OVARIAN AND

PROSTATE CANCER
GROUP 4A

Pagas, Pardo, Plana, Racho, Raymundo

 TABLE OF CONTENTS
01 02 03
CANCER OF THE Assessment and Diagnostic findings
and MANAGEMENTS (Ovarian
CANCER OF THE
OVARY Cancer) PROSTATE
Jasmine Pagas Janelle Alliah Raymundo Ma. Angelica Allysa Racho

04 05
PATIENT UNDERGOING NURSING PROCESS
PROSTATE SURGERY
Jessa Plana Cinderella Mae Pardo
01 CANCER OF
THE OVARY
The growth of cells that forms in the ovaries.
OVERVIEW

➢ Ovarian cancer is the leading cause of gynecologic cancer deaths in the

United States, and the fifth deadliest cancer for women following lung, breast,
colorectal, and pancreatic.
➢ Despite careful examination, ovarian tumors are often difficult to detect
because they are usually deep in the pelvis.
➢ Tumor-associated antigens are helpful in determining follow-up care after
diagnosis and treatment to evaluate for recurrent disease but are not useful in
early general screening.
EPIDEMIOLOGY
● One in 70 women will develop ovarian cancer in her lifetime. The incidence of this type of
cancer increase with age until 70 years with most cases diagnosed by age 60. The
frequency is highest in the industrialized countries and affects women of all races and
ethnic backgrounds.
● Most cases are random, but 5%-10% are familial. The mutation most cases of BRCA1 gene
and sometimes in BRCA2 gene (tumor suppressor gene).
● The family history of ovarian cancer are one of the risk factor (mother, sister, or daughter),
early menarche, late menopause, and obesity may increase the risk of ovarian cancer.
● Women with inherited types of ovarian cancer tend to be younger when the diagnosis is
made than the average age at the time of diagnosis.
● Hereditary nonpolyposis colorectal cancer also known as Lynch syndrome increases the
risk of ovarian cancer.
● Lifetime risk of developing this condition has been shown to decreased by one half with
long term suppression of ovulation through the use of oral contraceptives.
PATHOPHYSIOLOGY
➢ Types of tumors include :
Germ cell tumor- arises from the cell that produce eggs and are the most common
cause of ovarian cancer in women younger than 20 years.
Stromal cell tumors- arises from connective tissue cells that produce hormones.
Epithelial tumors- originates from the outer surface of the ovary and constitutes
90%.
➢ Primary peritoneal carcinoma is closely related to ovarian cancer.
➢ Extraovarian primary peritoneal carcinoma resembles ovarian cancer histologically
and can occur in women with or without ovaries.
➢ OOPHORECTOMY- Lessens the chance, but does not guarantee, that the patient will
not develop carcinoma.
 CLINICAL MANIFESTATIONS
➔ Symptoms of ovarian cancer are nonspecific
and may include:
-Abdominal Girth, Pelvic Pressure, Bloating,
Back pain, Constipation, Abdominal pain,
Urinary Urgency, Indigestion, Flatulence,
Increased Waist Size, Leg Pain, and Pelvic
Pain.
➔ Ovarian Cancer is often silent.
➔ Enlargement of the abdomen from an
accumulation of fluid is a common sign.
➔ Early ovarian malignancy symptoms should
alert the nurse: persistent gastrointestinal
symptoms.
➔ Ovaries are normally become smaller and
less palpable after menopause.
02
Assessment,
Diagnostic findings
and Management
(OVARIAN CANCER)
Janelle Alliah Raymundo
 ASSESSMENT

BENIGN No proliferation or
invasion

BORDERLINE There is proliferation but

no invasion

MALIGNANT There is invasion

 20%
Of all new cases of ovarian cancer, 20% are classified as borderline and
have low malignant potential.
DIAGNOSTIC TESTS

Transvaginal and
MRI scan
Pelvic ultrasound
a type of scan that uses strong ultrasound used to identify
magnetic fields and radio waves to abnormalities within female
produce detailed images of the inside reproductive organs.
of the body.

Blood test for

Chest x-ray
CA-125
projection radiograph of the chest
used to diagnose conditions measures the amount of the
affecting the chest, its contents, protein CA 125 in your blood.
and nearby structures.
SURGICAL STAGING, EXPLORATION, AND
REDUCTION OF TUMOR MASS ARE THE
BASIC TREATMENT. SURGICAL REMOVAL
IS THE TREATMENT OF CHOICE.
MAIN STAGES OF OVARIAN CANCER
STAGE I Cancer is contained within the ovary (or ovaries)

STAGE II
Cancer is in one or both ovaries and has involved
other organs within the pelvis

STAGE III
Cancer involves one or both ovaries, and one or both of the
following are present: (1) cancer has spread beyond the
pelvis to the lining; (2) cancer has spread to lymph nodes

STAGE IV
The cancer is in one or both ovaries. There is distant
metastasis to the liver, lungs, or other organs outside the
peritoneal cavity are evidence of stage IV disease
 Likely treatments involves:
Total abdominal hysterectomy with removal of the fallopian
tubes and ovaries and possibly the omentum, tumor
debulking, para-aortic and pelvic lymph nodes sampling,
diaphragmatic biopsies, random peritoneal biopsies, and
cytologic washings.

Borderline tumors resemble ovarian cancer but have much more

favorable outcomes. Women diagnosed with this type of cancer
tend to be younger (early 40s).
Pharmacologic Therapy
● Chemotherapy is usually administered IV on an outpatient basis using a
combination of platinum and taxane agents.
● Paclitaxel (Taxol) + carboplatin (Paraplatin)
● Leukopenia, neurotoxicity, and fever may occur

PACLITAXEL
● Paclitaxel often causes leukopenia, patients may need granulocyte colony-stimulating factor
as well
● Paclitaxel is contraindicated in patients with hypersensitivity to medication formulated in
polyoxyethylated castor oil and in patients with baseline neutropenia
● Because of possible adverse cardiac effects, paclitaxel is not used in pt with cardiac disorders
● Hypotension, dyspnea, angioedema, and urticaria indicates the severe reaction that usually
occur soon after the first and second dose given.
● Nurses who administer chemotherapy are prepared to assist in treating anaphylaxis
● Patient should be prepared for inevitable hair loss
Pharmacologic Therapy
Carboplatin
● May be used in the initial treatment and in patient with recurrence
● It is used with caution in patient with renal impairment
● Usually, six cycles are given

Liposomal Therapy
● Delivery of chemotherapy in a liposome, allows the highest possible dose of chemotherapy to
the tumor target with a reduction in adverse effect.
● Liposomes are used drug carriers because they are nontoxic, biodegradable, easily available,
and relatively inexpensive
● This encapsulated chemotherapy allows increased duration of action and better targeting
● The encapsulation of doxorubicin (Doxil) lessens the incidence of nausea, vomiting and
alopecia
● Patients must be monitored for bone marrow suppression and gastrointestinal and cardiac
effects
Pharmacologic Therapy

Combination IV and Intraperitoneal Chemotherapy

● This treatment is more toxic and side effects are more severe than regular chemotherapy

NOTE!
Recurrence of ovarian cancer
Treatment is directed toward control of the cancer, maintenance of quality of life, and palliation.
Liposomal preparation, intraperitoneal drug administration, anticancer vaccines, monoclonal
antibodies directed against cancer antigen, gene therapy, and antiangiogenic treatments may be
used in the treatment for recurrence.
Nursing Management

Childbearing, if desired, is encouraged in

the near future

After childbirth, surgical exploration may

be performed, and the remaining ovary
may be removed

If both ovaries are involved, bilateral

oophorectomy is performed and
chemotherapy follows
 NURSING CARE IN PT WITH ADVANCED OVARIAN CANCER THAT DEVELOP ASCITES AND PLEURAL EFFUSION

Administering IV fluids

Administering parenteral nutrition

Providing post-op care after intestinal bypass

Comfort measures for women with ascites may

include small frequent meals, decreasing
fluid intake, administering diuretics agents,
and rest.

Patients with pleural effusion may experience

sob, hypoxia, pleuritic chest pain and cough.
Thoracentesis is usually performed to relieve
the symptoms
 MALE
REPRODUCTIVE
SYSTEM
03 CANCER OF
THE PROSTATE
What is prostate?

- The prostate is a small walnut-shaped gland in males that produces the seminal fluid
that nourishes and transports sperm.

Prostate cancer is one of the most common types of cancer, accounting for about 5% of all
cases. Many prostate cancers are slow-growing and confined to the prostate gland, where
they are unlikely to cause serious harm if detected early. On the other hand, while some types
of prostate cancer grow slowly and may require little or no treatment, others are aggressive
and can spread quickly.
Clinical Symptoms of
manifestations metastases
-Backache
-Urinary obstruction
-Hip pain
-Blood in the urine/semen
-Perineal and rectal discomfort
-Painful ejaculation
-Anemia

-Weight loss

-Weakness

-Nausea

-Oliguria

-Spontaneous pathologic fractures

Assessment and diagnostic findings
Assessment
● Abnormal finding with the DRE
● Serum PSA
● Ultrasound-guided TRUS with biopsy
Diagnosis
● Histologic examination of tissue removed surgically by TURP
● Open prostatectomy
● Ultrasound-guided transrectal needle biopsy.
Medical Management
Treatment is based on the patient’s life expectancy, symptoms, risk of recurrence after definitive
treatment, size of the tumor, Gleason score, PSA level, likelihood of complications, and patient
preference.

Management may be nonsurgical and involve watchful waiting or be surgical and entail
prostatectomy.
Disadvantages
Advantages
* Missed chance at cure
* Absence of side effects of more aggressive treatment
* Risk of metastasis
* Improved quality of life
* Subsequent need for more aggressive
* Avoidance of unnecessary treatment treatment

* Decreased initial costs. * Anxiety about living with untreated cancer

* Need for frequent monitoring

Surgical Management
Radical prostatectomy is considered first-line treatment for prostate cancer and is
used with patients whose tumor is confined to the prostate. It is the complete surgical
removal of the prostate, seminal vesicles, tips of the vas deferens, and often the
surrounding fat, nerves, and blood vessels. Laparoscopic radical prostatectomy and
robotic-assisted laparoscopic radical prostatectomy have become the standard
surgical approaches for localized cancer of the prostate. Although sexual impotence is
a common side effect, these laparoscopic radical prostatectomy approaches result in
low morbidity and more favorable postoperative outcomes, including improved quality of
life and less sexual dysfunction if the nerves are spared.
Radiation Therapy
Two major forms of radiation therapy are used to treat cancer of the prostate:
● Teletherapy (external) - It uses a device such as a clinical linear accelerator
to deliver orthovoltage or supervoltage radiation at a distance from the
patient. The energy beam can be modified to adapt the dose distribution to
the volume of tissue being irradiated.

● Brachytherapy (internal) - a type of internal radiation that uses radiation to

destroy cancer cells and shrink tumors. The radiation often comes in the
form of seeds, ribbons, or wires. These are put into your body, in or near the
cancer.
Hormonal Strategies
Hormone therapy is also called androgen suppression therapy. The goal is to
reduce levels of male hormones, called androgens, in the body, or to stop them
from fueling prostate cancer cells. Androgens stimulate prostate cancer cells to
grow. The main androgens in the body are testosterone and dihydrotestosterone
(DHT). Most androgens are made by the testicles, but the adrenal glands (glands
that sit above your kidneys) as well as the prostate cancer itself, can also make a
fair amount. Lowering androgen levels or stopping them from getting into prostate
cancer cells often makes prostate cancers shrink or grow more slowly for a time.

(Hormone therapy alone does not cure prostate cancer.)

Chemotherapy
Recent studies have shown clear benefits in terms of survival with chemotherapy
treatment that includes a docetaxel-based regimen for non–androgen-dependent
prostate cancer. Other studies are underway to determine the importance of the
vascular endothelial growth factor system. Tumor angiogenesis is essential for
tumor growth, including growth of prostate carcinomas and other high-grade
cancers. Therefore, antiangiogenic treatment in combination with conventional
therapies may play a future role in treatment. Gene-based therapy in prostate
cancer is an emerging and promising adjuvant to conventional treatment
strategies.
Other Therapies
● Cryosurgery
- a procedure to freeze prostate tissue and cause the cancer cells to die.
During cryotherapy, thin metal probes are inserted through the skin and into
the prostate. The probes are filled with a gas that causes the nearby
prostate tissue to freeze.
● Bisphosphonate therapy with pamidronate (Aredia)
- to reduce the risk of pathologic fracture. In advanced prostate cancer, blood
transfusions are given to maintain adequate hemoglobin levels when bone
marrow is replaced by tumor.
● Acupuncture
- used to treat both PE and erectile dysfunction with some limited, anecdotal
success
04 PATIENT
UNDERGOING
PROSTATE
SURGERY
SURGICAL PROCEDURES

01 Transurethral
Resection of the
Prostate
05 Transurethral Incision
of the Prostate

02 Suprapubic
Prostatectomy
06 Laparoscopic Radical
Prostatectomy

03 07
Robotic-Assisted
Perineal Laparoscopic Radical
Prostatectomy Prostatectomy

04 Retropubic
Prostatectomy 08 Pelvic Lymph Node
Dissection
 Transurethral
Resection of the
Prostate

● The most common procedure used.

● Carried out through endoscopy.
● Rarely causes erectile dysfunction but
may trigger retrograde ejaculation.
 Transurethral Resection
SYNDROME
Interventions

Signs & Symptoms ● Discontinue irrigation.

● Administer diuretic agents as prescribed.
● Replace bladder irrigation with normal saline.
● Collapse ● Monitor intake and output.
● Headache ● Monitor the patient’s vital signs and level of
● Hypotension consciousness.
● Lethargy and confusion ● Differentiate lethargy and confusion of TURP
● Muscle spasms syndrome from postoperative disorientation and
● Nausea and vomiting hyponatremia.
● Seizures ● Maintain patient safety during times of confusion
● Tachycardia ● Assess lung and heart sounds for indications of
pulmonary edema, heart failure, or both as fluid
moves back into the intravascular space.
 SUPRAPUBIC
PROSTATECTOMY

● Removal of the prostatic tissue through

abdominal incision.
● An open surgical Procedure.

Nursing Implication:
● Monitor indication of hemorrhage and shock
● Provide METICULOUS aseptic care to the area
around suprapubic tube.
 PERINEAL
PROSTATECTOMY

● Removal of gland through an incision in the

perineum; preferred approach for patients who are
obese.
● practical when other approaches are not possible
and is useful for an open biopsy.

Nursing Implications:
● Anticipate urinary leakage around the wound after
catheter has been removed.
● Use of drainage pads to absorb excess urinary
drainage.
● Avoid using perennial tubes, thermometers, enema
after procedure.
 RETROPUBIC
PROSTATECTOMY

● Retropubic prostatectomy is used more commonly

than the suprapubic approach.
● This procedure is suitable for large glands located
high in the pelvis.
● Low abdominal incision.

Nursing Implications:
● Monitor Hemorrhage
● Anticipate Post-urinary leakage for several days
after the catheter has been removed.
TRANSURETHRAL INCISION
OF THE PROSTATE

● Indicated when the prostate gland is small (30 g or

less), and it is an effective treatment for many
cases of BPH.
● Has a lower complication rate than other more
invasive prostate procedures.

Disadvantages:
● Recurrent obstruction of urethral trauma and
delayed bleeding

Nursing Implication:
● Monitor for Hemorrhage.
LAPAROSCOPIC RADICAL
PROSTATECTOMY

● Laparoscopic instruments are used to dissect the

prostate.
● 4-5 small incisions are made in the abdomen
(1cm/0.5 inch)
● has fewer risks compared with open radical
prostatectomy.
● Better Visualization of surgical field than other
approaches.

Nursing Implications:
● Observe for symptoms of dysuria, straining, weak
urinary stream.
● Monitor hemorrhage and shock.
● Provide aseptic care to the area around suprapubic
tube.
 Robotic-Assisted
Laparoscopic Radical
Prostatectomy
● is a minimally invasive approach that uses a computer console
and a robot to move instruments, replicating the movements of
the surgeon’s hands.
● 6 small, (1cm/0.5 inch) incision are made in the abdomen.

Advantages:
● Minimally invasive technique
● Shorter hospital stay
● Reduced risk for infection
● Decreased blood loss

Nursing Implications:
● Observe for symptoms of dysuria, straining, weak urinary
stream.
● Monitor hemorrhage and shock.
● Provide aseptic care to the area around suprapubic tube.
 COMPLICATIONS

● Hemorrhage
● Clot formation
● Catheter obstruction
● Sexual dysfunction.
● Sexual activity may be resumed in 6 to 8
weeks, which is the time required for the
prostatic fossa to heal.
 NURSING

05
PROCESS OF A
PATIENT
UNDERGOING
PROSTATECTOMY
ASSESSMENT
Asking Questions about the changes of patientʼs lifestyle such as:
1. Has the patientʼs activity level or activity tolerance changed?
2. What is his presenting urinary problems?
3. Has he experience decreased ability to initiate voiding, urgency, frequency, nocturia, dysuria,
urinary retention or hematuria?
4. Does the patient report back pain, flank pain or lower abdominal or suprapubic discomfort?
5. Has the patient experienced erectile dysfunction or changes in frequency or enjoyment of
sexual activity?
Asking Questions about the patientʼs family history of cancer and heart or kidney disease and HTN
such as:
1. Has he lost weight?
2. Does he appear pale?
3. Can he raise himself out of the bed and return to bed without assistance?
4. Can he perform usual activities of daily living?
DIAGNOSIS
Preoperative Postoperative
● Anxiety about ● Risk for imbalanced
surgery and its fluid volume
outcome ● Acute pain related to
● Acute pain related to the surgical incision,
bladder distention catheter placement
● Deficient knowledge and bladder spasms
about factors related ● Deficient knowledge
to the disorder and about postoperative
the treatment care
protocol
PLANNING AND GOALS
The goals for the patient in PREOPERATIVE goals may include:
● Reduced anxiety and learning about his prostate disorder and the
perioperative experience

The goals for the patient in POSTOPERATIVE goals may include:

● Maintenance of fluid volume balance
● Relief of pain and discomfort
● Ability to perform self-care activities
● Absence of complications
INTERVENTION
PREOPERATIVE NURSING INTERVENTION POSTOPERATIVE NURSING
INTERVENTION
● Reducing Anxiety
● Relieving Discomfort ● Maintaining Fluid Balance
● Providing Education ● Relieving Pain
● Preparing the Patient
● Monitoring and Managing Potential
Complications
○ Hemorrhage
○ Infection
○ Venous Thromboembolism
○ Potential Catheter Problems
○ Urinary Incontinence
○ Sexual Dysfunction
● Promoting Home, Community-Based, and
Transitional Care
EVALUATION
EXPECTED PREOPERATIVE PATIENT EXPECTED POSTOPERATIVE PATIENT
OUTCOMES MAY INCLUDE: OUTCOMES MAY INCLUDE THE
FOLLOWING:
1. Demonstrates reduced anxiety
2. States that pain and discomfort are 1. Reports relief of discomfort
decreased
2. Exhibits fluid and electrolyte
3. Relates understanding of the
surgical procedure and balance
postoperative course and practices 3. Participates in self-care measures
perineal muscle exercises and other 4. Is free of Complications
techniques useful in facilitating
bladder control
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