Ovarian cancer is defined as a type of cancer that is found in the ovaries. The ovaries are two tiny, almond-shaped structures on either side of the uterus.
Ovarian cancer may develop in either of the two fallopian tubes or in the peritoneum. In the early stages of the disease, it is usually asymptomatic. The majority of cases are diagnosed when the disease has already progressed, which results in poor health outcomes.
Abdominal bloating or swelling, unintentional weight loss, or changes in bowel habits, including constipation, are typical signs that can manifest. Ovarian cancer is multifactorial in origin, which means that for the disease to progress, a number of independent causes must come into play.
Signs and Symptoms of Ovarian Cancer
The signs and symptoms of ovarian cancer are non-specific and can be attributed to other potential disease processes. Hence, they can be overlooked easily at the early stage of the disease. In most cases, the symptoms manifest only at the advanced stage (stage III or stage IV). The clinical presentation of the disease includes a combination of the following:
- abdominal fullness
- bloating
- nausea
- abdominal distention
- early satiety
- exhaustion
- changes in bowel habits (i.e., constipation, indigestion)
- urine symptoms
- lower back pain
- dyspareunia
- weight loss or weight gain
- a change in the menstrual cycle
- vaginal bleeding
- pain during intercourse
These symptoms have a sudden onset and become vaguely apparent months before the diagnosis of ovarian cancer.
Types of Ovarian Cancer
The ovaries are made up of a variety of cell types, including epithelial, germ, and specialized gonadal stromal cells. Ovarian cancer may originate from any of these cell types, however, ovarian carcinomas account for the majority of ovarian cancers and cause most of the ovarian cancer-related fatalities. There are three major types of ovarian cancer and are classified based on the cell of origin.
- Epithelial ovarian carcinomas. These ovarian cancers are the most prevalent type. The cells that line the ovary’s outer surface are involved in about 85% to 90% of these malignancies. They frequently invade the lining and internal organs of the pelvis and abdomen first before spreading to other body regions. About 70% of women with this type of ovarian cancer are diagnosed in the late stages of the disease.
- Germ cell tumors. This type comprises less than 2% of all ovarian cancer cases and originates from cells that produce ova. About 90% of women diagnosed with germ cell tumors survive 5 years after the diagnosis. This type of ovarian cancer is more common in teenagers and women in their 20s. They can be large and develop at a fast rate. Sometimes, tumor cells produce human chorionic gonadotropin (hCG), yielding a false positive pregnancy test result.
- Stromal cell tumors. This type represents 1% of all ovarian cancers and originates in the tissues supporting the ovaries. This type is rare and develops slowly. They secrete ovarian hormones, such as estrogen and testosterone. Excessive estrogen and testosterone levels can cause uterine bleeding and facial hair growth, respectively. These symptoms are clinically apparent, which makes this type of ovarian cancer more likely to be diagnosed at an early stage.
Cause of Ovarian Cancer
Scarce information is available regarding the etiology of most ovarian cancers. The most recent and significant discovery regarding the origin of ovarian cancer is that it does not always begin in the ovary itself but rather in cells at the ends of the fallopian tubes. Some theories about the cause of ovarian cancer have been postulated and are discussed below.
- Effect of frequency of ovulation. Birth control pills and pregnancy both reduce the risk of ovarian cancer. Some studies hypothesize that ovulation and the risk of developing ovarian cancer may be related in some way since both of these factors decrease the frequency of ovulation.
- Effect of tubal ligation and hysterectomy. Hysterectomy and tubal ligation both reduce the risk of ovarian cancer. This can be explained by the theory that some cancer-causing agents could enter the body through the vagina, travel through the uterus, and then exit the body through the fallopian tubes to reach the ovaries.
- Presence of androgens. Androgens, which are produced by men, are thought to be a potential cause of ovarian cancer.
Risk Factors to Ovarian Cancer
Risk factors associated with ovarian cancer are discussed below.
- Age. Ovarian cancer primarily affects postmenopausal women and is rarely diagnosed in women under the age of 40. As a woman gets older, the incidence, stage, and reported survival rate of the disease are increased.
- Parity. A few case-control studies have shown that parity has a protective effect, with older childbearing ages being associated with a lower incidence of ovarian cancer. Women who have never been pregnant are at a higher risk than those who have been pregnant and breastfed their children.
- Family history of ovarian or breast cancer. A family history of ovarian or breast cancer is the strongest risk factor of ovarian cancer. A family history of colorectal or fallopian tube cancer also increases the risk.
- Personal medical history. A personal history of breast cancer also increases the risk of developing ovarian cancer. A diagnosis of conditions of the reproductive system such as endometriosis and polycystic ovary syndrome (PCOS) also increases ovarian cancer risk.
- Reproductive history. Women who use birth control have a reduced risk of developing ovarian cancer while those who use fertility medications have an increased risk.
- Smoking. Numerous studies have demonstrated that smoking increases ovarian cancer risk, particularly the risk of developing mucinous epithelial cancers.
- Body mass index (BMI). Women whose BMI is above 30 have a higher risk of developing ovarian cancer.
- Ethnicity. Non-hispanic white women have the highest risk of developing ovarian cancer followed by black and Hispanic women.
Complications of Ovarian Cancer
In the last 6 months of their lives, patients who passed away due to ovarian cancer were found to have several complications, the most frequent of which were:
- Severe weakness or fatigue
- Vomiting or nausea
- Constipation
- Pedal edema
- Anemia
In cases where the condition was left untreated, patients experience serious complications of ovarian cancer such as:
- Ascites
- Pleural effusion
- Bowel and bladder obstruction
- Disorders of nutrition
Diagnosis of Ovarian Cancer
The following procedures are necessary in establishing the diagnosis of ovarian cancer.
- Comprehensive history taking and physical examination. Establishing a thorough medical history and physical examination are the initial steps in diagnosing ovarian cancer. In clinical situations of high suspicion, a comprehensive physical examination should be performed, including rectovaginal examination on an empty bladder to look for pelvic and abdominal tumors. In more severe situations, it is possible to find a palpable pelvic mass, ascites, or reduced breath sounds due to pleural effusions.
- Radiological imaging. Transvaginal ultrasonography (TVUS, extremely sensitive and preferable) and/or abdominal and pelvic ultrasonography are performed on patients who have a high level of clinical suspicion. It provides a good idea of the ovarian mass’s size, location, and complexity. Additional imaging techniques, such as pelvic MRI, PET scan, and/or chest and abdominal pelvis CT scan, can be used to define tumor expansion.
- Measurement of CA-125 levels. Radiological imaging is typically done in conjunction with the measurement of CA-125 levels. Most epithelial ovarian tumors have increased CA-125 levels overall, while only 50% of those with early stage epithelial ovarian cancers do.
- Blood tests. Levels of hCG, alpha-fetoprotein, lactate dehydrogenase, inhibin, estrogen, and testosterone in the blood must be measured. These markers are often elevated in ovarian cancers. Increased hCG, alpha-fetoprotein, and lactate dehydrogenase levels suggest the presence of a germ cell tumor, while elevated estrogen and testosterone levels may indicate the presence of a stromal cell tumor.
- Kidney and liver function tests. These tests will help determine if the cancer has metastasized to other parts of the body, specifically to the liver and kidneys.
- Optimal staging and biopsy. Optimal staging of the disease through exploratory laparotomy and close evaluation of abdominal and pelvic regions is performed. This also includes inspection of the peritoneal surfaces through obtaining a biopsy specimen and/or pelvic washings. Tissue biopsies aid in the final diagnosis of the disease in terms of histological type, staging, and grade.
Treatment for Ovarian Cancer
Chemotherapy and surgery are typically used in the standard treatment of ovarian cancer. The treatment and management of the disease should usually include:
- Debulking surgery. When lesions demonstrate a low likelihood of developing to malignancy in the early stages of invasive epithelial ovarian cancer, a unilateral salpingo-oophorectomy is performed while conserving the uterus and the contralateral ovary. However, in advanced stages of the disease, performing a debulking surgery involving a hysterectomy and bilateral salpingo-oophorectomy (BSO) has demonstrated better results.
- Neoadjuvant chemotherapy. For patients who are considered to be poor surgical candidates and have a low chance of achieving adequate cytoreduction, neoadjuvant chemotherapy is advised to relieve the tumor burden. Patients should have a histological diagnosis of invasive ovarian cancer confirmed by biopsy prior to receiving neoadjuvant chemotherapy. Biopsies are preferred over specimens obtained through fine-needle aspiration or paracentesis.
- Maximal Cytoreductive Surgery. Maximal cytoreduction is one of the most significant independent predictors of enhanced median survival in patients with stage III or IV ovarian cancer. Optimal cytoreduction is strongly advised to achieve absence of residual disease, regardless of the surgery sequence, whether it occurs before or after neoadjuvant chemotherapy.
Nursing Diagnosis for Ovarian Cancer
Nursing Care Plan for Ovarian Cancer 1
Nursing Diagnosis: Fear/Anxiety related to threat to alteration in health/socioeconomic status, interaction patterns and role functioning, separation from family, and threat of death secondary to ovarian cancer as evidenced by increased tension, trembling, restlessness, and insomnia, expressed worry over evolving life events, feelings of hopelessness, inadequacy, and helplessness, somatic complaints, and sympathetic stimulation.
Desired Outcomes:
- The patient will show an appropriate spectrum of emotions and lessened fear.
- The patient will report that their anxiety has decreased to a manageable level and will appear relaxed.
- The patient will use sensible coping techniques and actively engage in the treatment regimen.
| Nursing Interventions for Ovarian Cancer | Rationale |
| Review the patient’s and significant other’s prior experience on ovarian cancer treatment. Analyze the patient’s reasoning and the information the doctor has provided. | This clarifies the patient’s perspective and helps identify fears and misconceptions based on the diagnosis and previous experiences with ovarian cancer. |
| Encourage the patient to express their feelings. | This gives the patient the chance to investigate reasonable fears and misconceptions associated with the diagnosis of ovarian cancer. |
| Provide an open and relaxed environment where the patient feels comfortable talking about their feelings or remaining silent. | This promotes a sense of dignity and control while assisting the patient in feeling accepted in their current state without feeling criticized. |
| Keep in close contact with the patient. As necessary, speak with and touch the patient. | This reassures the patient that they are not alone or rejected. This conveys respect and acceptance to the patient, which promotes trust. |
| When isolation is necessary due to immunosuppression or a radiation implant, be cognizant of the effects of isolation to the patient. Limit the use of isolation masks and garments as much as possible. | When there is insufficient stimulation, sensory deprivation may occur, which can exacerbate feelings of fear, anxiety, and isolation. |
Nursing Care Plan for Ovarian Cancer 2
Nursing Diagnosis: Grieving related expected decline in physiological function, lifestyle alteration, and patient’s perceived risk of dying secondary to ovarian cancer as evidenced by modifications in eating habits, changes in sleeping patterns, amount of activity, libido and communication patterns, denial of possible loss, anger, and choked feelings
Desired Outcomes:
- The patient will effectively identify and convey their emotions.
- The patient will maintain their normal daily routine while planning for the future and looking ahead one day at a time.
- The patient will verbalize an understanding of the dying process and feeling of being supported as they go through the grieving process.
| Nursing Interventions for Ovarian Cancer | Rationale |
| Anticipate initial shock and disbelief following the diagnosis of ovarian cancer and traumatic procedures (e.g., hysterectomy and bilateral salpingo-oophorectomy) | Some patients may not readily accept the changes that may actually take place as a result of their ovarian cancer diagnosis. |
| Determine the patient’s and significant other’s current stage of grief and explain the process as necessary. | Understanding the grief process reinforces the normalcy of feelings and helps the patient deal with their feelings and reactions more effectively. |
| Encourage the patient to verbalize their thoughts or worries. Accept expressions of sadness, rage, or rejection and reassure the patient that these feelings are normal. | Understanding that intense, frequently conflicting emotions are common in this trying situation and are experienced by others may give the patient confidence to share their sentiments. |
| Be on the lookout for aggression, mood swings, and other acting-out behaviors. Limit incorrect actions and refocus the patient’s negative thoughts. | These are signs of inadequate coping and necessitate additional interventions. The patient can keep control and maintain a sense of self-esteem by avoiding damaging behavior. |
| Talk about how the patient and significant other can make future plans together. Encourage them to set attainable goals. | Allowing the patient to engage in crafting plans and solving problems might give them a sense of control over subsequent events associated with the disease process. |
Nursing Care Plan for Ovarian Cancer 3
Imbalanced Nutrition: Less Than Body Requirements
Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements related to hypermetabolic state, consequences of chemotherapy and surgery, fatigue, emotional distress, and poorly controlled pain secondary to ovarian cancer as evidenced by abdominal cramping, constipation, reported inadequate food intake, changes in taste perception, loss of interest in food, body weight 20% or more below the healthy range for one’s height and frame, decreased subcutaneous fat, and decreased muscle mass.
Desired Outcomes:
- The patient will be free of any indications of malnutrition and exhibit a stable weight or progressive weight increase toward a goal with normalized laboratory test findings.
- The patient will explain an understanding of individualized barriers to a sufficient intake.
- The patient will participate in targeted initiatives to enhance nutritional intake and stimulate appetite.
| Nursing Interventions for Ovarian Cancer | Rationale |
| Observe the patient’s daily food consumption and ask them to keep a food diary as directed. | This will help determine nutritional deficiencies and strengths. |
| Measure the patient’s height, weight, and skinfold thickness of their triceps (or other anthropometric measurements as appropriate). Find out how much weight has recently been lost by the patient. Weigh the patient frequently or as directed. | If these readings are below the minimum standards, the patient’s main energy reserve (fat tissue) is depleted. |
| Encourage the patient to have a diet that is rich in nutrients and calorie-dense. Advise the patient to consume enough fluids. Promote frequent or smaller meals spaced out throughout the day and the use of supplements. | In order to efficiently eliminate waste products from the body, both fluid and metabolic tissue requirements must be increased. Supplements may help in maintaining a sufficient protein and calorie intake. |
| Put environmental variables, such as strong or noxious odors or noise, under control. Advise the patient to avoid eating food that is too fatty, sweet, or spicy. | These can cause an episode of nausea and vomiting. |
| Determine if the patient is experiencing anticipatory nausea and vomiting, and take the necessary action. | Psychogenic nausea and vomiting that occurs prior to chemotherapy are usually not relieved by antiemetic medications. Changing the patient’s routine or modifying the treatment environment may be beneficial on the day of treatment. |
Nursing Care Plan for Ovarian Cancer 4
Nursing Diagnosis: Fatigue related to hypermetabolic state, effects of treatment, changes in body chemistry and overwhelming emotional/psychological demands secondary to ovarian cancer as evidenced by overpowering lack of energy, inability to carry out daily activities, decline in performance, difficulty focusing, and lethargy/listlessness and disregard for the environment.
Desired Outcomes:
- The patient will report feeling more energized.
- The patient will perform activities of daily living and take part in preferred activities that are appropriate for their level of activity.
| Nursing Interventions for Ovarian Cancer | Rationale |
| Ask the patient to rate their level of fatigue, preferably on a numeric scale, and identify the time of day when it is the worst. | This aids in creating a plan to deal with the patient’s fatigue. |
| Set reasonable activity targets together with the patien. | This gives the patient a sense of control and achievement. |
| When necessary, assist the patient with self-care needs. Maintain a low bed. Keep walkways free of clutter and aid with ambulation. | Weakness may make performing activities of daily living challenging or can put the patient at risk for injury when engaging in activities. |
| Monitor the patient’s physiological response to exercise such as changes in blood pressure, heart rate and respiratory rate). | The degree of tolerance varies significantly according to the stage of ovarian cancer, nutritional status, fluid balance, and response to the treatment plan. |
| Assess the patient for pain and provide pain management. | Fatigue may be caused by poorly controlled pain attributed to ovarian cancer. |
Nursing Care Plan for Ovarian Cancer 5
Nursing Diagnosis: Risk for Infection related to immunosuppression, inadequate secondary defenses, malnutrition, and invasive procedures secondary to ovarian cancer
Desired Outcomes:
- The patient will maintain an afebrile state and achieve timely healing.
- The patient will determine and participate in interventions to lower or prevent infection risk.
| Nursing Interventions for Ovarian Cancer | Rationale |
| Encourage both hospital staff and visitors to wash their hands properly. Visitors who might be infected should be screened and limited. As specified, place in reverse isolation. | This safeguards the patient from infection sources, such as visitors and personnel who might have upper respiratory infections (URIs). |
| Emphasize the importance of good personal hygiene. | This reduces the risk of infection and uncontrolled growth. |
| Monitor the patient’s complete blood count (CBC), differential WBC and granulocyte counts, and platelets as needed. | Radiation therapy, progression of ovarian cancer, chemotherapy can all decrease bone marrow activity. In order to avoid subsequent complications, such as infection, anemia, or hemorrhage, myelosuppression must be closely monitored. This will also aid in the scheduling of drug delivery. |
| Give antibiotics as directed. | When an infection has been diagnosed as a consequence of the ovarian cancer, antibiotics may be given prophylactically to patients who are immunocompromised. |
| Monitor the patient’s temperature. | A rise in temperature may occur due to a variety of reasons such as side effects of chemotherapy, disease process, presence of infection. Early detection of infection enables timely initiation of the necessary treatment. |
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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