What are the risks and signs and symptoms of ovarian cancer.
A 35 year old woman has been diagnosed with Polycystic Ovarian Syndrome (PCOS). She has been trying to get pregnant for
the past 3 years. Her male partner was married before and has 2 children. As the nurse practitioner, describe the
following to this woman:
What is the pathophysiology of PCOS and how does it affect fertility?
Polycystic ovary syndrome has at least two of the following conditions: oligo-ovulation or anovulation, elevated
levels of androgens, or clinical signs of hyperandrogenism and polycystic ovaries. Polycystic ovaries do not have to be
present to diagnose PCOS, and their presence alone does not establish the diagnosis. Although no single factor appears to
be the main culprit a hyperandrogenic state is a cardinal feature in the pathogenesis of PCOS, usually accompanied by
glucose intolerance/insulin resistance, and hyperinsulinemia significantly aggravating the hyperandrogenic state. Obesity
makes insulin resistance worse; insulin in turn affects follicular decline by suppressing apoptosis and stimulates
androgen secretion resulting in increased free testosterone levels that affect follicular growth. There appears to be a
genetic defect in PCOS making the ovaries more sensitive to insulin’s stimulation of androgen production. In addition
there is a dysfunction in follicle development initiated by elevated leptin levels which influence gonadotropin releasing
hormone (GnRH). Inapropriate secretion of GnRH initiates a vicious cycle that perpetuates anovulation. Increased frequency
of GnRH pulses seems to increase frequency of luteinizing hormone pulses, which in turn causes an increase in androgens;
increased androgen secretion by the ovaries contributes to premature follicular failure and persistent anovulation, thus
significantly affecting fertility (McCance&Huether 2014).
What are signs and symptoms of PCOS and what diseases are associated with PCOS?
Signs and symptoms of PCOS may appear within 2 years of puberty or after a period of normal menstrual function. They
are related to anovulation and hyperandrogenism and include dysfunctional bleeding or amenorrhea, hirsutism, acne, obesity
and infertility. Diseases associated with PCOS include Cushing syndrome, acromegaly, premature ovarian failure, simple
obesity, congenital adrenal hyperplasia, thyroid disease, androgen-producing adrenal tumors or ovarian tumors, and
syndromes with hyperprolactinemia (McCance&Huether 2014).
References
McCance, K., &Huether, S. (2014). Pathophysiology: The biologic basis for
disease in adults and children (7th ed.). St. Louis, Mo: Mosby Elsevier.
Classmate 2 (CA)
Although the incidence is lower than other cancers, ovarian cancer causes more deaths than any other reproductive cancer.
1 Explain the pathophysiology of ovarian cancer and why more deaths occur due to ovarian cancer than other reproductive
cancers.
2 What are the risks and signs and symptoms of ovarian cancer
The pathogenesis of ovarian cancer is said to be controversial. Some are associated with genetic mutations but
most being sporadic and not associated with inheritance patterns. Newer theories state that sporadic, spontaneous tumors
arise from migration of mesoderm origin tissue to the surface of the ovary. Cells of intra-abdominal locations can attach
to the ovary and can then interact with transplanted cells to enhance growth and encourage metastases (McCance&Huether,
2014). Two major types of ovarian cancer are epithelial ovarian neoplasms that begin in cells on the surface of the ovary,
and germ cell neoplasms that begin in egg cells (Ovarian, Fallopian Tube, and Primary Peritoneal Cancer, n.d.). Epithelial
ovarian neoplasms are the most common of the two. Most epithelial malignancies rise from a single cell because of a loss
of tumor-suppressor genes and activation of oncogenes. Germ cell tumors can be benign or malignant; malignant tends to be
highly aggressive with poor prognosis (McCance&Huether, 2014). Tumors are classified as type I being low grade, or type II
known as high grade, based on cellular type. Type I tumors tend to grow slowly and are more resistant to chemotherapy.
Type II tumors rapidly grow and are more aggressive but respond well to chemotherapy. Only about 15 percent of cancers are
diagnosed early in stage I (McCance&Huether, 2014).
Because of the lack of early symptoms in ovarian cancer and the lack of cost effective screening techniques for early
detection, most disease is diagnosed after metastasis has occurred. This is why ovarian cancer is commonly referred to as
a silent killer, contributing to the reason why ovarian cancer causes more deaths than any other reproductive cancer
(McCance&Huether, 2014).
Risks linked to ovarian cancer include women over 40 with conditions associated with increased ovulation such as early
menarche, late menopause, nulliparity, and the use of fertility drugs. Some additional risk factors include obesity and
genetic mutations specifically related to the breast cancer susceptibility gene. Factors that reduce the risk of ovarian
cancer involve factors that suppress ovulation including pregnancy, prolonged lactation, and contraceptive use that limit
ovulation (McCance&Huether, 2014).
Ovarian cancer is generally asymptomatic in early stages, so women do not start noticing symptoms until the disease
progresses. Common first symptoms include abdominal distention, loss of appetite, and pelvic pain, but the symptoms are
vague so many women fail to notice them (McCance&Huether, 2014). Manifestations of advanced disease can include pain and
abdominal swelling, dyspepsia, vomiting, alterations in bowel habits due to obstruction, and abnormal vaginal bleeding in
postmenopausal women. Ulcerations through the vaginal wall that can cause bleeding can also develop from the tumor, and
tumor obstruction of vascular channels can cause thrombosis (McCance&Huether, 2014).
References
McCance, K., &Huether, S. (2014). Pathophysiology: The biologic basis for disease in
adults and children (7th ed., p. 831-834). St. Louis, Mo.: Mosby Elsevier.
Ovarian, Fallopian Tube, and Primary Peritoneal Cancer. (n.d.). Retrieved
March 21, 2015, from http://www.cancer.gov/cancertopics/types/ovarian
Classmate 3
An adolescent who’s 16, has had 12 boyfriends in the past 2 years that she has been sexually intimate with and has
sporadically used condoms. She is taking oral contraceptives. She is coming to the clinic because of pelvic pain.
1. How would you confirm the diagnosis of pelvic inflammatory disease (PID) and describe the pathophysiology of PID?
Pelvic inflammatory disease (PID) is an acute inflammatory process involving a single organ or a combination of organs
in the upper genital tract. PID is mainly caused by sexually transmitted diseases such as chlamydia and gonorrhea
(McCance&Huether, 2014). Being that this patient has had 12 boyfriends with sporadic condom use, she is at high risk of
contracting a sexually transmitted disease. Her pelvic pain causes much concern for her reproductive system. To confirm
diagnosis, I would have to perform a pelvic exam with a witness present; bimanual pelvic examination could reveal pelvic
organ tenderness. PID should be considered if a sexually active woman presents with pelvic or abdominal tenderness and at
least one of the following: “cervical motion tenderness, uterine tenderness, or adnexal tenderness” (McCance&Huether,
2014, p. 815). I would make sure a thorough history and physical is performed and if the patient were to have fever,
vaginal discharge, elevated serum CRP or ESR levels then PID is highly suspected (McCance&Huether, 2014). Absolute
criteria for PID would be diagnosed by transvaginal ultrasound, doppler studies, or laparoscopic visualization. Pelvic
inflammatory disease is polymicrobial, meaning several microorgansims can cause this disease. The cervix normally produces
mucus that prevents upward spread; during PID, bacteria may penetrate the cervical mucus and spread the infection
ascending from the vagina and cervix. The resulting inflammatory response causes pain and localized edema
(McCance&Huether, 2014). A patient with pelvic inflammatory disease can present with severe symptoms such as
abdominal/pelvic pain, fever, dysuria, or vaginal bleeding to no symptoms at all (McCance&Huether, 2014). This patient
must inform all of her sexual partners if she does have an STI.
2. List at least 3 other sexually transmitted infections she is at risk for & list the main signs of symptoms of these
other STI’s (be brief)
This patient is at risk for gonorrhea, chlamydia, and bacterial vaginosis. Gonorrhea presents with symptoms such as
sudden onset of dysuria or purulent discharge in men. Women diagnosed with gonorrhea sometimes don’t present with symptoms
until the infection has spread to the upper reproductive tract and appear with dysuria, vaginal discharge, lower
abdominal/pelvic pain, and fever (McCance&Huether, 2014). Chlamydia presents with symptoms of vaginal discharge,
bleeding/spotting, and painful urination. Gonorrhea and chlamydia are often asymptomatic. Bacterial vaginosis is not
always considered an STI; it is characterized by thin grey-white discharge with a strong odor (McCance&Huether, 2014).
References:
McCance, K., Huether, S. (2014). Pathophysiology: The biologic basis for disease in adult and children (7th ed., p. 813-
What are the risks and signs and symptoms of ovarian cancer
