Cancer of ovary

1. OVARIAN CANCER

2. • It is the malignant neoplastic growth of the
ovary.

3. Incidence
• Ovarian cancer constitutes about 15 to 20
percent of genital malignancy.
• It is more prevalent in USA but less in Japan
and India

4. ETIOLOGY
• Advanced age
• Nulliparity – woman who has never given
birth
• Infertility
• Personal history of breast or colon cancer
• Genetic
• Early menarche

5. • Late menopause.
• High fat diet.
• Obesity.
• Use of perineal talcum powder or hygienic sprays.
• Older than 30 years at first pregnancy.
• Hormone replacement therapy for more than 10 years.

6. Classification
• Epithelial cancer - Malignant epithelial
tumors are both cystic and solid types.
• Germ cell tumors - Commonly occur in
young women
• Specialized stromal cell cancers - Usually
involve one ovary

7. • Cancers metastatic to the ovaries are called
Krukenberg tumors.

8. Clinical features
- Feeling of abdominal discomfort or pain
which the patient may express as gas,
indigestion, bloating, swelling or cramps.
- Nausea, diarrhea, constipation
- Loss of appetite
- Feeling full even after a light meal

9. • Sudden loss of weight
• Urinary frequency or incontinence
• Abnormal vaginal bleeding
• Pelvic pain, back pain
• Fatigue and pallor
• Edema of leg or vulva
• Respiratory distress due to ascites or pleural
effusion

10. Diagnostic measures
• Cytology examination of fluid collected from
abdominal paracentesis
• Chest X ray to exclude pleural effusion and chest
metastasis
• Barium enema to detect any lower bowel malignancy.

11. • Ultrasound abdomen and pelvis
• CT scan – retroperitoneal lymph node assessment
• MRI – to detect the involvement of lymph nodes
• PET scan
• Tumor markers - CEA, CA125, AFP, HCG, placental
alkaline phosphatase.

12. Staging Of Ovarian Cancer
• Stage I – limited to the ovaries
• Stage IA – one ovary is involved
• Stage IB – both ovaries involved
• Stage IC – Both ovaries involved with rupture of
ovarian cyst, malignant ascites
• Stage II – spread to adjacent pelvic structures

13. • Stage IIA – spread to uterus or fallopian tubes
• Stage IIB – Spread to pelvic peritoneum
• Stage III – spread to upper abdomen
• Stage IV – distant spread beyond the
abdomen, liver, lung etc.

14. Pathophysiology
• Epithelial type : serous or mucinous type’ the
epithelial type originates from cells on the
surface of the germinal epithelium
• Non epithelial type: germ cell type[ ova]
• Direct metastasis
• Lymphatic spread
• Peritoneal spread helps in the wide spread

15. Management
• Surgical management
• Chemotherapy
• Radiation therapy
• Immunotherapy
• Adjuvant therapy

16. Surgical management
• total abdominal hysterectomy with bilateral
salpingio-oophrectomy.

17. • Chemotherapy:
 Alkylating agents (melphelan, cyclophosphamide,etc.)
 Platinum compounds (cisplatin, carboplatin)
 Taxame derivatives (paclitaxel, docetaxel)
 Combination chemotherapy.

18. • Radiotherapy:-
Very little scope. Total abdomino peritoneal
irradiation is employed.
Radioactive isotopes.
• Immunotherapy - combination of BCG,
corynebacterium parvum or alpha interferon

19. • NURSING
MANAGEMENT

20. • Acute pain
• Fatigue
• Deficient fluid volume
• Imbalanced nutrition
• Situational low self-esteem
• Risk for infection