A Case Analysis on Ovarian Cancer

In Partial Fulfillment of the Requirements in NCM 209-RLE

OBSTETRIC ROTATION

Submitted to:

MRS. RODELIE B. GULLE, RN

Clinical Instructor

Submitted by:

BENIGNOS, RAINA VALERIE

ESMAIL, MAAROUPHA

HIBAYA, ERRON JAMES

MAYANGAO, CRISEL MAE

RECTO, DIANE

TRONO, ASIA STEPHANIE

BSN-2D Group 5 Subgroup 1

February 11, 2021

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 TABLE OF CONTENTS

Pages

Cover Page......................................................................................................... i

Table of Contents............................................................................................... ii

Introduction and Objectives .............................................................................. 3

Pathophysiology................................................................................................. 8

Etiology .............................................................................................................. 8

A. Predisposing ...................................................................................... 8

B. Precipitating ....................................................................................... 10

Symptomatology ................................................................................................ 13

Management ..................................................................................................... 17

A. Medical Management ....................................................................... 17

B. Nursing Management ....................................................................... 38

a. Nursing Diagnosis ...................................................................38

b. Nursing Interventions ............................................................. 38

Prognosis ......................................................................................................... 40

Discharge Planning (METHOD Format)............................................................ 42

Nursing Theory ................................................................................................. 49

Review of Related Literature ………………………………………………………. 50

References ....................................................................................................... 52

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 INTRODUCTION

Cancer is when cells in the body change and develop out of control. It is made
from ordinary cells that develop despite the fact that your body doesn't want them. In
cancer, the ordinary cells develop to shape a lump or mass referred to as a tumor. If
cancer cells are in the body long enough, they could develop into (invade) nearby
areas. They may even unfold to different parts of the body (metastasis). Hence, cancer
is the most common cause of mortality in most parts of the world, and presently is the
most common impediment to attaining appropriate existence expectancy in most
countries. One type of cancer that is present in most females is ovarian cancer. Ovarian
cancer (OC) is one of the most common gynecologic cancers that has the highest
mortality rate that ranks third after cervical and uterine cancer. It is the eighth most
commonly occurring cancer in women and the 18th most commonly occurring cancer
overall. Besides, there have been almost 300,000 new instances in 2018 and
Philippines rank 16 with an age-standardized rate per 100,000 of 10.6 among the 25
countries.

The term "ovarian cancer" encompasses numerous forms of cancer that all arise
from the cells of the ovaries in the female reproductive system. Ovarian cancer is a
cancer that starts in your ovaries or at the cease of the fallopian tubes subsequent to
the ovary. Most ovarian cancers are epithelial, originating in the lining tissues of the
ovary. Rarer forms of ovarian cancer occur in the stroma, the connective tissue that
supports the ovary, and in the germ cells, those that form the egg. Only women have
ovaries, so only ladies get this form of cancer.

Moreover, many forms of tumors can begin developing in the ovaries. Some are
benign. This means that they’re not cancer. Benign tumors don’t unfold. They can
generally be handled through getting rid of one ovary or a part of the ovary. Ovarian
cancer, however, is a malignant (cancerous) tumor. Malignant ovarian lesions consist of
primary lesions arising from normal structures within the ovary and secondary lesions
from cancers arising elsewhere in the body. Primary lesions consist of epithelial ovarian
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carcinoma (70% of all ovarian malignancies). Consequently, if a cancerous tumor isn’t
treated, it could develop and unfold to different parts of your body.

Additionally, it has the worst prognosis and the highest mortality rate. Although
ovarian cancer has a decreased occurrence in comparison with breast cancer, it is three
times more lethal, and it is anticipated that through the year 2040, the mortality rate of
this cancer will spring up significantly. The excessive mortality rate of ovarian most
cancers is resulting from asymptomatic and mystery increase of the tumor, delayed
onset of symptoms, and shortage of proper screening that result in its diagnosis in the
advanced stages. Thus, silent killer is a name that has been given to this cancer.

In 2012, an estimated 238,719 ovarian cancer incident cases and an ASR

(age-standardized rate) of 6.1 per 100,000 women worldwide were registered. In more
developed regions, there were roughly 9.2 per 100,000 ASR women and 5 per 100,000
women in less developed regions. In Central and Eastern Europe, the highest ASR was
observed, with 11.4 per 100,000 women, while the lowest ASR was observed in
Micronesia, with 3.0 per 100,000 women. The prevalence of ovarian cancer in the
United States is 11.2 per 100,000 people a year, based on cases from 2013-2014.
Since at least the mid-1970s, the incidence of ovarian cancer among women younger
than 65 years of age has decreased by around 1 percent per year, but only since the
early 1990s among older women. Internationally, with almost 300,000 new cases and
almost 200,000 deaths in 2018, ovarian cancer is the eighth most common cancer in
women and the 18th most common cancer overall. Age-standardized rates per 100,000
ranged from 9.5 in Japan to 16.6 in Serbia.

Ovarian cancer deaths in the Philippines reported for 1,836 or 0.30 percent of
total fatalities, according to the new WHO data released in 2018. The age-adjusted
death rate for the Philippines is #90 in the world at 4.51 per 100,000 people. In 2020
there are 5, 395 new cases of Ovarian Cancer and 3 379 deaths females in- all ages
which is why Philippines ranks #10 among all countries. For the local prevalence of
ovarian cancer, there are no current and updated statistical results yet as of now.

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 Furthermore, conducting this case analysis can be essential in nursing practice,
education, and research. For nursing education, students' nurses may obtain
information about the disease and its process as it will provide knowledge about ovarian
cancer. For nursing practice, this analysis could aid health workers and medical
students to acquire and enhance skills in providing nursing care to ovarian cancer
patients. The information imparted by the paper can be used in the practice of providing
relevant and sufficient care. Lastly, conducting this case analysis can be essential in
nursing research, especially to student nurses who will encounter obstetric exposure. It
could help in providing data and updates regarding ovarian cancer and may also
contribute to broaden knowledge about the nature of the disease. This paper can also
serve as a related literature for further studies that researchers could improve on, in
order to impart more factual information about ovarian cancer.

OBJECTIVES

General Objectives​:
At the end of the case analysis, we the nursing students will be able to come up
with a comprehensive and reliable case analysis about ovarian cancer, consisting of
information about its nature and occurrence, pathophysiology, management, prognosis,
discharge planning following the METHOD format, nursing theory and review of related
literature in connection to our given topic which would help extend our knowledge and
develop our skills and attitude in providing care to our future clients.

Specific Objectives:

At the end of the case analysis, the proponents aim to accomplish the following:

1. To identify the definition of ovarian cancer, its causes and effects on the client;
2. To provide local, national and global statistical reports of ovarian cases;

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3. To know the manner of its causation (etiology);
4. To cite the set of symptoms characteristics exhibited by the client;
5. To determine the effectiveness of each possible treatments;
6. To state the possible prognosis;
7. To plan and implement health teachings particularly, Discharge planning following the
METHOD format;
8. To relate the case with different nursing theories;
9. To link the connections among the data with RRL; and
10. To cite credible references of data that were used for the study.

PATHOPHYSIOLOGY

Cancer is a disease in which abnormal cells in the body grow out of control.
Cancer is always named for the part of the body where it starts, even if it spreads to
other body parts later. Ovarian cancer is a group of diseases that originates in the
ovaries, or in the related areas of the fallopian tubes and the peritoneum. Women have
two ovaries that are located in the pelvis, one on each side of the uterus. The ovaries
make female hormones and produce eggs. Women have two fallopian tubes that are a
pair of long, slender tubes on each side of the uterus. Eggs pass from the ovaries
through the fallopian tubes to the uterus. The peritoneum is the tissue lining that covers
organs in the abdomen. Moreover, these are the following risk factors of having ovarian
cancer: predisposing factors (​Age at menarche and age at menopause​, genetics,
benign gynecologic conditions and gynecologic surgery, parity and infertility, and
previous condition) and precipitating factor (Oral contraceptives and other forms of
contraception, hormone replacement therapy (HRT), parity and infertility, diet and
nutrition, and obesity).

No specific symptoms are recognized until the advanced stage, then abdominal
swelling or pain, bloating or a feeling of fullness, vague but persistent gastrointestinal
complaints, and bowel and bladder dysfunction manifest. Many of these symptoms also
occur earlier, but patients tend to attribute them to other causes
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 Unlike the Papanicolaou test for cervical cancer, there is no specific screening
test for ovarian cancer. A woman at high risk is recommended to have a pelvic
examination, a CA-125 blood test, and an ultrasound performed twice a year beginning
at 30 years of age and continuing for the rest of her life or until her ovaries are removed.
Pelvic examination is used for masses and growths. This examination can be
challenging in obese women. CA-125 is a tumor marker for ovarian cancer; however,
many false positive results are possible. Pelvic ultrasound evaluates shape and size of
ovaries. CT scans MRI provide detailed cross sectional images. Laparoscopy and
biopsy are used to determine the stage and extent of the disease, guiding therapy.
Staging guides the treatment of options. Stage three is the most common stage at
diagnosis.

Treatment depends on the stage and extent of the disease. For stage 1, the
usual treatment is total hysterectomy to remove as much tumor as possible. In addition,
chemotherapy or intraperitoneal radiation implants are usually included. At stage 2,
external or internal radiation or systemic chemotherapy is used after tumor debulking.
Stages three and four are usually treated with chemotherapy. Common drugs include
carboplatin, cisplatin, docetaxel, and paclitaxel. Overall, combination therapy is required
to treat this malignant disease. Intraperitoneal chemotherapy is also used. Patients are
encouraged to participate in available trials either researching new treatments or
comparing different treatments. Such participation will provide knowledge about the best
way to treat this cancer

Every ovarian cancer patient is different and treatment starts with knowing what
type of ovarian cancer you have, making your treatment plan tailored to their needs and
their specific diagnosis. Cancerous ovarian tumors develop most commonly in the
epithelial cells, which make up the outer layer of the ovary; the germ cells, which form
eggs; or in the stromal cells, which produce and release hormones.

Ovarian epithelial carcinoma account for more than 85-90% of ovarian cancers
and they are often referred to by their subtype (mucinous, endometrioid, clear cell and

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undifferentiated. They are commonly spread to the linings and organs of the pelvis and
abdomen first before spreading. A subtype of ovarian epithelial tumor namely Ovarian
Low Malignant Potential Tumors which occurs when abnormal cells form in the tissue
covering the ovary and they have a low likelihood of turning into cancer. But in the rare
cases they become malignant, they tend to affect younger women and do not typically
spread beyond the ovary, where they respond well to treatment. Primary peritoneal
carcinoma and fallopian tube cancer, which are two types of cancer similar to epithelial
ovarian cancer (resulting with the same treatment, approached, and techniques), are
both rare with the former found in developing in the lining of the pelvis/abdomen and the
latter in the fallopian tubes.

Some tumors may be found developing in the germ cells (egg-producing cells) of
the ovaries. While most of these are benign, some of these cancerous germ cell tumors
make up less than 2 percent of ovarian cancers. Teens and women in their 20s are
more likely to have this type of ovarian cancer. Ovarian germ cell tumors are divided
into the following subtypes:
● Teratomas are germ cell tumors that are either benign (mature) or cancerous
(immature). Immature teratomas are rare. Their cells commonly contain different
types of tissue, such as hair, muscle and bone.
● Dysgerminoma ovarian germ cell cancer is rare, but it’s the most common germ
cell ovarian cancer. Dysgerminomas don’t typically grow or spread quickly. They
may also occur in other parts of the body, such as the central nervous system.
● Endodermal sinus tumor (yolk sac tumor) and choriocarcinoma tumors are
extremely rare. Choriocarcinomas may start in either the placenta during
pregnancy, which are more common, or in the ovaries.

Sex cord tumors or Sex cord-gonadal stromal tumors and ovarian stromal
tumors, sex cord-stromal tumors are rare, making up about 1 percent of ovarian
cancers. They develop from the stroma tissue cells that produce the female hormones
estrogen and progesterone. Because sex-cord stromal tumors make an overabundant

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supply of estrogen, they often cause abnormal vaginal bleeding. Subtypes of sex
cord-stromal tumors include granulosa cell tumors, granulosa-theca tumors and
Sertoli-Leydig tumors.

There are also rarer types of ovarian cancer that occur more than others which
includes:
● Ovarian sarcoma: Unlike their carcinoma counterparts, ovarian sarcoma tumors
develop in the connective tissues of ovarian cells. Their most common subtypes
are carcinosarcomas, adenosarcomas, leiomyosarcomas and fibrosarcomas.
● Krukenberg tumors: A Krukenberg tumor is cancer that spreads to the ovaries
from other organs, typically from the gastrointestinal tract. Gynecologic
oncologists usually treat Krukenberg tumors in collaboration with the medical
oncologist and other members of the care team treating the patient’s original
cancer.
● Ovarian cysts: Ovarian cysts are fluid-filled sacs that develop inside the ovary.
They’re common during ovulation and often go away on their own without
treatment. Although most ovarian cysts are benign, some may develop into
cancer (Markman, 2020).

ETIOLOGY

There is no way to know for sure if you will get ovarian cancer. Most women get it
without being at high risk. However, several factors may increase a woman’s risk for
ovarian cancer.

PREDISPOSING FACTOR RATIONALE

Gender
All women, simply because they are
women and have ovaries are at risk to

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 varying degrees for developing ovarian
cancer. This fact alone should motivate all
females to be on guard for any signs or
symptoms of this cancer

Age at menarche and age at menopause Early age at menarche and late age at
menopause increases risk by increasing
the number of ovulatory cycles.

Genetics Family history: ​Women with a mother,

sister, grandmother or aunt who has had
ovarian cancer have a higher risk of
developing the disease.

Genetic mutations:​ Some women who

develop ovarian cancer have an inherited
mutation on one of two genes called
breast cancer gene 1 (BRCA1) and
breast cancer gene 2 (BRCA2).

Lynch syndrome and Peutz-Jeghers

syndrome:​ Women who have these
inherited genetic disorders have a higher
risk of developing ovarian cancer.

Benign gynecologic conditions and

Several gynecologic conditions have
gynecologic surgery
been examined as risk factors for OC,
including PCOS, endometriosis, and
pelvic inflammatory disease (PID).

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Infertility
Pregnancy causes anovulation and
suppresses secretion of pituitary
gonadotropins and is thus consistent with
both the ‘incessant ovulation’ and the
‘gonadotropin’ hypotheses

Parity Parous women have a 30%-60% lower

risk than nulliparous women and each
additional full-term pregnancy lowers risk
by approximately 15%.

Previous conditions
Breast, colorectal or endometrial cancer:
Women who have been diagnosed with
these cancers have a higher risk of
developing ovarian cancer.

PRECIPITATING FACTOR RATIONALE

The epidemiological literature over the

Oral contraceptives and other forms of
past several decades has consistently
contraception
reported that use of oral contraceptives is
inversely associated with the risk of OC.

Hormone replacement therapy (HRT) Conversely, postmenopausal HRT may

enhance estrogen-induced proliferation of
(Taking hormone therapy after
ovarian cells and therefore increase the
menopause)

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 risk of ovarian cancer.

Women using estrogens alone or with

progesterone after menopause have an
increased risk of developing ovarian
cancer compared to women who have
never used hormones.

Diet and nutrition The meta-analysis of EPIC cohort study

and Netherlands Cohort Study found that
women with a high intake of saturated
fats had elevated risks.

Obesity In postmenopausal women the

predominant source of circulating
estrogens is aromatization of androgens
in adipose tissue. The compelling role of
obesity in the pathogenesis of
hormone-related cancers, such as
endometrial and post-menopausal breast
cancers, has prompted research on the
potential association with OC.

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SYMPTOMATOLOGY

The following are the symptoms of ovarian cancer

SIGNS/SYMPTOMS RATIONALE

Bloating Persistent bloating that doesn’t go

away is actually one of the most
common symptoms of ovarian cancer.

Bloating that's related to ovarian cancer

may cause visible swelling in your
abdomen. Your belly might feel full,
puffy, or hard. You may also have other
symptoms, like weight loss

Prolonged Pain Persistent pressure in the abdomen

and pelvis and/or lower back pain that
lasts for one to three weeks can signal
a problem.

Constipation GI issues can be linked to everything

from stress and anxiety to irritable
bowel syndrome and ovarian cancer.

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Change in bladder function Bladder-related issues can also signal
a gynecologic or reproductive problem,
like ovarian cancer.Specific urinary
symptoms associated with ovarian
cancer include the following:

Feeling pressure or pain in the bladder

Frequent urination

Sudden, urgent need to urinate

Difficulty eating A loss of appetite is a common ovarian

cancer symptom.

Nausea According to Dr. Holcomb, symptoms of

ovarian cancer are not an isolated
symptom, but a constellation of them, in
combination with nausea and bloating.

Menstrual irregularities if there is a tumor in your ovary, it can

throw your cycle out of whack. If you
notice any big changes, like more or
less frequent periods or no periods at
all, check with your doctor.

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 Pain during sex If sex is painful, you could have a tumor
that’s pushing into your vagina and
being aggravated by sex. Ovarian
cancer can also cause hormonal
changes that lead to vaginal dryness,
which can also cause discomfort during
sex.which can also cause discomfort
during sex.

DISEASE PROCESS

It begins with the dedifferentiation of the cells overlying the ovary. During
ovulation, these cells can be incorporated into the ovary, where they then proliferate.
However, new evidence indicates that the majority of these tumors actually originate in
the fimbria of the fallopian tube. Detailed pathologic studies have pushed much of the
thinking about the origin of these tumors in this direction.
Ovarian cancer typically spreads to the peritoneal surfaces and omentum.
Spread can occur by local extension, lymphatic invasion, intraperitoneal implantation,
hematogenous dissemination, or transdiaphragmatic passage. Intraperitoneal
dissemination is the most common and recognized characteristic of ovarian cancer.
Malignant cells can implant anywhere in the peritoneal cavity but are more likely to
implant in sites of stasis along the peritoneal fluid circulation.
These mechanisms of dissemination represent the rationale to conduct surgical
staging, debulking surgery, and intraperitoneal administration of chemotherapy. In
contrast, hematogenous spread is clinically unusual early on in the disease process,
although it is not infrequent in patients with advanced disease.

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Management

There are three ways in managing Ovarian cancer. The medical

management, which are the tests that are instituted by the physician and
medications to help reverse ovarian cancer, and the nursing management
which are simple interventions but could create a dramatic effect when applied
properly. Surgery is the main ​treatment for ovarian cancer​, recommended
primarily when the vast majority of the ​cancer or affected tissue can be
removed successfully. Surgical treatment depends on the stage and the extent
of the disease.

Medical management

Test Rationale

This test can help identify potential

Transvaginal ultrasound (TVUS)
growths and determine whether they
are solid growths or cysts. If a solid
growth is identified. A biopsy will be
requested to determine whether the
growth is cancerous or benign.

This test involves passing special

Computed tomography (CT) scans X-rays through the abdomen. A

computer processes the results to
create cross-sectional images that

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 allow doctors to see sections of the
abdominal cavity and pelvis.

Pelvic ultrasound
This test is used to check for any
enlargement or abnormalities of the
ovaries which may be due to a cyst or
tumour. It can also be used to show the
size and position of a cancer.

Biopsy A biopsy involves inserting a very fine

needle into the body and withdrawing a
small section of the growth or mass,
which is sent to a laboratory to check for
signs of cancer. The results of a biopsy
are an essential element in making a
final diagnosis of ovarian cancer.

Generic Brand Classific Indication Contraindicat Nursing

name name ation ions responsibil
ity

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OVARIAN CANCER | 18
 and
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OVARIAN CANCER | 19
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OVARIAN CANCER | 20
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OVARIAN CANCER | 21
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OVARIAN CANCER | 22
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OVARIAN CANCER | 23
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OVARIAN CANCER | 24
 m, CV
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OVARIAN CANCER | 25
in those with
renal or
hepatic
impairment.

Prolonged
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b12
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than 30 years
old

OVARIAN CANCER | 26
Surgical management
Treatment
Total abdominal hysterectomy and
bilateral salpingo-oophorectomy
Rationale
is a surgery to remove the uterus and
cervix. “Abdominal” is the surgical
technique that will be used. This means the
surgery will be done through an incision in
your abdomen. A bilateral
salpingo-oophorectomy is surgery to
remove both 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.
OVARIAN CANCER | 27
Chemotherapy
Chemotherapy is the use of anti-cancer
(cytotoxic) drugs to destroy cancer cells.
The drugs work by disrupting the growth of
cancer cells. Ovarian cancer is usually very
sensitive to chemotherapy and in most
women the tumours will become smaller or
disappear

Chemotherapy is sometimes given before

surgery (neoadjuvant chemotherapy), or if
you are too unwell for a major operation. It
is also often used after surgery to try to
shrink any remaining tumours.

If the cancer has spread to the liver, or

beyond the abdomen, it may not be
possible to remove it and so chemotherapy
is the main treatment used. Chemotherapy
is also used if the cancer comes back after
surgery.

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Radiation therapy (external or
Radiotherapy treats cancer by using
implanted)
high-energy rays to destroy the cancer
cells,while doing as little harm as possible
to normal cells. This type of treatment is
rarely used to treat cancer of the ovary. It
may occasionally be used to treat an area
of cancer that has come back after surgery
and chemotherapy, when other treatment
options are no longer appropriate. It may
also be used to reduce bleeding or feelings
of pain and discomfort. This is known as
palliative radiotherapy.

Clinical trials
Trials are the only reliable way to find out if
a different operation, type of chemotherapy,
radiotherapy, or other treatment is better
than what is already available.

Trials help to improve knowledge about

cancer and develop new treatments. You
will also be carefully monitored during and
after the study. Usually, several hospitals
around the country take part in these trials.
It‟s important to bear in mind that some
treatments that look promising at first are
often later found not to be as good as
existing treatments, or to have side effects
that outweigh the benefits.

OVARIAN CANCER | 29
Nursing management

Nursing Diagnosis Nursing Intervention

Fatigue related to altered body Independent:

chemistry 1. Identify presence of physical and
psychological disease states
R: To assess causative factors
2. Measure physiological response to
activities like changes in blood
pressure, heart and respiratory rate
R:To determine degree of fatigue
3. Instruct in stress-management
skills of visualization and
relaxation
R: To assist client to cope with fatigue
and manage within individual limit of
ability

Dependent:
1.Refer to physical/ occupational
therapy for programmed daily
exercise and activities

R: To maintain/ increase strength and

muscle tone and to enhance sense of
well-being

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​Activity intolerance related to generalized
weakness secondary to underlying disease
process
​Independent:
1. Note presence of factors contributing to
fatigue
R: To identify the causative factors
2. Evaluate current limitations
R: Provides comparative baseline
3. Have patients perform self-care
activities. Begin slowly and increase daily,
as tolerated.
R:Activities will help patient regain health
4. Provide emotional support and
encouragement
R: To help improve a patient's self-concept
and motivation to perform activities of
daily living.
5. Note treatment-related factors, such as
side effects/interactions of medications
R: To identify precipitating factors
6. Adjust activities
R: To prevent overexertion
7. Plan care with rest periods between
activities
R: To reduce Fatigue
OVARIAN CANCER | 31
 8. Assist with activities and provide client’s
use of assistive devices
R: To protect client from injury

9. Encourage client to maintain positive

attitude; suggest use of relaxation
techniques
R:To enhance sense of well-being

​Risk for infection related to Independent:

pharmaceutical agents and
immunosuppression - Monitor WBC count
R: Elevated total WBC count indicates
infection.

- Wash hands before doing any procedure

R: To decrease transfer of pathogens
- Teach patients how to properly wash
hands before and after meals and after
using the bathroom, bedpan, or urinal.

R: Hand washing prevents spread of

pathogens to other objects and food

- Instruct patient to report incidents of

loose stools or diarrhea.
R: Diarrhea or loose stools may indicate
need to discontinue

- Provide reverse isolation as indicated

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 R: Reduce risk of cross contamination

- Monitor visitors/caregivers
R: To prevent exposure of client

- Review individual nutritional needs,

appropriate exercise program, and need
for rest
R: To promote wellness
Dependent:
-Assist with medical procedures
R: to reduce existing risk factors
-Administer and monitor medication
regimen and note clients response
R: To determine effectiveness of therapy
and presence of side effects

Imbalanced nutrition less than body Determine the ability to chew, swallow,
requirements r/t inability to digest food and taste
because of physiological, physical factors. R: It can be the factor that can affect
ingestion of nutrients

Ascertain understanding of individual

nutritional needs
R: To determine what info to provide
the client
Assess weight, body and build strength
R: provide comparative baseline

Note total daily intake

OVARIAN CANCER | 33
 R: To reveal changes that should be
made in client’s dietary intake

Encourage to choose food that are

appealing
R: to stimulate to appetite

Consult the dietitian as necessary

R: For long term needs

Weigh weekly and document results

R: To monitor effectiveness of dietary
plan

Prognosis

Ovarian cancer is primarily staged using the FIGO (International Federation of

Gynecology and Obstetrics) staging system. The system is based mainly on a physical
exam and other tests that measure the size of the tumor, how deeply the tumor has
invaded tissues in and around the ovaries, and the cancer’s spread to distant areas of
the body (metastasis). If surgery is performed, it can help doctors more accurately
determine the size of the primary tumor. Accurate staging is important in understanding
the chances that the cancer will be curative.

The prognosis of ovarian cancer is generally poor as it is considered to be the

fifth highest cause of death for women who have any form of cancer. The overall
survival rate for ovarian cancer prognosis ranges from 35 to 38 percent, but if it is
detected in its early stages, the survival rate rises to as high as 98 percent. Ovarian
cancer usually shows up in the later stages of life. About two-thirds of the deaths from
ovarian cancer occur in women age 55 and older. Many times, death due to ovarian
OVARIAN CANCER | 34
cancer can be prevented. Women often will have symptoms, but not major symptoms,
so they won’t go to the doctor. By the time they do go to the doctor, the cancer has
already progressed to a later stage which significantly lowers the survival rate. This is
why ovarian cancer is known as the silent killer.

DISCHARGE PLANNING (METHOD FORMAT)

A. ​Nausea medicine helps calm your stomach and prevents

vomiting.

B. ​Prescription pain medicine may be given. Ask your

healthcare provider how to take this medicine safely. Some
prescription pain medicines contain acetaminophen. Do not
take other medicines that contain acetaminophen without
MEDICINE
talking to your healthcare provider. Too much acetaminophen
may cause liver damage. Prescription pain medicine may
cause constipation. Ask your healthcare provider how to
prevent or treat constipation.

C. ​Take your medicine as directed. Contact your healthcare

provider if you think your medicine is not helping or if you
have side effects. Tell him or her if you are allergic to any
medicine. Keep a list of the medicines, vitamins, and herbs
you take. Include the amounts, and when and why you take
them. Bring the list or the pill bottles to follow-up visits. Carry
your medicine list with you in case of an emergency.

Do not smoke. Nicotine can damage blood vessels. increase

your risk for new or returning cancer, and delay healing after
treatment. Do not use e-cigarettes or smokeless tobacco in
OVARIAN CANCER | 35
 place of cigarettes or to help you quit. They still contain
nicotine. Ask your healthcare provider for information if you
currently smoke and need help quitting.

After surgery​:
A. Ask others to help with chores and errands while you
EXERCISE
recover. Do not do strenuous housework like vacuuming.
B. To prevent straining your incisions, don't lift anything
heavier than 12 pounds/5.4 kg for at least 6 weeks after
surgery.
C. Limit climbing stairs to once or twice a day for the first 2
weeks after surgery. Go slow and rest after every few
steps.
D. Walk as often as you feel able. It is important to move as
much as you can as you recover from surgery.
E. Plan rest breaks to avoid shortness of breath. Don't
over-do it. If you get tired, rest.
F. Don't drive for at least 3 weeks after surgery unless it is
OK with your healthcare provider. Don't drive if you're still
taking pain medicine.
G. Do the coughing and deep breathing exercises you
learned in the hospital.
H. Don't put anything in your vagina until your healthcare
provider says it's safe to do so. Don't use tampons or
douches. Don't have sex until your healthcare provider
says it's OK.
I. If you ride in the car for more than short trips, stop often to
stretch your legs.

After chemotherapy:

OVARIAN CANCER | 36
 A. Try to exercise, which keeps you strong and your heart
and lungs active. It helps you feel less tired. Walk as much
as you can comfortably.

Depends on the size of the tumor and stage of the cancer. You
may need more than one of the following:
A. ​Surgery may be needed to remove one or both of your
TREATMENT ovaries.

B. ​Chemotherapy​ medicines are used to kill cancer cells.

C. ​Radiation is used to kill cancer cells and to shrink the

tumor or tumors with x-rays or gamma rays.

After surgery:
A. Wash the incision site with warm water. Pat dry and do not
scrub or rub it.
B. Do not use oils, powders, lotions, or creams on your
incision unless told to do so by your healthcare provider.
C. Check your incision site every day for increased redness,
drainage, swelling, or opening of the skin. Change the
bandage as instructed.
D. Be sure you have a post-operative appointment set up to
have the sutures or staples removed.

HYGIENE After chemotherapy, ​prevention or management of mouth sores:

A. Brush your teeth with a soft-bristle toothbrush after every
meal and at bedtime.
B. If your platelet count is low, or if your gums are inflamed,
flossing may cause gum bleeding. You may need to limit
flossing.

OVARIAN CANCER | 37
 C. Use an oral swab or special soft toothbrush if your gums
bleed during regular brushing.
D. Use any mouthwashes given to you as directed.
E. Keep your mouth moist. Use salt and baking soda to clean
your mouth. Mix 1 teaspoon of salt and 1 teaspoon of
baking soda into an 8-ounce glass of warm water. Swish
and spit as often as you like.
F. Observe mouth and tongue for white patches. This can be
a sign of fungal or yeast infections, common side effects of
chemo. Tell your healthcare provider about these patches.
You may need medicine to help you fight the fungal
infection.
G. Keep dentures clean and limit the time you wear them.
H. Take short baths or showers with warm water. Avoid very
hot or cold water.
I. Use moisturizing soap. Treatment can make your skin dry.
J. Use lotion several times a day to help relieve dry skin
(“Discharge Instructions for Cancer of the Ovary”, 2019).

Seek medical attention if any of the unprecedented situations

occur:
A. You suddenly feel lightheaded and short of breath.
B. You have chest pain when you take a deep breath or
cough.
OUT-PATIENT
C. You cough up blood.
D. Your arm or leg feels warm, tender, and painful. It may
look swollen and red.
E. You vomit many times and cannot keep any food or liquids
down.

Contact your oncologist​ if:

OVARIAN CANCER | 38
 A. You have a fever.
B. Your pain is worse or does not go away after you take pain
medicine.
C. You have questions or concerns about your condition or
care.

A. ​Drink liquids as directed. You may need extra liquid to

prevent dehydration. Ask how much liquid to drink each day
and which liquids are best for you.

B. ​Eat enough protein and calories. Foods may taste

DIET
different during cancer treatment. You may not feel like eating,
and you may lose weight. Eat a variety of health foods.
Healthy foods include fruits, vegetables, whole-grain breads,
low-fat dairy products, beans, lean meats, and fish. Eat small
meals every 2 to 3 hours. Ask a dietitian for more information
about the best eating plan for you.

C. ​Weigh yourself daily. Weigh yourself in the morning

before breakfast. Weight gain can be a sign of extra fluid in
your body. Call your healthcare provider if you gain at least 2
pounds in a day (“Ovarian Cancer, 2020).

Nursing Theory

Jean Watson’s Theory of Human Caring

The theory focuses on the health promotion of

the patient in which the nurse instills the philosophy and
science of caring. The nursing model states that “nursing
is concerned with promoting health, preventing illness,

OVARIAN CANCER | 39
caring for the sick, and restoring health.” It focuses on health promotion and treatment
of diseases. According to Watson, caring is central to nursing practice and promotes
health and growth. It can be demonstrated and practiced by nurses with compassion
and sincere concern for the patient.

Moreover, the theory has 10 Carative Factors that outlines principles and
ideas that should be used by nurses to create the best environment for healing of
the patient and of the nurse and Caritas processes that provide the basis for a
professional approach to care, a means by which to conduct caring in a spiritual
and compassionate manner.

Carative Factors Caritas Process

1. “The formation of a “Practice of loving-kindness and

humanistic-altruistic system of equanimity within the context of caring
values” consciousness”

2. “The instillation of faith-hope” “Being authentically present and enabling

and sustaining the deep belief system and
subjective life-world of self and one being
cared for”

3. “The cultivation of sensitivity to “Cultivation of one’s own spiritual

one’s self and to others” practices and transpersonal self-going
beyond the ego self”

4. “Development of a helping-trust “Developing and sustaining a helping

relationship” became trusting authentic caring relationship”
“development of a helping-trusting,
human caring relation”

OVARIAN CANCER | 40
5. “The promotion and acceptance
of the expression of positive and
negative feelings”
6. “The systematic use of the
scientific problem solving method
for decision making” became
“systematic use of a creative
problem solving caring process”
7. “The promotion of transpersonal
teaching-learning”
8. “The provision of supportive,
protective, and (or) corrective
mental, physical, societal, and
spiritual environment”
9. “The assistance with
gratification of human needs”
“Being present to, and supportive of, the
expression of positive and negative
feelings as a connection with deeper spirit
and self and the one-being-cared for”
“Creative use of self and all ways of
knowing as part of the caring process; to
engage in the artistry of caring-healing
practices”
“Engaging in genuine teaching-learning
experience that attends to unity of being
and meaning, attempting to stay within
others’ frame of reference”
“Creating healing environment at all levels
(physical as well as nonphysical, subtle
environment of energy and
consciousness, whereby wholeness,
beauty, comfort, dignity, and peace are
potentiated)”
“Assisting with basic needs, with an
intentional caring consciousness,
administering ‘human care essentials,’
which potentiate alignment of mind body
spirit, wholeness, and unity of being in all
aspects of care”
OVARIAN CANCER | 41
 10. “The allowance for
existential-phenomenological
forces” became “allowance for
existential-phenomenological
spiritual forces”
“Opening and attending to
spiritual-mysterious and existential
dimensions of one’s own life-death; soul
care for self and the one-being-cared for”

In our case, the theory helps nurses provide care to the patient with ovarian
cancer in a more holistic manner as they involve attentive, authentic, and personal
interactions with their patients. This theory also helps build transpersonal relationships
that can provide care to the patient with compassion and empathy. The 10 Carative
Factors serve as their guide when caring for their patients, which translated into the
Caritas Process. The Caritas Process is the nurse's role in how they should
demonstrate the care to their patient. The "Development of a helping-trusting human
care relationship" is one factor that is applicable when dealing with patients with ovarian
cancer. The nurse should establish rapport and care to the patient to express one's
​ ecome involved with the patient and their family's lives and
feelings and consciously b
issues. Another factor in this situation's relevance is the "systematic use of a creative
problem-solving care process" To execute the nursing care that the client needs, nurses
must have prior scientific knowledge about this condition, such as the signs, symptoms,
and its preventive measures. With that, nurses must also learn how to use that
knowledge creatively and accurately. Lastly, the ninth factor of this concept, which is the
"The assistance with the gratification of human needs," is also significant in this
condition because, with appropriate interventions and solutions, nurses need to respond
to the complication of ovarian cancer that would be best for her. Additionally, nurses can
also provide emotional support by allowing their patients to express their worries
regarding their condition.

MODELING AND ROLE MODELING THEORY

OVARIAN CANCER | 42
 The theory was developed by ​Helen Erickson​, Evelyn
M. Tomlin, and Mary Anne P. Swain and was first
published in 1983 in their book ​Modeling and Role
Modeling: A Theory and Paradigm for Nursing​. The
theory enables nurses to take care of and nurture
each patient with awareness and respect for the
individual patient's uniqueness. This exemplifies
theory-based clinical practice that focuses on the
patient's needs. Moreover, the theory is based on
concepts from various sources, including Maslow's Theory of the Hierarchy of Needs,
Erikson's Theory of Psychosocial Stages, Piaget's Theory of Cognitive Development,
and Seyle and Lazarus' Syndrome of General Adaptation.

According to the theory, modeling is the process by which the nurse seeks to
know and understand the patient's personal model of his or her own world and learns to
appreciate its value and significance. Role modeling is the process by which the nurse
facilitates and nurtures the individual in attaining, maintaining, and promoting health.
The five nursing intervention goals are to build trust, promote the patient's positive
orientation, promote the patient's control, affirm and promote the patient's strengths,
and set mutual, health-directed goals. Furthermore, the role of nursing is facilitation,
nurturance, and unconditional acceptance.

In relation to our case, this theory of modeling and remodeling enables nurses to
care for and nurture the client with an awareness of the possible effects of the said
complication, which is ovarian cancer. Ovarian cancer has numerous interrelated needs
that require holistic care to address appropriately. In applying this theory, nurses' role is
to know and understand their client's strengths that could help to prevent or begin the
treatment. It also helps nurses plan an intervention based on medical research theory to
meet the needs and patient and to be able to grow, heal and transcend.

OVARIAN CANCER | 43
Review of Related Literature/Studies

The deadliest gynecologic cancer is ovarian cancer. It affects women of all ages,
but most commonly is diagnosed after menopause whose ages 55 to 64 years of age.
After diagnosis, less than half the patients live for more than five years. At an advanced
stage, more than 75% of affected women are diagnosed because early-stage illness is
usually asymptomatic and symptoms of late-stage illness are non-specific. Progress in
age and family history of ovarian and breast cancer are the main risk factors. Physical
examination, transvaginal ultrasound and assessment of biomarkers such as cancer
antigen 125 should be done in women with symptoms linked to ovarian cancer. Despite
the low rate of early diagnosis, guidelines recommend against routine screening in
average-risk women for ovarian cancer because screening is ineffective and has long
term damage, including routine pelvic examinations. A recent research has identified a
possible advantage of annual screening using an algorithm based on measurements of
serial cancer antigen 125. (Doubeni et. al., 2016)

According to Doubeni et al., (2016). A full physical examination should be done in

patients with symptoms that may be associated with ovarian cancer, including a
rectovaginal examination with an empty bladder to determine pelvic and abdominal
masses. The physical examination, however, has limited accuracy, especially in obese
patients, and the mass could easily be missed or triggered by conditions other than
ovarian cancer if detected. Transvaginal ultrasonography should be conducted on
women with suspected ovarian cancer based on clinical appearance or pelvic mass.
This will determine the architecture and vascularity of the ovary, determine cystic from
solid masses, and recognize ascites. If ovarian cancer is suspected, a full blood count,
blood chemistry, including liver function tests and calcium (to assess for paraneoplastic
syndromes), and serum biomarkers should be collected. The biomarker widely
assessed is cancer antigen (CA) 125, but its diagnostic utility depends on disease risk

OVARIAN CANCER | 44
and stage at the time of presentation. CA 125 is elevated in about 80% of epithelial
ovarian cancers overall, but in only 50% of early-stage epithelial ovarian cancers.

Nearly 90% of tumors are epithelial ovarian cancers that occur primarily in
women who are postmenopausal. Germ cell tumors, which occur primarily in women in
their early 20s, comprise 5% of tumors and sex cord-stromal tumors (most commonly in
the 50s of a patient) which secrete sex steroids and occur at any age. In addition, in
benign conditions like endometriosis and fibroids, CA 125 may be elevated. In
postmenopausal women, the specificity and positive predictive value of CA 125 was
higher than in premenopausal women, in part because of the higher pre-test risk of
cancer and the lower prevalence of postmenopausal benign lesions. The most
significant prognostic factor is early diagnosis when tumors are small and still confined
to the ovaries. Only about 45% of women with ovarian cancer survive for a period of five
years or longer from the date of diagnosis. For women with Stage I epithelial ovarian
cancer, the five-year survival rate is 92 percent, but only 17 percent to 28 percent for
those with advanced-stage tumors. (Doubeni et. al, 2016).

According to Ali (2018), Ovarian cancer risk factors include modifiable and
non-modifiable factors, this includes cigarette smoking, obesity, high fat diet, genetic
mutations. The most effective prophylactic procedure for BRCA carriers is risk-reducing
bilateral salpingo-oophorectomy. It decreases the risk of ovarian cancer by 69 to 100
percent. The main objective is to minimize the risk of developing ovarian cancer and
other cancers, such as breast and/or peritoneal cancer, substantially. It has been shown
that the use of non-surgical preventive measures such as oral contraceptives, parity and
breastfeeding has been highly protective against the development of ovarian cancer. It
has also been reported that targeting inflammation is linked with a protective trend
against ovarian cancer and can be accomplished either by non-steroidal
anti-inflammatory drugs (NSAIDs) such as aspirin or lifestyle changes, or both.

OVARIAN CANCER | 45
Modification of the lifestyle including frequent exercise, a healthy diet combined mainly
with glutathione, antioxidants and anti-inflammatory elements further decreases the risk
of the disease.

REFERENCES:

Ali, A. T. (2018). Current Cancer Drug Targets. ​Towards Prevention of Ovarian Cancer​,
522-537.

Discharge Instructions for Cancer of the Ovary. (June 1, 2019). Retrieved from
www.mountnittany.org

Doubeni, C. A., Doubeni, A. R., & Myers, A. E. (2016). Ovarian Cancer. ​Diagnosis and
Management of Ovarian Cancer,​ 937-944. Retrieved from ​www.aafp.org

Joly F, Ahmed-Lecheheb D, Kalbacher E, et al. ​Long-term fatigue and quality of life

among epithelial ovarian cancer survivors: A GINECO case/control VIVROVAIRE I
Study.​ Annals of Oncology; Published online 9 March 2019. pii: mdz074. doi:
10.1093/annonc/mdz074.

Gonzalo, A., BSN, RN. (2019). Jean Watson: Theory of Human Caring. Retrieved from
https://nurseslabs.com/jean-watsons-philosophy-theory-transpersonal-caring/

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Green, A. E. (2020, August 10). Ovarian Cancer. Retrieved from Medscape:
emedicine.medscape.com

Markman, M. (2020).Ovarian Cancer Symptoms.Cancer treatment centers of America.

https://www.cancercenter.com/cancer-types/ovarian-cancer/symptoms

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Ovarian Cancer. (2020). Retrieved from ​www.drugs.com

Ovarian cancer statistics. (2018). Retrieved from ​www.wcrf.org

Reid, B. M., Permuth, J. B., & Sellers, T. A. (2017). Epidemiology of ovarian cancer: a review. Cancer
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​ ttps://doi.org/10.20892/j.issn.2095-3941.2016.0084

World Cancer Research Fund. (2018, July 29). Ovarian cancer statistics. Retrieved from
American Institute for Cancer Institute: ​www.wcrf.org

Zhang, Y., Luo, G., Li, M., Guo, P., Xiao, Y., Ji, H., & Hao, Y. (2019). Global patterns
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