Chapter 46 Flashcards
How does a patient with Acites present?
Expanding abdominal girth for the past week and early satiety bloating anorexia. Smoker and drinker
What is a differential diagnosis for a patient with ascites?
Cirrhosis, congestive heart failure, ovarian cancer
What makes ovarian cancer more likely then the other causes of ascites?
Nulliparous post menopausal female with a few risk for cirrhosis and congestive heart failure
What does a physical examination for ovarian cancer show?
Fixed right pelvic mass. Abdominal distention
What is the preferred initial test? Showing what? What does CBC show? What is the diagnosis?
Pelvic ultrasound, Malignant appearing right ovarian mass with Peritoneal seeding and anemia; Metastatic ovarian cancer
What can be used for a diagnostic, therapeutic and staging?
Surgical intervention
What are the other cancers that are metastatic to the ovary?
Breast cancer G.I. cancer or cervical cancer
What work up should be done for this patient in order to help stage and exclude other cancer?
CA-125, abdominal/pelvic CT, CXR, gyn or Gynecological oncology consult, Colonoscopy/FOBT, mammogram, Pap smear, pre-op orders.
After ovarian cancer stage two is confirmed we should be done?
Admit the patient to the hospital for surgical resection
What is the definitive treatment for ovarian cancer?
Laparotomy for Abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO)
What should be done for suspected gastric cancer? Endometrial cancer?
Upper G.I. series, endocervical curettage
What could be done if the diagnosis is uncertain?
Obtain biopsy of peritoneal lesions
What are the standard a pre-op orders?
ECG, PT, PT/INR, type and crossmatch, NPO, DVT prophylaxis
What should be the preop thromboprophylaxis?
Heparin or LMWH plus compression device
What should be the preop Parenteral antibiotic prophylaxis?
Cephalosporin (cefazolin) or ampicillin sulbactam
Why isn’t laparoscopic resection used in ovarian cancer?
Laparoscopic resection of ovarian cancer is not recommended because complete removal of the tumor is impossible
What is the Definitive therapy for ovarian cancer therapy?
Cytoreductive surgery achieved by laparotomy
Who should be consulted after the surgery? Why?
Consult oncology for post op adjuvant/Palliative chemotherapy (Carboplatin plus paclitaxel)
Why is it important to get C-125 prior to surgery?
To obtain baseline level, rising CA 125. Suggest disease progression
What are all the markers for the different cancers?
CEA (colon), CA 19-9 (pancreas), CA-125 (Ovarian)
What should be to counseling for this patient?
Cancer diagnosis, no smoking, no alcohol
Where is the location for this patient?
Office, home, office, home, office the ward/ER
