Cellular Aberration Lecture Notes PDF

CELLULAR ABERRATION LECTURE NOTES NCM 112 1ST SEMESTER – MS. KATRINE ALFEREZ, RM, MAN – WED 4:00-6:00 PM It is also responsible for the men’s recycling of...

CELLULAR ABERRATION LECTURE NOTES NCM 112 1ST SEMESTER – MS. KATRINE ALFEREZ, RM, MAN – WED 4:00-6:00 PM It is also responsible for the men’s recycling of the women so this is actually being affected ENDOMETRIAL UTERINE, CERVICAL, by the hormones, especially the estrogen and AND OVARIAN CANCER progesterone flactuation. Additional Information TOPIC OVERVIEW Main etiology of cancer takes place at the cellular level. Meaning to say that the very A. ENDOMETRIAL UTERINE CANCER main reason for an individual to develop a. Introduction cancer is genetics. b. Risk Factors It actually started in its genes, in its cellular c. Assessment level so these are non-modifiable factors d. Staging of Uterine Cancer that actually occur that an individual might e. Non Surgical Interventions develop some gene mutation as they are f. Surgical Intervention predisposed to the other factors in the g. Nursing Intervention outside environment. h. Preventive Aspects GENETICS (Cellular level) - main etiology. B. CERVICAL CANCER a. Introduction b. Causes UTERINE CANCER c. Risk Factors Slowly growing tumor arising from the d. Signs and Symptoms endometrial mucosa. e. Assessment and Diagnostic Associated with menopausal years. Findings Metastasis occurs through the lymphatic f. Stages of Cervical Cancer system, to the ovaries and pelvis via the blood g. Medical Management to the: h. Surgical Management ○ Lungs i. Nursing Management ○ Liver j. Preventive Aspects ○ Bone C. OVARIAN CANCER ○ Intraabdominally a. Introduction b. Risk Factors Additional Information c. Diagnosis Endometrial mucosa - something d. Assessment occurring from the muscles that’s why it is e. Stages of Ovarian Cancer capable of creating contractions during f. Management delivery and it is considered as one of the g. Nursing Management powerful muscles in the body because it has the ability to push the baby out of the women during delivery. A ENDOMETRIAL UTERINE CANCER Good thing about endometrial cancer is that it is slow growing compared to ovarian cancer which is actually a fast growing type A1 INTRODUCTION of cancer. Associated with menopausal years because it is attributed to the exposure of the WHAT IS UTERUS? woman to a specific hormone which A pear shaped organ found within the actually predisposed it or its mutation reproductive system of the women. which is estrogen. Being used for fertilized eggs to implant until Metastasis occurs in uterine cancer that is birth. due to the lymphatic system - it has its An environment or the avenue for the own circulation that is attached to the growing fetus until delivery. main organ which predisposes it and gives Nourishment, environment and the like takes an entry to the surrounding tissues for place in this area. metastasis. PAGE 1 TRIXIE ARROYO – BSN 3A  CELLULAR ABERRATION LECTURE NOTES NCM 112 1ST SEMESTER – MS. KATRINE ALFEREZ, RM, MAN – WED 4:00-6:00 PM ○ Some hormonal effect on the other organs of the body. A2 RISK FACTORS ★ Diabetes ○ Some hormonal effect on the other organs of the body. ★ ERT (Estrogen Replacement Therapy) ○ Taking some pills or taking some treatments that require an increased A3 ASSESSMENT level of estrogen because it didn’t give time for the progesterone to give rise on its reproductive years in its Possible signs and symptoms an individual child bearing phase, it prolongs the might see when having cancer. exposure of the woman to an increased level of estrogen. ★ ABNORMAL BLEEDING ○ Dapat ang babae ay nanganganak ○ CAUTIONUP - unplanned or para magkaroon ng proper unexpected bleeding tendencies. fluctuation of hormonal level ○ Abnormal bleeding actually occurs - according its stages of childbearing. there is a certain cycle for a woman ★ NULLIPARITY that they release shed blood during ○ Hindi pa nanganganak. menstruation. Abnormal bleeding ○ Also attributed to first pregnancy at a occurs in between those menstrual later age (35 y/o). cycles. ★ POLYCYSTIC OVARY DISEASE ○ They have abnormal bleeding ○ If they have extra cyst within the because of the hormonal factor ovaries, it predisposes the ovary to occuring within the uterus (the one produce more hormones as usual responsible for menstrual cycle) that that’s why it creates another is affected by the level of hormones environment for long exposure for (they fluctuate). estrogen. ★ VAGINAL DISCHARGES ★ INCREASED AGE ○ There are vaginal discharges that is ○ This is something that is normal for woman which is wet and not-modifiable and it's something dry season that you cannot remove from the ○ Wet season - discharges that actually individual. come out from the orifice but these ○ This is exemplified in the cancer are considered normal especially if it's ladder screening wherein for each clear or a little bit of whitish. staging at every age of an individual, ○ Other colors are considered to be there are necessary procedures to be abnormal like pinkish to brownish done for early detection of possible and foul smelling. These are some cancer formation. vaginal discharges that should be ○ Age is a great factor for the given with attention because these development of cancer. are considered abnormal or vaginal ★ LATE MENOPAUSE discharges that actually have an ○ Another example wherein estrogen increased amount level as compared exposure is prolonged because of late to normal. stop of menstruation. ★ LOW BACK, PELVIC OR ABDOMINAL ★ FAMILY HISTORY OF UTERINE CANCER PAIN (PAIN occurs late in the disease ○ Another genetic trait. process) ★ OBESITY ○ The occurrence of the pain especially ○ The common risk factors between for cancer patients actually indicates breast cancer and uterine cancer are already in the later phase. almost the same because they are ○ If it has already pain in the area/site, both influenced by estrogen, they are this is considered in the later stage both hormonal in nature. already because the development of ★ Hypertension the tumor itself could actually be in the circulation (naipit na blood PAGE 2 TRIXIE ARROYO – BSN 3A  CELLULAR ABERRATION LECTURE NOTES NCM 112 1ST SEMESTER – MS. KATRINE ALFEREZ, RM, MAN – WED 4:00-6:00 PM nerves) and sometimes it could have metastasis especially in the bone area. A5 NON SURGICAL INTERVENTIONS ○ The pain could due to: bone distraction metastasis over the area ★ EXTERNAL OR INTERNAL RADIATION occurs an occlusion ○ External - something to use with the there’s a destruction of blood external beam. supply because of the ○ Internal - putting an implant in the development of the tumor uterus since it includes a solid tumor or may specific tumor na pwedeng ★ ENLARGED UTERUS (in advanced paliitin. process) ○ Radiation therapy is applicable ○ The uterus gets larger than the usual because they are solid tumors as that is bought by hyperplasia and in compared to other types of tumors or manifestation, it would occur with cancer that are actually affecting the hypertrophy (lalaki ang organ). circulation. ○ You will see and it will be noticed ★ CHEMOTHERAPY especially during ultrasonography or ○ In general, most of the patients are ultrasound and it will really be receiving chemotherapy, so once manifested specially in advanced again we will go back to the nursing stages because by TNM staging alone, intervention concerning the tumor gets larger than 5cm. chemotherapy. ★ PROGESTERONE THERAPY (for A4 STAGING OF UTERINE CANCER estrogen-dependent tumors) ○ There are types of uterus cancer that are estrogen-dependent. ○ Estrogen-dependent - they had cancer formation because of the increased level of estrogen exposure of the body. ○ If they had developed there and that is the main factor where an individual or a woman developed cancer it will come to the use of progesterone because it lowers estrogen. ★ TAMOXIFEN (anti-estrogen) - late stage ○ In some cases, the use of tamoxifen is being used. STAGE 1 ○ Tamoxifen is also known as an ○ Cancerous cells are found only in anti-estrogen agent but there are the uterus. some ethical dilemmas occurring STAGE 2 with tamoxifen because the use of it ○ The cancer has spread to the cervix. in other cases actually predispose an individual to develop either breast STAGE 3 cancer or uterine cancer because of ○ The cancer has spread outside the its effect. uterus to the nearby lymph nodes, ○ But in rare scenarios, tamoxifen is ovaries, fallopian tubes, or vagina. It being used for uterine cancer has not spread to the bladder, because they have done some rectum, outside the pelvis. research that tamoxifen has an STAGE 4 anti-estrogen effect in the later stage ○ The cancer has spread to the of uterine cancer. bladder, rectum, or outside the ○ Last form, tamoxifen, is used because pelvis, such as the lungs or it is already applicable in the later abdomen. stage. PAGE 3 TRIXIE ARROYO – BSN 3A  CELLULAR ABERRATION LECTURE NOTES NCM 112 1ST SEMESTER – MS. KATRINE ALFEREZ, RM, MAN – WED 4:00-6:00 PM RADICAL HYSTERECTOMY A6 SURGICAL INTERVENTION ○ Type 2 - the whole uterus including the vagina is affected by cellular aberration. TOTAL ABDOMINAL HYSTERECTOMY AND BILATERAL SALPINGO-OOPHORECTOMY (TAHBSO) A7 NURSING INTERVENTION ○ Total Abdominal Hysterectomy Will incise through the abdomen to remove Once there is a surgical procedure that entails hysterectomy (removal of the reproductive system specially for the uterus). women and men, proper explanation should ○ Bilateral be done specially if they are very particular with regards to childbearing. Salpingo-oophorectomy Bilateral means two and Salpingo means fallopian PREOPERATIVE NURSING INTERVENTION tube while oophorectomy 1. Assist patient to seek information on the means removal of the ovaries stage of cancer and treatment options. ○ This procedure is only being done if Explain about side effects of radiation all of the reproductive organ is and chemotherapy. already affected by cellular aberration 2. Give explanation to patient about secondary to either ovary or uterine physical pre operation and procedures cancer. ○ But in some cases there are some that are performed pre and post conservative treatments that need to operatively. be done. Like for eg., is your uterus 3. Administer analgesics and tell the (this is another story or another type patient that heavy lifting, strenuous of surgery that the doctors have to exercise and sexual intercourse may perform). increase pain. 4. Prepare skin for surgery, skin preparation may include cleansing the lower abdomen, inguinal areas, upper thighs before surgical procedure. POST OPERATIVE NURSING INTERVENTION 1. Observe the patient for signs of shock, check wound dressing regularly. If there is a wound drain, check the amount and type of drainage regularly. This operation may lead to massive bleeding and possible occurrence of shock (hypovolemic shock) may occur TYPES OF HYSTERECTOMY if not monitored accordingly. 2. Hemorrhage may occur within 24 hours, PARTIAL HYSTERECTOMY the nurse should observe for signs of ○ If only a small portion of the uterus is affected by cellular aberration. internal and external bleeding. TOTAL HYSTERECTOMY Hemorrhage is more common after ○ When cellular aberration affects all vaginal hysterectomy. parts of the uterus. Hemorrhage - there is an increased RADICAL HYSTERECTOMY blood loss more than 500mL, it may ○ Type 1 - all of the uterus involved by occur within 24 hours. cellular aberration except from External bleeding - hemorrhage is vagina. very common after vaginal PAGE 4 TRIXIE ARROYO – BSN 3A  CELLULAR ABERRATION LECTURE NOTES NCM 112 1ST SEMESTER – MS. KATRINE ALFEREZ, RM, MAN – WED 4:00-6:00 PM hysterectomy because there is an To increase the circulation and organ being removed (nakikita natin, decrease the pain of the patient. lumalabas mismo ang dugo). 8. Administer Antiemetics. Internal bleeding - could occur in a Antiemetics - increase gastric form of ecchymosis over the area motility (pinapagalaw para hindi (nangingitim ang abdominal area). sumuka). The pressure is increased inside The easiest way to prevent this from resulting in increased size, bulging of happening (emesis) is to make the abdomen (examples of internal patient ambulate as early as possible. bleeding s/sx). 9. Maintain intake and output chart. 3. Give appropriate analgesic drugs This is to monitor if the fluid volume prescribed. balance is equated accordingly. Patient after surgery for the first 24 10. Patient may require catheterization if hours should receive pain medication unable to pass urine. because pain is expected after Because the urethra is very proximate surgery. to the reproductive organ. Since the Once pain is not addressed, it will incision site is very proximate or near actually stop or inhibit the patient in the bladder, urethra or passageway from moving or turn to sides, of the urine, there are some cases preventing the development of deep that the patients from post vein thrombosis. hysterectomy have difficulty The early the possible, the patient urinating. should ambulate. If the patient is in pain, definitely the patient will not move and activity will A8 PREVENTIVE ASPECTS not be initiated. Activity alone can actually decrease the level of pain sensation for the Although most cases of endometrial patient and it will increase the cases aren’t preventable, certain factors circulation. can lower risk of developing the disease. 4. Encourage frequent changes of These include: position in bed, activity decreases pain ○ Taking hormone therapy with by increasing circulation. Progestin This should be monitored because if Taking synthetic Progestin, a not, internal bleeding might occur. form of the hormone 5. Monitor stool characteristics and progesterone with estrogen frequency. Restrict oral fluid and food causes the lining of the until peristalsis resumes. uterus to shed. This kind of Most of the patients who had combination hormone undergone operation might have therapy lowers risk. paralytic ileus. ○ A history of using birth control Paralytic Ileus - the intestines are not pills moving, secondary effect of the Use of oral contraceptives can anesthesia. reduce endometrial cancer 6. Ensure adequate hydration with risk even as long as 10 years intravenous fluids. after stop taking them. As a response to the procedure, they ○ Maintaining a healthy weight need to replace the lost blood during Help prevent endometrial hysterectomy, that is to rehydrate the cancer by maintaining a patient - return the circulating healthy weight. Excess fat volume with the use of intravenous tissue can increase levels of fluid. estrogen in the body, which 7. Encourage the patient to ambulate as increases risk of endometrial soon as possible, early ambulation cancer. promotes peristalsis. ○ Exercise PAGE 5 TRIXIE ARROYO – BSN 3A  CELLULAR ABERRATION LECTURE NOTES NCM 112 1ST SEMESTER – MS. KATRINE ALFEREZ, RM, MAN – WED 4:00-6:00 PM Women who engage in approximately 90% of all cervical exercise everyday have half cancers. the risk of endometrial cancer ○ About half of the sexually transmitted compared with women who HPVs are associated with cervical don’t exercise. cancer. SEXUAL HISTORY ○ A woman has a higher-than-average B CERVICAL CANCER risk of developing cervical if she: Has had multiple sexual partners WHAT IS CERVIX? Began having sexual relations Serves as a connection between the uterus before the age of 18. and vaginal canal. Has a partner who has had It serves as a passageway to some fluids sexual contact with a woman coming from the uterus as it goes out in the with cervical cancer. opening, it includes vaginal discharges some of the fluids and even blood during menstruation B3 RISK FACTORS It widens during delivery. This is the one to measure in dilatation to know if a pregnant woman is about to deliver. SMOKING It also serves as a protective covering for the ○ It has carcinogenic effects so if they developing fetus because if the moment the have the genetic composition for cervix opens, imminent abortion might occur, cellular aberrations, once it is exposed it can terminate the pregnancy in this type of with the nicotine agent with the incident. carcinogenic effect, then it potentiates the development of cellular aberration. B1 INTRODUCTION WEAKENED IMMUNE SYSTEM ○ The main microorganism that causes cervical cancer is HPV which is a virus Cervical cancer is the third most common in nature. cancer in women worldwide. ○ Viruses are opportunistic in nature, It is a disease that develops quite slowly and meaning to say they are purulent and begins with a precancerous condition known they have a high possibility to infect if as dysplasia (changes that occur in the size, the immune system of an individual is arrangement of the form of the cells). weak. Dysplasia is easily detected in a routine Pap ○ The more weakened the immune smear and is completely treatable and is system, the more the chance to have actually detected through microscope. an exposure to a certain virus. Cervical cancer is a malignant tumor derived from cells of the cervix. SEVERAL PREGNANCIES ○ Although nulliparity could predispose an individual, especially a woman, to CERVICAL CANCER develop breast cancer and uterine A malignant tumor derived from cells of cancer, the successive births could the “cervix uteri” which is the lower part, actually trigger the development of the “neck” of the womb, the female cervical cancer because it stretches reproductive organ. the cervix every time the woman had multiple births. ○ The moment it had stretched, the B2 CAUSES higher the exposure to possibility of HPV. ○ Several pregnancies with HPV HUMAN PAPILLOMAVIRUS infection because the moment it had ○ Infection with the common human stretched or tear then there is a lean papillomavirus (HPV) is a cause of of access of the virus towards the PAGE 6 TRIXIE ARROYO – BSN 3A  CELLULAR ABERRATION LECTURE NOTES NCM 112 1ST SEMESTER – MS. KATRINE ALFEREZ, RM, MAN – WED 4:00-6:00 PM tissue so there’s a possibility to have Menstrual periods that last longer and HPV infection that could possibly lead are heavier than before to cervical cancer. ○ Whenever there is an aberration in GIVING BIRTH AT A VERY YOUNG AGE the area, it could either mas nagkaka ○ The physical stress that is created in hyperactive or hypoactive ang isang the cervical lining specially if it's not function. yet ready for that activity, it could ○ In this case, cellular aberration can create mutation leading to the lead to hyperactivity. formation of aberration in the cellular ○ Shedding of blood during level. menstruation can double and it could LONG-TERM USE OF THE last longer and it could be much CONTRACEPTIVE PILL heavier than the usual. ○ Hindi lahat ng sobra ay pwede. Bleeding after going through ○ Although contraceptive pills are menopause being used in such ○ The moment that women stopped activities/programs, we still have to shedding of blood because there is follow. already cessation of bleeding, ○ There is a specific range on how long because of irritation of the area, there an individual should only use is a formation of the tumor in the area contraceptive pills. and that type of tumor could still ○ With the long-term use of produce bleeding and this is the contraceptive pills, it actually reason why bleeding (menstruation) increases the sexual activity or still manifests to the patient and not partners wherein it does not have because of the normal menstrual protective measures to have a barrier cycle. against the exposure of HPV. ○ The bleeding is not related to the ○ The mere fact that they are having menstrual cycle but actually the pills, they feel safe of not getting bleeding that is being produced is pregnant but the exposure to a now because of the tumor formation. certain virus is not guaranteed. Increased vaginal discharge FAMILY HISTORY ○ That is the mechanism of the vagina ○ It still has something to do with (the irritation). genetics. ○ It is the normal response because the inflammation is taking place in the area that’s why vaginal discharges are B4 SIGNS AND SYMPTOMS increased in the form of secretions. Pelvic pain Bleeding that occurs between regular ○ Since the location of the uterus and the cervix is in between the pelvic menstrual periods cavity, the pain will manifest in the ○ Remember that the cervix is in the pelvic area. opening of the uterus, if there are irritations in the area proof about the cellular aberration, there could create B5 ASSESSMENT AND DIAGNOSTIC some bleeding tendencies and it FINDINGS could manifest if bleeding in between occurs. Bleeding after sexual intercourse, 1. PAP TEST douching, or a pelvic exam Routine screening for cervical ○ Whenever there is physical stress abnormalities can detect early-stage (nadadaanan or napapasukan) or cancer and precancerous conditions having contact with a hard object, that could progress to invasive once the lining is so thin because of disease. The process begins with a irritation, it occurs from scratch Pap test, also known as a Pap smear. leading to episodes of bleeding with It can be done right away when an this type of activity. individual turns 18 y/o or the PAGE 7 TRIXIE ARROYO – BSN 3A  CELLULAR ABERRATION LECTURE NOTES NCM 112 1ST SEMESTER – MS. KATRINE ALFEREZ, RM, MAN – WED 4:00-6:00 PM individual had an exposure to sexual 5. CT (Computerized Tomography Scan) activity at an early age. The patient is in a lithotomy position. 6. MRI (Magnetic Resonance Imaging 2. HPV DNA TEST Scan) Like the Pap test, the HPV DNA test involves collecting cells from the 7. Pelvic Ultrasound cervix for lab testing. Specific test detecting the presence of human papillomavirus. CT, MRI, AND PELVIC ULTRASOUND For diagnosis of cervical cancer. To determine the extent of activation of the cellular aberration. This will be used for staging. B6 STAGES OF CERVICAL CANCER STAGE 1 3. COLPOSCOPY ○ Cancer is confined to the cervix. Opy means visualization, there is a STAGE 2 use of a certain machine or ○ Cancer at this stage includes the instrument which is known as cervix and uterus, but hasn’t colposcope. spread to the pelvic wall or the iIlluminates the cervix for biopsy. lower portion of the vagina. The patient is in a lithotomy position. STAGE 3 ○ Cancer at this stage has moved beyond the cervix and uterus to the pelvic wall or the lower portion of the vagina. STAGE 4 ○ At this stage, cancer has spread to nearby organs, such as the bladder or rectum, or it has spread to other areas of the body, such as the lungs, liver or bones. 4. COLD CONE BIOPSY A large tissue around the cervix is B7 MEDICAL MANAGEMENT excised for examination. Cervix viewed through speculum with patient in lithotomy position. 1. CHEMOTHERAPY The entire opening of your cervix Chemotherapy is the use of creating cone shape around it is chemicals (medication) to destroy excised or taken to be examined cancer cells. Cytotoxic medication under a microscope. prevents cancer cells from dividing The patient is in a lithotomy position. and growing. The use of cytotoxic medications or the antineoplastic agents to eradicate the rapidly dividing cells. Chemotherapy for cervical cancer, as well as most other cancers, is used to target cancer cells that surgery cannot or did not remove, or to help the symptoms of patients with advanced cancer. PAGE 8 TRIXIE ARROYO – BSN 3A  CELLULAR ABERRATION LECTURE NOTES NCM 112 1ST SEMESTER – MS. KATRINE ALFEREZ, RM, MAN – WED 4:00-6:00 PM CISPLATIN, a chemotherapy drug, is 4. HYSTERECTOMY frequently used in combination with If cervical cancer progresses and it radiotherapy. involves the adjacent organs, 2. RADIOTHERAPY hysterectomy could be done. Radiotherapy is also known as radiation therapy. Radiotherapy works by damaging the DNA inside the tumor cells, destroying their ability to reproduce. For patients with advanced cervical cancer radiation combined cisplatin-based chemotherapy is the most effective treatment. Sometimes, radiation is in the form of brachytherapy (sealed radiation source is placed inside). B9 NURSING MANAGEMENT B8 SURGICAL MANAGEMENT 1. DIETARY MANAGEMENT 1. LASER SURGERY Flavonoids are chemical compounds A narrow beam of intense light in fruits and vegetables that are destroys cancerous and precancerous thought to be a leading source of cells. protection against cancer. A little bit not too invasive and does The flavonoid-rich foods are apples, not require an opening to remove the black beans, broccoli, brussels surgery. sprouts, cabbage, garlic, onions, The patient is in a lithotomy position. soy, spinach. 2. LEEP (Loop Electrosurgical Excision Folate (a water-soluble B vitamin) Procedure) reduces the risk of cervical cancer in A wire loop which has an electric people with HPV. Foods rich in folate current cuts through tissue include avocados, breads, lentils, removing cells from the mouth of orange juice, and strawberries. the cervix. Carotenoids (a source of vitamin A) The electrical current is being used to are also helpful in preventing cervical cut the portion of the cervix. cancer risk. Foods such as carrots, 3. CRYOSURGERY sweet potatoes and pumpkin are Compressed nitrogen gas flows rich in vitamin A. through cryoprobe making the metal cold enough to freeze and destroy the abnormal cervical tissue. B10 PREVENTION Cervix is viewed through a speculum with a patient in lithotomy position. 1. HPV (Human Papillomavirus Vaccine) If every female adheres to current HPV vaccination programs the total number of female deaths from cervical cancer globally will drop by hundreds of thousands each year. Aside from HPV testing, it is being advised that HPV vaccine should be administered to women. As early as 25 years old, you can receive your HPV vaccine. PAGE 9 TRIXIE ARROYO – BSN 3A  CELLULAR ABERRATION LECTURE NOTES NCM 112 1ST SEMESTER – MS. KATRINE ALFEREZ, RM, MAN – WED 4:00-6:00 PM 2. SAFE SEX patients who have cyst in the ovary Safe sex, monogamy, use of condoms, are having multiple examinations and avoiding multiple partners. every three months because they 3. CERVICAL SCREENING need to determine if the growth of This is in the form of Pap Test or Pap the specific tumor or cyst is fast or Smear. slow because once it has the 4. HAVE FEW SEXUAL PARTNERS characteristic of a fast growing cyst As much as possible, limit sexual or tumor, it is being correlated to activity to your partners. the development of cellular 5. DELAY FIRST SEXUAL INTERCOURSE aberration in the ovary. There is a certain age that needs to Early Stages: often asymptomatic be followed before starting the first ○ Asymptomatic - there’s no sexual contact because of the manifestation of signs and probability of mutation and the symptoms. unreadiness of tissue per sexual ○ It seems that a woman is very contact. normal until they have signs and 6. DON’T SMOKE symptoms relating to the It has a predisposing factor for abnormality, that’s the only time carcinogenic effect because of the that the patient will be diagnosed nicotine component then smoking with ovarian cancer. should be avoided as much as Advance Stages: higher mortality rate possible. ○ There’s a higher mortality rate of patients with ovarian cancer as compared to the other C OVARIAN CANCER reproductive organ cancer. This type of cancer develops in ovaries specially in the females. C2 RISK FACTORS C1 INTRODUCTION 1. WHITE WOMEN There’s a racial consideration regarding the development of ovarian WHAT ARE OVARIES? cancer which are the caucasians or A pair of glands that actually produce the whites. eggs and they are responsible for the female 2. AGE 55 AND 65 YEARS OLD hormone in a form of estrogen and That is the middle and it is also progesterone. correlated to hormonal imbalances. Also responsible for the female physical traits At the same time, age is a factor for which include the breast, body shape, and development of cancer. even the texture of the hair. 3. NORTH AMERICA OR EUROPEAN It is also involved in the reproductive, DESCENT menstrual cycle, fertility, and even with Geographically location wise, they are pregnancy. mostly in North America and European descent. OVARIAN CANCER Grows rapidly, spreads fast and often C3 DIAGNOSIS bilateral ○ Means that the two ovaries could be involved. ★ EXPLORATORY LAPAROTOMY Metastasis to organs in the pelvis (Diagnosis and Staging) ○ It is very high because they have ○ There is an incision in the abdominal the speed form of spread. cavity, they open it to exactly ○ They are fast to grow that’s why determine specially if they will remove the ovaries. PAGE 10 TRIXIE ARROYO – BSN 3A  CELLULAR ABERRATION LECTURE NOTES NCM 112 1ST SEMESTER – MS. KATRINE ALFEREZ, RM, MAN – WED 4:00-6:00 PM ○ Too see the extent of the affectation ○ Since having fluctuation in this type of cellular aberration that originates of hormones, it could be manifested in the ovary. in the gastrointestinal activity for eg., ★ TRANSVAGINAL ULTRASOUND stomach ache, bloating, altered bowel ○ Lesser invasive procedure to pattern like constipation and all of a determine the involvement of the sudden it relaxes having normal ovary or create an imaging test on bowel movement or having diarrhea how big it is with regards to the size episodes. and that is with the use of ★ DYSFUNCTIONAL VAGINAL BLEEDING transvaginal ultrasound. ○ There are tendencies to have ○ The probe is inserted in the vagina of bleeding episodes during the patient to have a closer look to menstruation, the same thing with the ovaries because even though it abnormal bleeding between could be detected on the outside menstrual periods because it is not (Transabdominal Ultrasound) it’s not expected to happen. that clear since the ovary is too small. ○ If you experience bleeding in the ○ This kind of procedure is not done ovary, it will either go to the uterus or when the patient is still considered uterine cavity that will be expelled virgin. from the orifice. ○ Transrectal Ultrasound – another ○ It is also possible that the bleeding in option which is inserted into the the ovary might set in the adjacent rectum. organs since the ovaries are outside. ★ ABDOMINAL MASS ○ The problem in ovarian cancer is that C4 ASSESSMENT it is being detected in the later stage. ○ You will observe that your tummy is bulging because may lumaking Signs and symptoms that can be assessed on organ and that is the ovaries. Kapag a patient with ovarian cancer. lumaki ang ovary, it will exaggerate as in malaki creating abdominal mass ★ ABDOMINAL DISCOMFORT OR within the area. SWELLING ★ ELEVATED TUMOR MARKERS ○ When the patient always complains ○ This is CA 125 and the like since these about the discomfort that they feel are biomarkers that could indicate (unidentified type of discomfort) in that cellular aberration is taking place. the lower portion of abdomen in the ○ It will be elevated because of the pelvic area, there is a possibility that protein being created by these there’s a growing cyst or tumor within tumors. the pelvic organs (uterus, cervix, or ovaries). ★ GASTROINTESTINAL DISTURBANCES C5 STAGES OF OVARIAN CANCER ○ The ovaries have something to do with the hormones, estrogen and progesterone have also effects in the gastrointestinal mobility. ○ If the patient’s progesterone level is high, there is a tendency that they experience constipation. ○ That’s why the progesterone lowers the gastrointestinal mobility which is the main reason why pregnant women often experience constipation episodes because of high estrogen levels (during pregnancy, mas mataas ang progesterone). PAGE 11 TRIXIE ARROYO – BSN 3A  CELLULAR ABERRATION LECTURE NOTES NCM 112 1ST SEMESTER – MS. KATRINE ALFEREZ, RM, MAN – WED 4:00-6:00 PM HEALTHY OVARIES and the nursing management will also be ○ There are still no tumors inside the the same. ovaries. EARLY-STAGE CANCER ○ Sometimes there are tumor-like formations but it's not too detectable unless it has reproduction of abnormal cells creating lumps. LATE-STAGE CANCER ○ The tumor is growing bigger and bigger. C6 MANAGEMENT ★ EXTERNAL RADIATION ○ Since this is a solid tumor, external radiation is possible and applicable in this type of cancer. ★ CHEMOTHERAPY ○ Will come into management because it will come to eradicate the abnormally dividing cells. ★ INTRAPERITONEAL CHEMOTHERAPY ○ Inserting in a cavity which is the peritoneum (the area in the abdominal cavity) the chemotherapy is inserted to have a better access to the ovaries where it will take effect. ★ TAHBSO WITH TUMOR DEBULKING ○ If the ovaries had an involvement in its adjacent organs (uterus, fallopian tube, cervix) it has to remove all of them and that procedure is called TAHBSO. C7 NURSING MANAGEMENT SAME WITH ENDOMETRIAL CANCER NOTE: The management in the reproductive organs which occurs after surgery are almost the same because they are all close together in one area. If ever they have metastasis in one organ since they are all close together in one area, they will be having almost the same type of surgery. They will be doing the same type of surgery PAGE 12 TRIXIE ARROYO – BSN 3A