Ovarian cancer is the eighth most commonly occurring cancer in women and the 18th most commonly occurring cancer overall. There were 295,414 new cases and 184,799 deaths worldwide in 2018. Usually by the time ovarian cancer is detected, it has spread to other organs within the pelvis. Incidence rate has slowly been decreasing at a rate of about 0.9% per year since the mid-1980’s. Ovarian cancer accounts for about 5% of cancer deaths for women and causes more deaths than any other female reproductive cancer.
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Ovarian tumors are never biopsied with a needle, or cut into, because doing so could allow cancerous cells to escape. Most ovarian cancer clients are past menopause, thus making a hysterectomy a viable option when necessary. As with pancreatic cancer, ovarian cancer is considered silent and deadly. Often there are no symptoms of early ovarian cancer, which makes it difficult to detect at an early stage when there is the greatest chance for a cure. An ovarian tumor can grow for some time before pressure or pain can be felt. Symptoms, when they do occur, can include abdominal swelling or bloating, discomfort in the lower part of the abdomen, feeling full after a light meal, nausea or vomiting, lack of appetite, gas or indigestion, unexplained weight loss, diarrhea, constipation, or frequent urination, shortness of breath, and bleeding that is not part of a regular menstrual cycle.
A strong family history of breast or ovarian cancer is the most important risk factor. Women who have tested positive for mutations in the inherited BRCA1 and BRCA2 genes have about a 50% chance of developing ovarian cancer in their lifetime. Those with pelvic inflammatory disease and Lynch syndrome are also at an increased risk. Several large studies have linked an increase in ovarian cancer to the use of estrogen hormone replacement therapy. Smoking cigarettes increase the risk of mucinous ovarian cancer. On the flip side, pregnancy and long-term use of oral contraceptives seem to reduce the risk.
When a malignant ovarian mass has spread to other organs, the surgeon will remove the reproductive organs, the omentum, and the lymph nodes, and cut out, or debulk, as much of the tumor as possible. The goal, of course, is to eliminate any visible traces of cancer. If the tumor left behind measures half an inch or less, it’s called optimal residual cancer. Larger tumors are referred to as suboptimal residual cancers. Chemotherapy cannot penetrate a large, bulky ovarian tumor because the flow of the treatment is blocked. By removing as much of the tumor as possible through debulking, the chemotherapeutic treatment can penetrate the tumor more effectively. This means that the tumor will be much more responsive to chemotherapeutic treatment, which improves treatment success and potentially adds years to a patient’s survival. In some cases, a piece of colon is removed and then the 2 ends that remain are sewn back together (resected). If the ends can’t be sewn back together right away, the top end of the colon is attached to an opening (stoma) in the skin of the abdomen to allow body wastes out. This is known as a colostomy. Most often, this is only temporary, and the ends of the colon can be reattached later in another operation. Debulking surgery may also involve removing a piece of the bladder. If this occurs, a catheter (to empty the bladder) will be placed during surgery. This will be left in place for a time after surgery until the bladder recovers enough to be able to empty on its own. Then, the catheter can be removed. Debulking may also require removing the spleen and/or the gallbladder, as well as part of the stomach, liver, and/or pancreas.
Most patients will remain in the hospital from 3-7 days after laparotomy and tumor debulking with full recovery taking 10-12 weeks. Walking is essential to a smooth recovery and should be a part of each day’s activities in the recovery period. Patients should not lift anything weighing over ten pounds for the first 6 weeks after surgery and should also avoid, sit-ups, crunches, planks, and high-impact activities during that time.
When the uterus is removed through an incision in the abdomen, it is called a simple or total abdominal hysterectomy. If the uterus is removed through the vagina, it is known as a vaginal hysterectomy. Removing the ovaries and fallopian tubes, a bilateral salpingo-oophorectomy, is not actually part of a hysterectomy; it is a separate procedure that is often done during the same operation. For endometrial cancer, removing the uterus but not the ovaries or fallopian tubes is seldom recommended. To stage the cancer, lymph nodes in the pelvis and around the aorta will also need to be removed. This can be done through the same incision as the abdominal hysterectomy. If a vaginal hysterectomy is done, lymph nodes can be removed by laparoscopy. Conventional abdominal hysterectomy leaves a five-inch vertical scar from just below the belly button to the pubic bone; or, if it’s a bikini incision, from side to side.
A laparoscopic procedure and vaginal hysterectomy usually require a hospital stay of 1 to 2 days and 2 to 3 weeks for recovery. The hospital stay for open surgery is usually 3-7 days and the recovery period is generally 6-8 weeks. Walking is essential to a smooth recovery and should be a part of each day’s activities in the recovery period. Pelvic floor and core exercises will be extremely important to incorporate regularly. Patients should not lift anything weighing over ten pounds for the first 6 weeks after surgery and should also avoid, sit-ups, crunches, planks, and high-impact activities during that time.
Points to remember:
- If your client has diarrhea or vomiting, they should NOT exercise for 24-26 hours and they must re-hydrate and replenish electrolytes
- If they have chills, fever and abdominal pain, they must report this to their doctor immediately
- If lymph nodes are removed or irradiated. take initial lower body measurements, begin each exercise session with lower body lymph drainage exercises, and make sure client is wearing compression garments if they have been prescribed.
- Your client will now be in menopause and have to deal with side-effects like weight gain and a higher risk of osteoporosis. Losing extra body fat is critical to minimize the risk of lymphedema and prevent future cancers, diabetes, heart disease etc. Weight-bearing exercise will need to be a part of your training to help increase their bone density.
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