal of reproductive organs. 
Pt goal: Patient will verbalize positive body image statements, and is able to look at, touch, and talk about the surgery and scars in a comfortable manner.
Nursing Plan: teach patient about the normalcy of grief and the grieving process; help patient identify coping mechanisms that have been useful in the past; introduce patient to support groups for patients experiencing similar struggles; incorporate motivational interviewing into patient interactions

For more information on nursing care for patients with disturbed body image, see these websites:
http://www1.us.elsevierhealth.com/SIMON/Ulrich/Constructor/diagnoses.cfm?did=74
http://medsurggroup6.wikispaces.com/6.+Nursing+Management

Picture from: http://www.healthychief.com/health-news/what-is-ovarian-cancer

 

Nursing Care

Nursing Care for Women with Ovarian Cancer

Women who are being treated for Ovarian Cancer may be undergoing chemotherapy and major surgery, often at the same time. Along with these massive medical treatments, they may be dealing with severe psychological stress and self-image issues because of the effects of the treatment on their bodies. Some common nursing diagnoses for patients with ovarian cancer include:

1. Disturbed body image r/t removal of reproductive organs, or hair loss
2. Acute pain r/t gynecologic surgery 
3. Ineffective sexuality pattern r/t physiologic limitations and mood 
4. Risk for infection r/t immuno-suppressed status in chemo 

Nursing care related to the first diagnosis would include: therapeutic listening, providing information on recovery groups, help patient identify positive changes, teach patient adaptive behavior

Nursing care related to acute pain would include: frequent pain assessment, utilization of pharmacolical and non-pharmacological pain management techniques

Nursing care for ineffective sexuality pattern would include: access to resources, using a relaxed, accepting normalizing approach to talking about sexuality, assisting patient and significant other in exploring and verbalizing fears, thoughts, preferences surrounding sexuality

Nursing care for infection includes: monitoring WBCs, temperature, BP and HR, maintaining sterile technique in administering chemo medications,  scrupulous hand washing, educating on importance of no sick visitors coming to visit

Treatment for Ovarian Cancer

Treatment for Ovarian Cancer

When you first get a diagnosis of Ovarian Cancer, your first question might be, "So what do I do to get rid of it?" There are several different types of treatment for ovarian cancer-- your doctor will recommend one or several, depending on several different factors, including: the type and stage of cancer, possible side effects, the patient’s preferences and overall health, and personal considerations, such as the woman's age and if she is planning to have children. Sometimes, multiple treatments will be used in combination, namely chemotherapy and surgery. Before starting any treatment, it is important to know about side effects, effect on reproductive ability, pain management, and other issues.

Surgery: This is one of the most common treatments for ovarian cancer. The extent of the surgery will depend on the type of cancer, and how far it has spread. Depending on these factors, the surgeon may perform one of several types of hysterectomy. To the right,  you can see that different organs are removed in different situations. The lymph nodes or omentum may also be removed.

Chemotherapy:  Chemo for ovarian cancer is most often a combination of 2 or more drugs, given IV every 3- to 4-weeks. Giving combinations of drugs rather than just one drug alone seems to be more effective in the initial treatment of ovarian cancer. The typical course of chemo for epithelial ovarian cancer involves 3 to 6 cycles. A cycle is a schedule of regular doses of a drug, followed by a rest period. Different drugs have varying cycles; your doctor will let you know what schedule planned for your chemo.


Here you can see how intraperitoneal chemotherapy is administered. Administering chemo directly into the pelvic area ensures that the most concentrated chemo meds come into direct contact with the infected organs (the ovaries, fallopian tubes, uterus, etc). While this type of chemo works very well, the side effects are more severe than that of chemo administered through a different IV site). 

 Hormone Treatment: There are several different types of hormone treatments for ovarian cancer.

1. Luteinizing-hormone-releasing hormone (LHRH) agonists

2. Tamoxifen

3. Aromatase Inhibitors

Common side effects of these hormones include hot flashes, joint pain, bone loss, and osteoporosis. 

For more information on ovarian cancer treatments, research the American Cancer Society's ovarian cancer section, as well as the American Coalition for Ovarian Cancer. 

Photos from Medline Plus.

 

Signs and Symptoms

Symptoms of Ovarian Cancer

Ovarian cancer is difficult to detect, especially, in the early stages. This is partly due to the fact that these two small, almond shaped organs are deep within the abdominal cavity, one on each side of the uterus. These are some of the potential signs and symptoms of ovarian cancer:

• Bloating
• Pelvic or abdominal pain
• Trouble eating or feeling full quickly
• Feeling the need to urinate urgently or often

Other symptoms of ovarian cancer can include:

• Fatigue
• Upset stomach or heartburn
• Back pain
• Pain during sex
• Constipation or menstrual changes

 In most cases, ovarian cancer symptoms are not apparent in the early stages of the disease. As a result, ovarian cancer tends to be diagnosed at a more advanced stage. Because there is no routine screening test for ovarian cancer, women with a family history of the disease or other risk factors should talk with their doctor about genetic testing and other steps they can take to monitor or reduce their risk. Routine gynecologic care and annual pelvic exams are currently the best way to screen for symptoms of ovarian cancer.

For my information, consider using these resources:
-Cancer Treatment Centers of America
-National Ovarian Cancer Coalition
-Ovarian Cancer National Alliance 

http://www.ovariancancer.org/about/symptoms-of-ovarian-cancer-detection/

Ovarian Cancer Diagnosis

A diagnosis of Ovarian Cancer has several different steps

1. Physical Exam: this may include a thorough health history and a pelvic exam. An enlarged ovary palpated in a pelvic exam, or ascites (fluid over the lower abdomen) are cause for a second step.

2. CA-125 Test: This blood test determines if the level of CA-125, a protein produced by ovarian cancer cells, has increased in the blood of a woman at high risk for ovarian cancer or with an abnormal pelvic examination. NOTE: Several non-cancerous diseases of the ovaries may result in an increased CA-125 level. This is not a singular diagnosis tool! However, a positive CA-125 test and an enlarged ovary should initiate the next step.

3. Gynecologic Oncologist: This specialist focuses in cancers of the female reproductive system. A gynecologic oncologist is trained to diagnose and treat these specific cancers. They will most likely perform a ultrasound or MRI to determine whether any masses are liquid or fluid filled. These doctors are also the most qualified to help a women move forward with selecting a treatment for the cancer. 



Still have questions about how an Ovarian Cancer diagnosis is made? Check out these helpful organizations and their websites: 

The American Cancer Society has excellent information @ http://www.cancer.org/cancer/ovariancancer/detailedguide/ovarian-cancer-diagnosis. They are an authoritative voice on every cancer and type of treatment. 

National Ovarian Cancer Coalition @ http://www.ovarian.org/detection.php. This is a smaller organization that focuses specifically on ovarian cancer. They have a really helpful resource section.

Pathophysiology

Pathophysiology of Ovarian Cancer

Ovarian cancer, like many other types of cancer, starts with the disregulation or disturbance of apoptsis. Apoptosis is the normal, programmed death of cells that occurs when the cell is damaged or no longer needed. Apoptosis disregulation is a dangerous situation because this crazy overgrowth of cells is very damaging to the cells around it. Unnatural clumps of prolific cells steal oxygen, blood and nutrients from other cells, depriving them and causing them damage. A quick growing mass of unnatural cells also mechanically compresses healthy tissue, causing ischemia of healthy cells.

There are several different subtypes of ovarian cancer that can occur, depending on which part of the ovary the apoptosis starts in. The 5 main types are:

●High-grade serous carcinoma (70 to 80 percent): High-grade serous carcinoma is the most common type of ovarian cancer and accounts for approximately 70 to 80 percent of all malignant ovarian neoplasms. Very quick-growing and aggressive.

●Endometrioid carcinoma (10 percent)  Endometrioid carcinoma of the ovary accounts for approximately 10 percent of all ovarian carcinomas. They have a much better prognosis than serous carcinomas, as they are normally detected earlier and are more responsive to chemotherapy. Endometrioid ovarian carcinoma is associated with carcinoma of the endometrium in 15 to 20 percent of cases. It is possible that endometrioid carcinoma is a metastasis of endometrian cancer.

●Clear cell carcinomas (10 percent)  Similar to endometrioid carcinoma, clear cell ovarian carcinoma is often associated with, and likely arises from, endometriosis.

●Mucinous carcinoma (3 percent) Approximately 80 percent are benign mucinous cystadenomas, and the majority of the rest are mucinous borderline neoplasm. In addition, most mucinous carcinomas within the ovary are metastases, frequently from the gastrointestinal tract.

●Low-grade serous carcinoma (<5 percent) Slower-growing than high-grade serous carcinoma. 

The above photo illustrates the progression that ovarian cancer takes as it develops. First in stage 1 it affects only the ovary. Next it progresses, and then finally in stage 3 it can be seen metastasizing to other secondary sites. 

For more information on the pathophysiology of ovarian cancer, please see these informative sites: 

www.uptodate.com/contents/epithelial-carcinoma-of-the-ovary-fallopian-tube-and-peritoneum-histopathology (This is a great information on the different types of ovarian cancer)

http://www.ovarian.org/what_is_ovarian_cancer.php (This is an easy-to-ready, informative site on how cancer starts in the body)

Epidemiology of Ovarian Cancer

Because ovarian cancer is often detected so late (and consequently difficult to treat because of the late stage at which it is detected), studying the epidemiology of the disease is important. Epidemiology answers questions like:

Who gets this disease?
Does it affect some groups more than others?
What is the frequency at which patients are diagnosed with this disease?
What kinds of patterns does this disease follow?

Answering questions on epidemiology helps researchers pinpoint patterns that may hold clues to how we treat and combat specific diseases.

Who gets ovarian cancer? 
Each year, about 20,000 women in the US get ovarian cancer. Ovarian cancer causes more deaths than any other cancer of the female reproductive system, but it accounts for only about 3% of all cancers in women. This means it is a very deadly type of cancer. Caucasian women get ovarian cancer the most, followed by Hispanic women, with black women and Asian women getting it less frequently.

Does it affect some groups more than others? 
Yes! Besides the previously mentioned racial patterns, age, parity, and patter of menstrual cycle influences who is at risk for ovarian cancer. Several factors are protective against ovarian cancer, such as having children, breastfeeding, and taking oral contraceptives. Groups at risk for ovarian cancer include:
-Women who have never conceive a child (nulliparity)
- Women over the age of 40
-Women who began menses early, or who reached menopause late
-Women who receive hormone replacement therapy 

What is the frequency at which this disease is diagnosed? 
Ovarian cancer is the seventh most commonly diagnosed cancer in women (and 18th most common overall) worldwide. Approximately 239,000 cases were diagnosed in 2012, accounting for about 4% of new cancer cases in women worldwide. This type of cancer is higher in low- to middle- income countries. This correlation could be diet related, as research is showing that ovarian cancer may be related to body fat content. With lower incomes being associated with poor diets, empty calories, and obesity, it is not hard to see how poor diets contribute to hyperinsulineamia, which increases the risk of many types of cancer.


For more information on ovarian cancer please visit these websites (which were used in the making of this blog):
Center for Disease Control and Prevention @ http://www.cdc.gov/cancer/ovarian/statistics/index.htm
http://www.aicr.org/continuous-update-project/reports/ovarian-cancer-2014-report.pdf
National Ovarian Cancer Coalition @ http://www.ovarian.org/research.php





 

On Ovarian Cancer

For patients diagnosed with ovarian cancer, there can be a lot of confusion. There can be a lot of questions.

"What is my prognosis?"
"What kind of treatment will I get?"
"How can two tiny glands cause me to get so sick?"

This blog will try and cover all the basics of ovarian cancer and answer common questions, and help readers gain some basic knowledge of and insight to ovarian cancer.

 

Ovarian cancer is a cancer that starts in the ovaries. Most women are born with two ovaries, one on each side of the uterus. The ovaries, each about the size of an almond, are key components of the reproductive system: they release hormones called estrogen and progesterone, which help cause the release of an ova, or an egg. Normal cells are programed to die when they get old or damaged. In cancer, the ovary cells start to reproduce in an abnormal pattern. The abnormal pattern can be either overproduction, or cells not dying when they are damaged.This is dangerous because the cells grow out of control, taking blood supply from other cells and prohibiting growth of surrounding cells and organs.

Classifications of Ovarian Cancer

There are more than 30 different types of ovarian cancer which are classified according to the type of cell from which they start. Cancerous ovarian tumors can start from three common cell types:

• Surface Epithelium - cells covering the lining of the ovaries
• Most epithelial ovarian tumors are benign (non-cancerous), but the most dangerous ovarian cancer, a carcinoma, also arises in the epithelium 
• Germ Cells - cells that are destined to form eggs
• Most germ cell tumors are benign (non-cancerous), although some are cancerous and may be life threatening. Most women who have germ cell malignancies are younger (in their late teens or 20's)
• Stromal Cells - Cells that release hormones and connect the different structures of the ovaries
• This rare type of ovarian cancer develops in the tissue that holds the ovary together 

National Ovarian Cancer Coalition.  http://www.ovarian.org/types_and_stages.php
American Cancer Society. http://www.cancer.org/cancer/ovariancancer/
National Cancer Institute. http://www.cancer.gov/cancertopics/types/ovarian