NCLEX Review Guide: Ovarian Cancer

Disease Overview

• Ovarian cancer is a malignancy affecting the ovaries, often called the "silent killer" because early symptoms are vague and nonspecific.
• Most cases are epithelial ovarian cancers arising from the surface cells of the ovary, with serous adenocarcinoma being the most common type.
• Disease typically spreads by direct extension and peritoneal seeding rather than lymphatic or hematogenous routes initially.

Signs and Symptoms

• Early symptoms are often dismissed as GI issues: bloating, pelvic pressure, urinary frequency, and early satiety.
• Advanced disease presents with ascites, bowel obstruction, and palpable abdominal mass.
• CA-125 tumor marker is elevated in 80% of cases but can be falsely elevated in benign conditions.

Diagnostic Workup

• Transvaginal ultrasound is the initial imaging study to evaluate ovarian masses and detect ascites.
• CT scan of abdomen/pelvis determines extent of disease and guides surgical planning.
• Definitive diagnosis requires tissue biopsy obtained during surgical exploration.

1. Pelvic examination and history
2. CA-125 tumor marker
3. Transvaginal ultrasound
4. CT imaging for staging
5. Surgical exploration and biopsy

Surgical Intervention

• Cytoreductive surgery involves total abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy.
• Optimal debulking means residual tumor nodules <1cm, which improves chemotherapy effectiveness.
• Post-operative nursing focuses on monitoring for complications like bowel obstruction and infection.

Chemotherapy Management

• Standard regimen includes carboplatin and paclitaxel (Taxol) administered IV every 3 weeks.
• Monitor for peripheral neuropathy with paclitaxel and nephrotoxicity with carboplatin.
• Intraperitoneal chemotherapy may be used for optimal debulked Stage III disease.

Priority Nursing Interventions

• Monitor CBC and renal function before each chemotherapy cycle due to myelosuppression and nephrotoxicity risks.
• Assess for signs of bowel obstruction: absent bowel sounds, abdominal distension, and vomiting.
• Provide emotional support and facilitate referrals to support groups and palliative care as appropriate.

1. Pre-chemotherapy: Verify labs, assess vital signs
2. During infusion: Monitor for hypersensitivity reactions
3. Post-treatment: Educate on infection precautions
4. Ongoing: Assess for neuropathy and fatigue

• Common Pitfall: Don't assume GI symptoms in older women are benign - always consider ovarian cancer.
• Remember: CA-125 can be elevated in benign conditions like endometriosis and PID.
• Safety Alert: Never perform percutaneous biopsy of suspected ovarian mass due to seeding risk.