MEDICAL-SURGICAL LECTURE
OVARIAN CANCER
LIPOSOMAL THERAPY
• 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 encapsulated chemotherapy allows increased
duration of action and better targeting. The encapsulation
of doxorubicin lessens the incidence of nausea, vomiting,
and alopecia. The patient must be monitored for bone
marrow suppression.
• Gastrointestinal and cardiac effects may also occur.
These medications are administered by oncology nurses as
a slow intravenous infusion over 60 to 90 minutes.
NURSING MANAGEMENT
• Nursing care may include administering intravenous
therapy to alleviate fluid and electrolyte imbalances,
initiating parenteral nutrition to provide adequate
nutrition, providing postoperative care after intestinal
bypass to alleviate an obstruction, and providing pain relief
and managing drainage tubes.
• Comfort measures for women with ascites may include
providing small frequent meals, decreasing fluid intake,
administering diuretic agents, and providing rest.
• Patients with pleural effusion may experience shortness
of breath, hypoxia, pleuritic chest pain, and cough.
CERVICAL CANCER
Surgical Procedures done for Cervical Cancer
Surgical procedures that may be carried out to treat
cervical cancer include the following:
• Total hysterectomy—removal of the uterus, cervix, and
ovaries
• Radical hysterectomy—removal of the uterus, ovaries,
fallopian tubes, proximal vagina, and bilateral lymph nodes
through an abdominal incision (Note: “radical” indicates
that an extensive area of the paravaginal, paracervical,
parametrial, and uterosacral tissues is removed with the
uterus.)
• Radical vaginal hysterectomy—vaginal removal of the
uterus, ovaries, fallopian tubes, and proximal vagina.
• Bilateral pelvic lymphadenectomy—removal of the
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
MEDICAL-SURGICAL LECTURE

Assessment Findings

• Endometrial aspiration or biopsy

• Ultrasonography

Medical Management

• Treatment of endometrial cancer consists of total

hysterectomy (discussed later in this chapter) and bilateral
salpingo-oophorectomy and node sampling. Depending on
the stage, the therapeutic approach is individualized and is
based on stage, type, differentiation, degree of invasion,
and node involvement.

• Whole pelvis radiotherapy is used if there is any spread

beyond the uterus. Preoperative and postoperative
treatments for stage II and beyond may include pelvic,
abdominal, and vaginal intracavitary radiation.

• Recurrent cancer usually occurs inside the vaginal vault

UTERINE CANCER
• Cancer of the uterine endometrium (fundus or corpus)
has increased in incidence, partly because people are living
longer and because reporting is more accurate. Most
uterine cancers are endometrioid (that is, originating in the
lining of the uterus).
or in the upper vagina, and metastasis usually occurs in
lymph nodes or the ovary. Recurrent lesions in the vagina
are treated with surgery and radiation. Recurrent lesions
beyond the vagina are treated with hormonal therapy or
chemotherapy. Progestin therapy is used frequently.
Patients should be prepared for such side effects as
nausea, depression, rash, or mild fluid retention with this
therapy.

• After breast, colorectal, and lung cancer, endometrial

cancer is the fourth most common cancer in women and
the most common pelvic neoplasm. Cumulative exposure
to estrogen is considered the major risk factor.

• This exposure occurs with the use of estrogen

replacement therapy without the use of progestin, early
menarche, late menopause, never having children, and
anovulation. Other risk factors include infertility, diabetes,
hypertension, gallbladder disease, and obesity.

• Tamoxifen may also cause proliferation of the uterine

lining, and women receiving this medication for treatment
or prevention of breast cancer are monitored by their
oncologists.

Risk Factors for Uterine Cancer

• Age: at least 55 years; median age, 61 years

• Postmenopausal bleeding

• Obesity that results in increased estrone levels (related

to excess weight) resulting from conversion of
androstenedione to estrone in body fat, which exposes the
uterus to unopposed estrogen

• Unopposed estrogen therapy (estrogen used without

progesterone, which offsets the risk of unopposed
estrogen)

• Other: nulliparity, truncal obesity, late menopause (after

52 years of age) and, possibly, use of tamoxifen