Analysis of Ovarian Cancer Case - Term Paper Example

Ovarian cancer Name Institution Date Case study background Katherine Bishop, 55 presented to her GP complaining of increased lower back pain over the past 3 months. She also identified she has lost about 4kg without any effort yet she was not fitting into many of her clothes due to her increase in her waist measurement. Katherine identified she had been constipated abdominal cramping and dysuria. The GP ordered an abdominal ultra/abdominal CT sound resulting in diagnosis of an ovarian tumor. The incidence/prevalence of ovarian cancer in Australia In Australia, every year approximately 1300 females get ovarian cancer diagnosis (Australian Institute of Health and Welfare & Australasian Association of Cancer Registries, 2012). It is cited that cancer of the ovary can develop at whichever age. In 2008, almost 1,272 ovarian cancer cases were diagnosed, thus ranking it as the second leading gynecological cancer within Australia (Cancer Australia, 2012). In general, ovarian cancer was positioned 10th with respect to the most frequently diagnosed cancers among women. Every ten hours, an Australian woman dies of cancer of the ovary. One in seventy women develop cancer of the ovary during their lifetime; of these females, 1400 turn out to be Australian. From the 1400 women in Australia diagnosed yearly, only 20 percent of the women will live for more than 10 years, contrary to cancer of the breast which has survival rate of 80% (Australian Institute of Health and Welfare, & National Breast and Ovarian Cancer Centre, 2010). Between the year 1982 and 2008, there was an increase of 52 percent every year in ovarian cancers, whereas the incidence rate of ovarian cancer reduced by 15 percent (Australian Institute of Health and Welfare & Australasian Association of Cancer Registries, 2012). The prevalence rate of cancer of the ovary rose with age. Ovarian cancer prognosis is comparatively poor for women. The pathophysiology of ovarian cancer and the clinical manifestations of Ms Bishop in relation to the pathophysiology of ovarian cancer Cancer of the ovary is considered a growth that is cancerous originating from ovaries (Bristow & Armstrong, 2010). Ovarian cancers are constitutes of surface epithelial-stromal tumors which are regarded the leading types among neoplasm of the ovary (Furuya, 2012). The sporadic ovarian tumors etiology is not understood fully, however, a sequence of investigations argue that particular conditions like genetic predisposition in addition to benign inflammatory illnesses are engaged within the molecular system of carcinogenesis (Deligdisch, et al, 2013). Majority of cancers of the ovary develop like cystic masses, furthermore, cancer cells simply spread into pelvic cavity the moment the cysts leak or rupture (McQueen, 2009). Once there is dissemination of cancer cells of the ovary into the cavity of peritoneum, metastatic nests might develop within the cul-de-sac, moreover, in stages that are more advanced; the surfaces of peritoneum of the higher abdomen turn out to be the next major soil for progression of cancer (Goodwin, 2010). There is also frequent production of ascites in cancers of the ovary, facilitating distant metastasis. Among several molecules involved during ovarian carcinogenesis, particular genes like BRCA1, BRCA2 and TP53 have been investigated well (Furuya, 2012). These genes, generally, are broadly acknowledged as predisposing factors which activate malignant alteration of the ovary’s epithelial cells. Additionally, adnexal inflammatory states like ovarian endometriosis and chronic salpingitis have been great investigation concern within the perspective of ovarian cancers’ carcinogenic background (Clarke-Pearson & Soper, 2010). Cancers of the ovary are histologically different. Almost 80 percent come from the epithelium; of these cancers, 75 percent are basically serous cystadenocarcinoma; and 20 percent of the remaining ovarian cancers arise from the primary germ cells of the ovary or within the stromal cells and sex cord or are actually metastases to ovaries (most frequently, from GI tract or the breast) (McQueen, 2009). Ovarian cancer multiplies through direct extension, cells’ exfoliation into peritoneal cavity, lymphatic dissemination into the aortic region and the pelvis, or, less frequently, hematogenously to the lungs or the liver (Furuya, 2012). Some risk factors like increased age and smoking might raise the possibility of developing cancer of the ovary, although their presence may not guarantee occurrence of cancer (Bohnenkamp, 2007). Ovarian cancer denotes a fraction of cancers which has the worst prognosis is adult female. Not less than half of individual with clinical presentations like fullness feeling and abdominal bloating already demonstrate advanced stages. Other clinical manifestations of ovarian cancers include swollen belly region, lower or pelvic abdominal pain, abnormal cycles of menstruation, indigestion, appetite loss, weight loss or gain, nausea, vomiting, constipation, abrupt urination urge, vaginal bleeding in between menses, and excessive growth of hair (Clarke-Pearson & Soper, 2010). It is important to note that some of these symptoms may also be seen in women who lack cancer. With regards to the case study, it is evident that Mrs. Bishop had ovarian cancer as illustrated by symptoms such as weight loss of about 4kg. She also had been constipation, abdominal pain and dysuria. The aims of the treatment strategies for ovarian cancer, including the surgical, pharmacological and non pharmacological management Ovarian cancer treatment is grounded on the disease’s stage which reflects cancer’s spread or extent to other body parts (Furaya, 2012). Staging is done during the removal of ovarian cancer by the gynecologic oncologist. In the course of the surgical procedure, biopsies will be obtained from several abdominal cavity sites. With respect to the extent or stage of the condition, the surgeon either removes the fallopian tube and the ovary or removes both the fallopian tubes, ovaries, and the uterus (Clarke-Pearson & Soper, 2010). Staging is important so as to establish the course of treatment. In stage I, cancer is detained to both or one ovary. Stage II cancer is when either ovaries or one is engaged and there is spread to fallopian tubes and/or the uterus or other areas within the pelvis. In stage III, the cancer involves one or both ovaries and has multiplied to the lymph nodes or different areas outside the pelvis although is still in the abdominal cavity, like the liver or intestine surface (McQueen, 2009). Cancer is categorized stage IV if either ovaries or one is concerned and has multiplied beyond the abdomen or there is multiplication within the liver (Clarke-Pearson & Soper, 2010). Generally women who have ovarian cancer in stage I have an entire abdominal hysterectomy (Furaya, 2012). In stage two, treatment is nearly constantly hysterectomy in addition to bilateral salpingo-oophorectomy and debulking the tumor as much as possible (Clarke-Pearson & Soper, 2010). In stage II, treatment is similar as for the second stage of ovarian cancer. After the surgery, the client might either get combination chemotherapy perhaps followed by other surgery to get and eliminate any cancer remaining. In stage IV, treatment will almost certainly be surgery so as to eliminate the tumor as much as possible and combination chemotherapy afterward (McQueen, 2009). Normally in ovarian cancer management, there is postoperative chemotherapy, frequently with paclitaxel (inhibits division of cancer cell through prevention of microtubules’ disassembly) and carboplatin (sticks to and brings about DNA cross linking, causing apoptosis of cancer cells) (Furaya, 2012). In case there is recurrence or progression of cancer following effective chemotherapy, the chemotherapy is usually restarted. Other drugs that are useful may include doxorubin, topotecan, docetaxel, gemicitabine, hexamethylmelamine, oral etoposide, vinorelbine, and liposomal. The chemotherapy agents that are most active used in cancer of the ovary are the analogues of platinum, carboplatin and cisplatin (Helm & States, 2009). For people diagnosed with cancer (like Mrs. Bishop), management of pain is an essential element of the management plan (Bristow & Armstrong, 2010). A lot of patients with cancer in its advanced stage experience pain in the course of the disease and pain that is unrelieved can considerably diminish their life quality. The objective of management of cancer pain is to relieve pain and to maintain the normal Qol of the patient (Bohnenkamp, et al, 2007). Apart from the pharmacological cancer pain management like analgesic use for Mrs. Bishop, a couple of non pharmacological interventions would be of help. For instance, physical therapy, application of heat or ice, acupressure, acupuncture and massage therapy would be of help (Bohnenkamp, et al, 2007). Additionally, there are interventions that are non-physical which focus on the patient’s mental health. These include relaxation therapy, hypnosis, cognitive behavioral; remedy, and psychotherapy (Bristow & Armstrong, 2010). The implications to nursing and interprofessional practice when caring for people diagnosed with the varying stages of the condition The management of ovarian cancer has evolved during the past twenty years (Bast & Markman, 2009). Even though successful early diagnosis is still vague and the treatment of relapsed cancer of the ovary does not provide a cure, latest therapeutic advances provide a lot of women longer intervals that are disease free as well as improved Qol with the disease (Deligdisch, et al, 2013). Nursing efforts ought to focus on educating Mrs. Bishop together with her family, with regards to recommendations of treatment. For instance, in case there is anticipation of debulking surgery, the patient needs to get preoperative education and assist in planning postoperative recovery (Bohnenkamp, et al, 2007). It is very important that the nurse in charge of Mrs. Bishop unites with the physician into team approach toward management of the disease using continuous patient support and education, assessing Qol using the psychologic, spiritual, sociologic, and physiologic domains, and employing care plans using clinical practice that is based on evidence to support choices of treatment (Bohnenkamp, et al, 2007). Understanding the continuing and extensive effects of psychological and physical issues linked to ovarian cancer helps the nurse and the physicians in providing care in a holistic approach (Goodwin, 2010). Molecular, epidemiologic, and clinicopathologic studies about cancers of the ovary have enhanced nurses understanding as well as therapeutic approaches, however, still further attempts are needed to decrease the risks among the patients predisposed to the lethal illness and the patients’ mortality during advanced stages (Bast & Markman, 2009). Ovarian cancer diagnosis comes as a surprise to majority of women (Bristow & Armstrong, 2010). According to Bukowski (2007) even though all cancers add to uncertainty sense, ovarian cancer, due to its late manifestation and aggressive regimes of treatment, is related to a greater degree of uncertainty, depression and anxiety. This is why management of patients with cancer in a holistic approach is very imperative (Winkelman, et al, 2010). With respect to Mrs. Bishop’s weight loss which is related to her illness, it is imperative for her to consider the nutritionist’s recommendation concerning her diet in order to gain weight. It is argued that dietary treatment ought to bring about an upbeat energy as well as a balance in nitrogen in the patient who loses weight rapidly (Clarke & Bailey, 2010). The physician can prescribe medications that improve appetite such as megestrol or oxandrolone. With a team approach in managing Mrs. Bishop, the overall health outcome and Qol will be improved. Nurses should appreciate that, for cancer of the ovary, surgery is principally a control treatment and, only seldom, a cure (Bohnenkamp, et al, 2007). Additional to physical concerns about postoperative healing, it is important to note that nurses play a significant task in the client’s psychological adaptation as well as Qol in relation to continuing treatment and management (Clarke & Bailey, 2010). Conclusion In conclusion, cancer of the ovary is frequently fatal since it is normally advanced during diagnosis. Usually, symptoms are not present during the initial stages and vague during advanced stages. Normally, evaluation entails MRI or CT, ultrasonography, and tumor markers’ measurement. Diagnosis is through analysis of histology. Staging is basically surgical. Treatment calls for hysterectomy, tissue excision, bilateral salpingo-oophorectomy, and, unless there is localization of cancer, chemotherapy. Regardless of the contemporary standard remedy general survival in females with ovarian cancer is still comparatively poor. Cisplatin remains the chemotherapeutic agent that is most active but satirically most individual whilst initially reacting to cisplatin finally die with disease that is platinum-resistant. Arsenic is the potential agent to assist overcome resistance of platinum. Together with its natural tumoricidal action, it has compound biochemical relations that might increase cytotoxicity of cisplatin. Reference Australian Institute of Health and Welfare & Australasian Association of Cancer Registries 2012. Cancer in Australia: an overview, 2012. Cancer series no. 74. Cat. no. CAN 70. Canberra: AIHW. Australian Institute of Health and Welfare., & National Breast and Ovarian Cancer Centre (Australia). (2010). Ovarian cancer in Australia: An overview, 2010. Canberra: Australian Institute of Health and Welfare. Bristow, R. E., & Armstrong, D. K. (2010). Ovarian cancer. Philadelphia: Saunders/Elsevier. Bast, R. C., & Markman, M. (2009). Ovarian cancer. Chicago, IL: ReMEDICA. Goodwin, T. M. (2010). Management of common problems in obstetrics and gynecology. Chichester, West Sussex: Wiley-Blackwell. Deligdisch, L., Kase, N. G., & Cohen, C. J. (2013). Altchek's diagnosis and management of ovarian disorders. Bukowski, R. M. (2007). The management of recurrent ovarian cancer. Philadelphia, PA: Saunders. Cancer Australia. Report to the nation - ovarian cancer (2012). Cancer Australia, Surry Hills, NSW, 2012. Furuya, M. (2012).Ovarian Cancer Stroma: Pathophysiology and the Roles in Cancer Development. Cancers, 4(3), p. 701-724. Helm, C., & States, C. (2009). Enhancing the efficacy of cisplatin in ovarian cancer treatment-could arsenic have a role. Journal of Ovarian Research, 2(2). 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