Question

Janet is a 67-year-old Caucasian client coming to your office today to receive her test results after being seen a week ago for complaints of pelvic and abdominal discomfort, urinary frequency and urgency, and abdominal bloating despite not eating much. You are in the room with Janet when her doctor enters the room and gives Janet the diagnosis of probable ovarian cancer. He wants to schedule surgery immediately. He leaves you and Janet to discuss the situation and come up with a decision regarding immediate surgery. Janet is stunned and has a lot of questions. (Learning Objectives 3, 4, and 7)

1. Janet wants to know how she got ovarian cancer. Relate the etiology to Janet in terms she can understand.

2. Janet wants to know what this means. Janet asks “Am I going to die from this?” Explain the treatment options and prognosis for ovarian cancer to Janet.

3. As the nurse caring for Janet, how can you support her and her family as they journey through this event?                                                                                                            

Answer 1

A)

It's not clear what causes ovarian cancer, the factors that can increase the risk of the disease.

In general, cancer begins when a cell develops errors (mutations) in its DNA. The mutations tell the cell to grow and multiply quickly, creating a mass (tumor) of abnormal cells. The abnormal cells continue living when healthy cells would die. They can invade nearby tissues and break off from an initial tumor to spread elsewhere in the body (metastasize).

Factors that can increase your risk of ovarian cancer include:

• Older age. Ovarian cancer can occur at any age but is most common in women ages 50 to 70 years.

• Inherited gene mutations. A small percentage of ovarian cancers are caused by gene mutations you inherit from your parents. The genes known to increase the risk of ovarian cancer are called breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2). These genes also increase the risk of breast cancer.

  Other gene mutations, including those associated with Lynch syndrome, are known to increase the risk of ovarian cancer.

• Family history of ovarian cancer. People with two or more close relatives with ovarian cancer have an increased risk of the disease.
• Estrogen hormone replacement therapy, especially with long-term use and in large doses.
• Age when menstruation started and ended. Beginning menstruation at an early age or starting menopause at a later age, or both, may increase the risk of ovarian cancer.

2)

Stage I Ovarian Cancer

Stage I: Cancer is found in one or both ovaries:

• Stage IA: Cancer is found inside a single ovary.
• Stage IB: Cancer is found inside both ovaries.
• Stage IC: Cancer is found inside one or both ovaries and one of the following is true:
  • cancer is also found on the outside surface of one or both ovaries; or
  • the capsule (outer covering) of the ovary has ruptured (broken open); or
  • cancer cells are found in the fluid of the peritoneal cavity (the body cavity that contains most of the organs in the abdomen) or in washings of the peritoneum (tissue lining the peritoneal cavity).\

Stage I Treatment

Generally women with Stage I ovarian cancer have a total abdominal hysterectomy, removal of both ovaries and fallopian tubes (called a salpingo-oopherectomy), an omentectomy (removal of the omentum, a sheet of fat that covers some abdominal organs), biopsy of lymph nodes and other tissues in the pelvis and abdomen. Women of childbearing age who wish to preserve their fertility and whose disease is confined to one ovary may be treated by a unilateral salpingo-oophorectomy without a hysterectomy. (Omentectomy and the other parts of the staging procedure are still performed.) Depending on the pathologist’s interpretation of the tissue removed, there may be no further treatment if the cancer is low grade, or if the tumor is high grade the patient may receive combination chemotherapy.

Stage II Ovarian Cancer

Stage II: Cancer is found in one or both ovaries and has spread into other areas of the pelvis.

Stage II Treatment

Treatment for Stage II ovarian cancer includes: hysterectomy and bilateral salpingo-oophorectomy (removal of both ovaries and fallopian tubes), debulking of as much of the tumor as possible, and sampling of lymph nodes and other tissues in the pelvis and abdomen that are suspected of harboring cancer. After the surgical procedure, treatment may be one of the following: 1) combination chemotherapy with or without radiation therapy or 2) combination chemotherapy

Stage III Ovarian Cancer

Stage III: Cancer is found in one or both ovaries and has spread outside the pelvis to other parts of the abdomen and/or nearby lymph nodes. Cancer that has spread to the surface of the liver is also considered stage III ovarian cancer.

Stage III Treatment

Treatment for Stage III ovarian cancer is the same as for Stage II ovarian cancer: hysterectomy and bilateral salpingo-oophorectomy (removal of both ovaries and fallopian tubes), debulking of as much of the tumor as possible, and sampling of lymph nodes and other tissues in the pelvis and abdomen that are suspected of harboring cancer. After surgery, the patient may either receive combination chemotherapy possibly followed by additional surgery to find and remove any remaining cancer

Stage IV Ovarian Cancer

Stage IV: In stage IV, cancer has spread beyond the abdomen to other parts of the body, such as the lungs or tissue inside the liver. Cancer cells in the fluid around the lungs is also considered stage IV ovarian cancer.

Stage IV Treatment

Treatment for Stage IV ovarian cancer will consist of surgery to remove as much of the tumor as possible, followed by combination chemotherapy.

3) nursing care

The standard chemotherapy is usually a platinum and a taxane. With these agents, what nurses and physicians worry about is lowering of the blood count. There's a risk for infection, but patients don't necessarily feel that. So, we educate them and monitor their blood counts. We talk to them about infection precautions.

What patients most often care about is if they're going to lose their hair. Unfortunately, with a taxane, they will lose their hair. We now have new technologies where perhaps patients can keep their hair by using cold cap devices. If they do lose their hair, it starts to fall out about 2 to 3 weeks after they start chemotherapy, and it begins to grow back about a month or two after they finish chemotherapy. So, it takes about six months when they complete chemotherapy before they have regrown a full head of short, chic hair.

Other side effects patients are concerned about include getting sick and throwing up. Not a lot of nausea is associated with this regimen, which is good. One of the reasons is that we have wonderful anti-nausea medicines. That's where the advanced practice nurses and the nurses come in, because we're the ones who are going to manage this. I think we manage it very effectively. I let patients know that I can help them have good days, but I also need them to tell me when they’re not having a good day. I need them to call me or email me.

Patients will also have fatigue, especially if they're receiving chemotherapy right after surgery, which would be about a month after surgery. Believe it or not, I remind patients that being active will actually help decrease fatigue., I want them up and moving around. Even if they had surgery, I need them walking around, expanding the lungs so they don't get pneumonia, decreasing muscle weakness — that type of thing. But also, they have to pace themselves.

Another very common side effect is something called peripheral neuropathy, which is manifested by some numbness and tingling in the fingertips and toes. That's something that's subjective, so we will monitor that, and there are some medications that we can advise patients on. Acupuncture works very well for that, too.