Course Learning Outcomes:: University of Northern Philippines

Republic of the Philippines
UNIVERSITY OF NORTHERN PHILIPPINES

Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
Website: www.unp.edu.ph
Mail: unp_nursingvc@yahoo.com
CP# 09177148749, 09175785986
This module will introduce to the art and science of Oncology Nursing. Oncology patients receive
care from all health care settings-including acute care teaching hospitals, tertiary care centers,
general hospitals and community care. Given the increasing complexity of the growing population,
caring for people with cancer and their families involves a particular set of advanced skills and
knowledge. Furthermore, this module provides essential discussion on the concepts of the Female
Reproductive Disorders such as Cervical cancer, ovarian cancer and uterine cancer including its
management.
Course Learning Outcomes:

At the end of the module, the learners will be able to:
1. Identify risk factors and clinical manifestations of the disease.
2. Summarizes the disease process for some female reproductive disorders such as cervical,
ovarian and uterine cancer.
3. Explain collaborative management including the nursing responsibilities.
4. Incorporate health education to clients afflicted with any type of cancer.
Read and analyze each question and encircle the best answer.
1. Which is the most common type of cervical cancer?

a. Adenocaecinoma
b. Squamous cell carcinoma
c. Adenoquamous carcinoma
d. All of the above
2. Which of the following is not a risk factor for cervical cancer?
a. Smoking
b. History of genital warts
c. High socio-economic status
d. Micronutrient deficiency
3. What remains the gold standard for determining ovarian cancer staging?
a. Blood tests
b. Imaging
c. Surgery
d. Palliation
2
e.
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
CP# 09177148749, 09175785986
4. Where does ovarian cancer occur?

a. On the tissue within the ovary
b. On the surface of the ovary
c. In egg-forming germ cells with in the ovary
d. Any of these
5. Who is the most at risk for developing ovarian cancer?
a. A woman who has had multiple children
b. A woman who is underweight
c. A woman over the age of 60
d. Any of the above
6. Which of the following is usually one of the earliest symptoms of uterine cancer?
a. Abnormal or excessive bleeding without pain
b. Excessive bleeding and pelvic pain
c. Abdominal pressure and watery discharge
d. Enlarged lymph nodes
7. Which treatment option/s are best while the cancer is still localized to the uterus?
a. Surgery
b. Hormone therapy
c. Surgery and chemotherapy
d. Surgery and hormone therapy
8. Which of the following is considered a main risk factor and a necessary cause of cervical
cancer?
a. Human torovirus
b. Human papillomavirus
c. Rotavirus
d. Coronavirus
9. Which of the following tests can be used to detect precancerous stages of cervical
cancer?
a. Mammography
b. Pap test
c. Blood test
d. Cone Biopsy
10. High fat diet may be factor in the development of certain cancer of the:
a. Breast and colon
b. Prostate
c. Uterine
d. All of the above
2
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
CP# 09177148749, 09175785986
CERVICAL CANCER
 It is the 3rd most common cancer worldwide.
 Occurs most commonly in women ages 30-40 years old, but can occur as early as age 18.
 A type of cancer that occurs in the cells of the cervix.
 It is the only gynecological Ca that can be prevented through routine screening.
Risk Factors:
1. Human Papilloma Virus (HPV) infection
-Vaccination against HPV is effective to avoid HPV infection.
2. Cigarette smoking, both active and passive.
3. Reproductive behavior including early 1st intercourse and early childbearing
-Screening via gynecological exams and Pap Smear, with treatment of precancerous abnormalities,
decreases the incidence and mortality of cervical cancer.
4. Low socioeconomic status (maybe related to early marriage and early childbearing)
5. Nutritional deficiencies (folate, beta-carotene and vitamin C levels are lower in women with
cervical cancer than in women without it.)
6. Chronic cervical infection
Assessment:
1. Painless vaginal postmenstrual and postcoital bleeding
2. Foul-smelling or serosanguineous vaginal discharge
3. Pelvic, lower back leg, or groin pain
4. Anorexia and weight loss
5. Leakage of urine and feces from the vagina
6. Dysuria
7. Hematuria
8. Weight loss, anemia and fever- signal advanced disease
9. Cytological change on Pap smear
 Most cancers originate in squamous cells, while remainder are adenocarcinomas or mixed
adenosquamous carcinomas.
 Adenocarcinomas begin in mucus- producing glands and are and often due to HPV
infection.
 Most cervical cancers, if not detected and treated, spread to regional pelvic lymph nodes.
2
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
CP# 09177148749, 09175785986
Diagnostic Evaluation:
1. Annual Pap test-
o should begin 3 years after 1st sexual intercourse, but no later than age 21.
o at 30 y/o, women who have had 3 normal pap test result in a row may get screened
every 2-3 years.
o At 70 or older, may decide with their health care provider after having no abnormal
Pap test in the 10 years to stop having Pap tests.
o Women who have had a total hysterectomy, do not need to screened for cervical Ca,
unless the surgery was done for cervical precancer or cancer.
o The finding of an abnormal Pap test indicates the need for follow up:
o Women with minor changes may be followed with a repeated pap test in 4-6 months
for 2 years.
2. Colposcopy
o involves examination of the cervix with a binocular microscope w/ low levels of
magnifications.
o Helps in the identification of possible epithelial abnormalities and suggests areas for
biopsy.
3. Metastatic work ups (CXR, CBC, Dilation and Curettage (D&C), CT Scan, MRI and IV
urography)
MEDICAL TREATMENT:
o Precursor or Pre-invasive lesion:
 Loop Electrocautery Excision Procedure (LEEP)
- It is used to remove abnormal cells where a thin wire with laser is used to cut away a thin
layer of cervical tissue.
- It is an outpatient procedure usually performed by a gynecologist that takes only few
minutes.
2
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
CP# 09177148749, 09175785986
 Cone Biopsy/ Conization

- It is a surgery that removes the abnormal, precancerous cells from the cervix.
- Conization is essentially an intensified biopsy of the cervix that removes a large cone-shape
section of the abnormal tissue, as well as a small amount of normal tissue so an area of
normal tissue remains in the cervix.
- Conization may be performed in conjunction with LEEP.
- Conization removes the cone-shape tissue for biopsy and LEEP is used to remove abnormal
tissue.
o Invasive Cancer:
 Total hysterectomy- removal of the uterus, cervix and ovaries
 Radical hysterectomy – removal of uterus, ovaries, fallopian tubes, proximal vagina
and bilateral lymph nodes through an abdominal incision.
 Radical vaginal hysterectomy – vaginal removal of the uterus, ovaries, fallopian tubes,
and proximal vagina
 Bilateral pelvic lymphadenectomy – removal of common iliac, external iliac,
hypogastric and obturator lymphatic vessels and nodes.
 Pelvic exenteration – removal of the pelvic organs, including the bladder or rectum and
pelvic lymph nodes and construction of diversional conduit, colostomy and vagina
 Radical trachelectomy – removal of the cervix and selected nodes to preserve
childbearing capacity in a woman of reproductive age with cervical cancer.
 Cryosurgery - Involves freezing of the tissues using a probe, with subsequent necrosis
and sloughing.
- No anesthesia is required, although cramping may occur during the
procedure.
- A heavy watery discharge will occur for several weeks following the
procedure.
- Instruct the client to avoid intercourse and the use of tampons while the
discharge is present.
NURSING RESPONSIBILITIES:
2
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
CP# 09177148749, 09175785986
1. Encourage client to use relaxation technique to promote comfort during diagnostic

procedures.
2. Provide emotional support and comfort measures to alleviate anxiety.
3. Watch for complications related to therapy to ensure that measures can be instituted to
prevent complications.
4. Assess pain level and administer pain medications, as needed and note its effectiveness to
promote comfort.
5. Maintain diet to promote recovery.
NAME: YR&SEC: DATE:
Critical Thinking Exercise:

Nursing Management of the client with CERVICAL CANCER
SITUATION: Celia, a 33-year old woman underwent a loop electrosurgical excision procedure
(LEEP) for cervical cancer 1 week ago. Pathology reports confirmed the cancer was preinvasive
2
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
CP# 09177148749, 09175785986
and due to dysplasia. The client is greatly relieved, but understands she will have to maintain
close follow-up care for the next few years.
1. How does preinvasive differ from invasive cervical cancer?
2. Cite three goals of collaboration care for the client with preinvasive cancer of the
cervix.
3. What can the nurse do to help the client with invasive cervical cancer cope with the
situation while she is being prepared for a treatment such as hysterectomy.
OVARIAN CANCER
- It is a malignant tumor of the ovaries.
- It is recognized as the 12th most prevalent cancer in the Philippines and is ranked as 5th
most prevalent cancer for females.
Types of ovarian cancer
2
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
CP# 09177148749, 09175785986
The four main types of ovarian cancer are:

 epithelial – cancer of the epithelium, which consists of the outer cells covering the ovary. This is
the most common type – nine out of 10 ovarian cancers are epithelial cancers
 germ cell – cancer of the cells inside the ovary that mature into eggs. This uncommon form of
ovarian cancer usually affects women less than 30 years of age
 sex-cord stromal cell – cancer of the cells that release female hormones. This uncommon form
of ovarian cancer can affect women of any age
 borderline tumors – types of epithelial tumors that are not as aggressive as other forms.
CONTRIBUTING FACTORS:
 Age at menopause
- Most ovarian cancers occur in women over 50 years, with the highest risk for those over
60
 Exposure to asbestos, talc and industrial pollutants
- Asbestos-contaminated talcum powder products have caused cancer in people who
inhaled the powder on a regular basis. Some researchers suggest when women applied
contaminated talcum powder to their genitals after showering or bathing, asbestos fibers
may have also traveled up the reproductive tract to their ovaries.
 Familial tendency and history of breast or uterine cancer
- Genetic predisposition is the strongest risk factor for ovarian cancer. Women who have
relatives with ovarian cancer have an approximately 3-fold increased risk, with multiple
affected relatives further raising the risk.
 Fertility drugs
- Use of fertility drugs is highly correlated with many other factors that affect ovarian cancer
risk, which complicates teasing out the contribution of fertility drug treatments.
- Fertility drugs promote maturation of multiple follicles and, consequently, multiple
ovulations by increasing gonadotropin levels. Commonly prescribed fertility drugs are
clomiphene citrate, a selective estrogen receptor modulator with chemical properties
similar to tamoxifen that is often the first choice for treating infertility
 High -fat diet

There has been research linked that fat intake, particularly fat from animal sources,
increases risk of ovarian cancer. The association of total fat intake with ovarian cancer may
be modified by hormone and reproductive factors such as parity and oral contraceptive use.
Stages of Ovarian Cancer

2
I – Growth to limited to the ovaries
II – Growth involves 1 or both ovaries with pelvic extension
III – Growth involves 1 or both ovaries with metastases outside the pelvis or
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
CP# 09177148749, 09175785986
ASSESSMENT FINDINGS:
Symptoms are often vague, and many women ignore the symptoms. Ovarian cancer is often
silent, but enlargement of the abdomen from accumulation of fluid is the most common sign.
 Pelvic or abdominal pain
 Bloating
 Urinary urgency or frequency
 Difficulty in eating or feeling full quickly
Ovarian cancer metastasizes by shedding malignant cells, which frequently

implant on the uterus, bladder, bowel, and omentum. Ovarian cancer can
also metastasize by lymphatic spread.
DIAGNOSTIC TEST:
Abdominal ultrasonography, CT scan or X-ray may delineate tumor size.
1. Chest x-ray -may reveal distant metastasis and pleural effusion.
2. Barium enema- may reveal obstruction and size of tumor
3. Lymphangiography – may show lymph node involvement
4. Mammography – may rule out primary breast cancer
5. Liver scan – may rule out liver metastasis
6. Blood tests, such as ovarian carcinoma antigen, carcinoembryonic antigen (CEA), and human
chorionic gonadotropin- reveals presence of cancer
7. Exploratory laparotomy including lymph node evaluation and tumor resection – confirms
diagnosis and staging.
TREATMENT:
Conservative treatment:
The following conservative approach may be appropriate:
2
1. Resection of the involved ovary

Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
CP# 09177148749, 09175785986
2. Biopsies of the omentum (a large flat adipose tissue layer nestling on the surface of the
intra-peritoneal organs) and the involved ovary
3. Peritoneal washing for cytologic examination of pelvic fluid
4. Periodic chest x-ray to rule out lung metastasis.
Aggressive treatment:
Ovarian cancer usually requires more aggressive treatment, including:
 Total abdominal hysterectomy and bilateral salphingo-oophorectomy (TAHBSO) with
tumor resection, omentectomy, and appendectomy
In total abdominal hysterectomy and bilateral salphingo-oophorectomy (TAHBSO), a surgery

will be done through an incision in the abdomen. A bilateral salpingo-oophorectomy is
surgery to remove both of the ovaries and fallopian tubes. The hysterectomy and bilateral
salpingo-oophorectomy will both be done during one procedure. This surgery will remove the
uterus, cervix, ovaries, and fallopian tubes. After a hysterectomy, the patient will no longer
have periods or be able to become pregnant
For ovarian cancer in younger women wishing to preserve their

fertility, it may be possible to leave the healthy ovary and uterus.
This is possible if the tumor is localized to one ovary and the patient
is at low risk for recurrence.
 Lymph node biopsies with lymphadenectomy, tissue biopsies and peritoneal

washing
Pharmacologic Therapy:
 Chemotherapy
Paclitaxel, Cisplatin, Carboplatin are most often used because of their excellent clinical
benefits and manageable toxicity.
Watch out for : Leukopenia, neurotoxicity, and fever.
Altretamine (Hexalen) -are used for palliative treatment of persistent, recurrent ovarian
cancer
2
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
CP# 09177148749, 09175785986
Paclitaxel (Taxel) and Topotecan (Hycamtin) -are used to treat metastatic ovarian
cancer.
Gemcitabine (Gemzar) and Carboplan (Platinol) are used to treat recurrent ovarian
cancer.
 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 because they are nontoxic, biodegradable, easily
available, and relatively inexpensive.
- This is given by oncology nurse as slow IV infusion for 60-90 minutes.
- Watch out for: bone marrow suppression, GI and cardiac effects.
NAME: YR&SEC: DATE:

Nursing Management of the Client with OVARIAN CANCER
2
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
CP# 09177148749, 09175785986
SITUATION: A 62-year old female client is being evaluated for possible ovarian cancer. She has been
experiencing vague GI symptoms and urinary urgency for several months. The primary care provider has
discovered a small pelvic mass and has ordered a group of diagnostic studies.
1. Why is a PAP (Papanicolau) Test of limited value in diagnosing ovarian cancer?
2. What is the purpose of exploratory surgery?
3. What are the stages of Ovarian Cancer?
4. What is the treatment of choice for clients with ovarian cancer?
UTERINE CANCER
 It is a slow-growing tumor arising from endometrial mucosa of the uterus, associated
with the menopausal years.
 Metastasis occurs through the lymphatic system to the ovaries and pelvis, via the
blood to the lungs, liver, and bone, or intra-abdominally to the peritoneal cavity.
2
 The most common gynecological cancer, and the third leading cancer in women.
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
CP# 09177148749, 09175785986
Etiology: Unknown
Risk Factors:
1. Use of estrogen replacement therapy (ERT)
- Treating the symptoms of menopause with hormones is known as menopausal hormone
therapy (or sometimes hormone replacement therapy). Estrogen is the major part of
this treatment.
- Estrogen treatment can help reduce hot flashes, improve vaginal dryness, and help
prevent the weakening of the bones (osteoporosis) that can occur with menopause.
- But using estrogen alone (without progesterone) can lead to endometrial cancer in
women who still have a uterus.
2. Nulliparity-
- Nulliparous women had a 24% risk of ovarian/uterine cancer compared with women
with one child, with 50% higher risk of endometroid and a 70% higher risk of clear cell
ovarian/ uterine cancer
3. Polycystic ovary disease
- The major reason PCOS increases the risk of endometrial cancer is the prolonged exposure of
the endometrium to unopposed estrogen caused by anovulation. This prolonged exposure can
cause endometrial hyperplasia and may lead to endometrial cancer.
4. Increased age- Most cases occur in women older than age 55.
5. Late menopause
- If menopause occurs after age 50, the risk for this cancer might increase as the uterus
might be exposed to estrogen for more years.
6. Family Hx of uterine cancer
Like many cancers, there is also a genetic link associated with uterine cancer. A family
history that includes a mother, sister or daughter diagnosed with the disease puts women
at greater risk. In addition, women who have an inherited form of colorectal cancer
(known as Lynch syndrome) have a 60 percent higher risk of developing uterine cancer.
7. Obesity
- Obesity is a strong risk factor for endometrial/uterine cancer and linked to hormone
changes. A woman's ovaries produce most of her estrogen before menopause. But fat
tissue can change some other hormones (called androgens) into estrogens. This can
impact estrogen levels, especially after menopause. Having more fat tissue can increase a
woman's estrogen levels, which increases her endometrial cancer risk.
- Gaining weight as you get older age and weight cycling (gaining and losing a lot of weight
many times in your life) have also been linked to a higher risk of endometrial cancer after
menopause
2
8. Hypertension
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
CP# 09177148749, 09175785986
- Published observational studies of hypertension and the risk of endometrial cancer and

our results confirm that hypertension is a strong risk factor for endometrial cancer with a
61% increase in the relative risk
9. Diabetes mellitus
- Disorders associated with hyperglycemia (Type I and II diabetes mellitus) have an increased risk
of Endometrial/ uterine Cancer, indicating that poor control of blood glucose may be an
important contributor to the growth of these tumors in women
Diagnostic Evaluation:
1. Pelvic examination -may reveal an enlarged uterus, and endocervical aspirate may show
abnormal cells.
2. Endometrial biopsy- may be helpful, but is not sensitive
3. Dilation and curettage -most accurate diagnostic tool
4. Additional testing includes metastatic workup (X-ray studies and cystoscopy)
Management:
1. Radiation Therapy – is the usual treatment, either after surgery, or instead of surgery in
advanced cases. Therapy may be intracavitary or external; it is individualized according to the
stage of disease and the patient’s response to and tolerance of radiation.
a. Intracavitary radiation – radium by way of applicator in endocervical canal.
 Applicator remains in place 24 to 72 hours.
 Complications include hemorrhagic cystitis, proctitis, vaginal stenosis, uterine
perforation.
b. External radiation – by way of linear accelerator or cobalt.
 External radiation over pelvis may supplement intracavitary radiation to eliminate
cancer spread by way of lymphatic system.
 Complications include bone marrow depression, bowel obstruction, fistula.
2. Chemotherapy – is used to treat advanced or recurrent disease.
- Is given for metastatic and recurrent disease; low response rate of short duration.
3. Hormonal therapy (progestational therapy) such as medroxyprogesterone (Depo-Provera) or
megestrol acetate (Megace) is used for estrogen dependent tumor.
- To alter receptor sites in endometrium for estrogen and thus decrease growth in
metastatic disease.
- Tamoxifen (Nolvadex), an antiestrogen, also may be described.
4. Surgery
- Hysterectomy with bilateral salpingo-oophorectomy is the treatment of choice for early
stage I cancer; advanced stage I and stage II require node dissection as well.
2
Side Effects of Surgery:

Any hysterectomy causes infertility.
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
CP# 09177148749, 09175785986
NURSING RESPONSIBILITIES:
A. Monitoring
1. Monitor patient’s response to pain control medication.
2. Observe for s/s of radiation sickness: N/v, fever, diarrhea, abdominal cramping.
3. Monitor for complications of surgery – bleeding, infection.
B. Administer pain medications and encourage use of relaxation techniques such as DBE,
imagery, and distraction to help promote comfort.
1. Support the patient thru the diagnostic process, and reinforce information given by health
care provider about treatment options.
2. If indicated, prepare the patient for intracavitary radiation:
- A type of internal radiation therapy in which radioactive
material sealed in needles, seeds, wires or catheters is placed
directly into a body cavity such as the chest cavity or the vagina.
Before the procedure:

 Advise patient that you will administer an enema and vaginal
douche and IFC.
 Encourage the patient to bring diversional materials because
she will remain on bed rest
During intracavitary radiation:
 Maintain patient on strict bed rest on her back with head elevated 20 to 30 degrees.
 The patient may be log-rolled 3 to 4x / day.
 Use egg- crate mattress .
2
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
CP# 09177148749, 09175785986
 Maintain the patient on low residue diet to prevent BM w/c could dislodge the
apparatus.
 Inspect IFC frequently to ensure proper drainage. A distended bladder may cause severe
radiation burns.
 Encourage oral fluids to prevent bladder infection.
 Check patient frequently to minimize anxiety, but minimize time spent at bedside to
reduce radiation exposure.
During radiation removal:
 Make sure that sterile gloves, long forceps, and lead container are available.
 Check number of tube removed against number applied; should be noted in chart.
 Practice radiation precaution in handling and returning source to radiation dept.
 Administer cleansing enema and douche before the patients gets out of bed.
 Provide assistance during ambulation because of postural hypotension from prolonged
bedrest.
C. Education and Health Maintenance:
 Explain the importance of reporting any postmenopausal bleeding.
 Encourage keeping follow-up visits.
 Explain that surgery or radiation therapy does not prevent satisfying sexual activity.


Nursing Management of the Client with HYSTERECTOMY
SITUATION: A 53-year old woman with dysfunctional uterine bleeding underwent an abdominal
hysterectomy and oophorectomy this morning. Her VS are stable and her dressing is dry and intact. She is
able to administer her own pain medication by means of PCA (Patient-controlled analgesia).
1. What other assessments need to be made by the nurse?

2
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
CP# 09177148749, 09175785986
2. How can a hysterectomy have both a negative and positive effect on a woman’s image?
3. Agree with or refute the idea that women undergoing a vaginal hysterectomy have fewer problems than
women undergoing an abdominal hysterectomy?
REFERENCES:
Udan, J.Q. (2017). Medical-Surgical Nursing “Concepts and clinical application.

Borromeo, A. et.al, (2011), Medical-Surgical Nursing:Wiley-Blackwell Publishing.
Smeltzer, S., et.al (2009), Textbook of Medical-Surgical Nursing:Lippincott-Raven Publishers.
Black, J.M & Hawks, J.H. 2009. Medical-Surgical Nursing “Clinical management for positive
outcomes.
2
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
CP# 09177148749, 09175785986
REFLECTION:
Write a reflection about your personal experience caring for a patient with cancer.
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Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES

Course Learning Outcomes:

1. Which is the most common type of cervical cancer?

4. Where does ovarian cancer occur?

 Cone Biopsy/ Conization

1. Encourage client to use relaxation technique to promote comfort during diagnostic

NAME: YR&SEC: DATE:

Critical Thinking Exercise:

1. How does preinvasive differ from invasive cervical cancer?

The four main types of ovarian cancer are:

 High -fat diet

Stages of Ovarian Cancer

I – Growth to limited to the ovaries

II – Growth involves 1 or both ovaries with pelvic extension

Ovarian cancer metastasizes by shedding malignant cells, which frequently

1. Resection of the involved ovary

In total abdominal hysterectomy and bilateral salphingo-oophorectomy (TAHBSO), a surgery

For ovarian cancer in younger women wishing to preserve their

 Lymph node biopsies with lymphadenectomy, tissue biopsies and peritoneal

NAME: YR&SEC: DATE:

Critical Thinking Exercise:

1. Why is a PAP (Papanicolau) Test of limited value in diagnosing ovarian cancer?

2. What is the purpose of exploratory surgery?

3. What are the stages of Ovarian Cancer?

4. What is the treatment of choice for clients with ovarian cancer?

- Published observational studies of hypertension and the risk of endometrial cancer and

Side Effects of Surgery:

Before the procedure:

Critical Thinking Exercise:

1. What other assessments need to be made by the nurse?

Udan, J.Q. (2017). Medical-Surgical Nursing “Concepts and clinical application.

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