Case Study - Reproductive System Disorders A. J. is a 20-year-old Caucasian female who visited her gynecologist complain

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Case Study - Reproductive System Disorders
A. J. is a 20-year-old Caucasian female who visited her
gynecologist complaining of abdominal pain, pelvic pain, and pain
in the small of her back, which had begun to worsen. She also felt
bloated and was having frequent problems with indigestion and gas.
In addition, she was tired all the time and rarely went to the gym
anymore. 
A. J.'s medical history showed her to be a healthy and athletic
female. She admitted to drinking occasionally at social events but
denied having ever smoked. A. J. had been receiving annual
gynecological testing since she was 18 years old, and her menstrual
history has been unremarkable. Her family history showed that her
mother was a breast and ovarian cancer survivor. The patient was
not on birth control medication, but she stated that she practices
safe sex with the use of condoms. 
During the initial interview, what additional questions will you
ask A. J.?
What will be your priority assessment? Explain?
The gynecologist performed a pelvic testing of the patient's
vagina, uterus, rectum and pelvis, including ovaries, and checked
for masses or growths. He followed the pelvic testing with a
transvaginal ultrasound to better detect the presence of abnormal
growths in the reproductive organs. A. J.'s transvaginal ultrasound
revealed a mass on her right ovary. Additional laboratory work-up,
including a CA-125 assay of her blood sample, was
ordered.  
What is the significance of the CA-125 assay?
How will this affect A. J.’s plan of care?
When A. J. went back to her GYN for a follow-up visit to discuss
her lab results, the physician had concerning news. He said, "I am
very sorry but your CA-125 level is very high and your ovary may
have a tumor and not a cyst. I'm going to refer you to a
gynecologic oncologist for further evaluation."
As you were preparing the referral for the physician, A. J.
became very anxious. She asked you, “What will happen to me now. Am
I going to die?” What will be your response?
Her GYN-ONC biopsied the lesion and consulted with a pathologist
to verify the diagnosis of ovarian cancer.  He recommended removal
of both ovaries, fallopian tubes, and the uterus.
AJ was stunned. She confided in her physician, "I'm only 20
years old; how could I have ovarian cancer? Isn't this an illness
older women get?"
The physician gave A. J. a brief explanation. What client
education will you reinforce regarding A. J.’s condition?
What are the risk factors of ovarian cancer that you have
identified with A. J.?
What interventions will you expect in A. J.’s plan of
care?
You gathered information from the American Cancer Society (ACS).
Overview: Ovarian Cancer and the ACS. Ovarian Cancer: Treatment
Guidelines for Patients.
Typically, ovarian cancer is more common in older women.
However, patients who have a genetic predisposition may develop the
condition at a much earlier age.
Ovarian cancer occurs when normal cells in the ovaries begin to
grow in an uncontrolled, abnormal manner and produce malignant
tumors in one or both ovaries. Ovarian cancer causes more deaths
than any other type of cancer of the female reproductive system,
according to the American Cancer Society (ACS). The ACS ranks it
fifth in cancer deaths among women.
Bloating or abdominal distention - caused by the accumulation of
fluid - is the most common symptom of the disease. There are
usually no obvious symptoms of ovarian cancer early on in the
disease process. Studies indicate that some women with cancer of
the ovaries may experience persistent, nonspecific symptoms, such
as bloating, pelvic or abdominal pain, difficulty eating or feeling
full quickly, and/or urinary urgency or frequency. Women who
experience these symptoms for prolonged periods of time are advised
to seek prompt medical evaluation. Although it is rarely indicative
of ovarian cancer, abnormal vaginal bleeding is another symptom
some women may experience.
The causes of ovarian cancer are not entirely understood. Some
studies indicate that malignancy develops due to genetic errors
that interfere with normal ovulation. Others indicate that the
increased hormone levels before and during ovulation may stimulate
the growth of abnormal cells.
9. Based on this information, what
signs and symptoms have you identified in A. J.’s history that may
manifest her present condition?