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Risk factors for Ovarian Cancer
1. An inherited gene mutation is one risk factor for ovarian cancer and is found in a small precentage of ovarian cancers. The genes BRCA1(Breast cancer gene 1) and BRCA2(Breast cancer gene 2) were originally identified in families with multiple cases of breast cancer, but women with these genes are at an increased risk of developing breast cancer. Another inherited genetic link is hereditary nonpolyposis colorectal cancer (HNPCC). Women with this syndrome have an increased risk of developing ovarian cancer, along with other cancers such as, colon, stomach, and endometrium cancer. If you have previously been diagnosed with any of these other cancers, this increases the risk of developing ovarian cancer.*

2. A family history of ovarian cancer increases the risk.*

3. Women that have never been pregnant have an increased risk of developing ovarian cancer.*

4. Ovarian cancer most often develops with increasing age(after menopause) but can develop at any age.*

5. Hormone replacement after menopause can possibly increase the risk of developing ovarian cancer, but studies have shown both sides (there is a risk and there is not).*

*Information retrieved from: []

Incidence for Ovarian Cancer
Incidence refers to the number of people who get a disease each year. The map below shows the incidence of ovarian cancer by state in 2007. Ovarian cancer is a disease that principally affects middle and upper-class women in industrialized nations. It is uncommon in underdeveloped countries, perhaps because of different dietary factors in these regions (see also Causes of Ovarian Cancer). Among American women, ovarian cancer is the fifth most common cancer, and it is the leading cause of death from all types of gynecologic cancer.
 * ~ Color on Map ||~ Interval ||~ States ||
 * Light green || 7.3 to 11.3 || Alabama, Arkansas, District of Columbia, Kentucky, Louisiana, Maryland, Mississippi, Montana, Nebraska, Utah, Vermont, Virginia, and Wyoming ||
 * Medium green || 11.4 to 11.9 || Arizona, Florida, Indiana, Maine, Massachusetts, Missouri, New Mexico, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, and West Virginia ||
 * Medium blue || 12.0 to 12.7 || California, Connecticut, Hawaii, Illinois, Kansas, Minnesota, New Hampshire, North Carolina, Ohio, Oregon, Washington, and Wisconsin ||
 * Dark blue || 12.8 to 15.4 || Alaska, Colorado, Delaware, Georgia, Idaho, Iowa, Michigan, New Jersey, New York, North Dakota, Oklahoma, and Pennsylvania ||
 * Light Grey || Did not meet USCS data quality criteria || Nevada ||
 * Rates are per 100,000 and are age-adjusted to the 2000 U.S. standard population.

Approximately 30,000 new cases of ovarian cancer will be diagnosed every year, with 15,000 women dying from this disease. Nearly 2% of women born in the United States develop ovarian cancer in their lifetime. Ovarian cancer primarily affects women over 60 in age. Approximately 5% of cancer deaths in women are from ovarian cancer.

Source: U.S. Cancer Statistics Working Group. //[|United States Cancer Statistics: 1999–2007 Incidence and Mortality Web-based Report.]// Atlanta (GA): Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute; 2010. Available at: [|http://www.cdc.gov/uscs.]

SEER Incidence
From 2005-2009, the median age at diagnosis for cancer of the ovary was 63 years of age. Approximately 1.3% were diagnosed under age 20; 3.6% between 20 and 34; 7.4% between 35 and 44; 18.6% between 45 and 54; 23.4% between 55 and 64; 20.1% between 65 and 74; 17.6% between 75 and 84; and 8.1% 85+ years of age. The age-adjusted incidence rate was 12.7 per 100,000 women per year. These rates are based on cases diagnosed in 2005-2009 from 18 SEER geographic areas. Incidence Rates by Race||~ Race/Ethnicity http://seer.cancer.gov/statfacts/html/ovary.html
 * ~ Female ||
 * All Races || 12.7 per 100,000 women ||
 * White || 13.4 per 100,000 women ||
 * Black || 9.8 per 100,000 women ||
 * Asian/Pacific Islander || 9.8 per 100,000 women ||
 * American Indian/Alaska Native [|a] || 11.2 per 100,000 women ||
 * Hispanic [|b] || 11.3 per 100,000 women ||

=Clinical Manifestations= Signs: -Bloating - Pelvic or abdominal pain - Trouble eating - Clothes that fit tighter around waste. - heavy feeling in pelvis

Symptoms - Fatigue - heartburn or upset stomach - low back pain - constipation or menstrual changes - persistent lack of energy - Increase in abdominal size -Gas, nausea, vomiting, or loss of appetite - bleed from the vagina

=**How is the cancer diagnosed?****= According to the Center for Disease Control - there are no reliable way of screening for ovarian cancer in women with no signs or symptoms. Pelvic exams and abdominal/vaginal ultrasound can be used to detect ovarian masses. For women who has a history of ovarian cancer, CA-125 (a blood serum marker) is used to detect recurrent ovarian cancer. CA-125 is not beneficial for screening of asymptomatic women in the average risk population.


 * Information retrieved from: http://www.cdc.gov/cancer/ovarian/index.htm

=**Treatment**= There are several ways to treat ovarian cancer. The treatment depends on the type of ovarian cancer and how far it has spread. Treatments include surgery, chemotherapy, and/or radiation.
 *  **Surgery**: Surgery to remove the cancerous growth is the most common method of diagnosis and therapy for ovarian cancer. Treatment for ovarian cancer usually involves an extensive operation that includes removing both ovaries, fallopian tubes, and the uterus as well as nearby lymph nodes and a fold of fatty abdominal tissue known as the omentum, where ovarian cancer often spreads. The surgeon also removes as much cancer as possible from your abdomen (surgical debulking). Less extensive surgery may be possible if the ovarian cancer was diagnosed at a very early stage. For women with stage I ovarian cancer, surgery may involve removing one ovary and its fallopian tube. This procedure may preserve the ability to have children in the future.
 * **Chemotherapy**: Chemotherapy involves the use of drugs to stop or slow the growth of cancer cells. Chemotherapy may cause side effects, but these often get better or go away when chemotherapy is over. Chemotherapy is used in the majority of cases as a follow-up therapy to surgery. Chemotherapy may also be used as the initial treatment in some women with advanced ovarian cancer. Chemotherapy drugs can be administered in a vein (intravenously) or injected directly into the abdominal cavity, or both methods of administering the drugs can be used. Chemotherapy drugs can be given alone or in combination.
 * **Radiation**: Radiation uses high-energy rays (similar to X-rays) to try to kill the cancer cells and stop them from spreading. The rays are aimed at the part of the body where the cancer is (only rarely used in the treatment of ovarian cancer in the United States).

** Complementary Therapies ** Some women with ovarian cancer turn toward the whole-body approach of complementary therapy to enhance their fight against the disease, as well as to relieve stress and minimize side effects such as fatigue, pain and nausea. Complementary therapies are diverse practices and products that are used in conjunction with conventional medicine. Many women have tried and benefited from the following complementary therapies.
 * Acupuncture - An ancient Chinese method of healing in which small sterilized needles are inserted into the body's energy centers to promote healing.
 * Aromatherapy - The use of essential oils from flowers, herbs and trees to promote health and well being.
 * Herbal Medicine - Use of remedies using plant parts to treat symptoms and illnesses. (Consult your healthcare professional prior to using herbal medicine).
 * Massage - Manipulating the body's muscle and connective tissue through rubbing, kneading and patting to promote relaxation and well being.
 * Meditation - Conscious relaxation and focused breathing to relax the mind and body.
 * Qi Gong (chee-GUNG) - A type of Chinese medicine that combines movement, meditation and breathing to enhance the flow of qi (an ancient term given to what is believed to be vital energy) in the body, improve blood circulation and enhance immune function.
 * Stress Reduction - Use of stress reduction methods such as exercise, meditation, etc. which have been found to be beneficial in reducing cancer progression and recurrence.
 * Yoga, Tai Chi - Postures, movements and breathing exercises to strengthen and heal the body, mind and spirit.

Sources: [|http://www.ovarian.org/symptoms.php][], http://www.cdc.gov/cancer/ovarian/index.html

=**Nursing Management**=

Ovarian cancer patients can be a challenging task for the nurse. There are many nursing diagnoses that can help but not limited to:


 * //Anxiety related to threat of a malignancy and lack of knowledge bout the disease process and prognosis//
 * //Acute pain related to pressure secondary to an enlarging tumor//
 * //Disturbed body image related to loss of body part and loss of good health//
 * //Ineffective sexuality pattern related to physiologic limitations and fatigue//
 * //Ineffective breathing pattern related to presence of ascites and effusions//
 * //Grieving related to poor prognosis of advanced disease (Lewis, Vol 2, p 1405)//

The most important goal for the patient is to have them become actively involved in all phases of decisions and treatments. The nursing diagnoses of Powerlessness may have to be used at this point and interventions will be needed to reproduce autonomy to the patient. Other possible nursing diagnoses may be: Nutrition less than body requirements and Depression related to diagnoses. Pain management is all very important for the cancer patient. It will need to be discussed what is an acceptable level of pain for the client. The goal may be a desire to be relieved of all pain but this may or may not be a realistic goal.

A collaborative approach is needed for the nurse to provide education and health promotion. It is important to stress that the clients preferred lifestyle remain unchanged for as long as possible. The patient needs to recognize signs and symptoms of reportable problems and to effectively practice and have the skill sets in place to detect future issues, i.e., detecting lumps. It is very important for the nurse to campaign and encourage health promotion. Yearly pelvic exams and PAP smears are heavily encouraged. A high fat diet should be avoided as this increases the risk of cancer. Smoking should be discouraged as well as high risk behaviors.

Sources: [|http://www.ovarian.org/symptoms.php] [], [], http://www.cdc.gov/cancer/ovarian/index.htm